RESUMO
Epithelial to mesenchymal transition (EMT) is an important mechanism of invasion in cutaneous squamous cell carcinomas (cSCCs) and has been found to be enhanced in tumors originated from actinic keratosis with transformation limited to the basal epithelial layer -differentiated pathway-, compared to cases with invasion subsequent to complete epidermal transformation -classical pathway-. Several microRNAs and proteins can contribute to EMT modulation in cSCCs. MicroRNA21 and microRNA31 are involved in posttranscriptional regulation of protein expression and could play a relevant role in EMT and cSCC progression. Throughout the EMT process upregulation of matrix metalloproteinases (MMPs) enhances invasiveness and MMP-1 and MMP-3 contribute to local invasion, angiogenesis and metastasis in cSCCs. Additionally, cSCC development is associated with PTEN loss and NF-κB, NOTCH-1 and p63 activation. The aim of this work is to identify differences in the expression of those molecules between both pathways of cSCCs development. Eight tissue microarrays from 80 consecutive cSCCs were analyzed using LNA-based miRNA in situ hybridization for miRNA21 and miRNA31 evaluation, and immunohistochemistry for MMP-1, MMP-3, PTEN, NOTCH-1, NF-κB, p63 and CD31. Significantly higher expression of miRNA31 (p < 0.0001) and MMP-1 (p = 0.0072) and angiogenesis (p = 0.0199) were found in the differentiated pathway, whereas PTEN loss (p = 0.0430) was more marked in the classical pathway. No significant differences were found for the other markers. Our findings support a contribution of miRNA31 and MMP-1 in the differentiated pathway, associated to EMT and increased microvascularization. The greater PTEN loss in the classical pathway indicate that its relevance in cSCC is not EMT-related.
Assuntos
Carcinoma de Células Escamosas , MicroRNAs , Neoplasias Cutâneas , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patologia , Linhagem Celular Tumoral , Transição Epitelial-Mesenquimal/genética , Regulação Neoplásica da Expressão Gênica , Humanos , Metaloproteinase 1 da Matriz/genética , Metaloproteinase 1 da Matriz/metabolismo , Metaloproteinase 3 da Matriz/genética , MicroRNAs/genética , NF-kappa B/metabolismo , Invasividade Neoplásica , Neoplasias Cutâneas/patologiaRESUMO
In this update of the consensus of the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica-SEOM) and the Spanish Society of Pathology (Sociedad Española de Anatomía Patológica-SEAP), advances in the analysis of biomarkers in advanced colorectal cancer (CRC) as well as susceptibility markers of hereditary CRC and molecular biomarkers of localized CRC are reviewed. Recently published information on the essential determination of KRAS, NRAS and BRAF mutations and the convenience of determining the amplification of human epidermal growth factor receptor 2 (HER2), the expression of proteins in the DNA repair pathway and the study of NTRK fusions are also evaluated. From the pathological point of view, the importance of analysing the tumour budding and poorly differentiated clusters, and its prognostic value in CRC is reviewed, as well as the impact of molecular lymph node analysis on lymph node staging in CRC. The incorporation of pan-genomic technologies, such as next-generation sequencing (NGS) and liquid biopsy in the clinical management of patients with CRC is also outlined. All these aspects are developed in this guide, which, like the previous one, will remain open to any necessary revision in the future.
