Development of novel mucoadhesive gels containing nanoparticle for buccal administration of dexamethasone

Abstract This study aimed to develop promising and innovative mucoadhesive gel systems containing dexamethasone-loaded nanoparticle to increase the effectiveness of treatment for oral precancerous lesions and to reduce side effects. In this respect, a dexamethasone-loaded nanoparticle formulation was prepared by using emulsification/solvent evaporation method. The nanoparticle has high zeta potential (-10.3±0.5 mV), low particle size (218.42±2.1), low polydispersity index (0.070±0.014) and high encapsulation efficiency (95.018±2.982%). To improve the mucosal retention time, the dexamethasone-loaded nanoparticle was dispersed in mucoadhesive gel using gellan gum. The developed gels offered appropriate pH value, high drug content, suitable mechanical and mucoadhesive performance and appropriate viscosity for mucosal administration. All formulations exhibited plastic flow and typical gel-type mechanical spectra after the determined frequency value. The developed formulations exhibited extended drug release as intended for these systems. Cytotoxicity was tested by MTT assay in human epithelioid carcinoma cell (HeLa) in vitro. The MTT assay showed that the blank formulations were non-toxic to cells. It was observed that the bioactivity of the free dexamethasone was potentiated by mucoadhesive gels containing dexamethasone-loaded nanoparticle in HeLa cells. Results from this study indicate that mucoadhesive gels are effective for the local treatment of precancerous lesions. Our findings showed that the developed formulations were worthy of further studies.

Carcinoma del conducto salival: presentación de un caso / Salivary duct carcinoma: report of a case

El carcinoma de conductos salivales (CCS) es una neoplasia maligna primaria clínica y patológicamente distinta de las glándulas salivales. Debido a su rareza existe una falta de documentación exhaustiva en la literatura con respecto a sus características, manejo y resultados clínicos. En la presente publicación se presenta un caso de un paciente de sexo masculino de 74 años, que acudió al servicio de odontología del Hospital Interzonal General de Agudos Presidente Perón de Avellaneda. El resultado ecográfico arrojó a nivel submaxilar derecho una imagen nodular de aspecto solido que mide 25 x 24 mm Se le realizó la intervención quirúrgica y el resultado anatomopatológico confirmó el diagnóstico de carcinoma de conductos salivales, una de las neoplasias salivales más agresivas. En la actualidad, la muerte ocurre en 60 a 80% de los pacientes, por lo general dentro de los 5 años; alrededor del 33% desarrolla recidiva local y más del 50% metástasis a distancia, en sitios que incluyen pulmones, huesos, hígado, cerebro y piel (AU)

Salivary duct carcinoma (SDC) is a clinically and pathologically distinct primary malignant neoplasm of the salivary glands. Due to its rarity, there is a lack of exhaustive documentation in the literature regarding its characteristics, management, and clinical results. This publication presents a case of a 74-year-old male patient who attended the dentistry service of the Interzonal General Acute Hospital President Perón by Avellaneda. The ultrasound result revealed a nodular image at the right submaxillary level solid aspect measuring 25 x 24 mm. Surgical intervention was performed, and the pathological result confirmed the diagnosis of salivary duct carcinoma, one of the most aggressive salivary neoplasms. Currently, death occurs in 60% to 80% of patients, usually within 5 years; about 33% develop local recurrence and more than 50% distant metastases, at sites including the lungs, bones, liver, brain, and skin (AU)

Nova classificação da OMS para tumores odontogênicos: o que mudou? / Updated WHO classification for odontogenic tumors: what has changed?

Objetivo: apresentar e discutir as mais relevantes modificaçõesna quarta classificação de tumores de cabeçae pescoço da Organização Mundial de Saúde (OMS),no ano de 2017, especialmente para os tumores odontogênicos.Revisão de literatura: o trabalho baseia-seem uma revisão da literatura relacionada ao tema, emespecial no artigo publicado pelos professores John M.Wright e Marilena Vered no Head & Neck PathologyJournal, no ano de 2017, o qual apresenta as principaisatualizações desde as reuniões de 1992 e 2005. O quefoi excluído da terceira edição, o que foi retomado dasegunda edição, as novas descobertas e o porquê detais mudanças serão alguns pontos abordados. Consideraçõesfinais: observa-se que as atualizações foramorientadas pelos princípios de simplicidade, relevânciaclínica, validade científica e utilidade, no intuito defornecer uma classificação contemporânea e menoscomplexa, servindo como base para o clínico e o patologistaem termos de diagnóstico e condução dos casos. (AU)

