Clear Cell Papillary Renal Cell Tumors: A Study of 42 Tumors with Emphasis on the Fibrous Capsule, Cystic Component, and GATA3 Immunohistochemistry.

Clear cell papillary renal cell tumor is a common and sometimes underdiagnosed renal cell neoplasm. Its proper recognition is important because its diagnosis implies a remarkably high probability of indolent behavior. This study aimed to evaluate the frequency of a fibrous capsule, a cystic component, and a GATA3 expression in clear cell papillary renal cell tumors. We assessed 419 renal cell neoplasms from three institutions located in northeastern Brazil and identified 42 clear cell papillary renal cell tumors (from 39 patients), which were the fourth most common renal cell neoplasm. These tumors commonly exhibited fibrous capsules (all showed complete or partial capsules) and cystic component (93%). Eighteen out of 42 tumors (43%) showed some expression of GATA3, and weak and focal staining was common among the positive tumors. Clear cell papillary renal cell tumor must always be included in the differential diagnosis of predominantly cystic renal cell neoplasms. As GATA3 is inconsistently expressed in clear cell papillary renal cell tumors, it is not useful in this diagnosis.

Primary cutaneous B-cell lymphoma leg type: good response with the RADHAP 21 protocol

Abstract Primary cutaneous lymphomas are defined as the ones that exclusively affect the skin for up to 6 months after the diagnosis. B-cell lymphomas represent 20-25% of primary cutaneous lymphomas and have, among its subtypes, the leg type, which represents 10 to 20% of cutaneous B-cell lymphomas, generally affecting elderly people and with an intermediate prognosis. This is the report of a rare case of a leg-type B-cell lymphoma with an exuberant clinical presentation affecting a young male patient.

Primary cutaneous B-cell lymphoma leg type: good response with the RADHAP 21 protocol.

Primary cutaneous lymphomas are defined as the ones that exclusively affect the skin for up to 6 months after the diagnosis. B-cell lymphomas represent 20-25% of primary cutaneous lymphomas and have, among its subtypes, the leg type, which represents 10 to 20% of cutaneous B-cell lymphomas, generally affecting elderly people and with an intermediate prognosis. This is the report of a rare case of a leg-type B-cell lymphoma with an exuberant clinical presentation affecting a young male patient.

Absence of multinucleated giant cell reaction as an indicator of tumor progression in oral tongue squamous cell carcinoma.

PURPOSE: The aim of this study was to evaluate the presence and distribution of multinucleated giant cell (MGC) reactions in 61 cases of OTSCC and to verify the association of this microscopic finding with clinicopathological parameters (gender, age, tumor size/extent, regional lymph node metastasis, distant metastasis, clinical stage, and histopathological grade of malignancy). METHODS: Clinical data were collected from medical records and the histopathological grade of malignancy of OTSCCs was evaluated using the World Health Organization (WHO) grading system. The presence and distribution of MGC reaction in high power fields (HPFs) were evaluated in hematoxylin-eosin-stained histological sections. In all cases containing MGCs, immunohistochemical analysis for CD68 was performed in order to confirm the histiocytic nature of these cells. RESULTS: Twenty-one (34.4%) cases had MGC reactions, with a higher frequency of the focal distribution pattern (57.1%). All MGCs were immunohistochemically positive for CD68. The absence of MGC reaction was significantly associated with regional lymph node metastasis (PR: 2.75; 95% CI 1.05-7.20; p = 0.027), advanced clinical stage (PR: 3.37; 95% CI 1.28-8.85; p = 0.006), and moderately/poorly differentiated tumors (PR: 3.36; 95% CI 1.51-7.48; p = 0.001). No significant associations were observed between the distribution of MGCs and clinicopathological parameters (p > 0.05). CONCLUSION: Taken together, the results of this study suggest that the absence of MGC reaction may represent an indicator of tumor progression in OTSCCs.

IMMUNOHISTOCHEMICAL PROFILE OF BREAST CANCER SUBTYPES IN PATIENTS SEEN AT NAPOLEÃO LAUREANO HOSPITAL, PARAÍBA, BRAZIL / Perfil dos subtipos de câncer de mama baseado no estudo imuno­histoquímico em pacientes do Hospital Napoleão Laureano ­ Paraíba

