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Eosinophilic solid and cystic renal cell carcinoma (ESC-RCC) is a novel and uncommon type of renal cell carcinoma, which has been recently recognized and introduced as a distinct entity in the WHO 2022 kidney tumor classification. Previously known as "unclassified RCC", followed by "tuberous sclerosis complex (TSC)-associated RCC", ESC-RCC is now a distinct category of kidney tumor, with its own name, with specific clinical manifestations, and a unique morphological, immunohistochemical and molecular profile. Due to its recent introduction and the limited available data, the diagnosis of ESC-RCC is still a complex challenge, and it is probably frequently misdiagnosed. The secret of diagnosing this tumor lies in the pathologists' knowledge, and keeping it up to date through research, thereby limiting the use of outdated nomenclature. The aim of our case-based review is to provide a better understanding of this pathology and to enrich the literature with a new case report, which has some particularities compared to the existing cases.
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Carcinoma de Células Renais , Neoplasias Renais , Humanos , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/patologia , Neoplasias Renais/diagnóstico , Eosinofilia/patologia , Eosinofilia/diagnóstico , MasculinoRESUMO
We report three primary thyroid angiosarcoma (PTA) cases revealing distinctive morphological features. A systematic literature review completed our analysis to evaluate the most important morphological factors for predicting prognosis in PTAs. Three rare PTA cases were analysed. In addition, we identified 46 previously reported PTAs with available follow-up data to compare morphological features related to prognosis between patients with a favourable versus aggressive outcome. The three PTAs displayed considerable architectural heterogeneity: case 1 presented a well circumscribed tumour, extensively necrotic, with only a few highly pleomorphic vascular proliferation; cases 2 and 3 both exhibited plump epithelioid cells forming rudimentary vascular spaces or solid sheets. Case 3 also presented angioinvasion. Cases 1 and 2 were alive and disease-free at 40 and 73 months following diagnosis, respectively, whereas case 3 died within 14 months. Other significant prognostic factors were highlighted by our review and literature data analysis: increased tumour size (p = 0.042), extrathyroidal extension (p = 0.009), and distant metastases at diagnosis (p = 0.001). Although regarded as highly aggressive, PTA can also be characterised by an unusual favourable outcome. For the first time we highlight the importance of reporting angioinvasion, in cases of PTA, as a possible adverse prognostic factor.
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Vasos Sanguíneos/patologia , Hemangiossarcoma/patologia , Neoplasias da Glândula Tireoide/patologia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Intervalo Livre de Doença , Feminino , Hemangiossarcoma/terapia , Humanos , Imuno-Histoquímica , Masculino , Invasividade Neoplásica , Neoplasias da Glândula Tireoide/terapia , Fatores de Tempo , Resultado do TratamentoRESUMO
Myelolipomas represent 3-7% fromthe primary tumors of the adrenal gland. Most often they are incidental findings. In most cases are asymptomatic, rarely they present symptoms (pain, abdominal discomfort, hematuria or signs of internal hemorrhage). Histologically benign, this variety of tumor requires only local excision, in symptomatic forms. Their dimensions are generally up to 4-5 cm, so the laparoscopic approach seems the most appropriate. We present the case of a 65 years old patient, electively operated for a right adrenal tumor formation.Alaparoscopic right adrenalectomy was performed using an anterior transabdominal approach. No ligatures, clips or sutures were used. The intervention was accomplished with the Ligasure Maryland forceps and the Force Triad platform (Covidien Medtronic-USA). The postoperative evolution was favorable and the pathological examination highlighted an adrenal myelolipoma with intratumoral hemorrhage.
