P16INK4A en el diagnóstico diferencial entre atrofia cervicouterina y neoplasia intraepitelial cervical de alto grado (NIC III): reporte de caso

Lía Barrios; Orlando Borre; Eusebio Contreras

doi:10.31403/rpgo.v58i99

Authors

Lía Barrios Médico especialista en patología
Orlando Borre Médico especialista en obstetricia y ginecología
Eusebio Contreras Estudiante de medicina

DOI:

https://doi.org/10.31403/rpgo.v58i99

Abstract

Introduction: Uterine cervix atrophic changes in postmenopausic women can mimic premalignant lesions, difficulting colposcopy and citopathology diagnosis. Immunohistochemical detection of p16INK4a could be useful as a diagnostic tool to differentiate between these changes. However, clinical evidence must be provided in order to accept this technique. Case report: Postmenopausic patient with insatisfactory colposcopy and cyto-hystopathology findings suggestive but not conclusive of high grade cervical intraepithelial neoplasia. p16INK4a immunohistochemical detection was negative and hystology of diagnostic/therapeutic conization did not find intraepithelial lesion or malignancy. This case is a contribution favouring p16INK4a as a differential biomarker between atrophic and premalignant changes in order to avoid unnecessary interventions. Both patient’s informed consent and Universidad de Cartagena and E.S.E. Clinica “Maternidad Rafael Calvo” scientific subdirection institutional consent were obtained for the writing of this presentation.

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References

Freeman T, Walker P. Colposcopy in special circumstances: Pregnancy, immunocompromise, including HIV and transplants, adolescence and menopause. Best Pract Res Clin Obstet Gynaecol. 2011;25(1):653-65.

Piccoli R, Mandato D, Lavitola G, Acunzo G, Bifulco G, et al. Atypical squamous cells and low squamous intraepithelial lesions in postmenopausal women: Implications for management. Eur J Obstet Gynecol Reprod Biol. 2008;140:269–74.

Halford J, Walker K-A, Duhig J. A review of histological outcomes from peri-menopausal and post-menopausal women with a cytological report of posible high grade abnormality: an alternative management strategy for these women. Pathology. 2010;42(1):23–7.

Khan A, Saleh S, Singer P. Why do women visit colposcopy clinic after menopause? Maturitas. 2009;63(S1):129.

Boulanger J, Gondry J, Verhoest P, Capsie C, Najas S. Treatment of CIN after menopause. Eur J Obstet Gynecol Reprod Biol. 2001;95:175-80.

Chuery A, Speck N, de Moura K, Belfort PN, Sakano C, Ribalta JC. Efficacy of vaginal use of topical estriol in postmenopausal women with urogenital atrophy. Clin Exp Obstet Gynecol. 2011;38(2):143-5.

Tsoumpou I, Arbyn M, Kyrgiou M, Wentzensen N, Koliopoulos G, et al. p16INK4a immunostaining in cytological and histological specimens from the uterine cervix: a systematic review and meta-analysis. Cancer Treat Rev. 2009;35:210-20.

Jackson JA, Kapur U, Ersahin C. Utility of p16, Ki-67, and HPV test in diagnosis of cervical intraepithelial neoplasia and atrophy in women older than 50 years with 3- to 7-year follow-up. Int J Surg Pathol. 2011 [Publicación electrónica antes de impresión].

Cremer M, Alonzo T, Alpasch A. Diagnostic reproducibility of cervical intraepithelial neoplasia 3 and atrophy in menopausal women on hematoxylin and eosin, ki-67, and p16 stained slides. J Low Genit Tract Dis. 2010;14(2):108-12.

Qiao X, Bhuiya T, Spitzer M. Differentiating high-grade cervical intraepithelial lesion from atrophy in postmenopausal women using ki-67, cyclin e, and p16 immunohistochemical analysis. J Low Genit Tract Dis. 2005;9(2):100–7.