Immunohistochemical assessment of symptomatic postmenopausal endometrial polyps in tamoxifen users and nonusers: a case control study.

BACKGROUND: Endometrial polyps are common in postmenopausal women, and the effect of tamoxifen use (a risk factor for endometrial polyps) on their pathogenesis is unclear. OBJECTIVES: To evaluate the expression of hormone receptors and markers for proliferation/apoptosis (Ki-67 and Bcl-2) in endometrial polyps in postmenopausal users and nonusers of tamoxifen. DESIGN AND SETTING: Cross-sectional analytical study in a tertiary-level academic hospital. METHODS: 46 women (14 tamoxifen users and 32 nonusers) with postmenopausal bleeding underwent hysteroscopic resection of endometrial polyps. Polyp samples were immunohistochemically assessed for detection of Ki-67, Bcl-2 and estrogen and progesterone receptors. RESULTS: Analysis on the glandular component of the polyps revealed progesterone receptor expression in the polyps of 96.9% of the nonusers of tamoxifen, and 92.3% of the tamoxifen users (P = 0.499). All polyps in nonusers and 92.3% of those in users were also positive for estrogen receptors (P = 0.295). Ki-67 was expressed in 75% of the polyps in the tamoxifen users and 82.8% of those in the nonusers. All endometrial polyps expressed Bcl-2. CONCLUSIONS: The immunohistochemical analysis on endometrial polyps demonstrated that, although tamoxifen is considered to be a risk factor for endometrial polyps, there were no significant differences in the expression of hormone receptors between users and nonusers of tamoxifen. There were no between-group differences in Ki-67 and Bcl-2 expression, and all patients displayed inhibition of apoptosis by Bcl-2, thus supporting the theory that polyps develop due to inhibition of apoptosis, and not through cell proliferation.

Immunohistochemical assessment of symptomatic postmenopausal endometrial polyps in tamoxifen users and nonusers: a case control study

ABSTRACT BACKGROUND: Endometrial polyps are common in postmenopausal women, and the effect of tamoxifen use (a risk factor for endometrial polyps) on their pathogenesis is unclear. OBJECTIVES: To evaluate the expression of hormone receptors and markers for proliferation/apoptosis (Ki-67 and Bcl-2) in endometrial polyps in postmenopausal users and nonusers of tamoxifen. DESIGN AND SETTING: Cross-sectional analytical study in a tertiary-level academic hospital. METHODS: 46 women (14 tamoxifen users and 32 nonusers) with postmenopausal bleeding underwent hysteroscopic resection of endometrial polyps. Polyp samples were immunohistochemically assessed for detection of Ki-67, Bcl-2 and estrogen and progesterone receptors. RESULTS: Analysis on the glandular component of the polyps revealed progesterone receptor expression in the polyps of 96.9% of the nonusers of tamoxifen, and 92.3% of the tamoxifen users (P = 0.499). All polyps in nonusers and 92.3% of those in users were also positive for estrogen receptors (P = 0.295). Ki-67 was expressed in 75% of the polyps in the tamoxifen users and 82.8% of those in the nonusers. All endometrial polyps expressed Bcl-2. CONCLUSIONS: The immunohistochemical analysis on endometrial polyps demonstrated that, although tamoxifen is considered to be a risk factor for endometrial polyps, there were no significant differences in the expression of hormone receptors between users and nonusers of tamoxifen. There were no between-group differences in Ki-67 and Bcl-2 expression, and all patients displayed inhibition of apoptosis by Bcl-2, thus supporting the theory that polyps develop due to inhibition of apoptosis, and not through cell proliferation.

Main prognostic and predictive immunohistochemical factors in breast cancer: a retrospective cohort study

Introduction: Breast cancer is a constant focus of studies on prevention and treatment. Immunohistochemistry is a useful tool for defining the conducts toward the treatment of this disease. Objective: To evaluate patients' survival according to prognostic and predictive immunohistochemical factors. Method: This is a retrospective cohort study. Medical reports of 787 patients were analyzed, which contained parts of surgical specimens of the mastectomy or quadrantectomy procedures. A total of 404 patients were eligible for the study. Results: The mean age at diagnosis of the disease was 55.4 years. The main diagnosis was infiltrating ductal carcinoma (80.7%). Of the total, 45% of the patients had tumors of up to 2 cm in diameter, and 32.9% had lymph node involvement. Among the patients, and according to luminal molecular classification, 48.3% were classified as luminal A, 27% were luminal B, 12.1% were recipient of human epidermal growth factor type 2 (HER2), and 12.6% were triple-negative. Furthermore, of 23.3% patients with tumor recurrence, 12.6% of them died. The 1% increase in Ki-67 values increases the risk of death and recurrence by 2% and 1%, respectively. The presence of lymph node metastasis increases, on average, 4.78 times and 2.63 times the risk of death and recurrence, respectively. Conclusion: The triple negative molecular classification had the lowest overall survival and the greatest risk of recurrence. The luminal A classification presented the best prognosis. Tumor size, lymph node metastasis, skin invasion, and presence of Ki-67 were shown to be the prognostic and predictive factors that most influenced the patients' survival.

