Prevalence of anal intraepithelial lesions in patients with inflammatory bowel disease

Introduction: Anal intraepithelial neoplasia (AIN) is a premalignant lesion of the anal canal associated with HPV, with a higher prevalence in immunosuppressed individuals. Patients with inflammatory bowel disease (IBD) are at potential risk for their development, due to the use of immunosuppressants and certain characteristics of the disease. Method: This is a prospective, cross-sectional, and interventional study that included 53 patients with IBD treated at a tertiary outpatient clinic, who underwent anal smear for cytology in order to assess the prevalence of AIN and associated risk factors. Results: Forty-eight samples were negative for dysplasia and 2 were positive (4%). Both positive samples occurred in women, with Crohn's disease (CD), who were immunosuppressed and had a history of receptive anal intercourse. Discussion: The prevalence of anal dysplasia in IBD patients in this study is similar to that described in low-risk populations. Literature data are scarce and conflicting and there is no evidence to recommend screening with routine anal cytology in patients with IBD. Female gender, history of receptive anal intercourse, immunosuppression and CD seem to be risk factors. (AU)

¿Permiten la citología, el genotipado y la anoscopia de alta resolución establecer un protocolo para la detección precoz del carcinoma epidermoide de canal anal en población de riesgo? / Do cytology, genotyping, and high resolution anoscopy allow to establish a protocol for early detection of squamous cell carcinoma of the anal canal in risk population?

Introducción: El cáncer anal ha experimentado un aumento de incidencia en los últimos años. Está mediado por el VPH y precedido de cambios precancerosos planteando la posibilidad de dirigir los esfuerzos preventivos hacia los grupos de alto riesgo. Sigue siendo controvertida la indicación de cribado y los métodos de detección ideales. Objetivo: Validar las pruebas de cribado implementadas en la actualidad comparadas con la biopsia como "gold standard". Material y Métodos: Estudio transversal con recogida de datos prospectiva, en una cohorte de hombres VIH+ que tienen sexo con hombres, pertenecientes al Hospital Gregorio Marañón e Infanta Leonor en un periodo de 2 años. Resultados: Se seleccionaron 179 pacientes con 286 visitas a la consulta de screening en las que se llevaron a cabo 3 pruebas de cribado en paralelo (citología anal, genotipado del VPH y anoscopia de alta resolución (AAR) con toma de biopsia dirigida sobre zona sospechosa o aleatoria). La sensibilidad y especificidad para la detección de displasia de alto grado y cáncer y su grado de concordancia con la biopsia fue la siguiente: citología 3,23%/94,43% (k: 0,03), genotipado de VPH de alto riesgo 90,32%/27,45% (k: 0,05), AAR 32,26%/87,45 (k: 0, 17) siendo el rendimiento diagnóstico de las tres pruebas muy bajo. Conclusión: La citología presenta un rendimiento diagnóstico muy bajo comparado con el genotipado que representa el mayor. A la luz de nuestros resultados, los protocolos clínicos tal y como vienen desarrollándose en la actualidad deberían de ser abandonados.

Introduction: The incidence of anal cancer has increased in recent years. It is mediated by HPV and preceded by precancerous changes, raising the possibility of directing preventive efforts towards high-risk groups. The indication of screening remains controversial and which methods would be the ideal ones. Objective: To validate the screening tests established actually, comparing it with the biopsy considered as the "gold standard". Materials and Methods: A cross-sectional study was performed, with prospective data collection in a cohort of VIH+ patients, who have male homosexual anal relations, belonging to Gregorio Marañón and Infanta Leonor Hospitals in a period of 2 years. Results: A total of 179 patients were selected with 286 visits to the screening Outpatient Clinic in which 3 parallel screening tests were performed (anal cytology, HPV genotyping and high resolution anoscopy (AAR) with a biopsy directed on a suspicious or random area). The sensitivity and specificity for the detection of high-grade dysplasia and cancer and their degree of agreement with the biopsy was as follows: cytology 3.23%/94.43% (k: 0.03), high HPV genotyping. risk 90.32%/27.45% (k: 0.05), AAR 32.26%/87.45 (k: 0, 17), the diagnostic accuracy of the three tests being very low. Conclusion: Cytology shows a very low diagnostic accuracy compared to the genotype that represents the highest one. In light of our results, clinical protocols as they are currently being developed should be abandoned.

