Blood formed elements of the women with uterine tumors as one of the criterion for assessment of severity of the pathology

The indicators for structural analysis of blood formed elements are prominent in the assessment of pathologies, diagnostics and the degree. Therefore, we aimed to evaluate the ongoing alterations that reflect on the structural characteristics of blood formed elements based on the hormonal imbalance among menopausal women with uterine tumors. Blood samples from the women with benign (n=20), malignant (n=20) uterine tumors, and healthy menopausal women (control, n=20) were used. Enzyme-linked Immunosorbent assay (ELISA) kits were used for the quantitative determination of hormones. The blood formed elements ultrastructure observations were conducted using transmission electron microscope. Compared to control (33.8±0.7 pg/mL), estradiol level was higher in benign (45.7±0.9 pg/mL) and malignant (70.7±3.7 pg/mL) cases (P< 0.001). Similar pattern was noted in testosterone levels [control=0.38±0.03 ng/mL, benign=0.55±0.04 ng/mL (P< 0.01), malignant=1.56±0.14 ng/mL (P< 0.001)] was higher in malignant cases. In contrast, progesterone levels were decreased in the disease cases [control=0.93±0.05 ng/mL, benign=0.44±0.003 ng/mL, malignant=0.31±0.02 ng/ml (P< 0.001)]. Assessments of the morphologic structure of erythrocytes revealed pathological forms of erythrocytes (poikilocytosis) in case of benign, as well as in malignant tumors. particularly target cells (codocytes), hamlet cells, teardrop cells (dacrocytes), sickle cell (drepanocytes) erythrocytes. Using ELISA and transmission electron microscopy our results demonstrate that in case of malignant uterine tumor quantitative/structural changes occur in blood formed elements indicating ongoing alterations in hormonal imbalance. Assessing these changes in structural characteristics would be useful in examining uterine pathologies and subsequent treatment plans

A Case of Non-Bacterial Thrombotic Endocarditis with Atypical Massive Vegitation / 日本心臓血管外科学会雑誌

The patient was a 68-year-old woman. She was diagnosed with uterine cancer after experiencing irregular genital bleeding. Contrast-enhanced computed tomography showed a 30 mm left ventricular mass and splenic infarction, and head MRI showed multiple cerebral infarctions. The patient was suffering from systemic embolism caused by the cardiac mass, and we decided to perform cardiac mass removal prior to uterine cancer treatment. A yellowish-white thrombus-like mass attached to the mitral valve, subvalvular tissue, and left ventricular endocardium was removed by a trans-septal approach under cardiopulmonary bypass. Pathological examination revealed that the mass was a fibrin-based thrombus with almost no inflammatory findings, we diagnosised non-bacterial thrombotic endocarditis (NBTE). Postoperatively, the patient developed Takotsubo cardiomyopathy, and treatment for uterine cancer, was delayed. Hypercoagulability was not controlled well, and she developed recurrence of left ventricle vegitation, acute arterial occlusion of the lower extremities and inferior vena cava thrombosis, making active intervention for uterine cancer difficult. The patient was treated palliatively and died on POD 36. NBTE tends to be characterized by multiple small growths, but giant vegetation may also occur as in this case. Unless the primary disease causing the hypercoagulability is treated, recurrence of NBTE is possible, and prompt treatment of the primary disease is required.

Citologías alteradas en mujeres pertenecientes a un grupo básico de trabajo de Camagüey

RESUMEN Introducción: El cáncer de cuello uterino es una neoplasia maligna que se encuentra asociada a un número notable de factores de riesgo y, dentro de ellos, a la conducta sexual. Objetivo: Analizar las características clínico-epidemiológicas de mujeres con citologías alteradas de un grupo básico de trabajo perteneciente al Policlínico Comunitario Docente "Joaquín de Agüero y Agüero", municipio Camagüey. Método: Se realizó un estudio de corte transversal, descriptivo, durante el período enero-diciembre de 2020. Se trabajó con un universo de 62 mujeres pertenecientes a los 11 consultorios urbanos del Grupo Básico de Trabajo 1, con presencia de citologías alteradas diagnosticadas mediante estudio histológico y/o citológico. Las variables utilizadas fueron: grupo de edad, antecedentes familiares de patologías de cuello y cuerpo uterino, factores de riesgo, infección con el virus del papiloma humano (VPH) y los resultados histopatológicos de Papanicolaou. El procesamiento y análisis de datos se realizó utilizando el paquete estadístico SPSS versión 21.0. Resultados: La mayor incidencia de lesiones de cuello uterino ocurrió en el grupo de edad de 25 a 34 años (43,5 %), con antecedentes familiares maternos (45,1 %). La infección vaginal (100 %) y la multiparidad (82,2 %) fueron consideradas como principales factores de riesgo. Predominaron las pacientes con el virus del papiloma humano en un 87,1 %. Además, la citología con resultados de neoplasia cervical intraepitelial (NIC I) fue la más diagnosticada (40,3 %). Conclusiones: Los factores de riesgo analizados muestran una importante relación directa entre el virus del papiloma humano y los resultados de las citologías cervicales alteradas.

