Tumor desmoide abdominal / Abdominal desmoid tumor

Los tumores desmoides son infrecuentes, presentan crecimiento localmente agresivo, no suelen dar metástasis pero con frecuencia desarrollan un crecimiento infiltrante que amenaza la vida y puede conducir a una gran morbi-mortalidad. Representan el 0.03% de todos los tumores. En base a la experiencia, los expertos recomiendan la administración de dosis altas de tamoxifeno y sulindac como tratamiento primario para los pacientes con tumores desmoides asociados a poliposis adenomatosa familiar (PAF). Sin embargo, el mejor enfoque después de la intervención quirúrgica para pacientes con tumores desmoides esporádicos, aún no se ha determinado (AU)

Desmoid tumors are infrequent, locally aggressive growth, do not usually metastasize but often develop an infiltrating growth that threatens life and can lead to great morbidity and mortality. They represent 0.03% of all tumors. Based on experience, experts recommend the administration of high doses of tamoxifen and sulindac as a primary treatment for patients with desmoid tumors associated with familial adenomatous polyposis (FAP). However, the best approach after surgical intervention for patients with sporadic desmoid tumors has yet to be determined (AU)

Liposarcoma bien diferenciado con extensa metaplasia ósea y desdiferenciación osteosarcomatosa / Well-differentiated liposarcoma with extensive bone metaplasia and osteosarcomatous dedifferentiation

Dentro de la familia de los liposarcomas, el subtipo bien diferenciado es el más frecuente, caracterizado por su alta tendencia a la recaída local y ubicación retroperitoneal. La desdiferenciación ocurre en alrededor del 10% de los casos y habitualmente se manifiesta histológicamente como sarcoma pleomorfo de alto grado. La desdiferenciación heteróloga es un hecho que ocurre inhabitualmente. Presentamos un caso que debutó como un liposarcoma de bajo grado (lipoma like) que en su evolución tomografica muestra extensas áreas calcificadas y su histología confirma la trasformación a un sarcoma de alto grado con diferenciación osteosarcomatosa (AU)

Within the family of liposarcomas, the welldifferentiated subtype is the most frequent, characterized by its high tendency to local relapse and retroperitoneal localization. Dedifferentiation occurs in about 10% of cases and usually manifests histologically as high-grade pleomorphic sarcoma. Heterologous dedifferentiation is unusual. We present a case that debuted as a low grade liposarcoma (lipoma like) that in its tomographic evolution shows extensive calcified areas and its histology confirms the transformation to a high grade sarcoma with osteosarcomatous differentiation (AU)

Experiencia monoinstitucional en carcinoma de pulmón de células no pequeñas con reordenamiento EML4-ALK / Monoinstitutional experience in non-small cell lung carcinoma with EML4-ALK rearrangement

El gen de fusión EML4-ALK es producto de la inversión dentro del brazo corto del cromosoma 2 que da lugar a una proteína quimérica con actividad tirosinquinasa y oncogénica. EML4-ALK está presente en una pequeña proporción de pacientes con carcinoma no microcítico de pulmón (aproximadamente el 5%), principalmente en histología de adenocarcinoma y ausencia de hábito tabáquico. De 2012 a 2016 se analizó el reordenamiento EML4-ALK en 340 casos en nuestro centro. Se analizaron los pacientes con el reordenamiento por sexo, edad, hábito tabáquico, estadio diagnóstico, sitios metastásicos, respuesta al tratamiento y tiempo del mismo con inhibidores específicos. Del análisis de 340 casos, se detectó el reordenamiento EML4-ALK en 22 (6.4%), 10 de ellos de sexo masculino, edad promedio 52.4 años (23 a 86 años), 13 no tabaquistas, 13 con enfermedad metastásica al diagnóstico. De estos 22, 15 iniciaron tratamiento con crizotinib, presentando 10 de ellos beneficio clínico, con un tiempo promedio de tratamiento de 18 meses. Entre los pacientes con re arreglo cromosómico ALK, 2/22 casos presentaron concomitantemente la mutación ALK más la del gen EGFR, ambos en posición L858R del exon 21. El reordenamiento EML4-ALK es una condición infrecuente, vista generalmente en pacientes con adenocarcinoma, aunque puede presentarse en pacientes con carcinoma indiferenciado o epidermoide; en tres encontramos alteraciones del EGFR, de distinta significancia clínica. El tratamiento con inhibidores específicos es bien tolerado, con alta tasa de respuesta y beneficio clínico prolongado (AU)

