Orbital metastatic neuroblastoma presenting as posttraumatic exophthalmos.

A 2-year-old female patient with a recent history of head trauma was admitted to the Ophthalmology Clinic with left exophthalmos. A differential diagnosis between traumatic and tumoral etiology was made. The orbitocranial MRI and fine needle ganglion biopsy settled the malignant etiology of the exophthalmia. Further investigations at the Pediatric Oncology Clinic decided on the diagnosis of orbital metastatic neuroblastoma. This case report presented an unusual association: orbital metastatic neuroblastoma becoming clinically positive soon after a head trauma.

Ethical acceptability of using generic consent for secondary use of data and biological samples in medical research / Aceptabilidad ética de usar consentimiento genérico para uso secundario de datos y de muestras biológicas en investigación médica / Aceitabilidade ética do uso de consentimento genérico para uso secundário

Abstract: The research idea starts from the previous identification of certain elements of generic consent for research activities found in informed consent (IC) forms used in therapeutic activities in hospitals that have the right to conduct medical research on human subjects in Northeast Romania. The paper questions the ethical acceptability of secondary use of data and biological samples in medical research, in the context of obtaining generic therapeutic consent from patients. The objective of the research is to analyze the Romanian context of using the IC obtained in therapeutic purposes as a starting point for the research activity. We wish to argue that the practice of obtaining a generic consent - for using the data obtained and the biological samples collected in the therapeutic process for secondary analysis - raises serious ethical issues regarding the validity and effectiveness of the IC.

Resumen: La idea de este estudio proviene de la identificación previa de ciertos elementos de consentimiento genérico para actividades de investigación, que se encuentran en formularios de consentimiento informado usados en actividades terapéuticas en hospitales que tienen la potestad de realizar investigación médica con sujetos humanos en el Noreste de Rumania. Este estudio cuestiona la aceptabilidad ética del uso secundario de datos y muestras biológicas en el contexto de obtener consentimiento genérico de pacientes en terapia. El objetivo de esta investigación consiste en analizar el contexto en Rumania al usar consentimiento informado en terapia como punto inicial de actividad de investigación. Argumentamos que la práctica de obtener consentimiento genérico -para usar los datos obtenidos y las muestras biológicas recolectadas en el proceso terapéutico en análisis secundario- preocupa éticamente respecto de la validez y efectividad del consentimiento informado.

Resumo: A ideia de pesquisa tem sua origem a partir da identificação anterior de certos elementos do consentimento genérico para atividades de pesquisa encontrados em formulários de consentimento informado (CI) usados em atividades terapêuticas em hospitais que têm o direito de realizar pesquisa médica em seres humanos no nordeste da Romênia. O artigo questiona a aceitabilidade ética de uso secundário de dados e amostras biológicas na pesquisa médica, no âmbito da obtenção do consentimento genérico terapêutico de pacientes. O objetivo da pesquisa é analisar o contexto romeno do uso do CI obtido por fins terapêuticos como ponto de partida para a atividade de investigação. Nós gostaríamos de argumentar que a prática de obter um consentimento genérico - para utilizar os dados obtidos e as amostras biológicas coletadas no processo terapêutico para análise secundária - levanta sérias questões éticas a respeito da validade e da eficácia do IC.

Response to chemoradiotherapy and lymph node involvement in locally advanced rectal cancer.

AIM: To establish the association between lymph node involvement and the response to neoadjuvant therapy in locally advanced rectal cancer. METHODS: Data of 130 patients with mid and low locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiation followed by radical surgery over a 5-year period were reviewed. Tumor staging was done by endorectal ultrasound and/or magnetic resonance imaging. Tumor response to neoadjuvant therapy was determined by T-downstaging and tumor regression grading (TRG). Pathologic complete response (pCR) is defined as the absence of tumor cells in the surgical specimen (ypT0N0). The varying degrees TRG were classified according to Mandard's scoring system. The evaluation of the response is based on the comparison between previous clinico-radiological staging and the results of pathological evaluation. χ (2) and Spearman's correlation tests were used for the comparison of variables. RESULTS: Pathologic complete response (pCR, ypT0N0, TRG1) was observed in 19 cases (14.6%), and other 18 (13.8%) had only very few residual malignant cells in the rectal wall (TRG2). T-downstaging was found in 63 (48.5%). Mean lymph node retrieval was 9.4 (range 0-38). In 37 cases (28.5%) more than 12 nodes were identified in the surgical specimen. Preoperative lymph node involvement was seen in 77 patients (59.2%), 71 N1 and 6 N2. Postoperative lymph node involvement was observed in 41 patients (31.5%), 29 N1 and 12 N2, while the remaining 89 were N0 (68.5%). In relation to ypT stage, we found nodal involvement of 9.4% in ypT0-1, 22.2% in ypT2 and 43.7% in ypT3-4. Of the 37 patients considered "responders" to neoadjuvant therapy (TRG1 and 2), there were only 4 N+ (10.8%) and the remainder N0 (89.2%). In the "non responders" group (TRG 3, 4 and 5), 37 cases were N+ (39.8%) and 56 (60.2%) were N0 (P < 0.001). CONCLUSION: Response to neoadjuvant chemoradiation in rectal cancer is associated with lymph node involvement.

Predictive markers of response to neoadjuvant therapy in rectal cancer.

BACKGROUND: Neoadjuvant therapy followed by radical surgery is the standard treatment in locally advanced rectal cancer. It is important to predict the response because the treatment has side effects and is costly. The aim of this study was to establish the relationship among clinical, pathologic, and molecular biomarkers and the response to neoadjuvant therapy. METHOD: A total of 130 patients with locally advanced mid and low rectal cancer who underwent long-course radiotherapy with 5-FU based chemotherapy followed by radical surgical resection were included in the study. Clinical and pathologic data were collected. Paraffin-embedded sections obtained in diagnostic biopsies were assessed by immunohistochemical staining for molecular markers and classified using a semiquantitative method. Results were related with T-downstaging and tumor regression grade using Mandard scoring system on surgical specimens. RESULTS: Pathologic complete response was found in 19 patients (14.6%), while in another 18 (13.8%) only minor residual disease was seen in the rectal wall. T-downstaging was observed in 63 (48.5%). The average of lymph node retrieval in the surgical specimens was 9.4. Regarding predictive markers of response, there was significant correlation between the expression of B-cell lymphoma 2 (P = 0.005), ß-catenin (P = 0.03), vascular endothelial growth factor (P = 0.048) and apoptotic protease activating factor 1 (P = 0.03), tumor differentiation grade (P < 0.001), and response in the univariate analysis. T-downstaging was associated with vascular endothelial growth factor expression (P = 0.03) and tumor differentiation grade (P < 0.001). Significant parameters found in the multivariate analysis were tumor differentiation grade and Bcl-2 expression. CONCLUSIONS: Pathologic and molecular biomarkers in the diagnostic biopsies may help us predict tumor response to chemoradiation in rectal cancer patients.

Myofibroblastoma of the breast with smooth muscle differentiation showing deletion of 13q14 region: report of a case.

Breast myofibroblastomas are rare benign mesenchymal tumors belonging to the group of stromal breast tumors composed of spindle-shaped cells and characterized by a broad morphologic spectrum. Among the different morphologic variants described, breast MFBs can show smooth muscle cell differentiation in very rare cases. In terms of the genetic abnormalities found in this type of tumor, a deletion of chromosome 13q14 was recently confirmed by FISH in some cases of mammary MFB. In this paper, we report an unusual case of MFB with smooth muscle differentiation showing a deletion of chromosome 13q14.