RESUMO
@#Neuroendocrine carcinoma (NEC) of the endometrium is a rare, aggressive subtype of endometrial cancer. We report a 61-year-old female with a history of breast cancer, s/p modified radical mastectomy, chemotherapy, radiotherapy and hormonal (tamoxifen) therapy, who presented with post-menopausal bleeding. Patient underwent TAH-BSO with lymph node dissection, and was diagnosed with a mixed small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC), confirmed by positive immunohistochemical staining for neuroendocrine markers. No other lesions were identified on PET-CT, making a primary endometrial NEC the most likely diagnosis. We review the clinical and pathologic characteristics of endometrial neuroendocrine carcinomas.
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Neoplasias do Endométrio , Carcinoma Neuroendócrino , Carcinoma de Células Grandes , Carcinoma de Células PequenasRESUMO
OBJECTIVE: We conducted a retrospective, multi-institutional, collaborative study to accumulate cases of neuroendocrine carcinoma of the endometrium, to clarify its clinicopathologic features, treatment, prognosis and prognostic factors to collate findings to establish future individualized treatment regimens. To our knowledge, this is the largest case study and the first study to statistically analyze the prognosis of this disease. METHODS: At medical institutions participating in the Kansai Clinical Oncology Group/Intergroup, cases diagnosed at a central pathologic review as neuroendocrine carcinoma of the endometrium between 1995 and 2014 were enrolled. We retrospectively analyzed the clinicopathologic features, treatment, prognosis and prognostic factors of this disease. RESULTS: A total of 65 cases were registered from 18 medical institutions in Japan. Of these, 42 (64.6%) cases were diagnosed as neuroendocrine carcinoma of the endometrium based on the central pathological review and thus included in the study. Advanced International Federation of Gynecology and Obstetrics stages (stage III and IV) and pure type small cell neuroendocrine carcinoma cases had a significantly worse prognosis. Upon multivariate analysis, only histologic subtypes and surgery were significant prognostic factors. Pure type cases had a significantly worse prognosis compared to mixed type cases and complete surgery cases had a significantly better prognosis compared to cases with no or incomplete surgery. CONCLUSION: Our findings suggest that complete surgery improves the prognosis of neuroendocrine carcinoma of the endometrium. Even among cases with advanced disease stages, if complete surgery is expected to be achieved, clinicians should consider curative surgery to improve the prognosis of neuroendocrine carcinoma of the endometrium.
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Feminino , Carcinoma de Células Grandes , Carcinoma Neuroendócrino , Carcinoma de Células Pequenas , Neoplasias do Endométrio , Endométrio , Ginecologia , Japão , Oncologia , Análise Multivariada , Obstetrícia , Prognóstico , Estudos RetrospectivosRESUMO
High-grade endometrial carcinomas are aggressive neoplasms of difficult histological classification. Neuroendocrine differentiation in endometrial carcinomas is rare. This is the report of an endometrial large cell neuroendocrine carcinoma with foci of melanocytic differentiation in a 75-year-old woman with abnormal post-menopausal uterine bleeding for 2 years. Two initial biopsies were inconclusive. Histopathological examination of the uterus revealed large cell neuroendocrine carcinoma associated with endometrioid carcinoma and foci of melanocytic differentiation, pT3a (FIGO IIIA). There were metastases in the rectum serosa and lungs. After 8 months of diagnosis and surgical treatment, the patient is on chemotherapy and radiotherapy. We highlight the morphological characteristics and criteria that allow the definitive anatomopathological diagnosis, including immunohistochemical markers used to identify the cell types present in this unprecedented association.
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Humanos , Feminino , Idoso , Neoplasias do Endométrio/diagnóstico , Carcinoma Neuroendócrino/diagnóstico , Imuno-Histoquímica , Neoplasias do Endométrio/cirurgia , Carcinoma Neuroendócrino/cirurgia , Carcinoma de Células Grandes , MelanócitosRESUMO
Large-cell neuroendocrine tumors (NETs) are poorly differentiated malignancies of rare incidence and aggressive nature. NETs mostly arise in the lung followed by the gastrointestinal tract, although they are potentially ubiquitous throughout the body. Primary unknown NET has a worse prognosis and shorter survival comparing with other NETs, with limited available data in the literature concerning this subgroup. The authors report the case of large-cell NET with supraclavicular lymph node presentation. Total excisional biopsy revealed an enlarged adenopathy 18 × 15 × 10 mm, which was extensively infiltrated by a solid malignant neoplasm composed of large cells with granular chromatin, nuclear pseudo-inclusions, high mitotic index, and focal necrosis, with a Ki 67 index 25-30% and positive immunohistochemical study for the expression of cytokeratin 8/18, chromogranin, synaptophysin, and thyroid transcriptional factor-1 (TTF-1). There was no evidence of primary location apart from two infracentimetric lung lesions that could not be accessed for biopsy and were negative at both somatostatin receptor scintigraphy and positron emission tomography. The NET relapsed with three mediastinal masses, so the patient was started on chemotherapy with carboplatin and etoposide with initial total response. Early progression showed no response to further chemotherapy regimens (temozolomide, oral etoposide); therefore, the patient was treated with local radiotherapy. This patient has an atypical long survival (54 months) compared to the literature data. In fact, there are few long-term survivors of large-cell NET and they are all related to complete surgical resection.
