Risk factors for the development of endometrial lesions in breast cancer patients using tamoxyphen: a retrospective cohort study.

INTRODUCTION: breast cancer is the cancer with the highest incidence in women in Brazil, representing 29.7% of all cancers. More than two thirds of women with breast cancer show expression for hormone receptors, and in these cases, hormone therapy with tamoxifen is indicated, which may represent a risk factor for the development of endometrial cancer (four-fold greater relative risk). OBJECTIVE: this study aimed to evaluate the association of tamoxifen and the development of endometrial disturbances and to assess possible other associated risk factors. PATIENTS AND METHOD: a total of 364 breast cancer patients were evaluated, 286 who used tamoxifen and 78 who did not use this hormone therapy. Results: patients who used tamoxifen had a mean follow-up time of 51.42 months similar to those without hormone therapy (p=0.081). A total of 21 (7.3%) women who used tamofixen and no cases among women without hormone therapy presented endometrial changes during follow-up (p=0.01). Despite information regarding obesity was available for only 270 women, obesity was also significantly associated with the development of endometrial changes (p=0.008). CONCLUSION: furthermore, the association between tamofixen and endometrial changes remained significant (p=0.039) after adjusting for obesity.

Risk factors for the development of endometrial lesions in breast cancer patients using tamoxyphen: a retrospective cohort study / Estudo de coorte retrospectivo para avaliação de fatores de risco para desenvolvimento de lesão endometrial em pacientes com câncer da mama em uso de tamoxifeno

ABSTRACT Introduction: breast cancer is the cancer with the highest incidence in women in Brazil, representing 29.7% of all cancers. More than two thirds of women with breast cancer show expression for hormone receptors, and in these cases, hormone therapy with tamoxifen is indicated, which may represent a risk factor for the development of endometrial cancer (four-fold greater relative risk). Objective: this study aimed to evaluate the association of tamoxifen and the development of endometrial disturbances and to assess possible other associated risk factors. Patients and method: a total of 364 breast cancer patients were evaluated, 286 who used tamoxifen and 78 who did not use this hormone therapy. Results: patients who used tamoxifen had a mean follow-up time of 51.42 months similar to those without hormone therapy (p=0.081). A total of 21 (7.3%) women who used tamofixen and no cases among women without hormone therapy presented endometrial changes during follow-up (p=0.01). Despite information regarding obesity was available for only 270 women, obesity was also significantly associated with the development of endometrial changes (p=0.008). Conclusion: furthermore, the association between tamofixen and endometrial changes remained significant (p=0.039) after adjusting for obesity.

RESUMO Introdução: o câncer da mama é o câncer de maior incidência no sexo feminino no Brasil, representando 29,7% de todos os cânceres. Mais de dois terços das mulheres com câncer da mama apresentam expressão para receptores hormonais, estando, nestes casos, indicada a terapia hormonal com tamoxifeno, que pode representar fator de risco para o desenvolvimento do câncer do endométrio (risco relativo quatro vezes maior). Objetivo: este trabalho teve como objetivo avaliar a associação entre o uso de tamoxifeno e o desenvolvimento de distúrbios endometriais bem como eventuais outros fatores associados. Pacientes e método: Estudo de coorte retrospectivo de 364 pacientes com câncer da mama, das quais 286 utilizaram tamoxifeno e 78 não utilizaram esta hormonioterapia. Resultados: pacientes que usaram tamoxifeno tiveram um seguimento médio de 51,42 meses, semelhante àquelas sem terapia hormonal (p=0,081). Um total de 21 (7,3%) mulheres que usaram tamofixeno e nenhuma mulher sem terapia hormonal apresentaram alterações endometriais durante o seguimento (p=0,01). Nas 270 mulheres que tinham informação sobre obesidade, esta se associou significantemente com o desenvolvimento de alterações endometriais (p=0,008). A associação entre tamofixeno e alterações endometriais permaneceu significante (p=0,039) após ajustar para interação com obesidade. Conclusão: o uso de tamoxifeno no tratamento do câncer da mama esteve associado ao maior risco para desenvolvimento de alterações endometriais especialmente quando associado à obesidade.

