Assessment of the aerosol distribution pattern of a single-port device for intraperitoneal administration of therapeutic substances.

BACKGROUND: In the last 20 years, intraperitoneal chemotherapy (IPC) has been explored as a modality for the management of peritoneal metastases of gynecologic, gastrointestinal, and primary peritoneal tumors. Direct delivery of chemotherapeutic agents to the peritoneal cavity space has proved superior to systemic chemotherapy when evaluating characteristics such as drug concentration reached in the peritoneal space, penetration into peritoneal metastases, and chemotherapy-related toxicity. Traditionally, IPC is delivered by peritoneal lavage with a liquid solution. This form of delivery has limitations, including inhomogeneous intraperitoneal distribution and limited ability to penetrate tissues and metastatic nodules. An alternative mode of delivery is so-called pressurized intraperitoneal aerosol chemotherapy (PIPAC). Within this context, the present study sought to identify the pattern of spatial distribution of therapeutic solutions aerosolized into the peritoneal space using a single-port PIPAC device and ascertain whether the aerosolized method is superior to the traditional (liquid) mode of IPC delivery. METHODS: Analysis of the rate of intra-abdominal staining with aerosolized 2% silver nitrate in five porcine models. RESULTS: Assessment of differences in stain impregnation between the upper, middle, and lower abdomen did not reveal significant differences (p = 0.42). The median sum scores were 1 for the upper abdomen and 3 for the middle and lower abdomen. CONCLUSIONS: Aerosolization does not reach all regions of the abdomen homogeneously. However, adequate exposure of the upper abdomen, mid-abdomen, and lower abdomen to chemotherapeutic agents can be achieved with PIPAC.

Oxidative Stress in Aortas of Patients with Advanced Occlusive and Aneurysmal Diseases.

BACKGROUND: Aortoiliac occlusive disease (AOD) and abdominal aortic aneurysm (AAA) are very important cardiovascular diseases that present different aspects of pathophysiology; however, oxidative stress and inflammatory response seem be relevant in both of them. Our objective was to evaluate oxidative damage and degree of inflammatory infiltrate in aortas of patients surgically treated for AOD and AAA. MATERIALS AND METHODS: Levels of reactive oxygen species (ROS), nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity, and myeloperoxidase (MPO) expression as well as nitrite levels and superoxide dismutase (SOD) and catalase (CAT) activities were evaluated in aortas of patients with AOD (n = 16) or AAA (n = 14), while the control group was formed by cadaveric organ donors (n = 10). We also analyzed the degree of inflammatory infiltrate in these aortas. RESULTS: There was an increase in ROS levels and NADPH oxidase activity in patients with AOD and AAA when compared with the control group, and the AOD group demonstrated higher ROS production and NADPH oxidase activity and also nitrite levels when compared with the AAA group (P < 0.001). On the other hand, an increase of SOD activity in the AOD group and CAT activity in the AAA group was observed. Inflammatory infiltrate and MPO expression were higher in the AOD group when compared with the control group (P < 0.05). CONCLUSIONS: Oxidative stress is relevant in both AOD and AAA, though AOD presented higher ROS levels and NADPH activity. Increased activities of antioxidant enzymes may be a compensatory phenomenon which occurs in aortas of patients with AOD and AAA. Perhaps, a relationship between oxidative stress and degree of inflammatory infiltrate may exist in the pathophysiology of AOD and AAA.

Differential diagnosis of mesenchymal neoplasms of the digestive tract by cell block and immunohistochemistry.

OBJECTIVES: To evaluate the diagnostic yield of the cell block (CB) technique with immunohistochemistry in patients with mesenchymal neoplasms of the gastrointestinal tract collected by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). METHODS: Tissue samples from consecutive patients with subepithelial lesions collected by EUS-FNA, without analysis by on-site cytopathology, were evaluated by the same pathologist only using CBs in AAF fixative. Sections were stained with haematoxylin-eosin and underwent complementary immunohistochemical staining for SMA, CD117, DOG-1 and S100 in the presence of mesenchymal neoplasms. Specimens were defined as diagnostic when sufficient tissue was present for histopathological evaluation and immunohistochemistry analysis. If they were insufficient for complete evaluation, the specimens were considered nondiagnostic. RESULTS: Between September 2012 and December 2016, a total of 158 patients (median age: 57 years, 64.5% women) underwent EUS-FNA with an average of three needle passes for every lesion. The median lesion size was 17 mm. There were 113 mesenchymal neoplasms confirmed by immunohistochemistry (66 leiomyomas, 44 GISTs, two schwannomas, one leiomyosarcoma). The overall diagnostic yield of CBs was 84.17%. However, diagnosis was obtained in 98.5% (133/135) of the cases after exclusion of 23 cases in which EUS-FNA sampling was insufficient or without tumoural tissue. Only two mesenchymal neoplasms were not confirmed by CBs even after immunohistochemistry. CONCLUSIONS: CBs collected by EUS-FNA and analysed by immunohistochemistry showed a high diagnostic yield in patients with mesenchymal neoplasms, even without on-site cytopathology.

