Sexually transmitted infections lesions found during colonoscopies

Introduction: Anal examination and videoanoscopy (VA) are rarely performed during colonoscopies. In recent years, there has been a considerable increase in lesions of sexually transmitted anal and rectal infections, but these conditions are not noticed or reported during routine colonoscopy. Objective: To raise awareness regarding the fortuitous findings of lesions and sexually transmitted infections (STIs) in colonoscopy exams and to demonstrate that anal examination and VA provide important information and should be routinely performed. Methods: We conducted a descriptive retrospective study in 16,132 patients screened by colonoscopy and VA between 2006 and 2018. Among numerous other findings, the presence of anal condylomata and sexually transmitted retitis or perianal dermatitis was observed. The rates of each finding were calculated, and the patients were subdivided by sex and into age groups by blocks of ten years. Results: Among the 16,132 colonoscopies performed, 26 cases of condyloma (0.16%) and 50 cases of proctitis or perianal dermatitis suspicious for STI (0.33%) were found. Conclusion: Performing anal examination and VA systematically in all routine colonoscopies enabled the identification of numerous anal conditions, including several fortuitous cases of STIs. The study proposes that anal examination and VA should be performed in all routine colonoscopies and, in suspected cases, complementary tests for STIs. (AU)

Anal PAP, HPV tests and magnifying chromoendoscopy with biopsies in the diagnosis of anal intraephitelial neoplasia / Papanicolau anal, testes de HPV e cromoendoscopia de ampliação com biópsias no diagnóstico de neoplasia intraepitelial anal

Abstract Introduction: Anal intraepithelial neoplasia (AIN) is the most likely precursor of squamous cells cancer which represents 90% of anal cancers. The use of biomolecular tests as a screening method has been extended by gynecology. Given the similarities that exist between the HPV disease in the lower genital tract and anorectal sectors, it is expected that HPV tests can provide information for the diagnosis, treatment and follow-up for AIN-affected patients. Objectives: Comparing the performance of anal cytology, PAP and HPV tests (Hybrid Capture and Papillocheck) against the histology of the diagnosis of low- and high-grade AIN in risk groups. Material and methods: A cross-sectional study was carried out to evaluate diagnostic methods for low- and high-grade AIN in 73 patients. Samples for anal PAP, Papillocheck and Hybrid Capture were taken from all patients who then, regardless of the results, underwent magnifying chromoendoscopy (MCE) along with biopsy. Diagnostic test performances and their 95% confidence intervals (CI: 95%) were calculated as well as the likelihood ratio for each test. Results: Of the 73 patients, 49 (67%) were women. The average age of the patients was 38 years. In 38 patients (52%), the histology was positive with 10 (14%) grade II AIN or higher. There were no statistically significant differences in sensitivity nor in specificity for low- and high-grade AINs between any of the tests. Conclusion: Anal PAP, the Hybrid Capture test (HC2, Qiagen) and PapilloCheck (Greiner Bio One) were highly sensitive but not specific for low- and high-grade AINs. Therefore, a biopsy should be conducted against a positive result of any of the tests to confirm AIN and the degree of dysplasia. The screening method selection depend on the availability but also costs of the test should be considered, since all the diagnostic tests have similar performance.

Resumo Introdução: A neoplasia intraepitelial anal é o precursor mais provável do câncer de células escamosas, que representa 90% dos tumores anais. O uso de exames biomoleculares como método de triagem foi ampliado pela ginecologia. Considerando-se as semelhanças entre as apresentações de HPV no trato genital inferior e anorretal, espera-se que os exames de HPV possam fornecer informações para o diagnóstico, tratamento e acompanhamento dos pacientes com neoplasia intraepitelial anal. Objetivo: Comparar o desempenho da citologia anal, Papanicolau, exames para HPV (teste de captura híbrida e Papillocheck) e histologia no diagnóstico de neoplasia intraepitelial anal de baixo e alto grau em grupos de risco. Material e métodos: Foi realizado um estudo transversal para avaliar métodos de diagnóstico de neoplasia intraepitelial anal de baixo e alto grau em 73 pacientes. Amostras para Papanicolau anal, Papillocheck e captura híbrida foram coletadas de todos os pacientes; independentemente dos resultados desses exames, todos foram submetidos a cromoendoscopia de ampliação (CEA) e biópsia. O desempenho dos exames e seus intervalos de confiança de 95% (95% CI) foram calculados, bem como a razão de verossimilhança para cada teste. Resultados: Dos 73 pacientes, 49 (67%) eram mulheres. A idade média dos pacientes foi de 38 anos. A histologia foi positiva em 38 pacientes (52%), dos quais dez (14%) apresentaram neoplasia intraepitelial anal grau II ou superior. Não foram observadas diferenças estatisticamente significativas na sensibilidade ou especificidade para as neoplasias intraepiteliais anal de baixo e alto grau entre qualquer um dos exames. Conclusão: O Papanicolau anal, o teste de captura híbrida (HC2, Qiagen) e o Papillocheck (Greiner Bio One) foram altamente sensíveis, mas não específicos para neoplasia intraepitelial anal de baixo e alto grau. Portanto, uma biópsia deve ser realizada após um resultado positivo em qualquer um dos testes para confirmar o diagnóstico de neoplasia intraepitelial anal e seu grau. A seleção do método de triagem depende da disponibilidade, mas os custos devem ser considerados, uma vez que todos os testes apresentam desempenho semelhante.

