Uterine transposition for fertility and ovarian function preservation after radiotherapy.

OBJECTIVE: To evaluate the feasibility of uterine transposition as a method of preserving fertility and ovarian function after pelvic radiation. METHODS: This prospective multicenter observational study included patients with non-gynecologic pelvic cancers who underwent pelvic radiation as part of their cancer treatment between June 2017 and June 2019. For inclusion in the study, patients were required to have normal menstrual cycles and hormone levels (follicle-stimulating hormone, luteinizing hormone, and estrogen) before treatment. Uterine transposition to the upper abdomen was performed prior to irradiation. Clinical examinations and Doppler ultrasonography were used to evaluate the gonadal vasculature post-surgery. The uterus was repositioned into the pelvis 2-4 weeks after radiation therapy or at the time of rectosigmoid resection in patients with rectal cancer who had undergone neoadjuvant treatment. Cancer treatment and follow-up were performed according to standard guidelines. RESULTS: Eight patients (seven with rectal cancer and one with pelvic liposarcoma) underwent uterine transposition at a median age of 30.5 years (range 19-37). The uterus was successfully preserved in six patients, accompanied by normal menses, hormonal levels, and vaginal intercourse after treatment. One patient with rectal cancer died of carcinomatosis 4 months after uterine transposition. One patient presented with uterine necrosis 4 days after uterine transposition, and the uterus was removed; however, one ovary was preserved. Cervical ischemia was the most common post-surgical complication in three (37.5%) patients. Three patients attempted to conceive, and two (66%) were spontaneously successful and delivered healthy babies at 36 and 38 weeks by cesarean section without complications. CONCLUSIONS: Uterine transposition is a feasible procedure for preserving gonadal and uterine function in patients requiring pelvic radiotherapy for non-gynecological cancer, with the potential for achieving spontaneous pregnancy and successful delivery.

First live birth after uterine transposition.

OBJECTIVE: To our knowledge, to report the first case of live birth of a child after uterine transposition (UT), pelvic radiotherapy, and subsequent uterine repositioning. DESIGN: Case report. SETTING: Tertiary referral cancer hospital. PATIENT(S): A 28-year-old nulligravid woman with left iliac and thoracic synchronous myxoid low-grade liposarcoma, which was resected with close margins. INTERVENTION(S): The patient underwent UT before undergoing pelvic (60 Gy) and thoracic (60 Gy) radiation on October 25, 2018. After radiotherapy, her uterus was reimplanted in the pelvis on February 20, 2019. MAIN OUTCOME MEASURE(S): The patient became pregnant in June 2021 and experienced an uneventful pregnancy until 36 weeks, when the patient started preterm labor and had a cesarean section delivery on January 26, 2022. RESULT(S): A boy was delivered after a gestation period of 36 weeks and 2 days (2686 g and 46.5 cm), with Apgar scores of 5 and 9, respectively; both mother and child were discharged the following day. After 1 year of follow-ups, the infant maintained normal development and the patient showed no signs of recurrence. CONCLUSION(S): To our knowledge, this case of the first live birth after UT is a proof-of-concept for the viability of UT as a procedure to prevent infertility in patients requiring pelvic radiotherapy.

Surgical analysis of lymph node positivity after neoadjuvant therapy / Análise cirúrgica da positividade linfonodal após neoadjuvância quimioterápica

Introduction: Breast cancer is the most prevalent tumor in women around the world, affecting 1 in 10 women in Brazil. Therefore, providing surgeries that can increase cure rates and provide less comorbidities than those that occur today is a challenge. Until the last decade, performing lymphadenectomy, after neoadjuvant therapy was mandatory. However, new studies could prove that, for some cases, the sentinel lymph node biopsy can be an option. Objective: To analyze the positivity rates of lymphadenectomy, after neoadjuvant therapy. Methods: A total of 152 patients who underwent lymphadenectomy were assessed, from 2012 to 2014; they were separated into two groups of arms: those that had clinically positive armpit results before chemotherapy in one arm, and those that had negative armpit results before chemotherapy. Results: Out of 152 patients, 57 had negative armpit results before chemotherapy, 71% continued to have negative results following lymphadenectomy. In the group containing 95 patients with positive armpit results (following neoadjuvant therapy), 43.6% of them were free from neoplasms after undergoing lymphadenectomy. Discussion: T he r esults o f t his s tudy w ere similar to those found in worldwide literature for lymph node rates in all groups. It means that both the staging before chemotherapy and neoadjuvant therapy are performed with the same efficacy rates as in other studied hospitals. Moreover, there is evidence on the authorization to perform sentinel lymph node biopsy after chemotherapy in those patients who had clinically negative armpit results prior to neoadjuvant therapy. Conclusion: Sentinel lymph node biopsy is a safe and efficient technique to be used in patients who underwent chemotherapy and had negative armpit results. Whenever needed, such technique should always be encouraged.