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Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Hemorragia/etiologia , Laparoscopia , Mielolipoma/cirurgia , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Adrenalectomia/instrumentação , Adrenalectomia/métodos , Idoso , Feminino , Humanos , Achados Incidentais , Laparoscopia/métodos , Mielolipoma/complicações , Mielolipoma/diagnóstico , Suturas , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
We aimed to evaluate the prognostic value of BRAFV600E mutation in a series of 127 papillary thyroid carcinoma (PTC) cases as a single factor, and in synergic interaction with other standard risk factors. BRAFV600E mutation was assessed by real-time PCR. Event-free survival (EFS) was calculated between the date of the first evaluation and the date of occurrence of an adverse event or the date of the last known status. The prevalence of BRAFV600E mutation was 57.2%. The Kaplan-Meier analysis showed a significant reduction of EFS among cases harboring BRAFV600E mutation compared to non-mutated cases (p = 0.010). In addition, BRAFV600E mutation was found to better predict adverse outcomes when associated with the following risk factors: age ≥ 55 years old (p < 0.001), male gender (p < 0.001), conventional (p = 0.005) and tall cell (p = 0.014) histology, tumor size > 40 mm (p = 0.001), extrathyroidal extension (p = 0.001), multifocality (p = 0.001) and lymph node metastasis (p < 0.001). In univariate analysis, a 3.74-fold increased risk for a reduced EFS (p = 0.018) was found for BRAFV600E-mutated cases, but no increased risk was further confirmed by multivariate analysis. Our results highlight that BRAFV600E mutation cannot be used alone as an independent predictive factor in PTC patients, but is prognostically valuable if integrated in the context of other clinicopathological risk factors.
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The aim of the study was to better understand the interplay between genetic factors and the aging process in the human retina through mapping complement factor H (CFH) and related proteins. Two human eyes, from 92- and 64-year-old donors, were genotyped for the expression of CFH-related 1 (CFHR1) and CFH-related 3 (CFHR3) genes. Deoxyribonucleic acid (DNA) was extracted and analyzed for concentration and purity with a spectrophotometer, at 260 nm. The results showed a DNA concentration of 469.17 ng∕µL in the aged retina and of 399.20 ng∕µL in the younger one. Through polymerase chain reaction (PCR) genotyping, the DNA CFHR1 and CFHR3 were visible as bands of 175 bp and 181 bp. Immunohistochemistry by immunofluorescence method was used with a panel of specific antibodies for CFH, CFHR1, CFHR3 and GFAP, a marker for Müller cells. All the samples were examined, and images captured using confocal microscopy. In the younger retina, CFH was localized in the inner plexiform layer and below the outer nuclear layer, while in the aged retina, it was found in the photoreceptors. CFH was also detected in the choriocapillaris and within the end-feet of the Müller cells. Our controls showed autofluorescence of the retinal pigment epithelium shedding light on a false positive CFH immunostaining of this layer. GFAP immunoreactivity highlighted an increased gliosis within the aged retina. CFHR3 signal was found in the microglia, while CFHR1 was detected in the choriocapillaris. In summary, underpinning the expression of these components can show the potential involvement of these modulators in implementing new treatment strategies.
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Envelhecimento , Proteínas Inativadoras do Complemento C3b , Idoso , Envelhecimento/genética , Biomarcadores , Proteínas Inativadoras do Complemento C3b/genética , Proteínas Inativadoras do Complemento C3b/metabolismo , DNA , Genótipo , Humanos , RetinaRESUMO
Programmed death ligand-1 (PD-L1) immunohistochemical (IHC) status is used to predict which patients with metastatic urothelial carcinoma (UC) will respond to immunotherapy. We aimed to compare QR1(Quartett), 22C3 (Dako), and SP263 (Ventana) detection of PD-L1 expression in muscle-invasive UCs and determine the best scoring algorithm for assessment of PD-L1 expression when using the QR1 clone. Our study included 69 UCs. For SP263 and 22C3, PD-L1-positive tumor cell (TC) and/or immune cell (IC) percentages (TC%/IC%) and the Combined Positive Score (CPS) were assessed, respectively (positivity cut-offs of ≥ 25% and ≥ 10). For QR1, both interpretation systems were evaluated. The concordances between assays were calculated. PD-L1 IHC staining characteristics were comparable between QR1, 22C3, and SP263 in both conventional and variant histology UCs. We demonstrated strong or very strong correlations between clones; the strongest correlation for TCs was between QR1 and SP263 (r = 0.92; p = 0.001) and for ICs was between QR1 and 22C3 (r = 0.85; p = 0.001). Our comparative analysis of the scoring algorithms revealed very good concordances among the three assays (range 0.791-0.878); the highest concordance was between QR1 and SP263 when CPS was used as the scoring algorithm for QR1 (0.878; p < 0.001). Our study is the first to demonstrate that the QR1 clone can be used to evaluate PD-L1 status in UCs, with a very good agreement rate with the reference clones. QR1 appeared to be more similar to the SP263 clone. With regard to the scoring algorithm, when evaluating PD-L1 expression using QR1 clone, CPS performed better compared with the TC%/IC% score.
