Uterine POLE mutant endometrioid carcinoma combined with human papilloma virus-associated cervical adenocarcinoma: A case report and literature review / 北京大学学报(医学版)

Independent primary uterine and cervical adenocarcinoma are rare and difficult to identify their origins, which makes treatment decision difficult. A 46-year-old female with endometrioid carcinoma and adenocarcinoma, human papilloma virus (HPV)-associated of the uterine cervix was reported. The patient presented with increased menstrual flow, contact bleeding and watery leucorrhea for more than one year, and the imaging findings showed abnormal uterine morphology, irregular margins, and multiple abnormal signals in uterine cavity and myometrium, which suggested multiple leiomyomas of the uterus. The signal intensity in the right muscle layer was markedly enhanced, suggesting a smooth muscle tumor of uncertain malignant potential. A large number of cystic hypointensity was seen in the cervix, and multiple cysts were considered. The initial preoperative diagnosis was multiple leiomyoma of the uterus, and a hysterectomy operation was planned. During the operation, the uterus was sent for frozen sections. There was a mass in the endometrium of the fundus, with a soft grayish-red cut surface and a clear border with the myometrium, and there was a grayish-white nodule in the cervix with a hard grayish-white cut surface. The two masses were well demarcated from each other, and the distance between them was 30 mm. The result of the frozen sections indicated the malignant tumor of the endometrium, and the extended hysterectomy+pelvic lymphadenectomy+partial resection of the greater omentum was performed. After the operation, the paraffin sections were sent to the Department of Pathology of the Peking University Third Hospital for histochemistry, POLE gene sequencing and HPV RNAscope tests, and the final diagnosis was a synchronous endometrioid carcinoma (POLE-mutant according to the WHO classification) and an adenocarcinoma, HPV-associated of the uterine cervix. Now the patient had been treated with 2 cycles of chemotherapy and her condition was fine. Through the analysis of the histological, immunohistochemical and molecular detection results of this case, the importance of applying HPV RNAscope and TCGA molecular typing in the diagnosis of cervical adenocarcinomas and endometrial carcinomas was emphasized. At the same time, gynecologists should not blindly rely on intraoperative frozen sections, and should pay attention to preoperative pathological examination, and make appropriate operation methods according to the results in order to prevent passivity in the surgery.

Value of albumin RNAscope in situ hybridization in diagnosis and differential diagnosis of hepatocellular carcinoma / 中华病理学杂志

Objective: To investigate the utility of albumin RNAscope in situ hybridization in the diagnosis and differential diagnosis of hepatocellular carcinoma and its mimics. Methods: One hundred and fifty-two cases of hepatocellular carcinoma and its mimics and 33 cases of normal tissue were selected from the pathology database of the Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2013 to December 2019. Tissue microarrays were constructed and RNAscope in situ hybridization was performed to detect the expression of albumin mRNA. Results: No albumin mRNA expression was detected in normal tissues except for the liver. All hepatocellular carcinoma regardless of its degree of differentiation and primary or metastatic nature had detectable albumin mRNA, with strong and diffuse staining in 90.7% (49/54) of cases. While the positive rate of HepPar-1, Arg-1 or one of them by immunohistochemistry was 87.0% (47/54), 85.2% (46/54) and 92.6% (50/54) respectively. The positive rates of albumin mRNA in intrahepatic cholangiocarcinoma and biphenotypic hepatocellular carcinoma were 7/15 and 9/10, respectively. The former showed focal or heterogeneous staining, while the latter showed strong and diffuse staining. The positive rate of hepatoid adenocarcinoma was 8/19, and the albumin expression could be diffuse or focal. Sporadic cases of poorly differentiated gastric adenocarcinoma and metastatic colon adenocarcinoma showed focal staining of albumin mRNA. Conclusions: Detection of albumin mRNA by RNAscope in situ hybridization is of great value for the diagnosis and differential diagnosis of HCC, and the sensitivity may be improved by combining with HepPar-1 and Arg-1. It also offers different diagnostic clues according to different expression patterns.

Hemofilia paraneoplásica adquirida secundaria a adenocarcinoma de la ampolla de Vater / Acquired paraneoplastic hemophilia secondary to Vater's ampulla adenocarcinoma

Resumen La hemofilia adquirida A es un desorden hemorrágico inusual de origen autoinmune que resulta en la formación de autoanticuerpos dirigidos contra el factor VIII de la coagulación. Estos autoanticuer pos pueden actuar neutralizando parcial o completamente la activación o función del factor, o también pueden acelerar su eliminación de la circulación. La incidencia mundial de la enfermedad es de 1.5 casos por millón de habitantes por año. En cerca del 50% de los pacientes se puede detectar una enfermedad subyacente que se presume responsable de la producción de los autoanticuerpos. Se presenta el caso de un varón con hemofilia adquirida A, en contexto de adenocarcinoma de la ampolla de Vater.

Abstract Acquired hemophilia A is an unusual bleeding disorder of autoimmune origin resulting in the formation of autoantibodies directed against coagulation factor VIII. These autoantibodies can act by partially or completely neutralizing the activation or function of the factor, or they can also accelerate its elimination from the circulation. The global incidence of the disease is 1.5 cases per million inhabitants per year. In nearly 50% of cases, an underlying disease that is presumed responsible to produce autoantibodies can be detected. We report a case with acquired hemophilia A, in a patient with Vater's ampulla adenocarcinoma.

Perforated Jejunal Adenocarcinoma in a COVID-19-Positive Patient* / Adenocarcinoma jejunal perfurado em paciente positivo para covid-19

Abstract Jejunal adenocarcinoma is a rare type of primary small bowelmalignancy. It is generally diagnosed at late stages and as a surgical finding, with abdominal pain or discomfort being the main associated symptom. Cases presenting with perforation are even rarer, especially without disseminated disease. The relationship between cancer and coronavirus disease 2019 (COVID-19) is still being studied, as well as the postsurgical evolution of COVID-19 patients and its possible causality of intestinal perforation. We present the case of a perforated jejunal adenocarcinoma in a COVID-19-positive patient, in whom the symptomatology secondary to the perforation led to an early diagnosis, treatment and adequate postsurgical evolution, despite the concomitant condition.

