RESUMO
BACKGROUND: The Maharashtra government has banned the production, sale, distribution and storage of gutka, and pan masala in the Maharashtra State due to the increasing burden of cancer and reproductive health problems attributable to the use of these products. In view of this, it is important to understand the way producers', sellers' and users' are adapting to the ban. OBJECTIVE: During the two months following the ban (July 19 th through Sept 30, 2012), a research team studying smokeless tobacco use and promotion in a low income community of Mumbai conducted rapid surveillance to assess the impact of the ban in the study community. MATERIALS AND METHODS: Assessment involved documenting new points of sale, informal observations of tobacco use, and interviews with thirteen shop owners and eight gutka users'. Overall changes in accessibility, availability, patterns of use of tobacco products, perception of ban, social norms and surveillance activities were assessed. RESULTS: Tobacco companies were marketing new products that resembled gutka, under similar brand logos. Surveillance, financial and social cost of selling gutka or using it in public have had an immediate effect on reducing local supply, demand and use and increasing stigma associated with its use. There was an increased recognition of ill-effects of gutka on cancer among sellers' but not overall. CONCLUSIONS: To reduce the overall consumption of tobacco in the community, it is critical to include programs that create awareness about effects of smokeless tobacco on health and sustain surveillance levels. This would maintain requirements of the ban, and sustain limits on accessibility, availability and use of these products in the community and other similar communities.
Assuntos
Infertilidade/epidemiologia , Neoplasias/epidemiologia , Abandono do Uso de Tabaco/estatística & dados numéricos , Tabagismo/epidemiologia , Tabaco sem Fumaça/estatística & dados numéricos , Adolescente , Adulto , Arecaceae , Feminino , Regulamentação Governamental , Humanos , Índia , Infertilidade/etiologia , Infertilidade/prevenção & controle , Masculino , Neoplasias/etiologia , Neoplasias/prevenção & controle , Pobreza , Política Antifumo , Indústria do Tabaco , Abandono do Uso de Tabaco/métodos , Tabagismo/prevenção & controle , Tabaco sem Fumaça/efeitos adversos , População Urbana , Adulto JovemRESUMO
Inflammatory pseudotumor (IPT) of the spleen is a rare benign tumor with unknown etiology. It causes problems in the diagnosis because of mimicking some hematopoetic malignancies. Here we report the case of a 36-yr-old woman complaining of nausea and insomnia. Laboratory investigations were limited to increase of leukocyte and thrombocyte count. Ultrasonography and magnetic resonance (MR) imaging showed circumscribed solid lobulated mass, measuring about 6.5 cm in diameter, located in the dorsal region of the spleen. Splenectomy was performed with the differential diagnosis including hamartoma and lymphoma of the spleen. Histological examination of the sharply demarcated splenic mass consisted of myofibroblasts and admixture of inflammatory cells. Immunohistochemistry and in situ hybridization were performed. IPT of the spleen was diagnosed. Epstein-Barr virus (EBV) was detected in the tumor by in situ hybridization. This rare entity is presented because of its clinical, radiological and pathological difficulties in the differential diagnosis.
Assuntos
Infecções por Vírus Epstein-Barr/virologia , Granuloma de Células Plasmáticas/virologia , Herpesvirus Humano 4/isolamento & purificação , Esplenopatias/virologia , Adulto , Diagnóstico Diferencial , Feminino , Granuloma de Células Plasmáticas/diagnóstico , Granuloma de Células Plasmáticas/cirurgia , Hamartoma/diagnóstico , Humanos , Hibridização In Situ , Linfoma/diagnóstico , Imageamento por Ressonância Magnética , Esplenectomia , Esplenopatias/diagnóstico , Esplenopatias/cirurgiaAssuntos
Carcinoma Adenoide Cístico/secundário , Neoplasias Pulmonares/secundário , Linfonodos/patologia , Invasividade Neoplásica/patologia , Neoplasias Cutâneas/patologia , Axila , Biópsia por Agulha , Carcinoma Adenoide Cístico/patologia , Carcinoma Adenoide Cístico/cirurgia , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/terapia , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Metástase Linfática , Pessoa de Meia-Idade , Neoplasias Cutâneas/cirurgia , Resultado do TratamentoRESUMO
A 4-year-old girl had a left side cervical swelling for three months. The mass was free from surrounding tissues and excised completely. Histopathologic diagnosis of the specimen was lipoblastoma. Cervical lipoblastoma is a rapidly growing neoplasm. Only two cases of cervical lipoblastomas caused airway obstruction have been reported. Recurrence is rare in cases of lipoblastoma. Complete excision of the tumor is the treatment of choice. Seventeen cases of cervical lipoblastoma have been reported until now in the literature, but we think that lipoblastoma is more frequent than reported. Lipoblastoma must be remembered as a rare cause of cervical masses in childhood.
Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Lipoma/patologia , Pré-Escolar , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Lipoma/cirurgiaRESUMO
A 60-year-old man presented with impotence ultrasonography demonstrated bilateral irregular hypoechoic infiltration of testes and normal epididymis. Colour Doppler sonography showed only peripheral but no intralesional flow. Since the lesion was presumed as malignancy bilateral high inguinal orchiectomy was performed and bilateral idiopathic granulomatous orchitis was diagnosed. It was concluded that granulomatous orchitis should be considered in the differential diagnosis of diffuse testicular hypoechoic involvement which showed only peripheral low-resistance flow on colour Doppler sonography, in the proper clinical setting. Although this may be a helpful sign in the differential diagnosis of diffuse testicular infiltrations, high inguinal exploration remains mandatory.
Assuntos
Granuloma/diagnóstico por imagem , Orquite/diagnóstico por imagem , Doenças Testiculares/diagnóstico por imagem , Disfunção Erétil/etiologia , Granuloma/patologia , Granuloma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Orquiectomia , Orquite/patologia , Orquite/cirurgia , Doenças Testiculares/patologia , Doenças Testiculares/cirurgia , Ultrassonografia Doppler em CoresRESUMO
During the 14-year period from 1984 to 1997 there were 85 firearm fatalities investigated by the Department of Forensic Medicine and the Department of Pathology in Edirne, Turkey. We determined the characteristics of these 85 firearm deaths which comprised 17.03% of all medicolegal autopsies. The overall incidence was 1.58 per 100,000 population. The median age was 35.5 years. Fifty-four percent of the victims were aged between 20 and 40 years. Males constituted 82% of the victims. The most frequent manner of death was homicide (68.3%). Handguns accounted for 62.4% of the weapons used. The most common sites for the firearm entrance wounds were both head-neck-nape (32.8%) and chest (32%). In conclusion, our study shows that, in spite of legal restrictions, illegal access to firearms is easy and deaths by firearms are still increasing.
Assuntos
Ferimentos por Arma de Fogo/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Criança , Pré-Escolar , Feminino , Armas de Fogo/estatística & dados numéricos , Homicídio/estatística & dados numéricos , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Suicídio/estatística & dados numéricos , Turquia/epidemiologia , Ferimentos por Arma de Fogo/epidemiologiaRESUMO
Patellar metastases are very rare. There have been approximately 20 cases reported in the literature. We have also noted two other reports of patellar metastasis from lung carcinoma as the first manifestation of lung cancer in our literature review. We present a case of patellar metastasis as the first manifestation of lung epidermoid carcinoma in a patient who was a smoker for 33 years.
Assuntos
Neoplasias Ósseas/secundário , Carcinoma de Células Escamosas/secundário , Neoplasias Pulmonares/diagnóstico por imagem , Patela , Artrografia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
The phenomenon of tumor angiogenesis is an important aspect of understanding tumor biology. Studies in breast carcinoma have shown microvessel density (MVD) assessed by immunohistochemistry to be of prognostic importance in primary breast cancer. On the other hand, recently developed highly sensitive color-coded Doppler techniques offer a noninvasive method to examine neovascularisation in breast tumors. The purpose of this study was to determine the relationship between Doppler flow parameters and microvessel count assessed by immunohistochemistry. Fifty-three patients with primary breast cancer were examined preoperatively with color-coded Doppler ultrasound. The obtained Doppler frequency spectra were analyzed for peak systolic flow velocity (Vmax). Following surgery, paraffin-embedded microsections were immunohistochemically stained for factor VIII-related antigen. Tumor angiogenesis was assessed by microvessel count under light microscopy. Undifferentiated tumors correlated with high MVD (p=0.009) whereas other clinicopathological parameters were not associated with MVD. Color Doppler signals were detected in 50 out of 53 breast tumors. Evaluation of tumor flow velocity with various clinicopathological parameters showed a significant correlation with tumor size (p=0.0001) and lymph node metastasis (p=0.02). However, there was no significant correlation between MVD and intratumoral blood flow velocity assessed by color-coded Doppler. Our findings showed that Doppler flow measurement did not correlate with the extent of tumor angiogenesis of breast cancer. The present data give circumstantial evidence that microvessel count assessed by immunohistochemistry reflects the microvascular network, whereas tumor vasculature documented by Doppler ultrasound supplies information on the macrovasculature.
