The relationship between tumour infiltrating lymphocytes, Epstein-Barr virus and Helicobacter pylori infection in gastric cancer.

Objective: Epstein-Barr virus (EBV) and Helicobacter pylori (HP) infections have been extensively recognised as gastric cancer (GC) triggers, and recent publications suggest they could behave as predictive markers for immune-modulating therapies. Tumour-infiltrating lymphocytes (TILs) have also been identified as a predictive biomarker for immunotherapy in different malignancies. This study aimed to investigate the association between EBV and HP infection with TIL levels in GC. Methods: TIL evaluation in haematoxylin-eosin was performed by a pathologist and density of CD3, CD8 and CD163 positive (immunohistochemistry staining) immune cells was calculated with the use of digital pathology software. EBV infection was detected by in situ hybridisation (ISH) and by quantitative polymerase chain reaction (qPCR). Methylation status of EBV-related genes was detected by PCR and a methylome analysis was performed by the Illumina Infinium MethylationEPIC BeadChip. HP status was detected by qPCR. Results: We included 98 resected GC Peruvian cases in our evaluation. Median TIL percentage was 30. The proportion of EBV+ detected by ISH was 24.1%, of EBV+ detected by qPCR was 41.8%, while 70% showed methylation of EBV-related genes, and 58.21% of cases were HP+. Younger age (p = 0.024), early stages (p = 0.001), HP+ (p = 0.036) and low CD8 density (p = 0.046) were associated with longer overall survival (OS). High TIL level was associated with intestinal subtype (p < 0.001), with grade 2 (p < 0.001), with EBV qPCR+ (p = 0.001), and with methylation of EBV-related genes (p = 0.007). Cases with high TIL level and cases that are EBV positive share eight genes with similarly methylated status in the metabolomic analysis. High CD8 density was associated with EBV PCR+ (p = 0.012) and HP- (0.005). Conclusion: Lower CD8 density and HP+ predict longer OS. High TIL level is associated with EBV+ and methylation of EBV-related genes, while lower CD8 density is associated with HP+ GC.

Detection of Helicobacter pylori in gastric cancer tissue through histopathology, immunohistochemistry and real-time reverse transcription-PCR.

Aim:Helicobacter pylori is usually detected based on hematoxylin-eosin (H-E) features, but, immunohistochemistry (IHC) and real-time PCR (RT-PCR) are more precise in chronic-gastritis. We evaluated the relevance of these tests in Peruvian gastric cancer samples. Materials & methods: We performed and evaluated H-E, IHC staining and RT-PCR in 288 gastric tumors. Slides were independently evaluated by three pathologists. Results:H. pylori was detected in 167/287 through H-E, 140/288 through IHC and 175/288 through RT-PCR, and positive-status were associated (p < 0.001). H. pylori detection by H-E had a good concordance with IHC (kappa index = 0.632) but poor with RT-PCR (kappa index = 0.317). Higher median gene-copies were found in high H. pylori density through H-E or IHC (p < 0.001). Conclusion: H-E evaluation is accurate in gastric cancer, and IHC and RT-PCR can complement its results.

Testicular plasmacytoma as presentation of multiple myeloma: case report and review of the literature.

OBJECTIVE: We present the case of a patient with testicular plasmacytoma as initial presentation of multiple myeloma, and we carry out a literature review of this uncommon pathology. METHODS: 63 year-old male who consulted for a testicular mass for three months. After clinical and diagnostic studies he underwent radical orchiectomy. RESULTS: Pathologic study of the specimen revealed the presence of round cells, some with plasmocytic aspect. Immunohistochemical studies gave the final diagnosis of plasmacytoma. Studies on disease extension showed rounded lytic lesions spread over the vault of the skull bones. Bone marrow studies, as well as bone biopsy showed infiltration by plasma cell neoplasia in more than 90%, consistent with the diagnosis of multiple myeloma. The patient received treatment, developing disease progression and subsequently died from the disease. CONCLUSIONS: Solitary plasmacytoma represents only 6% of all plasma cell neoplasms. Testicular presentation is an unusual event, representing 2% of cases. Although this is usually an autopsy finding, it may constitute the first manifestation of multiple myeloma or exceptionally be the unique location of a plasma cell neoplasm. To date there are few reports published in the literature. This case constitutes a contribution for the knowledge of testicular plasmacytoma.