Prevalencia de infección anal por el virus del papiloma humano en el Hospital Comandante Manuel Fajardo / Prevalence of HPV anal infection at Comandante Manuel Fajardo Hospital

Introducción: la infección anal por el virus del papiloma humano, se ha convertido en una entidad muy frecuente y se ha demostrado su relación con el cáncer anal. Objetivo: estimar la prevalencia del virus del papiloma humano en pacientes atendidos en el servicio de coloproctología del Hospital Comandante Manuel Fajardo. Métodos: se realizó estudio observacional descriptivo y transversal en 102 pacientes sin patologías agudas anorrectales que dieron su consentimiento. El estudio se realizó desde enero de 2010 hasta diciembre 2013. Se aplicó entrevista a los pacientes, recogida de datos de historia clínica, examen físico anogenital y examen citológico anal. Las variables de estudio fueron: edad, color de la piel, estado civil, nivel escolar y factores de riesgo. Resultados: de 102 citologías realizadas, 29, (25,66 por ciento) fueron positivas a la infección anal por el virus del papiloma humano. La prevalencia de citologías positivas a la infección anal por el virus del papiloma humano según variables fue: sexo femenino: 57 (55,80 por ciento); edades entre 18 y 40 años; mestizos (35 por ciento); divorciados (55,55 por ciento); pacientes con nivel primario; portadores al VIH (73,07 por ciento). Conclusiones: la citología anal constituyó un procedimiento factible para la detección de la incidencia por la infección anal por el virus del papiloma humano y los factores de riesgo son similares a los encontrados en otras regiones y publicaciones(AU)

Introduction: Human papillomavirus anal infection has become a very common entity and been proved its relationship with anal cancer. Objective: To estimate the prevalence of HPV in patients treated by the coloproctology service at Manuel Fajardo Hospital. Methods: A observational, descriptive and cross-sectional study with 102 patients without any acute anorectal pathologies, and who gave their informed consent. The studied was conducted from January 2010 to December 2013. The patients were interviewed, clinical record data were gathered, anal-genital physical examination and anal-cytological examination were performed. The study variables were age, skin color, marital status, educational level and risk factors. Results: Out of 102 smear tests performed, 29 (25.66 por ciento) were Human papillomavirus anal infection-positive. The prevalence of Human papillomavirus anal infection-positive smears according to variables were: female sex (57, 55.80 por ciento), aged 18-40; mestizos (35 por ciento); divorced (55.55 por ciento); primary education patients; HIV-carriers (73.07 por ciento). Conclusions: Anal cytology was an effective procedure for detecting the incidence of HPVAI, and the risk factors are similar to those found in other regions and publications(AU)

Protocolo para la pesquisa de la displasia anal mediante citología y anoscopía de alta resolución / Protocol for the investigation of anal dysplasia by cytology and high resolution anoscopy

Introducción: El carcinoma anal escamoso (CAE) representa el 2% de todas las neoplasiascolorrectoanales. Afecta a 2/100.000 habitantes por año en la población general. Se incrementa en lospacientes con serología positiva para el virus de la inmunodeficiencia humana (VIH-positivos), 60/100.000habitantes por año y asciende a 92-144/100.000 habitantes por año en los hombres que tienen sexocon hombres (HSH) VIH-positivos. Al igual que en el carcinoma escamoso del cuello uterino, el virus delpapiloma humano (VPH) está implicado en su génesis, y se encuentra presente en el 92% de los casos.El cáncer cervical y anal comparten el mismo origen embriológico, formando la zona de transformación,sitio donde se desarrollan las lesiones intraepiteliales escamosas (SIL) como resultado de la infección ypersistencia del VPH, en especial de los genotipos de alto riesgo que pueden progresar a CAE invasor. Elaumento significativo de CAE en las últimas décadas ha llevado a desarrollar la pesquisa de SIL anal (ASIL)mediante citología (PAP) y anoscopía de alta resolución (AAR) con técnica colposcópica, emulando losprotocolos de detección temprana para prevención el cáncer de cuello uterino.Objetivo: Conocer prevalencia de lesiones precursoras del CAE. Determinar sensibilidad (S), especificidad (E),valor predictivo positivo (VPP) y negativo (VPN) del PAP para la detección de displasias en población de riesgo.Material y Método: Diseño: Prospectivo, transversal, observacional, analítico. Se incluyeron individuos dealto riesgo (VIH-positivos, HSH, individuos con historia de VPH anogenital, mujeres con antecedentes decáncer o neoplasia intraepitelial genital inferior) estudiados en forma consecutiva, entre abril 2012 y febrero2014, en Consultorio de Detección Temprana del Cáncer Ana...

