RESUMEN
Liposarcoma is the most common soft tissue sarcoma and accounts for 15%-20% of all mesenchymal malignancies. The tumor occurs most frequently in limbs and retroperitoneum, with only rare instances of visceral location reported. Pancreas is a very rare site of primary liposarcoma, with a total of seven cases reported since 1979 and only four of those in the English literature. We review the literature specific for primary liposarcoma of the pancreas and discuss radiological and pathological aspects of this rare tumor type as well as emerging options of treatment. The review is illustrated by findings of a recent case of a dedifferentiated liposarcoma of the pancreas coupled with undifferentiated pleomorphic sarcoma, including the first description of this rare tumor by magnetic resonance imaging. The patient was successfully treated with distal pancreatectomy and splenectomy, followed by adjuvant chemotherapy and radiotherapy. At the 5-year follow-up, the patient showed no signs of recurrence.
Asunto(s)
Liposarcoma/patología , Neoplasias Pancreáticas/patología , Adulto , Humanos , Liposarcoma/diagnóstico por imagen , Liposarcoma/cirugía , Imagen por Resonancia Magnética , Masculino , Recurrencia Local de Neoplasia , Pancreatectomía , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/cirugíaRESUMEN
Cystic neoplasms account for approximately 10-20% of all pancreatic cysts and 1% of pancreatic cancers. Serous cystadenomas are considered benign tumors with almost no malignant potential, and thus the management is typically only observation with serial imaging. According to the current World Health Organization classification, cases with distant metastases are defined as serous cystadenocarcinomas. To date, only 17 such cases with concomitant synchronous or metachronous liver metastasis have been described in the literature, and eight of these reports described treatment of secondary liver lesions. This report describes the first case of synchronous resection of pancreatic serous cystadenocarcinoma and liver metastasis in a 56-year-old female patient. The patient is currently well after 30 months of follow-up with no tumor recurrence or new metastatic liver nodules based on magnetic resonance imaging.
Asunto(s)
Cistadenocarcinoma Seroso/patología , Cistadenocarcinoma Seroso/cirugía , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Femenino , Humanos , Persona de Mediana EdadRESUMEN
PURPOSE: It is controversial whether tumor extent in radical prostatectomies predicts biochemical recurrence following surgery. We compared the predictive value of total tumor extent vs dominant nodule (index tumor) extent. MATERIALS AND METHODS: A mean of 32 paraffin blocks was processed from prostate surgical specimens step sectioned at 3 to 5 mm intervals from 300 patients treated with radical retropubic prostatectomy. Each transverse section was subdivided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evaluated by a semiquantitative point count method. Dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer in the quadrants. Time to biochemical recurrence was analyzed by Kaplan-Meier product limit analysis. Prediction of shorter time to biochemical recurrence was determined by univariate and multivariate Cox proportional hazards models. RESULTS: Except for age and race, total and index tumor extent was significantly associated with higher preoperative prostate specific antigen, clinical stage T2, pathological stage greater than T2, positive surgical margins and higher radical prostatectomy Gleason score. Total and index tumor extent was significantly associated with time to biochemical recurrence in Kaplan-Meier estimates. Total and index tumor extent significantly predicted shorter time to biochemical recurrence on univariate analysis but only index tumor extent was an independent predictor of time to biochemical recurrence on multivariate analysis. CONCLUSIONS: The study indicates that any tumor extent estimate in surgical specimens should be related to the dominant nodule (index tumor) and not to total tumor extent.
