Immunohistochemical assessment of symptomatic postmenopausal endometrial polyps in tamoxifen users and nonusers: a case control study.

BACKGROUND: Endometrial polyps are common in postmenopausal women, and the effect of tamoxifen use (a risk factor for endometrial polyps) on their pathogenesis is unclear. OBJECTIVES: To evaluate the expression of hormone receptors and markers for proliferation/apoptosis (Ki-67 and Bcl-2) in endometrial polyps in postmenopausal users and nonusers of tamoxifen. DESIGN AND SETTING: Cross-sectional analytical study in a tertiary-level academic hospital. METHODS: 46 women (14 tamoxifen users and 32 nonusers) with postmenopausal bleeding underwent hysteroscopic resection of endometrial polyps. Polyp samples were immunohistochemically assessed for detection of Ki-67, Bcl-2 and estrogen and progesterone receptors. RESULTS: Analysis on the glandular component of the polyps revealed progesterone receptor expression in the polyps of 96.9% of the nonusers of tamoxifen, and 92.3% of the tamoxifen users (P = 0.499). All polyps in nonusers and 92.3% of those in users were also positive for estrogen receptors (P = 0.295). Ki-67 was expressed in 75% of the polyps in the tamoxifen users and 82.8% of those in the nonusers. All endometrial polyps expressed Bcl-2. CONCLUSIONS: The immunohistochemical analysis on endometrial polyps demonstrated that, although tamoxifen is considered to be a risk factor for endometrial polyps, there were no significant differences in the expression of hormone receptors between users and nonusers of tamoxifen. There were no between-group differences in Ki-67 and Bcl-2 expression, and all patients displayed inhibition of apoptosis by Bcl-2, thus supporting the theory that polyps develop due to inhibition of apoptosis, and not through cell proliferation.

Immunohistochemical assessment of symptomatic postmenopausal endometrial polyps in tamoxifen users and nonusers: a case control study

ABSTRACT BACKGROUND: Endometrial polyps are common in postmenopausal women, and the effect of tamoxifen use (a risk factor for endometrial polyps) on their pathogenesis is unclear. OBJECTIVES: To evaluate the expression of hormone receptors and markers for proliferation/apoptosis (Ki-67 and Bcl-2) in endometrial polyps in postmenopausal users and nonusers of tamoxifen. DESIGN AND SETTING: Cross-sectional analytical study in a tertiary-level academic hospital. METHODS: 46 women (14 tamoxifen users and 32 nonusers) with postmenopausal bleeding underwent hysteroscopic resection of endometrial polyps. Polyp samples were immunohistochemically assessed for detection of Ki-67, Bcl-2 and estrogen and progesterone receptors. RESULTS: Analysis on the glandular component of the polyps revealed progesterone receptor expression in the polyps of 96.9% of the nonusers of tamoxifen, and 92.3% of the tamoxifen users (P = 0.499). All polyps in nonusers and 92.3% of those in users were also positive for estrogen receptors (P = 0.295). Ki-67 was expressed in 75% of the polyps in the tamoxifen users and 82.8% of those in the nonusers. All endometrial polyps expressed Bcl-2. CONCLUSIONS: The immunohistochemical analysis on endometrial polyps demonstrated that, although tamoxifen is considered to be a risk factor for endometrial polyps, there were no significant differences in the expression of hormone receptors between users and nonusers of tamoxifen. There were no between-group differences in Ki-67 and Bcl-2 expression, and all patients displayed inhibition of apoptosis by Bcl-2, thus supporting the theory that polyps develop due to inhibition of apoptosis, and not through cell proliferation.

