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O310 Parametrial gestational trophoblastic neoplasia: A rare site for a rare disease
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
were 25 years & above and their marital age were 8 years & above. The study population was counselled to make her confident at the VIA procedure, its advantages, outcome and consequences. Then the subject emptied her bladder and got lying down in the table within good privacy. The cervix was exposed by an adequate sized cuscos self retaining speculum. Acetic acid (5%) was applied to the cervix and after waiting 1 minute, the cervix was inspected using a 100 watt good light source to see whether there was any acetowhite area with well defined margin. Then the study population were diagnosed as a VIA positive and VIA negative cases. The positive cases were invited for colposcopy. Directed biopsies were obtained from women who were colposcopically positive. Results: Total 200 cases were studied. Among them 16 (8%) were VIA positive. These positive cases were also referred for colposcopy. Out of the 16 cases, 5 (31%) are colposcopically normal & 11 (69%) are CIN-1. Directed biopsy was done among colposcopically positive group. Histopathological examination showed that 9 (82%) and 2 (18%) were CIN-1 and chronic cervicities respectively. Conclusion: Screening for cervical precancerous lesion by VIA in high risk group of people may be a suitable alternative for control of cervical cancer in low resource setting. But VIA positive cases need further colposopic evaluation for eliminating the false positive case. O309 Breast arterial calcifications and cardiovascular disease in postmenopausal women J. Ferreira, L. Pompei, C. Fernandes, L. Azevedo, E. Cunha, R. Strufaldi, I. Carelli, S. Peixoto. ABC School of Medicine, Santo Andr´e, Brazil Objectives: The objective of this study was to evaluate the association between cardiovascular disease (CVD) and breast arterial calcification (BAC), as well as the prevalence rates of these conditions in postmenopausal women. Methods: A cross-sectional study was performed in 307 women over 40 years of age who were receiving care at the gynecology clinic of the Center for Women’s Integrated Healthcare (CAISM), ABC School of Medicine. All these women had been amenorrheic for at least 12 months and had undergone mammography in the preceding 12 months. Cardiovascular disease and its subtypes were evaluated, as well as its association with BAC. Means and standard deviations, absolute frequencies and percentages were calculated, and univariate analysis and multiple logistic regression were performed. Results: Mean age of patients was 55.2±6.8 years; age at menopause was 48.5±4 years; time since menopause was 80.2±75.4 months; 96.1% of patients were non-smokers, 46.3% were in use of hormone replacement therapy, 33.6% had systemic arterial hypertension; 4.9% had diabetes mellitus and 5.2% had hypercholesterolemia. Mean body mass index was 27.3±4.3 kg/m2 . CVD was found in 6.8% and BAC in 8.5% of the women. Significantly more women with BAC had CVD compared to the women who did not have this condition (23.1% versus 5.3%, p < 0.0006). Conclusions: In postmenopausal women, breast arterial calcification may represent a higher likelihood of cardiovascular disease. O310 Parametrial gestational trophoblastic neoplasia: A rare site for a rare disease L. Fernandez-Mondragon1 , A. Soriano-Estrella. 1 University of the Philippines College of Medicine – Philippine General Hospital We report an unusual case of a gestational trophoblastic neoplasia (GTN) located at the right parametria with ureteral invasion and no uterine lesion. The patient presented with hematuria and elevated hCG titers eight months after evacuation of a molar pregnancy. Patient achieved remission after receiving seven cycles single agent chemotherapy in the form of Methotrexate. Recurrence of
S181
hematuria was noted two months after achieving biochemical remission with no evidence of tumor recurrence. Resolution of hematuria was only noted after resection of the involved portion of the ureter with reanastomosis and stent insertion. This is the first reported case of a parametrial GTN with ureteral invasion and normal uterus. O311 Pulmonary resection in the management of chemotherapy resistant metastatic high-risk gestational trophoblastic neoplasia: An eight-year experience at the Philippine general hospital A. Soriano-Estrella, L. Fernandez-Mondragon. University of the Philippines College of Medicine-Philippine General Hospital Objective: To evaluate the factors that influence the prognosis of patients who had pulmonary metastasectomy for chemotherapy resistant, metastatic gestational trophoblastic neoplasia. Materials and Methods: The case records of all patients with gestational trophoblastic neoplasia (GTN) who underwent lung resection at the Section of Trophoblastic Diseases, Department of Obstetrics and