Aortic aneurysm in a patient with syphilis-related spinal pain and paraplegia.

The tertiary stage of syphilis is nowadays extremely rare, showing predilection for the cardiovascular and nervous systems. A 57-year-old Caucasian man sought medical assistance due to back pain that evolved to paraplegia of the lower limbs. A thoracic CT scan demonstrated an important aneurysmatic lesion of the descending thoracic aorta causing erosion of the vertebral bodies and VDRL and FTA-abs positivity. Although rare, syphilitic aortitis, the hallmark of cardiovascular syphilis, should be considered in the differential diagnosis in patients with thoracic aneurysm when in the absence of classic risk factors for atherosclerosis, especially in cases that progress with erosion of vertebral bodies.

Melanoma patterns of distant relapse: a study of 108 cases from a South Brazilian center.

BACKGROUND: The incidence of cutaneous melanoma has increased over the last decades. Recurrences occur most frequently within the first 2-3 years after diagnosis but patients carry a lifelong risk of relapse. Nevertheless, there is no consensus in the literature on what screening tests patients should undergo. OBJECTIVES: To evaluate the most common melanoma metastasis sites among a South Brazilian population from a city with one of the highest melanoma rates, and establish the best screening method for these patients. METHODS: A cross-sectional retrospective study of 108 consecutive melanoma patients followed up at a center from 2009 to 2013. Data were collected on demographic and tumoral characteristics, as well as the site of the first diagnosed metastasis. RESULTS: Patients were divided into 3 groups for analytical purposes: Non-visceral metastases (48% of patients), visceral metastasis (39%) and brain metastasis (13%). We tried to correlate age, gender, mean Breslow thickness, mitosis and death rates with the aforementioned groups but none showed any statistically significant association. CONCLUSION: Melanoma patients must be monitored to detect early relapse and subsequent effective treatment but the best follow-up strategy remains to be established.

Melanoma patterns of distant relapse: a study of 108 cases from a South Brazilian center

Abstract Background: The incidence of cutaneous melanoma has increased over the last decades. Recurrences occur most frequently within the first 2-3 years after diagnosis but patients carry a lifelong risk of relapse. Nevertheless, there is no consensus in the literature on what screening tests patients should undergo. Objectives: To evaluate the most common melanoma metastasis sites among a South Brazilian population from a city with one of the highest melanoma rates, and establish the best screening method for these patients. Methods: A cross-sectional retrospective study of 108 consecutive melanoma patients followed up at a center from 2009 to 2013. Data were collected on demographic and tumoral characteristics, as well as the site of the first diagnosed metastasis. Results: Patients were divided into 3 groups for analytical purposes: Non-visceral metastases (48% of patients), visceral metastasis (39%) and brain metastasis (13%). We tried to correlate age, gender, mean Breslow thickness, mitosis and death rates with the aforementioned groups but none showed any statistically significant association. Conclusion: Melanoma patients must be monitored to detect early relapse and subsequent effective treatment but the best follow-up strategy remains to be established.

Safety and efficacy of the combination of T-DM1 with radiotherapy of the central nervous system in a patient with HER2-positive metastatic breast cancer: case study and review of the literature.

Approximately 35% of patients with confirmed HER2 breast cancer progress to metastases of the central nervous system (CNS). Total cerebral radiotherapy is considered as standard treatment for these cases; however, studies have shown that some chemotherapy drugs can be used during radiotherapy without significantly increasing its toxicity. In this article, we report the case of a patient with HER2-positive breast cancer who showed isolated progression of the illness in the CNS, which was observed during the treatment period using T-DM1 concomitantly with radiotherapy of the CNS without apparent toxicity of the combination and keeping the illness controlled. Through a review of the literature on the use of radiotherapy and chemotherapy with T-DM1 for the treatment of cerebral metastases in HER2-positive breast cancer, we describe the efficacy and tolerance of the concomitant application of these treatments.

Epidemiology of melanoma in the South of Brazil: study of a city in the Vale do Itajaí from 1999 to 2013.

