Recurrent vaginal discharge: an unusual presentation of embryonal rhabdomyosarcoma of uterine cervix in an adolescent girl

Embryonal rhabdomyosarcoma (ERMS) is a rare tumor of the female genital tract. It tends to occur during childhood in the vagina and rarely it can arise in the uterine cervix, with a peak incidence in the second decade. We report a case of 15 year old adolescent girl who presented with recurrent vaginal discharge not responding to medical treatment. Examination under anesthesia showed friable growth arising from the cervix. Histopathological examination revealed embryonal rhabdomyosarcoma (botyroid variant) of the cervix. Patient underwent local excision of growth followed by IRS-4 protocol based chemotherapy and now patient is under follow up at our side and pediatric oncology and doing well. Young girls presenting with recurrent vaginal discharge not responding to medical treatment must undergo proper clinical examination and EUA and any suspicious lesions should be examined so as to avoid missing rare but aggressive etiology like rhabdomyosarcoma. Due to the young age of affected patients, embryonal rhabdomyosarcoma (sarcoma botyroides) poses a management challenge as the preservation of hormonal, sexual and reproductive function is essential. Awareness of such as uncommon lesion and its clinical implications is important for the counseling and management of the patient.

Real-world research on cervical cancer screening program and effect evaluation for Chinese population / 中华肿瘤杂志

Objective@#To evaluate the actual efficacy of cervical cancer and precancerous lesions screening approaches in real-world regions with different economic levels in China.@*Methods@#The demonstrative application and effect evaluation of cervical cancer screening program were conducted in 21 hospitals nationwide from 2015 to 2018. Multi-stage sampling method was adopted to divide the country into 7 large areas according to geographical location. Two to four screening sites of two types of cancer (cervical cancer and breast cancer) were selected in each area, and the grassroots screening sites were implemented under the guidance of superior hospitals. In rural areas, women were initially screened using cytology, human papillomavirus (HPV) testing and visual inspection. The women with positive cytology or visual inspection were referred for colposcopy, and the women with positive HPV infection were randomly referred for reflex cytology or visual inspection, or direct colposcopy examination. In urban areas, women were primarily randomized into cytology or HPV testing groups. The women with abnormal cytology or positive HPV 16/18 infection were directly referred for colposcopy examination, whereas the women with positive infection of the other 12 high-risk subtypes of HPV were referred for reflex cytology or colposcopy. All of recruited women would be follow-up and screened by the baseline screening techniques in the third year while the positive women underwent colposcopy examination. The positive rates, referral rates, the detection rates of grade 2 and above of cervical intraepithelial neoplasia (CIN 2+ ) were compared.@*Results@#A total of 63 931 women were recruited at the baseline. Among them, 11 rural sites included 33 823 women: 15 577, 11 157 and 7 089 women were screened by HPV testing, visual inspection via acetic acid or Lugol′s iodine (VIA/VILI) and cytology, respectively. Additionally, 30 108 women were from 10 urban sites: 9 907 and 20 201 women were screened by cytology and HPV subtyping, respectively. The HPV positive rate for urban women was 9.34%, whereas that for rural women was 12.53%. The abnormal rate of cytology for urban women was 5.63%, and that for rural women was 4.24%. The positive rate of VIA/VILI in the rural women was 12.25% Furthermore, the detection rate of CIN2+ at the baseline was 0.56%, and that was statistically higher in HPV-positive group than cytology-positive group (P<0.05).@*Conclusions@#All of screening sites completed the baseline screening tasks as expected. The prevalence of HPV infection is higher in rural women than urban women. The performance of HPV testing is better than cytology for detecting CIN2+ cases. This real-world demonstration study provides evidences for cervical cancer prevention and control in different regions.

Expression of Lgr5 in cervical squamous cell carcinoma and its significance / 临床与实验病理学杂志

Purpose To investigate the expression of Lgr5 in cervical squamous cell carcinoma (CSCC) and its significance.Methods Lgr5 protein expression was evaluated by immunohistochemistry of EnVision two-step in 83 paraffin-embedded CSCC specimens,56 normal cervical tissues specimens and 32 cervical intraepithelial neoplasia (CIN) specimens.The expression of Lgr5 mRNA was evaluated by RT-PCR in 13 pairs of surgically removed CSCC and adjacent normal cervical tissues.The correlation between Lgr5 expression and clinicopathological features were statistically analyzed.Results The positive proportion of Lgr5 protein in CSCC tissues was significantly higher than those in adjacent normal cervix (P ＜ 0.01) and CIN (P ＜ 0.05).The expression of Lgr5 in CSCC tissues was associated with grade of tumors (P ＜ 0.01) and depth of invasion (P ＜ 0.05),but not associated with age,tumor size,clinical stage and lymph node metastasis (P ＞ 0.05).Kaplan-Meier analysis showed that the 5-year survival rate of patients with Lgr5 overexpression was significantly lower than that of patients with lower expression (P ＜ 0.01).Conclusion The expression of Lgr5 in CSCC tissues may associated with grade of tumors and depth of invasion and may be involved in initiation and development of CSCC,and it may be a new assistant marker for prognosis of CSCC.

