Pleomorphic hyalinizing angiectatic tumor of the vulva: literature review based on a rare presentation.

Pleomorphic hyalinizing angiectatic tumor (PHAT) of soft tissues is a rare, non-metastatic tumor of unknown etiology and uncertain behavior, which may recur locally. There are few reports on this condition, and due to the rarity of the disease, its lineage has not yet been fully elucidated. The present study aims to report the case of an unusual entity observed for the first time in vulval topography. A female patient, 83 years old, presented with a tumor in the vulvar region that had evolved for approximately 4 months. Magnetic resonance imaging showed an expansive perineal formation of 8.5 × 3.5 cm, and a hemivulvectomy with a flap rotation was performed. The review of the slides revealed a mesenchymal lesion without significant atypia, which was richly vascularized. In the areas of interest, the immunohistochemical (IHC) study demonstrated positivity for CD34, estrogen, and progesterone receptors; it was negative for the other tested markers. Morphological findings associated with the IHC staining panel supported the diagnosis of PHAT. The main morphological features of PHAT are clusters of ectatic vessels of different sizes that show deposits of subendothelial and intraluminal fibrin. Fusiform and pleomorphic cells randomly arranged in leaves or long fascicles intermingle these vessels. It is essential to recognize this entity and consider it among the differential diagnoses of a mesenchymal lesion, given the wide variety of entities that comprise this group of lesions.

Pleomorphic hyalinizing angiectatic tumor of the vulva: literature review based on a rare presentation

Pleomorphic hyalinizing angiectatic tumor (PHAT) of soft tissues is a rare, non-metastatic tumor of unknown etiology and uncertain behavior, which may recur locally. There are few reports on this condition, and due to the rarity of the disease, its lineage has not yet been fully elucidated. The present study aims to report the case of an unusual entity observed for the first time in vulval topography. A female patient, 83 years old, presented with a tumor in the vulvar region that had evolved for approximately 4 months. Magnetic resonance imaging showed an expansive perineal formation of 8.5 × 3.5 cm, and a hemivulvectomy with a flap rotation was performed. The review of the slides revealed a mesenchymal lesion without significant atypia, which was richly vascularized. In the areas of interest, the immunohistochemical (IHC) study demonstrated positivity for CD34, estrogen, and progesterone receptors; it was negative for the other tested markers. Morphological findings associated with the IHC staining panel supported the diagnosis of PHAT. The main morphological features of PHAT are clusters of ectatic vessels of different sizes that show deposits of subendothelial and intraluminal fibrin. Fusiform and pleomorphic cells randomly arranged in leaves or long fascicles intermingle these vessels. It is essential to recognize this entity and consider it among the differential diagnoses of a mesenchymal lesion, given the wide variety of entities that comprise this group of lesions.

Early metabolic 18F-FDG PET/CT response of locally advanced squamous-cell carcinoma of head and neck to induction chemotherapy: A prospective pilot study.

OBJECTIVE: The objective of this study was to assess the clinical value of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) after the first cycle of induction chemotherapy (IC) in locally advanced squamous cell carcinoma of the head and neck (LASCCHN). METHODS AND FINDINGS: A prospective, single-arm, single center study was performed, with patients enrolled between February 2010 and July 2013.Patients (n = 49) with stage III/IVA-B LASCCHN who underwent IC with taxanes, cisplatin, and fluorouracil were recruited. Staging procedures included loco-regional and chest imaging, endoscopic examination, and PET/CT scan. On day 14 of the first cycle, a second PET/CT scan was performed. Patients with no early increase in regional lymph node maximum 18F-FDG standard uptake value (SUV), detected using 18F-FDG PET/CT after first IC had better progression-free survival (hazard ratio (HR) = 0.18, 95%, confidence interval (CI) 0.056-0.585; p = 0.004) and overall survival (HR = 0.14, 95% CI 0.040-0.498; p = 0.002), and were considered responders. In this subgroup, patients who achieved a reduction of ≥ 45% maximum primary tumor SUV experienced improved progression-free (HR = 0.23, 95% CI 0.062-0.854; p = 0.028) and overall (HR = 0.11, 95% CI 0.013-0.96; p = 0.046) survival. CONCLUSIONS: These results suggest a potential role for early response evaluation with PET/CT examination in patients with LASCCHN undergoing IC. Increased regional lymph node maximum SUV and insufficient decrease in primary tumor uptake predict poorer outcomes.

