Análisis de la aplicación clínica de la tomografía por emisión de positrones en el ejercicio de la ginecología oncológica en el Hospital de la Mujer / Study of the clinical use of positron emission tomography in the practice of oncological gynecology at the women's hospital / Análise da aplicação clínica da tomografia por emissão de positrons no exercicio da ginecología oncológica no Hospital de la Mujer

El PET (Positron Emission Tomography) con 18-flúor-desoxi-glucosa (18FDG) como radiofármaco es una técnica diagnóstica de medicina nuclear no invasiva cuyas indicaciones fundamentalmente se vinculan con patologías oncológicas. Objetivo: valorar la indicación y el impacto del PET con 18FDG en la atención de mujeres con patología oncológica ginecológica. Estudio: descriptivo retrospectivo mediante la revisión de historias clínicas de las pacientes con cáncer ginecológico asistidas en el Hospital de la Mujer (HM), a las cuales se les realizó un PET con 18FDG en la evaluación diagnóstica o en el seguimiento en el período comprendido entre 1/1/2014 y 31/12/2017. Se analizaron un total de 68 pacientes en las cuales se realizaron 112 PET con 18FDG. En cuanto a la indicación, en los casos de cáncer de cuello (CC), la mayoría (51,5%) de los PET se realizaron ante la sospecha de recidiva; en el cáncer de mama (CM) en el control evolutivo, (44,6%); en los cánceres de endometrio (CE) ante la sospecha de recidiva, (50%); en los cánceres de ovario el 37,5% ante sospecha de recidiva e igual porcentaje en control evolutivo; en los cánceres de vulva (CV) en control postratamiento o sospecha de recidiva, (50% c/u). En cuanto al impacto en la conducta clínica, globalmente, en los casos CC, el 60% de los estudios realizados determinaron modificaciones en la conducta clínica; en los CM, 49%; en los CE, 43%; en los CO, 50%; en los CV, 50%. El PET con 18FDG es una técnica que se ha incorporado a la práctica clínica ginecológica y que requiere aún incorporar las pautas de su utilización.

18 fluoro-2-deoxy-d-glucose (18FDG) PET (Positron Emission Tomography) is a diagnostic non- invasive nuclear medicine imaging technique, and it is usually associated to oncological pathologies. Objective: to assess the indication and impact of 18FDG PET in women with gynecologic cancer. Study: retrospective, descriptive study by reviewing the medical records of patients with gynecologic cancer who were seen at the Women's Hospital. They underwent an 18FDG PET in the diagnostic assessment or follow-up between January 1, 2014 and December 31, 2017. 68 patients were studied, and 112 18FDG PETS were carried out. As to indication, in the case of cervical cancer (CC) most PET studies (51.5%) were used upon suspicion of relapse; in breast cancer to control evolution (44.6%); in endometrial cancer upon suspicion of relapse (50%); in ovarian cancer 37.5% upon suspicion of relapse and same percentage to control evolution; in vulvar cancer in the post-treatment follow-up or upon suspicion of relapse (50% each). As to global impact in the clinical practice, in the case of cervical cancer 60% of the studies resulted in modifications of the clinical behavior; in breast cancer this percentage was 49%; in endometrial cancer it was 43%, in ovarian cancer 50%, and vulvar cancer 50%. 18FDG PET is a technique that has been included in the gynecological clinical practice and guidelines for its use are still required.

O PET (Positron Emission Tomography) com 18-Flúor-Desoxi-Glucosa (18FDG) como radio fármaco, é uma técnica diagnóstica de medicina nuclear não invasiva, cujas indicações fundamentalmente estão vinculadas às patologias oncológicas. Objetivo: avaliar a indicação e o impacto do PET com 18FDG na atenção de mulheres com patologia oncológica ginecológica. Estudo: descritivo retrospectivo feito pela revisão dos prontuários de pacientes com câncer ginecológico atendidas no Hospital de la Mujer (HM), que foram submetidas a PET com 18FDG na avaliação diagnóstica ou no seguimento durante o período compreendido entre 1/1/2014-31/12/2017. Foram analisadas 68 pacientes submetidas a PET com 18FDG. Com relação à indicação, nos casos de câncer de colo de útero (CC) a maioria (51,5%) dos exames PET foi realizada devido à suspeita de recidiva; no câncer de mama (CM) no controle evolutivo (44,6%); nos cânceres de endométrio (CE) devido à suspeita de recidiva (50%); nos cânceres de ovário 37,5% devido a suspeita de recidiva e a mesma proporção no controle evolutivo; nos cânceres de vulva (CV) tanto no controle pós-tratamento com também na suspeita de recidiva (50% c/u). Com relação ao impacto sobre a conduta clínica, de maneira geral nos casos CC, 60% dos estudos realizados determinaram modificações da conduta clínica; nos CM 49%; nos CE 43%; nos CO e nos CV em 50% dos casos. O PET com 18FDG é uma técnica que está sendo incorporar à prática clínica ginecológica sendo necessário incorporar pautas para sua utilização.

