Heleusa Ione Monego

P53 and BCL-2 as prognostic markers in endometrial carcinoma.

The objective of this study was to verify the frequency of p53 and BCL-2 immunohistochemical expression in patients with endometrial carcinoma and to correlate it with histological factors (histological type, tumor grade, depth of myometrial invasion, lymph node involvement and surgical staging) and survival. Forty-eight patients with endometrial carcinoma who were submitted to primary surgical treatment were assessed. p53 and BCL-2 immunohistochemical expression was determined using paraffin blocks containing the tumor area. p53 and BCL-2 expression was detected in 39.6% and 58.3% of the tumors, respectively. No significant difference was found regarding the frequency of p53 expression when analyzing histological type (33.3% in endometrioid tumors, 58.3% in non-endometrioid tumors; p = 0.176), depth of myometrial invasion (p = 0.632) and surgical staging (I—11.1%, II—66.7%, III—57.1%; p = 0.061). p53 expression was significantly more frequent in undifferentiated tumors (p = 0.007) and in those showing lymph node involvement (p = 0.030). Univariate analysis showed a positive association with death (RR, 3.358; CI, 1.386–8.134; p = 0.005) and short-term survival. The present study did not reveal any correlation between BCL-2 expression and histopathologic markers or survival. In conclusion, this study showed that p53 expression is directly correlated with undifferentiated tumors, lymph-node involvement and risk of death. On the other hand, BCL-2 expression was not correlated with any known histological factors.

Vaginal Adenosis in a Non-Diethylstilbestrol-Exposed 6-Year-Old Patient

Vaginal adenosis is rare, and it is defined as the presence of metaplastic cervical or endometrial epithelium within the vaginal wall. It is associated with in utero exposition to diethylstilbestrol and a high risk of vaginal carcinomas. A case of vaginal adenosis arising in a non-diethylstilbestrol-exposed 6-year-old patient is presented. Few cases have been described in children and adolescents, and since the withdrawal of diethylstilbestrol from the market, this condition is rarely described in the medical literature. However, it should be considered as a possible diagnosis in girls with persistent vaginal discharge.

Comparison of Loop Electrosurgical Conization with One or Two Passes in High-Grade Cervical Intraepithelial Neoplasias

The use of loop electrosurgical conization (LEC) for the treatment of large high-grade cervical intraepithelial neoplasias (CINs) is often associated with a difficult procedure that results in accidental sample fragmentation, thermal damage and sometimes the presence of positive margins. This study aims to compare LEC that removes the cervical cone in two blocks (anterior and posterior cervical lips – LEC2) with LEC performed with one pass of the loop (LEC1). In a randomized, controlled trial, patients that needed conization due to high-grade CIN were assigned to one of the techniques. There were no differences in terms of age, cone histopathological diagnosis, blood loss, vaginal injuries, stenosis of the cervical os and specimen artifacts. LEC2 required less hemostatic sutures. LEC2 showed no specimen fragmentation, while LEC1 did (0 vs. 5.9%; p = 0.10). As expected, LEC2 samples were heavier (p = 0.01), included a larger ectocervical area (p = 0.001) and, therefore, had a greater volume (p < 0.001) compared to LEC1 samples. The height of the LEC2 specimens was smaller than that of LEC1 specimens (p < 0.001). LEC2 yielded fewer cases of positive margins (12.7%) than LEC1 (33.3%; p = 0.021). We conclude that the LEC2 technique is an effective treatment choice: it is safe for the patient, with better outcomes regarding sample quality than LEC1. Further studies are encouraged regarding this procedure.

