A prospective randomized trial comparing patent blue and methylene blue for the detection of the sentinel lymph node in breast cancer patients.

INTRODUCTION:: Methylene blue is more widely available and less expensive than patent blue, with an apparently lower risk of anaphylaxis. OBJECTIVE:: The two dyes were compared regarding detection of the sentinel lymph node (SLN). METHOD:: A prospective, randomized trial involved 142 patients with invasive breast carcinoma. Sixty-nine (49.3%) assigned to patent blue (group A) and 71 (50.70%) to methylene blue (group B). Thirty-five patients (25.0%) were clinical stage III or IV; 55 (38.7%) had axillary lymph nodes affected; and 69 (49.3%) underwent neoadjuvant chemotherapy. Two patients were excluded because the dye type was not recorded. RESULTS:: Patients and tumor characteristics were similar in both groups. SLNs were identified in 47 women (68.1%) in group A and 43 (60.6%) in group B (p=0.35). SLNs were affected in 22 cases (51.2%) in group A and 21 (48.8%) in group B (p=0.62). The SLN was the only node affected in 12 cases (54.5%) in group A and six (33.3%) in group B (p=0.18). The time and degree of difficulty involved in identifying the SLN were similar in both groups. There were no complications or allergies. CONCLUSION:: Methylene blue performed as well as patent blue in identifying the SLN in breast cancer patients.

A prospective randomized trial comparing patent blue and methylene blue for the detection of the sentinel lymph node in breast cancer patients / Estudo randomizado prospectivo comparando o azul patente ao azul de metileno para a detecção do linfonodo sentinela em pacientes com câncer de mama

Summary Introduction: Methylene blue is more widely available and less expensive than patent blue, with an apparently lower risk of anaphylaxis. Objective: The two dyes were compared regarding detection of the sentinel lymph node (SLN). Method: A prospective, randomized trial involved 142 patients with invasive breast carcinoma. Sixty-nine (49.3%) assigned to patent blue (group A) and 71 (50.70%) to methylene blue (group B). Thirty-five patients (25.0%) were clinical stage III or IV; 55 (38.7%) had axillary lymph nodes affected; and 69 (49.3%) underwent neoadjuvant chemotherapy. Two patients were excluded because the dye type was not recorded. Results: Patients and tumor characteristics were similar in both groups. SLNs were identified in 47 women (68.1%) in group A and 43 (60.6%) in group B (p=0.35). SLNs were affected in 22 cases (51.2%) in group A and 21 (48.8%) in group B (p=0.62). The SLN was the only node affected in 12 cases (54.5%) in group A and six (33.3%) in group B (p=0.18). The time and degree of difficulty involved in identifying the SLN were similar in both groups. There were no complications or allergies. Conclusion: Methylene blue performed as well as patent blue in identifying the SLN in breast cancer patients.

Resumo Introdução: O azul de metileno é mais facilmente encontrado para comercialização e a um preço menor que o azul patente. Parece ainda haver menor risco de anafilaxia. Objetivo: Comparar a taxa de detecção do linfonodo sentinela com o azul patente e com o azul de metileno. Método: Foram incluídas, de forma randomizada e prospectiva, 142 pacientes com diagnóstico de carcinoma mamário invasor, que consentiram em participar livremente do estudo. Foram injetados 2 mL de azul patente (grupo A) em 69 (49,3%) mulheres e de azul de metileno (grupo B) em 71 (50,70%), em localização periareolar ou peritumoral, seguido de 5 minutos de massagem. Trinta e cinco (25,0%) apresentavam estadiamento clínico 3 ou 4, e 55 (38,7%) apresentavam a axila clinicamente comprometida. Sessenta e nove (49,3%) fizeram quimioterapia neoadjuvante. Duas pacientes não tinham anotação do corante utilizado e foram excluídas. Resultados: Os dois grupos apresentaram características das pacientes e dos tumores semelhantes. Foram detectados linfonodos sentinela em 47 (68,1%) mulheres no grupo A e em 43 (60,6%) no grupo B (p=0,35). Havia linfonodos sentinela comprometidos em 22 (51,2%) casos no grupo A e em 21 (48,8%) casos no grupo B (p=0,62). O linfonodo sentinela foi o único gânglio comprometido em 12 (54,5%) casos no grupo A e em seis (33,3%) casos no grupo B (p=0,18). O tempo e o grau de dificuldade para identificação do linfonodo sentinela foram semelhantes nos dois grupos. Não houve relato de complicações ou de alergia em nenhum dos grupos. Conclusão: A utilização do azul de metileno para a identificação do linfonodo sentinela em pacientes com câncer de mama apresenta resultados semelhantes aos do azul patente.

Effect of Ki-67 on Immunohistochemical Classification of Luminal A to Luminal B Subtypes of Breast Carcinoma.