Gynecological cancer and metabolic screening of 1001 elderly Brazilian women

SUMMARY OBJECTIVE The aim of this study was to evaluate gynecological cancer and metabolic screening of Brazilian women aged 65 years or older. METHODS This retrospective descriptive study was conducted by including 1,001 Brazilian patients of the gynecological geriatric outpatient office of our institution to evaluate the influence of age on gynecological cancer and metabolic screening parameters at the first clinical visit. All patients were divided into three groups: a) 65 to 69 years; b) 70 to 74 years; c) ≥ 75 years. We considered clinical, laboratorial, and image data as variables of this study. The Chi-square test was used to assess the proportion of differences among the age groups, and Kruskal-Wallis was used for quantitative variables. RESULTS The values of BMI and height in the group over 75 years was lower than that of the 65 to 69 years (p = 0.001). Regardless of the age group, high arterial blood pressure levels were found in 85.45% of participants. Also, many patients had glucose intolerance in the blood. The pelvic ultrasonography showed abnormal endometrial echo thickness (> 5 mm) in 6.14% of patients, but with no significant statistical difference between the age groups. A total of 4.04% of patients had ovaries with high volume values ( > 6.1 mL). Abnormal mammography (BI-RADS 3 or 4) was observed in 12.21%. CONCLUSIONS our data suggest that a great reduction in BMI and stature is more frequent in the group over 75 years. Also, systemic arterial hypertension and carbohydrate disturbance are frequent morbidities in women over 65 years.

RESUMO OBJETIVO O objetivo deste trabalho foi estudar retrospectivamente alguns dados clínicos, laboratoriais e imagens de um grupo de idosas brasileiras. MÉTODOS Estudo observacional retrospectivo realizado com inclusão de 1.001 mulheres brasileiras atendidas no ambulatório de geriatria ginecológica de nossa instituição. Foram analisados: a idade dos pacientes na primeira consulta clínica e a idade na menopausa natural; alguns achados clínicos durante um exame ginecológico; resultados de análises laboratoriais. Considerou-se a relação dessas variáveis com o grupo da idade das mulheres. O teste do qui-quadrado foi utilizado para avaliar os dados e para algumas variáveis, Kruskal-Wallis ou Anova. RESULTADOS A avaliação do IMC e da estatura nas diferentes faixas etárias das mulheres mostrou que, com o aumento da idade, há diminuição do IMC e da estatura (p=0,001). Nível anormal de pressão arterial estava presente em 85,45%. De acordo com o grupo de idade, as medidas laboratoriais foram avaliadas pelo método estatístico Kruskal-Wallis, e a Anova mostrou diferença estatisticamente significante apenas no valor da creatinina, com pequeno aumento com a idade. A ultrassonografia pélvica foi alterada com espessura endometrial normal (>5 mm) em 29 (6,14%), mas sem diferença estatística significativa com os grupos de idade, e os ovários mostraram sete (4,04%) com volume anormal (>6,1). Mamografia anormal (BI-Rads 3 ou 4) foi observada em 104 pacientes (12,21%). CONCLUSÕES O estudo conclui que, com o aumento da idade, há redução do IMC e da estatura. A hipertensão é morbidade frequente. Os dados laboratoriais e a avaliação de imagens deste estudo são importantes para aumentar o conjunto de informações sobre mulheres idosas e talvez para melhorar a assistência à saúde.

Acessibilidade da População Negra ao Cuidado Oncológico no Brasil: Revisão Integrativa / Accessibility of Black Population to Oncological Care in Brazil: Integrative Review / Accesibilidad de la Población Negra a la Atención Oncológica en Brasil: Revisión Integrativa

Introdução:Tem-se apontado a persistência de desigualdades raciais na acessibilidade a bens e serviços de saúde, estando o indivíduo com câncer inserido nesse contexto. Objetivo: Analisar os fatores que impactam a acessibilidade da população negra ao cuidado oncológico no Brasil. Método: Por meio de uma revisão integrativa da literatura, buscaram-se, nas bases PubMed, LILACS e Embase, artigos originais publicados em português, inglês e espanhol sem limite temporal. Resultados: Foram incluídos 13 artigos, analisados a partir do tipo de câncer abordado: câncer de mama, câncer ginecológico, câncer de próstata e câncer de cavidade oral. Conclusão: As desigualdades raciais e socioeconômicas refletem nas ações de acessibilidade ao cuidado oncológico, maioritariamente na detecção precoce. Independentemente do tipo de câncer e das formas de diagnóstico e de tratamento, é inegável a dificuldade do paciente negro aos cuidados oncológicos por razões de natureza social e econômica.Os profissionais de saúde deveriam assegurar o atendimento à população negra ao mesmo nível prestado aos demais grupos sociais para garantir e superar as barreiras de acesso aos bens e serviços de saúde.

Introduction: The persistence of racial inequalities in the access to health services has been pointed out and the individual with cancer is within this scenario. Objective: To analyze the factors that impact the accessibility of the black population to cancer care in Brazil. Method: Through an integrative literature review, it were searched original articles published in Portuguese, English and Spanish in the databases PubMed, LILACS and Embase without time limitation. Results: Thirteen articles were included and analyzed based in the type of cancer addressed: breast cancer, gynecological cancer, prostate cancer and oral cancer. Conclusion: The racial and socioeconomic inequalities reflect upon the actions of accessibility to cancer care, mostly in early detection. Regardless of the type of cancer and the forms of diagnosis and treatment, it is unquestionable the difficulty the afro-descendant population has to access oncological care because of social and economic issues. Healthcare providers must ensure the care to the afro-descendant population as much as they do with other social groups to overcome the barriers to access health services.