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Carcinoma de Células de Transição , Neoplasias Pulmonares , Neoplasias da Bexiga Urinária , Antígeno B7-H1/metabolismo , Biomarcadores Tumorais/análise , Carcinoma de Células de Transição/patologia , Células Clonais/patologia , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/patologia , Músculos/química , Músculos/metabolismo , Músculos/patologia , Neoplasias da Bexiga Urinária/patologiaRESUMO
In the present study, we analyzed Programmed Death Ligand-1 (PD-L1) expression in radical cystectomy (RC) specimens from patients with muscle-invasive urothelial carcinoma (UC), in order to assess any correlations with specific clinicopathological features and its potential prognostic value. A multi-institutional study was performed within the departments of urology and pathology at the MureÈ County Hospital, Romania, and Centre Hospitalier Lyon Sud, France. Sixty-nine patients with MIBC were included, for whom tumor histology (conventional versus histological variant/differentiation), tumor extension (T), lymph node involvement (N), and distant metastases (M) were recorded. PD-L1 immunostaining was performed using the 22C3 clone and was interpreted using the combined positive score (CPS) as recommended (Dako Agilent, Santa Clara, CA, USA). Positive PD-L1 immunostaining was more prevalent among UCs with squamous differentiation compared to conventional UCs and trended towards an improved OS (p = 0.366). We found the T stage to be a risk factor for poor survival in PD-L1-positive patients (HR 2.9, p = 0.021), along with the N stage in PD-L1-negative patients (HR 1.98, p = 0.007). No other clinicopathological factor was found to be significantly associated with PD-L1 positivity. Thus, we confirm the need for PD-L1 immunostaining prior to initiating immune checkpoint inhibitor therapy for a more accurate assessment of the patients' chances of responding to treatment.
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AIM: This study aims to investigate any modification of serological FSCN1 in prostate cancer patients compared with patients without neoplasia. MATERIAL & METHODS: Clinical data and blood specimens from patients with and without prostate cancer were obtained. A quantitative sandwich ELISA method was used to determine serological values of FSCN1. RESULTS: Although serum values of FSCN1 were dissimilar in the two cohorts of patients (6.90 vs 7.33 ng/ml), the difference was not statistically significant (p = 0.20). Serum values of FSCN1 stratified for Gleason score groups were not significantly distinguishable (p = 0.65). A negative correlation (rho = -0.331; p = 0.009) was reported between FSCN1 and age. CONCLUSION: Further studies are required to evaluate a possible diagnostic role of FSCN1 in prostate cancer.
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Sjogren syndrome is a chronic autoimmune disease witch affects mostly lachrymal and salivary glands. The exocrinopathy can be encountered alone (primary Sjogren syndrome) or in association with other autoimmune disorders (secondary Sjogren syndrome). Visual prognosis of the patients with secondary Sjogren syndrome depends on the early diagnosis, applied therapy follow-up controls along with an effective collaboration between ophthalmologist and rheumatologist. We present therapeutic options in secondary Sjogren syndrome: hygiene and protective measures, medical nonspecific substitution treatment, treatment to stimulate tear secretion, autoimmune disease-specific medical treatment and surgery.
