Carcinoma neuroendocrino de la piel: Carcinoma de células de Merkel. Revisión de la Literatura, a propósito de un caso / Neuroendocrine skin carcinoma: Merkel cell carcinoma. Review of literature, about a case

El carcinoma de células de Merkel, también llamado carcinoma neuroendocrino de la piel, es un tipo de cáncer de piel muy poco frecuente que generalmente aparece como un nódulo de color carne o rojo azulado, más frecuentemente en región facial, cabeza y cuello. El carcinoma de células de Merkel se desarrolla principalmente en personas mayores ya que la exposición al sol a largo plazo o un sistema inmunitario débil pueden aumentar el riesgo de desarrollarlo. Las células de Merkel se encuentran en la base de la capa más externa de la piel (epidermis) y están conectadas a las terminaciones nerviosas que son responsables del sentido del tacto. Tiende a crecer rápido y diseminarse a otras partes del cuerpo. Por tanto, las opciones de tratamiento para el carcinoma de células de Merkel dependen de si el cáncer se ha diseminado más allá de la piel

Merkel cell carcinoma, also called neuroendocrine skin of the skin, is a very rare type of skin cancer that generally appears as a bluish meat or red color nodule, more frequently in the facial, head and neck region. Merkel cell carcinoma develops mainly in older people since long -term exposure or a weak immune system can increase the risk of developing it. Merkel cells are at the base of the outermost layer of the skin (epidermis) and are connected to nerve endings that are responsible for the sense of touch. It tends to grow quickly and spread to other parts of the body. Therefore, the treatment options for Merkel cell carcinoma depend on whether cancer has spread beyond the skin

Salivary gland tumor: atypical presentation of breast cancer

Breast cancer is a heterogeneous disease with various histological and molecular subtypes. Among them, salivary gland tumors are rare and can be divided into three groups: pure myoepithelial differentiation, pure epithelial differentiation and myoepithelial with mixed epithelial differentiation. In the last group, adenoid cystic carcinoma stands out, a rare entity with low malignant potential. It represents less than 0.1­3% of breast cancer cases and has the most frequent clinical presentation as a palpable mass. The diagnosis is confirmed by histology and immunohistochemistry. Classically, they are low-aggressive triple-negative tumors, with overall survival and specific cancer survival at five and ten years greater than 95%. However, there are rare reports of aggressive variants with a risk of distant metastasis and death. Treatment is based on surgical resection with margins. Lymphatic dissemination is rare, and there is no consensus regarding the indication of an axillary approach. Adjuvant radiotherapy is indicated in cases of conservative surgery and should be discussed in other cases. The benefit of chemotherapy remains uncertain, as most tumors are indolent. We report a case that required individualized decisions based on its peculiarities of presentation, diagnosed in an asymptomatic elderly patient during screening, in which mammography showed heterogeneous gross calcifications clustered covering 1.6 cm. Stereotacticguided vacuum-assisted biopsy was performed, and the area was marked with a clip. The anatomopathological examination led to a diagnosis of salivary gland-type carcinoma, triple-negative. The patient underwent segmental resection of the right breast and sentinel lymph node biopsy. The final anatomopathological result was similar to that of the biopsy, with an immunohistochemicalprofile of the adenoid cystic type and two sentinel lymph nodes free of neoplasia. Considering age and histological subtype, adjuvant therapy was not indicated. Follow-up for three years showed no evidence of disease

Carcinoma adrenal virilizante en una adolescente: reporte de caso / Virilizing adrenal carcinoma in an adolescent: case report

Los tumores suprarrenales virilizante son infrecuentes y representan 5-6% de los tumores de esas glándulas1. Pueden secretar diferentes andrógenos como dehidroepiandrosterona sulfato (DHEAS), androstenediona y testosterona. Las características clínicas dependen de la edad de presentación; en niños pueden determinar pubertad precoz y en mujeres en edad fértil ocasionar hirsutismo, amenorrea o ciclos oligomenorreicos y diversos grados de virilización2. Los carcinomas adrenocorticales son tumores raros y la incidencia es aproximadamente uno a dos por millón de habitantes/año3,4. Los exámenes de imagen como la tomografía o la resonancia confirman el origen suprarrenal, valoran la presencia de metástasis y definen la conducta terapéutica5. La presentación inicial en pacientes pediátricos mayoritariamente es con virilización6 y aproximadamente el 50% de los pacientes adultos con carcinoma adrenal tienen un estadio de la enfermedad relativamente avanzado7. El tratamiento de elección es la cirugía y sigue siendo la mejor esperanza para la supervivencia a largo plazo8. El pronóstico habitual para el carcinoma adrenocortical es generalmente malo con una supervivencia global a 5 años de 20 a 25%5 en adultos, pero en niños y adolescentes la supervivencia puede llegar al 100%9. Se presenta el caso de una paciente con fenotipo totalmente masculino con diagnóstico de carcinoma adrenal virilizante que comienza en la infancia y se diagnostica en la adolescencia.

Virilizing adrenal tumors are uncommon and represent 5-6% on tumors of these glands1. They can secrete different androgens such as dehydroepiandrosterone sulfate (DHEAS), androstenedione, and testosterone. Clinical features depend on the age of presentation; in children they can determine precocious puberty and in women of childbearing age cause hirsutism, amenorrhea or oligomenorrheic cycles and various degrees of virilization2. Diagnosis consists of clinical evidence of hyperandrogenism, accompanied by an increase in androgens in the blood, especially DHEAS, whose origin is mainly adrenal. Adrenocortical carcinomas are rare and the incidence is approximately one to two per million inhabitants/year3,4. Imaging tests such as tomography or resonance confirm the adrenal origin, assess the presence of metastases and define the therapeutic approach5. In initial presentation in most pediatric patients is with virilization6 and approximately 50% adult's patients with adrenal carcinoma have a relatively advanced stage of the disease7. The treatment of choice is surgery and is the best hope for long-term survival. The usual prognosis for adrenocortical carcinoma is generally poor with a 5-year overall survival of 20 to 25%5 in adults, but in children and adolescent's survival can reach 100%9. We present the case of a patient with a totally male phenotype diagnosed with virilizing adrenal carcinoma that begins in childhood and is diagnosed in adolescence.

