Fiebre de origen desconocido como presentación de carcinoma de cérvix

El carcinoma de cérvix constituye una causa rara de fiebre de origen desconocido (FOD). Se presenta el caso de una paciente femenina de 42 años de edad con fiebre de 80 días de evolución. Había estado ingresada en dos hospitales sin que se llegase a diagnosticar su causa. Se le habían administrado múltiples regímenes antibióticos sin lograrse remisión de la hipertermia. Fue remitida al hospital Hermanos Ameijeiras para continuar estudios en el protocolo de atención a pacientes con ese tipo de afección. Tenía anemia ferropénica y refería hipermenorrea. Al examen físico se encontró engrosamiento del cuello uterino al tacto vaginal y se visualizó una tumoración del mismo al examen con espéculo. La biopsia mostró un carcinoma y recibió tratamiento con radioterapia y quimioterapia con lo cual desapareció la fiebre. Se concluye que esta neoplasia puede presentarse a forma de fiebre prolongada producida directamente por el tumor primario, por lo que debe mantenerse un índice de sospecha en pacientes con FOD. Resulta importante tener en cuenta la asociación de fiebre y sangramiento vaginal como posible forma de presentación. Puede constituir una pista diagnóstica relevante para no perder tiempo. Este caso resalta la importancia de realizar un examen físico completo y exhaustivo a todos los pacientes.

Carcinoma of the cervix is a rare cause of fever of unknown origin. We present the case of a 42-year-old female patient with fever of 80 days of evolution. She had been admitted to two hospitals without a diagnosis of the cause. She had been administered multiple antibiotic regimens without achieving remission of hyperthermia. She was referred to the "Hermanos Ameijeirasˮ Hospital to continue studies under the protocol for the care of patients with this type of condition. She had iron deficiency anemia and reported hypermenorrhea. Physical examination showed thickening of the cervix on vaginal examination and a tumor was visualized on speculum examination. The biopsy showed a carcinoma and she was treated with radiotherapy and chemotherapy, with which the fever disappeared. It is concluded that this neoplasm can present as a prolonged fever directly produced by the primary tumor, so an index of suspicion should be maintained in patients with fever of unknown origin. It is important to take into account the association of fever and vaginal bleeding as a possible form of presentation. It may constitute a relevant diagnostic clue to avoid wasting time. This case highlights the importance of performing a complete and thorough physical examination in all patients.

Presentación inusual de compromiso metastásico cutáneo por carcinoma escamocelular de cuello uterino / Unusual presentation of metastatic skin involvement in a patient with squamous cell carcinoma of the cervix: Case report

Resumen El cáncer de cuello uterino ocupa el cuarto lugar dentro de las neoplasias de origen ginecológico a nivel global, representando un 85% de los casos en países en vías de desarrollo. Las metástasis cutáneas de origen ginecológico son altamente infrecuentes, observándose con mayor frecuencia en las neoplasias malignas de ovario, seguidas del adenocarcinoma endometrial y de cuello uterino y, menos frecuentemente, las de subtipo escamocelular. En la actualidad, existen alrededor de 80 reportes de casos citados en la literatura de metástasis cutáneas secundarias a un carcinoma de cuello uterino; sin embargo, ninguno con localización en la piel del cuello que se origine de un subtipo histológico escamocelular. En Colombia, no hay casos reportados hasta la fecha. Se presenta el caso de una paciente de 43 años que consulta por sangrado vaginal, dolor abdominal y una extensa placa tumoral exofítica de aspecto metastásico en la piel del cuello y del hombro izquierdo, encontrando al examen clínico inicial una masa tumoral en el cuello uterino con confirmación histológica de un carcinoma escamocelular como neoplasia primaria. Se hace diagnóstico de Carcinoma de cuello uterino estadio IVB y se inicia un tratamiento con intención paliativa con radioterapia y posterior quimioterapia sistémica. La enfermedad metastásica de origen ginecológico a nivel cutáneo confiere un mal pronóstico, con una supervivencia reportada de 1 a 37 meses después de su diagnóstico, por lo cual se deduce que la prevención y el diagnóstico temprano, particularmente en cáncer de cuello uterino, es de vital importancia en la población general.

