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Browsing GIN - Artigos by Subject "Carcinoma de Células Escamosas"
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- Carcinoma espinho-celular do colo do útero tipo linfoepitelioma-likePublication . Pires, MA; Andrade, MJ; Guerra, C; Silva, T; Oliveira, CF; Matos-Beja, ALymphoepithelioma-like carcinomas of the cervix uteri are very rare. They are poorly differentiated squamous cell carcinomas with intense stromal lymphocytic infiltration. These histologic features are similar to nasopharyngeal lymphoepithelioma and may have a better prognosis than other tumors of the cervix. A lymphoepithelioma-like lesion of the cervix uteri is described in a 33-year-old Caucasian woman who had an episode of vaginal bleeding. A review of the literature about these types of tumor is also presented.
- Estrogen receptor, progesterone receptor, and bcl-2 are markers with prognostic significance in CIN IIIPublication . Fonseca-Moutinho, JA; Cruz, E; Carvalho, L; Prazeres, HJ; Lacerda, MM; Silva, DP; Mota, F; Oliveira, CFThere are no known biological markers or technologies to predict the natural history of an individual CIN III. The probability of progression is considered greater with the persistence of high-risk human papillomavirus (HPV) infection and age. p53 polymorphism has been associated with cervical carcinogenesis. Hormone-induced cervical cancer is mediated by estrogen receptor (ER) and progesterone receptor (PR). In cervical cancer, increased bcl-2 and Bax immunoreactivity is generally associated with a better prognosis. The purpose of this study was to evaluate the value of HPV 16 and HPV 18 typing and p53 codon polymorphism genotyping by polymerase chain reaction and ER, PR, bcl-2, and Bax expression by immunohistochemistry in predicting the CIN III clinical behavior of CIN III lesions. We studied the expression of these prognostic factors in the CIN III adjacent to squamous cell microinvasive carcinomas of the cervix (MIC) from 29 patients with FIGO stage IA1 cervical cancer and in 25 patients with CIN III and no documented focus of invasion. In the MIC group, only the CIN III was considered at least 2 mm away from the microinvasive complex. The ER, PR, bcl-2, and Bax immunoreactivity was scored as positive (>10% staining cells) and negative (<10% staining cells). No significant difference was observed between MIC and CIN III group concerning HPV infection and p53 polymorphism. The ER, PR, bcl-2, and Bax immunohistochemical expression was stronger and more frequent in the CIN III group. After multivariable analysis, coexpression of ER, PR, and bcl-2 was the only independent factor in defining low risk of progression for CIN III. Our study suggests that coexpression of ER, PR, and bcl-2 may be a useful tool in identifying the CIN III lesions with low risk of progression to cervical cancer
- Microinvasive squamous carcinoma of the cervix: treatment modalitiesPublication . Mota, FPatients with FIGO stage IA1 squamous cell carcinoma of the cervix can be treated conservatively with simple hysterectomy or, if young and desiring to preserve their fertility, with conization only, provided surgical margins are free of dysplasia or invasive disease. When the surgical margins are involved a repeat conization should be performed. Patients with FIGO stage IA2 or stage IA1 carcinoma with extensive lymph vascular space invasion benefit from a modified radical hysterectomy with pelvic lymph node dissection. If preservation of fertility is an issue, then conization with extraperitoneal or laparoscopic pelvic lymphadenectomy can be performed. Alternatively, radical trachelectomy with pelvic lymphadenectomy may be a safer procedure. Individualization of therapy based on an exhaustive pathological evaluation of an adequate cone biopsy specimen is of paramount importance for treatment planning and disease control.
