Multidisciplinary approach in the clinical and laboratory investigation of a suspected case for anaplastic lymphoma associated with breast prosthesis

Introduction: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare subtype of CD30-positive and ALKnegative (anaplastic lymphoma kinase) T cell lymphoma, which can develop in the pericapsular fibrous tissue and the late seromas around breast implants. If BIA-ALCL is suspected, an adequate diagnostic flow is essential. Materials and methods: A flowchart of the procedures performed in the diagnostic investigation is discussed, associating a clinical case, and conducting a review on the topic. Results: In the assessment of late and recurrent periprosthetic seromas, prior communication from the surgeon and the pathologist is essential, aiming at the adequate collection and storage of the aspirated material. The material must be promptly fractionated for microbiological assessment by culture, immediate or transoperative cytologic assessment, immunophenotyping by flow cytometry (10 mL), direct cytopathological examination, and obtaining cell block material (50 mL). For flow cytometry, the material must be sent fresh, 70% alcohol or 10% buffered formalin can be added for the other procedures. If it is impossible to send the aspirated fluid to the laboratory in less than six hours, it can be temporarily stored in a refrigerator at 4°C. Immunophenotyping should be extensive, always assessing the expression of CD30 and ALK, regardless of cytological aspects. In cases of late and recurrent seromas in which BIA-ALCL is considered, even if initially discarded, it is suggested to perform capsulectomy with the removal of the prosthesis or careful clinical and laboratory monitoring. Conclusion: The diagnostic flowchart is essential, aiming at false-negative tests.

CAIX is a predictor of pathological complete response and is associated with higher survival in locally advanced breast cancer submitted to neoadjuvant chemotherapy.

BACKGROUND: Locally advanced breast cancer often undergoes neoadjuvant chemotherapy (NAC), which allows in vivo evaluation of the therapeutic response. The determination of the pathological complete response (pCR) is one way to evaluate the response to neoadjuvant chemotherapy. However, the rate of pCR differs significantly between molecular subtypes and the cause is not yet determined. Recently, the metabolic reprogramming of cancer cells and its implications for tumor growth and dissemination has gained increasing prominence and could contribute to a better understanding of NAC. Thus, this study proposed to evaluate the expression of metabolism-related proteins and its association with pCR and survival rates. METHODS: The expression of monocarboxylate transporters 1 and 4 (MCT1 and MCT4, respectively), cluster of differentiation 147 (CD147), glucose transporter-1 (GLUT1) and carbonic anhydrase IX (CAIX) was analyzed in 196 locally advanced breast cancer samples prior to NAC. The results were associated with clinical-pathological characteristics, occurrence of pCR, disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS). RESULTS: The occurrence of pCR was higher in the group of patients whith tumors expressing GLUT1 and CAIX than in the group without expression (27.8% versus 13.1%, p = 0.030 and 46.2% versus 13.5%, p = 0.007, respectively). Together with regional lymph nodes staging and mitotic staging, CAIX expression was considered an independent predictor of pCR. In addition, CAIX expression was associated with DFS and DSS (p = 0.005 and p = 0.012, respectively). CONCLUSIONS: CAIX expression was a predictor of pCR and was associated with higher DFS and DSS in locally advanced breast cancer patients subjected to NAC.

Uso do 123I-mIBG Cardíaco na Rotina Clínica: A Necessidade de Padronizar! / The use of Cardiac123 I-mIBG Scintigraphy in Clinical Practice: The Necessity to Standardize!

A avaliação da atividade adrenérgica cardíaca através de exames de imagem apresenta grande potencial em uma ampla variedade de aplicações clínicas. A cintilografia miocárdica com 123I-mIBG desempenha papel importante na avaliação de insuficiência cardíaca crônica (ICC) ao estratificar o risco de pacientes para eventos cardíacos. A mIBG, um análogo da norepinefrina (NE), pode ser utilizada para avaliar a atividade simpática cardíaca ao se analisar a diminuição da expressão do adrenorreceptor (AR) ß na ICC. Além disso, a cintilografia miocárdica com 123I-mIBG em combinação com outros parâmetros de função ventricular esquerda pode ser usada para identificar o melhor respondedor a dispositivos cardíacos implantáveis, assim como avaliar cardiotoxicidade oncológica. Ainda que útil, a cintilografia miocárdica com 123I-mIBG não é amplamente realizada devido à falta de padronização entre as diferentes instituições. Portanto, sua padronização e validação podem contribuir para sua aceitação na prática clínica