Plasmocitoma testicular como presentación inicial de mieloma multiple: presentación de un caso y revisión de la literatura / Testicular plasmacytoma as presentation of multiple myeloma: case report and review of the literature

OBJETIVO: Presentamos el caso de un paciente con diagnóstico de plasmocitoma testicular como presentación inicial de mieloma múltiple y realizamos la revisión de la literatura en relación a lo infrecuente de dicha patología. MÉTODOS: Paciente de sexo masculino de 63 años portador de un tumor testicular, de 3 meses de evolución, de crecimiento progresivo. Una vez evaluado clínicamente y con estudios de ayuda diagnóstica fue sometido a orquiectomía radical. RESULTADO: La anatomía patológica reveló la presencia de células redondas, algunas de aspecto plasmocítico; el estudio inmunohistoquímico concluyó que era Plasmocitoma. Estudios de extensión de enfermedad mostraron lesiones líticas redondeadas diseminadas en los huesos de la bóveda del cráneo. Los estudios de médula ósea, así como la biopsia de hueso demostraron infiltración por neoplasia de células plasmáticas en más del 90%, consistente con el diagnóstico de Mieloma Múltiple. Paciente recibe el tratamiento respectivo, presentando progresión de enfermedad y posteriormente fallece. CONCLUSIONES: El plasmocitoma solitario es una lesión poco frecuente que representa sólo el 6% de todas las neoplasias de células plasmáticas. El compromiso testicular por esta enfermedad constituye un evento inusual, estimado en el 2% de los casos. Aunque éste es generalmente un hallazgo de autopsia, carente de expresión clínica, en raras ocasiones, como en el presente caso, puede constituir la primera manifestación de un mieloma múltiple o excepcionalmente ser la única localización de una neoplasia de células plasmáticas. Hasta la fecha son pocos los reportes publicados en la literatura y éste constituye un aporte más al conocimiento del mismo(AU)

OBJECTIVE: We present the case of a patient with testicular plasmacytoma as initial presentation of multiple myeloma, and we carry out a literature review of this uncommon pathology. METHODS: 63 year-old male who consulted for a testicular mass for three months. After clinical and diagnostic studies he underwent radical orchiectomy. RESULTS: Pathologic study of the specimen revealed the presence of round cells, some with plasmocytic aspect. Immunohistochemical studies gave the final diagnosis of plasmacytoma. Studies on disease extension showed rounded lytic lesions spread over the vault of the skull bones. Bone marrow studies, as well as bone biopsy showed infiltration by plasma cell neoplasia in more than 90%, consistent with the diagnosis of multiple myeloma.The patient received treatment, developing disease progression and subsequently died from the disease. CONCLUSIONS: Solitary plasmacytoma represents only 6% of all plasma cell neoplasms. Testicular presentation is an unusual event, representing 2% of cases. Although this is usually an autopsy finding, it may constitute the first manifestation of multiple myeloma or exceptionally be the unique location of a plasma cell neoplasm. To date there are few reports published in the literature. This case constitutes a contribution for the knowledge of testicular plasmacytoma(AU)

[Surgical outcome of 801 patients with localized gastric cancer treated with d2 lymphadenectomy]. / Cancer gastrico localizado :resultados quirurgicos de 801 pacientes tratados con linfadenectomia d2.