Clinicopathological study on 18 cases of primary cervical small cell carcinoma / 临床与实验病理学杂志

Purpose To investigate the clinicopathological and immunohistochemical features of primary small cell carcinoma of the cervix ( SCCC) and its prognosis. Methods 18 cases of primary cervical small cell carcinoma were evaluated by histopathology, in si-tu hybridization and immunohistochemistry and relevant literatures were reviewed. Results The age of the patients ranged from 30 to 69 years ( mean age, 40 years) . Major clinical manifestation was irregular colporrhagia. Colposcopy often revealed a cervical mass or cervical erosion. Microscopically, the tumor cells were small and round and arranged in a solid distribution. The cell had little cyto-plasm and increased karyoplasmic ratio with deeply stained granular chromatin and increased pathological mitosis. Immunohistochemi-cally, the tumor cells were often positive for CKpan, variable positive for Syn, NES, CgA, CD56 and p16. HPV 16/18 were positive in 4 cases. Conclusion SCCC is a neuroendocrine tumor of high malignancy and poor prognosis with a possible pathogenesis of HPV 16/18 infection. CKpan, Syn, CgA, NSE and CD56 are useful markers for the diagnosis of SCCC.

Expression and association of IMP3 and MVD in squamous carcinoma of the cervix / 临床与实验病理学杂志

Purpose To investigate the expression of insulin-like growth factorIImRNA binding protein 3 ( IMP3 ) and microvessel density (MVD) in squamous carcinoma of the cervix (SCC) and analysis their relationship in SCC. Methods The expression of IMP3 and MVD was examined by immunohistochemistry SP method in normal cervical epithelium ( NCE) , low-grade cervical intraepi-thelial neoplasia (CIN-L), high-grade cervical intraepithelial neoplasia (CIN-H) and SCC. Results (1)The positive expression rates of IMP3 in NCE, CIN-L, CIN-H, SCC tissues were 0(0/15), 0(0/11), 37.5%(9/24) and 86.0%(43/50), the difference was statistically significant (x 2 =53.345, P=0.000). IMP3 expression was significant difference among NCE and CIN-H, SCC (P0.05). And the positive expression of IMP3 was closely related with MVD count in SCC tissues (rs =0.323, P<0.05). Conclusion IMP3 plays an important role in the occurrence, infiltration and metasta-sis of SCC, and the abnormal expression of IMP3 may relate with the angiogenesis of tumors.

Investigating precursor lesions of cancer of the uterine cervix in a town in Rio Grande do Norte / Investigando lesões precursoras do câncer de colo uterino em um município norte-rio-grandense / Investigando las lesiones precursoras del cáncer de cuello uterino en una ciudad en Rio Grande do Norte

Objective: To identify the types of precursor lesions of cervical cancer more prevalent in women living in a rural area of São José de Mipibu, Rio Grande do Norte, Brazil. Method: This study is of an exploratory-descriptive nature, designed in the form of documentary research. The sample comprised women who underwent oncotic cytology in the Health Unit of the studied community, 2005 to 2009, totaling 782 women. Results: considerations were made about the microbiology, diagnosis and descriptive of cellular atypia distributed by age found in the results of oncotic cytology, with subsequent reflections on the role of nurses in the prevention of cervical cancer. Conclusion: We conclude that the prevention of cervical cancer still remains a challenge for women's health.

Objetivo: identificar os tipos de lesões precursoras do câncer do colo do útero mais prevalentes em mulheres residentes de uma zona rural de São José de Mipibu, Rio Grande do Norte, Brasil. Método: trata-se de um estudo de natureza exploratório descritiva, delineado sob a forma de uma pesquisa documental. A amostragem englobou as mulheres que realizaram citologia oncótica na Unidade de Saúde da comunidade estudada, de 2005 a 2009, totalizando 782 mulheres. Resultados: foram tecidas considerações acerca da microbiologia, do diagnóstico descritivo e das atipias celulares distribuídas por faixa etária encontradas nos resultados de citologia oncótica, com posteriores reflexões acerca do papel do enfermeiro na prevenção do câncer cérvico-uterino. Conclusão: Concluiu-se que a prevenção do câncer do colo do útero ainda continua sendo um desafio para a saúde da mulher.