Gynecology, University of the PhilippinesPhilippine General Hospital from January 1999 to December 2007 were reviewed. Factors that influenced treatment outcome were identified. Results: Six patients with high-risk metastatic GTN underwent thoracotomy with lung resection from January 1999 to December 2007. Four of the patients achieved remission after surgery followed by multiagent cisplatin-based chemotherapy. Of these, three sustained remission and are currently alive, with no evidence of disease. Factors that influenced prognosis were: the extent of lung involvement, the presence or absence of primary malignancy, the presence or absence of extrapulmonary metastasis, the preoperative serum bhCG level, and the administration of postoperative chemotherapy delivered as consolidation treatment. Conclusion: Thoracotomy with resection of chemotherapy-resistant focus in the lung has a significant role in the management of appropriately selected patients with GTN. O312 Human T-cell lymphotropic virus (HTLV) infection in Brazilian pregnant women E. Figueiro-Filho, ´ L. Coelho, I. Breda, V. Oliveira, L. Melo, M. Goes, P. Turine-Neto, H. Torres. Faculty of Medicine of Federal University of Mato Grosso do Sul Objective: To evaluate the prevalence, epidemiological profile (age and origin) and vertical transmission rate of HTLVI/II infection on pregnant women screened by The Pregnant Protection Program of the State of Mato Grosso do Sul – Brazil. Methods: It was a descriptive and transversal study of 32.512 pregnant women prenatal screened from November 2002 to October 2003. HTLVI/II infection was diagnosed in all pregnant women by ELISA, confirmed by Western-Blot and PCR. Congenital HTLV infection was investigated by ELISA test, Western-Blot and PCR performed on the child blood sample. The associations between data (age, origin and HTLV infection) were statistically analyzed by chi-squared test considering p < 0.05 to reject the nullity hypothesis. Results: 0.1% HTLVI/II prevalence (37) among 32512 pregnant women was found. The age found within the infected women was 25.4+6.4 years, and 78.4% of them were from other areas than capital. There was no association between maternal age and the patients’ origin and infection. In all the eight newborn evaluated, which represented 21.6% of the sample, were found HTLVI/II serum antibodies. Only one newborn infant was breastfed. Conclusions: The HTLVI/II prevalence among pregnant women on the State of Mato Grosso do Sul – Brazil was lower than the rates reported by endemic HTLV countries. This rate was almost the same
were 25 years & above and their marital age were 8 years & above. The study population was counselled to make her confident at the VIA procedure, its advantages, outcome and consequences. Then the subject emptied her bladder and got lying down in the table within good privacy. The cervix was exposed by an adequate sized cuscos self retaining speculum. Acetic acid (5%) was applied to the cervix and after waiting 1 minute, the cervix was inspected using a 100 watt good light source to see whether there was any acetowhite area with well defined margin. Then the study population were diagnosed as a VIA positive and VIA negative cases. The positive cases were invited for colposcopy. Directed biopsies were obtained from women who were colposcopically positive. Results: Total 200 cases were studied. Among them 16 (8%) were VIA positive. These positive cases were also referred for colposcopy. Out of the 16 cases, 5 (31%) are colposcopically normal & 11 (69%) are CIN-1. Directed biopsy was done among colposcopically positive group. Histopathological examination showed that 9 (82%) and 2 (18%) were CIN-1 and chronic cervicities respectively. Conclusion: Screening for cervical precancerous lesion by VIA in high risk group of people may be a suitable alternative for control of cervical cancer in low resource setting. But VIA positive cases need further colposopic evaluation for eliminating the false positive case. O309 Breast arterial calcifications and cardiovascular disease in postmenopausal women J. Ferreira, L. Pompei, C. Fernandes, L. Azevedo, E. Cunha, R. Strufaldi, I. Carelli, S. Peixoto. ABC School of Medicine, Santo Andr´e, Brazil Objectives: The objective of this study was to evaluate the association between cardiovascular disease (CVD) and breast arterial calcification (BAC), as well as the prevalence rates of these conditions in postmenopausal women. Methods: A cross-sectional study was performed in 307 women over 40 years of age who were receiving care at the gynecology clinic of the Center for Women’s Integrated Healthcare (CAISM), ABC School of Medicine. All these women had been amenorrheic for at least 12 months and had undergone mammography in the preceding 12 months. Cardiovascular disease and its subtypes were evaluated, as well as its association with BAC. Means and standard deviations, absolute frequencies and percentages were calculated, and