Fatores prognósticos de resposta à quimioterapia em tumores avançados do colo uterino: o papel da neoangiogênese / Prognostic factors for response to chemotherapy in advanced tumors of the uterine cervix: the role of neoangiogenesis

RESUMO Objetivo: analisar a expressão do Fator de Crescimento do Endotélio Vascular (VEGF), seu receptor (VEGFR-2), idade e tipo histológico de carcinomas avançados de colo uterino com relação à resposta clínica à quimioterapia neoadjuvante. Métodos: foram incluídas 40 pacientes com diagnóstico de carcinoma de colo uterino (IB2 e IVA), com biópsias prévias ao tratamento. Todas as pacientes foram submetidas à quimioterapia neoadjuvante e avaliadas quanto à resposta clínica e à expressão do VEGF. Considerou-se boa resposta clínica uma regressão tumoral total ou maior do que 50%. Resultados: em relação à resposta à quimioterapia, 18 pacientes (45%) apresentaram boa resposta e 22 (55%), má resposta. Quanto à expressão do VEGF, em 16 pacientes foi considerada positiva e em 24, negativa. Quando os casos foram analisados separadamente em relação à resposta à quimioterapia, somente a expressão positiva de VEGF foi associada à boa resposta clínica (p=0,0157). Conclusão: a expressão de VEGF mostrou ser isoladamente, um importante marcador de boa resposta ao tratamento quimioterápico neoadjuvante das pacientes com carcinoma avançado de colo uterino.

ABSTRACT Objective: to analyze the expression of Vascular Endothelial Growth Factor (VEGF), its receptor (VEGFR-2), age and histological type of advanced cervical carcinomas with respect to the clinical response to neoadjuvant chemotherapy. Methods: we studied 40 patients with cervical carcinoma (IB2 and IVA) diagnosed by biopsies prior to treatment. All patients underwent neoadjuvant chemotherapy and evaluation for clinical response and expression of VEGF. We considered a tumor regression greater than 50% as a good clinical response. Results: eighteen patients (45%) had good response to chemotherapy, and 22 (55%), poor response. VEGF expression was positive in 16 patients and negative in 24. When analyzed separately for response to chemotherapy, only the positive expression of VEGF was associated with good clinical response (p=0.0157). Conclusion: VEGF expression alone was an important marker of good response to neoadjuvant chemotherapy in patients with advanced carcinoma of the cervix.

Primary adenosquamous cell carcinoma of the pancreas: the use of endoscopic ultrasound guided - fine needle aspiration to establish a definitive cytologic diagnosis / Carcinoma adenoescamoso primario de páncreas: uso de la técnica de biopsia por aspiración con aguja fina guiada por ultrasonido endoscópico para establecer un diagnóstico citológico definitivo

Pancreatic cancer is the second most common malignancy of the gastrointestinal tract in the US, and adenocarcinoma has been identified as the most common type of pancreatic cancer. Different types of pancreatic cancers have been classified: adenocarcinoma, ductal adenosquamous carcinoma, solid pseudopapillary tumors, endocrine neoplasms, acinar cell carcinoma, squamous cell carcinoma, cystic tumors, primary lymphoma of the pancreas, and metastatic lesions of the pancreas. Adenosquamous carcinoma is extremely rare, behave in a very aggressive way and is responsible for the 1 to 4% of the pancreatic exocrine neoplastic lesions. We describe the case of an 82-years-old African American female, presenting to our institution with quantifiable weight loss (12 kg in 3 months), jaundice and abdominal pain. On admission, laboratory tests were obtained: total bilirubin: 11.07 mg/dl with a direct fraction of 10.32 mg/dl. Cross-sectional abdominal CT scan with contrast, showed a lesion localized in the pancreatic head (hypodense on T1, measuring 3.5 x 3.5 x 2.5 cm), with vascular invasion of the portal vein. EUS showed a solid, hypoechoic, not well-defined lesion (measuring 3.98 x 3.80 cm), localized between the head and neck of the pancreas. EUS-FNA was performed with a 22G needle using the fanning technique. The cytological specimens demonstrated components of both squamous carcinoma and adenocarcinoma. The patient underwent ERCP procedure, and biliary drainage was performed with an entirely covered metallic stent placement. After a month from the procedures, the patient died due to the severity of the disease. Endoscopic ultrasound has proven to be the best method to diagnose solid pancreatic lesions, including rare and aggressive type of tumors like primary adenosquamous cell carcinoma that we described in this very interesting case report