Objective: To determine the profile of molecular subtypes of invasive breast carcinomas among women who underwent immunohistochemical study from May 2013 to December 2014, at Hospital Napoleon Laureano, Paraiba, Brazil, to characterize the mean age at diagnosis and describe the percentage of the following variables: estrogen and progesterone receptors, human epidermal growth factor 2 and proliferation index (Ki-67). Method: retrospective ecological study using the secondary databases at Hospital Napoleon Laureano Pathology Laboratory. The population consisted of 683 cases of invasive breast carcinoma with immunohistochemical study in this institution between May 2013 and December 2014. Results: Of the 683 patients, 46 were excluded because they presented inconclusive results for human epidermal growth factor 2 (++), totaling 637 recorded cases. Five hundred and fifty-six (87.28%) were 40 or older, and 81 (12.72%) under 40 years old. As for estrogen and progesterone receptor, 452 patients (70.96%) were positive for both receptors, while 185 (29.04%) showed no positivity. Four hundred and sixty-eight women (73.47%) did not show overexpressed human epidermal growth factor 2, while 169 (26.53%) did. The percentage of Ki-67 showed 474 individuals (74.41%) with a high proliferation index and 163 (25.59%) with a low index. The molecular subtypes showed the following prevalence: luminal A (143 cases; 22.45%), luminal B (250 cases; 39.25%), luminal B-enriched (113 cases; 17.84%), HER2 (57 cases; 8.95%) and triple-negative (74 cases; 11.62%). Conclusion: This study supported the notion of regional differences in the profile of breast tumors, since it showed a greater prevalence of triple-positive carcinomas and lower frequency of triple-negative tumors compared to studies of other Brazilian regions.

Objetivo: Determinar o perfil dos subtipos moleculares dos carcinomas invasivos de mama entre mulheres que realizaram o estudo imuno-histoquímico de maio 2013 a dezembro de 2014, no Hospital Napoleão Laureano, Paraíba, além de caracterizar a idade média ao diagnóstico e descrever os percentuais das seguintes variáveis: receptor de estrogênio e de progesterona, fator de crescimento epidérmico humano do tipo 2 e índice mitótico (Ki-67). Método: Estudo retrospectivo, ecológico, a partir da base de dados secundários do Laboratório de Anatomia Patológica do Hospital Napoleão Laureano. A população foi composta de 683 casos de carcinoma invasivo da mama, com estudo imuno-histoquímico realizado nessa instituição entre maio de 2013 e dezembro de 2014. Resultados: Dos 683 pacientes, foram excluídos 46 por apresentarem positividade para fator de crescimento epidérmico humano do tipo 2 inconclusiva (++), totalizando 637 casos contabilizados. Quinhentas e cinqüenta e seis pacientes (87,28%) eram ≥40 anos e 81 (12,72%), <40 anos. Quanto ao estrogênio e à progesterona, 452 pacientes (70,96%) possuíam receptores positivos para ambos, enquanto 185 (29,04%) não apresentaram positividade. Quatrocentas e sessenta e oito mulheres (73,47%) não superexpressaram fator de crescimento epidérmico humano do tipo 2, em contrapartida 169 (26,53%) o fizeram. A porcentagem do Ki-67 evidenciou 474 indivíduos (74,41%) com alto índice mitótico e 163 (25,59%) com baixo índice. Os subtipos moleculares apresentaram as prevalências: luminal A (143 casos; 22,45%), luminal B (250 casos; 39,25%), luminal B amplificado (113 casos; 17,84%), fator de crescimento epidérmico humano 2 (57 casos; 8,95%) e triplo negativo (74 casos; 11,62%). Conclusões: Este artigo ratificou a existência de diferenças regionais quanto ao perfil dos subtipos de tumores mamários, demonstrando maior prevalência de carcinomas triplo-positivos e menor frequência de tumores triplo-negativos quando comparado a outros estudos.

Dedifferentiated liposarcoma of the gallbladder: first reported case.

BACKGROUND: Liposarcoma of the gallbladder is an extremely rare sarcoma, with only five cases reported in the literature according to our knowledge. CASE PRESENTATION: A 71-year-old woman was referred to the Surgical Oncology Division of Napoleão Laureano Hospital (João Pessoa, PB, Brazil) due to a solid mass at the right side of the abdomen and fever, with no signs of jaundice. Abdominal ultrasonography and computed tomography (CT) evidenced an extensive gallbladder lobular formation adhered to the inferior border of the right hepatic lobe and cholelithiasis. The CT report suggested gallbladder liposarcoma. A cholecystectomy associated with resection of segments IV-B and V of the liver were performed. Intraoperative frozen sections were compatible with gallbladder sarcoma. Anatomopathological examination and immunohistochemistry confirmed dedifferentiated liposarcoma with foci of heterologous leiomyosarcomatous differentiation and undifferentiated fusocellular areas of high histological grade. CONCLUSION: This is the first case of dedifferentiated liposarcoma of the gallbladder to be reported.

