Ovarian squamous cell carcinoma.

Ovarian squamous cell carcinoma is a rare and aggressive ovarian neoplasm, where most of the cases arise from mature teratoma, which represents up to 20% of all ovarian tumors. Moreover, primary squamous cell carcinoma is considered to be related to human papillomavirus infection. The diagnosis is difficult and metastasis from bladder, genital tract, lung, and digestive tract cancers must be ruled out. There are no guidelines for treatment, however, radical surgery combined with adjuvant chemotherapy and radiation therapy, are the most common approach. We present the case of a young women diagnosed with a de novo ovarian squamous cell carcinoma, as well as the treatment and follow-up that she received.

Genotyping of human papillomavirus in cervical intraepithelial neoplasia in a high-risk population.

Infection with the human papillomavirus (HPV) is responsible for 99.7% of cervical cancers, the second most prevalent neoplasia in women worldwide and the fifth leading cause of death by cancer in this population. In Chile, the incidence rate is 14.4 cases per 100,000 women per year and it is considered a significant public health problem. The natural history of cervical cancer begins gradually from low-grade and high-grade squamous intraepithelial lesions to an invasive disease. In this study the frequency of HPV types was determined by HPV genotyping with reverse line blot hybridization in 200 cytobrushes of women with preneoplastic lesions in a high-risk population. HPV DNA was found in 89% of the lesions (83.3% of low-grade squamous intraepithelial lesions and 93.6% of high-grade squamous intraepithelial lesions). Multiple HPV infections were found in 14.4% and 15.5% of low- and high-grade lesions, respectively. HPV 16 was the most frequent genotype in single infections, followed by HPV 18. These results show that most of the preneoplastic lesions of the cervix (60%) were associated with HPV 16 and/or HPV 18, supporting the implementation of an HPV vaccination program in this high-risk population.

Maternal transfer of anti HPV 6 and 11 antibodies upon immunization with the 9-valent HPV vaccine.

BACKGROUND: This exploratory analysis was conducted to characterize the level of HPV types 6/11 antibodies in peripartum maternal blood and in cord blood of infants born to women who received 9-valent HPV (9vHPV) vaccine or quadrivalent HPV (qHPV) vaccine in a pivotal efficacy study (V503-001, NCT 00543543). METHODS: A total of 21 mother-infant pairs had evaluable HPV 6/11 results available for analysis. HPV6/11 antibodies were assessed using competitive Luminex immunoassay. The distribution of the ratios of infant to mother anti-HPV antibodies (i.e., infant-anti-HPV/mother- anti-HPV) was summarized. RESULTS: All mothers and infants were seropositive to HPV 6 and HPV 11. Anti-HPV 6/11 geometric mean titers (GMTs) in peripartum maternal blood and in cord blood of infant born to study participants were highly correlated. A 100% of infants born to seropositive mothers were also seropositive. The GMT ratios of peripartum maternal blood vs. those in cord blood were HPV 6: 1.23 [0.43, 3.49] and HPV 11: 1.29 [0.54, 3.07] in the 9vHPV vaccine group and HPV 6: 1.33 [0.41, 4.29] and HPV 11: 1.19 [0.45, 3.13] in the qHPV vaccine group, respectively. CONCLUSIONS: These results indicate that antibodies induced by the 9vHPV vaccine cross the placenta, which could potentially be beneficial against HPV6/11 infection and related disease such as recurrent respiratory papillomatosis.

Efficacy, immunogenicity, and safety of a 9-valent human papillomavirus vaccine in Latin American girls, boys, and young women.

BACKGROUND: A 9-valent human papillomavirus (HPV6/11/16/18/31/33/45/52/58; 9vHPV) vaccine was developed to expand coverage of the previously developed quadrivalent (HPV6/11/16/18; qHPV) vaccine. METHODS: Efficacy, immunogenicity, and safety outcomes were assessed in Latin American participants enrolled in 2 international studies of the 9vHPV vaccine, including a randomized, double-blinded, controlled with qHPV vaccine, efficacy, immunogenicity, and safety study in young women aged 16-26 years, and an immunogenicity and safety study in girls and boys aged 9-15 years. Participants (N=5312) received vaccination at Day 1, Month 2, and Month 6. Gynecological swabs were collected regularly in young women for cytological and HPV DNA testing. Serum was analyzed for HPV antibodies in all participants. Adverse events (AEs) were also monitored in all participants. RESULTS: The 9vHPV vaccine prevented HPV 31-, 33-, 45-, 52-, and 58-related high-grade cervical, vulvar, and vaginal dysplasia with 92.3% efficacy (95% confidence interval 54.4, 99.6). Anti-HPV6, 11, 16, and 18 geometric mean titers at Month 7 were similar in the 9vHPV and qHPV vaccination groups. Anti-HPV antibody responses following vaccination were higher among girls and boys than in young women. Most (>99%) 9vHPV vaccine recipients seroconverted for all 9 HPV types at Month 7. Antibody responses to the 9 HPV types persisted over 5 years. The most common AEs were injection-site related, mostly of mild to moderate intensity. CONCLUSIONS: The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Latin American young women, girls, and boys. These data support 9vHPV vaccination programs in Latin America, a region with substantial cervical cancer burden.

