ABSTRACT
Para testar a hipótese de que pacientes portadores de sarcomas sinoviais de extremidades com características clínicas similares podem apresentar evoluções distintas em decorrência de alterações moleculares tumorais, reações imuno-histoquímicas para p53, Ki67, EGFR, c-erbB-2, e sintases do óxido nítrico 1,2 e 3 foram realizadas em tecidos de 57 pacientes para análise de sua positividade como valor prognóstico. Fatores prognósticos adversos para recidiva local, metástases e morte por tumor na análise multivariada foram apresentação como recidiva (p=0,014) e Ki67 score ≥5 por cento (p<0,001); Ki67 score ≥5 por cento (p<0,001) e negatividade para c-erb-B2 (p=0,01); e o tamanho do tumor >8 cm (p=0,047), respectivamente. Verificou-se que o Ki67 e c-erbB2 são marcadores de prognóstico independentes de fatores clínicos / To test the hypothesis that extremity synovial sarcoma patients with similar clinical scenarios can have distinct outcomes due to tumor molecular alterations, immunohistochemical reactions for p53, Ki67, EGFR, c-erbB-2, and nitric oxide sinthases 1,2 and 3 were performed in tissues of 57 patients to analyze their positivity as prognostic factors. Adverse prognostic factors for local recurrence, metastasis and tumor related death on multivariate analysis were presentation as local recurrence (p=0.014) and Ki67 score ≥5 per cent (p<0.001); Ki67 score ≥5 per cent (p<0.001) and negativity for c-erb-B2 (p=0.01); and tumor size >8 cm (p=0.047), respectively. It was verified that both Ki67 and c-erbB2 are prognostic factors independent of clinical variables...
Subject(s)
Male , Female , Humans , Sarcoma, Synovial/pathology , Prognosis , Sarcoma, Synovial/physiopathologyABSTRACT
Chondrosarcoma is a rare malignant neoplasia that most of the time affects young adults. Its location is preferentially the pelvic and scapular girdle and surgery is its treatment of choice. There are no role for chemo or radiation therapy, because of their low index of response. We describe a case of a 45 year-old male patient with an extensive low grade right umerus chondrosarcoma. In spite of the local extension, there was no invasion of the shoulder neurovascular structures. Treatment proposed was the Tikhoff-Linberg procedure, and the operation was performed with success, with no complications. Free margins were obtained. The patient is now on two years follow-up with no evidence of recurrent disease and is able to drive, fish and carry packs. He can not abduct his arm, but he could not do that even before surgery, due to severe pain. We believe this is an excellent conservative approach to such tumors, that otherwise would require a forequarter amputation, and strongly recommend the technique.
ABSTRACT
Chordoma is a rare and locally invasive bone malignant tumor derived from embryonic notochordal remnants. Most of them originate from the sacrococcygeal region and present with a large size at the moment of the diagnosis. The treatment consists of extended resection en bloc with sacral nerves, if necessary. Chemotherapy and radiation therapy are of limited utility. The authors present the case of a 74-year-old male patient with a voluminous sacrococcygeal chordoma invading the pelvic sciatic foramen. His symptoms were lower limb pain and partial fecal and urinary incontinence. The tumor was resected by a combined approach (abdominal and posterior), with exiguous margins. The post-operative course was uneventful besides a liquor fistula which resolved spontaneously. The patient had resolution of the pain, but maintained the sphincter dysfunction. At the moment, he is at the 4th month of follow-up.