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2.
Zhonghua Fu Chan Ke Za Zhi ; 56(2): 89-95, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33631879

RESUMO

Objective: To investigate the clinical outcomes of different treatment options on singleton short cervix and its influence factors. Methods: Totally 435 cases of singleton pregnancies who were diagnosed with short cervix (≤25 mm) between 12 to 33+6 gestational weeks in Peking University First Hospital from January 2018 to December 2018 were enrolled, including 21 cases with cervical length <10 mm, 414 cases with cervical length between 10 to 25 mm. The onset time was <24 gestational weeks in 106 cases, while 104 cases were at 24-29+6 gestational weeks and 225 cases of ≥30 gestational weeks. Gestational outcomes including delivery before 37 weeks, delivery before 34 weeks, neonatal birth weight (NBW) and adverse neonatal outcome (ANO) were compared among three treatment groups: rest group, progesterone group and cerclage group. Influence factors were also investigated. Results: (1) The incidence of short cervix in pregnancy was 7.07% (435/6 155), while 106 cases were at <24 gestational weeks (1.72%, 106/6 155), 104 cases (1.69%, 104/6 155) at 24-29+6 gestational weeks and 225 cases (3.66%, 225/6 155) at ≥30 gestational weeks. (2) In the group of cervical length <10 mm, rate of delivery before 37 and 34 weeks were 62% (13/21) and 57% (12/21) respectively. One case of progesterone treatment underwent miscarriage. Compared with rest group (n=8), delivery weeks [28.5 (25.0-40.0) vs 37.0 (28.0-40.0), P=0.020] and NBW [1 245 g (630-3 830 g) vs 2 648 g (1 560-3 830 g), P=0.028] were higher in cerclage group (n=9), while ANO was not statistically different (P>0.05). (3) In the group of cervical length ≥10 mm before 24 gestational weeks, the delivery weeks, incidence of delivery before 34 weeks, adjusted incidence of delivery before 37 weeks, NBW and ANO were not statistically different (P>0.05) among rest group (n=36), progesterone group (n=26) and cerclage group (n=34). In vitro fertilization (OR=11.97, 95%CI: 1.88-76.44, P=0.009), infection (OR=46.03, 95%CI: 5.12-413.58, P=0.001), sludge on sonography (OR=9.87, 95%CI: 1.69-57.60, P=0.011) and history of short cervix (OR=7.24, 95%CI: 1.04-50.24, P=0.045) were independent risk factors of preterm birth. (4) In the group of cervical length ≥10 mm and gestational weeks between 24-29+6, the delivery weeks, incidence of delivery before 37 weeks, incidence of delivery before 34 weeks, NBW and ANO were not statistically different (P>0.05) among rest group (n=52), progesterone group (n=34) and cerclage group (n=9). Infection was an independent risk factor of preterm birth (OR=56.40, 95%CI: 4.67-680.61, P=0.002). (5) Outcomes of 223 cases were relatively good in the group of cervical length ≥10 mm beyond 30 gestational weeks. The incidence of delivery before 34 weeks was 6.3% (14/223). The delivery weeks, incidence of delivery before 37 and 34 weeks, NBW and ANO were not statistically different (P>0.05) among 3 groups. Infection (OR=10.91, 95%CI: 2.21-53.96, P=0.003) and history of preterm birth (OR=8.63, 95%CI: 1.25-59.65, P=0.029) were independent risk factors of preterm birth. Conclusions: Short cervix is a common complication of pregnancy. Cervical cerclage is related with better outcome for patients with cervical length <10 mm. Neither progesterone nor cervical cerclage improves pregnancy outcome for >10 mm cervical length patients comparing with rest. Infection, sludge, in vitro fertilization, history of short cervix and history of preterm birth are independent risk factors of preterm birth in short cervix pregnancies.


Assuntos
Cerclagem Cervical/métodos , Colo do Útero/cirurgia , Complicações na Gravidez/cirurgia , Nascimento Prematuro/prevenção & controle , Adulto , Cerclagem Cervical/efeitos adversos , Colo do Útero/patologia , Feminino , Humanos , Incidência , Recém-Nascido , Gravidez , Complicações na Gravidez/patologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Progesterona/administração & dosagem , Técnicas de Sutura
3.
Nat Cell Biol ; 23(2): 184-197, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33462395

RESUMO

The transition zones of the squamous and columnar epithelia constitute hotspots for the emergence of cancer, often preceded by metaplasia, in which one epithelial type is replaced by another. It remains unclear how the epithelial spatial organization is maintained and how the transition zone niche is remodelled during metaplasia. Here we used single-cell RNA sequencing to characterize epithelial subpopulations and the underlying stromal compartment of endo- and ectocervix, encompassing the transition zone. Mouse lineage tracing, organoid culture and single-molecule RNA in situ hybridizations revealed that the two epithelia derive from separate cervix-resident lineage-specific stem cell populations regulated by opposing Wnt signals from the stroma. Using a mouse model of cervical metaplasia, we further show that the endocervical stroma undergoes remodelling and increases expression of the Wnt inhibitor Dickkopf-2 (DKK2), promoting the outgrowth of ectocervical stem cells. Our data indicate that homeostasis at the transition zone results from divergent stromal signals, driving the differential proliferation of resident epithelial lineages.


