Carcinomas basocelulares localizados en áreas de la piel no expuesta a luz solar / Basal cell carcinomas located in areas of the skin not exposed to sunlight

RESUMEN Introducción: El carcinoma basocelular (CBC) es el cáncer humano más común. Es una neoplasia epitelial de malignidad limitada por un crecimiento lento y excepcional capacidad para dar metástasis a distancia. Es más frecuente en varones y en mayores de 40 años, foto tipos cutáneos I y II, una exposición solar intensa y prolongada, inmunosupresión y exposición a radiaciones ionizantes, ocurren de forma esporádica, aunque pueden ser hereditarios. Objetivo: Presentar un caso infrecuente de carcinoma basocelular en áreas no expuestas Presentación del caso: Paciente de 36 años, masculino, foto tipo III, sin antecedentes patológicos, medicamentosos, alérgicos y hereditarios; comerciante, sin antecedentes de exposición solar; consulta por lesión eritematosa en región antero-proximal del brazo derecho. Se observan otras dos lesiones, una en región pectoral derecha y otra en fosa ilíaca derecha; diagnóstico presuntivo CBC. Diagnóstico: Lesión 1: CBC. Lesión 2 y 3: CBC superficial. se solicita escisión quirúrgica convencional con ampliación de márgenes, la biopsia informa márgenes libres, se indican medidas de seguimiento y prevención. Conclusiones: se presenta un caso de CBC múltiples en áreas no expuestas a la radiación solar. Resulta fundamental el control y seguimiento de este paciente, pues tiene un alto riesgo de desarrollar melanoma.

ABSTRACT Introduction: Basal cell carcinoma (BCC) is the most common human cancer. It is an epithelial neoplasm of malignancy limited by slow growth and exceptional ability to metastasize at a distance. It is more frequent in men and in> 40 years, cutaneous phototypes I and II, a prolonged and intense solar exposure, immunosuppression and exposure to ionizing radiation, occur sporadically, although they can be hereditary. Objective: To present an infrequent case of basal cell carcinoma in unexposed areas Case presentation: Patient 36 years old, male, phototype III, without pathological, medicated, allergic and hereditary antecedents; merchant, not photo-exposed; consultation due to an erythematous lesion in the antero-proximal region of the right arm. Two other lesions are observed, one in the right pectoral region and the other in the right iliac fossa; presumptive diagnosis BCC. Diagnosis: Injury 1: BCC. Lesion 2 and 3: superficial BCC. conventional surgical excision with widening of margins is requested, biopsy reporting free margins, follow-up and prevention measures are indicated. Conclusions: a case with multiple CBC was presented in non-photoexposed areas without the clinic. Control and follow-up are essential given that they have a high risk of developing melanoma.

Tumor odontogénico adenomatoideo: reporte de un caso / Adenomatoid odontogenic tumor: report of a case

El tumor odontogénico adenomatoide (TOA) es una lesión benigna,infrecuente, clasificada por la OMS dentro de los tumores odontogénicoscon participación del ectomesénquima que muestra una morfología histológica muy peculiar. Esta entidad patológica es de baja prevalencia, representa 0.1% de los tumores y quistes de losmaxilares con raras recidivas. Su frecuencia de aparición es más comúnen pacientes jóvenes, generalmente mujeres, de mayor aparición en maxilar superior, asintomático, asociado a dientes sin erupcionar(principalmente caninos) que plantea diagnósticos diferenciales entre otras lesiones de mayor agresividad como el quiste dentígero y el ameloblastoma. Se presenta el caso de una paciente de nueve años de edad con lesión tumoral en el sector del maxilar superior izquierdo de 40 días de evolución. Clínicamente hay ausencia del órgano dentario número 23. Se indica la realización de una radiografía panorámica, en la cual se observa la presencia del órgano dental 23 en el piso de órbita del maxilar superior izquierdo. Se procede a la remoción quirúrgica con diagnóstico presuntivo de quiste dentígero, se biopsia el total de la lesión, con diagnóstico definitivo por histopatología de TOA, con buena evolución clínica odontológica.

The adenomatoid odontogenic tumor (TOA) is a rare, uncommon,WHO-classified lesion in odontogenic tumors with ectomesenchyma,which shows a very peculiar histological morphology. This pathologicalentity is of low prevalence representing 0.1% of the tumors and cystsof the jaws with rare recurrences. Its frequency of appearance is morecommon in young patients, generally females, of greater presentationin the upper jaw, asymptomatic, associated with unruptured teeth(mainly canines) that presents diff erential diagnoses among other moreaggressive lesions such as dentigerous cyst and ameloblastoma. Wepresent the case of a nine-year-old patient with tumor lesion in the leftupper jaw of 40 days of evolution. Clinically there is absence of the tooth23. A panoramic radiograph is indicated, in which the presence of thetooth 23 is observed in the orbital fl oor of the upper left jaw. Surgicalremoval is performed with a presumptive diagnosis of dentigerouscyst; the total of the lesion was biopsied, with defi nitive diagnosis byhistopathology of TOA with good odontological clinical evolution.