Role of moxifloxacin-dexamethasone in cardiac histomorphometric findings among Wistar rats from infected mothers.

PURPOSE: To investigate cardiac changes in young rats, whose mothers underwent autogenic fecal peritonitis, during organogenesis phase and to evaluate the role of intravenous administration of moxifloxacin and dexamethasone in preventing infection-related cardiac changes. METHODS: A prospective histomorphometric study was performed on 29 hearts of Wistar four-month old rats. Animals were divided into three groups: Negative Control Group (NCG) included 9 subjects from healthy mothers; Positive Control Group (PCG) included 10 subjects from mothers with fecal peritonitis (intra-abdominal injection of 10% autogenic fecal suspension in the gestational period) and did not receive any treatment; and Intervention Group (IG), with 10 animals whose infected mothers received moxifloxacin and dexamethasone treatment 24 hours after induction of fecal peritonitis. RESULTS: Nuclear count was higher in the IG group as compared to PCG (p = 0.0016) and in NCG as compared to PCG (p = 0.0380). There was no significant difference in nuclear counts between NCG and IG. CONCLUSION: Induced autogenic fecal peritonitis in pregnant Wistar rats determined myocardial changes in young rats that could be avoided by the early administration of intravenous moxifloxacin and dexamethasone.

Role of moxifloxacin-dexamethasone in cardiac histomorphometric findings among Wistar rats from infected mothers

Abstract Purpose: To investigate cardiac changes in young rats, whose mothers underwent autogenic fecal peritonitis, during organogenesis phase and to evaluate the role of intravenous administration of moxifloxacin and dexamethasone in preventing infection-related cardiac changes. Methods: A prospective histomorphometric study was performed on 29 hearts of Wistar four-month old rats. Animals were divided into three groups: Negative Control Group (NCG) included 9 subjects from healthy mothers; Positive Control Group (PCG) included 10 subjects from mothers with fecal peritonitis (intra-abdominal injection of 10% autogenic fecal suspension in the gestational period) and did not receive any treatment; and Intervention Group (IG), with 10 animals whose infected mothers received moxifloxacin and dexamethasone treatment 24 hours after induction of fecal peritonitis. Results: Nuclear count was higher in the IG group as compared to PCG (p = 0.0016) and in NCG as compared to PCG (p = 0.0380). There was no significant difference in nuclear counts between NCG and IG. Conclusion: Induced autogenic fecal peritonitis in pregnant Wistar rats determined myocardial changes in young rats that could be avoided by the early administration of intravenous moxifloxacin and dexamethasone.

Isopropyl Caffeate: A Caffeic Acid Derivative-Antioxidant Potential and Toxicity.

Phenolic compounds, among them isopropyl caffeate, possess antioxidant potential, but not without toxicity and/or adverse effects. The present study aimed to evaluate the antioxidant activity and toxicity of isopropyl caffeate through in silico, in vitro and in vivo testing. The results showed that isopropyl caffeate presents no significant theoretical risk of toxicity, with likely moderate bioactivity: GPCR binding, ion channel modulation, nuclear receptor binding, and enzyme inhibition. Isopropyl caffeate induced hemolysis only at the concentrations of 500 and 1000 µg/ml. We observed types A and O erythrocyte protection from osmotic stress, no oxidation of erythrocytes, and even sequestrator and antioxidant behavior. However, moderate toxicity, according to the classification of GHS, was demonstrated through depressant effects on the central nervous system, though there was no influence on water and food consumption or on weight gain, and it did present possible hepatoprotection. We conclude that the effects induced by isopropyl caffeate are due to its antioxidant activity, capable of preventing production of free radicals and oxidative stress, a promising molecule with pharmacological potential.

Assessment of HER-2 status in invasive breast cancer in Brazil.