BACKGROUND: Cutaneous melanoma is a highly aggressive malignancy with increasing incidence worldwide. The southern Brazilian state of Santa Catarina has one of the highest incidence rates of melanoma in the country. OBJECTIVE: To evaluate the epidemiological profile of melanoma patients in a southern city of Brazil. METHODS: a cross-sectional retrospective study was conducted, aiming to detect the clinical and histopathological characteristics of cutaneous melanoma diagnosed in the city of Brusque - SC, between 1999 and 2013. RESULTS: A total of 213 cases in 212 individuals were studied. More than 50% of the patients were females (p< 0.05). The trunk was the most commonly affected site (p< 0.05), followed by the upper limbs. Nodular and superficial spreading melanomas were the most commonly detected in histological analyses. They did not differ statistically in frequency, but were more prevalent than other histopathological subtypes (p< 0.05). There was no statistically significant difference between invasive and noninvasive melanomas (p= 0.2441). Among the invasive melanomas, those with Breslow thicknesses < 1 mm and between 1-2mm were more prevalent (p< 0.05). CONCLUSIONS: In this study we found a higher frequency of melanomas in female patients and patients aged over 51. The trunk was the most commonly affected site. Nodular and superficial spreading melanomas prevailed. Among invasive melanomas, those with Breslow thicknesses < 2 mm were the most frequent. This paper highlights the epidemiological profile of melanoma patients in the city and may help to identify and aid in the follow-up of those who are most likely to present the disease.

Epidemiology of Melanoma in the South of Brazil: study of a city in the Vale do Itajaí from 1999 to 2013

BACKGROUND: Cutaneous melanoma is a highly aggressive malignancy with increasing incidence worldwide. The southern Brazilian state of Santa Catarina has one of the highest incidence rates of melanoma in the country. OBJECTIVE: To evaluate the epidemiological profile of melanoma patients in a southern city of Brazil. METHODS: a cross-sectional retrospective study was conducted, aiming to detect the clinical and histopathological characteristics of cutaneous melanoma diagnosed in the city of Brusque - SC, between 1999 and 2013. RESULTS: A total of 213 cases in 212 individuals were studied. More than 50% of the patients were females (p< 0.05). The trunk was the most commonly affected site (p< 0.05), followed by the upper limbs. Nodular and superficial spreading melanomas were the most commonly detected in histological analyses. They did not differ statistically in frequency, but were more prevalent than other histopathological subtypes (p< 0.05). There was no statistically significant difference between invasive and noninvasive melanomas (p= 0.2441). Among the invasive melanomas, those with Breslow thicknesses < 1 mm and between 1-2mm were more prevalent (p< 0.05). CONCLUSIONS: In this study we found a higher frequency of melanomas in female patients and patients aged over 51. The trunk was the most commonly affected site. Nodular and superficial spreading melanomas prevailed. Among invasive melanomas, those with Breslow thicknesses < 2 mm were the most frequent. This paper highlights the epidemiological profile of melanoma patients in the city and may help to identify and aid in the follow-up of those who are most likely to present the disease. .

Pseudolinfoma cutâneo: relato de caso / Cutaneous pseudolymphoma: case report

Os pseudolinfomas cutâneos representam um grupo heterogêneo de reações linfoproliferativas benignos que podem simular clinica e histologicamente linfomas cutâneos. O objetivo deste estudo foi relatar a apresentação anatomoclínica de um caso de pseudolinfoma cutâneo para o aperfeiçoamento do seu diagnóstico diferencial com linfomas cutâneos. Paciente do gênero masculino, 66 anos procurou atendimento médico relatando história de nódulos em região superior do dorso há seis anos. Ao exame físico foram observados sete nódulos com aproximadamente 0,5 cm de diâmetro e sem sinais de linfonodomegalias. A biópsia de pele mostrava um denso infiltrado de linfócitos e histiócitos na derme. A análise imuno-histoquímica revelou uma população mista de linfócitos B (CD 20) e linfócitos T (CD 3). O diagnóstico diferencial entre as lesões benignas e malignas é a principal prioridade nesses casos. Tanto o pseudolinfoma, quanto o linfoma cutâneo se manifestam como nódulos solitários, pápulas e placas decorrentes de infiltração linfocitária. Para o diagnóstico diferencial, estão indicadas a avaliação imuno-histoquímica e técnicas de biologia molecular...