Introdução: O câncer de mama é a neoplasia que mais acomete mulheres no mundo, sendo uma a cada 10 mulheres que irão ser acometidas, no Brasil. Portanto, proporcionar cirurgias que tenham menor morbidade com as mesmas ou maiores taxas de cura é um desafio. De acordo com o exposto, até a década passada realizar linfadenectomia após quimioterapia neoadjuvante era mandatório, porém novos estudos estão conseguindo provar que para alguns casos a biópsia de linfonodo sentinela pode ser uma opção. Objetivo: Este estudo analisou o índice de positividade de linfadenectomias pós-quimioterapia neoadjuvante. Métodos: Foram avaliadas 152 pacientes, entre 2012 e 2014, que realizaram cirurgia de linfadenectomia, separado-as em dois braços, aquelas que eram axilas positivas clinicamente antes da quimioterapia em um braço, e no outro, axilas negativas antes do tratamento quimioterápico. Resultados: Desmembrando os 152 pacientes, 57 desses com axilas negativas anteriores à quimioterapia, obtivemos que 71% permaneceram negativas após linfadenectomia. No grupo de 95 pacientes com axilas positivas, após neoadjuvância quimioterápica, 43,6% resultaram estarem livres de comprometimento neoplásico após linfadenectomia . Discussão: Os resultados denotados no índice de positividade de linfonodos em todos os grupos foram muito semelhantes à literatura mundial, demonstrando que nosso estadiamento antes da quimioterapia e nosso tratamento neoadjuvante são realizados com a mesma eficácia do que de outros hospitais já estudados. Também pudemos denotar que estamos autorizados a realizar biópsia de linfonodo sentinela pós-quimioterapia naquelas pacientes as quais eram negativas as axilas clinicamente, antes do tratamento neoadjuvante. Conclusão: A biópsia de linfonodo sentinela é uma técnica segura e eficaz em pacientes pós-quimioterapia com axilas negativas e devemos sempre incentivar essa técnica, quando for indicado.

FREQUENCY AND FACTORS ASSOCIATED WITH INJURY TO THE AXILLARY VEIN IN WOMEN THAT UNDERWENT AXILLARY LYMPHADENECTOMY DURING BREAST CANCER SURGICAL TREATMENT / Frequência e fatores associados à lesão da veia axilar em mulheres submetidas à linfadenectomia axilar no tratamento cirúrgico do câncer de mama

Objective: To evaluate which variables are considered risk factors associated with injury to the axillary vein during lymphadenectomy in the surgical treatment of breast cancer patients. Methods: Retrospective study performed through the electronic record analysis of 1,007 patients who underwent axillary lymph node dissection at Hospital Erasto Gaertner, from January 2010 to December 2014. We assessed the following risk factors using a standard questionnaire: age, body mass index (BMI), presence of palpable axillary metastasis in the clinical examination, sentinel lymph node pre-lymphadenectomy, presence of axillary metastasis in the perioperative period, size of metastasis and if it was adhered to axillary vessels, presence of pectoralis muscle invasion, resection of the pectoralis minor muscle, axillary incision separated from breast incision, prior radiotherapy, neoadjuvant chemotherapy, and pre and postoperative staging. For each patient who presented injury to the axillary vein, we paired them with two homogeneous controls (age, BMI, preoperative staging, surgical proposal, and neoadjuvant treatment). Results: Thirteen patients had injury to the axillary vein. In the perioperative evaluation, in most of them, the axilla was positive in the injury group (10 cases = 76.9%) and control group (12 cases = 46.1%), and it was adhered to axillary vessels in 10 cases in the injury group (76.9%) and 7 in the control group (26.9%). Conclusion: In this study, the presence of axillary metastasis in the perioperative evaluation, as well as that adhered to the axillary vessels, is associated with an increased risk of injury to the axillary vein during lymphadenectomy.

