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Cervical cancer ranks among the most prevalent cancers globally with high-risk human papillomaviruses implicated in nearly 99% of cases. However, hidden players such as changes in the microbiota are now being examined as potential markers in the progression of this disease. Researchers suggest that changes in the vaginal microbiota might correlate with cervical cancer. This review provides a comprehensive look at the microbiota changes linked with the advancement of cervical cancer. It also scrutinizes the databases from past studies on the microbiota during healthy and cancerous stages, drawing connections between prior findings concerning the role of the microbiota in the progression of cervical cancer. Preliminary findings identify Fusobacterium spp., Peptostreptococcus spp., Campylobacter spp., and Haemophilus spp., as potential biomarkers for cervical cancer progression. Alloscardovia spp., Eubacterium spp., and Mycoplasma spp. were identified as potential biomarkers for HPVs (+), while Methylobacterium spp. may be indicative of HPV (-). However, the study's limitations, including potential biases and methodological constraints, underscore the need for further research to validate these findings and delve deeper into the microbiota's role in HPV development. Despite these limitations, the review provides valuable insights into microbiota trends during cervical cancer progression, offering direction for future research. The review summarizes key findings from previous studies on microbiota during healthy and cancerous stages, as well as other conditions such as CIN, SIL, HPV (+), and HPV (-), indicating a promising area for further investigation. The consistent presence of HPV across all reported cervical abnormalities, along with the identification of distinct bacterial genera between cancerous and control samples, suggests a potential link that merits further exploration. In conclusion, a more profound understanding of the microbial landscape could elucidate the pathogenesis of cervical diseases and inform future strategies for diagnosis, prevention, and treatment.

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CONTEXT AND OBJECTIVE: Vulvar melanoma is a rare disease. We describe the experience of a single institution and review the literature. DESIGN AND SETTING: Retrospective study at the Department of Gynecology, Hospital do Cancer A. C. Camargo. METHODS: Eleven patients with vulvar melanoma attended between January 1987 and December 2006 were reviewed regarding clinicopathological characteristics, surgical therapy and follow-up. RESULTS: The initial symptoms were vulvar lesions, pruritus, pain and bleeding. The median age was 64.8 years. The median depth of invasion was 3.08 mm. The staging ranged from IB to IIIC (American Joint Committee on Cancer, 2002). All the patients underwent vulvectomy. Two patients did not undergo primary elective lymphadenectomy. Bilateral inguinal lymphadenectomy was performed on five patients, and one had unilateral inguinal lymphadenectomy. Sentinel lymph node investigation was performed on three patients. Five patients had locoregional recurrence. Prolonged survival was only achieved in the absence of lymph node involvement. The median follow-up was 56 months. The median disease-free survival was 15 months and the median overall survival was 29 months. CONCLUSIONS: The prognosis for patients with vulvar melanoma is generally poor, with a high tendency towards regional and distant recurrence. Depth of invasion and lymph node involvement are the most important prognostic factors. In most cases, resection of the lesion with adequate margins may replace vulvectomy. Elective inguinal femoral lymphadenectomy remains the standard lymph node staging procedure. Sentinel lymph node investigation is feasible and should be performed by a multidisciplinary team with experience of this method.

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CONTEXT AND OBJECTIVE: Vulvar melanoma is a rare disease. We describe the experience of a single institution and review the literature. DESIGN AND SETTING: Retrospective study at the Department of Gynecology, Hospital do Cancer A. C. Camargo. METHODS: Eleven patients with vulvar melanoma attended between January 1987 and December 2006 were reviewed regarding clinicopathological characteristics, surgical therapy and follow-up. RESULTS: The initial symptoms were vulvar lesions, pruritus, pain and bleeding. The median age was 64.8 years. The median depth of invasion was 3.08 mm. The staging ranged from IB to IIIC (American Joint Committee on Cancer, 2002). All the patients underwent vulvectomy. Two patients did not undergo primary elective lymphadenectomy. Bilateral inguinal lymphadenectomy was performed on five patients, and one had unilateral inguinal lymphadenectomy. Sentinel lymph node investigation was performed on three patients. Five patients had locoregional recurrence. Prolonged survival was only achieved in the absence of lymph node involvement. The median follow-up was 56 months. The median disease-free survival was 15 months and the median overall survival was 29 months. CONCLUSIONS: The prognosis for patients with vulvar melanoma is generally poor, with a high tendency towards regional and distant recurrence. Depth of invasion and lymph node involvement are the most important prognostic factors. In most cases, resection of the lesion with adequate margins may replace vulvectomy. Elective inguinal femoral lymphadenectomy remains the standard lymph node staging procedure. Sentinel lymph node investigation is feasible and should be performed by a multidisciplinary team with experience of this method.

