Analysis of natural regression and influencing factors of HSIL in the cervix of childbearing age patients / 中华妇产科杂志

Objective: To investigate the natural regression and related factors of high-grade squamous intraepithelial lesion (HSIL) in the cervix of childbearing age women, and to evaluate the applicability of conservative management for future fertility needs. Methods: This study included 275 patients of reproductive age with fertility needs, who were diagnosed as HSIL by biopsy from April 30, 2015 to April 30, 2022, including 229 cases (83.3%) cervical intraepithelial neoplasia (CIN) Ⅱ and 46 cases (16.7%) CIN Ⅱ-Ⅲ. They were followed-up without immediate surgery in the First Affiliated Hospital of Nanjing Medical University. The median follow-up time was 12 months (range: 3-66 months). The regression, persistence and progression of lesions in patients with HSIL were analyzed during the follow-up period, the influencing factors related to regression and the time of regression were analyzed. Results: (1) Of the 275 HSIL patients, 213 cases (77.5%, 213/275) experienced regression of the lesion during the follow-up period. In 229 CIN Ⅱ patients, 180 cases (78.6%) regressed, 21 cases (9.2%) persisted, and 28 cases (12.2%) progressed. In 46 CIN Ⅱ-Ⅲ patients, 33 cases (71.7%) regressed, 12 cases (26.1%) persisted, and 1 case (2.2%) progressed to invasive squamous cell carcinoma stage Ⅰ a1. There was no significant difference in the regression rate between the two groups (χ2=1.03, P=0.309). (2) The average age at diagnosis, age <25 years old at diagnosis were independent influencing factor of HSIL regression in univariate analysis (all P<0.05). There was no significant difference between HSIL regression and pathological grading, the severity of screening results, human papillomavirus (HPV) genotype, colposcopy image characteristics, number of biopsies during follow-up and pregnancy experience (all P>0.05). (3) The median regression times for patients aged ≥25 years and <25 years at diagnosis were 15 and 12 months, respectively. Kaplan-Meier analysis showed that age ≥25 years at diagnosis significantly increased the median regression time compared to <25 years (χ2=6.02, P=0.014). Conclusions: For HSIL patients of childbearing age, conservative management without immediate surgical intervention is preferred if CINⅡ is fully evaluated through colposcopy examination. Age ≥25 years at diagnosis is a risk factor affecting the prognosis of HSIL patients.

A rare case of recurrent acute pancreatitis after EUS-FNA in a patient with pancreatic intraepithelial neoplasia type 2 / Un raro caso de pancreatitis aguda recurrente después de EUS-FNA en un paciente con neoplasia intraepitelial tipo 2

Pancreatic intraepithelial neoplasia (PanIN) is considered a pre-malignant lesion difficult to identify by imaging methods. EUS- FNA is an effective technique to obtain material for histopathological study of pancreatic cystic tumors, but it is not free of adverse events. We report a case of a 56 years old patient, with chronic abdominal pain (early 1994). MRI showed pancreatic cystic images. The etiologic diagnosis was doubtful and EUS-FNA was performed. Immediately after a FNA, patient had an episode of acute pancreatitis, requiring hospitalization. During one year after FNA he had five episodes of AP. A new EUS suspected of PanIN, which was confirmed by surgery. After surgery the patient is well and has no more episodes of AP. Although the risk of AP, EUS-FNA should be performed to determine the best treatment for these patients with chronic abdominal pain who have cystic changes of pancreatic gland.

La neoplasia intraepithelial pancreática (PanIN) es considerada una lesión premaligna con dificultad diagnostica mediante métodos imagenlógicos. La EUS-FNA es una técnica efectiva para obtener material para el estudio histopatológico de tumores quísticos pancreáticos, pero no está libre de efectos adversos. Nosotros reportamos un caso de un paciente de 56 años de edad, con dolor abdominal cronico (desde 1994). En la resonancia abdominal se observó un quiste pancreático. El diagnostico etiológico fue dudoso y EUS-FNA fue realizada, después de la cual el paciente presento un cuadro de pancreatitis, requiriendo hospitalización. Durante el periodo de un año posterior a la FNA, éste presento cinco episodios de pancreatitis aguda. Un nuevo estudio ecoendoscopico dio la sospecha de PanIN, la cual se confirmó con la realización de la cirugía. Después de la cirugía quedo asintomático y sin presentar nuevos episodios de pancreatitis aguda hasta el momento. Aunque exista riego de pancreatitis aguda, la EUS-FNA debe realizarse para determinar el mejor tratamiento para pacientes con dolor abdominal crónico que tienen cambios quísticos de la glándula pancreática.

