Prognostic role of 18F-FDG PET-CT in the prone position in the evaluation of invasive breast carcinoma

Introduction: The objective of this study was to correlate the features of invasive breast carcinoma in 18F-FDG positron emission tomography/computed tomography with histopathological results, findings from other imaging methods, and survival. Methods: This observational single-center study included patients who underwent staging 18F-FDG positron emission tomography/ computed tomography between September 2012 and April 2019; the results were correlated with the findings of other imaging tests and anatomopathological results. Lesions were evaluated for their maximum standardized uptake value on positron emission tomography/computed tomography performed in the prone position. Tumors were classified into three subtypes (luminal, HER2 and triple-negative) based on immunohistochemical analyses. Results: A total of 125 patients with a mean age of 52 years (24­90 years) were analyzed. The primary tumor showed an increased 18F-FDG concentration on positron emission tomography/computed tomography in 122 (97.6%) patients, with a mean maximum standardized uptake value of 7.15 (1.0­32.9 range). The mean maximum standardized uptake value was higher in the triple-negative subtype (11.4; n=24) than in the luminal (6.2; n=89) and HER2 (5.0; n=9) subtypes (p<0.01). Tumors with more aggressive histological and immunohistochemical characteristics showed higher maximum standardized uptake values. Patients with a standardized uptake value greater than 7 in the primary tumor or greater than 6.7 in the axillary lymph nodes had poor overall survival (p=0.03 and p<0.01, respectively). Conclusions: Our study suggests that the maximum standardized uptake value obtained on positron emission tomography/computed tomography in the prone position may correlate with the tumor immunophenotype and overall survival regardless of the treatments performed, and can be used as a prognostic biomarker in invasive breast carcinoma patients

Polimorfismos genéticos e carcinoma de pulmão de células não pequenas: os paradigmas do futuro / Genetic polymorphisms and non-small-cell lung cancer: future paradigms

O presente artigo faz uma abordagem de questões atuais sobre os polimorfismos genéticos, que têm sido objeto de estudo translacional no contexto do carcinoma de pulmão de células não pequenas. Além disso, discute os novos potenciais biomarcadores de risco e prognóstico.

This article addresses some current issues about genetic polymorphisms studied in the non-small-cell lung cancer translational field. Furthermore, it discusses about new potential biomarkers regarding lung cancer risk and prognosis.

Renal failure due to primary amyloidosis: a case report and literature review / Falência renal devida a amiloidose primária: um relato de caso e revisão da literatura

CONTEXT: Primary amyloidosis, also known as AL amyloidosis, is commonly caused by clonal expansion of plasma cells in the bone marrow, thereby segregating light chains of clonal immunoglobulin that settle in tissues in the form of insoluble amyloid fibrils. The aim of this study was to report a case of primary amyloidosis with renal failure, diagnosed in Hospital São João, Porto, Portugal, focusing on the diagnostic difficulties and presenting a literature review. CASE REPORT: A 68-year-old Caucasian man was admitted to the Internal Medicine Department of the hospital with a condition of anasarca and nephrotic syndrome. After performing a renal biopsy that tested positive using Congo red and immunohistochemistry, lambda light chain amyloidosis was diagnosed. This evolved into terminal renal disease, which led to hemodialysis and several episodes of urinary and catheter infections. He was started on chemotherapy, consisting of bortezomib 0.7 mg/m² and dexamethasone 40 mg in six cycles. This led to clinical improvement, stabilization of the illness and good tolerance of the treatment. CONCLUSION: Amyloidosis is a rare entity that is difficult to diagnose. This is because of the unspecific early clinical manifestations of the disease. The hypothesis of amyloidosis is only considered when specific organ failure occurs. This case consisted of primary amyloidosis with involvement of the kidneys as an initial presentation of the disease and its difficulties were shown, going from the clinical approach to the final diagnosis.

CONTEXTO: A amiloidose primária, também conhecida como amiloidose AL, é geralmente causada pela expansão clonal de plasmócitos na medula óssea que segregam cadeias leves de imunoglobulina clonal, as quais se depositam nos tecidos na forma de fibrilas amiloides insolúveis. O objetivo deste estudo é relatar um caso de amiloidose primária com acometimento renal diagnosticado no Hospital São João, Porto, Portugal, enfatizando as dificuldades do diagnóstico e apresentando uma revisão da literatura. RELATO DO CASO: Homem de 68 anos, branco, foi admitido no Serviço de Medicina Interna do hospital com quadro de anasarca e síndrome nefrótica. Após realizar biópsia renal, que foi positiva para o vermelho congo e imunoistoquímica, foi diagnosticada amiloidose de cadeia leve lambda. Evoluiu para doença renal terminal, o que levou a hemodiálise e tendo vários episódios de infecções urinárias e do cateter. Iniciou a quimioterapia com bortezimib, 0,7 mg/m², e dexametasona, 40 mg em seis ciclos, levando a uma melhoria clínica, a estabilização da doença e boa tolerância ao tratamento. CONCLUSÃO: Amiloidose consiste em uma entidade rara e de difícil diagnóstico. Isso ocorre devido a manifestações clínicas da doença pouco específicas, e esta hipótese só é considerada quando do acometimento de um órgão em particular. O caso em questão refere-se a uma apresentação da amiloidose primária com envolvimento renal, como apresentação clínica inicial da doença, e as dificuldades desde a abordagem clínica até o diagnóstico final.