Evaluación del Miedo a la Recurrencia del cáncer en español: el Cuestionario de Miedo a la Recurrencia del Cáncer y Escala General del Miedo a la Recurrencia del Cáncer: un estudio piloto / Assessment of fear of cancer recurrence in Spanish: Fear of Recurrence Questionnaire and he General Scale of Fear of Cancer Recurrence: A pilot study

El objetivo de este estudio es la elaboración de un cuestionario de evaluación del miedo a la recurrencia del cáncer en español. Método: se presenta un estudio piloto de diseño correlacional trasversal elaborado en dos fases: 1) creación del cuestionario del miedo a la recurrencia del cáncer (CMRC) y de la Escala General del Miedo a la Recurrencia del Cáncer (EGMRC); 2) evaluación de sus propiedades psicométricas. Resultados: para la elaboración de los cuestionarios se utilizó el acuerdo entre expertos medido por la V de Aiken. El CMRC queda finalmente configurado con 8 ítems que se responden con una escala tipo Likert de 0-4 y un Alfa de Cronbach de 0,85. La EGMRC de una sola pregunta que se responde con una escala de 0-100 correlaciona hasta un 0,84 con el CMRC. Se utilizó una muestra de 50 mujeres supervivientes de cáncer ginecológico seleccionadas en el Hospital Universitario Clínico San Carlos de Madrid. Ambas escalas correlacionan con el nivel de ansiedad de las pacientes y la función emocional de calidad de vida. No se hallan correlaciones con los niveles de depresión. Conclusiones: El CMRC y la EGMRC son dos instrumentos que pueden ser válidos para la evaluación del miedo a la recurrencia del cáncer en pacientes supervivientes de cáncer ginecológico (AU)

The objective of this study is the elaboration of a questionnaire for the evaluation of the fear of recurrence of cancer in Spanish. Method: A pilot study with a cross-sectional correlational design is presented, elaborated in two phases: 1) creation of the Fear Cancer recurrence Questionnaire (CMRC) and the General Scale of Fear of Cancer Recurrence (EGMRC); 2) evaluation of their psychometric properties. Results: for the elaboration of the questionnaires, the agreement between experts was used, measured by Aiken’s V. The CMRC questionnaire is finally configured with 8 items that are answered with a Likert-type scale of 0-4 and a Cronbach’s Alpha of 0.851. The EGMRC consists of a single question that is answered with a scale of 0-100 correlates up to 0.84 with the CMRC. A sample of 50 female survivors of gynecological cancer selected from the Hospital Universitario Clínico San Carlos in Madrid was used. Both scales correlate with the level of anxiety of the patients and the emotional function of quality of life. No correlations with levels of depression were found. Conclusions: The CMRC and the EGMRC are two instruments that may be valid for the evaluation of FCR in Spanish for survivors of gynecological cancer (AU)

Effectiveness of Prophylactic Human Papillomavirus Vaccine in the Prevention of Recurrence in Women Conized for HSIL/CIN 2-3: The VENUS Study.

Background: Recent data have shown that the human papillomavirus (HPV) vaccine could impact on a decrease in high-grade cervical intraepithelial lesions (HSIL) in women who have undergone surgical treatment. This study aimed to evaluate the efficacy of human papilloma virus (HPV) vaccination against persistent/recurrent disease in patients undergoing conization for high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia-grade 2-3 (HSIL/CIN 2-3). Methods: From January 2009 to March 2019, 563 patients with HSIL/CIN 2-3 underwent conization. The population was divided into two groups according to vaccination status: vaccinated-group (V-Group) and non-vaccinated-group (NV-Group). Bivalent or quadrivalent vaccines were administered indiscriminately. A follow-up was scheduled every 6-12 months according to clinical guidelines. The mean follow-up was 29.6 vs. 36.5 months in the V-group and NV-group, respectively. Results: 277 (49.2%) women were vaccinated, while 286 (50.8%) were not. Overall, persistent/recurrent HSIL/CIN 2-3 was presented by 12/277 (4.3%) women in the V-Group and 28/286 (9.8%) in the NV-Group (HR: 0.43, 95% Confidence interval 0.22-0.84, p = 0.014). Vaccination was associated with a 57% reduction in HSIL persistence/recurrence after treatment. When no disease was present in the first 6-month follow-up visit, persistence/recurrence rates were very low in both groups: 1.1% in the V-Group vs. 1.5% in the NV-Group (p > 0.05). The factor associated with a high-risk of HSIL persistence/recurrence was the presentation of a positive co-test in the first control after treatment (p < 0.001). Conclusions: Our results corroborate the benefit of HPV vaccination in woman treated for HSIL/CIN 2-3, showing a reduction of persistent/recurrent HSIL/CIN 2-3.

Úlcera vulvar aguda de Lipschütz / Acute vulvar ulcer of Lipschütz

RESUMEN La úlcera de Lipschütz es una entidad poco frecuente e infradiagnosticada. Se presenta el caso de una paciente de 24 años sin antecedente de contacto sexual que consultó por aparición súbita de úlceras vulvares dolorosas, en el contexto de un cuadro pseudogripal. Se discuten los principales diagnósticos diferenciales, dado que es una enfermedad no relacionada con enfermedades de transmisión sexual y poco reconocida por los profesionales de la salud, que precisa de manejo conservador.