Objetivo: Avaliar quais variáveis se apresentam como fatores de risco associados à lesão da veia axilar durante a linfadenectomia no tratamento cirúrgico de pacientes portadoras de câncer de mama. Métodos: Estudo retrospectivo realizado por meio da análise de prontuário eletrônico de 1.007 pacientes submetidas a esvaziamento axilar no Hospital Erasto Gaertner, no período de janeiro de 2010 a dezembro de 2014. Foram avaliados, por meio de um questionário padrão, os seguintes possíveis fatores de risco: idade, índice de massa corpórea (IMC), presença de metástase axilar palpável no exame clínico, linfonodo sentinela pré-linfadenectomia, presença de metástase axilar no transoperatório, tamanho da metástase e se estava aderida aos vasos axilares, presença de invasão do músculo peitoral, ressecção do músculo peitoral menor, incisão axilar separada da incisão mamária, radioterapia prévia, quimioterapia neoadjuvante e estadiamento pré e pós-operatório. Para cada paciente que apresentou lesão de veia axilar foi realizado pareamento com dois controles homogêneos (idade, IMC, estadiamento pré-operatório, proposta cirúrgica e tratamento neoadjuvante). Resultados: Treze pacientes apresentaram lesão da veia axilar. Na avaliação transoperatória, em sua grande maioria, a axila estava positiva no grupo da lesão (10 casos = 76,9%) e no grupo controle (12 casos = 46,1%) e encontrava-se aderida aos vasos axilares em 10 casos no grupo da lesão (76,9%) e em 7 (26,9%) no grupo controle. Conclusões: Neste estudo, a presença de metástase axilar na avaliação transoperatória, bem como aderida aos vasos axilares, está associada ao risco aumentado de lesão de veia axilar durante a linfadenectomia.

Can a sentinel node mapping algorithm detect all positive lymph nodes in cervical cancer?

OBJECTIVES: The aims of this study were to determine the sensitivity and negative predictive value (NPV) of sentinel lymph node (SLN) detection in cervical cancer using a combination technique, and to test the SLN algorithm that was proposed by the Memorial Sloan Kettering Cancer Center (MSKCC). METHODS: The study included 57 FIGO stage IA2-IIA patients who were treated at the Erasto Gaertner Hospital, Curitiba, from 2008 to 2010. The patients underwent SLN mapping by technetium lymphoscintigraphy and patent blue dye injection. Following SLN detection, standard radical hysterectomy, including parametrectomy and systematic bilateral pelvic lymphadenectomy, was performed. The SLNs were examined by immunohistochemistry (IHC) when the hematoxylin and eosin results were negative. RESULTS: The median age of patients was 42 years (range 24-71), the median SLN count was 2 (range 1-4), and the median total lymph node (LN) count was 19 (range 11-28). At least one SLN was detected in 48 (84.2 %) patients, while bilateral pelvic detection of SLNs was noted in 28 (58.3 %) cases-one case had bilateral pelvic SLNs and a para-aortic SLN, 19 (39.6 %) had unilateral pelvic LNs, and one (2.1 %) had an SLN in the para-aortic area. Metastatic LNs were found in 9 of 57 (15.8 %) patients. Eight of nine patients with LN metastasis had a positive SLN, yielding an overall sensitivity of 88.9 % and NPV of 97.5 %. Of the 75 sides that were mapped, the SLN detection method predicted LN involvement in 74 (98.6 %) hemi-pelvises. A total of ten hemi-pelvises had LN metastasis, nine of which involved the SLN, resulting in a sensitivity of 90 %, NPV of 98.5 %, and a false negative (FN) of 10 %. In two cases (4.2 %), the SLN was positive only after IHC. CONCLUSIONS: Our SLN procedure is a safe and accurate technique that increases metastatic nodal detection rates by 4.2 % after IHC. The SLN method performed better when analyzing each side; however, one FN occurred, even after applying the MSKCC algorithm.

Linfonodo sentinela positivo e dissecção axilar: são os nomogramas úteis na decisão? / Positive sentinel lymph node and axillary dissection: are nomograms useful in the decision?

Os objetivos deste estudo foram: determinar a taxa de comprometimento axilar adicional em pacientescom câncer de mama inicial, as quais foram submetidas à biópsia do linfonodo sentinelacom resultado positivo; identificar fatores que possam predizer este acometimento e, principalmente,determinar a aplicabilidade dos principais nomogramas desenvolvidos com a intenção depredizer a chance de acometimento axilar além do linfonodo sentinela. Estudo retrospectivo queenvolveu 49 pacientes com câncer de mama inicial e axila clinicamente negativa, as quais foramsubmetidas à biópsia de linfonodo sentinela com resultado positivo, sendo então submetidas àdissecção axilar, no período de 01 de janeiro de 2009 a 31 de dezembro de 2011. A análise dasvariáveis estudadas ocorreu de maneira descritiva, as probabilidades de predizerem o acometimentodos linfonodos axilares adicionais foram calculadas pelos nomogramas do MSKCC,Stanford e Tenon, que tiveram acurácia calculada por meio de área sob a curva receiver operatingcharacteristic. Das 49 pacientes com linfonodo sentinela positivo, 18 (36,73%) apresentaram metástasesadicionais na linfadenectomia axilar. Nenhuma das características analisadas foi capazde identificar quais pacientes apresentaram comprometimento linfonodal além do sentinela. Osnomogramas MSKCC, Stanford e Tenon apresentaram, respectivamente, 64,6, 62,7 e 46,0% deacurácia. Concluiu-se que a linfadenectomia axilar foi desnecessária em 63% dos casos, nenhumavariável isoladamente foi capaz de predizer o cometimento axilar além do linfonodo sentinela eos nomogramas Stanford e MSKCC foram capazes de reconhecer, em torno de 63% das vezes,pacientes com ou sem doença em linfonodos adicionais.