Assuntos
Colo do Útero/patologia , Epitélio/patologia , Homeostase , Via de Sinalização Wnt , Adenocarcinoma/genética , Adenocarcinoma/patologia , Animais , Biomarcadores Tumorais/metabolismo , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patologia , Diferenciação Celular , Linhagem da Célula , Microambiente Celular , Receptores ErbB/metabolismo , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Queratinas/metabolismo , Metaplasia , Camundongos Endogâmicos C57BL , Organoides/patologia , Receptores Notch/metabolismo , Células-Tronco/patologia , Células Estromais/patologia , Transcrição Genética , Neoplasias do Colo do Útero/genética , Neoplasias do Colo do Útero/patologia
4.
PLoS One ; 15(10): e0240154, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33007050

RESUMO

BACKGROUND: The burden of HPV-associated premalignant and malignant cervical lesions remains high in HIV+ women even under ART treatment. In order to identify possible underlying pathophysiologic mechanisms, we studied activation and HIV co-receptor expression in cervical T-cell populations in relation to HIV, HPV and cervical lesion status. METHODS: Cervical cytobrush (n = 468: 253 HIV- and 215 HIV+; 71% on ART) and blood (in a subset of 39 women) was collected from women in Mbeya, Tanzania. Clinical data on HIV and HPV infection, as well as ART status was collected. T cell populations were characterized using multiparametric flow cytometry-based on their expression of markers for cellular activation (HLA-DR), and memory (CD45RO), as well as HIV co-receptors (CCR5, α4ß7). RESULTS: Cervical and blood T cells differed significantly, with higher frequencies of T cells expressing CD45RO, as well as the HIV co-receptors CCR5 and α4ß7 in the cervical mucosa. The skewed CD4/CD8 T cell ratio in blood of HIV+ women was mirrored in the cervical mucosa and HPV co-infection was linked to lower levels of mucosal CD4 T cells in HIV+ women (%median: 22 vs 32; p = 0.04). In addition, HIV and HPV infection, and especially HPV-associated cervical lesions were linked to significantly higher frequencies of HLA-DR+ CD4 and CD8 T cells (p-values < 0.05). Interestingly, HPV infection did not significantly alter frequencies of CCR5+ or α4ß7+ CD4 T cells. CONCLUSION: The increased proportion of activated cervical T cells associated with HPV and HIV infection, as well as HPV-associated lesions, together with the HIV-induced depletion of cervical CD4 T cells, may increase the risk for HPV infection, associated premalignant lesions and cancer in HIV+ women. Further, high levels of activated CD4 T cells associated with HPV and HPV-associated lesions could contribute to a higher susceptibility to HIV in HPV infected women.


Assuntos
Linfócitos T CD4-Positivos/imunologia , Colo do Útero/patologia , Infecções por HIV/imunologia , Linfócitos Intraepiteliais/imunologia , Ativação Linfocitária/imunologia , Depleção Linfocítica , Infecções por Papillomavirus/imunologia , Adulto , Colo do Útero/imunologia , Feminino , Infecções por HIV/sangue , Antígenos HLA-DR/metabolismo , Humanos , Integrinas/metabolismo , Contagem de Linfócitos , Pessoa de Meia-Idade , Infecções por Papillomavirus/sangue , Fenótipo , Receptores CCR5/metabolismo
5.
Med. clín (Ed. impr.) ; 155(5): 197-201, sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-195858

RESUMO

BACKGROUND: Lymph node (LN) metastases are the most important prognostic factor in locally advanced cervical cancer. Paraaortic lymphadenectomy is the only method able to confirm the presence of metastasis and thereby help to determine the most adequate treatment approach. There is no standard regarding the minimal number of LNs that should be removed in paraaortic lymphadenectomy. Women with undiagnosed positive paraaortic LNs (false negatives) due to a low LN count do not receive extended-field radiation therapy, which may lead to worse survival outcomes. The aim of this study is to confirm LN metastases as poor prognosis and to assess whether in cases of locally advanced CC with negative paraaortic LN status, the number of paraaortic LN laparoscopically removed carries a prognostic value. METHODS: We analyzed 78 patients with locally advanced cervical cancer that underwent complete paraaortic lymphadenectomy. RESULTS: Fifteen (19.2%) women had paraaortic LN metastases. The mean number of LN extracted was 11.1 (SD 7.5). Patients with paraaortic LN metastases presented a worse overall survival (127.1 months [95% CI 111.7-142.4] vs. 59.6 months [95% CI 31.2-87.9]; p < 0.01). Nevertheless, there were no differences regarding disease-free survival. There were no prognostic differences according to the number of LNs resected in patients with negative lymphadenectomy. CONCLUSIONS: Patients with locally advanced cervical cancer and paraaortic LN metastases present worse survival. In women with negative paraaortic LN, the number of LNs removed does not imply shorter survival