Assessment of Preoperative Endometrial Histopathological Sampling as a Predictor of Final Surgical Pathology in Endometrial Cancer.

OBJECTIVE: To evaluate the agreement between the histopathological diagnoses of preoperative endometrial samples and surgical specimens and correlate the agreement between the diagnoses with the impact on surgical management and the survival of patients with endometrial adenocarcinomas. METHODS: Sixty-two patients treated for endometrial cancer at a university hospital from 2002 to 2011 were retrospectively evaluated. The histopathological findings of preoperative endometrial samples and of surgical specimens were analyzed. The patients were subjected to hysterectomy as well as adjuvant treatment, if necessary, and clinical follow-up, according to the institutional protocol. Lesions were classified as endometrioid tumor (type 1) grades 1, 2, or 3 or non-endometrioid carcinoma (type 2). RESULTS: The agreement between the histopathological diagnoses based on preoperative endometrial samples and surgical specimens was fair (Kappa: 0.40; p < 0.001). However, the agreement was very significant for tumor type and grade, in which a higher concordance occurred at a higher grade. The percentage of patients with lymph nodes affected was 19.2%. Although most patients presenting with disease remission or cure were in the early stages (90.5%), there were no significant differences between those patients who had a misdiagnosis (11/16; 68.8%) and those who had a correct diagnosis (25/33; 75.8%) based on preoperative endometrial sampling (p = 0.605). CONCLUSION: Our findings corroborate the literature and confirm the under staging of preoperative endometrial samples based on histopathological assessment, especially for lower grade endometrial tumors. We suggest that the preoperative diagnosis should be complemented with other methods to better plan the surgical management strategy.

OBJETIVO: Avaliar a concordância entre os diagnósticos histopatológicos de amostras endometriais pré-operatórias e cirúrgicas de pacientes com adenocarcinomas endometriais e avaliar o impacto da concordância entre os diagnósticos no planejamento cirúrgico e sobrevida das pacientes. MéTODOS: Dados de 62 pacientes com câncer de endométrio operadas entre 2002 a 2011 em um hospital universitário foram avaliadas retrospectivamente. As pacientes foram submetidas à histerectomia e tratamento adjuvante, se necessário, e acompanhadas clinicamente de acordo com o protocolo institucional. Foram avaliados os resultados das análises histopatológicas das amostras endometriais pré-operatórias e cirúrgicas. As lesões foram classificadas como tumor endometrioide (tipo 1) graus 1, 2 ou 3 ou carcinoma não endometrioide (tipo 2). RESULTADOS: De modo geral, houve uma concordância baixa entre os diagnósticos histopatológicos das amostras endometriais pré-operatórias e cirúrgicas (Kappa: 0,40; p < 0,001). Entretanto, uma alta concordância entre os diagnósticos foi observada nos tumores de graus mais elevados. Comprometimento de linfonodos ocorreu em 19,2% das pacientes e a maioria das que apresentaram remissão ou cura foram diagnosticadas nos estágios iniciais da doença (90,5%). Não houve diferença significativa na taxa de remissão ou cura entre as pacientes que tiveram concordância (25/33; 75,8%) ou divergência (11/16; 68,8%) entre os resultados histopatológicos pré-operatórios e cirúrgicos (p = 0,605). CONCLUSãO: Nossos achados corroboram a literatura e confirmam o sub-estadiamento de amostras endometriais pré-operatórias com base na avaliação histopatológica, especialmente para tumores endometriais de baixo grau. Outros métodos complementares são necessários para um diagnóstico pré-operatório mais preciso a fim de melhorar o planejamento cirúrgico.

Confounder factors masking a Leydig-cell ovarian tumor in a post-menopausal woman treated for androgen-positive receptor breast cancer.