Objetivo: Identificar los tipos de lesiones precursoras del cáncer de cuello uterino más frecuente en las mujeres que viven en una zona rural de São José de Mipibu, Rio Grande do Norte, Brasil. Método: Este estudio es un estudio exploratorio-descriptivo, diseñado en forma de investigación documental. La muestra de mujeres que comprenden que se sometieron a cribado cervical en la comunidad de la Unidad de Salud estudió de 2005 a 2009, un total de 782 mujeres. Resultados: Se realizaron consideraciones acerca de la microbiología, diagnóstico descriptivo y de la atipia celular, distribuidas por edad encontrada en los resultados de la citología, con las reflexiones posteriores sobre el papel de las enfermeras en la prevención del cáncer cervical. Conclusión: Se concluye que la prevención del cáncer de cuello uterino sigue siendo un desafío para la salud de las mujeres.

Análisis de los motivos del abandono del proceso de seguimiento y tratamiento por parte de mujeres con lesiones precursoras de cáncer de cuello uterino en la provincia de Jujuy: implicancias para la gestión / Analysis of the reasons for abandoning the follow-up and treatment process in women with pre-cancerous cervical lesions in the province of Jujuy: implications for health management

El adecuado seguimiento y tratamiento de las mujeres con lesiones escamosas intraepiteliales de alto grado (HSIL, por sus siglas en ingles) y carcinoma es un aspecto clave para la reducción de la mortalidad por cáncer de cuello uterino. El objetivo de esta investigación es analizar la magnitud y los motivos del abandono en el proceso de seguimiento y tratamiento por parte de las mujeres con diagnóstico de HSIL y carcinoma atendidas en el sistema público de la provincia de Jujuy durante 2010. Se realizó el análisis de fuentes secundarias y entrevistas domiciliarias a las mujeres. El porcentaje de abandono en la población de estudio fue del 23,5%. Entre estas mujeres, el 40,5% mencionó motivos de abandono relacionados con la organización del sistema de salud y el 30,9% mencionó motivos subjetivos. Los resultados han sido utilizados como insumos para la reorganización del proceso de seguimiento y tratamiento que se está llevando a cabo en la provincia.

Adequate follow-up and treatment of women with high-grade squamous intraepithelial lesion (HSIL) and cancer is key in reducing cervical cancer mortality. This research study aims to analyze the magnitude of abandonment in the follow-up and treatment process, as well as the reasons for this abandonment, in women with HSIL who received care in public health services in the province of Jujuy in 2010. Secondary sources were analyzed and women were interviewed in their homes. The abandonment rate within the study population was 23.5%. Among these women, 40.5% mentioned organizational problems in the health care system as a reason for abandoning and 30.9% mentioned subjective reasons. Our results have been used in the reorganization of the follow-up and treatment process being carried out in the province.

A avaliação da rede venosa pela enfermagem em mulheres com câncer ginecológico durante o tratamento quimioterápico / Venous network assessment by nursing in women with gynecological cancer during chemotherapy treatment / Evaluación de la red venosa por la enfermería en mujeres con cáncer ginecológico durante el tratamiento de quimioterapia

Estudo de abordagem exploratória e descritiva que teve como objetivos: avaliar a rede venosa das mulheres com câncer cérvico uterino, no início e ao final do tratamento quimioterápico; analisar a ocorrência de flebite provocada pelas drogas utilizadas nos protocolos de quimioterapia neoadjuvante e adjuvante e relacionar os tipos de veia com os dispositivos mais utilizados, tempo de permanência e intercorrências. Utilizou-se um instrumento de avaliação da rede venosa para os membros superiores. Foram incluídas 20 mulheres atendidas em um hospital de ensino do interior do Estado de São Paulo. A avaliação da rede venosa demonstrou poucas alterações, e a intercorrência mais frequente foi o hematoma (60%). Os resultados deste estudo apontam para aspectos da prática de enfermagem relacionados à administração de quimioterápicos e ressaltam a necessidade de elaborar e implantar protocolos para o cuidado.

This descriptive and exploratory study aimed to evaluate the venous network of women with cervical uterine cancer, at the beginning and at the end of the chemotherapy treatment; to analyze the occurrence of phlebitis caused by the drugs used in protocols of neoadjuvant and adjuvant chemotherapy and to relate the types of vein with the most used devices, length of stay and complications. An instrument was used to evaluate the venous network for upper limbs. Participants were twenty women who received care at a teaching hospital in the interior of the state of Sao Paulo. The evaluation of the venous network presented little changes and hematoma was the most frequent complication (60%). The results point out aspects of the nursing practice, related to the administration of chemotherapeutic agents, and highlight the need to develop and implement care protocols.

Este estudio exploratorio y descriptivo tuvo como objetivos evaluar la red venosa de las mujeres con cáncer de cuello uterino en el comienzo y el final del tratamiento quimioterápico, analizar la ocurrencia de flebitis causada por los fármacos utilizados en los protocolos de quimioterapia neo adyuvante y adyuvante, y relacionar los tipos de venas con los dispositivos más utilizados, tiempo de permanencia y complicaciones. Se utilizó un instrumento para evaluar la red venosa de los miembros superiores. Participaron 20 mujeres tratadas en un hospital de enseñanza en el interior del estado de São Paulo. La evaluación de la red venosa mostró pocas alteraciones y la complicación más frecuente fue el hematoma (60%). Los resultados del estudio apuntan aspectos de la práctica de enfermería relacionados a la administración de agentes quimioterápicos y señalan la necesidad de desarrollar e implementar protocolos de atención.