Profile of women with anal neoplasia associated with cervical neoplasia receiving care at a tertiary healthcare facility in northeastern Brazil / Perfil de mulheres com neoplasia anal associada à neoplasia cervical atendidas em um serviço de saúde terciário do nordeste do Brasil

Abstract Objective: To describe the epidemiological, clinical and laboratory profiles of women with anal neoplasia associated with cervical neoplasia attending a tertiary healthcare facility in northeastern Brazil. Methods: This epidemiological, descriptive study was conducted using a database from a cross-sectional study carried out between December 2008 and January 2016. Women with a diagnosis of cervical neoplasia associated with anal neoplasia were included in the present study. Results: Of the women with cervical neoplasia, 14% were found to have an anal intraepithelial lesion or anal cancer. Median age was 33 years, 68% were non-white, and 70% were from urban regions, had little schooling and low income. Most reported having had anoreceptive (73%) and unprotected intercourse (84%). Regarding symptoms, 7% reported bleeding and 11% pruritus. Overall, 10% of the sample tested positive for the human immunodeficiency virus. Anal cytology was abnormal in 92%. High-resolution anoscopy was abnormal in all cases. Histopathology revealed three cases of invasive carcinoma and high-grade lesions in 32% of the cases. Conclusion: Women with a diagnosis of anal and cervical neoplasia are often young, non-white women, who initiated their sexual life at an early age, were exposed to unprotected anoreceptive intercourse, live in urban centers, have little schooling and a low-income level.

Resumo Objetivo: Descrever os perfis epidemiológico, clínico e laboratorial de mulheres com neoplasia anal associada à neoplasia cervical atendidas em uma unidade de saúde terciária no nordeste do Brasil. Métodos: Este estudo epidemiológico e descritivo usou um banco de dados de um estudo transversal realizado entre dezembro de 2008 e janeiro de 2016. Mulheres com diagnóstico de neoplasia cervical associada à neoplasia anal foram incluídas no presente estudo. Resultados: Das mulheres com neoplasia cervical, 14% apresentaram lesão intra-epitelial anal ou câncer anal. A mediana de idade foi de 33 anos; 68% das pacientes não eram brancas e 70% eram provenientes de regiões urbanas, com baixa escolaridade e baixa renda. A maioria relatou histórico de relações sexuais anoreceptivas (73%) e desprotegidas (84%). Quanto aos sintomas, 7% relataram sangramento e 11% prurido. No geral, 10% das pacientes apresentaram serologia positiva para o vírus da imunodeficiência humana. A citologia anal foi anormal em 92% da amostra. A anuscopia de alta resolução foi anormal em todos os casos. A histopatologia revelou três casos de carcinoma invasivo e lesões de alto grau em 32% dos casos. Conclusão: As mulheres com diagnóstico de neoplasia anal e cervical geralmente são jovens, não brancas, que iniciaram sua vida sexual em idade precoce, foram expostas a relações sexuais anoreceptivas desprotegidas, moram em centros urbanos e têm baixa escolaridade e baixo nível de renda.

Factores de riesgo de lesiones precursoras del cuello de útero / Risk factors for precursor lesions of the cervix

RESUMEN Introducción: El diagnóstico precoz del cáncer cérvicouterino es de importante práctica para mantener la salud. Objetivo: Identificar los factores de riesgo de lesiones precursoras del cuello de útero. Métodos: Estudio observacional de casos y controles en el Policlínico "Manuel Piti Fajardo" durante 2015. El universo estuvo constituido por 46 mujeres entre 25 y 59 años con citologías alteradas (grupo estudio) y, por muestreo aleatorio simple, se seleccionaron 46 mujeres de similar edad a las del estudio con citología negativa para el grupo control. La información se obtuvo aplicando una encuesta y de las tarjetas de citología orgánica, se utilizó el análisis porcentual, la media aritmética y la prueba de Chi-cuadrado para determinar asociaciones entre variables. Resultados: En el grupo estudio predominó el hábito de fumar (73,91 por ciento con X²= 35,28); el 60,87 por ciento con relaciones sexuales antes de los 15 años (X²=26,67); el condón fue utilizado por el 8,70 por ciento de las enfermas; el 36,96 % tuvo más de cuatro parejas sexuales y el 34,78 por ciento presentó papiloma humano (X²=134,08). Conclusiones: Se identificaron como factores de riesgo de lesiones precursoras del cuello de útero, el hábito de fumar, el inicio precoz de relaciones sexuales, no utilizar condón, tener varios compañeros sexuales y tener antecedentes de infecciones de transmisión sexual(AU)

ABSTRACT Introduction: Early diagnosis of uterine cervical cancer is an important practice to maintain health. Objective: To identify risk factors for precursor lesions of the cervix. Methods: An observational study of cases and controls in the Policlinico "Manuel Piti Fajardo" during 2015. The universe, consisting of 46 women between 25 and 59 years old with altered cytologies (study group), for the control group, by simple random sampling Selected 46 women of similar age to the negative cytology study. The information was obtained by applying a survey and the organic cytology cards, the percentage analysis, the arithmetic mean and the Chi-square test were used to determine associations between variables. Results: Smoking was predominant in the Study Group (73.91 percent with X² = 35.28); 60.87 percent with sexual intercourse before 15 years and (X² = 26.67); the condom was used by the 8.70 percent of the patients; 36.96 percent had more than four sexual partners and 34.78 % had human papilloma (X² = 134.08). Conclusions: Smoking factors, early onset of sexual intercourse, no condom use, multiple sexual partners, and a history of sexually transmitted infections were identified as risk factors for precursor cervical lesions(AU)

