Edward Araujo Júnior

Neoadjuvant chemotherapy with carboplatin and paclitaxel in pregnant women with advanced stage cervical cancer: Maternal and perinatal outcomes

Cervical cancer is the third most common cancer in Brazil. Although rare, its diagnosis during pregnancy represents a great challenge for the medical team and the patient. The objective of this study was to evaluate the maternal and perinatal outcomes of pregnant women who underwent neoadjuvant chemotherapy with carboplatin and paclitaxel for advanced stage cervical cancer. This was a descriptive, retrospective study that included pregnant women with advanced stage cervical cancer (IB3 a IIIC1) who were treated at our center over 12 years. These patients received neoadjuvant chemotherapy with carboplatin plus paclitaxel during pregnancy to prevent disease progression. Tumor shrinkage of at least 50 % was observed in four patients, while the disease remained stable in three others. There was one case of fetal death without apparent cause at 29 weeks, but all other mothers were discharged from the hospital at the same time as their healthy newborns. Chemotherapy with carboplatin and paclitaxel administered to pregnant women with advanced stage cervical cancer (IB3 - IIIC1) may have prevented disease progression without worsening neonatal outcomes.

Comparison of high-grade human papillomavirus-induced cervical lesions between human immunodeficiency virus-positive and human immunodeficiency virus-negative women

SUMMARY OBJECTIVE: The aim of this study was to compare the evolution of high-grade human papillomavirus-induced cervical lesions between human immunodeficiency virus-positive and human immunodeficiency virus-negative women. METHODS: Human immunodeficiency virus-positive and human immunodeficiency virus-negative women were enrolled in a retrospective cohort study after undergoing large-loop excision of the transformation zone between January 2008 and December 2017 as participants in the high-grade cervical lesion screening program. The evolution of human papillomavirus lesions induced in human immunodeficiency virus-infected women was evaluated in comparison with the general population. The following potentially confounding variables were examined: age at treatment and at the end of follow-up, histologic grade of treated intraepithelial disease, compromised margins, adequacy of colposcopy during follow-up, and recurrence of histopathologic diagnosis of high-grade squamous intraepithelial lesion. RESULTS: Of the 195 women, 51 were human immunodeficiency virus-positive (26.2%) and 144 were human immunodeficiency virus-negative (73.8%). Age of menarche (11.8±1.5) and sexarche (14.5±2.2) were earlier in human immunodeficiency virus-positive women (p=0.021 and 0.006, respectively). Parity (2.35±109) and number of pregnancies (2.86±1.47) were higher in human immunodeficiency virus-positive women (p=0.027 and 0.018, respectively). The prevalence of incomplete schooling was lower in human immunodeficiency virus-positive women (47.1 vs. 19.8%, p=0.002). Smoking was more common in human immunodeficiency virus-positive women (58.8 vs. 31.9%, p=0.001). Compromised surgical margins were found in 33.3% of human immunodeficiency virus-positive and 16.7% of human immunodeficiency virus-negative women (p<0.001). The risk of recurrence was 37.3% in human immunodeficiency virus-positive and 13.9% in human immunodeficiency virus-negative women (p<0.001). Cumulative survival over months was shortened in human immunodeficiency virus-positive women (p<0.001). CONCLUSION: human immunodeficiency virus-positive women in this cohort had a significantly higher risk of recurrence than human immunodeficiency virus-negative women in addition to shorter overall survival.

Serum hCG levels in the prediction of molar pregnancy below 11 weeks of gestational age

The aim of this study was to evaluate the serum hCG level in the differential diagnosis between non-molar miscarriage and complete hydatidiform mole in16,435 mUI/mL at 6-7 weeks, hCG>64,911 mUI/mL at 8-9 weeks, and hCG >126,278 mUI/mL at 10-11 weeks were most prevalent on complete hydatidiform mole diagnosis. On the contrary, hCG<30,000 mUI/mL at 10-11 weeks was most prevalent in non-molar miscarriage diagnosis.

Is the colposcopic lesion size a predictor of high-grade lesions in young patients?