A Study of Immunohistochemical Expression of Epidermal Growth Factor Receptor in Prostatic Lesions

Epidermal growth factor receptor (EGFR) is a 170-kDa tyrosine kinase transmembrane glycoprotein expressed in normal tissues in many organs and different types of tumours. In prostate, EGFR is expressed mainly in epithelial cells, phosphorylation of EGFR (pEGFR) which is assessed by immunohistochemical methods could be useful prognostic marker for prostate cancer cases. Tumours may affect the surrounding non-malignant tissue and pEGFR immunoreactivity in the morphologically normal prostate tissue can be used to retrieve prognostic information. In this study the membranous and cytoplasmic expression of EGFR is checked in both the basal and luminal cells. Intensity of the staining and the pattern of the staining were noted in benign, in-situ and malignant lesions and it was found that the staining intensity of the luminal cells increase with a subsequent decreased staining in the basal layer as the lesion progress towards malignancy. Subsequently the staining intensity and patterns were correlated with the Gleason grade for triaging of the cases into different prognostic groups.

Study on immunocytochemistry p16/Ki-67 double staining combined with DNA ploidy analysis for analyzing and predicting cervical high grade squamous intraepithelial lesion / 重庆医学

Objective To investigate the diagnostic value of DNA ploidy analysis combined with immunocytochemistry p16/ki-67 double staining in cervical high grade squamous intraepithelial neoplasia(HSIL) and cervical squamous cell carcinoma(SCC).Methods A total of 73 cases of cytological tests were randomly collected.Among them,53 cases were small DNA ploidy abnormal cells and 20 cases were DNA ploidy negative.The p16/Ki-67 results were detected by immunocytochemistry double staining.With the pathological results as the golden standard,the diagnostic values of DNA ploidy analysis and DNA ploidy analysis combined with p16/Ki-67 double staining in HSIL + was contrastively analyzed by pathologic results.Results Among 20 samples of DNA ploidy negative,the p16/Ki-67 double staining results all were negative.The positive predictive value of DNA ploidy analysis for HSIL + was 34.62％.The sensitivity of DNA ploidy analysis combined with p16/Ki-67 double staining for HSIL + was 84.62％,and its specificity was 92.31％,the positive predictive value was 78.57％ and the negative predictive value was 94.74％,which were significantly higher than those of DNA ploidy analysis(P＜0.05).Conclusion p16/Ki-67 double staining can significantly im prove the prediction value of HSIL.The DNA ploidy analysis combined with p16/Ki-67 double staining is an effective method for predicting HSIL +,which is suitable for the implementation in the areas with lack of medical resources.

Utilidad de la detección de virus papiloma de alto riesgo en pacientes con citología atípica y de neoplasia intraepitelial de bajo grado de cuello uterino

Antecedentes: La citología cervical atípica y de bajo grado son hallazgos frecuentes pero no siempre relevantes. Objetivo: Estudio prospectivo que analiza la utilidad de la determinación del virus papiloma humano (VPH) de alto riesgo, en detectar patología intraepitelial de alto grado. Método: 94 pacientes con citología atípica y 116 pacientes con citología de NIE 1 fueron evaluadas con la prueba de VPH de alto riesgo. Resultados: En pacientes con citología atípica, la prueba positiva de VPH identificó a 23% con patología de alto grado versus solo en 4% en aquellas con prueba negativa (p=0,0124). En pacientes con citología de NIE 1, la prueba positiva de VPH identificó a 13% con patología de alto grado versus en 5,5% en aquellas con prueba negativa (p=0,6923). Conclusiones: La determinación de presencia viral de alto riesgo es un examen útil en pacientes con citología atípica pero no contribuye en pacientes con citología de NIE 1.

Background: Atypical and low grade cervical cytology are frequent findings, however, not always relevant. Aims: Prospective study, that analyzes the usefulness of determining high risk human papilloma virus test (HPV), in detecting high grade intra epithelial neoplasia in these patients. Method: 94 patients with atypical cytology and 116 patients with CIN 1 cytology were evaluated with the high risk HPV test. Results: In patients with atypical cytology, a positive HPV test identified 23% with high grade CIN versus only in 4% when the test was negative (p=0.0124). In patients with CIN 1 cytology, a positive test identified 13% with high grade CIN versus 5.5% in those with a negative test (p=0.6923). Conclusion: High risk HPV determination is a useful test in patients with atypical cytology, however non contributory in patients with low grade CIN cytology.

Risk factors for under-diagnosis of esophageal intra-epithelial neoplasia with endoscopic forceps biopsy in comparison with endoscopic submucosal dissection / 中华消化内镜杂志

Objective To study the risk factors for pathological upgrading after diagnosis of esophageal low?grade intra?epithelial neoplasia with ESD preoperative biopsy. Methods The endoscopic and pathological data of 85 lesions with ESD preoperative biopsy were analyzed, and grouped based on pathological upgrading after ESD. The risk factors for pathological upgrading after ESD was studied through single and multiple factor analysis. Results Pathological upgrading occurred in 45(52?94%) lesions after ESD, among whom 38 lesions developed up to high?grade intra?epithelial neoplasia and 7 lesions developed to esophageal early cancer. NBI?ME was performed on 37 patients and the accuracy of detecting the pathological invasion was 83?8%(31/37).Multi?factor analysis showed that reddish surface(OR=9?478, 95%CI:2?775?32?368, P = 0?000 3 ) and nodular lesion ( OR = 15?628, 95%CI:1?475?165?617, P =0?022 5) were independent factors for pathological upgrading after ESD. Conclusion Pathological upgrading of low?grade intra?epithelial neoplasia was common, especially esophageal mucosa with red surface and nodular lesion.Biopsy combined with NBI?ME is of significant importance to improve diagnostic accuracy.