Células glandulares atípicas e câncer de colo uterino: revisão sistemática / Atypical glandular cells and cervical cancer: systematic review

Atipias de células glandulares em esfregaços cervicovaginais é um achado citológico na rotina de rastreamento do câncer cervical, que aumentou nas últimas décadas. Sua constatação é importante clinicamente, pois é alta a percentagem de casos associados com doença cervical e endometrial de alto grau e câncer. Este trabalho avaliou, por meio de uma revisão sistemática, estudos que investigaram o perfil das lesões de colo uterino em avaliações histológicas de seguimento de pacientes já diagnosticadas com células glandulares atípicas. Foram excluídos os estudos cuja investigação diagnóstica não incluísse o diagnóstico histopatológico. Realizou-se uma busca abrangente de publicações no período de 1966 a 2009, nas bases do LILACS, SciELO, PubMed/Medline e Old Medline. Os artigos omitidos na busca eletrônica também foram incluídos. Estavam de acordo com os critérios de inclusão 19 artigos, que foram selecionados. Este estudo tem como objetivo avaliar se a atipia celular glandular observada inicialmente na citologia relacionava-se histologicamente com a presença de lesões benignas, pré-neoplásicas ou neoplásicas. Dos 19 estudos selecionados, 11 mostraram maior correlação entre atipia glandular com patologias benignas e seis com lesões escamosas pré-malignas.

Atypical glandular cells are a common finding in cervical cytology in cervical cancer screening and its occurrence has increased in the last decades. The identification of these cells is clinically very important due to its association with cervical and endometrial dysplasic lesions and cancer. Using a systematic approach, this article reviewed studies investigating cervical lesions that are characteristic in patients previously diagnosed as having atypical glandular cells. Studies in which diagnostic investigation did not include histopathological diagnosis were excluded. A comprehensive search for available material in LILACS, SciELO, PubMed/ Medline and Old Medline databases, dated between 1966 and 2009 was performed. Articles omitted by the electronic database search were also included. Nineteen articles met the inclusion criteria and were selected. This report aims at evaluating whether atypical glandular cells, initially found in cervical cytology and subsequently identified at the histological analysis, are related to the presence of benign, pre-malignant and malignant lesions. Eleven out of 19 selected articles showed the highest correlation between atypical glandular cells with benign diseases and six with squamous pre-malignant lesions.

Percepções das mulheres acerca do exame de prevenção do câncer cérvico-uterino / Perceptions of women concerning preventive examination of uterine cervical cancer

Objetivo: Compreender a percepção das mulheres que irão se submeter ao exame preventivo do câncer cérvico-uterino. Metodologia: Tratou-se de um estudo exploratório descritivo. A amostra foi composta por 25 mulheres pertencentes à faixa etária de 18 a 59 anos, usuárias da Unidade de Atenção Primária na região sul do estado do Ceará ? Brasil. A coleta de dados ocorreu entre maio e junho de 2009, mediante a utilização de entrevistas semiestruturadas, contendo as seguintes questões norteadoras: o que você sabe sobre a finalidade do exame preventivo do câncer cérvico-uterino? O que levou você a procurar a unidade para realização desse exame? O que você sente quando decide submeter-se ao exame? Os dados foram analisados a partir da categorização dos discursos dos sujeitos, e em seguida discutidos à luz da literatura referente ao assunto. Resultados: A investigação apontou que as sujeitas percebem o exame de prevenção sob uma ótica curativa, já que a maioria procura o serviço mediante alguma sintomatologia; a vergonha e o medo são os principais sentimentos verbalizados quanto ao exame. Esses fatores podem contribuir para a não adesão ao citopatológico. Conclusão: As mulheres entrevistadas demonstraram que detém conhecimentos superficiais e muitas vezes equivocados sobre o exame de prevenção do câncer ginecológico. Isso revela a necessidade de reorientação dos serviços de saúde com foco na promoção da saúde, proporcionando às usuárias conhecimento e sensibilização para atuarem como corresponsáveis da sua saúde, aderindo ao exame e, provavelmente, reduzindo o número de casos de câncer de colo de útero.

