Gustavo Py Gomes da Silveira

Tamoxifen use and endometrial lesions : hysteroscopic, histological, and immunohistochemical findings in postmenopausal women with breast cancer

Objective: To evaluate immunohistochemical, hysteroscopic, and histological findings in postmenopausal women taking tamoxifen for breast cancer. Methods: Forty postmenopausal women taking 20 mg/day tamoxifen for breast cancer underwent hysteroscopy and endometrial biopsy from January 2000 to December 2003. Medical records and paraffin blocks were analyzed retrospectively, and Ki-67, estrogen receptors (ERs), and progesterone receptors were measured using an immunohistochemical technique. Results: The mean ± SD age of the women was 59 ± 14 years at hysteroscopy (95% CI, 54.2-63.7) and 45.1 ± 7 years at menopause (95% CI, 42.6-47.6). Mean ± SD duration of tamoxifen therapy was 27.3 ± 16.5 months (95% CI, 22.0-32.5). Hysteroscopies were performed because of abnormal sonographic findings in 60% of the women and postmenopausal bleeding in 40%. The most common hysteroscopic and histological findings were endometrial polyps (32.5%) and atrophic endometria (22.5%). Immunohistochemistry showed that 85% of the women were progesterone receptor positive, 75% were ER positive, and 50% were Ki-67 positive. Endometrial polyps and polyps associated with atrophic endometrium were ER positive (P = 0.019). Results that were ER negative were more frequent in atrophic endometria (P = 0.01). The longer the time since menopause, the lower the Ki-67 expression in the endometrium was (P = 0.03). Ki-67 expression was greater in the endometrium of younger postmenopausal women (P = 0.01). Conclusions: The expression of steroid receptors in the endometrium was high in our series. All cases of endometrial polyps were ER positive. Estrogen receptors may play a major role in the development of endometrial polyps in postmenopausal women taking tamoxifen. Although most histological findings were benign, 22.5% were atrophic.

A expressão da proteína p16 e herpes simples vírus tipo 2 em lesões pré-neoplásicas e neoplásicas do colo do útero

PURPOSE to demonstrate the expression of biomarkers, detected by immunohistochemical techniques in healthy tissues, as well as in preneoplastic and neoplastic lesions of the uterine cervix. METHODS in order to evaluate the immunohistochemical reactivity of tissues from the uterine cervix to p16 and to type 2 herpes simplex virus (HSV-2), 187 samples of low-grade intraepithelial lesions (LG-IEL) and high-grade intraepithelial lesions (HG-IEL), and of uterine cervix carcinoma were compared with a group of patients without uterine cervix lesions. Statistical analysis was done by the chi2 test for trends. The significance level was alpha=0.05. RESULTS the reactivity to p16 was assessed showing the following distribution: group without uterine cervix lesions: 56% (24/43), LG-IEL: 92% (43/47), HG-IEL: 94% (43/46), and cancer: 98% (46/47) (p<0.001, linear trend). Concerning the HSV-2: group without uterine cervix lesions: 27% (12/45), LG-IEL: 58% (22/38), HG-IEL: 78% (35/45), and cancer: 59 % (29/49) (p<0.001, linear trend). There was an increase in the reactivity ratio for the two markers in the pathological groups (LG-IEL, HG-IEL and uterine cervix cancer, at p<0.001) compared to controls. There was no significant difference between the LG-IEL and the HG-IEL groups. CONCLUSIONS a progressive increase of reactivity ratios of the studied immunohistochemical markers as a function of lesion severity was observed.

Radical Vaginal Trachelectomy

Cervical cancer is the fourth most common cancer in women, with estimated rates of incidence age standardized (ASRs) ranging from 5.5 per 100,000 in Australia/New Zealand to 42.7 in Eastern Africa. Around 84% of new cervical cancer and 87% of cervical cancer deaths occur in the less developed regions.

Laparoscopic Isthmocervical Cerclage with Mersilene Tape After Radical Vaginal Trachelectomy.

performed via open, laparoscopic, and robotic approach. Uterine isthmovaginal anastomosis could be performed in vaginal or intra-corporeal approach and interrupted suture is used in most of the cases. A barbed suture is an attractive suture option that allows for easier and faster laparoscopic suturing by eliminating repeated knots and the need to maintain tension on the suture line. Here we present the case of successful uterine isthmo-vagina anastomosis with barbed suture in robotic radical trachelectomy. Uterine Isthmo-vaginal anastomosis is technically challenging when performed intra-corporeal approach and implementation of a barbed suture is able to decrease operative time without compromising surgical outcome.