Hisopado endocervical en mujeres con síntomas de COVID-19 provenientes de departamentos del Paraguay / Endocervical swabbing in women with COVID-19 symptoms from departments of Paraguay

INTRODUCCIÓN: El COVID-19 es eminentemente una infección de transmisión e inicio respiratorio, se discute la existencia de otras fuentes de contagio. El receptor viral ACE2 también ha sido detectado en el útero y en la vagina; de allí se ha planteado el compromiso del virus SARS-CoV-2 sobre el sistema genitourinario y sus posibles repercusiones en el embarazo. OBJETIVO: Determinar la presencia de SARS-CoV-2 en muestras endocervicales de mujeres con COVID-19 en departamentos del Paraguay. PACIENTES Y MÉTODOS: Diseño observacional prospectivo, de corte transverso. Se reclutaron 200 mujeres desde agosto 2020 hasta febrero 2021, con no más de 48/72 h de un resultado previo positivo de hisopado nasofaríngeo para SARS-CoV-2 por retrotranscriptasa reversa-reacción en cadena de la polimerasa (en inglés rt-RT-PCR) y que aceptaron ingresar al estudio. Se llenó un cuestionario clínico epidemiológico. Las tomas de muestras se realizaron en servicios de salud del Ministerio de Salud Pública y Bienestar Social (MSP y BS), domicilios y albergues de los distintos departamentos de Paraguay. Cada paciente fue sometida a un hisopado con hisopos de dacron o citobrush endocervical para la detección de SARS-CoV-2 por rt RT-PCR. Resultados: Las mujeres estudiadas tenían una edad media de 46,5 años (IC 95% 31,5-62,5). Refirieron contagio comunitario con SARS-CoV-2 en 75,5%, 13,5% en el hogar, 8,5% en el lugar de trabajo y 1,5% en el extranjero. Las manifestaciones clínicas fueron: 30%, síndrome gripal, fiebre 22,5%, tos 20%, anosmia 15,5%, trastornos digestivos 15,5%, y otros se presentaron con menor frecuencia. Las muestras de hisopados o citobrush endocervical sometidas a rt-RT-PCR para la deteccción de SARS Cov-2, resultaron negativas en las 200 mujeres de estudio. Discusión: Cabe destacar que las muestras vaginales fueron tomadas dentro de las 24-72 h de haber obtenido un resultado positivo para SARS-CoV-2 en el hisopado nasofaríngeo y que 62,5% de las mujeres se encontraban internadas en módulos respiratorios. Se discute la razón de la negatividad de los exámenes y su trascendencia. CONCLUSIÓN: No se detectó infección con SARS-CoV-2 en la región endocervical de 200 mujeres con manifestaciones clínicas de COVID 19 y evaluadas dentro de las 48/72 h de un resultado positivo nasofaríngeo para SARS Cov-2. Los resultados en la población de estudio concuerdan con otros estudios reportados en la literatura científica.

BACKGROUND: COVID-19 is an eminently respiratory transmissible infection of respiratory initiation, the existence of other sources of contagion is discussed. The ACE2 viral receptor has also been detected in the uterus and vagina; Hence, the involvement of the SARS-CoV-2 virus on the genitourinary system and its possible repercussions on pregnancy has been raised. AIM: To determine the presence of SARS-CoV-2 in endocervical samples of women with COVID-19 in the departments of Paraguay. METHODS: Designed as a prospective observational of transverse cohort. Two hundred women were recruited from August 2020 to February 2021, with no more than 48/72 hours of a previous positive nasopharyngeal swab result for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction (rt-RT-PCR) and who agreed to participate in the study. A clinical epidemiological questionnaire was completed. The samples were taken in health services of the MSPYBS (Public Ministry of Health and Social Welfare), homes and shelters in the different departments of Paraguay. Each patient underwent a swab (dacron swabs) or endocervical cytobrush for the detection of SARS-CoV-2 by rt-RT-PCR. RESULTS: Women recruited had a mean age of 46.5 years (95% CI 31,562.5). They reported contagion with SARS-CoV-2: 75.5% in the community, 13.5% at home, 8.5% in the place of work and 1.5% abroad. The clinical manifestations were: 30% flu syndrome, 22.5% fever, 20% cough, 15.5% anosmia, 15.5% digestive disorders, among other symptoms. The swabs or endocervical cytobrush samples subjected to rt-RT-PCR for the detection of SARS-CoV-2 were negative in the 200 study women. Discussion: It should be noted that the vaginal samples were taken within 24-72 hours after obtaining a positive result for SARS-CoV-2 in the nasopharyngeal swab and that 62.5% of the women were hospitalized in respiratory modules. The reason for the negativity of the exams and their significance are discussed. CONCLUSION: No SARS Cov-2 infection was detected in the endocervical region of 200 women with clinical manifestations of COVID 19 and evaluated within 48/72 hours of a positive nasopharyngeal result for SARS Cov-2. The results in the study population agree with the findings of other studies reported in the literature.