Introduction: Anal squamous cell carcinoma (SCC) represents 2% of all colo-recto-anal malignancies. It is confirmed a higher rate of anal cancer among HIV-infected population in comparison with the HIVuninfected population (60/100,000 person-years, versus 2/100,000 person-years). Among HIV-infected men who have sex with men (MSM), the incidence of anal cancer is as high as 92-144/100,000 population. Like cervical cancer, squamous-cell canal cancer is caused predominantly by high-risk, oncogenic strains of human papillomaviruses (HPV) detected in 92% of HIV-positive MSM. The cervical and anal cancer share the same embryological origin, and occurs at a squamo-columnar transition zone, site of squamous intraepithelial lesions (SIL) as a result of the persistence HPV infection, especially the high-risk genotypes that may progress to invasive cancer. In the last decades, the incidence of squamous-cell anal carcinoma is increasing rapidly forcing the research of anal SIL (ASIL) cytology (PAP) and high-resolution anoscopy (HRA) colposcopic technique, emulating protocols for early detection of cervical cancer as a primary prevention. Objective: This study aimed to determine the prevalence of SCC precursor lesions. Determine sensitivity (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) for the detection of anal dysplasia in the risk population. Material and Methods: Design prospective, cross-sectional, observational, analytical study. High-risk patients (HIV-positive MSM, patients with history of anogenital HPV, women with history of cancer or lower genital intraepithelial neoplasia) were included consecutively between April 2012 and February 2014 in Anal Early Detection Cancer Clinic...

Prevalência de alterações citológicas anais em pacientes com citologia cervical anormal / Prevalence of cytological anal abnormalities in patients with abnormal cervical cytology

A incidência do carcinoma escamoso anal vem crescendo expressivamente. Principal fator associado a ele é o Papiloma Vírus Humano (HPV). Estudos epidemiológicos mostram fases pré-clínicas antes do início do câncer anal. Esse trabalho visou a estimar a prevalência de alterações citológicas anais em pacientes com citologia cervical anormal e sem lesão macroscópica HPV induzida na região anal. Foram selecionadas 70 mulheres com citologia cervical alterada, soronegativas para o Vírus da Imunodeficiência Humana (HIV) e sem lesão perianal macroscópica pelo HPV. As pacientes foram submetidas a um questionário e foram realizadas coletas de captura híbrida anal e cervical, bem como de uma amostra de citologia oncológica cervical e duas amostras anais. A prevalência das alterações citológicas anais encontrada foi de 71,4%, sendo que 57,1% apresentaram captura híbrida anal positiva. A prevalência de captura híbrida anal positiva para HPV de alto risco oncogênico em paciente com citologia cervical de atipia escamosa de significado indeterminado, provavelmente não neoplásico (ASC-US) e de lesão intraepitelial escamosa de baixo grau (LSIL) foi de 27,1% e, em pacientes com citologia cervical de atipia escamosa de significado indeterminado, não podendo excluir lesão intraepitelial de alto grau (ASC-H), lesão intraepitelial escamosa de alto grau (HSIL), e carcinoma epidermóide do colo do útero foi de 30%. Pacientes com captura cervical positiva tiveram 4 vezes mais chance de apresentar captura anal positiva (OR=4; p=0,018). Concluímos haver alta prevalência citológica anal alterada na população estudada. O risco de contaminação anal é significativo nas pacientes com HPV de alto poder oncogênico em cérvice, portanto todas as pacientes com citologia cervical anormal merecem investigação anal, independente da gravidade do laudo citológico