Adjuvant whole abdominal radiotherapy in epithelial cancer of the ovary.

PURPOSE: To reexamine the use of adjuvant radiotherapy in optimally debulked patients. METHODS AND MATERIALS: Between January 1985 and April 1998, 60 patients were treated with adjuvant whole abdominal radiotherapy (A-WART). The stage distribution was Stage IC in 17 patients, Stage II in 9, and Stage III in 34. The grade distribution was Grade 1 in 9 patients, Grade 2 in 27, and Grade 3 in 24; thus, 60% of the patients had Stage III disease and 40% had Grade 3 tumors. After surgery, no residuum was left in 42 (70%), 2 cm in 5 (8%) of 60 patients. Of the 60 patients, 19 also received platinum-based chemotherapy; in 12 of the 19, the chemotherapy was before A-WART. Thirty-seven of the patients had undergone previous abdominal procedures and a second-look operation was performed in 25% of them. A-WART consisted of 22 Gy in 22 fractions, at 5 fractions weekly in 90% of the patients. The remaining 10% received 25 Gy in 25 fractions within 5 weeks. The A-WART was delivered using a 4-MV linear accelerator. After abdominal irradiation, a boost to the pelvis was given to reach 45 Gy at 1.8 cGy/fraction, using a 4-15-MV linear accelerator. RESULTS: Treatment was delivered in a median of 50 days (range 48-70). In 12 (20%) of the 60 patients, a transient treatment interruption occurred because of acute toxicity, mainly vomiting and diarrhea. The overall survival rate was 55% at 5 years (median follow-up 96.5 months). Patients with low-histologic grade tumors (Grade 1-2) had a better 5-year survival rate (66%) than those with Grade 3 tumors (35%; p <0.03). A tendency for better survival was found for those with Stage I-II than for those with Stage III (69% vs. 43%). Nonetheless, this difference did not reach statistical significance (p = 0.17). For patients receiving chemotherapy, the 5-year survival rate was 51%, not statistically different from the 58% 5-year survival rate observed among those patients without adjuvant chemotherapy (p = 0.9). The abdominal control rate was 83%. Thirty-five percent of the patients sustained acute Grade 2-3 complications. Late complications were observed in 6 of 60 patients, 4 had Grade 3 (7%) and 2 had Grade 4 (3%). Two patients died of intestinal occlusion, both had undergone previous abdominal procedures and in 1, no tumor was found in the abdomen at the postmortem examination. CONCLUSION: A-WART achieves a quite favorable 5-year survival rate with a low complication rate in properly selected patients. A-WART should be included in the elective postoperative treatment of ovarian cancer patients who are at risk of abdominal failure, and this should be explored in a randomized trial.

HPV genotyping from invasive cervical cancer in Chile.

OBJECTIVE: To determine the prevalence rates of the different HPV types in cervical cancer lesions in Chile to facilitate the development of prophylactic human papillomavirus (HPV) vaccines effective for that country. METHOD: Biopsy samples of 312 cervical cancer lesions were assessed for HPV type by reverse-line blotting assay. RESULTS: HPV DNA was found in 94.2% of the lesions, 67.2% harboring 1 viral type and the remainder harboring more than 1 type. HPV-16 was the most frequent type in single infections (50.5%), followed by HPV-18 (7.8%), HPV-31 (2.4%), and HPV-45 (2.0%). HPV-16 was also present in 98.7% of dual and multiple infections, its most frequent association being with HPV-18. CONCLUSIONS: HPV types 16, 18, 31, and 45, alone or combined with other types, were observed in the biopsy samples of up to 80.5% of cervical cancer lesions.

Cost-effectiveness of vaccination against cervical cancer: a multi-regional analysis assessing the impact of vaccine characteristics and alternative vaccination scenarios.