Differential diagnosis of mesenchymal neoplasms of the digestive tract by cell block and immunohistochemistry.

OBJECTIVES: To evaluate the diagnostic yield of the cell block (CB) technique with immunohistochemistry in patients with mesenchymal neoplasms of the gastrointestinal tract collected by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). METHODS: Tissue samples from consecutive patients with subepithelial lesions collected by EUS-FNA, without analysis by on-site cytopathology, were evaluated by the same pathologist only using CBs in AAF fixative. Sections were stained with haematoxylin-eosin and underwent complementary immunohistochemical staining for SMA, CD117, DOG-1 and S100 in the presence of mesenchymal neoplasms. Specimens were defined as diagnostic when sufficient tissue was present for histopathological evaluation and immunohistochemistry analysis. If they were insufficient for complete evaluation, the specimens were considered nondiagnostic. RESULTS: Between September 2012 and December 2016, a total of 158 patients (median age: 57 years, 64.5% women) underwent EUS-FNA with an average of three needle passes for every lesion. The median lesion size was 17 mm. There were 113 mesenchymal neoplasms confirmed by immunohistochemistry (66 leiomyomas, 44 GISTs, two schwannomas, one leiomyosarcoma). The overall diagnostic yield of CBs was 84.17%. However, diagnosis was obtained in 98.5% (133/135) of the cases after exclusion of 23 cases in which EUS-FNA sampling was insufficient or without tumoural tissue. Only two mesenchymal neoplasms were not confirmed by CBs even after immunohistochemistry. CONCLUSIONS: CBs collected by EUS-FNA and analysed by immunohistochemistry showed a high diagnostic yield in patients with mesenchymal neoplasms, even without on-site cytopathology.

Analysis of pattern of occurrence of thyroid carcinoma between 2001 and 2010 / Análise do padrão de ocorrência do carcinoma de tireoide entre 2000-2010

ABSTRACT INTRODUCTION: An ongoing discussion is found in medical literature about the reasons for changes in thyroid carcinoma incidence patterns over the last decades. OBJECTIVE: To analyze the clinical and pathological characteristics of thyroid carcinoma cases over a decade. METHODS: Cross-sectional study over an historical cohort. Medical records of 628 thyroid cancer cases in a single center were reviewed. 597 patients were included. Microcarcinoma cases were selected for a qualitative analysis phase, in which medical records were reviewed for better understanding of thyroid nodule and thyroid cancer diagnosis process. RESULTS: An increase in the proportion of cases with thyroid cancer diagnosis was observed throughout the decade; new cases were predominantly tumors of less than 2 cm, with histopathological signs of low aggressiveness. There was an increase in proportion of cases with malignant cytological results among microcarcinomas. CONCLUSION: There is a trend for increase in thyroidectomies due to cancer in this institution, with proportional increment of cases with histopathological characteristics indicative of early disease. Among microcarcinomas, there is an increasing group represented by cancer cases that were not incidentally diagnosed, related to an enhancement in preoperative diagnostic methods.

RESUMO Introdução: Persiste uma discussão na literatura sobre as razões para as mudanças no padrão de incidência do carcinoma de tireoide nas últimas décadas. Objetivo: Analisar as características clinicopatológicas dos casos de carcinoma de tireoide ao longo de uma década. Método: Estudo transversal sobre uma coorte histórica. Os registros médicos de 628 casos de câncer de tireoide de um único centro foram revisados. Foram incluídos 597 pacientes. Os casos de microcarcinoma foram selecionados para uma fase de análise qualitativa, na qual os registros médicos foram revisados para melhor entendimento do processo de diagnóstico do nódulo e do câncer. Resultados: Observamos um aumento na proporção de casos com diagnóstico de câncer de tireoide ao longo da década; os novos casos foram predominantemente de tumores < 2 cm, com sinais histopatológicos de baixa agressividade. Houve aumento na proporção de casos com resultado citológico maligno entre os microcarcinomas. Conclusão: Há uma tendência de crescimento nas tireoidectomias por câncer na nossa instituição, com incremento proporcional de casos com características histopatológicas indicativas de doença precoce. Entre os microcarcinomas, há um grupo em ascensão representado por casos com diagnóstico não-ocasional de câncer, relacionados à melhora dos métodos diagnósticos pré-operatórios.

