Value of postoperative radiotherapy and analysis of prognostic factors in early-stage neuroendocrine carcinoma of cervix / 中华妇产科杂志

Objective: To evaluate the effect of postoperative radiotherapy and high-risk pathological factors on the prognosis of early-stage neuroendocrine carcinoma of cervix (NECC). Methods: A single-center retrospective cohort study of early-stage NECC in Peking Union Medical College Hospital from January 2011 to April 2022 were enrolled. The patients were treated with radical hysterectomy±adjuvant treatment. They were divided into postoperative non-radiation group and postoperative radiation group. The possible postoperative recurrence risk factors identified by univariate analysis were assessed using multivariate logistic regression. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate. Results: (1) Sixty-two cases were included in the study, including 33 cases in postoperative non-radiation group and 29 cases in postoperative radiation group. (2) The median follow-up time was 37 months (ranged 12-116 months), with 23 cases (37%) experienced recurrences. There were 7 cases (11%) pelvic recurrences and 20 cases (32%) distant recurrences, in which including 4 cases (6%) both pelvic and distant recurrences. Compared with postoperative non-radiation group, the postoperative radiation group had a lower pelvic recurrence rate (18% vs 3%; P=0.074) but without statistic difference, a slightly elevated distant recurrence rate (24% vs 41%; P=0.150) and overall recurrence rate (33% vs 41%; P=0.513) without statistically significances. Univariate analysis showed that lymph-vascular space invasion and the depth of cervical stromal invasion≥1/2 were risk factors for postoperative recurrence (all P<0.05). Multivariate analysis showed lymph-vascular space invasion was an independent predictor for postoperative recurrence (OR=23.03, 95%CI: 3.55-149.39, P=0.001). (3) During the follow-up period, 18 cases (29%, 18/62) died with tumor, with 10 cases (30%, 10/33) in postoperative non-radiation group and 8 cases (28%, 8/29) in postoperative radiation group, without significant difference (P=0.814). The postoperative 3-year and 5-year survival rate was 79.2%, 60.8%. The depth of cervical stromal invasion≥1/2 was more common in postoperative radiation group (27% vs 64%; P=0.011), and postoperative radiation in such patients showed an extended trend in PFS (32.3 vs 53.9 months) and OS (39.4 vs 73.4 months) but without statistic differences (P=0.704, P=0.371). Compared with postoperative non-radiation group, the postoperative radiation did not improve PFS (54.5 vs 37.3 months; P=0.860) and OS (56.2 vs 62.4 months; P=0.550) in patients with lymph-vascular space invasion. Conclusions: Postoperative radiation in early-stage NECC patients has a trend to reduce pelvic recurrence but not appear to decrease distant recurrence and overall recurrence, and has not improved mortality. For patients with the depth of cervical stromal invasion≥1/2, postoperative radiation has a trend of prolonging OS and PFS but without statistic difference. Lymph-vascular space invasion is an independent predictor for postoperative recurrence, but postoperative radiation in such patients does not seem to have any survival benefits.

Comportamiento del cáncer de tiroides en la Unidad de Cirugía Adulto del Hospital Clínico Herminda Martín de Chillán: período 2017 al 2019 / Thyroid cancer behavior in the adult surgery unit of the Herminda Martin de Chillan Clinical Hospital: period from 2017 to 2019