Asunto(s)
Recurrencia Local de Neoplasia , Prostatectomía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/sangre , Recurrencia Local de Neoplasia/epidemiología , Valor Predictivo de las Pruebas , Antígeno Prostático Específico/sangre , Prostatectomía/métodos , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/epidemiología , Estudios RetrospectivosRESUMEN
BACKGROUND: Measurements of CFTR function in rectal biopsies ex vivo have been used for diagnosis and prognosis of Cystic Fibrosis (CF) disease. Here, we aimed to evaluate this procedure regarding: i) viability of the rectal specimens obtained by biopsy forceps for ex vivo bioelectrical and biochemical laboratory analyses; and ii) overall assessment (comfort, invasiveness, pain, sedation requirement, etc.) of the rectal forceps biopsy procedure from the patients perspective to assess its feasibility as an outcome measure in clinical trials. METHODS: We compared three bowel preparation solutions (NaCl 0.9%, glycerol 12%, mannitol), and two biopsy forceps (standard and jumbo) in 580 rectal specimens from 132 individuals (CF and non-CF). Assessment of the overall rectal biopsy procedure (obtained by biopsy forceps) by patients was carried out by telephone surveys to 75 individuals who underwent the sigmoidoscopy procedure. RESULTS: Integrity and friability of the tissue specimens correlate with their transepithelial resistance (r = -0.438 and -0.305, respectively) and are influenced by the bowel preparation solution and biopsy forceps used, being NaCl and jumbo forceps the most compatible methods with the electrophysiological analysis. The great majority of the individuals (76%) did not report major discomfort due to the short procedure time (max 15 min) and considered it relatively painless (79%). Importantly, most (88%) accept repeating it at least for one more time and 53% for more than 4 times. CONCLUSIONS: Obtaining rectal biopsies with a flexible endoscope and jumbo forceps after bowel preparation with NaCl solution is a safe procedure that can be adopted for both adults and children of any age, yielding viable specimens for CFTR bioelectrical/biochemical analyses. The procedure is well tolerated by patients, demonstrating its feasibility as an outcome measure in clinical trials.
Asunto(s)
Biopsia/instrumentación , Biopsia/métodos , Fibrosis Quística/patología , Satisfacción del Paciente , Recto/patología , Adulto , Anestésicos Intravenosos/administración & dosificación , Biopsia/efectos adversos , Western Blotting , Catárticos , Niño , Regulador de Conductancia de Transmembrana de Fibrosis Quística/análisis , Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Técnica del Anticuerpo Fluorescente , Glicerol , Humanos , Manitol , Mutación , Dolor/etiología , Pronóstico , Cloruro de Sodio , Instrumentos Quirúrgicos , Encuestas y CuestionariosRESUMEN
PURPOSE: To analyze controversial clinicopathologic predictors of biochemical recurrence after surgery: age, race, tumor extent on surgical specimen, tumor extent on needle biopsy, Gleason score 3 + 4 vs 4 + 3, and amount of extent of extraprostatic extension and positive surgical margins. MATERIALS AND METHODS: The needle biopsies and the correspondent surgical specimens were analyzed from 400 patients. Time to recurrence was analyzed with the Kaplan-Meier curves and risk of shorter time to recurrence using Cox univariate and multivariate analysis. RESULTS: Except for age, race, maximum percentage of cancer per core, and number of cores with cancer, all other variables studied were significantly predictive of time to biochemical recurrence using the Kaplan-Meier curves. In univariate analysis, except for focal extraprostatic extension, age, race, focal positive surgical margins, and maximum extent and percentage of cancer per core, all other variables were significantly predictive of shorter time to recurrence. On multivariate analysis, diffuse positive surgical margins and preoperative PSA were independent predictors. CONCLUSIONS: Young patients and non-whites were not significantly associated with time to biochemical recurrence. The time consuming tumor extent evaluation in surgical specimens seems not to add additional information to other well established predictive findings. The higher predictive value of Gleason score 4 + 3 = 7 vs 3 + 4 = 7 discloses the importance of grade 4 as the predominant pattern. Extent and not simply presence or absent of extraprostatic extension should be informed. Most tumor extent evaluations on needle biopsies are predictive of time to biochemical recurrence, however, maximum percentage of cancer in all cores was the strongest predictor.
