Human Papillomavirus (HPV) seroprevalence, cervical HPV prevalence, genotype distribution and cytological lesions in solid organ transplant recipients and immunocompetent women in Sao Paulo, Brazil.

INTRODUCTION: Solid organ transplant (SOT) recipients are at increased risk of Human Papillomavirus (HPV) persistent infection and disease. This study aimed to evaluate HPV seroprevalence, cervical HPV prevalence, genotype distribution, and frequency of HPV-related cervical lesions in SOT recipients in comparison to immunocompetent women. METHODS: Cross-sectional study including SOT and immunocompetent women aged 18 to 45 years who denied previous HPV-related lesions. Cervical samples were screened for HPV-DNA by a polymerase chain reaction (PCR)-based DNA microarray system (PapilloCheck®) and squamous intraepithelial lesions (SIL) by liquid-based cytology. A multiplexed pseudovirion-based serology assay (PsV-Luminex) was used to measure HPV serum antibodies. RESULTS: 125 SOT and 132 immunocompetent women were enrolled. Cervical samples were collected from 113 SOT and 127 immunocompetent women who had initiated sexual activity. HPV-DNA prevalence was higher in SOT than in immunocompetent women (29.6% vs. 20.2%, p = 0.112), but this difference was not statistically significant. High-risk (HR)-HPV was significantly more frequent in SOT than in immunocompetent women (19.4% vs. 7.9%, p = 0.014). Simultaneous infection with ≥2 HR-HPV types was found in 3.1% of SOT and 0.9% of immunocompetent women. HPV seropositivity for at least one HPV type was high in both groups: 63.8% of 105 SOT and 69.7% of 119 immunocompetent women (p = 0.524). Low-grade (LSIL) and high-grade SIL (HSIL) were significantly more frequent in SOT (9.7% and 5.3%, respectively) than in immunocompetent women (1.6% and 0.8%, respectively) (p = 0.001). CONCLUSIONS: These results may reflect the increased risk of HPV persistent infection and disease progression in SOT women due to chronic immunosuppression.

Microbiome and Cervical Cancer.

Persistent infection with some types of mucosal human papillomavirus (HPV) is the etiological factor for the development of cervical cancer and its precursor lesions. Besides, several cofactors are known to play a role in cervical disease onset and progression either by favoring or by preventing HPV infection and persistence. The microbiome of a healthy female genital tract is characterized by the presence of 1 or few varieties of lactobacilli. However, high-throughput studies addressing the bacterial diversity and abundance in the female genital tract have shown that several factors, including hormonal levels, hygiene habits, and sexually transmitted diseases may disrupt the natural balance, favoring the outgrowth of some groups of bacteria, which in turn may favor some pathological states. Recently, the vaginal microbiome has emerged as a new variable that could greatly influence the natural history of HPV infections and their clinical impact. In this context, changes in the vaginal microbiome have been detected in women infected with HPV and women with HPV-associated lesions and cancer. However, the role of specific bacteria groups in the development/progression or prevention/regression of HPV-associated pathologies is not well understood. In this review we summarize the current knowledge concerning changes in vaginal microbiome and cervical disease. We discuss the potential functional interplay between specific bacterial groups and HPV infection outcomes.

Actinomicose da mama em gestante / Actinomycosis of the breast in pregnancy

A actinomicose mamária é uma doença inflamatória rara, com poucos casos descritos na literatura. Pode ser primária da mama quando resultante de traumas na pele e papila mamária, e, secundária, quando de origem toracopleural. Sua apresentaçäo clínica é variável, devendo ser diferenciada das doenças mais comuns, dentre elas as mastites e também as neoplasias, como o carcinoma inflamatório. Seu diagnóstico é realizado pela cultura da secreçäo, com a identificaçäo das colônias de Actinomyces sp. Seu tratamento é a drenagem, quando indicada, a antibioticoterapia endovenosa e manutençäo oral por tempo prolongado. Os autores relatam caso de abscesso retromamário por Actinomyces sp. em gestante de 12 semanas que apresentava tumoraçäo mamária expansiva na mama esquerda.

Carcinossarcoma da mama feminina: tumor mesenquimal de abordagem axilar diferenciada / Carcinosarcoma of woman breast: a mesenquimal tumor with different approach of axila

O carcinossarcona da mama é tumor maligno no qual se encontra o componente mesenquintal dominante, podendo estar associado à carcinoma in situ, escamoso, ductal ou lobular invasivo. É mais comumente encontrado em sítios como cavidade oral, laringe, útero e ovários. Apresenta como sinonímias carcinoma escamoso com metaplasia fusiforme, pseudossarcoma, carcinoma sarcomatóide e carcinoma de células escamosas. Raramente encontrado na mama, sua incidência é menor do que 0,2 por cento de todos os tumores malignos. Os autores relatam caso de carcinossarcoma da mama em paciente de 52 anos que, à punçäo biópsia por agulha fina, apresentou citologia com grande quantidade proliferaçäo de células mesequimais, e à biópsia incisional conclui-se o diagnóstico de sarcoma fusocelular mamário. O resultado imunoistoquímico demonstram a origem epitelial e mesenquimal do tumor, sendo a citoqueratina marcador de células epiteliais e a vimentina, marcador mesenquimal. O carcinossarcoma é descrito por muitos autores como sendo o tumor mesequimal com maior número de casos com comprometimento linfonodal