CONTEXTO E OBJETIVO: Melanoma de vulva é uma doença rara. Descrevemos a experiência de uma instituição e revisamos a literatura. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo no Departamento de Ginecologia do Hospital do Câncer A. C. Camargo. MÉTODOS: De Janeiro de 1987 a Dezembro de 2006, foram revisados aspectos clínico-patológicos, tratamento cirúrgico e acompanhamento de 11 pacientes com melanoma de vulva. RESULTADOS: Lesão vulvar, prurido, dor e sangramento foram sintomas iniciais. A idade mediana foi 64,8 anos. A mediana da profundidade de invasão foi 3.08 mm. O estadiamento variou de IB a IIIC (American Joint Committee on Cancer, 2002). Todas as pacientes foram submetidas a vulvectomia. Duas pacientes não foram submetidas a linfadenectomia eletiva primária. A linfadenectomia inguinal bilateral foi realizada em cinco pacientes e uma foi submetida à linfadenectomia inguinal unilateral. A pesquisa do linfonodo sentinela foi realizada em três casos. Cinco tiveram recidiva locorregional. A sobrevida prolongada esteve relacionada com a ausência de comprometimento linfonodal. O tempo mediano de acompanhamento foi de 56 meses. A sobrevida mediana livre de doença foi de 15 meses e a sobrevida mediana global de 29 meses. CONCLUSÕES: O prognóstico das pacientes com melanoma de vulva geralmente é ruim, com tendência a recorrência regional e à distância. A profundidade de invasão e envolvimento linfonodal são os principais fatores prognósticos. Na maioria dos casos a ressecção da lesão com margens adequadas pode substituir a vulvectomia. A linfadenectomia inguino-femoral eletiva ainda é o procedimento padrão para estadiamento linfonodal. Pesquisa do linfonodo sentinela é factível e deve ser realizada por equipe multidisciplinar com experiência no método.

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Introdução: Os tumores neuroendócrinos são neoplasias raras que tipicamente apresentam uma história natural indolente. Apesar de serem considerados tumores de crescimento lento e de pequena agressividade, tendem a desenvolver doença metastática à distância com relativa frequência, acarretando uma redução importante na sobrevida e qualidade de vida dos pacientes. Em razão da raridade, complexidade, heterogeneidade clínica e biológica destas neoplasias, a identificação dos fatores prognósticos, a avaliação da sobrevida a longo prazo e a definição da melhor forma de tratamento tornam-se difíceis. Objetivos: Determinar fatores prognósticos clínicos, histológicos, biológicos e moleculares que possam ter impacto na mortalidade, morbidade e sobrevida de pacientes submetidos ao tratamento cirúrgico das metástases hepáticas de tumores neuroendócrinos. Casuística e Métodos: Foram estudados 22 pacientes submetidos à ressecção hepáticas devido à metástases hepáticas de tumores neuroendócrinos, admitidos pelo Departamento de Cirurgia Abdominal do Hospital A.C. Camargo de São Paulo, no período entre janeiro de 1997 e dezembro de 2007. Dados epidemiológicos, clínicos, anatomopatológicos e os obtidos pelas reações de imunoistoquímica para o Ki-67 e p53, foram correlacionados entre si e com as sobrevidas global e livre de doença. Resultados: A idade média foi de 48,5 anos e mediana de 57 anos (32-69 anos). Doze pacientes (54,5%) eram do sexo masculino e dez (45,5%) do feminino. Doença bilobar esteve presente em 17 pacientes (77,3%). Acometimento hepático maior ou igual a 50% foi detectado em 8 pacientes (36,4%). Sincronicidade com o tumor primário estava presente em 77,3% dos casos. Ressecção cirúrgica completa foi alcançada em 59,1%. O pâncreas foi a origem primária das metástases em 45,5% das vezes. Dez pacientes (45,5%) evoluíram com complicações no pós-operatório imediato, com 2 pacientes evoluindo ao óbito. A sobrevida global em 1 e 5 anos foi de 77,3% e 44,2% , em um seguimento médio de 37 meses. A sobrevida média livre de doença em 5 anos foi de 13,6%. Recorrência ocorreu em 46,15% dos pacientes submetidos à ressecção completa das metástases. Na análise univariada o tumor neuroendócrino primário de pâncreas (p=0,006), índice do Ki-67 (p=0,043) e a marcação imunoistoquímica para o p53 (p=0,036) foram associados com aumento na sobrevida global. Conclusão: Metástases hepáticas oriundas de tumores neuroendócrinos pancreáticos demonstraram ser um fator prognóstico negativo. O índice de Ki-67 e a imunomarcação para o p53 foram associados à redução na sobrevida global. O número de nódulos metastáticos foi associado à redução da sobrevida livre de doença. Pacientes submetidos à hepatectomia em dois tempos ou à re-hepatectomia evoluíram com maior taxa de complicações no período pós-operatório. Pacientes assintomáticos ao diagnóstico apresentaram menor sobrevida livre de doença.