curacy calculated using area under the receiver operating characteristic curve. Of the 49 patients with positive sentinel lymph node, 18 (36.73%) had additional metastases in the axillary dissection. None of the analyzed characteristics alone was able to identify which patients had lymph node involvement beyond the sentinel. The nomograms MSKCC, Stanford and Tenon were respectively 64.6, 62.7, and 46.0% of accuracy. We concluded that the axillary dissection was unnecessary in 63% of the cases, no variable was able to predict the axillary involvement beyond the sentinel, and MSKCC and Stanford nomograms were able to recognize around 63% of the times patients with or without additional disease in lymph nodes.

Correlação entre as alterações radiológicas e o diagnóstico histológico de lesões não palpáveis ressecadas por agulhamento / Correlation between radiological change and histological diagnosis of non-palpable breast lesions submitted a surgical excision after wire locazition

Objetivo: O estudo teve como objetivo avaliar o BI-RADS® como preditor de malignidade nas lesões não palpáveis e a indicação da ressecção cirúrgica guiada agulhamento, através da correlação entre as alterações radiológicas e o diagnóstico histológico. Métodos: Estudo retrospectivo do tipo analítico-descritivo que envolveu 99 mulheres submetidas a 100 biópsias cirúrgicas por agulhamento de alterações não palpáveis, marcadas pré-cirurgicamente por ultrassonografia ou estereotaxia no período de janeiro a outubro de 2010. Resultados: Do total de 100 casos analisados, 47% apresentaram-se como microcalcificações, 46% como nódulos, 5% como nódulos contendo microcalcificações, 1% como as simetria e 1% como distorção focal. A análise histológica confirmou o diagnóstico de lesões benignas, caracterizadas por alterações fibrocísticas, hiperplasias sem atipias, adenose simples, ectasia ductal e fibroadenoma em 37% dos casos. As lesões de alto risco para malignidade, representadas no estudo, por hiperplasias com atipias, adenose esclerosante, cicatriz radial, papilomas complexos e tumor filodes somaram 16%. As neoplasias in situ 11% e os carcinomas infiltrativos 36%. Os achados mamo gráficos mais relacionados às lesões malignas foram: 80% dos nódulos contendo microcalcificações, 51,8% dos nódulos e 40,3% das microcalcificações, sendo que 42% das lesões classificadas como categoria 4 do BI-RADS e 78,5% das alterações classificadas como categoria 5 confirmaram malignidade. Conclusão: Conclui-se que o sistema BI-RADS® pode ser utilizado com preditor de malignidades nas lesões não palpáveis das categorias quatro e cinco, que a ressecção cirúrgica foi bem indicada em 63% das pacientes, e que em 72,4% das pacientes com malignidade o mesmo procedimento cirúrgico foi diagnóstico e terapêutico.

Objective: The study aimed to evaluate BI-RADS® as predictor of malignancy in non-palpable breast lesions and indication for surgery resection through the correlation between radiological findings and histological diagnosis. Methods: Retrospective study analytical type involving 99 women undergoing 100 surgical biopsy needle guided, marked pre surgically by mammography or ultrasound, from january to October 2010. Results: of the total 100 cases examined, 47% presented as microcalcifications, 46% as solid mass, 5% as solid mass associated with microcalcifications, 1% as focal assimmetry, and 1% as parenchymal distortion. Histological analysis confirmed the diagnosis of benign lesions, characterized by fibrocystic disease hyperplasia without atypia simple adenosis, ductal ectasia and fibroadenomas, in 37% of cases. High risk for malignancy lesions, represented in this study, by hyperplasia with atypia sclerosing adenosis, radical scar, papilloma complex and phyllodes tumor added 16%. Non invasive carcinoma was found in 11% and infiltrative carcinoma in 36%. The mammographic fundings related malignant lesions were: 80% of solid mass with microcalcifications, 51,8% of solid mass and 40,3% of microcalsifications. Malignant lesions were found in 42% of lesions classified as BI-RADS 4 and 78,5% as lesions classified as BI-RAD 5. Conclusion: It was concluded that the BI-RAD system can be as a predctor of malignancy in nonpalpable breast lesions classified as category 4 and 5 of BI-RADS, surgery resection was surely indicated in 63% of patients and in 72,4% of the pacients with diagnosis of malignancy the same procedure was diagnostic and therapeutic.