Post-menopause hyperandrogenism is a condition that needs careful evaluation. Aromatase inhibitors (AI), which are important in the management of positive estrogen breast cancer, and chronic kidney disease (CKD) can puzzle the evaluation of this condition. A postmenopause female with type-2 diabetes and advanced CKD was attended due to progressive virilization, which has started after the introduction of an AI for breast cancer 5 years earlier. Clinical and radiological investigation has confirmed a pure Leydig cell tumor as source of hyperandrogenism. Re-evaluation of the breast tumor immunohistochemistry has shown positive androgen receptor expression and negative expression for estrogen, progesterone and HER-2 receptors. Even though an ovarian tumor was the source of androgen excess, we discuss that AI could exert a slight contribution to patient's virilization by reducing estradiol counterbalance. Also, although the onset of hyperandrogenic symptoms was unclear, we could not exclude that the ovarian tumor had produced enough androgens to play a role in breast tumor progression. This case report supports the literature regarding the possible association between Leydig cell tumor and androgen-receptor-positive breast cancer development. Finally, progressive hyperandrogenic symptoms in postmenopause, even under AI therapy or the presence of advanced CKD, impose a more detailed investigation.

Immunohistochemical expression of heparanases 1 and 2 in benign tissue and in invasive neoplasia of the endometrium: a case-control study.

OBJECTIVES: Our purpose was to compare the expression of heparanase isoforms, in normal and in neoplastic endometrium. In a pioneering way, we sought to evaluate the expression of heparanase 1 (HPSE1) and heparanase 2 (HPSE2) in glandular and in stromal tissues. METHODS: This is a case-control study, conducted retrospectively in a public hospital, using paraffin blocks of endometrial tissue from patients admitted from 2002 to 2011 with and without endometrial cancer, with regard to the immunohistochemical expression of HPSE1 and HPSE2. The paraffin blocks were used for tissue microarray analysis and immunohistochemistry study in glandular and stromal tissues. RESULTS: In the study period, 195 participants were enrolled, 75 with and 120 without cancer. There was no significant difference between them regarding HPSE1 expression, both in gland and in stromal tissues. Heparanase 1 expression in the glandular tissue was more frequent among those with high-grade carcinoma, compared with patients with carcinoma type I. The difference in the expression of HPSE2 was significant between groups: it was less frequent in the controls than in the patients with cancer in the glandular tissue. In the stromal tissue, HPSE2 expression was significantly higher in the controls than in the patients with cancer and different when patients of the secretory endometrium subgroup were compared with those with hypotrophic, proliferative endometriums or with architectural disorders. No significant difference was found in the heparanase expressions in patients with cancer according to prognosis factors. CONCLUSIONS: Heparanase 1 is more intensely expressed in the glandular tissue of high-grade compared with type I carcinomas. Heparanase 2 is more intensely expressed in the glandular tissue of cancer than in nonneoplastic endometrium, whereas the HPSE2 expression in the stromal tissue is higher in the nonneoplastic controls compared with the group of patients with cancer mainly in the secretory endometrium. This suggests that HPSE2 might be stimulated by progesterone, with a possible antineoplastic role, antagonist to HPSE1, to be further investigated.

The immunoexpression of heparanase 2 in normal epithelium, intraepithelial, and invasive squamous neoplasia of the cervix.