Objective: this study aimed to present and discuss the most relevant updates in the 4th classification of head and neck tumors by the World Health Organization (WHO) in 2017, especially for odontogenic tumors. Literature review: the study is based on a literature review related to the topic, particularly on the article published by Professors John M. Wright and Marilena Vered in the Head & Neck Pathology Journal in 2017, which presents the main updates since the meetings of 1992 and 2005. What was excluded from the third edition and resumed from the second one, the new findings and the reason for such changes will be some of the points addressed. Final considerations: it is observed that the updates were guided by the principles of simplicity, clinical significance, and scientific validity and utility, in order to provide a contemporary and simpler classification that works as a basis for practitioners and pathologists in terms of diagnosis and management of cases. (AU)

Cáncer sincrónico y metacrónico detectado con PET/CT en población oncológica / Multiple primary malignant neoplasms detected by PET/CT in cancer patients

Background Imaging with F18-fluorodeoxyglucose PET/CT is used to determine sites of abnormal glucose metabolism and can be used to characterize and localize many types of tumors. Aim To assess the prevalence of multiple primary malignant neoplasms (MPMN) detected by PET/CT in cancer patients. Material and Methods F18-fluorodeoxyglucose PET/CT scans performed to 800 patients with a newly diagnosed cancer or with already treated tumors were retrospectively reviewed. In patients whose examination described incidental findings not related to the primary tumor, a research was done about further laboratory, imaging or pathological studies. Results In 188 PET/CT scans (23%) an incidental finding was found. Of these, 66 (35%) were considered as MPMN, 12 as atypical metastases of a known primary tumor, 14 as false positive images (inflammatory or physiologic uptake) and 29 as benign or low grade tumors. In 67 cases (36% of all incidental tumors), the finding was not confirmed. Seven percent of patients with a newly diagnosed tumor had a synchronic MPMN detected by PET/CT. Nine percent of patients with treated tumors developed a metachronous MPMN during their follow up. The most common incidental tumors were thyroid cancer in 15 cases, kidney cancer in 13, lung cancer in 10, colorectal carcinoma in 9, breast cancer in 6, prostate cancer in 4, non-Hodgkin lymphoma in 3 and pancreatic cancer in 2. Conclusions A MPMN is detected by PET/CT in a significant number of cancer patients.

Leucoplasia verrucosa proliferativa e carcinoma verrucoso: semelhanças e diferenças histopatológicas e de proliferação celular por Ki67 / Proliferative verrucous leukoplakia and verrucous carcinoma: histopathological similarities and differences and cell proliferation by Ki67

Carcinoma verrucoso e leucoplasia verrucosa proliferativa, estão entre as lesões que apresentam difícil diagnóstico diferencial devido às semelhanças histopatológicas que ocorrem em determinada fase de evolução. Existe, para tanto, a necessidade de somar dados clínico-epidemiológicos ao histopatológico a fim de se estabelecer o diagnóstico final. A leucoplasia verrucosa proliferativa caracteriza-se por seu acometimento multifocal, grande potencial de recidiva e perfil progressivo que resulta em alto risco de transformação maligna. Por outro lado, o carcinoma verrucoso, variante de baixo grau do carcinoma epidermoide, é unifocal e dificilmente recidiva. A importância de novos estudos acerca das suas duas lesões mencionadas vem a agregar conhecimento de modo a facilitar um correto diagnóstico e, consequentemente, um apurado prognóstico. A leucoplasia verrucosa proliferativa, por se tratar de lesão com alto potencial de transformação maligna, pode evoluir para carcinoma epidermoide invasivo, menos diferenciado e mais agressivo com consequente prognostico obscuro, ao passo que, o carcinoma verrucoso não incorre em metástases e apresenta um prognóstico mais favorável. Isso posto, com o objetivo de aumentar a precisão diagnóstica, o presente trabalho propôs identificar e quantificar em porcentagem os critérios histopatológicos encontrados na leucoplasia verrucosa proliferativa e no carcinoma verrucoso visando diferenciar morfologicamente as lesões dos dois grupos.

Também buscamos comparar os dados epidemiológicos referentes aos casos inseridos no estudo, dentre eles vinte e dois casos de leucoplasia verrucosa proliferativa, dezoito casos de carcinoma verrucoso e dois casos apresentando tanto leucoplasia verrucosa proliferativa quanto carcinoma verrucoso, casos esses com diagnósticos estabelecidos previamente (baseando-se nos dados epidemiológicos somados ao histopatológico). A utilização de um marcador imuno-histoquímico da atividade proliferativa celular, o Ki67, também permitiu uma análise comparativa entre o comportamento biológico de ambas as lesões através de um ensaio quantitativo e qualitativo. A marcação mostrou-se escassa, mas evidente em células mitóticas da leucoplasia verrucosa proliferativa, mostrando, no entanto, maior número de células positivas no carcinoma verrucoso, estas visíveis nas camadas basal e parabasal. Os resultados do presente trabalho permitiram concluir então que o marcador Ki67 pode auxiliar no diagnóstico diferencial entre leucoplasia verrucosa proliferativa e carcinoma verrucoso. Foi possível depreender também que, histologicamente, o carcinoma verrucoso apresenta maior alteração em sua conformação epitelial, bem como maior número de atipias cito-arquiteturais quando comparado à leucoplasia verrucosa proliferativa, que, apesar de seu aspecto morfológico, evolui no sentido de uma potencial transformação maligna, apresentando, por sua vez, maior freqüência de projeções em gota.

