Neila Maria de Góis Speck

Cervical cancer screening in young and elderly women of the Xingu Indigenous Park: evaluation of the recommended screening age group in Brazil

Objective To analyze the occurrence of atypia in the cytology/histology examinations of young women under the age of 25 years and of elderly women aged over 64 years, in the Xingu Indigenous Park and to evaluate, in a subjective manner, if the age range for screening established by the Ministry of Health and the Instituto Nacional de Câncer is appropriate for this population. Methods The Xingu/UNIFESP Project, in partnership with the Center for Gynecological Disease Prevention, develops programs to prevent cervical cancer. The exploratory, retrospective and descriptive study of cytological and histopathological examinations of young (12-24 years) and elderly (aged 64 and over) women of the Xingu Indigenous Park, between 2005 and 2011. Results There was low occurrence of cytological atypia in the elderly female population, but there were occasional high-grade lesions in the indigenous youth. Conclusion Interrupting screening at the limit age of 64 years, as established by the Ministry of Health and the Instituto Nacional de Câncer is justified. However, screening of young women should begin at an earlier age.

Relação entre angiogênese e estádio no carcinoma do endométrio

OBJETIVO: avaliar se o numero de vasos neoformados e fator importante para o prognostico do adenocarcinoma endometrial, comparando-o com o grau de diferenciacao histologica e o estadiamento do tumor. METODOS: foram estudadas 56 amostras de tecido endometrial, sendo 11 com o diagnostico histologico de endometrio atrofico, 10 endometrios proliferativos (ambos caracterizados como grupos controle), 10 amostras de adenocarcinomas GI, 13 adenocarcinomas GII e 12 adenocarcinomas GIII, caracterizados como grupos de estudo. Dois cortes histologicos foram obtidos de cada caso: um foi corado pela hematoxilina-eosina e o outro, para estudo imuno-histoquimico, foi tratado com anti-CD34, com a finalidade de corar vasos. A contagem vascular foi realizada na interface do crescimento tumoral com o estroma adjacente, em dez campos de 100 vezes de aumento, mediante estudo morfometrico pelo sistema computadorizado Kontron S300. No grupo controle, foi selecionada a interface entre glândulas endometriais e estroma adjacente. RESULTADOS: a media de vasos contados em 10 campos foi de 11,6 para o endometrio atrofico; 13,2 para o proliferativo; 15,3 para o adenocarcinoma GI; 19 para o adenocarcinoma GII e 22,7 para o adenocarcinoma GIII. A media de quantificacao vascular para os tumores das pacientes incluidas no estadiamento clinico I foi 18,6, semelhante estatisticamente aquelas dos estadiamentos II, III e IV (20,9) computados em conjunto. CONCLUSAO: concluimos que o adenocarcinoma pouco diferenciado apresenta maior numero de vasos por campo que o endometrio normal e que o carcinoma bem diferenciado. A quantificacao vascular nao foi influenciada pelo estadiamento como fator isolado.

Association between the p53 arginine/arginine homozygous genotype at codon 72 and human papillomavirus E6/E7 mRNA expression

OBJECTIVE To evaluate the association between p53 polymorphisms and human papillomavirus (HPV) E6/E7 mRNA expression. METHODS We analyzed 175 cervical samples from women aged 16-69 years old who were tested for HPV E6/E7 mRNA expression (NucliSENS® EasyQ® HPV). The samples were divided into three groups: positive (n=75) those with positive HPV E6/E7 mRNA expression and positive high-risk HPV Hybrid Capture (HR-HC) test; negative (n=52) those with negative HPV E6/E7 mRNA expression and positive HR-HC; and control (n=48) those with negative HPV E6/E7 mRNA expression and negative HR-HC. The p53 polymorphisms at codons 11, 72, and 248 were evaluated through polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS The frequency of the arginine/arginine homozygous genotype at codon 72 was significantly higher in the positive (49.3%) than in the negative (32.7%) and control groups (20.8%, p=0.002*). The frequency of the arginine allele was also significantly higher in the positive (67.3%) than in the negative (53.8%) and control groups (38.5%, p<0.001*). The arginine/arginine homozygous genotype was significantly associated with positive HPV E6/E7 mRNA expression (positive group) compared with negative and control groups (odds ratio: 2.633; 95% CI, 1.399-4.954, p=0.003). The frequency of arginine/arginine homozygous genotype at codon 72 remained significantly more frequent in the positive group of women aged ≥30 years than in the other two groups. CONCLUSION The presence of the p53 arginine/arginine homozygous genotype at codon 72 was significantly associated with the positive HPV E6/E7 mRNA expression.