Cutaneous pseudolymphoma represents heterogeneous groups of benign lymphoproliferative reactions that may simulate clinically and histologically cutaneous lymphomas. The aim of this study was to report a case of cutaneous pseudolymphoma. Male patient, 66-year-old, came to us reporting a 6-year history of nodules on the upper back. On physical examination we noticed 7 nodules with 0.5 cm of diameter and no sign of adenopathy. The skin biopsy showed a dense infiltrate of lymphocytes and histiocytes in the dermis. The immunohistochemical analysis revealed a mixed population of B lymphocytes (CD 20) and T lymphocytes (CD 3). Differential diagnosis between benign and malignant lesions is the main concern in these cases. In some cases, pseudolymphoma manifests as solitary nodules, papules and plaques that are clinically indistinguishable from cutaneous lymphomas. The differentiation process can be further facilitated by immunohistochemical and molecular biological techniques...

[Cervical adenocarcinoma with lymphatic spread presenting as carcinoma "en cuirasse"of the vulva: case report]. / Adenocarcinoma de colo uterino com disseminação linfática apresentando-se como carcinoma en cuirasse da vulva: relato de caso.

UNLABELLED: We report the case of a patient with carcinoma "en cuirasse" of the vulva. CASE REPORT: A female patient presented complaining of inguinal lymphadenopathy. Lymph node excision, immunohistochemistry analyses, and further exams showed the presence of cervical adenocarcinoma. The cancer was surgically removed and the patient was treated with radiotherapy and chemotherapy with a good initial response. Some months later she presented with intense edema of the lower limbs, hardening and thickening of the labia majora, and pelvic and genital ulceration. A cutaneous biopsy with subsequent immunohistochemical staining showed lymphatic dissemination of adenocarcinoma to the vulva. DISCUSSION: Carcinoma "en cuirasse" is a rare presentation of cutaneous metastasis in which the affected skin shows hardening and induration, acquiring a sclerodermoid appearance. This is, to the best of our knowledge, the first report in Brazil of carcinoma "en cuirasse" of the vulva associated with cervical adenocarcinoma.

Changes in lymphocyte count induced by repeated cycles with low-dose interleukin-2 and interferon-α in 146 patients with renal cell carcinoma.

AIMS AND BACKGROUND: The exact mechanism by which recombinant interleukine-2 and interferon-α modulate the immunological response, inducing long-term responses in metastatic renal cell carcinoma, is still not clear. The aim of the study was to analyze the modifications in peripheral blood lymphocytes during cycles of low-dose immunotherapy as a marker of the biological response to the treatment in 146 patients with renal cell carcinoma (advanced and localized disease). METHODS AND STUDY DESIGN: Peripheral blood lymphocytes were evaluated before and after every cycle of treatment. RESULTS: We found a statistically significant overall difference between pre- and post-cycle values (mean increase of 39%). The differences between pre- and post-cycle lymphocyte counts for each cycle were significant. Also, the post-cycle lymphocyte count of each cycle remained higher than the baseline value. Furthermore, pre-cycle lymphocyte counts of each cycle were still higher than the baseline value, with no difference between a pre-cycle lymphocyte mean value and the other one (except that between the first and second cycle). From the end of each cycle, but before starting the next one, the absolute value of lymphocytes fell on the average by 15-30%, concurring with the fact that, even starting from pre-cycle values higher than baseline, the immune system remains sensitive to chronically repeated stimulation by immunotherapy. We also found that non-metastatic patients had a higher number of peripheral blood lymphocytes than metastatic patients, whereas the latter had a lower immune response to therapy. CONCLUSIONS: The results support the idea that "maintenance" immunotherapy may not develop resistance over time in terms of biological response and thus may have a role as chronic therapy in combination with other drugs such as target therapy. We suppose that the immune system of patients with metastases is in a state of relative impairment, resulting in less sensitivity to immunostimulating agents.

Pericardial breast cancer metastasis 25 years after mastectomy.