Resumo O adenocarcinoma jejunal é um tipo raro de malignidade primária do intestino delgado, o qual geralmente é diagnosticado em estágios tardios e como achado cirúrgico, sendo a dor ou o desconforto abdominal o principal sintoma associado. Casos que apresentam perfuração são ainda mais raros, principalmente sem doença disseminada. A relação entre câncer e a cornonavirus disease 2019 (covid-19) ainda está sendo estudada, assim como a evolução pós-cirúrgica de pacientes com covid-19 e sua possível causalidade de perfuração intestinal. Apresentamos o caso de um adenocarcinoma jejunal perfurado em um paciente positivo para covid-19, em que a sintomatologia secundária à perfuração levou a um diagnóstico precoce, tratamento e evolução pós-cirúrgica adequada, apesar da condição concomitante.

Caracterización epidemiológica del cáncer de mama / Epidemiological characterization of cancer breast

Con el objetivo de realizar la caracterización epidemiológica del cáncer de mama de las pacientes que asisten a la consulta externa de ginecología oncológica en el Instituto Guatemalteco de Seguridad Social (IGSS) de enero a marzo de 2,018, se realizó un estudio descriptivo transversal en 155 pacientes que acudieron a la clínica de mama del Hospital de Gineco Obstetricia del IGSS, con una media de edad de 62 años, el adenocarcinoma ductal infiltrante es el tipo histológico más frecuente en nuestra población tanto en edad reproductiva como en menopausia. Como factor protector el 69% dio lactancia materna. La etapa clínica más comúnmente diagnosticada es IIA. El Luminal A, el más frecuentemente diagnosticado por inmunohistoquímica, seguido del Luminal B y HER2neu. Se diagnostican pacientes mayormente en etapas clínicas tempranas (I y II).

In order to carry out the epidemiological characterization of breast cancer in patients attending the outpatient gynecology oncology consultation at the Guatemalan Social Security Institute (IGSS) from January to March 2018, a descriptive cross-sectional study was carried out in 155 patients who attended the breast clinic of the IGSS Obstetrics Gynecology Hospital, with a mean age of 62 years, infiltrating ductal adenocarcinoma is the most frequent histological type in our population both in reproductive age and in menopause. As a protective factor, 69% breastfed. The most diagnosed clinical stage is IIA. Luminal A, the most frequently diagnosed by immunohistochemistry, followed by Luminal B and HER2neu. Patients are diagnosed mostly in early clinical stages (I and II).

Aspectos clinicoepidemiológicos, endoscópicos e histológicos en ancianos con cáncer gástrico / Some clinical-epidemiological, endoscopic and histological aspects in elderly with gastric cancer

Introducción: El cáncer gástrico ocupa el quinto lugar en incidencia de todos los tipos de neoplasias malignas y la segunda causa de muerte por cáncer en el mundo, pues la mayoría de los pacientes presentan más de 60 años de edad al ser diagnosticados. Objetivo: Caracterizar a ancianos con cáncer gástrico según variables de interés. Métodos: Se realizó un estudio observacional y descriptivo, de serie de casos, de 56 pacientes mayores de 60 años con diagnóstico endoscópico e histológico de cáncer gástrico, quienes fueron ingresados en el Hospital Provincial Clínico-Quirúrgico Docente Saturnino Lora de Santiago de Cuba, en el período 2016-2019. Resultados: En la serie predominaron los ancianos de 60-69 años de edad (46,4 %), principalmente del sexo masculino (67,8 %), y los síntomas más frecuentes fueron la epigastralgia (82,1 %) y la saciedad precoz (67,8 %). Entre las características más relevantes de las lesiones tumorales figuraron la localización antropilórica (55,3 %), la forma ulcerada en la endoscopia (51,7 %) y la variedad hística adenocarcinoma moderadamente diferenciado (43,4 %); asimismo, se determinó la existencia de Helicobacter pylori en 52,5 % de los resultados anatomopatológicos de las biopsias. Conclusiones: Resulta importante considerar la presencia de un adenocarcinoma gástrico en los pacientes mayores de 60 años que refieran síntomas digestivos, sobre todos si son hombres y padecen epigastralgia, más aún si al realizarle la esofagogastroduodenoscopia se observa una lesión ulcerada de localización antropilórica.

Introduction: Gastric cancer occupies the fifth place in incidence among all types of malignancies and is the second cause of death in the world, as most of the patients are more than 60 years when being diagnosed. Objective: To characterize aged patients according to variables of interests. Methods: An observational, descriptive and series of cases study was carried out in 56 patients older than 60 years with endoscopic and histologic diagnosis of gastric cancer, who were admitted in Saturnino Lora Teaching Provincial Clinical-Surgical Hospital, during 2016-2019. Results: Elderly in the age group 60-69 years predominated (46.4 %), mainly of the male sex (67.8 %), and the most frequent symptoms were epigastralgia (82.1 %) and the early fullness sensation (67.8 %). Among the most relevant characteristics of the tumoral lesions there were the antropiloric location (55.3 %), the ulcerated presentation in the endoscopy (51.7 %), and the histic variety mildly differentiated adenocarcinoma (43.4 %), likewise, the existence of Helicobacter pylori was confirmed in 52,5 % of the pathological biopsy results. Conclusions: It is interesting to consider the presence of a gastric adenocarcinoma in patients older than 60 years expressing gastric symptoms, mainly if they are men or suffer from epigastralgia, even more if when carrying out the esophagogastroduodenoscopy, an ulcerated lesion of antropiloric location is observed.

Computed Tomography Colonography as a Sensible Option for Colorectal Cancer Screening: Evidence Based on Metanalysis / Colonografia por tomografia computadorizada como uma opção sensível para o rastreamento do câncer colorretal: Evidências baseadas em metanálise

Abstract Objective This metanalysis aimed to evaluate the sensitivity and specificity of computed tomography colonography in colorectal polyp detection. Methods A literature search was performed in the PubMed and Web of Science databases. Results A total of 1,872 patients (males 57.2%, females 42.8%) aged 49 to 82 years old (mean age 59.7 ± 5.3 years) were included in this metanalysis. The estimated sensitivity of computed tomography colonography was 88.4% (46.3-95.7%, coefficient of variation [CV]=28.5%) and the estimated specificity was 73.6% (47.4-100.0%, CV=37.5%). For lesions up to 9mm, the sensitivity was 82.5% (62.0-99.9%, CV =25.1%) and the specificity was 79.2% (32.0-98.0%, CV=22.9%). For lesions>9mm, the sensitivity was 90.2% (64.0-100.0%, CV=7.4%) and the specificity was 94.7% (80.0-100.0%, CV=6.2%). No statistically significant differences in sensitivity according to the size of the lesion were found (p=0.0958); however, the specificity was higher for lesions>9mm (p<0.0001). Conclusions Most of the studies analyzed in the present work were conducted before 2010, which is about a decade after computed tomography colonography started being indicated as a screening method by European and American guidelines. Therefore, more studies aimed at analyzing the technique after further technological advancements are necessary, which could lead to the development of more modern devices.