Ablación de las neoplasias intraepiteliales escamosas anales de alto grado, precursoras del cáncer anal, con coagulación infrarroja / Ablation of high-grade anal squamous intraepithelial neoplasms, anal cancer precursors, with infrared coagulation

Introducción: Las neoplasias intraepiteliales anales de alto grado (AIN-AG) sin tratamiento progresan a carcinoma anal escamoso invasor (CAE) en 8-13% de los casos. Esto disminuye al 1,2% con la ablación dirigida por anoscopía de alta resolución (AAR). El tratamiento ideal de la AIN-AG no está establecido. Goldstone, en 2005 introdujo el coagulador infrarrojo (CIR) para la ablación de estas lesiones y demostró que tiene tanta efectividad como la cirugía, aunque menor morbilidad y la ventaja de no requerir quirófano. No hemos encontrado publicaciones con esta técnica en nuestro medio. El objetivo de este trabajo es evaluar los resultados de la ablación de las AIN-AG con CIR, las complicaciones del método y la recurrencia temprana. Diseño: Observacional, retrospectivo, con base de datos prospectiva. Pacientes y Método: Se incluyeron individuos con AIN-AG en conducto anal y/o región perianal diagnosticadas en el Consultorio de Detección Temprana de Displasia Anal del Hospital Juan A. Fernández mediante biopsia dirigida por AAR y tratadas con CIR con el aparato Redfield®, entre marzo 2013-agosto 2014 previo consentimiento informado escrito. Tras infiltración con anestesia local las lesiones fueron coaguladas con repetidos pulsos de 1,5 segundos hasta visualizar los vasos de la submucosa. Se controló entre los 3 y 6 meses con AAR y biopsia de lesiones sospechosas. Resultados: Fueron 14 pacientes (10 hombres que tienen sexo con hombres, todos VIH-positivos y 4 mujeres, 2 VIH-positivas). Edad mediana: 37,5 (rango 20-59) años. La AIN-AG se localizaba en el conducto anal en 11 pacientes y en la región perianal en 3. En la AAR diagnóstica todos presentaban sólo un área de AIN-AG. El procedimiento fue bien tolerado. Una paciente VIH-positiva presentó secreción purulenta a los tres días de la ablación, que se trató con antibióticos. Esta paciente y otro más tuvieron dolor post-procedimiento manejado con anti-inflamatorios no esteroides. En la AAR de control se hallaron 2 (14,3%) recurrencias, una interpretada como persistencia por margen insuficiente de una lesión extendida y otra diagnosticada al momento de realizar CIR, que no había sido observada en la AAR realizada 1 mes antes. La eficacia por lesión individual tratada fue del 92,9%. Conclusiones: El tratamiento de las AIN-AG en el consultorio mediante CIR es bien tolerado, tiene mínimas complicaciones y resulta efectivo en el corto plazo. Es necesario un seguimiento más prolongado para evaluar la tasa de recidiva y la utilidad para prevenir la progresión al CAE. (AU)

Background: High-grade anal intraepithelial neoplasia (HGAIN) without treatment progresses to invasive squamous cell carcinoma (SCC) in 8-13% of cases, and that incidence decreases to 1,2% with ablation targeted with high resolution anoscopy (HRA). The ideal treatment for HGAIN is not established yet. Goldstone, in 2005 introduced the infrared coagulator (IRC) for the ablation of these lesions, and with great experience demonstrated that it is as effective as surgery but has less morbidity and the advantage of not requiring the operating room. To our knowledge there are not publications with this technique in our country. The aim of this study is to assess the results of HGAIN ablation with CIR, the method complications, and early recurrence. Design: Observational, retrospective study, with prospective database. Patients and Methods: Individuals with HGAIN in the anal canal or the perianal region, diagnosed with biopsy targeted with HRA and treated with the IRC in the Anal Dysplasia Clinic of the Hospital Juan A. Fernández, between March 2013 and August 2014, were included. After written informed consent, HRA was repeated in the outpatient clinic to localize the area to be treated with the IRC Redfield®. After local anesthesia the lesions were coagulated with repeated 1.5 seconds pulses until the submucosa vessels were visualized. Control with HRA and biopsy of suspicious lesions was performed between 3-6 months of the procedure. Results: Fourteen patients (10 men who have sex with men, all HIV-positive, and 4 women, 2 HIV-positive). Median age: 37.5 (range 20-59) years. The HGAIN was localized at the anal canal in 11 patients, and in the perianal region in 3. In the diagnostic HRA all patients presented only one area of HGAIN. The procedure was well tolerated. Only one HIV-positive woman presented purulent discharge 3 days after ablation, and was treated with antibiotics. The latter and another patient had post-procedure pain, managed with non-steroidal anti-inflammatory drugs. In the control HRA, 2 (14,3%) recurrences were found, 1 was interpreted as persistency due to insufficient margin of a extended lesion, and 1 diagnosed during the CIR of other lesion, that had went unaware at the initial HRA performed one month before. The efficacy for individual lesion treated was 92.9%. Conclusions: The treatment of HGAIN with IRC in the outpatient department is well tolerated, has minimal complications, and is effective in the short term. It is necessary a longer surveillance to assess the recurrence rate and the usefulness for preventing progression to SCC. (AU)