Asunto(s)
Recurrencia Local de Neoplasia/patología , Próstata/patología , Prostatectomía/métodos , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Adulto , Factores de Edad , Anciano , Biopsia con Aguja , Brasil , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Recurrencia Local de Neoplasia/sangre , Valor Predictivo de las Pruebas , Pronóstico , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Valores de Referencia , Estudios Retrospectivos , Factores de TiempoRESUMEN
OBJECTIVE: There is evidence that reactive stroma in different cancers may regulate tumor progression. The aim of this study is to establish any possible relation of reactive stroma grading on needle prostatic biopsies to biochemical recurrence. MATERIALS AND METHODS: The study group comprised 266 biopsies from consecutive patients submitted to radical prostatectomy. Reactive stroma was defined as stroma surrounding neoplastic tissue and graded as 0 (absent), 1 (slight), 2 (moderate), and 3 (intense) according to tumor stroma area relative to total tumor area. RESULTS: From the total of 266 needle prostatic biopsies, 143 (53.8%), 55 (20.7%), 54 (20.3%), and 14 (5.3%) showed grades 0, 1, 2, and 3, respectively. Increasing reactive stroma grade was significantly associated with clinical stage T2, higher preoperative PSA, higher biopsy and radical prostatectomy Gleason score, more extensive tumors in radical prostatectomy, and pathologic stage > T2. Only grade 3 was significantly associated with time and risk to biochemical recurrence. On multivariate analysis only preoperative PSA and 2 methods of biopsy tumor extent evaluation were independent predictors. CONCLUSION: Increasing reactive stroma grade on biopsies is significantly associated with several clinicopathologic adverse findings, however, only grade 3 predicts time and risk to biochemical recurrence following radical prostatectomy on univariate but not on multivariate analysis. We have not been able to show that reactive stroma grade 3 on biopsies is an independent predictor of biochemical recurrence beyond that of preoperative PSA and other pathologic findings on biopsy.
Asunto(s)
Adenocarcinoma/patología , Biomarcadores de Tumor/análisis , Recurrencia Local de Neoplasia/patología , Próstata/patología , Prostatectomía/métodos , Neoplasias de la Próstata/patología , Células del Estroma/patología , Anciano , Biopsia con Aguja Fina/métodos , Progresión de la Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Valor Predictivo de las Pruebas , Antígeno Prostático Específico/sangre , Factores de Riesgo , Análisis de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: The amount of extraprostatic extension and positive surgical margin correlates in most studies with biochemical recurrence following radical prostatectomy. We studied the influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression using a simple method for quantification. MATERIALS AND METHODS: A total of 360 prostates were step-sectioned and totally processed from 175 patients with stage T1c and 185 patients with clinical stage T2 submitted to radical retropubic prostatectomy. Extraprostatic extension was stratified into 2 groups: present up to 1 quadrant and/or section from the bladder neck or apex (Group 1, focal) and in more than 1 quadrant or section (Group 2, diffuse); and, positive surgical margin present up to 2 quadrants and/or sections (Group 1, focal) and in more than 2 quadrants or sections (Group 2, diffuse). The Kaplan-Meier product-limit analysis was used for the time to biochemical recurrence, and an univariate and multivariate Cox stepwise logistic regression model to identify significant predictors. RESULTS: Extraprostatic extension was found in 129/360 (35.8%) patients, 39/129 (30.2%) in Group 1 and 90/129 (69.8%) in Group 2. In univariate analysis but not in multivariate analysis, patients showing diffuse extraprostatic extension (Group 2) had a significant higher risk to develop biochemical recurrence in a shorter time. Positive surgical margin was present in 160/360 (44.4%) patients, 81/160 (50.6%) patients in Group 1 and 79/160 (49.4%) patients in Group 2. Patients with diffuse positive surgical margins (Group 2) had a significant higher risk in both univariate and multivariate analyses. Diffuse positive surgical margin was the strongest predictor on both analyses and an independent predictor on multivariate analysis. CONCLUSION: Diffuse extraprostatic extension in univariate analysis and positive surgical margins on both univariate and multivariate analyses are significant predictors of shorter time to biochemical progression following radical prostatectomy.