OBJECTIVE: Heparanase 2 (HPSE2) is expressed in various tissues, including the brain, intestine, prostate, breast, and endometrium. The aim of this study was to investigate the role of HPSE2 in cervical carcinogenesis, which has not been clarified to date. MATERIALS AND METHODS: The immunoexpression of HPSE2 in normal and neoplastic cervical squamous epithelia was determined using a semiquantitative (SQ) method and an index of expression (IE) method, using Image Lab Software. A total of 230 cervical tissue samples were analyzed and segregated into the following diagnostic groups: normal (27.4%), cervical intraepithelial neoplasia 1 (CIN 1, 15.2%), CIN 2 (16.5%), CIN 3 (15.2%), and invasive neoplasia (25.7%). The mean HPSE2 expression in the normal group was significantly lower than that of the other groups individually or combined (p < .001, for all combinations). The immunoexpression via the SQ method was significantly greater in the CIN 3 group compared with that in the CIN 1 group (p = .02). The mean immunoexpression of the high-grade squamous intraepithelial lesion groups was significantly greater than those of the normal and low-grade squamous intraepithelial lesion groups (p < .001) and lower compared with that of the invasive neoplasia group (p < .001). There were no statistically significant differences in the immunoexpression of HPSE2 among the different clinical states within the invasive neoplasia group. CONCLUSIONS: The SQ method produced a greater sensitivity and specificity than did the index of expression method. There was a progressive increase in the mean HPSE2 immunoexpression according to the severity of the cervical lesion from the low-grade squamous intraepithelial lesion group to the invasive neoplasm group, whereas the normal group displayed the lowest level of expression. This is a novel study concerning HPSE2 in the cervix and cervical cancer carcinogenesis.

Can mobile units improve the strategies for cervical cancer prevention?

Cervical cancer is a serious public health problem in women in developing countries because of absence or ineffectiveness of screening programs. Several biases to access medical care and inequity of public health system in a continental country like Brazil limit the implementation of adequate programs to appropriately prevent the cervical cancer. Therefore, the aim of this study was to evaluate the results of applying the mobile unit (MU) for cervical cancer screening. From May 2003 to May 2004, a cervical cancer screening was offered to women aged 20-69 years, residing in 19 municipal districts of the Barretos county region, in São Paulo. Out of the 9,560 examination available, 2,964 (31%) women underwent screening. The medium distance traveled by the MU was 45 km. The medium time spent by women in the MU for completion of the questionnaire and doing the exam was 20 minutes. It was observed that 17.0% of women screened had never had the test or had not had it repeated within the last 3 years. The negative response was more common among women aged 20 to 29 years and 60 to 69 years and among women with less schooling and lower socio-economic income (P < 0.05). MU can significantly overcome the chronic deficiency of public health system accessibility offering opportunity to these women to participate in screening programs.

Heparanase-2 expression in normal ovarian epithelium and in benign and malignant ovarian tumors.

INTRODUCTION: Studies have highlighted the changes that take place in the environment between the cell and the extracellular matrix during the process of neoplastic expansion. Several papers have associated the expression of heparanase 1 with various malignant tumors. Heparanase 2 is probably related to loss of cell adhesion. OBJECTIVE: The aim of this study was to evaluate the expression of heparanase 2 in epithelial neoplasia of the ovaries and in samples of normal ovarian tissue. METHODS: Seventy-five ovary specimens were analyzed and divided into 3 groups: 23 malignant and 35 benign epithelial ovarian neoplasia and 17 without ovarian disease. We used 2 methodological techniques for evaluating the immunoexpression of heparanase 2. The first followed the qualitative criterion of positive or negative in relation to enzymatic expression, and the second involved computerized quantification of this expression, performed on the same slides. RESULTS: In the quantitative analysis, we found positivity indices for heparanase 2 expression of 72.2% and 87.3% in the samples of benign and malignant neoplasias, respectively. In these, the intensity of expression and the expression index were 147.2 and 121.2, respectively, for the benign neoplasia and 134.1 and 118.0 for the malignant neoplasia. Qualitatively, its expression was strong or moderate in 44.2% of the benign and 78.2% of the malignant tumors; its expression in all of the nonneoplastic samples was negative, with the exception of one that was weakly positive. CONCLUSIONS: Heparanase 2 is involved in neoplastic proliferation, but it was not exclusively associated with the malignant process. Furthermore, there was no difference in its expression between benign and malignant ovarian epithelial neoplasia.

