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1.
Indian J Pathol Microbiol ; 65(2): 258-261, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35435356

RESUMO

Context: p16 is an important tumor suppressor gene and responsible for regulating the cell cycle. Diffuse positivity with p16 in the cervix and head/neck carcinomas can be regarded as a surrogate marker of the presence of high-risk human papillomavirus (HPV). Aim: The aim of our study was to search the existence of p16 expression in pterygium. We also analyzed the association of p16 expression with epithelial dysplasia and HPV expression. Subjects and Methods: The study enrolled 75 cases of pterygium. The conjunctival tissues of 10 patients excised by the strabismus surgery were used as control group. All of the slides were stained with p16 via the immunohistochemical method. Results: 49 (65%) of pterygiums showed low-grade epithelial dysplasia. None of the control groups showed dysplasia. Positive expression of p16 in patient group was significantly higher (P < 0.001). Staining percentage (SP) of p16 was between 0 and 26% in pterygium; mean SP was 5.1%. There was no staining in the control group. A total of 59 (72%) pterygium cases were positive with p16. Appoximately 42 of 49 (85%) cases with dysplasia showed p16 staining. There was a significant relation between dysplasia and positive expression of p16 (P < 0.001). Conclusions: P16 is significantly expressed in pterygium and correlated with epithelial dysplasia. Furthermore, the existence of p16 expression suggests that HPV is a possible ethiological factor in pterygium. We think that examination of p16 expression and analysis of HPV DNA in p16 positive cases can help us to understand the etiopathogenesis of the disease better.


Assuntos
Carcinoma in Situ , Neoplasias de Cabeça e Pescoço , Infecções por Papillomavirus , Pterígio , Biomarcadores Tumorais/análise , Carcinoma in Situ/complicações , Túnica Conjuntiva/anormalidades , Inibidor p16 de Quinase Dependente de Ciclina/análise , DNA Viral/análise , Feminino , Humanos , Imuno-Histoquímica , Pterígio/etiologia
2.
Pathologica ; 114(2): 138-145, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35481564

RESUMO

Objective: To identify and compare significant or relevant prognostic factors in pre-operatively diagnosed, surgically resectable, gallbladder cancer and in incidentally detected gallbladder cancer cases. Material and methods: Gallbladder resections (October 2009-March 2016) were identified on the histopathology Winpath database. Cases with a final histological diagnosis of gallbladder cancer (GBC) were categorised into: Group A: clinically suspected operable GBC (n = 13). Group B: incidental GBC with staged liver bed resection (n = 5). Group C: incidental GBC without staged liver bed resection (n = 15). The clinicopathological features were analysed in each group separately. Results: The overall incidence of primary (GBC) was 0.66% and all the cases were adenocarcinomas, of which, 6 of 33 (18.2%) were grade 1 and 15 of 33 (45.4%) were grade 3. Male to female ratio is 1:2.3. Of the 33 patients with GBC 14 (42.4%) has died of disease at 18-month follow-up. 15 of 33 had perineural invasion and 10/21 (47.6%) cases showed lymph node matastasis. Six cases had positive surgical margin and 9/15 showed direct liver invasion. Higher stage disease (T3/T4) was seen in 10/14 cases. Conclusion: The prognosis of primary GBC is poor and best clinical outcomes can be achieved with early diagnosis followed by radical cholecystectomy and staged liver resection with negative margins.


Assuntos
Carcinoma in Situ , Neoplasias da Vesícula Biliar , Carcinoma in Situ/cirurgia , Colecistectomia , Feminino , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Excisão de Linfonodo , Masculino , Margens de Excisão , Prognóstico , Reino Unido/epidemiologia
4.
Pathol Res Pract ; 233: 153877, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35398619

