RESUMO
INTRODUCTION: Although studies of risk factor profiles have been conducted to identify biological markers to predict the natural history of cervical intraepithelial neoplasia (CIN) grade III, there is not sufficient information to support the routine clinical use of any biomarker. OBJECTIVES: The purpose of this study was to examine aberrant promoter methylation, which is implicated in cancer development and progression, in CIN III lesions in order to identify markers associated with more aggressive biological behavior that could be used to recognize women who are at higher risk of recurrence. PATIENTS AND METHODS: We used methylation-specific polymerase chain reaction to analyze promoter hypermethylation of 8 genes (p16, RARbeta, GSTP1, MGMT, p14, TIMP3, E-cad and DAPk) in 33 uterine cervix cones with CIN III that were also submitted to human papillomavirus (HPV) genotyping. All 33 patients in this study had been clinically followed after conization with Papanicolaou smears, colposcopy, and biopsy when indicated, every 6 months during 5 years. RESULTS: Of the 33 patients, 12 (36%) underwent immediate hysterectomy after conization for having compromised cone margins, 14 (43%) have not relapsed, and 7 (21%) presented CIN relapse. The frequency of HPV infection in this group was 97% and no significant difference between the groups was observed. HPV of high oncogenic risk was present in 29 (87.9%) cases; HPV 16 was the most frequent (69.7%), while HPV 18 was found in 33.3%; however, it was associated with HPV 16 in 15.1%. Concomitant infection by HPV 6/11 was detected in 21.2% (15.1% with HPV 16 and 6.1 with HPV 18). 85.7% (6/7) of patients with recurrence had HPV 18 vs 0% (0/14) of patients without recurrence (P = 0.0001). At least 1 of the 8 genes was found hypermethylated in all samples. Concomitant hypermethylation of several genes was frequently found. However, CIN relapse was only seen in the cases with hypermethylation of 3 or more of the 8 genes studied (P = 0.0039). CONCLUSION: We suggest that aberrant promoter methylation may play a role and may serve as a useful biomarker in the recurrence of CIN.
Assuntos
Alphapapillomavirus/isolamento & purificação , Biomarcadores Tumorais/genética , Metilação de DNA , Infecções por Papillomavirus/complicações , Regiões Promotoras Genéticas , Displasia do Colo do Útero/genética , Neoplasias do Colo do Útero/genética , Adulto , Proteínas Reguladoras de Apoptose/genética , Caderinas/genética , Proteínas Quinases Dependentes de Cálcio-Calmodulina/genética , Conização , Inibidor p16 de Quinase Dependente de Ciclina/genética , Metilases de Modificação do DNA/genética , Enzimas Reparadoras do DNA/genética , Proteínas Quinases Associadas com Morte Celular , Progressão da Doença , Feminino , Glutationa S-Transferase pi/genética , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/isolamento & purificação , Papillomavirus Humano 6/isolamento & purificação , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase , Receptores do Ácido Retinoico/genética , Recidiva , Inibidor Tecidual de Metaloproteinase-3/genética , Proteínas Supressoras de Tumor/genética , Infecções Tumorais por Vírus/complicações , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/virologiaRESUMO
AIMS AND BACKGROUND: Factors linked to residual neoplasia and recurrence following conization of the uterine cervix for treating cervical intraepithelial neoplasia grade III (CIN III), such as the surgical margins, extension of CIN into the crypts and the number of mitoses, have been studied with contradictory results. We evaluated patients submitted to conization for CIN III and analyzed the aforementioned factors, relating them to recurrence and residual neoplasia in hysterectomy specimens. METHODS: The surgical specimen of cold-knife conization for CIN III performed in 63 patients (average age, 37.3 +/- 9.3 years) was fixed in 4% formaldehyde. The ectocervical and endocervical margins were removed and the cone was cut into fragments perpendicular to the surface of the endocervical mucosa (1 mm thick). One histological section (5 microm thick) was cut from each block and stained with hematoxylin-eosin. We studied the total number of fragments from each cone and affected by CIN, endocervical and ectocervical margins, extension to the crypts, number of mitoses and tripolar mitoses in 100 microscope fields using a 100x objective. RESULTS: The endocervical margin was involved in 34.9% vs 9.5% (P = 0.001) of ectocervical margins. Recurrence affected 53.8% of cases presenting involved margins versus 12.9% in the cases without involved margins (P = 0.0078). The average interval to recurrence was 3.2 years. CIN was present in 2.5 to 100% (median, 28%) of the cone fragments (median no., 28; range, 7-95). A median of 44.4% and 25% of cone fragments presented CIN with and without recurrence, respectively. Correlation of the number of mitoses with tripolar mitoses and the percentage of fragments involved by CIN with the number of mitoses and tripolar mitoses showed, respectively, P = 0.02, 0.05 and 0.005. A median of 142 mitosis and 4 tripolar mitosis were observed per case with disease recurrence versus 104 and 3 (P = 0.02, 0.6), respectively, when recurrence did not occur. Of 14 patients who underwent hysterectomy after conization (mean, 3.6 +/- 3 months afterwards) for endocervical or both margins involved by CIN in the cone specimen, 8 (57.1%) presented CIN III and one (7.1%) microinvasive carcinoma. In 96.8% of the conizations, the CIN extended to the crypts. CONCLUSIONS: Involved margins and mitoses are associated with a greater recurrence rate for CIN. Residual neoplasia in the hysterectomy specimen after an involved margin with conization is frequent.
Assuntos
Conização , Recidiva Local de Neoplasia , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Adulto , Conização/métodos , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Mitose , Neoplasia Residual , Resultado do TratamentoRESUMO
A apendicite crônica pode simular diversas situações clínicas, dificultando a conduta clínica. Descrevemos neste trabalho um caso de uma menina de 9 anos com dor abdominal há 13 meses, sendo visualizada massa expansiva no baixo ventre após exames de ultra-som e tomografia computadorizada abdominal e laparoscopia diagnóstica. Houve enorme dificuldade diagnóstica, pois o quadro clínico, laboratorial e imaginológico não foi conclusivo, levando a várias hipóteses diagnósticas. O diagnóstico definitivo de plastrão apendicular ocorreu somente após laparotomia exploradora. Discutem-se neste estudo vários diagnósticos diferenciais quando da presença de massa formada por plastrão apendicular com enfoque nas malformações ginecológicas, endometriose, neoplasias e pseudotumores.
Assuntos
Humanos , Feminino , Criança , ApendiciteRESUMO
Alguns trabalhos tem demonstrado maior incidencia de cesareas nas parturientes com feto masculino. Portanto, o objetivo deste trabalho foi avaliar as indicacoes de cesareas em associacao ao sexo fetal. A pesquisa foi retrospectiva por analise de prontuarios das mulheres atendidas na Disciplina de Ginecologia e Obstetricia da FMTM entre 1984 e 1988. Foram incluidas apenas nuliparas em trabalho de parto espontaneo com gestacao acima de 37 semanas e apresentacao cefalica. As indicacoes de cesareas ficaram restritas a desproporcao cefalo-pelvica (DCP) e sofrimento fetal agudo (SFA). De acordo com os requisitos, 575 mulheres se enquadraram no...