Impact of microvascular invasion on 5-year overall survival of resected non-small cell lung cancer.

OBJECTIVES: Non-small cell lung cancer (NSCLC) is an incidental and aggressive type of cancer. Although curative treatment can be offered, the recurrence rate is relatively high. Identifying factors that have a prognostic impact may guide changes in the staging system and recommendations for adjuvant therapy. The aim of this study was to evaluate the impact of microvascular invasion on the 5-year overall survival (OS) of patients with resected NSCLC treated at a reference cancer center. METHODS: This retrospective, observational cohort study included patients diagnosed with early-stage NSCLC (clinical stages I-IIIA), treated with curative-intent surgery at the Brazilian National Cancer Institute between 2010 and 2016. RESULTS: The dataset comprised 91 surgical patients, mostly females and white, with a mean age of 62 years (range between 29-83). Cases were distributed as stages I, II, and III in 55%, 29%, and 16%. Adenocarcinoma was the predominant histological subtype (67%), and microvascular invasion was present in 25% of the patients. The 5-year OS probability was 60% (95% CI, 48.3-68.9). Among all characteristics, advanced stages (p = 0.001) and the presence of microvascular invasion (p< 0.001) were related to a worse 5-year OS. After adjusting for age group and pathological stage, the presence of microvascular invasion was associated with a 4-fold increased risk of death (HR 3.9, 95% CI, 1.9-8.2). CONCLUSION: The presence of microvascular invasion was an independent factor related to worse survival and, therefore, should be routinely assessed in resected specimens.

Impact of microvascular invasion on 5-year overall survival of resected non-small cell lung cancer / Impacto da invasão microvascular na sobrevida global em 5 anos do câncer de pulmão não pequenas células ressecado

ABSTRACT Objectives: Non-small cell lung cancer (NSCLC) is an incidental and aggressive type of cancer. Although curative treatment can be offered, the recurrence rate is relatively high. Identifying factors that have a prognostic impact may guide changes in the staging system and recommendations for adjuvant therapy. The aim of this study was to evaluate the impact of microvascular invasion on the 5-year overall survival (OS) of patients with resected NSCLC treated at a reference cancer center. Methods: This retrospective, observational cohort study included patients diagnosed with early-stage NSCLC (clinical stages I-IIIA), treated with curative-intent surgery at the Brazilian National Cancer Institute between 2010 and 2016. Results: The dataset comprised 91 surgical patients, mostly females and white, with a mean age of 62 years (range between 29-83). Cases were distributed as stages I, II, and III in 55%, 29%, and 16%. Adenocarcinoma was the predominant histological subtype (67%), and microvascular invasion was present in 25% of the patients. The 5-year OS probability was 60% (95% CI, 48.3-68.9). Among all characteristics, advanced stages (p = 0.001) and the presence of microvascular invasion (p< 0.001) were related to a worse 5-year OS. After adjusting for age group and pathological stage, the presence of microvascular invasion was associated with a 4-fold increased risk of death (HR 3.9, 95% CI, 1.9-8.2). Conclusion: The presence of microvascular invasion was an independent factor related to worse survival and, therefore, should be routinely assessed in resected specimens.

RESUMO Objetivos: O câncer de pulmão não pequenas células (CPNPC) é um tipo incidental e agressivo de câncer. Embora o tratamento curativo possa ser oferecido, a taxa de recidiva é relativamente alta. A identificação de fatores que têm impacto prognóstico pode orientar mudanças no TNM e recomendações para terapia adjuvante. O objetivo deste estudo foi avaliar o impacto da invasão microvascular na sobrevida global (SG) em 5 anos de pacientes com CPNPC ressecado tratados em um centro de referência em câncer. Métodos: Este estudo de coorte retrospectivo e observacional incluiu pacientes diagnosticados com CPNPC em estágio inicial (estágios clínicos I-IIIA), tratados com cirurgia com intenção curativa no Instituto Nacional de Câncer entre 2010 e 2016. Resultados: Foram incluídos 91 pacientes tratados com cirurgia, a maioria mulheres e brancos, com média de idade de 62 anos (variação entre 29-83). Os casos foram distribuídos em estágios I, II e IIIA em 55%, 29% e 16%. Adenocarcinoma foi o subtipo histológico predominante (67%), e a invasão microvascular esteve presente em 25% dos pacientes. A probabilidade de SG em 5 anos foi de 60% (IC 95%, 48,3-68,9). Dentre todas as características analisadas, estágios mais avançados (p = 0,001) e a presença de invasão microvascular (p < 0,001) foram relacionados a uma pior SG em 5 anos. Após ajustar para faixa etária e estágio patológico, a presença de invasão microvascular foi associada a um aumento de 4 vezes no risco de morte (RR 3,9, IC 95%, 1,9-8,2). Conclusão: A presença de invasão microvascular foi um fator independente relacionado a uma pior sobrevida e, portanto, deve ser avaliada rotineiramente em espécimes ressecados.

