Ki-67 is a prognostic marker for hormone receptor positive tumors.

PURPOSE: To evaluate the utility of Ki67 as a prognostic marker in Luminal B node-negative breast cancer patients. METHODS: We identified 888 patients with invasive breast carcinomas who underwent surgery between 1997 and 2004. Several classical factors were collected: age, tumor size, node involvement, tumor grade, estrogen and progesterone receptors, HER2 and Ki-67 expression. We analyzed if these parameters could be considered as a prognostic factor. In early Luminal B group, we investigated which of the following biological features provide information about bad prognosis: lack of progesterone receptor expression, HER2 overexpression/amplification or high Ki-67 value. RESULTS: The majority of patients were alive and without relapse of tumor at the moment of the analysis (70 %). The prognostic factors founded in multivariate analysis were: tumor size, node involvement, grade 3 and Ki-67 expression. When we stratified the sample by immunohistochemistry (IHC) in tumor subtypes, we assessed 680 patients and we observed 191 Luminal B tumors. The biological parameter related to the worst survival in absence of nodal involvement was Ki-67 value. CONCLUSIONS: Ki-67 represents an additional predictor of survival in Luminal B node negative breast cancer. Conversely, neither Progesterone-receptor nor HER2 status proved prognostic significance in this group in our study.

Accuracy of preoperative biopsies compared with surgical specimens in the diagnosis of colorectal adenocarcinoma.

OBJECTIVE: Since the first data from a patient with colorectal adenocarcinoma are obtained by biopsy, this study evaluated the accuracy of diagnosis by biopsy as compared with the diagnostic potential of the surgical specimen, considering the histological type, grade of differentiation, and immunohistochemical expression of p53. METHODS: The specimens were obtained from 80 patients assisted at Hospital São Paulo. The biopsy and surgical specimen sections were stained by hematoxylin-eosin and immunohistochemistry and compared by 3 pathologists blinded to the evaluations. RESULTS: The accuracy for the histological types was 88%. The grade of differentiation presented an accuracy of 70% with Kappa = .48. The expression of protein p53 exhibited an accuracy of 68% with Kappa = .22. CONCLUSION: The preoperative biopsy of colorectal adenocarcinoma presented good accuracy compared with histopathological examination of the surgical specimen, but with weak to moderate effective degree of agreement between the results.

Gammagrafía con receptores de somatostatina en un caso de carcinoma medular de tiroides / Somatostatin receptor scintigraphy for thyroid medullary carcinoma: a case report

La gammagrafía con radiotrazadores que tienen afinidad por los receptores de somatostatina se ha convertido en metodología eficaz para el diagnóstico y estadificación de los tumores neuroendocrinos. Se presenta un caso en el cual el procedimiento radioisotópico muestra su efectividad en la localización del tumor primario.

Somatostatin receptor scintigraphy has become an important tool for diagnosis and evaluation of neuroendocrine tumors. This case report shows about the importance of the radionuclide procedure for the localization of the primary tumor.

Expression of matrix metalloproteinase 2 (MMP-2) and tissue inhibitor of metalloproteinase 2 (TIMP-2) in medullary thyroid carcinoma: prognostic implications.

BACKGROUND: Metalloproteinase 2 (MMP-2) and tissue inhibitor of metalloproteinase 2 (TIMP-2) participate in the degeneration of the extracellular matrix and are associated with carcinogenesis. MMP-2 is one of the main metalloproteinases active in neoplasia and is a marker of the malignant phenotype. Since the biological behavior of medullary thyroid carcinoma (MTC) varies widely, the present study was undertaken to determine if there is a correlation between the clinical evolution of MTC and the immunohistochemically detected expression of these enzymes in thyroid surgical specimens containing MTC. If so, their expression would be a novel indicator of the prognosis of MTC. METHODS: Thirty-seven patients with MTC who had undergone thyroid surgery were followed for an average of 73 months. Immunohistochemical staining for metalloproteinase-related enzymes was performed in surgical paraffin blocks. The clinical status of the patients after surgery and at the end of the study period was characterized to determine correlations between these and the immunohistochemical markers. A value of p < 0.05 was considered statistically significant. RESULTS: At the end of the study period, 15 patients (40.5%) were alive and without evidence of MTC, 17 (45.9%) had persistent MTC, and 5 (13.5%) had a relapse of their neoplasia. Four patients (10.8%) died during the course of the study. There was a significant correlation (p = 0.0005) between the immunohistochemical staining for MMP-2 and the clinical condition of the patients at the end of the study period, and a correlation between the state of apparent cure compared to persistence of MTC after thyroid surgery (p = 0.0207). No significant correlations were observed between either TIMP-2 expression or immune marking of metastatic lymph nodes and the clinical variables studied. CONCLUSION: Immunohistochemical expression of MMP-2 in thyroid surgical specimens from patients with MTC is a novel indicator of the prognosis of this cancer.

