Padilha Cátia Martins Leite, Araújo Mário Lúcio Cordeiro, Souza Sergio Augusto Lopes de
MSc in Pathology from Universidade Federal Fluminense (UFF). Staff (Cytopathology), Instituto Nacional de Câncer (Inca), Rio de Janeiro, RJ, Brazil.
PhD in Medical Sciences from Universidade do Estado do Rio de Janeiro (Uerj). MD, Anatomic Pathologist, and Vice-director (HC2) of INCA, Rio de Janeiro, RJ, Brazil.
Rev Assoc Med Bras (1992). 2017 Apr;63(4):379-385. doi: 10.1590/1806-9282.63.04.379.
Cervical cancer is an important public health problem. Pap smear is the leading strategy of screening programs for cervical cancer worldwide. However, delayed diagnosis leads to more aggressive and less effective treatments. Patients with uterine cervix malignancies who are referred for radiotherapy have advanced-stage disease, which results in high rates of locoregional recurrence. The use of radiotherapy as a treatment for cervical cancer causes morphological changes in neoplastic and non-neoplastic epithelial cells, as well as in stromal cells, which make it difficult to diagnose the residual lesion, resulting in a dilemma in cytopathological routine. Based on the difficulties of cytopathologic evaluation for the follow-up of patients treated with radiotherapy for cervical cancer, our objective was to describe the actinic cytopathic effects. Our paper was based on a structured review including the period from June 2015 to April 2016, aiming at an exploratory-descriptive study. Bibliographic investigations were carried out through selection and analysis of articles, list of authors and keywords, selection of new articles focused on the analysis of bibliographic references to previously selected documents, as well as textbooks of recognized merit. The most incident actinic cytopathological alterations as described in the literature are: cellular gigantism, nuclear and cytoplasmic vacuolization, dyskeratosis, bi- and multinucleated (B/M) cells, macro and multiple nucleoli, anisokaryosis, anisonucleolosis and nuclear pyknosis. To date, a protocol has not been established that can precisely differentiate the morphological characteristics between benign cells with actinic effects from recurrent malignant cells on post-radiotherapy smears.
宫颈癌是一个重要的公共卫生问题。巴氏涂片是全球宫颈癌筛查项目的主要策略。然而，诊断延迟会导致治疗更激进但效果更差。因子宫颈恶性肿瘤而接受放疗的患者病情已处于晚期，这导致局部区域复发率很高。使用放疗治疗宫颈癌会使肿瘤性和非肿瘤性上皮细胞以及基质细胞发生形态变化，这使得难以诊断残留病变，从而在细胞病理学常规检查中造成两难局面。基于宫颈癌放疗患者随访中细胞病理学评估的困难，我们的目标是描述光化性细胞病变效应。我们的论文基于一项结构化综述，涵盖2015年6月至2016年4月期间，旨在进行一项探索性描述性研究。通过对文章、作者名单和关键词的筛选与分析，选择专注于分析先前选定文献的参考文献的新文章以及具有公认价值的教科书来进行文献调查。文献中描述的最常见的光化性细胞病理学改变有：细胞巨大症、核及胞质空泡化、角化不良、双核及多核细胞、大核仁和多个核仁、核大小不等、核仁大小不等以及核固缩。迄今为止，尚未建立一个能够精确区分放疗后涂片上具有光化效应的良性细胞与复发性恶性细胞之间形态特征的方案。