Pericardial effusion in a patient with a history of cancer should always prompt a hypothesis of malignant involvement. We report the case of a 66-year-old white woman presenting with pericardial effusion 25 years after a mastectomy for ductal breast carcinoma. This is one of the cases with the latest recurrence ever reported.

Sequential chemotherapy with dose-dense docetaxel, cisplatin, folinic acid and 5-fluorouracil (TCF-dd) followed by combination of oxaliplatin, folinic acid, 5-fluorouracil and irinotecan (COFFI) in metastatic gastric cancer: results of a phase II trial.

PURPOSE: To evaluate a new strategy of two sequential, intensified chemotherapy regimens in metastatic gastric cancer. PATIENTS AND METHODS: Chemo-naïve patients with metastatic gastric cancer were enrolled to receive 4 cycles of TCF-dd (docetaxel initially 85 mg/m(2) and cisplatin initially 75 mg/m(2) on day 1 [later modified due to toxicity: 70 and 60 mg/m(2) respectively], l-folinic acid 100 mg/m(2) on days 1 and 2, 5-fluorouracil 400 mg/m(2) bolus and then 600 mg/m(2) as a 22 h continuous infusion on day 1 and 2, every 14 days). Subsequently, patients with CR, PR or SD received 4 cycles of COFFI (oxaliplatin 85 mg/m(2), irinotecan 140 mg/m(2), l-folinic acid 200 mg/m(2), 5-fluorouracil bolus 400 mg/m(2) on day 1 followed by 2,400 mg/m(2) as a 48 h continuous infusion, every 14 days). In both regimens pegfilgrastim 6 mg subcutaneously on day 3 was included. RESULTS: Forty consecutive patients were enrolled. TCF-dd regimen achieved an ORR of 55% (95% CI, 40-70). Twenty-three patients proceeded to COFFI. After this regimen the ORR was then increased to 60% (95% CI, 45-75). Among the 21 patients treated with TCF-dd after the protocol amendments, main grade 3-4 toxicities were: neutropenia (29%), thrombocytopenia (19%), asthenia (24%) and diarrhea (14%). COFFI caused grade 3-4 neutropenia (all not febrile) and diarrhea in 35% and 17% of patients respectively. CONCLUSIONS: A sequential strategy with TCF-dd followed by COFFI is very active and may be of special interest in selected patients.

Sigmoid adenocarcinoma with renal metastasis.

We report a case of a 75-year-old man submitted to a rectosigmoidectomy and partial cystectomy because of a sigmoid cancer and colovesical fistula. Seven months later and after four cycles of adjuvant chemotherapy, a lesion was detected in the kidney. Histology revealed tubular adenocarcinoma, which meant sigmoid cancer metastasis. Kidney metastases are very rare in colorectal cancer (CRC), but may be generally associated with an unfavorable prognosis. Thus, patients with metastatic CRC and kidney tumors are a diagnostic and therapeutic challenge.

Dose-dense chemotherapy in metastatic gastric cancer with a modified docetaxel-cisplatin-5-fluorouracil regimen.

AIMS AND BACKGROUND: Previous studies have reported that in early breast cancer, lymphomas and advanced bladder cancer, dose-dense chemotherapy may be more effective than conventional treatments. In metastatic gastric cancer, chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TCF) q3w is very active, and, even though there is no international consensus on the subject, it is the regimen of choice of many European centers as first-line chemotherapy in this subset of patients. Based on these studies, we tested for the first time the feasibility and activity of an intensified dose-dense TCF regimen (q2w) modifying the 5-fluorouracil infusion with 1-folinic acid/5-fluorouracil according to the "De Gramont regimen". METHODS AND STUDY DESIGN: Patients with histologically confirmed measurable metastatic gastric cancer, ECOG performance status or=65 years received the same schedule with a dose reduction of 30%. RESULTS: Thirty-two consecutive patients were enrolled (63% male, 37% female); median age, 64 years (range, 40-81). A median of 4 cycles (range, 1-7) per patient was administered. Eleven of 32 patients (34%) required a dose reduction, mostly for hematological grade III-IV toxicity and severe asthenia. Twelve patients (38%) completed the first 4 cycles of therapy within 7 weeks, thereby finishing without delay the initially planned dose-density schedule. Twenty-eight patients were evaluated for response (1 early suspension after the first cycle because of toxicity, 3 deaths before response evaluation due to progression of disease). There were 3 complete responses (9%), 15 partial responses (47%), 7 stable disease (22%) and 3 progression of disease (9%), for an overall response rate, by intention to treat, of 56% (95% CI, 39-73). The most frequent grade 3-4 toxicities were: neutropenia (53%), thrombocytopenia (34%), anemia (16%) febrile neutropenia (22%), asthenia (38%) and diarrhea (19%). Median time to progression was 9.1 months (95% CI, 6.0-12.2); median overall survival was 10.1 months (95% CI, 8.8-12.2). CONCLUSIONS: A dose-dense TCF regimen in metastatic gastric cancer is feasible, with activity comparable to previous results achieved with epirubicin-based chemotherapy and TCF q3wk in terms of overall survival and time to progression, and deserves to be further tested in randomized phase III studies.

