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.

Incidence of external genital lesions related to human papillomavirus among Mexican men. A cohort study / Incidencia de lesiones genitales externas relacionadas con el virus del papiloma humano entre hombres mexicanos. Un estudio de cohorte

Abstract: Objective: To determine external genital lesion (EGL) incidence -condyloma and penile intraepithelial neoplasia (PeIN)- and genital HPV-genotype progression to these EGLs. Materials and methods: Participants (healthy males 18-74y from Cuernavaca, Mexico, recruited 2005-2009, n=954) underwent a questionnaire, anogenital examination, and sample collection every six months; including excision biopsy on suspicious EGL with histological confirmation. Linear array assay PCR characterized 37 high/low-risk HPV-DNA types. EGL incidence and cumulative incidence were calculated, the latter with Kaplan-Meier. Results: EGL incidence was 1.84 (95%CI=1.42-2.39) per 100-person-years (py); 2.9% (95%CI=1.9-4.2) 12-month cumulative EGL. Highest EGL incidence was found in men 18-30 years: 1.99 (95%CI=1.22-3.25) per 100py. Seven subjects had PeIN I-III (four with HPV16). HPV11 most commonly progresses to condyloma (6-month cumulative incidence=44.4%, 95%CI=14.3-137.8). Subjects with high-risk sexual behavior had higher EGL incidence. Conclusion: In Mexico, anogenital HPV infection in men is high and can cause condyloma. Estimation of EGL magnitude and associated healthcare costs is necessary to assess the need for male anti-HPV vaccination.

Resumen: Objetivo: Determinar incidencia de lesiones genitales externas (LGE) -condiloma y neoplasia intraepitelial del pene (NIP)- y progresión de genotipos de VPH a LGE. Material y métodos: Se aplicaron cuestionarios, examen anogenital y recolección de muestras cada seis meses a hombres sanos (18-74 años, de Cuernavaca, México, reclutados 2005-2009, n=954) con biopsia y confirmación histológica. Se caracterizaron 37 tipos de ADN-VPH; se calculó incidencia de LGE (cumulativa con Kaplan-Meier). Resultados: Incidencia de LGE=1.84 (IC95%=1.42-2.39) por 100-persona-años (pa); 2.9% (IC95%=1.9-4.2) LGE acumulativa a 12 meses. Mayor incidencia de LGE entre hombres 18-30 años; 1.99 (IC95%=1.22-3.25) por 100pa. Siete sujetos tuvieron NIP I-III. VPH-11 más comúnmente progresa a condiloma (incidencia acumulativa a seis meses=44.4%, IC95%=14.3-137.8). Los sujetos con comportamiento sexual de alto riesgo tuvieron mayor incidencia de LGE. Conclusiones: En México la infección anogenital con VPH es alta y puede causar condiloma. La estimación de magnitud de LGE y los costos sanitarios asociados se necesita para evaluar la necesidad de vacunación contra VPH en hombres.

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)

Frecuencia de displasia epitelial y carcinoma escamoso en mucosa oral y orofaríngea en Chile, entre los años 1990 y 2009 / Frequency of oral squamous cell carcinoma and oral epithelial dysplasia in oral and oropharyngeal mucosa in Chile

Background: Oral cancer in Chile corresponds approximately to 1.6% of all cancer cases. There are few studies about oral epithelial dysplasia and oral squamous cell carcinoma in the Chilean population. Aim: To determine the frequency of hyperkeratosis, mild, moderate and severe oral epithelial dysplasia, in situ carcinoma and squamous cell carcinoma of the oral and oropharyngeal mucosa in a registry of the Oral Pathology Reference Institute of the Faculty of Dentistry, Universidad de Chile, in a ten years period. Material and Methods: Review of clinical records and pathological plates of 389 patients, obtained between 1990 and 2009. Cases were selected according to their pathological diagnosis, including hyperkeratosis, oral epithelial dysplasia, in situ carcinoma, squamous cell carcinoma and verrucous carcinoma. Results: Forty four percent of cases were squamous cell carcinoma, followed by hyperkeratosis in 37% and mild epithelial dysplasia in 11%. Squamous cell carcinoma was more common in men aged over 50 years. Most of the potentially malignant disorders presented clinically as leukoplakia and squamous cell carcinoma were clinically recognized as cancer. Conclusions: In this study, men aged over 50 years are the highest risk group for oral cancer. Early diagnosis is deficient since most of these lesions were diagnosed when squamous cell carcinoma became invasive. Leukoplakia diagnosis is mostly associated with hyperkeratosis and epithelial dysplasia, therefore biopsy of these lesions is mandatory to improve early diagnosis.

