Secretory carcinoma of salivary glands at the National Cancer Institute: A 20-year retrospective clinical, pathological, immunohistochemical and molecular study.

OBJECTIVES: This study aim was to review cases of acinic cell carcinoma (the main differential diagnosis of secretory carcinoma) that were diagnosed and treated at the National Cancer Institute of Brazil (INCA) between 1996 and 2016. The primary objective was to identify underdiagnosed cases of secretory carcinoma via a clinical, immunopathological and molecular reassessment. MATERIALS AND METHODS: This is a cross sectional study, with retrospective data collection from medical records and histological specimen review, with staining for periodic acid-Schiff (PAS) and PAS with diastase, immunohistochemistry for S-100, mammaglobin, and DOG-1, and droplet digital RT-PCR for ETV6-NTRK3. The Research Ethics Committee approved this study, and the patients allowed their participation through informed consent. RESULTS: Eighty-three cases of acinic cell carcinoma were diagnosed and treated in the specified period at INCA, of which, seven had their diagnosis changed to secretory carcinoma. CONCLUSION: The present study adds seven cases of secretory carcinoma to the literature, contributing to a better understanding of the epidemiological, histological, immunohistochemical and molecular characteristics of this recently described tumor. Also, the use of a comprehensive diagnostic approach, including immunohistochemical and molecular methods, along with classical morphological studies, allowed the reclassification of acinic cell carcinoma to secretory carcinoma.

A retrospective study of 30 basal cell adenomas of the salivary gland in a Brazilian population and literature review.

PURPOSE: The present study aimed to provide the clinicopathological data of Brazilian patients with basal cell adenoma (BCA). METHODS: Records of BCA cases were retrospectively gathered from the Brazilian National Cancer Institute database between 1996 and 2006. All cases were histopathologically reviewed, and the clinicopathological data were collected from the patients' medical files. In addition, an English literature review about this tumor is also presented. RESULTS: Of 1127 salivary gland tumors identified, 30 were BCAs (2.7%). Women were more affected than men (70.0% vs. 30.0%), and the majority (60.0%) were elderly (> 65 years old). The parotid gland was the most frequent location affected (93.3%), followed by the upper lip (3.3%) and submandibular gland (3.3%). Fine-needle aspiration was the main procedure applied to establish a preoperative diagnosis of tumor; however, the results were not always consistent. Histopathologically, the trabecular pattern was the most common type seen (50.0%) among our BCA samples. Most patients underwent superficial or partial parotidectomy. Frey's syndrome was reported only in one case during the follow-up. No recurrence was noted in the present series. The literature review revealed a total of 213 reported cases of BCA in the period investigated. CONCLUSIONS: This is the first case series of BCA reported in Brazil. As occurred in other previously reported series, the clinicopathological data of BCAs are similar and confirm that this type of tumor is rare, develops predominantly in the parotid gland, frequently affects older women, has an indolent behavior, and the affected patients have an excellent prognosis.

Ameloblastic Fibrosarcoma: A Case Report and Literature Review.

Here is described a case of ameloblastic fibrosarcoma (AFS) affecting the posterior mandible of a woman who was treated surgically and recovered without signs of recurrence or metastasis after 12 years of follow-up. Tumor sections were immunostained for cell cycle, epithelial and mesenchymal markers. Immunohistochemical analysis evidenced high Ki-67 positivity in stromal cells (mean of 20.9 cells/High power field). Epithelial cells displayed strong positivity for p53, p63 and cytokeratin 19. In addition to the case report, a systematic review of current knowledge is presented on the AFS's clinical-demographic features and prognostic factors. Based on the review, 88/99 cases were diagnosed as AFS, 9/99 as ameloblastic fibro-odontosarcoma and 2/99 as ameloblastic fibrodentinosarcoma. All these lesions displayed very similar clinical-demographic and prognostic features. Moreover, the review provided evidence that first treatment, regional metastasis, distant metastasis and local recurrence were significant prognostic values for malignant odontogenic mesenchymal lesions. Based on the findings, segregation among ameloblastic fibrosarcoma, ameloblastic fibrodentinosarcoma and ameloblastic fibro-odontosarcoma seems illogical, considering all these lesions have similar predilections and outcomes.