Verrucous carcinoma and proliferative verrucous leukoplakia, are among the injuries presenting difficult differential diagnosis due to histopathological similarities that occur at some stage of evolution. There is a need to add clinical, epidemiological and histopathological data to achieve the final diagnosis. Proliferative verrucous leukoplakia is characterized by its multifocal involvement, great potential for relapse and progressive profile that results in malignant transformation high risk. On the other hand, the verrucous carcinoma, which is considered low-grade variant of squamous cell carcinoma, is unifocal and unlikely to return. The importance of new studies on its two mentioned lesions is to generate knowledge aiming at a correct diagnosis and prognosis. The proliferative verrucous leukoplakia, since it is a lesion with high potential for malignant transformation, can develop into less differentiated and more aggressive invasive squamous cell carcinoma with subsequent poor prognosis, whereas the verrucous carcinoma incurs no metastases and presents a more favorable prognosis. Thus, aimed to increase the diagnostic accuracy, the present work looked for to identify and quantify in percentage the histopathological criteria found on proliferative verrucous leukoplakia and verrucous carcinoma, aiming morphologically differentiate the lesions from both groups.

We also seek to compare the epidemiological data related to cases included in the study, including twenty-two cases of proliferative verrucous leukoplakia, eighteen cases of verrucous carcinoma and two cases showing both proliferative verrucous leukoplakia as verrucous carcinoma, cases with these diagnoses established previously (based on epidemiological data added to histopathology data). Using a cell proliferation immunohistochemical marker, Ki67, we made a comparative analysis between the biological behavior of both lesions by quantitative and qualitative assay. We saw a few strongly positive mitotic cells in samples of proliferative verrucous leukoplakia, and numerous positive cells observed in the basal and parabasal layers of verrucous carcinoma samples. This study results indicate, then, that the Ki67 marker may help in the differential diagnosis between proliferative verrucous leukoplakia and verrucous carcinoma. It was also possible to conclude that, histologically, the verrucous carcinoma shows greater change in its epithelial conformation and a higher number of cyto-architectural atypia when compared to proliferative verrucous leukoplakia, which, despite its morphological appearance, evolves towards a potential malignant transformation, presenting, in turn, higher drop-shaped rete ridges frequency.

Achados de fibrobroncoscopia em pacientes com diagnóstico de neoplasia pulmonar / Fiberoptic bronchoscopy findings in patients diagnosed with lung cancer

OBJETIVO: Catalogar alterações encontradas em imagens obtidas por fibrobroncoscopia em pacientes com diagnóstico de neoplasia pulmonar e correlacionar esses achados com achados histopatológicos. MÉTODOS: Estudo retrospectivo envolvendo 212 pacientes com diagnóstico de câncer de pulmão confirmado por citologia obtida por lavado broncoalveolar e/ou histopatologia de biópsia endobrônquica ou transbrônquica. Os dados foram obtidos no Serviço de Endoscopia Respiratória do Hospital São Salvador (Goiânia-GO), entre 2005 e 2010. Os achados endoscópicos foram classificados como tumor endoscopicamente visível, tumor endoscopicamente não visível e lesão na mucosa, assim com quanto à pr sença/tipo de secreção. Os tumores visíveis também foram classificados de acordo com sua localização na árvore traqueobrônquica. RESULTADOS: O principal achado endoscópico foi a presença de massa endobrônquica (64%), seguido por infiltração da mucosa (35%). Quanto aos tipos histológicos (n = 199), os mais prevalentes foram carcinoma escamoso (39%), adenocarcinoma (21%), carcinoma de pequenas células (12%) e carcinoma de grandes células (1%). Mais de 45% dos tumores visíveis estavam localizados nos brônquios superiores. O carcinoma escamoso (n = 78) apresentou-se mais frequentemente como massa tumoral endobrônquica (74%), infiltração da mucosa (36%), estreitamento do lúmen (10%) e compressão extrínseca (6%). CONCLUSÕES: Nossos resultados indicam que a massa tumoral endobrônquica é o achado endoscópico que mais sugere malignidade. Proporcionalmente, infiltração da mucosa é mais comumente achada em carcinoma de pequenas células. Estreitamento do lúmen, compressão extrínseca, lesão na mucosa e secreção endobrônquica prevalecem no adenocarcinoma.