ABSTRACT Introduction: Cervical uterine cancer is a malignant neoplasm that is associated with remarkable number of risk factors, including sexual behavior. Objective: To analyze the clinical-epidemiological characteristics of women with altered cytology treated by a basic work group at the Policlínico Docente Comunitario "Joaquín de Agüero y Agüero", in Camagüey municipality. Method: A cross-sectional and descriptive study was conducted from January to December 2020. It worked with a total of 62 women (as universe) treated in 11 different urban clinics associated to the Basic Work Group 1, all women with altered cytology diagnosed by histological and/or cytological study. Variables used were as follow: group of age, family history linked to the cervical and uterine body pathologies, risk factors, human papilloma virus (HPV) infection and histopathological Papanicolaou results. Data processing and analysis were performed using the statistical package SPSS version 21.0. Results: The highest incidence of cervical uterine lesions occurred in the group of age 25 to 34 (43.5%), and the 45.1% showed a maternal family history. Vaginal infection (100%) and multiparity (82.2%) were considered the main risk factors. Patients with HPV predominated in 87.1%. In addition, cytology with findings of cervical intraepithelial neoplasia (CIN 1) was the most frequently diagnosed (40.3%). Conclusions: It is concluded that the risk factors analyzed show a significant direct relationship between HPV and altered cervical cytology outcomes.

RESUMO Introdução: O câncer do colo do útero é uma neoplasia maligna que está associada a um notável número de fatores de risco e, entre eles, ao comportamento sexual. Objetivo: Analisar as características clínico-epidemiológicas de mulheres com citologias alteradas de um grupo básico de trabalho da Policlínico Comunitario Docente "Joaquín de Agüero y Agüero", município de Camagüey. Método: Estudo transversal descritivo realizado no período de janeiro a dezembro de 2020. Trabalhamos com um universo de 62 mulheres pertencentes às 11 clínicas urbanas do Grupo de Trabalho Básico 1, com presença de citologias alteradas diagnosticadas por estudo histológico e/ou citológico. As variáveis utilizadas foram: faixa etária, história familiar de patologias cervicais e do corpo uterino, fatores de risco, infecção pelo papilomavírus humano (HPV) e resultado histopatológico do Papanicolaou. O processamento e a análise dos dados foram realizados no pacote estatístico SPSS versão 21.0. Resultados: A maior incidência de lesões cervicais ocorreu na faixa etária de 25 a 34 anos (43,5%), com história familiar materna (45,1%). Infecção vaginal (100%) e multiparidade (82,2%) foram considerados os principais fatores de risco. Pacientes com HPV predominaram em 87,1%. Além disso, a citologia com resultado de neoplasia intraepitelial cervical (NIC I) foi a mais diagnosticada (40,3%). Conclusões: Conclui-se que os fatores de risco analisados apresentam uma relação direta importante entre o HPV e os resultados das citologias cervicais alteradas.

Detección y control del cáncer de cuello uterino en mujeres de 35 a 44 años en Ecuador / Detection and control of cervical cancer in women aged 35 to 44 yearsin Ecuador

INTRODUCCIÓN: El cáncer de cuello uterino es un problema de salud pública que se origina en las células que recubren el cuello del útero, cuya etiología se relaciona frecuentemente con el virus del Papiloma Humano. Esta patología solo se presenta en las mujeres, siendo el segundo más común entre las tipologías de cáncer; su aparición puede ser prevenible mediante el control y la detección oportuna. OBJETIVO: Determinar el nivel de control y detección de cáncer cérvico-uterino que tienen las mujeres de 35 a 44 años. METODOLOGÍA: La investigación es cuantitativa, descriptiva y de corte transversal. La muestra fue de 267 mujeres de 35 a 44 años. Se aplicó una encuesta virtual de manera voluntaria y aleatoria a la población femenina de dichas edades, en la cual se establecieron preguntas categorizadas en: Conocimiento general, Control y Detección, éstas nos ayudarán a comprobar el grado de información, control y detección del cáncer cérvico-uterino que tenga dicha población. RESULTADOS: El porcentaje general varía de acuerdo a las categorías de las encuestas empleadas, a partir de las cuales se refleja que el 52,8% tiene conocimiento acerca de los métodos de control y detección del cáncer cérvico-uterino, el 44,3% no ha recibido información acerca del tema y, el 2,9% tiene un conocimiento incompleto. CONCLUSIÓN: El cáncer cérvico-uterino afecta con mayor frecuencia a las mujeres sexualmente activas dentro del rango de edad de 35 y 44 años, siendo la falta de información de la población femenina y la ausencia de controles sanitarios algunos de los factores que predisponen a una alta incidencia y prevalencia de la morbi ­mortalidad a causa de esta patología.

INTRODUCTION: Cervical cancer is a public health problem that originates in the cells lining the cervix, whose etiology is often associated with the Human Papillomavirus. This pathology only occurs in women, being the second most common among cancer typologies; its appearance can be preventable through control and timely detection. OBJECTIVE: To determine the level of control and detection of cervical-uterine cancer in women aged 35 to 44. METHODOLOGY: The research is quantitative, descriptive and cross-sectional. The sample was 267 women aged 35 to 44 years. A voluntary and random virtual survey was applied to the female population of these ages, in which questions categorized in: General knowledge, Control and Detection were established, these will help us to verify the degree of information, control and detection of cervical-uterine cancer in that population. RESULTS: The percentage varies according to the categories of surveys used, showing that 50.3 per cent have knowledge of methods for the control and detection of cervical-uterine cancer, 41.1 per cent have not received information on the subject and 8.6% have incomplete knowledge. CONCLUSIONS: Cervical-uterine cancer most often affects sexually active women in the 35-44 age range, The lack of information from the female population and the absence of health controls are some of the factors that predispose to a high incidence and prevalence of morbidity -mortality due to this pathology.