Ameloblastic Fibrosarcoma: A Case Report and Literature Review

Here is described a case of ameloblastic fibrosarcoma (AFS) affecting the posterior mandible of a woman who was treated surgically and recovered without signs of recurrence or metastasis after 12 years of follow-up. Tumor sections were immunostained for cell cycle, epithelial and mesenchymal markers. Immunohistochemical analysis evidenced high Ki-67 positivity in stromal cells (mean of 20.9 cells/High power field). Epithelial cells displayed strong positivity for p53, p63 and cytokeratin 19. In addition to the case report, a systematic review of current knowledge is presented on the AFS’s clinical-demographic features and prognostic factors. Based on the review, 88/99 cases were diagnosed as AFS, 9/99 as ameloblastic fibro-odontosarcoma and 2/99 as ameloblastic fibrodentinosarcoma. All these lesions displayed very similar clinical-demographic and prognostic features. Moreover, the review provided evidence that first treatment, regional metastasis, distant metastasis and local recurrence were significant prognostic values for malignant odontogenic mesenchymal lesions. Based on the findings, segregation among ameloblastic fibrosarcoma, ameloblastic fibrodentinosarcoma and ameloblastic fibro-odontosarcoma seems illogical, considering all these lesions have similar predilections and outcomes.

Resumo Aqui é descrito um caso de fibrossarcoma ameloblástico afetando região posterior da mandíbula de uma mulher. Após o tratamento, a paciente ficou livre da doença durante os 12 anos de acompanhamento. Foi realizado imunohistoquimica para marcadores epiteliais, mesenquimais e do ciclo celular. Além disso, uma revisão sistemática de literatura também foi realizada, na tentativa de descobrir as características clínico-demográficas e fatores prognósticos da lesão. 88/99 casos foram diagnosticados como fibrossarcoma ameloblastico, 9/99 como fibro-odontosarcoma ameloblastico e 2/99 como fibrodentinosarcoma ameloblastico. Todas estas lesões exibem características clínico-demográficas e prognósticos muito semelhantes. Além disso, esta revisão forneceu evidências de que primeiro tratamento, metástases regionais, metástases à distância e recorrência local são valores prognósticos significativos para lesões odontogênicas mesenquimais malignas. A análise imunohistoquímica demonstrou elevada marcação positiva em células do estroma para Ki-67 (média de 20,9 células /HPF). As células epiteliais exibiram forte marcação para p53, p63 e citoqueratina 19. A segregação entre fibrosarcoma ameloblastico, fibrodentinosarcoma ameloblastico e fibro-odontosarcoma ameloblastico é ilógica, uma vez que todas essas lesões têm predileções e resultados semelhantes.

Adenoid ameloblastoma: clinicopathologic description of five cases and systematic review of the current knowledge.

OBJECTIVE: To describe the clinicopathologic and immunohistochemical features of five cases of adenoid ameloblastoma. STUDY DESIGN: Clinicopathologic data were gathered from medical records and compared with those compiled from a systematic review. Slides were also immunohistochemically stained for Ki-67, p16, p53, and cytokeratins (7, 8, 14, 18, and 19). RESULTS: There were 3 males (60%) and 2 (40%) females. The mean age was 44 ± 10 years. Of the five adenoid ameloblastomas, 4 (80%) occurred in the posterior maxilla. Patients typically complained of asymptomatic swelling. All patients received surgical resection as primary therapy; 1 (20%) patient also received adjuvant radiotherapy. Recurrence was diagnosed in all patients. Immunohistochemically, the tumors stained focally positive for CK7, 8, 14, and 18 and diffusely positive for CK-19, p16, and p53. The mean Ki-67-positive cells were 72.4 ± 24.9 positive cells per high-power field (range 53-111). CONCLUSIONS: To our knowledge, this is the largest series of adenoid ameloblastoma reported in the literature. Our data suggest that this entity demonstrates aggressive behavior characterized by a high likelihood of recurrence.

Clear cell odontogenic carcinoma: report of 7 new cases and systematic review of the current knowledge.