[A borderline ovarian tumor in inguinal canal: case report]. / Tumor borderline do ovário localizado no canal inguinal: relato de caso.

The symptoms of ovarian tumor are not specific and a rare presentation of the tumor is as the content of an inguinal hernia. We reported a case of an 82-year-old woman, diagnosed with breast cancer and with a concomitant hypoecoic adnexal mass at the ecographic exam. The patient was treated with conservative breast surgery and laparotomy. A cystic-solid ovarian lesion was found inside the right inguinal canal. Frozen-section examination was negative for malignancy, and the anatomopathological analysis revealed a borderline ovarian tumor.

Tumor borderline do ovário localizado no canal inguinal: relato de caso / A borderline ovarian tumor in inguinal canal: case report

Os sintomas do tumor ovariano são inespecíficos e uma forma rara de apresentação é como conteúdo de uma hérnia inguinal. Relatamos o caso de uma paciente de 82 anos, com diagnóstico de câncer de mama e lesão anexial hipoecoica à ecografia. A mesma foi submetida à cirurgia conservadora da mama e à laparotomia, com achado de lesão ovariana sólido-cística no interior do canal inguinal à direita. A análise por congelação foi negativa para malignidade, e o exame anatomopatológico mostrou tratar-se de tumor ovariano borderline.

The symptoms of ovarian tumor are not specific and a rare presentation of the tumor is as the content of an inguinal hernia. We reported a case of an 82-year-old woman, diagnosed with breast cancer and with a concomitant hypoecoic adnexal mass at the ecographic exam. The patient was treated with conservative breast surgery and laparotomy. A cystic-solid ovarian lesion was found inside the right inguinal canal. Frozen-section examination was negative for malignancy, and the anatomopathological analysis revealed a borderline ovarian tumor.

Neoplasia intraepitelial cervical de alto grau durante a gestação: experiência de um serviço do Sul do Brasil / High-grade cervical intraepithelial neoplasia during pregnancy: experience in a service in southern Brazil

OBJETIVO: avaliar o tratamento instituído a portadoras de neoplasia intraepitelial cervical de alto grau e o seguimento destas pacientes durante a gestação. MÉTODOS: estudo retrospectivo baseado na revisão dos prontuários de 30 pacientes atendidas no período de 1990 a 2002 no Hospital Erasto Gaertner, com diagnóstico de neoplasia intraepitelial cervical de alto grau durante a gestação. O diagnóstico foi realizado por colposcopia e biópsia, e a colposcopia foi realizada novamente durante o período gestacional e após o parto. Foram avaliados os diagnósticos de regressão e progressão das lesões. RESULTADOS: das 30 pacientes, 3 foram excluídas por não-confirmação do diagnóstico de lesão intraepitelial escamosa de alto grau (LEAG) pela colposcopia com biópsia. Quatro pacientes foram submetidas ao tratamento durante a gestação, e uma delas apresentou parto pré-termo na 32ª semana de gestação. Vinte e três pacientes foram submetidas a tratamento expectante, realizando-se nova colposcopia e biópsia, sendo então submetidas à conização ou cirurgia de alta frequência em média na 11ª semana de gestação. Em 7,4 por cento dos casos houve regressão da lesão na peça cirúrgica, embora a biópsia evidenciasse lesão de alto grau após o término da gestação. CONCLUSÕES: toda paciente com diagnóstico de lesão intraepitelial escamosa de alto grau (LEAG) deve ser submetida à colposcopia e biópsia para excluir lesão invasiva. A conduta expectante para as lesões intraepiteliais é o tratamento de escolha e mais seguro pela possibilidade de regressão destas lesões no período pós-parto.

PURPOSE: to evaluate the results of treatment to which patients with high grade intraepithelial cervical neoplasia (HSIL) are submitted, as well as their follow-up during pregnancy. METHODS: retrospective study based on the review of the medical report of 30 patients with diagnosis of high-grade squamous intraepithelial lesions (HSIL) during pregnancy and attended to at a tertiary hospital in southern Brazil from 1990 to 2002. Diagnosis was performed by colposcopy and biopsy, with repetition of the colposcopy during the pregnancy and after delivery. The diagnoses of regression and progression of lesions were evaluated. RESULTS: from 30 patients, 3 were excluded of the sample because the diagnosis of high-grade squamous intraepithelial lesions (HSIL) was not confirmed by the colposcopy with biopsia. Four patients were submitted to treatment during pregnancy, and one of them presented preterm delivery at the 32nd week. Twenty-three patients were submitted to expectant treatment, underwent a new colposcopy and biopsy, and then were submitted to conisation surgery at about the 11th week after the end of pregnancy. In 7.4 percent of the cases, there was lesion regression in the surgical specimen. CONCLUSIONS: all patients with diagnosis should be submitted to colposcopy and biopsy to exclude the possibility of invasive lesion. The expectant procedure for intraepithelial lesions is the most widely chosen and safe due to the possibility of regression in the postpartum period.