Calidad de la toma exo-endocervical en la prevención del cáncer de cuello uterino / Quality of the exo-endocervical sampling in the prevention of uterine cervix cancer

La citología cérvico-vaginal, test de Papanicolaou (PAP), es la técnica diagnóstica de cribado más efectiva para la detección de lesiones precancerosas y la prevención del cáncer de cuello uterino. La sensibilidad de la prueba varía en las diferentes estadísticas entre el 50% y el 98%; la causa de esta amplitud depende de la toma de muestra. Para que la toma se considere satisfactoria es necesario que se realice de la zona escamocolumnar, zona de transformación, y según el sistema Bethesda en el extendido se deben observar células metaplásicas y/o endocervicales. El PAP convencional incluye la toma exo-endocervical con espátula de Ayre; sin embargo, solo el 50% aproximadamente de las muestras son representativas de la zona de transformación. Para ejemplificar esta situación se presenta el caso de una mujer de 40 años que, a pesar de tener citologías negativas durante cinco años, ninguna con células endocervicales o metaplásicas, una toma adecuada mostró un carcinoma in situ (HSIL: lesión intraepitelial escamosa de alto grado). Recalcamos la importancia de la correcta toma exo-endocervical para poder detectar todas las lesiones premalignas y prevenir este tipo de cáncer que aún tiene alta tasa de mortalidad en todo el mundo.

Cervical and vaginal cytology, Papanicolaou test (PAP), is the most effective test for screening of preneoplastic lesions, and cervical cancer prevention. Its sensitivity goes from 50 to 98%, according to different statistics, and this variation is related to the sampling procedure. A satisfactory smear should be taken from the transformation zone, the junction between endocervix and exocervix. According to Bethesda, metaplastic and/or endocervical cells should be observed under the microscope. The traditional PAP smear includes an exo-endocervical sampling using the Ayre spatula; however, only near 50% of the smears are representative of the transformation zone. In this case report, we present the case of a 40-year-old woman who had negative cytology in five consecutive annual PAP smears, none of which showed metaplastic or endocervical cells. A new sample evidenced a carcinoma in situ (HSIL: high-grade squamous intraepithelial lesion). We emphasize the importance of performing a correct exo-endocervical sampling to allow prompt detection of all premalignant lesions and to prevent cervical cancer, which still persists with high mortality worldwide.

Primary Papillary Serous Carcinoma of Cervix: A Rare Variant of Cervical Malignancy

Papillary serous carcinoma of the uterine cervix is a very rare tumour, and is a recently described variant of cervical adenocarcinoma. It is an aggressive tumour with unpredictable course and poor prognosis. The incidence of cervical adenocarcinoma is 5–15%. This variant accounts for less than 50 cases in literature, has bimodal age distribution with one peak occurring less than 40 years and other occurring greater than 65 years age groups. Here, we present a 53 year-old woman presented with severe low backache and lump abdomen of 4 months duration. Per vaginal examination showed endophytic growth high up in the cervix. Pap smear and cervical biopsy done. Histopathological examination of cervical biopsy revealed papillary serous adenocarcinoma. Later, we received hysterectomy specimen with regional lymph nodes, which showed tumour limited to endocervix.