OBJECTIVE: The goal of this study is to describe 7 cases of clear cell odontogenic carcinoma among a Brazilian population and compare these data with a systematic review of the English-language literature. STUDY DESIGN: Descriptive statististics were used to compare the clinicopathologic data gathered retrospectively with those compiled from a review. Tumor sections were immunostained for Ki-67, p16, p53, and cytokeratins (CKs) 7, 8, 14, 18, and 19. Log-rank tests were performed for survival analysis. RESULTS: Most cases occurred in the posterior mandible (5/7, 71.4%), and recurrence was diagnosed in all treated patients. Metastatic disease occurred in 2 patients (28.6%). Tumors were focally positive for CKs 7, 8, 14, and 18 and diffusely positive for CK19, p53, and p16. The mean number of Ki-67-positive cells was 35.2 cells/high-power field. Our systematic review provided evidence that tumor size (P = .046), histologic pattern (P = .034), regional metastasis (P = .001), distant metastasis (P = .001), and local recurrence (P = .05) were of significant prognostic value. CONCLUSIONS: This study has contributed to improved characterization of clear cell odontogenic carcinoma, which is an aggressive odontogenic malignant neoplasm diagnosed mainly in the posterior mandible of middle-aged women and typically at an advanced stage. Radical surgical procedures remain the gold standard treatment.

Assessment of BRAFV600E and SMOF412E mutations in epithelial odontogenic tumours.

The classification of ameloblastoma in multicystic or unicystic variants is associated with its clinical behaviour. Recently, BRAF and SMO mutations have been reported in ameloblastomas. However, it is not clear if such mutations are shared by the multi- and unicystic variants of ameloblastoma or by odontogenic carcinomas. We assessed BRAFV600E and SMOF412E in multicystic, unicystic and desmoplastic ameloblastomas. In addition, we investigated whether the BRAFV600E mutation occurs in odontogenic carcinomas. A total of 28 formalin-fixed paraffin-embedded samples, comprising 17 ameloblastomas and 11 odontogenic carcinomas, were included. The BRAFV600E mutation was assessed by real-time PCR with a specific TaqMan probe and confirmed by Sanger sequencing. The SMOF412E mutation was assessed by Sanger sequencing. Fourteen out of 17 (82 %) ameloblastomas showed the BRAFV600E mutation, specifically, 5/6 (83 %) unicystic, 7/9 (78 %) multicystic and 2/2 desmoplastic ameloblastomas. BRAFV600E mutation was detected in 4/11 (36 %) malignant tumours, specifically, 3/8 (38 %) ameloblastic carcinomas and 1/1 clear cell odontogenic carcinoma, while the two ghost cell odontogenic carcinomas did not harbour this mutation. The SMOF412E mutation was not detected in ameloblastoma. The BRAFV600E-activating mutation is a common event in ameloblastomas, occurring regardless of site or histological type. This mutation is also detected in odontogenic carcinomas. SMO somatic mutation is a secondary genetic event in the ameloblastoma pathogenesis. Our findings support the possibility for personalised, molecular-targeted therapy for ameloblastomas and odontogenic carcinomas harbouring the BRAFV600E mutation.

Adenoid cystic carcinoma of the salivary gland: a clinicopathological study of 49 cases and of metallothionein expression with regard to tumour behaviour.

AIMS: Adenoid cystic carcinoma (AdCC) of the salivary glands shows heterogeneous behaviour, with metastasis as a key indicator of poor prognosis. Metallothionein (MT) expression has been associated with poor prognosis of diverse neoplasms. We evaluated prognostic factors for AdCC and the role played by MT, focusing on metastatic behaviour. METHODS AND RESULTS: We reviewed the files of the Brazilian National Institute of Cancer between 1997 and 2004, obtaining 49 cases. Fourteen tumours had metastasized during follow-up. Among these, we identified cases presenting with metastasis at patient admission as showing the poorest survival rates. MT immunostaining of the tumours was performed (using the E9 antibody), and evaluated for the parameters of proportion, intensity and distribution in tumour cells. Extent and intensity of staining, and Quickscore (a combined measure of extent and intensity), were higher in metastatic than non-metastatic tumours (for Quickscore, P = 0.044), with highest values found for cases of early metastasis. Most cases showing weak staining, and all with a predominantly cytoplasm-restricted staining pattern, were non-metastatic. Metastatic tumours of solid type received higher scores than solid non-metastatic (Intensity, P = 0.0239; Quickscore, P = 0.0481). CONCLUSIONS: Our results demonstrated metastasis to be the most significant indicator of poor prognosis and deterioration for AdCC. Consistent patterns of MT expression were observed to correlate with metastatic behaviour, indicating that MT may potentially serve as a prognostic marker for AdCC.