Main prognostic and predictive immunohistochemical factors in breast cancer: a retrospective cohort study

Introduction: Breast cancer is a constant focus of studies on prevention and treatment. Immunohistochemistry is a useful tool for defining the conducts toward the treatment of this disease. Objective: To evaluate patients' survival according to prognostic and predictive immunohistochemical factors. Method: This is a retrospective cohort study. Medical reports of 787 patients were analyzed, which contained parts of surgical specimens of the mastectomy or quadrantectomy procedures. A total of 404 patients were eligible for the study. Results: The mean age at diagnosis of the disease was 55.4 years. The main diagnosis was infiltrating ductal carcinoma (80.7%). Of the total, 45% of the patients had tumors of up to 2 cm in diameter, and 32.9% had lymph node involvement. Among the patients, and according to luminal molecular classification, 48.3% were classified as luminal A, 27% were luminal B, 12.1% were recipient of human epidermal growth factor type 2 (HER2), and 12.6% were triple-negative. Furthermore, of 23.3% patients with tumor recurrence, 12.6% of them died. The 1% increase in Ki-67 values increases the risk of death and recurrence by 2% and 1%, respectively. The presence of lymph node metastasis increases, on average, 4.78 times and 2.63 times the risk of death and recurrence, respectively. Conclusion: The triple negative molecular classification had the lowest overall survival and the greatest risk of recurrence. The luminal A classification presented the best prognosis. Tumor size, lymph node metastasis, skin invasion, and presence of Ki-67 were shown to be the prognostic and predictive factors that most influenced the patients' survival.

Assessment of the aerosol distribution pattern of a single-port device for intraperitoneal administration of therapeutic substances.

BACKGROUND: In the last 20 years, intraperitoneal chemotherapy (IPC) has been explored as a modality for the management of peritoneal metastases of gynecologic, gastrointestinal, and primary peritoneal tumors. Direct delivery of chemotherapeutic agents to the peritoneal cavity space has proved superior to systemic chemotherapy when evaluating characteristics such as drug concentration reached in the peritoneal space, penetration into peritoneal metastases, and chemotherapy-related toxicity. Traditionally, IPC is delivered by peritoneal lavage with a liquid solution. This form of delivery has limitations, including inhomogeneous intraperitoneal distribution and limited ability to penetrate tissues and metastatic nodules. An alternative mode of delivery is so-called pressurized intraperitoneal aerosol chemotherapy (PIPAC). Within this context, the present study sought to identify the pattern of spatial distribution of therapeutic solutions aerosolized into the peritoneal space using a single-port PIPAC device and ascertain whether the aerosolized method is superior to the traditional (liquid) mode of IPC delivery. METHODS: Analysis of the rate of intra-abdominal staining with aerosolized 2% silver nitrate in five porcine models. RESULTS: Assessment of differences in stain impregnation between the upper, middle, and lower abdomen did not reveal significant differences (p = 0.42). The median sum scores were 1 for the upper abdomen and 3 for the middle and lower abdomen. CONCLUSIONS: Aerosolization does not reach all regions of the abdomen homogeneously. However, adequate exposure of the upper abdomen, mid-abdomen, and lower abdomen to chemotherapeutic agents can be achieved with PIPAC.

Immunohistochemical Expression of Cyclooxygenases in Hypertrophic Scars and Keloids.

BACKGROUND: There are studies demonstrating an increased expression of cyclooxygenase (COX) in keloids and hypertrophic scars, suggesting that anti-inflammatory drugs could be used in their treatment. However, a precise relationship between COX and pathological scarring has not been established in the literature yet. This study aims to evaluate the immunohistochemical expression of COXs in these scars. METHODS: Prospective study, including 54 patients (aged 18-60 years) undergoing scar excision: 18 normal scars (group 1), 18 hypertrophic scar (group 2), and 18 keloids (group 3). The group classification was performed by clinical criteria. Scars samples were collected and anatomopathological examination (through hematoxylin-eosin method) was performed to confirm the scar type. Immunohistochemistry was performed to assess the expression of COX1 and COX2 in epidermis and dermis. Results were compared among all groups and between group I versus II and III together (abnormal scars). RESULTS: For COX1, in the epidermis, there was no significant difference in the immunohistochemical expression when comparing the 3 groups. In the dermis, groups 2 and 3 had greater expression than group 1, with a significant difference being found when comparing all groups (P = 0.014), and in the comparison between normal versus abnormal scars (P = 0.004). For COX2, there was no significant difference between the groups in both the epidermis and dermis. CONCLUSIONS: The immunohistochemical expression of COX1 was greater in the dermis of abnormal scars when compared with normal scars. Future studies can be performed involving COX blockade as a perspective of these scars treatment.