El cáncer de páncreas es la segunda neoplasia maligna más común del tracto gastrointestinal en los EE.UU. y el adenocarcinoma ha sido identificado como el tipo más común de cáncer de páncreas. Se han clasificado diferentes tipos de cáncer de páncreas: adenocarcinoma, carcinoma adenoescamoso ductal, tumores pseudopapilares sólidos, neoplasias endocrinas, carcinoma de células acinares, carcinoma de células escamosas, tumores quísticos, linfoma primario del páncreas y lesiones metastásicas del páncreas. El carcinoma adenoescamoso es extremadamente raro y se comporta de manera muy agresiva, es responsable del 1 al 4% de las lesiones pancreáticas exocrinas neoplásicas. Presentamos el caso de una mujer afroamericana de 82 años de edad, que fue admitida a nuestra institución con pérdida de peso cuantificable (12 kg en 3 meses), ictericia y dolor abdominal. Al momento de la admisión, se obtuvieron pruebas de laboratorio: bilirrubina total: 11,07 mg/dl con una fracción directa de 10,32 mg/dl. La tomografía computarizada abdominal transversal con contraste mostró una lesión localizada en la cabeza pancreática (hipodensa en T1, 5 x 3,5 x 2,5 cm) con invasión vascular de la vena porta. El ultrasonido endoscópico mostró una lesión sólida, hipoecoica, no bien definida de 3,98 x 3,80 cm, localizada entre la cabeza y el cuello del páncreas. La biopsia por aspiración con aguja fina guiada por ultrasonido endoscópico se realizó con una aguja 22G utilizando la técnica de ventilación (Fanning). Los especímenes citológicos demostraron componentes de carcinoma escamoso y adenocarcinoma. El paciente se sometió a CPRE y el drenaje biliar se realizó con una prótesis metálica completamente cubierta. Después de un mes de los procedimientos, el paciente falleció debido a la gravedad de la enfermedad. El ultrasonido endoscópico ha demostrado ser el mejor método para diagnosticar lesiones pancreáticas sólidas, incluyendo tumores raros y agresivos como el carcinoma primario de células adenoescamosas que describimos en este interesante relato de caso

Adenosquamous carcinoma of the liver

No abstract available.

Tumor de colisión de cérvix uterino: presentación de 17 casos / Collision tumors of the uterine cervix: report of 17 cases

El tumor de colisión es una variante poco frecuente de tumores del cérvix uterino, originados de las células de reserva de la unión escamocelular y que debe ser diferenciado de los carcinomas adenoescamosos. El objetivo del presente artículo es determinar las características morfológicas de 17 casos de tumor de colisión de cérvix uterino. La edad promedio de presentación fue 48,7 años (rango: 34-87 años). Los 4 casos con metástasis ganglionares correspondieron al componente de adenocarcinoma.

Collision tumor is an uncommon variant of cervical tumors originating from the reserve cells of squamous cell union and must be differentiated from adenosquamous carcinomas. The aim of this paper is to determine the morphological characteristics of 17 cases of collision tumor of uterine cervix, in which it was found that the average age at diagnosis was 48.7 years (range: 34-87 years). In 5 cases lymph node metastases were of the adenocarcinoma component.

Carcinoma adenoescamoso metastásico cerebral de origen ginecológico: a propósito de un caso / Adenosquamous carcinoma metastatic brain gynecologic origin: a purpose of a case

Es infrecuente que tumores malignos del aparato genital femenino afecten al Sistema Nervioso Central (SNC). El carcinoma del cuello uterino raramente metastiza al SNC, siendo escasa la literatura científica relacionada con esta patología. El objetivo es presentar un nuevo caso de adenocarcinoma de cuello uterino el cual fue diagnosticado en el 2005, que metastizó al SNC a los 2 años del diagnóstico inicial. Se presenta femenina de 43 años de edad quien acude al Hospital Central de San cristóbal donde se le realizó histerectomía ampliada en el 2006. En el 2007 se diagnóstica Lesión Ocupante de Espacio Cerebral que es operado resultando ser metastasis cerebral de Adenocarcinoma Escamoso. Actualmente se encuentra en condiciones clínicas estables.

Association between prognostic factors and disease-free survival of cervical cancer stage IB1 patients undergoing radical hysterectomy.

This study was designed to identify prognostic factors of patients with cervical cancer stage IB1 undergoing radical hysterectomy. The medical records and specimens of two hundred and five patients with cervical cancer stage IB1 undergoing radical hysterectomy at Songklanagarind Hospital from July 1995 to June 2005 were reviewed. Patients' age, tumor size, histologic type, tumor grade, depth of invasion, degree of stromal invasion, lymph-vascular space invasion (LVSI), surgical margin status, pelvic node status, and adjuvant treatment were assessed for correlation with disease-free survival (DFS). The mean age of these patients was 44.2 years and the median follow up was 56 months. Twenty five patients (12.2%) developed recurrent disease. The overall 5-year DFS was 86%. In univariate analysis, depth of invasion, degree of stromal invasion, LVSI, and pelvic node status were significant prognostic factors. In multivariate analysis, degree of stromal invasion remained the only independent prognostic factor. In conclusion, degree of stromal invasion was the main independent predictor of prognosis in surgical cases of cervical cancer stage IB1.

