Marking axillary nodes with 4% carbon microparticle suspension before neoadjuvant chemotherapy improves sentinel node identification rate and axillary staging.

BACKGROUND AND OBJECTIVES: Marking positive lymph nodes (LNs) before neoadjuvant chemotherapy (NAC) may improve the accuracy of sentinel lymph node biopsy (SLNB). The aim of this study was to determine the feasibility of marking LNs with 4% carbon microparticle suspension (CMS) before NAC and to evaluate if this technique would improve the SLNB identification rate. METHODS: A prospective study of patients with cT1-T4, cN1-N2 breast cancer who underwent US-guided fine-needle aspiration biopsy (FNAB) of suspected LNs and concomitant marking with 4% CMS was performed. After NAC, LNs marked with 4% CMS and those marked with Patent Blue V dye (PBV) were identified and resected. RESULTS: Of the 123 patients included, 74 (60.1%) had positive LNs at FNAB. During axillary surgery, 4% CMS was identified in 121 of 123 patients (98.3%) and blue sentinel LNs in 91% (112 of 123 patients) (P = .0103). Comparing isolated results of PBV and 4%CMS + PBV, the association was better in identifying positive LNs (72.2% vs 97.7%) (P = .02). CONCLUSION: The association of 4% CMS and PBV is feasible and significantly increased the identification rate of positive LNs. 4% CMS may play an important role as a complementary technique in patients submitted to NAC.

Association of FOSL1 copy number alteration and triple negative breast tumors.

Copy number alterations (CNAs) are a frequent feature in human breast cancer, and one of the hallmarks of genomic instability. The FOSL1, GSTP1 and CCND1 genes are located at 11q13, a cytoband commonly affected by CNA in breast cancer, with relevant function in progression and invasion. Our main goal was to analyze CNAs of these genes and determine their association with breast cancer subtypes. Seventy-three cases of invasive breast tumors [52 Luminal, 7 HER2+ and 14 triple negative (TNBC) subtypes] were analyzed by TaqMan assays. CNAs were observed for all genes, with gains more frequently observed. Gains of the FOSL1 gene were observed in 71% of the cases. This gene was the only one with a statistically significant difference (p<0.001) among tumor subtypes, with increased copy number in TNBC compared to luminal and HER2+. No significant association of CNA and clinical and histopathological parameters from the patients was observed. Additional studies in larger breast cancer patient cohorts based on more refined molecular subtypes are necessary to confirm the observed association of FOSL1 gain with aggressive breast tumors phenotypes.

Platelet-rich plasma (PRP) impairs the craniofacial bone repair associated with its elevated TGF-ß levels and modulates the co-expression between collagen III and α-smooth muscle actin.

Transforming growth factor-ß (TGF-ß) is considered the main inducer of both the α-smooth muscle actin (α-SMA) phenotype and collagen synthesis and deposition and plays a significant role in the tissue repair and the development of fibrosis. Since the PRP constitutes an important source of TGF-ß and its efficacy on the craniofacial bone repair remains controversy, the aim of this study was to evaluate the effect of PRP in the presence of levels of TGF-ß on PRP samples, as well as in the presence of collagen III and α-SMA+ cells, while comparing these results by means of a histomorphometric analysis of the bone matrix and fibrous deposition on the bone repair. Four bone defects of 16 mm(2) were created on the calvarium of 21 rabbits. The surgical defects were treated with either particulate autograft, particulate autograft mixed with PRP and PRP alone. Animals were euthanized at 15, 30, and 45 days postoperative. Histomorphometric and immunohistochemical analyses were performed to assess repair time, as well as the expression of collagen III, and α-SMA. The histomorphometric results demonstrated intensive deposition of fibrous tissue while hinder bone deposition occurred in PRP groups. These results coincided with higher values of the TGF-ß on the PRP sample, also larger occurrence of diffuse collagen III deposition and higher presence of α-SMA+ cells spread among the fibrous tissue. Thus, the higher levels of TGF-ß associated with the both expression of collagen III and α-SMA on defect treated with PRP suggest that its biomaterial induce an effect that can be considered similarly to a fibroproliferative disorder.