Evaluation of survivin immunoexpression in the differentiation of high- and low-grade breast ductal carcinoma in situ / Expressão da proteína survivina em carcinoma ductal in situ de mama de alto e de baixo grau

ABSTRACT Objective To evaluate the expression of survivin protein in low- and high-grade ductal carcinoma in situ. Methods Breast tissue fragments obtained by incisional biopsy and surgical procedures of 37 women with ductal carcinoma in situ of the breast were subdivided into two groups: Group A, composed of women with low-grade ductal carcinoma in situ, and Group B, women with high-grade ductal carcinoma in situ. Survivin protein expression test was performed by immunohistochemistry, using a monoclonal antibody clone I2C4. The criterion to evaluate survivin immunoexpression was based on the percentage of neoplastic cells that presented brown-gold staining. This criterion was positive when the percentage of stained cells was ≥10%. Results The survivin protein was expressed in 22 out of 24 cases of high-grade ductal carcinoma in situ (78%), whereas, in Group A, of low-grade ductal carcinoma in situ (n=13), it was positive in only 6 cases (21.40%; p=0.004). Conclusion The frequency of expression of survivin was significantly higher in the group of patients with high-grade ductal carcinoma in situ compared to those in the low-grade ductal carcinoma in situ group.

RESUMO Objetivo Avaliar a imunoexpressão da proteína survivina nos carcinomas ductais in situ de mama de baixo e de alto graus. Métodos Fragmentos de tecido mamários obtidos por biópsia incisional e procedimentos cirúrgicos de 37 mulheres acometidas por carcinoma ductal in situ de mama foram subdivididos em dois grupos: Grupo A, formado por mulheres com carcinoma ductal in situ de baixo grau; e Grupo B, por mulheres com carcinoma ductal in situ de alto grau. A pesquisa de expressão da proteína survivina foi realizada pela técnica de imuno-histoquímica, utilizando-se anticorpo monoclonal clone I2C4. O critério de avaliação da imunoexpressão da survivina baseou-se na percentagem de células neoplásicas que apresentava coloração castanho-dourada. Considerouse tal critério positivo quando a percentagem de células apresentasse marcação ≥10%. Resultados A proteína survivina apresentou-se expressa em 22 dos 24 casos de carcinoma ductal in situ de alto grau (78%), enquanto no Grupo A, de carcinoma ductal in situ de baixo grau (n=13), apresentou-se positiva em apenas 6 casos (21,40%; p=0,004). Conclusão O índice de frequência de expressão da survivina foi significativamente mais elevado no grupo de pacientes com carcinoma ductal in situ de alto grau, quando comparado às do grupo com carcinoma ductal in situ de baixo grau.

Erythroplasia of Queyrat treated with topical 5-fluorouracil

Abstract We report a 33-year-old male patient diagnosed with erythroplasia of Queyrat. The patient had an erythematous and eroded lesion affecting more than 50% of the glans associated with bleeding and local pain. Despite previous indication of penectomy, he was successfully treated with topical 5-fluorouracil.

Ductal carcinoma in situ of the breast: Evaluation of main presentations on magnetic resonance imaging compared with findings on mammogram and histology / Carcinoma ductal in situ mamário: avaliação das principais apresentações à ressonância magnética em correlação com os achados da mamografia e histologia

SUMMARY Objective: The purpose of this study was to evaluate the various morphologies and kinetic characteristics of the ductal carcinoma in situ (DCIS) on breast magnetic resonance imaging (MRI) exam, to establish which are the most prevalent and to determine the effectiveness of the method in the detection of DCIS. Method: A prospective observational study, starting in May 2014. We evaluated 25 consecutive patients with suspicious or highly suspicious microcalcifications on mammography screening, BI-RADS categories 4 and 5, who underwent breast MRI and then surgery with proven diagnosis of pure DCIS. Surgery was considered the gold standard for correlation between histologic findings and radiological findings obtained on MRI. Results: The most frequent morphological characteristic of DCIS on MRI was non-mass-like enhancement (NMLE), p<0.001, observed in 22/25 (88%) patients (95CI 72.5-100). Of these, segmental distribution was the most prevalent, represented by 9/22 (40.91%) cases (95CI 17.4-64.4), p=0.306, and a clumped internal enhancement pattern was most commonly characterized in DCIS, observed in 13/22 (50.09%) cases. Conclusion: DCIS has a wide variety of imaging features on MRI and being able to recognize these lesions is crucial. Its most common morphological presentation is non-mass-like enhancement, while segmental distribution and a clumped internal enhancement pattern are the most common presentations. Faced with the combined analysis of these findings, percutaneous core needle biopsy (core biopsy) or vacuum-assisted biopsy (VAB) should be encouraged.

