Câncer de Mama Multifocal: Relato de Caso

Introdução: O câncer de mama é a neoplasia que mais acomete o sexo feminino, sendo a primeira causa de morte por câncer em mulheres. O carcinoma mamário representa um grupo heterogêneo de doenças. Casos individuais diferem uns dos outros na morfologia, fenótipo e prognóstico. As patologias malignas das mamas podem se manifestar como tumores unifocais, multifocais e/ou multicêntricos. A incidência de tumores multifocais e multicêntricos no câncer de mama varia de 13% a 70%. Relato do caso: Paciente L.C., sexo feminino, 65 anos, com relato de nódulo palpável em mama direita em setembro de 2015. O estudo anatomopatológico do nódulo mostrou carcinoma intraductal. Realizada quadrantectomia, com anatomopatológico que identificou carcinoma papilífero bem diferenciado intracístico e invasivo da mama, associado a componente intraductal cribriforme e papilar, com margens e linfonodo sentinela livres e imuno-histoquímica compatível com perfil triplo-negativo. Em fevereiro de 2019, apresentou duas novas lesões em mama contralateral, identificadas como carcinoma ductal invasivo multifocal com papiloma intraductal associado, e carcinoma ductal invasivo associado a componente intraductal in situ dos tipos papilar, sólido e cribriforme, com imuno-histoquímica com perfis moleculares distintos entre si, sendo uma lesão do tipo luminal A e a outra, luminal híbrido. Conclusão: Este estudo relata um caso de uma paciente que apresentou lesões neoplásicas em ambas as mamas, em tempos distintos e com perfis histológicos e imuno-histoquímicos diferentes. Dessa forma, destacam-se a raridade do caso e a relevância da terapia dirigida a alvos específicos, uma vez que a paciente apresentava lesões com perfis moleculares distintos.

High-risk HPV clearance and CIN 3 treated with MAL-PDT: A case report

High-grade cervical intraepithelial neoplasia (CIN) is the precursor to cervical cancer. HPV (human papillomavirus) infection is strongly related with this disease. The CIN treatment is generally excision of the transformation zone (ETZ). Photodynamic therapy (PDT) has also shown to be a promising treatment. We are reporting a case of a 33-years-old patient with high-grade CIN 3 treated with topical MAL (methyl aminolevulinate) PDT. Was applied 2.5 g of 20 % (w/w) MAL cream overnight and the cervix was illuminated twice, with three weeks apart, using a probe with LEDs simultaneously with a cylindrical laser fiber emitting both at 630 nm, with a fluency of 150 J/cm². CIN 3 and the presence of high-risk HPV virus was eliminated 120 days after the second procedure. There was no recurrence at 6 months follow-up. This case report using MAL-PDT and a different light arrangement with LEDs and laser fiber associated both cured the patient with CIN 3 and eliminated low and high-risk HPV in just two PDT sessions.

Long Term Effectiveness of Photodynamic Therapy for CIN Treatment

(1) Background: Cervical cancer is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in women worldwide. The highest incidence rates are in Africa, followed by South-Central Asia and South America. According to the Brazilian National Institute of Cancer (INCA), 16,370 new cases of cervical cancer were estimated for each year of the biennium of 2018-2019. About 90% of cervical cancers originate from the malignant progression of cervical intraepithelial neoplasia (CIN) which is classified based on cytohistological characteristics (low- and high-grade lesions). The present study reports the long-term effectiveness of topical photodynamic therapy (PDT) for CIN grades 1 and 2/3 with up to two years of follow up. (2) Methods: A total of 56 patients with CIN 1, ten with CIN 2, and 14 patients for the placebo group were enrolled in this study. (3) Results: 75% (n = 42) of CIN 1 patients presented a complete response to PDT and only 23.2% (n = 13) of recurrence, progression, and/or lesions remaining two years after PDT. For CIN 2/3 patients, 90% were observed to be cured after one and two years of follow up. (4) Conclusions: PDT presented best results two years after a non-invasive, fast, and low-cost procedure and in comparison with the placebo group, preventing the progression of cervical intraepithelial neoplasia and preserving the cervix.