OBJECTIVE: To characterize the frequency of HER-2-positive breast cancer in Brazil. METHOD: In this prospective observational study, we first ascertained the HER-2 status of invasive breast cancer specimens by automated immunohistochemistry (IHC). For specimens classified as 2+ by IHC, we performed in situ hybridization (ISH). RESULTS: From February, 2011 to December, 2012, 1,495 breast specimens were registered, and 1,310 samples collected at 24 centers were analyzed. Median patient age was 54 years, and the majority of samples were obtained from segmental (46.9%) or radical mastectomy (34.4%). The predominant histological type was invasive breast carcinoma of no special type (85%), 64.3% had tubule formation (grade 3), and estrogen/progesterone receptors (ER/PR) were positive in 77.4/67.8% of the specimens analyzed, respectively. Using IHC, we found a negative HER-2 status (0 or 1+) in 72.2% of specimens, and 3+ in 18.5%; the 9.3% scored as 2+ were further analyzed by ISH, of which 15.7% were positive (thus, 20.0% of samples were HER-2- -positive by either method). We found no association between HER-2 scores and menopausal status or histological type. Tumors classified as 3+ came from younger patients, and had higher histological grade and less frequent expression of ER/PR. In the North region of Brazil, 34.7% of samples were 3+, with lower frequencies in the other four regions of the country. CONCLUSION: Our findings provide estimates for the frequency of HER-2 positivity in Brazil and raise the hypothesis that biological differences may underlie the different distribution of breast-cancer phenotypes among different Brazilian regions.

Synovial sarcoma: case report / Sarcoma sinovial: relato de caso

ABSTRACT Introduction: Synovial sarcomas are rare and aggressive neoplasms located in the head and neck region and usually occurs in young adults. Presentation of case: This report presents a case of synovial sarcoma in a 15-year-old male patient who sought medical treatment for painful symptoms and associated dysphagia. The lesion was nodular, extensive, localized in the parotid region, and extended to the left cervical region. The patient was treated in a referral hospital with a treatment protocol that initially included chemotherapy for six months and surgery to attempt to excise the lesion, but the surgery was ineffective because removal could have damaged important vital structures. The Computed Tomography scan showed a hypodense area with diffuse growth and no involvement of the facial bones and the histopathological analysis revealed pleomorphic and oval spindle cells with rounded epithelial cells that formed nests surrounded by fibrous tissue. The Immunohistochemistry analysis was conclusive for the diagnosis of a high-grade SS in the parotid and left cervical regions. The medical team opted for palliative treatment with cervical radiotherapy. The patient remained hospitalized for four months after the surgery and died after 15 months since the diagnosis for compromise of airway by fast tumor growth. Conclusion: The synovial sarcoma, when diagnosed late may reduce the survival of patients because of the complications that tumor growth can bring to the prognosis and quality of life.

RESUMO Sarcomas sinoviais são neoplasias raras e agressivas, localizadas na região da cabeça e pescoço e geralmente ocorrem em adultos jovens. Relato do caso: este relato apresenta um caso de sarcoma sinovial em um paciente de 15 anos que procurou tratamento médico para sintomas dolorosos e associados à disfagia. A lesão era nodular, extensa, localizada na região da parótida e estendida à região cervical esquerda. O paciente foi tratado em um hospital de referência com um protocolo de tratamento que inicialmente incluiu quimioterapia por seis meses e cirurgia para tentar excisar a lesão, mas a cirurgia foi ineficaz porque a total remoção do tumor poderia comprometer estruturas vitais importantes. A tomografia computadorizada mostrou uma área hipodensa com crescimento difuso, sem envolvimento dos ossos faciais, e a análise histopatológica revelou células fusiformes pleomórficas e ovais, com células epiteliais arredondadas formando ninhos rodeados por tecido fibroso. A análise imunohistoquímica foi conclusiva para o diagnóstico de um sarcoma sinovial de alto grau na região cervical parotídea esquerda. A equipe médica optou pelo tratamento paliativo com radioterapia cervical. O paciente permaneceu hospitalizado por quatro meses após a cirurgia e faleceu 15 meses após o diagnóstico, devido à obstrução das vias aéreas pelo rápido crescimento tumoral residual. O sarcoma sinovial, quando diagnosticado tardiamente pode reduzir a sobrevida dos pacientes por causa de complicações que o crescimento do tumor pode trazer para o prognóstico e qualidade de vida.

Assessment of HER-2 status in invasive breast cancer in Brazil / Avaliação de HER-2 no câncer de mama invasivo no Brasil