End-to-end versus end-to-side motor and sensory neurorrhaphy in the repair of the acute muscle denervation.

BACKGROUND: The aim of this study was to experimentally compare end-to-end and end-to-side neurorrhaphy in perineural window model after motor nerve lesion, evaluating which one was the most effective to preserve nerves. Also, differences in motor and sensorial nerve regeneration were tested to verify differences in nerve regeneration. METHODS: A total of 20 adult male Wistar rats were randomly assigned to 5 groups, and, in each one, a different treatment was performed: besides the control group, and end-to-end or end-to-side graft with motor or sensorial nerves was performed. Silastic sheet was used as a mechanical barrier to prevent innervation from adjacent nerves. After 16 weeks, the specimens were histologically assessed and wet weight was evaluated as a direct parameter of atrophy. RESULTS: The end-to-end neurorrhaphy group presented the best results in terms of mass preservation, but it did not differ significantly from the control group. Motor nerves presented similar results in muscular atrophy. The end-to-side neurorrhaphy group with sensory nerve as donor showed the worst results. CONCLUSIONS: The use of sensory nerves to preserve skeletal muscle trophism is not justified, since, according to our model, it affects 50% to 80% of the muscle mass in a period of 16 weeks. End-to-side neurorrhaphy was demonstrated to be an option for re-enervation of a nerve-deprived motor muscle in selected cases.

Immunohistochemical assessment of symptomatic postmenopausal endometrial polyps in tamoxifen users and nonusers: a case control study.

BACKGROUND: Endometrial polyps are common in postmenopausal women, and the effect of tamoxifen use (a risk factor for endometrial polyps) on their pathogenesis is unclear. OBJECTIVES: To evaluate the expression of hormone receptors and markers for proliferation/apoptosis (Ki-67 and Bcl-2) in endometrial polyps in postmenopausal users and nonusers of tamoxifen. DESIGN AND SETTING: Cross-sectional analytical study in a tertiary-level academic hospital. METHODS: 46 women (14 tamoxifen users and 32 nonusers) with postmenopausal bleeding underwent hysteroscopic resection of endometrial polyps. Polyp samples were immunohistochemically assessed for detection of Ki-67, Bcl-2 and estrogen and progesterone receptors. RESULTS: Analysis on the glandular component of the polyps revealed progesterone receptor expression in the polyps of 96.9% of the nonusers of tamoxifen, and 92.3% of the tamoxifen users (P = 0.499). All polyps in nonusers and 92.3% of those in users were also positive for estrogen receptors (P = 0.295). Ki-67 was expressed in 75% of the polyps in the tamoxifen users and 82.8% of those in the nonusers. All endometrial polyps expressed Bcl-2. CONCLUSIONS: The immunohistochemical analysis on endometrial polyps demonstrated that, although tamoxifen is considered to be a risk factor for endometrial polyps, there were no significant differences in the expression of hormone receptors between users and nonusers of tamoxifen. There were no between-group differences in Ki-67 and Bcl-2 expression, and all patients displayed inhibition of apoptosis by Bcl-2, thus supporting the theory that polyps develop due to inhibition of apoptosis, and not through cell proliferation.

MnSOD gene polymorphism association with steroid-dependent cancer.

