SUMMARY OBJECTIVE: This study aims to investigate the association between the immunohistochemical expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 and plasma zinc in women with fibroadenoma. METHODS: This cross-sectional study included 37 premenopausal women with fibroadenoma. Waist circumference and body mass index of the participants were measured. Plasma zinc concentrations were determined using atomic flame absorption spectrophotometry. Fragments of breast tissue were fixed and incubated with primary mouse monoclonal antibodies (monoclonal antibodies matrix metalloproteinase -2 -507 and monoclonal antibodies matrix metalloproteinase -9-439). Semi-quantitative analysis of matrix metalloproteinase-2 and matrix metalloproteinase-9 immunoreactivity was performed. Spearman’s test and Friedman’s test were used for statistical analyses. The p<0.05 were considered statistically significant. RESULTS: The average age of the participants was 32.81±9.51 years. The body mass index and waist circumference values were within the normal range. The mean plasma zinc concentration was 42.73±13.84 µg/dL, with 94.6% inadequacy. A statistically significant difference was found between the positive expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 (p=0.0184). There was no significant correlation between the matrix metalloproteinase expression and the plasma zinc levels. CONCLUSIONS: Women with fibroadenoma had hypozincemia and positive expression of metalloproteinases.

Breast cancer is the most frequently diagnosed malignant neoplasm in women and is considered a multifactorial disease of unknown etiology. One of the major risk factors is genetic alteration. Changes in CYP19A1 gene expression levels have been associated with increased risk and increased aggressiveness of breast cancer. Increased CYP19A1 gene expression and/or aromatase activity are among the major regulatory events for intratumoral production of estrogens in breast malignant tissues. This systematic review aimed to investigate the influence of CYP19A1 gene expression levels in women with breast cancer. The research was carried out using the PubMed, Scopus, and Web of Science databases. Searches were conducted between February 2 and May 15, 2019. Inclusion criteria were studies published between 2009 and 2019, English language publications, and human studies addressing the gene expression of CYP19A1 in breast cancer. A total of 6.068 studies were identified through PubMed (n=773), Scopus (n=2,927), and the Web of Science (n=2,368). After selecting and applying the inclusion and exclusion criteria, six articles were included in this systematic review. This systematic review provides evidence that increased or decreased levels of CYP19A1 gene expression may be related to pathological clinical factors of disease, MFS, OS, DFS, WATi, markers of metabolic function, concentrations of E1, FSH, and in the use of multiple exons 1 of the CYP19A1 gene in breast cancer.

OBJECTIVE: This study aimed to determine the relationship between rs17576 (MMP-9) polymorphism and increased cancer risk in a Brazilian breast cancer cohort. METHODS: This study included 141 women (71 breast cancer patients and 70 controls without breast cancer) who donated 3 mL of their peripheral blood for genomic DNA extraction. This DNA was then genotyped using a real-time polymerase chain reaction. RESULTS: The AG (rs17576) genotype was identified in 26 (18.43%) participants in the case group and in 22 (15.60%) participants in the control group (p=0.274), while the GG genotype was identified in ten (7.09%) participants in the case group and in one (0.70%) participant in the control group (p<0.003 - OR (95% CI) 13.13 (1.73, 593.08). No significant difference in the incidence rates was observed for AG or GG rs17576 genotypes in premenopausal women, p=0.813 and p=0.556, respectively. However, in postmenopausal women, the AG genotype was shown to occur in 14 (22.5%) participants in the case group and in 4 (6.45%) participants in the control (p<0.043), while GG genotype occurred in eight (12.90%) of the individuals in the case group and in none of the individuals in the control group (p<0.006). CONCLUSION: In this study, the MMP-9 rs17576 GG polymorphic variant was shown to be significantly associated with breast cancer risk in premenopausal women, while the AG and GG genotypes were associated with increased cancer risk in postmenopausal women.