BACKGROUND: D2 gastrectomy has been regarded as an inconvenient procedure with high morbidity and no survival benefit in the West. Recent studies, however, have shown low mortality and a survival benefit of D2 gastrectomy. In the Instituto de Enfermedades Neoplasicas (INEN) of Lima Peru D2 gastrectomy is performed since 1990 after training of some of the authors in the NCC of Tokyo Japan. Distal Pancreatectomy was performed only if the pancreas was involved.The aim of this study was to evaluate the peri operative mortality and survival in a group of patients who had a standard D2 lymphadenectomy according to the rules of the Japanese Research Society for Gastric Cancer. Data were collected prospectively, and patients were followed for more than 7 years. METHODS: Between 1990 and 1999, 938 patients with localized gastric cancer were registered at INEN. Of these, 801 patients underwent curative resection with extended lymphadenectomy (D2). Postoperative morbidity/mortality, type of gastrectomy, mean of lymph nodes removed, pTNM stages and Survival Time and were analyzed. RESULTS: Sub total distal gastrectomy was performed in 511 patients and total gastrectomy in 290 patients. The mean number of lymph nodes removed was 46.48 per patient (54.91 nodes for total and 41.69 for sub total distal gastrectomy). Hospital mortality was 2.9%. 11% were Stage (TNM) IA, 9.4% stage IB, 19% stage II, 24.6% stage IIIA, 13.1% stage IIIB and 23% stage IV. Five-year actuarial survival was 47.5%. Five-year survival of patients with TNM stages IA, IB, II, IIIA, IIIB and IV were 85.8%, 79.4%, 60%, 46.7% 33% and 14.3% respectively. CONCLUSIONS: Gastrectomy with D2 lymphadenectomy may be performed with low morbidity and mortality if the operation is performed in specialized centers with a strict quality control system, and without removing the pancreas during total gastrectomy unless it is suspected to be involved. This procedure could provide a good probability of long-term survival, even for patients with invaded regional lymph nodes.

Cáncer gástrico localizado: resultados quirúrgicos de 801 pacientes tratados con linfadenectomia D2 / Surgical outcome of 801 patients with localized gastric cancer treated with D2 lymphadenectomy

ANTECEDENTES: La gastrectomía D2 es un procedimiento considerado inconveniente por la alta mortalidad y la falta de beneficio en la sobrevida. Sin embargo estudios recientes demuestran que también en occidente la D2 tiene baja mortalidad e impacto en la sobrevida. En el instituto de enfermedades neoplasicas la gastrectomía D2 se realiza desde 1990 después del entrenamiento de algunos de los autores en el NCC de Tokio Japón. El objetivo de este estudio es evaluar la mortalidad peri operatoria y sobrevida en un grupo de pacientes quienes tuvieron una gastrectomía D2 (con preservación de páncreas) de acuerdo a las reglas de la Japanese Research Society for Gastric Cancer.. Los datos fueron recolectados prospectivamente y los pacientes fueron seguidos por un mínimo de 7 años. METODOS: Una serie de 938 pacientes con cáncer gástrico localizado fueron admitidos al INEN entre 1990 y 1999, de estos 801 pacientes tuvieron una reseccion curativa D2. Se analizo la mortalidad post operatoria, tipo de gastrectomía, promedio de ganglios linfáticos resecados, estadios TNM y tiempo de sobrevida. RESULTADOS: Se realizo 511 gastrectomias sub total distal y 290 gastrectomias totales, el promedio de ganglios resecados fue de 46.8 por ciento (54.9 ganglios para total y 41.69 para sub total). La mortalidad hospitalaria fue de 2.9 por ciento. 11 por ciento fueron estadio TNM IA, 9.4 por ciento estadio IB, 24.6 por ciento estadio IIIA, 13.1 por ciento estadio IIIB y 23 por ciento estadio IV.La sobrevida a5 años fue de 47.5 por ciento , la sobrevida a 5 años para los estadios IA, IB, II, IIIA, IIIB y IV fue de 85.8 por ciento , 79.4 por ciento , 60 por ciento , 46.7 por ciento 33 por ciento and 14.3 por ciento respectivamente...

