RESUMO
PURPOSE: The incidence of pediatric adrenocortical tumors (ACTs) is remarkably high in southern Brazil, where more than 90% of patients carry the germline TP53 mutation R337H. We assessed the impact of early detection of this mutation and of surveillance of carriers. PATIENTS AND METHODS: Free newborn screening was offered at all hospitals in the state of Paraná. Parents of positive newborns were tested, and relatives in the carrier line were offered screening. Positive newborns and their relatives age < 15 years were offered surveillance (periodic clinical, laboratory, and ultrasound evaluations). ACTs detected by imaging were surgically resected. RESULTS: Of 180,000 newborns offered screening, 171,649 were screened, and 461 (0.27%) were carriers. As of April 2012, ACTs had been diagnosed in 11 of these carriers but in only two neonatally screened noncarriers (P < .001); six patient cases were identified among 228 carrier relatives age < 15 years (total, 19 ACTs). Surveillance participants included 347 (49.6%) of 699 carriers. Tumors were smaller in surveillance participants (P < .001) and more advanced in nonparticipants (four with stage III disease; two deaths). Neonatally screened carriers also had neuroblastoma (n = 1), glioblastoma multiforme (n = 1), choroid plexus carcinoma (n = 2), and Burkitt lymphoma (n = 1). Cancer histories and pedigrees were obtained for 353 families that included 1,704 identified carriers. ACTs were the most frequent cancer among carrier children (n = 48). CONCLUSION: These findings establish the prevalence of the TP53 R337H mutation in Paraná state and the penetrance of ACTs among carriers. Importantly, screening and surveillance of heterozygous carriers are effective in detecting ACTs when readily curable.
Assuntos
Neoplasias do Córtex Suprarrenal/epidemiologia , Neoplasias do Córtex Suprarrenal/genética , Predisposição Genética para Doença/epidemiologia , Testes Genéticos/métodos , Mutação em Linhagem Germinativa , Proteína Supressora de Tumor p53/genética , Neoplasias do Córtex Suprarrenal/diagnóstico , Brasil/epidemiologia , Criança , Pré-Escolar , Detecção Precoce de Câncer/métodos , Feminino , Regulação da Expressão Gênica , Heterozigoto , Humanos , Incidência , Recém-Nascido , Masculino , Triagem Neonatal/métodos , Linhagem , Medição de Risco , Distribuição por SexoRESUMO
Os autores apresentam o caso de paciente do sexo masculino, 62 anos de idade, com emagrecimento há quatro meses e diminuição da força muscular associada a parestesias em membros inferiores há dois dias. Foi submetido a mielotomografia, que demonstrou massa no mediastino posterior com destruição dos corpos vertebrais e invasão do canal medular, além de espessamento irregular das paredes do esôfago. Na evolução, foi submetido a estudo contrastado do esôfago, que demonstrou falha de enchimento irregular. A biópsia confirmou a presença de carcinoma de células escamosas. Este é o primeiro relato na literatura latino-americana (Lilacs) de carcinoma de esôfago com invasão de canal medular e manifestação inicial de síndrome de compressão medular.