Clinicopathological Aspects of 542 Cases of Pancreatic Cancer: a Special Emphasis on Small Pancreatic Cancer

Small pancreatic cancers (longest diameter < or =2 cm) have been regarded as preliminary to early pancreatic cancer, which was thought to be highly curable. During our experience since 1989, we evaluated 542 cases of pancreatic cancer. Among them we found 74 cases of tumors < or =2 cm in diameter, small pancreatic cancer (TS1 pancreatic cancer). Well-differentiated adenocarcinomas (18.9%) and absence of symptoms (8.1%) were more frequent in patients with TS1 than in those with larger pancreatic tumors. Only 16 of the 74 patients (21.6%) with small pancreatic cancers had T1 tumors. According to the International Union Against Cancer (UICC) staging, only 11 patients (14.9%) were stage IA: their 5-yr survival rate was 23.3% and their median survival was 30.0 months. Among these 11 patients, 3 had tumors <1 cm; their median survival time was 30.0 months and their 5-yr survival rate was 50.0%. These findings may indicate that 'small' pancreatic cancer is not equivalent to 'early' pancreatic cancer.

A Case of Primary Adenosquamous Carcinoma of the Liver with Formation of Colonic Fistula / 대한소화기학회지

Primary adenosquamous carcinoma of the liver is generally considered as an extremely rare subtype of cholangiocarcinoma. It has been reported mostly in a form of case studies. As far as we know, there was only one case report on tumor related with biliary fistula. Recently, we experienced a case of primary adenosquamous carcinoma of liver with a formation of tumor-colonic fistula. A 54-year-old man was transferred to our hospital due to liver mass detected by abdominal ultrasonogram. Dynamic computed tomogram of liver showed a large irregular hypodense mass without rim enhancement in right lobe of liver and also suggested a fistula formation between the tumor and hepatic flexure of right colon. Colonoscopic examination showed a large colonic wall defect in hepatic flexure and a friable, nodular mucosa around the defected colonic wall. Extended right lobectomy and right hemicolectomy were done. Microscopically, the tumor was composed of squamous cell carcinoma mainly with foci of the adenocarcinoma component.

Glassy cell carcinoma of the uterine cervix a rare histology. Report of three cases with a review of the literature.

Glassy cell carcinoma is a poorly differentiated variant of adenosquamous carcinoma of the cervix associated with an aggressive course and a poor prognosis. We present three cases of glassy cell carcinoma of the cervix. Patients presented with a cervical growth which was biopsied. Histology the tumours showed nests of cells with a granular or clear cytoplasm, displaying marked pleomorphism and mitoses. Stroma showed an eosinophilic infiltrate. Two tumours showed a pure glassy cell pattern and one showed glandular differentiation with intracellular and extracellular mucin. Patients were treated with a combination of surgery, radiotherapy and chemotherapy but showed a poor response. Two patients died of the disease of pelvic or distant metastases within two years of diagnosis and one was lost to follow up. Although glassy cell carcinoma runs an aggressive clinical course, an early diagnosis may help in a more effective management and offer a better prognosis.

Concurrent radiation therapy and irinotecan in stage IIIB cervical cancer.

The present study was to evaluate the efficacy and toxicity of concurrent radiation therapy and irinotecan in patients with stage IIIB cervical cancer. Fifteen patients with no prior radiation therapy and chemotherapy were enrolled in the study. These patients received 50 Gy of external radiation to whole the pelvis, 50 Gy with an additional dose of 6-10 Gy to the parametrium and 1 or 2 sessions of intracavitary Cesium-137. Weekly intravenous infusion of 40 mg/m2 irinotecan was given for 5 cycles during the course of radiation therapy. Of 14 evaluable patients, 4 (28.6%) achieved complete response and 7 (50.0%) achieved partial response. Treatment-related toxicity included grade 1 & 2 anemia, grade 1 & 2 leucopenia, grade 1 & 2 neutropenia and 7.1 per cent grade 3 diarrhea. No grade 4 toxicity or treatment-related death occurred in the present study. CONCLUSION: Irinotecan is a promising new cytotoxic agent in treatment concurrently with radiation therapy in newly diagnosed locally advanced cervical cancer. This modality of treatment appeared to be effective with acceptable toxicity.

Adenosquamous carcinoma of colon.