Resumo Objetivo Esta meta-análise teve como objetivo avaliar a sensibilidade e especificidade da colonografia por tomografia computadorizada na detecção de pólipos colorretais. Métodos Foi realizada uma pesquisa bibliográfica nas bases de dados da PubMed e da Web of Science. Resultados Um total de 1.872 pacientes, 57,2% homens e 42,8% mulheres, com idades entre 49 a 82 anos de idade (média de 59,7 ± 5,3 anos) foram incluídos nesta meta análise. A sensibilidade da colonografia por tomografia computadorizada foi estimada em 88,4% (46,3-95,7%; coeficiente de variância [CV]=28,5%) e a especificidade em 73,6% (47,4%-100,0%; CV=37,5%). Para lesões de até 9mm, a sensibilidade foi de 82,5% (62,0-99,9%; CV=25,1%) e a especificidade de 79,2% (32,0-98,0%; CV=22,9%). Para lesõesmaiores que 9mm, a sensibilidade foi de 90,2% (64,0-100,0%; CV=7,4%) e a especificidade de 94,7% (80,0-100,0%; CV=6,2%). Não houve diferença estatisticamente significante entre as sensibilidades por tamanho da lesão (p=0,0958), porém a especificidade foi maior em lesões acima de 9mm (p<0,0001). Conclusão A maioria dos estudos analisados no presente trabalho foi realizada antes de 2010, cerca de uma década depois que a colonografia por tomografia computadorizada passou a ser indicada como método de triagem pelas diretrizes europeias e americanas. Portanto, são necessários mais estudos com o objetivo de analisar a técnica apósmaiores avanços tecnológicos, o que poderia levar ao desenvolvimento de dispositivos mais modernos.

Assessment of Quality Indexes in Colonoscopy in the Coloproctology Service of a Tertiary Private Hospital in Southern Brazil / Avaliação de índices de qualidade em colonoscopia em um serviço de coloproctologia de um hospital terciário privado do Sul do Brasil

Abstract Background Colorectal cancer (CRC) is the third most common cancer among men, and the second among women worldwide. In Brazil, the incidence andmortality of CRC continues to increase. In colonoscopies, adenoma detection rates (ADRs) higher than 25% are associated linearly with better outcomes and lower rates of interval cancer. Objective To assess the colonoscopy quality indexes. Methods This is a cross-sectional retrospective study in which anatomopathological data and data regarding the colonoscopies were collected from the patient records of Hospital Moinhos de Vento, in Southern Brazil. The exams were performed by doctors from the Colorectal Service from June to August 2015. Results A total of 430 exams were included. Most patients were women (60.9% [262]), with a mean age of 56.96 years. The cecal intubation rate was of 96.7% (416). The quality of the bowel preparation was excellent or good in 92.95% (396) of the cases. The average time of removal of the colonoscope in normal exams was of 6.15 minutes. Polyps were detected in 201 patients (46.7%), and adenomas, in 125 patients (29.1%); 12 patients (2.8%) had advanced adenomas, and 6 (2.3%) had malignant neoplasms. The proximal serrated lesion detection rate (PSLDR) was of 6.7% (29). The prevalence ratio (PR) of adenomas among men was 1.78 times greater than in women (95% confidence interval [95%CI]: 1.16-2.75). The PR of adenomas among people aged 50 years or older was 2.41 times that of those under 50 years of age (95%CI: 1.43-4.06). Conclusion The data obtained are in line with international quality criteria in colonoscopy. More studies are needed to assess the ADR in the Brazilian population.

Resumo Introdução O câncer colorretal (CCR) é o terceiro mais comum em homens e o segundo mais comum em mulheres em todo o mundo. A incidência e mortalidade do CRC continuam a aumentar no Brasil. Taxas de detecção de adenoma superiores a 25% em colonoscopias estão associadas linearmente a melhores resultados emenores taxas de câncer de intervalo. Objetivo Avaliar a qualidade das colonoscopias analisadas. Métodos Este é um estudo transversal e retrospectivo no qual dados anatomopatológicos e relacionados às colonoscopias foram coletados de registros dos pacientes do Hospital Moinhos de Vento, no Sul do Brasil. Os exames foram realizados por médicos do Serviço de Coloproctologia de junho a agosto de 2015. Resultados Foram incluídos 430 exames. A maioria dos pacientes era do sexo feminino (60,9% [262]), com idade média de 56,96 anos. A taxa de intubação cecal foi de 96,7% (416). A qualidade do preparo intestinal foi excelente ou boaem92,95% (396) dos casos.O tempomédio de retirada do colonoscópio emexames normais foi de 6,15 minutos. Pólipos foram detectados em 201 pacientes (46,7%), e adenomas, em 125 (29.1%); 12 pacientes (2,8%) tinhamadenomas avançados, e 6 (2,3%), neoplasias malignas. A taxa de detecção de lesões serrilhadas foi de 6,7% (29). A razão prevalência (RP) de adenomas emhomens foi de 1,78 vezes emrelação amulheres (intervalo de confiança de 95% [IC95%]: 1,16-2,75). A RP de adenomas entre pacientes com 50 anos ou mais foi 2,41 vezes maior do que a daqueles com mais de 50 anos (IC95%: 1,43-4,06). Conclusão Os dados obtidos estão de acordo com os critérios internacionais de qualidade em colonoscopia. Mais estudos são necessários para avaliar as taxas de detecção de adenoma na população brasileira.