Analysis of pattern of occurrence of thyroid carcinoma between 2001 and 2010.

INTRODUCTION: An ongoing discussion is found in medical literature about the reasons for changes in thyroid carcinoma incidence patterns over the last decades. OBJECTIVE: To analyze the clinical and pathological characteristics of thyroid carcinoma cases over a decade. METHODS: Cross-sectional study over an historical cohort. Medical records of 628 thyroid cancer cases in a single center were reviewed. 597 patients were included. Microcarcinoma cases were selected for a qualitative analysis phase, in which medical records were reviewed for better understanding of thyroid nodule and thyroid cancer diagnosis process. RESULTS: An increase in the proportion of cases with thyroid cancer diagnosis was observed throughout the decade; new cases were predominantly tumors of less than 2 cm, with histopathological signs of low aggressiveness. There was an increase in proportion of cases with malignant cytological results among microcarcinomas. CONCLUSION: There is a trend for increase in thyroidectomies due to cancer in this institution, with proportional increment of cases with histopathological characteristics indicative of early disease. Among microcarcinomas, there is an increasing group represented by cancer cases that were not incidentally diagnosed, related to an enhancement in preoperative diagnostic methods.

Papillary thyroid carcinoma: does the association with Hashimoto's thyroiditis affect the clinicopathological characteristics of the disease? / Carcinoma papilífero da tireoide: a associação com tireoidite de Hashimoto influencia nas características clínico-patológicas da doença?

INTRODUCTION: Papillary carcinoma is the most common malignant thyroid neoplasm. The effect of the concurrent presence of Hashimoto's thyroiditis and papillary thyroid carcinoma remains controversial. OBJECTIVE: To evaluate the association between Hashimoto's thyroiditis and clinicopathological parameters in thyroid papillary carcinoma cases, based on an historical institutional cohort analysis. METHODS: Cross-sectional study obtained from a historical cohort, including all cases submitted to thyroidectomy for papillary thyroid carcinoma in a single institution during an 11-year period study. RESULTS: A total of 417 patients with papillary thyroid carcinoma were enrolled; 148 (35.4%) also had Hashimoto's thyroiditis. A female predominance among cases associated to Hashimoto's thyroiditis was observed. The thyroid tumor, in cases associated with Hashimoto's thyroiditis, had a smaller mean diameter, lower frequency of extra-thyroid extension, and earlier clinicopathological staging. CONCLUSIONS: A high proportion of papillary thyroid carcinoma cases are associated with Hashimoto's thyroiditis. There are associations among these cases with several histopathological factors already recognized for their prognostic value, which by themselves could impact outcomes. .

INTRODUÇÃO: O carcinoma papilífero é a neoplasia maligna mais comum da tireóide. O efeito da coexistência da tireoidite de Hashimoto (TH) no prognóstico do carcinoma papilífero da tireóide (CPT) permanece controverso. OBJETIVO: Avaliar a associação entre TH e parâmetros clínico-patológicos entre pacientes com diagnóstico de carcinoma papilífero da tireóide obtidos através da análise de uma série histórica institucional. MÉTODO: Coorte transversal com base em uma coorte histórica, envolvendo todos os casos submetidos à tireoidectomia total por motivo de carcinoma papilífero, realizadas na mesma Instituição ao longo de 11 anos. RESULTADOS: Um total de 417 pacientes foram incluídos no estudo, estando 148 (35,4%) associados à TH. Observamos preponderância de mulheres entre os casos associados à TH. Esses casos se apresentaram com menor média de diâmetro tumoral, menor frequência de comprometimento extra-tireoidiano e estadiamento clínico-patológico mais precoce. Conclusões: Um percentual expressivo de casos de CPT apresenta-se associado à TH. A associa ção entre esses casos com vários fatores histopatológicos já reconhecidos por seu valor prognóstico, pode, por si só, influenciar no desfecho desses pacientes. .

