Small cell melanoma and ulceration as predictors of positive sentinel lymph node in malignant melanoma patients.

Malignant melanoma (MM) early lymph node (LN) metastasis usually appears first in the sentinel LN (SLN). Breslow thickness is the main factor considered in the selection of patients to be submitted to SLN biopsy. The present study aimed to describe other independent prognostic factors useful in SLN candidate selection. During one year, 94 MM patients (90 primary cutaneous MM with Breslow thickness > or = 0.76 mm, and four cutaneous relapses), were submitted to SLN biopsy in the Melanoma Unit at the Hospital Clinic, Barcelona, Spain. The prognostic factors studied were: Breslow thickness, Clark's level of invasion, mitotic rate, cellular type (small, epithelioid, fusocellular, sarcomatoid), vertical growth phase, regression > 50%, severe vascularization, infiltrate (lymphocytic, plasmocytic), ulceration, neurotropism, intravascular/intraneural invasion, protein p16 expression and recurrence. Nineteen SLN (20.2%) were positive and 75 (79.8%) negative. No positive SLN occurred in MM with Breslow thickness < or = 1.0 mm. Breslow thickness > or = 2 mm (P = 0.005), severe vascularization (P = 0.005), small cell (P = 0.000) and ulceration (P = 0.005) were significant prognostic factors by univariate analysis. Small cell (P = 0.008) and ulceration (P = 0.05) were also significant prognostic factors in a multivariate analysis. The probability of finding a positive SLN for small cell was 56.9% [95% confidence interval (CI), 26.8-82.6%]. The probability of positive SLN for ulceration was 35.5% (95% CI, 14.2-64.7%). For small cell and ulceration together the probability increased to 86.3% (95% CI, 54.3-97.1%). The results of this study corroborated ulceration as a prognostic factor for SLN candidate selection and for the first time we have described small cell melanoma morphology as a significant factor associated with positive SLN.

Detection of occult breast cancer cells by amplification of CK19 mRNA by reverse transcriptase-polymerase chain reaction: role of surgical manipulation.

BACKGROUND: To assess if surgical manipulation increases peripheral blood cancer cells dissemination in early stage (I and II) breast cancer patients. PATIENTS AND METHODS: We analyzed 64 patients using RT-PCR for cytokeratin-19 as a marker for peripheral blood breast cancer cell dissemination. Peripheral blood was obtained at 4 different time-points (24 hours before and after surgery, one week and one month later). RESULTS: RT-PCR was positive in 14 (24%) out of 59 evaluable patients. Circulating cells were detected in 4 out of 14 patients before surgery (7%) while in the remaining 10, the positivity was observed after surgery (17%). The percentage of patients with occult breast cancer cells increased significantly after surgery (p = 0.01). CONCLUSION: 1) 7% of early breast cancer patients had circulating tumor cells before surgery. 2) After surgery tumor cells were detected in 17% of patients. 3) Surgery significantly increased the presence of occult breast cancer cells. 4) The clinical significance of occult breast cancer cells should be tested within a larger clinical trial trying to assess their role as an independent prognostic factor.

Placental pathology in malaria: A histological, immunohistochemical, and quantitative study*

Para caracterizar as alterações histológicas nas placentas da malária e sua relação com a paridade e parasitemias maternas e medulares, realizamos um estudo histológico em 1.179 placentas de Ifakara, na Tanzânia, uma área com transmissão intensa e perene da malária. Estudos imuno-histoquímicos e quantitativos para CD45, fibrina e área vilosa foram realizados em 60 casos. Quatrocentas e quinze placentas (35,2%) apresentaram parasitas (infecções ativas); em 303 deles, os parasitas coexistiam com pigmento coberto por fibrina (infecções crônicas) e em 112 apenas foram detectados parasitas (infecções agudas). Quatrocentos e setenta e cinco casos (40,3%) apresentaram deposição de hemozoína sem parasitas (infecções passadas). Das mulheres com placentas parasitadas, 46,3% não apresentaram parasitas no sangue periférico. Espessamento da membrana basal (P = 0,002), necrose fibrinóide (P = 0,004) e proeminência de nós sinciciais (P = 0,031) foram associados à infecção ativa por malária. Não foram encontradas diferenças quantitativas para deposição perivilosa de fibrina ou área vilosa. A associação mais significativa com infecção ativa por malária foi a infiltração intervilosa por células inflamatórias mononucleares (P < 0,001). As infecções crônicas foram associadas às alterações mais graves, particularmente à inflamação mononuclear intervilosa (OR, 28,7; IC 95% = 16,0 a 51,5, P<0,001). As infecções anteriores mostraram apenas diferenças mínimas com placentas não infectadas. As primíparas apresentaram infecções crônicas com mais frequência do que as multíparas (52% versus 15%, P < 0,001). Eles também mostraram parasitemias placentárias e infiltrado inflamatório interviloso significativamente maiores. Em conclusão, a histologia da placenta é mais sensível que o exame de sangue periférico na detecção de infecção malárica durante a gravidez. A maioria das infecções por malária recupera durante a gravidez, deixando poucas alterações residuais na placenta. A inflamação intervilosa é o achado mais frequente associado à malária e é especialmente grave em primíparas, sugerindo que outros mecanismos além da imunossupressão são responsáveis ​​pela elevada susceptibilidade neste grupo.