BACKGROUND: D2 gastrectomy has been regarded as an inconvenient procedure with high morbidity and no survival benefit in the West. Recent studies, however, have shown low mortality and a survival benefit of D2 gastrectomy. In the Instituto de Enfermedades Neoplasicas (INEN) of Lima Peru D2 gastrectomy is performed since 1990 after training of some of the authors in the NCC of Tokio Japan. Distal Pancreatectomy was performed only if the pancreas was involved. The aim of this study was to evaluate the peri operative mortality and survival in a group of patients who had a standard D2 lymphadenectomy according to the rules of the Japanese Research Society for Gastric Cancer. Data were collected prospectively, and patients were followed for more than 7 years.METHODS: Between 1990 and 1999, 938 patients with localized gastric cancer were registered at INEN. Of these, 801 patients underwent curative resection with extended lymphadenectomy (D2). Post operative morbidity/mortality, type of gastrectomy, mean of lymph nodes removed, pTNM stages and Survival Time and were analyzed. RESULTS: Sub total distal gastrectomy was performed in 511 patients and total gastrectomy in 290 patients. The mean number of lymph nodes removed was 46.48 per patient (54.91 nodes for total and 41.69 for sub total distal gastrectomy). Hospital mortality was 2.9 percent. 11 percent were Stage (TNM) IA, 9.4 percent stage IB, 19 percent stage II, 24.6 percent stage IIIA, 13.1 percent stage IIIB and 23 percent stage IV. Five-year actuarial survival was 47.5 percent. Five-year survival of patients with TNM stages IA, IB, II, IIIA, IIIB and IV were 85.8 percent, 79.4 percent, 60 percent, 46.7 percent 33 percent and 14.3 percent respectively...

Cervical tumor caused by the sexually mature stage of Fasciola hepatica.

A 58-year-old man presented with an asymptomatic 5cm left anterior cervical tumor that had been present for over a year. Histological analysis revealed chronic inflammation and granuloma with giant cells surrounding Fasciola hepatica eggs. Fas2 antigen was detected in the tissue by immunohistochemistry. Serology for F. hepatica was positive, but stool examinations were negative and eosinophil count was normal. A month later, the tumor recurred, and an adult parasite was found during excision. The patient received triclabendazole, and after 6 months serology was negative. Erratic localization of F. hepatica reveals a pathology involving chronic inflammation caused by a sexually mature parasite, although according to theory only immature parasites are located in ectopic lesions.

Virus de las hepatitis B/C y perfil de expresión de P53, P21ras, P21waf1/cip1 en hepatocarcinoma / Virus of hepatitis B / C and P53 expression profile, p21ras, p21WAF1/CIP1 in hepatocarcinoma

Las infecciones por los virus de las hepatitis B y C han sido estimadas en proporciones sustanciales en casos de enfermedades crónicas del hígado, entre las que se incluye el hepatocarcinoma (HC). Ambos virus codifican proteínas que modulan la actividad regulatoria de transcripción y modifican la post transducción de genes celulares. Objetivo: El propósito del estudio fue investigar los virus de las hepatitis B, C y el perfil de expresión de los genes celulares P53, P21ras y P21WAF1/Cip1 como marcadores moleculares en hepatocarcinomas de pacientes peruanos. Material y métodos: se estudiaron los virus de las hepatitis B y C (VHB, VHC) en muestras de sangre periférica y biopsia hepática de 22 pacientes con diagnóstico de HC mediante PCR y RT-PCR. Las proteínas P53, P21ras y P21 WAF1/Cip1 fueron estudiadas mediante inmunohistoquímica en tejido incluido en parafina. Resultados: El 95% de los HC se asociaron a los virus de las hepatitis. ADN-VHB se detectó en 77% de las biopsias y 54% en sangre. EL ARN-VHC en 27% de biopsias y 14% en sangre. La infección por alguno de los dos tipos virales se encontró en 82% de los casos, coinfección en 3 (14%) y 4% fue negativa para ambos. Infección simple por VHB fue detectada en 64% y por VHC en 18%. Asociación oculta (AO) VHC se detectó en 27% de los HC. Las proteínas P53, P21ras y P21 WAF1/Cip1 fueron sobre expresadas en 68%, 91% y 9% respectivamente. Conclusiones: En nuestra serie al 95% de los HC se asociaron a los virus de las hepatitis. El perfil proteómico prevalente (P21 WAF1/Cip1-, P53+, P21ras+) evidencia represión y sobre expresión de oncogenes y genes supresores celulares. La asociación HC-AO ARN-VHC de no ser pre detectada repercutirá a futuro en la variación del reloj molecular de presentación de HC en pacientes peruanos.

