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Advisor(s)
Abstract(s)
No presente artigo é relatado um caso de uma paciente de 42 anos, diagnosticada em 2011 com Adenocarcinoma in situ e displasia grave do epitélio de revestimento pavimentoso, que foi tratada por traquelectomia. Em Novembro de 2013, a paciente realizou uma citologia da cúpula vaginal, onde se observaram achados citológicos compatíveis com lesão intraepitelial de baixo grau mas também a presença de células que favorecem o diagnóstico de lesão intraepitelial de alto grau. Não sendo possível classificar a lesão intraepitelial como sendo claramente baixo ou alto grau, atribuiu-se a interpretação de lesão intraepitelial de grau indeterminado. Para confirmação e esclarecimento do diagnóstico foi efetuada biopsia com resultado de displasia grave do epitélio de revestimento pavimentoso vaginal sem evidência de invasão do estroma. Por fim foi indicada a pesquisa e tipificação de vírus do papiloma humano, com resultado positivo para o tipo 16. Diagnósticos citológicos de lesão intraepitelial de grau indeterminado apresentam um follow-up histológico estatisticamente diferente das lesões intraepiteliais de alto e baixo grau, e estão na sua maioria associadas a infeção por vírus do papiloma humano de alto risco. Os achados citológicos do presente estudo apoiam a necessidade de se estabelecer esta lesão como categoria de diagnóstico no Sistema de Bethesda, com um follow-up definido.
ABSTRACT - This article reports a case of a 42 year-old female patient diagnosed in 2011 with adenocarcinoma in situ and severe cervical intraepithelial neoplasia that was treated with trachelectomy. In November 2013 a vaginal vault cytology was performed, with cytological findings consistent with low-grade squamous intraepithelial lesion but also with the presence of cells that favour the diagnosis of high-grade intraepithelial lesion. Since it was not possible to grade the lesion as clearly low or high, it was attributed the result of squamous intraepithelial lesion of undetermined grade. In order to confirm and clarify the diagnosis, a biopsy was performed which showed results of severe squamous intraepithelial neoplasia without evidence of stromal invasion. Finally, the specimen was tested for human papillomavirus genotype, with a positive result for type 16. Cytologic diagnosis of intraepithelial lesions of undetermined grade present histologic outcomes that are statistically different from intraepithelial lesions of high and low grade, and are mostly associated with infection by high-risk human papillomavirus. This findings support retaining intraepithelial lesions of undetermined grade as a unique category in the Bethesda System, and define the management guidelines for this patients.
ABSTRACT - This article reports a case of a 42 year-old female patient diagnosed in 2011 with adenocarcinoma in situ and severe cervical intraepithelial neoplasia that was treated with trachelectomy. In November 2013 a vaginal vault cytology was performed, with cytological findings consistent with low-grade squamous intraepithelial lesion but also with the presence of cells that favour the diagnosis of high-grade intraepithelial lesion. Since it was not possible to grade the lesion as clearly low or high, it was attributed the result of squamous intraepithelial lesion of undetermined grade. In order to confirm and clarify the diagnosis, a biopsy was performed which showed results of severe squamous intraepithelial neoplasia without evidence of stromal invasion. Finally, the specimen was tested for human papillomavirus genotype, with a positive result for type 16. Cytologic diagnosis of intraepithelial lesions of undetermined grade present histologic outcomes that are statistically different from intraepithelial lesions of high and low grade, and are mostly associated with infection by high-risk human papillomavirus. This findings support retaining intraepithelial lesions of undetermined grade as a unique category in the Bethesda System, and define the management guidelines for this patients.
Description
Keywords
Anatomia patológica Citologia ginecológica Lesão intraepitelial Displasia grave vírus do papiloma humano tipo 16 Vaginal cytology Intraepithelial lesion Severe dysplasia Human papillomavirus type 16
Citation
Almeida B, Mendonça P, Fagulha R. Citologia da cúpula vaginal com suspeita de lesão intraepitelial de grau indeterminado: estudo de caso. Citotech Online. 2015;1(1):8-13.