Assuntos
Biomarcadores Tumorais/análise , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Consenso , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Biópsia Líquida , Oncologia , Mutação , Patologia , Sociedades Médicas , EspanhaRESUMO
BACKGROUND: The optimal regimen of preoperative chemoradiotherapy for resectable esophageal cancer has not been established. We evaluated accelerated hyperfractionated radiotherapy (RT) concurrent to low-dose weekly cisplatin and continuous infusion fluorouracil (LDCI-FU) followed by esophagectomy in patients with locally advanced squamous cell carcinoma (SCC) of the esophagus. METHODS: Patients with clinical stage II or III SCC of the esophagus received cisplatin 30 mg/m2/week (days 1, 8, 15), LDCI-FU 300 mg/m2/day (days 1-21), and concomitant RT to a dose of 45 Gy (150 cGy/fraction, 2 fractions/day) on tumor and affected lymph nodes, followed by radical esophagectomy. RESULTS: From 1997 to 2012, 64 patients were treated with this regimen. Twenty-four patients (37 %) had grade 3 esophagitis, 18 (28 %) of whom required hospitalization. The risk of hospitalization was reduced by placement of a jejunostomy tube before starting induction chemoradiotherapy. Six patients (9 %) had grade 3-4 neutropenia. Fifty-three patients (83 %) underwent esophageal resection and complete resection was achieved in 45 (70 %). The overall median survival was 28 months (95 % CI: 20.4-35.6) and 5-year survival was 38 %. In the 18 patients attaining a pathological complete response, median survival was 132 months and 5-year survival was 72 %. Positron emission tomography standardized uptake values (PET SUVmax) post-chemoradiotherapy were associated with pathological response (p = 0.03) and survival (p = 0.04). CONCLUSIONS: Intensive preoperative hyperfractionated RT concomitant to low-dose cisplatin and LDCI-FU is effective in patients with locally advanced SCC of the esophagus, with good pathological response and survival and manageable toxicities. Post-chemoradiotherapy PET SUVmax shows promise as a potential prognostic factor.
Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Quimiorradioterapia Adjuvante/métodos , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Terapia Neoadjuvante/métodos , Adulto , Idoso , Carcinoma de Células Escamosas/cirurgia , Quimiorradioterapia Adjuvante/efeitos adversos , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago , Esofagectomia , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Tomografia por Emissão de PósitronsRESUMO
BACKGROUND: Progression from actinic keratosis (AK) to invasive squamous cell carcinoma (iSCC) of the skin is thought to occur after the development of full thickness epidermal neoplasia, as in the classic pathway of cervical cancer. Nevertheless, cutaneous iSCC may also directly arise from a proliferation of atypical basaloid cells limited mostly to the epidermal basal layer (AK I), akin to what happens in the 'differentiated pathway' of iSCC of the vulva, oral cavity and other locations. OBJECTIVE: To evaluate the prevalence of classic and differentiated pathways in the development of cutaneous iSCC. METHODS: The epidermis adjacent to and overlying iSCC, assumed to be representative of pre-existing lesions, was histologically studied in 196 skin biopsy specimens showing iSCC. RESULTS: AK I, AK II and AK III lesions overlying iSCC were present in 63.8%, 17.9% and 18.4% of cases respectively. The corresponding percentages in the epidermis adjacent to iSCC were 77.9%, 6.6% and 8.3% respectively (stage could not be assessed in 8.1% of cases). Focal epidermal ulceration overlying iSCC was seen in 32% of AK I, 28.6% of AK II and 33.3% of AK III instances. Adnexal involvement by atypical keratinocytes (proliferative AK) was present more frequently in cases with overlying AK I (39/125, 31.2%) than with AK II (8/35, 22.9%) and AKII I (5/36, 13.9%). CONCLUSION: Direct invasion from proliferating basaloid atypical keratinocytes limited to the epidermal basal layer (AK I), known as the differentiated pathway, was the most common form of progression to cutaneous iSCC in our series. On the other hand, stepwise progression from AK I to AK II and AK III (classic pathway) was seen to be operative in a substantial proportion of iSCC cases. All AK lesions, irrespective of intraepidermal neoplasia thickness, are therefore potentially invasive and tumour advance along adnexal structures might facilitate iSCC development from AK I lesions.
Assuntos
Carcinoma de Células Escamosas/patologia , Transformação Celular Neoplásica/patologia , Epiderme/patologia , Ceratose Actínica/patologia , Neoplasias Cutâneas/patologia , Úlcera Cutânea/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Queratinócitos/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal disorder caused by mutations in DNA mismatch repair (MMR) genes. Tumors of the HNPCC-spectrum are associated with microsatellite instability (MSI) and loss of MMR protein expression. Lymphomas are not considered to be HNPCC-related tumors. We report and analyze a case of an HNPCC patient with three colorectal cancers and a B-cell non-Hodgkin lymphoma. Quantitative multiplex PCR of short fluorescent fragments detected a novel MSH2 rearrangement involving exons 9 and 10, which proved to be the pathogenic cause of the disease in the family. Tumor tissues including the lymphoma showed MSI and loss of MSH2 expression. Multiplex ligation-dependent probe amplification analysis revealed a somatic loss of the wild-type MSH2 allele in the lymphoma. These results support the fact that the total loss of a MMR gene can lead to lymphomagenesis, as seen in biallelic MMR-deficient families and knockout mice. Moreover, this is the first report of a B-cell non-Hodgkin lymphoma with a loss of the MSH2 protein expression, linked to a heterozygous germline MSH2 mutation in an HNPCC family.
