Avaliação da atividade proliferativa do fibroadenoma mamário apos a administração de anticoncepcional hormonal combinado oral, associado ou não ao estriol
Arquivos
Data
2007
Autores
Estevão, Rodrigo Augusto Fernandes 
Orientadores
Nazário, Afonso Celso Pinto
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar a atividade proliferativa do fibroadenoma mamário, por meio da expressão do Ki-67 e do c-myc, após a administração de anticoncepcional hormonal combinado oral, associado ou não ao estriol. Material e métodos: Foram estudadas 32 pacientes com fibroadenoma, das quais 10 constituíram o Grupo 1 e utilizaram anticoncepcional hormonal oral (ACO) composto de levonorgestrel (0,15 mg) e etinilestradiol (0,03 mg), associados a um comprimido de placebo na mesma cápsula, por quatro ciclos consecutivos, com intervalo de sete dias entre os mesmos. As 23 restantes foram alocadas no Grupo 2 e receberam, além do
anticoncepcional oral, um comprimido de estriol, na dose de 2 mg, que foi manufaturado conjuntamente com o anticoncepcional, em uma mesma cápsula, sendo utilizado de igual modo que as pacientes do Grupo 1. Realizamos medidas ultrasonográficas dos tumores antes e após a ingestão da medicação e, ao final dos quatro ciclos, praticou-se a exérese cirúrgica dos nódulos, com posterior envio para análise
imuno-histoquímica para Ki-67 e c-myc.
Resultados: Obtivemos diminuição significante da dimensão (largura) dos
fibroadenomas de pacientes usuárias apenas de anticoncepcional oral. No Grupo 1
(ACO com placebo), a largura média dos fibroadenomas antes do tratamento foi de
15,73 mm e, após a utilização de quatro ciclos de ACO, foi de 13,17 mm. Esta redução
foi estatisticamente significante (p = 0,043). No Grupo 2 (ACO com estriol), a largura
antes e após o tratamento foi de 15,30 e 13,76 mm, respectivamente, diferença não
estatisticamente significante (p = 0,157). Não houve alteração das outras dimensões
em nenhum dos outros grupos. A análise de Ki-67 e c-myc também não revelou
diferenças significantes entre os grupos estudados: 9,16 e 10,54 no Grupo 1 e 10,86 e
17,03 no Grupo 2, respectivamente. Houve, porém, tendência à maior expressão dos
marcadores entre as pacientes do Grupo 2.
Conclusões: Nossos resultados demonstram não haver diferença significante na
expressão de Ki-67 e de c-myc entre as pacientes que receberam ACO isolado ou
associado ao estriol. Houve apenas tendência a sua maior expressão entre as usuárias
de ACO e estriol. Notamos diminuição significante na largura dos fibroadenomas em
usuárias apenas de anticoncepcional oral.
Objective: Evaluate proliferate activity of breast fibroadenomas, by expression of Ki-67 and c-myc, after administration of combined oral contraceptives combined or not to estriol. Material e methods: We studied 32 patients with fibroadenomas, which 10 constituted Group 1 and used oral contraceptive compound by levonorgestrel (0,15 mg) and etinilestradiol (0,03 mg), associated to one pill of placebo, manufactured in the same capsule, for four consecutive cycles, with seven days of pause between them. The another 23 patients were distributed in Group 2 and received, besides oral contraceptives, one pill of estriol, 2 mg, which were manufactured with the contraceptive, in the same capsule, and it was taken in the same fashion of Group 1 patients. We took ultrasonic measures of the tumors before and after medication intake and, by the end of the four cycles, we promote the extraction of these tumors, sending them to imunohistochemistry analysis of Ki-67 and c-myc. Results: We observed a significant decrease in fibroadenomas width in patients who take oral contraceptives only. In Group 1 (oral contraceptives with placebo), the average width of fibroadenomas before treatment was 15,73 mm and, after use of four cycles of oral contraceptives, was 13,17 mm. This decrease was statistically significant (p=0,0043). In Group 2 (oral contraceptives with estriol), the width before and after treatment was 15,30 e 13,76 mm, respectively, which is not statistically significant (p=0,157). We did not observe changes in other measures in any of the groups. The analysis of Ki-67 and c-myc did not show either any significant difference between the studied groups: 9,16 and 10,54 in Group 1 and 10,86 and 17,03 in Group 2, respectively. We observed a tendency to a bigger expression of these antigens in patients of Group 2. Conclusions: Our results did not demonstrate significant difference in expression of Ki- 67 and c-myc in patients who takes oral contraceptives only, but show a tendency to a bigger expression in users of oral contraceptives with estriol. We realize a significant decrease in width of fibroadenomas in oral contraceptives only users.
Objective: Evaluate proliferate activity of breast fibroadenomas, by expression of Ki-67 and c-myc, after administration of combined oral contraceptives combined or not to estriol. Material e methods: We studied 32 patients with fibroadenomas, which 10 constituted Group 1 and used oral contraceptive compound by levonorgestrel (0,15 mg) and etinilestradiol (0,03 mg), associated to one pill of placebo, manufactured in the same capsule, for four consecutive cycles, with seven days of pause between them. The another 23 patients were distributed in Group 2 and received, besides oral contraceptives, one pill of estriol, 2 mg, which were manufactured with the contraceptive, in the same capsule, and it was taken in the same fashion of Group 1 patients. We took ultrasonic measures of the tumors before and after medication intake and, by the end of the four cycles, we promote the extraction of these tumors, sending them to imunohistochemistry analysis of Ki-67 and c-myc. Results: We observed a significant decrease in fibroadenomas width in patients who take oral contraceptives only. In Group 1 (oral contraceptives with placebo), the average width of fibroadenomas before treatment was 15,73 mm and, after use of four cycles of oral contraceptives, was 13,17 mm. This decrease was statistically significant (p=0,0043). In Group 2 (oral contraceptives with estriol), the width before and after treatment was 15,30 e 13,76 mm, respectively, which is not statistically significant (p=0,157). We did not observe changes in other measures in any of the groups. The analysis of Ki-67 and c-myc did not show either any significant difference between the studied groups: 9,16 and 10,54 in Group 1 and 10,86 and 17,03 in Group 2, respectively. We observed a tendency to a bigger expression of these antigens in patients of Group 2. Conclusions: Our results did not demonstrate significant difference in expression of Ki- 67 and c-myc in patients who takes oral contraceptives only, but show a tendency to a bigger expression in users of oral contraceptives with estriol. We realize a significant decrease in width of fibroadenomas in oral contraceptives only users.
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Citação
ESTEVÂO, Rodrigo Augusto Fernandes. Avaliação da atividade proliferativa do fibroadenoma mamário apos a administração de anticoncepcional hormonal combinado oral, associado ou não ao estriol. 2007. 81 p. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2007.