RESUMO

BACKGROUND: The expression status of HER2 is an important factor in evaluating the prognosis of breast cancer. We found that the positivity rate of HER2 varied with the diameter of invasive lesions in early breast cancer.We aimed to explore the relationship between the change of HER2 positivity rate of early breast cancer and the diameter of the invasive foci and its clinical significance. METHODS: A total of 217 patients with microinvasive breast cancer and T1a stage breast cancer were enrolled in this study. Machine learning algorithm was used to extract morphological features of invasive lesions in early breast cancer. Using Spearman to analysis the clinicopathological and morphological features related to HER2 expression McNemar test was used to analyze the consistency of HER2 expression between the carcinoma in situ area and the invasive cancer area. RESULTS: In early breast cancer, the diameter of the invasive foci was strongly negatively correlated with the expression status of HER2 (rho=-0.468, p < 0.001). As the diameter of the invasive foci increases, the HER2 positivity rate gradually decreases. When the diameter of the invasive foci> 2 mm, the positivity rate of HER2 was significantly reduced (from 52.6% to 16.1%, p < 0.001), which was close to the positivity rate of HER2 in ordinary invasive breast cancer. Moreover, most of the clinicopathological characteristics of breast cancer with an invasive lesion diameter of 1-2 mm and DCIS-MI were not significantly different (p > 0.05). Among 217 patients, the consistency rate of HER2 expression in carcinoma in situ and invasive foci areas was 97.7% (212/217), and there was no significant difference in HER2 expression status (p = 0.25 and p = 0.50, respectively). CONCLUSIONS: We recommend that breast cancer with an invasive lesion diameter of 1-2 mm should be classified as microinvasive breast cancer. In early breast cancer,the expression status of HER2 in the invasive foci area can refer to the HER2 expression status in carcinoma in situ area. However, it needs further support from a large amount of data and follow-up results.


Assuntos
Neoplasias da Mama , Carcinoma in Situ , Carcinoma Intraductal não Infiltrante , Neoplasias da Mama/patologia , Carcinoma in Situ/patologia , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Humanos , Prognóstico , Receptor ErbB-2/metabolismo
7.
J Transl Med ; 20(1): 188, 2022 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-35484565

RESUMO

BACKGROUND: Recent studies exploring the roles of invasion-metastasis associated miRNAs in gallbladder cancer (GBC) are limited. In the study, we aimed to identify the invasion-metastasis associated miRNAs in GBC by bioinformatics and experimental validation. METHODS: MiRNAs of different expression were identified by comparing GBC tumor samples with different survival from Gene Expression Omnibus database. MiRTarBase was used for identifying the potential target genes of miRNAs. Then, we performed Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. And miRNA-gene and protein-protein interaction (PPI) network were constructed for hub genes evaluation. We further explored and compared miR-642a-3p and miR-145-5p expression in both The Cancer Genome Atlas database and our hospital data. Finally, quantitative real-time PCR, wound healing assay, and Transwell assay were conducted to validate the invasion-metastasis associated miRNAs in GBC. RESULTS: In GSE104165 database, 25 up-regulated and 97 down-regulated miRNAs were detected with significantly different expression in GBC tumor samples. Then, 477 potential target genes were identified from the 2 most up-regulated miRNAs (miR-4430 and miR-642a-3p) and 268 genes from the 2 most down-regulated miRNAs (miR-451a and miR-145-5p). After GO and KEGG analysis, mTOR and PI3K-Akt signaling pathways were found associated with the potential target genes. Based on PPI network, the top 10 highest degree hub nodes were selected for hub genes. Furthermore, the miRNA-hub gene network showed significant miR-642a-3p up-regulation and miR-145-5p down-regulation in both GBC tissues and cell lines. In the experimental validation, miR-145-5p up-regulation and miR-642a-3p down-regulation were confirmed to suppress GBC invasion and metastasis. CONCLUSIONS: MiR-642a-3p and miR-145-5p were identified as invasion-metastasis associated miRNAs via bioinformatics and experimental validation, and both up-regulation of miR-642a-3p and down-regulation of miR-145-5p would be served as novel treatment options for GBC in the future.


Assuntos
Carcinoma in Situ , Neoplasias da Vesícula Biliar , MicroRNAs , Biologia Computacional , Neoplasias da Vesícula Biliar/genética , Neoplasias da Vesícula Biliar/patologia , Redes Reguladoras de Genes , Humanos , MicroRNAs/genética , MicroRNAs/metabolismo , Fosfatidilinositol 3-Quinases/genética
8.
Int J Gynecol Pathol ; 41(3): 298-306, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35444146

