Suzana Arenhart Pessini

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.

Paget's disease of the vulva: A review of 89 cases

The purpose of this study was to retrospectively review the clinical characteristics and outcomes of a series of women with Pagets disease of the vulva. A retrospective review was performed of 89 women with Pagets disease of the vulva evaluated at a single institution between 1966 and 2010. Medical records were reviewed for demographic information, clinical data, pathologic findings, treatment modalities and outcomes. We found that the primary treatment was surgery for 74 (83.1%) patients, with positive margins noted in 70.1% of cases. Five patients (5.6%) underwent topical treatment with imiquimod and/or 5-fluorouracil, one patient (1.1%) underwent laser ablation and treatment was unknown in 9 patients (10.1%). The majority of patients had multiple recurrences, with 18% having four or more recurrences. There were no significant differences in recurrence rates between patients who underwent surgery and those who did not. Furthermore, there was no association between positive margins following primary surgery and recurrence. Forty-one patients (46.1%) were diagnosed with 53 synchronous or metachronous cancers. Seven patients (7.9%) were found to have invasive vulvar cancer with 1 mm or more depth of invasion, but none of the patients died of Pagets disease or associated vulvar/vaginal cancer. Our findings suggest that the majority of patients with Pagets disease of the vulva develop multiple recurrences regardless of treatment modality or margin status. Alternatives to surgery are needed to better care for women with this disease.

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.

Surgery in ovarian cancer – Brazilian Society of Surgical Oncology consensus

Surgical management in epithelial ovarian cancer (EOC) has a significant impact in overall survival and progression‐free survival. The Brazilian Society of Surgical Oncology (BSSO) supported a taskforce of experts to reach a consensus: experienced and specialised trained surgeons, in cancer centres, provide the best EOC surgery. Laparoscopic and/or radiological staging prognosticates the possibility of complete cytoreduction (CC0) and helps to reduce unnecessary laparotomies. Surgical techniques were reviewed. Multidisciplinary input is essential for treatment planning. Quality assurance criteria are proposed and require national consensus. Genetic testing is mandatory. This consensus states the final recommendations from BSSO for management of EOC.

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.