RESUMO
Resumen El carcinoma mucinoso es una estirpe poco frecuente de cáncer de mama, la cual representa menos del 4% de todos los cánceres primarios. Suele presentarse en pacientes postmenopáusicas, alrededor de la séptima década de la vida. Clínicamente se caracteriza por manifestarse como un nódulo palpable, rara vez acompañado de otra sintomatología. Las herramientas de imagen, como la mastografía y el ultrasonido, son fundamentales para su diagnóstico; sin embargo, en algunas situaciones se puede subestimar el diagnóstico dado a las características similares que comparte con otras lesiones benignas. El diagnóstico definitivo se realiza por medio de histopatología. Debido a la rareza de estos tumores, no existe un consenso sobre el tratamiento más adecuado. Muchos autores concuerdan que la intervención quirúrgica continúa siendo la piedra angular, ya que tiene un impacto positivo en la supervivencia y baja incidencia de recurrencias. Esta se puede acompañar posteriormente de terapias endocrinas adyuvantes. Afortunadamente, el pronóstico de este tipo de tumores suele ser favorable, incluso la supervivencia supera el 90% a los 5 años.
Abstract Mucinous carcinoma is a rare type of breast cancer, which represents less than 4% of all primary cancers. It usually occurs in postmenopausal patients, around the seventh decade of life. Clinically, it is characterized by the presence of a palpable nodule, rarely accompanied by other symptoms. Imaging tools, such as mammogram and ultrasound, are essential for its diagnosis, however, in some situations the diagnosis can be underestimated due to the similar characteristics that it shares with other benign lesions. Definitive diagnosis is made by histopathology. Regarding treatment, there is no consensus on the most appropriate, due to the low incidence of these tumors. Many authors agree that surgical intervention continues to be the best option, showing a positive impact on survival and low recurrences. This can be accompanied later by adjuvant endocrine therapies. Fortunately, the prognosis of this type of tumor is usually favorable, even survival exceeds 90% at 5 years.
RESUMO
Objetivos: determinar a prevalência das neoplasias malignas epiteliais do colo uterino. Investigar a prevalência dos subtipos histológicos, o quadro clínico e a presença do papilomavírus humano em pacientes com adenocarcinoma endocervical. Método: foram analisados, por meio de microscopia óptica, todos os carcinomas do colo uterino do Grupo Hospitalar Conceição Porto Alegre, entre 1995 e 2003, determinando a prevalência dos tipos histológicos. Os casos de adenocarcinoma foram classificados quanto ao subtipo histológico (estabelecido pela Organização Mundial da Saúde), determinando, ainda, o número de lesões intra-epiteliais escamosas associadas e aferindo dados clínicos relevantes. Amostras dos casos de adenocarcinoma foram avaliadas por meio da Reação em Cadeia da Polimerase, a fim de investigar a presença do Papilomavírus Humano nessa neoplasia. Resultados: avaliaram-se 908 casos de carcinoma epidermóide (79,7%) e 229 (20,1%) de adenocarcinoma. Os subtipos mais freqüentes de adenocarcinoma compreenderam o mucinoso (190 casos 82,9%) e o endometrióide (12 casos 5,3%), havendo 72 lesões intra-epiteliais (31,5%) associadas. A idade média das pacientes correspondeu a 53,2 anos, sendo 93 assintomáticas (40,6%) e 139 multíparas (60,6%). A técnica de PCR permitiu a detecção do HPV em 182 (79,48%) dentre os 229 casos de adenocarcinoma do colo uterino, sendo o HPV 18 o tipo predominante (51,09%). Conclusão: é sugerido um aumento relativo da prevalência de adenocarcinoma endocervical, assim como seu provável vínculo com o HPV. Comprovou-se o subtipo mucinoso como o mais prevalente dentre o grupo de adenocarcinomas, sendo uma neoplasia que acomete, freqüentemente, pacientes assintomáticas, multíparas e em com idade média de 50 anos (AU)
Objectives: To determine the prevalence of neoplasias of the cervix. To investigate the prevalence of histological subtypes, the clinical picture, and the presence of the human papillomavirus (HPV) in patients with endocervical adenocarcinoma. Methods: We analyzed all cases of carcinoma of the uterine cervix, which has occurred in the Grupo Hospitalar Conceição, Porto Alegre, between 1995 and 2003, determining their prevalence. The cases of adenocarcinoma were classified according to histological subtype (as established by the World Health Organization), determining, too, the number of associated squamous intraepithelial lesions and appraising relevant clinical data. Samples of cases of adenocarcinoma were assessed by means of Polymerase Chain Reaction (PCR) to investigate the presence of the HPV in this neoplasia. Results: A total of 908 cases of epidermoid carcinoma (79.7%) and 229 (20.1%) cases of adenocarcinoma were evaluated. The most frequent subtypes of adenocarcinoma were the mucinous (190 cases 82.9%) and endometrioid (12 cases 5.3%) types, with 72 associated intraepithelial lesions (31.5%). The mean age of patients was 53.2 years, 93 patients were asymptomatic (40.6%), and 139 were multiparas (60.6%). The PCR technique allowed the detection of HPV in 182 (79.48%) of the 229 cases of adenocarcinoma, HPV 18 being the prevailing type (51.09%). Conclusion: A concerning increase in the prevalence of endocervical adenocarcinoma is suggested, as well as its likely connection with the HPV. The mucinous subtype was confirmed as the most prevalent one among the group of adenocarcinomas, being a neoplasia that often affects asymptomatic, multiparous patients with mean age of 50 years (AU)