Biomarker analyses in REGARD gastric/GEJ carcinoma patients treated with VEGFR2-targeted antibody ramucirumab.

BACKGROUND: Angiogenesis inhibition is an important strategy for cancer treatment. Ramucirumab, a human IgG1 monoclonal antibody that targets VEGF receptor 2 (VEGFR2), inhibits VEGF-A, -C, -D binding and endothelial cell proliferation. To attempt to identify prognostic and predictive biomarkers, retrospective analyses were used to assess tumour (HER2, VEGFR2) and serum (VEGF-C and -D, and soluble (s) VEGFR1 and 3) biomarkers in phase 3 REGARD patients with metastatic gastric/gastroesophageal junction carcinoma. METHODS: A total of 152 out of 355 (43%) patients randomised to ramucirumab or placebo had ⩾1 evaluable biomarker result using VEGFR2 immunohistochemistry or HER2, immunohistochemistry or FISH, of blinded baseline tumour tissue samples. Serum samples (32 patients, 9%) were assayed for VEGF-C and -D, and sVEGFR1 and 3. RESULTS: None of the biomarkers tested were associated with ramucirumab efficacy at a level of statistical significance. High VEGFR2 endothelial expression was associated with a non-significant prognostic trend toward shorter progression-free survival (high vs low HR=1.65, 95% CI=0.84,3.23). Treatment with ramucirumab was associated with a trend toward improved survival in both high (HR=0.69, 95% CI=0.38, 1.22) and low (HR=0.73, 95% CI=0.42, 1.26) VEGFR2 subgroups. The benefit associated with ramucirumab did not appear to differ by tumoural HER2 expression. CONCLUSIONS: REGARD exploratory analyses did not identify a strong potentially predictive biomarker of ramucirumab efficacy; however, statistical power was limited.

Marantic endocarditis and adenocarcinoma of unknown primary site.

Nonbacterial thrombotic endocarditis (NBTE) is a disease characterized by deposition of thrombi and fibrin on normal or degenerated cardiac valves in the absence of microorganisms. This condition is more commonly seen in chronic inflammatory states, and is associated with higher incidence of thromboembolic events than infective endocarditis. We report the case of a 63-year old male patient with adenocarcinoma of unknown primary site and systemic embolism.

Non-parasitic splenic cysts.

This article gives an overview of the topic, with emphasis on current concepts and management of the clinical situations in question, in particular the concepts related to treatment. An extensive review of the etiology and monitoring of patients with non-parasitic splenic cysts is also made. These reports are derived from major clinical studies published in the current medical literature.

[Giant cell tumour of distal femur with pulmonary metastases]. / Tumor de células gigantes de fémur distal com metástases pulmonares.

Gian cell is normally a benign primary skeletal lesion located in the epiphysis of the long bones. It is more frequente in the third and fourth decades of life but can exhibit the behaviour of a malignant tumour with distal metatasis. Up to 10% of patients present distal metatasis, usually in the lung, and it is concomitant to recurrence in the primary site. The treatment of primary tumour is extensive surgical resection. We report a case of a 35-year-old patient with lung metatases 21 months after curettage of giant cell tumour in distal femur.

True adrenal cyst mimicking renal cancer in a young woman: a case report.

The adrenal cyst is a rare disease that represents approximately 5% of discovered adrenal lesions, which are usually discovered incidentally. True adrenal cysts originate to cells from mesothelium. The potential of cyst adrenal to become malignant has been reported to be 7% and a radical excision of a potentially malignant mass are indicate. We report a case of a 48 year old woman that presented with pain in left hypochondrium and epigastrium, nausea, vomiting, weight loss and microscopic hematuria. After the diagnosis suspicion surgery was performed with a monoblock resection of left kidney and left adrenal gland because of kidney cancer diagnosis as considered. The microscopically analysis of surgical specimen, diagnosed a true epithelial cyst of adrenal gland.

Endocardite marântica e adenocarcinoma de sítio primário oculto / Marantic endocarditis and adenocarcinoma of unknown primary site / Endocarditis marántica y adenocarcinoma de sitio primario desconocido

A endocardite trombótica não bacteriana é caracterizada pela deposição de trombos e fibrina sobre valvas cardíacas normais ou degeneradas na ausência de germes. A patologia está relacionada a estados inflamatórios crônicos, com maior incidência de fenômenos embólicos quando comparada à endocardite infecciosa. Os autores relatam o caso de um paciente masculino, 63 anos, com adenocarcinoma de sítio primário oculto e embolia sistêmica.