Asunto(s)
Recurrencia Local de Neoplasia , Antígeno Prostático Específico/sangre , Prostatectomía/métodos , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Anciano , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasia Residual , Tamaño de los Órganos , Próstata/patología , Neoplasias de la Próstata/sangre , Estudios Retrospectivos , Vesículas Seminales/patologíaRESUMEN
BACKGROUND: Liposuction in plastic surgery consists of the removal of excess fatty tissue in healthy individuals. In recent decades, this procedure has become more common worldwide. Associated with liposuction, lipografting has also been used for improving body contours, and has become known as liposculpture. Liposuction sometimes causes complications, including fat embolism, as described in the medical literature. The present study aims at ascertaining whether there is intravascular mobilization of fat after mechanical liposuction surgery and/or fat graft when carried out using one of the most common specific procedures used for liposuction, the superwet technique. METHODS: A total of 30 Wistar rats were included in this study. Before the surgery, the animals were placed in the supine position and anesthetized with thiopental for 50 to 60 minutes, as it is generally performed in clinical practice. The animals were divided in the following 3 groups. Group A, consisting of 10 rats, served as controls, and were only anesthetized. Group B consisted of 10 rats, which underwent only liposuction. Group C also comprised 10 rats, which were liposuctioned and then lipografted in the dorsal region. Blood was collected just before and again, 48 hours after the procedure. After 48 hours, the animals were killed, and the lungs, kidneys, liver, and brain were histologically examined. RESULTS: All the collected samples were analyzed microscopically with 2 different stains, namely, hematoxylin and eosin, and Sudan black. Fat particles were found in the lungs of 3 animals in group B (those that underwent only liposuction) and in 6 animals of group C (liposuction and lipografting). No fat particles were found in any organ of the control group. CONCLUSIONS: With this experiment, the authors showed that there is a risk of systemic mobilization of fat after liposuction surgery and that this risk is even higher when fat grafts are also carried out.
Asunto(s)
Tejido Adiposo/trasplante , Embolia Grasa/etiología , Lipectomía/efectos adversos , Animales , Encéfalo/patología , Embolia Grasa/sangre , Embolia Grasa/patología , Riñón/patología , Lipectomía/métodos , Hígado/patología , Pulmón/patología , Masculino , Ratas , Ratas WistarRESUMEN
BACKGROUND: Neoadjuvant chemoradiotherapy (nCRxt) followed by radical surgery is the optimal treatment for advanced rectal adenocarcinoma. Patients with clinical complete response (cCR) may be followed closely without immediate surgery. Probe-based confocal laser endomicroscopy (pCLE) is a real-time in vivo method that allows acquisition of optical biopsies with 1000 times magnification, evaluating both epithelial and vascular patterns. AIM: To evaluate the role of pCLE in the diagnosis of cCR after nCRxt for advanced rectal adenocarcinoma. METHODS: pCLE was performed in 47 patients with locally advanced rectal adenocarcinoma (T3/T4, or N+) who underwent nCRxt (5-fluorouracil, 5040 cGy). RESULTS: Twenty-seven (57.5%) patients were men, and the mean age was 62.8 years. Thirty-seven had partial response confirmed by pCLE. Ten (21.3%) patients had good endoscopic response and presented small ulcer (n = 5) or residual scar (n = 5). After nCRxt, the essential features to differentiate malignancy from post-radiation alterations at pCLE were the presence of irregular crypts, budding, back-to-back glands, cribriform pattern, increased vessel/crypt ratio, and fluorescein leakage. A scoring system was created considering these epithelial and vascular features, with high accuracy for differentiating patients with complete response from those with residual neoplasia (p < 0.00001). pCLE sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100%, 71.4%, 95.2%, 100%, and 95.7%, respectively. CONCLUSIONS: (1) pCLE evaluation of epithelial and vascular features may improve the diagnosis of cCR and may alter patient management; (2) pCLE might be valuable for identifying patients with advanced rectal cancer who will benefit from watch and wait strategy, avoiding immediate surgical treatment.