Oxidative stress enhances carcinogenesis due to DNA damage. Manganese superoxide dismutase (MnSOD) Val16Ala polymorphism has been recently associated with breast and prostate cancer. The role of oxidative stress in male breast cancer is poorly investigated due to the low prevalence of this neoplasia. We studied the relationship between prostate cancer (PC), male (MBC) and female breast cancer (FBC) and this polymorphism in a case-control study. Human genetic polymorphism Val16Ala of MnSOD was obtained from blood and paraffin-embedded tumor samples. The polymorphism was determined in 11 cases of MBC, 51 cases of PC, 89 cases of FBC and 372 age-adjusted healthy controls by polymerase chain reaction-restriction fragment length polymorphism techniques using restriction enzyme Hae III. Chi-square or Fisher test were used to compare the MnSOD frequency distribution. The observed genotypic frequencies of all samples were AA = 9.6% (n = 50), VV = 25.4% (n = 133) and AV = 64% (n = 340), all at Hardy-Weinberg equilibrium. Breast and prostate cancer risk was elevated in male and female patients with the Ala/Ala genotype compared to controls (p = 0.006, odds ratio = 2.5, 95% confidence interval 1.393-4.541). Even though the frequency of the Ala allele was low (9.6%) in the studied population, these data support the hypothesis that MnSOD and oxidative stress play a significant role in breast cancer risk both in males and females and also brings new information on the role of this polymorphism in prostate cancer. This is the first study which provides some evidence that genetic polymorphism in the MnSOD gene may be associated with an increased risk of male breast cancer. Studies with a larger sample size are needed to confirm the findings.

Immunohistochemical Expression of Cyclooxygenases in Hypertrophic Scars and Keloids.

BACKGROUND: There are studies demonstrating an increased expression of cyclooxygenase (COX) in keloids and hypertrophic scars, suggesting that anti-inflammatory drugs could be used in their treatment. However, a precise relationship between COX and pathological scarring has not been established in the literature yet. This study aims to evaluate the immunohistochemical expression of COXs in these scars. METHODS: Prospective study, including 54 patients (aged 18-60 years) undergoing scar excision: 18 normal scars (group 1), 18 hypertrophic scar (group 2), and 18 keloids (group 3). The group classification was performed by clinical criteria. Scars samples were collected and anatomopathological examination (through hematoxylin-eosin method) was performed to confirm the scar type. Immunohistochemistry was performed to assess the expression of COX1 and COX2 in epidermis and dermis. Results were compared among all groups and between group I versus II and III together (abnormal scars). RESULTS: For COX1, in the epidermis, there was no significant difference in the immunohistochemical expression when comparing the 3 groups. In the dermis, groups 2 and 3 had greater expression than group 1, with a significant difference being found when comparing all groups (P = 0.014), and in the comparison between normal versus abnormal scars (P = 0.004). For COX2, there was no significant difference between the groups in both the epidermis and dermis. CONCLUSIONS: The immunohistochemical expression of COX1 was greater in the dermis of abnormal scars when compared with normal scars. Future studies can be performed involving COX blockade as a perspective of these scars treatment.

Role of N-acetylcysteine on fibrosis and oxidative stress in cirrhotic rats.

BACKGROUND: Hepatic cirrhosis is the final stage of liver dysfunction, characterized by diffuse fibrosis which is the main response to the liver injury. The inhalatory carbon tetrachloride is an effective experimental model that triggers cirrhosis and allows to obtain histological and physiological modifications similar to the one seen in humans. AIM: To investigate the effects of N-acetylcysteine (NAC) on the fibrosis and oxidative stress in the liver of cirrhotic rats, analyzing liver function tests, lipoperoxidation, activity of glutathione peroxidase enzyme, collagen quantification, histopathology, as well as the nitric oxide role. METHODS: The animals were randomly in three experimental groups: control (CO); cirrhotic (CCl4) and CCl4 + NAC. Evaluate the lipid peroxidation, the glutathione peroxidase enzyme, the collagen and the expression of inducible nitric oxide synthase (iNOS). RESULTS: The cirrhotic group treated with N-acetylcysteine showed trough the histological analysis and collagen quantification lower degrees of fibrosis. This group has also shown less damage to the cellular membranes, less decrease on the glutathione peroxidase levels and less expression of inducible nitric oxide synthase when matched with the cirrhotic group without treatment. CONCLUSION: N-acetylcysteine seams to offer protection against hepatic fibrosis and oxidative stress in cirrhotic rat livers.

Prognostic value of the immunohistochemistry correlation of Ki-67 and p53 in squamous cell carcinomas of the larynx.