ABSTRACT Lipschütz ulcer is a rare underdiagnosed entity. We present the case of a 24-year-old patient without history of sexual contact who consulted for sudden occurrence of painful vulvar ulcers, in the context of flu-like symptoms. The main differential diagnoses are discussed, as it is a disease unrelated to sexually transmitted diseases and little recognized by health professionals, which requires conservative management.

Linfoma cervical primario: presentación de un caso y revisión de la literatura / Primary lymphoma of the uterine cervix: a case report and literature review

El linfoma primario cervical es una enfermedad muy infrecuente que se presenta clínicamente como un carcinoma de cérvix. El diagnóstico del linfoma de cérvix requiere una biopsia profunda, ya que la citología puede ser negativa. Aunque no existe consenso en el tratamiento, tradicionalmente se empleaba radioterapia. Sin embargo, últimamente se sugiere realizar tratamiento quimioterápico, pudiendo completarse con cirugía. Se presenta el caso de una paciente con linfoma cervical que requirió varias tomas de biopsia para su diagnóstico y en la que se empleó con éxito quimioterapia neoadyuvante seguida de cirugía (AU)

Primary lymphoma of the uterine cervix is extremely rare and the clinical presentation is similar to that of carcinoma of the cervix. Diagnosis is made with a deep cervical biopsy because smear tests can show false negative results. The standard treatment has not yet been established but used to be radiotherapy. Currently, combination chemotherapy is used with or without surgery. We report a case of cervical lymphoma that needed several biopsies to establish the diagnosis and was successfully treated with neoadjuvant chemotherapy and surgery (AU)

La inmunosupresión es un factor mayor de riesgo en la recidiva de las lesiones del tracto genital inferior asociadas al virus del papiloma humano / Immunosuppression is a major prognostic factor in recurrence of human papillomavirus-associated lesions of the lower genital track

Objetivo: Analizar las características de las lesiones preneoplásicas del tracto genital inferior (TGI) y los factores asociados a su recidiva. Material y métodos: Se estudió a 376 mujeres tratadas de algún tipo de neoplasia intraepitelial del TGI, en la década de los 90. Las lesiones se agruparon en cervicales y vulvares, y estas en lesiones de alto (CIN II-III o VIN) y de bajo grado (CIN I o atipia vulvar por virus del papiloma humano [AV-VPH]). El tratamiento de las CIN se realizó con asa diatérmica y para las lesiones vulvares fue la resección con bisturí frío y/o láser CO2.ResultadosLa edad media de las mujeres fue 32 años. La multicentricidad fue identificada en el 57% de las CIN y en el 87% de las lesiones vulvares. Un 10% de las mujeres en ambos grupos presentó algún tipo de inmunosupresión. Se identificó VPH de riesgo alto en el 25% de los casos. Con un seguimiento medio de 21 meses, la recidiva global de la CIN fue del 17% y la acumulada a 5 años del 47%. En las lesiones vulvares fue del 15 y el 54%, respectivamente. En ambos grupos lesionales la recidiva apareció en los primeros 3 años en más del 90% de los casos y se asoció a la inmunosupresión y el genotipo viral de riesgo alto, aunque el único factor de riesgo independiente en el análisis multivariante fue la inmunosupresión. Ninguna paciente progresó a cáncer invasor. Conclusiones: La inmunosupresión es el factor riesgo predictivo más importante de recurrencia. Las conductas orientadas a estimular la inmunidad podrían ser eficaces en prevención de la recurrencia de la enfermedad por el VPH (AU)

Objective: To analyze the characteristics of preneoplastic lesions of the lower genital tract (LGT) and the factors associated with their recurrence. Material and methods: A total of 376 women treated for some type of intraepithelial neoplasm of the LGT between 1990 and 1999 were studied. The lesions were classified into cervical intraepithelial neoplasms (CIN) and vulvar intraepithelial neoplasms (VIN) and were further classified into high-grade lesions (CIN 2-3 or VIN) and low-grade lesions (CIN 1 or human papillomavirus vulvar atypia [HPV-VA]). Treatment of cervical lesions consisted of CO2 laser and / or loop electrosurgical excision while that of vulvar lesions consisted of cold-knife local excision and / or CO2 laser. Results: The mean age of women was 32 years. Multicentric disease was found in 57% of CIN lesions and in 87% of vulvar lesions. Ten percent of women in both groups had some type of immunosuppression. High-risk HPV was identified in 25% of patients. With a mean follow-up of 21 months, the overall CIN recurrence was 17% and accumulated recurrence rate at 5 years was 47%. In vulvar lesions, these values were 15% and 54%, respectively. In both groups, more than 90% of recurrences occurred in the first 3 years, and relapse was associated with immunosuppression and high-risk viral genotype. In multivariate analysis, the only independent risk factor was immunosuppression. None of the lesions progressed to invasive cancer. Conclusions: The most important risk factor predictive of recurrence is immunosuppression. Measures to stimulate immunity could be effective in preventing HPV-related disease (AU)