Different grades of gastric mucosa epithelial neoplasia tissues of Helicobacter pylori infection and the relationship between chemokine CXCL12 and its receptor CXCR4 expression and significance / 中国医师进修杂志

Objective To study the effect of different grades of gastric mucosa epithelial neoplasia tissues of Helicobacter pylori (Hp ) infection and the relationship between chemokine CXCL12 and its receptor CXCR4 expression and significance. Methods Based on a total of 138 cases of endoscopic specimens, there were normal gastric mucosa (NGM) in 32 cases, low grade intraepithelial neoplasia (LGIEN) in 35 cases, high grade intraepithelial neoplasia (HGIEN) in 36 cases, and gastric adenocarcinoma (GCA) in 35 cases. Hp infection was determined by 13C breath test and serum Hp antibodies,the double positive for Hp infection. CXCL12 and its receptor CXCR4 were detected by immunohistochemical method. Results The positive rates of CXCL12 and CXCR4 in LGIEN,HGIEN and GCA were higher than those in NGM:71.43%(25/35), 86.11%(31/36), 91.43%(32/35) vs. 25.00%(8/32);71.43%(25/35), 86.11%(31/36), 91.43%(32/35)vs. 28.12%(9/32), P0.05). The positive expression of CXCL12 and CXCR4 had no correlation with Hp infection (P>0.05). Conclusions The positive rates of CXCL12 and CXCR4 in LGIEN,HGIEN and GCA are higher than those in NGM.The positive rates of CXCL12 and CXCR4 in HGIEN and GCA are higher than those in LGIEN. The positive rates of CXCL12 and CXCR4 in HGIEN and GCA are similar. The positive expression of CXCL12 and CXCR4 have no correlation with Hp infection, it suggests that Hp infection may not play oncogenic role by CXCL12 and CXCR4 receptor expression.

A analysis of the risk factors of colorectal polyp malignant transformation / 重庆医学

Objective Colorectal polyp is a precancerous lesion of colorectal cancer .Aim of the study was to explore the risk fac-tors of colorectal polyp malignant transformation .Methods The related information of 75 084 colonoscopies performed from 2003 to 2012 in Southwest Hospital in Chongqing were collected and the relationship between polyp malignant transformation and the pa-tient age ,sex ,polyp location ,size or histological types was analyzed .Results From 2003 to 2012 ,polyps were diagnosed in 14 806 cases of the total 75 084 patients with a 19 .72% detection rate .There were significant difference of the left-side and right-side pol-yp detection rate in different age groups ,and the frequency of polyps distributed in the whole colorectum increased with the increase of age .The rates of epithelial neoplasia and malignant transformation increased with age .At the same time ,malignant transforma-tion rate was significant higher in polyps located in left-side than that in right-side (P<0 .0167) ,in adenoma than that in inflamma-tory hyperplastic polyp (P<0 .01) .The larger diameter and the more villus ,the higher rate of malignant transformation .Conclusion Patient age ,polyp size ,location and histological type could be considered as the significant predictors of colorectal polyp malignant transformation .It may be useful to treat the polyp with endoscopy in patient with age more than 45 and adenoma whose diameter was not less than 1 cm ,located in left-side for prevention of colorectal cancer .

Neoplasia intraepitelial cervical en un área de salud / Cervical intraepithelial neoplasia in a health area

INTRODUCCIÓN: El cáncer cérvicouterino es la segunda neoplasia maligna más frecuente en mujeres, cuya solución debe sustentarse en la aplicación de medidas organizativas, el conocimiento de la epidemiología de la afección y el perfeccionamiento de los métodos de detección temprana y tratamiento. OBJETIVOS: Determinar el comportamiento de factores de riesgo de neoplasia intraepitelial cervical en los estratos suburbano y rural de Santa Cruz del Norte. Identificar en los grupos caso y control el comportamiento de algunos factores en las áreas seleccionadas. Comparar el comportamiento de los factores seleccionados entre los estratos suburbano y rural. MÉTODOS: Se realizó un estudio analítico de casos y controles donde se incluyó una muestra constituida por 126 mujeres. Las variables estudiadas estuvieron relacionadas con la esfera sexual y conductual. Se evaluaron los factores de riesgo a través del odds ratio y el cálculo del Test chi-cuadrado. RESULTADOS: Los factores relacionados con los antecedentes de infecciones de transmisión sexual (OR= 3,1 y 9), y el tabaquismo (OR= 6,1 y 7,5) se comportaron como factores de riesgo para ambos estratos. El número de parejas sexuales, solo resultó factor de riesgo para las mujeres de la población suburbana (OR= 4,5). Las diferencias entre las pacientes de los estratos suburbano y rural fueron significativas en todos los factores analizados excepto para la de "el número de partos" (p< 0,05). CONCLUSIONES: Se evidenció que las infecciones de transmisión sexual, y el tabaquismo se comportaron como factores de riesgo para las poblaciones de ambos estratos, a diferencia del uso de anticonceptivos orales, la edad del primer parto, la paridad y el tipo de parto. El número de parejas sexuales, solo resultó factor de riesgo para las mujeres de la población suburbana