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Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/terapia , Anticorpos Monoclonais Murinos/uso terapêutico , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/terapia , Ciclosporina/uso terapêutico , Quimioterapia Combinada , Diagnóstico Precoce , Géis/administração & dosagem , Humanos , Fatores Imunológicos/uso terapêutico , Imunossupressores/uso terapêutico , Pomadas/administração & dosagem , Soluções Oftálmicas/administração & dosagem , Prognóstico , Rituximab , Síndrome de Sjogren/tratamento farmacológico , Síndrome de Sjogren/imunologia , Síndrome de Sjogren/cirurgia , Resultado do Tratamento , Vitamina A/administração & dosagem , Vitaminas/administração & dosagemRESUMO
We report the case of a 19-year-old male diagnosed with progressive keratoconus in both eyes. The therapeutic option was: intrastromal ring segment implantation in both eyes, followed by corneal collagen cross-linking with riboflavin and ultraviolet type A at left eye. The postoperative results were favorable: early improvement of vision, no intra- or postoperative complications and without signs of disease progression.
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Ceratocone/diagnóstico , Ceratocone/terapia , Implantação de Prótese , Colágeno/uso terapêutico , Quimioterapia Combinada , Humanos , Ceratocone/tratamento farmacológico , Ceratocone/cirurgia , Masculino , Procedimentos Cirúrgicos Oftalmológicos/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Próteses e Implantes , Riboflavina/uso terapêutico , Resultado do Tratamento , Terapia Ultravioleta , Acuidade Visual , Adulto JovemRESUMO
PURPOSE: The aims of our study were to evaluate the effectiveness of riboflavin-ultraviolet type A (UV-A) induced corneal collagen cross-linking (CCCL) in reducing the progression of keratoconus and to assess the improvement of visual acuity in patients with progressive keratoconus. MATERIAL AND METHOD: 32 eyes of 27 patients with progressive keratoconus were treated with combined riboflavin-UV-A rays CCCL. Postoperative examinations were performed at 1, 3, 6 and 12 months, including: uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), refraction, keratometry, corneal topography slit-lamp examination and these were referred to the preoperative dates. RESULTS: In all treated cases the progression of keratoconus was stopped. Comparative preoperative and postoperative results showed: increase of UCVA (p < 0.001), and BSCVA (p < 0.001), reduction of mean K (p < 0.001) and of the refractive errors--mean spherical equivalent (SE) (p < 0.001), mean cylinder values (Cyl) (p < 0.001). CONCLUSIONS: CCCL is an effective treatment option for progressive keratoconus stages I, II and III. This simple procedure can stop the progression of keratectazia in keratoconus and helps to avoid or delay the need for penetrating keratoplasty.