Summary Objective: To characterize the frequency of HER-2-positive breast cancer in Brazil. Method: In this prospective observational study, we first ascertained the HER-2 status of invasive breast cancer specimens by automated immunohistochemistry (IHC). For specimens classified as 2+ by IHC, we performed in situ hybridization (ISH). Results: From February, 2011 to December, 2012, 1,495 breast specimens were registered, and 1,310 samples collected at 24 centers were analyzed. Median patient age was 54 years, and the majority of samples were obtained from segmental (46.9%) or radical mastectomy (34.4%). The predominant histological type was invasive breast carcinoma of no special type (85%), 64.3% had tubule formation (grade 3), and estrogen/progesterone receptors (ER/PR) were positive in 77.4/67.8% of the specimens analyzed, respectively. Using IHC, we found a negative HER-2 status (0 or 1+) in 72.2% of specimens, and 3+ in 18.5%; the 9.3% scored as 2+ were further analyzed by ISH, of which 15.7% were positive (thus, 20.0% of samples were HER-2- -positive by either method). We found no association between HER-2 scores and menopausal status or histological type. Tumors classified as 3+ came from younger patients, and had higher histological grade and less frequent expression of ER/PR. In the North region of Brazil, 34.7% of samples were 3+, with lower frequencies in the other four regions of the country. Conclusion: Our findings provide estimates for the frequency of HER-2 positivity in Brazil and raise the hypothesis that biological differences may underlie the different distribution of breast-cancer phenotypes among different Brazilian regions.

Resumo Objetivo: Estimar a frequência de câncer de mama positivo para HER-2 no Brasil. Método: Neste estudo observacional e prospectivo, verificamos o escore de HER-2 de espécimes de câncer de mama invasivo por imuno-histoquímica automatizada (IHQ). Para amostras classificadas como 2+ por IHQ, fizemos hibridização in situ (HIS). Resultados: De fevereiro de 2011 a dezembro de 2012, 1.495 espécimes de mama foram registrados, e 1.310 amostras coletadas por 24 centros foram analisadas. A idade mediana das pacientes foi 54 anos, e a maioria das amostras foram obtidas a partir de mastectomia segmentar (46,9%) ou radical (34,4%). O tipo histológico predominante foi o carcinoma invasivo da mama, sem tipo especial (85%); 64,3% tinham formação de túbulos (grau 3); e os receptores de estrógeno (RE)/progesterona (RP) foram positivos em 77,4%/67,8% das amostras analisadas. Por IHQ, encontramos HER-2 negativo (0 ou 1+) em 72,2% das amostras, e 3+ em 18,5%; os 9,3% de casos classificados como 2+ foram analisados por HIS, e 15,7% deles foram positivos (assim, 20,0% das amostras foram positivas para HER-2 por qualquer método). Não encontramos associação entre escores de HER-2 e estado menopausal ou tipo histológico. Tumores classificados como 3+ vieram de pacientes mais jovens, tinham maior grau histológico e foi menos frequente a expressão de RE/RP. Na região Norte do Brasil, 34,7% das amostras foram 3+, com frequências mais baixas nas outras quatro regiões do país. Conclusão: Nossos resultados permitem estimar a frequência de positividade do HER-2 no Brasil, gerando a hipótese de que pode haver diferenças biológicas subjacentes à distribuição dos fenótipos de câncer de mama entre as diferentes regiões brasileiras.

Changes in the Immuno-Expression of Galectins -1, -3 and -7 in Relation to the Biological Behavior of Lip Squamous Cell Carcinoma

Objective: To evaluate the expression through immunohistochemistry of galectins -1, - 3 and -7 in cases of lip squamous cell carcinoma (SCC) in association with clinical data and morphological parameters proposed by Bryne (1998). Material and Methods: Thirty paraffin-embedded SCC cases were submitted to histological sections. Two independent pathologists performed the analysis of galectins -1, -3 and -7 through light microscopy evaluating the presence or absence of marking and intensity. The expressions of these proteins were submitted to statistical analysis (chi-square test, Fisher's exact test and Binomial test for the comparison of proportions). Results: Positive expression of galectins -1 and -3 was observed in 93.3% and 43.3% of cases, respectively. However, there was no statistically significant association between these proteins and the clinical variables used. Galectin-7 immuno-expression was present in all cases evaluated and showed statistical significance between marked cell type (parenchyma cells) and regional metastasis and between marked cell type (parenchyma cells) and histological gradation. Conclusion: Changes in the galectins -1, -3 and -7 expression suggest the participation of these proteins in the regulation of cellular functions and that the immuno-expression of these proteins can act as a marker of the biological behavior of lip squamous cell carcinoma.

Embryonal rhabdomyosarcoma in the maxillary sinus with orbital involvement in a pediatric patient: Case report.

This report presents a case of embryonal rhabdomyosarcoma (eRMS) located in the left maxillary sinus and invading the orbital cavity in a ten-year-old male patient who was treated at a referral hospital. The images provided from the computed tomography showed a heterogeneous mass with soft-tissue density, occupying part of the left half of the face inside the maxillary sinus, and infiltrating and destroying the bone structure of the maxillary sinus, left orbit, ethmoidal cells, nasal cavity, and sphenoid sinus. An analysis of the histological sections revealed an undifferentiated malignant neoplasm infiltrating the skeletal muscle tissue. The immunohistochemical analysis was positive for the antigens: MyoD1, myogenin, desmin, and Ki67 (100% positivity in neoplastic cells), allowing the identification of the tumour as an eRMS. The treatment protocol included initial chemotherapy followed by radiotherapy and finally surgery. The total time of the treatment was nine months, and in 18-mo of follow-up period did not show no local recurrences and a lack of visual impairment.