Incidence and clinical characteristics of lower urinary tract symptoms as a presenting symptom for patients with newly diagnosed bladder cancer

PurposeThe incidence of lower urinary tract symptoms (LUTS) as the sole presenting symptom for bladder cancer has traditionally been reported to be low. The objective of this study was to evaluate the prevalence and clinical characteristics of newly diagnosed bladder cancer patients who presented with LUTS in the absence of gross or microscopic hematuria.Materials and MethodsWe queried our database of bladder cancer patients at the Atlanta Veteran’s Affairs Medical Center (AVAMC) to identify patients who presented solely with LUTS and were subsequently diagnosed with bladder cancer. Demographic, clinical, and pathologic variables were examined.Results4.1% (14/340) of bladder cancer patients in our series presented solely with LUTS. Mean age and Charlson Co-morbidity Index of these patients was 66.4 years (range = 52-83) and 3 (range = 0-7), respectively. Of the 14 patients in our cohort presenting with LUTS, 9 (64.3%), 4 (28.6%), and 1 (7.1%) patients presented with clinical stage Ta, carcinoma in Situ (CIS), and T2 disease. At a median follow-up of 3.79 years, recurrence occurred in 7 (50.0%) patients with progression occurring in 1 (7.1%) patient. 11 (78.6%) patients were alive and currently disease free, and 3 (21.4%) patients had died, with only one (7.1%) death attributable to bladder cancer.ConclusionsOur database shows a 4.1% incidence of LUTS as the sole presenting symptom in patients with newly diagnosed bladder cancer. This study suggests that urologists should have a low threshold for evaluating patients with unexplained LUTS for underlying bladder cancer.

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.

Prevalence of human papillomavirus and Epstein-Barr virus DNA in penile cancer cases from Brazil

Penile cancer is a potentially mutilating disease. Although its occurrence is relatively rare worldwide, penile cancer rates can be high in developing countries. A few studies have been conducted on the involvement of human papillomavirus (HPV) in penile carcinoma, which have found HPV present in 30-70 percent of penile malignant lesions, with a higher prevalence of HPV 16 and 18. It has been assumed that cofactors, such as Epstein-Barr virus (EBV) infections, may play a role in the progression of penile neoplasia. The aim of this study was to determine HPV and EBV prevalence in 135 penile malignant lesions from Brazilian men through the use of MY09/11 polymerase chain reaction (PCR), type-specific PCR and restriction fragment length polymorphism analysis. HPV prevalence among the men tested was 60.7 percent. Of the men who tested positive, 27 presented with HPV 16 (29.7 percent), five with HPV 18 (5.5 percent), 21 with HPV 45 (23.1 percent) and nine with HPV 6 (9.9 percent). Seven mixed infections were detected (9.2 percent), while 11 cases remained untyped (13.4 percent). Regarding EBV positivity, 46.7 percent of the samples contained EBV DNA with EBV-1 as the most prevalent type (74.6 percent). More than 23 percent of the men were co-infected with both HPV and EBV, while 35 percent presented exclusively with HPV DNA and 20 percent presented only with EBV DNA. Penile carcinoma aetiology has not been fully elucidated and the role of HPV and EBV infections individually or synergistically is still controversial. Hence, more studies are needed to determine their possible role in carcinogenesis.

Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in Brazil / Lesões precursoras do câncer anal em pacientes HIV-positivos e HIV-negativos atendidos numa instituição de saúde terciária no Brasil

Purpose: To investigate the prevalence of anal squamous intraepithelial lesions (ASIL) or anal cancer in patients attended at the Tropical Medicine Foundation of Amazonas. Methods: 344 patients consecutively attended at the institution, in 2007/2008, were distributed in the following strata according to presence/abscense of at risk conditions for anal cancer: Group 1 _ HIV-positive men-who-have-sex-with-men (101); Group 2 _ HIV-positive females (49); Group 3 _ patients without any at risk condition for anal cancer (53); Group 4 _ HIV-positive heterosexual men (38); Group 5 _ HIV-negative patients, without anoreceptive sexual habits, but with other at risk conditions for anal cancer (45); Group 6 _ HIV-negative men-who-have-sex-with-men (26); and Group 7 _ HIV-negative anoreceptive females (32). The histopathological results of biopsies guided by high-resolution anoscopy were analyzed by frequentist and bayesian statistics in order to calculate the point-prevalence of ASIL/cancer and observe any eventual preponderance of one group over the other. Results: The point-prevalence of ASIL for all the patients studied was 93/344 (27 percent), the difference between HIV-positive and negative patients being statistically significant (38.3 percent versus 13.5 percent; p < 0.0001). The prevalence of ASIL for each one of the groups studied was: Group 1 = 49.5 percent, Group 2 = 28.6 percent, Group 3 = 3.8 percent, Group 4 = 21.1 percent, Group 5 = 11.1 percent, Group 6 = 30.8 percent and Group 7 = 18.8 percent. Standard residual analysis demonstrated that ASIL was significantly prevalent in patients of Group 1 and high-grade ASIL in patients of Group 2. The odds for ASIL of Group 1 was significantly higher in comparison to Groups 2, 3, 4, 5 and 7 (p < 0.03). The odds for ASIL of Groups 2, 4 and 6 were significantly higher in comparison to Group 3 (p < 0.03). Conclusions: In the patients studied, ASIL (low and/or high-grade) tended to be significantly more prevalent in HIV-positive patients. Nonetheless, HIV-negative anoreceptive patients also presented great probability to have anal cancer precursor lesions, mainly those of the male gender.

Objetivo: Investigar a prevalência de lesões intraepiteliais escamosas anais (ASIL) ou câncer anal em pacientes atendidos na Fundação de Medicina Tropical do Amazonas. Métodos: 344 pacientes consecutivamente atendidos na instituição, em 2007/2008, foram distribuídos nos seguintes estratos conforme a presença/ausência de fatores de risco para o câncer anal: Grupo 1 _ homens-que-fazem-sexo-com-homens HIV-positivos (101); Grupo 2 _ mulheres HIV-positivas (49); Grupo 3 _ pacientes sem condição de risco para o câncer anal (53); Grupo 4 _ homens heterossexuais HIV-positivos (38); Grupo 5 _ pacientes HIV-negativos, sem hábitos sexuais anorreceptivos, mas com outras condições de risco para o câncer anal (45); Grupo 6 _ homens-que-fazem-sexo-com-homens HIV-negativos (26); e Grupo 7 _ mulheres HIV-negativas, com hábitos sexuais anorreceptivos (32). Os resultados histopatológicos das biópsias anais dirigidas pela colposcopia anal foram analisados por meio de estatística frequentista e bayesiana para a determinação da prevalência-ponto de ASIL/câncer e verificar eventual preponderância estatística de um grupo sobre o outro. Resultados: A prevalência-ponto de ASIL para todos os pacientes estudados foi de 93/344 (27 por cento), sendo significativa a diferença entre HIV-positivos e negativos (38,3 por cento versus 13,5 por cento; p < 0,0001). A prevalência de ASIL para cada um dos grupos estudados foi: Grupo 1 = 49,5 por cento, Grupo 2 = 28,6 por cento, Grupo 3 = 3,8 por cento, Grupo 4 = 21,1 por cento, Grupo 5 = 11,1 por cento, Grupo 6 = 30,8 por cento e Grupo 7 = 18,8 por cento. A análise de resíduos demonstrou prevalência significante de ASIL para o Grupo 1 e de ASIL de alto-grau para o Grupo 2. A razão-de-chances do Grupo 1 para ASIL foi significantemente maior em comparação com os Grupos 2, 3, 4, 5 e 7 (p < 0,03). A razão-de-chances para ASIL dos Grupos 2, 4 e 6 foi significantemente maior em comparação com o Grupo 3 (p < 0.03). Conclusões: Nos pacientes estudados, ASIL (baixo e/ou alto-grau) foi significantemente mais prevalente em pacientes HIV-positivos. Entretanto, pacientes HIV-negativos anorreceptivos também apresentaram grande probabilidade de possuir as lesões, especialmente os do gênero masculino.

