Metalloproteinases and colorectal cancer. Correlation of gene expression and clinical-pathological parameters.

PURPOSE: To analyze gene and protein expression of metalloproteinases 1, 2, 9, 11 and 16 and their correlation with clinicopathological variables in colorectal adenocarcinoma. METHODS: A retrospective study of 114 patients with colorectal adenocarcinoma treated surgically in the period 2006 to 2008 in Hospital de Câncer de Barretos - Fundação Pio XII. The evaluation of gene expression was performed by RT-PCR, and protein by immunohistochemistry. The analysis of gene expression was classified as overexpressed genes and poorly expressed (fold change of approximately 2, p<0.05). The positivity of the markers in the immunohistochemical study was performed by semi-quantitative analysis. The tissue of TMA (Tissue Microarray) was done by two independent pathologists. RESULTS: The gene expression validated by immuno - histochemical was MMP-1(p= 0.00 and 1.57 fold change) and MMP - 2 (p= 0.01 and - 1.84 to fold change) when correlated with the histological types mucinous and adenocarcinoma NOS, MMP9 (p=0.01 and fold change of 1.13) and MMP-16 (p=0.03 and 1.61 fold change) when compared with the histological types villous and adenocarcinoma NOS, MMP - 11 statistically significant in relation to male (p = 0.04 and 1.65 fold change). CONCLUSIONS: The MMPs 1, 2, 9, 11 and 16 gene and protein expression with statistical significance in at least one of the clinicopathological variables studied. Thus, we conclude that these MMPs have potential as a prognostic factor in colorectal adenocarcinoma.

Carotid artery rupture following radioiodine therapy for differentiated thyroid carcinoma.

INTRODUCTION: Radioiodine therapy for patients with differentiated thyroid cancer aims at reducing tumor recurrence by eradicating residual macro- and microscopic foci. Side effects are generally rare, tenuous and transient, with little clinical significance. OBJECTIVE: To report a rare case of differentiated thyroid carcinoma presenting a large expansive solid mass at the base of the skull, with invasion of the left masticatory muscle and adjacent subcutaneous tissue, and without invasion of the carotid space, which evolved to carotid artery rupture following radioiodine therapy. DISCUSSION: Side effects are uncommon after radioiodine therapy and when present, have mild intensity. Serious adverse events are very rare, especially those arising from structures not directly invaded by metastatic tissue with radioiodine uptake, as occurred in this case. This occurrence serves to raise awareness of the need for increased care when using radioiodine therapy on high-avidity masses located close to important structures.

Carotid artery rupture following radioiodine therapy for differentiated thyroid carcinoma / Ruptura de carótida pós-iodoterapia em carcinoma diferenciado de tireoide

INTRODUCTION: Radioiodine therapy for patients with differentiated thyroid cancer aims at reducing tumor recurrence by eradicating residual macro- and microscopic foci. Side effects are generally rare, tenuous and transient, with little clinical significance. OBJECTIVE: To report a rare case of differentiated thyroid carcinoma presenting a large expansive solid mass at the base of the skull, with invasion of the left masticatory muscle and adjacent subcutaneous tissue, and without invasion of the carotid space, which evolved to carotid artery rupture following radioiodine therapy. DISCUSSION: Side effects are uncommon after radioiodine therapy and when present, have mild intensity. Serious adverse events are very rare, especially those arising from structures not directly invaded by metastatic tissue with radioiodine uptake, as occurred in this case. This occurrence serves to raise awareness of the need for increased care when using radioiodine therapy on high-avidity masses located close to important structures.

INTRODUÇÃO: Iodoterapia em pacientes com carcinoma diferenciado da tireoide tem o objetivo de reduzir a recorrência tumoral erradicando focos residuais macro e microscópicos. Os efeitos colaterais, em geral, são raros, tênues e transitórios, com pouca repercussão clínica. OBJETIVO: Relatar um caso raro de carcinoma diferenciado da tireoide apresentando grande massa sólida expansiva na base do crânio, com invasão da musculatura mastigatória esquerda e do tecido subcutâneo adjacente, sem invasão do espaço carotídeo que evoluiu com ruptura de carótida pós-iodoterapia. DISCUSSÃO: Os efeitos colaterais pós-iodoterapia são pouco frequentes e, quando presentes, de intensidade discreta. Os eventos adversos graves são muito raros, em especial, aqueles decorrentes de estruturas não invadidas diretamente pelo tecido metastático iodocaptante, como nesse caso, alertando também para a necessidade do aumento dos cuidados na terapia de grandes massas ávidas pelo radioiodo próximas às estruturas nobres.