Influencia del cáncer cérvico-uterino y la alteración de la salud mental en pacientes menores de 25 años en Ecuador / Influence of cervico-uterine cancer and the alteration of mental health in patients under 25 years of age in Ecuador

INTRODUCCIÓN: Los problemas sanitarios en los pacientes que padecen cáncer cérvico-uterino influyen en la satisfacción personal y evitan una gran adherencia a la terapia médica, y además están relacionados con un número más notable de efectos secundarios y la estancia en la clínica de emergencia junto afecciones depresivas y problemas de ansiedad. OBJETIVO: Identificar la influencia del cáncer cérvico -uterino en las alteraciones en la salud mental de pacientes menores de 25 años en el Ecuador. METODOLOGÍA: La investigación fue de tipo cuantitativo, descriptivo, y de corte transversal. Se utilizaron encuestas de manera virtual dirigida a pacientes menores de 25 años que padecen de cáncer al cuello uterino en diversas Fundaciones que luchan contra el cáncer, contando con una muestra de 178 mujeres, estas se dividieron en 4 categorías: Salud mental, Estrés, Depresión y Total de escalas. RESULTADOS: El porcentaje que se obtuvo de manera general tuvo un rango variado, el 32,9% dio como resultado que la alteración que causa en la mujer es contundente, seguido del 30,6 que su afección en la salud mental es más baja. CONCLUSIÓN: Se concluye afirmando que el cáncer uterino es el segundo cáncer más prevalente en la mujer, el cual influye de manera progresiva en la salud mental, presentando reacciones negativas y percepciones, falta de control en las emociones, consecuentemente aquello debilita el sistema inmunológico previamente comprometido, generando alteraciones en el curso del tratamiento.

INTRODUCTION: Health problems in patients suffering from cervical-uterine cancer influence personal satisfaction and prevent a high adherence to medical therapy, and are also related to a more notable number of side effects and stay in the emergency clinic together depressive conditions and anxiety problems. OBJECTIVE: To identify the influence of cervical cancer -uterine in the alterations in the mental health of patients under 25 years in Ecuador. MATERIALS AND METHODS: The research was quantitative, descriptive, andcross-sectional. Surveys were used in a virtual way directed at patients under 25 years of age who suffer from cervical cancer in various Foundations that fight against cancer, with a sample of 178 women, these were divided into 4 categories: Mental health, Stress, Depression and Total stopovers. RESULTS: The percentage that was obtained in a general way had a varied range, 32.9% gave as a result that the alteration it causes in women is overwhelming, followed by 30.6 that their mental health condition is lower. CONCLUSION: It is concluded by stating that uterine cancer is the second most prevalent cancer in women, which progressively influences mental health, presenting negative reactions and perceptions, lack of control over emotions, consequently that weakens the previously compromised immune system, generating alterations in the course of treatment.

Evolução da técnica de PCR: sua contribuição no diagnóstico da infecção por HPV / Evolution of techinique PCR: its contribution to infection diagnosis by HPV

Introdução: a reação em cadeia da polimerase (PCR) é a técnica de biologia molecular mais utilizada na detecção viral, principalmente em situações onde a quantidade de DNA disponível é pequena. O papilomavírus humano (HPV) representa um dos mais graves problemas de saúde pública e está associado ao câncer do colo do útero, especialmente em países em desenvolvimento, como o Brasil, que desde 2009 já apresentava 40 mil novos casos por ano. Objetivo: descrever a evolução da PCR e sua contribuição no diagnóstico do HPV. Metodologia: realizou-se uma revisão de literatura a partir de publicações disponíveis em base de dados eletrônicos, como Science Direct, SciELO, Pubmed, Instituto Nacional do Câncer e Ministério da Saúde do Brasil, nos últimos cinco anos. Resultados: dentre as técnicas citadas nesta revisão de literatura, todas têm alta relevância na detecção de genotipagem do HPV, embora a escolha quanto ao melhor desempenho fique a critério do pesquisador. A técnica de Nested PCR demonstra ser a mais vantajosa na detecção do vírus, pelo fato de ter uma maior sensibilidade, em comparação com as demais. Conclusão: a técnica PCR possui alta sensibilidade (90-100%) e apresenta 92,8 a 100% de especificidade, sendo padrão ouro para a detecção de DNA do HPV, em amostras citológicas do câncer de colo do útero. Assim, os dados obtidos permitem constatar que a técnica PCR, utilizada para o rastreamento do HPV, é considerada padrão ouro, tendo maior sensibilidade, especificidade e velocidade de análise, devendo ser o método de escolha para o diagnóstico eficiente do HPV.

Introduction: polymerase chain reaction (PCR) is the most widely used molecular biology technique for viral detection, especially in situations where the amount of available DNA is small. Human papillomavirus (HPV) represents one of the most serious public health problems and is associated with cervical cancer, especially in developing countries such as Brazil that has had 40,000 (forty thousand) new cases a year, since 2009. Objective: to describe the evolution of PCR and its contribution to HPV diagnosis. Methodology: a literature review was conducted from publications available in electronic databases, such as Science Direct, SciELO, Pubmed, National Cancer Institute and Ministry of Health of Brazil, in the last five years. Results: among the techniques cited in this literature review, all have high relevance in the detection of HPV genotyping, although the choice for the best performance is at the discretion of the researcher. The Nested PCR technique proves to be the most advantageous in detecting the virus because it has a higher sensitivity compared to the others. Conclusion: the PCR technique has high sensitivity (90-100%) and presents 92.8 to 100% specificity, being the gold standard for the HPV DNA detection in cytology samples of uterus cervix cancer. Thus, the data obtained show that the PCR technique used for HPV screening is considered the gold standard, having greater sensitivity, specificity and speed of analysis, and should be the method of choice for the efficient diagnosis of HPV.