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Humanos , Feminino , Idoso , Carcinoma Neuroendócrino , Neoplasias Primárias Desconhecidas , Carboplatina/uso terapêutico , Carcinoma de Células Grandes , Etoposídeo/uso terapêutico , Tumores NeuroendócrinosRESUMO
Large cell neuroendocrine carcinoma [LCNC] is a rare and aggressive cancer accounting for 3% of all lung cancers. A small percentage of LCNC called combined LCNC, can be seen in combinations with other lung tumor types. Multimodal therapy is proposed for this type of tumor but there is no any significant therapy since it is very rare tumor. This patient was a 66-year male and a heavy smoker with no symptoms of lung disease. Computed tomography core biopsy showed suspected adenocarcinoma. Right lower lobectomy was performed with mediastinal lymph node dissection via mini thoracotomy. The tumor was diagnosed as combined LCNC with adenocarcinoma. The patient was discharged on the seventh postoperative day and sent to the oncology clinic for chemotherapy. There has been no recurrence for eight months after surgery
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Humanos , Masculino , Idoso , Carcinoma de Células Grandes , Adenocarcinoma , Neoplasias Pulmonares/diagnóstico , Fumar , Toracotomia , Neoplasias Pulmonares/cirurgiaRESUMO
ABSTRACT Objective: To describe the implementation of a robotic thoracic surgery program at a public tertiary teaching hospital and to analyze its initial results. Methods: This was a planned interim analysis of a randomized clinical trial aimed at comparing video-assisted thoracoscopic surgery and robotic surgery in terms of the results obtained after pulmonary lobectomy. The robotic surgery program developed at the Instituto do Câncer do Estado de São Paulo, in the city of São Paulo, Brazil, is a multidisciplinary initiative involving various surgical specialties, as well as anesthesiology, nursing, and clinical engineering teams. In this analysis, we evaluated the patients included in the robotic lobectomy arm of the trial during its first three months (from April to June of 2015). Results: Ten patients were included in this analysis. There were eight women and two men. The mean age was 65.1 years. All of the patients presented with peripheral tumors. We performed right upper lobectomy in four patients, right lower lobectomy in four, and left upper lobectomy in two. Surgical time varied considerably (range, 135-435 min). Conversion to open surgery or video-assisted thoracoscopic surgery was not necessary in any of the cases. Intraoperative complications were not found. Only the first patient required postoperative transfer to the ICU. There were no deaths or readmissions within the first 30 days after discharge. The only postoperative complication was chest pain (grade 3), in two patients. Pathological examination revealed complete tumor resection in all cases. Conclusions: When there is integration and proper training of all of the teams involved, the implementation of a robotic thoracic surgery program is feasible and can reduce morbidity and mortality.