OBJECTIVE: To compile fiberoptic bronchoscopy findings in patients diagnosed with lung cancer and to correlate those with histopathological findings. METHODS: This was a retrospective study involving 212 patients with a confirmed diagnosis of lung cancer by cytological evaluation of BAL specimens or by histopathological evaluation of endobronchial or transbronchial biopsy specimens. The data were collected at the Respiratory Endoscopy Sector of Hospital São Salvador, located in the city of Goiânia, Brazil, between 2005 and 2010. The endoscopic findings were classified as endoscopically visible tumor, endoscopically invisible tumor, mucosal injury, as well as being classified by the presence/type of secretion. The visible tumors were also classified according to their location in the tracheobronchial tree. RESULTS: Endobronchial mass (64%) and mucosal infiltration (35%) were the main endoscopic findings. The histological type was determined in 199 cases, the most prevalent types being squamous carcinoma, in 78 (39%), adenocarcinoma, in 42 (21%) small cell carcinoma, in 24 (12%), and large cell carcinoma, in 2 (1%). More than 45% of the visible tumors were at the upper bronchi. Squamous carcinoma (n = 78) was most commonly visualized as an endobronchial mass (in 74%), mucosal infiltration (in 36%), luminal narrowing (in 10%), or external compression (in 6%). CONCLUSIONS: Our results show that the endobronchial mass is the most common bronchoscopic finding that is suggestive of malignancy. Proportionally, mucosal infiltration is the most common finding in small cell carcinoma. In adenocarcinoma, luminal narrowing, external compression, mucosal injury, and endobronchial secretion prevail.

Estrogen and progesterone receptor testing in breast carcinoma: concordance of results between local and reference laboratories in Brazil / Teste de receptores de estrógeno e progesterona em carcinoma de mama: concordância dos resultados entre laboratórios locais e de referência no Brasil

CONTEXT AND OBJECTIVE: Breast cancer accounts for approximately one quarter of all cancers in females. Estrogen and progesterone receptor testing has become an essential part of the clinical evaluation of breast carcinoma patients, and accurate results are critical in identifying patients who may benefit from hormone therapy. The present study had the aim of investigating the concordance of the results from hormone receptor tests between a reference laboratory and local (or community) laboratories in Brazil. DESIGN AND SETTING: Retrospective study at a reference pathology laboratory. METHODS: The concordance in the results from hormone receptor tests between a reference laboratory and 146 local laboratories in Brazil was compared in relation to 500 invasive breast carcinoma cases, using immunohistochemistry. RESULTS: There was concordance in 89.4 percent (447/500 cases) and 85.0 percent (425/500 cases) of the results from estrogen (κ = 0.744, P < 0.001) and progesterone (κ = 0.688, P < 0.001) receptor tests, respectively, between local and reference laboratories. This was similar to findings in other countries. The false negative rates from estrogen and progesterone receptor tests in local laboratories were 8.7 percent and 14.4 percent, respectively. The false positive rates from estrogen and progesterone receptor tests in local laboratories were 15.5 percent and 16.0 percent, respectively. CONCLUSION: Technical and result interpretation issues may explain most of the discordances in hormone receptor testing in local laboratories. Validation of estrogen and progesterone receptor tests at local laboratories, with rigorous quality control measures, is strongly recommended in order to avoid erroneous treatment of breast cancer patients.

CONTEXTO E OBJETIVO: O carcinoma de mama é responsável por cerca de um quarto de todos os cânceres em mulheres. O teste de receptores de estrógeno e progesterona se tornou parte essencial da avaliação clínica de pacientes com carcinoma de mama; assim, resultados precisos são fundamentais para identificação de pacientes que podem se beneficiar da terapia hormonal. O presente estudo tem por objetivo investigar a concordância nos resultados do teste de receptores hormonais entre um laboratório referência e laboratórios locais (ou comunitários) do Brasil. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo em laboratório referência em patologia no Brasil. MÉTODOS: A concordância nos resultados dos testes de receptores hormonais entre um laboratório referência e 146 diferentes laboratórios locais brasileiros foi comparada em 500 casos de carcinoma invasivo de mama através da imunoistoquímica. RESULTADOS: Houve concordância de 89,4 por cento (447/500 casos) e 85,0 por cento (425/500 casos) nos resultados dos testes de receptores de estrógeno (κ = 0,744, P < 0,001) e progesterona (κ = 0,688, P < 0,001), respectivamente, entre laboratórios locais e referência, similar à descrita em outros países. A taxa de resultados falso-negativos nos testes de receptores de estrógeno e progesterona em laboratórios locais foi de 8,7 por cento e 14,4 por cento, respectivamente. A taxa de resultados falso-positivos nos testes de receptores de estrógeno e progesterona em laboratórios locais foi de 15,5 por cento e 16,0 por cento, respectivamente. CONCLUSÃO: Questões técnicas e de interpretação dos resultados podem explicar a maior parte das discordâncias nos testes de receptores hormonais em laboratórios locais. A validação dos testes de receptores de estrógeno e progesterona pelos laboratórios locais com medidas de controle de qualidade rigorosas é fortemente recomendada de modo a evitar o tratamento errôneo de pacientes com carcinoma de mama.