Lack of association between LOH in the 9p region and clinicopathologic parameters in primary breast cancer.

Previous studies have suggested the involvement of the 9p region in the genesis and progression of several types of cancer. To perform a more in-depth investigation of the 9p region in samples from breast carcinomas, we analyzed loss of heterozygosity (LOH) in 230 patients with primary breast cancer using five microsatellite markers spanning a genomic region of approximately 16.2 megabases. Genomic DNA was obtained from frozen tumor tissue, and peripheral blood was used as a normal reference. Among all samples, 171 (74%) were informative for at least 1 marker and 44 (25.73%) showed LOH. The LOH rates detected for all markers ranged from 10.29% (D9S169) to 15.97% (D9S1749). Among the informative cases for intragenic markers D9S1748 (CDKN2A) and D9S1749 (MTAP), we noticed a concordant loss of 90% (9/10). Associations between LOH frequencies and clinicopathologic parameters were found between marker D9S200 and tumor grade (P < 0.05), and between marker D9S1748 and estrogen receptor (ER) status (P < 0.05). In conclusion, our results agree with other data from the literature that point to LOH as a secondary mechanism of tumor suppressor inactivation on 9p in breast cancer, showing lower frequencies than those observed in other types of cancer. On the other hand, our results point to an interesting association between the concordant loss of genes CDKN2A and MTAP, which was not sufficiently explored in primary breast cancer.

Immunoexpression of p53 and p16 proteins as biomarkers in oral carcinogenesis

Objective: Defects in the cell cycle control system can lead to phenotype changes and consequently to the progression of oral cancer. Thus, the aim of this study was to analyze the immunohistochemical expression of p53 and p16 and their connection with hyperplastic and neoplastic progression. Materials and Methods: Sixty-four histopathologic specimens were submitted to immunohistochemical technique to anti-p53 and anti-p16. Results: This study showed a significant increase in the level of p53 in dysplasia and oral carcinomas. Regarding p16 immunoexpression, a decrease was observed in mild to moderate dysplasia, and remained consnt between moderate dysplasia to poorly differentiated carcinoma. Conclusion: The study confirmed that the higher expression of p53 protein plays a significant role in tumor development and oral cancer progression, while the loss of p16 expression seems to be related only for the progression of carcinogenesis.Keywords: Proteins. Immunohistochemical. Genes, p53. Genes, p16. Mouth. Neoplasms.

Linfonodo sentinela após mamoplastia de aumento pela via transaxilar: estudo prospectivo controlado por meio de linfocintilografia em 43 pacientes / Sentinel lymph node detection after transaxillary augmentation mammoplasty: a prospective controlled study utilizing lymphoscintigraphy in 43 breasts

OBJETIVO: Verificar se a mamoplastia de aumento pela via transaxilar apresenta potencial de prejudicar a identificação futura do linfonodo sentinela. MATERIAIS E MÉTODOS: Estudo prospectivo controlado em que foram selecionadas 22 pacientes divididas em grupo pós-mamoplastia e grupo controle, totalizando 43 mamas (22 no grupo pós-mamoplastia e 21 no grupo controle) avaliadas por meio de linfocintilografia imediatamente após injeções periareolares de fitato-99mTc. Os testes estatísticos consideraram como diferenças significativas valores de p < 0,05. RESULTADOS: Todas as mamas do grupo pós-mamoplastia apresentaram drenagem linfática para a cadeia axilar, sem diferença com o grupo controle (p = 0,488). A média de linfonodos captantes foi de 1,27 ± 0,46 no grupo pós-mamoplastia e 1,33 ± 0,58 no grupo controle (p = 0,895). A média de tempo para visualização do primeiro linfonodo foi de 3,14 ± 4,42 minutos no grupo pós-mamoplastia e 5,48 ± 5,06 minutos no grupo controle, novamente sem diferença significativa (p = 0,136). CONCLUSÃO: A mamoplastia de aumento pela via transaxilar não acarretou prejuízo na identificação futura do linfonodo sentinela.