ANTECEDENTES: Las metástasis linfáticas son el factor pronóstico más importante en el cáncer de cérvix localmente avanzado. La linfadenectomía paraaórtica es el único método capaz de confirmar la presencia de metástasis y, por lo tanto, ayudar a determinar el enfoque de tratamiento más adecuado. No existe una norma con respecto al número mínimo de ganglios que deben resecarse en la linfadenectomía paraaórtica. Las mujeres con ganglios paraaórticos positivos no diagnosticados (falsos negativos) debido a un bajo recuento no reciben radioterapia de campo extendido, lo que puede conducir a peores resultados de supervivencia. El objetivo de este estudio es confirmar las metástasis ganglionares como principal factor pronóstico y evaluar si, en los casos de cáncer de cérvix localmente avanzado sin metástasis ganglionares paraaórticas, el número de ganglios extraídos por laparoscopia tiene un valor pronóstico. MÉTODOS: Se analizaron 78 pacientes con cáncer cervical localmente avanzado que se sometieron a una linfadenectomía paraaórtica completa. RESULTADOS: Quince (19,2%) mujeres tuvieron metástasis ganglionares paraaórticas. El número medio de ganglios extraído fue de 11,1 (DE 7,5). Las pacientes con metástasis paraaórticas presentaron una peor supervivencia global (127,1 meses [IC del 95%: 111,7-142,4] frente a 59,6 meses [IC del 95%: 31,2 a 87,9]; p < 0,01). Sin embargo, no hubo diferencias en cuanto a la supervivencia libre de enfermedad. No hubo diferencias pronósticas según el número de ganglios resecados en pacientes con linfadenectomía negativa. CONCLUSIONES: Las pacientes con cáncer cervical localmente avanzado y metástasis paraaórticas presentan peor supervivencia. En las mujeres con linfadenectomía paraaórtica negativa, el número de ganglios extraídos no implica una supervivencia peor


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Excisão de Linfonodo/métodos , Prognóstico , Neoplasias do Colo do Útero/diagnóstico , Metástase Neoplásica/diagnóstico , Neoplasias do Colo do Útero/patologia , Colo do Útero/patologia , Estudos Retrospectivos
6.
Ginekol Pol ; 91(7): 428-431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32779165

RESUMO

The Polish Society of Gynecologists and Obstetricians and Polish Society of Colposcopy and Cervical Pathophysiology Interim Guidelines goal at aiding gynecologists in providing a cervical cancer prevention care during the evolving SARS-CoV-2 pan-demic. Presented guidelines were developed on a review of limited data and updated when new relevant publications were revealed. Timing for deferrals of diagnostic-therapeutic procedures were mostly covered in the guidelines. Also, a support for the existing Polish recommendations on abnormal screening results in a subject of minor and major screening abnor-malities terminology were given. The guidelines are obligatory for the specified COVID-19 pandemic period only and they might be changed depending on the new available evidence.


Assuntos
Neoplasia Intraepitelial Cervical , Colo do Útero/patologia , Colposcopia , Infecções por Coronavirus , Detecção Precoce de Câncer , Pandemias , Pneumonia Viral , Neoplasias do Colo do Útero , Betacoronavirus , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/patologia , Colposcopia/métodos , Colposcopia/normas , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Diagnóstico Diferencial , Detecção Precoce de Câncer/normas , Feminino , Humanos , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Polônia/epidemiologia , Prevenção Secundária/métodos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle
7.
Acta Cytol ; 64(6): 556-562, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32814324

RESUMO

OBJECTIVE: To investigate the cytological findings of lobular endocervical glandular hyperplasia (LEGH) associated with adenocarcinoma and to clarify its characteristics and the coexisting adenocarcinoma using histochemistry and immunohistochemistry. METHODS: Eighteen surgical cases of LEGH of the uterine cervix were retrospectively reviewed and classified into 3 groups: pure (pure type), atypical (atypical type), and LEGH with adenocarcinoma (mixed type). The mixed type is defined as LEGH or atypical LEGH with in situ or invasive adenocarcinoma. Cytological findings of conventional endocervical smear specimens (Papanicolaou stain) were analyzed. Histochemistry (periodic acid-Schiff reaction) and immunohistochemistry (M-GGMC-1, Muc-6 glycoprotein, and Ki-67) were performed using tissue specimens. RESULTS: Cytologically, the pure type (7 cases) is characterized by glandular cell clusters that tended to form monolayered sheets with uniformly small nuclei and contain golden-yellowish mucin, whereas atypical (5 cases) and mixed (6 cases) types are characterized by glandular cell clusters similar to those of the pure type, but with complex glandular structures and mucin localization on the surface of glandular cell clusters. Ki-67 labeling index was significantly higher in atypical and mixed types than that in the pure type. Gastric-type mucinous carcinoma (MC-G) was observed in 2 out of 6 cases with mixed type. CONCLUSIONS: LEGH is found to be associated with adenocarcinoma types other than MC-G. Complex glandular structures or mucin localization on the surface of glandular cell clusters may be useful cytological findings to detect atypical and mixed types of LEGH.


Assuntos
Adenocarcinoma/patologia , Colo do Útero/patologia , Hiperplasia/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Feminino , Humanos , Imuno-Histoquímica/métodos , Pessoa de Meia-Idade , Mucinas/metabolismo
8.
Anticancer Res ; 40(8): 4741-4748, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32727800

RESUMO

BACKGROUND/AIM: We aimed to investigate the efficacy of immune-cell therapy in terms of the survival of patients with neuroendocrine carcinoma of the uterine cervix (NECC), which lacks standardized therapeutic approaches. PATIENTS AND METHODS: We identified 17 patients who were diagnosed as having NECC and treated with immune-cell therapy. The clinical characteristics of these patients were extracted from their records and their overall survival was measured. RESULTS: Of the 17 patients, two patients with early-stage NECC without recurrence and three patients with less than four treatments were excluded. The median survival times from the time of diagnosis and from the initial administration of immune-cell therapy were 49.7 and 24.4 months, respectively. The overall survival rates at 1, 2, and 5 years were 63.6%, 38.2%, and 25.5%, respectively. Long-term survival was observed in the patients with distant metastases. CONCLUSION: The preliminary results of this retrospective study suggested the potential efficacy of immune-cell therapy for NECC.


