Profile of women with anal neoplasia associated with cervical neoplasia receiving care at a tertiary healthcare facility in northeastern Brazil / Perfil de mulheres com neoplasia anal associada à neoplasia cervical atendidas em um serviço de saúde terciário do nordeste do Brasil

Abstract Objective: To describe the epidemiological, clinical and laboratory profiles of women with anal neoplasia associated with cervical neoplasia attending a tertiary healthcare facility in northeastern Brazil. Methods: This epidemiological, descriptive study was conducted using a database from a cross-sectional study carried out between December 2008 and January 2016. Women with a diagnosis of cervical neoplasia associated with anal neoplasia were included in the present study. Results: Of the women with cervical neoplasia, 14% were found to have an anal intraepithelial lesion or anal cancer. Median age was 33 years, 68% were non-white, and 70% were from urban regions, had little schooling and low income. Most reported having had anoreceptive (73%) and unprotected intercourse (84%). Regarding symptoms, 7% reported bleeding and 11% pruritus. Overall, 10% of the sample tested positive for the human immunodeficiency virus. Anal cytology was abnormal in 92%. High-resolution anoscopy was abnormal in all cases. Histopathology revealed three cases of invasive carcinoma and high-grade lesions in 32% of the cases. Conclusion: Women with a diagnosis of anal and cervical neoplasia are often young, non-white women, who initiated their sexual life at an early age, were exposed to unprotected anoreceptive intercourse, live in urban centers, have little schooling and a low-income level.

Resumo Objetivo: Descrever os perfis epidemiológico, clínico e laboratorial de mulheres com neoplasia anal associada à neoplasia cervical atendidas em uma unidade de saúde terciária no nordeste do Brasil. Métodos: Este estudo epidemiológico e descritivo usou um banco de dados de um estudo transversal realizado entre dezembro de 2008 e janeiro de 2016. Mulheres com diagnóstico de neoplasia cervical associada à neoplasia anal foram incluídas no presente estudo. Resultados: Das mulheres com neoplasia cervical, 14% apresentaram lesão intra-epitelial anal ou câncer anal. A mediana de idade foi de 33 anos; 68% das pacientes não eram brancas e 70% eram provenientes de regiões urbanas, com baixa escolaridade e baixa renda. A maioria relatou histórico de relações sexuais anoreceptivas (73%) e desprotegidas (84%). Quanto aos sintomas, 7% relataram sangramento e 11% prurido. No geral, 10% das pacientes apresentaram serologia positiva para o vírus da imunodeficiência humana. A citologia anal foi anormal em 92% da amostra. A anuscopia de alta resolução foi anormal em todos os casos. A histopatologia revelou três casos de carcinoma invasivo e lesões de alto grau em 32% dos casos. Conclusão: As mulheres com diagnóstico de neoplasia anal e cervical geralmente são jovens, não brancas, que iniciaram sua vida sexual em idade precoce, foram expostas a relações sexuais anoreceptivas desprotegidas, moram em centros urbanos e têm baixa escolaridade e baixo nível de renda.

Frecuencia de displasia epitelial y carcinoma escamoso en mucosa oral y orofaríngea en Chile, entre los años 1990 y 2009 / Frequency of oral squamous cell carcinoma and oral epithelial dysplasia in oral and oropharyngeal mucosa in Chile

Background: Oral cancer in Chile corresponds approximately to 1.6% of all cancer cases. There are few studies about oral epithelial dysplasia and oral squamous cell carcinoma in the Chilean population. Aim: To determine the frequency of hyperkeratosis, mild, moderate and severe oral epithelial dysplasia, in situ carcinoma and squamous cell carcinoma of the oral and oropharyngeal mucosa in a registry of the Oral Pathology Reference Institute of the Faculty of Dentistry, Universidad de Chile, in a ten years period. Material and Methods: Review of clinical records and pathological plates of 389 patients, obtained between 1990 and 2009. Cases were selected according to their pathological diagnosis, including hyperkeratosis, oral epithelial dysplasia, in situ carcinoma, squamous cell carcinoma and verrucous carcinoma. Results: Forty four percent of cases were squamous cell carcinoma, followed by hyperkeratosis in 37% and mild epithelial dysplasia in 11%. Squamous cell carcinoma was more common in men aged over 50 years. Most of the potentially malignant disorders presented clinically as leukoplakia and squamous cell carcinoma were clinically recognized as cancer. Conclusions: In this study, men aged over 50 years are the highest risk group for oral cancer. Early diagnosis is deficient since most of these lesions were diagnosed when squamous cell carcinoma became invasive. Leukoplakia diagnosis is mostly associated with hyperkeratosis and epithelial dysplasia, therefore biopsy of these lesions is mandatory to improve early diagnosis.

