Experiencia en cirugía de condilomas anales en mayores de 15 años / Experience in anal condyloma surgery in patients older than 15 years

Resumen Objetivo: Describir la experiencia en cirugía electiva de condilomas anales en pacientes mayores de 15 años en un hospital terciario de la Región Metropolitana. Material y Método: Estudio observacional retrospectivo y descriptivo, en el cual se analizan las intervenciones quirúrgicas electivas realizadas entre 2008 a 2021. Resultados: Dentro del período analizado se obtuvo 165 cirugías de condilomas anales, lo que corresponde a 137 pacientes en total. El 85% de los pacientes son de sexo masculino, el 68% de los pacientes son VIH positivo, un 87% de los pacientes MSM (hombres que tienen sexo con otros hombres) son VIH positivo, el 34% de los pacientes tiene antecedente de ETS, el 46% de los pacientes recibió terapia tópica como tratamiento preoperatorio o posoperatorio. Un 25% de los pacientes presenta recidiva en su historia personal, un 21% de los pacientes presenta lesiones anales intraepiteliales de alto grado, un 6% presenta carcinoma escamoso infiltrante. No hubo mortalidad descrita. Discusión: El presente estudio, describe la experiencia en cirugía de condilomas de un hospital terciario de la Región Metropolitana de Chile, cuya población corresponde a un estrato socioeconómico medio y bajo. Se logra describir a la población que es intervenida de condilomas acuminados, además de sus resultados quirúrgicos precoces y a largo plazo. Conclusión: El presente estudio, presenta una población de 137 pacientes operados de condilomas anales, a partir de los hallazgos de la cirugía. Se cumple el objetivo del estudio de caracterizar en un período de 12 años los resultados quirúrgicos de dicha serie, algo no reportado previamente en la literatura chilena.

Objective: To describe the experience in elective surgery for anal condylomas in patients over 15 years of age in a tertiary hospital in the Metropolitan Region. Materials and Method: Retrospective and descriptive observational study about elective surgical interventions performed between 2008 to 2021. Results: Within the analyzed period, 165 anal warts surgeries were obtained, corresponding to 137 patients. 85% of the patients are male, 68% are HIV positive, 87% of the MSM patients are HIV positive, 34% of the patients have a history of STDs, 46% of the patients received topical therapy as preoperative or postoperative treatment. 25% present recurrence in their personal history, 21% present high-grade anal intraepithelial lesions, 6% present infiltrating squamous carcinoma. There was no reported mortality. Discussion: The present study describes the experience in condyloma surgery in a tertiary hospital in the Metropolitan Region of Chile, whose population corresponds to a medium and low socioeconomic stratum. It is possible to describe the population that undergoes surgery for this reason, in addition to its early and long-term surgical results. Conclusion: The present study presents a population of 137 patients operated on for anal condylomas, based on the findings of the surgery. The objective of the study to characterize the surgical results of this series over a 12-year period is fulfilled, something not previously reported in the Chilean literature.

Case of large lentigo maligna melanoma of the scalp treated with 5% and 3. 75% Imiquimod

Abstract The paper presents a case of lentigo maligna melanoma of the scalp in an elderly patient treated for the nodular part with surgery and the residual melanoma in situ with 5% Imiquimod and subsequently with 3.75% Imiquimod (each concentration for 4 months, 5 times per week), with complete regression of the lesion. 3.75% Imiquimod, which is already used for the treatment of actinic keratosis, could be a useful weapon with the same effectiveness and fewer side effects compared to 5% Imiquimod.

Efficacy and safety of oral pyrotinib in HER2 positive metastatic breast cancer: real-world practice / 北京大学学报(医学版)