Assuntos
Carcinoma Neuroendócrino/imunologia , Carcinoma Neuroendócrino/terapia , Colo do Útero/patologia , Neoplasias do Colo do Útero/imunologia , Neoplasias do Colo do Útero/terapia , Adulto , Carcinoma Neuroendócrino/patologia , Terapia Baseada em Transplante de Células e Tecidos/métodos , Feminino , Humanos , Imunoterapia Adotiva/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/imunologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias/métodos , Prognóstico , Neoplasias do Colo do Útero/patologia
9.
Arch Virol ; 165(10): 2241-2247, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32681408

RESUMO

Cervical cancer is primarily caused by persistent infection with high-risk human papillomavirus (HPV), and 70% of cases are associated with HPV16 and 18 infections. The objective of this study was to establish rapid, simple, and sensitive internally controlled recombinase-aided amplification (IC-RAA) assays for the detection of HPV16 and 18. The assays were performed at 39 ℃ and were completed within 30 min. A total of 277 clinical samples of exfoliated cervical cells were tested by IC-RAA assays and commercial HPV real-time fluorescent PCR kits using extracted DNA and samples treated with nucleic acid releasing agent. The analytical sensitivity of the IC-RAA assay was found to be 10 copies/µL for the detection of HPV16 and 18 when using recombinant plasmids as targets. The optimal concentration of the internal control (IC) plasmid and 18 was 1000 copies/µL for HPV16 and 100 copies/µL for HPV18. The clinical sensitivity of the IC-RAA assays for HPV16 using extracted DNA and samples treated with nucleic acid releasing agent was 98.73% and 97.47%, respectively, with kappa values of 0.977 (P < 0.01) and 0.955 (P < 0.01), respectively, and 100% The specificity in both cases. For HPV18, the sensitivity and specificity were 100%, and the kappa value was 1 for both samples (P < 0.01). The IC-RAA assay is a promising tool for the detection of HPV16 and HPV18, especially in resource-constrained settings.


Assuntos
DNA Viral/genética , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Técnicas de Amplificação de Ácido Nucleico , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Idoso , Colo do Útero/patologia , Colo do Útero/virologia , Primers do DNA/síntese química , Primers do DNA/genética , Células Epiteliais/patologia , Células Epiteliais/virologia , Feminino , Papillomavirus Humano 16/classificação , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/classificação , Papillomavirus Humano 18/isolamento & purificação , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia
10.
PLoS One ; 15(6): e0234505, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32544169

RESUMO

In order to improve treatment selection for high grade neuroendocrine carcinomas of the cervix (NECC), we performed a comparative genomic analysis between this rare tumor type and other cervical cancer types, as well as extra-cervical neuroendocrine small cell carcinomas of the lung and bladder. We performed whole exome sequencing on fresh-frozen tissue from 15 NECCs and matched normal tissue. We then identified mutations and copy number variants using standard analysis pipelines. Published mutation tables from cervical cancers and extra-cervical small cell carcinomas were used for comparative analysis. Descriptive statistical methods were used and a two-sided threshold of P < .05 was used for significance. In the NECC cohort, we detected a median of 1.7 somatic mutations per megabase (range 1.0-20.9). PIK3CA p.E545K mutations were the most frequency observed oncogenic mutation (4/15 tumors, 27%). Activating MAPK pathway mutations in KRAS (p.G12D) and GNAS (p.R201C) co-occurred in two tumors (13%). In total we identified PI3-kinase or MAPK pathway activating mutations in 67% of NECC. When compared to NECC, lung and bladder small cell carcinomas exhibited a statistically significant higher rate of coding mutations (P < .001 for lung; P = .001 for bladder). Mutation of TP53 was uncommon in NECC (13%) and was more frequent in both lung (103 of 110 tumors [94%], P < .001) and bladder (18 of 19 tumors [95%], P < .001) small cell carcinoma. These comparative genomics data suggest that NECC may be genetically more similar to common cervical cancer subtypes than to extra-cervical small cell neuroendocrine carcinomas of the lung and bladder. These results may have implications for the selection of cytotoxic and targeted therapy regimens for this rare disease.


Assuntos
Carcinoma Neuroendócrino/genética , Variações do Número de Cópias de DNA/genética , Genômica , Neoplasias do Colo do Útero/genética , Adulto , Carcinoma Neuroendócrino/patologia , Colo do Útero/metabolismo , Colo do Útero/patologia , Cromograninas/genética , Classe I de Fosfatidilinositol 3-Quinases/genética , Estudos de Coortes , Feminino , Subunidades alfa Gs de Proteínas de Ligação ao GTP/genética , Humanos , Pessoa de Meia-Idade , Mutação/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Proteína Supressora de Tumor p53 , Neoplasias do Colo do Útero/patologia , Sequenciamento Completo do Exoma
11.
Arch Gynecol Obstet ; 302(3): 649-655, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32488400