Objective: To understand the perception of women that will undergo the preventive examination of uterine cervical cancer. Methods: It was an exploratory-descriptive study. The sample was comprised by 25 women in the age group from 18 to 59 years, users of the Mother-Child Health Center in Barbalha-CE-Brazil. Data collection happened between May and June 2009 using semi-structured interviews with the following guiding questions: What do you know about the purpose of the preventive examination of uterine cervical cancer? What made you seek the health unit to perform this examination? What do you feel when you undergo the examination? Data were analyzed based on the subjects? speeches categorization, and later discussed according to the literature concerning the subject. Results: The service facing some symptoms; shame and fear are the main expressed feelings concerning the examination. These factors can contribute to the non adherence to Pap test. Conclusion: The women interviewed showed to have superficial and often wrong knowledge on the examination of cervical cancer. This reveals the need for re-orientation of health services focusing on health promotion, providing the users knowledge and awareness to act as jointly responsible for their health, by adhering to the examination and probably reducing the number of cases of uterine cervical cancer.

Active search of women as an efficacy factor for a breast and cervical cancer screening program in the city of Jundiaí, São Paulo, Brazil / Busca ativa de mulheres como fator de eficácia de programa de rastreamento de câncer de mama e colo uterino no município de Jundiaí

Objective: To compare the profile of women looking for gynecological care to the profile of women invited to participate in the program, assessing breast and cervical cancer risk factors in each group and comparing Papanicolaous test and mammography results. Methods: Medical records of 46 women participating in a breast and cervical cancer prevention program and 42 medical reports of women that regularly visited the primary healthcare unit from August to December 2006 were examined. Results: The mean interval between the last Papanicolaous tests was of approximately 19.7 months when comparing women visiting their physician and 25.3 participants in the program. There was one case (1.1%) of high grade intraepithelial lesion in one woman included in the program. Regarding breast cancer, when comparing both groups, we verified that all women above the age of 40 years that participated in the program underwent mammography; this was not verified in the group seeing a physician. This shows the efficacy of this screening, actively looking for women in the age group at risk for breast cancer. Conclusions: Active search is important to recruit women; the screening program needs improvement to show its real impact on morbidity and mortality of these cancers.

Objetivo: Comparar o perfil das mulheres que buscam atendimento ginecológico ao perfil de mulheres convidadas a participarem do programa, avaliando-se fatores de risco para câncer de mama e de colo uterino presentes em cada grupo e comparando os resultados dos exames de Papanicolaou e mamografia. Métodos: Foi realizado levantamento de 46 prontuários de mulheres de um programa de prevenção de câncer de colo do útero e mama e de 42 prontuários de pacientes que consultaram rotineiramente o médico da unidade básica de saúde entre agosto e dezembro de 2006. Resultados: Constatou-se que o intervalo médio entre os dois últimos exames de Papanicolaou foi de aproximadamente 19,7 meses entre as mulheres que consultaram o médico e 25,3 entre as participantes do programa. Houve um caso (1,1%) de lesão intraepitelial de alto grau em uma paciente incluída no programa. Com relação ao câncer de mama, comparando-se os dois grupos, observou-se que todas as mulheres acima de 40 anos do Grupo Programa realizaram mamografia, o que não ocorreu no Grupo Médico. Isso mostra a eficiência do programa de rastreamento na busca ativa de mulheres que se encontram na faixa etária de risco para o câncer de mama. Conclusões: A busca ativa é importante para o recrutamento de mulheres, havendo necessidade de aprimorar o programa de rastreamento para evidenciar seu impacto na morbiletalidade das doenças.

Observation of hyperfractional integrated intracavitary brachytherapy on efficacy and complications in patients with middle and advanced squamous cell carcinoma of the cervix / 中华放射医学与防护杂志

Objective To observe and cpmpare the efficacy and complications of hyperfractional integrated intraeavitary brachtherapy in middle-advanced squamous-cell carcinoma with the traditionsl brachytherapy.Methods In the observed group,328 patients with cervical cancer received hypeffractional integrated intracavitary after loading therapy between Jan 2004 and Jan 2005 were selected.The dose of point A was 2.5 Gy-3.0 Gy/fraction,2 fractions per week,and the total dose of reference point A was 49.8 Gy in stage Ⅱ b,52.6 Gy in stage in Ⅲb.In the control group,331 cases treated with traditional aflerloading brachytherapy between Jan 2002 and Dec 2003 were selected.The dose of point A was 5.0～7.0 Gy/fraction,1 fraction per week,and the total dose of point A was 50.1 Gy in stage Ⅱb,53.5 Gy in stage Ⅲb.In vitro irradiation began at the same time with the intracavitary brachytherapy.The whole pelvic was irradiated with 15 MV X-rays.Results In the observed group,the recent control rate of stage Ⅱb was 97.2%(104/107),94.1%(208/221)for stage Ⅲb.The 3-year survival rate was 80.5%(264/328).and the 5-year survival rate was 68.6%(225/328).The complication rate was 5.2%(17/328)for cystitis, 14.6%(48/328) for proctitis.Out of 331 cases in control group,the recent control rate of stage Ⅱb was 95.4%(103/108),92.8%(207/223)for stage Ⅲb.The 3-year survival rate was 75.2%(249/331),the 5-vear survival rate was 62.5%(207/331).The complication rate was 13.3%(44/331)for cystitis,and 32.3%(107/331)for proctitis.Conclusions Compared with combination of traditional brachytherapy and external radiotherapy,combination of hyperfraetional integrated brachtherapy therapy and external radiotherapy has no significant improvement for recent control rate and long-term survival rate,but could reduce the complication rates of cystitis and proctitis.