The incidence of anal squamous cell carcinoma has been growing significantly. The main risk factor associated with this injurie is the Human Papilloma Virus (HPV). As studies have shown preclinical stages before the onset of anal cancer. This study aimed to estimate the prevalence of anal cytological abnormalities in patients with abnormal cervical cytology and without macroscopic HPV induced lesions in the anal region. The sample consisted of 70 women with abnormal cervical cytology, seronegative for human immunodeficiency virus (HIV) and without macroscopic anal lesions. Patients answered a questionnaire a were submited to collection of anal and cervical hybrid capture assay and collection of a sample of cervical cytology of two anal samples. Prevalence of anal cytological abnormalities found in patients with cervical cytological abormalities without macroscopic anal lesions was 71.4% and 57.1% of patients showed positive anal capture. Prevalence of positive hybrid capture to oncogenic anal HPV in patients with cervical cytology of atypical squamous cells of undetermined significance (ASC-US) and of low grade squamous intraepithelial lesion (LSIL) was 27.1%. Prevalence in patients with cervical cytology of atypical squamous cells – cannot exclude (ASC-H), high grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma of the uterine cervix in situ or were 30%. Patients with positive cervical capture were 4 times more likely to present positive anal capture (OR=4, p=0.018). In conclusion, we found a high prevalence of anal cytology abnormalities in this population. The risk of anal contamination is significant in patients with oncogenic HPV in cervix, so all patients with abnormal cervical cytology deserve anal investigation, regardless of the severity of cytological report

A citologia na prevenção do câncer anal / The cytology in anal cancer prevention

O câncer anal não tem sido considerado problema de saúde pública. No entanto, sua incidência vem aumentando em pessoas que praticam sexo anal receptivo, promíscuos e portadores de doenças sexualmente transmissíveis, principalmente HPV (papilomavírus humanos) e HIV (vírus da imunodeficiência humana). Nos últimos anos, em vários países, a incidência do câncer anal aumentou 1,5 vezes entre os homens e triplicou nas mulheres. Embora a literatura não reforce o rastreamento de rotina das lesões intraepiteliais anais nas populações de risco, seu uso racional baseia-se no sucesso obtido com o rastreamento por meio da citologia cervical na redução da incidência do câncer cervical. Neste artigo revisamos os métodos diagnósticos disponíveis e as possibilidades de tratamentos das lesões precursoras anais a fim de prevenir a evolução para o câncer anal. Os aspectos biológicos das lesões precursoras anais são semelhantes aos das lesões cervicais. Dessa forma, como o ginecologista é o principal responsável pelo acompanhamento das mulheres, poderia

Anal cancer was not considered a neoplasm of public health concern until recently. Nevertheless, it may be object of attention in groups in which its incidence is increasing: people who have anoreceptive intercourse, promiscuous people and people who have sexual transmitted diseases (HPV and HIV infection). The incidence of anal cancer increased 1.5 fold among men and tripled among women in recent years. Although there is no strong literature evidence that document the value of screening for ASILs (anal squamous intraepithelial lesions) in the risk population, the rationale screening relies upon the success of cervical cytology screening in the reduction of cervical cancer incidence. It was reviewed the availability of screening modalities that effectively diagnosis the precursor lesion and the possibility of treatments that can prevent ASILs from progressing to anal cancer. The biologic consequences of anal dysplasia or ASIL are considered analogous of those of cervical dysplasia so the gynecologists may contribute to this diagnosis and to the prevention of anal cancer.