Comportamiento del cáncer de vejiga en Matanzas desde diciembre de 2014 hasta enero de 2020 / Behavior of bladder cancer in Matanzas from December 2014 to January 2020

RESUMEN Introducción: el cáncer de la vejiga es la segunda neoplasia urológica. En Cuba constituye la séptima causa de cáncer en el sexo masculino y entre las primeras quince, cuando se combinan ambos sexos. Objetivo: evaluar el comportamiento del cáncer de vejiga en pacientes del Hospital Universitario Comandante "Faustino Pérez Hernández". Materiales y Métodos: se realizó un estudio observacional, descriptivo y transversal en el período comprendido desde diciembre de 2014 hasta enero de 2020. Los pacientes se dividieron en tres grupos tratados con cirugía de mínimo acceso, cirugía abierta y no operados, se describieron los grupos histológicos y estadiaje tumoral y se les aplicó tratamiento según protocolo del servicio, sus complicaciones y la presencia de recidivas tumorales también fueron descritas. En el universo se incluyeron en el estudio 222 pacientes diagnosticados de cáncer de vejiga. Resultados: se comprobó que el mayor número de pacientes diagnosticados con cáncer de vejiga son del sexo masculino, el tipo histológico es el carcinoma de células uroteliales de bajo grado y el estadio T1. Las recidivas se presentaron antes de los 5 años en el 10,8% de los casos. 196 pacientes presentaron complicaciones. Conclusiones: el cáncer de vejiga es más frecuente en las edades comprendidas entre 60 a 69 años, las recidivas aparecieron mayormente entre 1 y 3 años. Se presentó complicaciones en 196 pacientes, siendo la cirugía la modalidad terapéutica que mayor por ciento tuvo con un 32.22% y las infecciones son las complicaciones más frecuentes (AU).

SUMMARY Introduction: Cancer of the bladder (CV) is the second urological neoplasm. In Cuba it constitutes the seventh cause of cancer in males and among the first fifteen, when both sexes are combined. Objective: To evaluate the behavior of bladder cancer (CV) in patients of the Faustino Pérez Hernández Hospital. Materials and methods: An observational, descriptive and cross-sectional study was carried out in the period from December 2014 to January 2020. The patients were divided into 3 groups treated with Minimum Access Surgery (CMA), Open Surgery (CA) and No Operated (NO), the histological groups and tumor staging were described and treatment was applied according to the service protocol, their complications and the presence of tumor recurrences were also described.Universe: 222 patients diagnosed with bladder cancer were included in the study. Results: It was found that the greatest number of patients diagnosed with CV are male, the histological type is low-grade urothelial cell carcinoma and stage T1. Recurrences occurred before 5 years in 10.8% of cases. 196 patients presented complications. Conclusions: The CV is more frequent in the ages between 60 to 69 years, the recurrences appeared mainly between 1 and three years. Complications occurred in 196 patients, with Surgery being the therapeutic modality with the highest percentage with 32.22% and infections being the most frequent complications (AU).

Late recurrence of low-grade serous carcinoma of the ovary mimicking colorectal neoplasia

A case report (images in medicine) of late recurrence of low grade serous carcinoma of the ovary mimicking colorectal neoplasia.

Sebaceoma on the scalp simulating a malignant pigmented neoplasia

Abstract The correct identification of pigmented nodular lesions of the scalp is often challenging. Despite the importance of clinical patterns and dermoscopy, important adjuvant tools that are usually helpful, their interpretation sometimes is not clear-cut. Here, the authors discuss a case of sebaceoma mimicking a malignant pigmented neoplasia, with conclusive histopathology.

The role of Survivin as a biomarker and potential prognostic factor for breast cancer

SUMMARY Breast cancer (BC) is one of the primary health problems worldwide. As the most common cancer in women in the world and in Brasil, behind only non-melanoma skin cancer, this neoplasm corresponds to approximately 28% of new cases per year in the country. BC also affects men, although the incidence corresponds to only 1% of total cases. Currently, most of the chemotherapeutic agents used in BC treatment are extremely toxic and cause long-term side effects. There is also a need to obtain earlier diagnoses, more accurate prognoses and make new therapies available that are more selective and effective in order to improve the current scenario. Therefore, this work sought to evaluate the importance of the biomarker survivin (Sur) in relation to BC, through the detailing of the role of Sur as a biomarker, the correlation between this protein and the prognosis of BC patients, and a summary of therapeutic strategies that target Sur for the development of new anticancer therapies.

RESUMO O câncer de mama (CM) é um dos principais problemas de saúde em todo o mundo. Como o câncer mais comum em mulheres no mundo e no Brasil, precedido apenas pelo câncer de pele não melanoma, essa neoplasia corresponde a aproximadamente 28% dos novos casos por ano no país. O CM também afeta homens, embora a incidência corresponda a apenas 1% do total de casos. Atualmente, a maioria dos agentes quimioterápicos utilizados no tratamento do CM são extremamente tóxicos e causam efeitos colaterais a longo prazo. Há também a necessidade de se obterem diagnósticos mais precoces, prognósticos mais precisos e disponibilizar novas terapias seletivas e efetivas, a fim de melhorar o cenário atual. Portanto, este trabalho buscou avaliar a importância do biomarcador Survivina (Sur) em relação ao CM, por meio do detalhamento do papel do Sur como biomarcador, da correlação entre essa proteína com o prognóstico de pacientes com CM e de um resumo do tratamento terapêutico e das estratégias que visam utilizar a Sur para o desenvolvimento de novas terapias anticâncer.