univariate analysis and multiple logistic regression were performed. Results: Mean age of patients was 55.2±6.8 years; age at menopause was 48.5±4 years; time since menopause was 80.2±75.4 months; 96.1% of patients were non-smokers, 46.3% were in use of hormone replacement therapy, 33.6% had systemic arterial hypertension; 4.9% had diabetes mellitus and 5.2% had hypercholesterolemia. Mean body mass index was 27.3±4.3 kg/m2 . CVD was found in 6.8% and BAC in 8.5% of the women. Significantly more women with BAC had CVD compared to the women who did not have this condition (23.1% versus 5.3%, p < 0.0006). Conclusions: In postmenopausal women, breast arterial calcification may represent a higher likelihood of cardiovascular disease. O310 Parametrial gestational trophoblastic neoplasia: A rare site for a rare disease L. Fernandez-Mondragon1 , A. Soriano-Estrella. 1 University of the Philippines College of Medicine – Philippine General Hospital We report an unusual case of a gestational trophoblastic neoplasia (GTN) located at the right parametria with ureteral invasion and no uterine lesion. The patient presented with hematuria and elevated hCG titers eight months after evacuation of a molar pregnancy. Patient achieved remission after receiving seven cycles single agent chemotherapy in the form of Methotrexate. Recurrence of
S181
hematuria was noted two months after achieving biochemical remission with no evidence of tumor recurrence. Resolution of hematuria was only noted after resection of the involved portion of the ureter with reanastomosis and stent insertion. This is the first reported case of a parametrial GTN with ureteral invasion and normal uterus. O311 Pulmonary resection in the management of chemotherapy resistant metastatic high-risk gestational trophoblastic neoplasia: An eight-year experience at the Philippine general hospital A. Soriano-Estrella, L. Fernandez-Mondragon. University of the Philippines College of Medicine-Philippine General Hospital Objective: To evaluate the factors that influence the prognosis of patients who had pulmonary metastasectomy for chemotherapy resistant, metastatic gestational trophoblastic neoplasia. Materials and Methods: The case records of all patients with gestational trophoblastic neoplasia (GTN) who underwent lung resection at the Section of Trophoblastic Diseases, Department of Obstetrics and Gynecology, University of the PhilippinesPhilippine General Hospital from January 1999 to December 2007 were reviewed. Factors that influenced treatment outcome were identified. Results: Six patients with high-risk metastatic GTN underwent thoracotomy with lung resection from January 1999 to December 2007. Four of the patients achieved remission after surgery followed by multiagent cisplatin-based chemotherapy. Of these, three sustained remission and are currently alive, with no evidence of disease. Factors that influenced prognosis were: the extent of lung involvement, the presence or absence of primary malignancy, the presence or absence of extrapulmonary metastasis, the preoperative serum bhCG level, and the administration of postoperative chemotherapy delivered as consolidation treatment. Conclusion: Thoracotomy with resection of chemotherapy-resistant focus in the lung has a significant role in the management of appropriately selected patients with GTN. O312 Human T-cell lymphotropic virus (HTLV) infection in Brazilian pregnant women E. Figueiro-Filho, ´ L. Coelho, I. Breda, V. Oliveira, L. Melo, M. Goes, P. Turine-Neto, H. Torres. Faculty of Medicine of Federal University of Mato Grosso do Sul Objective: To evaluate the prevalence, epidemiological profile (age and origin) and vertical transmission rate of HTLVI/II infection on pregnant women screened by The Pregnant Protection Program of the State of Mato Grosso do Sul – Brazil. Methods: It was a descriptive and transversal study of 32.512 pregnant women prenatal screened from November 2002 to October 2003. HTLVI/II infection was diagnosed in all pregnant women by ELISA, confirmed by Western-Blot and PCR. Congenital HTLV infection was investigated by ELISA test, Western-Blot and PCR performed on the child blood sample. The associations between data (age, origin and HTLV infection) were statistically analyzed by chi-squared test considering p < 0.05 to reject the nullity hypothesis. Results: 0.1% HTLVI/II prevalence (37) among 32512 pregnant women was found. The age found within the infected women was 25.4+6.4 years, and 78.4% of them were from other areas than capital. There was no association between maternal age and the patients’ origin and infection. In all the eight newborn evaluated, which represented 21.6% of the sample, were found HTLVI/II serum antibodies. Only one newborn infant was breastfed. Conclusions: The HTLVI/II prevalence among pregnant women on the State of Mato Grosso do Sul – Brazil was lower than the rates reported by endemic HTLV countries. This rate was almost the same