Mathematical models provide valuable insights into the public health and economic impact of cervical cancer vaccination programmes. An in-depth economic analysis should explore the effects of different vaccine-related factors and vaccination scenarios (independent of screening practices) on health benefits and costs. In this analysis, a Markov cohort model was used to explore the impact of vaccine characteristics (e.g. cross-type protection and waning of immunity) and different vaccination scenarios (e.g. age at vaccination and multiple cohort strategies) on the cost-effectiveness results of cervical cancer vaccination programmes. The analysis was applied across different regions in the world (Chile, Finland, Ireland, Poland and Taiwan) to describe the influence of location-specific conditions. The results indicate that in all the different settings cervical cancer vaccination becomes more cost-effective with broader and sustained vaccine protection, with vaccination at younger ages, and with the inclusion of several cohorts. When other factors were varied, the cost-effectiveness of vaccination was most negatively impacted by increasing the discount rate applied to costs and health effects.

Oral manifestations of graft versus host disease. Case report.

This study has been carried out in order to understand and increase our knowledge about the oral manifestations and the treatment required for Graft Versus Host Disease. The complication of allogeneic transplants with haematopoietic cells is revised. The clinical case report deals with a nine-year-old girl who was treated in our unit of Integrated Paediatric Dentistry after referral by her paediatrician. The symptoms of Graft Versus Host Disease are basically characterised by immunodeficiency, diarrhoea, weight loss, dermatological and hepatic alterations and oral manifestations. This group of syndromes, caused by the fact that the receptor acquires 30% to 50% of the donor's immune system, can become acute leading to a 20% to 30% mortality rate. The syndromes are chronic in 50% of cases, when sometimes the destruction of the salivary glands is the only manifestation and has a mortality rate of 5%. From the odontological point of view 80% of patients are affected, although we should make the distinction between the manifestations which are directly caused by the disease, and those caused by chemotherapy or radiotherapy. Oral manifestations (caries, mucositis, ulcers, infections, etc) should be treated as soon as possible. Positive co-operation between physicians is of vital importance.

Neoplasias ováricas: análisis factorial Hospital Paula Jaraquemada, período 1975-1984 / Ovaric neoplasms: factorial analysis at the Hospital Paula Jaraquemada, 1975-1984

Se revisan los datos clínicos e histopatológicos de 10.558 pacientes hospitalizadas e intervenidas en la división de Ginecología Servicio de Obstetricia, Ginecología y Neonatología Hospital Paula Jaraquemada en el período 1975-1984; de ellas se estudian 510 pacientes en las cuales el diagnóstico histopatológico correspondió a una tumoración ovárica. Se exponen los conceptos básicos para decidir conducta ante un tumor ovárico. En el grupo de estudio se analizan: histología de los distintos tumores, frecuencia relativa de cada variedad histopatológica y edad de la paciente

Resultados del tratamiento de cáncer vaginal / Results of the treatment of vaginal cancer

Se presentan 22 pacientes portadoras de Ca. vaginal primario invasor tratadas en el período comprendido entre 1977 - 1983, mediante Radioterapia externa y/o intracavitaria, intersticial o cirugía; correspondiendo a: Estadío I = 13 pacientes; Estadío II = 5 pacientes; Estadío III = 3 pacientes y Estadío IV = 1 paciente. (Tabla 1). Con un seguimiento mínimo de 18 meses, la sobrevida sin evidencia de enfermedad del grupo total es de 66% con un control local del 73% (curvas actuariuales a 8 años, "Berkson Gage")

Avances en el tratamiento del carcinoma endometrial / Advances in the treatment of endometrial carcinoma

Desde comienzos de este siglo hasta mediados de la década del 50 la evolución de la superviviencia de cáncer endometrial ha sido modificada únicamente por el advenimiento de nuevos avances en técnicas anestésicas, mejor manejo para la enfermedad asociada, cirugía más acuciosa, con mayor rango de operabilidad y con el desarrollo de máquinas de alto voltaje (Cobalto 60, aceleradores lineales). Desde la década del 60 hasta comienzos del 80, si bien se incrementó la supervivencia libre de enfermedad a cinco años por el conocimiento de factores de riesgo asociados, ésta no ha sufrido mayor variación, independiente de las metodologías de tratamientos protocolizados en distintos centros. En la década actual, estudios recientes muestran la importancia de la citología peritoneal, diseminación microscópica en anexos e intra-abdominal, que va a incidir en un manejo más adecuado de la enfermedad pelviana y abdominal, que podría permitir una mayor supervivencia, que ha sido modificada en las dos últimas décadas