Deep Vein Thrombosis as Initial Manifestation of Whipple Disease.

INTRODUCTION: Wipple disease (WD) is a rare chronic disease caused by the bacillus Tropheryma whipplei. Constitutive, rheumatologic, gastrointestinal, cardiac, cerebral, lymphatic, cutaneous, and ophthalmological signs are possible systemic symptoms. However, thrombotic manifestations are rarely described as "stroke-like syndrome" or arterial thrombosis. Diagnosis is based on clinical manifestations and pathological examination. Laboratory findings may include anemia, leukocytosis, and thrombocytosis. OBJECTIVE: We report a case of venous thrombosis as initial manifestation of WD. CASE REPORT: We describe the case of a 53-year-old male with iliofemoral vein thrombosis followed by intermittent diarrhea, loss of appetite, abdominal distension, and bloating. A mild malnutrition state with a weight loss of 13 kg, pallor (+/4 +), presence of lower-limb edema (+/4 +), and hypertympanic distended abdomen occurred. Laboratory tests on admission revealed anemia, positive inflammatory activity tests, and normal coagulation. Endoscopic examination showed villous edema with white dotted infiltrates in the second duodenal portion and intestinal lymphangiectasia in the terminal ileum. Pathological examination revealed numerous macrophages with positive periodic acid-Schiff inclusions. Venous Doppler ultrasound showed extensive deep thrombosis on the left lower limb and recanalization of the femoral vein in the right lower limb. The patient was treated with ceftriaxone and enoxaparin sodium, which led to an improvement of gastrointestinal and thrombosis symptoms. COMMENTS: Hypercoagulability, endothelial damage, vasculitis, and blood stasis are present in T. whipplei infection, which are associated with the activation of inflammatory mechanisms as well as procoagulant and thromboembolic events. WD should be part of the differential diagnosis of diseases that cause venous thrombosis of unknown origin.

Clinical findings and risk factors to oral squamous cell carcinoma in young patients: A 12-year retrospective analysis

BACKGROUND: In recent years have been observed an increased incidence of OSCC in young individuals. Based on this, the aim this study was to describe the clinical characteristics of all cases of OSCC in younger patients, diagnosed in two oncology referral hospitals, at the northeast region of Brazil within a 12-year period. MATERIAL AND METHODS: Data regarding general characteristics of patients (age, gender and tobacco and/or alcohol habits) and information about the lesions (tumor location, size, regional lymph node metastasis, distant metastasis and clinical stage) were submitted to descriptive and inferential analysis. Statistical analysis included Chi-square and Fisher's exact tests ( < 0.05). RESULTS: Out of 2311 registered cases of OSCC, 76 (3.3%) corresponded to OSCC in patients under 45 years old. Most of them were male (n = 62, 81.6%) and tobacco and/or alcohol users (n = 40, 52.8%). The most frequent site was the tongue (n = 31, 40.8%), with predominance of cases classified at advanced clinical stage (III and IV, n = 46, 60.5%). The advanced stage of OSCC (III and IV) was statistically associated with male gender (P = 0.035), lower education level (P=0.007), intraoral sites (P < 0.001), presence of pain symptomatology (P = 0.006), and consumption of tobacco and/or alcohol (P=0.001). CONCLUSIONS: The profile of OSCC in young patients resembles to the commonly characteristics reported for overall population. The late diagnosis in young patients usually results in poor prognosis, associated with gender, harmful habits and tumor location. Although prevalence is low, stimulus to prevention and to early diagnosis should be addressed to young individuals exposed to risk factors

Clinical findings and risk factors to oral squamous cell carcinoma in young patients: A 12-year retrospective analysis.