Papillary thyroid carcinoma: does the association with Hashimoto's thyroiditis affect the clinicopathological characteristics of the disease?

INTRODUCTION: Papillary carcinoma is the most common malignant thyroid neoplasm. The effect of the concurrent presence of Hashimoto's thyroiditis and papillary thyroid carcinoma remains controversial. OBJECTIVE: To evaluate the association between Hashimoto's thyroiditis and clinicopathological parameters in thyroid papillary carcinoma cases, based on an historical institutional cohort analysis. METHODS: Cross-sectional study obtained from a historical cohort, including all cases submitted to thyroidectomy for papillary thyroid carcinoma in a single institution during an 11-year period study. RESULTS: A total of 417 patients with papillary thyroid carcinoma were enrolled; 148 (35.4%) also had Hashimoto's thyroiditis. A female predominance among cases associated to Hashimoto's thyroiditis was observed. The thyroid tumor, in cases associated with Hashimoto's thyroiditis, had a smaller mean diameter, lower frequency of extra-thyroid extension, and earlier clinicopathological staging. CONCLUSIONS: A high proportion of papillary thyroid carcinoma cases are associated with Hashimoto's thyroiditis. There are associations among these cases with several histopathological factors already recognized for their prognostic value, which by themselves could impact outcomes.

Predictive factors for lymph node metastasis in solitary papillary thyroid carcinomas: a retrospective study.

Identifying risk factors for neck lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) is important for patient prognosis establishment. We conducted a retrospective study among 317 patients with solitary PTC. Factors associated with clinically evident LNM were evaluated. LNM were identified in 69 (21.7%) patients. Central compartment (17.3%) and lateral compartment (9.4%) were involved. Thyroid capsule invasion and extrathyroidal extension were found to be independent risk factors for both central and lateral compartment metastasis in multivariate analysis. Larger diameter was associated with central compartment metastasis in logistic regression model, whereas male gender only with lateral compartment metastasis. As closer tumors were positioned in relation to glandular capsule we expected rising rates of nodal spread. It was unlikely to find clinically evident neck LNM among patients with centrally located tumors.

Mesenchymal stem cells and nanofibers as scaffolds for the regeneration of thyroid cartilage.

OBJECTIVES/HYPOTHESIS: The aim of this study has been to establish an alternative approach in the form of regeneration of the thyroid cartilage. STUDY DESIGN: Four 1-month old pigs (Sus scrofa) were used (divided into 3 groups) and submitted to general anesthetic to perform cervictomy with exposure of the thyroid cartilage in a total of 12 (twelve) samples. METHOD: A resection of 4.0 cm(2) of cartilage was carried out in the right upper region and in the left upper and lower left region of the cartilage, where a scaffold with or without stem cells was implanted. In the left lower region, no biomaterial was implanted and the defect was left open (lesion control [L]). RESULTS: The average extension of the cartilaginous neoformation of L group was 136.3 µm (± 9.6) and 387.7 µm (± 43.2) in the scaffold (SCA) group, presenting a significant statistical difference (P < 0.01). The analysis carried out on the lesion site sections of the cartilage of the larynx of the animals from the SCA group + mesenchymal stem cells (SCA+MSC) showed an average of the extension of neocartilage of 825.4 µm (± 122.1), showing a more extensive area of neocartilage when compared to the other groups. These results demonstrated a high significantly statistical difference (P < 0.001) when compared with the L and SCA groups. CONCLUSION: In 100% of the cases for which SCA+MSCs were used, a significant success in the cartilage growth and closing of the lesion in the thyroid cartilage was obtained compared to the other two groups for which MSCs were not used. LEVEL OF EVIDENCE: N/A.

Variantes do carcinoma papilifero da tireoide: associacao com fatores prognosticos histopatologicos / Variants of papillary thyroid carcinoma: association with histopathological prognostic factors