The infections by HBV or HCV have been studied in the chronic liver disease as the hepatocarcinoma (HC). Both viruses modulate the regulatory transcription activity and modify the proto-oncogene and tumor suppressor genes post transduction. Objective: to determinate the correlation between the hepatitis B and C viruses with the expression profile of the P53, P21ras and P21WAF/Cip1 cellular genes as molecular markers in hepatocellular carcinoma. Materials and methods: were studied the hepatitis B and C viruses in peripherical blood samples and hepatic biopsy from 22 patients with HC using PCR and RT-PCR. The P53, P21ras and P21WAF1/Cip1 proteins were studied by immunohistochemistry in embedded paraffin tumor tissue. Results: 95% of the HC were associated to hepatitis viruses. Was found HBV DNA in the 77.3% of the biopsy and in 52.4% of the blood samples, ARN VHC in 27.3% of the biopsy and in blood 4.3%. Infection by some of the two viral types was observed in 18 cases (82%), co infection in 14% and 4% were negative for both. Simple infection by HBV was found in 64% and by HCV in 18%. HCV occult association was detected in 27% in HC. The proteins P53, P21ras y P21 WAF1/Cip1 were detected in 68%, 91% and 9% respectively.

Biosilicification (chalcedony) in human cerebral cortex, hippocampus and cerebellum from aged patients.

Aluminum and silicon have been observed to be present in the human degenerated brain and normal elderly brains by using a combination of scanning electron microscopy and X-ray spectrometry (EDS-SEM). Al and Si of electric organs were also reported--in electrocytes and cholinergic nerves--from living electric fish (family Rajidae). A biogenically produced crystalline mineral phase (i.e., chalcedony) has also been observed in electric organs by using a mineralogical microscope. Based on this evidence we decided to explore the presence of chalcedony (SiO2) in the human central nervous system (CNS). Sections from aged patients (mean, 81 years) were collected after autopsy and observed using a Leica DMLP mineralogical microscope. Chalcedony was detected in cerebral cortex and cerebellum. In plane-polarized light, chalcedony is rounded in shape, 12-20 microm in size, translucent, with a low refraction index. The crossed-polarizer image shows first order birefringence color (grey-white) and radial extinction. Chalcedony was also detected in the hippocampus in large amounts and sizes (50-60 microm). Chalcedony is a microcrystalline fibrous form of silica. It consists of nanoscale intergrowths of quartz and the optically length-slow fibrous silica polymorph moganite. Chalcedony precipitation occurs at a specific pH (7-8) and oxidation potential (Eh; 0.0 to -0.2) in geological environments. This observation supports the important role played by pH and Eh conditions in silica precipitation in elderly brains, as has also been reported in peripheral cholinergic nerves in electric organ from living electric fish. Carbonic anhydrases (CAs) (silicase) are involved in physiological pH regulation and may also be participating in the polymerization-depolymerization of chalcedony in the human brain. This is the first time a biogenically produced crystalline mineral phase (i.e., chalcedony) has been observed in the human CNS from aged patients.

Melanoma maligno de vulva en el Instituto Nacional de Enfermedades Neoplásicas: experiencia de 50 años / Malignant vulvar melanoma at the National Institute of Neoplastic Diseases: Fifty years experience

