Therapeutic Assessment of Vulvar Squamous Intraepithelial Lesions with CO2 Laser Vaporization in Immunosuppressed Patients.

OBJECTIVE: A vulvar squamous intraepithelial lesion is deemed to be a preceding lesion to vulvar cancer, especially in women aged under 40 years, holders of an acquired or idiopathic immunosuppression. Several treatments have been used to treat these lesions. One of the aesthetically acceptable therapeutic methods is the CO2 laser vaporization. METHODS: In a transversal study, 46 records of immunosuppressed women bearing a vulvar low grade and/or high grade squamous intraepithelial lesion were selected out of the retrospective analysis, computing age, date of record, date of vulvar lesion treatment with CO2 laser, the time elapsed between the first and the last visit (in months), the number of visits, the presence or absence of condylomatous lesions in other female lower genital tract sites and whether or not recurrences and persistence of intraepithelial lesions have been noticed during the follow-up. RESULTS: Patients bearing vulvar high-grade squamous intraepithelial lesion and immunosuppressed (serum positive for human immunodeficiency virus [HIV] or with solid organs transplantation) have shown a higher level of persistence of lesions and a higher chance of having other areas of the female lower genital tract involved. CONCLUSION: While the CO2 laser vaporization is the most conservative method for the treatment of vulvar high-grade intraepithelial lesions, it is far from being the ideal method, due to the intrinsic infection features considered. The possibility of persistence, recurrences and spontaneous limited regression indicates that a closer surveillance in the long-term treated cases should be considered, in special for immunosuppressed patients.

OBJETIVO: A lesão intraepitelial escamosa da vulva é considerada uma lesão precursora do câncer vulvar, em especial em mulheres com idade inferior a 40 anos, portadoras de imunossupressão adquirida ou idiopática. Vários tratamentos têm sido utilizados para tratar esse tipo de lesão. Um dos métodos terapêuticos esteticamente aceitáveis é a vaporização a laser CO2. MéTODOS: Em um estudo transversal, foram selecionados da análise retrospectiva de prontuários arquivados no setor de patologia do trato genital inferior 46 prontuários de mulheres com imunossupressão e portadoras de lesão intraepitelial escamosa de baixo grau e/ou alto grau computando-se: idade, data de registro, data do tratamento da lesão vulvar com laser CO2, tempo entre a primeira e a última consulta (em meses), número de consultas, presença ou ausência de lesões condilomatosas em outros locais do aparelho reprodutor feminino e a ocorrência ou não de recidivas e persistência de lesões intraepiteliais durante o período de acompanhamento. RESULTADOS: Pacientes com lesão intraepitelial de alto grau vulvar e imunocomprometidas (soropositivas para HIV ou com transplante de órgãos sólidos) mostraram maior índice de persistência das lesões e maior chance de ter outras áreas do órgão genital feminino comprometidas. CONCLUSãO: Embora a vaporização a laser CO2 seja o método mais conservador para o tratamento das lesões intraepiteliais vulvares de alto grau, está longe de ser o método ideal pelas características intrínsecas da afecção em foco. A possibilidade de persistência, recidivas e regressão espontânea limitada recomenda maior vigilância para os casos tratados a longo prazo, em especial para as pacientes com imunossupressão.

Therapeutic assessment of vulvar squamous intraepithelial lesions with CO2 laser vaporization in immunosuppressed patients / Avaliação terapêutica das lesões intraepiteliais escamosas da vulva com vaporização a laser CO2 em pacientes com imunossupressão

Abstract Objective A vulvar squamous intraepithelial lesion is deemed to be a preceding lesion to vulvar cancer, especially in women aged under 40 years, holders of an acquired or idiopathic immunosuppression. Several treatments have been used to treat these lesions. One of the aesthetically acceptable therapeutic methods is the CO2 laser vaporization. Methods In a transversal study, 46 records of immunosuppressed women bearing a vulvar low grade and/or high grade squamous intraepithelial lesion were selected out of the retrospective analysis, computing age, date of record, date of vulvar lesion treatment with CO2 laser, the time elapsed between the first and the last visit (in months), the number of visits, the presence or absence of condylomatous lesions in other female lower genital tract sites and whether or not recurrences and persistence of intraepithelial lesions have been noticed during the follow-up. Results Patients bearing vulvar high-grade squamous intraepithelial lesion and immunosuppressed (serumpositive forhumanimmunodeficiency virus [HIV] or with solid organs transplantation) have shown a higher level of persistence of lesions and a higher chance of having other areas of the female lower genital tract involved. Conclusion While the CO2 laser vaporization is the most conservative method for the treatment of vulvar high-grade intraepithelial lesions, it is far frombeing the ideal method, dueto the intrinsic infection features considered. The possibility of persistence, recurrences and spontaneous limited regression indicates that a closer surveillance in the long-term treated cases should be considered, in special for immunosuppressed patients.