Epithelioid hemangioendothelioma: 15 years at the National Cancer Institute. Literature review / Hemangioendotelioma epitelioide: 15 anos no Instituto Nacional de Câncer. Revisão da literatura

INTRODUCTION: Hemangioendotheliomas are locally aggressive vascular tumors with intermediate malignity and metastasis risk. The epithelioid variant, the most aggressive one, equally affects men and women at any age and it is rare in children. It occurs as a solitary tumor, which is usually painful, affecting superficial or deep soft tissues. Furthermore, it is less frequent in the liver, lung, bones, skin, lymph nodes and central nervous system. Microscopically, they present epithelioid cells with intracytoplasmic vacuoles, low mitotic activity and little or no necrosis. Additionally, its vascular nature is confirmed by immunohistochemical studies (CD31, CD34 and factor VIII). OBJECTIVE, MATERIAL AND METHODS: Through search in the archives of the Pathology Division of the National Cancer Institute (Instituto Nacional de Câncer [INCA]) from 1996 to 2011, 13 cases of epithelioid hemangioendothelioma (HEE) were identified and analyzed. RESULTS AND DISCUSSION: seven cases occurred in male patients and six in female patients, mean age 42 years, ranging from 7-66. The most common locations were: soft tissue (three patients; 23%); head and neck, mediastinum, bone and lung (two patients each; 15%); liver and lymph nodes (one patient each; 8%). There was clinical follow-up of nine patients: five were alive and disease-free (one to six years after diagnosis); three out of four patients with aggressive disease progressed to death (one month to five years after diagnosis); one relapsed two years after diagnosis and is alive with disease. CONCLUSION: This series of 13 cases of HEE, whose diagnoses were based on morphological and/or immunohistochemical analyses, demonstrates the different patterns of clinical presentation and biologic behavior of this disease.

INTRODUÇÃO: O hemangioendotelioma é um tumor vascular de malignidade intermediária, localmente agressivo e com risco de metástase. A variante epitelioide, a mais agressiva, acomete igualmente homens e mulheres em qualquer idade e é rara na infância. Apresenta-se como tumoração solitária, geralmente dolorosa, em partes moles, superficiais ou profundas; menos frequentemente, acomete fígado, pulmão, ossos, pele, linfonodos e sistema nervoso central. Microscopicamente, mostram células epitelioides com vacúolos intracitoplasmáticos, baixa atividade mitótica, pouca ou nenhuma necrose, tendo sua natureza vascular comprovada por estudos imuno-histoquímicos (CD31, CD34, Fator VIII). OBJETIVOS E MATERIAL E MÉTODOS: Por meio de busca nos arquivos da Divisão de Patologia (DIPAT) do Instituto Nacional de Câncer (INCA), de 1996 a 2011, foram encontrados e revisados 13 casos de hemangioendotelioma epitelioide (HEE). RESULTADOS E DISCUSSÃO: Sete casos ocorreram em homens e seis, em mulheres, com idade média de 42 anos, variando de 7 a 66 anos de idade. As localizações mais frequentes foram partes moles (três pacientes; 23%); cabeça-pescoço, mediastino, osso e pulmão, (dois pacientes cada; 15%); fígado e linfonodo (um paciente cada; 8%). Houve seguimento clínico de nove pacientes: cinco estavam vivos e livres de doença (de um a seis anos após o diagnóstico); dos quatro pacientes que apresentaram HEE agressiva, três evoluíram a óbito com doença (de um mês a cinco anos) e um recidivou dois anos após o diagnóstico e está vivo com a doença. CONCLUSÃO: Esta série de 13 casos de HEE, cujos diagnósticos foram firmados em bases morfológicas e/ou imuno-histoquímicas, demonstra os diferentes padrões de apresentação clínica e o comportamento biológico da doença.