Differential diagnosis of mesenchymal neoplasms of the digestive tract by cell block and immunohistochemistry.

OBJECTIVES: To evaluate the diagnostic yield of the cell block (CB) technique with immunohistochemistry in patients with mesenchymal neoplasms of the gastrointestinal tract collected by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). METHODS: Tissue samples from consecutive patients with subepithelial lesions collected by EUS-FNA, without analysis by on-site cytopathology, were evaluated by the same pathologist only using CBs in AAF fixative. Sections were stained with haematoxylin-eosin and underwent complementary immunohistochemical staining for SMA, CD117, DOG-1 and S100 in the presence of mesenchymal neoplasms. Specimens were defined as diagnostic when sufficient tissue was present for histopathological evaluation and immunohistochemistry analysis. If they were insufficient for complete evaluation, the specimens were considered nondiagnostic. RESULTS: Between September 2012 and December 2016, a total of 158 patients (median age: 57 years, 64.5% women) underwent EUS-FNA with an average of three needle passes for every lesion. The median lesion size was 17 mm. There were 113 mesenchymal neoplasms confirmed by immunohistochemistry (66 leiomyomas, 44 GISTs, two schwannomas, one leiomyosarcoma). The overall diagnostic yield of CBs was 84.17%. However, diagnosis was obtained in 98.5% (133/135) of the cases after exclusion of 23 cases in which EUS-FNA sampling was insufficient or without tumoural tissue. Only two mesenchymal neoplasms were not confirmed by CBs even after immunohistochemistry. CONCLUSIONS: CBs collected by EUS-FNA and analysed by immunohistochemistry showed a high diagnostic yield in patients with mesenchymal neoplasms, even without on-site cytopathology.

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.

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.

Tumor sólido pseudopapilar de pâncreas: relato de caso de uma rara neoplasia / Solid pseudo papillary tumor of the pancreas: case report of a rare neoplasia

O tumor sólido pseudopapilar de pâncreas (TSPP) é uma neoplasia maligna de baixo grau, que acomete predominantemente mulheres jovens e corresponde a um processo tumoral ovoide pardo-avermelhado e de crescimento lento. Os autores relatam um caso incidental de TSPP, e discutem os achados anatomopatológicos e clínicos desta rara neoplasia. Paciente feminino, 45 anos, obesa mórbida, sem outras queixas clínicas, em avaliação para procedimento de cirurgia bariátrica, apresentou, nos exames de ultrassonografia e tomografia computadorizada do abdome, lesão tumoral sólido-cística na cauda do pâncreas, que mediu 7,1 cm no maior eixo. A paciente foi submetida à ressecção do processo. Aos cortes, foi identificada uma lesão tumoral ovoide, pardo-avermelhada, predominantemente sólida, circunscrita, que mediu 7,4 x 6,0 x 5,3 cm. Ao exame microscópico, identificou-se uma neoplasia de cé- lulas epitelioides monomórficas de tamanho intermediário, com citoplasma exibindo pequenos glóbulos hialinos, dispostas em áreas sólidas e císticas. O processo exibiu imunoexpressão positiva para pancitoqueratina, betacatenina, sinaptofisina, cromogranina A, CD56 e receptores de progesterona, e imunoexpressão negativa para E-caderina, CDX-2 e TTF-1. O diagnóstico de Tumor Sólido Pseudopapilar do Pâncreas foi então estabelecido. Após um seguimento de quatro meses, não foram encontradas evidências clínicas ou radiológicas de recidiva tumoral(AU)