Tratamiento quirúrgico del cáncer infiltrante de cuello uterino. Supervivencia / Surgical treatment of the infiltrative cervical cancer. Survival rate

El cáncer de cuello uterino ocupa el segundo lugar entre los tipos de cáncer de la mujer y el quinto entre todos los tipos de cáncer que afectan al ser humano. Se realizó un estudio retrospectivo y longitudinal a las pacientes con cáncer infiltrante de cuello uterino que recibieron tratamiento quirúrgico entre los años 1988 y 1993 en el Hospital "Abel Santamaría Cuadrado", de Pinar del Río. Para esta investigación se confeccionó encuesta, que fue aplicada a las 37 pacientes estudiadas; los datos fueron obtenidos de las historias clínicas y el interrogatorio a las pacientes. Las variables estudiadas fueron: edad, número de partos, edad del primer coito y del primer parto y la supervivencia. Entre los principales resultados se encontró que el grupo de edades entre los 40-49 años fue el más frecuente en las pacientes estudiadas, todas las pacientes habían parido, más de la mitad de las pacientes comenzaron las relaciones sexuales antes de los 17 años. La adolescencia predominó como edad del primer parto en las pacientes estudiadas y solo una paciente falleció en este periodo.

The cervix cancer takes the second place among the types of cancer in women and the fifth place among all of the types affecting the human being. A retrospective, longitudinal study was performed in patients suffering from infiltrative cervix cancer and they were given surgical treatment between 1988 and 1993 at Abel Santamaría Cuadrado General Hospital in Pinar del Río. A survey was made applying it to 37 patients; data were collected from the clinical records and from the interview to patients. Age, number of deliveries, age at the first coitus and first delivery and survival were the studied variables. It was found that 40-49 year old group was the most frequent among the studied patients, all the patients had given birth, over more than half of patients started sexual relations before 17 years of age. Adolescence prevailed as first - delivery age in patients and only one of them died during this period.

Alterations in Promoter Usage and Expression Levels of Insulin-like Growth Factor-II and H19 Genes in Cervical and Endometrial Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The biallelic expression of insulin-like growth factor-II (IGF2) and H19 has been reported to be associated with the progression of several tumors. Here, the promoter usage and expression levels of IGF2 and H19 are reported to be altered in cervical and endometrial cancers showing loss of imprinting (LOI). MATERIALS AND METHODS: The imprinting status of IGF2 and H19 was examined in 32 cervical carcinomas, their matched normal tissues, 13 endometrial cancer and 33 normal endometrial tissues. RESULTS: The LOI of IGF2 was observed in 7 of 18 (39%) and 1 of 13 (8.3%) informative cervical carcinomas and informative endometrial cancers, respectively. The LOI of the H19 gene was detected in 5 of 14 (36%) and in all 11 (100%) informative cervical carcinoma cases and informative endometrial cancer cases, respectively. The use of promoter P1 was observed in the LOI tumors of IGF2, but not in the tumors showing maintenance of IGF2 imprinting (MOI), or in cervical and endometrial cancers. Unlike MOI tumors, some LOI tumors revealed a lack of IGF2 transcription from the promoter P3. The LOI tumors of IGF2 showed increased expression of the IGF2 level, but a down-regulation of the H19, relative to normal tissues, whereas the MOI tumors revealed no significant alterations. CONCLUSION: These results suggest that the promoter P1 could be involved in the biallelic expression of IGF2, and that the altered expression of the IGF2 and H19 levels might be associated with the progression of cervical and endometrial cancers that exhibit biallelic IGF2 expression.

Clinical Implications of VEGF and p53 Expression in Squamous Cell Carcinoma of the Cervix Treated with Radiation Therapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The present study was designed to analyze the relationship between vascular endothelial growth factor (VEGF) and p53, and their impact on clinical outcome in squamous cell carcinoma of the cervix treated with radiation therapy. MATERIALS AND METHODS: This immunohistochemical study involved 23 patients with available paraffin blocks among 46 patients who were treated during the period from 1994 to 1997 in Eulji University Hospital in Korea. Anti-VEGF mouse monoclonal antibody and DO-7 anti- p53 mouse monoclonal antibody were used as the primary antibodies. Antibody binding was detected with a LSAB kit. Staining was defined as positive for VEGF and p53, when more than 10% and 5% of the tumor cells were stained out of 500 cells counted, respectively. RESULTS: FIGO stage (p=0.05) and tumor size (p=0.04) were significant prognostic factors for survival. p53 expression was present in 17 (77%) cases. There was no significant relationship between p53 staining and the clinicopathologic factors, such as FIGO stage (p=0.98), tumor size (p=0.43), lymph node status (p=0.82), parametrial invasion (p=0.96), and age (p=0.18). The five year survival rates according to the p53 expression status were 80% for the p53 negative group and 66% for the p53 positive group (p=0.58). Positive VEGF expression was observed in 11 (47%) of the total of 23 patients. Statistical evaluation of VEGF expression according to stage (p=0.36), tumor size(p=0.11), lymph node status (p=0.82), parametrial invasion (p=0.49), and age (p=0.55) revealed no significant difference in any of these parameters. The five year survival rates according to the VEGF expression status were 89% for the VEGF negative group and 41% for the VEGF positive group (p=0.07). CONCLUSION: We suggest that VEGF expression may have an effect on the prognosis of cervix cancer patients treated with radiation therapy, and further evaluation with a large sample size is warranted.