Abstract Cervical cancer is the fourth most common cancer among gynecological neoplasms globally, representing 85% of cases in developing countries. Cutaneous metastases of gynecological origin are very rare, observed more frequently in ovarian malignancies, followed by endometrial and cervical adenocarcinoma and less frequently those of the squamous cell subtype. Currently there are about 80 case reports cited in the literature of cutaneous metastases secondary to cervical carcinoma, however, none with localization in the skin of the neck originated from a squamous cell histological subtype. In Colombia, there are no reported cases to date. We present the case of a 43-year-old patient who consulted for abdominal pain, vaginal bleeding and an extensive exophytic tumor plaque of metastatic appearance in the skin of the neck and left shoulder, finding a tumor mass in the cervix with histological confirmation of a squamous cell carcinoma as primary tumor. A diagnosis of stage IVB cervical carcinoma is made, and treatment is initiated with palliative intention with radiotherapy and subsequent systemic chemotherapy. Cutaneous metastatic disease of gynecological origin confers a poor prognosis, with a reported survival of 1 to 37 months after its diagnosis, for which prevention and early diagnosis, particularly in cervical cancer, is of vital importance in the general population.

Adenocarcinoma de células claras de colo uterino em paciente gestante / Adenocarcinoma of clear uterine cervical cells in pregnant patient

O adenocarcinoma de células claras (CCA) primário de colo uterino em pacientes jovens é uma doença rara, de etiologia desconhecida e que no passado estava associada ao uso do dietilestilbestrol durante a gestação, quando sua comercialização era permitida. A queixa mais frequente do CCA é o sangramento vaginal irregular. Relatamos o caso de CCA de endocérvice em paciente jovem que engravidou naturalmente após o diagnóstico da neoplasia.(AU)

Primary cervical clear cell adenocarcinoma (CCA) in young patients is a rare disease of unknown etiology in the past associated with the use of diethylstilbestrol during pregnancy when its use was permitted. The most frequent complaint is irregular vaginal bleeding. We report the case of endocervous clear cell adenocarcinoma in a young patient who became naturally pregnant, even after the diagnosis of the neoplasia.(AU)

Comparatively Analysis on Clinicopathological Characteristics and Prognosis of Small Cell Carcinoma of the Cervix(SCCC) and Non-SCCC-A Single Center of Clinical Research / 实用妇产科杂志

Objective:To investigate the differences between patients with small cell carcinoma of the cervix and other type of cervical cancer on clinicopathological characteristics,treatment,prognosis through the retrospective analysis,also study the prognostic factors in patients with SCCC.Methods:The patients with SCCC(63 cases,research group) and patients with Non-SCCC(60 cases,control group) such as squamous cell carcinoma and adenocarcinoma of cervix were chosen during May 2003 and June 2015 in department of obstetrics and gynecology,west China second university hospital.The clinical pathological and survival data were collected,sort out,checked and analyzed.Chi-square test or Fisher's exact probability method was used to compare the differences of clinical features between the two groups.The 5-year disease-free survival(DFS) rate and 5-year overall survival(OS) rate were generated using the Kaplan-Meier method.Univariate and multivariate analysis were applied to research the prognostic factors.Results:①The median age of the patients in research group was 40 years old,younger than control group whose median age was 44 years old (P =0.001).The rate of lymph node metastasis,parametrial infiltration,vascular involvement and positive surgical margins in research group were significantly higher than those of control group (P ＜ 0.05).There were no significantly differences between two groups in clinical symptoms,FIGO stage,therapeutic schedule.②In the survival analysis,the research group estimated 5-year overall survival (OS) rate (29.2％) and estimated 5-year disease-free survival rate (DFS)(26.6％) was significantly lower than those of the control group(82.6％,and 76.7％,respectively) P ＜ 0.05.③In the COX multivariate regression analysis,the results showed that the lymph node metastasis was the independent factor influencing overall survival rate and disease-free survival rate(HR =4.784、3.067,P ＜ 0.05).In addition,the tumor size was the independent factor influencing overall survival rate (HR =3.610,P ＜ 0.05),and advanced FIGO staging was the independent factor influencing disease-free survival rate (HR =2.793,P ＜ 0.05).Conclusions:The patients with SCCC were younger than other cervical cancer,and the clinical symptoms,cervical appearance,treatment between the two types are almost the same.However,The rate of lymph node metastasis,parametrial infiltration,vascular involvement and positive surgical margins in patients with SCCC were significantly higher than other cervical cancer,and the prognosis of the patients with SCCC was very poor.The main prognostic factors were lymph node metastasis,advanced FIGO stage and tumor size.