This study aimed to evaluate whether severity changes with colposcopic lesion size, regardless of age. This retrospective comparative study reviewed the records of 428 women with altered cytopathology reports who were directed by primary health care. Only those women with colposcopic alterations were evaluated (n=411). Histopathological analyses were restricted to patients who underwent excisional treatment (n=345). According to their age, they were grouped into the following: 35 years, and also, ≤24 and ≥25 years. The cytopathological, colposcopic, and histopathological findings were grouped according to severity. Lesion size was subjectively assessed from the colposcopic drawing recorded in the chart and according to the number of quadrants of the total cervical surface affected by colposcopic alterations in the transformation zone. Statistical significance was set at p<0.05. The evaluations suggested that the lesion size was directly related to the severity of the cytopathology, colposcopy, and histopathology reports for the age groups ≤24 or ≥25 years. We observed associations between lesion size and severity of the cytopathology (≤24 years, p=0.037) and histopathology (≥25 years, p=0.003) findings. The size of the lesion was directly related to the severity of the histopathological lesion in patients aged ≥25 years and cytopathological in patients aged ≤24 years.

Atypical placental site nodule detected via hysteroscopy – first case report from Brazil

Atypical placental site nodule (APSN) is a rare form of gestational trophoblastic disease (GTD) originating from the proliferation of intermediate trophoblasts, with uncertain clinical behavior. It is considered a potential precursor to rare forms of gestational trophoblastic neoplasia (GTN), such as placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). This report describes the first Brazilian case of APSN diagnosed via hysteroscopy in a 43-year-old woman following miscarriage. Histopathological analysis revealed a circumscribed, hyalinized aggregate of intermediate trophoblasts with nuclear atypia, positive immunostaining for PLAP and p63, and a Ki-67 index &gt; 5%. The patient declined hysterectomy, opting for conservative management with close monitoring. After 12 months of follow-up, no progression was observed. This case emphasizes the diagnostic challenges of APSN, given its subtle presentation and overlap with benign placental site nodules or even PSTT/ETT. Hysteroscopy proved valuable for both diagnosis and fertility-preserving management. Although hysterectomy remains the definitive treatment in many cases, individualized approaches balancing oncologic safety and reproductive goals are increasingly considered. Long-term clinical vigilance is essential, as APSN may precede aggressive GTN forms. Multicenter studies and registries are urgently needed to establish evidence-based guidelines for the diagnosis, treatment, and follow-up of this rare lesion, improving patient outcomes in these uncommon forms of GTD. Key words: atypical placental site nodule – gestational trophoblastic disease – gestational trophoblastic neoplasia – placental site trophoblastic tumor – epithelioid trophoblastic tumor

Analysis of the epidemiologic, clinical, laboratory, ultrasonographic, and anatomopathological profile of women with hydatidiform mole at two referral centers in Northeastern Brazil

Objective: To determine the profile of women undergoing uterine evacuation for suspected hydatidiform mole (HM) according to their clinical, laboratory, ultrasound, and anatomopathological characteristics at two referral centers in Northeastern Brazil. Methods: Retrospective cohort study was performed in two referral centers between October 2016 and December 2022 with women undergoing uterine evacuation for suspected HM. Socio-demographic characteristics, clinics, biochemistry, ultrasound, anatomopathology, and outcome were evaluated. Results: A total of 507 women were admitted with clinical suspicion of gestational trophoblastic disease, of which 334 were confirmed, with 107 being in Center-1 and 227 being in Center-2. Mean distance between the referral center and the patient‘s home was 88 km. Mean age of the women was 27 ± 9 years, with a predominance of 19 to 39 years (72%), and approximately 60% of the cases were diagnosed ≤ 12 weeks of gestation. Vaginal bleeding was observed in 79% of women. Transvaginal ultrasound showed a typical appearance in 90% of the examinations. The macroscopic aspect was described as a vesicle in 70% of cases. Uterine evacuation was mainly performed by uterine curettage (43%). The majority of women had no complications (69%). The outcome considered to be remission was achieved in 37.1% of cases, but 38.9% abandoned follow-up, and 9% did not start follow-up after hospital discharge. Conclusion: The distance traveled by women to the referral centers was significant, but the majority of women had no complications. Remission was observed in 37.1% of women, but there was a high abandonment rate of 38.9%. Key words: hydatidiform mole – clinics – ultrasound – anatomopathology – outcomes

