The Profile of Heparanase Expression Distinguishes Differentiated Thyroid Carcinoma from Benign Neoplasms.

INTRODUCTION: The search for a specific marker that could help to distinguish between differentiated thyroid carcinoma and benign lesions remains elusive in clinical practice. Heparanase (HPSE) is an endo-beta-glucoronidase implicated in the process of tumor invasion, and the heparanase-2 (HPSE2) modulates HPSE activity. The aim of this study was to evaluate the role of heparanases in the development and differential diagnosis of follicular pattern thyroid lesions. METHODS: HPSE and HPSE2 expression by qRT-PCR, immunohistochemistry evaluation, western blot analysis and HPSE enzymatic activity were evaluated. RESULTS: The expression of heparanases by qRT-PCR showed an increase of HPSE2 in thyroid carcinoma (P = 0.001). HPSE activity was found to be higher in the malignant neoplasms than in the benign tumors (P<0.0001). On Western blot analysis, HPSE2 isoforms were detected only in malignant tumors. The immunohistochemical assay allowed us to establish a distinct pattern for malignant and benign tumors. Carcinomas showed a typical combination of positive labeling for neoplastic cells and negative immunostaining in colloid, when compared to benign tumors (P<0.0001). The proposed diagnostic test presents sensitivity and negative predictive value of around 100%, showing itself to be an accurate test for distinguishing between malignant and benign lesions. CONCLUSIONS: This study shows, for the first time, a distinct profile of HPSE expression in thyroid carcinoma suggesting its role in carcinogenesis.

Immunohistochemistry as an important tool in biomarkers detection and clinical practice.

The immunohistochemistry technique is used in the search for cell or tissue antigens that range from amino acids and proteins to infectious agents and specific cellular populations. The technique comprises two phases: (1) slides preparation and stages involved for the reaction; (2) interpretation and quantification of the obtained expression. Immunohistochemistry is an important tool for scientific research and also a complementary technique for the elucidation of differential diagnoses which are not determinable by conventional analysis with hematoxylin and eosin. In the last couple of decades there has been an exponential increase in publications on immunohistochemistry and immunocytochemistry techniques. This review covers the immunohistochemistry technique; its history, applications, importance, limitations, difficulties, problems and some aspects related to results interpretation and quantification. Future developments on the immunohistochemistry technique and its expression quantification should not be disseminated in two languages-that of the pathologist and another of clinician or surgeon. The scientific, diagnostic and prognostic applications of this methodology must be explored in a bid to benefit of patient. In order to achieve this goal a collaboration and pooling of knowledge from both of these valuable medical areas is vital.

O ramo peitoral da artéria tóraco-acromial como pedículo principal do retalho miocutâneo de peitoral maior: estudo anatômico em cadáver / The pectoralis branch of thoracoacromial artery as the main pedicle of pectoralis major myocutaneous flap: cadaveric anatomic study

Introdução: O sucesso dos retalhos miocutâneos é baseado no seu adequado aporte sanguíneo, sendo importante o conhecimento da localização e a preservação de pedículos vasculares para que um músculo seja empregado como retalho. O retalho miocutâneo de peitoral maior é um dos mais utilizados nas reconstruções em cabeça e pescoço. Objetivos: 1) Estudar a anatomia topográfica do ramo peitoral da artéria toracoacromial (principal pedículo vascular do retalho miocutâneo de peitoral maior), em relação a parâmetros anatômicos fixos; 2) determinar o comprimento do pedículo vascular após a confecção do retalho; 3) verificar se fatores antropométricos ou o lado de dissecção influenciam no comprimento do pedículo vascular. Casuística: 50 retalhos dissecados em 25 cadáveres adultos frescos. Métodos: Identificou-se a origem do ramo peitoral da artéria toracoacromial, classificada em três tipos: tipo A quando situada mais de 2cm medialmente à linha medioclavicular; tipo B quando distante, medial ou lateralmente a esta, em até 2cm; e tipo C quando situada mais de 2cm lateralmente a esta linha. O comprimento do pedículo foi medido do ponto medioclavicular até borda superior da ilha de pele. Resultados: A origem do ramo peitoral da artéria toracoacromial deu-se na artéria axilar em todos os casos. O comprimento médio do pedículo foi de 17,67 ± 2,24cm, sendo este determinado pelas seguintes variáveis antropométricas (p<0,05 - correlação de Pearson): distância biacromial, relação entre a distância mastóide-fúrcula pela distância acrômio-trocantérica e a relação entre a distância mastóide-fúrcula pela distância biacromial. Conclusões: Estabeleceu-se a linha medioclavicular como referência anatômica para a classificação da origem do ramo peitoral da artéria toracoacromial, sendo que o comprimento do pedículo vascular pode ser influenciado por fatores antropométricos.

Introduction: The success of myocutaneous flaps is based on a reliable blood supply. To transfer a muscle as a flap it is important to know the location and to preserve the vascular pedicles. The pectoralis major myocutaneous flap is one of the most employed flaps in head and neck reconstruction. Objectives: 1) To study the topographic anatomy of the pectoralis branch of the thoracoacromial artery (the main vascular pedicle of pectoralis major myocutaneous flap) and its relationship to fixed anatomic parameters; 2) to measure the pedicle length after the flap was harvested; and 3) to verify if anthropometric data and the side of dissection influence the pedicle length. Casuistic: 50 flaps were dissected in 25 adult fresh cadavers. Methods: The origin of the pectoralis branch of the thoracoacromial artery was identified and classified in three types based on its relationship to the midclavicular line: type A and C when up to 2cm medial or lateral, respectively, to this line; and type B when between the two other described types. Pedicle length was measured from the clavicle's medium point to the skin island superior border. Results: The origin of the pectoralis branch of the thoracoacromial artery was in the axillary artery in all cases. The average length of the pedicle was 17.67 ± 2.24cm, showing statistical significant relationship with: the interacromion distance and the ratio between the mastoids-supraesternal notch distance and acromion-trochanter distance and also the ratio between the mastoids-supraesternal notch distance and the interacromion distance. Conclusion: Midclavicular line was established as the anatomic reference to classify the origin of the pectoral branch of the thoracoacromial artery. The results obtained suggest that the pedicle length might be influenced by anthropometric data.

The subclavicular versus the supraclavicular route for pectoralis major myocutaneous flap: a cadaveric anatomic study.

The aim of this paper was to determine if the subclavicular route of rotation improved the pectoralis major myocutaneous flap's ability to reach head and neck sites in comparison to the traditional supraclavicular rotation. We dissected 50 flaps in 25 fresh adult male cadavers. The length of the pedicle and the flap's ability to reach five anatomical head and neck sites (laryngeal prominence of thyroid cartilage, mentum, angle of the mandible, external auditory canal, and orbit) were tested by supraclavicular and subclavicular rotation. Although the average length of the flap's pedicle was higher when the subclavicular rotation was employed, there was no statistical difference between the two techniques concerning the flap's ability to reach the studied sites. Our results suggest that the subclavicular route apparently adds little to the reconstruction of head and neck defects using the pectoralis major myocutaneous flap. We believe that the indication of this technique should be evaluated on a case-by-case basis before it is recommended to keep from unnecessarily increasing the potential morbidity of the reparative procedure.