RESUMO Objetivo: avaliar as várias morfologias e características cinéticas do carcinoma ductal in situ (CDIS) ao exame de ressonância magnética (RM) de mama, estabelecer as mais prevalentes e determinar a eficácia do método na detecção do CDIS. Método: estudo prospectivo e observacional, com início em 2011 e duração de 24 meses. Foram avaliadas 25 pacientes consecutivas que apresentaram microcalcificações suspeitas ou altamente suspeitas ao exame mamográfico de rastreamento, categorias 4 e 5 de BI-RADS, que realizaram RM mamária e, posteriormente, foram submetidas à cirurgia com resultado comprovado de CDIS puro. A cirurgia foi considerada padrão-ouro para correlação entre os resultados histológicos e os achados radiológicos obtidos à RM. Resultados: a característica morfológica do CDIS mais frequente à RM foi o realce não nodular (p<0,001), observada em 22/25 (88%) casos (IC 95% 72,5-100). Dentre estes, a distribuição segmentar foi a mais prevalente, representada por 9/22 (40,91%) casos (IC 95% 17,4-64,4), p=0,306, e o realce interno tipo clumped foi o padrão mais frequentemente caracterizado no CDIS, observado em 13/22 (50,09%) casos. Conclusão: o CDIS tem uma grande variedade de características imaginológicas à RM e é fundamental reconhecê-las. A apresentação morfológica mais comum é o realce não nodular, sendo a distribuição segmentar e o padrão interno de realce tipo clumped as apresentações mais frequentes. Diante da análise combinada desses achados, a biópsia percutânea por agulha grossa (core biopsy) ou assistida a vácuo (mamotomia) deve ser encorajada.

Excisão, crioterapia e mitomicina C no tratamento da neoplasia intraepitelial córneo-conjuntival / Excision, cryotherapy and mitomycin c for the treatment of conjunctival-corneal intraepithelial neoplasia

RESUMO Objetivo: Avaliar a segurança e eficácia de três técnicas distintas para o tratamento de neoplasia intraepitelial córneo-conjuntival. Métodos: Vinte e seis pacientes, 11 mulheres e 15 homens, com idade entre 32 e 88 anos (média 64,84 anos), atendidos entre 1999 e 2014, foram incluídos neste estudo. Todos os pacientes foram submetidos à exérese da lesão com margem de segurança de 4mm e crioterapia a 2mm do limbo. Conforme o tratamento complementar, os pacientes foram divididos em três grupos: Grupo 1 (8 olhos): recobrimento conjuntival e 2 ciclos de mitomicina C 0,02% (MMC) 4x/dia por 10 dias, com intervalo de 30 dias entre os ciclos. Grupo 2 (9 olhos): recobrimento com membrana amniótica e 3 ciclos de MMC 3x/dia por 10 dias, com intervalo de 10 dias entre o 1º e o 2º ciclo e 30 dias entre 2º e o 3º ciclo. Grupo 3 (9 olhos): recobrimento com membrana amniótica sem o uso de MMC. O acompanhamento dos pacientes variou de 3 meses a 14 anos (média: 4 anos). Resultados: Vinte e três pacientes apresentaram erradicação da lesão com um único tratamento. Três pacientes do Grupo 3 apresentaram recidiva da lesão após 3 meses, 6 meses e 1 ano do tratamento. Dois deles foram retratados pela técnica 1, sem nova recidiva após seguimento de 3 e 4 anos; o outro paciente foi submetido à enucleação. Não foram observados efeitos colaterais relacionados ao uso da mitomicina C durante o seguimento. Conclusão: Após exérese da lesão e crioterapia, os pacientes tratados com recobrimento conjuntival ou membrana amniótica associado à mitomicina C mostraram tendência a resultados mais eficazes.