The fusion oncogene EML4-ALK, results by a small inversion in the short arm region of chromosome 2, resulting in a chimeric protein with tyrosine kinase and oncogenic activity. EML4-ALK was found in a small proportion of patients with non-small cell lung carcinoma (about 5%), mainly in adenocarcinoma histology and never on light smokers. Between 2012 and 2016 we evaluated EML4-ALK rearrangement in 340 patients in our center. We analized sex, age, smoke habit, tumoral stage, metastasic sites, treatment response and treatment duration with specific inhibitors. Of 340 cases, the EML4-ALK rearrangement was found in 22 (6.4%), all diagnosed with adenocarcinoma, 10 of them male, mean age 52.4 years (23-86 years), 13 were nonsmokers and 13 with metastatic disease at diagnosis. The 15 patients started treatment with crizotinib, 10 of them presented clinical benefit (stable disease or partial response) and an average treatment time of 18 months; 2/22 patients with ALK mutations had concomitant in the EGFR gene, both L858R mutation in exon 21. The EML4-ALK rearrangement is a rare condition, which is usually seen in patients with adenocarcinoma and no history of smoking;although our experience with the use of specific inhibitors is limited, this treatment appears to be well tolerated with prolonged clinical responses (AU)

Prognostic value of E-cadherin, beta-catenin, MMPs (7 and 9), and TIMPs (1 and 2) in patients with colorectal carcinoma.

BACKGROUND AND OBJECTIVES: Therapy of colorectal tumors (CRC) based on histology and clinical factors is insufficient to predict the evolution of each patient. The finding of molecular abnormalities able to differentiate subgroups of patients with bad prognosis will improve our ability to treat them successfully. Our purpose was to analyze retrospectively the prognostic input of E-cadherin, beta-catenin, metalloproteinases (MMPs) (7 and 9), and tissue inhibitors of metalloproteinases (TIMPs) (1 and 2) in patients with a follow-up period of 5 years. METHODS: Antigen expression was analyzed by immunohistochemistry. Prognostic evaluation was performed with the multivariate proportional hazards model. RESULTS: We demonstrated a concomitant loss of E-cadherin and beta-catenin at membranous level and an abnormal accumulation of nuclear beta-catenin. Besides, we found that all MMPs and TIMPs studied were overexpressed in CRC tissue. There was no association between the expression of any of these molecules and the known clinical-pathological parameters employed in CRC pathology. A multivariate analysis demonstrated that the overall survival could be independently predicted by the loss of E-cadherin and the overexpression of TIMP-2. CONCLUSIONS: The expression of E-cadherin and TIMP-2 could be relevant in determining the prognosis of CRC patients and providing a more accurate mechanism for their classification.

[Predictive response variables to recombinant human erythropoietin treatment in patients with anemia and cancer]. / Variables predictivas de respuesta a la eritropoyetina recombinante humana en pacientes con anemia y cáncer.

The use of human recombinant erythropoietin (rHuEpo) has been approved by the Food and Drug Administration (FDA) in patients with anemia and cancer. Although good results have been obtained, it is too expensive to permit its use massively. For the purpose of evaluating the therapeutic effect of rHuEpo, including toxicity, predictive response variables and quality of life parameters, a prospective trial was carried out in patients with anemia and cancer. Hematimetric parameters, ferritin, Epo, cytokines, transfusions and quality of life were registered. A total of 36 patients were treated in the protocol (34 were evaluable): 16 men and 20 women, with a medium age 56.4 years; 27 patients were treated with chemotherapy (16 with cisplatinum); 15 patients presented medullar infiltration. In 73.5% patients an increase in the level of hemoglobin was registered, and in 64.7% its normalisation was attained. Transfusional requirements were reduced by 50%. The hemoglobin increase greater than 0.5 g/dl at the second week of treatment was the most significant variable of early response. Patients treated with cisplatinum, seric ferritin lower than 1,100 ng/dl and those without medullar tumoral infiltration responded best. Serum Epo, cytokines (IL-1, IL-6 and TNF) and reticulocyte count at the second week did not correlate with response. Quality of life parameters were better in patients with good response to rHuEpo. It can be concluded that good results in the treatment of patients with anemia and cancer are obtained with rHuEpo.

CD44 expression in human gliomas.