Disección endoscópica submucosa en el tratamiento del cáncer precoz de esófago / Submucosal endoscopic dissection in the treatment of early esophageal cancer

Reportamos el caso de un paciente masculino, 80 años, con historia de dispepsia y sin antecedente familiar de neoplasias. En la endoscopia digestiva alta, en tercio distal, se observó una lesión deprimida plana con aspecto de carcinoma precoz IIC que fue diagnosticada por biopsia como carcinoma escamoso in situ e infiltrante, no queratinizante moderadamente diferenciado grado II. Fue sometido a disección endoscópica submucosa, sin complicaciones. La histopatología concluyo: carcinoma de células escamosas, predominantemente in situ de esófago distal, midiendo 0,6 cm, con foco de 0,1 cm de infiltración en la lámina propia; ausencia de invasión neoplásica angiolinfática o perineural con márgenes de resección quirúrgica libre de neoplasia. Estadio pT1a. Tres meses después, en la endoscopia de control con toma de biopsias de la zona, no hubo evidencia de carcinoma. Presentamos el caso debido a que sigue siendo todo un reto establecer el diagnóstico de cáncer de esófago en etapa temprana, sobre todo en pacientes poco sintomáticos, resaltando la importancia de la cromoendoscopia y de una buena exploración endoscópica para llegar al diagnóstico. La disección endoscopia submucosa podría considerarse como un tratamiento alternativo seguro y eficaz a la cirugía radical.

We report the case of a male patient, 80 years old, with a history of dyspepsia and no family history of neoplasias. In the upper digestive endoscopy in the distal esophagus, a flat depressed lesion with the appearance of early carcinoma, type IIC of Paris classification, was diagnosed by biopsy as a squamous carcinoma in situ, infiltrating, moderately differentiated non-keratinizing grade II carcinoma. He underwent submucosal endoscopic dissection without complications. Histopathology concluded: carcinoma of squamous cells, predominantly in situ of distal esophagus, measuring 0.6 cm, with focus of 0.1 cm of infiltration in the own lamina; absence of angiolymphatic or perineural invasion. The histopathology specimen had margins of surgical resection free of neoplasia. Stage pT1a. Three months later, in the endoscopy control with biopsy of the area, there was no evidence of carcinoma. We present the case because it is still a challenge to establish the diagnosis of esophageal cancer at an early stage, especially in patients without symptoms, highlighting the importance of chromoendoscopy and a good endoscopic examination to reach the diagnosis. Submucosal endoscopy dissection could be considered as a safe and effective alternative treatment to radical surgery.

Populosis bowenoide en pene. Dos casos con buena respuesta a crioterapia / Bowenoid populosis in penis. Two cases with good response to cryotherapy

La papulosis bowenoide es un carcinoma espinocelular in situ de bajo grado que se observa mayormente en genitales. El agente etiológico es el virus del papiloma humano. Existen múltiples opciones terapéuticas médicas y quirúrgicas pero debería ser tratado de forma conservadora. Presentamos dos casos de papulosis bowenoide tratados exitosamente con crioterapia (AU)

Bowenoid papulosis is a low grade squamous cell in situ carcinoma. It is usually seen in genitals. Etiologic agent is the human papilloma virus. There are many treatments available but it should be treated conservatively. Two cases of bowenoid papulosis with good response to cryotherapy are reported (AU)

Diagnóstico clínico e histopatológico del carcinoma in situ en la mucosa bucal / Clinical, histological and pathological diagnosis of carcinoma in situ of the oral mucous

Se realizó un estudio descriptivo y transversal de 25 pacientes, adictos al tabaco, con carcinoma in situ en la mucosa bucal, atendidos en la consulta estomatológica del Policlínico de Especialidades perteneciente al Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde abril del 2008 hasta igual periodo del 2013, a fin de evaluar los resultados del diagnóstico clínico e histopatológico de esta neoplasia. Mediante la técnica clásica de inclusión en parafina se confirmó la existencia de cambios celulares. En la casuística prevalecieron el sexo masculino y la ausencia de síntomas subjetivos en la forma leucoplásica. El sitio anatómico más susceptible correspondió al borde lateral de la lengua. Entre las alteraciones hísticas más comunes figuraron: hipercromatismo nuclear, membrana basal intacta, pérdida de la polaridad, así como pleomorfismo nuclear y celular...

A descriptive and cross-sectional study of 25 patients, with tobacco addition and carcinoma in situ of the oral mucous, assisted in the stomatological department of the Specialties Polyclinic belonging to "Saturnino Lora Torres" Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba was carried out from April, 2008 to same period of the 2013, in order to evaluate the results of the clinical, histological and pathological diagnosis of this neoplasia. By means of the classic technique of inclusion in paraffin the existence of cellular changes was confirmed. The male sex and the absence of subjective symptoms prevailed in the leucoplasic form in the case material. The most susceptible anatomical site corresponded to the lateral border of the tongue. Among the most common tissue alterations there were: nuclear hyperchromatism, intact basal membrane, loss of the polarity, as well as nuclear and cellular pleomorphism...