Cell-Specific Growth Inhibition of Human Cervical Cancer Cell by Recombinant Adenovirus p53 in vitro and in vivo / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Despite the significance of the p53 adenoviral vector in cancer gene therapy, an advanced strategy for the development of preferential tumor cell-specific delivery and the long-term persistent gene expression control of p53 are required. In this study, the time-course expression patterns of p53 and E6, on cervical cancer cells, were investigated to obtain a molecular level understanding of the cell-dependent tumor growth suppression effects of a recombinant adenovirus expressing p53, both in vitro and in vivo. MATERIALS AND METHODS: The expressions of p53 and E6 in CaSki, SiHa, HeLa, HeLaS3, C33A and HT3 cervical cancer cell lines were examined. After infection with AdCMVp53, the cell growth inhibition was studied via cell count, MTT and Neutral red assays. After transfecting the AdCMVp53 and AdCMVLacZ into the cancer cells-xenografted nude mice, the anti-tumor effects were investigated for one month. RESULTS: The p53 protein levels were more notably expressed in the CaSki and HeLa than in the SiHa and HeLaS3 On day 6, the p53 was only detected in the HeLaS3. In contrast, the p53 expression was highly maintained in the C33A and HT3. The E6 mRNA levels gradually decreased in only the CaSki and HeLa. The growth suppression effects also showed cell-dependent patterns, which were consistent with the reciprocal expression patterns of p53 and E6. After transfection of the AdCMVp53, into the CaSki- and SiHa-xenografted nude mice, the tumor size was remarkably decreased in the SiHa cells as compared to that in the AdCMVLacZ transfected mice, indicating cell-specific growth inhibition patterns. CONCLUSION: The adenovirus-mediated p53 gene transfection was very effective both in vitro and in vivo. Also, the anti-tumor effects were accomplished via the differential role of p53-specific apoptotic cell death, which was dependent on the cervical cancer cell line.

Significance of p53 Immunoreactivity in Squamous Cell Carcinoma of the Cervix Treated with Radiotherapy Alone / 대한암학회지

PURPOSE: We undertook this study to evaluate the significance of p53 immunoreactivity in squamous cell carcinoma of the cervix, treated with radiotherapy alone. MATERIALS AND METHODS: Immunohistochemical staining of p53 proteins were performed in eighty patients with squamous cell carcinoma of the cervix, and who completed curative radiotherapy between Jan. 1996 and Apr. 1998 at the Department of Therapeutic Radiology, Chonnam National University Hospital. External- beam radiotherapy was combined with intracavitary brachytherapy. Results were analyzed for the end points of pelvic tumor control and distant failure rates. The follow-up time ranged from 7 to 58 months with a median of 40 months. RESULTS: p53 positive and negative groups involved 45 and 35 patients, respectively, and the positive p53 immunoreactivity rate was 56% (45/80). p53 immunoreactivity showed no significant correlation with age, tumor size, serum tumor marker (SCC), or HPV18 expression, while there was a statistically marginally significant correlation with HPV16 expression. The pelvic tumor control rate of the p53 positive group was 87% and that of p53 negative group was 83% (0.05). The other parameters influencing negatively to the pelvic tumor control and with statistical significance were tumor ulceration and barrel type. Multivariate analysis also showed that p53 immunoreactivity had no prognostic value for pelvic tumor control of the disease, and that the statistically significant factor was tumor ulceration. The treatment failure rate of the p53 positive group was 23% and that of the negative group was 26% (p>0.05). CONCLUSION: p53 immunoreactivity in the cervix cancer stage IB, II patients seems to have no value as a predictor of tumor behavior after curative radiotherapy.

