Jorge Saad Souen

Cellular immunity in squamous cell carcinoma of the uterine cervix

The thymus-dependent immunity of 42 patients with SCCC was evaluated by: delayed cutaneous reactions to ubiquitous antigens, DNCB sensitization, and lymphocyte response to PHA. In addition, T and B lymphocytes were detected in peripheral blood and in tumor sections, by adherence to E and HEAC. Depressed CMI was more intense in patients with disseminated disease, although a premature impairment of CMI was observed in some patients with initial-stage tumors. The absolute number of peripheral T lymphocytes showed association with both cutaneous reactions and PHA response. However, there appeared to be no significant correlation between the stage of the tumor and the pattern of adherence of E or HEAC to the biopsies.

Trochar site metastasis after laparoscopic pelvic lymphadenectomy for cervical squamous cell carcinoma

The role of diagnostic laparoscopy in the staging of uterine malignancies is not well defined. Recent experimental studies suggest that laparoscopic surgery for abdominal malignancy may be w x associated with increased tumor implantation 1 . Clinical reports of port site metastasis following laparoscopic resection of intra-abdominal malignancy suggest that laparoscopy promotes tumor metastasis to wounds. We present a case of metastasis to four laparoscopic trochar sites in a 33-year-old patient with squamous cell cervical carcinoma, stage Ib2 FIGO submitted to pelvic laparoscopic lymphadenectomy, with positive lymph nodes metastasies in both pelvic lymph node chains. Six weeks after laparoscopy when the patient

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.

Wertheim-Meigs radical hysterectomy

Wertheim-Meigs hysterectomy is the treatment of choice for invasive cervix cancer stage IB and IIA at the University of São Paulo Medical School. It was performed in 168 patients between 1974 and 1993. Pelvic lymph node metastases were found in 19 patients (11.3%) and 149 were negative lymph node. The recurrence rate was 21% in the positive lymph node and 6% in the negative lymph node patients. Complications occurred in 35 patients (20.83%) and were as follows: atonic bladder in 9.52%; fistulae in 5.59%; urinary incontinence in 4.76%; ureteral stenosis in 2.97%; dehiscence in 2.38% and lymphedema in 1.19%. Intraoperative complications occurred at a rate of 4.76% and involved injuries to the bladder, ureter and great vessels.

Do Estrogens improve bone mass in osteoporotic women over ten years of menopause

A retrospective analysis of 24 patients with established osteoporosis and with ten or more years of menopause treated with conjugated estrogen, progesterone and calcium followed for one year has been performed. Treated women received 0.625 mg/day of conjugated estrogen from day 1 to 25, 5 mg/day of medroxiprogesterone from day 13 to 25, of each cycle, plus calcium (500-1000 mg/day), during one year (12 cycles). As control group was used 18 age-matched that received only calcium (500 a 1000 mg/day). All patients had at least two dual-photon spine and proximal femur (neck, Wards triangle and trocanter) densities measurements performed 12 months apart. Estrogen treatment was associated with increased bone mineral density at spine and trocanter. Control group did not present any statistically change after one year in any site studied. We concluded that women with ten or more years of menopause and established osteoporosis treated with replacement hormonal therapy and calcium results in improvement of bone mineral density. These data support that women with ten or more years of menopause respond to estrogen replacement therapy with absolute increments in bone density similar to those seen in younger women, in the early menopause.