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Colágeno/uso terapêutico , Reagentes de Ligações Cruzadas/uso terapêutico , Ceratocone/tratamento farmacológico , Ceratocone/cirurgia , Fármacos Fotossensibilizantes/uso terapêutico , Riboflavina/uso terapêutico , Adolescente , Adulto , Colágeno/farmacologia , Córnea/efeitos dos fármacos , Córnea/cirurgia , Progressão da Doença , Feminino , Humanos , Ceratoplastia Penetrante , Masculino , Período Pós-Operatório , Período Pré-Operatório , Riboflavina/farmacologia , Resultado do Tratamento , Terapia UltravioletaRESUMO
OBJECTIVE: The present study aimed to investigate the influence of several important preanalytical factors (storage period of the tumor block, maximal diameter of the tumor circled area, tumor volume and tumor fraction) on the isolated DNA from formalin-fixed paraffin-embedded (FFPE) tissues in a series of thyroid carcinomas. DESIGN: Our study included 212 FFPE blocks, archived in the Department of Pathology, Târgu-MureÈ Emergency County Hospital for up to 10 years. DNA isolation was performed using a commercially available kit (MasterPure DNA purification kit, Epicentre). The DNA parameters (concentration and purity) were determined using a spectrophotometer and the Qubit 2.0 Fluorometer (Thermo Fisher Scientific) for an accurate and sensitive DNA quantification. RESULTS: The mean DNA concentration and purity for the study cases were 489.3±372.6 ng/µl and 1.667±0.1912, respectively. The DNA concentration was correlated with the maximal diameter of the tumor circled area (p<0.0001), the tumor volume (p<0.0001) and tumor fraction (p=0.0462). No statistically significant differences both in terms of DNA concentration (p=0.374) and purity (p=0.125) in relation with the storage period of the tumor blocks were observed. When using a fluorometric quantification method, the DNA concentration was lower (mean DNA concentration: 47.15±32.85 ng/µl), but similar correlations with the morphological factors were observed. Apart for three cases, the real-time PCR amplification of the BRAF gene was successfully assessed in all cases. CONCLUSION: The maximal diameter of the tumor circled area, tumor volume and tumor fraction are important morphological factors that correlate with the DNA concentration and should be carefully assessed in routine practice prior to performing DNA isolation from FFPE tissues.
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DNA/isolamento & purificação , Manejo de Espécimes , Neoplasias da Glândula Tireoide/genética , Formaldeído , Humanos , Inclusão em Parafina , Reação em Cadeia da Polimerase em Tempo Real , Estatísticas não Paramétricas , Neoplasias da Glândula Tireoide/patologia , Carga TumoralRESUMO
INTRODUCTION: We aimed to determine whether two clinically accessible parameters, tumor size and location within the thyroid, correlate with clinicopathological features that are predictors of high risk in papillary thyroid microcarcinomas (PTMCs). MATERIALS AND METHODS: PTMC cases were obtained from the database of the Department of Pathology, Emergency County Hospital, Târgu Mures, Romania. Four tumor groups were created based on tumor size and location: Group I (≥5 mm, subcapsular), Group II (≥5 mm, nonsubcapsular), Group III (<5 mm, subcapsular), and Group IV (<5 mm, nonsubcapsular) PTMCs. Clinicopathological features and follow-up data were compared by univariate and multivariate analysis. RESULTS: Our study included 164 PTMCs (n=70/20/19/55 in Groups I∕II∕III∕IV, respectively). High-grade morphological features, such as plump pink cells (p=0.010), tumor desmoplasia (p=0.022) and sclerosis (p=0.001), infiltrative tumor borders (p=0.005), positive resection margins (p=0.005), invasion into the perithyroid adipose tissue (p=0.001), irregular nuclear membranes (p=0.004), and pseudoinclusions (p=0.001) were significantly more prevalent among Group I PTMCs. Group IV PTMCs were characterized by a paucity of the above-mentioned morphological features, while Group II and III PTMCs displayed intermediate morphological profiles. CONCLUSIONS: Group I PTMCs proved to be associated with more aggressive morphological features and might need a more careful clinical approach.
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Carcinoma Papilar , Neoplasias da Glândula Tireoide , Humanos , Medição de RiscoRESUMO
PURPOSE: Our study aimed to describe the evolution of the rate of pathological subtypes of well-differentiated follicular-cell derived thyroid carcinomas (DTCs) in the Department of Pathology, Emergency County Hospital Targu-Mures, Romania over a 15 year period and to assess the impact the new 2017 WHO and TNM classifications of thyroid tumors had on our cases. METHODS: The pathological data were retrieved from the original pathological reports. After applying the exclusion criteria the remaining cases were reviewed on a double-headed microscope and reclassified according to the 2017 WHO and TNM staging system. The follow-up data were collected from the Institute of Oncology Cluj-Napoca, Romania. RESULTS: Our study included 396 cases of DTCs (375 papillary, 11 follicular, and 10 Hürthle cell carcinomas). PTCs revealed a significant increasing trend over the study period, whereas follicular and Hurthle cell carcinomas remain rare; 125/131 of noninvasive encapsulated follicular variant PTC (EFVPTC) were reclassified as noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTPs), resulting in a 33.3% reduction in the number of PTCs. According to 2017 TNM stage-grouping 31% of 271 patients with DTC were downstaged. Follow-up data were available for most of the patients (65.7%, mean period 58.1 months). All patients with noninvasive EFVPTC were disease free at the last clinical assessment. CONCLUSIONS: The increasing rate of PTC was maintained even after exclusion of NIFTP. By applying 2017 TNM criteria, a significant number of DTC cases were downstaged into a more favorable group. Follow-up data highlight the indolent behavior of noninvasive EFVPTCs reclassified as NIFTPs.