Alterações neoplásicas e não neoplásicas das mãos e dos pés de cães (2003-2016) / Neoplastic and non-neoplastic lesions of the hands and feet of dogs (2003-2016)

Mãos e pés de cães são comumente afetados por lesões neoplásicas e não neoplásicas. Estas alterações podem apresentar prognóstico histopatológico ou clínico ruim e a amputação tende a ser o tratamento de escolha. Estudos prévios avaliando a prevalência e os aspectos clínicopatológicos de alterações digitais em cães têm sido realizados em outros países, entretanto trabalhos similares não foram realizados no Brasil. O objetivo do presente estudo foi descrever e caracterizar histologicamente as lesões das mãos e pés de cães. Amostras de 105 lesões tumoriformes das mãos e pés de cães foram avaliadas. Essas amostras foram coletadas entre 2003 e 2016 e foram obtidas de três laboratórios brasileiros de diagnóstico veterinário. Todos espécimes foram fixados em formol tamponado 10%, processados rotineiramente e corados por hematoxilina-eosina. Adicionalmente, as colorações de azul de toluidina, Brown e Breen, periodic acid Schiff (PAS), Grocott Methenamine Silver (GMS) e Ziehl Neelsen foram utilizados em casos específicos. Imuno-histoquímica foi realizada usando os anticorpos anti-Leishmania spp., anti-CD117, anti-CD79, anti-CD3, anti-Melan A, anti-lisozima, anti-Pancytokeratin AE1/AE3 e anti-vimentina. Os neoplasmas (62,9%) foram as alterações mais frequentes, seguidas por inflamações (19%) e outras alterações (18,1%). Entre os neoplasmas, 40,9% foram mesenquimais, 39,4% epiteliais e 19,7% de células redondas. Todos os neoplasmas de células redondas e a maioria dos epiteliais e mesenquimais eram malignos. Não se observou predileção de prevalência dos neoplasmas em relação ao sexo. As raças Labrador Retriever, Schnauzer, Teckel, SRD, Pastor Alemão, Rottweiler e Pit Bull foram as mais afetadas. Fila Brasileiro, Pit Bull e Schnauzer tiveram alta incidência de neoplasmas mesenquimais, epiteliais e de células redondas, respectivamente. Inflamação foi mais comumente observada em cães Labrador Retriever e as outras alterações em Teckel, Labrador Retriever e SRD. A idade e o peso médio dos animais afetados foram de 8,4 anos e 28,5 kg, respectivamente. O diâmetro médio das lesões tumoriformes foi de 2,5 cm e as lesões neoplásicas apresentaram as maiores médias. As lesões ocorreram principalmente em animais de pelagem amarela. A maioria das biópsias incisionais (56,4%) e amputações (85,3%) consistiram de neoplasmas. O principal membro afetado foi o torácico direito e o dígito foi a estrutura anatômica acometida mais frequentemente. Carcinoma de células escamosas (14,2%) foi o neoplasma mais frequente, seguido do mastocitoma (7,6%), melanoma (7,6%) e sarcoma indiferenciado (7,6%). Em metade dos casos de inflamação, a lesão acometeu o folículo piloso e derme adjacente, e o infiltrado foi predominantemente piogranulomatoso ou lnfoplasmocítico. Cistos foliculares, calcinose circunscrita e acrocordoma foram as principais lesões não neoplásicas e não inflamatórias diagnosticadas.(AU)

Hands and feet of dogs are commonly affected by neoplastic and non-neoplastic lesions. These lesions may commonly present poor clinical or histopathological prognosis and amputation tends to be the treatment of choice. Previous studies regarding the prevalence and the clinicopathological aspects of digital changes in dogs have been performed abroad, with no similar investigations in Brazil. The aim of this manuscript was to perform a histopathological study to characterize hands and feet lesions of dogs from Brazil.Tissue samples from 105 tumor-like lesions of dogs hands and feet were used in this study. The samples came from three Brazilian veterinary diagnostic laboratories and were collected between 2003 and 2016. All specimens were fixed in 10% buffered formalin, and routinely processed for paraffin embedding and hematoxylin-eosin staining. Additionally, toluidine blue, Brown and Breen, periodic acid Schiff (PAS), Grocott Methenamine Silver (GMS) and Ziehl Neelsen were used in selected cases. Immunohistochemistry using anti-Leishmania spp., anti-CD117, anti-CD79, anti-CD3, anti-Melan A, anti-lysozyme, anti-Pancytokeratin AE1/AE3, and anti-vimentin antibodies were also performed. Neoplasia (62.9%) was the most frequently found lesion, followed by inflammation (19%), and other changes (18.1%). Among the neoplasms, 40.9% were mesenchymal, 39.4% epithelial, and 19.7% round cells. All round cells and most of the epithelial and mesenchymal neoplasms were malignant. There was no difference between males and females regarding neoplasia prevalence. Labrador Retriever, Schnauzer, Teckel, mongrel, German Shepherd, Rottweiler, and Pit Bull were the most frequently affected breeds. Fila Brasileiro (aka Brazilian Mastiff), Pit Bull and Schnauzer had higher incidence of mesenchymal, epithelial, and round cells neoplasms, respectively. Inflammation was more commonly observed in the Labrador Retriever and other changes were more commonly in Teckel, Labrador Retriever, and mongrel dogs. Medium age and weight were 8.4 years and 28.5 kg, respectively. Medium diameter of the tumor-like lesions was 2.5 cm and the neoplastic lesions presented higher averages. Lesions were mainly in yellow-coated dogs. Incisional biopsy samples (56.4%) and amputations (85.3%) were mostly from neoplastic cases. Right forelimb was the most affected limb, and digits were the main injured anatomic structures. Squamous cell carcinoma was the most (14.2%) commonly diagnosed neoplasm, followed by mast cell tumor (7.6%), melanoma (7.6%), and undifferentiated sarcoma (7.6%). In half of the inflammatory cases, the lesion was centered in hair follicle and surrounding dermis. The inflammatory infiltrate was predominantly piogranulomatous or lymphoplasmacytic. Follicular cyst, calcinosis circumscripta, and acrochordons were the main non neoplastic and non-inflammatory changes.(AU)

Exuberant case of cutaneous metastasis of breast cancer

Abstract: Cutaneous metastasis is the main cause of morbidity and mortality of cancer patients, denoting a guarded prognosis. The clinical spectrum of the disease is broad and can mimic benign conditions. The diagnosis depends on thorough clinical examination and complementary exams, with emphasis on the histopathological study and immunohistochemistry. Because it indicates a systemic relapse, it is necessary to intervene with intravenous chemotherapy, to which local therapies can be associated. We report the case of a 65-year-old woman with cutaneous metastasis from breast cancer treated 14 years back, manifested by extensive firm and infiltrated red-purple plaques on the sides of the trunk, with a course of six months. After evaluation, she was referred to the regional cancer center. She passed away one month and a half later.