[Effects of tamoxifen on the expression of TGF-beta and p27 proteins in polyps and adjacent endometrium in postmenopausal women]. / Efeitos do tamoxifeno sobre a expressão das proteínas TGF-beta e p27 em pólipos e endométrio adjacente de mulheres após a menopausa.

PURPOSE: to evaluate the effects of tamoxifen on the expression of TGF-beta and p27 proteins in polyps and adjacent endometrium of women after menopause. METHODS: prospective study with 30 post-menopausal women with diagnosis of breast cancer, taking tamoxifen (20 mg/day), presenting diagnosis of suspect endometrial polyps through transvaginal ultrasonography, and submitted to diagnostic and surgical hysterectomy to withdraw the polyps and adjacent endometrium. A immunohistochemical study has been done to verify the expression of the TGF-beta and p27 proteins in the polyps and adjacent endometrium. These proteins' quantification has been done by morphometry. RESULTS: the patients' average age was 61.7 years old; their average age at the menopause onset was 49.5; and the average of using tamoxifen was 25.3 months. The average concentration of positive cells for TGF-beta protein in the glandular and stroma polyp epithelium was 62.6+/-4.5 cells/mm(2). For the p27, in the glandular polyp epithelium, it was 24.2+/-18.6 cells/mm(2) and for the stroma, 19.2+/-15.2 cells/mm(2). There was no significant difference between the expression of TGF-beta and p27 in the glandular epithelial form the polyps and the adjacent endometrium. The expression of proteins in the polyp and adjacent endometrium with its respective glandular and stroma epithelium showed a significant difference for the p27 protein (r=0.9, p<0.05). CONCLUSIONS: we have concluded that the TGF-beta expression is not related to the effect of tamoxifen on the growing of endometrial polyps, but the absence of polyps' malignization by tamoxifen may be explained by the high expression of p27 protein in its glandular epithelium.

Efeitos do tamoxifeno sobre a expressão das proteínas TGF-β e p27 em pólipos e endométrio adjacente de mulheres após a menopausa / Effects of tamoxifen on the expression of TGF-β and p27 proteins in polyps and adjacent endometrium in postmenopausal women

OBJETIVO:avaliar os efeitos do uso do tamoxifeno sobre a expressão das proteínas TGF-β e p27 em pólipos e endométrio adjacente de mulheres após a menopausa. MÉTODOS: estudo prospectivo, com 30 mulheres, após a menopausa com diagnóstico de câncer de mama, usuárias de tamoxifeno (20 mg/dia), que apresentavam diagnóstico de pólipo endometrial suspeito por meio de ultrassonografia transvaginal, submetidas à histeroscopia diagnóstica e cirúrgica para retirada dos pólipos e do endométrio adjacente. Realizado estudo imunoistoquímico para verificar a expressão das proteínas TGF-β e p27 nos pólipos e no endométrio adjacente. A quantificação dessas proteínas foi realizada por morfometria. RESULTADOS: a média de idade foi 61,7 anos; média da idade na menopausa, 49,5 anos; e o tempo médio de uso do tamoxifeno, de 25,3 meses. A concentração média de células positivas para proteína TGF-β no pólipo epitélio glandular e estroma foi 62,6±4,5 células/mm². Para a p27, no pólipo epitélio glandular, foi de 24,2±18,6 cel/mm² e estroma 19,2±15,2 cel/mm². Não houve diferença significante entre a expressão do TGF-β e p27 nos epitélios glandulares dos pólipos e do endométrio adjacente. A expressão das proteínas do pólipo e endométrio adjacente com os seus respectivos epitélios glandular e estromal apresentou diferença significativa para a proteína p27 (r=0,9, p<0,05). CONCLUSÕES: concluímos que a expressão do TGF-β não está relacionada ao efeito do tamoxifeno sobre o crescimento dos pólipos endometriais, mas a ausência de malignização dos pólipos induzida pelo tamoxifeno pode ser explicada pela alta expressão da proteína p27 no seu epitélio glandular.