Resumo Objetivo A lesão intraepitelial escamosa da vulva é considerada uma lesão precursora do câncer vulvar, emespecial emmulheres com idade inferior a 40 anos, portadoras de imunossupressão adquirida ou idiopática. Vários tratamentos têm sido utilizados para tratar esse tipo de lesão. Um dos métodos terapêuticos esteticamente aceitáveis é a vaporização a laser CO2. Métodos Em um estudo transversal, foram selecionados da análise retrospectiva de prontuários arquivados no setor de patologia do trato genital inferior 46 prontuários de mulheres comimunossupressão e portadoras de lesão intraepitelial escamosa de baixo grau e/ou alto grau computando-se: idade, data de registro, data do tratamento da lesão vulvar com laser CO2, tempo entre a primeira e a última consulta (em meses), número de consultas, presença ou ausência de lesões condilomatosas em outros locais do aparelho reprodutor feminino e a ocorrência ou não de recidivas e persistência de lesões intraepiteliais durante o período de acompanhamento. Resultados Pacientes com lesão intraepitelial de alto grau vulvar e imunocomprometidas (soropositivas para HIV ou com transplante de órgãos sólidos) mostraram maior índice de persistência das lesões e maior chance de ter outras áreas do órgão genital feminino comprometidas. Conclusão Embora a vaporização a laser CO2 seja o método mais conservador para o tratamento das lesões intraepiteliais vulvares de alto grau, está longe de ser o método ideal pelas características intrínsecas da afecção em foco. A possibilidade de persistência, recidivas e regressão espontânea limitada recomenda maior vigilância para os casos tratados a longo prazo, em especial para as pacientes com imunossupressão.

Association between the p53 arginine/arginine homozygous genotype at codon 72 and human papillomavirus E6/E7 mRNA expression

ABSTRACT Objective: To evaluate the association between p53 polymorphisms and human papillomavirus (HPV) E6/E7 mRNA expression. Methods: We analyzed 175 cervical samples from women aged 16-69 years old who were tested for HPV E6/E7 mRNA expression (NucliSENS® EasyQ® HPV). The samples were divided into three groups: positive (n = 75) those with positive HPV E6/E7 mRNA expression and positive high-risk HPV Hybrid Capture (HR-HC) test; negative (n = 52) those with negative HPV E6/E7 mRNA expression and positive HR-HC; and control (n = 48) those with negative HPV E6/E7 mRNA expression and negative HR-HC. The p53 polymorphisms at codons 11, 72, and 248 were evaluated through polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: The frequency of the arginine/arginine homozygous genotype at codon 72 was significantly higher in the positive (49.3%) than in the negative (32.7%) and control groups (20.8%, p = 0.002*). The frequency of the arginine allele was also significantly higher in the positive (67.3%) than in the negative (53.8%) and control groups (38.5%, p < 0.001*). The arginine/arginine homozygous genotype was significantly associated with positive HPV E6/E7 mRNA expression (positive group) compared with negative and control groups (odds ratio: 2.633; 95% CI, 1.399-4.954, p = 0.003). The frequency of arginine/arginine homozygous genotype at codon 72 remained significantly more frequent in the positive group of women aged ≥30 years than in the other two groups. Conclusion: The presence of the p53 arginine/arginine homozygous genotype at codon 72 was significantly associated with the positive HPV E6/E7 mRNA expression.

Association between the p53 arginine/arginine homozygous genotype at codon 72 and human papillomavirus E6/E7 mRNA expression.