Resumen Objetivo: Describir las características demográficas del cáncer de tiroides en la Región de Ñuble en pacientes operados en el servicio de cirugía del Hospital Clínico Herminda Martin del 2017 al 2019. Materiales y Método: Mediante estudio descriptivo, se revisaron las historias clínicas de los pacientes operados en la Unidad de Cirugía de Adultos del hospital entre enero de 2017 y diciembre de 2019, tabulando las variables demográficas, clínicas e histopatológicas y método diagnóstico. Resultados: Se operaron 124 pacientes con afecciones tiroideas, 58 resultaron tener cáncer. Predominó el sexo femenino (50 pacientes). Se realizaron 43 tiroidectomías totales como primera cirugía y 15 disecciones cervicales. El carcinoma papilar fue el más diagnosticado (93,1%). Hubo discrepancias entre las categorías Bethesda II y IV en cuanto al diagnóstico definitivo. En mujeres el 36% de los tumores tuvo extensión extra tiroidea y el 54% tenían un diámetro mayor a 1 cm. Discusión: La prevalencia en el sexo femenino corresponde con los datos que se aportan a nivel mundial y en Chile. La discrepancia en el sistema Bethesda pudo corresponder a errores de la toma de muestra o su interpretación citológica. Los hallazgos de extensión y tamaño tumoral pueden estar en relación con el tiempo de espera para la cirugía. Conclusiones: El cáncer tiroideo es más frecuente en el sexo femenino. El carcinoma papilar fue el más diagnosticado. La asociación de tiroiditis con cáncer tiroideo fue de 98%. No se realizó ninguna cirugía conservadora.

Aim: To describe the demographic characteristics of thyroid cancer in the Ñuble Region in patients operated on by the Herminda Martín de Chillán Clinical Hospital surgery service from 2017 to 2019. Materials and Method: Through a descriptive study, the medical records of the patients operated on in the Adult Surgery Unit of the hospital between January 2017 and December 2019 were reviewed, tabulating the demographic, clinical and histopathological variables and method diagnosis. Results: 124 patients with thyroid conditions were operated on, 58 had cancer. The female sex predominated (50 patients). 43 total thyroidectomies were performed as the first surgery and 15 cervical dissections. Papillary carcinoma was the most diagnosed (93.1%). There were discrepancies between Bethesda categories II and IV regarding the definitive diagnosis. In women, 36% of the tumors had an extra-thyroid extension and 54% had a diameter greater than 1 cm. Discussion: The prevalence in the female sex corresponds to the data provided worldwide and in Chile. The discrepancy in the Bethesda system could correspond to errors in the sampling or its cytological interpretation. The findings of tumor extension and size may be related to the waiting time for surgery. Conclusions: Thyroid cancer is more frequent in females. Papillary carcinoma was the most diagnosed. The association of thyroiditis with thyroid cancer was 98%. No conservative surgery was performed.

Robotic transanal ressection for rectal tumor: a description of the technique / Ressecção transanal robótica para tumor retal: uma descrição da técnica

ABSTRACT Introduction: Robotic transanal surgery (RTS) is the analog of TAMIS and represents a new focus for the advancement of transanal platforms robotic transanal surgery is sometimes referred to as robotic TAMIS. Though limited to only a few centers world-wide, experience with robotic transanal surgery has been encouraging. Most research with robotic transanal surgery has concentrated on local excision of rectal neoplasia, although more complex procedures such as transanal proctectomy are possible using the robotic approach. This article reports the surgical technique of R-TAMIS performed in the Brazilian National Cancer Institute (INCA, Rio de Janeiro). Methods: 71-year-old, female with cardiologic disease (heart failure), with a 1.5 cm rectal neoplasm at 4 cm from the anal verge in the right anterolateral position. Biopsy revealed neuroendocrine tumor. A compete colonoscopy revealed no evidence of synchronous lesions. Work-up included 3D endorectal ultrasonography and magnetic resonance imaging, which demonstrated the lesion to be uT1uN0. The patient was counseled about surgical options − local excision versus low anterior resection. Due to the cardiologic condition, the patient was elected to proceed with local excision with robotic transanal surgery. Conclusion: Robotic TAMIS is a safe and effective operative procedure for high selected cases of rectal neoplasm. It enhances surgeon ergonomics and facilitates tumor removal and suture in the transanal approach.