The incidence and histological characteristics of intratubular germ cell neoplasia in postpubertal cryptorchid testis

PURPOSE: It is well known that testicular germ cell tumors arise with increased frequency in patients with cryptorchidism. In addition, intratubular germ cell neoplasia (ITGCN) is a precursor lesion to testicular germ cell tumor. Approximately 50% of patients with ITGCN will develop an invasive of testicular germ cell tumors within 5 years. Therefore, we evaluated that the incidence of ITGCN in postpubertal cryptorchidism. MATERIALS AND METHODS: Between January 2002 and August 2012, orchiectomy specimens from 31 postpubertalpatients (aged 12 or over) with cryptorchid testis were reviewed. The specimens were evaluated for ITGCN using immunohistochemical stains of placental-like alkaline phosphatase and Oct 3/4 with routine hematoxylin-eosin stain. Additionally, the degree of spermatogenesis was assessed using the Johnsen score. RESULTS: Mean age was 34 years (range, 17 to 74 years) at surgery. All patients were diagnosed as unilateral cryptorchidism. One patient (3.2%) of 20-year-old had ITGCN in surgical specimen with all positive markers. Histological assessment of spermatogenesis showed that mean Johnsen score was 3.42 (range, 1 to 9). Majority of patients (27 of 31) presented impaired spermatogenesis with low Johnsen score lesser than 5. CONCLUSIONS: Considering the risk of malignancy and low spermatogenesis, we should perform immunohistochemical stains and discuss preventative orchiectomy for the postpubertal cryptorchidism.

Carcinoma in situ ex adenoma pleomorfo en glándula parótida, descripción de un caso inusual / Carcinoma ex pleomorphic adenoma

Objective: To report a case of carcinoma ex pleomorphic adenoma on a young patient. Introduction: Carcinoma ex pleomorphic adenoma typically presents in patients in the sixth decade of life, with a history of parotid tumor of long standing. Alarm symptoms are present in 50 percent of cases and survival is mainly correlated with the degree of differentiation and tumor invasion. Case report: A 33 years old woman with right parotid tumor of five years of evolution with slow growing and no symptoms. During the last year, present accelerated growth and stabbing pain. Total parotidectomy was performed without complications or sequelae. The biopsy confirms carcinoma ex pleomorphic adenoma. Discussion: The long-standing pleomorphic adenoma may present malignant transformation in up to 12 percent. We discuss risk factors, clinical presentation and diagnosis of carcinoma ex pleomorphic adenoma.

Objetivo: Presentar un caso clínico de carcinoma ex adenoma pleomorfo en una paciente joven. Introducción: El carcinoma ex adenoma pleomorfo se presenta típicamente en pacientes en la sexta década de la vida, con historia de tumor de parótida de larga data. Tiene síntomas de alarma en el 50 por ciento de los casos y la sobrevida se correlaciona principalmente con el grado de diferenciación y de invasión del tumor. Caso clínico: Paciente de 33 años con tumor de parótida derecho de 5 años de evolución, de lento crecimiento y asintomático. Que durante el último año de evolución presenta dolor punzante y crecimiento acelerado. Se realiza parotidectomía total sin complicaciones ni secuelas. La biopsia confirma un carcinoma ex adenoma pleomorfo. Discusión: El adenoma pleomorfo de larga data puede presentar malignización en hasta un 12 por ciento. Se discute los factores de riesgo, forma de presentación y diagnóstico del carcinoma ex adenoma pleomorfo.

Caracterización epidemiológica de la neoplasia intraepitelial de la conjuntiva en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" / Epidemiological characterization of conjunctival intraepithelial neoplasia in "Ramón Pando Ferrer" Cuban Institute of Ophtalmology

OBJETIVO: identificar el patrón epidemiológico de la neoplasia intraepitelial de la conjuntiva en el Instituto Cubano de Oftalmología «Ramón Pando Ferrer¼ (2005-2010). MÉTODOS: se realizó un estudio descriptivo en 106 pacientes con neoplasia intraepitelial unilateral según edad, sexo, enfermedad ocular asociada y años de diagnóstico. Se calcularon porcentajes, tasa de incidencia y prevalencia proporcional y se estimó la tendencia por método gráfico. RESULTADOS: el 59,4 % perteneció al sexo femenino (n = 63); el 53,8 % (n = 57) se encontró en edades entre 30 y 39 años, seguido por ³ 60 años con 33 % (n = 35); el 18,9 % (n = 20) presentó enfermedad ocular asociada, donde el 60 % (n = 12) correspondió al pterigium. Hubo entre 34 % (n = 36), 31, 1 % (n = 33) y 30,2 % (n = 32) con NIC I, NIC II y NIC III respectivamente, y el 4,7 % (n = 5) con carcinoma in situ. La incidencia en el 2009 alcanzó 3,1 % (n = 34) y 85,8 % de prevalencia (n = 91), con tendencia lineal al incremento. CONCLUSIONES: se manifiesta tendencia al incremento de la enfermedad; por eso merece atención el estudio de los factores de riesgo como enfoque preventivo para reducir este comportamiento, si se parte del aumento de la expectativa de vida de la población cubana con tendencia al envejecimiento, pues la neoplasia intraepitelial de la conjuntiva es característica de personas en edad avanzada.