A case of endometrial glassy cell carcinoma: a rare entity which necessitates of better understanding

Endometrial glassy cell carcinoma (EGCC) is a rare neoplasm, accounting for 0.5% of the carcinomas in the endometrium, composed of cells with granular eosinophilic or amphophilic cytoplasm, giving it a ground glass appearance. Till date, only 14 cases of this carcinoma have been reported. In this report, we have described a case of EGCC to help define standard diagnostic criteria and better understand the course, ideal treatment, and accurate prognosis of this disease. We report a case of a 64-year-old woman diagnosed with EGCC after an abnormal pap smear. She underwent a hysteroscopy, which led to the histological diagnosis. Laparotomic total hysterectomy and bilateral salpingo-oophorectomy were performed with pelvic lymphadenectomy and peritoneal and omental biopsies. Final pathological examination confirmed the initial diagnosis. Pelvic nodes removed during surgery and peritoneal and omental biopsies were negative for tumor cells. Treatment was considered appropriate and the patient did not require additional therapies. She was subsequently assigned to clinical follow-up and is alive, with no evidence of the disease.

"Ter câncer mudou minha vida": cartografia de Luiza na micropolítica das redes de cuidado oncológico / "Having cancer changed my life": Luiza's cartography in the micropolitics of cancer care networks

Resumo Garantir cuidado integral à saúde de mulheres com câncer cérvico-uterino ainda é um desafio para a Saúde Coletiva, embora se evidencie o enraizamento de políticas, práticas e saberes na conformação de redes oncológicas de cuidado. Este estudo apostou na necessidade de mergulhar nas experimentações da micropolítica do cuidado para conhecer as nuances do fenômeno investigado. Ao fundamentar-se no aporte teórico-metodológico de Deleuze e Guattari, objetivou-se cartografar linhas de composição da produção de cuidado oncológico, na cidade de São Luís-MA, tendo como dispositivo a rede da usuária-guia Luiza. Investigaram-se 28 participantes através de entrevistas em profundidade e rodas de conversas. Como resultado, desenhou-se uma rede vulnerável, fragmentada e centralizada no cuidado biomédico, tendo um hospital que acolhe demandas da doença e uma atenção primária que abandona prevenção e promoção de saúde. Destaca-se a importância de conhecer a mulher com câncer atrelada à comunidade, à religiosidade e aos vínculos familiares. Ter câncer mudou a vida de Luiza e demandou conexões para além do biomédico. Essa cartografia convoca à percepção dos gargalos existentes na produção de redes oncológicas, convidando a quebrar muros tecnoassistenciais e criar enfrentamentos centrados na promoção de saúde e qualidade de vida.

Abstract Ensuring comprehensive health care for women with cervical-uterine cancer remains a challenge for public health, although evidence of the established policies, practices and knowledge in shaping of cancer care networks. This study focused on the need to deepen in the micropolitics of care experiments to know the nuances of the investigated phenomenon. Based on the theoretical and methodological approach of Deleuze and Guattari, it aimed to map the composition lines of cancer care production in the city of São Luis-MA, Brazil, using the network of the guide-user Luiza as a device. Twenty-eight participants were investigated through in-depth interviews and conversation groups. As a result, a vulnerable, fragmented, centralized network of biomedical care was designed, with a hospital that welcomes demands of the disease, and primary care that abandons prevention and health promotion. The importance of knowing women with cancer linked to the community, religiosity and family ties is highlighted. Having cancer changed Luiza's life and required connections beyond the biomedical sphere. This cartography calls for the perception of narrowing in the production of cancer care networks, inviting the breaking of techno-assistance walls and creating confrontations focused on health promotion and quality of life.

Educación sobre cáncer cervicouterino en la adolescencia / Education on cervical uterine cancer in the adolescence

RESUMEN El cáncer cervicouterino es el segundo en frecuencia entre féminas y causa importante de mobimortalidad. El riesgo de padecerlo está asociado a estilos de vida insanos, sobre todo en la adolescencia, momento en que se inicia la formación de actitudes y consolidan valores. Con el objetivo de estructurar los referentes teóricos que sustentan la relevancia de la educación en cáncer cervicouterino desde la adolescencia como contribución a su prevención, se revisaron 41 artículos científicos. Este es un proceso anarquicoproliferativo celular que se inicia con cambios neoplásicos intraepiteliales, que entre 10 y 20 años pueden transformarse en invasor. Dentro de los factores de riesgo se destacan el inicio precoz de las relaciones sexuales, promiscuidad, no uso de condón, uso prolongado de contraceptivos hormonales, multiparidad, embarazo juvenil, factores inmunológicos, tabaquismo, dieta baja en carotenos, antecedentes familiares de la enfermedad e infecciones de transmisión sexual, sobre todo por el virus del papiloma humano que constituye el principal. La prevención se sostiene fundamentalmente en la citología cervicovaginal, para la detección precoz de la lesión, así como en la promoción de salud a través de actividades educativas, preferentemente desde la adolescencia. El inicio temprano de la actividad sexual, las conductas sexuales de las nuevas generaciones y la alta frecuencia de infección por papiloma virus en adolescentes, hace que se presente este cáncer a edades más tempranas, por lo que debe modificarse la cobertura de edad para la citología cervicovaginal, así como considerar la vacunación masiva, antes del inicio de las relaciones sexuales (AU).

