Thyroid Leiomyoma: Case Report.

37-year-old Colombian male with mass in the anterior region of the neck. Initial ultrasonography and computed tomography (CT) scan showed a large solid mass (67 × 20.7 mm), dependent on the thyroid isthmus. Total thyroidectomy (TT) was performed. The latest pathological and immunohistochemical findings showed a mesenchymal neoplasm compatible with primary thyroid leiomyoma. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04356-2.

Neuroendocrine Tumor Metastases to the Breast: A Case Report and Review of the Literature.

Breast metastases from neuroendocrine neoplasms (NENs) are considered infrequent. We report a case of a patient with ileocecal neuroendocrine tumor (NET) metastases to both breasts, for whom the initial clinical presentation was chronic diarrhea. Breast metastasis was initially suspected by a 68-Gallium DOTANOC positron emission tomography (PET)/CT and was confirmed by histopathology. We also performed a literature review in which we identified 116 cases of NENs metastatic to the breast reported so far. Most cases occurred in older women, were caused by NETs, and had the gastrointestinal tract as the primary site.

hTERT and IGF-1R Proteins Expression in Response to Treatment in Patients with HPV Alpha 9-Positive Cervical Cancer.

Human papillomavirus (HPV) infection is strongly associated with cervical cancer (CC). Genomic alterations caused by viral infection and subsequent dysregulation of cellular metabolism under hypoxic conditions could influence the response to treatment. We studied a possible influence of IGF-1Rb, hTERT, HIF1a, GLUT1 protein expression, HPV species presence and relevant clinical parameters on the response to treatment. In 21 patients, HPV infection and protein expression were detected using GP5+/GP6+PCR-RLB and immunohistochemistry, respectively. The worse response was associated with radiotherapy alone compared with chemoradiotherapy (CTX-RT), anemia and HIF1a expression. HPV16 type was the most frequent (57.1%) followed by HPV-58 (14.2%) and HPV-56 (9.5%). The HPV alpha 9 species was the most frequent (76.1%) followed by alpha 6 and alpha 7. IGF-1Rb (85.7%), HIF1a (61.9%), GLUT1 (52.3%), and hTERT expression [cytoplasm and nucleus (90.4%)] were detected. The MCA factorial map showed different relationships, standing out, expression of hTERT and alpha 9 species HPV, expression of hTERT and IGF-1Rb expression [Fisher's exact test (P = 0.04)]. A slight trend of association was observed between, GLUT1 and HIF1 a expression, hTERT and GLUT1 expression. A noteworthy finding was the subcellular localization of hTERT in the nucleus and cytoplasm of CC cells and its possible interaction with IGF-1R in presence of HPV alpha 9 species. Our findings suggest that the expression of HIF1a, hTERT, IGF-1Rb and GLUT1 proteins that interact with some HPV species may contribute to cervical cancer development, and the modu lation of treatment response.

Acute appendicitis secondary to metastatic uterine cervix squamous cell carcinoma. Case report / Apendicitis aguda como manifestación clínica secundaria a metástasis de un carcinoma de células escamosas del cérvix. Reporte de caso

Primary and secondary neoplasms of the appendix are rare and found in approximately 1% of surgical appendectomy specimens. Cervical squamous cell carcinoma (CSCC) spreads mainly by direct local invasion of adjacent tissues and lymphatics and, less commonly, through blood vessels. The spread of CSCC via lymphatics occurs early and is present in 25-50% of patients with stage IB and II carcinomas. We present a 31-year-old female with a history of stage IVB CSCC. The patient received palliative radiotherapy (3 Gy divided for a total of 30 Gy) and later chemotherapy (cisplatin 50 mg/m2 IV and paclitaxel 175 mg/m2 IV). Two months after the onset of therapy with radiotherapy and chemotherapy, she was admitted to the hospital, presenting with abdominal pain, fever, and vomiting. Laparotomy revealed perforated appendicitis and an intra-abdominal abscess with no evidence of ovary or fallopian tube compromise. Histopathological examination of the excised specimen evidenced a severe acute inflammatory process and the presence of CSCC. In summary, we describe the second case of acute appendicitis secondary to metastatic CSCC, published in the medical literature. This is an interesting case due to the rarity of acute appendicitis associated with metastatic cervical cancer in the appendix via lymphatic vessels. The history of CSCC played a significant role in defining the histopathological diagnosis.