RESUMO Introdução: A cirurgia transanal robótica (RTS,Robotic Transanal Surgery) é análoga da TAMIS (cirurgia minimamente invasiva transanal) e representa um novo foco para o avanço das plataformas transanais. A cirurgia transanal robótica é algumas vezes chamada de TAMIS robótica. Embora limitada a apenas alguns centros em todo o mundo, a experiência com a cirurgia transanal robótica tem sido encorajadora. A maioria das pesquisas com cirurgia transanal robótica tem se concentrado na excisão local da neoplasia retal, embora procedimentos mais complexos, como a proctectomia transanal, sejam possíveis utilizando a abordagem robótica. Este artigo relata a técnica cirúrgica de R-TAMIS realizada no Instituto Nacional do Câncer (INCA, Rio de Janeiro). Métodos: paciente de 71 anos, sexo feminino, com doença cardiológica (insuficiência cardíaca), com neoplasia retal de 1,5 cm a 4 cm da borda anal em posição anterolateral direita. A biópsia revelou tumor neuroendócrino. Uma colonoscopia completa não revelou evidências de lesões sincrônicas. A investigação incluiu ultrassonografia endorretal em 3D e ressonância magnética, que demonstrou que a lesão era uT1uN0. A paciente foi aconselhada sobre as opções cirúrgicas - excisão localversus ressecção anterior baixa. Devido à condição cardiológica, optou-se por proceder à excisão local com cirurgia transanal robótica. Conclusão: A TAMIS robótica é um procedimento cirúrgico seguro e eficaz para casos altamente selecionados de neoplasia retal. Ela melhora a ergonomia do cirurgião e facilita a remoção do tumor e a sutura na abordagem transanal.

Carcinoma adenoneuroendocrino mixto de la ampolla de Vater: reporte de caso / Mixed adenoneuroendocrine carcinoma of the ampulla of Vater: case report

INTRODUCCIÓN: Los carcinomas adenoneuroendocrinos mixtos (MANEC) son tipos de tumores bifásicos, reconocidos morfológicamente ante la presencia de una formación neoplásica constituida de manera simultánea por epitelio glandular y células neuroendocrinas. Dentro del tracto gastrointestinal, estas neoplasias predominan en el estómago o el colon. Solo 19 casos localizados en la ampolla de Vater han sido reportados por la literatura. OBJETIVO: Reportar un caso de MANEC; revisar la epidemiología, pronóstico y tratamiento de estos tumores. MATERIALES Y MÉTODO: Presentación de caso clínico de una paciente con diagnóstico de adenocarcinoma neuroendocrino mixto de la región ampular. DISCUSIÓN: La presentación clínica, el manejo y el pronóstico son similares al del adenocarcinoma ampular. Se diagnostican con el examen histopatológico de la muestra resecada. Ambos componentes deben ser histológicamente malignos, y cada uno de ellos debe representar al menos el 30% de la lesión. CONCLUSIÓN: Los MANEC ampulares son tumores poco comunes a nivel mundial, siendo éste el primer caso reportado en nuestro instituto.

INTRODUCTION: Mixed adenoneuroendocrine carcinomas (MANEC) are types of biphasic tumors, morphologically recognized in the presence of a neoplastic formation constituted simultaneously by glandular epithelium and neuroendocrine cells. Only 19 cases located in the ampulla of Vater have been reported in the literature. Within the gastrointestinal tract, these neoplasms predominate in the stomach or colon. AIM: Report a case of MANEC; review of the epidemiology, prognosis and treatment of these tumors. MATERIALS AND METHOD: Case presentation of a patient diagnosed with mixed adeno-neuroendocrine carcinoma of the ampullary region. DISCUSSION: The clinical presentation, management and prognosis are similar to ampullary adenocarcinoma. These tumors are diagnosed with a histopathological examination of the resected specimen. Both components must be histologically malignant, and each of them must represent at least 30% of the lesion. CONCLUSION: MANEC of the ampulla are rare tumors worldwide, being this case the first reported in our institute.

Serum calcitonin nadirs to undetectable levels within 1 month of curative surgery in medullary thyroid cancer