It has recently been proposed to include an immunohistochemical marker of cell proliferation, Ki-67, as an element with which to classify the molecular subtypes of breast cancer. The objective of this study was to evaluate the effect of the introduction of the Ki-67 marker on the molecular classification of breast cancer by immunohistochemistry. This study was performed on 234 cases of invasive ductal carcinoma of the breast submitted to two immunohistochemical classification panels, one including Ki-67 and the other not. The data obtained with the two classifications were correlated with well-established prognostic factors such as histologic grade, the number of lymph nodes affected and tumor size. The molecular classification without Ki-67 identified: 136 cases of luminal A (58.1%), 19 cases of luminal B (8.1%), 27 cases of human epidermal growth-factor receptor 2 overexpressing (11.5%), 27 cases of basal-like (11.5%), and 25 cases of nonbasal-like triple-negative tumors (10.7%). When Ki-67 was included, this situation changed significantly, with the following cases being identified: 72 cases of luminal A (30.8%) and 83 cases of luminal B tumors (35.5%), resulting in a Kappa score of 0.216. Evaluation of correlations between the luminal A and luminal B tumor subtypes and the selected prognostic factors showed a statistically significant difference only when Ki-67 was included and only with respect to histologic grade (p < 0.001). The new classification with Ki-67 significantly altered the prevalence of the luminal A and luminal B subtypes and improved correlation with the histologic grade.

Mucoepidermoid carcinoma of the penis: Case report and literature review.

We describe the fifth case of mucoepidermoid carcinoma. The patient had penile ulcer with bilateral inguinal and pelvic lymphadenopathy and underwent total penectomy. After antibiotic therapy, the patient began outpatient chemotherapy, but the treatment was discontinued due to his intolerance. The patient died due to infectious complications of the inguinal lymphatic fistula 7 months after the histological diagnosis. Notably, the periurethral area was involved in the anatomopathological evaluation of the excised penis. The penile mucoepidermoid carcinoma was aggressive and the perimeatal region was involved. This case helps demystify the origins and prognosis of this rare case. More reports documenting patient characteristics and their evolution with penile mucoepidermoid carcinoma are needed.

Gestação gemelar com mola hidatiforme completa e feto vivo / Twin pregnancy with a complete hydatidiform mole and live fetus

A gestação gemelar com mola hidatiforme completa que coexiste com feto vivo (GGMC) é uma entidade rara. Embora as recomendações sejam de conduta expectante, são descritas diversas complicações maternas e fetais, como o aumento da incidência de abortamento espontâneo, de parto prematuro, de sangramento vaginal, de pré-eclampsia grave e de doença trofoblástica persistente, entre outras complicações. Neste trabalho, descrevemos a evolução clínica de um caso de GGMC que evoluiu para crise tireotóxica, pré-eclâmpsia grave, interrupção da gestação e necessidade de cuidados intensivos maternos. A necropsia fetal evidenciou feto do sexo feminino, sem malformações aparentes, com alterações placentárias que favorecem cromossomopatia. A avaliação dos restos ovulares evidenciou vilosidades com hiperplasia do trofoblasto e vesículas, achados compatíveis com mola hidatiforme completa. Atualmente, após 15 meses de seguimento, a paciente permanece assintomática e com níveis indetectáveis de gonadotrofina coriônica.

Twin pregnancy with complete hydatidiform mole coexisting with a live fetus is a rare entity, and although the recommendations are expectant management of various maternal and fetal complications are described, such as increasing the number of spontaneous abortion, premature delivery, vaginal bleeding, pre-eclampsia and severe persistent trophoblastic disease, among other complications. In this paper, we describe the clinical course of a case of GGMC who developed thyrotoxic crisis, preeclampsia severe, termination of pregnancy and maternal need for intensive care. Fetal autopsy showed a female fetus with no apparent defects; with placental changes favoring chromosomal disorders. The evaluationof ovular remains showed villi with trophoblastic hyperplasia and vesicles, suggestive of complete mole. Currently, after 15 months of follow up, the patient remains asymptomatic with undetectable levels of chorionic gonadotropin.

Utility of Ki-67, CD10, CD34, p53, CD117, and mast cell content in the differential diagnosis of cellular fibroadenomas and in the classification of phyllodes tumors of the breast.

Adequate management of phyllodes tumors of the breast (PTB) remains a challenge because of the difficulty in correctly establishing preoperative diagnosis. The aim of this study was to evaluate the usefulness of Ki-67, CD10, CD34, p53, CD117, and of the number of mast cells in the differential diagnosis of benign PTB and cellular fibroadenomas (CFs) as well as in the grading of PTB. Fifty-one primary PTB and 14 CFs were examined by immunohistochemistry.When evaluating CD117 expression, higher epithelial expression was present in CF as well as an increased number of mast cells in benign PTB. Stromal expression of Ki-67, CD10, CD34, and p53 were relevant to PTB grading, of which the first 3 showed significance in the distinction of benign and borderline PTB, as well as between benign and malignant PTB. P53 was relevant only for the discrimination between benign and malign PTB. None of the markers showed significance in distinguishing between borderline and malign PTB.

Balantidíase intestinal: relato de um caso / Intestinal balantidíasis: report of a case

A Balantidíase é uma doença rara em nosso meio. Na oportunidade, relatamos um caso em paciente idoso que veio a óbito, com perfuraçäo intestinal e revisamos a literatura pertinente