Adenocarcinoma of the Endometrium — The Art of Its Diagnosis

The diagnostic process begins at the first meeting with the patient, where we must relate the symptoms and signs associated with endometrial disease. Communication skills are fundamental for excellence in medical care. Even with the development and improvement of new technologies in recent decades, be it endoscopy, ultrasound, computed tomography or magnetic resonance imaging, the communication is also essential. We must have skills to recognize and elucidate a wide variety of signs and symptoms when we take a history and do a physical examination of the patient, where abnormal uterine bleeding is the first main sign that can lead to an early diagnosis of endometrial cancer. The endometrium, as every target organ of steroid hormones, shows involutional changes during ovarian failure. In peri-menopause, however, tissue hyperactivity stages occur with some frequency, showing a marked endometrial sensitivity to hormonal fluctuations, whether on an absolute or relative level. Irregular blood loss occurs in many women during this period, and although being most times of functional origin, it requires investigation. It is noteworthy that the most frequent cause of abnormal bleeding of organic origin in menopause is endometrial. Endometrial pathologies appear with advancing age. Therefore an appropriate workup should diagnose or rule out disease at this site. Thus, preventive measures should be adopted, such as screening and early diagnosis, and the best treatment for the patient should be established

Cancer of the Vulva — A Review

Cancer of the Vulva: a review In reporting on cancer of the vulva, we should keep in mind some important aspects of its epidemiology and its early detection. Most of the papers on the subject refer to vulvar cancer as a rare disease, accounting for 4 to 5% of all malignant neoplasms of the female genital tract and less than 1% of women\u27s cancers. The incidence varies from 1 to 3.6 cases per 100,000 women, with peak incidence at ages 70-79 years. Even though the incidence increases with age, the proportion of young patients with vulvar cancer has greatly increased due to its association with infection with human papillomavirus (HPV). The risk of developing cancer of the vulva is related to behavioral, reproductive, hormonal and genetic aspects. Factors that increase risk include other genital cancers, chronic inflammatory diseases of the vulva, smoking, history of genital warts and vulvar intraepithelial neoplasia (VIN). We can consider that, given the epidemiological evidence, there are two etiologic pathways for vulvar cancer: one related to older patients, in the seventh or eighth decades of life, associated with mutations in TP53 and non-neoplastic epithelial disorders such as chronic inflammation or vulvar lichen, shows precursor lesions of differentiated VIN; the other is more common in young patients, accounts for approximately 43-60% of squamous carcinoma of the vulva, is associated with HPV infection, and is a common precursor lesion of VIN. Eighty-five to ninety percent of vulvar cancers are squamous in origin (squamous cell carcinoma); however, when considering the embryological origin of the vulva - the three germ layers - different histologic types can compose neoplasms affecting the region

Associação entre o polimorfismo no códon 72 da p53 e as lesões pré-malignas e malignas cervicais

OBJETIVOS: testar a hipótese de que o polimorfismo no códon 72 do gene TP53 é fator de risco para as lesões pré-malignas e malignas cervicais associadas ou não ao papilomavírus humano (HPV). MÉTODOS: foram incluídas amostras de cérvice uterina, para pesquisa de DNA de HPV e do polimorfismo no códon 72 da p53 com o uso da reação em cadeia da polimerase (PCR), de 155 pacientes que se submeteram à biópsia cervical. Foram formados três grupos de acordo com o diagnóstico histológico: lesão escamosa intra-epitelial de baixo grau (LSIL), lesão escamosa intra-epitelial de alto grau (HSIL) e carcinoma cervical. Aquelas pacientes sem alterações displásicas, citológicas e histológicas, foram consideradas controles. Para testar a associação entre o polimorfismo no códon 72 do gene TP53 e os grupos, foi utilizado o teste de chi2. Considerou-se como significativo o intervalo de confiança no nível de 95% (alfa=0,05). RESULTADOS: quarenta pacientes tiveram o diagnóstico histológico de carcinoma cervical, 18 tinham HSIL, 24 tinham LSIL e 73 foram consideradas controles. O genótipo Arg/Arg p53 foi encontrado em 60,0% das pacientes com câncer, 50,0% dos casos com HSIL, 45,8% dos casos com LSIL e em 45,2% dos controles. Não houve diferença significativa entre as proporções de cada genótipo da p53 nos diferentes grupos independente da presença do HPV (chi2: 3,7; p=0,716). CONCLUSÕES: nossos dados não suportam a hipótese de que o polimorfismo no códon 72 do gene TP53 é importante no desenvolvimento de lesões cervicais pré-malignas e malignas associadas ou não ao HPV

Villoglandular adenocarcinoma of the uterine cervix

Objetivo: o adenocarcinoma viloglandular (AVG) da cérvice foi identificado como uma variante do adenocarcinoma cervical que ocorre em mulheres jovens e traz um excelente prognóstico. Diante da escassez de estudos relacionados ao tema, nós relatamos seis casos de AVG de cérvice. Métodos: acompanhamos a evolução de seis casos de AVG, no período de 1995 a 2006, no Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS). Coletamos informações clínicas e histológicas de todas as pacientes e submetemos todas as peças cirúrgicas para revisão histológica. Resultados: a idade média da apresentação foi de 43,5 anos (variando de 27 a 61 anos). Quatro pacientes submeteram-se à histerectomia radical de Wertheim-Meigs e linfadenectomia pélvica bilateral, uma submeteu-se a conização e subseqüente radioterapia e uma a linfadenectomia pélvica seguida de radioterapia. Todas as pacientes estão vivas e bem, sem evidência de recorrência. Conclusões: as implicações da terapia são discutidas. Propomos aqui a inclusão do estudo do padrão de envolvimento linfovascular na determinação diagnóstica do AVG. Assim, ao referenciarmos este diagnóstico, poderemos optar, com cautela, pela terapia conservadora, salvo particularidades de cada caso.Purpose: the villoglandular adenocarcinoma (VGA) of the cervix has been identified as a variant of cervical adenocarcinoma that occurs in young women, which has an excellent prognosis. Considering the scarcity of studies related to the subject, we report six cases of VGA of the cervix. Methods: we followed the development of six cases of VGA in the period from 1995 to 2006 at Hospital São Lucas of Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS). We collected clinical and histologic information of the patients and submitted all the surgical specimens to histological review. Results: mean age at diagnosis was 43.5 years (range 27-61 years). Four patients were submitted to Wertheim-Meigs radical hysterectomy and bilateral pelvic lymphadenectomy, one to conization and subsequent radiotherapy and one to pelvic lymphadenectomy followed by radiotherapy. All the patients were alive and well at the time of this writing, without evidence of recurrence. Conclusions: the implications of therapy are discussed. We propose here the inclusion of the study of the pattern of lymphovascular involvement in determining the diagnosis of VGA. Thus, in referring to this diagnosis, we will be able to opt, with caution, for conservative therapy, except for particularities of each case