VEGF and podoplanin (PDPN) have been identified as angiogenesis and/or lymphangiogenesis regulators and might be essential to restrict tumor growth, progression, and metastasis. In the present study, we evaluate the association between the expression of these markers and CIN grade. Immunohistochemistry was performed in 234 uterine cervical samples using conventional histologic sections or TMA with the monoclonal antibodies to VEGF (C-1 clone) and podoplanin (D2-40 clone). Positive-staining rates of VEGF in 191 CIN specimens were significantly associated with histological grade (P < 0.001). Negative and/or focal immunostaining for PDPN were more frequent in CIN 3 (P = 0.016). We found that patients with CIN 3 more frequently had strong and more diffuse staining for VEGF and diminished staining for PDPN (P = 0.018). Strong and more diffuse VEGF immunoexpressions in CIN 2 and CIN 3 were detected when compared to CIN 1. Negative and/or focal PDPN immunoexpression appear to be more frequent in CIN 3. Moderate to strong VEGF expression may be a tendency among patients with high-grade lesions and diminished PDPN expression.

Aim: To evaluate cyclin-dependent kinase inhibitor 2A (CDKN2A) and cytokeratin 7 (CK7) expression in cervical intraepithelial neoplasia (CIN) formalin-fixed samples. Materials and Methods: Staining with antibody clones G175-405 for CDKN2A and OV-TL 12/30 for CK7 were evaluated and the detection of protein expressions were compared in 147 patients with CIN. Results: Clinical follow-up of patients with CIN1 and CIN2 showed that most patients had a favorable outcome. Single CDKN2A or CK7 expression and their combined expression had a greater sensitivity and negative predictive value in CIN1, corresponding to the non-development of the disease. The positive predictive value of CDKN2A was greater than that of CK7. Combined expression of CDKN2A and CK7 showed that the sensitivity, specificity, positive predictive values, and negative predictive values had their maximum index in the CIN1 group. Analysis of combined expression of CDKN2A and CK7 showed that 85.7% of patients presented unfavorable clinical outcomes, with positive expression for both markers identified in CIN2. Conclusion: Combined expression of CK7 and CDKN2A was associated with a better diagnosis of CIN, and negative expression in CIN1/2 groups had a greater negative predictive value for patient clinical outcome.Persistent cervical infection caused by high-risk human papillomavirus (HPV) is necessary for the development of precursor lesions and cervical cancer (1). Although carcinogenesis does not progress in the majority of infected women, cervical cancer is still the second leading cause of cancer-related deaths worldwide (2, 3). Cervical intraepithelial neoplasia (CIN), and squamous intraepithelial lesion (SIL) correspond to different stages of epithelial proliferation of undifferentiated basal cells. This progresses from CIN1 [lowgrade (L)SIL], which is very similar to normal fullydifferentiated squamous epithelium, to high-grade CIN (CIN2/3) or high-grade (H)SIL, containing mostly undifferentiated cells, and then to cervical carcinoma (4-6). CIN1 (LSIL) and CIN3 (HSIL) are more easily classified, justifying conservative management for the former and ablation for the latter (6). However, the intermediate point of distinction for CIN2, between CIN1 and CIN3, is not always clear-cut; there is a significant, well-known interobserver variability in this diagnosis. Thus, the Lower Anogenital Squamous Terminology (LAST) Project recommends the use of p16 immunohistochemistry as an adjunct to the morphological assessment of biopsies when the differential diagnosis includes high-grade lesions (7, 8).Cyclin-dependent kinase 2A (CDKN2A) protein, also known as p16 INK4A , is a CDK inhibitor that blocks CDK4-and CDK6mediated phosphorylation of RB transcriptional corepressor 1 (RB) to inhibit E2F-dependent transcription and cell-cycle progression (9). It is a tumor-suppressor located at chromosome 9p21 (10), and it has been shown to be a surrogate marker of high-risk (HR) HPV oncogenic activity (11). Immunostaining of CDKN2A has an important value in the diagnosti...

No abstract

A colpocitologia oncótica cérvico-vaginal é um importante exame de rastreio de câncer do colo do útero que deve ser realizado pelas mulheres com periodicidade, inclusive durante a gravidez. Apesar de não ser seu objetivo principal, o exame é capaz de diagnosticar algumas espécies de parasitas vaginais, mesmo em pacientes assintomáticas. O objetivo desse estudo foi relatar um caso de gestante com parasitose vaginal diagnosticada e tratada no Núcleo de Prevenção de Doenças Ginecológicas da Escola Paulista de Medicina da Universidade Federal de São Paulo. O presente documento relata o caso de uma gestante primigesta que foi encaminhada ao serviço terciário por quadro de sangramento vaginal persistente no primeiro trimestre gestacional e que, durante investigação, teve o diagnóstico de vaginite e o achado raro de ovos de Enterobius vermicularis na citologia oncótica cérvico-vaginal. O sucesso do tratamento não é o principal desafio, mas a prevenção de reinfecção ou autoinfecção. Para isso, hábitos de higiene devem ser incentivados a todos os membros da casa, como: lavar as mãos com frequência, evitar coçar o ânus, realizar higiene diária íntima no sentido ântero-posterior (ou seja, da região genital para a região anal) e não compartilhar toalhas e itens de higiene pessoal.

Objetivo: Relatar um caso da Síndrome de Vogt-Koyanagi-Harada em uma mulher e o tratamento do vitiligo. Detalhamento do caso: Trata-se de um relato de caso, apreciado e aprovado pelo Comitê de Ética em Pesquisa local, aprovado sob o número do CAAE 61783722.3.0000.5505. Paciente feminina, 39 anos, parda, casada, ajudante geral, natural e procedente de São Paulo, com queixa de mancha acrômica em vulva, realizou tratamento com tracolimo com melhora clínica. A paciente realizou o tratamento da síndrome com azatioprina e na região da mancha acrômica vulvar com tacrolimo com repigmentação total. A Síndrome de Vogt – Koyanagi – Harada conhecida como síndrome uveomeningoencefálica é caracterizada por uma panuveíte bilateral crônica, comprometimento neurológico, auditivo e cutâneo. Considerações finais: Considera-se que a doença é de etiologia autoimune celular – mediada que atinge os melanócitos. Considerando-se a diversificação das manifestações clínicas, muitas vezes, seu diagnóstico se torna difícil ou delongo. Diante dessa realidade, é imperativo considerar tratamentos que envolvam efeito imunossupressor, para que a paciente consiga atingir o tratamento em sua totalidade.