Asunto(s)
Neoplasias del Recto , Quimioradioterapia , Humanos , Rayos Láser , Masculino , Microscopía Confocal , Persona de Mediana Edad , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/terapia , RectoRESUMEN
BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice for patients with refractory ulcerative colitis (UC) and for familial adenomatous polyposis (FAP) with many rectal polyps. Pouchitis is one of the more frequent complications after IPAA in UC patients; however, it is rare in FAP. OBJECTIVE: Evaluate pro-apoptotic activity in endoscopically and histological normal mucosa of the ileal pouch in patients with UC and FAP. METHODS: Eighteen patients (nine with UC and nine with FAP) with J pouch after total rectocolectomy were studied. Biopsies were obtained from the mucosa of the pouch and from normal ileum. The specimens were snap-frozen and the expressions of Bax and Bcl-2 were determined by immunoblot of protein extracts and by immunohistochemistry analysis. FADD, Caspase-8, APAF-1 and Caspase-9 were evaluated by immunoprecipitation and immunoblot. RESULTS: Patients with UC had significantly higher protein levels of Bax and APAF-1, Caspase-9 than patients with FAP, but were similar to controls. The expressions of Bcl-2 and FADD, Caspase-8 were similar in the groups. Immunohistochemistry for Bax showed less intensity of immunoreactions in FAP than in UC and Controls. Bcl-2 immunostaining was similar among the groups. CONCLUSION: Patients with FAP present lower levels of pro-apoptotic proteins in all methods applied, even in the absence of clinical and endoscopic pouchitis and dysplasia in the histological analysis. These findings may explain a tendency of up-regulation of apoptosis in UC patients, resulting in higher rates of progression to pouchitis in these patients, which could correlate with mucosal atrophy that occurs in inflamed tissue. However, FAP patients had low pro-apoptotic activity in the mucosa, and it could explain the tendency to low cell turn over and presence of adenomas in this syndrome.
Asunto(s)
Poliposis Adenomatosa del Colon/cirugía , Apoptosis/fisiología , Colitis Ulcerosa/cirugía , Reservorios Cólicos/patología , Mucosa Intestinal/patología , Poliposis Adenomatosa del Colon/patología , Animales , Proteínas Reguladoras de la Apoptosis/metabolismo , Factor Apoptótico 1 Activador de Proteasas/metabolismo , Caspasa 8/metabolismo , Caspasa 9/metabolismo , Colitis Ulcerosa/patología , Reservorios Cólicos/efectos adversos , Humanos , Íleon/anatomía & histología , Íleon/patología , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Proteína X Asociada a bcl-2/metabolismoRESUMEN
BACKGROUND/AIMS: The importance of lateral node dissection has not yet been fully investigated in advanced rectal cancer. To evaluate tumor cells in perirectal and lateral lymph nodes dissection from rectal adenocarcinomas considered free of disease by the hematoxylin-eosin test. METHODOLOGY: Fifteen patients submitted to neoadjuvant therapy and surgery for rectal adenocarcinoma with lateral node dissection were studied, retrospectively. The paraffin blocs of the nodes were analyzed with a immunohistochemical study and multiples cross section of the nodes. RESULTS: A total of 331 lymph nodes from these 15 patients were assessed, distributed as 258 perirectal nodes, 73 non perirectal, and 27 lateral nodes. The average was 22.1 lymph nodes per patient. Three patients out of 15 (20%) with histological negative lateral lymph node had occult metastasis detected by pancytokeratins AE1 and AE3. One of these cases didn't present tumor in the surgical specimen of the rectum. A case of positive lateral node identified by hematoxylin-eosin was also identified by immunohistochemical study. CONCLUSIONS: Although we had a small number of patients in the present study, lateral node dissection is important in selected cases of advanced cancer. Pancytokeratins AE1 and AE3 had a potential to improve study for detection of occult node metastasis, being helpful in rectal cancer prognosis.