Las neoplasias primarias y secundarias del apéndice son raras y se encuentran en aproximadamente el 1% de las muestras de apendicectomía quirúrgica. El carcinoma de células escamosas del cuello uterino (CECU) se disemina principalmente por invasión local directa de los tejidos y por vía linfática, y con menor frecuencia a través de los vasos sanguíneos. La diseminación de CECU por vía linfática ocurre de manera temprana y está presente en el 25-50% de los pacientes con carcinomas en estadio IB y II. Presentamos el caso de una mujer de 31 años con antecedente de CECU estadio IVB. La paciente recibió radioterapia paliativa (3 Gy fraccionada para un total de 30 Gy) y posteriormente quimioterapia (cisplatino 50 mg/m2 IV y paclitaxel 175 mg/m2 IV). Dos meses después del inicio de la terapia con radioterapia y quimioterapia, ingresó al hospital presentando dolor abdominal, fiebre y vómitos. La laparotomía reveló apendicitis perforada y un absceso intraabdominal sin evidencia de compromiso de ovario o trompa de Falopio. El examen histopatológico del espécimen extirpado evidenció un proceso inflamatorio agudo severo y la presencia de CECU. En conclusión, describimos el segundo caso de apendicitis aguda secundaria a CECU metastásico, publicado en la literatura médica. Este es un caso interesante debido a la rareza de la apendicitis aguda asociada con el cáncer de cuello uterino metastásico en el apéndice a través de los vasos linfáticos. La historia previa de CECU tuvo un papel importante para definir el diagnóstico histopatológico.

Metástasis tumor a tumor en pulmón: reporte de tres casos y revisión de la literatura / Tumor-to-tumor metastasis in the lung: report of three cases and review of the literature

Las metástasis tumor a tumor (MTT) corresponden a un evento poco frecuente en el cual se presenta metástasis de un tumor primario a otro tumor primario, bien sea benigno o maligno. El carcinoma de pulmón es un receptor poco habitual, pero uno de los donantes más frecuentes. En el presente articulo presentamos tres casos de MTT como órgano receptor el pulmón: el primero, de una mujer con antecedente de carcinoma papilar de tiroides y carcinoma ductal in situ de la mama, con presencia de MTT y carcinoma papilar de tiroides a un adenocarcinoma primario pulmonar. El segundo caso, es una mujer con MTT de carcinoma ductal de mama a un adenocarcinoma primario pulmonar. Y el tercero, de un MTT de un carcinoma ductal de mama a un hamartoma pulmonar. En los tres casos, fue fundamental la correlación clínico-patológica y los estudios complementarios de inmunohistoquímica.

Tumor-to-tumor metastases (TTM) correspond to a rare event in which a primary tumor metastasizes to another primary tumor, whether benign or malignant. Lung carcinoma is an unusual recipient, but one of the most frequent donors. In this article, we present three cases of TTM to the lung: the first one is of a woman with a history of papillary thyroid carcinoma and ductal carcinoma in situ of the breast, with the presence of TTM and papillary thyroid carcinoma to a primary adenocarcinoma of the lung. The second case is of a woman with TTM from ductal carcinoma of the breast to a primary pulmonary adenocarcinoma, and the third is TTM from a breast ductal carcinoma to a pulmonary hamartoma. In all three cases, the clinical-pathological connection and complementary immunohistochemical studies were essential

KRAS Promoter Methylation Status and miR-18a-3p and miR-143 Expression in Patients With Wild-type KRAS Gene in Colorectal Cancer.