ABSTRACT Cervical uterine cancer is the second one in frequency among women and an important cause of morbimortality. The risk of suffering it is associated to insane life styles, mainly in the adolescence, when attitudes began their formation and values are consolidated. 41 scientific articles were reviewed with the aim of structuring the theoretical references backing the relevance of education in cervical uterine cancer since the adolescence as a contribution to its prevention. Cervical uterine cancer is an anarchic proliferative cell process that begins with neoplastic intra epithelial changes; during the age period from 10 to 20 years it could become invasive. Among the risk factors stand out the precocious beginning of sexual relations, promiscuity, not using condoms, the long use of hormonal contraceptives, multiparity, youth pregnancy, immunologic factors, smoking, low-carotene diet, familiar antecedents and sexually transmitted diseases, mainly in the case of human papilloma virus. Preventions is sustained mainly on the cervical-vaginal cytology for the precocious detection of the lesion, and also the health promotion through educative activities preferably since the adolescence. The early beginning of the sexual activity, the sexual behavior of the new generations and the high frequency of infections caused by human papilloma virus in teenagers lead to the presentation of this cancer at earlier ages, consequently the age coverage for the cervical vaginal cytology should be modified, and also the massive vaccination before the beginning of the sexual relationships should be considered (AU).

Treatment outcomes of patients with stage II pure endometrioid-type endometrial cancer: a Taiwanese Gynecologic Oncology Group (TGOG-2006) retrospective cohort study / 부인종양

OBJECTIVE: Choice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid endometrial cancer (EEC) is still controversial. Aims of this study were to evaluate survival benefits and adverse effects of different hysterectomies with or without adjuvant radiotherapy (RT), and to identify prognostic factors. METHODS: The patients at 14 member hospitals of the Taiwanese Gynecologic Oncology Group from 1992 to 2013 were retrospectively investigated. Patients were divided into simple hysterectomy (SH) alone, SH with RT, radical hysterectomy (RH) alone, and RH with RT groups. Endpoints were recurrence-free survival (RFS), overall survival (OS), disease-specific survival (DSS), adverse effects and prognostic factors for survival. RESULTS: Total of 246 patients were enrolled. The 5-year RFS, OS, DSS and recurrence rates for the entire cohort were 89.5%, 94.3%, 96.2% and 10.2%, respectively. Patients receiving RH had more adverse effects including blood loss (p < 0.001), recurrent urinary tract infections (p = 0.013), and leg lymphedema (p = 0.038). Age over 50-year (HR = 9.2; 95% confidence interval [CI], 1.2–70.9) and grade 3 histology (HR = 7.28; 95% CI, 1.45–36.6) were independent predictors of OS. Grade 3 histology was an independent predictor of RFS (HR = 5.13; 95% CI, 1.38–19.1) and DSS (HR = 5.97; 95% CI, 1.06–58.7). Patients receiving adjuvant RT had lower locoregional recurrence (p = 0.046), but no impact on survival. CONCLUSION: Different treatment modalities yield similar survival outcomes. Patients receiving SH with RT had lower locoregional recurrent with acceptable morbidity. Age and tumor grading remained significant predictors for survival among patients with FIGO 2009 stage II EEC.

Avaliação crítica do papel da citologia cervical em meio líquido no rastreamento do câncer do colo uterino / Critical evaluation of the role of liquid based cervical cytology in screening for cervical cancer

A citologia cervical em meio líquido (CML) foi aprovada pela Administração de Drogas e Alimentos dos EUA (Food and Drug Administration - FDA) com objetivo de reduzir as falhas da citologia cervical convencional (CC). Segundo a literatura atual, a CML aumenta a sensibilidade da citologia cervical, a adequabilidade das amostras e diminui o número de esfregaços insatisfatórios quando comparada com a CC. Embora alguns países tenham legitimado o modelo de CML no rastreio de neoplasia do colo do útero, há controvérsias a respeito da escolha do melhor método de exame citopatológico cervical. Dessa forma, o objetivo da presente revisão é avaliar o impacto da introdução da CML em termos de eficácia, custos, conhecimento técnico necessário e implicações para a sua introdução.(AU)

The liquid based cervical cytology has been approved by the Food and Drug Administration (FDA) in order to reduce failures of conventional cervical cytology (CC). According to current literature, CML increases the sensitivity of cervical cytology, the suitability of the samples and reduce the number of poor smears compared with CC. Although some countries have legitimized the CML model in screening cancer of the cervix, there is a controversy about the choice of the best cervical Pap smear method. Thus, the aim of the current review is to evaluate the impact of the introduction of CML in terms of effectiveness, costs, necessary technical knowledge and implications of its introduction.(AU)

Clinical Significance of Plasma D-Dimer Detection in Cervical Cancer, Uterine Cancer and Ovarian Cancer / 现代检验医学杂志

Objective To explore the clinical significance of detection of plasma D-dimer in patients with cervical cancer,uterine cancer and ovarian cancer.Methods Total 35 cervical cancer patients,32 uterine cancer patients and 30 ovarian cancer patients were collected from Yunxiao Traditional Chinese Medicine Hospital of Zhangzhou city and the First Hospital of Zhangzhou China Merchants Economic and Technological Development Zone from October 2013 to July 2015.The plasma D-dimer was detected and compared with cervicitis,hysteromyoma,ovarian cyst and healthy control respectively.Relativity between the level of plasma D-dimer with the International Federation of Gynecology and Obstetrics (FIGO) staging was anslyzed.The diagnostic value of plasma D-dimer in cervical cancer,uterine cancer and ovarian cancer was assessed by receiver operating characteristic (ROC)curves.Results The level of plasma D-dimer in the cervical cancer group was significantly higher than that in the cervicitis group,the uterine cancer group was higher than that in the uterine leiomyoma group,and the ovarian cancer group was higher than that in the ovarian cyst group too (t=5.91 ～ 7.17,all P＜0.01).It was no significantly differentia compare with cervical cancer group,uterine cancer group and ovarian cancer group (F=0.10,P＞0.05).Plasma D-dimer level in cervicitis group,hysteromyoma group and ovarian cyst group was no significantly differentia (F=2.47,P＞0.05) but it was significantly high in cervicitis than hysteromyoma at post test (P＜0.05).Compared with healthy control group,the plasma D-dimer level was significantly rise in cervical cancer,uterine cancer,uterine cancer,cervicitis and ovarian cyst (t=2.43～7.53,P＜0.01～0.05),while no significantly differentia in hysteromyoma (t=1.04,P＞0.05).It was significantly differentia and increases as the FIGO staging in cervical cancer,uterine cancer and uterine cancer (F=15.06 ～ 19.02,all P＜0.01,r=0.625 ～ 0.855,all P＜0.01).The area under the ROC curve (AUC) of the three tumors diagnosed by D-dimer was 0.964,0.980 and 0.983,with sensitivity of 82.9 ％,90.6 ％ and 86.7 ％ respectively,and specificity of all 100％,which was of high diagnostic value.Conclusion There are hyperactivity of thrombosis and fibrinolysis in cervical cancer,uterine cancer and ovarian cancer.The plasma D-dimer levels can be used as the reference index of diagnosis and staging.