[Breast cancer: comparison between biochemical and immunohistochemical determination of estrogen receptors]. / Cáncer de la mama: comparación entre la determinación bioquímica e inmunohistoquímica de los receptores de estrógenos.

Immunohistochemical (IH) assessment of nuclear estrogen receptor has been considered an alternative method to conventional biochemical assay. The present work intends to compare specificity and sensitivity of IH and biochemical technique to assess nuclear estrogen receptor in formalin-fixed and paraffin-embedded mammary carcinoma samples. IH positive reaction was defined as 14% or more nuclear staining in 100 cells counted under high magnification (400x). Biochemical assay was considered positive over 10 fmol/mg of protein. 66 cases were collected with a mean age of 55.6 years and a mean tumor size of 25.2 mm. Histologically, 62 cases were ductal carcinomas, 2 lobular carcinomas, and 2 medullary carcinomas. Biochemical assay for estrogen receptor was positive in 35 cases (63%) and IH in 40 cases (71%). The present results show that IH assessment of estrogen receptor is highly specific and sensitive. Estrogen receptor present in non-tumor cells and blood vessels walls may disclose false positive biochemical results and false negative result if the tumor mass is small or there are isolated tumor cells. IH assessment of estrogen receptor can be performed in small samples, including in situ lesions. The method of fast, reliable, and of lower cost, IH may be considered the method of choice in cases with insufficient sample for biochemical assay and/or in tumors containing scant cells.

Açöes do 17B-estradiol sobre a secreçäo de calcitonina "in vitro" / Action of 17B-estradiol on calcitonin secretion \"in vitro\"

Em doses farmacológicas a Calcitonina (CT) é tida como um hormônio poupador de cálcio (Ca) e protetor da massa óssea. Devido a isto, tem sido utilizada como alternativa terapêutica das osteoporose pós-menopáusica, doença de grande prevalência entre as mulheres. O papel da CT no desenvolvimento desta forma de osteoporose, entretanto, apesar do grande número de trabalhos respeito, ainda permanece controverso na literatura, assim como a existência de um efeito direto dos estrógenos sobre a secreçao e síntese de CT. Nossa proposta foi avaliar a açao do 17B-estradiol (E2) sobre a secreçao basal e estimulada de CT "in-vitro". Para isso utilizamos uma linhagem de células de carcinoma medular de tireóide humano (TT), na qual já havia sido descrita a presença de receptores estrogênicos. Estudamos o efeito de diferentes concentraçoes de E2 (1 e 100nM) sobre a secreçao basal de CT após períodos de incubaçao que variaram de 6 horas a 6 dias, além do efeito sobre a estimulaçao das células com TPA+Forskolina após 6 dias de pré-incubaçao com E2. A incubaçao das células TT com E2 nao resultou em nenhum incremento na secreçao basal ou estimulada de CT em comparaçao aos grupos controles, em nenhum dos períodos de tempo estudados. O efeito observado, ao contrário, foi de inibiçao transitória da secreçao de CT, de forma dose-dependente (80,5 porcento e 59,1 porcento do controle para 1 a 100 nM respectivamente), cujo nadir apresentou-se após 24h de incubaçao, retornando aos níveis dos grupos controles após 72h. Somado a isto, E2 levou a um efeito estimulatório dose-dependente sonre o conteúdo celular protéico, mas sem qualquer efeito sobre a incorporaçao de timidina triciada, indicando induzir a uma hipertrofia ao invés de uma hiperplasia das células TT. Os dados obtidos demonstraram ausência de qualquer efeito estimulatório direto do E2 sobre a secreçao basal ou estimulada de CT, revelando adicionalmente em efeito de inibiçao transitória na secreçao de CT. (Arq Bras Endocrinol Metab 1994; 38/1:23-28).