RESUMO Objetivo: Descrever a implantação de um programa de cirurgia torácica robótica em um hospital terciário público universitário e analisar seus resultados iniciais. Métodos: Este estudo é uma análise interina planejada de um ensaio clínico aleatorizado cujo objetivo é comparar resultados da lobectomia pulmonar por videotoracoscopia com a robótica. O programa de cirurgia robótica do Instituto do Câncer do Estado de São Paulo, localizado na cidade de São Paulo (SP), foi uma iniciativa multidisciplinar que envolveu diversas especialidades cirúrgicas e equipes de anestesia, enfermagem e engenharia clínica. Nesta análise, avaliamos os pacientes incluídos no braço lobectomia robótica durante os primeiros três meses do estudo (de abril a junho de 2015). Resultados: Dez pacientes foram incluídos nesta análise. Eram oito mulheres e dois homens. A média de idade foi de 65,1 anos. Todos apresentavam tumores periféricos. Foram realizadas lobectomia superior direita, em quatro pacientes; lobectomia inferior direita, em quatro; e lobectomia superior esquerda, em dois. Os tempos cirúrgicos variaram bastante (variação, 135-435 min). Não foi necessária a conversão para técnica aberta ou videotoracoscópica em nenhum paciente. Não foram observadas complicações intraoperatórias. Apenas o primeiro paciente foi encaminhado à UTI no pós-operatório. Não houve mortalidade nem reinternações em 30 dias após a alta. A única complicação pós-operatória observada foi dor torácica (grau 3), em dois pacientes. O exame anatomopatológico revelou a ressecção completa do tumor em todos os casos. Conclusões: A implantação de um programa de cirurgia torácica robótica, quando há integração e treinamento adequado de todas as equipes envolvidas, é factível e pode reduzir a morbidade e a mortalidade.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adenocarcinoma/cirurgia , Carcinoma de Células Grandes/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adenocarcinoma/patologia , Carcinoma de Células Grandes/patologia , Tempo de Internação , Neoplasias Pulmonares/patologia , Excisão de Linfonodo/métodos , Duração da Cirurgia , Reprodutibilidade dos Testes , Cirurgia Torácica Vídeoassistida/métodos , Resultado do TratamentoRESUMO
<p><b>OBJECTIVE</b>To explore the value of serum neuron-specific enolase (NSE) before treatment in predicting brain metastases and prognosis of advanced non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>A total of 128 hospitalized patients with advanced NSCLC from Jan 2012 to Mar 2012 were followed up, and their clinicopathological data, serum NSE, carcinoembryonic antigen, cytokeratin 21-1 (cyfra21-1) levels, albumin (ALB), white blood cell (WBC) before treatment were analyzed retrospectively to determine the factors affecting brain metastasis and prognosis of advanced NSCLC.</p><p><b>RESULTS</b>Among the 128 NSCLC patients, 90 cases were of adenocarcinoma, 30 cases were of squamous cell carcinoma, and 8 cases were of large cell carcinoma. The median levels of pre-treatment NSE, CEA and cyfra21-1 were 13.6 ng/ml, 7.8 ng/ml and 6.1 ng/ml, respectively. The average levels of ALB and WBC were (35.41 ± 5.60) g/L and (8.16 ± 2.53) × 10⁹/ml, respectively. Multi-variate logistic regression analysis showed that serum NSE before treatment was associated with brain metastasis of advanced NSCLC (P = 0.030). Pre-treatment NSE levels were (34.18 ± 28.48) ng/ml in 28 patients with brain metastasis and (13.87 ± 4.49) ng/ml in 98 patients without brain metastasis (P < 0.05). The median survival time were 3.5 months in patients with normal levels of NSE, and 10.7 months in patients with elevated levels of NSE pre-treatment (P < 0.05).</p><p><b>CONCLUSIONS</b>A higher pre-treatment level of NSE is closely correlated with brain metastasis of advanced NSCLC, and can be used as a predictor of brain metastases in advanced NSCLC. High pre-treatment levels of NSE indicate a poor prognosis in advanced NSCLC patients.</p>
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Humanos , Adenocarcinoma , Sangue , Antígenos de Neoplasias , Sangue , Neoplasias Encefálicas , Antígeno Carcinoembrionário , Sangue , Carcinoma de Células Grandes , Sangue , Carcinoma Pulmonar de Células não Pequenas , Sangue , Carcinoma de Células Escamosas , Sangue , Queratina-19 , Sangue , Contagem de Leucócitos , Neoplasias Pulmonares , Sangue , Patologia , Fosfopiruvato Hidratase , Sangue , Prognóstico , Estudos Retrospectivos , Albumina SéricaRESUMO