BACKGROUND/AIM: Although some mutations of KRAS proto-oncogene, GTPase (KRAS) have been associated with the prognosis and therapeutic management of colorectal cancer (CRC), the epigenetic mechanisms (DNA methylation and microRNA expression) that regulate wild-type KRAS expression in patients with CRC are poorly known. The aim of this study was to establish whether there is a relationship between the expression of the wild-type KRAS gene, the methylation status of its distal promoter, and miR-143 and miR-18a-3p levels in samples of sporadic CRC. PATIENTS AND METHODS: A total of 51 cases of sporadic CRC with wild-type KRAS were analyzed. The expression levels of KRAS mRNA, miR-18a-3p, miR-143, and KRAS protein, as well as methylation in the distal promoter of the KRAS gene were evaluated. RESULTS: In the analyzed cases, KRAS mRNA expression was detected in 51.1%; wild-type KRAS protein was found in the membrane in 31.4% and in the cytoplasm in 98% of cases. An inverse relationship of marginal significance was observed between miR-18a-3p and KRAS protein expression in the cytoplasm (odds ratio=0.14, 95% confidence interval=0.012-1.092; p=0.08). The methylation status of the distal promoter of KRAS at four CpG islands was analyzed in 30 cases (58.8%): partial methylation of the four CpG islands evaluated was observed in two cases (6.7%). In these cases, KRAS protein expression was not evidenced at the membrane level; miR-18a-3p expression was not detected either but high expression of miR-143 was observed. CONCLUSION: No association was found between the expression levels of KRAS mRNA, miR-18a-3p, miR-143 and methylation status. Methylation status was detected with low frequency, thus being the first report of methylation in wild-type KRAS.

Synchronous or collision solid neoplasms and lymphomas: A systematic review of 308 case reports.

BACKGROUND: The presence of a lymphoma associated with a solid synchronous neoplasm or collision neoplasm has been rarely in the literature, and a detailed characterization of these cases is lacking to date. OBJECTIVE: To describe the main clinicopathological features of synchronous/collision tumors. METHODS: A systematic search in PubMed, Scielo, and Virtual Health Library literature databases for cases or case series of synchronous or collision lymphoma and other solid neoplasms reported up to March 2021 was performed. Three reviewers independently screened the literature, extracted data, and assessed the quality of the included studies. The systematic review was performed following the Preferred Reporting Items for Systematic Meta-Analyses guidelines. RESULTS: Mean age of patients was 62.9 years (52.9% men). A total of 308 cases were included (62% synchronous and 38% collision). The most frequent location of both synchronous and collision tumors was the gastrointestinal tract with the most common solid neoplasm being adenocarcinoma, and the most frequent lymphoma diffuse large B-cell lymphoma (21.7%) and mucosa-associated lymphoid tissue lymphoma (20.4%). Of the total number of mucosa-associated lymphoid tissue lymphomas and gastric adenocarcinomas, the presence of Helicobacter pylori infection was documented in 47.3% of them. Only 2% of all cases had a previous history of lymphoma. Thus, in most cases (98%), lymphoma was discovery incidentally. In addition, nodal lymphoma was associated with metastasis in 29 (9.4%) cases as collision tumor, most commonly (90%) in locoregional lymph nodes of the solid neoplasm. CONCLUSIONS: The frequent association of some type of B-cell lymphoma and adenocarcinoma in synchronous/collision tumors of the gastrointestinal tract points to common pathogenic mechanisms in both neoplasia, particularly related to chronic inflammation in this location. In most cases, lymphoma identified in locoregional lymph nodes or distant of a carcinoma seems to represent an incidental finding during the carcinoma diagnostic/therapeutic approach. A synergy between carcinoma and lymphoma (involving inflammation and immunosuppression mechanisms) may favor tumor progression and dissemination. A better understating of the interactions lymphoma/carcinoma in the setting of synchronous/collision tumors may help to improve patient management and prognosis.

Transoral robotic resection of unusual spindle cell/pleomorphic lipoma of the larynx.

Spindle cell/pleomorphic lipoma (SC/PL) is a subcutaneous mass usually localised on nape, shoulder or upper back. It is a benign lipogenic tumour composed of primitive CD34-positive spindle cells, floret-like multinucleated giant cells and mature adipocytes. Complete surgical excision is the optimal treatment. This unusual tumour in the larynx has only been reported in the medical literature once and was treated surgically by open approach. Actually, transoral robotic surgery (TORS) is most suitable because provides tridimensional magnified view plus a greater mobility with instruments, allowing complete and safe removal of the supraglottic mass, allowing rapid healing and recovery. We present the first case of a SC/PL of larynx managed with TORS. Four hours after surgery, the patient was able to take a soft diet and was discharged 2 h later. The follow-up showed an excellent clinical and functional outcome.

hTERT Protein Expression in Cytoplasm and Nucleus and its Association With HPV Infection in Patients With Cervical Cancer.