The solid pseudopapillary tumor of the pancreas (SPTP) is a malignant neoplasm of low degree, which predominantly affects young women and corresponds to an ovoid reddish-brown tumor process of slow growth. The authors report an incidental case of SPTP and discuss the clinical and pathological findings of this rare neoplasm. A female patient, 45 years old, morbidly obese, with no other clinical complaints, in evaluation for bariatric surgery procedure, presented, in ultrasound examination and computed tomography of the abdomen, a solid-cystic tumor lesion in the pancreas tail, which measured 7.1 cm in the major axis. The patient underwent resection process. The cuts showed an ovoid reddish-brown tumor lesion predominantly solid, circumscribed, which measured 7.4 x 6.0 x 5.3 cm. Microscopic examination identified a tumor of monomorphic epithelioid cells of intermediate size, with cytoplasm exhibiting small hyaline globules arranged in solid and cystic areas. The process showed positive immunoreactivity for pancytokeratin, beta-catenin, synaptophysin, chromogranin A, CD56 and progesterone receptors, and negative immunoreactivity for E-cadherin, CDX-2 and TTF-1. The diagnosis of solid pseudopapillary tumor of the pancreas was then established. At a four-month follow-up, there was no clinical or radiological evidence of tumor recurrence(AU)

Analysis of pattern of occurrence of thyroid carcinoma between 2001 and 2010 / Análise do padrão de ocorrência do carcinoma de tireoide entre 2000-2010

ABSTRACT INTRODUCTION: An ongoing discussion is found in medical literature about the reasons for changes in thyroid carcinoma incidence patterns over the last decades. OBJECTIVE: To analyze the clinical and pathological characteristics of thyroid carcinoma cases over a decade. METHODS: Cross-sectional study over an historical cohort. Medical records of 628 thyroid cancer cases in a single center were reviewed. 597 patients were included. Microcarcinoma cases were selected for a qualitative analysis phase, in which medical records were reviewed for better understanding of thyroid nodule and thyroid cancer diagnosis process. RESULTS: An increase in the proportion of cases with thyroid cancer diagnosis was observed throughout the decade; new cases were predominantly tumors of less than 2 cm, with histopathological signs of low aggressiveness. There was an increase in proportion of cases with malignant cytological results among microcarcinomas. CONCLUSION: There is a trend for increase in thyroidectomies due to cancer in this institution, with proportional increment of cases with histopathological characteristics indicative of early disease. Among microcarcinomas, there is an increasing group represented by cancer cases that were not incidentally diagnosed, related to an enhancement in preoperative diagnostic methods.

RESUMO Introdução: Persiste uma discussão na literatura sobre as razões para as mudanças no padrão de incidência do carcinoma de tireoide nas últimas décadas. Objetivo: Analisar as características clinicopatológicas dos casos de carcinoma de tireoide ao longo de uma década. Método: Estudo transversal sobre uma coorte histórica. Os registros médicos de 628 casos de câncer de tireoide de um único centro foram revisados. Foram incluídos 597 pacientes. Os casos de microcarcinoma foram selecionados para uma fase de análise qualitativa, na qual os registros médicos foram revisados para melhor entendimento do processo de diagnóstico do nódulo e do câncer. Resultados: Observamos um aumento na proporção de casos com diagnóstico de câncer de tireoide ao longo da década; os novos casos foram predominantemente de tumores < 2 cm, com sinais histopatológicos de baixa agressividade. Houve aumento na proporção de casos com resultado citológico maligno entre os microcarcinomas. Conclusão: Há uma tendência de crescimento nas tireoidectomias por câncer na nossa instituição, com incremento proporcional de casos com características histopatológicas indicativas de doença precoce. Entre os microcarcinomas, há um grupo em ascensão representado por casos com diagnóstico não-ocasional de câncer, relacionados à melhora dos métodos diagnósticos pré-operatórios.

Analysis of pattern of occurrence of thyroid carcinoma between 2001 and 2010.

INTRODUCTION: An ongoing discussion is found in medical literature about the reasons for changes in thyroid carcinoma incidence patterns over the last decades. OBJECTIVE: To analyze the clinical and pathological characteristics of thyroid carcinoma cases over a decade. METHODS: Cross-sectional study over an historical cohort. Medical records of 628 thyroid cancer cases in a single center were reviewed. 597 patients were included. Microcarcinoma cases were selected for a qualitative analysis phase, in which medical records were reviewed for better understanding of thyroid nodule and thyroid cancer diagnosis process. RESULTS: An increase in the proportion of cases with thyroid cancer diagnosis was observed throughout the decade; new cases were predominantly tumors of less than 2 cm, with histopathological signs of low aggressiveness. There was an increase in proportion of cases with malignant cytological results among microcarcinomas. CONCLUSION: There is a trend for increase in thyroidectomies due to cancer in this institution, with proportional increment of cases with histopathological characteristics indicative of early disease. Among microcarcinomas, there is an increasing group represented by cancer cases that were not incidentally diagnosed, related to an enhancement in preoperative diagnostic methods.