Assuntos
Adenocarcinoma/genética , Neoplasias Colorretais Hereditárias sem Polipose/genética , Deleção de Genes , Linfoma de Células B/genética , Proteína 2 Homóloga a MutS/genética , Proteínas Adaptadoras de Transdução de Sinal/genética , Adenocarcinoma/patologia , Adulto , Idoso , Neoplasias Colorretais Hereditárias sem Polipose/patologia , Análise Mutacional de DNA , Proteínas de Ligação a DNA/genética , Diagnóstico Diferencial , Feminino , Rearranjo Gênico , Mutação em Linhagem Germinativa , Humanos , Linfoma de Células B/complicações , Linfoma de Células B/diagnóstico , Masculino , Repetições de Microssatélites , Pessoa de Meia-Idade , Proteína 1 Homóloga a MutL , Mutação , Proteínas Nucleares/genética , Linhagem , Reação em Cadeia da PolimeraseRESUMO
BACKGROUND: We reviewed radiologic features of gastrointestinal stromal tumors (GISTs) and correlated them with clinical and pathologic findings. METHODS: We investigated a series of 39 c-Kit-positive GISTs. Clinical and radiologic findings and management of these patients were recorded. RESULTS: Twenty women and 19 men (mean age 64 years) had histologically proved GIST. Tumor locations were the small bowel (n = 20), stomach (n = 14), rectum (n = 4), and omentum (n = l). Symptoms at presentation were most frequently gastrointestinal bleeding (n = 14) and abdominal pain (n = l1). Tumors were classified as very low risk (n = 2), low risk (n = 10), intermediate risk (n = 12), and high risk (n = 11). Ultrasonography, computed tomography, magnetic resonance, digital subtraction angiography, and barium series were used in the evaluation of these tumors. Most tumors were seen as well-delineated soft tissue masses with heterogeneous contrast enhancement. Necrosis, calcification, and ulceration were most commonly seen in large tumors that presented a more aggressive behavior. CONCLUSION: GISTs can arise anywhere in the gastrointestinal tract and present a great variety of clinical and radiologic features, depending mostly on size and location.
Assuntos
Tumores do Estroma Gastrointestinal/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Sulfato de Bário , Benzamidas , Meios de Contraste , Feminino , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/terapia , Humanos , Mesilato de Imatinib , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
AIMS: To compare the immunohistochemical expression of prognostic markers p27(Kip1), p45(Skp2) and Ki67 in Merkel cell carcinoma (primary neuroendocrine carcinoma of the skin, MCC), small cell neuroendocrine carcinoma of lung and urinary bladder (SNC), and cutaneous squamous cell carcinoma (SCC). METHODS AND RESULTS: Immunohistochemistry was performed using antibodies directed against p27(Kip1), p45(Skp2) and Ki67 on 72 tumour cases: 24 MCC, 25 SCC, and 23 SNC (15 from the lung and eight from the urinary bladder). Percentages of positive cells were determined for each marker and statistically analysed. Expression profiles on MCC and SCC were significantly different for all three markers. MCC and SNC exhibited significant similarities in their p27(Kip1) and p45(Skp2) expression profiles. In contrast, MCC and SNC differed significantly in their Ki67 proliferation indices, which were much higher in SNC. Additionally, MCC cases showed an association between increased proliferation indices and the appearance of local recurrence(s) and/or metastases. CONCLUSION: The immunohistochemical profile of MCC differs from that of SCC, in spite of their common oncogenesis and the supposed metaplastic origin of MCC, and resembles that of SNC, except for Ki67 levels, which were higher in the latter (characterized by greater biological aggressiveness). High levels of Ki67 also appear to be a prognostic factor in MCC.