Sintomas urinários pós-histerectomia radical: revisão de literatura e análise de dados / Urinary symptons after radical hysterectomy: bibliographic review and analysis of data

O carcinoma do colo uterino representa um importante problema de saúde pública. Mundialmente é a quarta maior causa de mortes por câncer, e no Brasil é a neoplasia mais frequente do trato genital feminino, sendo a segunda maior causa de morte por câncer em mulheres e a primeira de morte em mulheres em idade reprodutiva. Uma das formas de tratamento é a histerectomia radical, sendo que neste tratamento 70 por cento das mulheres apresentam disfunção vesical após o procedimento. O objetivo do estudo foi analisar a relação de sintomas urinários pós-cirurgia. Foi realizado levantamento bibliográfico com publicações entre os anos de 1997 a 2007. Percebeu-se que sintomas urinários são cada vez mais frequentes após histerectomia radical e entre as causas a mais provável é a lesão nervosa durante o procedimento, prejudicando ainda mais a qualidade de vida destas pacientes. Sabendo-se disto, é de fundamental importância o acompanhamento multidisciplinar destas doentes, incluindo-se nesta equipe o fisioterapeuta, o qual poderá contribuir significantemente no tratamento proposto.

The carcinoma of the uterine cervix is a great public health problem. In the world, it is the fourth leading cause of cancer deaths and in Brazil, it is the most common cancer of the female genital tract, and the second cause of cancer deaths in women and the first of death in women at reproductive age. One of the treatment methods is the radical hysterectomy. In this treatment, 70 percent of women present bladder dysfunction after surgery. The objective of the study was to examine the relation of urinary symptoms after radical hysterectomy for cancer of the cervix, and to examine the causes of the presence of urinary symptoms after surgery. The bibliographic survey was done on publications between the years of 1997 and 2007. It is possible to emphasize that urinary symptoms are increasingly frequent after radical hysterectomy. The disease itself undermines the physical, psychological and social well-being of the patient, and after the withdrawal of the uterus other consequences may appear, further damaging the quality of life of these patients. Bearing this in mind, it is a fundamental importance multidisciplinary monitoring of these patients, including in this team the physical therapist, who could contribute significantly in the proposed treatment.

Aspectos de imagem das lesões vulvo-vaginais / Imaging of the vagina and vulva

Na pratica ginecológica diária, a vulva e a vagina são examinadas durante inspeção visual, entretanto, há situações em que isso não é possível ou que se necessita determinar a extensão de umalesão através de métodos de imagem. A ressonância magnética é um método excelente e cada vez é mais indicado na avaliação de alterações da vulva e vagina, em virtude da sua capacidade deavaliação multiplanar e alto contraste tecidual, fornecendo informações que auxiliam o ginecologista. Outros métodos de imagem que podem ser indicados são a ultra-sonografia e a tomografia computadorizada da pelve. Este trabalho pretende, de forma sintética, analisar as principais alterações vulvo-vaginais que podem ser identificadas e diagnosticadas pelo radiologista.

In gynecological daily practices, the vulva and vagina are examined during physical examination, however there are situations where this is not possible or it is needed to determine the extension of an injury through imaging methods. The magnetic resonanceimaging is an excellent cross-sectional modality for evaluation the alterations of vulva and vagina due its multiplanar evaluation and high tecidual contrast. Other cross-sectional modalities are ultrasound and enhanced computed tomography. This paper intends togive an overview of vaginal and vulvar pathology that can be identifiedby the radiologist.

Neoplasia "borderline" do ovário e gestação: relato de caso / Ovary borderline tumor with pregnancy: a case report

Os autores relatam um caso de uma paciente de 35 anos de idade, tercípara e com história de incompetência istmo-cervical que, durante exames obstétricos iniciais, apresentou massa pélvica à esquerda. A paciente foi encaminhada para o departamento de diagnóstico por imagem, onde se submeteu a avaliação por ultra-sonografia e ressonância magnética. Foi indicada a cirurgia e o tumor foi ressecado, com diagnóstico final de cistadenoma seroso borderline ou de baixo potencial de malignidade. Os principais achados de imagem são descritos e discutidos, associados com breve revisão de literatura.