RESUMO

Accurate diagnosis of differentiated vulvar intraepithelial neoplasia (dVIN) is challenging, in part due to the sometimes subtle nature of its atypia. Many dVIN lesions demonstrate aberrant p53 staining; however, staining patterns overlap between dVIN and benign/reactive entities. We evaluate a p53/CK17 dual stain in an initial cohort of dVIN (n=30), benign vulvar skin (n=5), lichen sclerosus (LS, n=10), lichen simplex chronicus (LSC, n=10), and pseudoepitheliomatous hyperplasia (PEH, n=10). In the initial cohort, aberrant p53 staining was seen only in dVIN (50%, 15/30). Equivocal p53 staining patterns were seen in dVIN (37%, 11/30), LS (50%, 5/10), LSC (40%, 4/10), and PEH (40%, 4/10). All 30 dVIN cases were positive for CK17 (strong partial-thickness or full-thickness staining), but positive CK17 staining was also seen in LS (70%, 7/10), LSC (50%, 5/10), and PEH (100%, 10/10). In the initial cohort, the combination of aberrant p53 and positive CK17 was seen only for dVIN (50%, 15/30). Forty cases of LS with known follow-up (20 with progression to dVIN, 20 without) were stained to assess prognostic value. Three LS cases showed aberrant p53 staining with CK17 positivity; all progressed to dVIN. Equivocal p53 staining and CK17 positivity were seen in cases with and without progression. The p53/CK17 dual stain is more diagnostically useful than either stain alone. Negative/focal staining for CK17 argues against a diagnosis of dVIN, while aberrant p53 staining with CK17 positivity strongly supports the diagnosis.


Assuntos
Carcinoma in Situ , Carcinoma de Células Escamosas , Lesões Intraepiteliais Escamosas , Proteína Supressora de Tumor p53/metabolismo , Líquen Escleroso Vulvar , Neoplasias Vulvares , Biomarcadores Tumorais , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/patologia , Carcinoma de Células Escamosas/patologia , Corantes , Feminino , Humanos , Líquen Escleroso Vulvar/patologia , Neoplasias Vulvares/diagnóstico , Neoplasias Vulvares/patologia
9.
Diagn Cytopathol ; 50(6): 289-294, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35262275

RESUMO

BACKGROUND: The role of urinary cytology as a diagnostic test for the detection and surveillance of urothelial cancer is crucial. Intravesical bacillus Calmette-Guerin (BCG) is the appropriate therapeutic strategy for patients with high-grade urothelial carcinoma (HGCU) or in situ carcinoma. We investigate how applicable is the Paris System for reporting urinary cytology (TPS) and how accurate is urinary cytology, in patients who undergo intravesical BCG instillations. METHODS: Our study contains urine samples from patients during the period January 1, 2017 to December 31, 2019. The inclusion criteria were patients with history of urothelial bladder carcinoma who had been treated with intravesical BCG instillation and cytology was followed by histology. We report our results and estimate the risk of high-grade malignancy (ROHM) for each TPS category and cytology accuracy. RESULTS: Four hundred thirty-eight samples corresponding to 146 patients fulfilled the criteria to be included in the study. There were 2 inadequate, 118 negative for high-grade urothelial carcinoma (NHGUC), 14 atypical urothelial cells (AUC), 6 suspicious for high-grade urothelial carcinoma (SHGUC), and 6 cases HGUC. Corresponding histology assessment has shown that the ROHM amounted to 0 for inadequate, 3.4% for NHGUC, 57% for AUC, 100% for SHGUC and HGUC. Sensitivity was 50%, specificity 100%, PPV 100%, NPV 91%, and accuracy 91.7%, considering inadequate, NHGUC and AUC as negative and SHGUC and HGUC as positive result. However, considering AUC a positive result, the accuracy parameters were different; sensitivity 83.3%, specificity 95%, PPV 76.9%, NPV 96.67%, and accuracy 93%. CONCLUSION: The Paris system for reporting urinary cytology can be safely applied to patients during follow-up after BCG intravesical administration.


Assuntos
Carcinoma in Situ , Carcinoma de Células de Transição , Mycobacterium bovis , Neoplasias da Bexiga Urinária , Neoplasias Urológicas , Vacina BCG/uso terapêutico , Carcinoma in Situ/patologia , Carcinoma de Células de Transição/diagnóstico , Citodiagnóstico/métodos , Feminino , Humanos , Masculino , Neoplasias da Bexiga Urinária/patologia , Urina , Neoplasias Urológicas/patologia , Urotélio/patologia
10.
Head Neck Pathol ; 16(1): 31-39, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35312977

