Squamocolumnar junction visibility among cervical cancer screening population in Peru might influence upper age for screening programs.

Cervical cancer screening and treatment of screen positives is an important and effective strategy to reduce cervical cancer morbidity and mortality. In order to have an accurate cervical cancer screening and evaluation of positives, the entire Squamocolumnar Junction (SCJ) must be visible. Throughout the life course, the position of the SCJ changes and affects its visibility. SCJ visibility was analyzed among participants screened at the League Against Cancer Clinic in Lima, Peru. Of the 4247 participants screened, the SCJ was fully visible in 49.7% of participants, partially visible in 23.1%, and not visible in 27.2%. Visibility decreased with age, and by age 45 years old, the SCJ was not fully visible in over 50% of participants. Our results show that a high percentage of participants at ages still recommended for screening do not have totally visible SCJ, and we may need to reconsider the upper age limit for screening and find new strategies for evaluation of those with a positive screening test and non-visible SCJ.

Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen-positive women: results from the ESTAMPA study.

VIA is recommended for triage of HPV-positive women attending cervical screening. In the multicentric ESTAMPA study, VIA performance for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) among HPV-positive women was evaluated. Women aged 30-64 years were screened with HPV testing and cytology and referred to colposcopy if either test was positive. At colposcopy visit, study-trained midwives/nurses/GPs performed VIA ahead of colposcopy. VIA was considered positive if acetowhite lesions were observed in or close to the transformation zone. Ablative treatment eligibility was assessed for VIA positives. Performance indicators were estimated. Three thousand one hundred and forty-two HPV-positive women were included. Sensitivity for CIN3+ was 85.9% (95% CI 81.2-89.5) among women <50 years and, although not significant, slightly lower in women 50+ (78.0%, 95% CI 65.9-86.6). Overall specificity was 58.6% (95% CI 56.7-60.5) and was significantly higher among women 50+ (70.3%, 95% CI 66.8-73.5) compared to women <50 (54.3%, 95% CI 52.1-56.5). VIA positivity was lower among women 50+ (35.2%, 95% CI 31.9-38.6) compared to women <50 (53.2, 95% CI 51.1-55.2). Overall eligibility for ablative treatment was 74.5% and did not differ by age. VIA sensitivity, specificity, and positivity, and ablative treatment eligibility varied highly by provider (ranges: 25%-95.4%, 44.9%-94.4%, 8.2%-65.3%, 0%-98.7%, respectively). VIA sensitivity for cervical precancer detection among HPV-positive women performed by trained providers was high with an important reduction in referral rates. However, scaling-up HPV screening triaged by VIA will be challenging due to the high variability of VIA performance and providers' need for training and supervision.

Liver Resection as Part of Cytoreductive Surgery for Ovarian Cancer.

Objective: The aim of this study was to describe and evaluate the safety of hepatic resections for ovarian cancer liver metastases and the benefit in terms of survival as part of cytoreductive surgery among peritoneal seeding and parenchymal metastases. Materials and Methods: Data were reviewed retrospectively from patients who underwent liver resection as part of cytoreductive surgery for ovarian cancer at the Instituto Nacional de Enfermedades Neoplásicas, in Lima, Perú, from January 2009 to December 2017. Results: From January 2009 to December 2017, 1211 patients underwent surgical cytoreduction for ovarian cancer; 39 of these patients had liver resection as part of their surgical treatment, with 9, 17, and 13 patients receiving primary, secondary, and tertiary, resections, respectively. The mean age of the patients was 46, the majority (87%) had stage III/IV ovarian cancer. In addition, 21 patients had parenchymal metastasis resections, and 95% of the patients had Dindo-Clavien I and II grade complications. The 30-day mortality rate was 0. Conclusions: Liver resection for advanced ovarian cancer is a safe procedure for primary up to quaternary cytoreduction and may confer survival benefits to patients.

