Diane Isabelle Magno Cavalcante

Prognostic markers of high-grade squamous intraepithelial lesions: the role of p16INK4a and high-risk human papillomavirus.

Background. p16INK4a seems to be an indicator of the grade of Human Papillomavirus‐induced lesions and a possible predictor of the lesion evolution. There are few studies about the role of HPV test and p16INK4a in diagnosis of high‐grade cervical lesions in South‐American women. The aim of the present study was to evaluate the presence of p16INK4a and high‐risk HPV‐DNA expression in cases diagnosed as squamous intra‐epithelial lesion and evaluate their role in the approach of high‐grade squamous intra‐epithelial lesion. Methods. p16INK4a and high‐risk Human papillomavirus were investigated in 96 samples of the cervix (13 cases of high grade squamous intraepithelial lesions, 26 cases of low grade intraepithelial lesions and 57 normal tissues). The p16INK4a was identified by immunohistochemistry using the p16INK4a kit (E6H4 clone, DakoCytomation, Carpinteria, CA) and Human papillomavirus DNA was classified by hybrid capture (Digene®). Associations were evaluated by the KAPPA index. Results. The p16INK4a was detected in 92.3% of the high‐grade squamous intraepithelial lesions, in 15.4% of the low‐grade and in none of the normal tissues. The sensitivity, specificity, positive predictive value and negative predictive value for high‐grade lesion were 92.3%, 100%, 100%, and 98.3%, respectively when considering p16INK4a expression, and 100%, 70.2%, 43.3% and 100%, respectively when considering high‐risk HPV. Conclusions. p16INK4a test was better associated with high‐grade intraepithelial lesion (κ = 0.95) than was the presence of high‐risk HPV (κ = 0.47). Both tests could be complementary to high‐grade squamous intra‐epithelial lesion screening and help to define the diagnosis of the inconclusive low‐grade/high‐grade squamous intraepithelial lesion cases.

Fine-needle aspiration cytology of scar endometriosis: study of seven cases and literature review.

Endometriosis is defined as the presence of endometrial‐like glands and stroma outside the uterine endometrial lining. Endometrial tissue has also been identified in numerous surgical or procedure scars, including cesarean section and laparoscopic trocar tract.

Postmortem Findings for 7 Neonates with Congenital Zika Virus Infection

Postmortem examination of 7 neonates with congenital Zika virus infection in Brazil revealed microcephaly, ventriculomegaly, dystrophic calcifications, and severe cortical neuronal depletion in all and arthrogryposis in 6. Other findings were leptomeningeal and brain parenchymal inflammation and pulmonary hypoplasia and lymphocytic infiltration in liver and lungs. Findings confirmed virus neurotropism and multiple organ infection.

Contagem de morfotipos de Mobiluncus sp e concentração de leucócitos em esfregaços vaginais de pacientes com vaginose bacteriana

OBJECTIVE: to evaluate the presence of curved rods, suggesting Mobiluncus sp, and leukocytosis on Gram and Papanicolaou-stained vaginal smears in cases of bacterial vaginosis. METHODS: two hundred and five vaginal smears were studied by the Papanicolaous method and other 205 vaginal smears, in the same patients, were evaluated by Gram staining. The diagnosis of bacterial vaginosis was made clinically by one of the authors (J.E.J.) using Amsels criteria. In the Gram method stained smears the Nugents score was calculated and the presence of curved rods was evaluated. In Papanicolaous smears curved rods were searched as well the presence of leukocytes. The data were analyzed by Prism 3.0® with confidence interval of 95% using the Fisher exact test with modified Walds method. RESULTS: on Pap smears the curved rods were present in 51.7% of the cases. The number of leukocytes varied, although the leukopenia was more frequent. In Gram-stained smears the curved rods were present in 46.8% of the cases and the Nugents score was 8 in 48.3% of the cases. The finding of Mobiluncus sp in both methods occurred in 82%. When curved rods were observed leukocytosis occurred in 57.5% (p < 0.0001). In the same way, leukocytosis was more frequent in Nugents scores 9 and 10. CONCLUSION: curved rods were observed in about 52% of bacterial vaginosis. Leukocytosis in Pap smears was more frequent when Mobiluncus sp were found with higher Nugents scores.

Actinomyces-like organisms from a vaginal granuloma following intravaginal slingplasty with polypropylene mesh.

a Division of Genital Tract Pathology and Colposcopy, Universidade Federal do Ceara (UFC) , Fortaleza, Brazil b Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, Sao Paulo, Brazil c Division of Surgical Pathology and Molecular Biology, Laboratory Prof. Eleuterio da Costa (LABPEC), Fortaleza, Brazil d Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil e Jundiai Faculty of Medicine, Sao Paulo, Brazil

Ductal carcinoma of the breast: morphological aspects according to the age

Introduction:Breast cancer is the most common cancer in women worldwide, and its morphological characteristics, despite the current molecular classification, also provide important information about the pattern of this disease.Objective:To analyze the morphological characteristics of invasive ductal breast carcinoma among women older and younger than 50 years.Method:302 cases of invasive ductal carcinoma patients treated at the Division of Mastology of the Universidade Federal do Ceara, in the period 2005-2014, aged ≤ 50 years and older. The following morphological characteristics were analyzed: larger tumor diameter (TD), lymph node metastasis (MX), and histological grade (HG).Results:The mean age of patients was 55.6 years. The average tumor size was 3.4 cm, 40% of tumors have diameter ≤ 2 cm and 60% > 2 cm. As for the histological grade, 23.7% were grade 1, 32.1% grade 2, and 42% grade 3. Axillary metastasis were present in 66% of the cases and 34% did not. Women aged ≤ 50 years had fewer tumors grade 1 (p = 0.002), compared with grades 2 and 3. Women older than 50 years had more grade 3 tumors (p = 0.002), and more tumors larger than 2 cm diameter (p < 0.001). The presence of metastasis predominated in both age groups when analyzed separately (p < 0.001).Conclusion:Women older than 50 years had larger and more morphologically undifferentiated tumors. Women aged ≤ 50 years had less well-differentiated tumors. There were no differences in morphology between these two age groups when compared each other.