INTRODUCTION: The cervicouterine cancer is the second malignant neoplasia more frequent in women, whose solution must to be based in implementation of organizing measures, the knowledge of affection epidemiology and the improvement of early detection methods and of treatment. OBJECTIVES: To determine the behavior of risk factors related to cervical intraepithelial neoplasia in suburban and rural strata of Santa Cruz del Norte municipality. To identify in case-control groups the behavior of some factors in selected areas. To compare the behavior of factors selected among the suburban and rural strata. METHODS: A analytical study of case-controls was conducted including a sample of 126 women. The study variables were related to this sexual and behavioral sphere and the risk factors by odds ratio and the chi² test calculus were assessed. RESULTS: Factors related to a history of sexual transmitted infections (OR= 3.1 and 9) and smoking (OR= 6.1 and 7.5) were considered as risk factors for both sexes. The number of sexual partners only was a risk factor for the suburban female population (OR= 4.5). The differences among patients of suburban and rural strata were significant in all factors analyzed except for that related to the "number of labors" (p< 0.05). CONCLUSIONS: It was evidenced that the sexual transmission infections and smoking were considered as risk factors for populations of both strata unlike the use of oral contraceptives, age in the first labor, parity and the type of labor. The number of sexual partners only was considered a risk factor for the women from the suburban population

Human papilloma virus screening by hybrid capture II in chinese women of Jiangsu Province / Tamizaje del virus del papiloma humano mediante captura híbrida en mujeres chinas de la Provincia de Jiangsu

OBJECTIVE: To survey Human Papilloma Virus (HPV) infection in Chinese Women of Jiangsu Province and discuss the relationship between HPV and the biology of cervical cancer. METHODS: Two thousand, one hundred and fifty-three sexually active women (including 66 cases of cervical cancer) were selected for high-risk human papilloma virus DNA test with Hybrid Capture II (HCII). RESULTS: The overall HPV prevalence was 32.6% (701/2153) with higher positive rates in cervical carcinoma and Cervical Interstitial Neoplasia (CIN) [93.9% and 54.6%] respectively. For women aged 40-59 years, the overall high-risk HPV prevalence was higher than those of other age groups. Compared with CIN I, the positivity rate and viral load of HPV DNA in CIN III is much higher (80.2% vs 29.9%, 11.89 vs 0.53). Ninety-four per cent (64/66) of patients with Cervical cancer were detected to be HPV positive. There was no significant difference in HPV DNA among each clinical stage and pathologic grade. But the positive rates and the value of HPV DNA were higher in the patients with cervical interstitial incursion. Eighty per cent of patients (20/25) could become negative within six months after operation. CONCLUSIONS: High-risk HPV DNA test is effective in screening for cervical diseases. HC II is an effective method to detect HPV DNA.

OBJETIVO: Investigar la infección por el virus del papiloma humano (VPH) en las mujeres chinas de la Provincia de Jiangsu y analizar la relación entre VPH y la biología del cáncer cervical o del cuello uterino. MÉTODOS: Dos mil ciento cincuenta y tres mujeres sexualmente activas (incluyendo 66 casos de cáncer cervical) fueron seleccionadas para una prueba de ADN con el fin de detectar el virus del papiloma humano de alto riesgo mediante Captura Híbrida 2 (HC2). RESULTADOS: La prevalencia general de VPH fue 32.6% (701/2153), hallándose las tasas positivas más altas en el carcinoma cervical y la neoplasia intersticial cervical (NIC) [93.9% y 54.6%]. Para las mujeres de 40-59 años de edad, la prevalencia general de VPH de alto riesgo fue mayor que para los otros grupos etarios. En comparación con el CIN, la tasa de positividad y la carga viral de ADN del VPH en el CIN es mucho mayor (80.2% vs 29.9%, 11.89 vs 0.53). Se detectó que noventa y cuatro por ciento (64/66) de las pacientes con cáncer del cuello uterino eran VPH positivas. No hubo ninguna diferencia significativa en el ADN del VPH ADN entre cada fase clínica y el grado patológico. No obstante, tanto las tasas positivas como el valor de VPH ADN fueron más altos en las pacientes con incursión intersticial cervical. Ochenta por ciento de las pacientes (20/25) podrían volverse negativas en seis meses tras la operación. CONCLUSIONES: La prueba de ADN para la detección del virus del papiloma humano de alto riesgo es un medio efectivo para el tamizaje de las enfermedades cervicales. El HC2 es un método efectivo para detectar el ADN del VPH.