An interesting finding in the uterine cervix: Schistosoma hematobium calcified eggs

Schistosoma hematobium infection is an endemic parasitic disease in Africa, which is frequently associated with urinary schistosomiasis. The parasite infection causes epithelial changes and disruption, facilitating the infection by the human papilloma virus and human immunodeficiency virus (HIV). The authors report the case of a 44-year-old African HIV-positive woman who presented an abnormal routine Pap smear. Colposcopy examination revealed dense acetowhite micropapillary epithelium covering the ectocervix, iodine-negative, an erosion area in endocervical canal, and atypical vessels. Histologic examination of the surgical specimens showed numerous calcified schistosome eggs (probably S. hematobium) and a high-grade cervical intraepithelial neoplasia. The relation between S. hematobium infection and bladder cancer is well known; however, this relationship with cervical cancer remains controversial. The symptoms of schistosomiasis of the female genital tract are rather non-specific, and are often misdiagnosed with other pelvic diseases. The familiarity of health professionals with schistosomiasis of the female genital tract is less than expected, even in endemic regions. Therefore, great awareness of this differential diagnosis in routine gynecological practice is of paramount importance.

Therapeutic Assessment of Vulvar Squamous Intraepithelial Lesions with CO2 Laser Vaporization in Immunosuppressed Patients

OBJECTIVE  A vulvar squamous intraepithelial lesion is deemed to be a preceding lesion to vulvar cancer, especially in women aged under 40 years, holders of an acquired or idiopathic immunosuppression. Several treatments have been used to treat these lesions. One of the aesthetically acceptable therapeutic methods is the CO2 laser vaporization. METHODS  In a transversal study, 46 records of immunosuppressed women bearing a vulvar low grade and/or high grade squamous intraepithelial lesion were selected out of the retrospective analysis, computing age, date of record, date of vulvar lesion treatment with CO2 laser, the time elapsed between the first and the last visit (in months), the number of visits, the presence or absence of condylomatous lesions in other female lower genital tract sites and whether or not recurrences and persistence of intraepithelial lesions have been noticed during the follow-up. RESULTS  Patients bearing vulvar high-grade squamous intraepithelial lesion and immunosuppressed (serum positive for human immunodeficiency virus [HIV] or with solid organs transplantation) have shown a higher level of persistence of lesions and a higher chance of having other areas of the female lower genital tract involved. CONCLUSION  While the CO2 laser vaporization is the most conservative method for the treatment of vulvar high-grade intraepithelial lesions, it is far from being the ideal method, due to the intrinsic infection features considered. The possibility of persistence, recurrences and spontaneous limited regression indicates that a closer surveillance in the long-term treated cases should be considered, in special for immunosuppressed patients.

Cervical squamous intraepithelial lesions grades 1 and 2: value of an alternative morphological classification and of p16 immunohistochemistry in the prediction of clinical outcome

Introduction: Diagnostic reproducibility and determination of prognostic factors in cervical intraepithelial neoplasias grades 1 and 2 are still relevant problems in the daily practice of gynecological histopathology. Objective: To correlate the value of morphological reclassification and of p16 immunoexpression in cervical intraepithelial neoplasias grades 1 and 2 with clinical outcome. Materials and methods: Sixty-six patients were included (34 with cervical intraepithelial neoplasia grade 1, and 32 with grade 2); an immunohistochemical study with p16 and reclassification according to the Lower Anogenital Squamous Terminology (LAST) Consensus and by the alternative proposal of Herfs and Crum were done; unfavorable outcome was defined as a subsequent histologic diagnosis of cervical intraepithelial neoplasia grade 3 or invasive squamous cell carcinoma. Results: We observed superior performance of the alternative morphological classification (p = 0.002) to determine unfavorable outcome. We also detected superior performance of p16 in the same determination (p = 0.002). Conclusion: The use of an alternative morphological classification is promising; in the context of the use of immunohistochemical antibodies as biomarkers, p16 showed good sensitivity and negative predictive value in the determination of cases in which the outcome was unfavorable.

