RESUMO
Nowadays, the impact of the tumor-immune microenvironment (TME) in non-small-cell lung cancer (NSCLC) prognosis and treatment response remains unclear. Thus, we evaluated the expression of PD-L1, tumor-infiltrating lymphocytes (TILs), and transforming growth factor beta (TGF-ß) in NSCLC to identify differences in TME, detect possible new prognostic factors, and assess their relationship. We retrospectively analyzed 55 samples from patients who underwent NSCLC surgery and had over a 5-year follow-up. PD-L1 expression was determined by immunohistochemistry following standard techniques. The presence of TILs was evaluated at low magnification and classified into two categories, "intense" and "non-intense". Cytoplasmic TGF-ß staining visualization was divided into four categories, and unequivocal nuclear staining in >1% of viable tumor cells was defined as "present" or "absent". Our aim was to identify differences in disease-free survival (DFS) and overall survival (OS). Tumor stage was the only objective prognostic factor for OS. PD-L1 expression and the presence of TILs had no prognostic impact, neither their combination. There seems to be a lower expression of PD-L1 and a higher expression of TILs in early stages of the disease. Our TGF-ß nuclear staining analysis was promising, since it was associated with worse DFS, revealing this protein as a possible prognostic biomarker of recurrence for resectable NSCLC.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma de Pequenas Células do Pulmão , Humanos , Antígeno B7-H1/metabolismo , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Coloração e Rotulagem , Fator de Crescimento Transformador beta , Microambiente TumoralRESUMO
PURPOSE: Computerized posturography is the gold standard for balance assessment. Because of the great cost and dimensions of commercial equipments, low-cost and portable devices have been developed and validated, such as RombergLab, a software in open source term which works connected with a low-cost force platform. The objective of this study was to obtain normative posturography data using this software. METHODS: A multicentric prospective and descriptive study, with 350 healthy participants, was designed. Static postural stability (measured using the modified clinical test of sensory interaction on balance) was evaluated using the software connected to the force platform. Using the confidence ellipse area (CEA) in each condition, global equilibrium score (GES) was calculated and adjusted for significant variable factors using cluster analysis. RESULTS: Mean (SD) GES was 0.72 (0.22). Age (p < 0.01), height (p < 0.01) and recruitment center (p < 0.05) were found as influence factors for GES. Cluster analysis obtained 16 groups stratified by age and height. GES decreases with age and height (p < 0.005). No significant interaction of age nor height was found with GES in these clusters (p > 0.05). After correction for height and age, GES was no longer influenced by the recruitment center (p > 0.05). CONCLUSIONS: With the introduction of the global equilibrium score values of the present study into the software, we consider RombergLab v1.3 a reference posturography tool for healthy individuals. Further studies are needed for validating it as a suitable instrumented test for screening between healthy and pathologic subjects and its reliability over time for the follow-up of patients.
Assuntos
Diagnóstico por Computador/métodos , Técnicas de Diagnóstico Neurológico , Equilíbrio Postural/fisiologia , Software , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Adulto JovemRESUMO
The recent addition of novel immunotherapy drugs for the treatment of urothelial carcinoma makes it necessary the establishment of criteria to harmonize the immunohistochemical assessment of PD-L1, both as a prognostic factor and for the selection of patients to be treated. In this scenario, a group of uropathologists from the Spanish Society of Pathological Anatomy, together with a medical oncologist as an external collaborator subspecialized in uro-oncology, have prepared this document of recommendations based on the available evidence. During PD-L1 assessment it is especially relevant the selection of the sample, its processing, the immunohistochemical platform and antibody used, and the algorithm applied in the interpretation of results. All these aspects must be indicated in the results report, which should be easily interpretable in a context of rapid evolution of immunological therapies.
Assuntos
Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Humanos , Neoplasias da Bexiga Urinária/terapia , Carcinoma de Células de Transição/terapia , Antígeno B7-H1 , Consenso , Imunoterapia/métodosRESUMO
Diffuse leptomeningeal glioneuronal tumors (DLGNTs) are a rare indolent neoplasm described in the 2016 WHO classification of tumors of the central nervous system (CNS). We describe a case of an 11 year old boy who initially presented intermittent headache, low back pain and communicating hydrocephalus, misdiagnosed as having tuberculous meningitis. Further clinical deterioration with seizures was observed and follow-up MRI showed further aggravation of leptomeningeal enhancement in the basal cisterns. Biopsy of the brain and leptomeninges revealed a diffuse leptomeningeal glioneuronal tumor. DLGNT should be considered in the differential diagnosis of conditions presenting as communicating hydrocephalus with nodular lesions and leptomeningeal enhancement. A timely histologic diagnosis through a biopsy of the brain is necessary to confirm the diagnosis.
Assuntos
Hidrocefalia , Neoplasias Meníngeas , Neoplasias Neuroepiteliomatosas , Masculino , Humanos , Criança , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/patologia , Imageamento por Ressonância Magnética , Encéfalo , Hidrocefalia/etiologiaRESUMO
A 72-year-old female with no relevant medical history consulted in the emergency room for a two-week history of headache, vomiting and gait disturbance. Head CT scan revealed obstructive hydrocephalus secondary to a pineal mass with compression of the third ventricle. Magnetic Resonance showed another mass located in the right Lushcka foramen. Endoscopic third-ventriculostomy and biopsy of pineal mass were performed. Pathological analysis was consistent with metastasis of carcinoma. Full-body CT scan showed a lung mass related to primary carcinoma. The patient received systemic treatment for metastatic lung cancer. She died two months after diagnosis.
Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Hidrocefalia/etiologia , Neoplasias Pulmonares , Glândula Pineal , Idoso , Biópsia/métodos , Neoplasias Encefálicas/secundário , Carcinoma/secundário , Evolução Fatal , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Neuroendoscopia , Glândula Pineal/diagnóstico por imagem , Glândula Pineal/patologia , Tomografia Computadorizada por Raios X , VentriculostomiaRESUMO
OBJECTIVES: This study aimed to determine whether, in asymmetric hearing loss, the presence of an ear with a better or worse hearing threshold is related to either better or worse speech-in-noise (SiN) intelligibility. MATERIALS AND METHODS: A total of 618 subjects with different degrees of hearing loss were evaluated for their ability to understand SiN. A stepwise forward logistic regression analysis was performed to identify the factors that affect performance. The influencing factors of very high or very low performance were determined. RESULTS: Age, especially after 70 years of age, and hearing loss, especially from moderate hearing loss, negatively influence SiN intelligibility. Remarkably high intelligibility was identified in subjects with a contralateral ear presenting a better auditory threshold. CONCLUSION: Although age and hearing loss are known factors that affect SiN intelligibility, the presence of a healthy contralateral ear is presented as the first description of preservation of SiN hearing ability.
Assuntos
Compreensão/fisiologia , Perda Auditiva/fisiopatologia , Ruído , Inteligibilidade da Fala/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Audiometria de Tons Puros , Limiar Auditivo/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemAssuntos
Cisto Folicular/etiologia , Neoplasias de Anexos e de Apêndices Cutâneos/complicações , Neoplasias Cutâneas/complicações , Pele/patologia , Biópsia , Diagnóstico Diferencial , Cisto Folicular/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias de Anexos e de Apêndices Cutâneos/diagnóstico , Neoplasias Cutâneas/diagnósticoAssuntos
Neoplasias Faciais/patologia , Neoplasias Cutâneas/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Queixo , Diagnóstico Diferencial , Neoplasias Faciais/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Neoplasias Cutâneas/cirurgia , Neoplasias das Glândulas Sudoríparas/cirurgiaAssuntos
Injúria Renal Aguda/induzido quimicamente , Analgésicos Opioides/efeitos adversos , Nefrite Intersticial/induzido quimicamente , Tramadol/efeitos adversos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/tratamento farmacológico , Corticosteroides/uso terapêutico , Idoso , Analgésicos Opioides/uso terapêutico , Artralgia/tratamento farmacológico , Biópsia , Diagnóstico Diferencial , Feminino , Granuloma/induzido quimicamente , Humanos , Rim/patologia , Mieloma Múltiplo/diagnóstico , Nefrite Intersticial/diagnóstico , Nefrite Intersticial/tratamento farmacológico , Recuperação de Função Fisiológica , Tramadol/uso terapêuticoRESUMO
OBJECTIVE: This study aimed to evaluate the long-term effects of intratympanic corticoid therapy on vertigo control and hearing changes. STUDY DESIGN: The study design was retrospective. SETTING: Tertiary medical centers. PATIENTS: Fifty-six patients with definite unilateral Ménière's disease, diagnosed using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines, were included. Twenty-two patients were treated with a fixed protocol of 3 consecutive daily intratympanic injections of a 4 mg/ml dexamethasone commercial preparation. Thirty-four patients were treated with a fixed protocol of 3 consecutive weekly injections of the same preparation. MAIN OUTCOME MEASURE: The 1995 AAO-HNS criteria for reporting treatment outcome in MD were used. The treatment results were expressed in terms of vertigo control. A Kaplan-Meier analysis was used to evaluate the control of vertigo over a 2-year period. Separate curves were created depending on the protocol used and the class of vertigo control obtained. RESULTS: Complete vertigo control (class A) was achieved in 40.9% and 44.1% of patients on the daily and weekly protocols, respectively. Substantial vertigo control was obtained in an additional 18.2% and 14.7% of patients on the daily and weekly protocols, respectively. No significant differences were found between the 2 fixed protocols. CONCLUSION: Intratympanic dexamethasone (4 mg/ml) perfusion provides an alternative treatment for definite Ménière's disease. The Kaplan-Meier analysis was useful for analyzing the control of vertigo and the recurrence of Ménière's disease.
Assuntos
Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Doença de Meniere/tratamento farmacológico , Vertigem/tratamento farmacológico , Adulto , Audiometria de Tons Puros , Dexametasona/administração & dosagem , Esquema de Medicação , Feminino , Glucocorticoides/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Membrana TimpânicaRESUMO
OBJECTIVE: To evaluate the frequency and duration of episodes of definitive vertigo in Ménière's disease. DESIGN: Prospective longitudinal study. SETTING: Multiple tertiary referral centers. PATIENTS: Five hundred ten individuals from 8 hospitals that met the American Academy of Otolaryngology-Head and Neck Surgery diagnostic criteria for definitive Ménière's disease. INTERVENTION: Conservative treatment. MAIN OUTCOME MEASURE: Frequency and duration of episodes of definitive vertigo during follow-up. RESULTS: Ménière's disease affects both sexes and both ears equally, with onset generally in the fourth decade of life. The number of episodes of vertigo is greater in the first few years of the disease. Although episodes of vertigo that last longer than 6 hours are less frequent than shorter episodes, they occur with similar frequency throughout the natural course of the disease. The percentage of patients without episodes of vertigo increases as the disease progresses, and 70% of patients who did not have an episode of vertigo for 1 year will continue to be free of episodes during the following year. Thus, there is a relationship between the frequency of episodes in consecutive years, although this association decreases rapidly as the number of years increases. CONCLUSION: The frequency of definitive episodes of vertigo in Ménière's disease decreased during follow-up, and many individuals reached a steady-state phase free of vertigo.