Análise morfométrica, imunocitoquímica e molecular das citologias cérvico-vaginais com atipias de significado indeterminado / A morphometric, immunocytochemistry and molecular analysis of atypical cells of undetermined significance on cervicovaginal cytology

Introdução: o câncer de colo uterino é a terceira causa mais frequente de câncer em mulheres no mundo. O HPV é o agente etiológico envolvido nos casos de lesões cervicais, sendo detectado em 95 a 100% dos casos. Entretanto,a infecção pelo HPV é transitória e não, necessariamente, produz lesões neoplásicas. A situação onde o resultado do exame citológico é de significado indeterminado (ASC-US, ASC-H, ACG-US e ACG-H) é de especial interesse pelo potencial risco de abrigar lesão neoplásicas e pela dificuldade que causa na decisão clínica. Objetivo:avaliar a contribuição da complementação diagnóstica às citologias cérvico-vaginais com atipias de significado indeterminado pelas análises morfométrica, imunocitoquímica e genotipagem viral do HPV. Métodos: 260 casos de citologia em meio líquido foram analisadas pelo parâmentros morfométrico(ImageJ/NIH institute); imunocitoquímico,anticorpo CINtec Plus e genotipagem para HPV, pelo Linear Array®; incluindo casos positivos, negativos e indeterminados. Resultados: 260 casos: 64 ASC-US, 9 ASC-H, 5 ACG-US, 2 ACG-H, 83 LIBG, 41 LIAG, 6 de carcinomas, 50 negativos. 239 foram amostras genotipadas: 132 positivas para HPV AR, 20 positivas para HPV BR e 83 negativas. O teste de genotipagem de HPV, nos casos indeterminados, apresentou sensibilidade de 0,86; especificidade de 0,52; VPP de 0,21 e VPN de 0,96. Nos casos indeterminados, o teste morfométrico não apresentou valor de p significativo para nenhum parâmetro avaliado. A ICQ, nos casos indeterminados, obteve sensibilidade de 0,67; especificidade de 0,61; VPP de 0,21 e VPN de 0,92. Conclusões: a genotipagem para HPV e a ICQ se mostraram bons métodos complementares ao exame citológico para rastramento das citologias indeterminadas, auxiliando na identificação das pacientes que abrigam lesões clinicamente relevantes.

Multiple mutations in the Kras gene in colorectal cancer: review of the literature with two case reports.

PURPOSE: Kras mutations are negative predictors of anti-EGFR therapy, occurring in 40% of colorectal carcinomas (CRCs). Point substitutions in codon 12 or 13 are the most frequent mutations in Kras, but multiple mutations (MMs) in other codons can also develop. Few data exist on MMs with regard to their frequency and the codons and amino acids that are affected. We report two cases of Kras double mutations in codons 12 and 13 and review Kras MMs in primary CRC in PubMed databases. CASE REPORT: A 53-year-old woman and a 70-year-old man presented with deep, invasive, moderately differentiated CRC at an advanced clinical stage. The former had regional lymph node involvement and vaginal wall neoplastic implantation, and the latter had liver metastasis. Primary tumors were examined for Kras mutations by pyrosequencing, which were confirmed by direct sequencing. Both tumors had a mutation in codons 12 and 13, wherein codon 12 was mutated to GAT, and codon 13 became GAC. CONCLUSIONS: We identified 69 reported cases of Kras MMs and reported two other cases, representing 2.1% of all mutated tumors; the incidence of such mutations is 1.0% in CRC patients. In most cases (59%), MMs develop in a single codon, usually codon 12. Codons 12 and 13 are affected simultaneously in only 27% of cases. These findings add information about the impact of specific amino acid changes in the Kras gene.