UNLABELLED: Prognostic histological factors may contribute to determine the evolution of this neoplasia. AIM: To correlate p53 and Ki-67 immunohistochemical expression with age, histological degree, lymph node involvement and pathological staging in patients with laryngeal epidermoid carcinomas. METHODS: We assessed thirty consecutive cases of laryngeal epidermoid carcinomas submitted to immunohistochemistry to check the expression of p53 e Ki-67 antibodies. RESULTS: Mean age was of 56.2 years and the immunoexpression of the markers was observed in the group with more than 50 years of age, especially that o the ki-67 antibody (p=0.032). There was no relation between p53 and Ki-67 with lymph node involvement. Ki-67 was expressed in 70% of the high histology level cases and in 80% in the low histology ones; while p53 was of 70% only in the high level cases. Pathology staging showed that in the group of advanced carcinomas, p53 expression was of 61.5%, while Ki-67 proved positive for the early cases (100%) and advanced (73.1%). CONCLUSION: There were no significant differences between p53 and Ki-67 immunoexpression in laryngeal epidermoid carcinoma, except in the group of patients with more than 50 years of age, when Ki-67 expression was significantly higher.

[Experimental model of liver oxidative damage induction in rats by halothane]. / Modelo experimental de indução de lesão oxidativa hepática em ratos por halotano.

BACKGROUND: The anesthetic halothane can be reductively metabolized to reactives intermediates that may initiate lipid peroxidation accompanied by hepatic injury. Hypoxia and phenobarbital pretreatment in rats increases metabolism of halothane, the oxidative stress, cause liver antioxidant enzymes changes and tissue damage. AIMS: We investigated the effect of halothane on hepatic lipid peroxidation and on hepatic histology after increases reductive metabolism of halothane caused by hypoxia and phenobarbital pretreatment. METHODS: Twenty-five male wistar rats were divided in five equals groups: CO (Control), HO14 (Halothane/Hypoxia), F (fenobarbital alone), O14 (Hypoxia alone) and H (Halothane alone). After 24 hours the rats were killed, their livers removed to determine chemoluminescence, thiobarbituric acid-reactive substances, catalase, superoxide dismutase, and blood samples were taken to determine AST and ALT. The histopathologic evaluation was performed with hematoxylin and eosin staining. Histopathologic scores are presented as 25th-75th percentile/range values and median +/- range. RESULTS/CONCLUSION: Halothane-hypoxic exposure resulted in a significant changes in the activities of antioxidant enzymes, and induced hepatic lipoperoxidation. Moreover it resulted in histopathologic liver injury as well as significant increase of serum activity of AST and ALT.

Assessment of HER-2 status in invasive breast cancer in Brazil.

OBJECTIVE: To characterize the frequency of HER-2-positive breast cancer in Brazil. METHOD: In this prospective observational study, we first ascertained the HER-2 status of invasive breast cancer specimens by automated immunohistochemistry (IHC). For specimens classified as 2+ by IHC, we performed in situ hybridization (ISH). RESULTS: From February, 2011 to December, 2012, 1,495 breast specimens were registered, and 1,310 samples collected at 24 centers were analyzed. Median patient age was 54 years, and the majority of samples were obtained from segmental (46.9%) or radical mastectomy (34.4%). The predominant histological type was invasive breast carcinoma of no special type (85%), 64.3% had tubule formation (grade 3), and estrogen/progesterone receptors (ER/PR) were positive in 77.4/67.8% of the specimens analyzed, respectively. Using IHC, we found a negative HER-2 status (0 or 1+) in 72.2% of specimens, and 3+ in 18.5%; the 9.3% scored as 2+ were further analyzed by ISH, of which 15.7% were positive (thus, 20.0% of samples were HER-2- -positive by either method). We found no association between HER-2 scores and menopausal status or histological type. Tumors classified as 3+ came from younger patients, and had higher histological grade and less frequent expression of ER/PR. In the North region of Brazil, 34.7% of samples were 3+, with lower frequencies in the other four regions of the country. CONCLUSION: Our findings provide estimates for the frequency of HER-2 positivity in Brazil and raise the hypothesis that biological differences may underlie the different distribution of breast-cancer phenotypes among different Brazilian regions.

The Effects of Passive Smoking on Laryngeal and Tracheal Mucosa in Male Wistar Rats During Growth: An Experimental Study.