ABSTRACT Purpose: To evaluate the safety and efficacy of three different techniques for the treatment of conjunctival-corneal intraepithelial neoplasia. Methods: Twenty-six eyes of 26 patients, 11 women and 15 men were included in a nonrandomized, retrospective, observational case series. Mean patient age was 64 years (range, 32-88 years).All patients were treated from 1999 to 2014. Mean postoperative follow-up was 4 years (range, 3 months to 14 years). All patients underwent excision of the lesion with a 4-mm safety margin and a 2-mm from the limbus cryotherapy. As further treatment the patients were divided into three groups: Group 1 (8 eyes): conjunctival autograft and 2 cycles of mitomycin C 0.02% (MMC) eye drops, four times daily for 10 days with an interval of 30 days between cycles. Group 2 (9 eyes): amniotic membrane (AM) graft and 3 cycles of MMC eye drops, three times daily for 10 days with an interval of 10 days between the 1st and 2nd cycle and 30 days between the 2nd and 3rd cycle. Group 3 (9 eyes): AM graft without MMC eye drops. Results: After a single treatment, the lesions were eradicated in twenty-three patients. Recurrence was noted in three patients from Group 3 at 3 months, 6 months and 1 year after treatment. Two of them were retreated by the technique used in Group 1 without further recurrence; the other patient underwent enucleation. No adverse effects related to the use of mitomycin C were observed during. There were no side effects related to the use of mitomycin C during follow-up. Conclusion: After surgical excision and cryotherapy, patients treated with conjunctival or amniotic membrane graft associated with mitomycin C, showed a tendency to more effective results.

In situ carcinoma developed over oral lichen planus: a case report with analysis of BUB3, p16, p53, Ki67 and SOX4 expression

AbstractOral lichen planus (OLP) represents a common mucocutaneous disease. Various authors have suggested that OLP has malignant potential; however, the mechanisms involved in malignant transformation have not yet been elucidated. A 79-year-old man presented a white lesion for five months in the buccal mucosa diagnosed as OLP. After two months using 0.05% clobetasol ointment for treatment, the lesion became ulcerated. A new biopsy of the same lesion was performed, and histological analysis showed an in situ oral carcinoma (ISOC). An immunohistochemistry panel was performed, and p16 expression was negative in OLP, however, it showed weak cytoplasmic staining in ISOC. There was strong nuclear BUB3 staining in both OLP and ISOC areas. p53 showed less intense nuclear staining in both regions. Ki67 was negative in OLP area, but showed nuclear staining in the ISOC. SOX4 was negative in both studied areas. BUB3 expression, first reported in this case, and the p16 expression may suggest some influence of these genes on pathogenesis or malignant potential of OLP.

Gene expression of estrogen receptor-alpha in orbital fibroblasts in Graves’ ophthalmopathy

Graves’ ophthalmopathy (GO) is one of the most severe clinical manifestations of Graves’ disease (GD), and its treatment might involve high-dose glucocorticoid therapy. The higher incidence of GO among females, and the reported association between polymorphisms of estrogen receptor (ER) and GD susceptibility have led us to question the role of estrogen and its receptor in GO pathogenesis. We, thus, assessed estrogen receptor-alpha (ERA) gene expression in cultures of orbital fibroblasts from a patient with GO before (controls) and after treatment with 10 nM and 100 nM dexamethasone (DEX). Orbital fibroblasts showed ERA gene expression. In the cells treated with 10 nM and 100 nM DEX, ERA gene expression was, respectively, 85% higher and 74% lower, than in the control group. We concluded that ERA gene expression is found in the orbital fibroblasts of patient with GO, which may be affected by glucocorticoids in a dose-related manner. Arch Endocrinol Metab. 2015;59(3):273-6.

Auditory Brainstem Response in Term and Preterm Infants with Neonatal Complications: The Importance of the Sequential Evaluation

Introduction Literature data are not conclusive as to the influence of neonatal complications in the maturational process of the auditory system observed by auditory brainstem response (ABR) in infants at term and preterm. Objectives Check the real influence of the neonatal complications in infants by the sequential auditory evaluation. Methods Historical cohort study in a tertiary referral center. A total of 114 neonates met inclusion criteria: treatment at the Universal Neonatal Hearing Screening Program of the local hospital; at least one risk indicator for hearing loss; presence in both evaluations (the first one after hospital discharge from the neonatal unit and the second one at 6 months old); all latencies in ABR and transient otoacoustic emissions present in both ears. Results The complications that most influenced the ABR findings were Apgar scores less than 6 at 5 minutes, gestational age, intensive care unit stay, peri-intraventricular hemorrhage, and mechanical ventilation. Conclusion Sequential auditory evaluation is necessary in premature and term newborns with risk indicators for hearing loss to correctly identify injuries in the auditory pathway. .