Diagnostic value of α-enolase expression and serum α-enolase autoantibody levels in lung cancer / Valor diagnóstico da expressão de α-enolase e dos níveis séricos de autoanticorpos contra α-enolase no câncer de pulmão

ABSTRACT Objective: To investigate the diagnostic value of α-enolase (ENO1) and serum ENO1 autoantibody levels in lung cancer. Methods: Immunohistochemistry staining and ELISA were performed to detect ENO1 expression in lung tissue and serum ENO1 autoantibody levels, respectively. Results: The expression of ENO1 was higher in lung cancer tissues than in benign lung disease tissues (p < 0.001). The proportion of lung cancer samples expressing ENO1 was not significantly different among the various pathological classification groups. The proportion of samples expressing ENO1 was higher in lung cancer patients in stages I/II than in those in stages III/IV (χ2 = 5.445; p = 0.018). The expression of ENO1 in lung cancer tissues was not associated with age, gender, or smoking history. Serum ENO1 antibody levels were significantly higher in the lung cancer group than in the benign lung disease and control groups (p < 0.001). The differences among the pathological classification groups were not statistically significant. Serum ENO1 antibody levels were also in lung cancer patients in stages I/II than in those in stages III/IV (p < 0.01). Serum ENO1 antibody levels were not associated with age, gender, or smoking history in lung cancer patients. The ROC curve representing the diagnosis of lung cancer based on ENO1 antibody levels had an area under the curve of 0.806. Conclusions: Our results suggest that high levels of ENO1 are associated with the clinical stage of lung cancer and that ENO1 expression and its serum autoantibody levels show diagnostic value in lung cancer.

RESUMO Objetivo: Investigar o valor diagnóstico da α-enolase (ENO1) e dos níveis séricos de autoanticorpos contra ENO1 no câncer de pulmão. Métodos: Marcação imuno-histoquímica e ELISA foram realizados para detectar a expressão de ENO1 no tecido pulmonar e os níveis séricos de autoanticorpos contra ENO1, respectivamente. Resultados: A expressão de ENO1 foi maior nos tecidos de câncer de pulmão que nos tecidos de doença pulmonar benigna (p < 0,001). Não houve diferença significativa entre os diversos grupos de classificação patológica quanto à proporção de amostras de câncer de pulmão que expressaram ENO1. A proporção de amostras que expressaram ENO1 foi maior nos pacientes com câncer de pulmão nos estágios I/II que naqueles com câncer de pulmão nos estágios III/IV (χ2 = 5,445; p = 0,018). Não houve relação entre a expressão de ENO1 em tecidos de câncer de pulmão e idade, sexo ou histórico de tabagismo. Os níveis séricos de anticorpos contra ENO1 foram significativamente maiores no grupo câncer de pulmão que nos grupos doença pulmonar benigna e controle (p < 0,001). As diferenças entre os grupos de classificação patológica não foram estatisticamente significativas. Os níveis séricos de anticorpos contra ENO1 foram também significativamente maiores nos pacientes com câncer de pulmão nos estágios I/II que naqueles com câncer de pulmão nos estágios III/IV (p < 0,01). Nos pacientes com câncer de pulmão, não houve relação entre os níveis séricos de anticorpos contra ENO1 e idade, sexo ou histórico de tabagismo. A curva ROC do diagnóstico de câncer de pulmão baseado nos níveis de anticorpos contra ENO1 apresentou área sob a curva = 0,806. Conclusões: Nossos resultados sugerem que há relação entre níveis elevados de ENO1 e o estágio clínico do câncer de pulmão e que a expressão de ENO1 e os níveis séricos de autoanticorpos contra ENO1 têm valor diagnóstico no câncer de pulmão.

Resultados del tratamiento del cáncer de mama, Programa Nacional de Cáncer del Adulto / Impact of the Chilean Explicit Guaranties Health System (GES) on breast cancer treatment

Background Breast cancer is the most common malignant tumor in women in the world. In 2005, it was incorporated to the Explicit Guaranties Health System (GES) in Chile. Aim To describe the demographic and clinical characteristics of breast cancer patients and to determine the effect of incorporating these women to GES. Material and Methods Medical records of 5,119 women with breast cancer aged 59 ± 14 years, attended at six public hospitals between 2000 and 2010 were reviewed. Median follow up was 87 months (range 1-182). Mortality was assessed using death certificates obtained at the National Identification Registry. Results Sixty six percent of women were in stage I-II, 29% in stage III and 5% in stage IV. Surgery was performed in 4023/5119 cases (79%), adyuvant radiotherapy in 3627/4517 cases (80%), chemotherapy in 3,204/3,424 cases (94%) and hormone therapy in 1,695/2,375 cases (71%). Between 2000 and 2010, there was a significant increase in the proportion of cases in stage I, from 8% to 25%, (p < 0.01). Overall survival (OS) increased 1% per year, since the beginning of GES system (p = 0.024). Five year OS was 75.1%. The figures for Stage I, II, III and IV were 93, 84, 62 and 27% respectively (p < 0.01). Patients without lymph node involvement and who were not triple negative, had a significantly better OS. Conclusions There was a significant increase in stage I cases, and a 1% per year OS improvement after GES system started, compared with the previous period.