Evolução dos doentes com citologia oncótica alterada e colposcopia anal normal / Outcome of patients with anal oncotic cytology alterations and normal anal colposcopy

A citologia anal vem sendo usada para rastreamento do carcinoma anal e suas lesões precursoras nas populações de risco. Quando o raspado do canal anal mostra alterações citológicas está indicada o exame com colposcópio e ácido acético para identificar e realizar biópsia para confirmar o achado. Poucos estudos mostram o seguimento dos doentes tratados de condilomas acuminados perianais. Temos usado os métodos em associação e encontrado lesões subclínicas em metade dos doentes, cujo exame proctológico não revelava doença HPV induzida. Essas lesões são tratadas com tópicos. Entretanto, algumas citologias estavam alteradas e a colposcopia anal não revelou doença HPV induzida. O objetivo deste estudo foi observar o comportamento dessas lesões no seguimento semestral, durante 12 meses, e avaliar se a periodicidade da reavaliação foi suficiente para evitar o aparecimento das lesões de alto grau ou superior. Encontramos 58 (21 por cento) entre 273 doentes nessas condições. As reavaliações de 22 deles após um ano mostraram que as colposcopias permaneceram normais em 17 (74 por cento), sendo que em cinco (22 por cento) a citologia voltou aos padrões normais e 12 (52 por cento) persistiram com alterações. Os outros seis (26 por cento) desenvolveram lesões clínicas ou subclínicas provocadas pelo HPV. As contagens de linfócitos T CD4 dos doentes HIV-positivos foram inferiores nos doentes cujas lesões progrediram. Os resultados permitiram concluir que as alterações podem progredir ou regredir neste grupo distinto de doentes, sendo relacionada à imunidade, e que o intervalo de seis meses é suficiente para cada reavaliação.

Anal cytology has been used for screening the anal carcinoma and its precursors in risk populations. When anal canal smear shows cytological alterations, examination with colposcope and acetic acid is indicated to identify and perform biopsy to confirm the finding. Few studies show the follow-up of patients treated with anal HPV induced lesions. We are using both methods in association and subclinical lesions have been found in 50 percent of patients, whose proctological examinations are free from HPV lesions. However, some smears have cytological alterations, despite anal colposcopy being normal. The aim of this study was to observe these lesions' behavior in a six-month follow-up, during a year, and to assess whether this periodicity of re-evaluations was enough to avoid high grade or superior lesions. We have found 58 (21 percent) among 273 patients with these parameters. One year re-evaluations of 22 of the patients showed that anal colposcopies remained normal in 17 (74 percent). In five (22 percent), the cytology returned to normality and in 12 (52 percent), the same abnormality was seen. The other six patients (26 percent) developed clinical or subclinical HPV induced lesions. T CD4+ lymphocytes counts of HIV-positive patients were inferior in those whose lesions progressed. These results permitted us to conclude that cytological alterations can progress or clear in these patients, and they have close relationship with the immunity, and the six-month interval is enough to each re-evaluation.

Infección por virus de papiloma humano: asociación entre infección genital y anal-perianal / Infection with human papillomavirus: association between anal-genital and perianal infection

Describir las características de la infección por virus de papiloma humano anal y perianal asociada a la infección por genital por el mismo virus. Se seleccionaron 65 pacientes con virus de papiloma humano genital, a quienes se les realizó citología, identificación viral por reacción en cadena de polimerasa y colposcopia de región genital, ano y periano. En el Servicio de Ginecología de la Maternidad "Concepción Palacios". Se observó una frecuencia de detección del virus en ano y periano de 31,3 por ciento. En 19,67 por ciento de las pacientes hubo concordancia entre la infección en genitales y la de ano y región perianal (P > 0,397). Entre los genotipos virales hubo concordancia del 33,74 por ciento (P= 0,0053), esta correlación fue mayor para el virus 6. Fueron evaluables 38 citologías anales y perianales (59,4 por ciento) y ninguna diagnosticó anormalidades. Entre estas citologías, al hacer la reacción en cadena de polimerasa, 15 resultaron positivas para virus de papiloma humano, 21 negativas y 2 insatisfactorias. Las lesiones más frecuentes fueron subclínicas. La distribución del resultado de la anoscopia, refleja que la normalidad es lo más frecuente (67,2 por ciento). El riesgo de infección por virus de papiloma humano en ano y periano se incrementa en pacientes con infección genital. Consideramos que es importante extender la evaluación ginecológica a la región anal y perianal a pesar de las limitaciones del uso de la citología y la colposcopia