O carcinoma papilífero é a malignidade tireoidiana mais comum. Muitas variantes desse tumor foram descritas, com diferentes características morfológicas e moleculares. Embora a maioria dos casos apresente um excelente prognóstico, a relação entre a arquitetura tumoral e o comportamento biológico dessas neoplasias ainda permanece controversa. OBJETIVO: Apresentamos a experiência de um único serviço acerca da prevalência das variantes do carcinoma papilífero da tireoide e sua relação com os demais fatores prognósticos histopatológicos. MÉTODO: Estudo retrospectivo envolvendo todos os casos submetidos à tireoidectomia por carcinoma papilífero na mesma Instituição ao longo de 11 anos de estudo. RESULTADOS: Foram incluídos 517 pacientes, sendo 81,9% dos casos representados mulheres. A média de idade foi de 47,2 anos. As variantes reconhecidas por terem maior potencial de agressividade corresponderam a 5,6% da amostra. Observamos associação desses subtipos tumorais com maior diâmetro da lesão, estadiamento T, invasão linfovascular e da cápsula da glândula. CONCLUSÃO: Um pequeno percentual de casos de carcinomas papilíferos é representado por variantes reconhecidas por seu maior potencial de agressividade. Existem associações entre essas variantes e diversos outros fatores histopatológicos já reconhecidos por seu valor prognóstico, o que pode, por si, só influenciar no desfecho desses casos. .

Papillary carcinoma is the most common thyroid malignancy. Many variants of this tumor have been described, with different morphological and molecular characteristics. Although most cases have excellent prognosis, the relationship between tumor architecture and its biological behavior remains controversial. OBJECTIVE: To present the experience of a single center on the prevalence of thyroid papillary carcinoma variants and their relationship with other histopathological prognostic factors. METHOD: Retrospective study of all the cases submitted to thyroidectomy for papillary carcinoma in the same institution over 11 years. RESULTS: We included 517 patients, 81.9% of them were women. The average age was 47.2 years. The variants recognized to have higher aggressiveness potential corresponded to 5.6% of the sample. We found an association of tumor subtypes with greater lesion diameter, T staging, lymphovascular and gland capsule invasion. CONCLUSION: A small percentage of papillary carcinoma cases is represented by variants recognized by their greater potential for aggression. There are associations between these variants and several other histopathological factors already recognized for their prognostic value, which may, by themselves, influence the outcome of these cases. .

Variants of papillary thyroid carcinoma: association with histopathological prognostic factors.

UNLABELLED: Papillary carcinoma is the most common thyroid malignancy. Many variants of this tumor have been described, with different morphological and molecular characteristics. Although most cases have excellent prognosis, the relationship between tumor architecture and its biological behavior remains controversial. OBJECTIVE: To present the experience of a single center on the prevalence of thyroid papillary carcinoma variants and their relationship with other histopathological prognostic factors. METHOD: Retrospective study of all the cases submitted to thyroidectomy for papillary carcinoma in the same institution over 11 years. RESULTS: We included 517 patients, 81.9% of them were women. The average age was 47.2 years. The variants recognized to have higher aggressiveness potential corresponded to 5.6% of the sample. We found an association of tumor subtypes with greater lesion diameter, T staging, lymphovascular and gland capsule invasion. CONCLUSION: A small percentage of papillary carcinoma cases is represented by variants recognized by their greater potential for aggression. There are associations between these variants and several other histopathological factors already recognized for their prognostic value, which may, by themselves, influence the outcome of these cases.

Carcinoma adenoide cístico de mama: relato de caso de uma rara neoplasia / Adenoid cystic carcinoma of the breast: a case report of a rare neoplasm

O carcinoma adenoide cístico representa aproximadamente 0,1% dos carcinomas da mama e corresponde a uma neoplasia de baixo grau de malignidade constituída por dois tipos celulares distintos (basaloides/mioepiteliais e ductais/epiteliais). Relacionado com o padrão molecular dos tumores de fenótipo basal, este carcinoma geralmente revela imunoexpressão negativa para os receptores hormonais e HER-2. No presente relato, os autores descrevem as características clinicas e histopatológicas de um carcinoma adenoide cístico originado no quadrante superior lateral da mama direita em uma paciente de 50 anos(

Adenoid cystic carcinoma represents approximately 0.1% of breast carcinomas and corresponds to a neoplasm of low grade malignancy composed of two different cell types (basaloid/myoepithelial and ductal/epithelial). Related to the molecular pattern of basal phenotype tumors, this cancer usually reveals negative immunostaining for hormone receptors and HER-2. In this report the authors describe the clinical and histopathologic features of an adenoid cystic carcinoma originated in the upper side of the right breast in a 50-year-old patient

End-to-end versus end-to-side motor and sensory neurorrhaphy in the repair of the acute muscle denervation.

