Prevalence of p21 immunohistochemical expression in esophageal adenocarcinoma.

BACKGROUND: In western societies, the prevalence of adenocarcinoma of the gastroesophageal junction has increased in recent years. It is commonly accepted today that esophageal adenocarcinoma develops from a premalignant lesion: Barrett's esophagus. This type of carcinoma is hardly diagnosed at early stages, which results in significant mortality. Molecular biology studies have shown that most malignant tumors originate from the interaction between inherited characteristics and external factors, which may cause genetic changes that interfere with the control over the differentiation and growth of cells in susceptible individuals. p21 (WAF1/CIP1) has a key role in the regulation of the cell cycle, and its immunohistochemical expression has been investigated in several tumors, showing that it influences the prognosis of various neoplasms. AIM: To check the prevalence of p21 protein expression in patients with esophageal adenocarcinoma diagnosed in the last 5 years by the Group for Surgeries of the Esophagus and Stomach of "Hospital de Clínicas de Porto Alegre", RS, Brazil. METHODS: The study population consisted of 42 patients with esophageal adenocarcinoma diagnosed by the Group for Surgeries of the Esophagus and Stomach between January 1998 and December 2002. The expression of p21 protein was determined by immunohistochemistry using primary antibody, p21, clone SX118, code M7202 (Dako), and assessed according to the immunoreactive scoring system. RESULTS: Of 42 analyzed patients, 83.3% were male and older than 40 years. Among these, 56.2% were submitted to curative resection: total gastrectomy and transhiatal esophagogastrectomy. The remaining patients were submitted to palliative surgery or did not undergo any surgical treatment. Only five patients received adjuvant chemotherapy and radiation therapy, either alone or combined. Advanced disease (stages III and IV) was detected in 78.6% of the patients. Only nine patients were positive for p21, according to the immunoreactive scoring system. CONCLUSION: p21 was expressed in 9 of 42 patients (21.4%) with esophageal adenocarcinoma diagnosed in the last 5 years by the Group for Surgeries of the Esophagus and Stomach of Hospital de Clínicas de Porto Alegre. In our patient population, the accumulation of p21 did not play a key role in the carcinogenesis of esophageal adenocarcinoma.

Prevalence of p21 immunohistochemical expression in esophageal adenocarcinoma / Prevalência da expressão imunoistoquímica da proteína p21 em adenocarcinoma do esôfago

BACKGROUND: In western societies, the prevalence of adenocarcinoma of the gastroesophageal junction has increased in recent years. It is commonly accepted today that esophageal adenocarcinoma develops from a premalignant lesion: Barrett's esophagus. This type of carcinoma is hardly diagnosed at early stages, which results in significant mortality. Molecular biology studies have shown that most malignant tumors originate from the interaction between inherited characteristics and external factors, which may cause genetic changes that interfere with the control over the differentiation and growth of cells in susceptible individuals. p21 (WAF1/CIP1) has a key role in the regulation of the cell cycle, and its immunohistochemical expression has been investigated in several tumors, showing that it influences the prognosis of various neoplasms. AIM: To check the prevalence of p21 protein expression in patients with esophageal adenocarcinoma diagnosed in the last 5 years by the Group for Surgeries of the Esophagus and Stomach of "Hospital de Clínicas de Porto Alegre", RS, Brazil. METHODS: The study population consisted of 42 patients with esophageal adenocarcinoma diagnosed by the Group for Surgeries of the Esophagus and Stomach between January 1998 and December 2002. The expression of p21 protein was determined by immunohistochemistry using primary antibody, p21, clone SX118, code M7202 (Dako), and assessed according to the immunoreactive scoring system. RESULTS: Of 42 analyzed patients, 83.3 percent were male and older than 40 years. Among these, 56.2 percent were submitted to curative resection: total gastrectomy and transhiatal esophagogastrectomy. The remaining patients were submitted to palliative surgery or did not undergo any surgical treatment. Only five patients received adjuvant chemotherapy and radiation therapy, either alone or combined. Advanced disease (stages III and IV) was detected in 78.6 percent of the patients. Only nine patients were positive for...