Introducción: Se ha señalado la persistencia de las desigualdades racial e la accesibilidad a los bienes y servicios de salud, con el individuo con cáncer insertado en este contexto. Objetivo: Analizar los factores que afectan la accesibilidad de la población negra a la atención del cáncer en Brasil. Método: A través de una revisión bibliográfica integradora, se realizar búsquedas en las bases de datos PubMed, LILACS e Embase artículos originales publicados en portugués, inglés y español sin límite de tiempo. Resultados: Se incluyeron 13 artículos, analizado sen función del tipo de cáncer abordado: cáncer de mama, cáncer ginecológico, cáncer de próstata y cáncer de cavidad oral. Conclusión: Las desigualdades raciales y socioeconómicas se reflejan en las acciones de accesibilidad a la atención del cáncer, principalmente en la detección temprana. Independientemente del tipo de cáncer y las formas de diagnóstico y tratamiento, la dificultad del paciente negro en la atención del cáncer es innegable por razones sociales y económicas. Los profesionales de la salud deben garantizar la atención de la población negra al mismo nivel que otros grupos sociales para garantizar y superar las barreras de acceso a los bienes y servicios de salud.

Fatores que interferem na adesão da mulher idosa a programas de prevenção do câncer ginecológico / Factors affecting adhesion by older women to gynecological cancer prevention programs / Factores que influyen en la adhesión de mujeres mayores a los programas de prevención de cáncer ginecológico

Objetivo: discutir os fatores que interferem na adesão da mulher idosa a programas de prevenção do câncer ginecológico. Método: revisão da literatura, realizada na base de dados LILACS, SCIELO e BIREME (2006-2017), em documentos oficiais do Ministério da Saúde e da Sociedade Brasileira de Cancerologia. Foram encontrados 142 artigos, permanecendo no estudo19 artigos, após aplicados os critérios de inclusão. Resultados: foram encontrados cinco fatores que interferem na adesão da mulher a programas de prevenção do câncer ginecológico: a dificuldade de acesso e acessibilidade aos serviços de saúde; os preconceitos da sociedade em geral em relação à velhice; a disponibilidade de uma pessoa para acompanhar a mulher idosa ao serviço de saúde; a insuficiente capacitação dos profissionais de saúde para atuar com a mulher idosa e; pouco investimento em ações de educação em saúde nesta área. Conclusão: para garantir a adesão da mulher idosa aos programas de prevenção de doenças oncológicas, é necessário romper o preconceito de muitos profissionais em relação ao envelhecimento, trabalhando a educação em saúde, a prevenção e a detecção precoce.

Objective: to discuss the factors that affect older women's adhesion to gynecological cancer prevention programs. Method: a literature search of the LILACS, SCIELO and BIREME databases (published in 2006-2017) and in official documents of the Ministry of Health and the Brazilian Cancerology Society found 142 articles, 19 of which were retained for review after applying the inclusion criteria. Results: women's adherence to gynecological cancer prevention programs was found to be affected by five factors: health service access and accessibility difficulties; social prejudices in relation to old age; availability of a person to accompany the older woman to the health service; insufficient training for health professionals to work with older women; and inadequate investment in health education in this area. Conclusion: health education to break down health professionals' prejudice towards aging will help to ensure that older women adhere to cancer prevention programs and facilitate the prevention, early detection and treatment of oncological diseases.

Objetivo: discutir los factores que interfieren en la adhesión de mujeres mayores a programas de prevención del cáncer ginecológico. Método: revisión de la literatura, realizada en las bases de datos LILACS, SCIELO y BIREME (publicadas en 2006-2017), en documentos oficiales del Ministerio de Salud y de la Sociedad Brasileña de Cancerología. Se encontraron 142 artículos, siendo que 19 de ellos permanecieron en el estudio, tras aplicar los criterios de inclusión. Resultados: se encontraron cinco factores que interfieren en la adhesión de la mujer a programas de prevención del cáncer ginecológico: la dificultad de acceso y accesibilidad a los servicios de salud; los prejuicios de la sociedad en general respecto a la vejez; la disponibilidad de una persona para acompañar a la anciana al servicio de salud; la insuficiente capacitación de los profesionales de salud para actuar con la mujer mayor y; baja inversión en acciones de educación en salud en esta área. Conclusión: para garantizar la adhesión de la mujer mayor, hace falta romper el prejuicio de muchos profesionales en relación al envejecimiento, trabajando la educación en salud, la prevención y la detección precoz.

Evaluation of Probably Benign Adnexal Masses in Postmenopausal Women / Avaliação de massas anexiais benignas em mulheres pós-menopáusicas

Abstract Background Preoperatively identification of malignancy potential of a postmenopausal adnexal masses is important. Aim To evaluate the effectiveness of the Risk of Malignancy Index-2 in presumably benign adnexal masses in postmenopausal women. Study Design Retrospective, observational study. Methods 119 women with postmenopausal adnexal masses with a preliminary diagnosis of benign tumors according to the Risk of Malignancy Index-2 were included. Age, duration of menopause, ultrasonographic findings, and serum CA-125 levels were recorded preoperatively. The definitive diagnosis was based on postoperative histopathological examination. Results Of 119 adnexal mass, 10 were malignant and 109 were benign. There was no statistically significant difference with regard to age and tumor size between the groups. The two significant ultrasonographic parameter between groups were the presence of solid area in the mass and bilaterality. Moreover, if the cut off point for serum CA-125 was adjusted to 14.75 IU/mL according to ROC curve, a sensitivity value of 80% and a specificity value of 72% could be achieved to discriminate benign and malign cysts. Conclusion In the differential diagnosis of benign and malignant adnexal masses in postmenopausal women, the presence of a solid component, bilaterallity based on ultrasonography and high CA-125 values may be used as discriminative criteria. There is no direct relation between the size of the adnexal mass and malignancy potential. Therefore, in the malignancy indexes of postmenopausal women, we recommend lower cut-off values of CA-125 to increase the sensitivity of preoperative evaluation tests without having a great impact on negative predictive values.