RESUMO

In this article, we review the chapter on tumors of the larynx, hypopharynx, trachea and parapharyngeal space in the new edition of the WHO book, focusing on the new developments in comparison to the previous edition. Squamous cell carcinoma (SCC) and its variants are by far the most common malignancies at these locations, with very limited new insights. The most important is the introduction of new targeted treatment-checkpoint inhibitors, with a new task for pathologists, who may help to predict the response to treatment by analyzing the expression of targeted proteins in biopsy samples. Precancerous lesions remain a controversial topic and, similarly to other organs, it is acceptable to use the terms "dysplasia" or "squamous intraepithelial lesion" (SIL), but there is a slight difference between low-grade dysplasia and low-grade SIL: in the former, mild atypia must be present, while the latter also includes hyperplastic epithelium without atypia. Two approaches have been proposed: a two-tiered system with low- and high-grade dysplasia/SIL and a three-tiered system with an additional category, carcinoma in situ. We are still searching for reliable diagnostic markers to surpass the subjectivity in biopsy diagnosis, with a few potential candidate markers on the horizon, e.g., stem cell markers. Other tumors are rare at these locations, e.g., hematolymphoid, neuroendocrine and salivary gland neoplasms, and are no longer included in Chapter 3. They must be diagnosed according to criteria described in specific chapters. The same holds true for soft tissue tumors, with the exception of cartilaginous neoplasms, which are still included in Chapter 3.


Assuntos
Carcinoma in Situ , Neoplasias de Cabeça e Pescoço , Laringe , Humanos , Hipofaringe , Espaço Parafaríngeo , Traqueia , Organização Mundial da Saúde
11.
Int J Gynecol Cancer ; 32(3): 344-351, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35256422

RESUMO

Vaginal cancer is a rare cancer. A lot of the data used in the treatment of this cancer are extrapolated from cervical cancer data. Radiation therapy plays a significant role in the treatment of vaginal cancer. The advances in radiation therapy in both external beam and brachytherapy have improved local control, survival, and toxicity. Brachytherapy plays an important role in treating vaginal cancer, but treatment should be individualized to each tumor. Imaging, particularly magnetic resonance imaging, plays an essential role in the management of patients with vaginal cancer, from diagnosis to staging to treatment management to surveillance.


Assuntos
Braquiterapia , Carcinoma in Situ , Neoplasias do Colo do Útero , Neoplasias Vaginais , Braquiterapia/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/radioterapia , Vagina/patologia , Neoplasias Vaginais/radioterapia
12.
Mol Med Rep ; 25(5)2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35266015

RESUMO

Presence of nuclear atypia during histological investigation is often a cause of concern for pathologists while identifying tumor and non­tumor cells in a biopsy sample of oral mucosa. Nuclear atypia is observed in severe inflammation, ulcers and reactive changes. Therefore, additional methods, such as immunohistochemistry, may help precise diagnosis. When the atypia is suggestive of tumorous or reactive origin, the lesion is diagnosed as atypical squamous epithelium (ASE). When there is severe nuclear atypia in the mucosa, such as in disorders of nuclear polarity, large nuclei, and clear nucleolus, the lesion is diagnosed as carcinoma in situ (CIS). However, it is not easy to distinguish ASE and CIS using hematoxylin and eosin staining. The present study aimed to distinguish ASE from CIS using immunohistochemistry. A total of 32 biopsy samples of either ASE or CIS cases were selected and the level of casein kinase 1ε (CK­1ε), differentiated embryonic chondrocyte gene 1 (DEC1), proliferating cell nuclear antigen (PCNA) and CD44, which are four protein markers which have been previously linked to cancer progression, were analyzed. CK­1ε and CD44 expression was higher in CIS samples than in ASE samples. However, DEC1 expression was lower in CIS samples than in ASE samples. PCNA expression was not markedly different between the two groups. Additionally, it was found that DEC1­overexpressing cells had decreased levels of CK­1ε and CD44 compared with control cells, while CK­1ε­overexpressing cells had relatively unchanged levels of CD44, DEC1 and PCNA. These results suggested that DEC1 negatively regulates the expression of CK­1ε and CD44. Thus, DEC1, CK­1ε, and CD44 were identified as mechanistically linked and clinically relevant protein biomarkers, which could help distinguish ASE and CIS.