Infecção cervical por papilomavírus humano: genotipagem viral e fatores de risco para lesão intraepitelial de alto grau e câncer de colo do útero / Human papillomavirus cervical infection: viral genotyping and risk factors for high-grade squamous intraepithelial lesion and cervix cancer

OBJETIVO: analisar, em mulheres com HPV em colo do útero, as características da infecção viral e os fatores de risco para lesão intraepitelial de alto grau e carcinoma cervical. MÉTODOS: realizou-se um estudo caso-controle com mulheres com HPV em colo do útero atendidas em serviço de Ginecologia de referência vinculado ao SUS, em Recife, Nordeste do Brasil. No grupo de casos (72 mulheres com lesão intraepitelial de alto grau ou carcinoma cervical) e de controles (176 mulheres com colpocitologia normal ou com alterações benignas), foram pesquisados seis genótipos virais (HPV 16, 18, 31, 33, 6 e 11) em material da ecto- e endocérvice com primers MY09/MY11. As variáveis independentes foram hierarquizadas em três níveis de determinação: distal (sociodemográficas), intermediário (comportamentais) e proximal (realização anterior de colpocitologia). A homogeneidade das proporções foi testada (χ2). Obtiveram-se ORs não ajustadas e, na modelagem final, realizou-se regressão logística hierarquizada com o ajuste do efeito de cada variável sobre o desfecho pelas variáveis do mesmo nível e de níveis anteriores de causalidade. RESULTADOS: em 76,6 por cento das 248 mulheres participantes do estudo, o genótipo viral da infecção cervical foi identificado. Predominaram genótipos de alto risco oncogênico (83,4 por cento nos casos e 67,1 por cento nos controles), principalmente HPV 16 e 31. Foram identificados como fatores de risco (a) distais: residir em zona rural (OR=2,7; IC95 por cento: 1,1-6,2), menos de três anos de estudo (OR=3,9; IC95 por cento: 2,0-7,5) e renda familiar inferior a dois salários mínimos (OR=3,3; IC95 por cento: 1,0-10,5); (b) intermediário: número de gestações igual ou superior a quatro (OR=2,0; IC95 por cento: 1,0-3,7); (c) proximal: ausência de colpocitologia anterior (OR=9,7; IC95 por cento: 2,4-38,2). CONCLUSÕES: em mulheres usuárias do SUS do Nordeste do Brasil predominam os genótipos virais 16 e 31 em infecções cervicais ...

PURPOSE: to analyze the characteristics of viral infection and the risk factors for high-grade squamous intraepithelial lesion and cervical carcinoma in women with cervical HPV infection. METHODS: a case-control study was conducted on women with cervical HPV at a Gynecology reference service enrolled at the Public Health System, located in Recife, Northeastern Brazil. The groups of cases (72 women with high-grade squamous intraepithelial lesion or cervical cancer) and controls (176 women with normal Pap smear or benign alterations) were investigated for six viral genotypes (HPV 16, 18, 31, 33, 6, 11) in ecto- and endocervical material using MY09/MY11 primers. The independent variables were ranked in three levels of determination: distal (sociodemographic), intermediate (behavioral) and proximal (previous Pap smear). The homogeneity of proportions was tested (χ2), unadjusted Odds Ratios (OR) were obtained and hierarchical logistic regression was applied to the final model, with adjustment of the effect of each variable to the outcome based on the variables in the same and previous levels of causality. RESULTS: the viral genotype of cervical infection was identified in 76.6 percent of the 248 women participating in the study. High-risk HPV genotypes (83.4 percent of cases and 67.1 percent of controls) were predominant, especially HPV 16 and 31. The distal risk factors identified were: living in a rural area (OR=2.71, 95 percentCI: 1.18-6.23), less than three years of study (OR=3.97, 95 percentCI: 2.09-7.54) and family income below two minimum wages (OR=3.30, 95 percentCI: 1.04-10.51); intermediate: four or more pregnancies (OR=2.00, 95 percentCI: 1.06-3.76); and proximal: absence of a previous Pap smear (OR=9.74, 95 percentCI: 2.48-38.28). CONCLUSIONS: genotypes 16 and 31 of cervical HPV infection are predominant among women assisted by the Public Health System in Northeastern Brazil. Socioeconomic and reproductive factors, as well ...