BACKGROUND: Few studies have analyzed the association between human telomerase reverse transcriptase (hTERT) protein expression (nuclear and cytoplasmic localization), hTERT methylation status, and human papillomavirus (HPV) genotype infection in cervical cancer. PATIENTS AND METHODS: One hundred seventy-three patients with cervical cancer were analyzed. hTERT protein expression was detected by immunohistochemistry. hTERT DNA methylation analysis was performed using a PCR-RLB-hTERT assay, targeting two regions of the hTERT promoter. Type specific HPV infection was detected by using GP5+/GP6+PCR-RLB. RESULTS: hTERT protein expression was found in both cytoplasm and nucleus (78.0% of the samples showed a cytoplasmic localization and 79.8% had a nuclear localization). A statistically significant association was found between alpha 9 and 7 HPV species with a non-methylation pattern of the hTERT promoter and between these species and high expression of hTERT protein with nuclear localization. CONCLUSION: hTERT protein is found in both the nucleus and cytoplasm of patients with cervical cancer and confirm the relationship between the non-methylated status of hTERT promoter and some HPV species as well as the relationship between these species and hTERT protein expression.

Persistent High-Risk HPV Infection and Molecular Changes Related to the Development of Cervical Cancer.

This article is a preliminary investigational study that is aimed at giving hints about the interesting biomarkers involved in the transition process from low-grade cervix lesion to invasive cervical cancer. Our study focuses on the risk factors and tumour molecular changes in one patient. First in 1986, she was diagnosed a preinvasive cervix lesion. Then, 16 years later, she was diagnosed an invasive cervical cancer. The 2002 diagnosis was a squamous cell carcinoma of the cervix, stage IIIB (FIGO), whereas in 1986, she had been diagnosed a high-grade squamous intraepithelial cervical lesion. Retrospectively, the analysis of samples of preneoplastic lesions and invasive cervical cancer confirmed the histopathological diagnoses and detected the presence of HPV type and HPV-16 variants, as well as the overexpression of proteins such as hTERT, IGF1Rα, IGF1Rß, CAIX, and GLUT1. Finally, the Arg72Pro polymorphism was detected in TP53. The role of high-risk HPV and HPV-16 variants and of hTERT, IGF1Rα, IGF1Rß, CAIX, and GLUT1 variations seemed confirmed in the development and progression of cervical cancer. As a result, analyzing the molecular changes in one and same tumour that progresses from a low-grade cervix lesion to invasive cervical cancer could provide valuable information in order to improve detection, diagnosis, and treatment in the future.

Advantages of the 99mTc-sestamibi Single-Photon Emission Computed Tomography/Computed Tomography in Occult Parathyroid Adenoma and Concomitant Thyroid Papillary Carcinoma.

Hyperparathyroidism and concurrent thyroid nodular disease are prominent. In contrast, concomitant papillary thyroid cancer and hyperparathyroidism are uncommon (1%-2%). Parathyroid adenomas in unusual locations are difficult to detect by conventional diagnostic imaging. 99mTc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) has increased the localizing success rate of these lesions since it provides specific functional and anatomical information, improving exploratory parathyroid surgery planning and decreasing operative time, unnecessary dissections, complications, and morbidity. We confirmed its usefulness in a patient with an occult parathyroid adenoma that was clearly identified by 99mTc-sestamibi SPECT/CT 2 weeks after a thyroidectomy for papillary carcinoma. The SPECT/CT results allowed us to successfully perform efficient reexploration of the thyroid bed, in a retroesophageal parathyroid adenoma by minimally invasive surgery.

Single Photon Emission Computed Tomography/Computed Tomography Detects a Second Ignored Intrathyroidal Parathyroid Adenoma.