OBJECTIVE: To evaluate the association between p53 polymorphisms and human papillomavirus (HPV) E6/E7 mRNA expression. METHODS: We analyzed 175 cervical samples from women aged 16-69 years old who were tested for HPV E6/E7 mRNA expression (NucliSENS® EasyQ® HPV). The samples were divided into three groups: positive (n=75) those with positive HPV E6/E7 mRNA expression and positive high-risk HPV Hybrid Capture (HR-HC) test; negative (n=52) those with negative HPV E6/E7 mRNA expression and positive HR-HC; and control (n=48) those with negative HPV E6/E7 mRNA expression and negative HR-HC. The p53 polymorphisms at codons 11, 72, and 248 were evaluated through polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: The frequency of the arginine/arginine homozygous genotype at codon 72 was significantly higher in the positive (49.3%) than in the negative (32.7%) and control groups (20.8%, p=0.002*). The frequency of the arginine allele was also significantly higher in the positive (67.3%) than in the negative (53.8%) and control groups (38.5%, p<0.001*). The arginine/arginine homozygous genotype was significantly associated with positive HPV E6/E7 mRNA expression (positive group) compared with negative and control groups (odds ratio: 2.633; 95% CI, 1.399-4.954, p=0.003). The frequency of arginine/arginine homozygous genotype at codon 72 remained significantly more frequent in the positive group of women aged ≥30 years than in the other two groups. CONCLUSION: The presence of the p53 arginine/arginine homozygous genotype at codon 72 was significantly associated with the positive HPV E6/E7 mRNA expression.

Immunohistochemical Expression of VEGF and Podoplanin in Uterine Cervical Squamous Intraepithelial Lesions.

VEGF and podoplanin (PDPN) have been identified as angiogenesis and/or lymphangiogenesis regulators and might be essential to restrict tumor growth, progression, and metastasis. In the present study, we evaluate the association between the expression of these markers and CIN grade. Immunohistochemistry was performed in 234 uterine cervical samples using conventional histologic sections or TMA with the monoclonal antibodies to VEGF (C-1 clone) and podoplanin (D2-40 clone). Positive-staining rates of VEGF in 191 CIN specimens were significantly associated with histological grade (P < 0.001). Negative and/or focal immunostaining for PDPN were more frequent in CIN 3 (P = 0.016). We found that patients with CIN 3 more frequently had strong and more diffuse staining for VEGF and diminished staining for PDPN (P = 0.018). Strong and more diffuse VEGF immunoexpressions in CIN 2 and CIN 3 were detected when compared to CIN 1. Negative and/or focal PDPN immunoexpression appear to be more frequent in CIN 3. Moderate to strong VEGF expression may be a tendency among patients with high-grade lesions and diminished PDPN expression.

Treatment of Bartholin gland cyst with CO2laser.

OBJECTIVE: To describe the results of treatment with CO2 laser for Bartholin gland cysts. METHODS: Thirty-one women with Bartholin gland cysts were treated with CO2laser at an outpatient´s setting. Skin incision was performed with focused laser beam, the capsule was opened to drain mucoid content, followed by internal vaporization of impaired capsule. RESULTS: There were no complications. Five patients had recurrence of the cyst and were submitted to a second and successful session. CONCLUSION: CO2 laser surgery was effective to treat Bartholin gland cysts with minimal or no complications, and can be performed at an outpatient´s setting.

Treatment of Bartholin gland cyst with CO2laser / Tratamento do cisto da glândula de Bartholin comlaser de CO2

ABSTRACT Objective To describe the results of treatment with CO2 laser for Bartholin gland cysts. Methods Thirty-one women with Bartholin gland cysts were treated with CO2laser at an outpatient´s setting. Skin incision was performed with focused laser beam, the capsule was opened to drain mucoid content, followed by internal vaporization of impaired capsule. Results There were no complications. Five patients had recurrence of the cyst and were submitted to a second and successful session. Conclusion CO2 laser surgery was effective to treat Bartholin gland cysts with minimal or no complications, and can be performed at an outpatient´s setting.

RESUMO Objetivo Descrever os resultados do tratamento com laser de CO2 para o cisto da glândula de Bartholin. Métodos Foram tratadas 31 mulheres com cisto da glândula de Bartholin em regime ambulatorial com o laser de CO2. Foram realizados: incisão da pele com feixe de laser focalizado, abertura da cápsula com drenagem do conteúdo mucoide e vaporização interna da cápsula doente. Resultados Não ocorreram complicações. Cinco pacientes apresentaram recidiva do cisto, sendo submetidas à segunda sessão, com sucesso em todas. Conclusão A cirurgia com laser de CO2 foi efetiva para o tratamento do cisto da glândula de Bartholin, com mínima ou nenhuma complicação, podendo ser realizada em ambiente ambulatorial.