Cigarettes contain toxic and carcinogenic substances. In this context, cigarette smoking, and similar activities, are associated with numerous pathologies, being considered a risk factor in up to 10% of the total number of deaths in adults. Recent evidence suggests that the exposure of children to smoking in the early days of their development causes many diseases. Using light microscopy, this study aims to analyze the possible histopathological effects of an experimental model of chronic inhalation of cigarette smoke (passive smoking) on the laryngeal and tracheal mucosa of young Wistar rats. A total of 24 young Wistar rats were studied for a period of 120 days. The animals were divided into two groups: passive smoking (n = 16) and control (n = 8). The level of exposure to cigarette smoke was evaluated from the urinary cotinine level. Although no cancerous lesions were identified, histopathological analysis in the laryngeal and tracheal mucosa of all the animals in the experimental group showed that the proportion of moderate and focal inflammation was higher in animals exposed to chronic inhalation of cigarette smoke (P = 0.041). Histopathologic analysis revealed moderate and focal inflammatory lesions in the region of the infraglottic mucosa in exposed animals, although without dysplastic or neoplastic lesions in the laryngeal and tracheal mucosa.

Halothane induces oxidative stress and NF-kappaB activation in rat liver: protective effect of propofol.

We investigated the effects of propofol on markers of oxidative stress, nuclear factor kappa B (NF-kappaB) activation and inducible nitric oxide synthase (iNOS) expression in liver of rats treated with halothane under hypoxic conditions. Male Wistar rats received halothane 1%/oxygen 14%, oxygen 14%/propofol 60 mg kg(-1) i.p., or halothane 1%/oxygen 14%/propofol 60 mg kg(-1) i.p. Morphological examination showed complete loss of architecture with massive necrosis of parenchyma in the halothane group, while only minor histological abnormalities were observed in rats receiving halothane plus propofol. The cytosolic concentration of TBARS and the hydroperoxide-initiated chemiluminescence increased significantly in the liver of animals from the halothane group (+62% and +40% versus controls, respectively), and this increase was abolished by propofol administration. Halothane induced a marked activation of NF-kappaB (+180%), and resulted in a significant decrease of the nonphosphorylated form of the inhibitor IkappaBalpha (-53%), while phosphorylated IkappaBalpha protein level was markedly increased (+146%). Propofol administration lowered these effects to +30% (NF-kappaB), -26% (nonphosphorylated IkappaBalpha), and +56% (phosphorylated IkappaBalpha). The increase of iNOS protein level (+59%) induced by halothane was significantly reduced to +22% by additional administration of propofol. Results obtained show that administration of propofol inhibits oxidative stress, NF-kappaB nuclear traslocation and iNOS overexpression in liver of rats receiving halothane. Propofol treatment, by inhibiting the NF-kappaB signal transduction pathway, might block the production of noxious mediators involved in the development of halothane-induced injury.

Immunohistochemical expression of p16 and p53 in vulvar intraepithelial neoplasia and squamous cell carcinoma of the vulva.

This study was undertaken to examine the expression of p16 and p53 in vulvar intraepithelial neoplasia (VIN) and squamous cell carcinoma (SCC) of the vulva. We also analyzed the relationship between p16 and p53 immunoexpression in women younger vs. older than 55 years of age. Seventyseven histologic samples of vulvar tissue, treated surgically between June 2000 and November 2004 at the Complexo Hospitalar Santa Casa (Porto Alegre, Brazil), were investigated. We analyzed 28 cases of VIN, 37 cases of SCC and 12 normal vulvar tissues. The percentage of immunohistochemical positivity for p16 had the following distribution across the groups: VIN: 21.4% (6/28), cancer: 24.3% (9/37) and control: absent (p=0.202). p53 expression showed the following percentages: VIN: 60.7% (17/28), cancer: 18.9% (7/37) and control: 8.3% (1/12) (p=0.01). p16 expression in the cancer group (mean age: 63.4 years) was positive in 6 and 3 cases of women younger or older than 55 years, respectively (54.5% vs. 11.5%, p=0.01). p53 expression was not detected in young females with cancer, while it was expressed in 7/26 (26.9%) cases of the group of females older than 55 years of age (p=0.08). Our results suggest an increase in the immunohistochemical expression of p16 protein in young women with squamous cell carcinoma of the vulva, and a possible association with a low expression of p53.

[Cox-2 and CD105 expression in breast cancer and disease-free survival]. / Expressão da cox-2 e CD105 no câncer de mama e sobrevida livre de doença.