Basal-like immunophenotype markers and prognosis in early breast cancer.

AIMS AND BACKGROUND: Basal-like breast cancer is a distinct group of tumors with heterogeneous behavior, and not all have a poor prognosis. The present study analyzed the prevalence and prognosis of early basal-like breast cancer. METHODS AND STUDY DESIGN: A total of 112 patients with stage I and II breast cancer were retrospectively analyzed using immunohistochemical stains for estrogen receptor, progesterone receptor, HER2, cytokeratin 5/6 and epidermal growth factor receptor. Basal-like tumors were defined as being estrogen receptor, progesterone receptor and HER2 negative and cytokeratin 5/6 and/or epidermal growth factor receptor positive. RESULTS: Of the 112 cases, respectively 13 (11.6%) were basal-like, 77 (68.8%) luminal A or B, 13 (11.6%) HER2 positive and 9 (8%) undefined. In basal-like tumors, epidermal growth factor receptor and cytokeratin 5/6 expression was positive in 5 patients (38.5%) and 12 patients (92%), respectively. There was no significant correlation between basal-like breast cancer and age (P = 0.207), lymph node status (P = 1.0) or clinical stage (P = 0.53). Among all tested biomarkers, positivity was found in 81 (72.3%) for estrogen receptor, 13 (11.6%) for HER2, 11 (9.8%) for epidermal growth factor receptor and 36 (32.1%) for cytokeratin 5/6. Epidermal growth factor receptor expression was significantly correlated with estrogen receptor-negative (P = 0.01) and HER2-positive (P = 0.02) tumors. During a median follow-up of 81 months, there were 26 (23%) disease relapses and 12 (10.7%) deaths. No significant difference relating to disease-free survival and overall survival was noted between basal-like breast cancer and subtypes luminal A and B, HER2 positive and undefined. CONCLUSIONS: The addition of cytokeratin 5/6 and epidermal growth factor receptor defines a small subgroup of patients with basal-like tumors. In a population with early breast cancer, basal-like tumors did not have a prognosis different from the other subtypes. Neither was there a significant association with clinicopathological features. The high frequency of epidermal growth factor receptor positivity in estrogen receptor-negative and HER2-positive tumors represents a potential target in clinical trials.

Treatment of recurrent thyroid cancers--is there a light in the horizon?

PURPOSE OF REVIEW: Thyroid cancer is a rare tumour. In spite of this, its incidence is increasing faster than any other tumour. The reported response rates of recurrent thyroid cancer to chemotherapy are generally poor. Molecular studies have provided some information on their biology and have identified new targets with therapeutic potential. RECENT FINDINGS: Ever since the seventies, no major breakthrough has been achieved in terms of chemotherapy in advanced/recurrent thyroid cancer. Anaplastic thyroid cancer, for instance, has not shown any improvement in overall survival during the past 40 years. Several agents are currently being tested that target molecular signalling and cancer cell biology, and will be reviewed in this paper. SUMMARY: Some of these new targeted approaches hold promise for our future ability to treat patients with advanced thyroid cancer unresponsive to traditional therapy. The success of these molecular-targeted agents is dependent on the molecular abnormalities involved in carcinogenesis as well as on well designed clinical trials to study these new agents.