Cervical cancer screening in young and elderly women of the Xingu Indigenous Park: evaluation of the recommended screening age group in Brazil.

OBJECTIVE: To analyze the occurrence of atypia in the cytology/histology examinations of young women under the age of 25 years and of elderly women aged over 64 years, in the Xingu Indigenous Park and to evaluate, in a subjective manner, if the age range for screening established by the Ministry of Health and the Instituto Nacional de Câncer is appropriate for this population. METHODS: The Xingu/UNIFESP Project, in partnership with the Center for Gynecological Disease Prevention, develops programs to prevent cervical cancer. The exploratory, retrospective and descriptive study of cytological and histopathological examinations of young (12-24 years) and elderly (aged 64 and over) women of the Xingu Indigenous Park, between 2005 and 2011. RESULTS: There was low occurrence of cytological atypia in the elderly female population, but there were occasional high-grade lesions in the indigenous youth. CONCLUSION: Interrupting screening at the limit age of 64 years, as established by the Ministry of Health and the Instituto Nacional de Câncer is justified. However, screening of young women should begin at an earlier age.

Cervical cancer screening in young and elderly women of the Xingu Indigenous Park: evaluation of the recommended screening age group in Brazil / Rastreamento do câncer de colo uterino em jovens e idosas do Parque Indígena do Xingu: avaliação quanto à faixa etária preconizada no Brasil

Objective To analyze the occurrence of atypia in the cytology/histology examinations of young women under the age of 25 years and of elderly women aged over 64 years, in the Xingu Indigenous Park and to evaluate, in a subjective manner, if the age range for screening established by the Ministry of Health and the Instituto Nacional de Câncer is appropriate for this population. Methods The Xingu/UNIFESP Project, in partnership with the Center for Gynecological Disease Prevention, develops programs to prevent cervical cancer. The exploratory, retrospective and descriptive study of cytological and histopathological examinations of young (12-24 years) and elderly (aged 64 and over) women of the Xingu Indigenous Park, between 2005 and 2011. Results There was low occurrence of cytological atypia in the elderly female population, but there were occasional high-grade lesions in the indigenous youth. Conclusion Interrupting screening at the limit age of 64 years, as established by the Ministry of Health and the Instituto Nacional de Câncer is justified. However, screening of young women should begin at an earlier age. .

Objetivo Analisar a ocorrência de atipias nos exames citológicos e histológicos de jovens e idosas indígenas, e também avaliar se a faixa etária preconizada pelo Ministério da Saúde e pelo Instituto Nacional de Câncer em rastreamento do câncer de colo uterino é adequada para essa população. Métodos O Projeto Xingu/UNIFESP, em parceria com o Núcleo de Prevenção de Doenças Ginecológicas, desenvolve programas de prevenção do câncer do colo de útero. Foi realizado estudo exploratório, retrospectivo e descritivo de exames cito/histopatológicos em jovens do Parque Indígena do Xingu de 12 a 24 anos e em idosas a partir dos 64 anos, no período de 2005 a 2011. Resultados Em idosas, houve baixa ocorrência de atipias citológicas, mas nas jovens indígenas, ocorreram casos eventuais de lesão de alto grau. Conclusão Justifica respeitar o limite de 64 anos para a interrupção do rastreamento, como o estabelecido pelo Ministério da Saúde/Instituto Nacional de Câncer, mas, nas jovens, seria importante iniciar o rastreamento mais precocemente. .

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia.

CONTEXT AND OBJECTIVE: Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). DESIGN AND SETTING: Cross-sectional study at Universidade Federal de São Paulo (Unifesp). METHODS: The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. RESULTS: The patients' mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CONCLUSION: CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia / Número de fragmentos, status das margens e artefatos térmicos de peças conizadas de cirurgia com alças de ondas de alta frequência no tratamento da neoplasia intraepitelial cervical

CONTEXT AND OBJECTIVE: Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). DESIGN AND SETTING: Cross-sectional study at Universidade Federal de São Paulo (Unifesp). METHODS: The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. RESULTS: The patients' mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CONCLUSION: CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.