Carcinoma diferenciado de tiroides (CDT) en niños y adolescentes: Evolución clínica y factores pronósticos / Differentiated thyroid carcinoma in children and adolescents: Clinial outcome and prognostic factors

Si bien la forma de presentación del CDT es más agresiva en la edad pediátrica que en los adultos, la tasa de sobrevida es superior al 90%.Objetivo: analizar retrospectivamente las características clínico-patológicas,la evolución y los factores pronósticos en pacientes prepuberales (PP) y puberales (P) con diagnostico de CDT controlados en nuestro servicio. Resultados se incluyeron 43 pacientes seguidos por un tiempo X (±DS) de 5.99 años(a) (3.57) a, rango 1 -14 a. El tratamiento consistió en tiroidectomía con vaciamiento ganglionar, Iodo131 y levotiroxina en dosis inhibitoria de TSH. Al diagnóstico: edad cronológica (EC) X (±DS)10.9 (3.84) a, rango: 4.7 -17a, relación femenino /masculino 2.9. Diecinueve PP y 24 P. El 53.5% (n:23) presentó nódulos confinados a la glándula con o sin extensión ganglionar y el 46.5% (n:20) tenia un estadío tumoral más avanzado con invasión local y metástasis (MTS) pulmonar. Treinta y ocho pacientes (88.4%) tenían MTS ganglionar cervical y 16(37.2%) MTS pulmonar. El grupo PP comparado con el P tenía EC significativamente menor X (±DS) 7.25 (2.03) a vs 13.83a (p <0.001), estadío tumoral más avanzado 84.2 vs16.8% (p<0.001) y mayor ocurrencia de MTS pulmonar 68.4 vs 12.5% (p<0.003). La sobrevida global fue de 92% y libre de enfermedad 78%.Las variables predictoras de persistencia de enfermedad más significativas fueron presencia de MTS pulmonar al diagnóstico y niveles séricos de tiroglobulina superiores a 8.5 ng/ml posterior al tratamiento inicial. Conclusión: el CDT pediátrico tiene una presentación agresiva especialmente en los pacientes prepuberales. El pediatra debería incorporar el examen clínico del cuello para realizar un diagnóstico y tratamiento precoz (AU)

Children-DTC has been found to behave differently than in adults. At diagnosis, children present in a more aggressive way. However the overall survival rates is greater than 90%. The aim of this study was to perform a retrospective analysis of clinicopathologycal features at diagnosis, evolution and prognostic factors for DTC in pre-pubertal (PP)and pubertal (P)children treated at our centre. Results: 43 CDT patients were included. Mean follow up was X (±DS) 5.99 (3.57) years (y) range: 1 -14 y. Treatment consisted on total thyroidectomy with lymph node dissection, radioiodine therapy, and TSH suppressive therapy with L-thyroxine. At diagnosis: chronological age (CA) was (±DS) :10.9 (3.84) y, range: 4.7 - 17y,sex: female/male ratio: 32/11,nineteen were PP and 24 P. Twentythree ( 53.5%) presented intrathyroidal nodes with or without lymph node MTS, Twenty patients (46.5%) had advanced disease, with adjacent tissue invasion and lung MTS. Thirty-eight patients (88.4%) had cervical lymph node MTS, 16 (37.2%) lung MTS.PP group had significant less CA X (±DS) 7.25 (2.03) y vs 13.83 (1.95)y (p <0.001),advanced tumor stage 84.2 vs16.8% (p<0.001) and more lung MTS occurrence 68.4 vs 12.5% (p<0.003). Global survival rate was 92% and disease free survival rate was 78%.Lung metastases (MTS) and serum thyroglobuline levels greater than 8.5 ng\ml post initial treatment were the most significant prognostic factor related to persistent disease. Conclusion: CDT had a more aggressive presentation in children; especially in PP children. Pediatricians should be aware of this in order to realize a precocious diagnosis and treatment (AU)

Carcinomas cutáneos: historia y clasificación / Cutaneous carcinomas: history and classification