RESUMO

PURPOSE: To evaluate the prevalence of cervical pre-malignancies in the cervical cytology of female renal transplant recipients (RTR) and compare to immunocompetent patients. METHODS: A prospective case-control study of 165 RTR (cases) and 372 immunocompetent women (controls) was carried out from May 2015 to August 2016. The participants completed a questionnaire with demographic characteristics, habits, reproductive history, and information about the renal transplant. Cervical cytology samples were collected at their visit for cervical cancer screening. Relevant medical history was obtained from medical records and previous cervical cytology results were retrieved: from the time of kidney transplantation to the beginning of this study for RTR and all collected throughout life for controls. RESULTS: The mean age was similar between groups (42.6 ± 11.4 vs. 41.8.2 ± 11.1 years, p = 0.447). Considering cervical cytology collected since the kidney transplant, RTR had three times higher rates of abnormal cervical cytology test (24.8% of RTR vs. 6.3% for controls), and the abnormalities were more frequent (p < 0.001) for low squamous intraepithelial lesion (LSIL) (n = 23, 13.9%) and high squamous intraepithelial lesion (HSIL) (n = 9, 5.5%). Cervical cytology collected during the study had normal results in 152 RTR (92.1%) vs. 326 controls (93.9%) (p > 0.05). When the altered results were broken down, a higher frequency of LSIL could be seen in RTR (3.6% vs 0.0%, p = 0.008). CONCLUSION: RTR had significantly higher rates of cervical cytology abnormalities comparing to the control group and most of it was composed of LSIL.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Colo do Útero/patologia , Hospedeiro Imunocomprometido , Transplante de Rim/efeitos adversos , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/métodos , Adulto , Brasil , Estudos de Casos e Controles , Neoplasia Intraepitelial Cervical/patologia , Detecção Precoce de Câncer , Feminino , Humanos , Imunocompetência , Pessoa de Meia-Idade , Papillomaviridae , Infecções por Papillomavirus , Estudos Prospectivos , Neoplasias do Colo do Útero/parasitologia , Vagina/patologia , Adulto Jovem
12.
Asia Pac J Clin Oncol ; 16(5): e236-e241, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32573088

RESUMO

AIM: Cervical basaloid squamous cell carcinoma (BSCC) is a rare variant of squamous cell carcinoma with little recognition. Our objective was to identify difference in characteristics and outcomes between BSCC and squamous cell carcinoma, usual type (SSC, UT). METHODS: A total of 32 BSCC patients and 6387 SCC, UT patients, diagnosed from 2004 to 2014, were identified using the Surveillance, Epidemiology, and End Results database. RESULTS: More BSCC patients presented with older age as compared to SCC, UT (patients over 40 years old: 87.5% vs 60.5%, P  < .01). Univariate survival analysis shows that overall survival (OS) and disease-specified survival (DSS) in the BSCC group were slightly better than SCC, UT group, but without statistical significance. Furthermore, BSCC presented similar prognosis in both DSS and OS compared to SCC, UT when matching other parameters with the propensity score matching methods. CONCLUSION: BSCC tends to appear in older people. However, BSCC appears to carry a similar prognosis compared to SCC, UT.


Assuntos
Carcinoma de Células Escamosas/fisiopatologia , Colo do Útero/patologia , Adolescente , Adulto , Idoso , Carcinoma de Células Escamosas/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Programa de SEER , Adulto Jovem
13.
J Infect Public Health ; 13(9): 1304-1313, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32564935

RESUMO

BACKGROUND: Human papillomavirus (HPV), one of the most common sexually transmitted viral infections worldwide, is the leading cause of cervical cancer. In Middle East and North Africa (MENA) Region HPV data is at scarce, and most of the countries haven't implemented any vaccination programs. This present meta-analysis and systematic review aimed to describe human papillomavirus (HPV) epidemiology by clinical subgroups in the (MENA) region. METHODS: Studies assessing HPV prevalence rates were systematically reviewed, and the selected articles were reported following the PRISMA guideline. Random-effects meta-analyses and meta-regression were used to estimate HPV pooled mean prevalence rates and their association with other factors. RESULTS: For the cervical cancer population in the MENA region, the pooled HPV prevalence rate was 81% (95% CI, 70%-90%). HPV detected in cervical cancer samples was most prevalent in the Maghreb countries (88%; 95% CI, 78%-96%) and least prevalent in Iran (73%; 95% CI, 62%-83%).For the subgroup with abnormal-cervical cytology in the MENA region, the pooled HPV prevalence rate was 54% (95% CI, 41%-67%), with the highest prevalence reported in Northeast Africa (94%; 95% CI, 91%-96%), and the lowest prevalence in the Levant region (31%; 95 CI, 16%-49%). In the general population subgroup in the MENA region, the pooled HPV prevalence rate was 16% (95% CI, 14%-17%), HPV was most prevalent in the Northeast Africa region (21%; 95 CI, 7%-40%) and least prevalent in the Levant region (7%; 95 CI, 2%-14%). CONCLUSION: The present meta-analysis comprehensively described the current HPV prevalence rates in the MENA region and found that the rates have continued to increase with time, especially in African regions. Designing personalized awareness and vaccination programs that respect the various cultural and religious values remains the main challenge in prevention of cervical cancer in the MENA region.