ABSTRACT Objective: Because serum calcitonin (CT) is a reliable marker of the presence, volume, and extent of disease in medullary thyroid cancer (MTC), both the ATA and NCCN guidelines use the 2-3 month post-operative CT value as the primary response to therapy variable that determines the type and intensity of follow up evaluations. We hypothesized that the calcitonin would nadir to undetectable levels within 1 month of a curative surgical procedure. Subjects and methods: This retrospective review identified 105 patients with hereditary and sporadic MTC who had at least two serial basal CT measurements done in the first three months after primary surgery. Results: When evaluated one year after initial surgery, 42 patients (42/105, 40%) achieved an undetectable basal calcitonin level without additional therapies and 56 patients (56/84, 67%) demonstrated a CEA within the normal reference range. In patients destined to have an undetectable CT as the best response to initial therapy, the calcitonin was undetectable by 1 month after surgery in 97% (41/42 patients). Similarly, in patients destined to have a normalize their CEA, the CEA was within the reference range by 1 month post-operatively in 63% and by 6 months in 98%. By 6 months after curative initial surgery, 100% of patients had achieved a nadir undetectable calcitonin, 98% had reached the CEA nadir, and 97% had achieved normalization of both the calcitonin and CEA. Conclusion: The 1 month CT value is a reliable marker of response to therapy that allows earlier risk stratification than the currently recommended 2-3 month CT measurement.

Primary endometrial large cell neuroendocrine carcinoma with melanocytic differentiation

High-grade endometrial carcinomas are aggressive neoplasms of difficult histological classification. Neuroendocrine differentiation in endometrial carcinomas is rare. This is the report of an endometrial large cell neuroendocrine carcinoma with foci of melanocytic differentiation in a 75-year-old woman with abnormal post-menopausal uterine bleeding for 2 years. Two initial biopsies were inconclusive. Histopathological examination of the uterus revealed large cell neuroendocrine carcinoma associated with endometrioid carcinoma and foci of melanocytic differentiation, pT3a (FIGO IIIA). There were metastases in the rectum serosa and lungs. After 8 months of diagnosis and surgical treatment, the patient is on chemotherapy and radiotherapy. We highlight the morphological characteristics and criteria that allow the definitive anatomopathological diagnosis, including immunohistochemical markers used to identify the cell types present in this unprecedented association.

Mixed adenoneuroendocrine carcinoma of the gastric stump following Billroth II gastrectomy: case report and review of the literature / Adenocarcinoma neuroendócrino misto do coto gástrico após gastrectomia à Billroth II: relato de caso e revisão de literatura

CONTEXT: Gastric stump cancer after gastric resection is a well-known disease. It may be a newly developed cancer after resection due to benign disease, or recurrent or residual disease after oncological surgery. The predominant histological type is usually adenocarcinoma. This study aimed to report on a rare occurrence of a mixed adenoneuroendocrine carcinoma (MANEC) on the gastric stump. CASE REPORT: The case of an 83-year-old female who presented a locally aggressive gastric stump MANEC, 35 years after Billroth II gastrectomy to treat a peptic ulcer, is reported. The patient underwent resection and adjuvant therapy. She has been followed up for one year without signs of recurrence. CONCLUSION: MANEC is a rare type of gastrointestinal neoplasm. The classification, histopathology, clinical features, treatment issues and prognosis are discussed along with a brief review of the literature.

CONTEXTO: O câncer de coto gástrico após gastrectomia é uma condição extensamente documentada. Pode se tratar de doença desenvolvida após a ressecção por doença benigna, ou ainda doença recorrente ou residual após cirurgia oncológica. Geralmente, o tipo histológico predominante é o adenocarcinoma. Este estudo tem como propósito relatar a rara ocorrência de um adenocarcinoma neuroendócrino misto (MANEC) no coto gástrico. RELATO DE CASO: É relatado o caso de uma mulher de 83 anos que apresentou um MANEC localmente agressivo 35 anos após uma gastrectomia à Billroth II devido a úlcera péptica. Foi submetida a ressecção e terapia adjuvante e foi seguida por 12 meses sem sinais de recorrência. CONCLUSÃO: Os MANECs constituem raro tipo de neoplasia gastrointestinal. Sua classificação, histopatologia, aspectos clínicos, tratamento e prognóstico são discutidos junto com uma breve revisão de literatura.