OBJECTIVE: To verify the expression of CD105 in primary breast cancer, and the expression of cyclooxygenase-2 in primary breast cancer and in the respective axillary lymph nodes. METHODS: Seventy two women from 18 to 80 years of age, with a diagnosis of Ductal Infiltrative Breast Cancer, stage II, histological type non special, with their respective axillary lymph nodes were submitted to surgical treatment at the "Hospital Nossa Senhora da Conceição" between 2001 and 2002. Immunohistochemical analyses of CD 105 in the primary breast cancer and of COX 2 in the local axillary lymph node were compared for local recurrence. RESULTS: Of the 72 patients with primary tumors, 40 had positive axillary lymph nodes, while 32 were negative. For each primary tumor, only one lymph node was analyzed. . Fifteen patients had local recurrence after 26 months (CI 95% 24-28). Presence of COX-2 in the primary tumors was verified in 52 cases, and presence of CD105 in 34 cases. These independent prognostic factors were not correlated to local recurrence (P= 0.203 e P=0.145, respectively). The period free of local recurrence for patients with positive expression of COX-2 in axillary lymph nodes (with metastasis or not) was of 19 months, while patients with negative expression had a 28.3 months long period free of local recurrence. CONCLUSION: The positive expression of COX-2 in axillary lymph nodes (either positive or negative) seems to be an independent prognostic factor for local recurrence.

The role of ischemic preconditioning at the gracilis muscle of rats in the early phase of reperfusion injury.

PURPOSE: Verify the role of ischemic preconditioning (IPC) in ischemia and reperfusion injury on gracilis muscle of rats. METHODS: Wistar rats (n=30) were distributed in three groups, I/R and IPC groups were subdivided concerning ischemia time. A near-amputation model of the posterior limb was produced by a hip joint level incision, preserving the vascular bundle and the femur bone and ischemia was induced for 2 h and 4 h, G-I 2 h/R (n=6) and G-I 4 h/R (n=6), followed by 1 h of vascular reperfusion. The preconditioned groups, G-PCI 2 h (n=6) and G-PCI 4 h (n=6), were preceded by 3 cycles of 5 min of ischemia followed by 5 min of vascular reperfusion before sustained ischemia. In the Control Group, C-G (n=6) animals were subjected to regional approach. The analysis was done with Light Microscopy (LM). RESULTS: The levels of fibril fragmentation were progressive in the G-I 2 h/R (67% of muscle preservation) and in the G-I 4 h/R (0% of muscle preservation). However in the group of the precondition the lesion degree being in level similar to the group controls in the G-I 2 h/R (100% of muscle preservation) while at G-I 4 h/r occur less protection (67% of muscle preservation). The degree of tissue inflammatory reaction was worst at G-I 4 h/R (0% without inflammation signals) than at G-I 2 h/R (50% without inflammation signals); while in the precondition group G-IPC-2 h (83% without inflammation signals) was better than the G-IPC-4 h (67% without inflammation signals). The vascular stasis was absent only in 17% of the G-I 4 h/R and in 33% of the G-I 2 h/R. In precondition group, however, the vascular stasis was absent in 33% at G-IPC 2 h and absent in 50% at G-IPC 4 h. CONCLUSION: The IPC showed, in an earlier phase, a beneficial role at I/R derived injury on gracilis muscle of rats, as proven for the largest preservation of the fibers muscular, smaller inflammatory reaction and smaller vascular stasis.

Expression of Ki-67 and squamous intraepithelial lesions are related with HPV in endocervical adenocarcinoma.

To estimate the association between human papillomavirus (HPV) status and the expression of p53, Ki-67 and bcl-2 in cases of endocervical adenocarcinoma, and the relation with squamous intraepithelial lesions (SIL) and age, 229 cases were selected, treated between 1995 and 2003 in the Hospital Nossa Senhora da Conceiçao. All samples were evaluated by polymerase chain reaction to determine HPV status. Immunohistochemical technique was used to investigate the expression of p53, Ki-67 and bcl-2. The joint occurrence of endocervical adenocarcinoma and SIL were estimated too. In the 229 evaluated cases, 182 cases (79.48%) were associated with the presence of the HPV. The most common types were HPV18 (93 cases - 51.09%) and HPV16 (62 cases - 34.06%). Expression of Ki-67 (p=0.009) and the presence of SIL (p=0.018) were associated to HPV infection. Expression of p53 (p=0.647) and bcl-2 (p=0.671) were not related to HPV status. The mean age of the patients was 53.2 years, without clear correlation between age group and HPV (p=0.095). The presence of HPV, especially type 18 in endocervical adenocarcinoma suggests that this agent can be an important cofactor in the development and progression of glandular neoplasms of the uterine cervix. The joint occurrence of endocervical adenocarcinoma and SIL may support this hypothesis. HPV may promote an increased proliferation index in endocervical adenocarcinoma, shown by the expression of Ki-67.