Papillary thyroid carcinoma: does the association with Hashimoto's thyroiditis affect the clinicopathological characteristics of the disease? / Carcinoma papilífero da tireoide: a associação com tireoidite de Hashimoto influencia nas características clínico-patológicas da doença?

INTRODUCTION: Papillary carcinoma is the most common malignant thyroid neoplasm. The effect of the concurrent presence of Hashimoto's thyroiditis and papillary thyroid carcinoma remains controversial. OBJECTIVE: To evaluate the association between Hashimoto's thyroiditis and clinicopathological parameters in thyroid papillary carcinoma cases, based on an historical institutional cohort analysis. METHODS: Cross-sectional study obtained from a historical cohort, including all cases submitted to thyroidectomy for papillary thyroid carcinoma in a single institution during an 11-year period study. RESULTS: A total of 417 patients with papillary thyroid carcinoma were enrolled; 148 (35.4%) also had Hashimoto's thyroiditis. A female predominance among cases associated to Hashimoto's thyroiditis was observed. The thyroid tumor, in cases associated with Hashimoto's thyroiditis, had a smaller mean diameter, lower frequency of extra-thyroid extension, and earlier clinicopathological staging. CONCLUSIONS: A high proportion of papillary thyroid carcinoma cases are associated with Hashimoto's thyroiditis. There are associations among these cases with several histopathological factors already recognized for their prognostic value, which by themselves could impact outcomes. .

INTRODUÇÃO: O carcinoma papilífero é a neoplasia maligna mais comum da tireóide. O efeito da coexistência da tireoidite de Hashimoto (TH) no prognóstico do carcinoma papilífero da tireóide (CPT) permanece controverso. OBJETIVO: Avaliar a associação entre TH e parâmetros clínico-patológicos entre pacientes com diagnóstico de carcinoma papilífero da tireóide obtidos através da análise de uma série histórica institucional. MÉTODO: Coorte transversal com base em uma coorte histórica, envolvendo todos os casos submetidos à tireoidectomia total por motivo de carcinoma papilífero, realizadas na mesma Instituição ao longo de 11 anos. RESULTADOS: Um total de 417 pacientes foram incluídos no estudo, estando 148 (35,4%) associados à TH. Observamos preponderância de mulheres entre os casos associados à TH. Esses casos se apresentaram com menor média de diâmetro tumoral, menor frequência de comprometimento extra-tireoidiano e estadiamento clínico-patológico mais precoce. Conclusões: Um percentual expressivo de casos de CPT apresenta-se associado à TH. A associa ção entre esses casos com vários fatores histopatológicos já reconhecidos por seu valor prognóstico, pode, por si só, influenciar no desfecho desses pacientes. .

Effects of L-arginine and L-NAME on ischemia-reperfusion in rat liver.

PURPOSE: To evaluated the effects of L-arginine (a NO donor) and L-NAME (Nw-nitro-L-arginine methyl ester - a NOS inhibitor) on ischemia-reperfusion in rat livers. METHODS: One hundred fifty two male Wistar rats were divided into four groups: control (simulated surgery); hepatic IR; pretreatment with L-arginine plus hepatic IR; and L-NAME plus hepatic IR. The hepatocellular damage was evaluated at the first, third and seventh days after the procedures through the alanine-aminotransferase (ALT) and aspartate-aminotransaminase (AST) levels, as well as histopathological features: vascular congestion (VC); steatosis (STE); necrosis (NEC); and inflammatory infiltration (INF). The mortality rate was also evaluated. RESULTS: The pretreatment with L-NAME significantly worsened the AST levels after hepatic IR (p<0.05) at first day and L-arginine demonstrated an attenuating effect on ALT levels at seventh day (p<0.05). Furthermore, the administration of L-arginine was able to reduce the VC and STE in the seventh day after hepatic IR (p<0.05). The analysis of the mortality rates did not demonstrate any difference between the groups. Nevertheless, there was not effect of L-arginine and L-NAME on the mortality of the animals. CONCLUSION: L-arginine/NO pathway has a role in the hepatic IR because the pretreatment with L-arginine partially had attenuated the hepatocellular damage induced by hepatic IR in rats.