Tumor neuroendocrino en cérvix uterino: reporte de caso / Neuroendocrine tumor of the uterine cervix: case report

Los tumores neuroendocrinos de cuello uterino son extremadamente raros. Las mujeres con diagnóstico de carcinoma neuroendocrino de células pequeñas del cuello uterino tienen mayor frecuencia de metástasis en los ganglios linfáticos, invasión linfovascular, recurrencia y peor pronóstico en comparación con aquellos con otros tipos de neoplasias cervicales. Se presenta el caso de una mujer de 58 años, con un tiempo de enfermedad de seis años antes del ingreso, caracterizado por sangrado vaginal irregular posmenopáusica, además de sintomatología relacionada a anemia crónica. En el examen ginecológico, se evidenció tumoración de 4 cm que ocupaba tercio superior de vagina y protruía por el cérvix. Fue diagnosticado como mioma abortivo y enviada a estudio anatomopatológico. El resultado fue carcinoma neuroendocrino de células pequeñas grado III en el 90% y carcinoma epidermoide en el 10%. La paciente fue sometida a histerectomía radical más salpingo-ooferectomía bilateral y linfadenectomía pélvica bilateral y para-aortica. El estudio anatomopatológico de la pieza quirúrgica encontró endometrio y miometrio comprometido por neoplasia maligna. Parametrios, anexos y ganglios linfáticos se encontraron libres de neoplasia. A la microscopía el resultado fue carcinoma neuroendocrino grado III (carcinoma de células pequeñas, infiltrante), con extensa embolia linfovascular. El estudio de inmunohistoquímica arrojó sinaptofisina positivo en las áreas con diferenciación neuroendocrina.

Neuroendocrine tumors of the cervix are extremely rare. Women diagnosed with small cell neuroendocrine carcinoma of the cervix have a higher frequency of metastases in the lymph nodes, lymphovascular invasion, recurrence and worse prognosis compared to those with other types of cervical neoplasia. We report the case of a 58-year-old female, with a history of six years of postmenopausal irregular vaginal bleeding, in addition to symptoms related to chronic anemia. Gynecological examination showed a tumor of 4 cm that occupied the upper third of the vagina and protruded through the cervix initially diagnosed as an abortifacient myoma, and sent to histopathology study. 90% of the tumor was small cell neuroendocrine carcinoma grade III, and the remaining 10% was squamous cell carcinoma. The patient underwent into a radical hysterectomy plus bilateral salpingo-oophorectomy, and bilateral pelvic and para-aortic lymphadenectomy. Histopathologic examination of the surgical specimen found endometrium and myometrium compromised by malignancy. Parametrium, annexes and lymph nodes were free of neoplasia. At microscopy, the result was a grade III neuroendocrine carcinoma (small cell carcinoma, infiltrating), with extensive lymphovascular emboli. The immune-histochemical study showed synaptophysin positive in areas with neuroendocrine differentiation.

Large Cell Poorly Differentiated Neuroendocrine Carcinoma of the Maxilla: An extremely Rare Tumor.

Neuroendocrine carcinomas are epithelial neoplasm with predominant neuroendocrine differentiation. Mostly they are found in gastrointestinal and respiratory system. In the nasal and paranasal sinus regions, squamous cell carcinoma is the most common tumor, followed by adenocarcinoma, malignant lymphoma, sinonasal undifferentiated carcinoma, and olfactory neuroblastoma. Large cell neuroendocrine carcinoma of head and neck region is extremely rare. Until now, very few cases of neuroendocrine tumors of paranasal sinuses have been documented. Compared to other organ systems, the neuroendocrine carcinoma involving sinuses are much more aggressive and with poor prognosis. The rarity of this carcinoma has restricted the understanding of its etiology and clinical outcome. We herein reporting a case of large cell poorly differentiated neuroendocrine tumor of maxilla with orbital extension with the purpose of analysis of the available information of this rare malignancy.

