Epstein-Barr virus-positive gastric cancer: a distinct molecular subtype of the disease?

Abstract: Approximately 90% of the world population is infected by Epstein-Barr virus (EBV). Usually, it infects B lymphocytes, predisposing them to malignant transformation. Infection of epithelial cells occurs rarely, and it is estimated that about to 10% of gastric cancer patients harbor EBV in their malignant cells. Given that gastric cancer is the third leading cause of cancer-related mortality worldwide, with a global annual incidence of over 950,000 cases, EBV-positive gastric cancer is the largest group of EBV-associated malignancies. Based on gene expression profile studies, gastric cancer was recently categorized into four subtypes; EBV-positive, microsatellite unstable, genomically stable and chromosomal instability. Together with previous studies, this report provided a more detailed molecular characterization of gastric cancer, demonstrating that EBV-positive gastric cancer is a distinct molecular subtype of the disease, with unique genetic and epigenetic abnormalities, reflected in a specific phenotype. The recognition of characteristic molecular alterations in gastric cancer allows the identification of molecular pathways involved in cell proliferation and survival, with the potential to identify therapeutic targets. These findings highlight the enormous heterogeneity of gastric cancer, and the complex interplay between genetic and epigenetic alterations in the disease, and provide a roadmap to implementation of genome-guided personalized therapy in gastric cancer. The present review discusses the initial studies describing EBV-positive gastric cancer as a distinct clinical entity, presents recently described genetic and epigenetic alterations, and considers potential therapeutic insights derived from the recognition of this new molecular subtype of gastric adenocarcinoma.

Cardiomiopatia hipertrófica e gravidez / Hypertrophic cardiomyophaty and pregnancy

A cardiomiopatia hipertrófica (CMH) é doença incomum na gestação, caracterizada pela hipertrofia do ventrículo esquerdo, com expressão fenotípica e manifestações clínicas variáveis. O diagnóstico pode ser confirmado pelo ecocardiograma com Doppler. Trata-se de enfermidade bem tolerada na gestação, entretanto, pode desencadear insuficiência cardíaca congestiva, com grave comprometimento materno e perinatal. O tratamento para a gestante com CMH depende da obstrução do fluxo do ventrículo esquerdo. Em paciente sintomática portadora da forma obstrutiva, devem-se evitar grandes perdas sanguíneas e uso de drogas vasodilatadoras durante o trabalho de parto. O parto vaginal mostrou-se seguro, mas o período expulsivo deve ser abreviado com uso de fórceps naquelas que apresentam sintomatologia obstrutiva. Raras complicações podem acontecer, o que requer planejamento do parto e adequada monitorização materna e fetal. (AU)

The Hypertrophic Cardiomyopathy (HCM) is an uncommon condition during pregnancy, which attends with a left ventricular hypertrophy, and phenotypic expression and clinical are both variable. The diagnosis can be confirmed by Doppler echocardiography. Several studies show that it is a disease well tolerate during pregnancy, however it may trigger congestive heart failure with severe maternal and perinatal commitment. The treatment of pregnant patients with HCM depends on the presence of symptoms caused by obstruction of the left ventricle. In symptomatic patient carrying the obstructive form should be avoided large blood loss and use of vasodilator drugs during labor. Vaginal delivery is safe, but the expulsive period should be abbreviated with the use of forceps in those with obstructive symptoms. Rare complications can occur and therefore it is necessary a delivery planning and an adequate maternal and fetal monitoring. (AU)