Assuntos
Neoplasias da Mama/irrigação sanguínea , Neovascularização Patológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Neoplasias da Mama/patologia , Feminino , Humanos , Microcirculação , Pessoa de Meia-Idade , Ultrassonografia Doppler em CoresRESUMO
OBJECTIVE: Because angiogenesis is considered essential for tumor growth and the development of metastasis, we assessed the correlation of microvessel density with overall survival in patients with clinical stage IB carcinoma of the uterine cervix. STUDY DESIGN: Histologic slides were immunostained for factor VIII-related antigen. Microvessel density was determined within each tumor by enumeration under a light microscope at 200x magnification and an examination area of 0.25 mm2. The Cox proportional hazards model was used for multivariate analysis. RESULTS: In 166 patients with stage IB cervical cancer the 5-year survival was as follows: 89.7% in 102 patients whose tumors had a microvessel density < or =20/field, and 63.0% in 64 patients whose tumors had a microvessel density >20/field (log rank p < 0.0001). In the multivariate Cox model microvessel density, lymph node involvement, tumor size, and the application of radiation therapy remained independent prognostic factors for survival, whereas lymphatic vascular space involvement failed to retain a significant value. CONCLUSION: High microvessel density adversely influences patients' survival in clinical stage IB cervical cancer and identifies patients with negative nodes at risk for relapse.
Assuntos
Microcirculação/patologia , Neovascularização Patológica , Neoplasias do Colo do Útero/irrigação sanguínea , Neoplasias do Colo do Útero/mortalidade , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Taxa de Sobrevida , Neoplasias do Colo do Útero/radioterapiaRESUMO
BACKGROUND: There is controversy over the question of whether the involvement of vascular spaces influences the prognosis of patients with carcinoma of the uterine cervix. The aim of the current study was to compare patterns of vascular space involvement determined by hematoxylin and eosin (H & E) staining with those patterns determined by immunostaining for factor VIII-related antigen (F8-RA) with regard to their prognostic impact on the disease free survival (DFS) and overall survival (OS) of patients with clinical Stage IB cervical carcinoma. Staining for F8-RA is known to highlight blood vessels predominantly, whereas the presence of tumor cell emboli in vascular spaces of H & E-stained sections mainly indicates lymphatic vessel invasion. METHODS: The authors analyzed data on 163 patients for whom vascular space involvement (VSI) was determined by H & E (VSI/H & E) and F8-RA (VSI/F8) staining from the same block in two separate runs. RESULTS: The median follow-up period was 85 months (range, 5-170 months). The 25% quantile for OS was 109 months (median not reached; range, 5-170 months). The overall rates of VSI/H & E and VSI/F8 were 29.4% and 24.5%, respectively. The findings obtained by H & E and F8-RA staining were concurrent in 60.7% of cases. Lymph node involvement and VSI/F8 remained independent prognostic factors for DFS and OS. Due to a highly significant correlation of pelvic lymph node status with both VSI/H & E and tumor size, the last two parameters failed to retain a significant value. For lymph node negative patients, the estimated OS probability was 92% for those without VSI/F8 and 62% for those with VSI/F8. CONCLUSIONS: VSI/F8 may provide additional information on the outcome of clinical Stage IB cervical carcinoma. Lymph node negative patients with VSI/F8 positive tumors may benefit from more intense postsurgical treatment. Further trials involving larger series of patients are necessary to confirm these findings.