PURPOSE: to evaluate the effects of tamoxifen on the expression of TGF-β and p27 proteins in polyps and adjacent endometrium of women after menopause. METHODS: prospective study with 30 post-menopausal women with diagnosis of breast cancer, taking tamoxifen (20 mg/day), presenting diagnosis of suspect endometrial polyps through transvaginal ultrasonography, and submitted to diagnostic and surgical hysterectomy to withdraw the polyps and adjacent endometrium. A immunohistochemical study has been done to verify the expression of the TGF-β and p27 proteins in the polyps and adjacent endometrium. These proteins' quantification has been done by morphometry. RESULTS: the patients' average age was 61.7 years old; their average age at the menopause onset was 49.5; and the average of using tamoxifen was 25.3 months. The average concentration of positive cells for TGF-β protein in the glandular and stroma polyp epithelium was 62.6±4.5 cells/mm². For the p27, in the glandular polyp epithelium, it was 24.2±18.6 cells/mm² and for the stroma, 19.2±15.2 cells/mm². There was no significant difference between the expression of TGF-β and p27 in the glandular epithelial form the polyps and the adjacent endometrium. The expression of proteins in the polyp and adjacent endometrium with its respective glandular and stroma epithelium showed a significant difference for the p27 protein (r=0.9, p<0.05). CONCLUSIONS: we have concluded that the TGF-β expression is not related to the effect of tamoxifen on the growing of endometrial polyps, but the absence of polyps' malignization by tamoxifen may be explained by the high expression of p27 protein in its glandular epithelium.

[High-grade cervical intraepithelial neoplasia during pregnancy: experience in a service in southern Brazil]. / Neoplasia intraepitelial cervical de alto grau durante a gestação: experiência de um serviço do Sul do Brasil.

PURPOSE: to evaluate the results of treatment to which patients with high grade intraepithelial cervical neoplasia (HSIL) are submitted, as well as their follow-up during pregnancy. METHODS: retrospective study based on the review of the medical report of 30 patients with diagnosis of high-grade squamous intraepithelial lesions (HSIL) during pregnancy and attended to at a tertiary hospital in southern Brazil from 1990 to 2002. Diagnosis was performed by colposcopy and biopsy, with repetition of the colposcopy during the pregnancy and after delivery. The diagnoses of regression and progression of lesions were evaluated. RESULTS: from 30 patients, 3 were excluded of the sample because the diagnosis of high-grade squamous intraepithelial lesions (HSIL) was not confirmed by the colposcopy with biopsia. Four patients were submitted to treatment during pregnancy, and one of them presented preterm delivery at the 32nd week. Twenty-three patients were submitted to expectant treatment, underwent a new colposcopy and biopsy, and then were submitted to conisation surgery at about the 11(th) week after the end of pregnancy. In 7.4% of the cases, there was lesion regression in the surgical specimen. CONCLUSIONS: all patients with diagnosis should be submitted to colposcopy and biopsy to exclude the possibility of invasive lesion. The expectant procedure for intraepithelial lesions is the most widely chosen and safe due to the possibility of regression in the postpartum period.

Validade de análise prognóstica do Adjuvant Online no Hospital Erasto Gaertner / Validity pf prognostic analysis of Adjuvant Online at Erasto Gaertner Hospital

Adjuvant! é um programa de computador mundialmente utilizado por oncologistas na decisão da adjuvância do câncer de mama precoce, porém apenas foi testado e validado na população norte-americana e britânica, não tendo nunca antes sido testado em populações de países menos desenvolvidos. Métodos: selecionaram-se 181 pacientes com câncer de mama estádios I e II tratadas há mais de 10 anos e aplicaram-se as variáveis do programa para previsão da mortalidade global, mortalidade específica por câncer, sobrevida livre de doença e probabilidade de recidiva em 10 anos. Comparou-se a média de todas as pacientes com o resultado observado. Resultados: a maior diferença entre os valores previstos e observados foi de 6,4% no cálculo da mortalidade pelo câncer. Quanto à mortalidade global, a diferença foi de 4% e, em relação ao intervalo livre de doença, 3,1%. Conclusão: não se observou diferença estatística entre os valores, demonstrando o programa ser uma boa ferramenta nesta instituição.

Projeto de responsabilidade social do Instituto de Oncologia do Paraná: tabaco: uma questão de consciência / Project of social responsibility of Oncology Institute of Paraná: tobacco: a matter of consciousness

Introdução: De acordo com a Organização Mundial de Saúde, o tabagismo é responsável por 30% das mortes por câncer. Contudo, o número de tabagistas está aumentando, especialmente entre os adolescentes. Curitiba é a segunda capital do Brasil em número de fumantes com idades igual ou superior a 15 anos. Objetivo: O Instituto de Oncologia do Paraná (IOP) idealizou a campanha de prevenção à adição nas escolas. Métodos: O projeto consiste em uma peça teatral educativa que aborda os males do tabaco na classe de aula, com o intuito de estimular a discussão entre alunos e professores. Conseqüentemente, as crianças e adolescentes podem desenvolver uma consciência crítica contra os males do tabaco. A peça Tabaco: uma questão de consciência foi apresentada em escolas públicas e privadas. No palco, um ator representa um garoto que está pensando em começar a fumar conversa com sua consciência, representada por uma atriz. Resultados: Até o momento, a peça foi apresentada em 15 escolas. Os estudantes mostraram-se interessados e motivados a debater o assunto. Atingindo o público jovem, esperamos prevenir, no futuro, inúmeras doenças relacionadas ao tabaco.