Treatment of Bartholin gland cyst with CO2laser

ABSTRACT Objective To describe the results of treatment with CO2 laser for Bartholin gland cysts. Methods Thirty-one women with Bartholin gland cysts were treated with CO2 laser at an outpatient´s setting. Skin incision was performed with focused laser beam, the capsule was opened to drain mucoid content, followed by internal vaporization of impaired capsule. Results There were no complications. Five patients had recurrence of the cyst and were submitted to a second and successful session. Conclusion CO2 laser surgery was effective to treat Bartholin gland cysts with minimal or no complications, and can be performed at an outpatient´s setting.

Immunohistochemical Expression of VEGF and Podoplanin in Uterine Cervical Squamous Intraepithelial Lesions.

VEGF and podoplanin (PDPN) have been identified as angiogenesis and/or lymphangiogenesis regulators and might be essential to restrict tumor growth, progression, and metastasis. In the present study, we evaluate the association between the expression of these markers and CIN grade. Immunohistochemistry was performed in 234 uterine cervical samples using conventional histologic sections or TMA with the monoclonal antibodies to VEGF (C-1 clone) and podoplanin (D2-40 clone). Positive-staining rates of VEGF in 191 CIN specimens were significantly associated with histological grade (P < 0.001). Negative and/or focal immunostaining for PDPN were more frequent in CIN 3 (P = 0.016). We found that patients with CIN 3 more frequently had strong and more diffuse staining for VEGF and diminished staining for PDPN (P = 0.018). Strong and more diffuse VEGF immunoexpressions in CIN 2 and CIN 3 were detected when compared to CIN 1. Negative and/or focal PDPN immunoexpression appear to be more frequent in CIN 3. Moderate to strong VEGF expression may be a tendency among patients with high-grade lesions and diminished PDPN expression.

Rela??o entre angiog?nese e est?dio no carcinoma do endom?trio ]]>

OBJETIVO: avaliar se o numero de vasos neoformados e fator importante para o prognostico do adenocarcinoma endometrial, comparando-o com o grau de diferenciacao histologica e o estadiamento do tumor. METODOS: foram estudadas 56 amostras de tecido endometrial, sendo 11 com o diagnostico histologico de endometrio atrofico, 10 endometrios proliferativos (ambos caracterizados como grupos controle), 10 amostras de adenocarcinomas GI, 13 adenocarcinomas GII e 12 adenocarcinomas GIII, caracterizados como grupos de estudo. Dois cortes histologicos foram obtidos de cada caso: um foi corado pela hematoxilina-eosina e o outro, para estudo imuno-histoquimico, foi tratado com anti-CD34, com a finalidade de corar vasos. A contagem vascular foi realizada na interface do crescimento tumoral com o estroma adjacente, em dez campos de 100 vezes de aumento, mediante estudo morfometrico pelo sistema computadorizado Kontron S300. No grupo controle, foi selecionada a interface entre glândulas endometriais e estroma adjacente. RESULTADOS: a media de vasos contados em 10 campos foi de 11,6 para o endometrio atrofico; 13,2 para o proliferativo; 15,3 para o adenocarcinoma GI; 19 para o adenocarcinoma GII e 22,7 para o adenocarcinoma GIII. A media de quantificacao vascular para os tumores das pacientes incluidas no estadiamento clinico I foi 18,6, semelhante estatisticamente aquelas dos estadiamentos II, III e IV (20,9) computados em conjunto. CONCLUSAO: concluimos que o adenocarcinoma pouco diferenciado apresenta maior numero de vasos por campo que o endometrio normal e que o carcinoma bem diferenciado. A quantificacao vascular nao foi influenciada pelo estadiamento como fator isolado.