Effects of L-arginine and L-NAME on ischemia-reperfusion in rat liver

PURPOSE: To evaluated the effects of L-arginine (a NO donor) and L-NAME (Nw-nitro-L-arginine methyl ester - a NOS inhibitor) on ischemia-reperfusion in rat livers.METHODS: One hundred fifty two male Wistar rats were divided into four groups: control (simulated surgery); hepatic IR; pretreatment with L-arginine plus hepatic IR; and L-NAME plus hepatic IR. The hepatocellular damage was evaluated at the first, third and seventh days after the procedures through the alanine-aminotransferase (ALT) and aspartate-aminotransaminase (AST) levels, as well as histopathological features: vascular congestion (VC); steatosis (STE); necrosis (NEC); and inflammatory infiltration (INF). The mortality rate was also evaluated.RESULTS: The pretreatment with L-NAME significantly worsened the AST levels after hepatic IR (p 0.05) at first day and L-arginine demonstrated an attenuating effect on ALT levels at seventh day (p 0.05). Furthermore, the administration of L-arginine was able to reduce the VC and STE in the seventh day after hepatic IR (p 0.05). The analysis of the mortality rates did not demonstrate any difference between the groups. Nevertheless, there was not effect of L-arginine and L-NAME on the mortality of the animals.CONCLUSION: L-arginine/NO pathway has a role in the hepatic IR because the pretreatment with L-arginine partially had attenuated the hepatocellular damage induced by hepatic IR in rats.(AU)

Effects of L-arginine and L-NAME on ischemia-reperfusion in rat liver

PURPOSE: To evaluated the effects of L-arginine (a NO donor) and L-NAME (Nw-nitro-L-arginine methyl ester - a NOS inhibitor) on ischemia-reperfusion in rat livers. METHODS: One hundred fifty two male Wistar rats were divided into four groups: control (simulated surgery); hepatic IR; pretreatment with L-arginine plus hepatic IR; and L-NAME plus hepatic IR. The hepatocellular damage was evaluated at the first, third and seventh days after the procedures through the alanine-aminotransferase (ALT) and aspartate-aminotransaminase (AST) levels, as well as histopathological features: vascular congestion (VC); steatosis (STE); necrosis (NEC); and inflammatory infiltration (INF). The mortality rate was also evaluated. RESULTS: The pretreatment with L-NAME significantly worsened the AST levels after hepatic IR (p<0.05) at first day and L-arginine demonstrated an attenuating effect on ALT levels at seventh day (p<0.05). Furthermore, the administration of L-arginine was able to reduce the VC and STE in the seventh day after hepatic IR (p<0.05). The analysis of the mortality rates did not demonstrate any difference between the groups. Nevertheless, there was not effect of L-arginine and L-NAME on the mortality of the animals. CONCLUSION: L-arginine/NO pathway has a role in the hepatic IR because the pretreatment with L-arginine partially had attenuated the hepatocellular damage induced by hepatic IR in rats. .

Papillary thyroid carcinoma: does the association with Hashimoto's thyroiditis affect the clinicopathological characteristics of the disease?

INTRODUCTION: Papillary carcinoma is the most common malignant thyroid neoplasm. The effect of the concurrent presence of Hashimoto's thyroiditis and papillary thyroid carcinoma remains controversial. OBJECTIVE: To evaluate the association between Hashimoto's thyroiditis and clinicopathological parameters in thyroid papillary carcinoma cases, based on an historical institutional cohort analysis. METHODS: Cross-sectional study obtained from a historical cohort, including all cases submitted to thyroidectomy for papillary thyroid carcinoma in a single institution during an 11-year period study. RESULTS: A total of 417 patients with papillary thyroid carcinoma were enrolled; 148 (35.4%) also had Hashimoto's thyroiditis. A female predominance among cases associated to Hashimoto's thyroiditis was observed. The thyroid tumor, in cases associated with Hashimoto's thyroiditis, had a smaller mean diameter, lower frequency of extra-thyroid extension, and earlier clinicopathological staging. CONCLUSIONS: A high proportion of papillary thyroid carcinoma cases are associated with Hashimoto's thyroiditis. There are associations among these cases with several histopathological factors already recognized for their prognostic value, which by themselves could impact outcomes.