Epidemiological Profile of Patients with Colorectal Cancer from a Hospital in Rio Grande do Sul, Brazil / Perfil epidemiológico de pacientes com câncer colorretal de um Hospital no Rio Grande do Sul, Brasil

Abstract Objective The present study describes the epidemiological profile of patients with colorectal cancer (CRC) from the Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brazil, between January 1, 2007 and December 31, 2016. Method Retrospective analysis of secondary data of 1,001 patients from the Hospital Cancer Registry. Results Most subjects were Caucasianmales, with a mean age of 63.68 years old. The majority of patients had incomplete elementary education and were married. In addition, 44.5% of the patients had a family history of cancer. Most subjects with a positive past or current history of alcohol intake or smoking were male. The diagnosis was mostly based on anatomopathological findings, with a predominance of adenocarcinomas and upper rectum and distal colon localization. Most lesions were in advanced stages, and the liver was the most common site for metastasis. The predominant treatment was surgery with neoadjuvant/adjuvant therapy. After the first treatment, 49.0% of the patients reported complete remission. The survival rate was 78.8% in 10 months. Conclusion The present research analyzed the profile of CRC patients.

Resumo Objetivo Descrever o perfil de pacientes com câncer colorretal (CCR) no Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brasil, de 01 de janeiro de 2007 a 31 de dezembro de 2016. Método Análise retrospectiva de dados secundários de 1.001 pacientes obtidos através do Registro Hospitalar de Câncer. Resultados Evidenciou-se predomínio do sexo masculino, com média de idade de 63,68 anos, majoritariamente caucasianos. O grau escolar prevalente foi fundamental incompleto e o estado civil foi casado. Um total de 44,5% dos pacientes tinha histórico familiar de neoplasia. Em relação ao consumo de álcool/cigarro, dentre os que faziam ou já fizeram uso, a maioria era homem. O diagnóstico foi majoritariamente por meio anatomopatológico, com predomínio de adenocarcinoma e localização no reto superior e no cólon distal, ocorrendo mais comumente em estágios avançados, com a metástase hepática sendo a mais presente. O tratamento predominante foi cirurgia com adjuvância/neoadjuvância. Após o primeiro tratamento, 49,0% dos pacientes apresentaram remissão completa. A sobrevida foi de 78,8% em 10 meses. Conclusão A presente pesquisa possibilitou a análise do perfil dos pacientes com CCR.

Increased Expression of Type-I Collagen in Malignant Colorectal Lesion and Positive Correlations with Clinical Factors / Expressão aumentada do colágeno tipo I na lesão colorretal maligna e correlações positivas com fatores clínicos

Abstract Objective Type-I collagen (Col-I) is one of the main macromolecules of the extracellular matrix, and it is involved in the desmoplastic stromal reaction, an indicator of worse prognosis in cases of colorectal cancer (CRC). The purpose of the present study was to investigate Col-I expression in cases of CRC and adenoma and to correlate with the clinical data and the data regarding the lifestyle of the patients. Methods A retrospective study including 22 patients with adenoma and 15 with CRC treated at a coloproctology service. The clinical and lifestyle data were obtained through medical records, and Col-I expression was investigated by immunohistochemistry. Results Women represented most cases of adenoma (63.64%), whereas CRC was found mainly in men (73.33%) (p=0.0448). Immunoexpression of Col-I showed a basement membrane thickening in areas of lining of epithelium and around the glands in both lesions. The cases of CRC had a quite evident fibrosis process in the stroma. The quantitative analysis demonstrated a higher protein expression in CRCs compared to adenomas (p=0.0109), as well as in female patients (p=0.0214), patients aged ≥ 50 years (p=0.0400), and in those with a positive family history of colorectal disease (p=0.0292). These results suggested a remodeling of the microenvironment of the Worked developed at the Department of Morphology, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, ES, Brazil. Conclusion The immunohistochemical analysis encourages the performance of more comprehensive studies to ascertain if our results could be a tool for the diagnosis and monitoring of the patients.

Resumo Objetivo O colágeno tipo I (Col-I) é uma das principais macromoléculas da matriz extracelular, e está envolvido na reação desmoplástica estromal, um indicador de pior prognóstico em casos de câncer colorretal (CCR). O objetivo foi investigar a expressão do Col-I emcasos de CCR e adenoma, e correlacioná-la comdados clínicos e de estilo de vida dos pacientes. Metodologia Foi realizado umestudoretrospectivo com22pacientes comadenoma e 15 comCCR tratadosemumserviço de coloproctologia.Os dados dos pacientes foramobtidos dos prontuários médicos, e a expressão do Col-I foi investigada por imunohistoquímica. Resultados As mulheres representaram a maioria dos casos de adenomas (63,64%), enquanto o CCR (73,33%) (p=0,0448) foi mais comum entre os homens. A imunoexpressão de Col-I mostrou espessamento da membrana basal em áreas de revestimento do epitélio e em volta de glândulas em ambas as lesões. O CCR apresentou fibrose no estroma. As análises quantitativas demonstraram maior expressão proteica no CCR (p=0,0109), assim como em mulheres (p=0,0214), pacientes com idade ≥ 50 anos (p=0,0400), e em pacientes com histórico positivo de doença colorretal na família (p=0,0292). Estes resultados sugerem a remodelação do microambiente tumoral na carcinogênese do CCR. As correlações clínico-patológicas positivas mostram uma ligação plausível entre o perfil do paciente e os achados imunohistoquímcos, o que indica uma possível forma de estratificação dos pacientes. Conclusão As análises imunohistoquímicas estimulam a execução de estudos mais abrangentes para confirmar se nossos resultados poderão ser uma ferramenta para o diagnóstico e o monitoramento dos pacientes.