A case of borderline serous cystadenoma in a 35 years pregnancy woman with previous history of cervix incompetence is reported. This tumor was discovered during initial obstetric exams, and evaluated by ultrasound and magnetic resonance imaging scans. Theauthors describe the clinical and diagnostic finding with a brief review of the literature.

Cervical biopsy-based comparison of a new liquid-based thin-layer preparation with conventional Pap smears.

The objective of this study is to compare the diagnostic efficacy of universal collection medium (UCM) liquid-based cytology (LBC) (Digene Corp., MD) and the conventional Pap smear in a comparative study, using histologic results as the gold standard. This was a cross-sectional study. Conventional Pap smears and UCM LBC specimens, obtained from women in a low socioeconomic outpatient population referred to a tertiary center for gynecologic care, were compared. For the purpose of this study, when cervical specimens were collected for cytology, all women underwent colposcopy and biopsy was done if a cervical abnormality was observed. Cytologic evaluation of UCM LBC and conventional Pap smears were carried out separately, masked to the results of the other method. Agreement beyond chance between the two cytologic methods was ascertained by means of the unweighted kappa statistic. Sensitivity, specificity, and predictive values with 95% confidence intervals were calculated for both methods. McNemar's test was used to determine the level of association between the two cytology procedures. A total of 800 women were evaluated. Assessment of the overall agreement between the two cytologic methods yielded a kappa of 0.777 (P < 0.0001). After adjustment for histologic diagnosis, the computed kappa in each stratum was as follows: normal = 0.733; CIN 1 = 0.631; CIN 2/3 = 0.735; cancer = 0.652. The sensitivity and specificity of UCM LBC for detection of cervical intraepithelial lesions and cancer were 75.3% and 86.4%, respectively, not statistically different from the 81.8% and 85.2% seen with the conventional method. This study demonstrates that the UCM LBC method is as accurate as the conventional Pap smear cytology in detecting cervical intraepithelial lesions and cancer even so the UCM samples were systematically prepared from a second sampling of the cervix.

Atypical glandular cells of undetermined significance. Cytologic predictive value for glandular involvement in high grade squamous intraepithelial lesions.

OBJECTIVE: To verify the cytologic predictive value of a diagnosis of atypical glandular cells of undetermined significance (AGUS) in high grade squamous intraepithelial lesions (HSIL) cases. STUDY DESIGN: In a retrospective study, 98 cases of HSIL were reviewed. All patients were referred for colposcopy and directed biopsy to confirm the cytologic diagnoses. Loop excision of the transformation zone was performed to treat clinical lesions. Sensitivity, specificity, positive and negative predictive value were evaluated. Kappa statistics and logistic regression analysis were used to evaluate the findings statistically. RESULTS: By logistic regression analysis, we found that the chance of finding squamous intraepithelial lesions involving glands in AGUS smears was 5.32 times higher than in those with no AGUS. It was 5.74 times higher in cervical intraepithelial neoplasia (CIN) 3 lesions than in CIN 2. CONCLUSION: The cytologic predictive value for HSIL involving glands is statistically significant when specific and objective criteria are used for the AGUS diagnosis.

Importance of peniscopy, oncologic cytology and histopathology in the diagnosis of penile infection by human papillomavirus

Introduction: Male genital infection by human papillomavirus is of particular importance since it is often asymptomatic. The patient generally presents no clinical lesion. Therefore, men represent an important reservoir of virus, playing a special role in the transmission and perpetuation of the disease. Patients and methods: In the present prospective clinical trial study, 190 sex partners of women with genital infection by human papillomavirus, associated or not with cervical intraepithelial neoplasia, were investigated. All patients were unaware of or denied the presence of a genital lesion. Results: Cytologic examination revealed koilocytosis in 9 cases (4,7 per cent) in the urethra and in 3 cases (1.6 percent) in the corona of the glans and the distal prepuce. Peniscopy with the previous use of 5 percent acetic acid revealed white lesions in 97,9 per cent of the patients. Toluidine blue stained most to the lesions. At least one fragment revealed koilocytosis in the histopathologic study of 97 cases (51.05 per cent). Conclusion: The three methods complement one another, allowing a more precise diagnosis of this infection in men.