Cervical Cancer Posttreatment Follow-up: Critical Analysis

Objective The aim of this study was to evaluate the role of follow-up tests and examinations in diagnosing symptomatic and asymptomatic relapses after treatment for cervical cancer. Methods Data were collected from medical records for all patients diagnosed as having cervical cancer from January 1985 to June 2010. The significance level was P < 0.005. Results Sixty-four (17.8%) of the 358 patients investigated suffered tumor relapse. Thirty-four (53.1%) were symptomatic, and 30 (46.9%) were asymptomatic. Most patients had tumor relapse diagnosed during physical examination, both among the symptomatic patients (50%) and the asymptomatic patients (66.7%) (P = 0.27). Cytopathology was responsible for detecting relapse in only 1 case in each group, corresponding to 2.9% and 3.3%, respectively (P = 0.99). Imaging examinations confirmed 10 relapses (29.4%) among symptomatic patients and 8 cases (26.6%) among asymptomatic patients (P = 0.77). There were no statistically significant differences between the 2 groups or between the different methods of detecting relapses. There was still no association after adjustment for potential confounding factors such as age and type of treatment. Conclusions Physical examination was the preeminent method for detecting tumor relapse in this study. None of the other tests or examinations were capable of detecting relapses in both symptomatic and asymptomatic patients. These results highlight the urgent need for prospective studies that compare the efficacy of different follow-up regimens, analyzing factors such as global survival, quality of life, and cost.

Randomized clinical trial comparing cold knife conization of the cervix with and without lateral hemostatic sutures.

OBJECTIVE Compare blood loss during cold knife conization of the cervix with and without lateral hemostatic sutures in the cervical branches of the uterine arteries. DESIGN Randomized clinical trial. SETTING Hospital de Clínicas de Porto Alegre (HCPA). POPULATION 102 patients that underwent cold knife conization. METHODS Women that underwent cold knife conization of the cervix were randomized to undergo the procedure with or without lateral hemostatic sutures. MAIN OUTCOME MEASURES PRIMARY OUTCOME MEASURE blood loss measured in grams. SECONDARY OUTCOME MEASURES operative time and postoperative intervention. Only the participants were blinded to group assignment. RESULTS From March 2009 to August 2012, patients were randomly assigned to one of the study groups. There were no differences in amount of blood loss between patients that underwent the procedure with and without sutures (p = 0.39). Operative time was shorter in the group without suture (p = 0.020). There were no differences in intervention due to bleeding (p = 0.20). Blood loss was greater among menstruating women than for menopausal women (p = 0.011). There were no differences in amount of blood lost between smoking and nonsmoking patients (p = 0.082). CONCLUSIONS Lateral hemostatic sutures do not affect the amount of intraoperative bleeding or the number of postoperative interventions. Their use is not necessary because they result in longer operative time, have a higher cost due to the use of suture material and pose the risk of ureter lesion in case the sutures are not placed at a lower position in the cervix. ClinicalTrials. gov identifier: NCT02184975.

Adenocarcinoma de endométrio : epidemiologia, tratamento e sobrevida de pacientes atendidas no Hospital de Clínicas de Porto Alegre

Introducao: Neste estudo, descreve-se o perfil clinico das pacientes e as caracteristicas histopatologicas dos carcinomas de endometrio tratados no setor de Oncologia Genital do Hospital de Clinicas de Porto Alegre (HCPA), assim como as formas de tratamento, fatores prognosticos e sobrevida. Metodos: Estudo de coorte historica incluindo todas as pacientes submetidas a tratamento cirurgico primario entre 1996 a 2012. Apos revisao de prontuarios medicos, foram analisadas as variaveis idade, status hormonal, tipo histologico e grau tumoral, invasao miometrial, estadiamento cirurgico, cirurgia realizada, tratamento complementar e sobrevida. Resultados: Cento e sessenta e quatro pacientes foram incluidas no estudo, com idade media de 64,2 anos (31-95 anos), sendo quase 90% delas pos-menopausicas. O tempo de seguimento variou de 4 dias a 14,6 anos. O tipo histologico endometrioide foi o mais encontrado (78% dos casos). A histerectomia com salpingo-ooforectomia bilateral com linfadenectomia pelvica foi a cirurgia mais realizada (77,5%). Tratamento complementar foi realizado em 57,9% das pacientes, sendo a radioterapia o tratamento de escolha em 87,4% deles. Ocorreram 36 obitos (22%) durante o seguimento, com uma sobrevida media global de 125 meses. Em analise bivariada, idade ≥ 65 anos, tipo histologico nao endometrioide, tumores pouco diferenciados (G3), invasao miometrial ≥ 50% e metastase linfonodal relacionaram-se significativamente a um menor tempo de sobrevida. Em analise multivariada, a histologia nao endometrioide estadio III e IV, e a presenca de comprometimento linfonodal foram significativamente associados ao obito. Conclusao: Os resultados encontrados sao compativeis com a literatura existente e vem em acrescimo a escassa estatistica nacional.