Introduction: According to the World Health Organization, tobacco is responsible for 30% of deaths from cancer. Even so, the number of users is increasing, especially among teenagers. Curitiba is the second Capital in Brazil in number of smokers aged 15 and over. Objective: the Institute of Oncology of Paraná idealized the prevention campaign of tobacco addiction in schools. Methods: It consists of performing an educative play about tobacco harms in the classrooms in order to stimulate the discussion about tobacco harms between students and teachers, as well as with the parents at home. Consequently, children can create a critical conscience against tobacco harms. The play Tobacco: A question of conscience is performed in public and private schools. On stage, a boy, represented by an actor, is thinking on starting smoking talks with his conscience, an actress. Results: Up to now, the play was performed in more than fifteen schools. The students have been quite motivated and interested in debating the subject. By reaching the young public, we hope to prevent innumerable tobacco related diseases in the future.

Experiência dos casos de biópsia do linfonodo sentinela em câncer de mama do Hospital Erasto Gaertner / Clinical experience with the cases of sentinel node biopsy in breast cancer at the Erasto Gaertner Hospital

A cirurgia conservadora da mama ou a mastectomia, associada com a biópsia do linfonodo sentinela, representa uma importante estratégia para as pacientes com câncer precoce de mama e axila clinicamente negativa. A biópsia do linfonodo sentinela é uma abordagem conservadora da cadeia linfática regional para o estadiamento da axila. Analisamos, retrospectivamente, 130 pacientes que realizaram biópsia do linonodo sentinela com média de idade de 53 anos. A técnica de identificação do linfonodo sentinela mais utilizada foi por meio do gama probe em 52,31% dos casos e em 40% das pacientes se utilizou injeção de corante azul. O número global de complicações foi de 12 casos (9,24%), sendo 3,85% de seroma e 3,08% de infecção em ferida operatória. A média de sobrevida foi de 42 meses e, na data da última consulta das 130 pacientes, 127 vivas sem tumor e recorrência. Em um caso, a paciente apresentava metástase a distância, e em dois casos, houve óbito por neoplasia disseminada. O objetivo do presente estudo é relatar a experiência do Serviço de Ginecologia e Mama do Hospital Erasto Gaertner com a utilização do linfonodo sentinela em câncer de mama. Os autores destacam as técnicas de biópsia do linfonodo sentinela empregadas, a morbidade do procedimento, o follow-up e fazem uma revisão da literatura.

Conservative surgery of the breast or mastectomy associated with sentinel lymph node biopsy represent an important strategy for patients with early breast cancer and clinically negative axillary nodes. The sentinel lymph node biopsy is a conservative approach of the regional lymphatic chain to determine axially nodal status. We retrospectively analyses 130 patients who had been submitted to sentinel node biopsy being 53 years of age on average. The technique os sentinel lymph node biopsy most used was radioactive colloid in 52.31% of cases. Vital blue dye injection was used in 40% of patients. The overall number of complications was 9.24%, 3.85% seroma and 3.08% infection in the surgical wound. The average follow-up time was 42 months, and on the date of the last consultation, 127 of the 130 patients were alive without tumor recurrence. In one case a patient presented distant metastase and in two cases there were death due to neoplasm spread. The purpose of this analysis is to report a research conducted at the Department for Gynecology and Breast Erastus Gaertner Hospital which focused the observation of the sentinel node in breast cancer. In this article the authors present techniques of biopsy in breast cancer, the morbidity of the procedure, the follow-up and a review of literature.

Tratamento cirúrgico do câncer de mama: experiência de 27 anos do Hospital Erasto Gaertner / Surgical treatment of breast cancer: 27-years experience of Erasto Gaerner Hospital

O último século foi de extraordinária evolução na apresentação clínica, no entendimento biológico e no manejo do câncer de mama. Estudos clínicos randomizados demonstraram claramente que procedimentos cirúrgicos menos radicais são tão efetivos como aqueles desenvolvidos na virada do século, como a mastectomia radical. Este estudo foi realizado com o objetivo de demonstrar a evolução do tratamento cirúrgico do câncer de mama na instituição no que se refere à radicalidade cirúrgica. Através da correlação da modalidade cirúrgica e do período que este tratamento foi realizado com o estádio clínico da doença, relatando também os índices de recidiva local, foi possível caracterizar três décadas distintas no que se refere à radicalidade cirúrgica do tratamento do câncer de mama no Hospital Erasto Gaertner