Reduction in Renal Specimen After Laparoscopic Radical Nephrectomy: A Histopathologic Analysis.

Abstract Background and Purpose: There is no consensus on the most appropriate way to extract the kidney after laparoscopy. A previous study evaluated the reduction in total kidney volume and incision size (40%) after perfusion with a 5% hypertonic solution in a porcine model. The purpose of the current study was to compare the histopathologic renal tumor diagnosis before and after this perfusion. Furthermore, fluid drained from the renal vein was analyzed for the presence of neoplastic cells. Materials and Methods: After radical nephrectomy, specimens of 21 cases of renal tumors were studied. A small piece of the tumor was removed and fixed in formaldehyde. After that, 500 mL of a 5% NaCL solution was infused through the renal artery. The first 10 mL drained from the vein was collected and sent for cytologic study. The specimens and the fragment were analyzed. The parameters studied were histologic subtypes, Fuhrman grade, necrosis, and microvascular invasion. Results: Clear-cell renal carcinoma was found in 81% of the cases. Two cases of chromophobic renal carcinoma, one case of papillary tumor, and one case of oncocytoma were found. There were no differences in histologic subtypes, Fuhrman grade, necrosis, and microvascular invasion before and after perfusion in most of the cases. All cytologic analysis of drained liquid from the renal vein was negative for neoplastic cells. Conclusions: Renal perfusion with 5% NaCL solution after laparoscopic radical nephrectomy did not interfere with the histopathologic and cytologic characteristics of the kidney. In addition, all samples from the liquid drained from the renal vein were negative for neoplastic cells. These findings suggest that renal shrinkage with hypertonic saline after laparoscopic radical nephrectomy is feasible and might be useful for patients with kidney cancer. Validation of our results as well as their impact on clinical outcomes is warranted.

Examining ERBB2 as a candidate gene for susceptibility to leprosy (Hansen’s disease) in Brazil

Leprosy remains prevalent in Brazil. ErbB2 is a receptor for leprosy bacilli entering Schwann cells, which mediates Mycobacterium leprae-induced demyelination and the ERBB2 gene lies within a leprosy susceptibility locus on chromosome 17q11-q21. To determine whether polymorphisms at the ERBB2 locus contribute to this linkage peak, three haplotype tagging single nucleotide polymorphisms (tag-SNPs) (rs2517956, rs2952156, rs1058808) were genotyped in 72 families (208 cases; 372 individuals) from the state of Pará (PA). All three tag-SNPs were associated with leprosy per se [best SNP rs2517959 odds ratio (OR) = 2.22; 95% confidence interval (CI) 1.37-3.59; p = 0.001]. Lepromatous (LL) (OR = 3.25; 95% CI 1.37-7.70; p = 0.007) and tuberculoid (TT) (OR = 1.79; 95% CI 1.04-3.05; p = 0.034) leprosy both contributed to the association, which is consistent with the previous linkage to chromosome 17q11-q21 in the population from PA and supports the functional role of ErbB2 in disease pathogenesis. To attempt to replicate these findings, six SNPs (rs2517955, rs2517956, rs1810132, rs2952156, rs1801200, rs1058808) were genotyped in a population-based sample of 570 leprosy cases and 370 controls from the state of Rio Grande do Norte (RN) and the results were analysed using logistic regression analysis. However, none of the associations were replicated in the RN sample, whether analysed for leprosy per se, LL leprosy, TT leprosy, erythema nodosum leprosum or reversal reaction conditions. The role of polymorphisms at ERBB2 in controlling susceptibility to leprosy in Brazil therefore remains unclear.