RACIONAL: No mundo ocidental, a prevalência de adenocarcinoma da junção esôfago-gástrica vem crescendo nas últimas décadas. Atualmente, é aceito que o adenocarcinoma do esôfago se desenvolve de uma lesão pré-maligna: esôfago de Barrett. Este carcinoma é de difícil diagnóstico nos seus estágios iniciais, o que resulta em mortalidade significativa. O estudo da biologia molecular tem demonstrado que grande parte dos tumores malignos tem origem na interação entre o componente hereditário e influências externas, que em indivíduos predispostos podem ocasionar alterações genéticas que influenciem o controle da diferenciação e crescimento celular. O p21(WAF1/CIP1) tem papel fundamental na regulação do ciclo celular e sua expressão imunoistoquímica tem sido estudada em diversos tumores, mostrando influência no prognóstico de várias neoplasias. OBJETIVO: Verificar a prevalência da expressão da proteína p21 em pacientes com adenocarcinoma de esôfago diagnosticados nos últimos 5 anos no Grupo de Cirurgia de Esôfago e Estômago do Hospital de Clínicas de Porto Alegre, RS (GCEE/HCPA). PACIENTES E MÉTODOS: A população em estudo foi constituída de 42 pacientes com adenocarcinoma de esôfago diagnosticados no GCEE/HCPA entre janeiro de 1998 e dezembro de 2002. A expressão da proteína p21 foi avaliada por meio de imunoistoquímica, com anticorpo primário, p21, clone SX118, código M7202 da DAKO, e quantificada de acordo com o sistema de escore de imunorreatividade ("Immunoreactive scoring system" - IRS). RESULTADOS: Foram estudados 42 pacientes, 83,3 por cento eram do sexo masculino, com idade superior a 40 anos. Destes, 56,2 por cento foram submetidos a procedimentos cirúrgicos com intenção curativa: gastrectomia total e esofagogastrectomia transhiatal. Os demais foram submetidos a cirurgia paliativa ou não sofreram tratamento cirúrgico. Apenas cinco pacientes receberam tratamento adjuvante com quimioterapia e radioterapia, isoladas ou combinadas. Quanto ao estádio, 78,6 por cento ...

Divertículo único do ceco: experiência de um hospital geral brasileiro / Solitary diverticulum of the cecum: experience of a Brazilian general hospital

RACIONAL: A diverticulite cecal é uma condição rara, especialmente em populações ocidentais. Sua importância reside no fato de fazer parte do diagnóstico diferencial da apendicite aguda e do carcinoma ulcerado de ceco. CASUíSTICA E MÉTODOS: Apresenta-se a experiência de um hospital geral do sul do Brasil no tratamento da diverticulite cecal. Descrevem-se quatro casos de divertículo único inflamado de ceco. Um destes teve diagnóstico pré-operatório através de tomografia computadorizada de abdome, tendo o paciente tratado clinicamente com remissão do quadro de diverticulite. Os outros três pacientes foram submetidos a colectomia direita com íleo-transverso anastomose. RESULTADOS: A mortalidade foi nula e nos casos operados não houve complicações pós-operatórias. Quando se consegue obter diagnóstico pré-operatório, pode-se optar por manejo clínico. CONCLUSAO: Recomendamos laparotomia exploradora quando não há certeza diagnóstica. Preconizamos manejo cirúrgico radical quando o diagnóstico é efetuado através de laparotomia.