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Adenocarcinoma Folicular , Neoplasias da Glândula Tireoide , Adenocarcinoma Folicular/epidemiologia , Adenocarcinoma Folicular/patologia , Humanos , Estadiamento de Neoplasias , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Organização Mundial da SaúdeRESUMO
Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the gastrointestinal tract. Major advances in their definition and classification and the understanding of their molecular mechanisms have recently been made. These advances have become a model of targeted therapy in oncology. The diagnosis of GISTs relies on histological arguments--proliferation of spindle-shaped cells in 70% of cases, of epithelioid cells in 20%, histological variants are rare--, and on immunohistochemical arguments--expression of CD117 in 95%, usually associated with CD34 expression in 70% of cases. Most GISTs are associated with molecular abnormalities in low target genes: KIT and PDGFRA. The differential diagnosis of GISTs includes the other mesenchymal tumors of the gastrointestinal tract, such as leiomyomas, leiomyosarcomas, schwannomas and intra-abdominal fibromatosis. The evaluation of the prognosis is essential and is based on a simple algorithm using two histoprognostic parameters, tumor size and mitotic index. The treatment of localized GISTs is surgical resection and that of advanced or unresecable GISTs is based on the use of targeted therapy, imatinib, which is a pharmacological antagonist of the c-kit protein. Proper understanding and utilization of the diagnostic criteria and classification of GISTs by pathologists are essential for good patient management.
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Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/terapia , Diagnóstico Diferencial , Tumores do Estroma Gastrointestinal/genética , Tumores do Estroma Gastrointestinal/patologia , HumanosRESUMO
The isolation of good quality genomic DNA from formalin-fixed, paraffin-embedded tissues is challenging, especially in cases of small tissue specimens. The aim of our study was to evaluate a DNA extraction protocol using formalin-fixed, paraffin-embedded tissues in our laboratory and apply this method to a series of papillary thyroid microcarcinomas (PTMCs). A total of 25 PTMCs and 3 papillary thyroid carcinoma control cases were included in the study. We assessed a DNA extraction protocol on the basis of a precipitation method (MasterPure DNA purification kit, Epicentre), according to the manufacturer's instructions. All PTMCs were subject to real-time polymerase chain reaction (PCR) amplification targeting the BRAF gene and a housekeeping gene (GAPDH). BRAF gene mutations were then assessed by high-resolution melting analysis and confirmed by sequencing of the PCR products. Using this extraction method, we produced good yields of DNA (mean concentration, 147.4±77.8 ng/µL), in addition to high levels of purity (mean A260/A280 ratio: 1.63±0.1). We successfully assessed the BRAF mutation status in 24 cases (16 BRAF-negative; 8 BRAF positive), although 1 case revealed an inconclusive pattern following high-resolution melting analysis and sequencing of the PCR products. We observed no differences in the tumor size (P=0.693), storage period of the tumor block (P=0.282), DNA concentration (P=0.243), DNA purity (P=0.458), CpGAPDH (P=0.173), or CpBRAF (P=0.217) values between the BRAF-mutated and nonmutated group of PTMCs. Our findings demonstrate the importance of a reliable, reproducible DNA extraction technique for efficient PCR amplification, uniformly applied to all cases in this study, regardless of the BRAF mutation status.