Assuntos
Papillomaviridae/genética , Infecções por Papillomavirus/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , África do Norte/epidemiologia , Colo do Útero/patologia , Colo do Útero/virologia , Feminino , Genótipo , Humanos , Oriente Médio/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Prevalência , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Neoplasias do Colo do Útero/virologia , Vacinação
14.
PLoS One ; 15(6): e0234518, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525936

RESUMO

BACKGROUND/OBJECTIVE: Human papillomavirus (HPV) genotyping and cytology have been recommended for colposcopy triage, but it is unclear which combinations of high-risk HPV (hrHPV) types and cytology with various thresholds provide clinically useful information for the triage after primary HPV screening on self-collected samples. METHOD: Chinese Multi-site Screening Trial (CHIMUST) database focused on self-collected samples was reviewed using the results of Cobas4800 HPV assay. Absolute risks of each genotype for cervical intraepithelial neoplasia 2 or worse/ 3 or worse (CIN2+/CIN3+) were calculated. Triage of atypical squamous cells of undetermined significance (ASCUS) or worse cytology was used as the comparator, and diagnostic accuracy for paired comparisons between algorithms was obtained using McNemar's test. RESULTS: A total of 10, 498 women were included, the overall prevalence of hrHPV, HPV16, HPV18, and Other hrHPV genotypes were 13.7%, 2.4%, 0.8%, and 10.5%, respectively. HPV16-positive women had the highest absolute risk among various genotypes for CIN2+/CIN3+ whether in normal or abnormal cytology (ASCUS or worse) and among all age groups. When compared with the comparator, combining HPV16 positivity and/or high-grade squamous intraepithelial lesion (HSIL) or worse yielded higher specificity (97.7% vs. 97.0%, p<0.0001), similar sensitivity (90.7% vs. 96.3%, p = 0.256) for detection of CIN3+, and a decrease in colposcopy referral rate from 3.5% to 2.7%, similar results were found for CIN2+. Positivity for HPV16 and/or (ASCUS or worse), and positivity for (HPV16 and/or HPV18) and/or (ASCUS or worse) achieved favorable sensitivity compared with the comparator (80.6% and 81.3% vs. 70.1% respectively for CIN2+, p<0.0001; both 96.3% vs. 96.3% for CIN3+, p = 1.000), these algorithms would reduce the colposcopy referral rate to 5.0% and 5.6% respectively, compared with 13.7% of that for HPV alone. CONCLUSIONS: Triage of HPV-positive women on self-collected samples by combining HPV16 or HPV16/18 genotyping with different thresholds of cytology could provide tradeoffs in sensitivity for detecting cervical lesions and colposcopy referral rates, and tailor management in various circumstances of clinical practice.


Assuntos
Técnicas de Genotipagem/métodos , Programas de Rastreamento/métodos , Infecções por Papillomavirus/diagnóstico , Triagem/métodos , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/métodos , Adulto , Biópsia/estatística & dados numéricos , Colo do Útero/citologia , Colo do Útero/patologia , Colo do Útero/virologia , Colposcopia/estatística & dados numéricos , DNA Viral/genética , DNA Viral/isolamento & purificação , Feminino , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/genética , Papillomavirus Humano 18/isolamento & purificação , Humanos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/virologia , Encaminhamento e Consulta/estatística & dados numéricos , Medição de Risco/métodos , Sensibilidade e Especificidade , Manejo de Espécimes/métodos , Triagem/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia
15.
Am J Clin Pathol ; 154(3): 381-386, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32405650

RESUMO

OBJECTIVES: The 2014 Bethesda System (TBS 2014) guidelines for reporting cervical cytology revised the age for reporting benign endometrial cells (BECs) from 40 years or older to age 45 years or older. We evaluated this change and further investigated if extending the reporting age to 50 years or older may be acceptable. METHODS: We reviewed cases with BECs reported on Papanicolaou tests in women age 40 years or older and 45 years or older before and after implementation of TBS 2014. Follow-up endometrial biopsy/curettage results were categorized as benign, endometrial hyperplasia with or without atypia, or malignant. Hyperplasia and malignant follow-up were considered clinically significant. Clinical data were documented. Results were compared for women age 40 to 44, 45 to 49, and 50 years or older. RESULTS: Follow-up in 15 (100%) women age 40 to 44 years was benign. In women age 45 to 49 years, 61 (96.8%) had benign follow-up, one (1.6%) had atypical hyperplasia, and one (1.6%) had malignant follow-up. In women age 50 years or older, 57 (86.5%) had benign follow-up, four (6%) had malignant follow-up, and seven (7.5%) had atypical or nonatypical hyperplasia. There was a significant difference in follow-up between the age groups of 40 to 49 and 50 or older (P = .023). CONCLUSIONS: We conclude that the TBS 2014 revision was justified. Our data suggest that age 50 years or older rather than age 45 years or older may be an acceptable cutoff for reporting BECs.


