RESUMO
BACKGROUND: We report our surgical series of 35 patients with giant nonfunctioning pituitary adenomas (GNFPA). We analyzed the rule of Ki-67 antigen expression in predicting recurrence. METHODS: Thirty-five patients were operated between 2000 and 2010. Suprassellar extension of the tumors were classified according to Hardy and Mohr based on magnetic resonance (MR) studies. Pituitary endocrine function and MR scans were assessed preoperatively and at 1, 6, and 12 months postoperatively. Immunohistochemical studies were based in regard to the expression of the proliferative Ki-67 index and the hormonal receptor for luteinizing hormone, follicle stimulating hormone, growth hormone, thyroid stimulating hormone, adrenocorticotropic hormone, and prolactin. Tumors specimens were obtained from 35 patients with GNFPA. Endoscopic transsphenoidal surgery was the approach of choice. RESULTS: Thirty-five patients were submitted to 49 surgeries, 44 (89.8%) were transsphenoidal and 5 (10.2%) were transcranial. The most frequent preoperative complaints were visual acuity impairment and visual field defect in 25 (71.2%) and 23 (65.7%) cases, respectively. Improvement of visual acuitiy and visual field deficit after surgery was seen in 20 (80%) and 17 (73.9%) patients, respectively. Endocrinological deficits were encountered in 20 patients (57.1%). After surgery, 18 patients (51.4%) required hormonal replacement. Three patients had visual symptoms related to pituitary apoplexy and recovered after surgery. The Ki-67 labeling index (LI) ranged from <1% to 4.8%. The rate of recurrence in tumors with Ki-67 <3% was 7.7% (2 patients), Ki-67 >3% was present in 5 patients and the recurrence committed 3 patients. CONCLUSION: In our series, regardless the improvement of visual function and compressing symptoms, 5 patients with expression of Ki-67 LI more than 3% experienced a recurrence.
RESUMO
INTRODUÇÃO E OBJETIVO: O carcinoma de células renais (CCR) é umas das doenças urológicas de maior malignidade, correspondendo a 1 por cento-3 por cento de todos os tumores sólidos dos adultos. As lesões pré-malignas do CCR ainda não foram totalmente descritas. Achados de displasia intraepitelial tubular renal (DIETR) em áreas próximas ao tumor, livres de neoplasia, sugerem que esta alteração possa ser a precursora biológica de alguns tipos de CCR. O objetivo deste estudo é avaliar a possibilidade do uso de tissue microarray (TMA) no estudo da DIETR e do CCR e os parâmetros para sua utilização imuno-histoquímica (IHQ) utilizando os anticorpos anti-Ki-67 e p53 para confirmar a evidência de DIETR como precursora biológica do CCR. MATERIAL E MÉTODOS: O estudo foi realizado em 10 peças cirúrgicas de nefrectomias realizadas em pacientes com diagnóstico de CCR selecionadas no período de 2000 a 2005, em material arquivado no Instituto Nacional de Câncer (INCA). DISCUSSÃO: A utilização da técnica de TMA permite amostragem de várias áreas e realização da IHQ utilizando apenas duas lâminas, uma para cada marcador. Como não há na literatura descrição de utilização de TMA para estudo da DIETR, foi necessário inicialmente realizar estudo de validação para saber se haveria representatividade de lesões focais no TMA. RESULTADOS: A análise estatística não mostrou diferença entre a utilização de TMA com dois ou quatro cilindros de tecido ou o corte inteiro. CONCLUSÃO: O teste de validação de técnica artesanal de TMA autorizou o uso de dois cilindros de 1 mm² por caso.
INTRODUCTION AND OBJECTIVE: Renal cell carcinoma is one of the most malignant urological diseases, corresponding to 1 percent-3 percent of solid tumors in adults. The finding of intratubular epithelial dysplasia (IED) next to tumor areas suggests that this can be the biological precursor of some types of renal cell carcinoma (RCC). The objective of this study is to evaluate the use of tissue microarray (TMA) to study IED and RCC by immunohistochemistry (IHC) with Ki-67 and p53 protein to confirm the evidence that IED is the biological precursor of RCC. MATERIAL AND METHOD: This study was performed in archival material from ten nephrectomy surgical specimens from Instituto Nacional de Câncer, between 2000 and 2005. DISCUSSION: TMA technique allows to sample and study several different areas from many patients in the same slide, using just one slide for each IHC marker. Once there was no previous study on IED by TMA, a validation test was needed first. RESULTS: There was no statistical difference between 2 or 4 tissue cores and the whole section analysis. CONCLUSION: TMA validation assay demonstrated that the use of two tissue cores with 1 mm² each was suitable to evaluate RCC and IED.