OBJECTIVE: to identify the epidemiological pattern of intraepithelial neoplasia of the conjunctiva in the «Ramón Pando Ferrer¼ Cuban Ophthalmology Institute (2005-2010). METHODS: a descriptive study was conducted in 106 patients with unilateral intraepithelial neoplasia by age, sex, associated eye disease and number of years since diagnosis. Percentages, incidence and proportional prevalence rates, and tendency by the graphic method were all estimated. RESULTS: in the study group, 59,4 % (n = 63) were females 53,8 % (n = 57) were 30-39 years old, followed by 33 % of ³ 60 years-olds (n = 35), 18,9 % (n = 20) had associated eye disease with 60 % (n = 12) affected by pterygium. There was 34 % (n = 36), 31,1 % (n = 33) and 30,2 % (n = 32) with CINI, CIN II and CIN III, respectively, and 4,7 % (n = 5) with in situ carcinoma. The incidence rate in 2009 was 3,1 % (n = 34) and 85,8 % prevalence rate (n = 91), with linear tendency to increase. CONCLUSIONS: this study showed increasing tendency of the disease, so it must be paid attention to the preventive approach-oriented study of the risk factors to reduce this tendency, taking into account the rise of the life expectancy of the Cuban population and their aging tendencies and the fact that the conjunctival intraepithelial neoplasia is characteristic of the elderly people.

Alteración en la circulación de líquido cefalorraquídeo relacionada a neoplasia de alto grado (xantoastrocitoma) / Altered cerebrospinal fluid circulation related high-grade neoplasia (xanthoastrocytoma)

Introducción: La alteración en la circulación de líquido cefalorraquídeo es conocida como fístulas de líquido cefalorraquí- deo (LCR). En el Instituto Nacional de Neurología y Neurocirugía se presentó un incremento notable en 2011, reportándose 18 casos; para 2012 se incrementaron a 42 casos en el Servicio de Neurocirugía, de los cuales 22 son hombres y 20 mujeres. Esta complicación sucede como inconveniente de procesos neuroquirúrgicos hipofisiarios, de fosa posterior o de etiología múltipleξ ; se manifiesta en el paciente con la presencia de salida de líquido cefalorraquídeo por nariz (rinolicuorrea), oído (otolicuorrea) y en la herida quirúrgica; los pacientes refieren síntomas como: cefalea, vértigo, mareo, náuseas y fiebre; al ver esto, acuden a urgencias. Objetivo: Describir el estudio de caso de un paciente con neoplasia de alto grado (xantoastrocitoma) con presencia de fístula de líquido cefalorraquídeo más neuroinfección. Metodología: Para la descripción sistemática se recurrió al proceso enfermero en sus diferentes etapas. Procedimiento: Para la valoración se recurrió a la historia clínica y exploración neurológica; el cuadro clínico fue de gran apoyo para la realización de diagnósticos de enfermería utilizando el formato: problema, etiología y signos y síntomas (PES); se presentó un plan de cuidados en el que se ejecutan las intervenciones y se evalúan de acuerdo con las necesidades del enfermo. Éste presenta complicaciones por neuroinfección más fístula de líquido cefalorraquídeo (FLC). Conclusiones: El conocimiento en el tratamiento de las fístulas de líquido cefalorraquídeo facilita la recuperación y evita complicaciones; aunque hay casos en que, a pesar de implementar las medidas para el tratamiento, el proceso es devastador.

Introduction: The altered cerebrospinal fluid circulation related known as cerebrospinal fluid fistulas (CSF) in the National Institute of Neurology and Neurosurgery presented a significant increase in 2011 reported 18 cases; in 2012, 42 cases in the neurosurgical service, of which 22 are men and 20 women. This complication occurs after neurosurgery complicating pituitary, posterior fossa or multiple etiologies; the patient manifests the presence of cerebrospinal fluid output by nose (rhinoliquorrhea) and heard (otolicuorrea), patients report symptoms like headache, dizziness, lightheadedness, nausea and fever, to see this come to the emergency. Target: Describe a case study in a patient with high-grade neoplasia (xanthoastrocytoma) neurosecondary infection presence of cerebrospinal fluid fistula. Methodology: For the case study nursing process is used at different stages. Procedure: The evaluation was based on the clinical history, the neurological examination and the clinical manifestations were conducted formatted nursing diagnosis: problem, etiology and signs and symptoms (PES) presents a care plan in which interventions are implemented and evaluated according to the needs of the patient presented further complications neuro FLC infection. Conclusions: Knowledge in the treatment of fistulae, facilitating recovery and avoids complications that although cases despite the measures to implement the process treatment is devastating.