Objetivo: Determinar las características clínicas del melanoma maligno vulvar en el Instituto Nacional de Enfermedades Neoplásicas (INEN). Material y métodos: Estudio observacional longitudinal, se recolectó información de los casos de melanoma vulvar diagnosticados en el INEN, Lima-Perú, entre 1955 y 2004, a partir de la revisión de las historias clínicas. Se realizó el cálculo de distribuciones de frecuencia, medidas de tendencia central y dispersión, y curvas de supervivencia de Kaplan-Meier. Resultados: Se registraron 60 casos de melanoma vulvar. Se observa una tendencia creciente del número de casos diagnosticados por quinquenio. El promedio de edad fue 56.8 años, mientras que la mediana del tiempo promedio de enfermedad fue 6 meses. El lugar más frecuente de aparición de la lesión fue el lado izquierdo (30%), seguido de la región clitoriana (26.7%). La molestia más frecuentementereferida fue la presencia de una tumoración (91.7%), seguida de prurito (68.3%). La mediana del área del tumor fue 12cm2. El 53.3% presentócompromiso de los ganglios inguinales derecho e izquierdo y el 31.7% no presentó compromiso ganglionar inguinal. El 46.7% presentómetástasis, siendo el compromiso pulmonar el más frecuente (10% del total de casos). El tratamiento recibido fue principalmente del tipo soloquirúrgico radical (50%). La supervivencia a cinco años fue del 9.9%.Conclusiones: El melanoma vulvar es una neoplasia con una tendencia creciente en su diagnóstico, las pacientes buscan atención médica concuadros bastante avanzados y la supervivencia a cinco años es tan solo del 9.9%.

Objective: To determine the clinical characteristics of malignant vulvar melanoma at the National Institute of Neplastic Diseases, Lima-Peru (INEN). Methods: Longitudinal observational study. Information from cases of vulvar melanoma diagnosed at INEN between 1955 and 2004 was collected after reviewing the medical records. We performed the calculation of frequency distributions, measures of central tendency and dispersion, and Kaplan-Meier survival curves. Results: There were 60 cases of vulvar melanoma. There is a growing trend in the number of cases diagnosed at five years periods. The average age was 56.8 years, while the median time of disease was 6 months. The most frequent site of the injury was the left side (30%), followed by clitoral region (26.7%). The sign/symptom most frequently mentioned was the presence of a tumor (91.7%), followed by itching (68.3%). The median area of the tumor was 12cm2. 53.3% had the commitment of right and left groin lymph nodes and 31.7% did not have inguinal lymphnode involvement. The 46.7% had metastases, with lungs as the most common commitment (10% of total cases). The treatment was mainlyradical surgeryl (50%). The survival to five years was 9.9%. Conclusions: The vulvar melanoma is a cancer with an increasing trend in their diagnosis, patients seeking medical care at well advanced stages and survival to five years is only 9.9%.

Hepatic fibrosis and Fasciola hepatica infection in cattle.

This study focuses on the development of fibrosis of the liver of cattle with Fasciola hepatica infection, correlating with the intensity of infection. Animals with an established diagnosis of chronic F. hepatica infection were identified in a slaughterhouse in Lima, Peru. The study included 24 fresh cattle livers from infected animals and two uninfected controls. Tissues were stored at 4 degrees C for approximately 8 h after which they were brought to a necropsy room and examined. Between 9 and 12 biopsies were randomly obtained from each liver. Histological staining of formalin-fixed liver sections with haematoxylin and eosin (H & E) and Masson's trichrome were performed. Liver samples were examined using a pathology protocol that included 30 items. Histopathologically, 16 out of 30 liver specimens (67.6%) showed diffuse fibrotic lesions (cirrhosis) with a mean number of Fasciola of 116 +/- 30 (range 4-435). Pathological data were matched to number of adult parasites and presence of cirrhosis after being reviewed by two independent pathologists. There was concordance between the two pathologists (K = 0.72). The group with cirrhosis showed an average of 116 +/- 30 adult parasites whereas the group not showing cirrhosis contained 56 +/- 28 flukes (P = 0.2). To measure how number of flukes and diagnosis of cirrhosis are related we used Kendall's tau-b coefficient; the correlation was +0.296 (P = 0.04). Receiver Operating Characteristic (ROC) curve results showed that the best point was 38 parasite adults, which had 93.8% sensitivity and 75% specificity. We conclude that as the number of F. hepatica adult forms increases, the likelihood of developing liver fibrosis will also increase in cattle.