- Randomized phase III trial of bleomycin, vindesine, mitomycin-C, and cisplatin (BEMP) versus cisplatin (P) in disseminated squamous-cell carcinoma of the uterine cervix: an EORTC Gynecological Cancer Cooperative Group studyPublication . Vermorken, JB; Zanetta, G; Oliveira, CF; Van der Burg, ME; Lacave, AJ; Teodorovic, IPURPOSE: Three previous mitomycin-cisplatin-based chemotherapy trials conducted within the EORTC Gynecological Cancer Cooperative Group (GCCG) in patients with disseminated squamous-cell carcinoma of the uterine cervix (SCCUC) suggested that with such regimens a higher overall response rate and a higher complete response rate could be obtained compared to what might have been expected from cisplatin alone. In that respect the combination of bleomycin, vindesine (Eldesine), mitomycin C and cisplatin (BEMP) was the most promising. In the present study BEMP has been compared with the best single agent, cisplatin (P) in the expectation that improved response rates might translate into a better survival. PATIENTS AND METHODS: Eligible patients were those with SCCUC and disseminated measurable disease outside previously irradiated areas, aged < or = 75 years, with a WHO performance status < or = 2 and adequate bone marrow, renal, hepatic and pulmonary function, who gave consent according to regulations followed in individual institutions. Patients were randomized to BEMP: E 3 mg/m2 day 1, P 50 mg/m2 day 1, B 15 mg (24-hour infusion) day 2-4 and M 8 mg/m2 (at alternate cycles), or P 50 mg/m2. The first four cycles were given every 3 weeks (induction phase). Subsequent cycles were given every four weeks (maintenance phase), during which B was deleted from BEMP (MEP). Patients failing on P could be treated with BEM. Of the 287 patients entered, 235 were eligible and 201 evaluable for response. RESULTS: BEMP induced a significantly higher response rate than P (42% vs. 25%, P = 0.006). There was no difference in complete response rate (11% vs. 7%). BEMP was significantly more toxic than P (+/- BEM), both with respect to hematologic and nonhematologic toxicities. After a median follow-up of 6.1 years, survival curves were not significantly different. Median progression-free survival and overall survival were 5.3 and 10.1 months with BEMP and 4.5 and 9.3 months with P (+/- BEM), respectively. In a multivariate analysis of prognostic factors for survival, a lower age (P = 0.003), a lower performance status (P = 0.0001) and a short (<1 year) interval since diagnosis (P = 0.0152) were all associated with an increased risk of dying. For progression-free survival, lower age, prior radiotherapy, locoregional involvement and no prior surgery were associated with a high risk. Treatment with BEMP or P had no significant impact on survival, but for progression-free survival there was a trend in favor of BEMP (P = 0.0893). Adjusting for prognostic factors did not change the effect of treatment. CONCLUSIONS: Combination chemotherapy with BEMP produces more toxicity and more responses compared with cisplatin alone in patients with disseminated SCCUC, but this does not translate into a better survival. Therefore, in the palliative setting single-agent cisplatin should remain the standard therapy for these patients.
- Serologic profile of some sexually transmitted diseases in women with squamous intraepithelial lesionsPublication . Gomes, C; Dias, MF; Falcão, F; Oliveira, CFThe purpose of this study consisted of the evaluation of some sexually transmitted diseases in patients with cervical pathology, namely squamous intraepithelial lesions. METHODS: a prospective study was performed. Patients with an abnormal cervical smear were submitted to colposcopy, directed biopsy and an immunologic assay for Chlamydia, Herpes Simplex Virus (HSV) types 1 and 2, Cytomegalovirus, Treponema pallidum, Hepatitis B and Human Immunodeficiency Virus I and II. The same parameters were evaluated in women with normal cervical cytology in a matched control group. A comparative study was performed evaluating some epidemiological parameters and the referred immunologic assays. RESULTS: 118 patients were separated into four groups. Statistically significant differences were observed in the personal history of fungi infections, as well as Chlamydia and HSV 2 IgM. CONCLUSION: immunologic assays may prove useful in identifying sexually-transmitted diseases, especially Chlamydia and HSV 2 infections, in Human Papillomavirus infected women.