Primary adenosquamous carcinoma of the colon is an aggressive entity. We report a 41-year-old man with a combination of adenocarcinoma and squamous cell carcinoma of the cecum, treated by right hemicolectomy and ileo-transverse anastomosis. Postoperatively he received adjuvant chemotherapy. However, the tumor recurred at the original site within two months and thereafter the patient was lost to follow up.

Adenosquamous carcinoma of the prostate

An unusual adenosquamous carcinoma originating in the prostate of a 73-year-old man is described. The histological finding showed a well differentiated squamous cell carcinoma admixed in an adenocarcinomatous area. A transitional area of 2 carcinomatous elements was also noted. Seven months prior to the development of this lesion, a diagnosis of adenocarcinoma had been established by transurethral resection of the prostate and the patient had been treated with bilateral orchiectomy. This is the first case of adenosquamous carcinoma of the prostate reported in Korea. The pathogenesis and previous reports of this lesion will be discussed.

Carcinoma adenoescamoso primário do estômago / Primary adenosquamous carcinoma of the stomach

O carcinoma adenoescamoso primário do estômago é um tumor raro, cuja incidência nao excede 1 por cento dos tumores gástricos. Esse tumor mostra dois tipos celulares distintos: um escamoso e outro adenocarcinomatoso. Material e Método. Os autores reportam um caso de carcinoma adenoescamoso primário do estômago em um paciente branco de 55 anos, cuja patologia e imuno-histoquímica mostram a presença dos dois tipos celulares: adenocarcinomatoso e escamoso. Conclusao. É discutido um caso de um tumor raro e interessante do estômago, com relaçao à sua patogênese, diagnóstico e aspectos clínico-patológicos.

Re-classification of carcinoma cervix uteri by mucin histochemistry.

Biopsies of cervix uteri from 166 patients with benign and malignant lesions (12 normal, 48 inflammatory lesion, 6 adenocarcinoma, 2 adenosquamous carcinoma and 98 from squamous cell carcinomas) were studied histochemically. The stains used were PAS with/without diastase, AB/PAS (pH 2.5) and OR/AB. In inflammatory lesions neutral mucin was predominent which was replaced by sialomucin and sulphomucin in endocervical polyps. In malignant lesions sulphomucin was predominent. Seventeen percent cases of squamous cell carcinomas needed reclassification after mucin staining. Of the fourteen large cell non-keratinizing squamous cell carcinomas, 12 were reclassified as squamous cell carcinoma with mucin secretion and 2 as adenosquamous carcinoma. One case of small cell non-keratinizing squamous cell carcinoma was reclassified as moderately differentiated adenocarcinoma. None of the keratinizing carcinomas had evidence of mucin secretion. Mucin histochemistry should be done routinely on non-keratinizing squamous cell carcinomas to pick up more cases of carcinoma with evidence of mucin secretion which can be missed on routine haematoxylin and eosin stains. Such carcinomas are known to pursue a more aggressive clinical course and have a poorer prognosis than non-mucin secreting type of squamous cell carcinoma.

Carcinoma adenoescamoso del cuello uterino: estudio clínico patológico cervix uteri / Adenosquamous carcinoma: clinic-patologic study

Se describen las características clínicas y morfológicas de 45 casos de carcinoma adenoescamosos diagnosticados en el Intituto Anatomopatológico, y se comparan con las otras variantes histológicas de carcinoma cervical invasor. Se evidenció un incremento relativo en el porcentaje de carcinomas adenoescamosos durante el período de las pacientes fué una década menor a la observada en los casos de carcinoma epidermoide y la asociación con el embarazo fué del 16,67 por ciento. La frecuencia de permeación linfovascular fué del 51,11 por ciento. La persistencia del carcinoma adenoescamoso fué mayor, en estados clínicos avanzados, que el carcinoma epidermoide. Toda clasificación de carcinomas cérvico-uterinos requiere la aplicación previa de tinciones para mucinas epiteliales para detectar este grupo de tumores de comportamiento agresivo

Adenosquamous carcinoma of the thyroid: a case report and review of the literature.

A case of mixed squamous cell carcinoma and papillary adenocarcinoma of the thyroid in a 75-year-old woman is described. Review of 19 reported adenosquamous carcinoma including the present case revealed that they tended to occur in the sixth and seventh decades of life with an average age of 63.84 years and without sexual predilection. Local invasion and metastases of this highly fatal neoplasm are common.

Carcinoma adenoescamoso de células en vidrio esmerilado / Adenoscamous carcinoma of cells in emery glass

Se presenta un caso clínico de carcinoma de células en vidrio esmerilado de cuello uterino, en una mujer joven, embarazada, de curso agresivo, con rápida progresión a estadio clínico fuera del alcance terapéutico