Vascular endothelial growth factor and thymidine phosphorylase expression in salivary gland tumors with distinct metastatic behavior.

BACKGROUND: Metastasis of salivary gland tumors has a negative impact on survival. Angiogenesis and its factors are potential markers for predicting metastasis in different malignant tumors, but this is not the case for salivary gland tumors. METHODS: Salivary gland tumors of distinct biologic behavior were analyzed according to the semiquantitative immunoexpression of vascular endothelial growth factor (VEGF) and thymidine phosphorylase (TP). RESULTS: Vascular endothelial growth factor expression was predominantly weak in benign tumors. Weak TP expression was observed in 100% cases of benign tumors and in 74.3% of primary malignant tumors. High VEGF and TP expression levels were significantly associated with primary malignant tumors but not with primary non-metastasizing and primary metastasizing malignant tumors or with subtypes of malignant tumors. CONCLUSIONS: Vascular endothelial growth factor and TP expression levels discriminate benign and malignant tumors but cannot predict metastasis from non-metastasizing tumors.

Warthin's tumor at the Brazilian National Cancer Institute: additional evidence of homogeneous sex prevalence and association with other neoplasms.

PURPOSE OF THE STUDY: To report the largest Brazilian series of Warthin's tumor (WT). PROCEDURES: The medical files of 76 patients with WT treated in the Brazilian National Cancer Institute from 1996 to 2006 were reviewed. RESULTS: The male:female ratio was 2:1, with a predominance of white, old, and smoking patients. However, there were more women among the nonsmokers. One fifth of the patients presented with synchronous multiple lesions. Parotid lesions were prevalent, but there were patients with lesions in cervical lymph nodes and in the inferior lip. Most cases were treated by superficial parotidectomy, without recurrences. One fourth of the patients also developed other primary neoplasms. CONCLUSIONS: The observed data do not differ from those in the international literature. Multiplicity and the development of other neoplastic diseases require close clinical management of patients with WT. MESSAGE: The previously unreported observation of female prevalence among nonsmoking people with WT should be confirmed and explored in future studies.

Fatores prognósticos do câncer de mama sem comprometimento de linfonodos axilares: revisão da literatura / Prognostic factors of breast cancer without axillary lymph node involvement: review of the literature

Os autores traçam um perfil de incidência e mortalidade do câncer de mama no Brasil e nos Estados Unidos, comparando as tendências de ambos os países. Discorrem sobre a importância do diagnóstico precoce dessa neoplasia e seus efeitos na diminuição das taxas de mortalidade nos países onde existe uma política de rastreamento através da mamografia. Enfatizam a importância dos fatores prognósticos na escolha da terapêutica de pacientes com câncer de mama e linfonodos axilares negativos, mostrando as grandes controvérsias existentes na literatura e citando os resultados obtidos na Conferência de Consenso sobre os Fatores Prognósticos, patrocinada pelo Colégio Americano de Patologistas (CAP). Os autores apresentam, ainda, os resultados encontrados na literatura de uma série de estudos da sobrevida (geral e/ou livre de doença) de pacientes com câncer de mama invasor, de modo subseqüente à observação de linfonodos axilares negativos ao diagnóstico.

Sobrevida de cinco anos para pacientes com carcinoma ductal infiltrante de mama sem comprometimento de linfonodos axilares: coorte hospitalar, 1992-1996

