Brazilian Society of Surgical Oncology guidelines for surgical treatment of endometrial cancer in regions with limited resources.

BACKGROUND: Approximately 70% of cancer-related deaths occur in low- and middle-income countries. In addition to social and racial inequalities, treatment options in these countries are usually limited because of the lack of trained staff and equipment, limited patient access to health services, and a small number of clinical guidelines. OBJECTIVES: The Brazilian Society of Surgical Oncology developed this guideline to address these barriers and guide physicians treating patients with endometrial cancer (EC) in regions with limited resources and few specialized centers. METHODS: The guideline was prepared from 10 January to 25 October 20192019 by a multidisciplinary team of 56 experts to discuss the main obstacles faced by EC patients in Brazil. Thirteen questions considered critical to the surgical treatment of these patients were defined. The questions were assigned to groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments for presentations in meetings, classified the level of evidence, and voted on the recommendations. RESULTS: For all questions including staging, fertility spearing treatment, genetic testing, sentinel lymph node use, surgical treatment, and other clinical relevant questions, major agreement was achieved by the participants, always using accessible alternatives. CONCLUSIONS: It is possible to provide adequate treatment for most EC patients in resource-limited areas, but the first option should be referral to specialized centers with more resources.

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer.

BACKGROUND AND OBJECTIVES: The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high-dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. METHODS: A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow-up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. RESULTS: Most conducts and management strategies reviewed were strongly recommended by the participants. CONCLUSIONS: Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.

Acurácia da densidade tomográfica no diagnóstico de tumores de ovário / Accuracy of computed tomography density in the diagnosis of ovarian tumors

Objetivo: identificar a acurácia da densidade tomográfica no diagnóstico de tumores de ovário. Materiais e Métodos: Foi realizado um estudo prospectivo, com 25 mulheres consecutivas com massas anexiais complexas ou suspeitas, que foram solicitadas Tomografia Computadorizada (TC) para o diagnóstico. Os valores estatísticos incluem sensibilidade, especificidade, valor preditivo positivo e negativo e acurácia da densidade tomográfica para ambas as modalidades de imagem (com e sem contraste) na caracterização de malignidade de massa ovariana. Usamos o diagnóstico histopatológico como padrão ouro. Resultados: entre os tumores malignos, a idade média foi de 58,8 anos (±12,2) e nos tumores benignos foi de 40,4 anos (±12,2). A sensibilidade, a especificidade, o valor preditivo positivo, o valor preditivo negativo e a acurácia da densidade tomográfica com contraste em mulheres com mais de 47 anos para distinguir tumores malignos e benignos foram de 85,7% (6/7), 100% (5/5). 100% (6/6), 83,3% (06/05) e 91,6% (11/12), respectivamente. Conclusão: a tomografia computadorizada pode ser uma boa opção para os tumores ovarianos.

Objective: to identify the accuracy of computed tomography density in the diagnosis of ovarian tumors Materials and Methods: It was performed a prospective study with 25 consecutive women with complex or suspicious adnexal masses which requested computed tomography for the diagnosis. Statistical values including sensitivity, specificity, positive and negative predictive values and accuracy of density computed tomography imaging for both imaging modalities (with and without contrast) in the characterization of ovarian mass malignancy. We used the histopathologic diagnosis, as gold standard. Results: Among the malignant tumor the mean age was 58.8 (±12.2) and in the benign tumor was 40.4 (±12.2). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of computed tomography mean of density with contrast in women older than 47 years for distinguishing malignant from benign adnexal tumors were 85.7% (6/7), 100% (5/5), 100% (6/6), 83.3% (5/6) and 91.6% (11/12), respectively. Conclusion: The computed tomography could be a good option for ovarian masses.

Frequência de microcarcinoma papilífero em doenças benignas da tireóide / Frequency of papillary microcarcinoma in thyroid benign diseases

Objetivo: Conhecer a frequência de microcarcinoma papilífero (MCP) em doenças benignas da tireóide. Métodos: Estudo transversal e retrospectivo, realizado no laboratório Alice de Patologia, na cidade de Criciúma, SC, no período de 1996 a 2006. Foram analisados 636 laudos anatomopatológicos de tireoidectomias totais, dos quais 409 preencheram os critérios de inclusão. Destes, estudou-se as seguintes variáveis: cidade de origem, gênero, idade, doenças benignas associadas ao MCP, tamanho dos tumores, lateralidade, focalidade, localização e invasão das bordas cirúrgicas. A análise estatística foi realizada através do programa EPIINFO versão 6.0. Resultados: Dos 636 laudos estudados, 409 preencheram os critérios de inclusão. Destes, 90,7% (371) eram mulheres e 9,3% (38) homens, sendo a média de idade 48,17 anos. A maioria (95,6%) dos pacientes estudados era de Criciúma. A frequência de MCP em doenças benignas da tireóide foi de 8,8%, sendo a doença de maior coexistência com MCP o bócio multinodular, seguido pelos adenomas foliculares. O diâmetro médio dos tumores foi de 4,7mm, sendo a maioria unilateral (88,9%) e unifocal (91,7%). A variante histológica do MCP encontrada com maior frequência foi a papilífera pura (61,11%). Não houve diferença significativa na localização dos tumores. Na maioria (88,9%) dos casos as bordas cirúrgicas estavam livres de doença. Conclusão: A frequência de MCP em doenças benignas da tireóide é alta no local de realização desta pesquisa, devendo chamar a atenção dos médicos para o seu possível diagnóstico, que na maioria das vezes acaba sendo um achado incidental na análise anatomopatológica de glândulas tireóideas retiradas por doenças aparentemente benignas.