Asunto(s)
Adenocarcinoma/patología , Metástasis Linfática/patología , Neoplasias del Recto/patología , Adenocarcinoma/terapia , Adulto , Anciano , Femenino , Humanos , Inmunohistoquímica , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Estadificación de Neoplasias , Neoplasias del Recto/terapiaRESUMEN
PURPOSE: Perineural invasion (PNI) on needle prostatic biopsies (NPB) has been controversial as a marker of extraprostatic extension and consequently for planning of nerve-sparing radical prostatectomy (RP). The aim of this study was to find whether tumor extent on NPB influences the value of PNI to predict stage > pT2 on RP. MATERIALS AND METHODS: This retrospective study was based on 264 consecutive patients submitted to radical retropubic prostatectomy. Their NPB were matched with whole-mount processed and totally embedded surgical specimens. Tumor extent on NPB was evaluated as the percentage of linear tissue in mm containing carcinoma in all cores. Considering the median value, patients were stratified into 2 groups: harboring less or more extensive tumors on NPB. Univariate and multivariate logistic regression analyses were used to relate stage > pT2 to PNI and other clinical and pathological variables. RESULTS: In patients with more extensive tumors, PNI was predictive of stage > pT2 in univariate analysis but not in multivariate analysis. In less extensive tumors, PNI showed no association between any clinical or pathological variables studied; no difference in the time to biochemical progression-free status compared to patients without PNI; and, no predictive value for pathological stage > pT2 on both univariate and multivariate analyses. CONCLUSION: Tumor extent on NPB influences the predictive value of PNI for pathologic stage > pT2 on RP. With a higher number of small tumors currently detected, there is no evidence that perineural invasion should influence the decision on preservation of the nerve during radical prostatectomy.
Asunto(s)
Carcinoma/patología , Próstata/patología , Neoplasias de la Próstata/patología , Adulto , Anciano , Análisis de Varianza , Biopsia con Aguja , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Próstata/inervación , Estudios RetrospectivosRESUMEN
Primary mucosal malignant melanomas of the gastrointestinal tract are rare tumors associated to poor prognosis. Primary duodenal involvement by pigmented lesions is even more uncommon, and only a few reports exist in the literature. We report the case of a patient with large primary duodenal melanoma that presented with upper intestinal obstruction and bleeding that was submitted to urgent pancreaticoduodenectomy followed by adjuvant systemic therapy with an oral alkylating agent (temozolomide) plus intravenous cisplatin. The patient presents no signs of recurrence 3 years after the surgery. We consider that radical surgical resection followed by systemic therapy is a safe and effective treatment strategy option for primary mucosal gastrointestinal melanomas.
Asunto(s)
Melanoma , Recurrencia Local de Neoplasia , Terapia Combinada , Humanos , Melanoma/tratamiento farmacológico , Melanoma/cirugía , Pancreatectomía , PancreaticoduodenectomíaRESUMEN
Early diagnosis of Lyme disease (LD) is critical to successful treatment. However, current serodiagnostic tests do not reliably detect antibodies during early infection. OspC induces a potent early immune response and is also one of the most diverse proteins in the Borrelia proteome. Yet, at least 70% of the amino acid sequence is conserved among all 21 known OspC types. We performed a series of comprehensive seroprofiling studies to select the OspC types that have the most cross-reactive immunodominant epitopes. We found that proteins belonging to seven OspC types detect antibodies from all three infected host species regardless of the OspC genotype of the infecting strain. Although no one OspC type identifies all seropositive human samples, combinations of as few as two OspC proteins identified all patients that had anti-OspC antibodies.
Asunto(s)
Antígenos Bacterianos , Proteínas de la Membrana Bacteriana Externa , Enfermedad de Lyme/diagnóstico , Animales , Antígenos Bacterianos/genética , Antígenos Bacterianos/inmunología , Proteínas de la Membrana Bacteriana Externa/genética , Proteínas de la Membrana Bacteriana Externa/inmunología , Reacciones Cruzadas/inmunología , Perros , Genotipo , Humanos , Epítopos Inmunodominantes/inmunología , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Inmunoglobulina M/sangre , Inmunoglobulina M/inmunología , Enfermedad de Lyme/inmunología , Masculino , Ratones , Ratones Endogámicos C3H , Peromyscus , Proteínas Recombinantes/inmunología , Pruebas SerológicasAsunto(s)
Carcinoma de Células Escamosas/diagnóstico , Neoplasias Gástricas/diagnóstico , Anciano , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Gastrectomía , Humanos , Inmunohistoquímica , Escisión del Ganglio Linfático , Masculino , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugíaRESUMEN
PURPOSE: At an International Society of Urological Pathology consensus conference in 2005 the Gleason grading system for prostatic carcinoma underwent its first major revision. We compared the concordance of pattern and change of prognostic groups for the conventional and the modified Gleason grading, and checked the discriminative power of the modified Gleason grading. MATERIALS AND METHODS: The grading was based on 172 prostatic needle biopsies of patients subsequently undergoing radical prostatectomy. Four prognostic Gleason grading groups were considered, divided into scores of 2-4, 5-6, 7 and 8-10. To check the discriminative power of the modified Gleason grading we compared the time of biochemical (prostate specific antigen) progression-free outcome according to prognostic groups between standard and revised grading. RESULTS: The greatest impact of the International Society of Urological Pathology consensus recommendations for Gleason grading was seen on the secondary pattern which had the lowest percentage of concordance and was reflected in a change toward higher Gleason prognostic groups. Of 172 patients in whom the Gleason prognostic group was changed (to higher grades) based solely on the consensus criteria, 46 (26.7%) had higher preoperative prostate specific antigen, more extensive tumors and positive surgical margins, and higher pathological stage. The revised Gleason grading identified in this series a higher number of patients in the aggressive prognostic group Gleason score 8-10 who had a significantly shorter time to biochemical progression-free outcome after radical prostatectomy (log rank p = 0.011). CONCLUSIONS: The findings of this study indicate that the recommendations of the International Society of Urological Pathology are a valuable refinement of the standard Gleason grading system.