Utilidade da citologia anal no rastreamento dos homens heterossexuais portadores do HPV genital / Anal cytology for screening heterosexual men harboring genital HPV infection

Os papilomavírus humanos (HPV) de alto risco estão fortemente relacionados à etiologia do carcinoma espinocelular (CEC) anogenital e suas lesões precursoras. O HPV-16 é o tipo mais frequente, estando presente em até 87 por cento dos CEC do canal anal HPV-positivo. Apesar de ser relativamente raro, vem sendo cada vez mais diagnosticado, nas últimas décadas, sobretudo em indivíduos do sexo masculino. A incidência é ainda mais elevada nos grupos considerados de risco, particularmente, os homens e as mulheres HIV-positivo e os homens que fazem sexo com homens (HSH). Grande parte das pesquisas direcionadas à infecção anal pelo HPV e sua relação com neoplasia intraepitelial-anal (NIA) e com o carcinoma esteve focada nos grupos de risco. Pouco interesse vem sendo destinado à investigação dos homens heterossexuais. Estudos epidemiológicos da prevalência da infecção pelo HPV em homens, mostraram que os heterossexuais masculinos apresentavam infecção anal pelo HPV em até 12 por cento. As Sociedades médicas e os especialistas recomendam o rastreamento dos portadores de imunodepressão e dos HSH com citologia do raspado do canal anal. Entretanto, até o momento, não há recomendação de rastreamento para homens que fazem sexo com mulheres.

The oncogenic human papillomaviruses (HPV) are straightly associated with anogenital cancer and dysplasia. The HPV-16 is the most common type, isolated in 87 percent of the HPV-positive anal squamous cell carcinoma (SCC). Despite being a rare tumor, the incidence of SCC has increased in the last decades, especially in males. Incidence is particularly high amongst men who have sex with men (MSM) and among HIV infected men and women. For decades anogenital HPV researches have largely focused risk groups. Poor interest was intended to men who have sex with women (MSW). Prevalence studies of HPV infection in MSW have demonstrated that anal infection was identified in as far as 12 percent. Medical societies and specialists recommend anal screening with cytology for HIV infected men and women, and MSM. Until now, there is no evidence to recommend anal screening for MSW.

Vacina contra o papilomavirus humano. O que é preciso saber / Human papillomavirus vaccines. What we must know

As vacinas contra o Papilomavirus Humano (HPV) já estão disponíveis para consumo. Temos dois tipos: a bivalente, que determina imunidade contra os tipos oncogênicos 16 e 18, os mais relacionados com os carcinomas anogenitais e da orofaringe, a quadrivalente, que além desses, imuniza contra os tipos 6 e 11, que provocam as verrugas anogenitais. Estão mais indicadas para mulheres dos 10 aos 25 anos, antes do início da vida sexual ou naquelas que não tiveram contato com os tipos virais envolvidos. As vacinas não têm efeito em quem já possui lesões provocadas pelos tipos virais imunizáveis. Podem ser usadas nas imunodeprimidas por qualquer causa, naquelas que estão amamentando, mas são contra-indicadas durante a gravidez. O uso em homens, guardando as mesmas indicações, foi liberado pelo FDA (Food and Drugs Administration) norte-americano, porém ainda não pela ANVISA (Agência Nacional de Vigilância Sanitária), o correspondente brasileiro. Para aqueles que já estão contaminados pelos tipos virais envolvidos, resta esperar pela vacina terapêutica que permanece em avaliação com ensaios clínicos.

Vaccines against human papillomavirus (HPV) are already available for use. There are two of them: bivalent, that provokes immunity against oncogenic types 16 and 18, the most involved in anogenital and oropharyngeal carcinomas, and the quadrivalent, that includes these types and the non-oncogenic types 6 and 11, responsible for most of anogenital warts. They are indicated for women from 10 to 25 years old, before sexual life beginning or to those that did not have been infected with HPV types of the vaccines. These vaccines have no therapeutic effects against pre-existing HPV infections and HPV-associated lesions. They can be used in immunosuppressed persons, in those who are breast feeding, but are contra-indicated during pregnancy. Their use in males, with the same indications, is already approved by the north-american FDA (Food and Drugs Administration), but not yet by ANVISA (Agência Nacional de Vigilância Sanitária), the correspondent Brazilian governmental agency. For those infected by vaccines enrolled viral types, therapeutic vaccines, nowadays in test in several controlled trials, remain a hope for a future effective treatment.

Genetic Instability in Gastric Epithelial Neoplasias Categorized by the Revised Vienna Classification

BACKGROUND/AIMS: The aim of this study was to determine the structural chromosomal aberrations, such as loss of heterozygosity (LOH) and microsatellite instability (MSI), at multiple tumor suppressor gene loci in gastric epithelial neoplasia categorized by the revised Vienna classification. METHODS: All tissue samples were excised by endoscopic mucosal resection. Sixty category 3 (low-grade adenoma) tissue samples and 51 category 4 samples (high-grade adenoma and intramucosal carcinoma with adenoma) were examined at the 7 sets of microsatellite loci linked to the tumor suppressor gene locus. RESULTS: For category 3 and 4 tissue samples, there were no differences in the frequencies of LOH-positive chromosomes or the extent of chromosomal loss. The Helicobacter-pylori (H. pylori)-positive rate was significantly higher in MSI-positive category 4 samples than in category 3 samples (p=0.04). The frequency of MSI positivity was significantly higher in category 4 samples than in category 3 samples (p=0.003). CONCLUSIONS: H. pylori infection is associated with genetic instability of the premalignant lesion. MSI occurs in the early stages of gastric carcinogenesis and its occurrence increases during malignant transformation. Detection of MSI in premalignant gastric lesions may be a surveillant of risk of malignant transformation.