OBJECTIVES: In breast cancer diagnosis, mammography (MMG), ultrasonography (USG) and magnetic resonance imaging (MRI) are the imaging methods most used. There is a scarcity of comparative studies that evaluate the accuracy of these methods in the diagnosis of breast cancer. METHODS: A cross-sectional study was carried out through the review of electronic medical records of 32 female patients who underwent breast imaging examinations at a imaging diagnostic center in Teresina, State of Piauí, Brazil. Patients who had these three imaging methods at the time of the evaluation of the same nodule were included. The nodule must have been classified as suspect by the BI-RADS® system in at least one of the methods. Data from each method were compared with the histopathological examination. Statistical analysis used the calculation of proportions in Excel 2010. RESULTS: MMG showed 56.2%, 87.5%, 81.8%, 66.7% and 71.8% of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy, respectively. USG had 75%, 18.8%, 48%, 42.8% and 46.9% of sensitivity, specificity, PPV, NPV and accuracy, respectively. In turn, MRI had 100%, 50%, 66.7%, 100% and 75% of sensitivity, specificity, PPV, NPV and accuracy, respectively. CONCLUSION: Thus, MRI and MMG were more accurate in evaluating suspicious breast lumps. MRI had a low specificity, mainly to high breast density, while MMG had also sensitivity limited due to high breast density and USG has been proven to be useful in these patients.

OBJECTIVES: Aromatase inhibitors are the first-choice drugs for the treatment of hormone sensitive breast cancer. However, in addition to the scarcity of studies, there are controversies about their effects on vaginal epithelial cell proliferation in rats, especially those in persistent estrus. METHODS: To investigate vaginal epithelial cell proliferation by Ki-67 antigen expression, persistent estrus was induced in 42 randomly selected rats. These rats were randomly divided into 2 groups: group I (control, n=21), which received 0.1 mL of propylene glycol (vehicle) daily, and group II (experimental, n=21), which received 0.5 mg/kg or 0.125 mg/day of anastrozole diluted with 0.1 mL of propylene glycol. RESULTS: Light microscopy showed a higher concentration of cells with brown Ki-67 stained nuclei in the control compared to the experimental group. The mean percentage of Ki-67 stained nuclei per 500 cells in the vaginal epithelium was 68.64±2.64 and 30.46±2.00 [mean±standard error of the mean (SEM)] in the control and experimental groups, respectively (p<0.003). CONCLUSION: This study showed that anastrozole, at the dose and treatment duration selected, significantly decreased cell proliferation in the vaginal mucosa of the rats in persistent estrus.

RESUMO OBJETIVO: O objetivo deste estudo é comparar a expressão do receptor de estrogênio entre astrocitomas de baixo e alto grau. MÉTODO: Foi realizado um estudo usando blocos de parafina de tumores gliais dos arquivos de Anatomia Patológica do Hospital São Marcos e iniciado após aprovação pelo Comitê de Ética da Universidade Federal do Piauí. Os espécimes foram marcados histoquimicamente com anticorpo anti-ER alpha. Os núcleos corados em marrom foram considerados positivos, independentemente da intensidade da reação. Os dados foram analisados estatisticamente utilizando o teste de Mann-Whitney e a correlação de Spearman. A significância estatística foi estabelecida em p<0,05. RESULTADOS: A porcentagem média de núcleos corados com anti-ER alfa em astrocitomas de baixo e alto grau foi de 0,04 e zero, respectivamente, enquanto a correlação de Spearman mostrou uma forte correlação negativa entre tumores de baixa e alta qualidade (p<0,001) e (r=-0,67), respectivamente. CONCLUSÕES: No presente estudo, a expressão do receptor de estrogênio foi positiva apenas em astrocitomas de baixo grau e nula em astrocitomas de alto grau, mostrando que a expressão de ER diminui com o grau de malignidade tumoral.