Assuntos
Carcinoma in Situ , Carcinoma de Células Escamosas , Proteínas Supressoras de Tumor/metabolismo , Biomarcadores Tumorais , Carcinoma in Situ/patologia , Carcinoma de Células Escamosas/patologia , Caseína Quinases , Epitélio/patologia , Humanos , Receptores de Hialuronatos , Imuno-Histoquímica
14.
Cancer Res ; 82(9): 1803-1817, 2022 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-35247892

RESUMO

Biliary cancer has long been known to carry a poor prognosis, yet the molecular pathogenesis of carcinoma of the extrahepatic biliary system and its precursor lesions remains elusive. Here we investigated the role of Kras and canonical Wnt pathways in the tumorigenesis of the extrahepatic bile duct (EHBD) and gall bladder (GB). In mice, concurrent activation of Kras and Wnt pathways induced biliary neoplasms that resembled human intracholecystic papillary-tubular neoplasm (ICPN) and biliary intraepithelial neoplasia (BilIN), putative precursors to invasive biliary cancer. At a low frequency, these lesions progressed to adenocarcinoma in a xenograft model, establishing them as precancerous lesions. Global gene expression analysis revealed increased expression of genes associated with c-Myc and TGFß pathways in mutant biliary spheroids. Silencing or pharmacologic inhibition of c-Myc suppressed proliferation of mutant biliary spheroids, whereas silencing of Smad4/Tgfbr2 or pharmacologic inhibition of TGFß signaling increased proliferation of mutant biliary spheroids and cancer formation in vivo. Human ICPNs displayed activated Kras and Wnt signals and c-Myc and TGFß pathways. Thus, these data provide direct evidence that concurrent activation of the Kras and canonical Wnt pathways results in formation of ICPN and BilIN, which could develop into biliary cancer. SIGNIFICANCE: This work shows how dysregulation of canonical cell growth pathways drives precursors to biliary cancers and identifies several molecular vulnerabilities as potential therapeutic targets in these precursors to prevent oncogenic progression.


Assuntos
Neoplasias dos Ductos Biliares , Neoplasias do Sistema Biliar , Carcinoma in Situ , Lesões Pré-Cancerosas , Animais , Neoplasias dos Ductos Biliares/genética , Neoplasias dos Ductos Biliares/patologia , Pigmentos Biliares/metabolismo , Neoplasias do Sistema Biliar/genética , Carcinoma in Situ/patologia , Humanos , Camundongos , Lesões Pré-Cancerosas/patologia , Proteínas Proto-Oncogênicas p21(ras)/genética , Proteínas Proto-Oncogênicas p21(ras)/metabolismo , Fator de Crescimento Transformador beta/metabolismo , Via de Sinalização Wnt/genética
15.
Int J Colorectal Dis ; 37(5): 983-988, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35332364

RESUMO

PURPOSE: People living with HIV (PLWH) are at an elevated risk for developing anal cancer. As screening is invasive, markers predicting those at highest risk for anal cancer could guide individualized screening. Neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and prognostic nutritional index (PNI) are surrogate inflammatory/immune markers known to correlate with cancer outcomes. This study aims to assess whether these markers correlate with anal cancer risk in PLWH. METHODS: This is a retrospective single-institution cohort study of PLWH at a single academic medical center who were diagnosed with or screened for anal dysplasia between 2001 and 2019. Aforementioned markers collected within one year of diagnosis were recorded. Regression modeling was used to estimate odds of anal cancer. Receiver operating characteristic analysis was utilized to determine optimal cutoff for screening values. RESULTS: Five-hundred-fourteen patients were included. NLR and PNI were significantly associated with cancer risk on univariate (p = 0.03, p = 0.001) and multivariate analyses (p = 0.03, p = 0.01). NLR increased across all grades of dysplasia. PLR was not associated with cancer risk. A NLR of ≥ 1.64 can be utilized to capture 76% of cancer patients in our cohort. CONCLUSIONS: NLR values in patients living with HIV correlate with risk of anal cancer and increasing grades of dysplasia. A cutoff NLR of ≥ 1.64 can be used to help capture those at risk. NLR is a promising marker of risk of anal cancer and progression of anal dysplasia in patients with HIV infection and could be used to risk-stratify screening and surveillance intervals.