Asunto(s)
Adenocarcinoma/patología , Biopsia con Aguja/normas , Guías de Práctica Clínica como Asunto/normas , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/patología , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Humanos , Inmunohistoquímica , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Prostatectomía/métodos , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/cirugía , Sensibilidad y Especificidad , Estadísticas no Paramétricas , Análisis de Supervivencia , Resultado del Tratamiento , Urología/normasRESUMEN
Primary sensory afferent neurons modulate the hyperdynamic circulation in cirrhotic rats with portal hypertension. The stomach of cirrhotic rats is prone to damage induced by ethanol, a phenomenon associated with reduced gastric hyperemic response to acid-back diffusion. The aim of this study was to examine the impact of ablation of capsaicin-sensitive neurons and the tachykinin NK(1) receptor antagonist A5330 on the susceptibility of the portal hypertensive gastric mucosa to ethanol-induced injury and its effects on gastric cyclooxygenase (COX) and nitric oxide synthase (NOS) mRNA expression. Capsaicin was administered to neonatal, male, Wistar rats and the animals were allowed to grow. Cirrhosis was then induced by bile duct ligation in adult rats while controls had sham operation. Ethanol-induced gastric damage was assessed using ex vivo gastric chamber experiments. Gastric blood flow was measured as well as COX/NOS mRNA expression. Topical application of ethanol produced significant gastric damage in cirrhotic rats compared to controls, which was reversed in capsaicin- and A5330-treated animals. Mean arterial and portal pressure was normalized in capsaicin-treated cirrhotic rats. Capsaicin and A5330 administration restored gastric blood flow responses to topical application of ethanol followed by acid in cirrhotic rats. Differential COX and NOS mRNA expression was noted in bile duct ligated rats relative to controls. Capsaicin treatment significantly modified gastric eNOS/iNOS/COX-2 mRNA expression in cirrhotic rats. Capsaicin-sensitive neurons modulate the susceptibility of the portal hypertensive gastric mucosa to injury induced by ethanol via tachykinin NK(1) receptors and signalling of prostaglandin and NO production/release.