SUMMARY OBJECTIVE: This study aims to compare estrogen receptor expression between low and high-grade astrocytomas. METHOD: A study using paraffin blocks of glial tumors from the Anatomy Pathology archives of São Marcos Hospital was carried out and began after approval by the Review Board of the Federal University of Piaui. Specimens were histochemically marked with an anti-ER alpha antibody. Brown-stained nuclei were considered positive, regardless of reaction intensity. Data were statistically analyzed using the Mann-Whitney test and Spearman's correlation. Statistical significance was established at p<0.05. RESULTS: The mean percentage of nuclei stained with anti-ER alpha in low-and high-grade astrocytomas was 0.04 and zero, respectively, while Spearman's correlation showed a strong negative association between low and high-grade tumors (p<0.001) and (r= −0.67), respectively. CONCLUSION: In the current study, estrogen receptor expression was positive only in low-grade astrocytomas and nil in high-grade astrocytomas, showing that ER expression declines with the grade of tumor malignancy.

Resumo Os inibidores de aromatase têm emergido como uma endocrinoterapia alternativa para o tratamento de câncer de mama sensível a hormônios em mulheres pós-menopáusicas. A utilização de inibidores de terceira geração, representados por exemestano, letrozol e anastrozol, é atualmente indicada. Anastrozol é um composto não esteroide e um inibidor potente e seletivo da enzima aromatase. Embora alguns estudos tenham demonstrado que as suas propriedades farmacodinâmicas e farmacocinéticas podem ser afetadas pela variabilidade interindividual, esse fármaco tem sido recentemente utilizado em todas as configurações de tratamento do câncer de mama. Na doença metastática, é atualmente considerado o tratamento de primeira linha em mulheres pós-menopáusicas com tumores de mama e receptor de estrogênio positivo. O anastrozol tem mostrado resultados promissores no tratamento adjuvante do câncer de mama em estágio inicial em mulheres na pós-menopausa. Ele também conseguiu resultados interessantes na quimioprevenção da doença. Portanto, em virtude da importância do anastrozol tanto no tratamento endócrino quanto na quimioprevenção do câncer de mama hormoniossensível em mulheres na pós-menopausa, propusemos a atual revisão da literatura na base de dados SciELO e PubMed de artigos publicados nos últimos 10 anos.

Summary Aromatase inhibitors have emerged as an alternative endocrine therapy for the treatment of hormone sensitive breast cancer in postmenopausal women. The use of third-generation inhibitors represented by exemestane, letrozol and anastrozole is currently indicated. Anastrozole is a nonsteroidal compound and a potent selective inhibitor of the aromatase enzyme. Although a few studies have shown that its pharmacodynamic and pharmacokinetic properties may be affected by interindividual variability, this drug has been recently used in all configurations of breast cancer treatment. In metastatic disease, it is currently considered the first-line treatment for postmenopausal women with estrogen receptor-positive breast tumors. Anastrozole has shown promising results in the adjuvant treatment of early-stage breast cancer in postmenopausal women. It has also achieved interesting results in the chemoprevention of the disease. Therefore, due to the importance of anastrozole both for endocrine treatment and chemoprevention of hormone-sensitive breast cancer in postmenopausal women, we proposed the current literature review in the SciELO and PubMed database of articles published in the last 10 years.

Resumo O zinco é componente catalítico de proteínas que regulam respostas a danos no DNA, enzimas de sinalização intracelular e metaloproteinases de matriz, proteínas importantes na carcinogênese. O objetivo desta revisão é trazer informações atualizadas sobre a participação do zinco e das metaloproteinases de matriz dos tipos 2 e 9 em mecanismos envolvidos na patogênese do câncer de mama. Realizou-se um levantamento bibliográfico, mediante consulta às bases de dados PubMed, Scielo e Lilacs. O zinco e os resíduos de cisteína são elementos estruturais compartilhados por todos os membros da família das metaloproteinases de matriz, as quais parecem estar envolvidas na propagação de vários tipos de neoplasias, incluindo o câncer de mama. Além disso, é provável que o zinco transportado seja utilizado para metalação do domínio catalítico das metaloproteinases recentemente sintetizadas antes de serem segregadas. Nesse sentido, o aumento das concentrações de zinco em compartimentos celulares e a redução desse oligoelemento no sangue de pacientes com câncer de mama parecem alterar a atividade das metaloproteinases 2 e 9, contribuindo para a ocorrência de tumor maligno. Assim, faz-se necessária a realização de novos estudos na perspectiva de esclarecer o papel do zinco e das metaloproteinases 2 e 9 na patogênese do câncer de mama.