Occurence of carcinoma in situ in association with invasive cancer of breast

The objectives of this study were to find out the frequency and the pattern of carcinoma in situ occurring in association with different types of breast cancers. This study was conducted in the Department of Clinical Oncology and the Department of Pathology, King Edward Medical University/ Mayo Hospital, Lahore on breast cancer patients diagnosed between 1[st] January 2001 and 31[st] December 2005. The age, menopausal status, histopathological type, grade, and presence or absence of carcinoma in situ were recorded. Histopathological features were recorded according to WHO system. Grade was recorded only when it was assigned according to the Elston-Ellis modification of Scarff-Bloom-Richardson grading system. A total of 1230 histopathologically documented invasive and non-invasive breast cancers patients were included in the study. DCIS alone was seen in seven patients [00.57%] and LCIS alone in two patients [00.16%]. Invasive ductal carcinoma was seen in 998 patients [81.14%] and invasive lobular carcinoma in 96 patients [07.80%]. Majority of breast cancers were grade II whereas grade I seen in 23.90% patients only. Areas of carcinoma in situ in different types of invasive cancers were seen in 328 [26.86%] patients. Majority of these patients were below 50 years of age. DCIS was present in 246 of 998 patients [24.65%] of invasive ductal carcinoma [NOS]. Comedo pattern was seen in 154 of 290 [53.10%] of DCIS. LCIS was present in 38 of 96 patients [39.58%] of invasive lobular carcinoma. Carcinoma in situ of breast is a turely diagnosed disease entity in our setting. It is seen mostly in association with invasive carcinoma of breast cancer. Ductal carcinoma in situ with comedo pattern is most frequent

Factors affecting residual lesion in women with cervical adenocarcinoma in situ after cone excisional biopsy.

The objective of this study was undertaken to evaluate the factors affecting residual lesion in women with adenocarcinoma in situ (AIS) on cervical conization specimens. The medical records of women with AIS who had no associated invasive carcinoma after cervical conization and underwent subsequent hysterectomy at Chiang Mai University Hospital were reviewed. During March 1998 and March 2006, 45 women were included for analysis. The mean age was 45.2 years (range, 30-66 years). Thirteen (28.9%) women presented with AIS on Pap smear. Thirty (66.7%) underwent loop electrosurgical excision procedure and the remaining 15 (33.3%) underwent cold-knife conization. Twenty (44.4%) women had mixed lesions of AIS and squamous intraepithelial lesion on cervical specimens. Surgical cone margins were clear in 25 (55.6%) women. Eighteen (40%) and two (4.4%) women had involved and non-evaluable cone margins, respectively. Residual lesion was noted in 14 (31.1%) hysterectomy specimens. There was no residual lesion in women with clear cone margins while 72% and 50% of women with involved and non-evaluable cone margins, had residual lesion, respectively. These differences were statistically significant (P<0.001). No significant association between the ECC results and the residual lesion was noted (P=0.29). In conclusion, approximately one-third of women with AIS on cervical conization have residual lesion on subsequent hysterectomy specimens. Only cone margin status is a significant predictor for residual lesion.

Northern Thai women with high grade squamous intraepithelial lesion on cervical cytology have high prevalence of underlying invasive carcinoma.