Incidence and clinical characteristics of lower urinary tract symptoms as a presenting symptom for patients with newly diagnosed bladder cancer

PurposeThe incidence of lower urinary tract symptoms (LUTS) as the sole presenting symptom for bladder cancer has traditionally been reported to be low. The objective of this study was to evaluate the prevalence and clinical characteristics of newly diagnosed bladder cancer patients who presented with LUTS in the absence of gross or microscopic hematuria.Materials and MethodsWe queried our database of bladder cancer patients at the Atlanta Veteran’s Affairs Medical Center (AVAMC) to identify patients who presented solely with LUTS and were subsequently diagnosed with bladder cancer. Demographic, clinical, and pathologic variables were examined.Results4.1% (14/340) of bladder cancer patients in our series presented solely with LUTS. Mean age and Charlson Co-morbidity Index of these patients was 66.4 years (range = 52-83) and 3 (range = 0-7), respectively. Of the 14 patients in our cohort presenting with LUTS, 9 (64.3%), 4 (28.6%), and 1 (7.1%) patients presented with clinical stage Ta, carcinoma in Situ (CIS), and T2 disease. At a median follow-up of 3.79 years, recurrence occurred in 7 (50.0%) patients with progression occurring in 1 (7.1%) patient. 11 (78.6%) patients were alive and currently disease free, and 3 (21.4%) patients had died, with only one (7.1%) death attributable to bladder cancer.ConclusionsOur database shows a 4.1% incidence of LUTS as the sole presenting symptom in patients with newly diagnosed bladder cancer. This study suggests that urologists should have a low threshold for evaluating patients with unexplained LUTS for underlying bladder cancer.

Caracterización epidemiológica de la neoplasia intraepitelial de la conjuntiva en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" / Epidemiological characterization of conjunctival intraepithelial neoplasia in "Ramón Pando Ferrer" Cuban Institute of Ophtalmology

OBJETIVO: identificar el patrón epidemiológico de la neoplasia intraepitelial de la conjuntiva en el Instituto Cubano de Oftalmología «Ramón Pando Ferrer¼ (2005-2010). MÉTODOS: se realizó un estudio descriptivo en 106 pacientes con neoplasia intraepitelial unilateral según edad, sexo, enfermedad ocular asociada y años de diagnóstico. Se calcularon porcentajes, tasa de incidencia y prevalencia proporcional y se estimó la tendencia por método gráfico. RESULTADOS: el 59,4 % perteneció al sexo femenino (n = 63); el 53,8 % (n = 57) se encontró en edades entre 30 y 39 años, seguido por ³ 60 años con 33 % (n = 35); el 18,9 % (n = 20) presentó enfermedad ocular asociada, donde el 60 % (n = 12) correspondió al pterigium. Hubo entre 34 % (n = 36), 31, 1 % (n = 33) y 30,2 % (n = 32) con NIC I, NIC II y NIC III respectivamente, y el 4,7 % (n = 5) con carcinoma in situ. La incidencia en el 2009 alcanzó 3,1 % (n = 34) y 85,8 % de prevalencia (n = 91), con tendencia lineal al incremento. CONCLUSIONES: se manifiesta tendencia al incremento de la enfermedad; por eso merece atención el estudio de los factores de riesgo como enfoque preventivo para reducir este comportamiento, si se parte del aumento de la expectativa de vida de la población cubana con tendencia al envejecimiento, pues la neoplasia intraepitelial de la conjuntiva es característica de personas en edad avanzada.

OBJECTIVE: to identify the epidemiological pattern of intraepithelial neoplasia of the conjunctiva in the «Ramón Pando Ferrer¼ Cuban Ophthalmology Institute (2005-2010). METHODS: a descriptive study was conducted in 106 patients with unilateral intraepithelial neoplasia by age, sex, associated eye disease and number of years since diagnosis. Percentages, incidence and proportional prevalence rates, and tendency by the graphic method were all estimated. RESULTS: in the study group, 59,4 % (n = 63) were females 53,8 % (n = 57) were 30-39 years old, followed by 33 % of ³ 60 years-olds (n = 35), 18,9 % (n = 20) had associated eye disease with 60 % (n = 12) affected by pterygium. There was 34 % (n = 36), 31,1 % (n = 33) and 30,2 % (n = 32) with CINI, CIN II and CIN III, respectively, and 4,7 % (n = 5) with in situ carcinoma. The incidence rate in 2009 was 3,1 % (n = 34) and 85,8 % prevalence rate (n = 91), with linear tendency to increase. CONCLUSIONS: this study showed increasing tendency of the disease, so it must be paid attention to the preventive approach-oriented study of the risk factors to reduce this tendency, taking into account the rise of the life expectancy of the Cuban population and their aging tendencies and the fact that the conjunctival intraepithelial neoplasia is characteristic of the elderly people.