Pap smear and colposcopy findings in female inmates of a prison unit in the state of Sao Paulo, Brazil

Objective: The objective of this study was to evaluate the Pap smear and colposcopy findings in female inmates in a prison unit in the state of Sao Paulo, Brazil. Methods: A retrospective cross-sectional study was carried out by analyzing the Pap smear and colposcopy examinations of female inmates in a prison unit. The fol lowing socio-demographic data were assessed: age, nationality, level of education, marital status, height, weight, ethnicity, occupation, religion, sexual orientation, and presence of tattoos. Results: The sample consisted of 894 women who had a Pap smear, the majority of whom were Brazilian (93.6%), 41.1% had an incomplete primary education, 58.5% were single, 50.1% were white, 60.7% had tattoos, and the predominant religion was Catholicism at 42.8%. Regarding sexual orientation, 124 (13.9%) women identified as bisexual, 640 (71.6%) as heterosexual, and 127 (14.2%) as homosexual. Most Pap smears showed benign findings (86.5%). Of the female inmates who had a Pap smear, 121 (13.5%) were referred for colposcopy. Altered colposcopy findings occurred in 95 (10.6%), with the most common findings being high-grade squamous intraepithelial lesions 36 (4.0%) and low-grade squamous intraepithelial lesions 27 (3.0%). The majority of women (96.0%) had no clinical signs of human papillomavirus – HPV (anogenital verrucous lesions) and only 36 (4.0%) had lesions suggestive of HPV on Pap smears. There were more HIV cases in the group with HPV verrucous lesions (P = 0.013). Conclusion: We observed 13.5% and 78.5% of abnormal findings in Pap smears and colposcopy, resp.), in female inmates in a prison unit in the state of Sao Paulo, Brazil. Key words: prison – female inmates – Pap smear – colposcopy – HPV

Elastographic and vascular findings of uterine myomas assessed by ultrasound

AbstractObjectiveThe objectives of this study were to evaluate the vascularization pattern of uterine myoma (UM) by ultrasonography using Superb Microvascular Imaging (SMI) and tissue stiffness elastography.MethodA prospective and cross‐sectional study was carried out between March 2020 and December 2022 among women with clinical and ultrasound diagnosis of UM who would subsequently undergo radiofrequency ablation. Ultrasound examination was performed using both transvaginal and transabdominal routes. UM vascularization pattern was assessed by power Doppler (PD) and SMI, while elastographic pattern was assessed by shear wave (SWE) and strain (STE). FIGO classification, location, and measurement of the largest UM were also described.ResultsA total of 21 women diagnosed with UM were evaluated. There was a predominance of nulliparous women and 20 women (95.2%) reported desire for pregnancy. Of the 18 women with abnormal uterine bleeding, 15 (83.3%) had abdominal cramping. As far as previous treatment, 7 (33.3%) had undergone myomectomy for other UM. The mean uterine and UM volumes were 341.9 cm3 (90–730) and 126.52 cm3 (6.0–430), respectively. There was a predominance of hypoechogenic lesions (90.5%). There was also preponderance of UM in the FIGO 2–5 classification (n = 9; 42.9%). Vascularization patter was mostly moderate (score 2) in 9 cases (42.9%). The majority of UM were considered to have intermediate stiffness (n = 10; 47.6%).ConclusionThe majority of UM showed vascularization and moderate stiffness. A relationship was observed between the stiffness of the UM assessed by elastography and its FIGO classification.

Vaginal leiomyoma: Advantages of clinical sonovaginography and ultrasound dynamic evaluation of uterine cervix‐related lesions

Abstract Evaluation of vaginal leiomyoma by dynamic transvaginal ultrasound improves the diagnosis, with the impact on surgical planning, and surgical outcomes. Sonovaginography using three‐dimensional ultrasound allows the assessment of spatial relationship between the cervix and the tumor.