Objective: To assess the frequency of papillary microcarcinoma in benign thyroid diseases. Methods: Retrospective cross-sectional study, conducted in the laboratory of Pathology Alice in the city of Criciúma, SC, from 1996 to 2006. We analyzed 636 reports of pathological total thyroidectomy, of which 409 met the inclusion criteria. Of these, the following variables were studied: city of origin, gender, age, benign diseases associated with papillary microcarcinoma, size of tumors, laterality, focus, location and invasion of the surgical margins. Statistical analysis was performed using the program EPIINFO version 6.0. Results: Of the 636 reports studied, 409 met the inclusion criteria. Of these, 90.7% (371) were women and 9.3% (38) men, with a mean age of 48.17 years. The majority (95.6%) of patients studied was Criciúma. The frequency of papillary microcarcinoma in benign thyroid disease was 8.8%, and the disease of greater coexistence with the papillary microcarcinoma was multinodular goiter, followed by follicular adenomas. The average diameter of tumors was 4.7 mm, the majority being unilateral (88.9%) and unifocal (91.7%). A histologic variant of papillary microcarcinoma found with more frequency was papillary pure (61.11%). There was no significant difference in the location of tumorsMost(88.9%) cases the surgical margins were free of disease. Conclusion: The frequency of MCP in benign thyroid diseases is high in the place of realization of this research, and should draw the attention of doctors for their possible diagnosis, which most often ends up being an incidental finding in the anatomopathological analysis of thyroid glands removed for apparently benign diseases.

Maffucci syndrome and soft tissue sarcoma: a case report.

BACKGROUND: Maffucci syndrome, a congenital mesodermal dysplasia characterized by multiple enchondromas and hemangiomas, was first described in 1881, and 200 cases have been reported in the literature since then. Its etiology is unknown, there is no predilection for race or sex, and the development of lesions usually occurs in puberty. The risk of sarcomatous transformation is about 25%. CASE PRESENTATION: The initial investigation of the case reported here focused on the diagnosis and treatment of malignancy, and the first diagnostic hypothesis was thrombosed hemangioma. After histopathologic confirmation of soft tissue sarcoma, examinations were performed to stage the tumor and enchondromas were found in ribs. The final diagnosis was Maffucci syndrome with malignant transformation. CONCLUSION: Treatment should aim at symptom relief and early detection of malignancies; no therapy is indicated for asymptomatic patients. As in the case reported here, bone or soft tissue lesions that grow or become painful should be biopsied.

Tratamento cirúrgico da icterícia obstrutiva / Surgical treatment in biliary obstructive jaundice surgical

O presente estudo reuniu 80 pacientes com icterícia obstrutiva submetidos a tratamento cirúrgico. Analisou-se o nível da obstrução, as técnicas cirúrgicas empregadas, os resultados obtidos e as principais complicações. Havia 42 pacientes do sexo masculino (52,5 por cento) e 38 do sexo feminino (47,5 por cento). A obstrução foi mais freqüente ao nível do colédoco terminal, e a técnica mais empregada foi a coledocoduodenoanastomose. As complicações analisadas foram fístula, insuficiência renal e sepse, relacionando-se as duas últimas com o nível de bilirrubina

Alternativa técnica para colocaçäo de cateter totalmente implantável para quimioterapia / Alternative technique to place the internals central venous catheters for chemotherapy

Os cateteres totalmente implantáveis säo a primeira escolha para os pacientes que necessitam do uso contínuo de quimioterapia sistêmica ou de outros tratamentos intermitentes. Com o intuito de proporcionar um adequado acesso venoso, reduzir os índices de complicaçöes, aumentar a praticidade e facilitar o aprendizado do procedimento, o Serviço de Cirurgia Oncológica do Hospital Santa Rita desenvolveu uma alternativa técnica para a colocaçäo de cateteres totalmente implantáveis para quimioterapia, diferindo das técnicas de Seldinger e por flebotomia já conhecidas.