Resumo Introdução É fundamental identificar o potencial maligno de massas anexiais pósmenopáusicas no período pré-operatório. Objetivo Avaliar a efetividade do risco de malignidade (risk of malignancy index-2, RMI2) em massas anexiais benignas presumíveis em mulheres na pós-menopausa. Desenho do Estudo Estudo observacional retrospectivo. Métodos Este estudo foi conduzido em nossa clínica de cirurgia de endoscopia e endoscopia de nosso hospital entre janeiro de 2013 e setembro de 2015. Um total de 119 mulheres com massas anexiais pós-menopausa com diagnóstico preliminar de tumores benignos de acordo com o RMI-2. A idade, a duração da menopausa, os achados ultrassonográficos e os níveis séricos de CA-125 foram registados no préoperatório. O diagnóstico definitivo foi baseado no exame histopatológico pósoperatório. Resultados A média de idade dos pacientes foi de 55,4 6,71 anos. O exame histopatológico revelou que 8,4% das massas anexiais eram tumores malignos ou limítrofes, enquanto 91,6% eram benignos. Não houve diferença estatisticamente significante quanto ao tamanho do tumor e do tamanho das lesões entre patologias malignas e benignas. Não houve diferença estatisticamente significativa entre pacientes benignos e malignos quanto à idade e tamanho do tumor. Os dois parâmetros ultrasonográficos estatisticamente significativos entre os grupos foram a presença de área sólida na massa e bilateralidade. Além disso, se o ponto de corte para CA-125 sérico fosse ajustado para 14,75 UI/mL de acordo com a curva receiver operating characteristic (ROC), um valor de sensibilidade de 80% e um valor de especificidade de 72% poderiam ser conseguidos para discriminar cistos benignos e malignos (área sob a curva [ASC]: 0,89). Conclusão No diagnóstico diferencial de massas anexiais benignas e malignas em mulheres pós-menopáusicas, a presença de um componente sólido, bilaterais com base na ultra-sonografia e valores elevados de CA-125 podem ser utilizados como critério discriminatório. Parece que não há relação direta entre o tamanho da massa anexial eo potencial maligno. Portanto, nos índices de malignidade de mulheres pósmenopáusicas, recomendamos valores de corte mais baixos de CA-125 para aumentar a sensibilidade dos testes de avaliação pré-operatória sem ter grande impacto em valores preditivos negativos.

Tailored therapy and long-term surveillance of malignant germ cell tumors in the female genital system: 10-year experience / 부인종양

OBJECTIVE: To explore the appropriate treatment of malignant germ cell tumor (MGCT) in the female genital system, and to analyze the factors influencing both therapeutic response and survival outcome. METHODS: A cohort of 230-Chinese women diagnosed with MGCT of the genital system was retrospectively reviewed and prospectively followed. The demographic and pathological features, extent of disease and surgery, treatment efficiency, recurrence and survival were analyzed. RESULTS: MGCTs from different genital origins shared a similar therapeutic strategy and response, except that all eight vaginal cases were infantile yolk sac tumors. The patients' cure rate following the initial treatment, 5-year overall survival and disease-free survival (DFS) were 85.02%, 95.00%, and 86.00%, respectively. Although more extensive excision could enhance the remission rate; it did not improve the patients' survival. Instead, the level of the medical institution, extent of surgery and disease were independent prognostic factors for relapse (p<0.05). Approximately 20% of patients had recurrent or refractory disease, more than half of whom were in remission following secondary cytoreductive surgery with salvage chemotherapy. CONCLUSION: Fertility-sparing surgery with or without standardized PEB/PVB (cisplatin, etoposide/vincristine, and bleomycin) chemotherapy is applicable for female MGCTs of different origins. Comprehensive staging is not required; nor is excessive debulking suggested. Appropriate cytoreduction by surgery and antineoplastic medicine at an experienced medical institution can bring about an excellent prognosis for these patients.

Câncer ginecológico e gravidez: uma revisão sistematizada direcionada para obstetras / Gynecological cancer and pregnancy: a systematic review aimed to obstetricians