Assuntos
Neoplasias do Ânus , Carcinoma in Situ , Infecções por HIV , Neoplasias do Ânus/complicações , Biomarcadores , Carcinoma in Situ/complicações , Estudos de Coortes , Infecções por HIV/complicações , Humanos , Linfócitos , Neutrófilos , Prognóstico , Estudos Retrospectivos
16.
Acta Gastroenterol Belg ; 85(1): 108-110, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35305003

RESUMO

Anal intraepithelial neoplasia is a premalignant lesion for anal squamous cell carcinoma. Current treatment options, consisting of topical therapy and local ablative procedures with electrocautery or radiofrequency ablation, are effective although recurrence rates are high. Experience with endoscopic submucosal dissection for anal lesions is limited, with only a few cases of anal intraepithelial neoplasia and early anal squamous cell carcinoma. We present a 65-year-old woman with high-grade anal intraepithelial neoplasia successfully removed by endoscopic submucosal dissection with no complications or signs of recurrence after 5 months, suggesting that this technique could be a safe and effective approach for management of anal premalignant lesions.


Assuntos
Neoplasias do Ânus , Carcinoma in Situ , Carcinoma de Células Escamosas , Ressecção Endoscópica de Mucosa , Lesões Pré-Cancerosas , Idoso , Neoplasias do Ânus/complicações , Neoplasias do Ânus/patologia , Neoplasias do Ânus/cirurgia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/patologia , Carcinoma in Situ/cirurgia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Lesões Pré-Cancerosas/cirurgia
17.
J Low Genit Tract Dis ; 26(2): 140-146, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35249976

RESUMO

OBJECTIVE: Vulvar intraepithelial neoplasia (VIN) is a premalignant condition with high recurrence rates despite treatment. Vulvar intraepithelial neoplasia develops through separate etiologic pathways relative to the presence or absence of human papillomavirus (HPV) and TP53 mutations. This systematic review was conducted (1) to identify historical risk factors for the development, recurrence, and progression of VIN and (2) to critique these risk factors in the context of advances made in the stratification of VIN based on HPV or TP53 status. MATERIALS AND METHODS: A systematic search was performed on MEDLINE, Embase, Cochrane Database, PsychInfo, and CINAHL from inception to July 5, 2021. Three gynecologic oncologists independently evaluated the eligibility of studies based on predetermined inclusion and exclusion criteria, abstracted data, and then analyzed the relevant data. RESULTS: A total of 1,969 studies (involving 6,983 patients) were identified. Twenty-nine studies met inclusion criteria. The quality of evidence was low; primarily level 2b (Oxford Centre for Evidence-Based Medicine). Risk factors associated with the development of VIN include: smoking and coexisting vulvar dermatoses. Risk factors associated with recurrence include: smoking, multifocal disease, and positive surgical margins. Recent studies identified the presence of differentiated VIN/TP53 mutation as the most significant risk factor for both VIN recurrence and malignant progression. CONCLUSIONS: The current body of evidence consists primarily of small retrospective observational studies. Well-designed retrospective case-control series and/or prospective observational studies are urgently needed. Ideally, future studies will collect standardized data regarding associated risk factors and stratify women with VIN based on HPV and TP53 status.


Assuntos
Carcinoma in Situ , Infecções por Papillomavirus , Neoplasias Vulvares , Carcinoma in Situ/patologia , Feminino , Humanos , Estudos Observacionais como Assunto , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Vulvares/patologia
18.
J Drugs Dermatol ; 21(3): 259-268, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-35254762

RESUMO

BACKGROUND: Patients with multiple actinic keratosis (AK), have pre-neosplastic abnormalities, constituting the sites of new tumors, this region is called the cancerization field. Due to the risk of malignant transformation, rigorous evaluation, follow-up, and treatment of the cancerization field is proposed. Recently, non-invasive diagnostic technologies such as confocal reflectance microscopy (RCM), detect AK, intraepithelial carcinomas (IEC), and SCC, without the need of repeated biopsies. There are few reports of the progression of AK assessed by dermatoscopy and RCM concomitantly. OBJECTIVES: Define morphological patterns and clinical applicability of dermatoscopy and MCR examinations of the AK lesions and their degrees of progression to IEC and SCC. METHODS: A retrospective cross-sectional study of dermatoscopy and RCM examinations was performed in 30 patients with histopathological diagnosis of AK (20), IEC (6), and SCC (4). RESULTS: In the comparative analysis of the dermatoscopic features, erythema was present in 100% of the lesions, the red pseudo-network in 75% of the AK (P=0.007), and linear and irregular vessels in 90% of the lesions of IEC/SCC. In the RCM of AK, the most striking finding was the presence of atypical honeycomb in the spinous layer, but typical in the granular layer. While the IEC/SCC group presented irregular epidermal architecture and atypical honeycomb in all epider-mal layers, it also showed a higher prevalence of individual corneocytes and nucleated cells, cellular pleomorphism, and nuclear atypia in the dermal papillae, irregular vessels within papilla, and cells with bright edges and dark central nuclei in the dermis. CONCLUSION: Dermoscopy and RCM may be considered as auxiliary methods for assessing lesions resulting from ke-ratinocyte atypia. The results of this study are consistent with published studies and it was possible to propose, with literature support, a model of progression of AK to IEC and SCC. J Drugs Dermatol. 2022;21(3):259-268. doi:10.36849/JDD.5086.