Infecção cervical por papilomavírus humano: genotipagem viral e fatores de risco para lesão intraepitelial de alto grau e câncer de colo do útero / Human papillomavirus cervical infection: viral genotyping and risk factors for high-grade squamous intraepithelial lesion and cervix cancer

OBJETIVO: analisar, em mulheres com HPV em colo do útero, as características da infecção viral e os fatores de risco para lesão intraepitelial de alto grau e carcinoma cervical. MÉTODOS: realizou-se um estudo caso-controle com mulheres com HPV em colo do útero atendidas em serviço de Ginecologia de referência vinculado ao SUS, em Recife, Nordeste do Brasil. No grupo de casos (72 mulheres com lesão intraepitelial de alto grau ou carcinoma cervical) e de controles (176 mulheres com colpocitologia normal ou com alterações benignas), foram pesquisados seis genótipos virais (HPV 16, 18, 31, 33, 6 e 11) em material da ecto- e endocérvice com primers MY09/MY11. As variáveis independentes foram hierarquizadas em três níveis de determinação: distal (sociodemográficas), intermediário (comportamentais) e proximal (realização anterior de colpocitologia). A homogeneidade das proporções foi testada (χ2). Obtiveram-se ORs não ajustadas e, na modelagem final, realizou-se regressão logística hierarquizada com o ajuste do efeito de cada variável sobre o desfecho pelas variáveis do mesmo nível e de níveis anteriores de causalidade. RESULTADOS: em 76,6 por cento das 248 mulheres participantes do estudo, o genótipo viral da infecção cervical foi identificado. Predominaram genótipos de alto risco oncogênico (83,4 por cento nos casos e 67,1 por cento nos controles), principalmente HPV 16 e 31. Foram identificados como fatores de risco (a) distais: residir em zona rural (OR=2,7; IC95 por cento: 1,1-6,2), menos de três anos de estudo (OR=3,9; IC95 por cento: 2,0-7,5) e renda familiar inferior a dois salários mínimos (OR=3,3; IC95 por cento: 1,0-10,5); (b) intermediário: número de gestações igual ou superior a quatro (OR=2,0; IC95 por cento: 1,0-3,7); (c) proximal: ausência de colpocitologia anterior (OR=9,7; IC95 por cento: 2,4-38,2). CONCLUSÕES: em mulheres usuárias do SUS do Nordeste do Brasil predominam os genótipos virais 16 e 31 em infecções cervicais ...

PURPOSE: to analyze the characteristics of viral infection and the risk factors for high-grade squamous intraepithelial lesion and cervical carcinoma in women with cervical HPV infection. METHODS: a case-control study was conducted on women with cervical HPV at a Gynecology reference service enrolled at the Public Health System, located in Recife, Northeastern Brazil. The groups of cases (72 women with high-grade squamous intraepithelial lesion or cervical cancer) and controls (176 women with normal Pap smear or benign alterations) were investigated for six viral genotypes (HPV 16, 18, 31, 33, 6, 11) in ecto- and endocervical material using MY09/MY11 primers. The independent variables were ranked in three levels of determination: distal (sociodemographic), intermediate (behavioral) and proximal (previous Pap smear). The homogeneity of proportions was tested (χ2), unadjusted Odds Ratios (OR) were obtained and hierarchical logistic regression was applied to the final model, with adjustment of the effect of each variable to the outcome based on the variables in the same and previous levels of causality. RESULTS: the viral genotype of cervical infection was identified in 76.6 percent of the 248 women participating in the study. High-risk HPV genotypes (83.4 percent of cases and 67.1 percent of controls) were predominant, especially HPV 16 and 31. The distal risk factors identified were: living in a rural area (OR=2.71, 95 percentCI: 1.18-6.23), less than three years of study (OR=3.97, 95 percentCI: 2.09-7.54) and family income below two minimum wages (OR=3.30, 95 percentCI: 1.04-10.51); intermediate: four or more pregnancies (OR=2.00, 95 percentCI: 1.06-3.76); and proximal: absence of a previous Pap smear (OR=9.74, 95 percentCI: 2.48-38.28). CONCLUSIONS: genotypes 16 and 31 of cervical HPV infection are predominant among women assisted by the Public Health System in Northeastern Brazil. Socioeconomic and reproductive factors, as well ...