The Inefficiency of Routine Performance of a Batch of Tests in the Clinical Staging Work-up of Cervical Carcinoma / 대한암학회지

PURPOSE: This study was to evaluate the efficiency of routine performance of a batch of tests in the clinical staging work-up of cervical carcinoma. MATERIALS AND METHODS: The medical records were reviewed for 1,393 consecutive cervical carcinoma patients who underwent pretreatment staging work-up in Seoul National University Hospital from January 1988 to December 1997. The impression stage -which is designated ten tatively by the findings of pelvic examination and biopsy-, the results of staging work-up, and the finally allotted FIGO clinical stage were reviewed. The annual trend of stage distribution and the positive yields of tests were evaluated. RESULTS: Annual trend shows that Ia is increasing. The positive yield of chest x-ray was 0.22% (3/1, 379; Ib: 1, IIa: 1, IIb: 1), intravenous pyelography (IVP) 2.50% (31/1, 242; Ib: 2, IIa: 4, IIb: 17, IIIb: 8), cystoscopy 0.55% (6/1, 093; IIb: 4, IIIb: 2), and proctosigmoidoscopy 0.086% (1/1, 157; Ib: 1). After completing the staging work-up, 29 patients (2.08%) were upstaged. The routine performance of IVP in impression stage Ia and cystoscopy in impression stage IIa or less was considered inefficient. The routine performance of proctosigmoidoscopy was considered inefficient because of its very low yield. CONCLUSION: The selective performance of tests according to the impression stage during staging work-up is recommended to minimize the unnecessary treatment delay, cost, and patients' discomfort.

Results of Radio-thermotherapy in Stage IIIb Uterine Cervical Cancer Local response, survival rate and analysis of prognostic factor / 대한암학회지

PURPOSE: This retrospective study was conducted to obtain local response and survival rates, and to analyze prognostic factors affecting survival of patients treated with radio-thermotherapy for stage IIIb uterine cervical cancer. MATERIALS AND METHODS: From May 1992 to Dec. 1996, 24 patients treated with radio-thermo therapy for stage IIIb uterine cervical cancer at department of Radiation Oncology in Kosin Medical College, Kosin University were enrolled. Radiotherapy used 6~10 MV linear accelerator was performed in whole pelvis with 4 portals box technique by conventional (180~200 cGy/ fraction, 5 fraction/week) method in 5 patients (20.8%) or hyperfractionated (120~135 cGy/fr., 2 fr./day, 10 fr./wk) in 19 patients (79.2%). Total dose of A-point was 67~112 Gy (median: 77.27 Gy). Hyperthermia used 8 MHz radiofrequency capacitive heating device was applied in pelvic area with 2~3 sessions per wk. Each course started within 15 to 20 minutes after radio therapy and took 40 to 60 minutes. Local progression free (LPFS), disease free (DFS) and overall (OS) rates were calculated in survival analysis. Statistics was calculated by Kaplan-Meier Method in survival and Log-rank test in statistical significance. Multivariate analysis for prognostic factor was applied to Cox Regression model. Follow-up duration was 6~82 months (median: 25 months). RESULTS: Overall local response rate was 95.8% (45.8% in CR/50.0% in PR). Five year LPFS, DFS, OS were 48.6%, 31.7%, 67.1%, respectively. In univariate analysis, an age was the signi ficant prognostic factor in terms of OS (p=0.03), but was insignificant in LPFS and DFS. In multivariate analysis, none of evaluated factors are important in LPFS, DFS or OS. CONCLUSION: Radio-thermotherapy for stage IIIb uterine cervical cancer did not increase 5 year LPFS, DFS and OS in spite of higher local response rate. Age was the only significant factor for OS in univariate analysis.

Clinical Significance of Apoptosis and p53 Protein Expression in Stage IIB Squamous Cell Carcinoma of the Cervix Treated with Radiotherapy Alone / 대한암학회지

PURPOSE: The purpose was to investigate the spontaneous apoptotic index (SAI) and p53 protein expression and to identify the role of SAI and p53 protein positivity. MATERIALS AND METHODS: Forty six patients with squamous cell carcinoma of the cervix, FIGO stage IIB, treated with curative radiotherapy alone between 1990 and 1993 were included in this study. Definitive radiotherapy including external beam and high-dose-rate brachytherapy was given. Pretreatment paraffin-embedded biopsy specimens of those patients were scored for apoptosis and p53 protein expression using mouse mondegrees Clonal antibody (DO-7) by immuno staining. Clinicopathologic characteristics were also studied in relation to SAI and p53 protein expression, and as prognostic factors for clinical outcome. RESULTS: SAI and p53 were not related to any clinical characteristics. The range of the SAI was 0.2~4.7% (median 1.1%, mean 1.5%). The rate of p53 protein expression was 65.2% (30/46). Patients whose tumors had high SAI and low p53 protein positivity had better treatment outcome than those with lower SAI. There was also a significant correlation between the SAI and p53 protein expression. CONCLUSION: The pretreatment SAI and p53 oncoprotein expression are clinically useful in predicting the clinical outcome of FIGO stage IIB squamous cell carcinoma of the uterine cervix patients treated with definitive radiotherapy.