Diagnóstico de HPV anal em mulheres com NIC: prevenção de câncer do ânus? / Anal HPV diagnosis in women with NIC: anal cancer prevention?

Os objetivos deste estudo foram avaliar a frequência de HPV anal em pacientes com neoplasia intraepitelial cervical (NIC), verificar a concordância entre os subtipos encontrados nos dois locais e investigar os fatores que influenciaram a ocorrência de HPV anal em mulheres com NIC sem evidências clínicas de imunodepressão. Foram avaliadas 52 mulheres com idades entre 16 e 72 anos e diagnóstico de neoplasia intraepitelial cervical graus I, II e III. A identificação do DNA (ácido desoxirribonucleico) do HPV e de sete subtipos dos vírus foi realizada por meio da reação em cadeia da polimerase (PCR) em material colhido no ânus e colo uterino. Foram pesquisados fatores que poderiam contribuir para a infecção anal, como paridade, número de parceiros, tabagismo, manipulação e coito anal e o tipo de doença ginecológica. Das 52 mulheres, foi diagnosticado HPV na região anal em 25 (48 por cento), das quais 23 (44 por cento) também apresentavam HPV no colo uterino - resultado significativo para existência do HPV em portadoras de NIC. Em 16 (31 por cento) o HPV foi diagnosticado somente no colo uterino e em 11 (21 por cento) não foi identificado em colo ou ânus. Houve associação significativa nas variáveis paridade (p=0,02) e número de parceiros (p=0,04). Concluiu-se que: as mulheres com HPV genital têm mais probabilidade de serem acometidas por HPV anal; não há concordância unânime entre os subtipos do HPV do colo do útero e do ânus e a paridade e o número de parceiros contribuem para aumentar a incidência de HPV anal nas mulheres sem imunodeficiência e com HPV cervical.

This study aims were to assess the frequency of HPV anal infection in patients with cervical intra-epithelial neoplasia (CIN), to find out the relation between the found subtypes, when present in both regions, and investigate factors that influenced the occurrence of anal HPV in women with CIN. Fifty two women with age between 16 and 72 years and cervical intra-epithelial neoplasia (CIN) diagnosis, grades I, II and III were studied. Material from anus and uterine cervix were obtained to identify the virus deoxyribonucleic acid (DNA) and seven virus subtypes through polymerase chain reaction (PCR). Factors that could contribute to anal infection like number of children, number of sexual partners, smoking practice, anal manipulation and intercourse, and grade of gynecologic disease were investigate. From the fifty two women, anal HPV diagnoses happened in 25 (48 percent), and 23 (44 percent) of them had HPV in uterine cervix as well; this result was significant to the presence of anal HPV in patients with CIN. In 16 (31 percent) the HPV diagnosis occurred only in uterine cervix and in 11 (21 percent) no HPV was detected in anus and uterine cervix. In conclusion, women with cervical intra-epihelial neoplasia have more probability to be infected with anal HPV; there is no unanimous concordance among HPV sub-types in uterine cervix and anus and the number of children and sexual partners contribute to increase the anal infection incidence in women without immuno-deficiency, with cervical HPV infection.

Papulose bowenóide: um aspecto clínico da infecção pelo HPV / Bowenoid papulosis: a clinical feature of the HPV infection

Papulose bowenóide é uma doença que acomete a pele da região anogenital e que se caracteriza pelas múltiplas pequenas pápulas planas ou aveludadas e de coloração que varia do róseo ao castanho-escuro. É provocada pelo HPV e a transmissão sexual é a forma mais freqüente de contaminação. As queixas mais comuns são prurido e dor. O aspecto é característico e o exame histopatológico confirma o diagnóstico. Junto com a doença de Bowen e a eritroplasia de Queyrat, é considerada como carcinoma in situ, ou neoplasia intra-epitelial de alto grau (NIAA), a lesão precursora do carcinoma espinocelular (CEC) anal. Sem tratamento, a maioria das lesões permanece benigna e estável. Várias modalidades terapêuticas estão disponíveis, incluindo as medicações tópicas para citodestruição e as técnicas ablativas. Os esquemas tópicos são efetivos. Cabe ao profissional médico escolher a terapia adequada, tendo em mente que a doença é benigna e raramente evolui para carcinoma. Como as recidivas são freqüentes e ainda persistem dúvidas quanto ao potencial de malignização, os doentes devem ser examinados periodicamente para diagnosticar as lesões iniciais.

Bowenoid papulosis is an anogenital skin disease characterized by multiple little papules, flat or velvet, which color varies from pink to dark brown. It is provoked by HPV and its transmission is sexual. Most common symptoms are anal pain and itching. Its appearance is characteristic and hystopathological examination confirms diagnosis. Together with Bowenïs disease and Queyrat erythroplasia, is considered as an in situ carcinoma, or high grade intra-epithelial neoplasia (HAIN), a precursor of the squamous-cell carcinoma. Most of lesions remain benign and stable without treatment. There are several kinds of treatment including topical drugs for cytodestruction and ablative techniques. Topic schemes are effectives. The consultant doctor may choose the most adequate therapy, keeping in mind this disease is benign and rarely evolutes to invasive carcinoma. As recurrences are frequent and remain doubts about malign potential, patients must be examined periodically to diagnose initial lesions.

