Carcinoma de colo uterino em mulheres de 20-29 anos : qualidade do rastreamento, características histopatológicas, expressão de marcadores de malignidade e sobrevida das pacientes

Tese (doutorado)—Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, 2018.OBJETIVOS: Avaliar a qualidade do rastreamento, características clínicas e anatomopatológicas, expressão de marcadores de malignidade e sobrevida entre pacientes diagnosticadas com Carcinoma de Células Escamosas de Colo Uterino (CECCU) na faixa etária de 20 a 29 anos e de 30 anos ou mais. PACIENTES E MÉTODOS: O estudo observou retrospectivamente todas as pacientes diagnosticadas com CECCU no Hospital São Marcos de Teresina (HSM) de janeiro de 2010 a dezembro de 2015. Coletou-se dados epidemiológicos, dados clínicos e anatomopatológicos no sistema do HSM, no Sistema de Informação do Câncer de Colo do Útero (SISCOLO) e no Sistema de Informação de Mortalidade (SIM) e dividiu-se as pacientes em dois grupos etários: de 20 a 29 anos e de 30 anos ou mais. Após isso, fez-se uma seleção dos blocos de parafina de pacientes de ambos os grupos etários e procedeu-se a análise imuno-histoquímica. Comparou-se todos os dados coletados dos dois grupos etários para definir se houve diferença estatística. RESULTADOS: Observou-se baixa adesão ao Programa Nacional de Controle do Câncer de Colo (PNCCC) em ambas as faixas etárias, com a maioria dos diagnósticos de CECCU sendo feito em estágios avançados da doença. Quando avaliamos a expressão de IMP3 e SOX4, observamos que não houve diferença entre os grupos. Foi feita análise de sobrevida pelo Método Kaplan-Meier (p=0,2021) e por Regressão de Cox (Hazard ratio=0,6377) e não houve diferença de sobrevida entre os grupos. CONCLUSÃO: O perfil epidemiológico, as características clínicas e anatomopatológicas, a expressão de marcadores de malignidade, a sobrevida em 2 anos e a adesão ao PNCCC são semelhantes entre as pacientes com CECCU nas faixas etárias estudadas, o que leva a crer que o CECCU em pacientes de 20 a 29 anos não apresenta um comportamento mais agressivo do que em mulheres com 30 anos ou mais. A doença é diagnosticada, em ambos os grupos etários, frequentemente já em estágios avançados e a adesão ao programa é baixa, indicando que o PNCCC precisa ser melhorado.AIMS: To compare the profile of subjects with squamous cell carcinoma of the cervix (SCCC) between 20-29-years of age with those of 30 years of age or older group by analyzing screening adherence, Survival analysis and anatomopathological data of patients. In addition, IMP3 and SOX4 histopathological expression. METHODS: This study retrospectively observed patients who were diagnosed with SCCC from January 2010 to December 2015. Patients who were between 20 and 29 years of age were assigned to group I, whereas patients who were 30 years of age or older were assigned to group II. Patients’ screening adherence, Survival and pathological data related to disease staging were collected and an immunohistochemical analysis of based on the IMP3 and SOX4 biomarkers were performed. The two groups were compared to ascertain significant differences. RESULTS: Most of 737 women were diagnosed with tumors at an advanced stage and only 184 women (25%) participated in the screening program. When we compared group I to group II, there were no prognostic parameters with significant difference. CONCLUSIONS: Many of the cases that were diagnosed in the 20-29-year age group were already in advanced stages. We believe that the probable cause of the early onset of cervical cancer was failure to screen patients, since the results indicate that the SCCC in such age group does not present a more aggressive behavior than in women 30 years old or more

Anti‑EpCAM antibodies for detection of metastatic carcinoma in effusions and peritoneal wash

Epithelial cell adhesion molecule (EpCAM) has been used as diagnostic/prognostic marker and therapeutic target. The aim of the present study was to compare immunoreactivity of antibodies against distinct epitopes in the ectodomain of EpCAM for detection of carcinoma from different primary sites and of different histological types in effusions and peritoneal wash. Two antibodies against epitopes in the EGF‑like domain I (clones Moc‑31 and Ber‑EP4) and one antibody against the epitope in the cysteine‑poor region (158210) of EpCAM were used (all commercially available). Independently of the clone used, EpCAM overexpression was observed in almost all samples when all the adenocarcinoma samples were analyzed together. By using Moc‑31, EpCAM overexpression was observed in all samples of adenocarcinoma. Absence of EpCAM overexpression was observed in a few adenocarcinoma samples at some sites of tumor origin, including ovary, breast and stomach, when Ber‑EP4 and 158210 were used. Regarding carcinomas aside from adenocarcinomas, histological types, such as squamous cell, urothelial and small cell carcinoma showed different degrees of EpCAM expression according to the antibody used. In squamous cell carcinoma, overexpression was observed only with the clone 158210. It was concluded that, overall, most samples of metastatic carcinoma from effusions showed overexpression of EpCAM. However, there are significant variations in its detection according to the primary site, histological type of the carcinoma and depending on the antibody used. Thus, the use of more than one type of anti‑EpCAM antibody would increase the chance of its detection in metastatic carcinoma effusion