Examining ERBB2 as a candidate gene for susceptibility to leprosy (Hansen's disease) in Brazil.

Leprosy remains prevalent in Brazil. ErbB2 is a receptor for leprosy bacilli entering Schwann cells, which mediates Mycobacterium leprae-induced demyelination and the ERBB2 gene lies within a leprosy susceptibility locus on chromosome 17q11-q21. To determine whether polymorphisms at the ERBB2 locus contribute to this linkage peak, three haplotype tagging single nucleotide polymorphisms (tag-SNPs) (rs2517956, rs2952156, rs1058808) were genotyped in 72 families (208 cases; 372 individuals) from the state of Pará (PA). All three tag-SNPs were associated with leprosy per se [best SNP rs2517959 odds ratio (OR) = 2.22; 95% confidence interval (CI) 1.37-3.59; p = 0.001]. Lepromatous (LL) (OR = 3.25; 95% CI 1.37-7.70; p = 0.007) and tuberculoid (TT) (OR = 1.79; 95% CI 1.04-3.05; p = 0.034) leprosy both contributed to the association, which is consistent with the previous linkage to chromosome 17q11-q21 in the population from PA and supports the functional role of ErbB2 in disease pathogenesis. To attempt to replicate these findings, six SNPs (rs2517955, rs2517956, rs1810132, rs2952156, rs1801200, rs1058808) were genotyped in a population-based sample of 570 leprosy cases and 370 controls from the state of Rio Grande do Norte (RN) and the results were analysed using logistic regression analysis. However, none of the associations were replicated in the RN sample, whether analysed for leprosy per se, LL leprosy, TT leprosy, erythema nodosum leprosum or reversal reaction conditions. The role of polymorphisms at ERBB2 in controlling susceptibility to leprosy in Brazil therefore remains unclear.

Torus palatinus: a graft option for alveolar ridge reconstruction.

The reconstruction of the alveolar ridge with particulate bone collected from the torus palatinus is presented in this case report. Bone loss at the maxillary right permanent central incisor was rehabilitated with an implant-supported fixed prosthesis. The success of this approach demonstrates that the torus palatinus and torus mandibularis, found in approximately 20% and 27% of the population, respectively, are feasible options for bone regeneration, with several advantages compared to other sources of bone. Thus, surgeons should look for these bony growths, which result in surgery with less morbidity when included in the treatment plan.

Tumor de Frantz: relato de dois casos: medidas terapêuticas e prognóstico / Frantz tumor: report of 2 cases: therapeutic measures and prognosis

Säo apresentados dois casos de um tumor pancreático raro (tumor de Frantz), que se encontravam em estágios evolutivos distintos, enfatizando a complexidade no estabelecimento de um diagnóstico anatomopatológico preciso. Exige-se abordagem cirúrgica agressiva, sempre que possível, devido ao excelente prognóstico. Discutem-se, ainda, a apresentaçäo clínica e origem histológica, bem como os fatores prognósticos e uma nova abordagem terapêutica, visando a conduçäo das metástases hepáticas que eventualmente apresentam.

Concordância diagnóstica e definiçäo das margens de ressecçäo entre a biópsia de congelaçäo e a parafina para tumores de pele / Diagnostic accuracy and definition of marginal compromise in malignant skin tumors. A comparison between frozen and paraffin sections

O presente estudo avaliou a concordância diagnóstica, bem como a definiçäo das margens de ressecçäo, através de exame anatomopatológico pelos métodos de congelaçäo e inclusäo em parafina para tumores de pele com diagnóstico clínico de carcinoma basocelular (CBC) e carcinoma espinocelular (CEC). Foram realizadas biópsias excisionais cujas margens de ressecçäo estenderam-se 5 mm além dos limites clínicos apresentados pelos tumores. Os resultados obtidos mostraram a eficiência do método de congelaçäo para definir as margens de ressecçäo para os dois tipos de tumores analisados. A concordância diagnóstica entre os métodos pela congelaçäo e pela parafina ocorreu em 99 das 104 biópsias excisionais realizadas (95 por cento). Houve apenas um diagnóstico falso-positivo e quatro diagnósticos falso-negativos

