Management of primary cardiac leiomyosarcoma.

Background: Primary cardiac cancer is a rare event with various clinical presentations and often causes unexpected symptoms or sudden death. Case reports with this diagnosis are scarce. Case presentation: We present an unusual manifestation of leiomyosarcoma of the left atrium in a female patient, 33 years old. Presenting difficulty to walk, dyspnoea at rest, skin pallor, cough with hemoptoics and syncope. A transthoracic echocardiogram showed cavitary enlargement of the left atrium, moderate to significant mitral stenosis with an adherent mass in the anterior leaflet, left ventricular systolic function preserved at rest, and mild aortic and tricuspid insufficiency. The procedure was complete resection of the tumour or negative microscopic margins (R0 resection), 25 sessions of radiotherapy, 5 cycles of adjuvant chemotherapy using gemcitabine (900 mg/m2 on days 1 and 8) and docetaxel (75 mg/m2 on day 8), with a resolution of the clinical picture. After 5 years of follow-up, the patient had no metastases or recurrence of the initial tumour. Conclusion: The nonspecific symptoms presented in the reported case demonstrate that the cardiac tumour can mimic other cardiac disorders, such as coronary artery disease or pericarditis, rarely representing the first manifestation of a previously unknown malignancy.

Impact of screening on cervical cancer incidence and mortality in a Northern Brazilian city.

Objective: To analyse the impact of screening actions on the incidence and mortality rates of cervical cancer (CC) in the city of Belém, Brazil. Methods: Based on the cancer registry data from 1998 to 2017, collected from the Belém Population-Based Cancer Registry, combined with local population data for the interval 1998-2017, CC incidence and mortality were calculated. The Segi world population 1960 was used for age-standardised incidence/mortality rates. Results: In the period analysed, there were 4,469 new cases and 1,660 deaths from CC. The median age at diagnosis of invasive cases was 51 years. The age-adjusted incidence rate decreased from 18.65/100,000 in 1998 to 11.79/100,000 in 2017, despite the increase observed in the first 5 years of the historical series, while there was stability in mortality rates in the same time lapse. Conclusion: CC is still one of the most common malignant tumours that threaten public health in northern Brazil. The trend of the disease depends on comprehensive prevention and control strategies regarding the local situation and age groups, with emphasis on the organisation of the screening programme and vaccination against human papillomavirus.