Assuntos
Biomarcadores Tumorais/biossíntese , Carcinoma de Célula de Merkel/patologia , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Cutâneas/patologia , Análise de Variância , Carcinoma de Célula de Merkel/metabolismo , Carcinoma de Células Pequenas/metabolismo , Carcinoma de Células Escamosas/metabolismo , Proteínas de Transporte/biossíntese , Inibidor de Quinase Dependente de Ciclina p27 , Humanos , Imuno-Histoquímica , Peptídeos e Proteínas de Sinalização Intracelular , Antígeno Ki-67/biossíntese , Metástase Neoplásica , Recidiva Local de Neoplasia , Prognóstico , Proteínas Quinases Associadas a Fase S/biossíntese , Neoplasias Cutâneas/metabolismoRESUMO
We report a patient who, 3 months after being diagnosed with ulcerative colitis, was admitted to hospital because of malaise and right lower abdominal pain. An open appendectomy was performed. Histological study showed ulcerative colitis affecting the appendix. After surgery, the patient presented a refractory outbreak of ulcerative colitis requiring treatment with steroids and cyclosporin A. Despite this treatment, the patient continued to pass abundant fresh blood associated with severe anemia. Colonoscopy showed only granular and congestive cecal mucosa. Biopsies showed intracytoplasmic inclusion bodies with immunohistochemical stains positive for cytomegalovirus (CMV) infection. Rectorrhagia and anemia quickly disappeared after beginning treatment with ganciclovir. Appendicular ulcerative colitis is not uncommonly associated with distal colitis. In addition, diffuse CMV infection complicating ulcerative colitis treatment is not unusual. By contrast, isolated, segmentary infection by CMV in the proximal colon is extremely rare. Until now, only three patients with localized CMV infection have been described, and all three cases occurred in the context of ileoanal anastomosis.
Assuntos
Apendicectomia/efeitos adversos , Doenças do Ceco/etiologia , Colite Ulcerativa/complicações , Infecções por Citomegalovirus/etiologia , Adulto , Feminino , HumanosRESUMO
We report a case of primary biliary tract malignant melanoma occurring in a 47-year-old male. Ultrasonography and computed tomography showed multiple masses in the gallbladder and distal common bile duct that caused biliary tract dilatation. Magnetic resonance imaging showed that the polypoid masses in the gallbladder and common bile duct were of low signal intensity on T2-weighted images and of high signal intensity on unenhanced T1-weighted images.
Assuntos
Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias da Vesícula Biliar/diagnóstico , Melanoma/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Helicobacter pylori-associated peptic ulcer is a frequent complication in cirrhotic patients and its morbidity rate is high. In spite of this, diagnostic methods for H. pylori infection have not been fully evaluated in these patients. AIM: To evaluate H. pylori diagnostic methods in patients with liver cirrhosis. METHODS: One hundred and one cirrhotic patients were included in the study. Three antral and two corpus biopsies were obtained for rapid urease test of the antral mucosa, and Giemsa stain and immunohistochemistry were performed for both the corpus and antrum. Serology, 13C-urea breath test and faecal H. pylori antigen determination were also carried out. RESULTS: Sixty-two patients were positive and 35 were negative for H. pylori infection; four were indeterminate. The sensitivity and specificity were 90.4% and 100%, respectively, for antral histology, 100% and 100% for gastric body histology, 90.4% and 100% for antral immunohistochemistry, 96.2% and 96.7% for body immunochemistry, 85.7% and 97% for rapid urease test, 83.6% and 55.9% for serology, 96.4% and 97.1% for 13C-urea breath test and 75.4% and 94.1% for faecal antigen. CONCLUSION: The most reliable tests for H. pylori infection in cirrhotic patients were the 13C-urea breath test and gastric body histology.
Assuntos
Infecções por Helicobacter/diagnóstico , Helicobacter pylori , Cirrose Hepática/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas Bacteriológicas , Biópsia , Testes Respiratórios , Feminino , Gastrite/microbiologia , Gastroscopia , Infecções por Helicobacter/complicações , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estômago/patologiaRESUMO
Idiopathic pylephlebitis and primary sclerosing peritonitis are two highly unusual entities. To our knowledge, the association of the two diseases has not been described previously. We report a 42-year-old patient with a protein S deficiency who presented with fever and chills, in whom idiopathic pylephlebitis was diagnosed. A year later, the patient was readmitted because of recurrent vomiting and weight loss. An exploratory laparotomy yielded diagnosis of sclerosing peritonitis, which resolved after surgery. The short time interval between the processes suggests that they were related to each other, and also to the protein S deficiency.
