ABSTRACT
BACKGROUND: We aimed to determine demographic and clinicopathological predictors for residual disease in women with cervical intraepithelial neoplasia (CIN 2/3) with endocervical cone margin involvement. METHODS AND FINDINGS: A cross-sectional study was conducted. The eligible patients were women who underwent hysterectomy as a treatment option after having a positive endocervical margin for CIN 2/3 in cervix conization specimens from 2000 to 2015. The patients were divided into two groups based on the persistence of CIN 2/3 and absence of CIN 2/3 in hysterectomy specimens. Demographic, clinical and histology information were collected in both groups. A total of 80 patients were eligible for the study; 37 (46.3%) had no persistence of CIN 2/3 and 43 (53.7%) had persistence of CIN 2/3 in the hysterectomy specimens. Demographic, clinical, and cone specimen characteristics, and a visible squamocolumnar junction and type of conization were analyzed as possible risk factors for the presence of residual lesions at hysterectomy, and none of these variables were associated with residual disease. Menopausal status was strongly associated with a high risk of persistent residual disease 81.2% (OR 4.9, CI 1.27-18.9), P = 0.014. In the multivariate analysis, only a menopausal status (P = 0.04) was associated with a high risk of persistent lesions. CONCLUSION: This analysis found that menopausal status exhibited an important association with persistent residual disease. Menopausal women with endocervical margin involvement exhibit a greater than 80% risk of persistent lesions.
Subject(s)
Conization/adverse effects , Margins of Excision , Menopause/physiology , Neoplasm, Residual/etiology , Uterine Cervical Dysplasia/surgery , Uterine Cervical Neoplasms/surgery , Adult , Female , Humans , Hysterectomy , Logistic Models , Middle Aged , Risk FactorsABSTRACT
The use of loop electrosurgical conization (LEC) for the treatment of large high-grade cervical intraepithelial neoplasias (CINs) is often associated with a difficult procedure that results in accidental sample fragmentation, thermal damage and sometimes the presence of positive margins. This study aims to compare LEC that removes the cervical cone in two blocks (anterior and posterior cervical lips - LEC2) with LEC performed with one pass of the loop (LEC1). In a randomized, controlled trial, patients that needed conization due to high-grade CIN were assigned to one of the techniques. There were no differences in terms of age, cone histopathological diagnosis, blood loss, vaginal injuries, stenosis of the cervical os and specimen artifacts. LEC2 required less hemostatic sutures. LEC2 showed no specimen fragmentation, while LEC1 did (0 vs. 5.9%; p = 0.10). As expected, LEC2 samples were heavier (p = 0.01), included a larger ectocervical area (p = 0.001) and, therefore, had a greater volume (p < 0.001) compared to LEC1 samples. The height of the LEC2 specimens was smaller than that of LEC1 specimens (p < 0.001). LEC2 yielded fewer cases of positive margins (12.7%) than LEC1 (33.3%; p = 0.021). We conclude that the LEC2 technique is an effective treatment choice: it is safe for the patient, with better outcomes regarding sample quality than LEC1. Further studies are encouraged regarding this procedure.
Subject(s)
Conization/methods , Uterine Cervical Dysplasia/surgery , Adult , Blood Loss, Surgical/statistics & numerical data , Cervix Uteri , Conization/adverse effects , Female , Humans , Intraoperative Complications/epidemiology , Sutures , Uterine Cervical Dysplasia/pathologyABSTRACT
Rabdomiossarcomas uterinos são raros. São caracterizados por diagnóstico tardio e prognóstico reservado. Neste artigo é relatada a manifestação deste tumor em uma paciente de 37 anos. Rabdomiossarcomas são tratados de forma semelhante à maioria dos sarcomas uterinos. A terapia inicial é laparotomia exploradora, com histerectomia total e salpingooforectomia bilateral. Devido à baixa frequencia, exames de rastreamento não estão indicados. São melhor tratados por especialistas, mas ginecologistas e clínicos gerais têm papel importante na precocidade do diagnóstico. Em casos suspeitos, biópsia endometrial ou dilatação e curetagem podem auxiliar o diagnóstico.
Subject(s)
Humans , Female , Cervix Uteri , Rhabdomyosarcoma , Hemorrhage , Uterine NeoplasmsSubject(s)
Humans , Female , Pregnancy , Uterine Cervical Dysplasia , Cervix Uteri , Placenta Diseases , Pregnancy , Pregnancy Complications , Uterine Cervical Neoplasms , Biopsy , Breast Neoplasms , Carcinoma, Squamous Cell , Precancerous Conditions , Melanoma , Prenatal Care , Uterine Cervical NeoplasmsABSTRACT
A tuberculose pélvica é uma forma de tuberculose extrapulmonar cuja incidência vem aumentando no mundo ocidental. Esta entidade freqüentemente é acompanhada de achados clínicos e laboratoriais que podem ser inespecíficos e mimetizar outras doenças, inclusive neoplasias ginecológicas. Os autores apresentam um caso de tuberculose pélvica associada à tuberculose peritoneal do abdome em uma mulher de 53 anos, que foi submetida a avaliaçäo laboratorial extensa, incluindo laparoscopia diagnóstica, dosagem de CA-125 e reaçäo de Mantoux. Os aspectos clinicopatológicos e os meios propedêuticos para elucidar o caso säo discutidos.
Subject(s)
Humans , Female , Adult , Middle Aged , Peritonitis, Tuberculous , Tuberculosis, Female Genital , Diagnosis, Differential , LaparoscopyABSTRACT
Os autores relatam o caso de uma paciente portadora de próteses valvulares cardíacas que fez uso de anticoagulantes orais durante toda a gestaçäo e deu a luz um recém-nascido com a síndrome Fetal do Warfarin (embriopatia por warfarin). Baseados neste caso e em outros da literatura mundial, os autores discutem a síndrome e enfatizam o risco teratogênico associado ao uso deste fármaco
Subject(s)
Infant, Newborn , Humans , Female , Abnormalities, Drug-Induced/etiology , Pregnancy/drug effects , Warfarin/adverse effectsABSTRACT
Relata-se uma experiência com LASER CO2 no tratamento das displasias do colo uterino com 42 pacientes