Mesenchymal stem cells and nanofibers as scaffolds for the regeneration of thyroid cartilage.

OBJECTIVES/HYPOTHESIS: The aim of this study has been to establish an alternative approach in the form of regeneration of the thyroid cartilage. STUDY DESIGN: Four 1-month old pigs (Sus scrofa) were used (divided into 3 groups) and submitted to general anesthetic to perform cervictomy with exposure of the thyroid cartilage in a total of 12 (twelve) samples. METHOD: A resection of 4.0 cm(2) of cartilage was carried out in the right upper region and in the left upper and lower left region of the cartilage, where a scaffold with or without stem cells was implanted. In the left lower region, no biomaterial was implanted and the defect was left open (lesion control [L]). RESULTS: The average extension of the cartilaginous neoformation of L group was 136.3 µm (± 9.6) and 387.7 µm (± 43.2) in the scaffold (SCA) group, presenting a significant statistical difference (P < 0.01). The analysis carried out on the lesion site sections of the cartilage of the larynx of the animals from the SCA group + mesenchymal stem cells (SCA+MSC) showed an average of the extension of neocartilage of 825.4 µm (± 122.1), showing a more extensive area of neocartilage when compared to the other groups. These results demonstrated a high significantly statistical difference (P < 0.001) when compared with the L and SCA groups. CONCLUSION: In 100% of the cases for which SCA+MSCs were used, a significant success in the cartilage growth and closing of the lesion in the thyroid cartilage was obtained compared to the other two groups for which MSCs were not used. LEVEL OF EVIDENCE: N/A.

The presence of metastases in regional lymph nodes is associated with tumor size and depth of invasion in sporadic gastric adenocarcinoma.

BACKGROUND: Gastric adenocarcinoma is more often found in men over 50 years in the form of an antral lesion. The tumor has heterogeneous histopathologic features and a poor prognosis (median survival of 15% in five years). AIM: To estimate the relationship between the presence of nodal metastasis and other prognostic factors in sporadic gastric adenocarcinoma. METHOD: Were evaluated 164 consecutive cases of gastric adenocarcinoma previously undergone gastrectomy (partial or total), without clinical evidence of distant metastasis, and determined the following variables: topography of the lesion, tumor size, Borrmann macroscopic configuration, histological grade, early or advanced lesions, Lauren histological subtype, presence of signet ring cell, degree of invasion, perigastric lymph node status, angiolymphatic/perineural invasion, and staging. RESULTS: Were found 21 early lesions (12.8%) and 143 advanced lesions (87.2%), with a predominance of lesions classified as T3 (n=99/60, 4%) and N1 (n=62/37, 8%). The nodal status was associated with depth of invasion (p<0.001) and tumor size (p<0.001). The staging was related to age (p=0.048), histological grade (p=0.003), and presence of signet ring cells (p = 0.007), angiolymphatic invasion (p = 0.001), and perineural invasion (p=0.003). CONCLUSION: In gastric cancer, lymph node involvement, tumor size and depth of invasion are histopathological data associated with the pattern of growth/tumor spread, suggesting that a wide dissection of perigastric lymph nodes is a fundamental step in the surgical treatment of these patients.