Staging classification for cancer of the ovary and the fallopian tube should include in situ carcinoma / 부인종양

No abstract available.

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

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

Long-Term Outcome after Endoscopic Submucosal Dissection in Patients with Superficial Esophageal Squamous Cell Carcinoma: A Single-Center Study

BACKGROUND/AIMS: Superficial esophageal squamous cell carcinoma (SESCC) is being increasingly detected during screening endoscopy. Endoscopic submucosal dissection (ESD) allows for en bloc and histologically complete resection of lesions. This study assessed the technical feasibility and long-term outcomes of ESD for SESCCs. METHODS: Between January 2005 and August 2012, 27 patients with 28 SESCCs underwent ESD at Pusan National University Hospital. The en bloc and pathologically complete resection rates, complication (perforation and bleeding) rate, incidence of esophageal stricture after ESD, and overall and disease-specific survival rates were evaluated. RESULTS: The en bloc and pathologically complete resection rates were 93% and 83%, respectively. No significant bleeding occurred, and perforation with mediastinal emphysema was observed in two patients (7%). Post-ESD stricture occurred in two patients (7%) who had mucosal defects involving more than three-fourths of the esophageal circumference. During a mean follow-up of 23 months, local tumor recurrence was seen in two of four lesions with pathologically incomplete resection; one was treated by re-ESD, and the other was treated by surgical esophagectomy. The 5-year overall and disease-specific survival rates were 84% and 100%, respectively. CONCLUSIONS: ESD seems to be a feasible, effective curative treatment for SESCCs. All patients should be closely followed after ESD.

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.

Pathological complete response in locally advanced breast cancer: Determinants and predictive significance.

Background. Neoadjuvant chemotherapy is now the standard approach for most large breast cancers including locally advanced cancers of the breast. The majority of patients respond satisfactorily to chemotherapy with effective downsizing of tumours to consider breast conservation surgery. Pathological complete response (pathCR) is known to be a strong predictor of good outcome; however, many factors are known to influence the extent of response to chemotherapy. It has been observed that smaller the tumour, better is the response achieved in contrast to larger and locally advanced tumours where only one-third may respond well enough to merit breast conservation. Various other clinical, biological and molecular factors are also being evaluated as effective predictors of chemosensitivity. Most of these are either not easily available for all patients in developing countries or are overtly expensive and not applicable for all patients. Methods. We evaluated the clinical and pathological predictors of response to chemotherapy in 1402 women with locally advanced breast cancer. Results. There was a higher rate of pathCR in smaller tumours, younger women and ER-negative as well as triple negative tumours. The presence of ductal carcinoma in situ (DCIS) and lymphatic and vascular invasion (LVI) were associated with lower pathCR. Conclusion. In the absence of ready availability of expensive molecular and genomic assays, clinical parameters and standard histopathological variables can also be useful indicators of response to neoadjuvant chemotherapy. Additionally, they can help identify those who could be eventually conserved or have a better outcome.

Splenogonadal fusion and testicular cancer: case report and review of the literature / Fusão esplenogonadal e câncer testicular: relato de caso e revisão da literatura

A 36 year-old man after tests for assessing male infertility was diagnosed with primary infertility, bilateral cryptorchidism, nonobstructive azoospermia and discontinuous splenogonadal fusion. Carcinoma in situ was found in his left testicle, which was intraabdominal and associated with splenogonadal fusion. To our knowledge, this is the fourth case of splenogonadal fusion associated with testicular cancer reported. One should always bear in mind the possibility of this association for the left cryptorchid testicle.