To describe the characteristics of the anal and perianal human papillomavirus infection associated with genital infection by the same virus. We selected 65 patients, with genital infection by human papillomavirus, who was made them cytology, polymerase chain reaction and colposcopy in genital region, anus and periano. Servicio de Ginecologia de la Maternidad "Concepción Palacios" The frequency of detection of papillomavirus in anus and periano was 31.3 percent. There was consistency between the genital papillomavirus infection and the anus and region parianal in 19.67 percent (P > 0,397) and between viral genotypes in 33.74 percent (P = 0,0053), this correlation was increased to virus 6. They were 38 evaluable Papanicolaou test anal and perianal (59.4 percent) and none diagnosed abnormalities. Among these, 15 were polymerase chain reaction positive for papillomavirus, 21 negative and 2 unsatisfactory. The most common lesions were subclinical. The distribution of the anoscopia result reflects normal is most often (67.2 percent). The risk of HPV infection in anus and periano is increased in patients with genital infection. We believe it is important to extend the gynecologic evaluation to the anal and perianal region despite the limitations of the use of Papanicolaou test and the colposcopy

Examen citológico anal: prevalencia y citomorfología de las anormalidades / Anal cytological examination: histological and cellular parameters

Introducción: El estudio citológico anal es usado más frecuentemente como un test de screening para detectar las lesiones intraepiteliales escamosas anales (ASIL en inglés). Este estudio tuvo como objetivo la evaluación del uso y limitaciones del citológico anal en busca de la ASIL. Método: Se realizó un examen citológico anal de un hemiano, raspando con un bisturí y colocando en portaobjetos. Estos se sumergieron por espacio de un minuto en alcohol 96 por ciento y luego se llevaron al laboratorio para tinción y análisis. Fueron recolectadas 200 muestras. Pacientes: 100 pacientes fueron operados del ano desde Julio 2007 hasta Mayo 2008, que se separaron en varios grupos según la patología anal. Resultados: 55 pacientes fueron mujeres. El promedio de edad fue 47 años. La patología más frecuente por la cual los pacientes fueron intervenidos quirúrgicamente fue hemorroides. También hubieron fistulas y fisuras, así como condilomas. Encontramos metaplasia en el 60 por ciento de los pacientes y ninguna displasia severa. Se describieron las morfologías celulares que acompañan a la metaplasia. Conclusiones: En este estudio el examen citológico anal tiene una alta sensibilidad para la detección de metaplasia y displasia en pacientes de la población general operados del ano. Por lo tanto sugerimos que se realice en todos los pacientes que vayan a ser operados del ano o que consulten por patología anal, pues es un estudio sencillo de realizar y poco costoso, demostrando que hay muchos pacientes con cambios en el epitelio anal.

Introduction: The anal cytological study is mostly used as a screening test to detect anal scamous intraepithelial lesions (ASIL), among high risk populations. The objective of this study was to assess the use and limitations of the anal cytological one, as well as, to establish the parameters of histology and cytology. Method: An anal histological examination was performed with a curettage, and the material obtained was placed in a slide. It is submerged in 96 per cent alcohol for one minute and then, it is taken to the laboratory to be tinted. 200 samples were collected from 100 patients. Patients: These 100 patients underwent anal surgery from July 2007 to May 2008. They were organized in several groups in accordance with the anal pathology. Results: 55 of them were women. Average age was 47 years old. The most frequent pathology the patients were operated on was hemorrhoids. There were also, fistulas and fissures, as well as condylomas. Metaplasia was observed in 60 per cent of the patients. The cellular morphologies that come with metaplasia were described. Conclusions: In this study, the anal cytological examination is highly sensitive to metaplasia and displasia detection, in patients who underwent anal surgery. Thus, we recommend this study to all patients who will undergo anal surgery or who enquire about any anal pathology. This is a simple and cheap study, and shows that there are a lot of patients with changes in the anal epithelium.

