ABSTRACT
Women with high-grade squamous intraepithelial lesions/cervical intraepithelial neoplasia (HSIL/CIN) are at high risk of anal human papillomavirus HPV infection, and it has also been suggested that self-inoculation of the virus from the anal canal to the cervix could explain HPV recurrence in the cervix after treatment of HSIL/CIN. We aimed to evaluate the bidirectional interactions of HPV infection between these two anatomical sites. We evaluated 68 immunocompetent women undergoing excisional treatment for HSIL/CIN. Immediately before treatment, samples from the anus and the cervix were obtained (baseline anal and cervical HPV status). Cervical HPV clearance after treatment was defined as treatment success. The first follow-up control was scheduled 4-6 months after treatment for cervical and anal samples. High resolution anoscopy (HRA) was performed on patients with persistent anal HPV infections or abnormal anal cytology in the first control. Baseline anal HPV was positive in 42/68 (61.8%) of the women. Anal HPV infection persisted after treatment in 29/68 (42.6%) of the women. One-third of these women (10/29; 34.5%) had HSIL/anal intraepithelial neoplasia (AIN). Among women achieving treatment success, cervical HPV in the first control was positive in 34.6% and 17.6% of the patients with positive and negative baseline anal HPV infection, respectively (p = 0.306). In conclusion, patients with persisting anal HPV after HSIL/CIN treatment are at high risk of HSIL/AIN, suggesting that these women would benefit from anal exploration. The study also suggests that women with anal HPV infection treated for HSIL/CIN might be at higher risk of recurrent cervical HPV even after successful treatment.
ABSTRACT
AIM: To analyse the possible relationship between the EQD2(α/ß=3Gy) at 2 cm3 of the vagina and late toxicity in vaginal-cuff-brachytherapy (VBT) after external-beam-irradiation (EBRT) for postoperative endometrial carcinoma (EC). MATERIALS AND METHODS: From 2014 to 2016, 62 postoperative EC patients were treated with EBRT + VBT. The median EBRT dose was 45 Gy (44 Gy-50.4 Gy). VBT involved a single 7 Gy dose. Toxicity was prospectively evaluated using the RTOG score for the rectum and bladder and the objective LENT-SOMA criteria for the vagina. EQD2(α/ß = 3Gy) at 2 cm3 of the most exposed part of the vagina was calculated by the sum of the EBRT + VBT dose. Statistics: Boxplot, Student's t and Chi-square tests and ROC curves. RESULTS: Mean follow-up: 39.2 months (15-68). Late toxicity: bladder:0 patient; rectum:2 patients-G1; Vagina: 26 patients-17G1, 9G2; median EQD2(α/ß=3Gy) at 2 cm3 in G0-G1 patients was 70.4 Gy(SD2.36), being 72.5 Gy(SD2.94) for G2p. The boxplot suggested a cut-point identifying the absence of G2: 100 % of G2p received >68 Gy, ROC curves showed an area under the curve of 0.72 (sensitivity of 1 and specificity of 0.15). CONCLUSIONS: Doses >68 Gy EQD2(α/ß=3Gy) at 2 cm3 to the most exposed area of the vagina were associated with late G2 vaginal toxicity in postoperative EC patients treated with EBRT + VBT suggesting a very good dose limit to eliminate the risk of G2 late toxicity. The specificity obtained indicates the need for prospective analyses.