Prevalencia y repercusión en las recidivas de la invasión linfovascular en el cáncer cervicouterino incipiente: prevalencia de la invasión linfovascular en el cáncer cervicouterino

Objetivo. El propósito de este estudio era determinar la prevalencia de la invasión linfovascular (ILV) en el cuello uterino y su repercusión en la supervivencia en mujeres con muestras de cáncer cervical incipiente sometidas a histerectomía radical. Materiales y métodos. Se revisó la invasión linfovascular en 107 casos de cáncer cervicouterino en estadios IB1 y IIA y se comparó con el examen anatomopatológico original. Además, se calculó adecuadamente la repercusión en las recidivas en cada paciente y se comparó con la presencia de ILV. Resultados. Se detectó invasión linfovascular en el cuello uterino en el 17,8% (19/107) de los casos (IC del 95% = 11,37‐ 25,87) en el examen anatomopatológico original, y cuando las muestras se revisaron específicamente en busca de esta alteración en el presente estudio, el 74,8% (80/107) de los casos (IC del 95% = 65,9‐82,31) eran positivos. Se hizo un seguimiento de las pacientes durante una media de 4,87 ± 2,66 años, y la recidiva tumoral no fue diferente entre las pacientes con (27,5%; 22/80) y sin (7,4% 2/27) ILV (p = 0,058), aunque se demostró una fuerte tendencia. Conclusiones. La prevalencia de la ILV se infravalora en los exámenes anatomopatológicos habituales, y su tasa aumenta considerablemente con una revisión meticulosa. Hay que seguir investigando la relación entre su presencia y un pronóstico peor.

Contents Vol. 67, 2009

M.A. Belfort, Provo, Utah J. Bornstein, Nahariya H.L. Brown, Durham, N.C. C. Chapron, Paris J. de Haan, Maastricht G.A. Dekker, Adelaide J.A. Deprest, Leuven K. Hecher, Hamburg S. Kahhale, São Paulo H. Kliman, New Haven, Conn. T.F. Kruger, Tygerberg J.A. Kuller, Raleigh, N.C. M.J. Kupferminc, Tel Aviv H. Minkoff , Brooklyn, N.Y. J. Moodley, Congella J.M. Mwenda, Nairobi H. Odendaal, Tygerberg J.T. Repke, Hershey, Pa. Founded 1895 as ‘Monatsschrift für Geburtshilfe und Gynäkologie’, continued 1946–1969 as ‘Gynaecologia’ and 1970–1977 as ‘Gynecologic Investigation’

Tuberculose Pélvica Simulando Tumor Ovariano: a Case Report

Pelvic tuberculosis is an extrapulmonary form of tuberculosis with increasing incidence in the western world. Clinical and laboratory findings of this disease are often unspecific and mimic a variety of other disorders, including gynecologic malignant tumors. The authors report a case of a 53-year-old woman with pelvic tuberculosis and associated abdominal tuberculous peritonitis. Laboratory investigation included laparoscopy, CA-125 levels and tuberculin test, among others. Discussion on the clinicopathological aspects and diagnostic methods used to elucidate this case is presented.