Non-squamous cell carcinoma diseases of the larynx: clinical and imaging findings / Carcinoma de células não escamosas da laringe: achados clínicos e de imagem

Abstract Introduction Squamous cell carcinoma is the most common laryngeal neoplasm and accounts for approximately 95% of all malignant neoplams of the larynx. However, various benign and malignant tumors and inflammatory diseases may affect the larynx. Objective The purpose of this study is to analyze the clinical and imaging findings of non-squamous cell neoplasms and inflammatory diseases of the larynx. Methods This retrospective study was conducted in 18 patients who were diagnosed with non-squamous cell carcinoma lesions of larynx at our institution between 2007-2017. Clinical symptoms, examination findings, imaging characteristics, histopathologic diagnosis and treatment modalities were analyzed. Results There were 9 malignant lesions (2 chondrosarcoma, 1 neuroendocrine tumor-atipical carcinoid, 1 Natural Killer/T-cell lymphoma, 1 diffuse large B-cell lymphoma, 3 plasmocytoma-multiple myeloma involvement, 1 adenocarcinoma metastasis), 3 benign neoplasms (chondroma, paraganglioma, lipoma), 2 tumor-like lesions (Brown tumor and inflammatory myofibroblastic tumor), 3 inflammatory lesions (Wegener granulomatosis, Behçet's disease and tuberculosis involvements), and 1 vascular malformation. The most common presenting symptom was hoarseness (66.6%). Paraganglioma was seen as hypervascular lesion on computed tomography and magnetic resonance imaging and showed intense tracer uptake on 68Gallium-DOTA-peptide PET/CT. Chondroid matrix calcifications were detected in chondroma and chondrosarcoma-grade 1. In patients with vascular malformation and lipoma, the typical imaging findings made it possible to diagnose. Conclusion Imaging studies may provide clues for diagnosis of non-squamous cell laryngeal lesions. Clinical and imaging findings and previous clinical history should be evaluated together in clinical management of laryngeal lesions.

Resumo Introdução O carcinoma de células escamosas é a neoplasia laríngea mais comum, representa aproximadamente 95% de todas as neoplasias malignas da laringe. No entanto, vários outros tumores benignos e malignos, e doenças inflamatórias, podem afetar a laringe. Objetivo O objetivo deste estudo é analisar os achados clínicos e de imagem de neoplasias de células não-escamosas e de doenças inflamatórias da laringe. Método Este estudo retrospectivo foi feito com 18 pacientes diagnosticados com lesões de carcinoma de células não escamosas da laringe em nossa instituição, entre 2007-2017. Foram analisados os sintomas clínicos, achados dos exames, características de imagens, diagnóstico histopatológico e modalidades de tratamento. Resultados Foram identificados 9 casos com lesão maligna (2 condrossarcomas, 1 tumor carcinoide neuroendócrino atípico, 1 linfoma de células T/NK, 1 linfoma difuso de grandes células B, 3 plasmocitomas com envolvimento de mieloma múltiplo, 1 metástase de adenocarcinoma, 3 neoplasias benignas (condroma, paraganglioma, lipoma), 2 lesões tumor like (tumor de Brown e tumor miofibroblástico inflamatório), 3 lesões inflamatórias (granulomatose de Wegener, doença de Behçet e tuberculose) e 1 malformação vascular. O sintoma mais comum foi a rouquidão (66,6%). O paraganglioma foi visto como lesão hipervascular na tomografia computadorizada e na ressonância magnética e mostrou intensa captação do traçador na PET/TC com 68Gálio-DOTA. Calcificações de matriz condroide foram detectadas no condroma e condrossarcoma grau 1. Em pacientes com malformação vascular e lipoma, os achados típicos de imagem tornaram possível o diagnóstico. Conclusão Estudos de imagem podem fornecer pistas para o diagnóstico de lesões laríngeas de células não escamosas. Achados clínicos e de imagem e histórico clínico prévio devem ser avaliados em conjunto no manejo clínico das lesões laríngeas.

Is There any Relationship Between Myocardial Repolarization Parameters and the Frequency of Ventricular Premature Contractions? / Há Alguma Relação entre os Parâmetros de Repolarização do Miocárdio e a Frequência de Contrações Ventriculares Prematuras?