Expression and clinicopathological significance of P-JAK2, P-STAT3 and mutant p53 proteins in cervical lesions / 天津医药

Objective To investigate the expression and prognostic significance of P-JAK2, P-STAT3 and mutant p53 in cervical lesions. Methods A total of 153 cervical biopsies of patients from Gynecology Department, The Second Hospital of Tianjin Medical University were recruited during December 2013 to June 2015. Fifty-seven cases of squamous carcinoma of cervix (SCC), 36 cases of low grade intraepithelial neoplasia (LSIL), 30 patients with high grade intraepithelial neoplasia (HSIL) and 30 cases of normal cervix (NC) were included in the study. Gene chip method was used to detect high-risk hu-man papillpmavirus(HR-HPV)infection. Hematoxylin-eosin staining was used to make pathological diagnosis. Immunohis-tochemical assay was used for the detection of P-JAK2, P-STAT3 and mutant type p53 protein expression in cervical le-sions. Results (1) HR-HPV infection rate and P-JAK2 expression were significantly higher in SCC group than those of HSIL group, LSIL group and NC group (P<0.05). (2) The expression of P-STAT3 and mutant type p53 were significantly higher in SCC group than those of LSIL group and NC group (P<0.05). However, there was no significant difference between SCC group and HSIL group. (3) The positive expressions of P-JAK2 and P-STAT3 showed significant differences in different FIGO stages, histopathological grade, lymph node metastasis and HR-HPV infection in SCC group, respectively ( P<0.05). There were significant differences in the positive expression of mutant type p53 between different FIGO stages and HR-HPV infection (P<0.05). (4) There was positive correlation between P-JAK2, P-STAT3, positive expression of mutant type p53 and HR-HPV infection in SCC tissues (P<0.05). There was a positive correlation between P-STAT3, p53 expression and HR-HPV infection (P<0.05). There was a positive correlation between mutant p53 expression and HR-HPV infection (P<0.05). Conclusion P-JAK2, P-STAT3 and mutant p53 protein expression rates are high in SCC group than those of NC and SIL groups, which may be associated with HR-HPV infection, cervical cancer occurrence and progression.

Analysis of 30 patients with persistent or recurrent squamous cell carcinoma of the cervix within one year after concurrent chemoradiotherapy / 中国肿瘤临床

Objective:To investigate the treatment failure sites, risk factors, and survival rates of patients with persistent or recur-rent squamous cell carcinoma (SCC) of the cervix within one year after concurrent chemoradiotherapy (CCRT). Methods:Clinical data of 30 patients with persistent or recurrent SCC of the cervix within one year after CCRT between June 2006 and June 2011 were ana-lyzed retrospectively. These data were compared with those of another 35 SCC cases without recurrence after complete remission. These 35 patients were treated homeochronously (from 2006 to 2011) and randomized in the control group. Results:Among the 30 pa-tients, 25 exhibited distant metastases;14 of these 25 patients were observed within six months after CCRT. Univariate analysis showed a higher incidence of pelvic or para-aortic lymphadenectasis and SCC-ag>10 ng/mL in the group with persistent or recurrent disease be-fore treatment (P10 ng/mL were found as the independent risk factors. Palliative chemotherapy ranked as the first method used to treat patients. The two-year survival rate was 21.7%, and the median survival time was 17 months. Conclusion:Patients with persistent or recurrent SCC of the cervix after CCRT possibly exhibited a high rate of distant metastasis with poor prognosis. The pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag>10 ng/mL were found as the independent risk factors of per-sistent or recurrent SCC within one year after CCRT.

Cáncer incidental de cérvix (CIC) / Incidental cervical cancer (ICC)

Ocasionalmentes luego de una histerectomía simple, aparece un cáncer de cuello uterino (CCU) como hallazgo incidental (CIC) a la Anatomía Patológica (AP). Esta entidad, es de alto riesgo de recidiva locorregional, por lo que requiere de un tratamiento complementario. Propósito: analizar retrospectivamente los resultados de Radioterapia (RTX) complementaria en mujeres con diagnóstico de CIC referidas al Hospital Las Higueras (HH) y Centro Onco-Radiológico Regional (CORR) y compararlos con similares a comunicados en la literatura. Se analizan 29 pacientes con diagnóstico de CIC, referidos a HH y CORR entre agosto 1988 y junio 2000, tratados complementariamente con radioterapia externa y/o intracavitaria. La sobrevida actuarial a 5 años fue de 86%. El control locorregional actuarial de la totalidad de la muestra fue de 86%. En 5/29 pacientes fallecidas, todas de CCU. De las 5 fallas a tratamiento, 4 con falla locorregional. Una, con histología carcinoma indiferenciado de células pequeñas, con control locorregional y falla distante a los 175 meses. La RTX complementaria es altamente efectiva en el tratamiento de CIC.

Twenty nine patients with proven invasive cervical cancer found after simple hysterectomy were treated with complementary external and/or intracavitary Radiotherapy, 5 year actuarial survival rate of 86%. Local and regional control was achieved in 25/29, 83%. One patient presented with a complication grade 2, no treatment related deaths.