Primary mediastinal choriocarcinoma is an extremely rare extragonadal germ cell malignancy. A 58-year-old male presented with a lung mass, which was incidentally discovered during a periodic medical checkup. Percutaneous needle biopsy showed poorly differentiated carcinoma with large pleomorphic morphology. After the patient underwent right upper lobectomy and lymphadenectomy, the final diagnosis was choriocarcinoma. The patient received four sequential cycles of BEP chemotherapy (bleomycin, etoposide, cisplatin). After completion of BEP chemotherapy, follow-up positron emission tomography (PET) showed a complete metabolic response. Although the mediastinum is one of the most common primary sites of extragonadal germ cell tumors, primary mediastinal choriocarcinoma is liable to be misdiagnosed as lung cancer or Hodgkin lymphoma. Notably, large cell carcinoma of the lung can be confused with choriocarcinoma even after percutaneous needle biopsy. We report a case of primary mediastinal choriocarcinoma mimicking large cell carcinoma of the lung in a male patient in his 50s.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Biópsia por Agulha , Carcinoma de Células Grandes , Coriocarcinoma , Diagnóstico , Tratamento Farmacológico , Etoposídeo , Seguimentos , Células Germinativas , Doença de Hodgkin , Neoplasias Pulmonares , Pulmão , Excisão de Linfonodo , Mediastino , Neoplasias Embrionárias de Células Germinativas , Tomografia por Emissão de PósitronsRESUMO
Large cell carcinoma with a rhabdoid phenotype is very rare. We report the case of a 53-year-old man who presented with multiple nodules on the scalp, face, and trunk. A skin biopsy revealed large cell carcinoma with a rhabdoid phenotype throughout the dermis. Tumor cells had abundant cytoplasm, eccentric nuclei, and prominent nucleoli and did not adhere to each other. Immunohistochemical tests showed positive reactions for vimentin, epithelial membrane antigen (EMA), and thyroid transcription factor-1 (TTF-1) and weakly focal reactions for pan-CK, CK7, and p63. Imaging studies and a percutaneous lung biopsy were performed and the results were consistent with a large cell lung carcinoma with a rhabdoid phenotype. Based on these clinical and histopathological findings, we concluded that his condition was a cutaneous metastasis from a large cell lung carcinoma with a rhabdoid phenotype, which occurs very rarely.
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Humanos , Pessoa de Meia-Idade , Biópsia , Carcinoma de Células Grandes , Citoplasma , Derme , Pulmão , Mucina-1 , Metástase Neoplásica , Fenótipo , Tumor Rabdoide , Couro Cabeludo , Pele , Glândula Tireoide , VimentinaRESUMO
No abstract available.
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Adulto , Humanos , Masculino , Adenocarcinoma/química , Antineoplásicos/uso terapêutico , Biópsia , Carcinoma de Células Grandes/química , Carcinoma Neuroendócrino/química , Carcinoma Pulmonar de Células não Pequenas/química , Resistencia a Medicamentos Antineoplásicos , Neoplasias Pulmonares/química , Imageamento por Ressonância Magnética , Inibidores de Proteínas Quinases/uso terapêutico , Quinazolinas/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Biomarcadores Tumorais/análiseRESUMO
<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics and the prognosis of bladder neuroendocrine carcinoma (NEC).</p><p><b>METHODS</b>Clinicopathological data from 17 NEC of the bladder cases were collected, and immunohistochemical staining was performed with follow-up analysis and literature review.</p><p><b>RESULTS</b>The recruited included 13 male and 4 female patients, aged from 48 to 86 years old (average 61 years; 14 patients >60 years). Gross hematuria of the whole urination course or intermittent was the initial symptom. Macroscopically, the outer surface of the tumor presented with polypoid, lobulated, fungating or ulcerous structures. Histologically, according to the criteria of WHO classification of neuroendocrine tumor of the lung, our NEC cases were divided into three histological types: 13 cases of small cell carcinoma, 3 cases of large cell neuroendocrine carcinoma and 1 case of atypical carcinoid. The urothelial carcinoma was concurrent with NEC in 6 cases, and adenocarcinoma was concurrent with NEC in 2 cases. Most tumor tissue infiltrated to the muscular layer, some infiltrated to the outer membrane. Immunohistochemically, the positive expression rates of CD56, Syn and CgA were 16/17, 16/17 and 12/17, respectively. The epithelial markers, including CK7 and CKpan, were also expressed with positive rates of 12/17 and 15/17, respectively. TTF-1 was positively expressed in 11 cases. The follow-up data were available in 14 cases, of which 9 patients died of the tumor 1-34 months after surgery (average, 11 months). Five patients lived uneventfully for 1-12 months after surgery.