Estudo dos aspectos da termografia digital infravermelha, da PAAF (citológico e imunocitologico), e dos achados histológicose imunohistoquimicos da endometriose subcutânea na mulher

Abstract

Endometriosis is defined as the presence of endometrial glands and stroma in an anatomical site other than the uterine cavity and muscles, which may be pelvic or extra - pelvic, affecting up to 5 - 1 5% of women of childbearing age, in its various presentations. Extra pelvic endometriosis affects 12% of women with endometriosis, a condition that is rare umbilical endometriosis - about 0.5% of all patients with ectopic endometrium. Most cases of subcuta neous endometriosis develop from pelvic organs to surgery scars in young women in the reproductive age. The complaints are tumor growth in the abdominal wall after interventional procedures and pain. It must be differentiated from incisional hernias, granu lomas, abscesses and benign and malignant tumors. The methods are based on clinical diagnosis and in fine needle aspiration (FNA) cytology. The excision and histopathological analysis, the ultrasound, the computed tomography and magnetic resonance imaging and in our research, teletermography use (not reported in the literature). The morphological characteristics allow the cytological diagnosis from fine needle aspiration (FNA). However, to date, the immunohistochemical profile and biological characteristics of this unusual type of endometriosis is poorly understood, requiring cellular phenotyping studies for understanding the pathophysiology and its possible treatments. Objectives : We formed a study group (20 cases) from the smears of fine needle aspiration and its analysis by immunocytochemistry, assessing the teletermography digital and histopathological lesions. In seven cases (07) were performed immunohistochemistry for estrogen receptors, progesterone and marker of cell proliferation (Ki - 67). The morphol ogical aspects will be faced with the possibility or not of the markers. To store data, will be created spreadsheet Excel/Office 2000. The database will be exported to the Soft Prism 5.0, which will be the logical consistency of the final typed information . Statistical significance will be performed by Fisher's exact test with a confidence interval of 95%. Results. Twenty patients with a mean age of 30.4±1.3 years were evaluated during the period January 2007 to December 2010. The location was more frequent in surgical scar resulting from cesarean section (n=18), in the suprapubic region level of the umbilicus (laparoscopy) (n=1), resulting in surgical scar of hysterectomy (n=1). Thirteen were primiparous, four secundiparous, two nulliparous and one tercípar ous. During this period, 6818 deliveries were performed by cesarean. The incidence of endometriosis in the scar was 0.26%, the time interval between surgery and onset of symptoms ranged from 6 to 36 months with a mean of 17±1.6. The most common complaint w as pain in the scar (80%) of these 40% reported pain cyclical. Lump in the scar was found in 17 patients (85%), fixed and painful. In two cases presented hematometra or hematoma. Eleven patients (55%) reported increased nodule during the pre and menstrual. FNA showed endometrial cells and stromal cells in the cytologig smears (65%), the digital telethermography was performed in all. The thermographic asymmetry indicates inflammation. All cases were treated with surgical resection. No clinical treatment was done before and after surgery. All patients were followed for a period exceeding two years and recurrence of 3 in 20 patients (15%). In two patients, the recurrence was after 12 months, the third was to 24 months, both with a history of peritoneal endometr iosis. The results of immunohistochemical showed epithelium and stroma receptor s in 80% and 100% and 72% Ki - 67