A estimativa de incidência de câncer em grávidas é baixa. Entretanto, com a procriação ocorrendo em idades mais avançadas nas últimas décadas, observou-se um aumento na incidência dos cânceres diagnosticados durante a gravidez. Neste artigo, foi realizada uma revisão sistemática sobre a ocorrência do câncer ginecológico concomitante à gravidez. O objetivo foi apresentar as evidências disponíveis sobre a triagem, diagnóstico, acompanhamento do tratamento oncológico, bem como a possibilidade de preservação da fertilidade nessas mulheres. A revisão de literatura foi realizada na base de dados Pubmed, de 2010 a 2014. Dos 352 artigos encontrados, 26 foram selecionados para leitura completa. Devido à baixa incidência de cânceres ginecológicos associado à gravidez a condução destas pacientes tem como base os relatos e séries de casos e poucas coortes históricas. Os cânceres ginecológicos mais frequentemente associados à gravidez são o câncer do colo do útero e o de ovário. Nestes grupos de pacientes, o obstetra desempenha papel fundamental na triagem, diagnóstico, avaliação inicial, e coordenação da equipe multidisciplinar de assistência. O tratamento deve ser individualizado, com o objetivo de alcançar as maiores taxas de cura. Entretanto, deve também vislumbrar a possibilidade de manter a gravidez, com mínimos danos ao feto e de preservar a fertilidade, se possível, o que é incentivado pela tendência de início tardio da vida reprodutiva.(AU)

Cancer incidence estimates during pregnancy are low. However, with procreation occurring at older ages in recent decades, an increased incidence of cancers diagnosed during pregnancy has been observed. In this article a systematic review on the occurrence of concomitant gynecological cancer to pregnancy was performed. The objective was to provide the available evidence on screening, diagnosis and monitoring of cancer treatment and preservation of pregnancy and fertility in these group of women. The literature review was performed in PubMed database from 2010 to 2014. Of the 352 reviewed articles, 26 were selected to complete reading. Due to the low incidence of gynecological cancers associated with pregnancy, the management of these patients is based on reports, case series, and a few historical cohorts. Gynecologic cancers most often associated with pregnancy are cervical cancer and the ovarian cancer. In these group, the obstetrician composes an important role in screening, diagnosis, initial evaluation, and coordination of the multidisciplinary team care. Treatment should be individualized in order to achieve the highest cure rates. However, it should also envisage the possibility to maintain the pregnancy, with minimal damage to the fetus and to preserve fertility, if possible, which is encouraged by the tendency of the late reproductive years.(AU)

Major clinical research advances in gynecologic cancer in 2014 / 부인종양

In 2014, 9 topics were selected as major advances in clinical research for gynecologic oncology: 2 each in cervical and corpus cancer, 4 in ovarian cancer, and 1 in breast cancer. For cervical cancer, several therapeutic agents showed viable antitumor clinical response in recurrent and metastatic disease: bevacizumab, cediranib, and immunotherapies including human papillomavirus (HPV)-tumor infiltrating lymphocytes and Z-100. The HPV test received FDA approval as the primary screening tool of cervical cancer in women aged 25 and older, based on the results of the ATHENA trial, which suggested that the HPV test was a more sensitive and efficient strategy for cervical cancer screening than methods based solely on cytology. For corpus cancers, results of a phase III Gynecologic Oncology Group (GOG) 249 study of early-stage endometrial cancer with high-intermediate risk factors are followed by the controversial topic of uterine power morcellation in minimally invasive gynecologic surgery. Promising results of phase II studies regarding the effectiveness of olaparib in various ovarian cancer settings are summarized. After a brief review of results from a phase III study on pazopanib maintenance therapy in advanced ovarian cancer, 2 outstanding 2014 ASCO presentations cover the topic of using molecular subtypes in predicting response to bevacizumab. A review of the use of opportunistic bilateral salpingectomy as an ovarian cancer preventive strategy in the general population is presented. Two remarkable studies that discussed the effectiveness of adjuvant ovarian suppression in premenopausal early breast cancer have been selected as the last topics covered in this review.

The molecular fingerprint of human papillomavirus infection and its effect on the Langerhans cell population in squamous cell carcinomas of the genital skin.

Background: Information is scarce about the presence of molecular alterations related to human papillomavirus (HPV) infection in squamous cell carcinomas of the genital skin and about the effect of this infection in the number of Langerhans cells present in these tumors. Aims: To determine the presence of HPV in genital skin squamous cell carcinomas and to see the relationship between HPV infection and changes in the expression of Ki-67 antigen (Ki-67), p53 protein (p53), retinoblastoma protein (pRb) and E-cadherin and to alterations in Langerhans cell density, if any. Methods: A descriptive, comparative, retrospective and cross-sectional study was performed with all the cases diagnosed as squamous cell carcinomas of the genital skin at the Dermatopathology Service from 2001 to 2011. The diagnosis was verified by histopathological examination. The presence of HPV was examined using chromogenic in situ hybridization, and protein expression was studied via immunohistochemical analysis. Results: The 34 cases studied were verified as squamous cell carcinomas and 44.1% were HPV positive. The degree of expression of pRb was 17.50% ±14.11% (mean ± SD) in HPV-positive cases and 29.74% ±20.38% in HPV-negative cases (P = 0.0236). The degree of expression of Ki-67 was 47.67% ±30.64% in HPV-positive cases and 29.87% ±15.95% in HPV-negative cases (P = 0.0273). Conclusion: HPV infection was related to lower pRb expression and higher Ki-67 expression in comparison with HPV negative samples. We could not find a relationship between HPV infection and the degree of expression of p53 and E-cadherin or with Langerhans cell density.