Introdução: No Brasil, o câncer de mama é um importante problema de saúde, pois é o câncer mais incidente em mulheres (cerca de 41.600 casos novos em 2003) e o que apresenta a maior taxa de mortalidade no sexo feminino (cerca de 9.300 óbitos em 2003). A detecção precoce desta neoplasia é importante para o tratamento e um dos fatores fundamentais para seu prognóstico é a presença de metástases para os linfonodos axilares. Porém, cerca de 20 a 30% das pacientes com câncer de mama, mesmo que inicialmente apresentem linfonodos axilares negativos, vão recidivar e têm maior probabilidade de morrer da doença e por isso são consideradas pacientes de alto risco. As investigações atuais são dirigidas para identificar estas pacientes de alto risco. Objetivos: Determinar a sobrevida geral de 5 anos e segundo variáveis selecionadas e construir modelo(s) multivariado(s) preditor(es) da sobrevida de mulheres com câncer de mama e linfonodos axilares negativos. Metodologia: Foram selecionadas pacientes com câncer de mama e linfonodos axilares negativos, matriculadas no Hospital do Câncer I / ‘ Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil, diagnosticadas entre 1/1/1992 e 31/12/1996. Resultados: A sobrevida geral de 5 anos foi de 80% e a sobrevida média de 54 meses (IC95%=53-55). Na análise univariada (Kaplan-Meier) as seguintes variáveis foram estatisticamente significativas: idade da paciente, tratamento, tipo de peça cirúrgica, comprometimento de pele, tamanho do tumor, formação tubular, pleomorfismo nuclear, número de mitoses, grau histológico, invasão vascular, receptor de estrogênio, MIB-l e p53. Na análise multivariada, foram confeccionados três diferentes modelos de riscos proporcionais de Cox e permaneceram significativas as seguintes variáveis: idade (harzard ratio, HR=I,7; 2,1; 2,3) e invasão vascular (HR=2,5; 1,8; 1,8) (nos 3 modelos), grau histológico (HR=I,0-2,7-4,8; 1,0-2,6-4,3) (em 2 dos modelos) e tratamento (HR=I,0-0,4-0,2-2,3), tamanho do tumor (HR=I,0-1,83,5), comprometimento de pele (HR=3,8) e MIB-l (HR=2,2) (em apenas um dos modelos). Conclusões: Idade, tratamento, tamanho do tumor, comprometimento de pele, grau histológico, invasão vascular e MIB-l foram as variáveis prognósticas independentes na sobrevida desta coorte de pacientes.

Introduction: Breast cancer is the most important tumor site in Brazil with expected 41.600 new cases and 9.300 deaths in 2003. Early detection is very important to treatment and survival because node metastasis represents one of the most important prognostic factors. Nevertheless, 20 to 30% of breast cancer patients with negative nodes at diagnosis will develop the disease, showing higher death risks and thus being considered as high risk patients. Attention has been driven in current research to identify those high risk women. Objectives: To ascertain overall five years survival and the respective prognostic factors, and to build a multivariate model aiming to predict survival among breast cancer women showing negative nodes at diagnosis. Methods: Five years survival curves were obtained in a hospital cohort (Hospital do Câncer I / Instituto Nacional de Câncer) of breast cancer patients diagnosed between 01/01/1992 and 31/12/1996 in Rio de Janeiro, RJ, Brazil, using Kaplan-Meyer and Cox models. Results: Five years overall survival was 80% and mean survival 54 months (95% C.I. 53-55 yr.). Age at diagnosis, kind of treatment, surgical specimen type, skin involvement, tumor size, tubular arrangement, nuclear pleomorphism, mitosis frequency, histological grade, vascular invasion, estrogen receptors, MIB-l and p53 were statistically significant variables in univariate models. Three different multivariate hazard models were obtained in which the following variables remained statistically significant: age (HR 1.7,2.1,2.3) and vascular invasion (HR: 2.5, 1.8; 1.8) in the three models; histological grade (HR 1.0-2.7-4.8; 1.0-2.6-4.3) in two models; and kind of treatment (HR 1.0-0.4-0.2-2.3), tumor size (HR 1.0-1.8-3.5), skin involvement (HR 3.8), and MIB-l (HR 2.2) in just one model. Conclusions: Age at diagnosis, kind of treatment, tumor size, skin involvement, histological grade, vascular invasion and MIB1 were independent prognostic variables in the studied cohort.