Main prognostic and predictive immunohistochemical factors in breast cancer: a retrospective cohort study

Introduction: Breast cancer is a constant focus of studies on prevention and treatment. Immunohistochemistry is a useful tool for defining the conducts toward the treatment of this disease. Objective: To evaluate patients' survival according to prognostic and predictive immunohistochemical factors. Method: This is a retrospective cohort study. Medical reports of 787 patients were analyzed, which contained parts of surgical specimens of the mastectomy or quadrantectomy procedures. A total of 404 patients were eligible for the study. Results: The mean age at diagnosis of the disease was 55.4 years. The main diagnosis was infiltrating ductal carcinoma (80.7%). Of the total, 45% of the patients had tumors of up to 2 cm in diameter, and 32.9% had lymph node involvement. Among the patients, and according to luminal molecular classification, 48.3% were classified as luminal A, 27% were luminal B, 12.1% were recipient of human epidermal growth factor type 2 (HER2), and 12.6% were triple-negative. Furthermore, of 23.3% patients with tumor recurrence, 12.6% of them died. The 1% increase in Ki-67 values increases the risk of death and recurrence by 2% and 1%, respectively. The presence of lymph node metastasis increases, on average, 4.78 times and 2.63 times the risk of death and recurrence, respectively. Conclusion: The triple negative molecular classification had the lowest overall survival and the greatest risk of recurrence. The luminal A classification presented the best prognosis. Tumor size, lymph node metastasis, skin invasion, and presence of Ki-67 were shown to be the prognostic and predictive factors that most influenced the patients' survival.

Analysis of pattern of occurrence of thyroid carcinoma between 2001 and 2010.

INTRODUCTION: An ongoing discussion is found in medical literature about the reasons for changes in thyroid carcinoma incidence patterns over the last decades. OBJECTIVE: To analyze the clinical and pathological characteristics of thyroid carcinoma cases over a decade. METHODS: Cross-sectional study over an historical cohort. Medical records of 628 thyroid cancer cases in a single center were reviewed. 597 patients were included. Microcarcinoma cases were selected for a qualitative analysis phase, in which medical records were reviewed for better understanding of thyroid nodule and thyroid cancer diagnosis process. RESULTS: An increase in the proportion of cases with thyroid cancer diagnosis was observed throughout the decade; new cases were predominantly tumors of less than 2 cm, with histopathological signs of low aggressiveness. There was an increase in proportion of cases with malignant cytological results among microcarcinomas. CONCLUSION: There is a trend for increase in thyroidectomies due to cancer in this institution, with proportional increment of cases with histopathological characteristics indicative of early disease. Among microcarcinomas, there is an increasing group represented by cancer cases that were not incidentally diagnosed, related to an enhancement in preoperative diagnostic methods.

Papillary thyroid carcinoma: does the association with Hashimoto's thyroiditis affect the clinicopathological characteristics of the disease?

INTRODUCTION: Papillary carcinoma is the most common malignant thyroid neoplasm. The effect of the concurrent presence of Hashimoto's thyroiditis and papillary thyroid carcinoma remains controversial. OBJECTIVE: To evaluate the association between Hashimoto's thyroiditis and clinicopathological parameters in thyroid papillary carcinoma cases, based on an historical institutional cohort analysis. METHODS: Cross-sectional study obtained from a historical cohort, including all cases submitted to thyroidectomy for papillary thyroid carcinoma in a single institution during an 11-year period study. RESULTS: A total of 417 patients with papillary thyroid carcinoma were enrolled; 148 (35.4%) also had Hashimoto's thyroiditis. A female predominance among cases associated to Hashimoto's thyroiditis was observed. The thyroid tumor, in cases associated with Hashimoto's thyroiditis, had a smaller mean diameter, lower frequency of extra-thyroid extension, and earlier clinicopathological staging. CONCLUSIONS: A high proportion of papillary thyroid carcinoma cases are associated with Hashimoto's thyroiditis. There are associations among these cases with several histopathological factors already recognized for their prognostic value, which by themselves could impact outcomes.