Nonbacterial thrombotic endocarditis (NBTE) is a disease characterized by deposition of thrombi and fibrin on normal or degenerated cardiac valves in the absence of microorganisms. This condition is more commonly seen in chronic inflammatory states, and is associated with higher incidence of thromboembolic events than infective endocarditis. We report the case of a 63-year old male patient with adenocarcinoma of unknown primary site and systemic embolism.

La endocarditis trombótica no bacteriana se caracteriza por el depósito de trombos de fibrina en las válvulas cardíacas normales o degenerados en ausencia de gérmenes. La patología se relaciona con estados inflamatorios crónicos, con una mayor incidencia de fenómenos embólicos cuando comparada a endocarditis infecciosa. Los autores refieren el caso de un paciente varón, de 63 años con adenocarcinoma de sitio primario desconocido y la embolia sistémica.

Cistos esplênicos não-parasitários / Non-parasitic splenic cysts

Este artigo apresenta uma revisão geral do tema, com ênfase em conceitos atuais e no manejo das situações clínicas em questão, em especial a conceitos referentes ao tratamento. Também é feita uma revisão extensa quanto à etiologia e seguimento dos pacientes com cisto esplênico não parasitário. São citadas informações derivadas dos principais estudos clínicos publicados na literatura médica atual.

This article gives an overview of the topic, with emphasis on current concepts and management of the clinical situations in question, in particular the concepts related to treatment. An extensive review of the etiology and monitoring of patients with non-parasitic splenic cysts is also made. These reports are derived from major clinical studies published in the current medical literature.

Gliossarcoma: um desafio clínico e terapêutico / Gliosarcoma: a clinical and therapeuctic challenge

O Gliossarcoma (GSa) é uma neoplasia primária rara do sistema nervoso central, caracterizada por padrão histológico bifásico que inclui os componentes glial e sarcomatoso. Os autores relatam o caso de um paciente masculino, de 49 anos de idade, que apresentou cefaleia como manifestação clínica predominante. O diagnostico foi suspeitado devido à arquitetura microscópica e confirmado pelo estudo imuno-histoquímico. Na terapêutica, foi submetido à craniotomia com microcirurgia para ressecção do tumor e tratamento radioterápico complementar. Dados epidemiológicos, histogênese e achados frequentes em exames de imagem são discutidos, assim como o tratamento e prognóstico.

The gliosarcoma (GSA) is a rare primary neoplasm of the central nervous system characterized by a biphasic histological pattern that includes the glial and sarcomatous components. Here the authors report the case of a 49-year-old male patient who presented headache as predominant clinical manifestation. The diagnosis was suspected on account of microscopic architecture and confirmed by immunohistochemical study. The patient underwent craniotomy with microsurgery for tumor resection and additional radiotherapy. Epidemiological data, histogenesis and common findings on imaging are discussed, as well as treatment and prognosis.

Carcinoma vesical de pequenas células / Small cell carcinoma of the bladder

O carcinoma neuroendócrino de pequenas células usualmente tem como sítio primário o pulmão e a sua origem na bexiga é rara. O diagnóstico dos tumores localizados na bexiga é realizado pela biópsia através da cistoscopia ou biópsia transuretral, com posterior análise histológica e imunohistoquímica. O prognóstico é sombrio, com sobrevida média de 8% em 5 anos. O objetivo do presente trabalho é relatar um caso de carcinoma de pequenas células com sítio primário na bexiga em paciente do sexo feminino

The small cell neuroendocrine carcinoma usually has as a primary site the lung, and its origin in the bladder is rare. The diagnosis of tumors in bladder is made through biopsy by cystoscopy or transurethral biopsy with subsequent histological and immunohistochemical analyses. The prognosis is bleak, with mean survival of 8% in 5 years. Here we report a case of small cell carcinoma with primary site in the bladder in a female patient

Cordoma sacral / Sacral chordomas

Cordomas são neoplasias raras que se originam dos remanescentes da notocorda primitiva 50% dos casos têm localização sacral, sendo mais frequente ao nível de S4/S5. Nós descrevemos um caso de cordoma sacral ao nível de S1 e discutimos a apresentação clínica, achados de imagem, tratamento cirúrgico e evolução.

Chordomas are rare neoplasias originating from the remaining primitive notochord. 50% of the cases have sacral localization, being more frequent at levels S4/S5. Here we report a case of sacral chordoma at level S1 and discuss its clinical presentation, imaging findings, surgical treatment, and progress.