BACKGROUND: The aim of this study was to experimentally compare end-to-end and end-to-side neurorrhaphy in perineural window model after motor nerve lesion, evaluating which one was the most effective to preserve nerves. Also, differences in motor and sensorial nerve regeneration were tested to verify differences in nerve regeneration. METHODS: A total of 20 adult male Wistar rats were randomly assigned to 5 groups, and, in each one, a different treatment was performed: besides the control group, and end-to-end or end-to-side graft with motor or sensorial nerves was performed. Silastic sheet was used as a mechanical barrier to prevent innervation from adjacent nerves. After 16 weeks, the specimens were histologically assessed and wet weight was evaluated as a direct parameter of atrophy. RESULTS: The end-to-end neurorrhaphy group presented the best results in terms of mass preservation, but it did not differ significantly from the control group. Motor nerves presented similar results in muscular atrophy. The end-to-side neurorrhaphy group with sensory nerve as donor showed the worst results. CONCLUSIONS: The use of sensory nerves to preserve skeletal muscle trophism is not justified, since, according to our model, it affects 50% to 80% of the muscle mass in a period of 16 weeks. End-to-side neurorrhaphy was demonstrated to be an option for re-enervation of a nerve-deprived motor muscle in selected cases.

The effect of neoadjuvant chemotherapy on hormone receptor status, HER2/neu and prolactin in breast cancer.

AIMS AND BACKGROUND: Histological and immunohistochemical findings may vary in cases of breast cancer. Possible changes in tumor markers between biopsies performed before and after neoadjuvant chemotherapy are controversial and pose a challenge when a clinical decision is needed. The objectives of the present study were: (i) to compare the immunohistochemical expression of estrogen, progesterone and prolactin receptors and HER-2/neu in breast cancer before and after neoadjuvant chemotherapy; and (ii) to correlate the expression of these tumor markers with partial tumor response to neoadjuvant chemotherapy. METHODS AND STUDY DESIGN: Immunohistochemical staining for breast tumor markers was performed in 90 cases of breast cancer. Statistical analysis was carried out using Fisher's exact test, McNemar's test, Spearman's correlation and the Kappa index with linear weighting (k). RESULTS: Agreement between markers before and after neoadjuvant chemotherapy was fair to moderate (k = 0.37-0.51). The immunohistochemical expression of HER-2/neu and prolactin receptors showed a significant, albeit weak correlation before and after neoadjuvant chemotherapy (HER-2/neu, rho = 0.34; P = 0.0009; k = 0.35 [95% CI, 0.19-0.51]). Prolactin status changed in 28/90 cases (P = 0.001; McNemar's test), whereas no changes were found in estrogen or progesterone receptors. No association was found between tumor marker expression and tumor response. CONCLUSIONS: It seems prudent to reevaluate immunohistochemical markers such as HER-2/neu after neoadjuvant chemotherapy, since the findings will guide the strategy for implementation of adjuvant systemic treatment. No correlation was found between the tumor markers analyzed in the present study and partial tumor response to neoadjuvant chemotherapy.

Liesegang rings in xanthogranulomatous pyelonephritis: a case report.

Liesegang rings are concentric noncellular lamellar structures, rarely seen in vivo, occurring as a consequence of the accumulation of insoluble products in a colloidal matrix. These characteristic structures are a rare phenomenon usually found in association with cystic or inflammatory lesions and may be mistaken for parasites. The authors examined Liesegang rings from an inflammatory kidney lesion identified previously as a tumoral lesion on computerized tomography. On microscopic evaluation, Liesegang rings can be mistaken for eggs and larvae of parasites, psammoma bodies and calcification. Special stains like PAS, Grocott, von Kossa and Masson's trichrome facilitate the diagnosis.

Associação entre metástases em linfonodos axilares e fatores prognósticos e preditivos no carcinoma ductal infiltrante de mama / Association between lymph node metastases and prognostic / predictive factors in breast invasive ductal carcinoma

