Objective: To compare the efficacy of fractional CO2 laser therapy with topical estrogen therapy for the treatment of postmenopausal genitourinary syndrome of menopause. Methods: We conducted a randomized controlled clinical trial involving 25 postmenopausal women. Participants were aged between 50 and 65 years with at least 1 year of amenorrhea and follicle-stimulating hormone levels of >40 IU/L. The women were randomized into two groups: the laser therapy group (n = 13) and the vaginal topical estrogen therapy group (n = 12). Changes in the vaginal epithelium thickness, Frost index, and cell maturation were analyzed in both the groups. The female sexual quotient of each woman was also evaluated. Subjective evaluation was performed through a physical examination. Results: Histological analysis showed a significant increase in the vaginal epithelium thickness at the end of treatment in females in both the laser therapy (P < 0.001) and topical estrogen therapy (P = 0.001) groups. The topical estrogen therapy group tended to present a higher maturation index at the end of treatment when compared with that of the other group. Sexual function increased significantly over time in both the topical estrogen therapy (P < 0.001) and laser therapy (P < 0.001) groups. Subjective evaluation through physical examination showed a significant improvement in atrophy in both the groups. Conclusion: Despite the nonequivalence with topical estrogen therapy, our data suggest that laser therapy is an effective method for the treatment of vulvovaginal atrophy.

Identifying factors, including human papillomavirus (HPV) genotypes, associated with abnormal anal cytology in HIV-infected women have implications for anal squamous cell cancer (SCC) prevention in HIV-infected women. Anal and cervical samples were collected for cytology, and tested for high-(HR-HPV) and low-risk HPV (LR-HPV) genotypes in a cross-sectional analysis of the IPEC Women's HIV Cohort (Rio de Janeiro, Brazil). Multivariate log-binomial regression models estimated prevalence ratios for factors associated with abnormal anal cytology [ ‡ atypical squamous cells of undetermined significance, (ASC-US)]. Characteristics of the 863 participants included: median age 42 years, 57% non-white, 79% current CD4 + T-cell count > 350 cells/mm 3 , 53% HIV-1 viral load < 50 copies/mL, median ART duration 5.8 years. Fifty-one percent of anal specimens contained ‡ 1 HR-HPV genotype; 31% had abnormal anal cytology [14% ASC-US, 11% low-grade squamous intra-epithelial lesion, (LSIL); 2% atypical squamous cells-cannot exclude high-grade SIL (ASC-H); 4% high-grade SIL/cancer (HSIL + )]. In multivariate analysis, cervical LSIL + , nadir CD4 + T-cell count £ 50 cells/mm 3 , HIV-1 viral load ‡ 50 copies/mL, and anal HPV 6,11,16,18,33, 45, 52, 56, and 58 were associated with ‡ anal ASC-US ( p < 0.05). Abnormal anal cytology and HR-HPV prevalences were high. HIVinfected women with cervical LSIL + , low nadir CD4 + counts, or detectable HIV-1 viral loads should be a particular focus for enhanced anal SCC screening efforts.

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Compared to other organs, the eyes are relatively infrequent sites of metastasis. In a landmark case series, Ferry and Font described 227 cases of carcinoma metastatic to the eyes.1,2 Among these cases, only 28 (12%) were orbital metastases, most frequently from tumors of the breast, lung, and genitourinary tract; in this series, the diagnosis of orbital metastasis preceded the diagnosis of the primary tumor in 61% of cases.2 Metastases represent from 1% to 13% of orbital tumors, the rest being accounted for by primary tumors. We present the case of a patient in whom orbital metastasis was the first manifestation of cancer.

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...

Hemangiopericytomas are rare tumors arising from the proliferation of pericytes. They may be found in the lungs, bones, skull, deep soft tissue or limbs. The tumor has an unpredictable prognosis and when it affects the orbital region, may have an aggressive behavior, with high incidence of recurrence. We report a case of orbital hemangiopericytoma and highlight clinical, surgical, and histopathological features of these tumors. Orbital hemangiopericytomas usually are solid, slow-growing tumors. They should be considered in the differential diagnosis of well-defined orbital masses along with epidermoid cysts, schwannomas, neurofibromas, fibrous histiocytomas, lipomas, and vascular malformations. The diagnosis is confirmed by anatomopathologic examination and sometimes complemented by immunohistochemistry. Complete excision of the tumor with wide margins is usually curative; however, radiotherapy and chemotherapy may be required for recurrent lesions.Keywords: Hemangiopericytoma. Neoplasms, vascular tissue. Orbit/surgery. RESUMOHemangiopericitomas são tumores raros originados a partir da proliferação de pericitos, ou seja, células que envolvem os capilares. São encontrados em ossos, pulmões, crânio, partes moles profundas ou membros inferiores, principalmente na coxa. É considerado um tumor com potencial de malignidade incerto e quando afeta a região orbitária pode apresentar um comportamento biológico agressivo, com grande chance de recidiva. O ob jetivo deste trabalho é relatar um caso de hemangiopericitoma orbital e destacar suas características clínicas, cirúrgicas e histopatológicas. Usualmente, os hemangiopericitomas da órbita são tumores sólidos, únicos e de crescimento lento. Devem ser lembra dos no diagnóstico diferencial dos tumores orbitários bem delimitados, como cistos epidermoides, schwannomas, neurofibromas, fibro-histiocitomas, lipomas e malformações vas culares. A confirmação diagnóstica é realizada pelo exame anatomopatológico e, por vezes, complementada pelo estudo imuno-histoquímico. O tratamento deve ser realizado com exérese completa do tumor, com margens amplas, sendo a radioterapia e a quimioterapia reservadas para casos de lesões reincidentes.Descritores: Hemangiopericitoma. Neoplasias de tecido vascular. Órbita/cirurgia.