Introduction: Neuroendocrine tumors are rare neoplasms that typically have an indolent natural history. Although there are considered slow-growing tumors and low-aggression, tend to develop metastatic disease with relative frequency, resulting in a significant reduction in survival and quality of life of patients. Because of the rarity, complexity, clinical and biological heterogeneity of these neoplasms, the identification of prognostic factors, assessment of long-term survival and determine the best form of treatment becomes difficult. Objectives: Determine clinical prognostic factors, histological, biological and molecular that may impact on mortality, morbidity and survival of patients undergoing surgical treatment of liver metastases of neuroendocrine. Casuistic and Methods: We studied 22 patients undergoing liver resection due to liver metastases of neuroendocrine tumors, admitted by the Department of Abdominal Surgery of A.C. Camargo Hospital, Sao Paulo, in the period between January 1997 and December 2007. Epidemiological, clinical, pathological data and those obtained by the reactions of immunohistochemistry for Ki-67 and p53, were correlated with each other and the overall survival and disease-free. Results: The mean age was 48.5 years and median of 57 years (32-69 years). Twelve patients (54.5%) were male and ten (45.5%) female. Bilobar disease was present in 17 patients (77.3%). Liver involvement greater than or equal to 50% was detected in 8 patients (36.4%). Synchronicity with the primary tumor was present in 77.3% of cases. Complete surgical resection was achieved in 59.1%. The pancreas was the primary source of metastases in 45.5% of the time. Ten patients (45.5%) developed complications in the immediate postoperative period with 2 patients progressing to death. The overall survival at 1 and 5 years was 77.3% and 44.2%, in a mean of 37 months. The median survival disease-free survival at 5 years was 13,6%. Recurrence occurred in 46.15% of patients undergoing complete resection. The primary neuroendocrine tumor of the pancreas (p=0,006), the immunohistochemical staining positive for p53 (p=0,036), and the index of Ki-67 ≥ 1% (p=0,043), were associated with reduction in overall survival. Patients with metastatic nodules ≥ 10 (p=0,03) and the asymptomatic patients (p=0,015) at diagnosis had lower disease-free survival. All six patients underwent rehepatectomy and/or hepatectomy in two stages had complications during the postoperative period. Conclusions: Liver metastases originating from pancreatic neuroendocrine tumors proved to be a negative prognostic factor. The index of Ki-67 ≥ 1% and immunostaining positive for p53 were associated with reduced overall survival. The number of metastatic nodules was associated with reduced diseasefree survival. Patients undergoing hepatectomy in two stages or re-hepatectomy evolved to a higher rate of complications during the postoperative period. Asymptomatic patients at diagnosis showed lower disease-free survival.

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