Adequacy of Fine-Needle Aspiration Cytology for Breast Lesions: The SurePath® Liquid-Based Technique versus Conventional Smears

Objective: We aimed to assess the cytological findings from fine-needle aspiration (FNA) of breast lesions with conventional smear (CS) and SurePath® (SP) cytology. Study Design: This was a cross-sectional study of women who underwent FNA from January 2012 to June 2013 for breast lesions with benign ultrasonography impressions in Fortaleza, Brazil. Two groups were formed. The first was composed of 102 samples subjected to CS and the second of 65 samples subjected to SP. The number of smears, the cellularity and the diagnostic hypotheses were compared. Fishers exact tests with 95% confidence intervals were applied. Results: The women ranged in age from 22 to 75 years. SP cytology indicated greater cellularity than CS for the cystic lesions (p < 0.05). In the CS group, 72.5% of the samples required 3-4 slides, but in the SP group, only 9.2% required a second slide. The cellularity of the cystic samples was significantly greater with the SP method (p < 0.01). Conclusion: In FNA cytology of the breast, SP is a tool that is comparable to CS, but with the added benefits of better cellularity results for cystic lesions and requiring fewer slides for analysis.

The risk of high-grade squamous intraepithelial lesions in women with low serum levels of vitamin A.

Background: The progression of the cervical squamous intraepithelial lesion (SIL) is associated with many cofactors, and nutritional aspects are gradually assuming an important role in understanding the physiopathogenesis. Objective: To assess the serum levels of retinol in women from a poor region of Brazil with a histological diagnosis of cervical high-grade SIL (HSIL). Methods: A cross-sectional study was conducted in 62 women aged 14-48 years who had a cervical biopsy and were treated at the Federal University of Ceara in Fortaleza, Brazil. Serum retinol levels were measured in peripheral blood by a spectrophotometry technique. Values were categorized as subnormal (<20 µg/dl) or normal (≥20 µg/dl). Multivariate logistic regression was used to determine the association between serum levels of retinol and HSIL for a confidence interval of 95%. Results: Twenty-six out of 62 women (42%) had a negative histopathological result for SIL and 36 (58%) were diagnosed with SIL (20 low SIL and 16 high SIL). The level of retinol was more frequently low in women with HSIL, but there was no statistical significance [p = 0.409, OR: 2.26 (0.33-15.59)]. Conclusion: There was no association between high SIL and low levels of retinol in peripheral blood.

The utility of p16 INK4a and Ki-67 to identify high-grade squamous intraepithelial lesion in adolescents and young women

BACKGROUND The repair of the immature squamous epithelium following HPV infection may mimic HSIL in adolescent women. AIM to study the utility of p16 INK4a and Ki-67 in diagnosis of cervical squamous lesions in adolescents and young adults. MATERIALS AND METHODS In a cross-sectional study, the evaluation of p16 INK4a and Ki-67 immunohistochemistry was performed on 72 cervical biopsies of adolescents and young adults women diagnosed as negative for malignancy and intraepithelial lesion (NML) (n = 18) or positive for low grade (LSIL) (n = 31) and high grade (HSIL) (n = 23) squamous intraepithelial lesions in two references services in Fortaleza-Brazil. Data was evaluated using Fishers test and Kappa index. RESULTS p16 INK4a was positive in 81% of HSIL, 19% of LSIL and in no NML (P < 0.0001). Ki-67 was positive in 74%, 32% and 5.5% of HSIL, LSIL and NML, respectively. p16 INK4a and Ki-67 in the diagnosis of HSIL showed high sensitivity and negative predictive value. Kappa index was very good for p16 INK4a (k = 0.72). CONCLUSIONS In adolescents and young adults p16 INK4a alone or with Ki-67 represents important tool to reduce mistaken diagnosis of HSIL and to avoid overtreatment.

HPV-DNA Hybrid Capture Test

OBJECTIVE To evaluate if the cellularity of Hybrid Capture samples (Digene, Sao Paulo, Brazil) influences the results of HPV-DNA Hybrid Capture tests in men. STUDY DESIGN We harvested material from penile scrapings for the Hybrid Capture HPV test. This material was then used to make cytologic smears, which we used to evaluate for the presence of nonnucleated squamous cells, nucleated squamous cells and glandular cells. The cellularity of nucleated squamous cells was classified as absent, low, moderate or high. Subsequently, we performed the Hybrid Capture test to identify the low and high risk of HPV and compared these results with the cytologic findings. We used the Fisher and odds ratio tests at CI of 95% to determine statistical significance. RESULTS Of the 88 tests performed, 65 (74.0%) were negative for HPV-DNA and 23 (26.0%) were positive. Nucleated and nonnucleated squamous cells were absent on nine slides, all of which tested negative for HPV. When only nonnudcleated squamous cells were found, 20% of the cases were positive for HPV-DNA (p < 0.0001; OR = 26.185). The presence of nucleated squamous cells correlated with 33% HPV-DNA positivity (p < 0.0001, OR = 49.05). CONCLUSION Assessing the presence of non-nucleated and nucleated squamous cells on cytologic smears prior to performing an HPV-DNA test is a useful tool for quality control in penile samples.