The primary hyperparathyroidism (PHPT) is a result of high levels of parathyroid hormone and serum calcium, the most frequent cause is a solitary parathyroid adenoma. Double parathyroid adenoma is <5% of the PHPT. Intrathyroidal parathyroid adenoma (IPA) occurs< 3.2%. We present a case of 58-year-old female with persistent primary hyperparathyroidism due to a second undetected IPA, suspected by ultrasound and confirmed by 99mTc sestamibi single-photon emission computed tomography/computed tomography.

Neuroendocrine neoplasms of gastrointestinal tract and secondary primary synchronous tumors: A systematic review of case reports. Casualty or causality?

BACKGROUND: Neuroendocrine neoplasms (NENs) can arise in most of the epithelial organs of the body and are not a rare condition in the gastrointestinal tract (GIT). The presence of NENs in GIT associated with other secondary primary malignancies (SPM) has been considered an exotic event. This study aims to describe the case reports of NENs accompanied by synchronous primary tumors. METHODS AND FINDINGS: We performed a systematic literature search of the databases Scopus, PubMed, Scielo and LILACS to identify case reports that described the presence of NENs in GIT with SPM. 78 case reports were included. The mean of age of the cases was 60.2 years. 60% were male. 95.4% were NENs G1. 17 cases of NENs had metastasis. 80% of SPM were recognized in the GIT (36% in stomach, 27% in large intestine, 11.2% in small intestine, and 5.6% in esophagus). The most common type of SPM was adenocarcinoma (49.4%), followed by GIST (13.5%), other NENs in different GIT segment (7.9%), lymphoma (6.8%), and squamous cell carcinoma (4.5%). The most common tumor in GIT was adenocarcinoma (97.6%) and the presence of adenocarcinoma in the same segment of GIT was found in 68.4% of the cases. Association between adenocarcinomas and NENs in GIT (p:<0.0001) and adenocarcinoma and tumor in the same segment of GIT location were observed (p<0.001). CONCLUSION: These results demonstrate that NENs with SPM are not a rare condition. Several theories have been proposed to explain this association; one of these is the ability of NENs to generate synchronous tumors by autocrine and paracrine effect. We observed an association between adenocarcinomas and NENs in the same segment of GIT.

Transoral robotic surgery for oncocytic ductal cyst of hypopharynx: a lesion with a high probability of recurrence.

Hypopharyngeal cysts are very uncommon pathology. They are presented in adult people over 60 years. Although oncocytic cysts are benign tumors, an incomplete resection causes recurrence. The symptoms are not specific, but the more frequent are dyspnea and foreign body sensation upon swallowing. Diagnosis usually is under general anesthesia during intubation. A flexible fiberoptic laryngoscopy could be insufficient; the trumpet maneuver during this examination can reveled occult cysts. To perform a total resection, the surgeon must have a complete exposition of the operative field. We present a new case of a patient with a symptomatic hypopharyngeal cyst successfully treated with transoral robotic extirpation; our view was tridimensional magnified and the robotic instruments provided great range of movement that permitted complete and safe removal hypopharyngeal lesion.

Reportes y series de casos en patología: una mirada más allá de la H&E / Reports and case series on pathology: a look beyond the H & E

Los primeros reportes y series de casos en patología aparecen en la medicina egipcia en los papiros de Edwin Smith (siglo 17 AC) y de Ebers (alrededor de 1550 AC). Desde aquellos tiempos pasando por Hipócrates, Aristóteles, Avicena, Harvey, Morgani y Virchow, entre otros ilustres médicos, el patólogo ha descrito sus observaciones a través de reportes y series de casos. Esta contribución científica ha sido fundamental en el desarrollo de la medicina moderna y de la investigación básica aplicada a la clínica A lo largo del tiempo estas publicaciones han sido y serán una fuente de educación para informar enfermedades nuevas o reclasificar entidades previamente descritas en términos de nuevas clasificaciones, las cuales han cambiado basadas en el comportamiento biológico o en nuevos hallazgos de la biología molecular o la genética. El objetivo de estos estudios es comunicar sobre la evaluación, el diagnóstico, el tratamiento y el pronóstico de las enfermedades, e incluso mejorar muchos aspectos de la educación médica. Por definición los reportes y series de casos se encuentran dentro de los estudios observacionales y descriptivos. Para definir uno como serie de casos tiene que incluir más de 6 pacientes, es decir que con 5 menos se clasifica como artículo de reporte de casos. Se ha propuesto diferentes niveles de evidencia de la literatura médica enfocado a patología.