Um homem de 36 anos, depois de ser submetido a exames para avaliação de infertilidade masculina, foi diagnosticado com infertilidade masculina primária, criptorquidia bilateral, azoospermia não obstrutiva e fusão esplenogonadal descontínua. Carcinoma in situ estava presente no testículo esquerdo, que tinha localização intra-abdominal e estava associado à fusão esplenogonadal. Esse é o quarto caso de fusão esplenogonadal associada a câncer testicular, segundo nossa avaliação. Deve-se sempre ter em mente a possibilidade dessa associação em testículos criptorquídicos à esquerda.

Morphometric analysis of dendritic cells from anal mucosa of HIV-positive patients and the relation to intraepithelial lesions and cancer seen at a tertiary health institution in Brazil / Análise morfométrica das células dendríticas da mucosa anal de pacientes HIV-positivos e relação com as lesões intraepiteliais e o câncer numa instituição de saúde terciária no Brasil

PURPOSE: To morphometrically quantify CD1a+ dentritic cells and DC-SIGN+ dendritic cells in HIV-positive patients with anal squamous intraepithelial neoplasia and to evaluate the effects of HIV infection, antiretroviral therapy and HPV infection on epithelial and subepithelial dendritic cells. METHODS: A prospective study was performed to morphometrically analyze the relative volume of the dendritic cells and the relationship between anal intraepithelial neoplasia and cancer in HIV-positive patients from the Tropical Medicine Foundation of Amazonas, Brazil. All patients were submitted to biopsies of anorectal mucosa to perform a classic histopathological and immunohistochemical analysis, employing antibodies against CD1a and DC-SIGN for the morphometric quantification of dendritic cells. RESULTS: HIV-negative patients displayed a CD1a DC density significantly higher than that of HIV-positives patients (3.75 versus 2.54) (p=0.018), and in patients with severe anal intraepithelial neoplasia had correlated between DC CD1a density with levels of CD4 + cells (p: 0.04) as well as the viral load of HIV-1 (p: 0.035). A not significant rise in the median density of CD1a+ DC was observed in the HIV positive/ HAART positive subgroup compared to the HIV positive/ HAART negative subgroup. The CD1a+ DC were also significantly increased in HIV-negative patients with anorectal condyloma (2.33 to 3.53; p=0.05), with an opposite effect in HIV-positive patients. CONCLUSIONS: Our data support an enhancement of the synergistic action caused by HIV-HPV co-infection on the anal epithelium, weakening the DC for its major role in immune surveillance. Notoriously in patients with severe anal intraepithelial neoplasia, the density of CD1a+ epithelial dendritic cells was influenced by the viral load of HIV-1. Our study describes for the first time the density of subepithelial DC-SIGN+ dendritic cells in patients with anal severe anal intraepithelial neoplasia and points to the possibility that a specific therapy for HIV induces the recovery of the density of epithelial DC.

OBJETIVO: Quantificar morfometricamente as células dendríticas DC CD1a+ e DC DC-SIGN+ em pacientes HIV positivos portadores de neoplasia escamosa intraepitelial anal e avaliar os efeitos da infecção pelo HIV, da terapia antirretroviral e da infecção pelo HPV sobre as células dendríticas epiteliais e subepiteliais. MÉTODOS: Um estudo prospectivo foi realizado para analisar morfometricamente o volume relativo das células dendríticas e as relações entre neoplasia intraepitelial anal e o câncer em pacientes HIV positivos da Fundação de Medicina Tropical do Amazonas, Brasil.Todos os pacientes foram submetidos a biópsia da mucosa retal para realizar uma análise clássica histopatológica e imunohistoquímica utilizando anticorpos contra anti-CD1a e anti-DC-SIGN, para a quantificação morfométrica das células dendríticas. RESULTADOS: Os pacientes HIV negativos apresentaram densidade das DC CD1a+ significativamente maior do que a dos pacientes HIV positivos (3,75 versus 2,54) (p:0,018), e os pacientes com severa apresentaram correlação das DC CD1a com os níveis de células TCD4(p:0,04) assim como a carga viral do HIV-1 (p:0,035). Observamos no subgrupo HIV-positivo/HAART positivo elevação não significativa na mediana da densidade das DC CD1a+ em relação ao grupo HIV-positivo/HAART negativo. As DC CD1a+ também se elevaram nos pacientes HIV negativo portadores de condiloma anorretal(2,33 para 3,53; p:0,05), com efeito inverso nos pacientes HIV positivos. CONCLUSÕES: Nossos dados confirmam a potencialização da ação sinérgica representada pela coinfecção HIV-HPV sobre o epitélio anal, fragilizando as DC em sua função primordial de vigilância imune. Notoriamente nos pacientes com neoplasia intraepithelial anal grave, a densidade das DC CD1a+ epiteliais sofreu influência da carga viral do HIV-1. Nosso estudo descreveu pela primeira vez a densidade das DC subepiteliais DC-SIGN+ em pacientes com neoplasia intraepithelial anal severa e apontamos para a possibilidade de que a terapia específica para o HIV induza a recuperação da densidade das DC epiteliais.