Diagnóstico da infecçäo por papilomavírus humano: relaçäo entre a peniscopia e a histopatologia das lesöes acetobrancas da genitália nasculina / diagnosis of infection of human papillmvirus: Relationship between peniscopy and a histopatologic aceto-white lesions of genitalia male

A infecção genital masculina pelo papilomavírus humano tem especial importância, pois freqüentemente é assintomática. Na maioria das vezes o não apresenta lesão clínica. Por isso, comporta-se como importante reservatório do vírus, exercendo papel especial na transmissão e perpetuação da doença. Até hoje não se estabeleceu um método ideal de rastreamento da infecção no homem. Pelas razões expostas, estudaram-se 433 parceiros de mulheres com infecção genital por papilomavírus humano, associada ou não à neoplasia epitelial cervical. A maioria dos pacientes era assintomática. Apenas 21 diziam ter lesão (5,24O/o). Trezentos e dezesseis não referiam lesão ou ela não era visível à olho nu. Do total, 43 pacientes referiam antecedentes de condiloma acuminado. A solução de azul de toluidina corou a maior parte das lesões observadas. O teste de SCHMLER na uretra distal foi positivo em 45 casos. A coilocitose foi observada em 20 das biópsias dessas áreas. Foram realizadas 1279 biópsias de lesões acetobrancas, sendo que a coilocitose foi encontrada em 301 (23,53 por cento). A região mais acometida foi a parte interna do prepúcio, onde foram feitas 853 biópsias. A lesão mais encontrada foi a mácula, biopsiada 447 vezes. A coilocitose foi descrita em 100 delas (22,37 por cento). Foi pouco freqüente o comprometimento da bolsa testicular, sendo submetida a 14 biópsias e a mácula foi a imagem mais freqüente. A coilocitose foi detectada em 8,70 por cento das vezes. A neoplasia intra-epitelial do pênis foi encontrada em 10 pacientes ou 12 das l279 biópsias (O,94 por cento) e muitas das imagens não foram diferentes de outras lesões acetobrancas em que não se encontraram sinais histológicos de infecção viral. Conclui-se que a peniscopia é freqüentemente positiva, porém sem relação com o resultado anátomo-patológico. Os resultados demonstram que o exame é pouco específico, porém, auxilia no diagnóstico, especialmente nos casos assintomáticos e com infecção subclínica

Condiloma acuminado gigante (tumor de Buschke-Loewenstein) com transformaçäo maligna: relato de caso / Giant condylomata acuminata (Buschke-Loewenstein tumor) with malignant transformation: report of case

O condiloma acuminado gigante (tumor de Buschke-Loewenstein) apresenta comportamento clínico destrutivo, embora histologicamente benigno, de início. Descreve-se caso de localizaçao vulvar e ano-retal com transformaçao maligna para carcinoma espinocelular invasivo. A paciente foi tratada com radioterapia pré-operatória seguida de excisao local ampla, com evoluçao favorável. Os autores fazem revisao pormenorizada desta rara entidade e comentam sobre as possibilidades terapêuticas.

Carcinoma espinocelular originado em teratoma cístico do ovário: relato de um caso / Carcinoma squamous cell caused by ovary teratoma: report of case

Descreve-se um caso de carcinoma espinocelular originado em teratoma cístico de ovário, discutindo-se seus aspectos clínicos, histopatológicos e terapeuticos. A paciente de 49 anos, apresentava quadro de dor e tumor abdominais e o tratamento consistiu em uma histerectomia total abdominal com salpingooferectomia bilateral e omentectomia. O estádio clínico final foi 1A e, após cinco anos de seguimento, näo há sinais de recidiva.