22 feb. 2011 COEXISTING CERVICAL NON-KERATINIZED SQUAMOS CARCINOMA AND TUBERCULOSIS. CASE REPORT. Literature review
Manuela Russu1, Ruxandra Stănculescu2, Serban Nastasia1, Daniela Degeratu3
1 “Carol Davila” University of Medicine and Pharmacy Bucharest, „Dr. I. Cantacuzino”
Discipline of Obstetrics and Gynaecology
2 “Carol Davila” University of Medicine and Pharmacy Bucharest, „St. Pantelimon” Emergency
Clinical Hospital, Discipline of Obstetrics and Gynaecology
3 „Dr. I. Cantacuzino” Pathology Laboratory
Rezumat: Coexistenţa carcinomului de col scuamos nekeratinizant şi a tuberculozei. Prezentare de caz şi review al literaturii.
Se prezintă şi discută cazul unei femei de 29 ani, cu sechele de tuberculoză pulmonară, diagnosticată prin biopsii cervicale multiple cu carcinom scuamos nekeratinizat cervical stadiul IB, şi care după radiochimioterapie suferă limfadeno- colpo- histerectomie totală cu anexectomie bilaterală cu evoluţie normală. Examenul histopatologic postoperator relevă tuberculoză endocervicală asociată cu mici insule persistente de carcinom exocervical. Se revăd cazurile publicate cu această rară asociere patologică de la prima înregistrare, cazul raportat fiind al doilea din România după 50 ani, ca şi cunoştinţele, controversele, ipotezele asupra coexistenţei HPV înalt oncogen – genotip 33 în cazul prezentat, şi a Mycobacterium tuberculosis (BK), a mecanismelor defensive directe/indirecte, a efectelor inhibitorii/stimulatorii ale factorilor infecţioşi. Tuberculoza endocervicală este secundară celei pulmonare, HPV reduce relativa imunitate cervicală la BK, şi poate contribui la pierderea/ apariţia mutaţiilor somatice a supresorului tumoral major LKB1, similar p53, pozitiv in acest caz. BK reduce imunitatea la HPV cu risc, autorii speculând că BK se asociază cu pierderea/apariţia mutaţiilor somatice a supresorului tumoral major LKB1, datorită persistenţei insulelor de cancer după radio-chimioterapie.
Abstract:
A 29 yrs Caucasian woman, sequelar of lung tuberculosis with cervical squamous non-keratinised cancer stage IB, diagnosed by multiple cervical biopsies, has suffered radio-chemotherapy, and a Wertheim’s radical hysterectomy with bilateral pelvic node excision, with normal evolution.
The pathological examination of postoperative uterus revealed endocervical tuberculosis associated to exocervical persistent small island of cancer. There are revisited published cases with the coexisting pathologies since their first registration, the reported case being the second in Romania after 50 years, and the knowledge, controversies, hypothesis on the pathogenesis of life-threatening coexistence of high risk oncogenic HPV- genotype 33 in the reported case, and Mycobacterium tuberculosis (BK), and explanations about specific defense, and stimulatory/inhibitory effects of infectious factors, direct/indirect mechanisms. Endocervical tuberculosis is secondary to lungs pathology, HPV reduces cervical relative immunity to BK, and may contribute to loss/somatically-acquired mutations of a major tumor supressor LKB1, similar to p53, positive in this case. BK reduces immunity to high risk HPV, and the authors speculate that BK is associated to loss/mutations in LKB1 tumor suppressor, because cancer persistency after radio-chemotherapy.
Key words: carcinom, tuberculoză, col uterin
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