Eduardo Vieira da Motta

MÜLLERIAN ADENOSARCOMA OF THE UTERUS WITH SARCOMATOUS OVERGROWTH FOLLOWING TAMOXIFEN TREATMENT FOR BREAST CANCER

Müllerian adenosarcoma with sarcomatous overgrowth presented by a 52-year-old female patient after adjuvant tamoxifen treatment for breast carcinoma is described. The diagnosis was made on histological basis after curettage and complementary total hysterectomy with bilateral salpingo-oophorectomy. The immunohistochemical study showed high expression of estrogen receptors in the epithelial component of the lesion and irregularly positive findings in the stroma. The proliferative activity evaluated by Ki-67 immunoexpression was higher in the stroma than the epithelium. Some of the stromal cells showed rhabdomyoblastic differentiation. The association of tamoxifen use and development of mesenchymal neoplasms is discussed.

Evaluation of the Combination of Cytology and Hybrid Capture to Safely Predict the High-Grade Lesion Status of Patients Treated with Conization with Large Loop Excision of the Transformation Zone

Objectives: This study aimed to verify whether human papillomavirus (HPV) testing after conization treatment has some potential usefulness for predicting patients’ outcome. Study Design: One hundred and twenty women were treated for HSIL by conization with large loop excision of the transformation zone (LLETZ). Cytology, colposcopy-guided biopsy, and hybrid capture 2 (HC2) HPV DNA tests were performed before the surgical procedure and every 6 months for 2 years at follow-up. Results: More than 90% of the patients tested positive for high-risk HPV prior to the surgical intervention. Six months after the cervical conization, 74.75% of the patients tested negative for high-risk HPV DNA, and 19.41% were positive. Of the women who were HC2 negative, 72 showed normal cytological smears, 3 ASC-US, 2 LSIL, and 1 HSIL. Of those who were HC2 positive, 8 showed normal smears, 2 ASC-US, 2 ASC-H, 5 LSIL, and 1 case had HSIL, AGC, and squamous cells invasive carcinoma. Clinically, the HSIL case with a negative HPV test did not show any sign of high-grade lesions, and the clinical follow-up did not show residual lesions. Conclusions: Negative HPV tests correlated with freedom from high-grade disease after 2 years of postconization follow-up, which strongly suggests that negative HPV tests predict the absence of cervical disease.

Characterization of p16 and E6 HPV‑related proteins in uterine cervix high‑grade lesions of patients treated by conization with large loop excision

Cervical cancer and its precursor lesions represent a significant public health problem for developing and less-developed countries. Cervical carcinogenesis is strongly correlated with persistent high-risk human papillomavirus (HPV) infection, which is mostly associated with expression of the p16 and E6 HPV-related proteins. The aim of this present study was to determine the expression of the p16 and E6 proteins in females with high-grade lesions treated with conization, and to discuss the role of these proteins as prognostic markers following treatment. In total, 114 females were treated for high-grade cervical intraepithelial neoplasia (CIN, grades 2/3) by conization with large loop excision of the transformation zone (LLETZ). Following surgery, the patients returned within 30–45 days for post-operative evaluation. A follow-up was conducted every 6 months for 2 years. At each follow-up appointment, a Pap smear, colposcopy and HPV DNA test were performed. E6 and p16 immunohistochemical tests were conducted on the surgical specimens. The positive expression of p16 was correlated with the presence of lesions with increased severity in the surgical specimens (P= 0.0001). The expression of E6 did not demonstrate the same correlation (P=0.131). The HPV DNA hybrid, collected in the first post-operative consultation as a predictor of the cytological abnormalities identified at the 24-month follow-up assessment, presented a sensitivity of 55.6%, a specificity of 84.8%, a positive predictive value of 33.3% and a negative predictive value of 93.3%. The role of p16INK4A as a marker of CIN was also demonstrated; the expression of p16 and E6, however, did not appear to be of any prognostic value in predicting the clearance of high-risk HPV following conization. A negative hybrid capture test was correlated with a disease-free outcome.

Heterotopic ovarian transplantation results in less apoptosis than orthotopic transplantation in a minipig model.

BackgroundOvarian autotransplantation has shown increasing promise as a clinical method for the preservation of fertility and hormonal function. However, information regarding the success rate of this type of transplantation is limited. We hypothesized that results vary according to the site of the ovarian transplantation. To test this hypothesis, fresh or cryopreserved ovarian strips were autotransplanted to orthotopic or heterotopic sites. The strips were later collected, and the morphology and expression of selected markers of apoptosis were evaluated. We compared the Bax, Bcl-2 and cleaved caspase-3 staining levels and the morphometric aspects of autotransplanted fresh and cryopreserved ovarian strips placed at orthotopic and heterotopic sites in minipigs.MethodsForty female minipigs were allocated to the following five groups: group 1 (control), ovarian tissue removed during oophorectomy; group 2, transplantation of fresh ovarian strips to a heterotopic site; group 3, transplantation of fresh ovarian strips to an orthotopic site; group 4, transplantation of cryopreserved ovarian strips to a heterotopic site; and group 5, transplantation of ovarian trips to an orthotopic site. On day 7 after transplantation, ovarian strips were collected, and the morphology and expression of apoptosis markers were evaluated.ResultsIn all groups, follicles across all stages of development were detected. The numbers of primordial, primary and secondary follicles were similar in all groups, but the numbers of antral follicles were lower in the cryopreserved groups in comparison with freshly derived ovarian tissue, with no significant differences observed between fresh and cryopreserved transplants. In all transplanted groups, Bcl-2 expression was lower and Bax expression was higher than in the control group. Furthermore, increased expression of apoptosis markers was detected in fresh intraperitoneal transplants. Lastly, the expression of cleaved caspase-3 was higher in the cryopreserved orthotopic group compared with the heterotopic group.ConclusionsOrthotopic and heterotopic ovarian strip transplantations are feasible options using these techniques. Importantly, we found that heterotopic transplantation preserves ovarian follicle integrity to a greater degree (i.e., lower expression of apoptosis markers) than orthotopic transplantation, and cryopreservation does not exacerbate expression of apoptosis’s markers. These findings have major clinical applications and enhance the discussion regarding the heterotopic transplantation of ovarian tissue.

Development of an animal model for endometrial ablation using trichloroacetic acid

OBJECTIVE To develop an animal model of endometrial ablation, and to evaluate the histologic effects of trichloroacetic acid (TCA) in the uterine cavity. DESIGN Experimental prospective. SETTING Department of gynecology. PATIENT(S) Thirty female adult rats. INTERVENTION(S) Animals were submitted to injection of TCA in one uterine horn and saline solution in the other. Group 1 was sacrificed the day after the procedure. Group 2 was sacrificed in phase of diestrus. Superficial epithelia of the endometrium, stromal thickness, endometrial glands, and myometrium thickness were compared among the uterine horns of the same rats of group 1. The same evaluation was performed in group 2. Endometrial regeneration was evaluated. MAIN OUTCOME MEASURE(S) Histologic effects. RESULT(S) In group 1, histologic parameters showed endometrial destruction on TCA injected uterine horn. In group 2, four rats died after the procedure, and six rats had no viable material. In the rest of the group, TCA-injected uterine horns showed endometrial destruction. Superficial epithelia of the endometrium and stromal thickness were similar between TCA uterine horn from groups. However, the number of endometrial glands was higher in group 1. CONCLUSION(S) The study developed an experimental model for endometrial ablation. TCA acid is a potent agent for endometrial ablation in rat model. No endometrial regeneration was observed after recovery of cycle.