Carcinoma de células de Merkel: apresentação clínica, fatores prognósticos, tratamento e sobrevida de 32 pacientes / Merk cell carcinoma: clinical presentation, prognostic factors, treatment and survival in 32 patients

INTRODUÇÃO: O carcinoma de células de Merkel é uma rara neoplasia cutânea primária neuroendócrina agressiva. O objetivo deste estudo foi avaliar o perfil epidemiológico dos pacientes acometidos com carcinoma de células de Merkel, as características clínicas da neoplasia, o tempo até o início do tratamento, a sobrevida e as causas de morte. MÉTODO: Foram avaliados, retrospectivamente, 32 pacientes portadores de carcinoma de células de Merkel. A história clínica e o estadiamento dos pacientes foram correlacionados em 1 ano e 2 anos de sobrevida. RESULTADOS: A maioria dos pacientes (69%) era do sexo feminino, com média de idade de 72 anos e 93% de pele clara. A localização mais acometida era cabeça e pescoço, seguida de tronco e membros. Outras neoplasias foram encontradas em 6 pacientes. O tempo médio entre o surgimento dos sinais/sintomas e o tratamento especializado foi de 12,2 meses, com acometimento de linfonodos regionais em 13 (40%) pacientes e metástases à distância em 4 (12%). Após o tratamento especializado, observou-se sobrevida em 1 ano de 53% e em 2 anos, de 47%. Tumor < 2 cm foi indicativo de melhor prognóstico. CONCLUSÕES: O diagnóstico tardio contribuiu para a alta taxa de letalidade da doença, em decorrência da rápida progressão local e à distância.

BACKGROUND: Merkel cell carcinoma is a rare, aggressive, malignant primary cutaneous neuroendocrine tumor. The objective of this study was to evaluate the epidemiological profile of patients with Merkel cell carcinoma, the clinical characteristics of the tumor, time between manifestation of signs and symptoms and initiation of treatment, survival and causes of death. METHODS: Thirty-two patients with Merkel cell carcinoma were evaluated retrospectively. Clinical history and staging were correlated with 1 and 2-year survival. RESULTS: Most patients (69%) were female, mean age was 72 years and 93% were fair-skinned. The most commonly affected sites were the head/neck, trunk and limbs. Other malignancies were found in 6 patients. Mean time between the appearance of signs/symptoms and initiation of specialist treatment was 12.2 months, with regional lymph nodes being affected at that time in 13 (40%) cases and distant metastases being present in 4 (12%). Following specialist treatment, 1 and 2-year survival was 53% and 47%, respectively. Tumor size < 2 cm was indicative of more favorable prognosis. CONCLUSIONS: Late diagnosis contributed to high lethality due to rapid local and distant progression of the disease.

Pancreatectomía central: relato de casos y descripción de la técnica / Central pancreatectomy: cases report and technique description

The conventional techniques of pancreatic resections, most of the time imply in the withdrawal of ex-tensive segments of pancreatic parenchyma, having as possible complications at the long time, the appearance of endocrine or exocrine insufficience. The central pancreatectomy consists in an alternative of pancreatic resection to resect benign or low grade malignant tumours located in the pancreatic isthmus. We present the clinical characteristics, image, and the surgical technique used, for withdraw of pancreatic isthmus nonfunctioning pancreatic neuroendocrine neoplasm and pancreatic serous cystic adenoma.

Las técnicas convencionales de resección pancreática para el tratamiento de enfermedades neoplásicas, en la mayoría de las veces implican la extirpación de segmentos extensos del parénquima pancreático, existiendo como eventuales complicaciones a largo plazo, el surgimiento de insuficiencia pancreática endocrina o exocrina. La pancreatectomía central se constituye en una alternativa de resección pancreática, que limita esta resección solamente al sector comprometido, especialmente en las neoplasias benignas o de bajo grado de malignidad. Presentamos las características clínicas, de imagen y la técnica empleada en dos pacientes, para el tratamiento quirúrgico de un tumor endocrino no funcionante y de un cistoadenoma seroso, localizados en el cuello del páncreas, mediante la pancreatectomía central.

p53 immunostaining is correlated with reduced survival and is not correlated with gene mutations in resected pulmonary large cell carcinomas