[Short and long-term results of liver resection for hepatocarcinoma in Peru: a Peruvian single center experience on 232 cases]. / Resultados a corto y largo plazo de la resección hepática por hepatocarcinoma. análisis de 232 resecciones consecutivas.

BACKGROUND: To evaluate the short and long term outcome of liver resections for hepatocellular carcinoma a retrospective analysis was performed on 232 consecutive patients with hepatocellular carcinoma resected between January 1990 and December 2006 at the Department of Abdomen of the Instituto de Enfermedades Neoplasicas of Lima Peru. METHODS: Disease-free survival (DFS) and overall survival (OS) were determined by Kaplan-Meier method, Prognostic factors were evaluated using univariate and multivariate analysis RESULTS: The median age was 36 years. 44.2% were associated with hepatitis B, only 16.3% had cirrhosis. The median size of the tumors was 15 cm. The median value of AFP was 5,467 ng/ml. The majority of patients underwent a major hepatectomy (74.2 % had four or more segments resected)Overall morbidity and mortality were 13.7% and 5.3% respectively. After a median follow-up of 40 months, tumour recurrence appeared in 53.3% of the patients. The 1, 3, and 5 year overall survival rates were 66.5%, 38.7% and 26.7%respectively. The 1, 3, and 5 year disease-free survival rates were 53.7%, 27.6%, and 19.9%. On multivariate analysis, presence of multiple nodules (p<0.000), cirrhosis (p=0.001), and macroscopic vascular invasion (p=0.001) were found to be independent prognostic factors related to a worse long-term survival. CONCLUSIONS: Surgical resection is the optimal therapy for large HCC and can be safely performed with a reasonable long-term survival.

Classic Kaposi's sarcoma presenting in the oral cavity of two HIV-negative Quechua patients.

Traditionally, classic KS lesions have a general distribution, often involving the skin of the feet and legs, and to a lesser extent, that of the hands, arms, and trunk. Oral involvement is a rare manifestation. Initial oral involvement is an even rarer occurrence. We report two unusual cases of classic KS presenting in the oral cavity of two patients from indigenous origin; the first patient with primary oral KS lesion on the hard palate, with no other signs of the condition in any other region of the body; the second patient with generalized dermal KS lesions with lymph node and lower lip involvement. In conclusion, clinicians and pathologists should be aware of the typical clinical, gross, and histologic features of KS. Moreover, we would like to emphasize that oral KS may affect patients without AIDS or exposure to immunosuppression. The awareness of oral classic KS as a diagnostic possibility is important in the work-up of vascular lesions in the oral cavity of non-immunosuppressed individuals.

Classic Kaposi’s sarcoma presenting in the oral cavity of two HIV-negative Quechua patients

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Traditionally, classic KS lesions have a general distribution, often involving the skin of the feet and legs, and to a lesser extent, that of the hands, arms, and trunk. Oral involvement is a rare manifestation. Initial oral involvement is an even rarer occurrence. We report two unusual cases of classic KS presenting in the oral cavity of two patients from indigenous origin; the first patient with primary oral KS lesion on the hard palate, with no other signs of the condition in any other region of the body; the second patient with generalized dermal KS lesions with lymph node and lower lip involvement. In conclusion, clinicians and pathologists should be aware of the typical clinical, gross, and histologic features of KS. Moreover, we would like to emphasize that oral KS may affect patients without AIDS or exposure to immunosuppression. The awareness of oral classic KS as a diagnostic possibility is important in the work-up of vascular lesions in the oral cavity of non-immunosuppressed individuals

Recurrence Factors In Stage II Colon Cancer

Objective and Methods: For evaluating recurrence factors in Stage II colon adenocarcinoma a clinical, non-experimental, longitudinal and retrospective study was done in the Department of Abdomen of INEN from January 1, 1990 to December 31,2000. Results: In 200 eligible patients 20 (10%) recurrence cases were observed that appeared in an average 2.3 years after surgery. The main site of recurrence was local-regional (5.5%), pulmonary (2.5%), hepatic (1%), and peritoneal (1%). The following factors were considered: age, sex, CEA level, type of operation (elective or emergency), site of the primary injury,invasion (T3 or T4), lymphatic vessel invasion, histologic differentiation, and synchronous carcinoma. We found that patients more than 70 years old (p=0.0305) have a lesser disease-free time. Be more than 70 years old was the only recurrencerelated factor; this group has 2.56 times more risk of recurrence. No other studied variable was related to recurrence.