Introdução: O carcinoma mamário corresponde a uma das neoplasias malignas mais comuns no Brasil, sendo uma causa frequente de óbito por tumores malignos em mulheres. Determinadas características histopatológicas do tumor, como grau, tamanho e presença de metástases, podem ser correlacionadas com o tempo de sobrevida livre de doença. No presente estudo, os autores avaliam a associação entre metástases em linfonodos axilares e fatores prognósticos e preditivos no carcinoma ductal infiltrante de tipo histológico não especial. Métodos: Foram avaliados 106 espécimes de setorectomia ou mastectomia entre janeiro e dezembro de 2008, sendo determinados os seguintes dados: tamanho tumoral, grau histológico, presença de metástases em linfonodos axilares, receptores de estrogênio e progesterona e expressão imuno-histoquímica de cerbB2. Resultados: A idade média correspondeu a 59,33 anos, com 46 casos (43,4%) na categoria T1, 40 casos (37,14%) na categoria T2 e 20 casos (18,87%) no grupo T3. Houve associação estatística entre a presença de metástases em linfonodos axilares em relação à idade (p=0,0025), grau histológico (p=0,014), tamanho tumoral (p=0,0036), receptores de estrogênio (p=0,021) e expressão de cerbB2 (p=0,0043). O tamanho tumoral esteve associado à idade (p=0,0078), grau (p=0,0027), receptores de estrogênio (p=0,0017) e expressão de cerbB2 (p=0,0032). Conclusão: No presente estudo, a presença de metástases nodais esteve associada a fatores prognósticos e preditivos, como tamanho tumoral, idade, grau e receptores de estrogênio, sendo necessária a avaliação desses fatores para determinar um índice prognóstico personalizado para cada paciente

Introduction: Mammary carcinoma represents one of the most common malignant neoplasms in Brazil and is a frequent cause of death from malignant tumors. Features of the tumor, such as grade, size and presence of metastases, can be correlated with the duration of disease-free survival. The aim here was to evaluate the association between axillary lymph node metastases and prognostic and predictive factors in infiltrating ductal carcinoma of no special histological type. Methods: We analyzed 106 specimens obtained by sectorectomy or mastectomy between Jan and Dec 2008 and determined the following data: Tumor size, histological grade, presence of metastases in axillary lymph nodes, estrogen and progesterone receptor expression and cerbB2 immunohistochemistry. Results: The mean age was 59.33 years, with 46 cases (43.4%) in category T1, 40 cases (37.14%) in category T2 and 20 cases (18.87%) in category T3. There was statistical association between the presence of metastases in axillary lymph nodes and age (p = 0.0025), histological grade (p = 0.014), tumor size (p = 0.0036), estrogen receptor (p = 0.021) and cerbB2 expression (p = 0.0043). Tumor size was associated with age (p = 0.0078), grade (p = 0.0027), estrogen receptors (p = 0.0017) and cerbB2 expression (p = 0.0032). Conclusion: In this study the presence of nodal metastases was associated with prognostic and predictive factors such as tumor size, age, grade and estrogen receptors, and these factors should be assessed in determining a customized prognostic index for an individual patient

Relação entre escore de Gleason e fatores prognósticos no adenocarcinoma acinar de próstata / The relation between Gleason score and prognostic factors in acinar adenocarcinoma of prostate

INTRODUÇÃO: O adenocarcinoma de próstata corresponde a uma das neoplasias malignas mais frequentes em homens, comprometendo principalmente da sexta a oitava décadas. Algumas características histopatológicas do tumor, como grau de diferenciação, invasão capsular e escore de Gleason, podem ser correlacionadas com o prognóstico da doença. OBJETIVOS: Estimar a associação entre o escore de Gleason e fatores prognósticos em casos de adenocarcinoma prostático. MATERIAL E MÉTODO: O estudo avaliou 118 espécimes de prostatectomia radical provenientes do Laboratório de Patologia da ULBRA entre 2003 e 2008. Em cada caso foram determinados os seguintes dados: idade, lateralidade, estadiamento, escore total e padrões primário e secundário de Gleason, grau de diferenciação, presença de invasão capsular, angiolinfática e perineural e extensão extraprostática. Foram usados os testes do qui-quadrado e o teste exato de Fischer para verificar a associação entre as variáveis, considerando um nível de significância menor que 5 por cento. RESULTADOS: A idade média correspondeu a 63,86 anos. Observou-se a predominância do escore 6 de Gleason (55 casos - 46,61 por cento), de bilateralidade (72 casos - 61,02 por cento) e do estádio T2c (57 casos - 48,31 por cento). O escore de Gleason esteve associado a idade (0,001), lateralidade (p < 0,001), invasão capsular (p < 0,005), invasão angiolinfática (p < 0,001), invasão perineural (p < 0,05), extensão extraprostática (p < 0,001) e estadiamento (0,001). Foi encontrada uma associação significativa entre invasão capsular e idade (p < 0,01) e invasão perineural (p < 0,001). CONCLUSÃO: No adenocarcinoma prostático, a determinação do escore de Gleason corresponde a um dos principais fatores histológicos a serem descritos, apresentando relação significativa com outros critérios anatomopatológicos, como extensão, invasão perineural e angiolinfática e estadiamento.