BACKGROUND AND OBJECTIVES: Glioma invasiveness involves the attachment of tumor cells to the brain extracellular matrix, rich in hyaluronic acid (HA). CD44, the principal receptor for HA is found as a standard molecule (CD44s) or as variants (CD44v). We undertook a retrospective study to evaluate the expression pattern of CD44s, the isoforms CD44v3, v4/5 and v6 and to correlate their expression with clinical-anatomopathological parameters and survival rate. METHODS: The expression of these molecules was evaluated immunohistochemically in 84 gliomas. RESULTS: No expression of CD44v was detected in any tumors. CD44s staining of tumor cells was found in 70 of 84 (83.3%) of the gliomas. In 23 of 39 (59.0%) of the GBM more than the 70% of the cells were stained, while only 2 of 21 (9.5%) of LGA showed high expression. The association between CD44 and histological grade remained when the prognostic variables were considered in a multivariate analysis. Higher expression of CD44 was associated with worse overall survival rate; however, the Cox analysis indicated that survival was not associated with CD44. CONCLUSIONS: Our results suggest that overexpression of CD44s could be relevant in determining the highly invasive behaviour of gliomas, though it does not behave as an independent prognostic factor for survival.

Variables predictivas de respuesta a la eritropoyetina recombinante humana en pacientes con anemia y cancer / Predictive response variables to recombinant human erythropoietin treatment in patients with anemia and cancer

The use of human recombinant erythropoietin (rHuEpo) has been approved by the Food and Drug Administration (FDA) in patients with anemia and cancer. Although good results have been obtained, it is too expensive to permit its use massively. For the purpose of evaluating the therapeutic effect of rHuEpo, including toxicity, predictive response variables and quality of life parameters, a prospective trial was carried out in patients with anemia and cancer. Hematimetric parameters, ferritin, Epo, cytokines, transfusions and quality of life were registered. A total of 36 patients were treated in the protocol (34 were evaluable): 16 men and 20 women, with a medium age 56.4 years; 27 patients were treated with chemotherapy (16 with cisplatinum); 15 patients presented medullar infiltration. In 73.5 percent patients an increase in the level of hemoglobin was registered, and in 64.7 percent its normalisation was attained. Transfusional requirements were reduced by 50 percent. The hemoglobin increase greater than 0.5 g/dl at the second week of treatment was the most significant variable of early response. Patients treated with cisplatinum, seric ferritin lower than 1,100 ng/dl and those without medullar tumoral infiltration responded best. Serum Epo, cytokines (IL-1, IL-6 and TNF) and reticulocyte count at the second week did not correlate with response. Quality of life parameters were better in patients with good response to rHuEpo. It can be concluded that good results in the treatment of patients with anemia and cancer are obtained with rHuEpo.

Variables predictivas de respuesta a la eritropoyetina recombinante humana en pacientes con anemia y cancer / Predictive response variables to recombinant human erythropoietin treatment in patients with anemia and cancer

The use of human recombinant erythropoietin (rHuEpo) has been approved by the Food and Drug Administration (FDA) in patients with anemia and cancer. Although good results have been obtained, it is too expensive to permit its use massively. For the purpose of evaluating the therapeutic effect of rHuEpo, including toxicity, predictive response variables and quality of life parameters, a prospective trial was carried out in patients with anemia and cancer. Hematimetric parameters, ferritin, Epo, cytokines, transfusions and quality of life were registered. A total of 36 patients were treated in the protocol (34 were evaluable): 16 men and 20 women, with a medium age 56.4 years; 27 patients were treated with chemotherapy (16 with cisplatinum); 15 patients presented medullar infiltration. In 73.5 percent patients an increase in the level of hemoglobin was registered, and in 64.7 percent its normalisation was attained. Transfusional requirements were reduced by 50 percent. The hemoglobin increase greater than 0.5 g/dl at the second week of treatment was the most significant variable of early response. Patients treated with cisplatinum, seric ferritin lower than 1,100 ng/dl and those without medullar tumoral infiltration responded best. Serum Epo, cytokines (IL-1, IL-6 and TNF) and reticulocyte count at the second week did not correlate with response. Quality of life parameters were better in patients with good response to rHuEpo. It can be concluded that good results in the treatment of patients with anemia and cancer are obtained with rHuEpo. (AU)

Variables predictivas de respuesta a la eritropoyetina recombinante humana en pacientes con anemia y cáncer. / [Predictive response variables to recombinant human erythropoietin treatment in patients with anemia and cancer]