Adenopatia cervical: uma apresentação rara de câncer da próstata / Cervical lymphadenopathy ­ a rare presentation of prostate cancer

A metastização ganglionar cervical por neoplasia da próstata é rara, sendo ainda menos frequente como manifestação inicial da doença. O presente estudo é um relato de um caso clínico de uma pessoa do sexo masculino, com 72 anos, que apresentava massa cervical esquerda, indolor, com 2 meses de evolução e dores ósseas lombar e torácica. A citologia aspirativa por agulha fina com estudo imuno-histoquímico revelou positividade para o antígeno prostático específico, concluindo se tratar de metástase ganglionar de carcinoma da próstata. Analiticamente, constatou-se que o valor do antígeno prostático específico foi maior que 1.000ng/mL, além da elevação da fosfatase alcalina. A cintilografia óssea de corpo inteiro revelou envolvimento ósseo secundário. Após o diagnóstico, o paciente iniciou hormonoterapia e recusou radioterapia com intuito paliativo. Oito meses após o diagnóstico, constatou-se a recorrência da doença, com elevação do valor do antígeno prostático específico novamente. Dessa forma, relata-se um caso de neoplasia da próstata com metastização óssea e ganglionar cervical esquerda em um indivíduo assintomático do ponto de vista urológico. Salienta-se que, no diagnóstico diferencial de adenopatias cervicais, deve-se considerar a neoplasia da próstata em pessoas do sexo masculino. (AU)

Cervical lymph nodes involvement is rare in prostate cancer and uncommon as an initial manifestation. This study is a clinical case report of a 72-year-old man who presented with a left cervical painless mass of 2-month progression, and bone pain on the lumbar and thoracic regions. Fine-needle aspiration cytology with immunohistochemistry staining was performed and revealed positivity for prostate-specific antigen consistent with prostate adenocarcinoma metastasis. Blood tests revealed a prostate-specific antigen of more than 1,000ng/mL, as well as high alkaline phosphatase. Whole-body bone scan showed secondary bone involvement. Following diagnosis, the patient started hormonal therapy and refused palliative radiotherapy. Eight months after diagnosis, recurrence was observed, with prostate-specific antigen elevation again. Thus, a clinical case of prostate cancer with bone and cervical lymph node metastasis in a patient with no urologic symptoms is reported. It should be noted that prostate cancer shall always be considered in the differential diagnosis of cervical lymphadenopathies in male patients. (AU)

Higher cut-offs for the number of lymph nodes harvested do not predict better prognosis in patients with colon cancer / Pontos de corte mais altos para o número de linfonodos coletados não predizem melhor prognóstico em pacientes com câncer de cólon

ABSTRACT Background Current threshold for minimum lymph node harvest may not be adequate for appropriate staging in colon cancer and newer surgical techniques may allow more lymph nodes to be harvested. The aim of this study was to examine the prognostic role of harvesting and examining lymph nodes higher in number than the recommended threshold (≥12), in patients with colon cancer. Methods This retrospective study included 179 patients that underwent open colon resection for adenocarcinoma of the colon. A D3 resection with high vascular ligation was made so that large number of lymph nodes was removed in most patients. Differences in overall survival between below and above three cutoff points (≥18, ≥24, ≥40) were estimated. Results During median 33 months of follow-up, 45 patients died and mean overall survival was 108.7 ± 5.6 months (95% CI, 97.7-119.7). The mean number of lymph nodes harvested and examined was 44.0 ± 25.7 (median 38; range, 7-150). No significant effect was found for three different cut-off values (≥18, ≥24, or ≥40 nodes) on mean overall survival (p > 0.05 for all comparisons). The same was true for the whole study population as well as for N0 (N negative) and N1-2 (N positive) patient subgroups, when they are analyzed separately. Conclusions Our findings do not support the survival benefit of substantially higher number of lymph nodes harvested in colon cancer.

RESUMO Fundamento: O limite atual para a coleta mínima de linfonodos pode não ser adequado para o estadiamento adequado no câncer de cólon e novas técnicas cirúrgicas podem permitir que um número maior de linfonodos seja coletado. O objetivo deste estudo foi examinar o papel prognóstico da coleta e exame de linfonodos em número maior do que o limite recomendado (≥ 12), em pacientes com câncer de cólon. Método: Este estudo retrospectivo incluiu 179 pacientes submetidos à ressecção aberta de cólon para adenocarcinoma de cólon. A ressecção D3 com ligadura vascular alta foi realizada para que um grande número de linfonodos fosse removido na maioria dos pacientes. As diferenças na sobrevida global entre abaixo e acima de três pontos de corte (≥ 18, ≥ 24, ≥ 40) foram estimadas. Resultados: Durante a mediana de 33 meses de seguimento, 45 pacientes morreram e a sobrevida global média foi de 108,7 ± 5,6 meses (IC 95%: 97,7-119,7). O número médio de linfonodos coletados e examinados foi de 44,0 ± 25,7 (mediana = 38; variação: 7-150). Nenhum efeito significativo foi encontrado para três valores de corte diferentes (≥ 18, ≥ 24 ou ≥ 40 linfonodos) na sobrevida global média (p >0,05 para todas as comparações). O mesmo foi verdadeiro para toda a população do estudo, bem como para os subgrupos de pacientes N0 (N negativos) e N1-2 (N positivos), quando analisados separadamente. Conclusões: Nossos achados não apoiam o benefício na sobrevida de um número substancialmente maior de linfonodos coletados no câncer de cólon.

Perianastomotic cyst following rectosigmoidectomy due to adenocarcinoma of the proximal rectum: a case report / Cisto perianastomótico pós-retossigmoidectomia por adenocarcinoma dereto alto: relato de caso

ABSTRACT The implantation cyst occurs from the imprisonment and subsequent proliferation of the colonic mucosa below the submucosa during mechanical stapling. The understanding and definition of the evaluation protocol of these lesions is important, since they can generate the need for a new complex surgical procedure and cause anxiety in patients and surgeons. This case reports the occurrence of a subepithelial lesion in follow-up imaging of a patient who underwent videolaparoscopic rectosigmoidectomy for adenocarcinoma of the proximal rectum, submitted to an endoscopic attempt to drain/detangle the lesion and subsequent histopathological analysis showing colic mucosa without changes. In line with Katsumata,it is suggested to asymptomatic patients without alteration of the CEA or suspicious imaging signs a follow up with periodic imaging methods. For symptomatic patients with normal CEA, or whose lesions are growing at follow-up exams, it is suggested to continue with the investigation, with biopsy and/or effluent sample for histopathological study in addition to an attempt at symptomatic resolution. Finally, in the presence of an alteration in CEA, despite symptoms, it is suggested that the lesion be managed as a suspected local tumor recurrence.