ABSTRACT
En los últimos años se han producido avances muy importantes en el manejo de los tumores ginecológicos, tanto en el diagnóstico, como en los posibles tratamientos, ya sean médicos o quirúrgicos. El diagnóstico precoz de los procesos tumorales es el factor más importante para mejorar el pronóstico de las pacientes y permitirnos el uso de estrategias de tratamiento menos agresivas, que mejoran no solo la supervivencia sino la calidad de vida de aquellas. La incorporación de la PET en la oncología permite la evaluación de parámetros biológicos y fisiológicos como complemento a las técnicas de imágenes convencionales como la TC o la RM y permite diferenciar lesiones benignas de malignas, estadificar los procesos neoplásicos con un solo estudio, detectar y localizar recurrencias (difíciles de diferenciar de procesos cicatriciales poscirugía o posradioterapia con técnicas convencionales) así como monitorizar los efectos del tratamiento. Aunque la aplicabilidad clínica parece clara y el uso de la PET (y de equipos híbridos como la PET-TC) se está generalizando por el acceso al entorno hospitalario de un equipamiento altamente sofisticado, debe tenerse en cuenta el impacto final en términos de coste-eficacia para su uso generalizado. La siguiente revisión pretende aportar una visión actual del uso de la PET y la PET-TC en la ginecología oncológica con las últimas indicaciones y proyecciones de futuro (AU)
In recent years, major advances have been made in the management of gynecological tumors, both in diagnosis and possible treatments, whether medical or surgical. Early diagnosis of the tumor is the most important factor to improve patient prognosis and allows the use of less aggressive treatment strategies that may increase both survival and quality of life in these patients. The incorporation of PET in oncology allows evaluation of biological and physiological parameters to supplement conventional imaging techniques such as CT or MR and helps to better differentiate benign from malignant lesions, stage tumors in a single study, detect and locate recurrences (difficult to distinguish from scarring processes after-surgery or radiotherapy with conventional techniques) and to monitor treatment effects. Although the clinical applicability seems clear and the use of PET (and hybrid equipment such as PET/CT) is becoming widespread due to access to highly sophisticated equipment in hospitals, the final impact in terms of cost-effectiveness needs to be considered. The following review aims to provide a current overview of the use of PET and PET-CT in gynecological oncology and discusses the latest indications and future prospects (AU)
Subject(s)
Humans , Male , Female , Positron-Emission Tomography/methods , Positron-Emission Tomography , Tomography, Emission-Computed/methods , Genital Neoplasms, Female/diagnosis , Genital Neoplasms, Female , Neoplasm Staging/instrumentation , Neoplasm Staging/methods , Neoplasm Staging , Early Diagnosis , Neoplasm Staging/statistics & numerical data , Neoplasm Staging/trends , Fluorodeoxyglucose F18 , Ovarian Neoplasms , Neoplasm Recurrence, Local/diagnosis , Endometrial NeoplasmsSubject(s)
Humans , Female , Young Adult , Peritonitis/diagnosis , Peritonitis/microbiology , Streptococcus pyogenes , Streptococcus pyogenes/isolation & purification , Gentamicins/therapeutic use , Clindamycin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Penicillins/therapeutic use , Ultrasonography , Laparoscopy/methods , Laparotomy/methods , LaparotomyABSTRACT
El tumor fibroso solitario (TFS) es una tumoración mesenquimal poco frecuente identificada inicialmente en la pleura, pero que puede presentarse en prácticamente todas las regiones. En los últimos años, se han descrito algunos casos aislados originados en el tracto genital femenino. Presentamos el caso de una mujer de 35 años de edad que consultó por una tumoración vulvar, a la que se le practicó exéresis quirúrgica. En el examen anatomopatológico la tumoración medía 20mm de diámetro, presentaba características típicas de TFS y estaba constituida por una proliferación fusocelular sin atipias, con áreas alternas hiper ehipocelulares, abundante colágena y un patrón vascular hemangiopericitomatoso. En la inmunohistoquímica era intensamente positiva paraCD34 y bcl-2 y negativa para S-100 y actina. El TFS presenta un comportamiento agresivo en alrededor de un 25% de los casos y debe considerarse siempre un tumor potencialmente maligno, por lo que es preciso un seguimiento clínico. Por tanto, su correcta identificación y diferenciación de otras lesiones del área genital femenina con características similares son de importancia crucial (AU)
Solitary fibrous tumour (SFT) is a rare mesenchymal tumour initially identified in the pleura, but that can be present in virtually all regions. Isolated cases arising in the female genital tract have been described in recent years. We report the case of a woman aged 35who presented with a vulvar tumour, which was resected. On pathological examination thet umour measured 20 mm in diameter and showed typical features of SFT, consisting of spindle cell proliferation without atypia, alternating with hyper- and hypo-cellular areas, presence of abundant collagen and with avascular hemangiopericy tomatous pattern. Immunohistochemistry was strongly positive forCD34 and bcl-2 and negative for S-100 and actin. SFT shows aggressive behaviour in approximately 25% of cases and should always be considered a potentially malignant tumour fusiforand requires a clinical follow-up. Therefore, the identification and differentiation from other lesions with similar features in the female genital area is essential (AU)