OBJECTIVE@#Pyrotinib, a novel irreversible pan-ErbB receptor tyrosine kinase inhibitor, showed promising antitumor activity and acceptable tolerability in phase II and phase III randomized clinical trials. We assessed the activity and safety of oral pyrotinib for human epidermal growth factor receptor 2 (HER2) positive metastatic breast cancer patients in the real world.@*METHODS@#We retrospectively analyzed 72 HER2 positive metastatic breast cancer (MBC) patients who received oral pyrotinib based regimens at Beijing Cancer Hospital and other four hospitals (Peking University First Hospital, China-Japan Friendship Hospital, General Hospital of PLA, Peking University Third Hospital) from August 2018 to September 2019. Progression free survival (PFS), objective response rate (ORR), adverse events (AE) of pyrotinib were investigated.@*RESULTS@#Seventy-two patients with HER2 positive MBC were enrolled. The median age of the patients was 55 years (range: 32-79 years). Sixty-nine (95.8%) patients had received anti-HER2 treatment in the metastatic and/or (neo) adjuvant settings; 61 (84.7%) patients had received anti-HER2 treatments in the metastatic setting in terms of trastuzumab 56 (77.8%) patients, lapatinib 36 (50.0%) patients, and T-DM1 4 (5.6%) patients. Among these 72 patients who received oral pyrotinib based regimens, 62 (86.1%) patients received pyrotinib (±trastuzumab) in combination with chemotherapy, 6 (8.3%) patients received pyrotinib (± trastuzumab) in combination with endocrine therapy and 4 (5.6%) patients received pyrotinib (±trastuzumab). Sixty-five (90.3%) patients received 400 mg pyrotinib once daily as initial dose, and 7 (9.7%) patients received 320 mg. OBJECTIVE response and safety to pyrotinib based therapy were evaluable in all the 72 patients. One (1.4%) patient achieved complete response (CR), 18 (25.0%) patients achieved partial response (PR), 41 (56.9%) patients had stable disease (SD), and 12 (16.7%) patients had progressive disease (PD). The ORR (CR+PR) was 26.4% and the median PFS was 7.6 months (95%CI: 5.5-9.7 months). Among the 36 patients with prior lapatinib therapy, the median PFS was 7.9 months (95%CI: 4.1-11.7 months). Among the 15 patients with brain metastasis, the median PFS was 6.0 months (95%CI: 2.2-9.8 months). The main toxicities related to pyrotinib were diarrhea in 57 (79.2%) cases, and 48 (66.7%) cases with grade 1-2 as well as 9 (12.5%) cases with grade 3.@*CONCLUSION@#Pyrotinib based therapy is an effective treatment for patients with HER2 positive MBC, including patients with lapatinib treatment failure and brain metastasis, and the toxicities can be tolerated.

Dermatoscopy-guided therapy of pigmented basal cell carcinoma with imiquimod

Abstract BACKGROUND: Dermatoscopy is a non-invasive diagnostic tool used to examine skin lesions with an optical magnification. It has been suggested as a useful tool for monitoring therapeutic response in lentigo maligna patients treated with imiquimod. OBJECTIVE: To examine the accuracy of dermatoscopy as a tool to monitor the therapeutic response of pigmented basal cell carcinoma treated with imiquimod. METHOD: The authors designed a prospective study. Patients with pigmented basal cell carcinoma were included and data regarding the dermatoscopy features were collected following the Menzies criteria, prior to initiating the imiquimod treatment. Subsequent dermatoscopic evaluations were performed at weeks 4 and 8, following imiquimod discontinuation. RESULTS: Twenty lesions were included. The most common pigmented dermatoscopy features were large blue-grey ovoid nests (80%), followed by blue-grey globules (50%) and leaf-like areas (30%). No spoke wheel areas were observed. In 17 out of 20 patients, a response was noted during the first evaluation at 4 weeks, while the clearance was noted at the second check-up after 8 weeks. In two patients, the clearance was found at the initial evaluation at 4 weeks, while in one patient, the response remained unchanged. Blue-grey globules were the fastest to exhibit clearance (50% at week 4), followed by leaf-like areas (15%) and large blue-grey ovoid nests (6.25%). CONCLUSION: According to our results, dermatoscopic evaluation enhances the accuracy in the assessment of the clinical response to imiquimod in pigmented basal cell carcinoma.

Neoplasia vaginal intraepitelial / Vaginal intraepithelial neoplasia

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

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

Herpes hipertrófico perianal tratado eficazmente com imiquimod / Hypertrophic perianal herpes successfully treated with imiquimod

A infecção pelo vírus herpes simples tipo 2 (HSV-2) é frequente em pacientes infetados pelo vírus de imunodeficiência adquirida (VIH). Nestes casos, o herpes genital pode ter uma apresentação clínica atípica. As variantes hipertróficas e vegetantes são pouco habituais. Os autores relatam um caso de herpes hipertrófico perianal em paciente infetada pelo VIH, com resposta insatisfatória ao aciclovir e valaciclovir, tratado eficazmente com imiquimod tópico. O herpes genital hipertrófico é, frequentemente, refratário aos tratamentos antivirais. Na nossa experiência, o imiquimod é um tratamento eficaz, seguro e bem tolerado que deverá ser considerado na abordagem terapêutica destes pacientes.

Herpes simplex virus type 2 (HSV-2) infections are frequent in HIV (human immunodeficiency virus) infected patients. In those cases, genital herpes may have an atypical clinical presentation. Hypertrophic and vegetating variants are unusual. The authors describe a case of hypertrophic perianal herpes in an HIV patient with unsatisfactory response to acyclovir and valacyclovir, successfully treated with imiquimod. Hypertrophic genital herpes cases are frequently refractory to antiviral treatments. In our experience, imiquimod is an efficient, safe and well tolerated treatment that should be considered in therapeutic approach of these patients.