RESUMO O cisto de implantação ocorre a partir do aprisionamento e subsequente proliferação da mucosa colônica abaixo da submucosa durante o grampeamento mecânico. A compreensão e definição do protocolo de avaliação dessas lesões é importante, pois podem gerar a necessidade de um novo procedimento cirúrgico complexo e causar ansiedade em pacientes e cirurgiões. Este caso relata a ocorrência de uma lesão sub-epitelial na imagem de seguimento de um paciente submetido à retossigmoidectomia por via videolaparoscópica devido a adenocarcinoma do reto proximal, submetido a uma tentativa endoscópica de drenar/remover a lesão e subsequente análise histopatológica mostrando a mucosa cólica sem alterações. De acordo com Katsumata, sugere-se que pacientes assintomáticos sem alteração do CEA ou sinais de imagem suspeitos tenham um seguimento com métodos de imagem periódicos. Para pacientes sintomáticos com CEA normal, ou cujas lesões mostrem crescimento nos exames de seguimento, sugere-se continuar a investigação, com biópsia e / ou amostra de efluente para estudo histopatológico, além de uma tentativa de resolução sintomática. Finalmente, na presença de uma alteração no CEA, apesar dos sintomas, sugere-se que a lesão seja tratada como uma suspeita de recorrência local do tumor.

Sincronismo colorrectal: adenocarcinoma de colon ascendente y carcinoma neuroendocrino de células pequeñas de recto / Colorectal synchronism: ascending colon adenocarcinoma and small-cell neuroendocrine carcinoma of the rectum

RESUMEN El cáncer colorrectal (CCR) es el tercer cáncer más frecuente en el mundo y la segunda causa de muerte de origen neoplásico. El sincronismo en CCR es de aproximadamente 3-6%. El tracto gastrointestinal es el lugar más frecuente de asiento de neoplasias neuroendocrinas (NNE), y de estos los carcinomas neuroendocrinos (CNE) son poco frecuentes. El tratamiento es un desafío, debido a la agresividad de la neoplasia y la falta de protocolos bien establecidos. Todo esto conlleva a la necesidad de un enfoque multidisciplinario, sin embargo, en la mayoría de casos el pronóstico resulta no ser el mejor. Presentamos el caso de un varón de 83 años que acude a emergencia con historia de 3 meses de diarrea, dolor perianal, pérdida ponderal y hematoquezia. El estudio endoscópico evidenció dos neoplasias y el estudio histológico confirmó la presencia de CNE de células pequeñas de recto y adenocarcinoma de colon ascendente, recibió quimioterapia sistémica sin embargo evolucionó desfavorablemente falleciendo a las 3 semanas.

ABSTRACT Colorectal cancer (CRC) is the third most frequent cancer in the world and the second cause of death of neoplastic origin. Synchronism in CCR is approximately 3-6%. The gastrointestinal tract is the most frequent place where neuroendocrine neoplasms (NNE) settle and a special type of these neuroendocrine carcinomas (CNE) are rare. Treatment is challenging, due to the aggressiveness of the malignancy and the lack of well-established protocols. Therefore a multidisciplinary approach is needed, however, in most cases the result is not the best. We present the case of an 83-year-old man who has an emergency with a 3-month history of diarrhea, perianal pain, weight loss, and hematochezia. The endoscopic study shows evidence of two malignancies and the histological study confirms the presence of CNE in small cells at the rectum and adenocarcinoma in the ascending colon. He underwent systematic chemotherapy, however, he evolved unfavorably, dying after 3 weeks.

Esôfago de Barrett: o estado da arte / Barrett's Esophagus: the state of the art

Objetivo: Demonstrar fatores envolvidos nos distúrbios do sono em profissionais que fazem plantões. Métodos: Trata-se de estudo transversal, cuja amostra foi composta de 244 voluntários, plantonistas da área da saúde, sendo 191 do sexo feminino, que responderam a um questionário socioeconômico, associado à aplicação da Escala de Sonolência de Epworth e ao Índice de Qualidade do Sono de Pittsburgh. Os dados foram analisados pelos coeficientes de Spearman e de Kendall Tau, com distribuição de probabilidade gama. Resultados: Houve significância (p<0,05) com o Índice de Qualidade do Sono de Pittsburgh e a atividade física (+0,216), ergonomia (+0,148), filhos (-0,146), valor da remuneração (+0,112) e disfunção durante o dia (+0,352). Também houve significância com a Escala de Sonolência de Epworth e atividade física (+0,138), renda familiar (-0,118), trabalho semanal (-0,151), latência do sono (-0,106), duração do sono (-0,107), eficiência do sono (-0,139) e disfunção durante o dia (+0,170). Por fim, a eficiência do sono teve significiância com profissão (-0,209), tabagismo (+0,402), Escala de Sonolência de Epworth (-0,139) e dissonias com a obesidade (índice de massa corporal >30; razão de chance de 1,40; intervalo de confiança de 95% de 1,02-1,94). Conclusão: As medidas autorrelatadas são prontamente obtidas com questionários validados, como a Escala de Sonolência de Epworth e o Índice de Qualidade do Sono de Pittsburgh, encontrando-se correlações com renda familiar, ter ou não filhos, índice de massa corporal, atividade física, ergonomia, condições de trabalho, tabagismo e componentes biopsicossociais. Em virtude do caráter transversal deste estudo é indispensável mais estudos com maior follow-up

Objective: To demonstrate factors involved in sleep disorders in professionals who take shifts. Methods: This is a cross-sectional study whose sample consists of 244 volunteers, on-duty health workers, 191 females, who answered a socioeconomic questionnaire, associated with application of the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index. Data were analyzed with Spearman's and Kendall Tau coefficients, and gamma probability distribution. Results: There was significance (p<0,05) with the Pittsburgh Sleep Quality Index and physical activity (+0,216), ergonomics (+0,148), children (-0,146), the wage (+0,112), dysfunction during the day (+0,352). Also there was significance with the Epworth Sleepiness Scale and physical activity (+0,138), family income (-0,118), weekly workload (-0,151), sleep latency (-0,106), sleep duration (-0,107), sleep efficiency (-0,139), and dysfunction during the day (+0,170). Finally, sleep efficiency was significant with occupation (-0,209), smoking habits (+0,402), Epworth Sleepiness Scale (-0,139), dyssomnia with obesity (body index mass >30; OR of 1,40; CI 95% 1,02-1,94). Conclusion: Self-reported measures are readily obtained with validated questionnaires such as Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, with correlations with family income, having children or not, body mass index, physical activity, ergonomics, working conditions, smoking habits, and biopsychosocial components. Due to the cross-sectional nature of this study, further research with longer follow-up is indispensable