Se efectua una apretada síntesis histórica desde los papiros egipcios hasta la actualidad. Luego se clasifica a los epiteliomas o carcinomas cutáneos en: 1- Carcinomas primitivos cutáneos. 2- Carcinomas intermediarios. 3- Carcinomas espinocelulares. 4- Carcinomas anexiales: sudoríparos, sebáceos, pilosos. 5- Carcinomas anexiales fundamentales. 6- Carcinomas "in situ" (intraepiteliales). Este sistema clasificatorio, basado en la histogénesis, ha demostrado ser de utilidad práctica a través del tiempo. Consideramos que se trata de un valioso trabajo de revisión y actualización producto de 5 décadas de experiencia. Se caracteriza por ser sintético, preciso y con criterio didáctico. Los conceptos están vertidos mediante 150 diapositivas demostrativas que expresan con certeza los caracteres clínicos e histológicos de las neoplasias cutáneas, salvo el melanoma. Uno de los autores (J.A) comienza el estudio en 1953 con su tesis de doctorado: "Epiteliomas cutáneos: ensayo de clasificación citogenética". Es un monumental ensayo ilustrado con numerosas microfotografías en blanco y negro, cuya consulta recomendamos en la Biblioteca de la Facultad de Ciencias Médicas de la UBA.

Value of scoring system in classification of proliferative breast disease on fine needle aspiration cytology.

Fine-needle aspiration (FNA) cytology is successful in identification of benign and malignant breast lesions, but its role in proliferative breast lesions which increase cancer risk is poorly defined. We have analyzed the cytomorphologic features of proliferative breast lesions in conjunction with cytologic scoring system proposed by Masood et al and with histopathology. Sixty two patients (14 cases of fibroadenoma, 15 cases of fibroadenoma with atypia, 11 cases of proliferative breast disease (PBD), 8 cases of PBD with atypia and 14 cases of carcinoma) diagnosed on routine FNA were subjected to scoring following Masood's criteria. All cases with the cytologic diagnosis of fibroadenoma were confirmed on histology. Of 11 cases of PBD on FNA, 10 were PBD without atypia on histology. One case, which showed atypical hyperplasia on histology, was missed by both the scoring system and cytomorphology and one case was over-diagnosed as PBD with atypia by the scoring system. FNA cytology correctly identified all the carcinoma cases, while the scoring system under-diagnosed 2 cases as PBD with atypia. Hence, in cases not suspected to be atypical or confirmed to be cancer on routine cytology, scoring added no information over and above cytomorphology and was not useful. All fourteen cases of fibroadenoma with atypia suspected on routine cytology were fibroadenoma on histology. Scoring system correctly placed 11/14 of these cases as PBD without atypia. Similarly 3/8 cases thought to be PBD with atypia were correctly placed as PBD without atypia by scoring. Only 2/8 cases thought to be PBD with atypia on cytology were confirmed to have atypical hyperplasia on histology. Scoring improved the diagnostic yield to 2/5. Hence, in cases of fibroadenoma or PBD, suspected on FNAC to have cytological atypia, Masood scoring gives additional information by eliminating benign cases and improving diagnostic yield. Application of scoring in a step-wise manner, on atypical aspirates, can help in selection of cases suitable for biopsy.

Role of fine needle aspiration cytology in the diagnosis of pulmonary lesions.

Fine needle aspiration cytology (FNAC) is a rapid, reliable and cost-effective method in the diagnosis of lung lesions. Cells are collected from the lesions usually under fluoroscopic or CT-guidance for cytological examination. Due to lack of these highly sophisticated radiologic imaging techniques in our institute we performed this test under X-Ray film guidance. This study was carried out in 59 patients, who underwent FNAC of lung lesions in the department of Pathology, Mymensingh Medical College, Bangladesh to find out the specimen adequacy and frequency of both benign and malignant lesions of the lungs in our areas. Out of 59 cases 54 were males and 5 were females with age ranged from 20 to 82 years. Adequate samples were obtained in 50 (84.75%) cases of which 35 (70%) were malignant, 10 (20%) were benign and 5 (10%) were suspicious for malignancy. Malignant lesions comprised of squamous cell carcinoma in 20 (57.14%), adenocarcinoma in 1(2.86%), large cell carcinoma in 8 (22.86%) and small cell carcinoma in 6 (17.14%) cases. All the benign lesions were inflammatory in nature, which included abscess in 6 (60%), tuberculosis in 3 (30%) and chronic non-specific inflammation in 1 (10%) case. Majority of the malignant lung lesions were encountered in the 6th decade of life. As the method is simple, rapid, cost-effective and without major complications, so it can be practiced in any centres in our country where specialised radiologists and pathologists are available.