Sensibilidade e especificidade da citologia anal com escova no diagnóstico das lesões clínicas provocadas pelo papilomavírus humano, comparando uma com duas coletas / Sensibility and specifity of anal cytology with cytobrush in the HPV induced clinical lesions diagnosis, comparing one to two smears

OBJETIVO: comparar os resultados da coleta única com duas amostras para avaliar se haverá melhora da sensibilidade e especificidade do exame. MÉTODO: Foram 112 doentes masculinos HIV-positivo com doença anal pregressa ou atual pelo Papilomavírus humano (HPV). As lesões HPV induzidas foram observadas em 58 deles. Colhemos material do canal anal utilizando duas escovas (cytobrush) Comparamos estatisticamente os resultados da primeira amostra com a soma das duas coletas. RESULTADOS: dos 58 doentes com lesões clínicas, a primeira amostra confirmou a doença em 40 (69 por cento) e a soma das duas coletas revelou lesões em 51 (88 por cento). Os resultados mostraram sensibilidade de 69 por cento com a primeira coleta e 88 por cento quando somadas as duas amostras. Essa diferença foi confirmada estatisticamente. A especificidade foi menor para as duas amostras, porém sem diferença estatística. CONCLUSÃO: Concluímos que a sensibilidade foi maior e a especificidade foi semelhante quando os resultados foram obtidos com a somação das duas amostras da citologia anal.

OBJECTIVE: The aim of this study was to know if two smears may have better sensibility and specificity than a unique smear for anal cytology. METHOD: There were 112 patients, males, HIV-positive, with current or previous anal HPV-induced lesions. Proctological examination revealed clinical disease in the anal canal of 58 of them. Smears were collect with cytobrushes. We compared results of the first smear to a sum of this with a second one. RESULTS: First smear was positive in 40 patients (69 percent), and with both smears this incidence reached 88 percent. Results showed sensibility of 69 percent to the unique smear, and 88 percent when both were summed. Statistics revealed significant difference. Specificity was higher when both smears were summed, but statistics showed no difference. CONCLUSION: We concluded sensibility of anal cytology was better and specificity was similar when results were obtained with a sum of two smears.

Rastreamento e seguimento dos portadores das lesões anais induzidas pelo papilomavírus humano como prevenção do carcinoma anal / Screening and follow-up of patients with anal HPV induced lesions for anal carcinoma prevention

O Papilomavírus humano (HPV) é o agente sexualmente transmissível mais comum na região perianal. O vírus provoca lesões clínicas e subclínicas que podem evoluir para carcinoma anal. É descrito o aumento da incidência desse tipo de tumor naqueles que praticam sexo anal; nos portadores, de ambos os sexos, de lesões genitais HPV induzidas; nas pessoas com neoplasias intraepiteliais anais de alto grau, o precursor do carcinoma, com maior incidência nos infectados pelo vírus da imunodeficiência humana (HIV), e com outras causas de supressão imunológica. Outra característica das lesões HPV induzidas é a elevada incidência de recidivas. Daí, a importância do seguimento por longo prazo e da pesquisa de meios terapêuticos para reduzir essa ocorrência. A possibilidade da detecção das lesões precursoras indica que programas padronizados de rastreamento para a prevenção do câncer anal deveriam ser instituídos. Os esfregaços anais para citologia vêm sendo realizados, com eficácia semelhante a das coletas cervicais e a colposcopia anal tem sido indicada para biópsias dirigidas quando a citologia mostrou-se alterada, embora muitos recomendam-na, também, como método de rastreamento. Nesse artigo, descrevemos a padronização da coleta de material para citologia anal e o método de realização da colposcopia anal, bem como a periodicidade com que devem ser repetidos.

The human papillomavirus is the most frequent sexually transmitted agent in anorectal area. This virus provokes clinical and sub-clinical lesions that can evolve to anal carcinoma. Its incidence is increasing among those who practice anal receptive sex; in both gender patients with genital HPV induced lesions; in those with high grade anal intra-epithelial neoplasia, anal carcinoma precursor, mainly among HIV infected persons or with other causes of immunodeficiency. Another HPV induced lesions characteristic is their elevated incidence of recurrences. Therefore, the follow-up for long periods and the new therapies research are required. The possibility of precursor lesions detection suggests that standardized programs for screening should be recommended. Anal cytology screening programs have been done with efficiency similar to genital cytology, and high resolution anoscopy has been indicated to direct biopsies, although, some authors recommended it as a method of anal cancer screening. This article described anal cytology standardization and how to perform high resolution anoscopy, as so, the periodicity they should be repeated.