Prognostic factors for response to chemotherapy in advanced tumors of the uterine cervix: the role of neoangiogenesis

OBJECTIVE

to analyze the expression of Vascular Endothelial Growth Factor (VEGF), its receptor (VEGFR-2), age and histological type of advanced cervical carcinomas with respect to the clinical response to neoadjuvant chemotherapy.

METHODS

we studied 40 patients with cervical carcinoma (IB2 and IVA) diagnosed by biopsies prior to treatment. All patients underwent neoadjuvant chemotherapy and evaluation for clinical response and expression of VEGF. We considered a tumor regression greater than 50% as a good clinical response.

RESULTS

eighteen patients (45%) had good response to chemotherapy, and 22 (55%), poor response. VEGF expression was positive in 16 patients and negative in 24. When analyzed separately for response to chemotherapy, only the positive expression of VEGF was associated with good clinical response (p=0.0157).

CONCLUSION

VEGF expression alone was an important marker of good response to neoadjuvant chemotherapy in patients with advanced carcinoma of the cervix.

Posteroventral medial pallidotomy in Parkinson's disease

There has been a resurgence in the use of functional neurosurgery for Parkinson's disease. An important factor that has played a role in this development is the recent understanding of the functional anatomy of the basal ganglia including a knowledge of the changes in the activities of neurons in the internal segment of the globus pallidus (Gpi) and the subthalamic nucleus (STN) in Parkinson's disease as well as the knowledge of the presence of segregated functional loops within the basal ganglia which include a sensory-motor loop that involves the posteromedial globus pallidus rather than the anterior GPi where earlier pallidotomy lesions had been made. Laitinen reintroduced the modern posteroventral medial pallidotomy (PVMP) in 1992. Since then it has become clear that this treatment has major effects on levodopa-induced dyskinesias and, unlike Vim thalamotomy, improves bradykinesia and rigidity as well as tremor. In this report, we review a number of topics related to PVMP including the clinical results of pallidotomy available in the literature as well as an update of our own 2 year follow-up data, studies evaluating factors that might predict the subsequent response to pallidotomy, the neuropsychological effects of the procedure, results of imaging studies including the correlation of clinical effects with lesion location, the question of bilateral pallidotomy and pallidotomy combined with deep brain stimulation and finally whether PVMP is effective in other parkinsonian disorders.

Wellness intervention with pregnant soldiers

The purpose of this study was to measure the effects that wellness program intervention for pregnant soldiers, exercise and/or education, had on methods of delivery, pregnancy outcomes, rates of complications, Army Physical Fitness Test scores, and labor and delivery costs. The study consisted of a retrospective review and analysis of 823 active duty Army obstetric and newborn records, 181 Army Physical Fitness Test records, and 411 initial and 148 postpartum subjective questionnaires. Data were collected from records of soldiers who delivered at Madigan Army Medical Center (Tacoma, Washington) between January 1992 and December 1994. Group I (N = 211) included soldiers who received wellness intervention, group II (N = 147) included those who did not receive wellness intervention. Limited data from the records of soldiers who delivered before a wellness program was offered on post constituted group III, a historical control group (N = 413). Group IV included data from a high-risk population (N = 52) collected during the wellness program. Data were also divided into additional subgroups to ascertain if one aspect of the wellness program (i.e., exercise versus education) influenced any or all of the dependent variables. A soldier's data were excluded if a pregnancy was terminated before 20 weeks of gestation or if it was a multiple gestation. Demographic data and variables were compared using multivariate methods of analysis to evaluate the effect of the independent variable, wellness intervention. Results indicated that infants of the wellness group participants had proportionately increased gestational age and birth weight, with reduced incidence of the complications fetal bradycardia, hyperbilirubinemia, preeclampsia, and premature labor. Likewise, African-American female soldiers in this study, assessed in other studies as a high-risk group, had a lower incidence of premature delivery and low birth weight when they participated in wellness intervention. Of clinical interest, it appeared as though wellness intervention shortened labor duration and reduced the number of neonatal intensive care unit admissions and the number of neonatal intensive care unit days, which resulted in reduced health care costs.