Frequency and clinicopathological presentation of gynaecological malignancies

To describe the frequency and clinicopathological presentation of malignancies of the female genital tract presenting to a tertiary care hospital. This descriptive study was carried out at Department of Obstetrics and Gynaecology, Unit A of Khyber Teaching Hospital, Peshawar from January 2008 to December 2012. A total of 4657 patients were admitted during the study period and all the patients having genital tract malignancies were included. Detailed history was taken and relevant examinations and investigations were carried out. Surgical procedures were performed where needed and specimens were sent for histopathology. Clinical and surgical staging was also carried out. All the details were noted down on a semi-structured proforma. There were 43 cases of gynaecological malignancies with mean age of 43.74 +/- 15.51 years. Ovarian cancer was the most common [n=22, 51.22%] followed by uterine cancer [n=10, 23.33%]. The majority of patients diagnosed with ovarian cancers [n=9/22, 40.94%] were nulliparous, whereas the majority of uterine and cervical cancers were multiparous [n=7/10, 70.0%] and grand multiparous [n=7/9, 77.78%], respectively. Ovarian cancers mostly presented with an abdominal mass [n=16/22, 72.7%] while uterine and cervical cancer presented with irregular cycles [n=7/10, 70.0%] and post coital bleeding [n=4/10, 40%]. Advanced stage cancer cases were 19/43 [44.22%]. Serouscystadeno carcinoma was the most common ovarian malignancy [n=16/22, 72.73%] while endometrioid adenocarcinoma [n=9/10, 90%] was the most common uterine carcinoma and squamous cell carcinoma was the most common cervical carcinoma [n=7/9, 77.88%].Conclusions: Ovarian cancer was the most commonly encountered malignancyal though all gynaecological malignancies are rare

Inclusão dos sintomas na discriminação entre tumores anexiais benignos e malignos / Inclusion of symptoms in the discrimination between benign and malignant adnexal masses

OBJETIVO: Avaliar a associação entre sintomas clínicos e malignidade em mulheres com tumores anexiais, submetidas à cirurgia. MÉTODOS: Estudo de corte transversal com coleta prospectiva, no qual foram incluídas 105 mulheres, atendidas em um hospital de ensino do Estado de São Paulo de novembro de 2009 a março de 2011, devido ao tumor anexial e à indicação de laparotomia/laparoscopia. Todas foram submetidas a uma entrevista estruturada sobre a ocorrência de 18 sintomas associados ao câncer de ovário. A entrevista incluiu gravidade, frequência e duração dos sintomas nos 12 meses prévios à primeira consulta. Também foram avaliados os níveis de CA125 e a classificação ultrassonográfica. Foi calculada para cada sintoma a razão de prevalência com intervalo de confiança de 95%. O padrão-ouro foi o resultado do exame anatomopatológico das peças cirúrgicas. RESULTADOS: Das 105 mulheres incluídas, 75 (71,4%) apresentaram tumores benignos e 30 (28,6%), malignos. Em mulheres com tumores malignos, os sintomas foram mais frequentes, dentre eles: inchaço abdominal (70%), aumento do volume abdominal (67%), dor pélvica (60%), irregularidade menstrual (60%), empachamento (53%), dor abdominal (50%), dor nas costas (50%) e saciedade precoce (50%). As mulheres com tumores benignos apresentaram essencialmente dor pélvica (61%), irregularidade menstrual (61%) e inchaço abdominal (47%). Os sintomas significativamente associados com malignidade foram: sensação de inchaço abdominal (RP=2,0; IC95% 1,01 - 3,94), aumento objetivo do volume abdominal (RP=2,16; IC95% 1,12 - 4,16), dor nas costas (RP=1,97; IC95% 1,09 - 3,55), empachamento (RP=2,25; IC95% 1,25 - 4,07), saciedade precoce (RP=2,06; IC95% 1,14 - 3,70), massa abdominal (RP=1,83; IC95% 1,01 - 3,30), dificuldade para deglutir (RP=1,98; IC95% 1,10 - 3,56) e sangramento pós-menopausa (RP=2,91; IC95% 1,55 - 5,44). A presença de dor pélvica, constipação, dispareunia, fadiga, dor abdominal, náusea e/ou vômito, irregularidade menstrual, perda de peso, diarreia e sinusorragia foram semelhantes nos dois grupos. CONCLUSÕES: Em mulheres com tumores anexiais com indicação cirúrgica, a avaliação pré-operatória dos sintomas pode auxiliar na predição da malignidade.

PURPOSE: To assess the association between clinical symptoms and the diagnosis of malignancy in women with adnexal tumors who underwent surgery. METHODS: Cross-sectional study, in which 105 women with adnexal tumors and indication for laparotomy/laparoscopy were included. All women were treated at a teaching hospital in the state of São Paulo between November 2009 and March 2011. All patients underwent a structured interview about the occurrence of 18 symptoms associated with ovarian cancer. The interview included the severity, frequency, and duration of these symptoms in the 12 months prior to the first medical consultation. The CA125 levels and the ultrasound classification of the tumors were also evaluated. We calculated for each symptom the prevalence ratio with 95% confidence intervals. The golden-standard was the result of the pathological examination of the surgical specimens. RESULTS: Of the 105 women included, 75 (71.4%) had benign tumors and 30 (28.6%) had malignant ones. In women with malignant tumors, the most frequent symptoms were: abdominal bloating (70%), increased abdominal size (67%), pelvic pain (60%), menstrual irregularity (60%), swelling (53%), abdominal pain (50%), backache (50%), and early repletion (50%). Women with benign tumors showed essentially pelvic pain (61%), menstrual irregularities (61%), and abdominal swelling (47%). Symptoms significantly associated with malignancy were: bloating (PR=2.0; 95%CI 1.01 - 3.94), increased abdominal size (PR=2.16; 95%CI 1.12 - 4.16), backache (RP=1.97; 95%CI 1.09 - 3.55), swelling (PR=2.25; 95%CI 1.25 - 4.07), early repletion (RP=2.06; 95%CI 1.14 - 3.70), abdominal mass (PR=1.83; 95%CI 1.01 - 3.30), eating difficulties (PR=1.98; 95%CI 1.10 - 3.56), and postmenopausal bleeding (PR=2.91; 95%CI 1.55 - 5.44). The presence of pelvic pain, constipation, dyspareunia, fatigue, abdominal pain, nausea or vomiting, menstrual irregularity, weight loss, diarrhea, and bleeding after intercourse was similar in both groups. CONCLUSIONS: In women with adnexal tumors including indication of surgical treatment, the preoperative evaluation of symptoms may help predicting malignancy.