Expresión de Podoplanina en Mucosa Oral Normal, Displasia Epitelial Oral y Carcinoma Oral de Células Escamosas / Immunoexpression of Podoplanin in Normal Oral Mucosa, Epithelial Displasia and Oral Squamous Cell Carcinoma

RESUMEN: Evaluar la inmunoexpresión de podoplanina (PDPN) en el epitelio y vasos linfáticos en muestras de mucosa oral normal (MON), displasia epitelial oral (DEO) y carcinoma espinocelular oral (CECO). Estudio descriptivo de serie de casos. La muestra estuvo constituida por 19 casos de MON, 18 de DEO y 19 de CECO. Se consideraron positivas aquellas células con tinción de membrana y/o citoplasmático. Para la evaluación de PDPN epitelial se realizó un análisis semicuantitativo a través del producto entre la intensidad y porcentaje de células teñidas (immunoreactive score- IRS), mientras que para la evaluación de los vasos linfáticos, se determinó la densidad media vascular (DMV) a partir del promedio de la densidad linfática en tres campos ópticos por muestra. El mayor valor de IRS se observó en el grupo de CECO, seguido por DEO y el menor valor fue en el grupo de MON, con diferencias estadísticamente significativas al comparar CECO/DEO (p= 0,0200) y CECO/MON (p= 0,0078). Al comparar los valores de DMV según diagnóstico, se obtuvo que estos fueron bastante similares y no presentaron diferencias significativas entre sí (p= 0,4273). Finalmente, se analizó la relación entre los valores de IRS de podoplanina epitelial y la densidad media vascular de los linfáticos, a través del test de independencia de Spearman, el cual determinó que no hay un grado de asociación entre ambas variables (p= 0,2056). Conclusión: el IRS epitelial aumenta su valor al comparar muestras de MON, DEO y CECO. No existen diferencias significativas, en las muestras estudiadas, entre los valores de DMV linfática. No existe relación entre la expresión de PDPN epitelial y DMV linfática en muestras de DEO y CECO.

ABSTRACT: The objective of this study was to evaluate the expression of Podoplanin (PDPN) in epithelium and lymphatic vessels in normal oral mucosa (NOM), oral epithelial displasia (OED) and oral squamous cell carcinoma (OSCC). A descriptive case study was carried out. Nineteen histological samples diagnosed with NOM, 18 diagnosed with OED and 19 with OSCC. Immunopositive cells for PDPN were those that presented membrane and/or cytoplasmic staining. A semi-quantitative analysis of the stained sections was made according to the immunoreactive score (IRS) for the extension and intensity of epithelial cells, while the evaluation of lymphangiogenesis was made through the calculation of the mean vascular density (MVD). The results indicated the higher IRS value was in OSCC followed by OED and lowest in NOM, with significant differences between OSCC/OED (p= 0.0200) and OSCC/NOM (p= 0.0078). No differences in MVD were found between the studied samples (p= 0.4273). Finally, the correlation between the value of epithelial IRS and MVD was analyzed through Spearman Independence test, which determined there was no statistically significant relationship between the studied variables (p= 0.2056). In conclusion, epithelial IRS value is greater in OSCC samples than OED and NOM. There was no statistically significant difference in lymphatic MVD in the studied samples. There is no correlation between the epithelial PDPN expression and lymphatic MVD in OSCC and OED samples.

Actinomicosis orofaríngea como diagnóstico diferencial de carcinoma de cavum: Reporte de un caso / Cervicofacial actinomycosis as differential diagnosis of cavum carcinoma: case report

La actinomicosis es una enfermedad infrecuente en pediatría que implica, habitualmente, un desafío diagnóstico. Es producida por bacterias del género Actinomyces. La forma cervicofacial suele originarse tras la disrupción de la mucosa oral secundaria a alteraciones odontógenas. Se presenta el caso de una adolescente que, tras la colocación de un piercing en la lengua, comenzó con odinofagia y cambios del tono de voz. Luego de ocho meses de persistencia de los síntomas y habiendo realizado múltiples tratamientos antibióticos con leve mejoría, se efectuó una biopsia y se diagnosticó carcinoma de cavum, por lo que se derivó a este Hospital para su tratamiento. Al analizar nuevamente la biopsia, se descartó la patología oncológica y se diagnosticó actinomicosis orofaríngea. Cumplió 6 meses totales de tratamiento antibiótico, con buena evolución. Si bien la colocación de piercings orales no ha sido descrita hasta el momento como factor de riesgo, la disrupción mucosa generada podría favorecer el inicio del cuadro.

Paediatric actinomycosis is an infrequent infectious disease caused by Actinomyces spp. Cervicofacial infections are usually related to disruption in oral mucosal membranes. We discuss the case of a 15-year-old girl who refers an 8-month history of odynophagia and changes in her tone of voice after getting a tongue piercing. She received multiple antibiotic treatments with slight improvement. Nasopharyngeal carcinoma was diagnosed by endoscopic biopsy. The patient was referred to our Hospital for treatment but, when the biopsy was analyzed again, oncological pathology was excluded and oropharyngeal actinomycosis was diagnosed. She received a total of 6 months of antibiotic treatment with favorable evolution.