Marcadores para el cribado del cáncer cervical

Los organismos producen sustancias, generalmente proteínas, cuya concentración y nivel de detección varía entre células sanas, células enfermas o afecciones benignas, los cuales son usados como marcadores de una patología dada, incluyendo el cáncer. Justamente, la importancia o valor de un marcador dado va a depender de la precisión de su uso a nivel clínico y de investigación, para el diagnóstico, pronóstico y estadifcación de la enfermedad, a tal punto que su detección puede ser fundamental para el establecimiento de una terapia o tratamiento a un paciente. A continuación, se presenta una revisión actualizada de los distintos marcadores utilizados en el cribado del cáncer uterino, incluyendo proteínas, ARN y cambios en secuencias de ADN, exponiendo sus ventajas y limitaciones.

Organisms produce substances, usually proteins, whose concentration and detection level varies between healthy cells, diseased cells or benign conditions, which are used as markers of a given pathology, including cancer. Precisely, the importance or value of a given marker will depend on the accuracy of their clinical and research use for the diagnosis, prognosis and staging of the disease. Thus, a marker detection may be central to the establishment of a therapy or treatment to a patient. Below a review is presented with an updated version of the various markers used in screening for uterine cancer, including proteins, RNA and DNA sequences changes, exposing their advantages and limitations.

Nivel de conocimientos y factores de riesgo predisponentes de cáncer cérvico-uterino en mujeres de Cumanayagua / Level of knowledge and risk factors predisposing Cumanayagua women to cervical-uterine cancer

Introducción: el cáncer de útero es, después del de mama, el que con más frecuencia afecta a la mujer, y su cura depende del diagnóstico precoz. Objetivo: identificar el nivel de conocimientos y factores de riesgo predisponentes de cáncer cérvico-uterino en mujeres de Cumanayagua. Métodos: estudio descriptivo de corte transversal, en el Policlínico de Cumanayagua durante el año 2013. El universo estuvo constituido por 51 mujeres entre 25 y 59 años de edad, con cáncer cérvico-uterino. Para la recolección de la información se revisaron las historias clínicas, tarjetas de citodiagnóstico y se aplicó una encuesta. Para el análisis de los resultados se utilizaron distribuciones de frecuencias absolutas y relativas (porcentajes). Resultados: el 80,39 por ciento tenía algún hábito tóxico, predominó el consumo de cigarrillos con el 41,17 por ciento, el 33,33 por ciento presentó infección por virus papiloma humano, El 23,53 por ciento se practicó abortos, el 17,64 por ciento fueron instrumentados, el síntoma predominante fue dispareunia en 47,05 por ciento, el 88,24 por ciento de las mujeres fueron diagnosticadas en la etapa adulta, el 92,15 por ciento posee desconocimiento sobre el cáncer cérvico-uterino, de ellas el 58,82 por ciento con conocimientos regulares y el 33,33 por ciento malos. Conclusiones: predominaron los factores de riesgo: hábitos tóxicos como tabaquismo; infecciones vaginales, práctica de abortos y dispareunia, el diagnóstico de la enfermedad en etapa adulta e insuficiente nivel de conocimientos sobre la misma(AU)

Introduction: uterine cancer is second to breast cancer as it affects women with the highest frequency, and its cure depends on early diagnosis. Objective: to identify the level of knowledge and risk factors predisposing Cumanayagua women to cervical-uterine cancer. Methods: descriptive cross-sectional study at Cumanayagua Polyclinic during the year 2013. The target group consisted of 51 women at ages 25-59 years and with cervical-uterine cancer. To gather the information, we reviewed the clinical and cytodiagnosis records and conducted a survey. To analyze the results, we used absolute and relative (percentages) frequencies. Results: 80.39 percent had toxic habits, cigarettes consumption predominated (41.17 percent). 33.33 percent presented human papillomavirus infection. 23.53 percent had practiced abortion, out of which 17.64 percent were instrumented. Dyspareunia was the predominating symptom in 47.05 percent. 88.24 percent of the women were diagnosed in adult age. 92.15 percent have any lack of knowledge on cervical-uterine cancer, 58.82 percent out of which with regular knowledge and 33.33 percent with bad. Conclusions: Among the predominating risk factors are toxic habits, such as smoking; vaginal infections, abortion and dyspareunia, the diagnosis of the disease in the adult age and insufficient level of knowledge about the topic(AU)

Representações sociais sobre a doença de mulheres acometidas do câncer cervico-uterino / Representaciones sociales acerca de la enfermedad de las mujeres con cáncer cérvico-uterino / Social representations about the disease of women with cervico-uterine cancer

Objective: understanding the social representation of women about cervical cancer and its implications for care of themselves. Method: this is a qualitative study of a descriptive approach that used as a theoretical role the social representations, taking the interview as a technique for data collection of information. We worked with 35 outpatient women of a referral public hospital in oncology. Results: within the dialogs it was observed that the concept of cervical cancer was closely related to the feeling factor, leading fear and sadness. The evidences also showed that women focused on sexuality and treatment as a life change along the disease. Conclusion: cancer of the cervix produces a great change of life in women who passed through the problem, not just by the physical factors, but quite by the subjective side in fighting the disease.