Mucopolysaccharidosis type II: skeletal-muscle system involvement.

Mucopolysaccharidosis type II (MPS-II) is a rare lysosomal storage disorder caused by deficiency in the activity of the enzyme iduronate-2-sulphatase. This enzyme is responsible for the catabolism of two different glycosaminoglycans (GAGs), dermatan sulfate and heparan sulfate. Lysosomal accumulation of these GAG molecules results in cell, tissue, and organ dysfunction. The skeletal-muscle system involvement is because of essential accumulated GAGs in joints and connective tissue. MPS-II has many clinical features and includes two recognized clinical entities, mild and severe, that represent two ends of a wide spectrum of clinical severity. The aim of this study is to review the involvement of the skeletal-muscle system in MPS-II.

Carcinoma epidermoide de mama / Squamous cell carcinoma of the breast

Foram investigados cinco casos de carcinoma espinocelular (CEC) da mama e um tumor raro, e foram descritos menos de 150 casos na literatura médica. Foram analisadas as características clínicas, anatomopatológicas e terapêuticas das pacientes portadoras de CEC da mama, atendidas no Hospital de Câncer de Barretos. Quatro pacientes chegaram ao hospital com tumores volumosos e localmente avançados (pT4b), sendo submetidas a mastectomia e esvaziamento axilar, e, ao contrário da literatura, todas apresentavam metástase axilar. A radioterapia foi realizada em todas as pacientes, e a quimioterapia com antracíclicos foi realizada em três pacientes. Os receptores de estrogênio, progesterona e c-erb B2 foram negativos. Todas as pacientes encontram-se vivas e sem doença em um período de seguimento mediano de 55,6 meses; fato superior ao observado para o carcinoma ductal. Esses casos vêm a contribuir para melhor conhecimento da biologia desse raro tumor.

The authors report five cases of breast squamous cell carcinoma, a very rare tumor, whose there were described lower than 150 cases in medical literature. We analyze the clinical, pathologic and therapeutic aspects of breast squamous cell carcinoma. Pour patients had large and locally advanced tumors (PT4b), and they were submitted to mastectomy and axillary dissection; whose were noted axillary metastases, uncommon fact. Radiotherapy was done in all patients, and three patients received antraciclic chemotherapy. The receptors of estrogen, progesterone and c-erb B2 were negative. The patients are live without disease in a median period of 55,6 months which is superior to invasive ductal carcinoma. This report of a case represents a contribution to better knowledge of biology of this rare tumor.

Carcinoma epidermóide de mama / Squamous cell carcinoma of the breast

Os autores analisaram quatro casos de carcinoma espinocelular da mama, um tumor raro, no qual foram descritos menos de cem casos na literatura médica. Analisaram-se as características clínicas, anatomopatológicas, terapêuticas das pacientes portadoras de carcinoma espinocelular da mama atendidas no Hospital de Câncer de Barretos. Todas as pacientes chegaram ao hospital com tumores volumosos e localmente avançados (pT4b). Os receptores de estrogênio, progesterona e c-erb B2 foram negativos. Todas as pacientes se submeteram a mastectomia e esvaziamento axilar e, ao contrário do que diz a literatura, todas apresentavam metástase axilar. Radioterapia foi realizada em todas as pacientes e quimioterapia com antracíclicos foi realizada em três pacientes. As pacientes encontram-se vivas e sem doença num período de seguimento mediano de 14,8 meses. Esses casos vêm a contribuir para melhor conhecimento da biologia desse raro tumor.

The authors report four cases of breast squamous cell carcinoma, a very rare tumor, whose with less than one hundred cases in described medical literature. We analyse the clinical, pathologic and therapeutic aspects of breast squamous cell carcinoma. All four patients had large e locally advanced tumors (pT4b). The receptors of estrogen, progesterone and c-erb B2 were negative. All patients were submitted to mastectomy and axillary dissection; whose were noted axillary metastases, uncommon fact. Radiotherapy was done in all patients, and three patients received antraciclic chemotherapy. The patients are alive without disease in a median period of 14,8 months. These cases represent a contribution to better knowledge of the biology of this rare tumor.