Abstract Background: Ventricular premature contractions (VPCs) may trigger lethal ventricular arrhythmias in patients with structural heart disease. However, this role of VPCs in healthy people remains controversial once that not enough clinical trials are available. Recently, some myocardial repolarization markers, such as Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, have been reported to be useful for predicting lethal ventricular arrhythmias in various clinical disorders without structural heart disease. Objective: In this study, we aimed to investigate the relation between VPC frequent and myocardial repolarization markers in individuals without structural heart disease. Methods: This study included 100 patients who had complaints of dizziness and palpitations. Twelve-lead electrocardiography and 24-hour ambulatory Holter recordings were obtained from all patients. VPC burden was calculated as the total number of VPCs divided by the number of all QRS complexes in the total recording time. P-values < 0.05 were considered significant. Results: Tp-e interval and Tp-e/QTc ratio were significantly higher in patients with higher VPC burden than in patients with lower VPC burden, and a positive correlation was found between these markers and VPC burden. Tp-e (β = 1.318, p = 0.043) and Tp-e/QTc (β = -405.136, p = 0.024) in the lead V5 were identified as independent predictors of increased VPC burden. Conclusions: Tp-e interval and Tp-e/QTc ratio increased in patients with high VPC number. Our study showed that VPCs may have a negative effect on myocardial repolarization. This interaction may lead to an increased risk of malignant arrhythmias.

Resumo Fundamento: As contrações ventriculares prematuras (CVPs) podem provocar arritmias ventriculares letais em pacientes com doença cardíaca estrutural, no entanto o papel das CVPs em indivíduos saudáveis permanece controverso, já que não há muitos estudos clínicos disponíveis. Recentemente, alguns marcadores de repolarização do miocárdio, tais como o intervalo Tp-e e as relações Tp-e/QT e Tp-e/QTc, foram relatados como úteis para prognosticar arritmias ventriculares letais em diversos transtornos clínicos sem doença cardíaca estrutural. Objetivo: Neste estudo, o objetivo foi investigar a relação entre os marcadores de repolarização do miocárdio e as CVPs frequentes em indivíduos sem doença cardíaca estrutural. Métodos: Este estudo incluiu 100 pacientes com queixas de tonturas e palpitações. Eletrocardiografia de 12 derivações e registros de Holter ambulatorial de 24 horas foram obtidos de todos os pacientes. A carga de CVP foi calculada como o número total de CVPs dividido pelo número de todos os complexos de QRS no tempo de registro total. Foram considerados significativos valores p < 0,05. Resultados: O intervalo Tp-e e a relação Tp-e/QTc foram significativamente mais altos em pacientes com carga de CVP mais alta do que nos pacientes com carga de CVP inferior, e encontrou-se correlação positiva entre esses marcadores e a carga de CVP. Tp-e (β = 1,318, p = 0,043) e Tp-e/QTc (β = -405,136, p = 0,024) na derivação V5 foram identificados como preditores independentes da carga de CVP aumentada. Conclusões: O intervalo Tp-e e a razão Tp-e/QTc foram mais altos em pacientes com um valor mais alto de CVP. Nosso estudo mostrou que CVPs podem ter um efeito negativo na repolarização do miocárdio. Essa interação pode resultar em risco aumentado de arritmias malignas.

Fascin expression in colorectal carcinomas

PURPOSE: The purpose of this study was to investigate the significance of fascin expression in colorectal carcinoma. METHODS: This is a retrospective study of 167 consecutive, well-documented cases of primary colorectal adenocarcinoma for which archival material of surgical specimens from primary tumor resections were available. We chose a representative tissue sample block and examined fascin expression by immunohistochemistry using a primary antibody against "fascin". We calculated the "immunohistochemical score (IHS)" of fascin for each case, which was calculated from the multiplication of scores for the percentage of stained cells and the staining intensity. RESULTS: Fascin immunoreactivity was observed in 59 (35.3 percent) of all cases with strong reactivity in 24 (14.4 percent), moderate reactivity in 25 (14.9 percent) and weak reactivity in 10 (6.0 percent) cases. Strong/moderate immunoreactivities were mostly observed in invasive fronts of the tumors or in both invasive and other areas. Fascin immunoreactivity scores were significantly higher in tumors with lymph node metastasis (p:0.002) and advanced stage presentation (p:0.007). There was no relation between fascin expression and age, gender, depth of invasion, distant metastasis or histological grade (p>0.05). There was a higher and statistically significant correlation between fascin immunoreactivity in the invasive borders of tumors and lymph node metastasis (r:0.747, p:0.005). In stage III/IV tumors, two-year survival was 92.2 percent in tumors without fascin immunoreactivity, and only 60.0 percent in tumors with a fascin IHS>10 (p:0.003). CONCLUSION: These findings suggest that fascin is heterogeneously expressed in approximately one third of colorectal carcinomas with a significant association with lymph node metastasis, tumor stage and location. Moreover, these results indicate that fascin may have a role in the lymph node metastasis of colorectal carcinomas.