INTRODUCTION: The prostate adenocarcinoma corresponds to one of the most frequent malignant neoplasias affecting 60 to 80 year old men. Some histopathological characteristics of the tumor, such as degree of differentiation, capsular invasion and Gleason score, may be correlated with the prognosis of the disease. OBJECTIVES: To assess the association of Gleason score and prognostic factors in cases of prostatic adenocarcinoma. MATERIAL AND METHOD: The study evaluated one hundred and eighteen specimens of radical prostatectomy from the laboratory of pathology of ULBRA between 2003 and 2008. In each case, the following data were recorded: age, laterality, staging, total score, primary and secondary patterns of Gleason, degree of differentiation, presence of capsular, angiolymphatic and perineural invasion and extraprostatic extension. Chi-square test and Fischer's exact test with significance < 5 percent were used. RESULTS: The mean age was 63.86. There was a prevalence of Gleason score 6 (55 cases - 46.61 percent), bilaterality (72 cases - 61.02 percent) and staging T2c (57 cases - 48.31 percent). Gleason score was associated with age (0.001), laterality (p < 0.001), capsular invasion (p < 0.005), angiolymphatic invasion (p < 0.001), perineural invasion (p < 0.05), extraprostatic invasion (p < 0.001) and staging (0.001). There was a significant association among capsular invasion, age (p < 0.01) and perineural invasion (p < 0.001). CONCLUSION: In prostate adenocarcinomas, the determination of Gleason score corresponds to one of the main histological factors to be described, showing significant relation with other anatomopathological criteria, such as extension, perineural and angiolymphatic invasion and staging.

Polymorphism (ALA16VAL) correlates with regional lymph node status in breast cancer.

We studied the possible association between Ala16Val manganese-dependent superoxide dismutase (MnSOD) gene genotypes and breast cancer lymph node status because previous investigations suggested an association between the AA genotype and breast cancer. We included 281 women (188 controls and 93 cases of invasive breast cancer with axillary lymph node metastasis (LN+) and without lymph node metastasis (LN-). DNA was extracted from paraffin-embedded tumor tissue or peripheral blood leukocytes, and MnSOD polymorphism was determined by polymerase chain reaction-restriction fragment length polymorphism techniques. In addition, the immunohistochemical profile (p53, Ki-67 and estrogen/progesterone receptors) was also compared between invasive breast cancer groups and different MnSOD genotypes. The frequency of the VV genotype was higher in the LN+ group than in the control and LN- groups (chi(2)=5.081, P=0.02). Subjects with LN+ breast cancer (LN+ group) showed a higher incidence of VV genotype carriers associated with positive Ki-67 marker. Subjects with LN+ breast cancer (LN+ group) showed a higher incidence of VV genotype carriers associated with negative p53 marker. Despite the fact that the AA genotype is well established as being associated with an increased risk of breast cancer, the VV genotype may be associated with a higher metastatic potential, suggesting that MnSOD imbalance is the condition associated with carcinogenesis.

Are the pure in situ breast ductal carcinomas and those associated with invasive carcinoma the same?

It has been reported that pure ductal carcinoma in situ of the breast has morphologic differences from the in situ component of the invasive ductal carcinoma, as well estrogen and progesterone receptors expression according to their cytokeratin expression. However, there is no data comparing other tumor markers without using the cytokeratin expression. The objective of this study is to compare the expression of estrogen receptor (ER) and progesterone receptor (PR), HER-2/neu, p53, and Ki67 between pure ductal in situ carcinoma (pDCIS) and the in situ component of the invasive ductal carcinoma (DCIS + IDC) of the breast, and the in situ component to the invasive component of the same tumor (DCIS + IDC). The immunohistochemistry expression of the tumor markers was performed in 45 cases of pDCIS and DCIS + IDC, yielding a total of 90 cases. Statistical analysis was carried out using Fisher exact test, having a P < 0.05, and Kappa index (kappa) to assess intratumoral concordance. In DCIS + IDC, the in situ and invasive components did not show a significant difference and Kappa index (kappa) was high (0.7-1) for positive and negative expression. ER and PR were significantly different between the pDCIS and DCIS + IDC (ER: 86.7 vs. 66.7% P = 0.04; PR: 80% vs. 55.6% P = 0.02). These findings suggest that in situ component of DCIS + IDC and pDCIS are distinct conditions.