Human herpesvirus-8 in Peruvian blood donors: a population with hyperendemic disease?

Serum samples from 128 blood donors were tested for antibodies specific for human herpesvirus-8 by an immunofluorescence assay that detects antibodies against mainly lytic antigens. An overall seroprevalence of 56.25% was found (male donors, 54.68%; female donors, 57.11%). These findings indicate that human herpesvirus-8 infection is hyperendemic in Peruvian blood donors.

Characteristics of Castleman's disease in Peru.

BACKGROUND: Castleman's disease (CD) is a very rare disorder of unknown etiology that is characterized by masses of lymphoid tissue. METHODS: The records of all patients with a histological diagnosis of CD who were seen at the Hospital Nacional Cayetano Heredia and the Instituto Nacional de Enfermedades Neoplásicas between 1985 and 2003 and 1985 and 2001, respectively, were reviewed. RESULTS: The study included 10 patients. The age of onset ranged from 5 to 65 years. Nine patients met the criteria for localized CD; six of them were asymptomatic. The most common sites of presentation were the cervical lymph nodes (n=5), submaxilar lymph nodes (n=2), parotid gland (n=1), and lung (n=1). Eight patients had histological evidence of the hyaline-vascular variant and one had the plasma-cell variant. The primary treatment was complete surgical resection. One patient met the criteria for multicentric CD; he was asymptomatic, had histological evidence of the plasma-cell variant, and was treated with combination chemotherapy. All ten patients are currently alive with no evidence of recurrence. CONCLUSION: The localized form of CD presents as progressive, painless, slow-growing lymph node enlargement that is generally asymptomatic. The locations most commonly involved in the localized form are the cervical lymph nodes, followed by the submaxillary lymph nodes, where it poses a diagnostic challenge to the clinician because it tends to mimic other head and neck diseases. Localized CD is almost always of the hyaline-vascular variant and complete surgical excision of the tumor allows full recovery in all cases.

Human papillomavirus in lung carcinomas among three Latin American countries.

The presence of human papillomavirus (HPV) genome in lung carcinomas has been reported worldwide but its frequency varies from country to country. We examined HPV genome in 36 lung carcinomas, consisting of 14 squamous cell carcinomas, 13 adenocarcinomas, and 9 small cell carcinomas, collected from Colombia, Mexico and Peru. PCR analysis using GP5+/GP6+ primers, combined with Southern blot hybridization, found the presence of HPV genome in 10 (28%) of 36 cases. This percentage is similar to the value of 22% reported by Syrjänen, who conducted a meta-analysis of nearly 2500 lung carcinomas examined to date. Genotype analysis revealed that the most predominant genotype was HPV-16 (7 cases), followed by HPV-18 (2 cases) and HPV-33 (1 case). HPV-16 was more frequently found among female than male cases (P=0.008) but was not detected in any adenocarcinoma cases. On the other hand, HPV-18 and HPV-33 were detected only among male cases. These HPV genotypes were detected only in adenocarcinomas, and all the HPV genotypes detected in this histological type were HPV-18 or HPV-33. The frequency of HPV-16 positive cases among all the HPV positive cases differed in the sexes (P=0.033) and differed in the three histological types (P=0.017). The presence of HPV tended to be more frequent in well-differentiated tumors when squamous cell carcinomas and adenocarcinomas were combined. However, it was not statistically significant (P=0.093). Neither p16 nor p53 expression in carcinoma cells was related to the proportion of HPV-positive cases. In conclusion, high-risk HPV DNA was detected in 28% of lung carcinomas. The predisposition of HPV-16 to female cases and to non-adenomatous carcinomas warrants further investigation.