Biopsia endocervical: uso de cánulas endometriales conectadas a un sistema de aspiración

Objetivo: Evaluar el uso de cánulas endometriales conectadas a un sistema de aspiración para la toma de biopsia endocervical comparándola con cureta de Duncan. Métodos: Estudio prospectivo, transversal y comparativo. Se incluyeron 126 pacientes que acudieron al Servicio de Ginecología de la Maternidad “Concepción Palacios”, con indicación para biopsia endocervical, distribuidas aleatoriamente en dos grupos: grupo A: se realizó biopsia endocervical con cureta de Duncan y grupo B: se utilizó cánula endometrial con aspiración. Se registraron antecedentes, se evaluaron percepción del dolor, mediante escala análoga de 0 a 10, cantidad, calidad de la muestra y hallazgos histopatológicos. Resultados: Las principales indicaciones de la biopsia endocervical para ambos grupos fueron citología anormal sin o con cambios colposcópicos: 33 pacientes del grupo A y 26 del grupo B. En ambos grupos predominaron pacientes que presentaron dolor moderado (52,2 % y 67,7 %). Diecinueve mujeres (28,3 %) manifestaron dolor severo, cuando se tomó biopsia con cureta de Duncan y 3 (5,0 %) cuando se utilizó cánula endometrial (P<0,005). Se obtuvo epitelio de revestimiento, glandular y estroma en 50,7 % y 49,1 % respectivamente (P=0,156). La presencia de componente hemorrágico predominante fue nula o escasa en ambos grupos (P=0,166). Se obtuvo mayor cantidad de material con la cánula de aspiración (P=0,001). La muestra fue insuficiente para interpretación diagnóstica o solo tejido endometrial en 25,3 % y 27,2 % (P=0,294). Conclusiones: La biopsia con cánula endometrial fue mejor tolerada, manteniendo la misma calidad de muestra.

Objective: To evaluate the use of endometrial cannula connected to a vacuum system for endocervical biopsy curette compared with Duncan and investigate factors. Method: Prospective, experimental, transversal and comparative study. It included a sample of 126 patients were seen at the Colposcopy and Cervical Pathology of Gynecology Maternity Concepción Palacios, between April 2011 and April 2012, they had an indication for biopsy endocervical. A history and clinical data related to pain perception through analog scale of 0 to 10. We assessed the quantity, quality of the sample and histopathology findings. Results: The main indications for endocervical biopsy for both groups were abnormal cytology with or without colposcopic abnormal findings (33 in group A and 26 in group B). Both groups showed a predominance of moderate pain patients (52.2 % and 67.7 %). There were 19 women (28.3 %) who reported severe pain, when we use Duncan curette biopsy and 3 patients (5.0 %) when endometrial cannula was used (P <0.005). In both groups, we obtain glandular epithelium lining and stroma (50.7.% y 49.1.%). The presence of predominantly hemorrhagic component was nil or low in both groups (P = 0.166). There was greater amount of material with the suction cannula (P = 0.001). Interpretation was considered insufficient for diagnosis or just was represented by endometrial tissue in 25.3 % in group A and 27.2 % in group B (P> 0.05). Conclusions: The biopsy taken with endometrial cannulas was more tolerated by patients, maintaining the same quality sample for diagnosis.

Mesonephric adenocarcinoma (endometrioid type) of endocervix with diffuse mesonephric hyperplasia involving cervical wall and myometrium: An unusual case report.

Malignant mesonephric tumors are rare variants of cervical adenocarcinoma, derived from remnants of mesonephric ducts and are associated with mesonephric remnants and/or mesonephric hyperplasia. Few cases have been described in literature. We report an unusual case of cervical mesonephric adenocarcinoma of endometrioid type with squamous morules in association with diffuse mesonephric hyperplasia involving the cervical walls and extending into the myometrium.

Detection of Neisseria gonorrhoeae in Palestinian women using polymerase chain reaction.