Summary Zinc is the catalytic component of proteins that regulate responses to DNA damage, intracellular signaling enzymes, and matrix metalloproteinases, which are important proteins in carcinogenesis. The objective of this review is to bring current information on the participation of zinc and matrix metalloproteinases types 2 and 9 in mechanisms involved in the pathogenesis of breast cancer. We conducted a literature review, in consultation with the PubMed, Lilacs, and Scielo databases. The zinc and cysteine residues are structural elements shared by all members of the family of matrix metalloproteinases, and these proteins appear to be involved in the propagation of various types of neoplasms, including breast cancer. Moreover, transported zinc is likely to be used for the metalation of the catalytic domain of the newly synthesized metalloproteinases before the latter are secreted. Accordingly, increase in zinc concentrations in cellular compartments and the reduction of this trace element in the blood of patients with breast cancer appear to alter the activity of metalloproteinases 2 and 9, contributing to the occurrence of malignancy. Thus, it is necessary to carry out further studies with a view to clarify the role of zinc and metalloproteinases 2 and 9 in the pathogenesis of breast cancer.

RESUMO A síndrome dos ovários policísticos (SOP) é uma desordem endócrina heterogênea com prevalência variável, que afeta cerca de uma em cada 15 mulheres no mundo. O diagnóstico da SOP requer, pelo menos, dois dos seguintes critérios: oligo-ovulação e/ou anovulação, evidência clínica e/ou bioquímica de hiperandrogenemia e morfologia dos ovários policísticos. As mulheres com SOP parecem ter um risco mais elevado de desenvolver distúrbios metabólicos, hipertensão e doenças cardiovasculares. O objetivo deste artigo foi apresentar uma revisão da literatura por meio de pesquisa nas bases de dados PubMed e Scielo, focada em publicações relacionadas com ovários policísticos, incluindo patogênese, manifestações clínicas, diagnóstico e aspectos terapêuticos, bem como associação com doenças cardiovasculares e hipertensão arterial.

SUMMARY Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder with variable prevalence, affecting about one in every 15 women worldwide. The diagnosis of polycystic ovary syndrome requires at least two of the following criteria: oligoovulation and/or anovulation, clinical and/or biochemical evidence of hyperandrogenism and morphology of polycystic ovaries. Women with PCOS appear to have a higher risk of developing metabolic disorders, hypertension and cardiovascular disorders. The aim of this article was to present a review of the literature by searching the databases Pubmed and Scielo, focusing on publications related to polycystic ovaries, including its pathogenesis, clinical manifestations, diagnosis and therapeutic aspects, as well as its association with cardiovascular and arterial hypertensive disorders.

Resumo Este estudo de revisão teve como objetivo fazer o mapeamento sistemático do ácido ascórbico na prevenção e/ou no tratamento do câncer como antioxidante e/ou pró-oxidante em estudos clínicos e não clínicos, entre 2011 e 2015, para o entendimento das variações de dose-resposta, bem como dos seus mecanismos de ação como agente antioxidante e antitumoral. Nas bases de dados Pubmed e Bireme, foram identificados 78 artigos, dos quais apenas 30 apontavam o ácido ascórbico na prevenção e/ou no tratamento do câncer. Contudo, há controvérsias sobre as doses utilizadas e faltam estudos clínicos que caracterizem melhor o seu mecanismo de ação. Outros estudos devem ser realizados para o entendimento das variações de dose-resposta, bem como de seus mecanismos de ação, como agente antioxidante ou antitumoral, para auxiliar o tratamento e a prevenção do câncer, visando à melhor qualidade de vida dos pacientes e da população em geral.