</p><p><b>CONCLUSIONS</b>NEC is a rare malignant tumor of the bladder. Immunohistochemical markers such as CD56, Syn, CgA and CKpan could be helpful in determining the diagnosis and differential diagnosis of the tumor. NEC is a highly invasive malignant tumor with poor prognosis. Based on its biological behavior, radical cystectomy is the preferred method of treatment for the tumor.</p>
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma , Patologia , Biomarcadores Tumorais , Carcinoma de Células Grandes , Patologia , Carcinoma Neuroendócrino , Classificação , Patologia , Carcinoma de Células Pequenas , Patologia , Carcinoma de Células de Transição , Classificação , Patologia , Cistectomia , Hematúria , Tumores Neuroendócrinos , Classificação , Patologia , Prognóstico , Neoplasias da Bexiga Urinária , Classificação , PatologiaRESUMO
<p><b>OBJECTIVE</b>To isolate lung cancer stem-like cells (LCSCs) from human large-cell lung cancer cell line NCI-H460 (H460) and explore their biological characteristics.</p><p><b>METHODS</b>H460 cells were cultured in serum-free medium in the presence of specific growth factors. Quantitative PCR (qPCR), flow cytometry and colony formation assay were performed to characterize the stemness of H460 spheres. Adherent H460 cells and H460 cell spheres were inoculated subcutaneously in nude mice and the tumor growth was assessed.</p><p><b>RESULTS</b>The isolated LCSCs from H460 cells in serum-free medium grew as floating cell spheres and exhibited stronger proliferative activity than H460 cells. Compared with H460 cells, H460 cells spheres showed higher expressions of stem cell markers Sox2, Oct4, and especially Nanog, and possessed a stronger tumorigenicity in nude mice.</p><p><b>CONCLUSION</b>The serum-free culture system can effectively enrich lung cancer stem cells from human lung cancer stem cell line H460, and the high expression of Nanog may importantly contribute to the maintenance of cancer stem cell-like properties of the isolated LCSCs.</p>
Assuntos
Animais , Humanos , Masculino , Camundongos , Carcinoma de Células Grandes , Patologia , Linhagem Celular Tumoral , Meios de Cultura Livres de Soro , Neoplasias Pulmonares , Patologia , Camundongos Nus , Células-Tronco Neoplásicas , Biologia CelularRESUMO
OBJECTIVE: To test the effectiveness of combining conventional antineoplastic drugs (cisplatin and etoposide) with metformin in the treatment of non-small cell lung cancer in the NCI-H460 cell line, in order to develop new therapeutic options with high efficacy and low toxicity. METHODS: We used the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and calculated the combination index for the drugs studied. RESULTS: We found that the use of metformin as monotherapy reduced the metabolic viability of the cell line studied. Combining metformin with cisplatin or etoposide produced a synergistic effect and was more effective than was the use of cisplatin or etoposide as monotherapy. CONCLUSIONS: Metformin, due to its independent effects on liver kinase B1, had antiproliferative effects on the NCI-H460 cell line. When metformin was combined with cisplatin or etoposide, the cell death rate was even higher. .
OBJETIVO: Testar a eficácia da combinação terapêutica de antineoplásicos convencionais (cisplatina e etoposídeo) com metformina em linhagem celular NCI-H460 de câncer de pulmão não pequenas células, a fim de desenvolver novas possibilidades terapêuticas com eficácia superior e reduzida toxicidade. MÉTODOS: Foi utilizado o ensaio de brometo de 3-(4,5-dimetiltiazol-2-il)-2,5-difeniltetrazólio (MTT) e calculado o índice de combinação dos fármacos estudados. RESULTADOS: Observamos que o uso de metformina em monoterapia reduziu a viabilidade celular metabólica da linhagem de células estudada. O uso de metformina em combinação com cisplatina ou etoposídeo foi sinérgico e superior à monoterapia com cisplatina ou etoposídeo. CONCLUSÕES: A metformina, devido às suas ações independentes em liver kinase B1, apresentou atividade antiproliferativa na linhagem NCI-H460 e, em combinação com cisplatina ou etoposídeo, ampliou a taxa de morte celular. .