Background: Neisseria gonorrohoeae is an exclusive human pathogen that primarily infects the urogenital epithelia. Infections caused by N. gonorrhoeae are considered the second major cause of sexually transmitted disease after Chlamydiae worldwide. Although the urethra and the uterine cervix serve as the initial sites for gonococcal infections in men and women, infection of the conjunctiva, pharynx, tendons, joints, as well as rectal mucosa are also reported. Objectives: The objectives of this study were to introduce molecular techniques such as polymerase chain reaction (PCR) to detect N. gonorrhoeae directly from endocervical swabs. In addition, it provides a picture of Neisseria gonorrohea infection among a sample of Palestinian women in West Bank. Methods: Two hundred and thirteen endocervical swabs were collected from sexually active married women with endocervical abnormalities attending healthcare clinics. DNA was extracted directly from the swabs and PCR was performed using specific primers targeting the orf1 region of the genome. Results: The results obtained indicated that the percentage of positive cases of N. gonorrhoeae among the women tested was 1.40%. Conclusion: Implementing guidelines for comprehensive screening of men and women with more sensitive tests may improve detection and management of sexually transmitted infections.

Lesión intraepitelial de bajo grado en endocérvix: conducta / Low grade intraepithelial lesion of endocervix: management

Describir la evolución espontánea de la lesiones intraepiteliales de bajo grado en endocérvix, bajo seguimiento cito-colposcópico e histológico. Estudio prospectivo, longitudinal y descriptivo en el que se incluyeron 25 pacientes con lesiones intraepiteliales de bajo grado endocervical evaluadas con citología, colposcopia de exo y endocérvix cada 4 meses e histológicamente al año de seguimiento. Servicio de Ginecología de la Maternidad “Concepción Palacios” Las lesiones intraepiteliales de bajo grado de endocérvix presentaron un 92 por ciento de regresión espontánea, 8 por ciento de persistencia y no hubo ningún caso de progresión. Las lesiones intraepiteliales de bajo grado en endocérvix presentan una elevada frecuencia de regresión espontánea. Recomendamos el tratamiento conservador y prolongar el seguimiento de los casos negativos para descartar falsos negativos.

Two Cases of Blue Nevus in the Endocervix of the Uterus / 대한산부인과학회잡지

Blue nevus of the endocervix is an uncommon lesion. Blue nevus commonly occurs on the skin of hands and feet, occasionally it has been observed in the mucosa of the oral cavity, and rarely observed in the uterine cervix, vagina, prostate, lymph nodes, and even breast. Most of them have been discovered incidentally. Our two cases (in 41 years and 45 years) were also incidentally found in the endocervix of the uterus, which were obtained by total abdominal hysterectomy under the diagnosis of leiomyoma. The expressions of S-100 protein in the blue nevus were noted. We report them with review of literatures.

A case of minimal deviation adenocarcinoma originated from uterine endocervix / 대한산부인과학회잡지

Minimal deviation adenocarcinoma (adenoma malignum) is a variant of adenocarcinoma and is expressed from uterine endocervix. As a result of ever reported cases in the world, it is rare enough to occur in 1 to 2% of invasive cervical adenocarcinoma. Minimal deviation adenocarcinoma is well-differentiated form of adenocarcinoma in which the cytoplasmic mucin is rich and the glandular pattern simulates that of normal endocervical glands. Because of this, the tumor may not be recognized as malignant in small specimens, thereby causing delay in diagnosis. But recent studies have found a favorable prognosis if the disease is detected early. We experienced a case of minimal deviation adenocarcinoma, rare disease in the world, so we report with a brief review of literature.

A case of minimal deviation adenocarcinoma originated from uterine endocervix / 대한산부인과학회잡지

Minimal deviation adenocarcinoma (adenoma malignum) is a variant of adenocarcinoma and is expressed from uterine endocervix. As a result of ever reported cases in the world, it is rare enough to occur in 1 to 2% of invasive cervical adenocarcinoma. Minimal deviation adenocarcinoma is well-differentiated form of adenocarcinoma in which the cytoplasmic mucin is rich and the glandular pattern simulates that of normal endocervical glands. Because of this, the tumor may not be recognized as malignant in small specimens, thereby causing delay in diagnosis. But recent studies have found a favorable prognosis if the disease is detected early. We experienced a case of minimal deviation adenocarcinoma, rare disease in the world, so we report with a brief review of literature.