The aim of this study was to determine the underlying pathology of women with high grade squamous intraepithelial lesion (HSIL) on cervical cytology. A total of 681 women with HSIL cytology undergoing colposcopic examination at Chiang Mai University Hospital (CMUH) between January 2000 and December 2005 were evaluated for the underlying cervical pathology. The final pathology was diagnosed from the most severe lesions obtained by punch biopsy, loop electrosurgical procedure, cold knife conization or hysterectomy. Underlying high grade cervical lesions including cervical intraepithelial neoplasia grade 2, 3 and adenocarcinoma in situ were noted in 502 (73.7%) women. Invasive cervical carcinoma was identified in 141 (20.7%). The remaining 38 (5.6%) had either low grade or no intraepithelial lesions. No significant difference in the prevalence of underlying high grade and invasive lesions was noted between women with cytologic diagnosis of HSIL from CMUH and other hospitals. In conclusion, northern Thai women with HSIL cytology are at significant risk of having underlying severe cervical lesions, and especially invasive carcinoma which is detected in approximately one-fifth of the cases.

Evaluation of risk factors in CA CX at Government Medical College and Hospital, Aurangabad (Marathwada).

The Department of Radiotherapy & Oncology at Government Medical College, Aurangabad is a major cancer treatment centre of Marathwada region. The case records of 737 patients of carcinoma cervix registered from January 1996 to December 1997, have been reviewed and the various contributing etiological factors for the causation of cervical cancer relevant to this part of Maharashtra state, are analysed and an attempt has been made to identify high risk group.

Factores de riesgo para cáncer cervicouterino en mujeres de Zacatecas / Risk factors for cervical cancer in women from Zacatecas, Mexico

Objetivo. Conocer las características sociodemográficas reproductivas y de conducta sexual de las usuarias del Programa de Prevención y Control del Cáncer Cervicouterino e identificar los factores de riesgo para dicha patología. Material y métodos. Se hizo un estudio de casos y controles en usuarios del Programa de Prevención y Control del cáncer Cervicouterino en Zacatecas; los casos fueron todas aquellas pacientes con diagnóstico corroborado por histopatología de displasia severa, cáncer in situ e invasor (251 en total), referidas a la Clínica de displasias (dependiente del mismo programa), durante el bienio 1993-1995. Los controles se seleccionaron aleatoriamente de entre la población con citología exfoliativa negativa y que era usuaria de dicho programa. Se seleccionó un control por caso, y se le pareó por edad y por la fecha en que se realizó la citología del caso. Resultados. El riesgo de neoplasia cervical aumentó con el número de gestaciones (RM 5.2, IC95 por ciento 2.6-10.5) para aquellas mujeres con más de 12 gestaciones en relación con las que tenían menos de tres. Por otra parte, el riesgo de neoplasia cervical se incrementa en la medida en que aumentan los partos. Así las mujeres que tuvieron 12 o más partos corren un riesgo cinco veces superior que aquellas que dieron a luz menos de tres veces (RM 5.1, IC95 por ciento 2.4-11.0). El inicio de las relaciones sexuales en edad temprana está asociado al riesgo de neoplasia cervical; así, las mujeres que postergaron el inicio de sus relaciones sexuales hasta después de los 19 años tuvieron dos veces menos riesgo que quienes comenzaron antes de los 15 años. El uso de anticonceptivos hormonales aumentó el riesgo de cáncer cervical en relación con las mujeres que utilizaron anticonceptivos no hormonales (RM 1.9, IC 95 por ciento 1.3-3.4). Conclusiones. El estudio de factores de riesgo para neoplasia cervical en la población usuaria del programa de prevención y control mostró que las mujeres con alta paridad, con inicio precoz de relaciones sexuales y la que consumen anticonceptivos de tipo hormonal constituyen una subpoblación con mayor riesgo de padecer neoplasia cervical

Biological behaviour of moderate dysplasia--a prospective study.