Associação de aciclovir oral e imiquimode no tratamento de herpes simples genital hipertrófico em paciente com sida: relato de dois casos / Association of oral acyclovir and imiquimod for the treatment of hypertrophic genital herpes simplex in HIV positive patients: report of two cases

Herpes simples crônico é doença capaz de gerar apresentações exuberantes, principalmente em pacientes com sida. O provável mecanismo da formação dessas lesões hiperplásicas consiste na invasão viral dos linfócitos T CD4 situados na epiderme. Diante das dificuldades terapêuticas e da grande taxa de insucesso do tratamento nesses pacientes, novas terapias têm sido citadas na literatura atualmente. O conhecimento da imunopatologia ratificou o mecanismo pelo qual o imiquimode poderia ser eficaz como terapia adjuvante aos antivirais. Relatamos aqui dois casos de pacientes tratados com aciclovir associado ao imiquimode tópico que obtiveram resposta clínica excepcional.

Chronic herpes simplex can present as exuberant clinical lesions, especially in HIV patients. The most probable mechanism of formation of these lesions is the invasion of the epidermal CD4 T cells by the herpes simplex virus. Due to the therapeutic difficulties and the high rates of treatment failure amongst these patients, new drugs are currently being discussed on the literature. Studies based on the immunophatology of these lesions have suggested that imiquimod might work as an adjuvant therapy to the antiviral drugs. Here we present two cases of excellent response to treatment with topical imiquimod as an adjuvant drug to acyclovir.

Lentigo maligno tratado com imiquimode tópico: o valor da dermatoscopia no monitoramento clínico / Lentigo maligna treated with topical imiquimod: dermatoscopy usefulness in clinical monitoring

A dermatoscopia tem seu uso consagrado na avaliação diagnóstica de lesões melanocíticas. Recentemente, entretanto, tem se revelado também como importante ferramenta no acompanhamento da resposta terapêutica em diversas dermatoses. Relatamos o caso de uma paciente idosa, com diagnóstico de lentigo maligno de difícil manejo cirúrgico, para a qual optamos pelo uso do imiquimode tópico. O acompanhamento dermatoscópico dessa alternativa terapêutica se mostrou de grande utilidade.

Dermoscopy has its usefulness well established in the diagnostic evaluation of melanocytic lesions. Recently, however, it has also shown to be an important tool in monitoring therapeutic response to various dermatoses. We report the case of an elderly patient diagnosed with lentigo maligna of difficult surgical management, which we have chosen to treat with topical imiquimod. The dermoscopic monitoring of this alternative therapy has shown to be of great usefulness.

Avanços no tratamento da leishmaniose tegumentar do novo mundo nos últimos dez anos: uma revisão sistemática da literatura / Advances in the treatment of cutaneous leishmaniasis in the new world in the last ten years: a systematic literature review

INTRODUÇÃO: O arsenal terapêutico contra a leishmaniose tegumentar é muito restrito. Os antimoniais pentavalentes permanecem como as drogas de escolha para seu tratamento há mais de 50 anos. Apesar da sua eficácia, necessita de injeções diárias, apresenta muitos efeitos colaterais e tempo de cura prolongado.

INTRODUCTION: The therapeutic arsenal against cutaneous leishmaniasis is very limited. Pentavalent antimonial compounds have been the drugs of choice for treatment of this disease for over 50 years. Despite their effectiveness, these drugs require daily injections, have many side effects and present prolonged healing time.

Remissão de lentigo maligno extenso após tratamento com imiquimod / Remission of extensive lentigo maligna after treatment with imiquimod

Lentigo maligno é um melanoma in situ que mais comumente surge em áreas expostas à radiação ultravioleta, nos pacientes idosos. O tratamento é realizado, principalmente, para minimizar o risco de progressão para lentigo maligno melanoma. O presente relato se refere a uma paciente idosa com lesões recorrentes de lentigo maligno na face, tratada com sucesso com imiquimod tópico, mostrando que este pode ser um tratamento útil, em determinados casos da doença.

Lentigno maligna is a melanoma in situ that most commonly appears on areas exposed to ultraviolet radiation, in elderly patients. Treatment is required mainly to minimize the risk of progression to lentigo maligna melanoma. The present report refers to an elderly patient with recurrent lesions of lentigo maligna in her face, who was successfully treated with topical imiquimod, which showed to be a useful therapy for some cases of the disease.