CONTEXTO E OBJETIVO: Cirurgia de alta frequência (CAF) é um método não traumático de corte e coagulação com muitas vantagens, porém induz a artefatos térmicos na região do corte. O objetivo foi avaliar a relação entre idade, número de fragmentos, grau da lesão e grau de artefatos térmicos e a qualidade das margens das peças cirúrgicas resultantes da CAF para neoplasia intraepitelial cervical (NIC). TIPO DE ESTUDO E LOCAL: Estudo transversal na Universidade Federal de São Paulo (Unifesp). MÉTODOS: Foram revisados prontuários e laudos histopatológicos de 118 mulheres que foram submetidas a conização por cirurgia de alta frequência no período de 1999 a 2007. Idade, número de fragmentos, grau da lesão, grau de artefatos térmicos e qualidade das margens foram avaliados. RESULTADOS: A idade média das pacientes foi de 27,14 anos; 63,6% tinham diagnóstico de NIC II e 36,4% de NIC III. A lesão foi retirada com um fragmento em 79,6%. As margens estavam livres de neoplasia em 85,6% e comprometidas na margem endocervical em 6,8%. Fragmentos prejudicados por artefatos ocorreram em 2,5%. Artefatos de grau severo ocorreram em 22,8%. Mulheres com idade igual ou superior a 30 anos apresentaram mais casos de NIC III (P < 0,0004). O comprometimento neoplásico de margens cirúrgicas e artefatos de grau severo ocorreram mais vezes nos casos em que foram retirados dois ou mais fragmentos e em pacientes com idade igual ou superior a 30 anos. CONCLUSÃO: NIC III em mulheres com idade superior a 30 anos, quando retiradas em dois ou mais fragmentos na CAF, apresentaram maior número de margens comprometidas e grau severo de artefatos térmicos.

Survivin and telomerase expression in the uterine cervix of women with human papillomavirus-induced lesions.

INTRODUCTION: Infection by human papillomavirus is the most important risk factor in the pathogenesis of uterine cervical cancer. The aims of this study were to evaluate the expression of survivin protein and telomerase enzyme in samples of uterine cervix from women with human papillomavirus-induced lesions and to determine the relationship between survivin and telomerase expression and the different grades of cervical squamous intraepithelial neoplasia and invasive cervical carcinoma. METHODS: Biopsy samples from the uterine cervix of 105 women aged 18 to 80 years were analyzed. The patients were divided into 5 groups: WN group, 20 patients without neoplasia; CIN-1 group, 24 patients with grade 1 cervical intraepithelial neoplasia (CIN), grade 1; CIN-2 group, 20 patients with CIN grade 2; CIN-3 group, 24 patients with CIN, grade 3; and ICC group, 17 patients with invasive cervical carcinoma. Human papillomavirus detection, telomerase activity, and survivin expression were assessed using polymerase chain reaction (PCR), real-time PCR (RT-PCR), and immunochemistry, respectively. RESULTS: There was a significant increase in the expression of telomerase and survivin associated with the severity of the lesion. CONCLUSIONS: The results suggest that mechanisms that promote both cell proliferation (telomerase activity) and cell survival (survivin expression) are active in cervical cancer and its precursor lesions. There was a negative correlation between survivin expression and the number of PCR cycles necessary to detect telomerase activity in the total sample, achieving statistical significance in patients in the CIN-3 group.

Ressonância magnética para avaliação dos limites dos campos clássicos de radioterapia em pacientes portadoras de neoplasia maligna de colo uterino / Magnetic resonance imaging in the evaluation of standard radiotherapy field borders in patients with uterine cervix cancer

OBJETIVO: Avaliar os limites de campo padronizados para radioterapia de neoplasia maligna de colo uterino com o uso de ressonância magnética e verificar a importância deste exame na redução de possíveis erros de planejamento com técnica convencional. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, exames de ressonância magnética do planejamento de 51 pacientes tratadas devido a neoplasia de colo uterino. Os parâmetros estudados foram limites anterior e posterior no corte sagital. RESULTADOS: Observou-se, no corte sagital das ressonâncias magnéticas, que o limite de campo anterior apresentou-se inadequado em 20 (39,2 por cento) pacientes e que houve perda geográfica em 37,3 por cento dos casos no limite posterior. A inadequação de ambos os limites de campo não se relacionou com parâmetros clínicos como idade das pacientes, estadiamento, tipo e grau histológico. CONCLUSÃO: A avaliação dos limites de campo padronizados pela literatura com o uso de ressonância magnética mostrou altos índices de inadequação dos limites do campo lateral, assim como a importância do uso deste exame no planejamento radioterápico de pacientes portadoras de câncer de colo uterino com a finalidade de reduzir a perda geográfica no volume alvo de tratamento.