Carcinoma de glándulas sebáceas limitado a conjuntiva bulbar / Sebaceous gland carcinoma restricted to bulb conjunctiva

El carcinoma de glándulas sebáceas es un tumor infrecuente que puede desarrollarse a partir de cualquier glándula sebácea en la piel. El 75 por ciento de las veces es de origen ocular y afecta principalmente las glándulas de Zeiss, Meibomio y de la carúncula. Se caracteriza por un comportamiento agresivo, con alta probabilidad de invasión a piel, conjuntiva y córnea. Sin embargo, el compromiso de la conjuntiva como localización primaria es raro. Se presenta un caso con diagnóstico de carcinoma sebáceo de patrón nodular primario de la conjuntiva bulbar, atendido en el Hospital Universitario de Santander durante los años 2014-2016. El propósito del presente estudio es dar a conocer el caso de una patología infrecuente con pocos casos reportados en la literatura, enfatizar su importancia dentro de los diagnósticos diferenciales de masas en la conjuntiva y del estudio histopatológico como método para obtener un diagnóstico definitivo y realizar un abordaje temprano(AU)

Sebaceous gland carcinoma is an uncommon tumor that may derive from any sebaceous gland of the skin. In 75 percent of cases is ocular and mainly affects the Zeiss, Melbonium and caruncle glands. It is characterized for its aggressiveness, high probability of passing into the skin, the conjunctiva and the cornea. However, the involvement of the conjunctiva as a primary location is rare. This is a case diagnosed with sebaceous carcinoma of primary nodullary pattern of the bulb conjunctiva, which was seen at the university hospital of Santander from 2014 to 2016. The objective of the study was to show the case of an infrequent pathology with very few cases reported up to now in literature, to make emphasis on its importance within the differential diagnoses of masses present in the conjunctiva and of the histopathological study as a method to obtain a final diagnosis and to make an early intervention(AU)

Crohn's disease: risk factor for colorectal cancer / Doença de Crohn: fator de risco para o carcinoma colorretal

ABSTRACT Background: Crohn's disease is an inflammatory disease that can reach any part of the gastrointestinal tract. This disease has been associated with an increased neoplastic risk, including colorectal carcinoma. Objective: The objective of this work is to describe the mechanisms present in two diseases, and that are responsible for the increased risk in Crohn's disease. Methods: A bibliographic research was conducted in PubMed database. In addition to the articles obtained with an inserted query in Pubmed, other references relevant to the topic in question were included. Results: Colorectal cancer risk varies according to the presence of certain factors, and an example of this is Crohn's disease. Chronic inflammation seems to be an important contribution to carcinogenesis, since it creates a microenvironment suitable for the onset and progression of the disease. There are molecular changes that are common to two conditions, thus justifying the fact of Crohn's disease being a risk factor for colorectal carcinoma. The disease control with an appropriate therapy and with surveillance are two ways to control this risk. Conclusions: A proinflammatory state is the cornerstone in the association between Crohn's disease and colorectal carcinoma. The implementation of surveillance strategies allowed a decrease in morbidity and mortality associated with this cancer.

RESUMO Introdução: A doença de Crohn é uma doença inflamatória que pode atingir todo o trato gastrointestinal. Esta patologia tem sido associada a um risco neoplásico aumentado, nomeadamente de carcinoma colorretal. Objetivo: O objetivo deste trabalho é descrever os mecanismos responsáveis pelo aumento do risco de carcinoma colorretal na doença de Crohn. Métodos: A pesquisa bibliográfica foi realizada na base de dados Pubmed. Para além dos artigos obtidos com a query inserida na Pubmed, foram também incluídas outras referências com relevância para o tema em questão. Resultados: O risco de carcinoma colorretal aumenta na presença de determinados fatores, entres eles a doença de Crohn. A inflamação crónica presente parece ser um importante contributo para a carcinogénese, porque permite a criação de um microambiente adequado ao aparecimento e progressão da doença. Existem alterações moleculares comuns às duas patologias justificando-se o fato desta doença inflamatória ser fator de risco para o carcinoma colorretal. O controlo da doença com terapêutica adequada e estratégias de vigilâncias são duas formas de controlar o risco. Conclusões: O estado pró-inflamatório é uma peça chave na associação entre doença de Crohn e carcinoma colorretal. A implementação de estratégias de vigilância permitiu a diminuição da morbi-mortalidade associada a esta neoplasia.

Carcinoma papilar de tiroides en un niño con hipotiroidismo congénito dishormonogénico: Reporte de un caso / Papillary thyroid carcinoma in a child with congenital dyshormonogenetic hypothyroidism: Case report

Introducción: El cáncer papilar de tiroides (CPT) es una enfermedad infrecuente en pediatría. La presentación de CPT asociado a hipotiroidismo congénito (HC) dishormonogénico es excepcional, y hay pocos casos reportados en la literatura. Objetivo: Presentar un caso de CPT en un paciente con HC dishormonogénico sin bocio, expuesto a radiación ionizante. Evaluar asociaciones entre estos factores y el desarrollo de CPT. Caso clínico: Paciente varón con antecedentes de HC dishormonogénico, por lo que recibió suplementación precoz con levotiroxina, logrando niveles normales de tirotropinas y hormonas tiroideas. Con antecedentes de cardiopatía congénita, fue sometido tratamiento intervencional con 10 cateterismos cardíacos y aproximadamente 26 radiografías de tórax con dosis pediátrica. A la edad de 6 años se encontró un nódulo tiroideo mediante ecografía. La citología por punción aspirativa con aguja fina confirmó alta sospecha de carcinoma tiroideo (Bethesda 5). El estudio de etapificación no mostró metástasis en el tórax ni en el cerebro. Fue sometido a tiroidectomía total y el análisis histopatológico reveló un microcarcinoma papilar de 0,5 cm intratiroideo, sin evidencia de diseminación. Conclusión: Las mutaciones genéticas propias de esta enfermedad y la exposición a radiación ionizante pudieran estar implicadas en el desarrollo de CPT. Es probable que haya vías fisiopatológicas comunes que requieren mayor investigación.