A citologia na prevenção do câncer anal / The cytology in anal cancer prevention

O câncer anal não tem sido considerado problema de saúde pública. No entanto, sua incidência vem aumentando em pessoas que praticam sexo anal receptivo, promíscuos e portadores de doenças sexualmente transmissíveis, principalmente HPV (papilomavírus humanos) e HIV (vírus da imunodeficiência humana). Nos últimos anos, em vários países, a incidência do câncer anal aumentou 1,5 vezes entre os homens e triplicou nas mulheres. Embora a literatura não reforce o rastreamento de rotina das lesões intraepiteliais anais nas populações de risco, seu uso racional baseia-se no sucesso obtido com o rastreamento por meio da citologia cervical na redução da incidência do câncer cervical. Neste artigo revisamos os métodos diagnósticos disponíveis e as possibilidades de tratamentos das lesões precursoras anais a fim de prevenir a evolução para o câncer anal. Os aspectos biológicos das lesões precursoras anais são semelhantes aos das lesões cervicais. Dessa forma, como o ginecologista é o principal responsável pelo acompanhamento das mulheres, poderia

Anal cancer was not considered a neoplasm of public health concern until recently. Nevertheless, it may be object of attention in groups in which its incidence is increasing: people who have anoreceptive intercourse, promiscuous people and people who have sexual transmitted diseases (HPV and HIV infection). The incidence of anal cancer increased 1.5 fold among men and tripled among women in recent years. Although there is no strong literature evidence that document the value of screening for ASILs (anal squamous intraepithelial lesions) in the risk population, the rationale screening relies upon the success of cervical cytology screening in the reduction of cervical cancer incidence. It was reviewed the availability of screening modalities that effectively diagnosis the precursor lesion and the possibility of treatments that can prevent ASILs from progressing to anal cancer. The biologic consequences of anal dysplasia or ASIL are considered analogous of those of cervical dysplasia so the gynecologists may contribute to this diagnosis and to the prevention of anal cancer.

HPV infection and intraepithelial lesions from the anal region: how to diagnose?

In the last years, the prevalence of HPV infection in the anal region has increased, especially in some groups like homosexual and HIV-positive people. Since this infection can be associated with the development of squamous anal cancer due to its progression from HPV infection to anal intraepithelial neoplasia (AIN) and finally to cancer, the screening and evaluation of these conditions are important. Anal cytology and high resolution anoscopy are good methods that are available and can be used. Although useful, these methods should be performed correctly and not indiscriminately in all patients. Patients for whom anal cytology screening is recommended are: HIV-infected patients, homosexuals, women who present with high-grade vulvar squamous intraepithelial neoplasia, vulvar cancer or cervical cancer. An abnormal anal cytology should be further evaluated with high resolution anoscopy.

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

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

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

Differential expression of e-cadherin in lobular and ductal carcinoma of breast in an Iranian Cancer Care Hospital

To determine the role of E-cadherin in differentiating Breast lobular carcinoma from Breast ductal carcinoma in Iranian patients. A total of 80 malignant breast samples were reviewed by two pathologists before undergoing E-cad immunohistochemistry [IHC] staining. The results from IHC were compared with the results from the morphological study of the samples and they were then analyzed statistically. The normal ductal cells had strong complete homogenous membrane E-cadherin reactivity in all cases. The complete absence of E-cadherin membrane staining occurred in 14 out of 16 cases of Lobular breast carcinoma. The mean score of E-cadherin expression in ductal carcinoma was 191.35 with a CVof 104.39. In lobular carcinoma, the mean score of E-cadherin was 9.36 with a CV of 25.68. Using the Mann-Whiteny test, the difference between E-cadherin expression score in ductal and lobular carcinoma was statistically significant [P=0.0009]. E-cadherin expression is a useful diagnostic tool in distinguishing ductal from lobular carcinoma of breast