Although indicative, none of the studied morphological criteria was always related to PCR virus detection, denoting some limitations for histological diagnosis.

The aim was to correlate histological findings in cervix lesions to human papillomavirus (HPV), as detected by polymerase chain reaction (PCR). One hundred and seven women with atypical Pap smear were submitted to colposcopic examination, and suspicious images were biopsied. The PCR assay was performed with the primers MY09/11 and GP05/06+ and, as control, the beta-globin gene was amplified. The morphological findings were correlated to HPV positivity: parakeratosis, acanthosis, koilocytotic atypia (KA), binucleation, dyskeratosis, and number of mitoses. From 107 patients, 61 biopsies were taken: 11 chronic cervicitis (CC), 36 cervical intraepithelial neoplasia (CIN) (13 CIN I; 10 CIN II; 13 CIN III), and 14 suggestive for HPV (SHPV). DNA extraction was not possible in eight cases. HPV was found in 35% CC, 77% CIN, and 64% SHPV. The analysis did not indicate any morphological criteria strongly related to HPV. The findings with highest sensitivity for HPV were KA (88.89%) and binucleation (75%), but with low specificity of 29.41 and 52.94%, respectively. The higher predictive positive values (PV+) for HPV were also KA (72.73%) and binucleation (77.14%). Considering KA, dyskeratosis and binucleation together, PV+ was 72.41%. Conclusion: Although indicative, none of the studied morphological criteria was always related to PCR virus detection, denoting some limitations for histological diagnosis.

Material teórico produzido a múltiplas mãos por docentes e colaboradora(e)s que auxiliaram na construção da Disciplina de Medicina Legal, vinculada ao Departamento de Saúde Coletiva da Faculdade de Ciência Médicas da Unicamp. Abordam-se tópicos relacionados à perícia médico legal na pessoa viva, amostras biológicas e no cadáver; deontologia médico legal, conceitos e reflexões sobre conflitos éticos, legislação, condutas com foco na valorização da autonomia e dignidade humanas; temas que surgiram por meio da discussão e construção coletiva ao lado do corpo discente. Mais que um instrumento de apoio, é um convite à pessoa curiosa a penetrar no complexo campo da Medicina Legal e Perícia Médica que se conectam com a Filosofia, Bioética, Direito, Medicina, Biologia, Física, Engenharia e outros conhecimentos. Junta(o)s, auxiliam na produção da verdade em relação às questões colocadas pela(o)s operadora(e)s de Direito nos processos judiciais e auxiliam a iluminar profissionais da saúde em relação às melhores condutas.

Human papillomavirus (HPV) is associated to uterine cervical intraepithelial neoplasia (CIN) and has an important role in cevical cancer. Subjective differences in evaluation lead to disagreement among examiners in relation to the cytological and histological diagnosis of HPV infection, which can lead to changes in clinic manegement. The aim of the present study was to test the histological and cytological criteria used for detection of HPV in uterine cervix, by comparing to the presence of viral DNA as detected by PCR. By cytological screening, 107 women with atypia were submitted to colposcopy, when new samples were collected for cytology and PCR and suspicious images were biopsied. The PCR assay was performed with primers MY09/11 and GP05/06+ and, as control, beta-globin was amplified. For cytological analysis, 101 samples were selected (6 excluded due to fixation artifacts) and 61 biopsies taken.DNA extraction was not possible in 8 cases. Parakeratosis, acanthosis, koilocytotic atypia, binucleation, dyskeratosis and number of mitoses were assessed histologically; and clear perinuclear halos, irregularly distributed chromatin, hyperchromatic nuclei, increased nuclear-cytoplasmic ratio, irregular nuclear outline, binucleation (in superficial and immature cells), indian files, formation of syncytia with atypia (in immature cells only) and dyskeratosis were examined in cytological preparations. The histological diagnoses were: 11 chronic cervicitis (CC); 36 CIN (13 CIN I; 10 CIN II; 13 CIN III) and 14 suggestive of HPV (SHPV). HPV was found in 37.5% of CC, 77.4 % of CIN (91.7% of CIN I, 66.7% of CIN II and 70% of CIN III) and 64.3% of SHPV.Among the histological criteria, the most highly correlated to HPV were koilocytotic atypia (positive predictive value or PPV = 72.7%) and binucleation (PPV = 77.1%).However, specificity was low: 29.4% and 52.9% respectively. Taken together, koilocytotic atypia, dyskeratosis and binucleation showed PPV of 72.4%. They could be used as markers of HPV infection, but false positive results were found in 27.6%.Among cytological criteria associated to immature cells for detection of CIN III, formation of syncytia with atypia had the highest PPV (69.2%), followed by irregularly distributed chromatin (62.5%).The negative predictive values (NPV) for HPV-DNA involving superficial or immature cells were low (about 40%). PPV were relatively high, ranging from 50% to 93.9%

Neste capítulo abordaremos: noções do conceito de identidade e identificação, finalidades, princípios fundamentais que estruturam e orientam os métodos; técnicas de identificação de pessoas e amostras biológicas; papel do polimorfismo dos marcadores biológicos do DNA; técnica de PCR aplicada à perícia envolvendo amostras biológicas, teste de vinculação genética (paternidade); procedimentos no laboratório, análise de resultados, laudos; possibilidade de ERROS em DNA.