«Tumor to tumor metástasis». Un evento poco frecuente. A propósito de un carcinoma renal metastásico a un carcinoma papilar de tiroides / 'Tumour to tumour metastasis': A rare event. Case report of a metastasic renal carcinoma in a papillary carcinoma of the thyroid

La presencia de un tumor metastásico a otro tumor es un evento poco frecuente denominado como «tumor to tumor metástasis». Uno de los principales tumores receptores es el carcinoma renal de células claras (CRCC), y de hecho se conoce que afecta a la glándula tiroides; sin embargo, la coexistencia de un tumor primario de glándula tiroides con metástasis de un CRCC es un hallazgo poco frecuente. Nosotros presentamos el que podría corresponder al cuarto caso reportado en la literatura de un CRCC asociado a un carcinoma papilar de tiroides. Se revisa adicionalmente los casos previamente publicados (AU)

The presence of metastatic tumour in another tumour is an infrequent event called tumor-to-tumor metastasis. One of the main recipients tumours is renal clear cell carcinoma (RCCC) which is known to affect the thyroid gland; however, RCCC metastases in a primary tumour of the thyroid are rare. We present a case of RCCC associated with a papillary thyroid carcinoma which is, to our knowledge, only the fourth reported case to date. In addition we review the previously published cases (AU)

Diferencias y controversias entre el reporte de patología y la interpretación clínica en patología tiroidea. I parte: Factores pronósticos / Thyroid pathology: differences and controversies between the pathology report and clinical interpretation. Part I: prognostic factors

Resumen El cáncer de la glándula tiroides es una neoplasia cuya detección, diagnóstico y tratamiento se realiza de manera interdisciplinaria, por lo tanto el diagnóstico definitivo histopatológico debe ser completo y claro; de modo que pueda ser interpretado de la misma manera por parte del grupo médico tratante. De manera frecuente, los médicos no patólogos que reciben el reporte de un estudio histopatológico de tiroides se enfrentan con dificultades al momento de interpretar el reporte histopatológico y，por lo tanto, en definir la posterior conducta médica. El objetivo de este primer artículo es revisar de manera breve algunos de los diferentes temas que más generan dudas en la interpretación del reporte histopatológico y de las técnicas diagnósticas usadas en patología por parte de los médicos tratantes que tienen un impacto en las decisiones clínicas originadas a partir de la clasificación, estadificación, pronóstico y seguimiento de la enfermedad.

Abstract Cancer of the thyroid gland is a neoplasia for which its detection, diagnosis and treatment is interdisciplinary. For this reason, the definitive diagnosis by histopathology should be complete and clear so that it can be interpreted in the same way by the treating medical group. Non-pathology physicians who receive the report of a histopathological study of the thyroid often have difficulties when interpreting the report and therefore in defining the subsequent medical behaviour. The objective of this first article is to review briefly some of the different subjects that generate most doubts in the interpretation of the histopathology report, and the diagnostic techniques used in pathology by the attending physicians that have an impact on clinical decisions arising from the classification, staging, prognosis, and follow-up of the disease.

Gliomas tipo astrocytoma pilocítico "atípico recurrente" y gen B-RAF: presentación de caso clínico, discusión / Glioma type pilocytic astrocytoma "atypical recurrent" and gen BRAF: Clinical case presentation, discussion

RESUMEN El astrocitoma pilocítico (AP) es una neoplasia bien diferenciada, grado I OMS,que predomina en la infancia y es raro en la población adulta. Se reportan casos atípicos con una biología tumoral agresiva que continúan preservando la histología benigna o se transforman hacia gliomas de alto grado. Algunos estudios genéticos en esté subtipo de tumor referencian la activación de la vía MAPK/ERK a través de cambios en el gen BRAF. El objetivo del grupo es presentar un caso clínico representativo de un AP con evolución "atípica" y realizar una revisión actualizada desde la biología, genética, las posibilidades terapéuticas emergentes y exponer las controversias del tratamiento desde lo quirúrgico y las terapias complementarias.

