Change in the risk stratification of prostate cancer after Slide Review by a uropathologist: the experience of a reference center for the treatment of prostate cancer

Introduction Brachytherapy is an option for treating low-risk prostate cancer (PC). Biochemical control of low-risk disease can reach 95%. The practice advocated is that a review of prostate biopsies should be mandatory before choosing the best treatment for patients with PC. Our objective was to evaluate the change in PC risk after review of a prostate biopsy by an experienced uropathologist at a reference hospital. Materials and Methods Between December 2003 and August 2012, 182 men were referred to our institution for brachytherapy to treat PC. Their slides were reviewed by the same uropathologist. Results and Discussion Classification risk disagreement occurred in 71 (39%) cases, including one in which no tumor was observed. The main cause of risk change was related to the Gleason score (GS), with 57 (81.4%) cases upgraded to GS 7 or 8. Tumor volume was also compared, although only the number of fragments was reported in most original reports. The concordance of the number of cores affected by tumor was 43.9%, and in 49% of the cases, the number was decreased by the uropathologist. Perineural invasion (PNI) was reported in one quarter of original reports, and the agreement was 58%. Conclusion Slide review by an uropathologist remains essential at reference radiotherapy centers for the treatment of PC. The change in PC risk evaluation is mainly due to the GS, but tumor volume and PNI, which are important for the characterization of tumor aggressiveness, are also misinterpreted and could drive a change in the therapy choice. .

Lack of mutations of exon 2 of the MEN1 gene in endocrine and nonendocrine sporadic tumors

In addition to the mutations that underlie most cases of the multiple endocrine neoplasia type 1 (MEN1) syndrome, somatic mutations of the MEN1 gene have also been described in sporadic tumors like gastrinomas, insulinomas and bronchial carcinoid neoplasm. We examined exon 2 of this gene, where most of the mutations have been described, in 148 endocrine and nonendocrine sporadic tumors. DNA was obtained by phenol/chloroform extraction and ethanol precipitation from 92 formalin-fixed, paraffin-embedded samples, and from 40 fresh tumor tissue samples. We used 5 pairs of primers to encompass the complete coding sequence of exon 2 of the MEN1 gene that was screened by the polymerase chain reaction-single-stranded conformation polymorphism (PCR-SSCP) technique in 78 sporadic thyroid cancers: 28 follicular adenomas, 35 papillary carcinomas, 14 follicular carcinomas, and 1 anaplastic thyroid carcinoma. We also examined 46 adrenal lesions (3 hyperplasias, 3 adenomas and 35 adrenocortical carcinomas, 2 pheochromocytomas, 2 ganglioneuroblastomas, and 1 lymphoma) and 24 breast cancers (6 noninvasive, 16 infiltrating ductal, and 2 invasive lobular tumors). The PCR product of 5 tumors suspected to present band shifts by SSCP was cloned. Direct sense and antisense sequencing did not identify mutations. These results suggest that the MEN1 gene is not important in breast, thyroid or adrenal sporadic tumorigenesis. Because the frequency of mutations varies significantly among tumor subgroups and allelic deletions are frequently observed at 11q13 in thyroid and adrenal cancers, another tumor suppressor gene residing in this region is likely to be involved in the tumorigenesis of these neoplasms

Analysis of p53 expression and proliferative assessment using PCNA in localized prostate carcinoma

The surgical specimens from 51 men submitted to radical prostatectomy for localized prostate cancer were examined by immunohistochemistry using proliferation cell nuclear antigen (PCNA) monoclonal antibody to evaluate the proliferative index (PI). The relationship between PI, biological variables and p53 protein expression was evaluated by immunohistochemistry. PI was low in invasive localized prostate carcinoma (mean, 12.4percent) and the incidence of PCNA-positive cells was significantly higher in tumors with p53 expression (P = 0.0226). There was no statistical difference in PCNA values when biological parameters such as Gleason score, tumor volume, extraprostatic involvement, seminal vesicle infiltration or lymph node metastasis were considered. We conclude that proliferative activity is usually low in prostate carcinoma but is correlated with p53 immune staining, indicating that p53 is important in cell cycle control in this neoplasm

Synchronous primary malignant lymphoma and carcinoma of the stomach

A case of synchronous concurrent carcinoma and primary malignant lymphoma developing as two independent tumors of the stomach is presented. The clinical and pathological diagnosis and therapeutic problemas associated with synchronous tumors of the stomach are discussed. A possible relationship between the two tumors and the role of Helicobacter pylori are also reviewed.