Factores pronósticos para pacientes con cáncer de ovario epitelial avanzado tratados con citoreducción óptima en el INEN 1998-2008 / Prognostic factors for patients with epithelial advanced ovarian cancer treated with optimal citoreduccion in INEN 1998-2008

Objetivo: El objetivo de este estudio fue determinar los factores pronóstico de la sobrevida global (SG) y la sobrevida libre de enfermedad (SLE) en las mujeres con cáncer de ovario epitelial (COE) estadio avanzado después de la cirugía citorreductora y quimioterapia de primera línea basada en platino. Material y métodos: Todas las mujeres con cáncer de ovario con estadios clínicos FIGO III y IV que tuvieron cito reducción óptima primaria seguida de seis cursos de quimioterapia basada en platino en el Instituto Nacional de Enfermedades Neoplásicas entre enero de 1998 y diciembre de 2008, fueron identificadas a partir de la base de datos de cáncer de ovario. Se evaluó la sobrevida global, la sobrevida libre de enfermedad y los factores que influyeron en ellas. Resultados: Se estudiaron un total de 56 pacientes. La sobrevida global a 5 años fue de 46,9 %. Se encontraron como factores pronósticos significativos de la sobrevida global al recuento plaquetario (p=0.002) y al dosaje de hemoglobina (p=0.003) preoperatoria. Y como factores pronósticos significativos de sobrevida libre de enfermedad al recuento plaquetario (p=0.002) y la enfermedad residual post operatoria (p=0.002).Conclusiones: El recuento de plaquetas preoperatorio y el volumen de enfermedad residual postoperatoria son factores pronósticos de la sobrevida libre de enfermedad, mientras que la hemoglobina sérica preoperatoria y el recuento plaquetario preoperatorio lo son para la sobrevida global.

Objective: The objective of this study was to determine prognostic factors of overall survival (OS) and disease-free survival (DFS) in women with epithelial ovarian cancer in advanced stage (EOC) after cytoreductive surgery and first-line chemotherapy based on platinum. Material and methods:All women with ovarian cancer FIGO clinical stages III and IV who had optimal primary cytoreduction followed by six courses of platinum-based chemotherapy at the Instituto Nacional de Enfermedades Neoplásicas between January 1998 and December 2008, were identified from the database of ovarian cancer. We assessed overall survival, disease-free survival and factors influencing them. Results: We studied a total of 56 patients. Overall survival at 5 years was 46.9%. Were found as significant prognostic factors of overall survival at platelet count (p = 0.002) and the dosage of hemoglobin (p = 0.003) preoperatively. And as significant prognostic factors for disease-free survival at platelet count (p = 0.002) and postoperative residual disease (p = 0.002).Conclusions: The preoperative platelet count and volume of postoperative residual disease were predictive of disease-free survival, whereas preoperative serum hemoglobin and platelet counts were for overall survival.

Tumor de células esteroideas de ovario: reporte de un caso y revisión de la literatura / Steroid cell tumor of the ovary: a case report and literature review

El tumor de células esteroideas de ovario es una neoplasia poco frecuente que se origina del estroma o de los cordones sexuales y es potencialmente maligno. La mayoría de estos tumores producen hormonas esteroides siendo la testosterona la que se eleva frecuentemente. Se presenta el caso de una paciente de 30 años que presentó signos de virilización asociado a masa pélvica, ascitis e incremento de la testosterona. Fue operada y sometida a estadiaje de ovario. El resultado del estudio anatomopatológico fue tumor de células esteroideas. Una revisión de los aspectos clínicos, diagnósticos y terapéuticos de estos tumores, es presentada.

Steroid cell tumor of the ovary is a rare malignancy originating from the stromal or sex cord and is potentially malignant. Most of these tumors produce steroid hormones testosterone being which arises frequently. We report a case of a patient 30 who showed signs of virilization associated with pelvic mass, ascites and increased testosterone. She was operated and subjected to ovarian cancer staging. The result of the pathology was steroid cell tumor. A review of clinical aspects, diagnostic, and treatment of these tumors, is presented.

Angiomixoma agresivo: presentación clínico patológica de caso y revisión de la literatura / Aggressive angiomyxoma: clinical pathological case presentation and review of literature

El angiomixoma agresivo es una neoplasia mesenquimal benigna, poco frecuente con predilección por la pelvis y periné femeninos, con tendencia a la recurrencia después de la excisión. Se presenta el caso de una mujer de 31 años con una tumoración polipoide en vulva. Histológicamente la tumoración presentaba estroma mixoide, hipocelular, vasculatura variable. Las células tenían aspecto miofibroblástico y su inmunofenotipo fue positivo para Desmina, Alfa Actina, Actina HHF-35 y receptor de estrógenos.

