RESUMO
PURPOSE: To report the outcomes of gestational trophoblastic neoplasia (GTN) at a single institution and to determine the factors affecting response to chemotherapy and survival. METHODS/PATIENTS: From 1979-2010, we retrospectively reviewed the data of 221 patients treated at our center. GTN Patients were assigned to low-risk (score ≤6) or high-risk (score ≥7) based on the WHO risk factor scoring system. Overall survival (OS) probabilities were estimated using Kaplan-Meier method. Logistic regression was applied to study the impact of different factors on the response to initial therapy. RESULTS: Patients' OS rate was 97 %. Median age at diagnosis was 37 year. 131 (59 %) patients had low-risk and 88 (40 %) cases had high-risk GTN. Complete remission rates to initial chemotherapy in low-risk group were 53 % and 87 % for single-agent methotrexate or dactinomycin, respectively. In high-risk group, 94 % achieved complete remission to initial chemotherapy with etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine (EMA-CO). Etoposide, cisplatin, and dactinomycin as primary therapy in high-risk patients was successful in 70 %, while bleomycin, etoposide, and cisplatin (BEP) was successful in 53 % of cases. Salvage chemotherapy, surgical intervention or radiation therapy resulted in overall complete remission of 90 % in low-risk and 73 % in high-risk groups. Factors associated with resistance to initial chemotherapy were advanced-stage III/IV (p = 0.005), metastatic site other than lung or vagina (p = 0.005) and high-risk prognostic score (p = 0.05). OS was significantly influenced by the type of antecedent pregnancy (molar 98 % vs. others 93 %; p = 0.04), FIGO stage (I, II 100 % vs. III, IV 94 %; p = 0.02), score (low-risk 100 % vs. high-risk 92 %; p = 0.01), and site of metastasis (lung/vagina 98 % vs. others 85 %; p = 0.002). CONCLUSIONS: GTNs have excellent prognosis if properly treated at experienced centers. Single-agent dactinomycin seems more effective for low-risk GTN. EMA-CO remains the preferred primary treatment regimen for high-risk group. The excellent outcome reflects the success of salvage therapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Coriocarcinoma/terapia , Doença Trofoblástica Gestacional/terapia , Neoplasias Uterinas/terapia , Adolescente , Adulto , Bleomicina/uso terapêutico , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Coriocarcinoma/secundário , Cisplatino/uso terapêutico , Ciclofosfamida/uso terapêutico , Dactinomicina/uso terapêutico , Etoposídeo/uso terapêutico , Feminino , Doença Trofoblástica Gestacional/secundário , Humanos , Histerectomia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Gravidez , Indução de Remissão , Estudos Retrospectivos , Fatores de Risco , Terapia de Salvação , Taxa de Sobrevida , Neoplasias Uterinas/patologia , Neoplasias Vaginais/secundário , Neoplasias Vaginais/terapia , Vincristina/uso terapêutico , Adulto JovemRESUMO
A ocorrência de metástases de carcinoma de células renais para a vagina é rara. Ocorre principalmente em mulheres na pós-menopausa e o principal fator prognóstico é se essa metástase apresenta-se ou não isolada. Poucos casos foram relatados na literatura mundial e a maioria destes envolve metástases originadas no rim esquerdo. Os autores apresentam um caso de metástase vaginal de carcinoma de células renais em uma paciente de 53 anos de idade cuja apresentação clínica inicial foi de uma massa pediculada com bordas irregulares na parede posterior da vagina. Realizou-se a retirada cirúrgica da lesão que revelou tratar-se de adenocarcinoma de células claras. A ultrasonografia abdominal evidenciou presença de massa incidental no rim esquerdo e foi realizada a nefrectomia deste rim. O estudo imunoistoquímico realizado demonstrou tratar de lesão neoplásica primária do rim com metástase para a vagina. A paciente, então, recebeu radioterapia adjuvante na vagina e na pelve. Após oito meses do início do tratamento, realizou-se imunoterapia com interferon 2 devido ao aparecimento de metástase também para ofígado. A paciente encontra-se viva 17 meses após a cirurgia.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Adenocarcinoma de Células Claras/secundário , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/terapia , Metástase Neoplásica , Neoplasias Renais/diagnóstico , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Neoplasias Vaginais/secundário , PrognósticoRESUMO
This study was undertaken to evaluate the telomerase activity both in the tumor and in the vaginal margins of radical hysterectomy in patients with squamous cell carcinoma (SCC) of the cervix. Thirty-three patients with SCC of the cervix (study group) and 13 patients with uterine myoma (control group) were prospectively studied. Tissue samples were taken from the tumor or cervix, anterior vaginal margin (AVM), and posterior vaginal margin (PVM). The specimens were analyzed by histopathology, by a telomerase PCR-TRAP-ELISA kit, and by polymerase chain reaction using human papillomavirus (HPV) DNA. The telomerase activity was significantly higher in the tumor than in the benign cervix (P < 0.001). There was no difference in telomerase activity in the AVM and PVM in patients with cervical carcinoma compared to the control group. Telomerase activity was associated with the presence of histologic malignancy in the PVM of patients submitted to radical hysterectomy (P= 0.03). This association was not observed with the presence of HPV in AVM or PVM in the study group. Telomerase activity is a marker of histologic malignancy in patients with SCC of the cervix. There was no association between the telomerase activity and the presence of HPV in vaginal margins of patients submitted to radical hysterectomy.