Melanoma maligno: achados histopatológicos em olhos enucleados pós-braquiterpia com cobalto-90 / Malignant melanoma: histopathological findings in enucleated eyes after coblat-60 plaque therapy

Os autores avaliam os achados histopatológicos de 13 olhos com melanoma uveal submetidos à braquiterapia e posteriormente enucleados por insucesso com o tratamento ou por complicaçöes como hemorragia vítrea, descolamento total da retina e glaucoma neovascular. Os achados säo comparados com os de 13 olhos com emlanoma uveal, de dimensöes equivalentes, enucleados no mesmo período, sem qualquer tratamento prévio. Foram avaliados: o tipo histológico, pigmentaçäo, ruptura da membrana de Bruch, infiltraçäo linfocitária, fibrose, necrose, alteraçöes vasculares, infiltraçäo de esclera, assim como dos vasos episclerais e número de mitoses em 10 campos de aumento. Fibrose ocorreu somente no grupo irradiado. Houve predomínio da necrose difusa no grupo

Computed tomography-guided fine-needle aspiration biopsy

The therapeutic and prognostic evaluation of malignant neoplasias depends largely upon a precise morphologic diagnosis. Several papers have focused on the importance of fine-needle aspiration under computed tomography guidance in the diagnosis of unresectable neoplasms and in the investigation of metastases. The objective of this study is to evaluate the diagnostic accuracy, the sensitivity, and the negative predictive value obtained with the technique. Fine-needle aspiration cytology (FNAC) was performed on 207 patients, with a total of 210 cases, from 1991 to 1994, under computed tomography (CT) guidance. There were 128 (61.8 percent) males and 79 (38.2 percent) females with a mean age of 41 years (range 1 to 91 years). Lung and liver were the most frequent anatomic sites. The analysis of this material disclosed 41 cases with cytological diagnosis of negative for malignancy (19.52 percent), and in 131 (62.38 percent), the diagnosis was positive. It was possible to define the cytologic lineage in 54 percent of the cases. The diagnosis in 14 (6.67 percent) cases was suspicious for malignancy, and in 24 (11.43 percent) cases the material was insufficient for the cytologic diagnossis. Of the 210 cases, 106 showed histological diagnosis and/or clinical follow-up. Forty-seven (44.3 percent) had histological diagnosis before the FNAC and 50 cases (56.7 percent) histological diagnosis after the procedure. The comparison between cytological and histological diagnosis showed a sensibility of 80.4 percent, specificity of 100 percent, positive predictive value of 100 percent and negative of 16.7 percent. The efficiency of the test was 81.1 percent. This study showed that FNAC, under computed tomography guidance, is a sensitive and specific technique for the diagnosis of deep-seated lesions.

Punção aspirativa de fígado dirigida por tomografia computadorizada / Liver CT-guided aspirative biopsies

No período de 1992 a 1995, foram realizadas 68 punções aspirativas de nódulos hepáticos guiadas por tomografia computadorizada, no Hospital A. C. Camargo, São Paulo. Esses casos foram assim distribuidos: 44 casos (64,7 por cento) com diagnóstico de positivo para células neoplásticas, 6 casos (8,8 por cento) com diagnóstico negativo e 14 casos (20,5 por cento) de material insuficiente. Dos casos positivos (neoplasmas primárias e metástases), em 39 foi possível a deteminação da linhagem citológica. Houve 36 casos de carcinoma (7 de hepatocarcinoma, 18 adenocarcinoma, 1 carcinoma de pequenas células e 10 carcinomas sem outra especificação - SOE), 2 casos de melanoma e 1 caso de sarcoma. A correlação com os exames histopatológicos revelou não haver falso-positivos e alta concordância entre os diagnósticos citológicos e anatomopatológicos. Os resultados demonstram que a punção aspirativa de nódulos hepáticos guiada por tomografia computadorizada permite diagnóstico rápido de lesões neoplásticas, principalmente na avaliação de metástases.

Diagnóstico do exame por congelação em patologia cirúrgica: análise de 1532 casos / Evaluation frozen section analysis in surgical pathology: a survey of 1532 cases

Foram avaliados 1532 casos de espécimes submetidos a exame por congelação durante ato cirúrgico, no ato de 1989, realizados pelo Departamento de Anatomia Patológica do Hospital A. C. Camargo da Fundação Antonio Prudente. Os diagnósticos dos exames por congelação foram comparados com os encontrados pelo exame de parafina e revelaram índices de especificidade de 98,3 porcento, sensibilidade de 96,5 porcento, e eficiência de 97,4 porcento valor preditivo positivo de 98 porcento e valor preditivo negativo de 96,9 porcento, que são semelhantes aos encontrados na literatura.