Interstitial cells of Cajal and intestinal function in Trinidadian children / Células intersticiales de Cajal y función intestinal en niños trinitenses

OBJECTIVE: This study was carried out to compare the density of the interstitial cells of Cajal (ICCs) in the bowel wall of children with Hirschsprung's disease (HD), anorectal malformations (ARM) and normal controls in Trinidad and Tobago. SUBJECTS AND METHOD: Segments of bowel wall excised from eight children with HD, three controls and two children with ARM were immunostained with c-Kit primary antibody. Cells with features of ICCs were counted. RESULTS: All three controls and the two children with ARM had dense distribution of ICCs. Most children (6/8;75%) with HD had markedly reduced counts in aganglionic bowel. Two (25%) also had a decrease in ganglionic bowel. Possible influences were patient age and gender and the level of bowel sectioned. CONCLUSION: Analysis of this sample suggests that immunostaining for c-Kit positive cells might be a useful screening test in the assessment of bowel motility disorders. The possible effects of age, gender and the level of bowel sampled await determination.

OBJETIVO: Este estudio se llevó a cabo con el propósito de comparar la densidad de las células intersticiales de Cajal (CIC) en las paredes intestinales de niños con la enfermedad de Hirschprung (EH), y malformaciones anorectales (MAR), frente a controles normales en Trinidad Tobago. SUJETOS Y MÉTODOS: Segmentos de las paredes intestinales les fueron extirpados a ocho niños con EH; tres controles y dos niños con MAR fueron inmunoteñidos con anticuerpo primario c-kit. Se contaron las células con características de CIC. RESULTADOS: Los tres controles y los dos niños con MAR presentaban una distribución densa de CICs. La mayor parte de los niños (6/8; 75%) con EH tuvieron conteos marcadamente reducidos de intestino agangliónico. Dos niños (25%) también tuvieron una disminución de intestino gangliónico. Entre las influencias posibles se cuentan la edad y el género del paciente así como el nivel de intestino seccionado. CONCLUSIÓN: El análisis de esta muestra sugiere que la inmunotinción para células c-kit positivas podría ser un útil test de pesquisaje a la hora de evaluar desórdenes en la motilidad intestinal. Los efectos posibles de la edad, el género y el nivel de intestino muestreado, están pendientes de determinación.

Utilidad de la anoscopía magnificada en la detección de lesiones preneoplásicas por HPV / High resolution anoscopy in the detection of HPV-pre-neoplasic lesions

El cáncer de anal es infrecuente, aunque su incidencia está aumentando. El HPV se asocia a su desarrollo a través de las lesiones intraepiteliales escamosas (SIL). Se propone la citología anal y la anoscopía magnificada, con técnica de colposcopía, para la detección de estas lesiones.

Papilomavirus humano e o câncer anal / Human Papillomavirus and the anus neoplasms

O Papilomavirus humano(HPV) é uma das causas mais comuns de doença sexualmente transmissível, podendo provocar os condilomas acuminados que são considerados fatores de risco para displasia e neoplasia. Embora os HPV de alto risco sejam causa necessária para o câncer cervical, eventos genéticos adicionais são indispensáveis para a transformação malígna da maioria dos carcinomas anais e de outros sítios. Os trabalhos da literatura especializada ainda não conseguiram demonstrar se esse vírus é o fato determinante ou associado ao carcinoma anal. É preciso que mais pesquisas sejam feitas para resolver esse dilema. De qualquer forma, sugerimos que o controle das lesões clínicas e das sub-clínicas provocadas pelo HPV possa evitar a eventual progressão para carcinoma invasivo.

Diganóstico, tratamento e aspectos relacionados à prevenção do câncer anal / Diagnosis, treatment and prevention aspects of anal cancer

O câncer anal é uma neoplasia rara, mas sua incidência tem aumentado nas últimas três décadas. Retardos no diagnóstico fazem com que cerca de uma terço dos pacientes faleçam vítimas desta doença. Os principais desafios terapêuticos continuam sendo o diagnóstico precoce, a prevenção de metástases e a preservação da função esfincteriana em longo prazo

Anal cancer is a very rare tumor but its incidence had risen significantly during the past three decades. About one-third of patients die mainly due to delays in the diagnosis. Early detection, avoiding metastasis and preserving long term sphincterian function are still the main challenges concerning anal cancer treatment