Frequência de alterações citológicas anais em pacientes com citologia cervical normal / Frequency of anal cytological abnormalities in patients with normal cervical cytology

Contexto e objetivo: O câncer anal corresponde a 4% de todas as neoplasias malignas do trato digestivo baixo.A incidência deste tipo de câncer e de suas respectivas lesões precursoras aumentou nos Estados Unidos, Europa eBrasil. A lesão intraepitelial escamosa anal de alto grau (LIEAG anal) é considerada provável precursora do tumor analinvasivo. Há alguma evidência de ligação entre o câncer anal e o câncer genital. O objetivo do presente estudo foiestimar a prevalência de alterações citológicas da mucosa anal em mulheres com citologia cervical positiva.Tipo de estudo e local: Corte transversal, realizado no Instituto de Infectologia Emílio Ribas.Métodos: Foram colhidas amostras para citologia cervical e anal de 104 mulheres (todas com lesões intraepiteliaisde baixo ou alto graus). Em um período de até um mês do resultado da primeira coleta citológica, foi realizada novacoleta cervical e duas amostras de esfregaço do canal anal. Todas as amostras foram obtidas com escova de coletacitológica cytobrush. As pacientes foram questionadas quanto à prática de intercurso anal. Os esfregaços citológicosforam classificados segundo a classificação de Bethesda 2001.Resultados: Das 104 pacientes com citologia cervical anormal, 51 (49%) apresentaram LIEAG cervical, 48 (46,2%)LIEBG cervical, 5 (4,8%) atipia escamosa de significado indeterminado (ASC-US) cervical. Destas 104 pacientes, 75(72%) também apresentaram citologia anal anormal e 29 (28%) esfregaços anais normais ou inflamatórios. Não houvediferença estatística entre os grupos com HSIL e LSIL cervicais, no que tange à propensão a apresentar citologia analanormal (P > 0,05). Não houve diferença estatística significante entre os grupos quanto à propensão da presença dealterações citológicas anormais anais nas pacientes que praticavam intercurso anal (P > 0,05).Discussão: Nossos resultados sugerem que a transmissão do vírus HPV da mucosa anal para cervical ou vice-versa sejadecorrente de questões anatômicas, como proximidade do orifício anal e hábitos de higiene pessoal, e não de relaçõessexuais anais.Conclusão: Houve prevalência de 72% de citologia anal anormal nas pacientes com citologia cervical positiva, porém,é necessária realização de mais estudos para se estabelecer se a mucosa anal é realmente um reservatório para oHPV, o que por si só já é epidemiologicamente importante para futuros programas de erradicação de lesões cervicaisrelacionadas ao HPV.

Neoplasia vaginal intraepitelial / Vaginal intraepithelial neoplasia

Objetivo: actualizar los conocimientos disponibles sobre la neoplasia vaginal intraepitelial (VAIN) especialmente en el diagnóstico y tratamiento. Métodos: revisión de la literatura en Pubmed de los últimos 20 años, especialmente de los publicados desde 2005 hasta la actualidad y considerando sobre todo los ensayos clínicos aleatorizados. Resultados: su prevalencia real es desconocida, aunque es una patología rara generalmente en mujeres posmenopaúsicas. Su fisiopatología es similar a la neoplasia cervical intraepitelial, con el HPV como principal factor de riesgo, sobre todo el serotipo 16, pero su progresión a cáncer es menor. Un grupo importante es el de VAIN tras histerectomía, que supone el 48-70 por ciento del total de las VAIN. La colposcopia para el diagnóstico no es sencilla y se aconseja preparación con estrógenos en las pacientes menopáusicas y utilización de ácido acético y lugol para identificar las zonas sospechosas. Las tres opciones terapéuticas son la cirugía (excisional, láser, ultrasonidos), braquiterapia y tratamiento médico (imiquimod, 5-fluorouracilo, ácido tricloroacético). Se expone la técnica y las ventajas e inconvenientes de cada uno de ellos. Conclusión: aunque la VAIN es una entidad rara, es preciso tenerla en cuenta ante un diagnóstico de lesión citológica. Su diagnóstico a veces no es sencillo y el tratamiento dependerá del grado, la localización y el tamaño de la lesión y las circunstancias personales de la paciente. Se necesitan más ensayos aleatorizados que comparen la eficacia entre las distintas opciones terapéuticas y su repercusión en la calidad de vida de las pacientes.

Aims: update the knowledge about vaginal intraepithelial neoplasia (VAIN) with special emphasis on diagnosis and therapeutic management. Method: electronic search of Pubmed of all kinds of articles about the VAIN, for the last 20 years with special attention to those published from 2005 to the present and considering especially randomized clinical trials. Results: its prevalence is unknown, although it is a rare condition that usually occurs in postmenopausal women. The physiopathology is similar to cervical intraepithelial neoplasia, being HPV the main risk factor, particularly serotype 16, but its progression to cancer is lower. An important group is VAIN after hysterectomy, 48-70 percent of total VaIN. Colposcopy for the diagnosis is not easy and in patients with postmenopausal the preparation with local estrogen is necessary and use both of acetic acid and lugol to identify suspicious areas. The three treatment options are surgery (excisional, laser, ultrasound), brachytherapy and medical management (imiquimod, 5-fluorouracil, tricholoroacetic acid). The technique and the advantages and disadvantages of each are explained. Conclusion: although VAIN is rare, it must take it into account before a cytological diagnosis of dysplasia. Its diagnosis is sometimes not easy and the treatment depends on the extent, location and size of the lesion and the individual preferences of the patient. We need more randomized trials comparing different treatment options and also their impact on quality of life of patients.