The presence of metastases in regional lymph nodes is associated with tumor size and depth of invasion in sporadic gastric adenocarcinoma / A presenca de metastases em linfonodos regionais esta associada ao tamanho tumoral e profundidade de invasao no adenocarcinoma gastrico esporadico

Background: Gastric adenocarcinoma is more often found in men over 50 years in the form of an antral lesion. The tumor has heterogeneous histopathologic features and a poor prognosis (median survival of 15% in five years). Aim: To estimate the relationship between the presence of nodal metastasis and other prognostic factors in sporadic gastric adenocarcinoma. Method: Were evaluated 164 consecutive cases of gastric adenocarcinoma previously undergone gastrectomy (partial or total), without clinical evidence of distant metastasis, and determined the following variables: topography of the lesion, tumor size, Borrmann macroscopic configuration, histological grade, early or advanced lesions, Lauren histological subtype, presence of signet ring cell, degree of invasion, perigastric lymph node status, angiolymphatic/perineural invasion, and staging. Results: Were found 21 early lesions (12.8%) and 143 advanced lesions (87.2%), with a predominance of lesions classified as T3 (n=99/60, 4%) and N1 (n=62/37, 8%). The nodal status was associated with depth of invasion (p<0.001) and tumor size (p<0.001). The staging was related to age (p=0.048), histological grade (p=0.003), and presence of signet ring cells (p = 0.007), angiolymphatic invasion (p = 0.001), and perineural invasion (p=0.003). Conclusion: In gastric cancer, lymph node involvement, tumor size and depth of invasion are histopathological data associated with the pattern of growth/tumor spread, suggesting that a wide dissection of perigastric lymph nodes is a fundamental step in the surgical treatment of these patients. .

Racional: O adenocarcinoma gástrico é encontrado mais frequentemente em homens acima de 50 anos sob a forma de lesão antral. A neoplasia apresenta características histopatológicas heterogêneas e prognóstico ruim (sobrevida média de 15% em cinco anos). Objetivo: Estimar a relação entre a presença de metástases nodais e demais fatores prognósticos no adenocarcinoma gástrico esporádico. Método: Foram avaliados 164 casos consecutivos de adenocarcinoma gástrico previamente submetidos à gastrectomia (parcial ou total), sem evidências clínicas de metástase à distância, sendo determinadas as seguintes variáveis: topografia da lesão, tamanho tumoral, configuração macroscópica segundo Borrmann, grau histológico, lesão precoce ou avançada, subtipo histológico segundo Lauren, presença de células em anel de sinete, grau de invasão, status dos linfonodos perigástricos, invasão angiolinfática/perineural e estadiamento. Resultados: Foram encontradas 21 lesões precoces (12,8%) e 143 avançadas (87,2%) com predomínio de lesões T3 (n=99/60,4%) e N1 (n=62/37,8%). O status nodal esteve associado à profundidade de invasão (p<0,001) e tamanho tumoral (p<0,001). O estadiamento esteve relacionado à idade (p=0,048), grau histológico (p=0,003) e presença de células em anel de sinete (p=0,007), invasão angiolinfática (p=0,001) e invasão perineural (p=0,003). Conclusão: No adenocarcinoma gástrico, o envolvimento linfonodal, o tamanho tumoral e a profundidade de invasão são dados histopatológicos associados ao padrão de crescimento/disseminação neoplásico, sugerindo que a dissecção ampla de linfonodos perigástricos seja etapa fundamental ...

How to identify patients with increased risk of breast cancer relapse?

A cohort of 362 breast cancer patients had subtype classification accomplished using 4 immunohistochemical markers: luminal A (ER or PR positive, HER2 negative, Ki-67<14%), luminal B (ER or PR positive, HER2 negative, Ki-67≥14%), luminal HER2 (ER or PR positive, HER2 positive), HER2 enriched (ER or PR negative, HER2 positive) or triple negative (ER, PR, and HER2 negative). Multivariable Cox analysis was used to determine the risk of local (LR) or distant (DR) relapse associated with the intrinsic subtypes, adjusting for standard clinicopathologic factors. There have been a total of 124 recurrences. Triple-negative patients were associated with increased risk of LR. Luminal B subtype showed statistical tendency (P=0.053) to LR. For patients undergoing breast conservation surgery, luminal B and HER2-enriched subtypes demonstrated an increased risk to LR, and this was statistically significant on multivariable analysis. After mastectomy, there was no statistical difference between subtypes of LR or DR on multivariable analysis. Luminal A tumors are associated with a low risk of LR or DR. Despite the existence of gene expression profiling, in the current study we demonstrate that analysis of 4 immunohistochemical markers is equally effective and less expensive alternative to identify higher recurrence risk patients.