Assuntos
Humanos , Antineoplásicos Fitogênicos/farmacologia , Antineoplásicos/farmacologia , Cisplatino/farmacologia , Etoposídeo/farmacologia , Hipoglicemiantes/farmacologia , Metformina/farmacologia , Antineoplásicos Fitogênicos/administração & dosagem , Antineoplásicos/administração & dosagem , Sobrevivência Celular , Carcinoma de Células Grandes/tratamento farmacológico , Linhagem Celular Tumoral/metabolismo , Proliferação de Células/efeitos dos fármacos , Cisplatino/administração & dosagem , Combinação de Medicamentos , Sinergismo Farmacológico , Etoposídeo/administração & dosagem , Hipoglicemiantes/administração & dosagem , Metformina/administração & dosagemRESUMO
Introducción: la inclusión del rituximab para el tratamiento del linfoma B difuso de células grandes generó la necesidad de reevaluar los factores pronósticos que se empleaban convencionalmente, y la de explorar otros que podrían resultar útiles para establecer el pronóstico. Objetivo: describir los principales factores clínicos, hematológicos, bioquímicos e inmunohistoquímicos que han sido útiles para el pronóstico en estudios de seguimiento de pacientes con linfoma B difuso de células grandes tratados con esquemas de quimioterapia que contenían rituximab. Resultados: entre los factores con significancia para el pronóstico se encontraron el Índice Pronóstico Internacional (IPI) revisado, la infiltración de la médula ósea, la presencia de masa voluminosa, la expresión de CD5 y el porcentaje de expresión de Ki-67; en contraste, es controversial la aplicación de otros factores como el IPI convencional, la expresión de Bcl-2, Bcl-6 y el perfil inmunohistoquímico.
Introduction: The inclusion of rituximab for treatment of diffuse large B cell lymphoma (DLBCL) generated the need to re-assess the conventionally employed prognostic factors and to explore others that could be useful for prognostic purposes. Objective: To describe the most important clinical, hematological, biochemical and immunohistochemical factors that have been useful for prognostic purposes in follow-up studies of patients with DLBCL treated with chemotherapy plus rituximab. Results: The following factors were found to have prognostic significance: the revised International Prognostic Index, bone marrow infiltration, the presence of a bulky mass, CD5 expression and the percentage of Ki-67 expression. Contrariwise, the application of other factors remains controversial: conventional IPI, Bcl-2 and Bcl-6 expression, and the immunohistochemical profile.
Assuntos
Humanos , Linfoma de Células B , Carcinoma de Células Grandes , Rituximab , Prognóstico , NeoplasiasRESUMO
BACKGROUND: Few studies on how to diagnose pulmonary neuroendocrine tumors through morphometric analysis have been reported. In this study, we measured and analyzed the characteristic parameters of pulmonary neuroendocrine tumors using an image analyzer to aid in diagnosis. METHODS: Sixteen cases of typical carcinoid tumor, 5 cases of atypical carcinoid tumor, 15 cases of small cell carcinoma, and 51 cases of large cell neuroendocrine carcinoma were analyzed. Using an image analyzer, we measured the nuclear area, perimeter, and the major and minor axes. RESULTS: The mean nuclear area was 0.318+/-0.101 microm2 in typical carcinoid tumors, 0.326+/-0.119 microm2 in atypical carcinoid tumors, 0.314+/-0.107 microm2 in small cell carcinomas, and 0.446+/-0.145 microm2 in large cell neuroendocrine carcinomas. The mean nuclear circumference was 2.268+/-0.600 microm in typical carcinoid tumors, 2.408+/-0.680 microm in atypical carcinoid tumors, 2.158+/-0.438 microm in small cell carcinomas, and 3.247+/-1.276 microm in large cell neuroendocrine carcinomas. All parameters were useful in distinguishing large cell neuroendocrine carcinoma from other tumors (p=0.001) and in particular, nuclear circumference was the most effective (p=0.001). CONCLUSIONS: Pulmonary neuroendocrine tumors showed nuclear morphology differences by subtype. Therefore, evaluation of quantitative nuclear parameters improves the accuracy and reliability of diagnosis.
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Tumor Carcinoide , Carcinoma de Células Grandes , Carcinoma Neuroendócrino , Carcinoma de Células Pequenas , Tumores NeuroendócrinosRESUMO
Large cell neuroendocrine carcinoma is a rare malignant tumor of the parotid gland and has poor prognosis due to its aggressive and rapid growth and easy metastasis. Large cell neuroendocrine carcinoma usually occurs in the lung and intestine. However, a few cases of large cell neuroendocrine carcinoma have been reported in other sites such as the uterine cervix, thymus, urinary bladder, ovary and the ampulla of vater. In large cell neuroendocrine carcinoma of the parotid gland, radical parotidectomy is the first therapeutic step and can be followed by local radiation therapy. We report one case of primary large cell neuroendocrine carcinoma occurring in the parotid gland, and discuss the literature.