OBJECTIVE: To evaluate, by means of magnetic resonance imaging, the standardized field borders in radiotherapy for malignant neoplasm of uterine cervix, and to determine the role of this method in the reduction of possible planning errors related to the conventional technique. MATERIALS AND METHODS: Magnetic resonance imaging studies for planning of treatment of 51 patients with uterine cervix cancer were retrospectively analyzed. The parameters assessed were the anterior and posterior field borders on sagittal section. RESULTS: The anterior field border was inappropriate in 20 (39.2 percent) patients and geographic miss was observed in 37.3 percent of cases in the posterior border. The inappropriateness of both field borders did not correlate with clinical parameters such as patients' age, tumor staging, histological type and degree. CONCLUSION: The evaluation of standardized field borders with the use of magnetic resonance imaging has demonstrated high indices of inappropriateness of the lateral field borders, as well as the relevant role of magnetic resonance imaging in the radiotherapy planning for patients with uterine cervix cancer with a view to reduce the occurrence of geographic miss of the target volume.

A Prevenção do câncer do colo do útero e seu conhecimento por educadores de Ensino Fundamental / The prevention of uterine cervical cancer and what primary school teachers know about it

Objetivos: avaliar os conhecimentos de um grupo de educadores sobre a prevenção do câncer do colo uterino, além de conhecer os perfis sociocultural, ginecológico e obstétrico de professoras do primeiro e segundo graus das escolas do município de Naviraí/MS e também avaliar o conhecimento básico sobre o câncer do colo uterino, sobre o papilomavírus humano e seu papel no desenvolvimento do câncer cervical. Métodos: foram avaliados 157 professores do sexo feminino, pertencentes a 10 escolas da rede pública, sendo cinco estaduais e cinco municipais do município de Naviraí/MS, por meio de questionário preestabelecido. Os tópicos questionados foram: idade, hábito de tabagismo, idade de início e exercício de atividade sexual, número de parceiros e antecedentes de doenças sexualmente transmissíveis (DST). Indagou-se sobre: paridade e métodos contraceptivos utilizados, atitudes de cuidados com a própria saúde, procura, regularidade e realização de exames ginecológicos preventivos. Constaram, ainda, perguntas referentes a noções básicas de prevenção do câncer uterino, da relação DST e câncer e da importância do papilomavírus humano na gênese da neoplasia cervical. Resultados: 75 professoras (47,8 porcento) referiam visitas periódicas à ginecologista, outras 73 (46,5 porcento)só quando sintomáticas e sete (4,4 porcento) só em situação de urgência. Apenas 42 (26,7 porcento)tinham conhecimento sobre o câncer de colo como uma DST, porém, 93,1 porcento (146) referiram nada saber ou demonstravam apenas conhecimento rudimentar sobre a doença; 49,6 porcento das educadoras tinham conhecimento de que o câncer cervical não apresenta sintomas até estar em fase avançada. A sigla HPV era de conhecimento de 45 (29,9 porcento) mulheres, no entanto, quanto ao seu significado e o que representava na gênese da neoplasia, 150 (95,5 porcento) delas revelaram ausência de qualquer informação. Apenas sete (4,4 porcento) manifestaram conhecimento específico do HPV e sua relação com o câncer...

Dermatoses vulvares: revisão de tema / Vulvar dermatosis: review of the literature

Em 1989, após amplo debate entre ginecologistas, dermatologistas e anatomopatologistas, a Sociedade Internacional para Estudo das Doenças da Vulva (International Society for the Study of Vulvar Disease - ISSVD) definiu uma clasificação baseada nas características histopatológicas das lesões vulvares, que foi aceita pelas especialidades, bem como por diferentes organizações internacionais. As dermatoses vulvares foram classificadas como Hiperplasia de Células Escamosas, Líquen Escleroso e outras Dermatoses. Os autores fizeram uma revisão bibliográfica, buscando sintetizar e harmonizar diferentes aspectos das patologias segundo a óptica de diferentes autores. Além da Hiperplasia de Células Escamosas e Líquen Escleroso, foram estudados Líquen Plano, Líquen Simples Crônico, Psoríase, Intertrigo, Eczema e Dermatite Seborréica, dermatoses mais comuns no ambulatório de atuação dos profissionais em Ginecologia.

Universal Collection Medium (UCM) is as suitable as the Standard Transport Medium (STM) for Hybrid Capture II (HC-2) assay.