Thrombopoietin is associated with a prognosis of gastric adenocarcinoma

SUMMARY OBJECTIVE Thrombopoietin (THPO) is well-known as a megakaryocyte growth and development factor (MGDF) involved in megakaryocyte proliferation and maturation. To explore the biological effects of THPO in gastric adenocarcinoma, we conducted this study. Methods: By accessing the TCGA database, the expression level of THPO was determined in tumor tissues. The association between THPO expression and clinical features, or prognostic significance was described by Cox regression analysis and Kaplan-Meier. The SiRNA method was used to decline the THPO expression; then cell viability, invasion, and migration were detected to verify the effects of the knockdown of THPO. qPCR and western blotting were implemented to examine the expression level of THPO. Results: The expression of THPO was increased in tumor tissue and cells, its high-regulation was associated with a poor prognosis in patients with gastric adenocarcinoma. Cell viability, invasion, and migration were suppressed in AGS with the down-regulation of THPO. Furthermore, on the basis of si-THPO transfection, E-cadherin was promoted while N-cadherin and Vimentin were attenuated. CONCLUSION Our results revealed that THPO may be a potent marker of gastric adenocarcinoma, providing a novel potential screening method for gastric adenocarcinoma.

RESUMO OBJETIVO Trombopoetina (THPO) é um conhecido fator de desenvolvimento e crescimento megacariócito (MGDF) envolvido na proliferação e maturação de megacariócitos. Realizamos este estudo para explorar os efeitos biológicos do THPO no adenocarcinoma gástrico. Metodologia: O nível de expressão do THPO em tecidos tumorais foi determinado acessando a banco de dados TCGA. A associação entre a expressão de THPO e características clínicas ou relevância no prognóstico foi descrita através da análise de Kaplan-Meier e regressão de Cox. O método SiRNA foi utilizado para reduzir a expressão da THPO e, em seguida, a viabilidade, invasão, e migração celular foram detectadas para verificar os efeitos da redução do THPO. qPCR e western blotting foram utilizados para examinar o nível de expressão do THPO. Resultados: A expressão do THPO estava aumentada em tecido e células tumorais, esse aumento estava associado com um prognóstico negativo para pacientes com adenocarcinoma gástrico. A invasão e migração celular foram suprimidos em AGS com a redução do THPO. Além disso, com base na transfecção de si-THPO, a E-caderina foi promovida, enquanto a N-caderina e Vimentina foram atenuadas. Conclusão nossos resultados demonstram que o thpo pode ser um potente marcador de adenocarcinoma gástrico, com potencial para ser um novo tipo de triagem para adenocarcinoma gástrico.

Unusual abscess masquerading as poorly differentiated adenocarcinoma of the colon showing characteristics of choriocarcinoma

Extragonadal non-gestational choriocarcinoma (ENC) is an uncommon malignant tumor occasionally found in the gastrointestinal tract. ENC is characterized by a biphasic tumor growth with distinct areas of adenocarcinoma and choriocarcinoma differentiation. Primary choriocarcinoma of the colon is extremely rare, with only 21 cases reported in the literature. Most of the perforation of colorectal cancers occurs in the abdominal cavity, while abdominal wall abscess is rare; the psoas abscess associated with colon carcinoma is even less observed. Herein, we report the case of a 61-year-old female with poorly differentiated adenocarcinoma of the ascending colon and sigmoid, with choriocarcinomatous differentiation, masquerading a psoas abscess formation. Unfortunately, despite the aggressive therapy, the patient's disease rapidly progressed, and she died within 2 months after the diagnosis. The typical morphological pattern, immunohistochemistry, and its correlation with serum β-human chorionic gonadotropin enabled a correct diagnosis.

Metástases Cutâneas e Neoplasia de Reto: Relato de Caso / Cutaneous Metastasis and Rectum Neoplasia: Case Report / Metástasis Cutáneas y Neoplasia Rectal: Relato de Caso

Introdução: As metástases cutâneas são as neoplasias que acometem a derme ou o tecido celular subcutâneo e podem ser um indicador de neoplasia desconhecida de mau prognóstico. Metástases cutâneas em adenocarcinoma de reto são consideradas raras. Relato do caso: Mulher de 80 anos de idade, hipertensa e diabética, apresentou dor abdominal e hematoquezia, relatando histórico familiar de câncer. Realizou colonoscopia com resultado de biópsia para adenocarcinoma. Um ano depois, recebeu terapia neoadjuvante e radioterapia concomitante por quatro meses, com boa resposta ao tratamento. Porém, relatou lesão mandibular de crescimento rápido, com o trato gastrointestinal como sítio primário de acordo com a biópsia. Em tomografias de reavaliação, foram diagnosticados também vários nódulos diminutos em tecido subcutâneo de abdome inferior, mama e pulmão. Foi realizada nova biópsia dos nódulos de mama e imuno--histoquímica, procedimentos que sugeriram o reto como sítio primário das lesões. Sendo assim, foi iniciada quimioterapia paliativa e a paciente apresentou resposta satisfatória das lesões cutâneas logo no segundo ciclo do tratamento antineoplásico. O projeto foi aprovado pelo Comitê de Ética em Pesquisa do Hospital Pompeia sob número de parecer 311.052. Conclusão: Este caso enfatiza que lesões na pele de crescimento progressivo ou sem resposta após terapia convencional podem ser a primeira manifestação de câncer visceral avançado e devem ser apropriadamente investigadas. Dessa forma, fica claro que, por meio de um diagnóstico precoce, é possível mudar o prognóstico da doença e o seu tratamento.