The Diagnosis and Treatment in 46 Cases with Microinvasive Carcinoma of the Cervix Uteri / 대한부인종양콜포스코피학회잡지

OBJECTIVE: To review recurrence and prognosis of microivasive squamous cell carcinoma of the cervix that are associated with depth of invasion, pathologic finding and management(conservative or radical treatment) STUDY DESIGN: We conducted retrospective study in order to evaluate the results of therapeutic approaches in 46 patients with microinvasive cervical cancer from Jan 1987 to Oct 1996. RESULT: The mean age of patients was 44.6+ 8.86 years. Only one woman was nullipara, and the mean parity was 2.8, Overall diagnostic accuracy of pap smear and punch biopsy were 54.3% and 79.4%. As the depth of invasion was deeper, the diagnostic accuracy of punch biopsy increased(p<0.05), The confluence pattern and lymphovascular space involvement were observed in 39.1% and 4.9%. The confluence pattern was observed with statistical significant in advanced depth of stromal invasion. In the surgical management, vaginal hysterectomy was done in 28 patients, conization(l patient), total abdominal hysterectomy(8 patients) and radical hysterectomy with pelvic lymph node dissection(9 patients) was done, no positive node was in 104 pelvic lymph node dissected. Though all cone margin was free and all endocervical curettage was negative, residual lesion(2 patients) was present in the hysterectomy after conization, The median follow-up period was 64 months. There was no recurrence in all cases and 5 years survival rate was 100% CONCLUSION: We suggest that microinvasive carcinoma of the cervix may be the disease of good prognosis and no recurrence, and less radical therapy for the patients with microinvasive carcinoma may be sufficient.

Results of Hyperfractionated Radiation Therapy in Bulky Stage Ib, IIa, and IIb Uterine Cervical Cancer / 대한치료방사선과학회지

PURPOSE: To evaluate the efficacy of hyperfractionated radiation therapy in carcinoma of the cervix, especially on huge exophytic and endophytic stage Ib, IIa and IIb. METHODS AND MATERIAl: Fourty one patients with carcinoma of the cervix treated with hyperfractionated radiation therapy at the Department of Therapeutic Radiology, Dongsan Hospital, Keimyung University, School of Medicine from Jul, 1991 to Apr, 1994. According to FIGO staging system, there were stage Ib (3 patients), IIa (6 patients) with exophytic (> or = 5cm in diameter) and huge endophytic mass, and IIb (32 patients) with median age of 55 years old. Radiation therapy consisted of hyperfractionated external irradition to the whole pelvis (120cGy/fraction, 2 fraction/day (minimum interval of 6 hours), 3600-5520cGy) and boost parametrial doses (for a total of 4480-6480cGy) with midline shield (4x10cm), and combined with intracavitary irradiation (up to 7480-8520cGy in Ib, IIa and 8480-9980cGy in IIb to point A). The maximum and mean follow up durations were 70 and 47 months respectively. RESULTS: Five year local control rate was 78% and the actuarial overall five year survival rate was 66.1% for all patients, 44.4% for stage Ib, IIa and 71.4% for stage IIb. In bulky IIb (above 5cm in tumor size, 11 patients) five year local control rate and five year survival rate was 88.9%, 73% respectively. Pelvic lymph node status (negative : 74%, positive:25%, P= 0.0015) was significant prognostic factor affecting to five year survival rate. There was marginally significant survival difference by total dose to A point (>84Gy : 70%, ; or =grade 3) and Three patients developed grade 3 gastrointestinal complication. Above grade 3 complication was not noted. There was no treatment related death noted. CONCLUSION: We thought that it may be necessary to increase A point dose to more than 85Gy in hyperfractionated radiotherapy of huge exophytic and endophytic stage Ib,IIa. We considered that hyperfractionated radiation therapy may be tolerable in huge exophytic and endophytic stage IIb cervical carcinoma with acceptable morbidity and possible survival gain but this was results in small patient group and will be confirmed by long term follow up in many patients.

Expression of the mutant p53 gene in the carcinoma of the cervix uteri / 대한부인종양콜포스코피학회잡지

The nuclear accumulation of p53 protein is known to correspond with mutation of p53 tumor supressor gene. To investigate the relationsbip between clinico-pathologic features and expression of p53 mutations, 65 cases of primary cervical carcinoma were analysed by an immunohistochemieal method using monoclonal antibody of p53. Immunostaining demonstrated varioua nuclear stinings of cancer cells in 48.4% of squamous cell carcinoma(51.9% in large cell carcinoma and 25.0% in small cell carcinomas) and 23.5% of adenocarcinoma(p<0.05) No differences in clinical stage and p53 positivity were found. There was no significant correlation between p53 positive cases and status of recurrence. This data suggests that p53 protein is not correlated with the disease progression and prognosis.