Aggressive angiomyxoma is a benign mesenchymal neoplasm, uncommon with a predilection for the female pelvis and perineum, with tendency to recur after excision. A case of a 31 year old woman with a polypoid tumor in the vulva. Histologically the tumor stroma showed myxoid, hypocellular, vasculature variable. Myofibroblastic cells had the appearance and the immunophenotype was positive for desmin, alpha actin, actin HHF-35 and estrogen receptor.

Laparoscopia versus laparotomía para el manejo de cáncer de endometrio en el INEN / Laparoscopy versus laparotomy for the management of endometrial cancer in the INEN

Objetivo: Comparar los resultados intraoperatorios y postoperatorios de las pacientes sometidas a cirugía laparoscópica versus laparotomía para el estadiaje por cáncer de endometrio. Material y Métodos: Se revisaron las historias clínicas de las pacientes con cáncer de endometrio sometidas a cirugía de estadiaje en el INEN desde el 2005 al 2008 encontrándose 20 operadas por laparoscopia y 100 por laparotomía que cumplieron con los criterios de inclusión y exclusión. Resultados: Las variables sociodemográficas fueron similares en los grupos de laparoscopia y laparotomía. No se encontró diferencia significativa entre las caracteristicas patológicas en ambos grupos, siendo predominante el adenocarcinoma endometrioide EC I G1-2. El tiempo operatorio fue menor en el grupo de laparotomía (173,8 min) en comparación con laparoscopia (225,25 min), (p<0.001). Por otro lado se encontraron diferencias significativas a favor de la laparoscopia en cuanto al volumen de sangrado intraoperatorio (177,5 vs 242,17 cc) y la estancia hospitalaria (3,25 vs 4,0 días respectivamente). En cuanto a las complicaciones operatorias y postoperatorias, no se encontraron diferencias significativas entre ambos grupos. Conclusiones: El presente estudio demuestra que la laparoscopía es una buena alternativa quirúrgica a la cirugía tradicional para el tratamiento de cáncer de endometrio, ofreciendo ventajas en el tiempo de hospitalización y menor sangrado intraoperatorio.

Objective: The purpose of this study was to compare operative and postoperative outcomes in women who underwent endometrial cancer staging by laparoscopy or laparotomy. Methods: Medical records from patients with endometrial cancer staging surgery were reviewed between 2005-2008, and included 120 patients (laparoscopic group 20; laparotomy group 100). Results: Patient characteristics were similar in the laparoscopy and laparotomy groups. No significant difference among pathological characteristics in both groups was observed. The endometrioid adenocarcinoma EC I G1-2 was the predominant group. The operative time was shorter in the laparotomy group (173.8 min) in comparison with laparoscopic (225.25 min), (p <0.001). There were additional significant differences in favor of the laparoscopic as for the lower blood lose and shorter hospital stay (177,5 vs 242,17 cc and 3,25 vs 4,0 days respectively). The operative and postoperative complications were minimum and there were not significant differences between groups.Conclusion: The present study demonstrates that the laparoscopic is a good surgical alternative to the open traditional surgery for the treatment of endometrial cancer, offering advantages in terms of hospital stay and intraoperative bleeding.

Genes reguladores de apoptósis y proliferación celular en mujeres VIH positivo y cáncer de cuello uterino / Regulatory genes of apoptosis and cellular proliferation in positive women VIH and cancer of uterine neck

La apoptósis o muerte celular programada, es un proceso de eliminación celular que asegura el equilibrio entre proliferación y muerte celular: La pérdida de esta estabilidad genética puede traducirse en el inicio y progresión de una neoplasia. Estudiamos por inmunohistoquímica (IHQ) la expresión de genes reguladores de apóptosis y proliferación celular en mujeres VIH positivo con cáncer de cuello uterino. Empleando la reacción en cadena de la polimerasa (PCR) se estudio el genotipo de los papilomavirus humano (PVH) 16, 18, 31 Y 33. BCL-2 fue detectada en el 57.1 por ciento, no se detectó BAX en ningún caso. P53 se observó en el 42.8 por ciento y PCNA en el 71.4 por ciento. El ADN - PVH fue detectado en el 85.7 por ciento. El PVH-16 en el 57.1 por ciento, PVH - 18 en el 28.5 por ciento y el PVH 33 en 14.28 por ciento. En conclusión los eventos moleculares de la expresión de genes celulares reguladores de apoptósis y proliferación celular interrelacionan por vías diferentes, en la cascada carcinogenética del cáncer del cuello uterino, con los productos de la expresión genética de la confección viral VIH-PVH.