Congenital syphilis (CS) is an important health problem in Chile, with a rate of 0.25/1,000 live newborn (NB) during year 2004. In 2000, the Chilean Ministry of Public Health recommended to perform a screening in cord blood at the moment of delivery. Instead, the Centers for Disease Control and Prevention guidelines recommend the screening in maternal serum since cord blood has up to 5% of false (-) versus 0.5% of maternal serum, both with respect to the NB serum. Objective: Maternal serum and NB cord blood were studied during one year to determine the best screening method at delivery. Methods: RPR was performed and positive results were confirmed by treponemic test (immunochromatographyDetermine®, ELISA Captia®, Ig and IgM, and MHA-Tp). Serologically confirmed patients were evaluated by the specialist to define CS cases. Results: Between June 1999 and August 2000 2,741 binomies were studied; of these, 37 (1.3%) were RPR reactive and 2.704 were non-reactive. In 11 of the 37 reactive cases, mother and NB were RPR reactive (Group I), in 9 cases the NB was RPR reactive and the mother was non-reactive (Group II), and the other 17 were NB non-reactive and mother reactive (Group III). In group I, 7/11 (64%) were true (+)s and 4/11(36%) false (+)s of RPR. In group II, 9/9 (100%) corresponded to false (+)s of RPR in cord blood, and in group III, 11/17 (65%) corresponded to false (+)s of RPR in maternal blood but 6/17 (35%) were found to be cases of syphilis during pregnancy. Three of them were not treated opportunely and were designed as CS. In total 9 NB corresponded to CS (6 in group I and 3 in group III). If the screening had been performed only in cord blood, three NB with CS would have not been diagnosed. Conclusion: Even when maternal serum has a high rate of false (+)s, it has better sensitivity than cord blood for the diagnosis of CS, thus it is suggested to perform the screening at delivery with maternal serum instead of cord blood samples.
RESUMENSe presenta el caso clínico de una paciente de 42 años con diagnóstico de adenocarcinoma seroso papilar del cuello uterino etapa Ib1 tratada mediante histerectomía radical más linfadenectomía pélvica bilateral. El estudio anatomopatológico demostró bordes quirúrgicos libres y ausencia de enfermedad metastásica ganglionar por lo que se consideró a la paciente tratada. Este es el primer caso de adenocarcinoma seroso papilar del cuello uterino reportado en el país. Hay que descartar el compromiso cervical secundario por tumores serosos de endometrio, ovario o trompa antes de plantear el origen primario de cuello uterino.No se conoce el real comportamiento, pronóstico y óptimo tratamiento en este tipo de tumores. La determinación de los niveles de CA-125 basal y seriados durante el seguimiento pudiese ser de utilidad en la evaluación del tratamiento realizado y en la sospecha de enfermedad persistente o recidivada.PALABRAS CLAVE: Adenocarcinoma seroso papilar, cervix SUMMARY A 42 year old patient with a diagnosis of serous papillary adenocarcinoma of the cervix stage Ib1 treated by radical hysterectomy and bilateral lymphadenectomy is reported. The patient was considered treated because the pathology study did not demonstrate tumor outside the cervix or lymphatic nodes. The serous papillary adenocarcinoma of the uterine cervix is an extremely infrequent tumor and therefore compels to discard a secondary cervical involvement by serous tumors derived from the endometrium, ovary or tube. This is the first chilean case reported.The prognosis and optimum treatment of these tumors is still uncertain. Basal Ca-125 and then during the follow-up could help in evaluation of treatment as well as in the suspicion of persistent illness or recidives. KEY WORDS: Serous papillary adenocarcinoma, cervix Casos Clínicos INTRODUCCIÓNEn Chile, el cáncer de cuello uterino es la principal neoplasia maligna de origen ginecológico, excluido el cáncer de mama. El 80% a 90% de los casos corresponde a carcinoma escamoso, el 10% a 20% a adenocarcinoma y el resto por los excepcionales casos de melanomas, sarcomas y metás-tasis. En las últimas décadas se ha observado un sostenido aumento en la proporción de adenocar-
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