Assuntos
Feminino , Ampola Hepatopancreática , Carcinoma de Células Grandes , Carcinoma Neuroendócrino , Colo do Útero , Intestinos , Pulmão , Metástase Neoplásica , Tumores Neuroendócrinos , Ovário , Glândula Parótida , Neoplasias Parotídeas , Prognóstico , Timo , Bexiga UrináriaRESUMO
<p><b>OBJECTIVE</b>To analyze the expression of co-stimulatory molecules PD-1/PD-L1 in peripheral blood mononuclear cells in lung cancer patients, and to explore its biological significance.</p><p><b>METHODS</b>One hundred and thirty-three lung cancer patients, 25 lung infection patients and 23 healthy donors were enrolled in this study. 100 µl of whole blood from these subjects were collected. Multi-color immunofluorescence staining and flow cytometry were used to detect PD-1/PD-L1 expression. The results were statistically analyzed.</p><p><b>RESULTS</b>The expression level of CD3⁺CD8⁺ T cells in the lung cancer patients was (38.83 ± 1.74)%, significantly lower than that in the control group [(43.25 ± 3.35)%, P < 0.05]. CD8⁺CD28⁺ T cell subset in the peripheral blood of lung cancer patients was (17.73 ± 1.21)% significantly lower than that of the healthy donors [(27.96 ± 2.72)%, P < 0.01]. The CD8⁺CD28⁻ T cell subset was (21.19 ± 1.92)% in the lung cancer patients, significantly higher than that of the healthy control group [(15.18 ± 2.93)%, P < 0.05]. The expression level of PD-1 on the surface of CD8⁺CD28⁺ T cells was (10.67 ± 1.12)% in the group of lung cancer patients, significantly higher than that of the control group [(5.32 ± 1.58)%, P < 0.01]. It was also found that the expression of PD-1 on CD8⁺CD28⁻ T cells was up-regulated in the group of lung cancer patients (7.46 ± 1.25)%, significantly higher than that of the healthy control group [(2.68+1.07)%, P < 0.01]. The expression level of PD-L1 on CD68⁺ cells in the lung cancer patients was (16.03 ± 2.06)%, significantly higher than that of the healthy control group [(9.32 ± 2.00)%, P < 0.05].</p><p><b>CONCLUSION</b>Up-regulation of PD-1/PD-L1 on peripheral blood cells in lung cancer patients negatively regulates the lymphocytes, inhibits the immune response for killing tumor cells, and promotes tumor development and immune escape.</p>
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma , Sangue , Patologia , Antígeno B7-H1 , Metabolismo , Antígenos CD28 , Metabolismo , Complexo CD3 , Metabolismo , Antígenos CD8 , Metabolismo , Carcinoma de Células Grandes , Sangue , Patologia , Carcinoma de Células Escamosas , Sangue , Patologia , Estudos de Casos e Controles , Neoplasias Pulmonares , Sangue , Patologia , Receptor de Morte Celular Programada 1 , Metabolismo , Carcinoma de Pequenas Células do Pulmão , Sangue , Patologia , Linfócitos T , Alergia e Imunologia , Metabolismo , Regulação para CimaRESUMO
OBJETIVO: Catalogar alterações encontradas em imagens obtidas por fibrobroncoscopia em pacientes com diagnóstico de neoplasia pulmonar e correlacionar esses achados com achados histopatológicos. MÉTODOS: Estudo retrospectivo envolvendo 212 pacientes com diagnóstico de câncer de pulmão confirmado por citologia obtida por lavado broncoalveolar e/ou histopatologia de biópsia endobrônquica ou transbrônquica. Os dados foram obtidos no Serviço de Endoscopia Respiratória do Hospital São Salvador (Goiânia-GO), entre 2005 e 2010. Os achados endoscópicos foram classificados como tumor endoscopicamente visível, tumor endoscopicamente não visível e lesão na mucosa, assim com quanto à pr sença/tipo de secreção. Os tumores visíveis também foram classificados de acordo com sua localização na árvore traqueobrônquica. RESULTADOS: O principal achado endoscópico foi a presença de massa endobrônquica (64%), seguido por infiltração da mucosa (35%). Quanto aos tipos histológicos (n = 199), os mais prevalentes foram carcinoma escamoso (39%), adenocarcinoma (21%), carcinoma de pequenas células (12%) e carcinoma de grandes células (1%). Mais de 45% dos tumores visíveis estavam localizados nos brônquios superiores. O carcinoma escamoso (n = 78) apresentou-se mais frequentemente como massa tumoral endobrônquica (74%), infiltração da mucosa (36%), estreitamento do lúmen (10%) e compressão extrínseca (6%). CONCLUSÕES: Nossos resultados indicam que a massa tumoral endobrônquica é o achado endoscópico que mais sugere malignidade. Proporcionalmente, infiltração da mucosa é mais comumente achada em carcinoma de pequenas células. Estreitamento do lúmen, compressão extrínseca, lesão na mucosa e secreção endobrônquica prevalecem no adenocarcinoma.