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Carcinoma Papilar/diagnóstico , DNA/análise , Mutação/genética , Proteínas Proto-Oncogênicas B-raf/genética , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Bancos de Espécimes Biológicos , Carcinoma Papilar/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Inclusão em Parafina , Reação em Cadeia da Polimerase , Neoplasias da Glândula Tireoide/genéticaRESUMO
INTRODUCTION: Length of hospital stay (LOS) is considered as a key factor in estimating outcomes after radical cystectomy (RC) in urothelial carcinoma (UC) patients. We aimed to assess whether clinical perioperative (age, gender, type of urinary diversion technique) and histopathological factors [UC variant, primary tumor, node, metastasis (pTNM) staging] could be a determining factor for LOS, as well as its influence on overall survival (OS) in a single institution, retrospective cohort study. PATIENTS, MATERIALS AND METHODS: We included a total of 69 UC patients that had RC performed in our Department during November 2011 and October 2018. Regular LOS was considered arbitrarily up to 12 days. All factors were analyzed in relation to LOS, using the chi-square and the Mann-Whitney tests. Impact of LOS on survival was assessed using the Kaplan-Meier and the Cox regression methods. RESULTS: Age was associated to increased LOS (p=0.042), as well as the type of urinary diversion (p=0.003). Patients with complex diversion were found more frequently in the prolonged LOS group (ileal conduit p=0.006, Mainz pouch p=0.15, Camey neobladder p=0.517). Histopathologically, N stage had a significant association to LOS (p=0.044). Survival analysis showed decreased survival in the prolonged LOS group (p=0.653). Cox regression found no influence of LOS (p=0.653), advanced age (p=0.518) or type of urinary diversion on OS. CONCLUSIONS: Advanced age, the complexity of urinary diversion and lymph node involvement were found as associated factors for prolonged LOS in RC patients. The impact of LOS on survival is uncertain, requiring larger, in-depth studies.
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Cistectomia , Tempo de Internação , Assistência Perioperatória , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Urotélio/patologia , Urotélio/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Cuidados Intraoperatórios , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Resultado do TratamentoRESUMO
INTRODUCTION: Urothelial carcinoma (UC) variants are considered as having a more aggressive behavior and a more advanced stage at presentation than conventional UC. However, the evidence supporting the role of UC variants on overall survival (OS) is conflicting. We aimed to assess the impact of demographic factors (age at surgery, gender) and tumor characteristics [conventional∕variant UC, associated carcinoma in situ (CIS), associated papillary component, Tumor, Node, Metastasis (TNM) staging, positive surgical margins] on OS in a series of patients treated for UC in our Department. PATIENTS, MATERIALS AND METHODS: We performed a retrospective, cohort study and included 69 UC patients treated by radical cystectomy (RC) in our Department over an eight-year period, with complete follow-up information. Associations of UC variants as well as demographic and morphological factors with OS were assessed using univariable and multivariable Cox analysis. RESULTS: Our data showed that UC variants were statistically significantly associated with the presence of distant metastases (p=0.036) and positive surgical margins (p=0.009), but had no influence on OS (p=0.504). Further on, we demonstrated that age at surgery (p=0.045), tumor stage (p=0.012), lymph node involvement (p=0.009), and presence of positive surgical margins (p=0.002) had a statistically significant influence on OS both by univariable and multivariable Cox analysis. CONCLUSIONS: Age, tumor stage and lymph node involvement, as well as positive surgical margins represent prognostic factors in RC patients. UC variants were more likely to be associated to metastases and positive surgical margins but had no influence on OS.