BACKGROUND: In recent years have been observed an increased incidence of OSCC in young individuals. Based on this, the aim this study was to describe the clinical characteristics of all cases of OSCC in younger patients, diagnosed in two oncology referral hospitals, at the northeast region of Brazil within a 12-year period. MATERIAL AND METHODS: Data regarding general characteristics of patients (age, gender and tobacco and/or alcohol habits) and information about the lesions (tumor location, size, regional lymph node metastasis, distant metastasis and clinical stage) were submitted to descriptive and inferential analysis. Statistical analysis included Chi-square and Fisher's exact tests (P<0.05). RESULTS: Out of 2311 registered cases of OSCC, 76 (3.3%) corresponded to OSCC in patients under 45 years old. Most of them were male (n=62, 81.6%) and tobacco and/or alcohol users (n=40, 52.8%). The most frequent site was the tongue (n=31, 40.8%), with predominance of cases classified at advanced clinical stage (III and IV, n = 46, 60.5%). The advanced stage of OSCC (III and IV) was statistically associated with male gender (P=0.035), lower education level (P=0.007), intraoral sites (P<0.001), presence of pain symptomatology (P=0.006), and consumption of tobacco and/or alcohol (P=0.001). CONCLUSIONS: The profile of OSCC in young patients resembles to the commonly characteristics reported for overall population. The late diagnosis in young patients usually results in poor prognosis, associated with gender, harmful habits and tumor location. Although prevalence is low, stimulus to prevention and to early diagnosis should be addressed to young individuals exposed to risk factors.

Análise dos achados ecográficos em nódulos de hiperplasia pseudoangiomatosa do estroma mamário diagnosticados por core biópsia / Analyzing the ecographic features of pseudoangiomatous stromal hyperplasia masses diagnosed by core biopsy

Objetivos: Descrever os aspectos ecográficos em nódulos de hiperplasia pseudoangiomatosa do estroma mamário, classificando-os segundo o BI-RADS®. Métodos: Foi realizado um estudo retrospectivo, de 2009 a 2010, da base de dados do nosso serviço (UD diagnóstico por imagem) para identificar nódulos evidenciados na ecografia mamária, com diagnóstico histopatológico confirmado de hiperplasia pseudoangiomatosa do estroma mamário, por meio de core biópsia orientada por ultrassonografia, com agulha de 16 gauge. Foram identificadas 16 pacientes com lesões ecográficas que tinham hiperplasia pseudoangiomatosa do estroma mamário como diagnóstico. Resultados: O fator determinante para a classificação em categorias 4a e 4b, segundo o léxico BI-RADS® para ultrassonografia, foi as margens não-circunscritas, que estavam presentes em 93,3% das lesões, as demais características ecográficas das lesões foram compatíveis com lesões benignas. Conclusão: Nódulos ecográficos de hiperplasia pseudoangiomatosa do estroma mamário podem apresentar características ecográficas que sejam determinantes para a realização de biópsias, mesmo sabendo-se que esta patologia tem curso tipicamente benigno.

Objectives: To describe the ecographic features of pseudoangiomatous stromal hyperplasia masses, classifying them according to the BI-RADS® lexicon. Methods: A retrospective review was performed during the period from 2009 to 2010, using the database of our service (UD diagnóstico por imagem), in order to find ecographic masses with pseudoangiomatous stromal hyperplasia diagnosis, which were performed with 16-gauge core biopsy ultrasound guided. We identified 16 patients with ecographic masses diagnosed with pseudoangiomatous stromal hyperplasia. Results: The most important finding that changes the classification of the BI-RADS® was noncircumscribed margins, which were foundin 93.3% of the lesions, other ultrasound characteristics found were benign features. Conclusion: Pseudoangiomatous stromal hyperplasiamasses may present ecographic findings that support biopsy indication; although it is known that it is a benign pathology.

Avaliação dos fatores preditivos de invasão neoplásica do complexo areolomamilar em pacientes com câncer de mama / Evaluation of the predictive factors involved in the neoplastic invasion of the nipple-areolar complex in patients with breast cancer