Introduction: Skin metastases are neoplasms that affect the dermis or subcutaneous cell tissue and may be an indicator of an unknown neoplasm with a poor prognosis. Skin metastases in rectal adenocarcinoma are considered rare. Case report: An 80-year-old woman, hypertensive and diabetic, had abdominal pain and hematochezia, reporting a family history of cancer. Colonoscopy was performed with biopsy results for adenocarcinoma. One year later, she received neoadjuvant therapy and concomitant radiation therapy for four months, with good response to treatment. However, she reported a fast-growing mandibular lesion, with the gastrointestinal tract as the primary site according to the biopsy. In reassessment CT scans, several small nodules in subcutaneous tissue of the lower abdomen, breast and lung were also diagnosed. A new biopsy of the breast nodules and immunohistochemistry were performed, procedures that suggested the rectum as the primary site of the lesions. Therefore, palliative chemotherapy was started and the patient presented a satisfactory response to skin lesions in the second cycle of antineoplastic treatment. The project was approved by the Institutional Review Board of Hospital Pompeia through report the opinion nº 311.052. Conclusion: This case emphasizes that progressive or unresponsive skin lesions after conventional therapy can be the first manifestation of advanced visceral cancer and should be properly investigated. Thus, it is clear that, through an early diagnosis, it is possible to change the prognosis of the disease and its treatment.

Introducción: Las metástasis cutáneas son neoplasias que afectan la dermis o el tejido subcutáneo y pueden ser un indicador de neoplasia desconocida con mal pronóstico. Las metástasis cutáneas en el adenocarcinoma rectal se consideran raras. Relato del caso: Una mujer de 80 años, hipertensa y diabética, presentaba dolor abdominal y hematoquecia, e informaba antecedentes familiares de cáncer. La colonoscopia se realizó con resultados de biopsia para adenocarcinoma. Un año después, recibió terapia neoadyuvante y radioterapia concomitante durante cuatro meses, con buena respuesta al tratamiento. Sin embargo, informó una lesión mandibular de rápido crecimiento, con el tracto gastrointestinal como el sitio primario según la biopsia. En las tomografías de reevaluación, también se diagnosticaron varios nódulos pequeños en el tejido subcutáneo de la parte inferior del abdomen, mama y pulmón. Se realizó una nueva biopsia de los nódulos mamarios y la inmunohistoquímica, procedimientos que sugirieron el recto como el sitio primario de las lesiones. Por lo tanto, se inició la quimioterapia paliativa y el paciente presentó una respuesta satisfactoria a las lesiones cutáneas en el segundo ciclo de tratamiento antineoplásico. El proyecto fue aprobado por el Comité de Ética e Investigación del Hospital Pompéia a través del dictamen número 311.052. Conclusión: Este caso enfatiza que las lesiones cutáneas progresivas o que no responden después de la terapia convencional pueden ser la primera manifestación de cáncer visceral avanzado y deben investigarse adecuadamente. Por lo tanto, está claro que, a través de un diagnóstico temprano, es posible cambiar el pronóstico de la enfermedad y su tratamiento.

Expresión de Ki67 y MUC-1 en el adenocarcinoma no especificado de otra manera (NOS) de glándulas salivales: su valor pronóstico / Ki67 and MUC-1 expression in adenocarcinoma not otherwise specified (NOS) of salivary glands: prognostic value

El adenocarcinoma NOS (no especificado de otra manera) es un tumor salival sin patrón especial poco mencionado en la literatura; su diagnóstico es un desafío porque estructuralmente no se identifica con otros carcinomas salivales más definidos. Por otro lado, Ki67 es un marcador de proliferación celular que brinda información pronóstica de las neoplasias. En cuanto a la mucina humana transmembrana MUC-1 se sobre-expresa en las neoplasias malignas perdiendo su localización exclusivamente apical. Presentamos dos casos de adenocarcinoma NOS diagnosticados con H/E y correlacionamos la expresión de Ki67 y la localización y sobreexpresión de MUC-1 con su grado histológico y pronóstico. Cortes histológicos de dos adenocarcinomas NOS de parótida en mujeres de 62 y 63 años respectivamente se colorearon con H/E e inmunomarcaron para Ki67 y MUC-1. En ambos tumores predominaban estructuras ductales, algunas quísticas, cordones celulares ramificados e islotes sólidos. Las formaciones glandulares presentaban células claras y algunas de aspecto oncocítico. Había importante atipia celular, comedonecrosis, invasión perineural, áreas hemorrágicas y compromiso de los márgenes quirúrgicos. La marcación nuclear con Ki67 fue importante; MUC-1 presentó una fuerte coloración en membranas y citoplasmas. Las dos lesiones se diagnosticaron como de alto grado de malignidad. Nuestros resultados demuestran que existe una importante proliferación marcada con Ki67 y una sobre-expresión de MUC-1 asociadas a atipia celular, infiltración perineural, necrosis y compromiso de márgenes quirúrgicos, factores asociados a un peor pronóstico. El reconocimiento de este tumor es trascendente para médicos y odontólogos ya que por la ausencia de rasgos distintivos que sí presentan otros carcinomas más específicos es fundamental el diagnóstico de exclusión.

Adenocarcinoma NOS (not otherwise specified) is a no special pattern salivary tumor briefly mentioned in the literature; its diagnosis is a challenge because structurally it is not identified with other more definite salivary carcinomas. On the other hand, Ki67 is a marker of cellular proliferation that provides prognostic information of neoplasms. As for human transmembrane mucin, MUC-1 is overexpressed in malignant neoplasms, losing their exclusively apical location. We present two cases of adenocarcinoma NOS diagnosed with H/E and correlate the expression of Ki67 and the location and over-expression of MUC-1 with its histological grade and prognosis. Histological sections of two NOS adenocarcinomas of parotid in women of 62 and 63 ages respectively were stained with H/E and immunolabelled for Ki67 and MUC-1. Both are predominated by ductal structures, some cystic, branched cell cords and solid islets. The glandular formations presented clear cells and some of oncocytic appearance. There was important cellular atypia, comedonecrosis, perineural growth, haemorrhagic areas and compromise of surgical margins. Nuclear marking with Ki67 was important; MUC-1 presented a strong staining in membranes and cytoplasms. They were diagnosed as high-grade malignancy. Our results show that there is an important proliferation marked with Ki67 and overexpression of MUC-1 associated with cellular atypia, perineural growth, necrosis and compromise of surgical margins, factorsassociated with a poor prognosis. The recognition of this tumor is transcendent for physicians and dentists since, due to the absence of distinctive features that other more specific carcinomas present, the diagnosis of exclusion is essential.