Sobrevida de cinco anos para pacientes com carcinoma ductal infiltrante de mama sem comprometimento de linfonodos axilares: coorte hospitalar, 1992-1996 / Survival analysis five years for patients with breast carcinoma infiltrating duct without comprometiment of axillary lymph nodes: hospital cohort, 1992-1996

Introdução: No Brasil, o câncer de mama é um importante problema de saúde, pois é o câncer mais incidente em mulheres (cerca de 41.600 casos novos em 2003) e o que apresenta a maior taxa de mortalidade no sexo feminino (cerca de 9.300 óbitos em 2003). A detecção precoce desta neoplasia é importante para o tratamento e um dos fatores fundamentais para seu prognóstico é a presença de metástases para os linfonodos axilares. Porém, cerca de 20 a 30 por cento das pacientes com câncer de mama, mesmo que inicialmente apresentem linfonodos axilares negativos, vão recidivar e têm maior probabilidade de morrer da doença e por isso são consideradas pacientes de alto risco. As investigações atuais são dirigidas para identificar estas pacientes de alto risco. Objetivos: Determinar a sobrevida geral de 5 anos e segundo variáveis selecionadas e construir modelo(s) multivariado(s) preditor(es) da sobrevida de mulheres com câncer de mama e linfonodos axilares negativos. Metodologia: Foram selecionadas pacientes com câncer de mama e linfonodos axilares negativos, matriculadas no Hospital do Câncer I / Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil, diagnosticadas entre 1/1/1992 e 31/12/1996. Resultados: A sobrevida geral de 5 anos foi de 80 por cento e a sobrevida média de 54 meses (IC95 por cento=53-55). Na análise univariada (Kaplan-Meier) as seguintes variáveis foram estatisticamente significativas: idade da paciente, tratamento, tipo de peça cirúrgica, comprometimento de pele, tamanho do tumor, formação tubular, pleomorfismo nuclear, número de mitoses, grau histológico, invasão vascular, receptor de estrogênio, MIB-1 e p53. Na análise multivariada, foram confeccionados três diferentes modelos de riscos proporcionais de Cox e permaneceram significativas as seguintes variáveis: idade (harzard ratio, HR=1,7; 2,1; 2,3) e invasão vascular (HR=2,5; 1,8; 1,8) (nos 3 modelos), grau histológico (HR=1,0-2,7-4,8; 1,0-2,6-4,3) (em 2 dos modelos) e tratamento (HR=1,0-0,4-0,2-2,3), tamanho do tumor (HR=1,0-1,8-3,5), comprometimento de pele (HR=3,8) e MIB-1 (HR=2,2) (em apenas um dos modelos). Conclusões: Idade, tratamento, tamanho do tumor, comprometimento de pele, grau histológico, invasão vascular e MIB-1 foram as variáveis prognósticas independentes na sobrevida desta coorte de pacientes

Câncer de mama: marcadores tumorais: revisão de literatura / Breast cancer: tumor markers: literature review

A identificação de marcadores que possam predizer o comportamento dos tumores é especialmente importante em câncer de mama devido, sobretudo, à variabilidade na progressão clínica da doença. Alguns marcadores tumorais e suas relações com o prognóstico são discutidos, dando-se ênfase àqueles que utilizam, para sua detecção, o método imuno-histoquímico e onde possa ser empregado material fixado em formol e embebido em parafina (material de arquivo). Os receptores hormonais (RH) são os menos polêmicos e os tumores positivos para estes marcadores, geralmente, apresentam menor tamanho, menor grau histológico e nuclear, uma melhor resposta à terapia hormonal e um melhor prognóstico. Para os outros marcadores tumorais aqui apresentados (c-erbB-2, catepsina D, MIB-1, PCNA, p53) existem muitas controvérsias, mas parte da literatura associa sua presença com tumores de alto grau histológico e com um pior prognóstico. As divergências existentes na literatura são discutidas e chega-se a conclusão que mais estudos são necessários antes que os marcadores tumorais possam ser utilizados como fatores prognósticos do câncer de mama.