Carcinoma gástrico: avaliação comparativa das classificações de Laurén e Carneiro / Gastric carcinoma: comparative evaluation of Lauren and Carneiro classifications

A classificação do carcinoma gástrico (CG) segundo Laurén não tem valor prognóstico. Recentemente, Carneiro propôs uma modificação da classificação de Laurén, que distingue o CG misto com pior prognóstico. Nosso objetivo foi avaliar comparativamente as classificações de Lauren e Carneiro. Cento e cinqüenta CO foram revistos e analisados segundo as duas classificações, avaliando-se ainda estadiamento e lesões da mucosa gástrica. Cinqüenta e três pacientes foram seguidos por periodo máximo de 103 meses. Observamos correspondência entre CG intestinal e glandular, CO difuso e de células isoladas, CO não-classificável e misto. O CG sólido não diferiu significativamente do intestinal. Quanto à sobrevida, não houve diferença estatisticamente significativa entre os diferentes subtipos das duas classificações. Os dados não justificam a utilização da classificação de Carneiro, muito semelhante à de Laurén, embora deva ser realizada análise da sobrevida com maior amostra de pacientes.

Gastric carcinoma (GC) classification according to Laurén does not have prognostic significance. Recently, Carneiro proposed a modification of Lauren's classification, in which mixed tumors have worse prognosis. A comparative evaluation of both classifications. One hundred and fifty cases of GC are revised and analyzed according to both classifications is made, together with pTNM evaluation and gastric mucosal lesions. Fifty three patients were followed up for period from 3 to 103 months. A correspondence between intestinal and glandular types, diffuse and isolated cell types, and unclassified and mixed types was observed. Solid type was not significantly, different from intestinal type. There was no different in survival among the different groups on both classifcations.

What is the Clinical Significance of Transudative Malignant Pleural Effusion?

BACKGROUND: A few reports of transudative malignant effusion on a small number of patients have suggested the need to perform routine cytologic examination in all cases of transudative pleural effusion, whether encountered for malignancy or not. The purpose of this study was to investigate whether cytologic examination should be performed in all cases of transudative pleural effusion for the diagnosis of malignancy. METHODS: We performed a retrospective study of 229 consecutive patients with malignant pleural effusion, proven either cytologically or with biopsy. In patients with transudative pleural effusion, we reviewed medical records, results of transthoracic echocardiography, fiberoptic bronchoscopy, chest X-ray, chest CT scan, and ultrasonogram of the abdomen. These data were examined with particular attention to identifying whether or not the malignancy was suggested on chest X-ray, examining the involvement of the superior vena cava, great vessels, and lymph nodes, determining the presence of pericardial effusion, and observing the endobronchial obstruction. RESULTS: Transudative malignant pleural effusion was observed in seven (3.1%) of the 229 patients, and was caused either by the malignancy itself (6 patients) or by coexisting cardiac diseases (1 patient). All the patients showed evidence suggesting the presence of malignancy at the time of initial thoracentesis, which facilitated the decision of most clinicians on whether to perform cytologic examination for the diagnosis of malignancy. CONCLUSION: Therefore, in all cases of transudative pleaural effusion, no clinical implications indicating malignancy were found on cytologic examination.

Aspectos gerais dos adenocarcinomas de mama, estadiamento e classificaçäo histopatológica com descrição dos principais tipos / General aspects of breast carcinomas, staging and histopathological classification, with description of the main patterns

O câncer de mama é o cancer de maior incidência entre as mulheres e o que apresenta a maior taxa de mortalidade no Brasil. Ele se localiza mais frequëntemente no quadrante superior externo da mama e em cerca de 13 porcento é multicêntrico, o que é mais comum entre os carcinomas lobulares e entre as mulheres que tem história familiar. Apesar da palpação ser o método mais simples para o diagnóstico, somente cerca de 60 porcento dos cânceres detectados por mamografia são palpáveis. O exame anatomopatológico é imprescindível para o diagnóstico do tumor primário e das metástases e para a classificação e o estadiamento. Os tumores malignos próprios da mama, isto é, os adenocarcinomas, são divididos em in situ e invasores e estes dois subgrupos, por sua vez, são divididos em ductais e lobulares...