Assuntos
Peritonite/etiologia , Flebite/etiologia , Veia Porta , Deficiência de Proteína S/complicações , Adulto , Humanos , Masculino , Peritonite/patologia , EscleroseRESUMO
Chromosome 18q is lost a high proportion of colorectal and pancreatic cancers. Three candidate tumor suppressor genes, DCC, Smad4 and Smad2 have been identified in this chromosome region. DCC and Smad4 aberrations have been previously identified in pancreatic and colorectal tumors. The aim of this study was to compare the presence of concurrent genetic aberrations in DCC and neighboring Smad4 and Smad2 genes during colorectal and pancreatic distal dissemination. We have used a panel of orthotopically implanted colorectal and pancreatic xenografts and corresponding metastases. We have shown that while LOH at DCC locus occurred at a similar frequency in both tumors, diminished DCC protein expression was exclusively present in colorectal tumors harboring intragenic DCC LOH. In contrast, in pancreatic xenografts loss of DCC protein and mRNA expression was restricted to metastases. Smad4 gene aberrations were detected at a similar frequency in both tumors and were selected for during distal dissemination. Acquisition of alterations in both genes occurred independently. Our results suggest that both DCC and Smad4 contribute to pancreatic and colorectal distal dissemination. However, the role of DCC may differ between both tumor types.
Assuntos
Adenocarcinoma/genética , Cromossomos Humanos Par 18/genética , Neoplasias Colorretais/genética , Proteínas de Ligação a DNA/genética , Genes DCC , Perda de Heterozigosidade , Metástase Neoplásica/genética , Proteínas de Neoplasias/genética , Oncogenes , Neoplasias Pancreáticas/genética , Transativadores/genética , Adenocarcinoma/patologia , Adulto , Idoso , Animais , Ascite/genética , Ascite/patologia , Neoplasias do Colo/genética , Neoplasias do Colo/patologia , Neoplasias Colorretais/patologia , Análise Mutacional de DNA , DNA de Neoplasias/genética , Proteínas de Ligação a DNA/fisiologia , Progressão da Doença , Humanos , Metástase Linfática , Masculino , Camundongos , Camundongos Nus , Pessoa de Meia-Idade , Proteínas de Neoplasias/fisiologia , Transplante de Neoplasias , Células Neoplásicas Circulantes , Neoplasias Pancreáticas/patologia , Neoplasias Peritoneais/genética , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/secundário , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transdução de Sinais/genética , Proteína Smad2 , Proteína Smad4 , Transativadores/fisiologia , Transplante HeterólogoRESUMO
PURPOSE: To evaluate proton fat-water chemical shift fast low-angle shot magnetic resonance (MR) imaging for differentiation of fat-containing hyperechoic liver nodules from hyperechoic liver nodules without a fatty component. MATERIALS AND METHODS: T1-weighted fast low-angle shot fat-water chemical shift gradient-echo MR imaging was performed in 96 patients without cirrhosis with 138 hyperechoic liver nodules. In-phase and opposed-phase breath-hold images were acquired. The percentage of signal intensity variation between in-phase and opposed-phase images and the spleen-to-lesion contrast ratio were used to differentiate liver nodules. RESULTS: Chemical shift MR images showed fat in 15 (11%) hyperechoic nodules (two angiomyolipomas and 13 nodular fatty infiltrations of the liver). The mean percentage of signal intensity variation between in-phase and opposed-phase images was 156% (standard error, 43.5%) in nodules with fat and -0.16% (standard error, 0.96%) in nodules without fat (P = .003). Spleen-to-lesion contrast was similar on in- and opposed-phase images in lesions without fat (mean difference, -0.0107; standard error, 0.012), whereas the mean difference in fat-containing nodules was 0.805 (standard error, 0.225; P = .003). The area under the receiver operating characteristic curve was 0.97 for signal intensity variation. CONCLUSION: Hyperechogenicity in certain liver nodules is caused by fat. Chemical shift MR imaging allows accurate differentiation between these and other hyperechoic lesions with no fat component.