Summary This review is aimed at the systematic mapping of ascorbic acid in the prevention and/or treatment of cancer in clinical and non-clinical studies from 2011 to 2015, in order to understand dose-response variations as well as its mechanisms of action as an antioxidant and antitumor agent. Seventy-eight articles were retrieved from the PubMed/Bireme database, of which only 30 included ascorbic acid in the prevention and/or treatment of cancer. However, there are controversies regarding doses and a lack of clinical studies featuring its mechanism of action more clearly. Other studies are needed to understand dose-response variations, as well as its targeting mechanisms of action, both as an antioxidant and antitumor agent, to assist treatment and prevention of cancer, aiming at better quality of life for both patients and the general population.

Paciente do gênero feminino, 42 anos, com queixas de dificuldade ao urinar e aumento de volume na região vulvar há 1 ano. Ao exame ginecológico, apresentava extensa lesão na região vulvar. Biópsia da lesão foi inconclusiva. Realizou-se a exérese da lesão. A paciente permanece livre de recorrências há 15 meses. Este caso destaca a necessidade de considerar o angiomixoma no diagnóstico diferencial de massas de causa desconhecida na região vulvar.

Female patient, 42-years-old, complaining of difficulty in urinating and swelling in the vulvar area for one year. Her gynecological examination showed extensive injury in the vulvar region and the biopsy done was inconclusive. The removal of the lesion was conducted. After the procedure, the patient remains free of recurrence for 15 months. This case highlights the need to consider angiomyxoma in the differential diagnosis for tumors of unknown cause in the vulvar region.

Introdução: Pacientes com a síndrome da apneia obstrutiva do sono (SAOS) geralmente apresentam alterações na morfologia das vias aéreas superiores e/ou na distribuição da gordura corporal, que podem ocorrer durante a vida e aumentar a gravidade da SAOS com a idade. Objetivo: Correlacionar medidas cefalométricas e antropométricas com a gravidade da SAOS em diferentes faixas etárias. Método: Estudo retrospectivo de medidas cefalométricas e antropométricas de 102 pacientes portadores de SAOS. Os pacientes foram divididos em três faixas etárias (≥20 e <40 anos, ≥40 e <60 anos, e ≥60 anos). Foi realizada correlação de Pearson destas medidas com o índice de apneia-hipopneia (IAH) na amostra completa e depois por faixa etária. Resultados: As medidas cefalométricas MP-H (distância entre o plano mandibular e o osso hioide) e PNS-P (distância entre a espinha nasal posterior e a ponta do palato mole) e as circunferências cervical e abdominal apresentaram correlação estatisticamente significante com o IAH tanto na amostra total quanto na faixa de <40 e ≥ 60 anos. Estas variáveis não mostraram correlação significante com as outras duas faixas etárias (≤ 40 e ≥ 60 anos). Conclusão: As medidas cefalométricas MP-H e PNS-P e as circunferências cervical e abdominal apresentaram correlação com a gravidade da SAOS em pacientes na faixa etária de ≥40 e <60 anos.

Introduction: Patients with obstructive sleep apnea syndrome usually present with changes in upper airway morphology and/or body fat distribution, which may occur throughout life and increase the severity of obstructive sleep apnea syndrome with age. Objective: To correlate cephalometric and anthropometric measures with obstructive sleep apnea syndrome severity in different age groups. Methods: A retrospective study of cephalometric and anthropometric measures of 102 patients with obstructive sleep apnea syndrome was analyzed. Patients were divided into three age groups (≥20 and <40 years, ≥40 and <60 years, and ≥60 years). Pearson's correlation was performed for these measures with the apnea-hypopnea index in the full sample, and subsequently by age group. Results: The cephalometric measures MP-H (distance between the mandibular plane and the hyoid bone) and PNS-P (distance between the posterior nasal spine and the tip of the soft palate) and the neck and waist circumferences showed a statistically significant correlation with apnea-hypopnea index in both the full sample and in the ≥40 and <60 years age group. These variables did not show any significant correlation with the other two age groups (<40 and ≥60 years). Conclusion: Cephalometric measurements MP-H and PNS-P and cervical and waist circumfer- ences correlated with obstructive sleep apnea syndrome severity in patients in the ≥40 and <60 age group.