INTRODUÇÃO: A escolha pela mastectomia com preservação do complexo areolomamilar (CAM), de melhor resultado estético, depende da ausência de envolvimento neoplásico do CAM. OBJETIVO: Identificar os fatores preditivos de invasão neoplásica do CAM. MÉTODO: Foi realizado estudo analítico, retrospectivo, clínico-patológico de 48 peças de mastectomia de pacientes portadoras de carcinoma da mama, atendidas no Hospital de Câncer da Paraíba - Fundação Napoleão Laureano, durante o período de abril de 2007 a janeiro de 2008, com idade média de 52,69 ± 10,72 anos. O CAM foi seccionado separadamente mediante cortes perpendiculares e paralelos a partir da papila, estendendo-se a 2 cm de profundidade do tecido retroareolar (com o intuito de incluir seios lactíferos e ductos coletores e segmentares), seguidos de cortes transversais até a base. RESULTADOS: Identificou-se frequência de envolvimento do CAM por carcinoma invasivo em 14,58 por cento dos casos. Pacientes jovens (média 42,3 ± 4,7 anos), distância do tumor a mamilo/aréola < 2 cm, tamanho da aréola < 3 cm, tipo histológico (carcinoma ductal invasivo associado a carcinoma ductal in situ padrão comedônico), status dos linfonodos axilares (sobretudo com metástases em 10 ou mais linfonodos), presença de invasão angiolinfática ou perineural e existência de infiltrado inflamatório dos estromas intratumoral e peritumoral foram associados a maior risco de envolvimento do CAM (p < 0,05). O menor diâmetro da aréola foi relacionado significativamente com o menor peso da mama (p < 0,0016), mostrando que o tamanho da mama teve maior impacto no encontro de invasão do CAM que o diâmetro tumoral. CONCLUSÃO: Os resultados desta pesquisa permitiram identificar fatores associados a maior risco de invasão neoplásica areolopapilar.

INTRODUCTION: The choice for having mastectomy with preservation of the nipple-areolar complex (NAC), with better esthetic results, depends on the abscence of neoplastic invasion of the NAC. OBJECTIVE: To identify the predictive factors related to neoplastic NAC invasion. METHODS: We carried out a retrospective, analytical and clinical-pathologic study comprising 48 mastectomy specimens of breast carcinoma from patients treated at Cancer Institute of Paraíba - Napoleão Laureano Foundation (Hospital de Câncer da Paraíba - Fundação Napoleão Laureano) from April 2007 to January 2008. The mean age was 52.69 ± 10.72. The NAC complex was sectioned separately and perpendicular and parallel cuts were performed from the papilla extending 2 cm deep into the retroareolar tissue (including collecting ducts, lactiferous sinuses and segmental ducts), followed by transverse cuts toward the deep margin. RESULTS: The frequency of NAC involvement by invasive carcinoma was 14.58 percent. The following characteristics were associated with a higher risk of NAC involvement (p < 0.05): younger patients (mean age 42.3 ± 4.7 years), distance between the tumor and the areola/nipple < 2 cm, size of the areola < 3 cm, histological type (invasive ductal carcinoma associated with comedo type ductal carcinoma in situ), status of axillary lymph nodes (mainly with metastasis in 10 or more lymph nodes), presence of lymphovascular and perineural invasion, and inflammatory infiltrate of intra/peritumoral stroma. Smaller areolas correlated significantly with decreased breast weights (p < 0.0016), which demonstrated that the breast size had a greater impact on NAC involvement in comparison with the tumor diameter. CONCLUSION: The results of this study enabled us to identify factors associated with an increased risk of neoplastic NAC invasion.

Sigmoidectomia na cirurgia citorredutora de carcinoma de ovário avançado / Sigmoid colectomy as citoreductive surgery in advanced ovarian carcinoma

Fazer um estudo retrospectivo descrevendo quatro casos de carcinoma de ovário, cuja terapêutica cirúrgica envolveu sigmoidectomia. Foram verificados os prontuários de 60 pacientes com carcinoma de ovário, atendidas no Centro de Atenção Integral à Saúde da Mulher no período de 1997 a janeiro de 2002. Entre elas, 38 apresentavam doença avançada - estádio III e IV da Federação Internacional de Ginecologia e Obstetrícia, e 4 (10,4 por cento) submetidas à ressecção de sigmóide.A idade média das quatro pacientes analisadas foi 60,5 anos e nenhuma delas tinha história de outra neoplasia ginecológica prévia ou associada. As pacientes apresentavam graus variáveis de acometimento do aparelho digestivo, e três se submeteram a retossigmoidectomia e uma, a sigmoidectomia parcial. A anastomose primária foi realizada em duas pacientes e, nas outras duas, foi realizada colostomia terminal. A citorredução foi considerada ótima em três pacientes e febre foi a complicação pós-operatória mais freqüente. As quatro mulheres avaliadas receberam tratamento subseqüente de quimioterapia com carboplatina e ciclofosfamida. Num seguimento de 18 a 60 meses, duas mulheres apresentaram recidiva com aumento do CA 125 e uma foi à óbito por metástase pulmonar. Apesar do pequeno número de pacientes submetidas à ressecção de sigmóide para citorredução por carcinoma avançado de ovário, é importante realizar o preparo pré-operatório adequado, orientar a paciente quanto ao porte cirúrgico, riscos e possíveis complicações e ter uma equipe cirúrgica habilitada para realização de cirurgias ginecológicas associadas a intervenções no trato gastrointestinal.