Asunto(s)
Capsaicina/farmacología , Etanol/toxicidad , Mucosa Gástrica/efectos de los fármacos , Hipertensión Portal/metabolismo , Cirrosis Hepática Experimental/metabolismo , Neuronas Aferentes/efectos de los fármacos , Receptores de Neuroquinina-1/metabolismo , Animales , Animales Recién Nacidos , Presión Sanguínea/efectos de los fármacos , Conducto Colédoco/cirugía , Mucosa Gástrica/irrigación sanguínea , Mucosa Gástrica/enzimología , Mucosa Gástrica/inervación , Mucosa Gástrica/patología , Regulación Enzimológica de la Expresión Génica/efectos de los fármacos , Hipertensión Portal/patología , Hipertensión Portal/fisiopatología , Ligadura , Hígado/efectos de los fármacos , Hígado/patología , Cirrosis Hepática Experimental/patología , Cirrosis Hepática Experimental/fisiopatología , Masculino , Antagonistas del Receptor de Neuroquinina-1 , Neuronas Aferentes/metabolismo , Óxido Nítrico Sintasa/genética , Óxido Nítrico Sintasa/metabolismo , Presión Portal/efectos de los fármacos , Prostaglandina-Endoperóxido Sintasas/genética , Prostaglandina-Endoperóxido Sintasas/metabolismo , ARN Mensajero/metabolismo , Ratas , Ratas Wistar , Flujo Sanguíneo Regional/efectos de los fármacos , Transducción de Señal/efectos de los fármacos , Factores de TiempoRESUMEN
INTRODUCTION: Serological cross-reactivity between leishmaniasis and Chagas disease, especially at low titers, leads to difficulties of the seroepidemiological interpretation. METHODS: We have studied the ability of urea as a chaotrope to select high-avidity antibodies in IgG ELISA, thus reducing low-avidity IgG cross-reactivity in serologically positive samples in both assays. RESULTS: Using 0.5M urea for diluting the sample efficiently defined leishmaniasis or double infections in high-avidity IgG ELISA and eliminated false-positive results. CONCLUSIONS: The use of a chaotropic diluting agent is useful for improving the specificity of Chagas disease and leishmaniasis immunoassays.
Asunto(s)
Anticuerpos Antiprotozoarios/sangre , Afinidad de Anticuerpos/inmunología , Enfermedad de Chagas/inmunología , Reacciones Cruzadas/inmunología , Inmunoglobulina G/sangre , Leishmaniasis/inmunología , Urea/farmacología , Biomarcadores/química , Brasil/epidemiología , Enfermedad de Chagas/complicaciones , Enfermedad de Chagas/diagnóstico , Enfermedad de Chagas/epidemiología , Ensayo de Inmunoadsorción Enzimática , Humanos , Leishmaniasis/complicaciones , Leishmaniasis/diagnóstico , Leishmaniasis/epidemiología , Vigilancia de la Población , Sensibilidad y Especificidad , Urea/químicaRESUMEN
Lipomas of the gastrointestinal tract are uncommon benign tumors of mature adipocytes and may occur in any portion along the gut. Depending on location they may have a variety of clinical presentations and even simulate malignant neoplasms. We report a case of a 58-year-old woman who presented with acute pelvic pain. An emergency sonogram detected a hyperechogenic mass in the left adnexal region, with no vascularization on Doppler. A computed tomography confirmed the hypothesis of a fat containing tumor with signals of torsion. The patient underwent laparoscopy which depicted a mass over the antimesenteric side of the sigmoid with signs of ischemia and twisted vascular pedicle. The lesion was resected, and the microscopy confirmed the diagnosis of lipoma. The multidisciplinary team in the emergency room must be aware of these possible complications in order to optimize patient care.
RESUMEN
BACKGROUND: Peritoneal carcinomatosis is usually a terminal disease with short median survival in patients with gastric cancer. Systemic FOLFOX is one of the most used regimens in the first-line treatment of metastatic gastric cancer. However, there is scarce evidence that cytoreductive surgery (CRS) and intraperitoneal heated chemotherapy (HIPEC) improves oncological outcomes of patients with advanced gastric cancer. METHODS: Herein we present a case of a young woman with advanced gastric cancer with omental and peritoneal metastases who achieved an excellent response after 6 months of FOLFOX followed by CRS and HIPEC. RESULTS: A 53-year-old woman was diagnosed with advanced gastric carcinoma, with extensive omental caking and several peritoneal implants measuring 2 cm at the largest diameter. The patient received mFOLFOX6 for 6 months with excellent clinical and radiographic response. She was then submitted to a D2 total gastrectomy followed by CRS and HIPEC with mitomycin. The final pathology report showed a focal adenocarcinoma in the stomach measuring 0.4 mm with no residual tumor in the peritoneum (ypT1ypN0). The patient has been well and disease free for more than 4 years. CONCLUSION: While still controversial, CRS followed by HIPEC may be a curative therapeutic option for highly selected patients.