The use of human recombinant erythropoietin (rHuEpo) has been approved by the Food and Drug Administration (FDA) in patients with anemia and cancer. Although good results have been obtained, it is too expensive to permit its use massively. For the purpose of evaluating the therapeutic effect of rHuEpo, including toxicity, predictive response variables and quality of life parameters, a prospective trial was carried out in patients with anemia and cancer. Hematimetric parameters, ferritin, Epo, cytokines, transfusions and quality of life were registered. A total of 36 patients were treated in the protocol (34 were evaluable): 16 men and 20 women, with a medium age 56.4 years; 27 patients were treated with chemotherapy (16 with cisplatinum); 15 patients presented medullar infiltration. In 73.5

patients an increase in the level of hemoglobin was registered, and in 64.7

its normalisation was attained. Transfusional requirements were reduced by 50

. The hemoglobin increase greater than 0.5 g/dl at the second week of treatment was the most significant variable of early response. Patients treated with cisplatinum, seric ferritin lower than 1,100 ng/dl and those without medullar tumoral infiltration responded best. Serum Epo, cytokines (IL-1, IL-6 and TNF) and reticulocyte count at the second week did not correlate with response. Quality of life parameters were better in patients with good response to rHuEpo. It can be concluded that good results in the treatment of patients with anemia and cancer are obtained with rHuEpo.

Características de los tratamientos quimioterápicos / Characteristics of chemotherapy treatments

Generalmente se efectúan trabajos tendientes a demostrar la efectividad de los tratamientos propuestos pero olvidamos observar que le pasa al paciente mientras lo realiza. Con el objetivo de describir las características de los tratamientos, de los pacientes y del personal que lo asiste realizamos el siguiente trabajo: durante 10 meses fueron recolectados por enfermería oncológica datos referentes a las características de los tratamientos realizados. Se registraron 997 ciclos de quimioterapia (444 en hombres y 553 en mujeres). No hubo aumento en el número de intentos en colocar las vías parenterales según el número creciente de ciclos realizados, el tipo de vía utilizada, diferentes enfermeros o el sexo. Las mujeres tuvieron peor acceso vascular (p<0,024). No hubo diferencias en cuanto al uso de vías tipo "Abbocath" o "Butterfly". Las complicaciones más frecuentes fueron: la ansiedad 19,06 por ciento y la infiltración/extravasación 3,5 por ciento. En los días de trabajo más intenso se registraron mayor número de complicaciones. La infiltración/extravasación fue mayor a medida que aumentaba el número de ciclos que había recibido el paciente. Hubo diferencias significativas al considerar mejor la cooperación del paciente respecto al sexo masculino (p<0,018), número de intentos en colocar la vía (p<0,001) el tipo de acceso vascular (p<0,0001), si había tenido infiltración/extravasación (p<0,001) y según el uso de catéter implantable (p<0,02). Durante los tratamientos quimioterápicos entran en juego factores independientes del paciente, de la enfermera y del médico. Su conocimiento y mejoramiento pueden lograr una mejor calidad en la atención y bienestar para el paciente

Características de los tratamientos quimioterápicos / Characteristics of chemotherapy treatments

Generalmente se efectúan trabajos tendientes a demostrar la efectividad de los tratamientos propuestos pero olvidamos observar que le pasa al paciente mientras lo realiza. Con el objetivo de describir las características de los tratamientos, de los pacientes y del personal que lo asiste realizamos el siguiente trabajo: durante 10 meses fueron recolectados por enfermería oncológica datos referentes a las características de los tratamientos realizados. Se registraron 997 ciclos de quimioterapia (444 en hombres y 553 en mujeres). No hubo aumento en el número de intentos en colocar las vías parenterales según el número creciente de ciclos realizados, el tipo de vía utilizada, diferentes enfermeros o el sexo. Las mujeres tuvieron peor acceso vascular (p<0,024). No hubo diferencias en cuanto al uso de vías tipo "Abbocath" o "Butterfly". Las complicaciones más frecuentes fueron: la ansiedad 19,06 por ciento y la infiltración/extravasación 3,5 por ciento. En los días de trabajo más intenso se registraron mayor número de complicaciones. La infiltración/extravasación fue mayor a medida que aumentaba el número de ciclos que había recibido el paciente. Hubo diferencias significativas al considerar mejor la cooperación del paciente respecto al sexo masculino (p<0,018), número de intentos en colocar la vía (p<0,001) el tipo de acceso vascular (p<0,0001), si había tenido infiltración/extravasación (p<0,001) y según el uso de catéter implantable (p<0,02). Durante los tratamientos quimioterápicos entran en juego factores independientes del paciente, de la enfermera y del médico. Su conocimiento y mejoramiento pueden lograr una mejor calidad en la atención y bienestar para el paciente