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Cistectomia/métodos , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Romênia , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologiaRESUMO
Fine-needle aspiration biopsy (FNAB) of the thyroid, although not perfect, is considered currently the best preoperative method in establishing malignancy in a thyroid nodule. We report the case of an 8-year-old girl with a thyroid mass in the right thyroid lobe. Endocrine investigations revealed subclinical hypothyroidism and high titer of anti-thyroid peroxidase antibodies. Fine Needle Aspiration Biopsy (FNAB) of the right side of the thyroid gland, where on thyroid ultrasonography (US) a poorly defined iso-/hypoechoic nodule with irregular margins was detected, revealed a background of lymphocytes and plasma cells mixed with follicular cells with reactive changes. After four months of treatment with L-thyroxine, ultrasonographic follow up showed an increase in nodule size. FNAB was performed again but showed non-diagnostic cytology. Right lobectomy was performed and the pathology report shows papillary carcinoma, follicular variant predominantly with components of insular growth. We discuss the false-negative FNAB interpretation because of the concomitant autoimmune thyroiditis. Management strategy for this case and the prognosis is also discussed.
Assuntos
Doença de Hashimoto/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Criança , Feminino , Doença de Hashimoto/complicações , Doença de Hashimoto/patologia , Doença de Hashimoto/terapia , Humanos , Nódulo da Glândula Tireoide/complicações , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/terapiaRESUMO
Objetivo : Determinar la correlación entre la glucosa salival con la glucosa en ayunas, HbA1c y el péptido C en personas con Diabetes Mellitus tipo 2 (DM2). Materiales y métodos : Estudio transversal llevado a cabo en el Centro de Investigación en Diabetes, Obesidad y Nutrición (CIDON) en Lima, Perú durante el año 2021. Se categorizó en buen control metabólico (HbA1c<7 %) y mal control metabólico (HbA1c≥7 %). Se midió la glucosa basal, HbA1c y el péptido C en sangre. La glucosa salival se midió con el método glucosa oxidasa. La correlación de Spearman fue usada para determinar la asociación entre la glucosa salival con la glucosa en ayunas, HbA1c y el péptido- C. Resultados : Participaron un total de 142 personas con DM2. La concentración de glucosa salival fue significativamente más elevada en DM2 con mal control metabólico (p<0.01). Se observó una correlación positiva débil significativa entre la glucosa salival y la glucosa basal (r=0.23, p=0.04) y HbA1c (r=0.26, p=0.02) en DM2 con mal control metabólico y una correlación negativa insignificante (r=-0.08; p=0.47) con el péptido C. Conclusiones : La glucosa salival presenta una asociación significativa y positiva con la glucosa en sangre y la HbA1c, pero no con el péptido C en personas con DM2 con mal control metabólico. Sin embargo, hay muchos factores que deben ser considerados y analizados más a fondo para determinar su posible uso.
Objetivo : To determine the correlation between salivary glucose levels with fasting blood glucose, HbA1c, and C-peptide in patients with type 2 diabetes mellitus (T2DM). Materials and methods : This is a cross-sectional study performed at the Centro de Investigación en Diabetes, Obesidad y Nutrición (CIDON) in Lima, Peru, during 2021. Patients were categorized as those with good metabolic control (HbA1c<7 %), and poor metabolic control (HbA1c≥7 %). Baseline fasting blood glucose, as well as blood HbA1c and C-peptide values were measured. Salivary glucose was measured using the glucose oxidase method. Spearman's correlation was used for determining an association between salivary glucose levels and fasting blood glucose, HbA1c, and C-peptide. Results : One-hundred and forty-two subjects with T2DM participated in the study. Salivary glucose was significantly higher in T2DM subjects with poor metabolic control (p<0.01). A weak positive correlation between salivary glucose and fasting blood glucose (r= 0.23, p= 0.04) and HbA1c (r= 0.26, p= 0.02) was observed in subjects with T2DM and poor metabolic control, and also a non-significant negative correlation (r=-0.08; p= 0.47) with C-peptide. Conclusions : Salivary glucose levels show significant and positive association with fasting blood glucose and HbA1c, but not with C-peptide in persons with T2DM and poor metabolic control. However, there are many factors that should be considered and analyzed in detail aiming to determine its potential use.