Predictive factors to lymph node involvement on breast cancer

A detecção precoce do câncer de mama (CM) é um fator de reconhecida importância no tratamento e prognóstico das pacientes, e as metástases para os linfonodos axilares (MLA) são os preditores mais importantes do seu prognóstico. A partir de um estudo caso-controle com 306 carcinomas ductais infiltrantes (CDI), foi construido um modelo preditivo da ocorrência de MLA em pacientes com CM (casos: CDI com MLA; controles: CDI sem MLA). Foram estudadas variáveis relacionadas às pacientes e ao tumor (características macro e microscópicas e marcadores tumorais). Na análise bivariada, algumas variáveis se associaram estatisticamente com o desfecho em questão, porém, na regressão logística não condicional, somente as seguintes variáveis foram fatores preditivos independentes: idade da paciente, tamanho do tumor, pleomorfismo nuclear, invasão vascular e/ou linfática (IV/IL) e o termo de interação tamanho do tumor e idade da paciente, onde o tamanho do tumor só foi fator preditivo em pacientes, com 60 anos ou mais. De acordo com os resultados deste estudo somente as variáveis idade da paciente, tamanho do tumor, pleomorfismo nuclear e IV/IL foram fatores preditivos para a ocorrência de MLA. Tanto os receptores hormonais quanto os marcadores tumorais estudados (c-erbB-2, catepsina D, MIB-1, PCNA e p53) não se mostraram importantes para predizer o desfecho em estudo, tanto na análise bivariada quanto na análise multivariada.

Hormone receptors: association with prognostic factors for breast cancer

Os tumores de mama positivos para receptores de estrogênio (RE) e/ou de progesterona (RP), além de apresentarem um prognóstico mais favorável, mostram associações com outras variáveis de bom prognóstico. A partir de um estudo com 306 carcinomas ductais infiltrantes de mama, foram construidos modelos preditivos para a positividade dos RE e dos RP. Foram estudadas variáveis relacionadas às pacientes e ao tumor (características macro e microscópicas e marcadores tumorais processados por imuno-histoquímica). Na análise bivariada, algumas variáveis se associaram estatisticamente com a positividade dos RE e RP, porém, na regressâo logística não condicional somente as seguintes variáveis foram fatores preditivos independentes: idade da paciente (RE e RP), idade da menarca (RP), grau histológico (RE e RP), RP (RE) e p53 (RE). De acordo com os resultados deste estudo as variáveis idade da paciente ao diagnóstico, grau histológico, RP e p53 foram fatores preditivos para a positividade dos RE, enquanto que a idade da paciente, a idade da menarca e o grau histológico o foram para os RP.

Fatores prognóstico do câncer de mama / Prognostic factors of breast cancer

Os fatores prognóstico para o câncer de mama säo empregados tanto para predizer o prognóstico da doença como para selecionar aquelas pacientes que provavelmente se beneficiariam da adoçäo de terapia adjuvante. Foi realizada uma revisäo da literatura sobre os fatores prognósticos histopatológicos do câncer de mama, sendo a presença de metástases para linfonodos axilares reconhecida como o mais importante fator preditor dessa neoplasia. Além da presença de linfonodos comprometidos e do seu número, säo também reconhecidos como fatores prognósticos independentes a idade da paciente (as mais jovens apresentando pior prognóstico), o tamanho do tumor, o grau histológico e a presença de invasäo vascular

Aspectos gerais dos adenocarcinomas de mama, estadiamento e classificaçäo histopatológica com descrição dos principais tipos / General aspects of breast carcinomas, staging and histopathological classification, with description of the main patterns

O câncer de mama é o cancer de maior incidência entre as mulheres e o que apresenta a maior taxa de mortalidade no Brasil. Ele se localiza mais frequëntemente no quadrante superior externo da mama e em cerca de 13 porcento é multicêntrico, o que é mais comum entre os carcinomas lobulares e entre as mulheres que tem história familiar. Apesar da palpação ser o método mais simples para o diagnóstico, somente cerca de 60 porcento dos cânceres detectados por mamografia são palpáveis. O exame anatomopatológico é imprescindível para o diagnóstico do tumor primário e das metástases e para a classificação e o estadiamento. Os tumores malignos próprios da mama, isto é, os adenocarcinomas, são divididos em in situ e invasores e estes dois subgrupos, por sua vez, são divididos em ductais e lobulares...