Analysis of conization results in patients undergoing hysterectomy for uterine adenocarcinoma / Análise dos resultados de conização nos pacientes submetidos a histerectomia por adenocarcinoma uterino

Abstract Objective To observe if the histopathological result of a conization performed after cervical adenocarcinoma in situ diagnosis is compatible with the histopathological analysis of a subsequent hysterectomy. Methods The present descriptive and observational research consisted of the analysis of the medical records of 42 patients who were diagnosed with in situ adenocarcinoma postconization. The analysis consisted of whether there was compatibility between the histopathological reports of conization and hysterectomy and if there was an association between adenocarcinoma in situ and another neoplasia (squamous disease). Interpretation of any immunohistochemistry reports obtained was also performed. In addition, clinical and epidemiological data were also analyzed. Results A total of 42 conizations were performed, 33 (79%) were cold knife conizations and 9 (21%) were loop electrosurgical excision procedures (LEEPs). Of the patients analyzed, 5 (10%) chose not to undergo subsequent hysterectomy to preserve fertility or were < 25 years old. Out of the 37 patients with adenocarcinoma in situ who underwent subsequent hysterectomy, 6 (16%) presented with residual disease. This findingprovedincompatiblewiththe finding of the conizations, which had ruled out invasive cancer. Conclusion The prevalence of adenocarcinoma in situ increased in the past years. There is still a large part of the medical literature that advocates the use of conservative treatment for this disease, even though it is common knowledge that it is a multifocal disease. However, the majority of studies advocate that hysterectomy should remain the preferred treatment for women who have already completed their reproductive purpose.

Resumo Objetivo Observar se o resultado proveniente de uma conização realizada após o diagnóstico de adenocarcinoma cervical in situ é compatível com a análise histopatológica da histerectomia. Métodos A pesquisa foi descritiva e observacional e consistiu na análise de prontuário de 42 pacientes que tiveram o diagnóstico de adenocarcinoma in situ obtidas por conização. Foram analisados se havia compatibilidade entre os laudos de conização e histerectomia, margens do cone, se havia associação com outra patologia (doença escamosa) e interpretação de eventuais laudos histoquímicos obtidos. Além disso, também foram analisados dados clínico-epidemiológicos. Resultados Foram realizadas 42 conizações, sendo 33 (79%) por cone clássico e 9 (21%) por cirurgia de alta frequência. Das pacientes analisadas, 5 (10%) não foram submetidas a histerectomia por desejarem manter a fertilidade ou por terem idade < 25 anos. Das 37 pacientes com adenocarcinoma in situ no exame prévio realizado e que foram submetidas à histerectomia posteriormente, 6 (16%) apresentaram doença residual após o procedimento cirúrgico, apresentando laudos do anatomopatológico pós-histerectomia incompatíveis com o achado na conização que atestava margens livres. Conclusão A prevalência do adenocarcinoma in situ vemaumentando cada vez mais. Ainda há uma grande parte da literatura que defende o uso do tratamento conservador para esta doença, mesmo sabendo que ela é uma doença multifocal e que pode estar presente mesmo em situações nas quais o anatomopatológico evidencie margens livres. Tendo em vista essas características, a maioria preconiza que a histerectomia continua a ser o tratamento preferencial nas mulheres que já completaram o seu intuito reprodutivo.

Fibroadenoma in axillary accessory breast: a case report

The mass are among the possible alterations observed in the axilla. When found, the most frequent differential diagnosis are lymphadenopathy, metastatic lymphadenomegaly, lymphoma, lipoma or tumors in the apocrine glands. Besides that, the presence of accessory breast tissue must also be considered and, as the topical breast tissue, can be the target of breast diseases, either benign or malignant. Female patient, 23 years old, with the presence of hardened palpable node in the right axilla. At the ultrasound, it presented characteristics that classified it as Bi-Rads® 4. An aspiration biopsy of the node was performed with fine-needle, which resulted in unsatisfying material. After the explanation of the therapeutic choices, the patient opted for the excision of the axillary node. The anatomical pathological result showed a nodular formation compatible with fibroadenoma. The occurrence of a node in the axillary region is common. However, in the vast majority of times, it is merely an inflammatory response, manifested as a lymphadenomegaly. In case of chronic mass with suspicious characteristics, it is convenient to suspect the presence of lymphoid neoplasms, locoregional metastasis of breast cancer or melanoma and alterations in accessory breast tissue. In young patients, it is important to evaluate the existence of accessory breast tissue with the presence of suspicious axillary node, because, although controversial, some authors believe that such alterations occur more frequently in these patients. Additionally, in cases of inconclusive imaging, an excision of the lesion must be performed for a definite diagnosis.

Recurrent vulvar condiloma treatment in infant: a case report / Tratamento de condiloma vulvar recorrente em lactente: um relato de caso

Introduction: Anogenital warts are one of the major clinical manifestations of the Human Papillomavirus (HPV). Case reports in children have grown in the last decades; however, there are still difficulties in determining the virus epidemiology and the best therapy for this age group. Objective: To report a case of recurrent vulvar condyloma in a sexually abused infant who presented complete resolution of the lesions after the use of topical imiquimod. Methods: Data research and medical record review were performed in addition to a qualitative study consisted of a wide literature appreciation on the subject. Results: After undergoing extensive therapy, the patient was successfully treated using topical imiquimod. Conclusion: Observation of this particular case suggests that imiquimod may be a safe and effective therapeutic alternative for the treatment of condyloma in the pediatric population. However, theoretical foundations for such conduct are scarce. Thus, the need for further studies on the subject is reinforced.

Introdução: As verrugas anogenitais constituem uma das principais manifestações clínicas da infecção pelo vírus do Papiloma Humano (HPV). Relatos de casos em crianças têm crescido nas últimas décadas; contudo, ainda há dificuldades em determinar a epidemiologia do vírus e definir a melhor terapêutica para essa faixa etária. Objetivo: Relatar um caso de condiloma vulvar recorrente em uma lactente abusada sexualmente que apresentou resolução completa das lesões após o uso de imiquimode tópico. Métodos: Foi realizado levantamento de dados e revisão de prontuário, além de estudo qualitativo composto por apreciação ampla da literatura acerca do tema em questão. Resultados: Depois de ser submetido à extensa terapêutica, a paciente foi tratada com sucesso utilizando imiquimode tópico. Conclusão: A observação desse caso específico sugere que o imiquimode pode ser uma alternativa terapêutica segura e eficaz para o tratamento de condiloma na população pediátrica. Entretanto, embasamentos teóricos para tal conduta são escassos. Assim, reforça-se a necessidade do desenvolvimento de mais estudos sobre a temática.