Avaliaçäo clínica e laboratorial de pacientes em uso de anticoagulantes orais / Clinical and Laboratory Management of Patients Under Oral Anticoagulation

Objetivo - Avaliar o acompanhamento clínico e laboratorial de pacientes em uso de drogas antivitamina K(AVK). MÉTODOS - Foram avaliados, retrospectivamente, 952 consultas ambulatoriais de 100 pacientes em uso de AVK, durante 7,6 meses. Havia 56 homens e 44 mulheres, 54 pacientes com obstruçäo arterial aguda, 34 com troboembolismo venoso e 12 com cardiopatia. O nível de anticoagulaçäo foi medido pelo tempo de protrombina expresso em razäo normalizada internacional (RNI). RESULTADOS - Nível adequado de anticoagulaçäo foi observado em 59 "por cento" das consultas dos 73 pacientes considerados estáveis, com intervalo entre consultas maior do que 3 semanas. Os 27 pacientes instáveis tinham 36 "por cento" das consultas com RNI adequado. Anticoagulaçäo insuficiente ocorreu por uso irregular (22 por cento), dieta rica em vitamina (19 por cento) e dose insuficiente (16 por cento). Quatro pacientes tiveram sangramento sem gravidade e näo houve recorrência da trombose durante o período de observaçäo. CONCLUSÄO - O controle clínico e laboratorial, através do RNI, é fundamental para evitar complicaçöes hemorrágicas ou trombóticas em pacientes que necessitam de anticoagulaçäo oral.

Leiomioblastoma gástrico / Gastric leiomyoblastoma

Os autores apresentam um caso de leiomioblastoma do estômago com rara associaçäo de úlcera gástrica crônica, que cursou com quadro clínico de obstruçäo antropilórica progressiva. O paciente foi submetido à gastrectomia parcial e com 20 meses de seguimento encontra-se sem sinais de recidiva

Lesoes arteriais actinicas: efeitos de uma dose de 2000 rads em arteria iliaca de coelho. / Actinic arterial lesions: effects of a dose of 2000 rads on the iliac artery of rabbits

Os autores estabelecem um metodo de se avaliar os efeitos da irradiacao pela telecobaltoterapia nas arterias iliacas de coelhos. Foram utilizados 20 animais divididos em dois grupos de dez cada.O primeiro foi submetido a dose de 2000 rads em quatro sessoes diarias e consecutivas de 500 rads. O segundo grupo foi submetido a simulacao da irradiacao com os animais anestesiados e colocados no aparelho, sem que este fosse ligado. No 14o. dia os animais de ambos os grupos foram sacrificados e as arterias iliacas foram retiradas e submetidas a exame anatomo-patologico com tres diferentes coloracoes - Hematoxilinaesoina, Tricromico de Masson e Verhoeff.Em quatro coelhos do grupo exposto e irradiacao foram encontradas pontos de fragmentacao da lamina elastica interna. Correlaciona-se estes achados com outros da literatura

Associacao da esquistossomose mansonica hepatoesplenica e linfoma histiocitico. / Association of hepatosplenic schistosomiasis mansoni with histiocytic lymphoma

Apresenta-se um caso de paciente portador de esquistossomose mansonica hepatoesplenica e linfoma histiocitico. Comenta-se a concomitancia dos dois processos patologicos, confrontando-se com outros casos da literatura e especulando-se sobre seu significado, havendo a possibilidade da esquistossomose ser relacionada como fator causal da doenca maligna

Tumor benigno da papila. / Benign tumor of the ampulla of Vater

Os autores descrevem um caso sintomatico de tumor benigno da papila. O diagnostico durante a laparotomia foi de tumor maligno da papila sendo praticada duodenopancreatectomia com boa evolucao pos-operatoria. O diagnostico definitivo so foi estabelecido mediante exame histopatologico da peca ressecada. Os tumores benignos da papila devem ser considerados no diagnostico diferencial das lesoes tumorais peripapilares

Linfoma nao-Hodgkin: estudo de 25 casos.II - Classificacao histopatologica e estadiamento. / Non-Hodgkin's lymphoma: study of 25 cases. II - Histopathological classification and staging

Os autores apresentam 25 pacientes portadoras de linfoma nao-Hodgkin estudados no Instituto da Crianca. No presente trabalho sao apresentados os resultados do ponto de vista histopatologico e estadiamento. Em 48% dos casos, o linfoma era de tipo linfoblastico, em 44% era do tipo histiocitico e em 8%, indiferenciado, tipo Burkitt. Quanto ao estadiamento, a distribuicao foi a seguinte: estadio I, 1 caso; estadio II, 4 casos; estadio III, 19 casos e estadio IV, 1 caso. Os resultados sao comparados com os da literatura