Assuntos
Carcinoma de Células Escamosas/enzimologia , Histerectomia , Neoplasia Residual/diagnóstico , Papillomaviridae/isolamento & purificação , Telomerase/metabolismo , Neoplasias do Colo do Útero/cirurgia , Vagina/enzimologia , Neoplasias Vaginais/enzimologia , Neoplasias Vaginais/secundário , Adulto , Idoso , Biomarcadores Tumorais/análise , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/virologia , Sondas de DNA de HPV , Feminino , Humanos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase/métodos , Vagina/patologia , Vagina/virologia , Neoplasias Vaginais/virologiaRESUMO
PURPOSE: This study was undertaken to evaluate clinical and pathologic findings that predicted pelvic lymph node metastasis and parametrial and vaginal involvement in patients with stage IB carcinoma of the cervix. METHODS: 71 patients with diagnosis of stage IB (FIGO) cervical cancer were prospectively studied from December 1997 to August 2002. The patient's age, clinical stage (IB1 or IB2), histological classification, grade of differentiation, tumor volume, and lymphatic vascular space invasion (LVSI) were evaluated. Statistical methods included chi2 test and Fisher's exact test to evaluate significant differences between the groups. The level of significance was set at p < 0.05. RESULTS: The clinical stage was IB1 in 51 patients (71.8%) and IB2 in 20 patients (28.2%). The histological classification identified squamous cell carcinoma in 60 patients (84.5%) and adenocarcinoma in 11 patients (15.5%). The average tumoral volume was 22.8 +/- 24.3 cm3 (0.3-140.0 cm3). The tumor was well differentiated (G1) in 8 (11.3%), moderately differentiated (G2) in 40 (56.3%) and poorly differentiated in 23 (32.4%) of the cases. The presence of LVSI was detected in 14 patients (19.7%) and was associated with pelvic lymph node metastasis and vaginal and parametrial involvement (p = 0.002, p = 0.001 and p < 0.001; respectively). The average number of positive pelvic lymph nodes was significantly higher in the patients with LVSI compared with patients without LVSI (2.47 +/- 2.8 vs. 0.33 +/- 0.74; p = 0.001). There was no association of age, clinical stage, histological classification, grade of differentiation or tumor volume with pelvic lymph node metastasis and vaginal and parametrial involvement. CONCLUSION: The presence of LVSI is significantly associated with pelvic lymph node metastasis and vaginal and parametrial involvement in patients with stage IB cervical carcinoma.
Assuntos
Adenocarcinoma/secundário , Carcinoma de Células Escamosas/secundário , Neoplasias Pélvicas/secundário , Neoplasias do Colo do Útero/patologia , Neoplasias Vaginais/secundário , Adulto , Idoso , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Neoplasias do Colo do Útero/diagnósticoRESUMO
BACKGROUND: Metastasis of renal cell carcinoma to the vagina is rare, although it may be the first evidence of the existence of the primary tumor. CASE: A metastatic deposit of renal cell carcinoma in the vagina was diagnosed by cytology as clear cell adenocarcinoma, which was confirmed by biopsy. Radiographic and ultrasound examinations confirmed the renal site of origin, which was corroborated by immunohistochemistry of the biopsy specimen. CONCLUSION: When a cytologic diagnosis of vaginal clear cell adenocarcinoma is made, metastasis of renal cell carcinoma should be considered in the differential diagnosis.