SUMMARY The pilocytic astrocytoma (PA), formerly referred to as juvenile pilocytic astrocytomas, are WHO grade I tumors, that commonly occur during childhood and rarely in the adult population. Genetic studies of this tumor report an activation of the MAPK / ERK pathway through changes in the BRAF gene. The aim of this article is to report a series of atypical PA cases with an aggressive tumor biology that continue preserving the benign histology or transformed into high-grade gliomas, and review the biology, genetics, and emerging therapeutic possibilities for these cases. And finally expose controversies from the surgical treatment and complementary therapies.

Novel predictive biomarkers for cervical cancer prognosis.

High hypoxic, glycolytic and acidosis metabolisms characterize cervical cancer tumors and have been described to be involved in chemoradioresistance mechanisms. Based on these observations, the present study assessed four selected novel biomarkers on the prognosis of locally advanced cervical carcinoma. A total of 66 patients with stage IIB/IIIB cervical cancer were retrospectively included. The protein expression levels of glucose transporter 1 (GLUT1), carbonic anhydrase 9 (CAIX) and hexokinase 1 (HKII) were investigated by immunohistochemistry on tumor biopsies, hemoglobin was measured and the disease outcome was monitored. A total of 53 patients (80.3%) presented a complete response. For these patients, the protein expression levels of GLUT1, CAIX and HKII were overexpressed. A significant difference was observed (P=0.0127) for hemoglobin levels (≤11 g/dl) in responsive compared with non-responsive patients. The expression of GLUT1 is associated with a lower rate of both overall and disease-free survival, with a trend of decreased risk of 1.1x and 1.5x, respectively. Co-expression of GLUT1 and HKII is associated with a decreased trend risk of 1.6x for overall survival. Patients with hemoglobin levels ≤11 g/dl had a 4.3-fold risk (P=0.02) in decreasing both to the rate of overall and disease-free survival. The presence of anemic hypoxia (hemoglobin ≤11 g/dl) and the expression of GLUT1 and/or HKII influence treatment response and are associated with a lower overall and disease-free survival. The present results demonstrated that these biomarkers may be used as predictive markers and suggested that these metabolic pathways can be used as potential novel therapeutic targets.

Linfoma leptomeníngeo primario. Reporte de tres casos y revisión de la literatura / Primary leptomeningeal lymphoma. Report of three cases and review of the literature

El linfoma leptomeníngeo primario (LLMP) es una entidad con baja frecuencia de presentación, representa del 1% al 2,4% de los linfomas primarios del sistema nervioso central; las variedades histológica más observadas son el linfoma de la zona marginal tipo MALT, el linfoma B de célula grande difuso y el linfoma linfoblástico de células B. La localización y su extensión determinan las manifestaciones clínicas; en radiología se prefieren las imágenes con medios de contraste, ya que tienden a confundirse con meningiomas como la primera impresión diagnóstica y son la cirugía y los estudios de patología los que confirman el diagnóstico. La quimioterapia es la base del tratamiento en esta entidad, la radioterapia se deja como una opción secundaria. El propósito de este trabajo es presentar tres casos clínicos representativos de LLMP y las variantes por imágenes de radiología, la revisión enfocada de la literatura y el tratamiento de esta infrecuente patología.

Primary Leptomeningeal lymphmoma (PLML) is a low frequency neoplasm representing 1% to 2,4% of primary lymphomas of the central nervous system (CNS). The most frequent histological variety is the extranodal marginal zone lymphoma (MALT lymphoma), but other variants are reported such as diffuse large cell B-cell lymphoma (DLBCL). The location and extent determine the clinical manifestations. In radiology, images with contrast are preferred to difference from meningiomas which are the main differential diagnosis; nevertheless surgery and histology confirm the diagnosis. Chemotherapy is the mainstay of treatment and radiation therapy is a secondary alternative. The purpose of this paper is to present three cases of PML, the radiological variants and to conduct a focused literature review with treatment of this pathology.