Objetivo: compreender a representação social de mulheres com câncer de colo de útero e suas implicações para o cuidado de si. Método: um estudo de natureza qualitativa e abordagem descritiva que utilizou como aporte teórico as representações sociais, tendo a entrevista como técnica de coleta de dados das informações. Trabalhamos com 35 mulheres do ambulatório de um hospital público de referência em oncologia. Resultados: dentre os discursos observou-se que o conceito de câncer de colo de útero foi muito relacionado com o fator sentimental, imperando o medo e a tristeza. Os depoimentos mostraram também que as mulheres focaram a sexualidade e o tratamento como mudança de vida no decorrer da doença.Conclusão: o câncer de colo de útero gera uma grande mudança de vida nas mulheres que passam pelo problema, não apenas pelo fator físico, mas muito pelo lado subjetivo no enfrentamento da doença.

Objetivo: comprender la representación social de las mujeres acerca del cáncer cervical y sus implicaciones para el cuidado de sí mismas. Método: este estudio cualitativo de enfoque descriptivo utilizó como aporte teórico las representaciones sociales, tomando la entrevista como técnica de recolección de datos de la información. Trabajamos con 35 mujeres del ambulatorio de un hospital público de referencia en oncología. Resultados: entre los discursos se observó que el concepto de cáncer cervical de útero estaba realmente relacionado con el factor sentimental, que reina el miedo y la tristeza. Los testimonios también mostraron que las mujeres se centraron en la sexualidad y el tratamiento como un cambio de vida ya que la enfermedad avanzaba. Conclusión: el cáncer del cuello del útero produce un gran cambio de vida en las mujeres que pasan por el problema, no sólo por factores físicos, sino todo el aspecto subjetivo en la lucha contra la enfermedad.

Efficacy of TVS colour doppler in comparison of primary infertility with endometrial biopsy

Background: Accurate prediction and diagnosis of uterine abnormalities has become a core part of the fertility work-up. A variety of modalities can be used for the diagnosis of uterine abnormalities Transvaginal ultrasonography (TVS) is one among all. Aim: To determine the efficacy of TVS ultrasonography in screening for endometrial disease and studied the concordance of abnormal endometrial thickness, as measured by ultrasonography, with diagnoses based on histopathological examination of endometrial biopsy specimens. Materials and methods: A total 200 Subjects were elected from OPD of ESIC Hospital, Hyderabad. All subjects were undergone to the routine clinical and blood investigation, ultrasound, transvaginal and colour doppler investigations. Results: Study of primary infertility the diagnosis by transvaginal ultrasound and histopathology matched in 82% cases, while in 18% cases there was a disparity among the two modes of investigation. Conclusion: TVS can play an effective role in diagnosis and management of primary infertility, as it has a greater patient compliance with non-invasive technique and without necessitating full bladder. It can replace the EB in the diagnostic work up of female infertility.

Frequência de amostras insatisfatórias dos exames preventivos do câncer do colo úterino na rede pública de saúde, em município do agreste pernambucano / Frequency of unsatisfactory samples of preventive exams of cervical cancer in the public health system in city located in pernambuco, Brazil

Objetivo: avaliar a frequência de amostras insatisfatórias em serviço público de saúde do Agreste Pernambucano,visando identificar as principais causas que comprometem a qualidade do exame citopatológico cervical. Método:através do levantamento de dados de amostras cérvico-vaginais insatisfatórias, obtidas no LACIAN- Laboratóriode Citologia e Anatomopatologia do Município de Caruaru, no período de janeiro de 2010 a dezembro de 2011.Resultados: foram identificadas 41.609 amostras, dessas 381 foram classificadas de acordo com o tipo de inadequação,em insatisfatórias para avaliação. Destas amostras, 34% (127/381) têm como causa das amostras inadequadas apresença de material acelular ou hipocelular (em menos de 10% do esfregaço), 21% (81/381) foram de amostrasrejeitadas por ausência ou erro na identificação da lâmina, frasco ou formulário, 14% (52/381) apresentaram a leituraprejudicada em mais de 75% pela presença de artefatos de dessecamento, 9% (33/381) por material acelular ouhipocelular e por presença de sangue em mais de 75% do esfregaço, 7% (25/381) leitura prejudicada por presençade piócitos em mais de 75% do esfregaço, 3% (13/381) material acelular ou hipocelular e presença de artefatos dedessecamento, 3% (11/381) por presença de sangue, 3% (10/381) amostra rejeitada por outras causas. Conclusão:Diante da pequena frequência de amostras insatisfatórias verificada, é possível destacar que a unidade de saúde emestudo realiza suas atividades laboratoriais de acordo com os parâmetros estabelecidos, garantindo assim resultadosfidedignos.