Oncofertilidade: opções na manutenção da fertilidade no tratamento do câncer ginecológico / Oncofertility: fertility considerations in the management of gynecological cancer

O diagnóstico do câncer ginecológico ocorre em pacientes cada vez mais jovens e em estadios mais precoces. Muitas dessas pacientes se encontram em idade fértil e desejam prole. A detecção mais precoce e a maior efetividade do tratamento têm propiciado, em casos selecionados, a conservação da fertilidade nesse grupo de paciente, sem prejuízo na cura oncológica. Foi realizada uma revisão da literatura com artigos entre 2004 e 2011, dos quais foram selecionados os mais relevantes. Revisamos as principais opções de preservação da fertilidade no tratamento do câncer ginecológico, abrangendo os tumores do colo uterino, do ovário e do endométrio

The diagnosis of gynecological cancer is increasingly occurring in younger patients and in earlier stages. Many of these patients are fertile and wish to become pregnant. The earlier detection and more effective treatment have allowed the preservation of fertility without prejudice to cure cancer, in selected cases. We conducted a literature review of articles between 2004 and 2011, which we selected the most relevant. We reviewed the main options for fertility preservation in the treatment of gynecological cancers including tumors of the cervix, ovary and endometrium

evaluation of pelvic mass

In female reproductive tract the differential diagnosis of pelvic mass is quite variable because abnormality may arise from gynaecological or non gynaecological origin. The present study was designed to evaluate the efficacy of clinical examination and abdomino-pelvic ultrasonography and find out the frequency of malignancy in patients diagnosed with pelvic mass. It was a cross sectional prospective study of one year duration. Cohort study design on 107 patients with complaints suggestive of pelvic mass underwent clinical examination including history, abdomino-pelvic examination followed by abdominal ultrasound were evaluated. Only the patients who underwent laparoscopy or laparotomy were included in the study. Final diagnosis was correlated with histopathological diagnosis. Overall sensitivity of clinical evaluation was 50% while ultrasound was 80% sensitive in diagnosing the type of pelvic mass. Positive predictive value of clinical examination 71.4% was higher than ultrasound 66.6%. Frequency of gynaecological malignancy was 84%, while 1.9% malignancies were of non gynaecological origin. Our study has supported the view that clinical evaluation and ultrasound are initial modalities and to increase the sensitivity for definitive diagnosis other imaging facilities and tumor marker are needed

Análise ética da revelação do diagnóstico e tratamento em pacientes com câncer genital ou mamário / Ethical issues of diagnosis disclosure and treatment in patients with genital or breast cancer

OBJETIVO: Verificar como se dá a comunicação entre médicos e pacientes na informação sobre o diagnóstico, o tratamento e o prognóstico das pacientes com câncer genital ou mamário, utilizando a bioética como referência de análise. MÉTODOS: Estudo epidemiológico descritivo-analítico de corte transversal de 120 pacientes atendidas no Hospital de Base do Distrito Federal e selecionadas aleatoriamente. Foi aplicado um questionário fechado, composto por nove questões assim distribuídas: três relacionadas ao diagnóstico, quatro ao tratamento e duas ao prognóstico. RESULTADOS: Os resultados mostraram que 73,3 por cento das pacientes consideraram "negativa" a qualidade da primeira informação que receberam sobre o diagnóstico de câncer; 54,2 por cento das pacientes entenderam as informações recebidas a respeito do diagnóstico e do tratamento; aproximadamente 60 por cento sabem o prognóstico do câncer e menos de 10 por cento não querem ter mais outras informações. No entanto, para quase 40 por cento das pesquisadas, existe algum problema na comunicação com o médico sobre o processo que envolve o câncer. A idade e a extensão da doença não repercutiram no grau de entendimento das pacientes sobre o diagnóstico, o tratamento e o prognóstico. CONCLUSÃO: A comunicação da informação sobre o diagnóstico, o tratamento e o prognóstico das pacientes com câncer genital ou mamário é adequada em cerca de 60 por cento das vezes. Contudo foram percebidos problemas concernentes à linguagem utilizada pelos médicos, a não consideração sistemática da autonomia das pacientes e à ausência de mecanismos que pudessem proporcionar o poder de decisão destas.