Assuntos
Hepatopatias/diagnóstico , Imageamento por Ressonância Magnética/métodos , Tecido Adiposo , Adulto , Idoso , Angiomiolipoma/diagnóstico , Água Corporal , Meios de Contraste , Diagnóstico Diferencial , Fígado Gorduroso/diagnóstico , Feminino , Gadolínio DTPA , Hemangioma/diagnóstico , Humanos , Aumento da Imagem , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Prótons , Curva ROC , Sensibilidade e Especificidade , Baço/patologiaRESUMO
BACKGROUND: To assess the putative prognostic value of K-ras mutations in nonmucinous ovarian tumors, the authors looked for K-ras point mutations at codons 12 and 13 in 144 nonmucinous ovarian tumors. METHODS: A series of 144 consecutive, unselected, archival, nonmucinous ovarian tumors (35 benign, 12 borderline, and 97 malignant) were studied. K-ras mutations at codons 12 and 13 were determined by polymerase chain reaction using the restriction fragment length polymorphism method with mismatched nested primers. Extensive clinicopathologic and follow-up data on all patients were evaluated. RESULTS: The overall prevalence of K-ras mutations at codons 12 and 13 was 30.5% (44/144). In benign tumors, it was 20% (7/35); in borderline tumors, 25% (3/12); and in carcinomas, 35% (34/97). The presence of K-ras point mutations did not correlate with survival. Among the benign tumors, K-ras mutations were detected in three Brenner tumors with a mucinous component. CONCLUSIONS: These results indicate that K-ras mutations are not initial events in the pathogenesis of nonmucinous ovarian tumors and do not appear to be related to survival.
Assuntos
Carcinoma/genética , Genes ras/genética , Neoplasias Epiteliais e Glandulares/genética , Neoplasias Ovarianas/genética , Mutação Puntual , Adulto , Idoso , Idoso de 80 Anos ou mais , Códon , DNA de Neoplasias/análise , Feminino , Humanos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Prevalência , Prognóstico , Análise de SobrevidaRESUMO
OBJECTIVE: To assess the sensitivity and specificity of pancreatic fine needle aspiration. STUDY DESIGN: Two hundred five fine needle aspirates were obtained from 149 patients over seven years. After excluding 40 patients lacking biopsy or follow-up, 125 aspirates from 109 patients were selected to analyze the accuracy of this method. (male:female ratio, 1.4:1; age range 43-79 years). RESULTS: The cytologic diagnosis was true positive in 50 studies (45.9%), false positive in 0, true negative in 25 (22.9%), false negative in 19 (17.4%) and suspicious for malignancy in 17 (15.6%); 14 aspirations (12.8%) yielded material unsatisfactory for a diagnosis. Of the 17 suspicious studies, 15 were from patients in whom a malignancy was confirmed later. The other two patients had chronic pancreatitis. CONCLUSION: The efficiency was 79.8%, sensitivity 72.5%, and specificity and predictive value of a positive result 100%. Cell blocks provided sufficient material in 96.8% of cases and smears in 90.4%. No major complications were reported after fine needle aspiration.
Assuntos
Biópsia por Agulha , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Pancreatite/patologia , Adulto , Idoso , Doença Crônica , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
A 58-year-old white woman presented with widespread pruritic brownish plaques and hyperpigmented flexural lesions with a velvety appearance. On histopathological examination, the macules were diagnostic of mycosis fungoides, plaque stage, and the flexural lesions showed epidermal hyperplasia with a seborrhoeic keratosis-like appearance. There was intense mucin deposition and marked reduction of elastic fibres in the papillary dermis, as well as a moderately dense dermal lymphoid infiltrate composed of CD4+ T cells with occasional atypia and focal epidermotropism. The clinical and pathological manifestations of cutaneous T-cell lymphomas, including mycosis fungoides (MF), may show considerable variation. Apart from the three classic stages, a number of unusual clinical presentations and a broad spectrum of histopathological findings have been reported in the literature. In this report, a case of MF, plaque stage, with flexural lesions clinically reminiscent of (pseudo)acanthosis nigricans is presented. On histopathological examination, there was epidermal hyperplasia with a seborrhoeic keratosis-like appearance, with intense deposition of mucin and marked reduction of elastic fibres in the papillary dermis, together with a lymphoid infiltrate composed mainly of CD4+ cells with occasional atypia and epidermotropism. Cytokines produced by the lymphocytes in the infiltrate might account for the epithelial and dermal changes that characterize this peculiar variant of MF.
