Mulheres submetidas ao transplante de medula óssea: impacto dos quimioterápicos e da doença do enxerto contra o hospedeiro sobre o sistema reprodutor / Women undergoing bone marrow transplantation: impact of chemotherapy and graft-versus-host disease (GVHD) on the feminine reproductive system

O transplante de medula óssea (TMO) é um procedimento indicado para o tratamento de doenças hematológicas, que afetam muitas mulheres jovens. O aperfeiçoamento dos cuidados durante o TMO proporciona altos índices de cura e de sobrevida. No entanto, pode deixar sequelas em vários órgãos e sistemas, entre eles o sistema reprodutor e os órgãos genitais, impactando negativamente a qualidade de vida das receptoras do TMO. O objetivo desta publicação foi realizar uma revisão narrativa sobre o tema e propor um protocolo assistencial que torne acessível os cuidados relacionados à saúde sexual e reprodutiva a esse grupo especial de mulheres, baseado em dados clínicos de um ambulatório de assistência ginecológica às mulheres transplantadas no Hospital Amaral Carvalho, em Jaú, no interior de São Paulo.(AU)

Bone marrow transplantation (BMT) is indicated for the treatment of hematological diseases which affect many young women. The improvement of care during BMT procedures provides higher cure and survival rates. however, it can cause sequelae in various organs and systems, including the reproductive system and genitals, negatively impacting quality of life. The purpose of this publication is to present a narrative review related to this theme and to propose a healthcare protocol that allows sexual and reproductive care in this special group of patients, based on the clinical experience of a gynecological outpatient clinic at the Amaral Carvalho Hospital, in Jaú (SP) which specifically care for these women.(AU)

Female genital tract chronic graft-versus-host disease: A narrative review

Abstract Graft-versus-host disease is one of the main causes of morbidity and mortality in patients submitted to hematopoietic stem cell transplantation. This study reviewed the prevalence of lower female genital tract graft-versus-host disease following hematopoietic stem cell transplantation. A systematic search of the literature for articles published between 1982 and 2015 was performed. A growing number of young women suffering from malignant and benign hematological diseases are receiving allogeneic hematopoietic stem cell transplantation with very satisfactory results in relation to the disease itself. However, these patients face gynecological problems due to graft-versus-host disease. Correct diagnosis and early management are needed to avoid irreversible complications.

Female genital tract chronic graft-versus-host disease: A narrative review.

Graft-versus-host disease is one of the main causes of morbidity and mortality in patients submitted to hematopoietic stem cell transplantation. This study reviewed the prevalence of lower female genital tract graft-versus-host disease following hematopoietic stem cell transplantation. A systematic search of the literature for articles published between 1982 and 2015 was performed. A growing number of young women suffering from malignant and benign hematological diseases are receiving allogeneic hematopoietic stem cell transplantation with very satisfactory results in relation to the disease itself. However, these patients face gynecological problems due to graft-versus-host disease. Correct diagnosis and early management are needed to avoid irreversible complications.

Genital manifestation of graft-vs.-host disease: a series of case reports.

INTRODUCTION: After hematopoietic stem cell transplantation (HSCT), many patients present genital graft-vs.-host disease (GVHD) that can culminate with sexual problems, which are poorly dimensioned. AIM: We hope to draw attention to the need to perform genital biopsy to diagnose genital GVHD, and thus to call attention to the need to incorporate careful attention to sexual health in the treatment of these patients. METHODS: Five allogeneic stem cell transplant recipients complaining of coital pain after HSCT were clinically diagnosed for genital GVHD. Genital biopsies were given for histological analysis, and microphotographs of the corresponding marked field in the slide were taken. Specimens were evaluated by the site pathologist and then sent to a reference pathologist, each blinded to the histological findings. A literature search was performed in PubMed/MEDLINE (1966-2009) for cross-sectional and cohort studies or trials related to genital GVHD. Expert opinions peer reviews and case reports were also considered. MAIN OUTCOME MEASURES: HSCT, genital GVHD, genital biopsy. RESULTS: The biopsy showed evidence of dilated apoptotic cells in the basal layer and detachment of the epithelial lining of the mucosa, hyalinization and thickening of collagen fibers, capillary ectasia, and mononuclear inflammatory infiltrate of the submucosa. Three patients presented vulval lesion such as leucoplasia and ulcer on the large lip. Histological analyses showed evidence of epithelial hyperplasia and influx of inflammatory cells to the epithelial surface, intercellular edema and spongiosis, apoptotic bodies on the basal layer of the epithelium, spongiosis, and nuclear vacuolization. A common treatment based on corticotherapy resulted in complete remission of coetaneous or mucous genital lesions in all five patients. CONCLUSION: Genital biopsy is important to differentially diagnose GVHD and secondary symptoms due to hypoestrogenism. Prevention is the most important step in controlling the evolution GVHD in the vagina to prevent vaginal obstruction and sexual dysfunction.

Carcinoma lobular invasivo de mama com pólipo endometrial metastático / Breast invasive lobular carcinoma with metastatic endometrial polyp

Tumores extragenitais com metástase para o útero são raros, e destes o mais comum é o da mama. O tamoxifeno é uma droga utilizada como terapia adjuvante em mulheres com câncer de mama. Trata-se de droga antiestrogênica; no entanto, no endométrio sua ação é agonista para receptores de estrogênio. Esta descrição de caso relata rara associação do uso do tamoxifeno em paciente com câncer de mama que apresentou metástase para pólipo endometrial. Trata-se de paciente de 70 anos, em hormonioterapia com tamoxifeno há 19 meses, com queixa de sangramento vaginal. Em histeroscopia, evidenciaram-se pólipo endometrial e sua exérese, com diagnóstico de adenocarcinoma metastático, com provável sítio primário em mama. A paciente havia sido submetida à mastectomia radical modificada há três anos, seguida de adjuvância. Pólipos endometriais são achados comuns em mulheres menopausadas e também são complicações da terapia com tamoxifeno. A metástase de carcinoma mamário em pólipo endometrial é rara. Na literatura, foram descritas as seguintes metástases em pólipos endometriais: cinco casos por carcinoma lobular invasivo, três casos por carcinoma ductal e um caso do carcinoma apócrino. Portanto, existe dificuldade em determinar o prognóstico para essas pacientes.

Extragenital tumors metastasizing to the uterine corpus is uncommon; out of those, the most common primary site is the breast. Tamoxifen is used as adjuvant treatment for breast carcinoma. It is an antiestrogenic drug; however has a partial agonist effect on estrogen receptor in the endometrium. This case report relates rare association between the use of tamoxifen in patient with breast cancer which presented metastasis to endometrial polyps. A 10 years old woman received tamoxifen for 19 months after surgery treatment and presented vaginal bleeding. She underwent hysteroscopy with biopsy, which showed endometrial polyp. The polyp was taken out and the pathological diagnosis was metastasis from breast adenocarcinoma. Endometrial polyps are found relatively common in postmenopausal women and they are also related complications to the tamoxifen therapy. Breast carcinoma metastasis to endometrial polyp is rare. There were some descriptions in the literature: five cases of invasive lobular carcinoma, three cases of ductal carcinoma and one case of the apocrine carcinoma. There are few cases shown in the literature and, therefore, there are difficulties in determining the prognosis of these patients.