Assuntos
Adenocarcinoma/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Endotélio Vascular/metabolismo , Neoplasias do Colo do Útero/diagnóstico , Fator de von Willebrand/metabolismo , Adenocarcinoma/irrigação sanguínea , Adenocarcinoma/metabolismo , Adulto , Idoso , Carcinoma de Células Escamosas/irrigação sanguínea , Carcinoma de Células Escamosas/metabolismo , Intervalo Livre de Doença , Amarelo de Eosina-(YS) , Feminino , Seguimentos , Hematoxilina , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Prognóstico , Coloração e Rotulagem/métodos , Neoplasias do Colo do Útero/irrigação sanguínea , Neoplasias do Colo do Útero/metabolismoRESUMO
BACKGROUND: Angiogenesis (the formation of new blood vessels) appears to be required for the growth of invasive tumors, but little information exists about its role in the development of preinvasive lesions. We examined microvessel density and expression of vascular endothelial growth factor in specimens of cervical intraepithelial neoplasia (CIN), a preinvasive lesion of the uterine cervix, to determine whether a connection could be established between these parameters of angiogenesis and the grade of dysplasia (i.e., tissue abnormality). METHODS: Sections of biopsy specimens from 83 patients with grades I-III CIN were examined retrospectively. Microvessels were localized by use of a polyclonal antibody directed against factor VIII-related antigen; vascular endothelial growth factor was detected by means of a monoclonal antibody. Reported P values are two-sided. RESULTS: Highest microvessel densities and highest expression of vascular endothelial growth factor were found in a narrow border region between CIN lesions and the underlying stroma. A significant correlation was observed between high vascular endothelial growth factor expression and high microvessel density (Kendall's tau = 0.27; 95% confidence interval [CI] = 0.03-0.50; P = .018). Mean microvessel density values +/- standard deviations for CIN I, CIN II, and CIN III lesions were 19.4 +/- 5.8, 21.9 +/- 7.0, and 34.1 +/- 14.8, respectively (Kendall's tau = 0.46; 95% CI = 0.30-0.61; P<.0001). Corresponding values for vascular endothelial growth factor expression were 8.3 +/- 3.5, 8.4 +/- 2.0, and 12.2 +/- 3.6, respectively (Kendall's tau = 0.41; 95% CI = 0.20-0.60; P<.0001). CONCLUSIONS: Our results are consistent with the idea that progression of cervical dysplasia is dependent on angiogenesis.
Assuntos
Fatores de Crescimento Endotelial/biossíntese , Regulação Neoplásica da Expressão Gênica , Linfocinas/biossíntese , Displasia do Colo do Útero/irrigação sanguínea , Displasia do Colo do Útero/metabolismo , Feminino , Humanos , Estudos Retrospectivos , Displasia do Colo do Útero/patologia , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio Vascular , Fator de von Willebrand/imunologiaRESUMO
Vulvar intraepithelial neoplasia (VIN) has been reported to be a precursor of invasive vulvar cancer. Switching to the angiogenic phenotype is considered a key step in tumor growth. Microvessel density (MVD) and vascular endothelial growth factor (VEGF), a highly angiogenic peptide, are important parameters of tumor angiogenesis. Forty-three histologic slides with 38 VIN I-III lesions were immunohistochemically stained for factor VIII-related antigen (F8-RA) and 44 slides with 37 VIN I-III for VEGF, since F8-RA reliably highlights tumor microvessels. Determination of MVD and VEGF expression was done by counting microvessels and VEGF-positive cells at a magnification of 200x and 400x. The highest concentration of F8-RA-stained MVD and VEGF expression was found at a small subepithelial area at the border of the VIN lesion to the stroma underneath but concentrations were low in all specimens of normal epithelium. High VEGF expression was significantly correlated to high MVD. For both MVD and VEGF expression the differences between VIN I and VIN III and between VIN II and VIN III were statistically significant (P < 0.0001). VIN III lesions are the clinical relevant precursors of invasive cancer of the vulva, as outlined by intense expression of VEGF protein and a highly dense network of microvessels underlying the dysplastic epithelium.