Assuntos
Carcinoma in Situ , Carcinoma de Células Escamosas , Ceratose Actínica , Neoplasias Cutâneas , Carcinoma in Situ/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Estudos Transversais , Dermoscopia/métodos , Humanos , Ceratose Actínica/diagnóstico por imagem , Ceratose Actínica/tratamento farmacológico , Microscopia Confocal/métodos , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia
19.
J Low Genit Tract Dis ; 26(2): 147-151, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35238809

RESUMO

OBJECTIVES: The aim of the study were to identify the risk factors for recurrent vaginal intraepithelial neoplasia (VaIN)1+ and to evaluate the efficacy of laser vaporization in patients who underwent hysterectomy for the treatment of cervical intraepithelial neoplasia (CIN). METHODS: Medical records of 374 women who underwent hysterectomy for the treatment of CIN were retrospectively reviewed. Recurrence was defined as VaIN1+ diagnosis by colposcopy-directed biopsy. RESULTS: Among 374 patients, 36 (9.6%) had VaIN1+ during a median follow-up of 32 (0-193) months: 13 (3.5%) had VaIN1, 6 (1.6%) VaIN2, 15 (4.0%) VaIN3, and 2 (0.5%) invasive cancer. Multivariate analysis showed that age of greater than 50 years was the only independent risk factor for VaIN1+ recurrence (odds ratio, 3.359; 95% CI, 1.60-7.07; p = .001). Among the 34 patients with VaIN, 21 (61.8%) were treated with laser vaporization and 11 (32.3%) were observed without treatment. Time to second recurrence was longer in the VaIN treated by laser vaporization group than that in the observation group (mean time to subsequent recurrence, 128.7 [95% CI, 101.4-156.0] vs. 41.8 [15.7-67.9] months; p = .003). Moreover, laser vaporization (hazard ratio, 0.125; 95% CI, 0.03-0.59; p = .009) was the only independent good prognostic factor for the second VaIN1+ recurrence. CONCLUSIONS: Patients older than 50 years who underwent hysterectomy for the treatment of CIN might be highly at risk of VaIN1+. Laser vaporization is the only independent prognostic factor that might prevent the second VaIN1+ recurrence.


Assuntos
Carcinoma in Situ , Neoplasia Intraepitelial Cervical , Neoplasias do Colo do Útero , Neoplasias Vaginais , Carcinoma in Situ/patologia , Neoplasia Intraepitelial Cervical/patologia , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Fatores de Risco , Neoplasias do Colo do Útero/diagnóstico , Neoplasias Vaginais/patologia
20.
Surg Pathol Clin ; 15(1): 95-103, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35236636

RESUMO

As the first node in treatment algorithms for breast disease, pathologists have the potential to play a critical role in refining appropriate therapy for lesions in the atypical ducal hyperplasia-ductal carcinoma in situ (ADH-DCIS) spectrum by conservatively approaching diagnosis of lesions limited in size on core needle biopsy. Appropriate efforts to downgrade the diagnosis of lesions at the borderline of ADH and DCIS will certainly lead to more breast conservation and avoid the common morbidities of mastectomy, sentinel node biopsy, and radiation therapy. Whether results of clinical trials of active surveillance will successfully identify a subset of women who may successfully forgo even limited breast-conserving surgery is eagerly anticipated. Given the increasing concern that a significant number of women with DCIS are overtreated, identification of patients at very low risk for progression who may forgo surgery and radiation therapy safely is of significant interest.


Assuntos
Neoplasias da Mama , Carcinoma in Situ , Carcinoma Intraductal não Infiltrante , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/patologia , Carcinoma in Situ/terapia , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/terapia , Feminino , Humanos , Hiperplasia/diagnóstico , Mastectomia
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