Carcinoma adenoideo quístico de glándula mamaria diagnosticado mediante biopsia con aguja fina / Cysto-adenoid carcinoma of breast diagnosed by means of a fine needle biopsy

El carcinoma adenoideo quístico es un tumor poco frecuente que representa menos del 1 por ciento de los carcinomas de la glándula mamaria, tiene mejor pronóstico en comparación con los tumores del mismo tipo histológico que se presentan en glándulas salivales, lagrimales y en otros sitios. Su morfología es idéntica en todas esta glándulas. Se informa el caso de un carcinoma adenoideo quístico, cuyo diagnóstico se efectuó mediante biopsia por aspiración con aguja fina y se corroboró por cortes histológicos de la pieza quirúrgica

Lesiones subclínical de la mama: manejo quirúrgico-Radiológico-patológico / Subclinical lesion of mama: surgical-radiological-pathologic-management

Doce pacientes femeninas fueron operadas en la Clínica Atías de Caracas, entre enero de 1993 y junio de 1997, por lesiones mamográficas no palpables, sospechosas o dudosas para malignidad. La edad promedio fue de 50 años. En el 66,6 por ciento de las pacientes, la mamografía fue indicada para pesquisa. La indicación quirúrgica fue: microcalcificaciones sospechosas en 75 por ciento y lesión densa espiculada en 25 por ciento. El método de localización fue planimetría en 4 casos, ultrasonido y azul de metileno en 4 casos, aguja tipo Kopans por mamografía en 2 casos, aguja por ultrasonido en 1 caso y estereotaxia y ultrasonido en 1 caso. En todos los casos se realizó confirmación radiológica del espécimen quirúrgico. Se realizó biopsia por congelación en la mitad de los casos. En 4 pacientes (33,33 por ciento) del total se diagnóstico cáncer. Dos resultaron carcinoma in situ (biopsia definitiva) y dos carcinomas infiltrantes (biopsia por congelación), de 11 y 7 mm respectivamente. En éstos dos ultimos se realizó la cirugía definitiva en el mismo acto operatorio

Valor de la punción-aspiración con aguja fina en el diagnóstico del cáncer mamario IOLR / The value of aspiration citology with fine needle in the diagnostic of breast neoplasms

La punción aspiración con aguja fina se ha convertido en un método fundamental en el diagnóstico del cáncer mamario, debido a las numerosas ventajas que ofrece ya que es un procedimiento simple, rápido, confiable, de bajo costo y con alta sensibilidad. Para evaluar de manera prospectiva, la eficacia de la misma frente a otros métodos de diagnóstico como son la citología por impronta y la biopsia extemporánea se estudiaron entre los meses de octubre de 1994 y julio de 1995, 46 pacientes que consultaron al servicio de patología mamaria del Instituto de Oncología "Luis Razetti", con diagnóstico clínico de carcinoma mamario. Se le practicó mamografía, citología por punción aspiración con aguja fina con reporte inmediato de los resultados y citología por impronta de la muestra para biopsia extemporánea. Los resultados citológicos obtenidos, fueron comparados con los de la biopsia extemporánea y el diagnóstico definitivo de anatomía patológica. La sensibilidad fué del 100 por ciento para todos los métodos. La especificidad para la biopsia extemporánea fué de 83,35 por ciento y 66,6 por ciento para la citología por impronta y 42,8 por ciento para la punción aspiración con aguja fina. El valor predictivo positivo para biopsia extemporánea fué de 96,5 por ciento, 93,7 por ciento para la citología por impronta y 90 por ciento para la punción aspiración. Junto al valor predictivo negativo fué de 100 por ciento para todos los métodos. En conclusión la punción aspiración con aguja fina es un método excelente con muy alta sensibilidad comparable a todos los métodos incluyendo la histología definitiva; pero que nuestra experiencia tiene una baja especificidad; en la actualidad no podemos tomar desiciones radicales o definitivas, solamente con el diagnóstico de la punción aspiración y seguimos ameritando de la biopsia extemporánea para definir la conducta terapéutica en carcinoma de mama

Mastectomías por carcinoma en el instituto anatomopatológico: estudio de parámetros morfológicos / Mastectomy by carcinomas in the Institute Anatomopathology: study of parameter morphologic

Se estudiaron retrospectivamente 102 casos de mastectomías por carcinoma mamarios en pacientes venezolanos. En cada uno de los casos, se analizaron las siguientes características: edad, lado afectado, dimensiones y diámetro del tumor, número de ganglios linfáticos identificados en el vaciamiento axilar y número de ganglios metastásicos, tipo histológico de carcinoma (OMS), grado tumoral (según el sistema de gradación de Scarff-Bloom-Richardson). Los resultados fueron los siguientes: Grupos etarios más afectados el de 41 a 51 años y de 51 a 60 años con 30,79 por ciento del total por cada grupo. Tipo de carcinoma más frecuente: ductal infiltrante (63,72 por ciento), seguido por el lobulillar infiltrante (10,78 por ciento). La mayor cantidad de carcinoma fue de Grado II (44,1 por ciento). La mayor parte de los tumores tuvieron un diámetro entre 2 y 5 cm (50,98 por ciento). En solo el 40,24 por ciento de los casos se conocieron los datos relacionados a los ganglios linfáticos axilares, y de este grupo, el 59,74 por ciento tuvieron metástasis en ganglios axilares