OBJECTIVE: To evaluate the potential influence of transaxillary augmentation mammoplasty on future detection of sentinel lymph node. MATERIALS AND METHODS: Prospective controlled study where 22 patients were selected and divided into two groups (post-mammoplasty and control) corresponding to 43 breasts (22 in the post-mammoplasty group and 21 in the control group) evaluated by lymphoscintigraphy immediately after periareolar 99mTc-phytate injections. In the statistical analysis, p values < 0.05 were considered as significant. RESULTS: All the breasts in the post-mammoplasty group presented lymphatic drainage to the axillary chain, with no difference as compared with the control group (p = 0.488). The average number of hot lymph nodes was 1.27 ± 0.46 in the post-mammoplasty group, and 1.33 ± 0.58 in the control group (p = 0.895). The mean time required to visualize the first lymph node was 3.14 ± 4.42 minutes in the post-mammoplasty group, and 5.48 ± 5.06 minutes in the control group (p = 0.136). CONCLUSION: Transaxillary augmentation mammoplasty did not affect the future detection of sentinel lymph node.

Chromosome alterations associated with positive and negative lymph node involvement in breast cancer.

Genetic heterogeneity is high in breast cancer, and hence it is difficult to link a specific chromosome alteration to a specific clinicopathologic feature. We examined clonal chromosome alterations in 45 breast carcinomas and statistically correlated the findings with clinical-histopathological parameters of the patients. The most common abnormalities were losses of chromosomes 19, 22, 21, X, and 17 and gains of chromosomes 9 and 18. A statistically significant correlation was found between clonal aberrations in chromosomes 17, 20, and 21 and positive lymph node involvement (LN+) and between clonal aberrations in chromosomes X and 6 and negative involvement (LN-). The average number of chromosome abnormalities was the same for both LN- and LN+ groups, and numerical and structural alterations were equally distributed. The mean number of chromosome aberrations did not differ significantly among tumor grades, but when aberrations were analyzed as monosomies, trisomies, and structural aberrations, a heterogeneous distribution was observed. Further cytogenetic investigation of breast tumors and their variable pathological features is undoubtedly necessary. The recognition and ultimately the molecular understanding of these abnormalities may improve breast cancer taxonomy and provide important prognostic information for both the patient and clinician.

Neoplasias intraepiteliais cervicais e câncer do colo do útero durante a gestação / Intraepitelial cervical neoplasia and cervix cancer in pregnancy

A incidência de câncer e gestação é de aproximadamente 1:1.000 gestações, sendo o câncer de colo um tipo que ocorre com maior freqüência. Há poucas pesquisas conclusivas sobre a melhor conduta, e suas repercussões sobre a mãe e o feto. Com a evolução da Medicina e com as análises mais recentes dos trabalhos sobre este tema, é possível sugerir algumas condutas nas lesões intra-epiteliais e no câncer de colo do útero durante a gestação. Em muitos casos, adiar o tratamento oncológico até a maturação pulmonar fetal é a melhor conduta, tanto para a mãe como para o feto. Em outros casos impõe-se a instituição imediata do tratamento adequado. Este texto visa avaliar as possibilidades de conduta nesta devastadora situação que é o binômio câncer de colo e gestação

Abscesso subareolar em homem / Subareolar abscess in male

O abscesso subareolar é condição benigna que raramente ocorre na população masculina. O processo iniciaðse com infecção na região subareolar que pode ou não evoluir para abscesso, o qual se apresenta clinicamente como um tumor mamário. O diagnóstico diferencial se faz com a ginecomastia e o carcinoma. Os autores relatam o caso de um paciente do sexo masculino com nódulo mamário, retirado por biópsia excisional, sendo confirmado o diagnóstico anátomoðpatológico de abscesso subareolar. A fisiopatologia do processo, bem como os achados histológicos e as formas de tratamento, será abordada neste artigo