Splenogonadal fusion and testicular cancer: case report and review of the literature / Fusão esplenogonadal e câncer testicular: relato de caso e revisão da literatura

A 36 year-old man after tests for assessing male infertility was diagnosed with primary infertility, bilateral cryptorchidism, nonobstructive azoospermia and discontinuous splenogonadal fusion. Carcinoma in situ was found in his left testicle, which was intraabdominal and associated with splenogonadal fusion. To our knowledge, this is the fourth case of splenogonadal fusion associated with testicular cancer reported. One should always bear in mind the possibility of this association for the left cryptorchid testicle.

Um homem de 36 anos, depois de ser submetido a exames para avaliação de infertilidade masculina, foi diagnosticado com infertilidade masculina primária, criptorquidia bilateral, azoospermia não obstrutiva e fusão esplenogonadal descontínua. Carcinoma in situ estava presente no testículo esquerdo, que tinha localização intra-abdominal e estava associado à fusão esplenogonadal. Esse é o quarto caso de fusão esplenogonadal associada a câncer testicular, segundo nossa avaliação. Deve-se sempre ter em mente a possibilidade dessa associação em testículos criptorquídicos à esquerda.

Tratamiento quirúrgico de las lesiones anales intra-epiteliales (AIN) de alto grado / Surgical treatment of high grade intraepitelial anal lesions (AIN)

Introducción: La incidencia del Cáncer de ano se encuentra en aumento tanto en pacientes HIV positivos o inmunosuprimidos como en los inmunocompetentes. Éste se asocia a la infección por HPV, con un comportamiento similar al del desarrollo del cáncer de cuello uterino, a través de la producción de lesiones intra-epiteliales escamosas (SIL). Para su diagnóstico se utiliza la anoscopía de alta resolución. Su tratamiento es aún controversial. Objetivo: Presentamos nuestra experiencia en el tratamiento quirúrgico de lesiones intra-epiteliales anales de alto grado (AIN III) guiadas con anoscopía de alta resolución. Lugar de aplicación o marco de referencia: Hospital Universitario. Diseño: Estudio retrospectivo. Material y métodos: Realizamos una revisión de los pacientes diagnosticados y operados (escisión/cauterización de las lesiones visualizadas con anoscopia de alta resolución) con diagnóstico de lesiones anales intra-epiteliales de alto grado (AIN III) en el marco del Programa de Prevención, Diagnóstico, Terapéutica y Vacunación en Patología del Tracto Genital Inferior del Hospital de Clínicas de Buenos Aires "José de San Martín". Resultados: A las pacientes con antecedentes de infección por HPV en el tracto genital inferior, se las evaluó con anoscopía magnificada. Entre enero de 2005 y agosto de 2010, se estudiaron 305 pacientes (32 inmunosuprimidas). De éstas, 18 (5.9%) presentaron lesiones intra-epiteliales de alto grado (AIN III) confirmadas por histología. Las mismas fueron remitidas para tratamiento quirúrgico. Tres eran inmunosuprimidas, dos por HIV. La edad media fue de 34 años (19-63 años). El seguimiento medio fue de 15 meses, 4 a 39 meses. Se produjo una recurrencia a los 4 meses. Ningún paciente desarrolló incontinencia, estenosis, infección postoperatoria, o hemorragia significativa después del tratamiento quirúrgico... (TRUNCADO)

Introduction: Over the last decades, anal cancer incidence rose to an epidemic range in general population and in some risk groups like inmuno-supressed or HIV patients. Anal cancer develops from squamous intraepithelial lesion (SIL) in the anal transitional zone produced by HPV infection. High resolution anoscopy is used to diagnose these dysplastic changes. There is no consensus about the best treatment option for high grade anal intraepithelial neoplasia (AIN III). Objective: To report our experience in the treatment of high grade anal intraepithelial neoplasia targeted by high resolution anoscopy. Design: Retrospective study. Material and method: Patients diagnose and treated for AIN III in the "Prevention, Diagnosis, Treatment and Vaccination of the Inferior Genital Tract" Program of the Hospital de Clínicas de Buenos Aires "José de San Martín". Results: Patients with history of HPV disease in the genital tract were studied with high resolution anoscopy. 305 patients (32 inmunosupressed) were studied between January of 2005 and August of 2010. 18 (5.9%) had AIN III and were surgically treated. Mean age was 34 years (19-63). Mean follow-up was 15 months (4 to 39). We observed one recurrenee at 4 month. No complications were present. Conclusions: High resolution anoscopy targeted surgery AIN III is feasible and seams to eradicate these lesions in the inmunocompetent patient.

Xanthogranulomatous Pancreatitis Combined with Intraductal Papillary Mucinous Carcinoma In Situ

Xanthogranulomatous lesion is a rare condition in which lipid-laden histiocytes are deposited at various locations in the body. Xanthogranulomatous pancreatitis (XGP) associated with an intraductal papillary mucinous tumor (IPMT) is extremely rare. In this study, we described a case of XGP associated with IPMT and include a review of the literature. A pancreatic cystic mass was detected in a 72-yr-old woman by abdominal computed tomography. Pylorus-preserving pancreaticoduodenectomy was performed and diagnosis of XGP combined with intraductal papillary mucinous carcinoma in situ was made. After 13 months of follow-up, the patient is in good health without any evidence of tumor recurrence. Although XGP associated with IPMT is rare, we suggest that such cases should be brought to the attention of clinical investigators, as it may produce clinical features that mimic pancreatic cancer.