Malignancy of pulmonary large cell carcinomas (LCC) increases from classic LCC through LCC with neuroendocrine morphology (LCCNM) to large cell neuroendocrine carcinomas (LCNEC). However, the histological classification has sometimes proved to be difficult. Because the malignancy of LCC is highly dependent on proteins with functions in the cell cycle, DNA repair, and apoptosis, p53 has been targeted as a potentially useful biological marker. p53 mutations in lung cancers have been shown to result in expression and protein expression also occurs in the absence of mutations. To validate the importance of both p53 protein expression (by immunostaining) and p53 gene mutations in lung LCC (by PCR-single strand conformational polymorphism analysis of exons 5, 6, 7, and 8) and to study their relationships with clinical factors and sub-classification we investigated the correlation of p53 abnormalities in 15 patients with LCC (5 classic LCC, 5 LCNEC, and 5 LCCNM) who had undergone resection with curative intent. Of these patients, 5/15 expressed p53 and none had mutant p53 sequences. There was a negative survival correlation with positive p53 immunostaining (P = 0.05). After adjustment for stage, age, gender, chemotherapy, radiotherapy, and histological subtypes by multivariate analysis, p53 expression had an independent impact on survival. The present study indicates that p53 assessment may provide an objective marker for the prognosis of LCC irrespective of morphological variants and suggests that p53 expression is important for outcome prediction in patients with the early stages of LCC. The results reported here should be considered to be initial results because tumors from only 15 patients were studied: 5 each from LCC, LCNEC and LCCNM. This was due to the rarity of these specific diseases.

[ case report of MerckLe Cell carcinoma in medial wall of orbit]

Merckle cell carcinoma [MCC] is a relatively rare tumor, originating from Neuroendocrine cells, with aggressive behavior and common recurrence. It is more common in males and in head and neck region. Pathologists diagnose it by immunohistochemical staining [IHC]. Its definite treatment is not still determined, however radical resection as the main cure and radiotherapy as the supporting treatment are suggested. Based on many reports the most common site of MCC in head and neck region is cheeck and eyelid. The site of MCC in this report is the medial wall of orbit, about which no report was found in medical literature. The interesting point in this case presentation is that one of the differential diagnoses of mass lesions in the medial wall of orbit is MCC and the colleagues should pay attention to this rare disease in such instances. Presently the reported case is under control with surgery and radiotherapy and chemotherapy

Relevância clínica dos carcinomas de grande células pulmonares com relação às características neuroendócrinas, biomoleculares e estromais / Neuroendocrine and biologic features of primary tumors and tissue in pulmonary large cell carcinomas

Avaliou-se p21 e outros marcadores em espécimes cirúrgicos de 61 pacientes com carcinoma de grande células de pulmão. Utilizamos imunohistoquímica para avaliar a proteína p21 e a densidade de microvasos. A análise através do modelo multivariado de Cox mostrou que após o tratamento cirúrgico, o subtipo histológico foi significante com relação a sobrevida (p=0.02), mas a quantificação do tumor para o p21 e a densidade de microvasos adicionaram importante informação ao estudo do prognóstico e foram fatores mais fortemente relacionados com a sobrevida do que o subtipo histológico (P=0.00).We examined p21waf1/cip1 and other markers in tissue from 61 patients with surgically excised large cell carcinoma. We used immunohistochemistry and morphometry to evaluate the amount of tumor staining for p21waf1/cip1 and microvessel density. The study outcome was survival time until death from recurrent lung cancer. Multivariate Cox model analysis demonstrated that after surgical excision control, histologic subtypes were significantly related to survival time (P=0.02), but quantitative staining of the tumor for p21waf1/cip1 and microvessel density added prognostic information and were more strongly prognostic than histologic subtype (P=0.00)...

Carcinoma neuroendócrino cutâneo primário (Ca de Merkel): relato de 6 casos e revisäo da literatura / Cutaneous primary neuroendocrine carcinoma (Ca de Merkel): report of 6 case and review of literature

Os autores apresentam seis casos de carcinoma neuroendócrino primário cutâneo tratados na INCa-RJ no período de janeiro/1980 a dezembro/1993 e confirmados pela imunohistoquímica. O trabalho enfatiza a necessidade de confirmaçäo diagnóstica pelo uso deste método além de recomendar tratamento radical baseado na ressecçäo cirúrgica ampla acompanhada por esvaziamento linfático regional eletivo que poderá ser complementado ou näo pela radioterapia e ou pela quimioterapia.