The present communication reports the biological behaviour of women with moderate dysplastic lesions of uterine cervix based on a long term prospective study. Two hundred and thirty nine women with moderate dysplasia by cervical cytology who satisfied the criteria for registration were longitudinally followed up at 3 +/- 1 monthly intervals along with age and parity matched controls for a period ranging from 4 to 132 months. The cumulative rate of progression from moderate dysplasia to malignancy (CIS) was observed to be 23.0% at the end of 72 months of follow up with mean transition interval of 24.2 months. Out of 239 cases, 142 women who had more than 24 months of follow up were considered for studying the biological behaviour of the lesion. It was observed that during a follow up of 132 months, 14(9.9%) and 15(10.6%) women progressed to carcinoma in-situ and severe dysplasia respectively. The persistence of lesion was observed in 21(14.8%) women while 11(7.3%) and 81(57.0%) regressed to mild dysplasia and normalcy respectively.

Incidencia de carcinoma in situ de testiculo en nuestro medio / Testis in situ carcinoma incidence in our environment

El cáncer de testículo es una enfermedad importante debido a las características de la población afectada y a las elevadas posibilidades de curación con los recursos terapéuticos actuales. El carcinoma in situ (CIS) de testículo es un reconocido precursor del tumor invasivo. Investigamos la incidencia de cis en grupo de riesgo para esta condición en nuestra población; no hubo ningún caso de CIS en 20 gónadas estudiadas

Experience in screening for cervical cancer in rural areas of Barsi Tehsil (Maharashtra).

The organization of cancer detection camps is gaining popularity in our country and it is therefore necessary to evaluate the effectiveness of this approach in the early diagnosis and treatment of cancer. This to our knowledge has not been done. This report analyses an experience in screening for cervical cancer in rural areas of Barsi Tehsil (Maharashtra). The Barsi Tehsil consists of 134 villages with a population of 34,080 women above the age of 30 years (1982-1987). Of these 2,846 were screened through a series of cancer detection camps between 1982 and 1987. The results of the cytological screening in these women have been presented. An evaluation of the camp approach was carried out by the Population based Cancer Registry set up under the National Cancer Registry Programme (Indian Council of Medical Research) in Barsi, Paranda and Bhum tehsils. It was shown that acceptance of cytological screening was poor, thereby indicating that the mere holding of camps was not in itself sufficient to motivate the people, to subject themselves to the Pap smear. Certain suggestions which would appreciably increase the acceptance of cytological screening have been put forward.

Displasia epitelial y carcinoma in situ bucal características clínicas y variables epidemiológicas(Venezuela) / Epitelial displasia and in situ oral carcinoma: clinical characteristics and epidemiological variability(Venezuela)

Estudio de la displasia epitelial y el carcinoma in situ bucal considerados como lesiones premalignas de la boca a fin de establecer la incidencia de estas lesiones y controlar ciertas variables epidemiológicas como son: edad, sexo, sitios, de altos riesgos y consideración de factores etiológicosasociados

Treatment of carcinoma in situ of the cervix experience at the Faculty of Medicine, University of Säo Paulo

The authors studied a total of 334 cases of carcinoma in situ of the cervix (1975-1990). The patients were 19 to 61 years old (mean age, 36.6 years). The following procedures were performed: cervical amputation in 54.5% of cases, cervical enlarged amputation with resection of the adjacent vaginal mucosa in 23.3%, abdominal hysterectomy in 15.3%, electrocauterization in 3.6%, simple conization in 2.4%, and vaginal hysterectomy in 0.9%. Recurrence rates were: 9.8% after cervical amputation, 1.3% after cervical enlarged amputation, 25% after simple conization, 5.8% after abdominal hysterectomy, and 33% after electrocauterization. Recurrences were detected before the 18th month after treatment and none of them was of the invasive type. The treatment procedure with the highest rate of complications was cervical enlarged amputation (16%), followed by simple conization (12%), total abdominal hysterectomy (3.9%), and cervical amputation (2.9%). The authors conclude that, although cervical enlarged amputation was followed by the lowest recurrence rate, it was also the treatment followed by the largest number of complications. On this basis, they recommend cervical amputation or hysterectomy. For young women who wish to have children, simple conization is recommended