Objective: to assess the frequency of unsatisfactory Pap smear samples in public health service of a city ofPernambuco to identify the main causes that compromise the quality of the cervical slide exams. Method: weconducted a screening of data of cervical samples categorized as unsatisfactory, obtained in LACIAN- Laboratoryof Cytology and Pathology of the Caruaru city, from January 2010 to December 2011. Results: it was evaluated41.609 samples. Of these, 381 were classified according to the type of inadequacy evaluation. Thirty four percentof these samples (127/381) had the presence of acellular or hypocellular material (in less than 10% of the smear)as cause of inadequate samples, 21% (81/381) of samples were rejected by absence or misidentification in the slideor in the sample container, 14% (52/381)had impaired sample more than 75% of desiccation artefacts, 9% (33/381)by acellular or hypocellular materials and presence of blood in more than 75% of the smear, 7% (25/381) wereunsuitable for analysis by the presence of degenerated leukocytes in more than 75% of the sample, 3% (13/381) hadacellular or hypocellular material and the presence of artefacts of desiccation, 3% (11/381) showed the presenceof blood, 3% (10/381) of the samples were rejected for other reasons. Conclusion: given the low frequency ofunsatisfactory samples we can highlight that the laboratory of analysis carries out its activities in accordance withestablished parameters, ensuring reliable results.

Conocimientos, actitudes y prácticas sobre virus del papiloma humano, cáncer cérvico uterino y prevención / Knowledge, attitudes and practices on human papilloma virus, cervical cancer and prevention

Objetivo: Explorar los conocimientos, actitudes y prácticas ante el cáncer cervicouterino (CCU), el virus del papiloma humano (VPH) y sus formas de prevención entre las mujeres de 25 a 64 años de edad en el Salvador. Métodos: Se llevó a cabo un estudio descriptivo de corte transversal mediante una encuesta poblacional en una muestra probabilística y representativa de 838 mujeres de áreas urbanas y rurales de los departamentos de Santa Ana y Sonsonate. Se aplicó un cuestionario estructurado con 84 preguntas mayoritariamente cerradas o semi-abiertas, este cuestionario fue validado por expertos de la Unión Internacional de Cáncer Control...

Objective: To explore the knowledge, attitudes and practices of Salvadorian women between the ages of 25 and 64 regarding cervical uterine cancer, human papillomavirus (HPV) and their prevention. METHODS: We carried out a cross-sectional descriptive study by conducting a population survey with a probabilistic and representative sample of 838 women in urban and rural areas of the departments of Santa Ana and Sonsonate. We administered a structured survey that was previously validated by experts fron the Union for International Cancer control (IUCC). The questionaire consisted of 84 primarily closed and semi-open questions...

Tumor neuroendocrino en cérvix uterino: reporte de caso / Neuroendocrine tumor of the uterine cervix: case report

Los tumores neuroendocrinos de cuello uterino son extremadamente raros. Las mujeres con diagnóstico de carcinoma neuroendocrino de células pequeñas del cuello uterino tienen mayor frecuencia de metástasis en los ganglios linfáticos, invasión linfovascular, recurrencia y peor pronóstico en comparación con aquellos con otros tipos de neoplasias cervicales. Se presenta el caso de una mujer de 58 años, con un tiempo de enfermedad de seis años antes del ingreso, caracterizado por sangrado vaginal irregular posmenopáusica, además de sintomatología relacionada a anemia crónica. En el examen ginecológico, se evidenció tumoración de 4 cm que ocupaba tercio superior de vagina y protruía por el cérvix. Fue diagnosticado como mioma abortivo y enviada a estudio anatomopatológico. El resultado fue carcinoma neuroendocrino de células pequeñas grado III en el 90% y carcinoma epidermoide en el 10%. La paciente fue sometida a histerectomía radical más salpingo-ooferectomía bilateral y linfadenectomía pélvica bilateral y para-aortica. El estudio anatomopatológico de la pieza quirúrgica encontró endometrio y miometrio comprometido por neoplasia maligna. Parametrios, anexos y ganglios linfáticos se encontraron libres de neoplasia. A la microscopía el resultado fue carcinoma neuroendocrino grado III (carcinoma de células pequeñas, infiltrante), con extensa embolia linfovascular. El estudio de inmunohistoquímica arrojó sinaptofisina positivo en las áreas con diferenciación neuroendocrina.

Neuroendocrine tumors of the cervix are extremely rare. Women diagnosed with small cell neuroendocrine carcinoma of the cervix have a higher frequency of metastases in the lymph nodes, lymphovascular invasion, recurrence and worse prognosis compared to those with other types of cervical neoplasia. We report the case of a 58-year-old female, with a history of six years of postmenopausal irregular vaginal bleeding, in addition to symptoms related to chronic anemia. Gynecological examination showed a tumor of 4 cm that occupied the upper third of the vagina and protruded through the cervix initially diagnosed as an abortifacient myoma, and sent to histopathology study. 90% of the tumor was small cell neuroendocrine carcinoma grade III, and the remaining 10% was squamous cell carcinoma. The patient underwent into a radical hysterectomy plus bilateral salpingo-oophorectomy, and bilateral pelvic and para-aortic lymphadenectomy. Histopathologic examination of the surgical specimen found endometrium and myometrium compromised by malignancy. Parametrium, annexes and lymph nodes were free of neoplasia. At microscopy, the result was a grade III neuroendocrine carcinoma (small cell carcinoma, infiltrating), with extensive lymphovascular emboli. The immune-histochemical study showed synaptophysin positive in areas with neuroendocrine differentiation.

Role of 18F-FDG PET/CT in the Carcinoma of the Uterus: A Review of Literature

In the present review we reported the value of 18F-fluorodeoxyglucose (FDG) PET/CT in face of uterine cancer, in terms of sensitivity, specificity and accuracy. Moreover, we made a comparison with the other imaging techniques currently used to evacuate these tumors including contrast-enhanced CT, contrast enhanced-MRI and transvaginal ultrasonography. FDG PET/CT has been reported to be of particular value in detecting occult metastatic lesions, in prediction of response to treatment and as a pro-gnostic factor.