Assuntos
Colo do Útero/patologia , Hiperplasia Endometrial/patologia , Endométrio/patologia , Lesões Pré-Cancerosas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Teste de Papanicolaou/métodos , Esfregaço Vaginal/métodos
16.
PLoS One ; 15(5): e0232107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379782

RESUMO

OBJECTIVE: To explore the relationship between the viral load reflected by the Ct value of Cobas 4800 HPV test and cervical lesions, and the effectiveness of the viral load for secondary triage of HPV-positive women. METHODS: The Chinese Multi-Center Screening Trial (CHIMUST) evaluated both self-collected samples and physician-collected samples from women, aged 30 to 59, who were screened for cervical cancer in 6 regions across China. Using physician collected samples, the relationship between the HPV-Ct values of different subtypes and the cervical lesions was analyzed. Then the combined use of the HPV-Ct values with the HPV subtypes was evaluated as a secondary screening algorithm for the women who were HPV positive. RESULTS: The Ct values of HPV16 and 12 other HPV subtypes(12-type pool), tested with Cobas decreased with the progression of cervical lesion (HPV16: r = -0.429, P<0.001; 12 other HR-HPV subtypes: r = -0.099, P<0.01). The HPV18-Ct value was not correlated with cervical lesion(P>0.05). Compared with HPV16/18 and cytology (HPV16/18 positive and 12-type pool plus cytology ≥ ASC-US), the sequential secondary screening using HPV16/18 and the viral load of 12-type pool (cut-point HPV-Ct≤31) had equal sensitivities for CIN2+ and CIN3+ (83.1%vs.80.3%,100%vs.92.6%,P>0.05), with slightly lower specificities (96.2%vs.94.4%,96.5%vs.93.9%,P<0.001) and higher colposcopy referral rate (4.90%vs.6.59%, P<0.05), but required no cytology. CONCLUSION: Type-specific HPV viral load is closely related to cervical lesions severity. It is feasible and efficient to use HPV16/18 and the viral load of 12 other HPV subtypes (with cut-point HPV-Ct≤31) as the secondary screening for HPV positive women. This algorithm may be useful in low resource regions.


Assuntos
Detecção Precoce de Câncer/métodos , Neoplasias do Colo do Útero/diagnóstico , Carga Viral/métodos , Adulto , Grupo com Ancestrais do Continente Asiático , Neoplasia Intraepitelial Cervical/virologia , Colo do Útero/patologia , China/epidemiologia , Feminino , Genótipo , Humanos , Pessoa de Meia-Idade , Papillomaviridae/patogenicidade , Infecções por Papillomavirus/virologia , Sensibilidade e Especificidade , Sorogrupo , Manejo de Espécimes/métodos , Triagem , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia
17.
Afr J Reprod Health ; 24(1): 53-61, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32358937

RESUMO

This study aimed to describe the current incidence and mortality rates of gynecologic cancer and their association with socio- economic development. The data for the age-standardized incidence rate (ASRI) and age-standardized mortality rate (ASRM) were acquired from the GLOBOCAN-2012 database. Human Development Index (HDI) data were obtained from the 2015- Human Development Report. The correlation between HDI and Mortality to Incidence Ratio (MIR) was assessed by Pearson- correlation. The effect of national-HDI on MIR was analyzed by linear regression analysis. The ASRI, ASRM, and MIR of cervix cancer were higher in the less developed regions (LDRs) than in more developed regions (MDRs). However, for corpus uteri cancer, the ASRI was 3.6 times and the ASRM was 1.5-times higher in the MDRs than in the LDRs. Strong inverse associations between MIR and HDI were reported from cervix (adjusted R2 = 0.825, ß = - 0.908, p < 0.001), corpus uteri (adjusted R2 = 0.554, ß = - 0.746, p < 0.001) and ovarian cancer (adjusted R2 = 0.579, ß = - 0.763, p < 0.001). The higher MIR of gynecologic cancer in LDRs demand for sustainable investment in health systems and balanced cancer control plans in the region.


Assuntos
Colo do Útero/patologia , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/mortalidade , Disparidades em Assistência à Saúde , Desenvolvimento Humano , Fatores Socioeconômicos , Adulto , Distribuição por Idade , Fatores Etários , Feminino , Humanos , Incidência , Expectativa de Vida , Pessoa de Meia-Idade , Mortalidade , Neoplasias Ovarianas/epidemiologia , Características de Residência , Neoplasias do Colo do Útero/epidemiologia , Neoplasias Uterinas/epidemiologia
18.
Rev Assoc Med Bras (1992) ; 66(2): 174-179, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32428152

RESUMO

OBJECTIVE: Although estrogen therapy is widely used against post-menopausal symptoms, it can present adverse effects, including endometrial cancer. Soy isoflavones are considered a possible alternative to estrogen therapy. However, there are still concerns whether isoflavones exert trophic effects on the uterine cervix. To evaluate the histomorphometric and immunohistochemical alterations in the uterine cervix of ovariectomized rats treated with soy isoflavones (Iso). METHODS: Fifteen adult Wistar rats were ovariectomized (Ovx) and divided into three groups: Group I (Ovx), administered with vehicle solution; Group II (OVX-Iso), administered with concentrated extract of Iso (150 mg/kg) by gavage; and Group III (OVX-E2), treated with 17ß-estradiol (10 µg/kg), subcutaneously. After 30 days of treatments, the uterine cervix was fixed in 10% formaldehyde and processed for paraffin-embedding. Sections were stained with Hematoxylin and eosin for morphological and morphometric studies or subjected to immunohistochemistry for detections of Ki-67 and vascular endothelial growth factor-A (Vegf-A). The data obtained were subjected to statistical analysis (p ≤ 0.05). RESULTS: We noted an atrophic uterine cervix in GI, whereas it was more voluminous in GII and even more voluminous in GIII. The thickness of the cervical mucosa was significantly higher in GIII, as compared to GI and GII. The cell proliferation (Ki-67) was significantly elevated in the estradiol and isoflavones treated groups, whereas Vegf-A immunoexpression was significantly higher in GIII, as compared to groups GII and GI. CONCLUSIONS: Soy isoflavones cause less trophic and proliferative effects in the uterine cervix of rats as compared to estrogen.