Procedimiento de escisión electro-quirúrgica por asa térmica y riesgo de parto prematuro: una revisión sistemática de la literatura / Loop electrosurgical excision procedure and risk of preterm delivery: a literature review

Antecedentes: A diferencia de la conización cervical por cono frío, no se ha podido demostrar una clara asociación entre el procedimiento de escisión electro-quirúrgica por asa térmica (LEEP) y el riesgo de parto prematuro. Objetivo: Análisis crítico de la literatura científica, en relación al riesgo de presentar un parto prematuro en pacientes que han sido sometidas a LEEP, y los resultados materno-perinatales asociados. Búsqueda sistemática en múltiples bases de datos. Resultados: Se encontraron sólo tres artículos que cumplían los criterios de inclusión, los cuales son incluidos en esta revisión. De éstos, el primero muestra que el LEEP no aumenta el riesgo de parto prematuro ni de recién nacidos de bajo peso. El segundo evidencia un aumento del riesgo de rotura prematura de membranas y parto prematuro secundario a esto, pero no de parto prematuro espontáneo. Sin embargo, el tercero, señala que el LEEP se asocia en forma significativa a riesgo aumentado de parto prematuro, parto prematuro secundario a rotura prematura de membranas y recién nacidos de bajo peso. Los tres estudios son de cohortes retrospectivas, lo cual les otorga un nivel de evidencia de tipo 2b. Conclusión: La evidencia indica que la excisión de la zona de transformación a través del uso de LEEP está asociada a un pequeño, pero real incremento del riesgo de presentar un parto de pretérmino.

Background: Unlike cold-knife conization, studies have shown conflicting results on the outcome of pregnancy following loop electrosurgical excision procedure (LEEP). Objective: Critical analysis of the literature to establish if the LEEP treatments increase risk of preterm delivery and its influence in maternal-perinatal results. Results: Only three studies were filling the inclusion criteria. The first study does not show that LEEP treatment increase risk of preterm delivery and low birth weight. The second study shows increased risk of premature rupture of membranes and the subsequent preterm delivery, but not spontaneous preterm delivery. Nevertheless, the third study shows increased risk of premature rupture of membranes and the subsequent preterm delivery, spontaneous preterm delivery and low birth weight. The three studies are based in retrospective cohorts, which grant them a level of evidence of type 2b. Conclusion: The evidence indicates that loop excision of the transformation zone by LEEP is associated with a small but real increase the risk of preterm delivery.

Manejo dos portadores das neoplasias intraepiteliais anais / Managment of anal intra-epithelial neoplasia patients

Acredita-se que a neoplasia intraepitelial anal (NIA), provocada pelo HPV, seja a lesão precursora do carcinoma anal. Segundo a literatura, são encontradas entre 11 por cento e 52 por cento dos homens infectados pelo HIV, entre 6 por cento a 20 por cento dos homens e 1 por cento a 2,8 por cento das mulheres sem essa infecção. Entre 8,5 por cento e 13 por cento das NIA de alto grau evoluirão para carcinoma invasivo, indicando a necessidade do rastreamento e do seguimento desses doentes para prevenção. Não há tratamento satisfatório com baixos índices de morbidez e a recidiva é comum. Em geral, as formas de tratamento podem de ser divididas em tópicas, entre elas, ácido tricloroacético, podofilina, podofilotoxina, imiquimod, terapia fotodinâmica, e ablativas, ou seja, excisão cirúrgica, ablação pelo LASER, coagulação pelo infravermelho e eletrofulguração. Há, ainda, os que consideram aceitável a conduta expectante. O tratamento tópico se justifica pelo caráter multifocal da lesão e os ablativos têm taxas de complicação e recidiva muito semelhantes. De qualquer forma, doentes com qualquer anormalidade histológica necessitam de seguimento adequado, principalmente com colposcopia e citologia anal.

Anal intra-epithelial neoplasia (AIN), provoked by HPV, is considered as an anal cancer precursor. Some articles noticed that it occurred among 11 percent and 52 percent of men who have sex with men (MSM) infected with HIV and, among seronegatives, from 6 percent to 20 percent of men and from 1 percent to 2.8 percent of women. From 8.5 percent to 13 percent of high grade AIN will evolve to invasive carcinoma, needing follow-up and screening for prevention. There is no satisfactory treatment with low morbidity and recurrence is frequent. There are two main forms of treatment: topics (trichloroacetic acid, podophylin, podophylotoxin, imiquimod, photodynamic therapy) and ablatives (chirurgical excision, LASER, infrared, eletrocautery). Others consider acceptable an expectant management. Topical therapy is justified because of multifocal presentation of HPV induced lesions and ablative treatments have similar incidences of morbidity and recurrence. Anyway, patients with histological abnormalities need suitable follow-up, with anal Pap smears and high resolution anoscopy.

Pathologic Diagnosis of Gastric Epithelial Neoplasia / 대한소화기학회지

Gastric epithelial neoplasia is a very common disease entity in Korea, encompassing gastric adenoma and adenocarcinoma. There are still discrepancies in pathologic diagnosis of gastric epithelial neoplasia between Western and Japanese pathologists after Vienna consensus classification. With increasing use of endoscopic therapy such as endoscopic mucosal resection and endoscopic submucosal dissection, it is very important to agree on the consensus criteria in the diagnosis of gastric epithelial neoplasia among pathologists in Korea. On this background, the current concepts, and contemporary issues of definition, diagnostic and classification criteria of gastric epithelial neoplasia were reviewed.