OBJECTIVE: To verify how the communication between physicians and patients takes place during diagnosis, treatment and prognosis of women with genital or breast cancer, utilizing bioethics as the reference for analysis. METHODS: A descriptive and analytical cross-sectional epidemiological study with 120 patients randomly selected at the Hospital de Base in the Federal District of Brasilia was conducted . Patients were given a questionnaire with the following nine questions three related to diagnosis, four related to treatment, and two questions related to prognosis. RESULTS: Results showed that 73.3 percent of the patients considered the quality of the initial information received on the diagnosis of cancer as negative; 54.2 percent understood the information given in relation to diagnosis and treatment; approximately 60 percent knew the prognosis of cancer while less than 10 percent did not want additional information. However, for almost 40 percent of the respondents, there were some problems in the physician - patient communication in relation to the process which involves cancer. Age and extent of the disease did not influence the patients' degree of understanding about diagnosis, treatment, and prognosis. CONCLUSION: Communication to patients with gynecological or breast cancer during diagnosis, treatment, and prognosis is adequate about 60 percent of the time. However, problems were perceived in relation to the language used by the physicians , the lack of systematic consideration towards autonomy of the patients and the absence of mechanisms that could support their power of decision.

Edema maciço de ovário / Massive ovarian edema

O edema maciço de ovário é uma condição benigna rara caracterizada pelo aumento tumoral símile do ovário comprometido. As doenças ovarianas de importância cirúrgica da infância não são frequentes e podem ser divididas em lesões neoplásicas, em cistos não neoplásicos e em alterações inflamatórias. Os autores descrevem um caso de edema maciço de ovário em uma paciente de treze anos que referia dor abdominal associada a uma lesão sólido-cística do ovário direito, avaliada como neoplasia pela ultrassonografia. Ao exame macroscópico, o ovário era bocelado e estava aumentado de volume, medindo 9,5×6,0×5,0 cm e apresentando uma lesão sólida com áreas císticas à superfície de corte. O aspecto microscópico fundamental desse processo era a presença de edema acentuado e difuso do estroma, envolvendo folículos, e associado a uma camada cortical com espessamento fibroso superficial. O conhecimento dessa entidade é fundamental para auxiliar no diagnóstico durante a avaliação ultrassonográfica de tumores ovarianos e prevenir tratamentos incorretos.

Massive ovarian edema is a rare benign condition characterized by similar tumor growth of the affected ovary. The ovarian disorders of surgical importance of childhood are not frequent and can be divided into neoplastic lesions, non-neoplastic cysts, and inflammatory alterations. Here the authors describe the case of a massive ovarian edema in a 13-year-old female patient who reported abdominal pain associated with a solid-cystic lesion of the right ovary evaluated as a neoplasm by ultrasonography. The macroscopic examination showed ovary with increased volume, measuring 9.5×6.0×5.0 cm, and presenting a solid lesion with cystic areas at the cutting surface. The key microscopic feature of this process was the presence of pronounced diffuse edema of the stroma, involving follicles and associated with a cortical layer with superficial fibrous thickening. Knowledge of this entity is key in aiding the diagnosis during the ultrasonographic evaluation of ovarian tumors and preventing improper treatments.

Pattern of pelvic mass among women attending a gynaecology department of university hospital in Sindh

To analyze patients with pelvic mass according to age, parity, clinical presentation, pathology and operative procedures according to the type of mass, at a tertiary care hospital of Sindh-Pakistan. Descriptive case series. Department of Obstetrics and Gynaecology [Unit I], Liaquat University Hospital, Hyderabad; from January to December 2007. All women of any age and parity presenting with pelvic mass, diagnosed on history, clinical examination and/or on ultrasound were included. Type of pelvic mass was confirmed at surgery and on histopathology. In total, 110 patients were studied. Sixty-one [55.45%] participants were aged between 30-50 years while only one patient was under 20 years and 2 over 70 years. The majority of women were parous. The main clinical presentation was lower abdominal pain in 42 [38.18%] patients, followed by menstrual disturbances in 38[34.54%] women. Eighty-four [76.36%] patients were diagnosed on first clinical examination, and confirmed further by ultrasound. Among all, 104 [94.54%] patients were diagnosed through ultrasound. Sixty-eight [61.82%] patients had genital tract tumors while 4 had non-gynaecological mass. In 10[9.1%] patients, size of mass was >20cm; however, malignant lesions were less common and under 10 cm in size. Every women presenting with pelvic mass irrespective of age and parity must be thoroughly investigated and treated. Non-gynaecological masses may also be diagnosed; therefore, surgeon must be competent enough to deal with these masses

Intraoperative frozen sections for assessment of female cancers.

Frozen sections offer an important and helpful adjunct to intraoperative diagnosis and its use has greatly impacted on the care of gynecological oncology patients. Frozen section diagnosis is a reliable method for surgical management of gynecology oncology patients. Sensitivity of frozen section is acceptable and its specificity is almost perfect. False negative rate is low and false positive rate is negligible. Diagnostic problems can occur due to technical limitations especially in mucinous and borderline tumors. A good communication established between clinicians and pathologists is necessary to obtain more accurate results and to minimize the number of deferred cases.

Papillary serous carcinoma of the broad ligament: a rare case report.

Primary broad ligament carcinomas unassociated with either uterine or ovarian disease are extremely rare. This case report deals with such a rare occurrence of primary broad ligament carcinoma of the serous papillary type with foci of transitional differentiation in a 40 yr old woman with a clinical diagnosis of multiple fibroids of uterus. The highlight of this case is that besides being a rare tumor occurring in an unusual site such as the broad ligament the papillary serous carcinoma reported here also has a unique feature of transitional cell differentiation.