Tumor de células da granular da mama / Granullar cell tumor of the breast. A case report

O tumor de células da granular da mama é patologia benigna pouco frequente, que pode simular clínica, mamográfica e histologicamente o carcinoma. Os autores relatam caso em mulher de 72 anos e realizam revisäo bibliográfica dessa entidade nosológica

Hemangiomas hepáticos: análise de 103 casos; consideraçöes clínicas e dos métodos de imagem / Hepatic hemangioma: analysis of 103 cases; clinical and image methods considerations

Hemangiomas sao neoplasias vasculares benignas, mais comumente detectadas no fígado. Expoem-se a experiência com 103 pacientes portadores desta lesao, consecutivamente examinadas no Centro Terapêutico Especializado em fígado do Hospital Beneficência Portuguesa da Sao Paulo. A incidência desta lesao predominou em pacientes do sexo feminino, entre 40 e 60 anos de idade, na sua maioria assintomáticos (66 por cento) e localizados no lobo direito (74 por cento). Sao descritos seus aspectos observados nos diferentes métodos de imagens, tais como ultra-sonografia, tomografia computadorizada, ressonância nuclear magnética e angiografia seletiva da artéria hepática. Tais características permitiram, uma vez adotados critérios radiológicos clássicos, serem eficazmente diferenciados de outros lesoes nodulares benignas ou malignas que ocupam espaço no fígado.

Hemorragia digestiva baixa após quimioterapia na doença leucêmica: relato de caso / Gastrointestinal bleeding after chemotherapy in leukemic disease: a case report

A hemorragia digestiva baixa é uma complicaçäo que com frequência pode acometer pacientes leucêmicos submetidos a tratamento quimioterápico. Qualquer segmento do trato gastrointestinal pode estar acometido nestas situaçöes, sendo no entanto o cólon direito o principal sítio dos processos inflamatórios. Relatamos um caso de paciente portador de úlcera hemorrágica de cólon direito como complicaçäo de quimioterapia no tratamento da doença leucêmica. Discutimos a etiologia dessa lesäo, assim como suas dificuldades diagnósticas e opçöes terapêuticas frente à urgência hemorrágica

Adenocarcinoma em esôfago de Barrett. Evoluçäo tardia após correçäo cirúrgica do refluxo gastro-esofágico / Adenocarcinoma in Barrett's esophagus. Evolution after surgical correction of gastroesophageal reflux

A regressäo do epitélio metaplásico do "Esofago de Barrett" e a reversäo do potencial para desenvolvimento de lesäo maligna após a correçäo cirúrgica do refluxo gastro-esofageano permanecem questöes controversas. É relatado um caso de malignizaçäo do epitélio colunar metaplásico diagnosticado seis anos após correçäo cirúrgica da hérnia hiatal e do refluxo gástrico esofágico (ER) associado a esofagite complicada por metaplasia de epitélio colunar (Esôfago de Barrett). A referida correçäo cirúrgica da ER pela técnica de Lind foi seguida de completo desaparecimento dos sintomas. O paciente engordou 10 quilos nos primeiros meses de pós-operatório e näo mais retornou para realizar o exame endoscópico e controle clínico como fora orientado, por estar assintomático. Cerca de seis anos após retornou referindo disfagia progressiva que se iniciara três meses antes. O exame endoscópico constatou estenose ao nível da transiçäo esôfago-gástrica e a biópsia dirigida do local revelou adenocarcinoma. Realizou-se imediatamente esofagectomia e esofagogastroplastia. O exame anátomo-patológico confirmou adenocarcinoma com inflitraçäo da camada muscular esofágica e de dois gânglios regionais comprometidos pela neoplasia (Estádio III). Verificou-se junto ao câncer epitélio esofágico metaplásico com áreas de displasia moderada. Os autores discutem o potencial maligno do "Esôfago de Barrett" e o papel da correçäo cirúrgica do refluxo gastro-esofageano para reverter tanto as alteraçöes histológicas como seu potencial de malignizaçäo. Destacam a necessidade de se observar controle esdoscópico rigoroso no portador de Esôfago de Barrett, quer se faça a correçäo do refluxo gastro-esofageano ou näo, com vistas à detecçäo precoce da neoplasia aí assestada