Introduction: Papillary thyroid carcinoma (PTC) is a rare childhood disease. The development of PTC in dyshormonogenetic congenital hypothyroidism (CH) is infrequent, with very few case reports in literature. Objective: To report a case of PTC in a boy with dyshormonogenetic CH without goitre and exposed to ionising radiation. To evaluate relationships between these factors and development of PTC. Case report: We present a boy with dyshormonogenetic CH since birth. Early hormonal substitution was initiated, with subsequent normal levels of thyrotropin and thyroid hormones. He has also congenital cardiomyopathy, exposed to interventional treatment with 10 heart catheterisations, and approximately 26 chest X-rays at paediatric doses. A thyroid nodule was found in thyroid echography at the age of 6 years old. Fine needle aspiration biopsy confirmed high probability of thyroid carcinoma (Bethesda 5). The pre-surgical thorax and cerebral scan showed no evidence of metastasis. The patient underwent total thyroidectomy. Pathological examination revealed a 0.5 cm papillary thyroid micro-carcinoma in the right lobe, with no evidence of dissemination. Conclusion: Genetic mutations and radiation exposure may play an important role in the development of PTC. There may be common pathways between dyshormonogenetic CH and thyroid carcinoma that need further investigation.

Epidemiological overview, advances in diagnosis, prevention, treatment and management of epithelial ovarian cancer in Mexico / Panorama epidemiológico, avances diagnósticos, prevención, tratamiento y manejo de cáncer ovárico epitelial en México

Abstract The epithelial ovarian cancer (EOC) has been underdiagnosed because it does not have a specific clinical presentation, and the signs and symptoms are similar to the irritable bowel syndrome and pelvic inflammatory disease. EOC is less common than breast and cervical cancer, but it is more lethal. On the whole, EOC has an early dissemination to peritoneal cavity, which delays a timely diagnosis and increases the rate of advanced diagnosed disease. The diagnosis usually surprises the women and the primary care physician. Therefore, it is necessary to count on prevention and early diagnosis programs. EOC has 80% response to surgical treatment, but nearly 70% of the patients may relapse in five years. The objectives of this document are presenting a summary of the EOC epidemiology and comment about advancements in prevention, diagnosis, and treatment of this cancer. That will raise awareness about the importance of this disease.

Resumen El cáncer ovárico epitelial (COE) ha sido subdiagnosticado debido a que no tiene presentación clínica específica y a que los signos y síntomas son similares al síndrome de colon irritable y a la enfermedad inflamatoria pélvica. Es menos común que el cáncer de mama o el cervicouterino, pero es más letal. En general, tiene diseminación temprana a cavidad peritoneal, lo cual retrasa un pronóstico oportuno e incrementa la tasa de diagnóstico de enfermedad avanzada. Usualmente, el diagnóstico sorprende a la mujer y al médico de primer contacto. Entonces, es necesario contar con programas de prevención y diagnóstico temprano. El COE tiene 80% de respuesta quirúrgica, pero cerca de 70% de las pacientes puede recaer en cinco años. Los objetivos de este documento son presentar un resumen de la epidemiología del COE y comentar los avances en prevención, diagnóstico y tratamiento de este cáncer. Esto despertará la conciencia acerca de la importancia de esta enfermedad.

Mixed Carcinoma as an Independent Prognostic Factor in Submucosal Invasive Gastric Carcinoma

Mixed carcinoma shows a mixture of glandular and signet ring/poorly cohesive cellular histological components and the prognostic significance of each component is not fully understood. This study aimed to investigate the significance of the poorly cohesive cellular histological component as a risk factor for lymph node metastasis and to examine the diagnostic reliability of endoscopic biopsy. Clinicopathologic characteristics of 202 patients who underwent submucosal invasive gastric carcinoma resection with lymph node dissection in 2005-2012 were reviewed. Mixed carcinoma accounted for 27.2% (56/202) of cases. The overall prevalence of lymph node metastasis was 17.3% (35/202). Lymphatic invasion (P < 0.001), family history of carcinoma (P = 0.025), tumor size (P = 0.004), Lauren classification (P = 0.042), and presence of any poorly cohesive cellular histological component (P = 0.021) positively correlated with the lymph node metastasis rate on univariate analysis. Multivariate analyses revealed lymphatic invasion, family history of any carcinoma, and the presence of any poorly cohesive cellular histological component to be significant and independent factors related to lymph node metastasis. Review of preoperative biopsy slides showed that preoperative biopsy demonstrated a sensitivity of 63.6% and a specificity of 100% in detecting the presence of the poorly cohesive cellular histological component, compared with gastrectomy specimens. The presence of any poorly cohesive cellular histological component was an independent risk factor associated with lymph node metastasis in submucosal invasive gastric carcinoma. Endoscopic biopsy had limited value in predicting the presence and proportion of the poorly cohesive cellular histologic component due to the heterogeneity of mixed carcinoma.

Carcinoma inflamatório de mama ­ Uma abordagem comparada / Inflammatory mammary carcinoma - A comparative approach / Carcinoma inflamatório de mama - Un enfoque comparativo

O Carcinoma Inflamatório de Mama (CIM) é um neoplasma maligno de rápida evolução que apresenta baixa ocorrência tanto em cadelas quanto em mulheres. É pouco relatado pelos médicos veterinários no Brasil, fato que pode ser relacionado à falta de conhecimento da doença associado à necessidade da relação dos achados clínicos com exame histopatológico para o diagnóstico definitivo. Esse neoplasma também acomete a glândula mamária de mulheres, nas quais demonstra características clássicas de inflamação como dor, turgor de pele e aumento de temperatura local. Para diagnóstico definitivo é considerado a presença de êmbolos de células tumorais em canais linfáticos da derme associados aos sinais clínicos de inflamação. Devido ao grau de infiltração local, os sinais de inflamação e a presença de êmbolos em linfáticos, o paciente humano e veterinário apresentam prognóstico desfavorável. O CIM é pouco responsivo à quimioterapia e devido às características de inflamação, não apresenta indicação cirúrgica na maioria dos casos. Devido à agressividade do CIM em mulheres e nas cadelas, do prognóstico desfavorável e das restritas opções terapêuticas essa revisão objetiva descrever os avanços das opções terapêuticas além do tratamento paliativo na literatura atual além de apresentar uma abordagem comparada, considerando a cadela um modelo de estudo para a doença na mulher.

