ABSTRACT
BACKGROUND: Cancer of the exocrine pancreas is a highly lethal malignancy. Surgical resection is the only potentially curative treatment. Unfortunately, because of the late presentation, the majority have either locally advanced cancer at initial diagnosis. Systemic chemotherapy provides benefit to patients with advanced pancreatic cancer, improving disease-related symptoms and survival when compared to best supportive care alone. Based on fase III study, FOLFIRINOX regimen became the standard first-line treatment. But, the optimal management strategy for patients who fail initial FOLFIRINOX is undefined. Despite the lack of clinical trials that report the real benefit of gemcitabine in patients with advanced exocrine pancreatic cancer as second line treatment. We aim at reporting our experience with this regimen. METHODS: Patients with advanced exocrine pancreatic cancer who received gemcitabine (1.000 mg/m(2) on days 1, 8 and 15 every 4 weeks) until disease progression, as second-line therapy at our institution were retrospectively evaluated. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method. RESULTS: A total of 20 patients were reviewed. Median age was 57 years (range, 43-74 years), and 55% were older than 60 years. Most patients were male (80%), had metastatic disease (60%), and ECOG performance status of 0 or 1 (65%). PFS and OS were 2.0 (95% CI, 1.2-2.8) and 5.7 months (95% CI, 3.9-7.4), respectively. There were no deaths due to the treatment. CONCLUSIONS: In this study, gemcitabine was a reasonable second-line treatment option for patients with advanced pancreatic adenocarcinoma and good ECOG performance status. Phase III trials are urgently needed comparing gemcitabine versus best supportive of care (BSC) can evaluate the real benefit of this chemotherapy after progression on FOLFIRINOX.
ABSTRACT
Objetivo: Comparar o diagnóstico inicial, geralmente a partir de serviços de patologia geral, com o laudo médico definitivo do serviço de patologia certificada. Métodos: Análise retrospectiva de pacientes em uma instituição com diagnóstico final de câncer de mama metaplásico (CMM) foi realizada entre janeiro de 2008 e janeiro de 2014. Resultados: Um total de 18 pacientes com diagnóstico de CMM do sexo feminino e idade média de 49,8 anos foi reportado. O tamanho tumoral foi menor do que 3,0 cm em 52,9% das pacientes. Linfadenopatia axilar não estava presente inicialmente em 72,2% das pacientes e, em nenhum caso, foi identificada metástase a distância ao diagnóstico. Diagnóstico prévio de carcinoma ductal invasivo (CDI) foi descrito em 60% dos casos. Cerca de 80% foram tratadas com quimioterapia neoadjuvante e apresentaram progressão. Apenas um caso com diagnóstico de CMM antes do início da terapia recebeu quimioterapia neoadjuvante com platina e apresentou resposta clínica. Conclusão: Devido às características histopatológicas de triplo-negativos, o CMM pode ter sido subdiagnosticado em serviços de patologia geral. Nos casos de ausência de resposta ou progressão da doença frente ao tratamento tradicional, o diagnóstico de CMM deve ser considerado e o laudo médico deve ser revisado.
Objective: To compare the initial diagnosis, usually from community pathology services, with the final pathology report from certified pathology service. Methods: A retrospective analysis of patients in an institution with final diagnosis of metaplastic breast cancer (MBC) was conducted from January 2008 to January 2014. Results: There were 18 female patients diagnosed with MBC. Median age was 49.8 years old; 52.9% of the patients had a tumor size less than 3.0 cm; 72.2% had no axillary lymphadenopathy at diagnosis. None of them had distant metastases at presentation. Initial diagnosis of invasive ductal carcinoma (IDC) occurred in 60% of patients. Eighty percent of patients were treated with neo-adjuvant chemotherapy and presented progression. Only one case with diagnosis of MBC prior to therapy was submitted to neo-adjuvant chemotherapy with a platinum-based regimen and presented clinical response. Conclusion: Due to the triple-negative histopathology features, MBC might have been underdiagnosed in community pathology services. In cases of non-response or progression of the disease regarding the traditional treatment, MBC diagnosis should be considered and the medical report must be reviewed.
ABSTRACT
Colloid cysts of the third ventricle are benign tumors but potentially dangerous, as they frequentlyundergo undiagnosed. Despite being histologically benign, colloid cysts of the third ventricle can obstruct the foramen of Monro and produce intense hydrocephaly. These lesions are known as a major cause of sudden death, underscoring the importance of establishing diagnosis as soon as possible. Computed tomography and Magnetic Resonance are important for diagnosing these cysts. In the present case report, the authors describe the clinical, diagnostic imaging and pathological findings of a 19-year old male, with a 3 cm colloid cyst of the third ventricle. Patient died within few days following complications of obstruction of the foramen of Monro