OBJECTIVE: To compile fiberoptic bronchoscopy findings in patients diagnosed with lung cancer and to correlate those with histopathological findings. METHODS: This was a retrospective study involving 212 patients with a confirmed diagnosis of lung cancer by cytological evaluation of BAL specimens or by histopathological evaluation of endobronchial or transbronchial biopsy specimens. The data were collected at the Respiratory Endoscopy Sector of Hospital São Salvador, located in the city of Goiânia, Brazil, between 2005 and 2010. The endoscopic findings were classified as endoscopically visible tumor, endoscopically invisible tumor, mucosal injury, as well as being classified by the presence/type of secretion. The visible tumors were also classified according to their location in the tracheobronchial tree. RESULTS: Endobronchial mass (64%) and mucosal infiltration (35%) were the main endoscopic findings. The histological type was determined in 199 cases, the most prevalent types being squamous carcinoma, in 78 (39%), adenocarcinoma, in 42 (21%) small cell carcinoma, in 24 (12%), and large cell carcinoma, in 2 (1%). More than 45% of the visible tumors were at the upper bronchi. Squamous carcinoma (n = 78) was most commonly visualized as an endobronchial mass (in 74%), mucosal infiltration (in 36%), luminal narrowing (in 10%), or external compression (in 6%). CONCLUSIONS: Our results show that the endobronchial mass is the most common bronchoscopic finding that is suggestive of malignancy. Proportionally, mucosal infiltration is the most common finding in small cell carcinoma. In adenocarcinoma, luminal narrowing, external compression, mucosal injury, and endobronchial secretion prevail.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Broncoscopia/métodos , Carcinoma/patologia , Neoplasias Pulmonares/patologia , Adenocarcinoma/patologia , Biópsia , Carcinoma de Células Grandes/patologia , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Escamosas/patologia , Carcinoma/classificação , Neoplasias Pulmonares/classificação , Pulmão/patologia , Estudos RetrospectivosRESUMO
We are presenting the clinical and pathological characteristics of lung cancer among patients reporting to Gulab Devi Chest Hospital Lahore, the largest and the oldest health care facility for chest diseases including lung cancer in Pakistan. It was a cross - sectional, descriptive study conducted at the department of histopathology, Gulab Devi Hospital Lahore between March 2011 and February 2012. A sample of 293 patients of primary lung cancer was taken. The demographic and clinical details i.e. age, sex, history of smoking and presenting symptoms were collected after the informed consent. Histopathological diagnosis and tumour grades were added in respective columns. Data was analysed with the help of S.P.S.S. version 17.0. Mean age was 53.19 +/- 0.92 years for male and 47.36 +/- 1.92 years for females. Male to female ratio was 3:1. History of tobacco smoking was present in 2/3[rd] of the patients. Smoking was strongly associated with squamous and small cell carcinoma of lung. Most common histological diagnoses were squamous cell, small cell and adenocarcinoma respectively. Majority of squamous cell carcinoma were poorly differentiated as compared to adenocarcinoma in which well and moderately differentiated tumours constituted 25% and 45% respectively. Most of patients presented at inoperable stage. Smoking is most strongly associated with the two most common histological entities of lung cancer viz. squamous cell carcinoma and small cell carcinoma. Bronchial biopsy was the commonest diagnostic procedure in practice and surgical resection is offered to only a few cases
Assuntos
Humanos , Masculino , Feminino , Fumar , Estudos Transversais , Carcinoma de Células Pequenas , Carcinoma de Células Escamosas , Adenocarcinoma , Carcinoma de Células Grandes , Carcinoma Pulmonar de Células não PequenasRESUMO
We observed a very rare case of primary lung cancer producing alpha-fetoprotein (AFP). A 70-year-old male with a history of smoking 50 packs per year was diagnosed with large cell carcinoma of the lung. The clinical stage was T2bN3M0 (IIIB), and serum AFP was 23,247 ng/mL. There was no evidence of metastasis to the liver, scrotum or other organs. While undergoing chemotherapy for 1 year, as the cancer progressed the AFP value steadily increased. The patient died of respiratory failure due to pneumonia 12 months after being diagnosed with lung cancer.