BACKGROUND: Collection of cervical-vaginal material in liquid media enables simultaneous evaluation of both oncologic cytology and molecular tests for the detection of Human papillomavirus (HPV), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). Universal Collection Medium (UCM) has been developed to fulfill this objective. OBJECTIVES: To compare Hybrid Capture II (HC-2) to diagnose HPV, NG and CT in specimens collected in UCM and in the current Digene Standard Transport Medium (STM). STUDY DESIGN: The study was cross-sectional. Three collections of endocervical and ectocervical material were performed in each of 893 women referred for colposcopy in the following order: (1) to prepare a conventional Pap smear slide using the accompanying brush of the STM kit and with Ayre spatula; (2) for HC-2 test and liquid-based cytology using a 1 ml UCM vial as transport medium; material was collected with another similar brush; (3) for HC-2 test using a 1 ml STM vial as transport medium; material was collected with the same brush that we used in the procedure no. (1) (conventional Pap smear). HC-2 results from samples taken from STM and UCM media were compared by using simple linear regression analysis and Kappa statistic. RESULTS AND CONCLUSIONS: HC-2 results from the two media were highly correlated: high-risk HPV (kappa=0.92; r(2)=0.92), low-risk HPV (kappa=0.85; r(2)=0.86) and NG/CT (kappa=0.96; r(2)=0.81). Despite being obtained from a second specimen, the UCM HC-2 results were equivalent to those obtained with the standard medium STM and the UCM medium.

Influência do uso de anticoncepcionais hormonais orais sobre o número de células de Langerhans em mulheres com captura híbrida negativa para papilomavírus humano / Langerhans' cells: influence of the of oral contraceptives by women with negative hybrid capture for human papillomavirus

OBJETIVO: estudar a influência do uso de anticoncepcionais orais (AO) sobre o número de células de Langerhans em mulheres sem infeccão cervical por papilomavírus humano (HPV). MÉTODOS: foram incluídas trinta mulheres com alteracões citológicas e biópsia dirigida pela colposcopia com amostras de colo uterino sem sinais de infeccão por HPV. A ausência de DNA de HPV foi confirmada pela captura híbrida. As células de Langerhans foram identificadas pela reacão de imuno-histoquímica com uso de antígenos anti-S100. As células visualizadas em microscopia de luz foram contadas utilizando o software Cytoviewer. Para análise estatística utilizou-se o teste não paramétrico de soma das ordens de Wilcoxon. RESULTADOS: a média do número de células de Langerhans em mulheres usuárias de AO foi de 320,7/mmy e em não usuárias 190,7/mmy, não sendo esta diferenca significante. Na camada intermediária do epitélio cervical observou-se tendência ao aumento dessas células, com as médias 192,1/mmy para usuárias e 93,4/mmy para não usuárias de AO (p=0,05). CONCLUSÕES: no presente estudo não se observou diferenca significativa no total de células de Langerhans entre as usuárias e não usuárias de AO, porém, na camada intermediária do epitélio observou-se tendência ao aumento no número dessas células entre as usuárias de AO. Este resultado sugere que os AO podem induzir alteracões no número das células de Langerhans, considerando porém o limitado número de casos, este achado não pode ser confirmado.

Os efeitos do tabagismo na densidade das células de Langerhans do colo uterino / Effects of smoking on the density of the uterine cervix Langerhans’ cells

A importância do tabagismo na oncogênese do colo uterino é conhecida, e a elevada concentração de derivados de tabaco como a nicotina tem sido associada à depressão das células de Langerhans (CL). A alta taxa de regressão da infecção por HPV e a evolução de alguns casos para malignização sugerem a existência de múltiplos fatores associados na imunodepressão. Objetivou-se estudar a influência do fumo nas alterações das CLs em mulheres com Captura Híbrida negativa. Foram estudadas 30 mulheres por meio do método clínico colposcópico. histopatológico, imuno-histoquímico, histométrico e teste de hibridização molecular. Dividiu-se a amostra em dois grupos: fumantes (n=8) e não-fumantes (n=22). Utilizou-se o teste não paramétrico de Wilcoxon (Ran sun test). As médias das densidade das CLs no epitélio foram de 232,41 células/mm2 para fumantes e de 221,08 células/mm2 para não-fumantes, sendo estes valores não significativos. Concluiu-se não haver diferença significativa na densidade dessas células entre fumantes e não-fumantes