RESUMO
OBJECTIVES: Metastatic lymph node affectation is the main prognostic factor in localised lung cancer. However, the pathological study of lymph nodes reveals tumour relapse for 20% of patients after oncological curative surgery. Recently, EMT (epithelial-mesenchymal transition) has been established as one of the main factors related to lymphatic dissemination and metastasis. This study evaluated the prognostic value of EMT-related gene expression in micrometastatic sentinel lymph nodes (SLN) of non-small cell lung cancer (NSCLC) patients. METHODS: The presence of genes CDH1, CDH2, VIM, TWIST1, SNAI1, SNAI2, ZEB1, and ZEB2 in mRNA was analysed in tumours and in the SLN of NSCLC patients for whom surgery was planned for treatment. The significant association between the expression level of EMT-related markers and patients' clinicopathological characteristics and relapse was assessed. RESULTS: Of the 96 patients, 56 (58.33%) presented molecular micrometastasis in SLN, which showed higher CDH1, CDH2, and VIM expressions than non-micrometastatic ones. An association linking a low CDH1/CDH2 ratio in SLN with molecular micrometastasis, adenocarcinoma, and non-smoking patients was found. The multivariate Cox regression analysis proved the prognostic accuracy of the CDH1/CDH2 ratio in SLN. CONCLUSIONS: The molecular EMT status of SLN could be used as an independent prognosis predictor in early stage NSLCL patients, and as a new tool to better stratify and predict patient outcomes.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Transição Epitelial-Mesenquimal/genética , Neoplasias Pulmonares/patologia , Linfonodo Sentinela/patologia , Idoso , Antígenos CD/genética , Antígenos CD/metabolismo , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Caderinas/genética , Caderinas/metabolismo , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Feminino , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/metabolismo , Metástase Linfática , Masculino , Micrometástase de Neoplasia , Prognóstico , Linfonodo Sentinela/metabolismo , Biópsia de Linfonodo SentinelaRESUMO
Adalimumab, an anti-tumour necrosis factor agent, especially used in the treatment of rheumatoid arthritis, has a good safety profile. One of the most common side-effects of adalimumab is the development of autoantibodies. Despite the induction of autoantibodies, the clinical presentation of immune-mediated complications upon adalimumab therapy, including a lupus-like syndrome, is very rare. We have recently evaluated a new case of adalimumab-induced lupus erythematosus.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Lúpus Eritematoso Sistêmico/induzido quimicamente , Adalimumab , Anticorpos Monoclonais Humanizados , Artrite Reumatoide/imunologia , Autoanticorpos/imunologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/patologia , Pessoa de Meia-Idade , Pele/patologiaRESUMO
Primary cutaneous anaplastic large cell lymphoma (ALCL) may be associated with keratoacanthoma (KA)-like epithelial hyperplasia and dense eosinophilic and neutrophilic infiltrates. Diagnosis in such cases is challenging both clinically and histologically, because the large atypical lymphoid cells may be obscured by the massive infiltrate of eosinophils and neutrophils, or confused with invasive squamous cell carcinoma or KA. We recently encountered two cases of CD30+ ALCL presenting with a KA-like tumour on the eyelid and nose, respectively. One showed features of KA histologically, with marked tissue eosinophilia and neutrophilia.
Assuntos
Neoplasias Faciais/diagnóstico , Ceratoacantoma/diagnóstico , Linfoma Anaplásico Cutâneo Primário de Células Grandes/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adulto , Diagnóstico Diferencial , Neoplasias Palpebrais/diagnóstico , Neoplasias Palpebrais/patologia , Neoplasias Faciais/patologia , Feminino , Humanos , Linfoma Anaplásico Cutâneo Primário de Células Grandes/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Nasais/diagnóstico , Neoplasias Nasais/patologia , Neoplasias Cutâneas/patologiaRESUMO
This retrospective study of 2,507 cases of spontaneous pneumothorax (SP) involves 1,873 patients treated at our hospital over nearly 20 years. Men represented 92.4% and most patients were between 16 and 30 years old (56.2%). Presenting more than one episode were 29.7%. The treatment of choice was placement of a pleural drain whenever SP had led to lung collapse amounting to more than 10% of volume. Thoracotomy was performed when the patient had experienced three or more episodes of SP; when a pleural drain had not resolved the condition 10 days after placement; in hemo-SP with severe hemorrhage; and in 2 cases in which SP was bilateral. A total of 419 thoracotomies were performed on 384 patients (20.7%). All episodes were resolved and complications were few. Six patients died (0.32%), three following thoracotomy. All of these had antecedents of chronic obstructive lung disease and all were over 70, excepting one who was 56.
Assuntos
Pneumotórax/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pleura , Pneumotórax/classificação , Pneumotórax/complicações , Pneumotórax/terapia , Punções , Recidiva , Estudos Retrospectivos , Espanha/epidemiologia , ToracotomiaRESUMO
Nineteen patients with low-grade malignant tumors of the tracheobronchial tree received Nd:YAG laser treatment. They were referred for palliation of symptomatic airway obstruction due to carcinoid (14 cases) or adenocystic carcinoma (five cases). In all patients, laser treatment was followed by symptomatic relief. Fifteen patients have done well and remain in good condition between six months and four years after laser photoresection. Two of the five patients with adenocystic carcinoma died because of hemoptysis at one and 49 months after laser therapy. In the group of 14 patients with carcinoids, two episodes of bleeding (more than 250 ml) occurred that were controlled by tamponade with the tube and coagulation by the laser beam itself. Two patients with carcinoid died of unrelated causes (stroke and gastric carcinoma).
Assuntos
Neoplasias Brônquicas/cirurgia , Tumor Carcinoide/cirurgia , Carcinoma Adenoide Cístico/cirurgia , Terapia a Laser , Neoplasias da Traqueia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Brônquicas/patologia , Tumor Carcinoide/patologia , Carcinoma Adenoide Cístico/patologia , Feminino , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias da Traqueia/patologiaRESUMO
Overall, 400 procedures with the Yag-Nd laser were carried out in 252 patients with tracheobronchial disease susceptible to photoresection during a 4-year period. Most procedures were carried out under general anesthesia and with a rigid bronchoscope. 149 tumors were treated. Of these, 118 were malignant, 16 had low malignancy and 15 were benign. These patients received overall 203 procedures. 92 patients with 113 tracheal stenoses underwent overall 185 procedures. Finally, a miscellaneous group of 11 patients with several conditions underwent 12 procedures. Immediate results were classified as excellent, good or poor, depending on the achieved tracheal or bronchial diameter. No significant complications were found. After a 4-year experience, the authors believe that laser photoresection is currently the most effective and safe procedure to relieve obstruction in the stenoses caused by malignant proliferative tracheal or bronchial diseases not amenable to surgery. It is also the ideal substitute for surgery in benign tumors and in some cases of non-tumoral tracheal stenosis.