Assuntos
Colo do Útero/efeitos dos fármacos , Estrogênios/farmacologia , Isoflavonas/farmacologia , Fitoestrógenos/farmacologia , Animais , Proliferação de Células/efeitos dos fármacos , Colo do Útero/patologia , Epitélio/efeitos dos fármacos , Feminino , Imuno-Histoquímica , Antígeno Ki-67/análise , Membrana Mucosa/efeitos dos fármacos , Ovariectomia , Distribuição Aleatória , Ratos Wistar , Reprodutibilidade dos Testes , Fatores de Tempo , Fator A de Crescimento do Endotélio Vascular/análise
19.
Tumori ; 106(5): 413-423, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32403994

RESUMO

BACKGROUND: Primary cervical leiomyosarcomas (CLMS) constitute 21% of all cervical sarcomas. Because of their rarity, to our knowledge, fewer than 40 cases have been reported. The aim of this study is to evaluate the clinical and surgical-pathological features, prognosis, treatment options, and survival of primary CLMS. METHODS: A systematic review of the medical literature was conducted to evaluate articles about primary CLMS. The literature was searched between 1959 and May 2019. On final evaluation, there were 29 articles (one consisted of 8 cases; one consisted of 3 cases) and 42 cases with the addition of our 4 cases. RESULTS: Age (⩾48 versus ⩽47 years) (hazard ratio.HR], 4.528; 95% confidence interval.CI], 1.550-13.227; p=0.006) and mitoses count (<10/10 high-power field [HPF] versus ⩾10/10 HPF) (HR, 3.865; 95% CI, 1.046-14.278; p=0.043) are independent prognostic factors for recurrence and age (HR, 5.318; 95% CI, 1.671-16.920; p=0.005) and hysterectomy (performed versus not performed) (HR, 4.377; 95% CI, 1.341-14.283; p=0.014) are independent prognostic factors for death because of disease on multivariate analysis. CONCLUSIONS: Information on primary CLMS is sparse and obtained from rare case reports and case series. Hysterectomy must be the first choice of treatment in these patients according to our results on multivariate analysis. The type of hysterectomy does not have an effect on oncologic outcome. Radical hysterectomy is not obligatory and more data are needed to make more accurate conclusions.


Assuntos
Colo do Útero/patologia , Leiomiossarcoma/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Quimioterapia Adjuvante/métodos , Feminino , Humanos , Histerectomia , Leiomiossarcoma/tratamento farmacológico , Leiomiossarcoma/patologia , Leiomiossarcoma/radioterapia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Prognóstico , Radioterapia Adjuvante/efeitos adversos , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/radioterapia
20.
Obstet Gynecol ; 135(6): 1409-1416, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459433

RESUMO

OBJECTIVE: To evaluate gestational latency in individuals who did and did not receive perioperative cefazolin and indomethacin after physical examination-indicated cerclage. METHODS: This is a retrospective cohort study of all pregnant women with a singleton gestation who underwent physical examination-indicated cerclage placement and delivered at Northwestern Memorial Hospital from 2009 to 2018. Physical examination-indicated cerclage was performed in the setting of painless cervical dilation of at least 1 cm between 16 0/7 and 23 6/7 weeks of gestation. After 2014, our practice universally implemented perioperative prophylaxis of cefazolin and indomethacin. Individuals were categorized based on exposure to perioperative prophylaxis. The primary outcome was pregnancy latency at least 28 days after cerclage placement. Secondary outcomes included median latency; median gestational age at delivery; preterm birth before 28 weeks of gestation; preterm prelabor rupture of membranes; chorioamnionitis; and median birth weight. Multivariable analyses were performed, as well as a sensitivity analysis using propensity score matching. RESULTS: Cerclages were placed in 142 people: 72 (50.7%) received perioperative prophylaxis. Baseline demographics were not significantly different between groups. On multivariable analyses, individuals who received perioperative prophylaxis had a higher incidence of achieving a pregnancy latency at 28 days or more (adjusted relative risk [aRR] 1.21, 95% CI 1.05-1.40). Individuals who received perioperative prophylaxis had a significant improvement in gestational latency (+17.8 days, 95% CI 1.4-34.2 days) and birth weight (+489.8 g, 95% CI 64.6-915.0 g), with no differences in other outcomes. On sensitivity analysis, individuals receiving perioperative prophylaxis had a higher incidence of achieving a pregnancy latency at 28 days or more, (aRR 1.17, 95% CI 1.01-1.36) with no differences in other outcomes. CONCLUSION: Perioperative use of cefazolin and indomethacin prophylaxis during physical examination-indicated cerclage placement is associated with a significant prolongation in gestational latency without an increase in incidence of chorioamnionitis.


Assuntos
Antibacterianos/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Cefazolina/administração & dosagem , Cerclagem Cervical , Indometacina/uso terapêutico , Trabalho de Parto Prematuro/prevenção & controle , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Antibioticoprofilaxia , Colo do Útero/patologia , Dilatação Patológica , Feminino , Idade Gestacional , Humanos , Indometacina/administração & dosagem , Modelos Lineares , Exame Físico , Gravidez , Estudos Retrospectivos , Incompetência do Colo do Útero/cirurgia
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