Neoplasias genitales intraepiteliales: a propósito de dos pacientes inmunosuprimidos / Penile intraepithelial neoplasia: two case report

Las neoplasias genitales intraepiteliales constituyen lesiones que afectan a todo el espesor de la epidermis e incluyen entidades específicas, como la eritroplasia de Queyrat, la enfermedad de Bowen y papulosis bowenoide. Actualmente se describe aumento de la frecuencia de neoplasias intraepiteliales, pero la real incidencia de los carcinomas in situ genitales es desconocida. Se describen factores predisponentes, tanto para las neoplasias in situ como para los carcinomas invasores, dentro de los que se encuentran los pacientes no circuncidados, deficiente higiene genital, balanitis recurrente, liquen escleroso, fimosis, inmunosupresión, infección por virus papiloma humano, etc. Existen distintas terapias descritas para estas lesiones; sin embargo, aún no hay consenso en su manejo. Las opciones de tratamiento dependen de la localización, de la extensión de la enfermedad, costo de la terapia, etc. En general se ha descrito recidiva de las lesiones, con todos los tratamientos mencionados; no obstante, la cirugía micrográfica de Mohs es considerada por algunos autores la terapia de elección en estos casos. En este artículo se presentan dos casos de neoplasias genitales intraepiteliales tratadas con Imiquimod 5 por ciento y 5-Fluoracilo con buenos resultados.

The intraepithelial neoplasias of genitals are lesions that affect all the thickness of the epidermis and include specific carcinomas such as erythroplasia of Queyrat, Bowen’s disease and bowenoid papulosis. Presently, there is an increase in the frequency of intraepithelial neoplasias, but the real incidence of in situ genital carcinoma is unknown. Many predisposing factors are described for both in situ and invasive carcinomas, for example, the lack of circumcision, poor genital hygiene, recurrent balanitis, penile lichen sclerosus, phimosis, immune suppression, HPV infections, etc. Different therapies are described for these illnesses, but there is no uniform guideline assessment. Treatment depends on location, extension of the illness, cost of the therapy, etc. In general, recurrence of carcinomas has been described with all treatments, although Mohs micrographic surgery is considered by some authors as the therapy of choice in these cases. We present two cases of intraepithelial neoplasias of genitals that were treated with Imiquimod 5 percent and 5-Fluoracilo with positive results.

Imiquimod 5 por ciento tópico en control de carcinoma verrucoso inguinal: caso clínico: seguimiento a siete años / Imiquimod 5 percent cream in control of verrucous carcinoma: seven years follow up

El carcinoma de Verrucous en el área anogenital ha sido reportado bajo una variedad de nombres, incluyendo el condiloma acuminado gigante o tumor de Buschke-Loewenstein. Histológicamente, corresponde a un carcinoma espinocelular bien diferenciado. Se ha descrito una variedad de alternativas terapéuticas, siendo de primera elección la extirpación quirúrgica. El Imiquimod en crema al 5 por ciento representa un modificador tópico de la respuesta inmune. Actualmente está siendo utilizado en el tratamiento de una variedad de enfermedades cutáneas. Objetivo: Revisión del tema y presentación del primer caso de carcinoma verrucous anogenital tratado con cirugía shaving más criocirugía e imiquimod al 5 por ciento en crema con un seguimiento de siete años. Caso clínico: Paciente de sexo masculino, de 55 años, heterosexual, con antecedentes de lesión tumoral inguino-escroto-perineal derecha de 15 años de evolución y de crecimiento lentamente progresivo. Su primera consulta dermatológica se efectúa el 04.02.99. Se extirpa nódulo de tamaño mayor tamaño para examen histopatológico tipificación VPH por PCR (positivo para genotipos 6 y 11) Se diagnostica carcinoma espinocelular de bajo grado de malignidad. Se utilizaron en su tratamiento múltiples técnicas combinadas con métodos citodestructivos e inmunoterapia. Posteriormente se iniciaron ciclos de imiquimod 5 por ciento (una aplicación nocturna tres veces por semana) por seis semanas y luego ciclos de cuatro semanas cada uno, dos-tres veces al año. Se hizo un seguimiento a siete años, logrando erradicar exitosamente la enfermedad clínica y controlando las recidivas de forma satisfactoria.

Verrucous carcinoma of the anogenetal region has been reported under a series of names, including giant condyloma acuminatum or Buschke-Loewenstein tumor. Histologically, it corresponds to a well differentiated squamous carcinoma. A number of therapeutic alternatives have been described, the first choice being surgical removal. Imiquimod cream 5 percent represents a topical modifier of the immune response, and is currently being used in the treatment of a series of skin diseases. Objective: We present a review of the literature and the first case of anogenital verrucous carcinoma treated with a seven-year follow-up. Clinical case: A55-year-old man, with a history of a giant condyloma acuminatum with histological evidence of a low degree multiple techniques combined with cytodestructive methods and immunotherapy. A seven-year follow-up was carried out, success-fully eradicating the clinical disease and controlling recurrence with cycles of imiquimod cream 5 percent treatment (average 3 monthly treatment cycles per year).