Assuntos
Micose Fungoide/complicações , Neoplasias Cutâneas/complicações , Pele/patologia , Feminino , Humanos , Hiperplasia/complicações , Hiperplasia/patologia , Pessoa de Meia-Idade , Micose Fungoide/patologia , Neoplasias Cutâneas/patologiaRESUMO
CD44 is a polymorphic family of cell adhesion molecules that seems to be instrumental in the mechanism of tumor invasion and metastasis. Tumor cell expression of CD44, or lack thereof, may be one of the factors conditioning the highly disparate ability to penetrate the brain extracellular matrix (ECM) exhibited by glioblastoma multiforme (GM) and conventional meningioma. To assess the presence of CD44 in these two tumor types we have immunohistochemically investigated the expression of CD44 standard form (CD44s) and the variant isoforms containing the domain encoded by variant exon 3 (CD44v3) and variant exon 6 (CD44v6) in paraffin-embedded tissue from 10 conventional meningiomas and 10 GMs. A CD44s-/CD44v-phenotype was discerned in the meningioma cases, whereas GMs featured a CD44s+/CD44v- expression profile. Consequently, the growth patterns of meningioma and GM seem to be, at least in part, a reflection of their CD44 expression status. Paucity of CD44 in meningioma cells would render them unable to infiltrate the brain ECM, whereas CD44-rich glioma cells would successfully migrate through it. Conversely, lack of CD44v expression would contribute to explain the lack of metastatic potential characterizing both conventional meningioma and GM.
Assuntos
Neoplasias Encefálicas/patologia , Glioblastoma/patologia , Receptores de Hialuronatos/fisiologia , Meningioma/patologia , Adulto , Idoso , Biomarcadores Tumorais/análise , Neoplasias Encefálicas/química , Neoplasias Encefálicas/imunologia , Feminino , Glioblastoma/química , Glioblastoma/imunologia , Humanos , Receptores de Hialuronatos/análise , Masculino , Meningioma/química , Meningioma/imunologia , Pessoa de Meia-Idade , Invasividade NeoplásicaRESUMO
The first case of pigmented epidermotropic breast carcinoma in a male, presenting as a pigmented lesion of the areola and nipple, is described. Immunohistochemical and ultrastructural studies demonstrated that the pigmentation was found to be primarily due to colonization of tumor nests by melanocytes, with numerous melanophages interspersed in the desmoplastic stroma and only occasional compound melanosomes within the epithelial tumor cells.
Assuntos
Neoplasias da Mama Masculina/patologia , Carcinoma Ductal de Mama/patologia , Melaninas/análise , Neoplasias da Mama Masculina/química , Neoplasias da Mama Masculina/ultraestrutura , Carcinoma Ductal de Mama/química , Carcinoma Ductal de Mama/ultraestrutura , Humanos , Masculino , Melanócitos/patologia , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/secundárioAssuntos
Dor Abdominal/patologia , Anorexia/patologia , Astenia/patologia , Transtornos do Sono-Vigília/patologia , Vômito/patologia , Redução de Peso , Idoso , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Peritonite Tuberculosa/patologia , Tuberculose Hepática/patologia , Tuberculose Miliar/patologia , Tuberculose Renal/patologiaRESUMO
AIM: To study the expression of p53 tumour suppressor gene in anaplastic carcinomas arising from thyroid papillary carcinomas. METHODS: Formalin fixed, paraffin wax embedded tissues from four cases of anaplastic carcinomas associated with thyroid papillary carcinomas were studied by immunohistochemistry with two different p53 monoclonal antibodies. RESULTS: The anaplastic component showed nuclear immunostaining in two cases, but not in the other two. In all cases the papillary carcinoma component was negative. CONCLUSION: The results support the hypothesis that p53 stimulates tumour progression in thyroid tumours.