The Inflammatory Mammary Carcinoma (IMC) is a low-occurrence malignant neoplasm with rapid evolution that affects dogs and women. There are few reports of this disease in the Brazilian veterinary literature, which may be related to the lack of knowledge of the disease associated with the need of relating clinical findings to histopathology exams for definitive diagnosis. This neoplasm also affects the mammary glands in women, which demonstrates classical signs of inflammation such as pain, skin turgor and increased local temperature. The diagnosis considers the presence of tumor cell emboli in the lymph vessels in the dermis associated with clinical signs of inflammation. Due to the degree of local infiltration, signs of inflammation and the presence of lymph emboli, both human and veterinary patients have unfavorable prognosis. The IMC is poorly responsive to chemotherapy and due to its inflammation characteristics, in most cases, surgical removal is not recommended. Due to the aggressiveness of the IMC on women and bitches, poor prognosis and limited therapeutic options, this paper aims to describe the advances of therapeutic options beyond palliative care in current literature, as well as presenting a comparative approach considering the bitch as a study model for treating the disease in women.

El carcinoma inflamatorio de mama (CIM) es una neoplasia maligna de evolución rápida que tiene una baja incidencia tanto en perras como en mujeres. Es poco relatado por médicos veterinarios en Brasil, hecho que puede estar relacionado a la falta de conocimiento de la enfermedad, asociada a la necesidad de la relación de los hallazgos clínicos con examen histopatológico para el diagnóstico definitivo. Esta neoplasia también afecta a las glándulas mamarias de mujeres, lo que demuestra características clásicas de inflamación, como dolor, la turgencia de la piel y el aumento de la temperatura local. Para el diagnóstico definitivo se considera la presencia de émbolos de células tumorales en los canales dermis ganglios, asociados con los signos clínicos de inflamación. Debido al grado de infiltración local, los signos de inflamación y la presencia de embolias en el linfático, el paciente humano y veterinario presentan pronóstico desfavorable. El CIM es poco sensible a la quimioterapia y debido a las características de inflamación no presenta indicación quirúrgica en la mayoría de los casos. Debido a la agresividad del CIM en mujeres y perras, del pronóstico desfavorable y de las restrictas opciones terapéuticas, esa investigación tuvo como objetivo revisar el progreso de las opciones terapéuticas además del tratamiento paliativo en la literatura actual, allende presentar un enfoque comparativo, teniendo en cuenta que la perra es un modelo de estudios para la enfermedad en mujeres.

Recurrencia y progresión del carcinoma transicional de alto grado superficial de vejiga tratado con Bacilo de Calmette-Guerín (BCG) en lesiones únicas o múltiples / Recurrence and progression of transitional cell carcinoma of high - grade surface treated with bacillus Calmette - Guerin (BCG) in single or multiple lesions

Introducción: El carcinoma transicional de vejiga ocupa el segundo lugar en frecuencia, detrás del adenocarcinoma de la próstata, dentro de los tumores malignos del tracto genitourinario. Entre el 75-85% de los pacientes afectos de carcinoma vesical se presentan en formas confinadas a la mucosa o a la submucosa. Son los considerados carcinomas superficiales de vejiga y se estima que entre el 10-20% de ellos su evolución es hacia formas clínicas invasoras músculo-infiltrantes y un 50-70% evolucionaránhacia la recurrencia de la enfermedad. Objetivo: Evaluar la incidencia de la recurrencia y progresión en pacientes con Carcinoma en estadio T1 tratados con BCG, teniendo en cuenta la uni o multifocalidad de las lesiones vesicales al diagnóstico. Materiales y métodos: Criterios de inclusión: Paciente con diagnóstico de carcinoma transicional de vejiga de alto grado superficial de Febrero del 2010 a Agosto del 2014, con un seguimiento de al menos 12 meses. Tratados conBCG endocavitario. Los criterios de exclusión fueron; controles cistoscópicos irregulares, ciclos incompletos de BCG y seguimiento menor a 12 meses. Resultados: 81 HC; Grupo “A” con lesión única, 54 pacientes (66.7%) y Grupo “B” con dos o más lesiones, 27 pacientes (33.3%). Grupo “A” 50 % de recurrencia, 16,6 % de progresión y 33,4 % libres de enfermedad. Grupo “B” 66,6 % de recurrencia, 18,6 % de progresión y 14,8 % libres de enfermedad Conclusión: La inmunoterapia intravesical con BCG después de la resección transuretral completa de una lesión por un carcinoma transicional de vejiga de alto grado superficial, se considera un tratamiento con resultados aceptables.

Introduction: The transitional bladder cell carcinoma is the secondone in frequency after the adenocarcinoma of prostate, withinmalignant tumors of the genitourinary tract. Between 75-85% ofpatients with bladder carcinoma are presented in ways confined tothe mucous membrane or submucous. These are consideredsuperficial bladder carcinomas and it is estimated that between 10-20% of them evolution is toward muscle-invasive clinical forms andevolve towards 50-70% recurrence of the disease.Objectives: To evaluate the incidence of recurrence andprogression in patients with carcinoma stage T1 treated with(BCG), taking into account the uni or multifocal lesions of bladderdiagnosis.Material and methods: Inclusion criteria: Patient diagnosed withtransitional bladder cell carcinoma of high-grade surface fromFebruary 2010 to August 2014, with a follow up of at least 12months treated with endocavity BCG. Exclusion criteria were;irregular cystoscopic controls, incomplete cycles of BCG and lowertrack of 12 months.Results: HC 81 was obtained; Group "A" with single lesion, 54patients (66.7%) and Group "B" with two or more lesions, 27patients (33.3%). Group "A": 50% of recurrence, 16.6% of disease progression and 33.4% of free disease. Group "B": 66.6% of recurrence, 18.6% of disease progression and 14.8% of freedisease Conclusion: Intravesical immunotherapy with BCG after completetransurethral resection of a lesion, by a transitional bladdercarcinoma of grade high surface, is considered a treatment with acceptable results.