Fatores prognósticos na ressecção de metástases hepáticas de câncer colorretal / Prognostic factors following liver resection for hepatic metastases from colorectal cancer

OBJETIVO: Determinar o impacto de fatores prognósticos na sobrevida de pacientes com metástases hepáticas ressecadas e originadas de câncer colorretal. CASUíSTICA E MÉTODOS: Foram analisados os prontuários de 28 pacientes submetidos a ressecção hepática de metástases de câncer colorretal de abril de 1992 a setembro de 2001. Foram realizadas 38 ressecções (8 pacientes com mais de uma ressecção no mesmo tempo cirúrgico e 2 pacientes submetidos a re-ressecções). Todos haviam sido submetidos previamente a ressecção do tumor primário. Utilizou-se protocolo de rastreamento de metástases hepáticas que incluiu revisões clínicas trimestrais, ecografia abdominal e dosagem de CEA até se completarem 5 anos de seguimento e após, semestralmente. Os fatores prognósticos estudados foram: estágio do tumor primário, tamanho das metástases > 5cm, intervalo entre ressecção do tumor primário e surgimento da metástase < 1 ano, CEA >100 ng/mL, margens cirúrgicas < 1cm e doença metastática extra-hepática. O estudo foi retrospectivo e a análise estatística foi feita pela curva de Kaplan-Meier, log-rank e regressão de Cox. RESULTADOS: A morbidade foi 39,3 por cento e a mortalidade operatória foi 3,6 por cento. A sobrevida em 5 anos foi de 35 por cento. Os fatores prognósticos independentes adversos foram: intervalo < 1 ano entre ressecção do tumor primário e surgimento da metástase, e doença metastática extra-hepática. CONCLUSÕES: A ressecção hepática de metástases de câncer colorretal é um procedimento seguro com sobrevida em 5 anos acima dos 30 por cento. Foram fatores prognósticos independentes adversos: doença metastática extra-hepática e intervalo < 1 ano entre ressecção do tumor primário e surgimento da metástase.

[Solitary diverticulum of the cecum: experience of a Brazilian general hospital]. / Divertículo único do ceco: experiência de um hospital geral brasileiro.

BACKGROUND: Cecal diverticulitis is a rare condition, specially in western people. Its importance concerns of being part of the differential diagnosis of acute appendicitis and ulcerated cecal carcinoma. AIM: To present the experience of southern Brazilian general hospital in the treatment of cecal diverticulitis. MATERIAL AND METHODS: We present four cases of single inflamed cecal diverticulum. One was diagnosed by pre-operatively computer tomography and was treated medically without complications. The other three cases were diagnosed during operation and treated by right hemicolectomy and ileotransverse anastomosis. RESULTS: There were no deaths or complications. When cecal diverticulitis is pre-operatively diagnosed it may be treated medically. We preclude laparotomy when the diagnosis is uncertain. CONCLUSION: We recommend radical surgical management when the diagnosis is made during operation.

[Prognostic factors following liver resection for hepatic metastases from colorectal cancer]. / Fatores prognósticos na ressecção de metástases hepáticas de câncer colorretal.

AIM: To determine the impact of prognostic factors on survival of patients with metastases from colorectal cancer that underwent liver resection. METHODS: The records of 28 patients that underwent liver resection for metastases from colorectal cancer between April 1992 and September 2001 were retrospectively analyzed. Thirty-eight resections were performed (more than one resection in eight patients and two patients underwent re-resections). The primary tumor was resected in all the patients. A screening protocol for liver metastases including clinical examinations every three months, ultrassonography and CEA level until 5 years of follow-up and after every 6 months, was applied. The prognostic factors analyzed regarding the impact on survival were: Dukes C stage of primary tumor, size of metastasis >5 cm, a disease-free interval from primary tumor to metastasis < 1 year, CEA level > 100 ng/mL, resection margins < 1 cm and extrahepatic disease. The Kaplan-Meier curves, log rank and Cox regression were used for the statistical analysis. RESULTS: Perioperative morbidity and mortality were 39.3% and 3.6%, respectively. The 5-year survival rate was 35%. The independent prognostic factors were: disease-free interval from primary tumor to metastasis < 1 year and extrahepatic disease. CONCLUSIONS: The liver resection for metastases from colorectal cancer is a safe procedure with more than 30% 5-year survival. Disease-free interval from primary tumor to metastasis < 1 year and extrahepatic disease were independent prognostic factors.