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1.
Ann Oncol ; 30(8): 1321-1328, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31125062

RESUMO

BACKGROUND: Anti-PD1/PD-L1 directed immune checkpoint inhibitors (ICI) are widely used to treat patients with advanced non-small-cell lung cancer (NSCLC). The activity of ICI across NSCLC harboring oncogenic alterations is poorly characterized. The aim of our study was to address the efficacy of ICI in the context of oncogenic addiction. PATIENTS AND METHODS: We conducted a retrospective study for patients receiving ICI monotherapy for advanced NSCLC with at least one oncogenic driver alteration. Anonymized data were evaluated for clinicopathologic characteristics and outcomes for ICI therapy: best response (RECIST 1.1), progression-free survival (PFS), and overall survival (OS) from ICI initiation. The primary end point was PFS under ICI. Secondary end points were best response (RECIST 1.1) and OS from ICI initiation. RESULTS: We studied 551 patients treated in 24 centers from 10 countries. The molecular alterations involved KRAS (n = 271), EGFR (n = 125), BRAF (n = 43), MET (n = 36), HER2 (n = 29), ALK (n = 23), RET (n = 16), ROS1 (n = 7), and multiple drivers (n = 1). Median age was 60 years, gender ratio was 1 : 1, never/former/current smokers were 28%/51%/21%, respectively, and the majority of tumors were adenocarcinoma. The objective response rate by driver alteration was: KRAS = 26%, BRAF = 24%, ROS1 = 17%, MET = 16%, EGFR = 12%, HER2 = 7%, RET = 6%, and ALK = 0%. In the entire cohort, median PFS was 2.8 months, OS 13.3 months, and the best response rate 19%. In a subgroup analysis, median PFS (in months) was 2.1 for EGFR, 3.2 for KRAS, 2.5 for ALK, 3.1 for BRAF, 2.5 for HER2, 2.1 for RET, and 3.4 for MET. In certain subgroups, PFS was positively associated with PD-L1 expression (KRAS, EGFR) and with smoking status (BRAF, HER2). CONCLUSIONS: : ICI induced regression in some tumors with actionable driver alterations, but clinical activity was lower compared with the KRAS group and the lack of response in the ALK group was notable. Patients with actionable tumor alterations should receive targeted therapies and chemotherapy before considering immunotherapy as a single agent.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/genética , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Imunológicos/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Antígeno B7-H1/antagonistas & inibidores , Antígeno B7-H1/imunologia , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/imunologia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Feminino , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Mutação , Oncogenes/genética , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Receptor de Morte Celular Programada 1/imunologia , Intervalo Livre de Progressão , Sistema de Registros/estatística & dados numéricos , Critérios de Avaliação de Resposta em Tumores Sólidos , Estudos Retrospectivos
2.
Br J Cancer ; 116(3): 287-292, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-28006819

RESUMO

BACKGROUND: The current literature indicates that a considerable number of patients in ovarian carcinoma clinical trials have histopathological diagnoses in conflict with inclusion criteria. It has been suggested that specialised pathology review prior to randomisation should become the standard procedure in study protocols. We hypothesised that our new, internet-based high-throughput infrastructure would be capable of providing specialised pathology review within 10 working days (w.d.). METHODS: Patients scheduled for the AGO OVAR17 ovarian carcinoma chemotherapy trial were registered for expert pathologic case review using a new internet-based central pathology review platform prior to randomisation. All original slides were requested from local pathologists. Slides were scanned and uploaded to a secured internet server. A network of experienced gynaecological pathologists was connected to the server through a custom-designed software platform. If deemed necessary by the expert pathologists, immunohistochemistry was available through a collaborating pathology lab. RESULTS: A total of 880 patients with an original diagnosis of ovarian epithelial carcinoma were registered for expert pathology review from October 2011 to July 2013. For case review, five gynaecopathologists from Austria, Switzerland and Germany were available online. Median number of w.d. required to complete the whole process from patient registration to transmission of final review diagnoses was 4 (range 2-31) (w.d.), and in 848 out of 880 (97.5%) cases, it amounted to ⩽10 w.d. In 2.5% (n=22) of cases, a major diagnostic discrepancy of potential clinical relevance was found leading to exclusion from the chemotherapy trial. CONCLUSIONS: Our results show that the use of a new internet-based infrastructure makes timely specialised case review, prior to patient randomisation feasible within ⩽10 w.d. Our new approach helped to protect against overtreatment with chemotherapy of patients with ovarian borderline tumours and inadequate treatment of patients with ovarian metastases, as a result of their inappropriate entry into a clinical trial designed for patients with primary ovarian carcinoma.


Assuntos
Recursos em Saúde/estatística & dados numéricos , Internet , Estadiamento de Neoplasias/normas , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Patologia Clínica/métodos , Qualidade da Assistência à Saúde , Feminino , Recursos em Saúde/organização & administração , Humanos , Estadiamento de Neoplasias/métodos , Patologia Clínica/organização & administração , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa
3.
Scand J Med Sci Sports ; 26(2): 235-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26648587

RESUMO

The King-Devick test appears to be a promising tool in screening for concussions. However, limited evidence exists on the baseline associations between the K-D test and age and baseline screening tools used after concussion. Additionally, there are no published reference values for the K-D test in high school football players. The K-D test, the Balance Error Scoring System, and the Limits of Stability (LOS) test were administered to 157 high school football players. Additionally, a subsample of 62 participants completed the test twice to examine the reliability of K-D test. There was no relationship between the K-D test and the BESS, or the reaction time and directional control of LOS test. Students aged between 16 and 18 years demonstrated faster K-D test performance compared to students between 13 and 15 years of age. However, there was no association between K-D test and history of concussion. The reliability of the K-D test was (ICC2,1 = 0.89), and the minimal detectable change was 6.10 s. Normative reference values for high school football players are presented in this study.


Assuntos
Atenção , Concussão Encefálica/diagnóstico , Testes Diagnósticos de Rotina/normas , Futebol Americano/lesões , Movimentos Sacádicos , Fala , Adolescente , Fatores Etários , Humanos , Masculino , Equilíbrio Postural , Valores de Referência , Reprodutibilidade dos Testes , Estados Unidos
5.
Br J Cancer ; 113(5): 716-21, 2015 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-26313663

RESUMO

BACKGROUND: Gastro-oesophageal adenocarcinomas rarely metastasize to the central nervous system (CNS). The role of the human epidermal growth factor receptor 2 (HER2) in patients with these cancers and CNS involvement is presently unknown. PATIENTS AND METHODS: A multicentre registry was established to collect data from patients with gastro-oesophageal adenocarcinomas and CNS involvement both retrospectively and prospectively. Inclusion in the study required a predefined clinical data set, a central neuro-radiological or histopathological confirmation of metastatic CNS involvement and central assessment of HER2 by immunohistochemistry (IHC) and in situ hybridisation (ISH). In addition, expression of E-cadherin and DNA mismatch repair (MMR) proteins were assessed by IHC. RESULTS: One hundred patients fulfilled the inclusion criteria. The population's median age was 59 years (interquartile range: 54-68), of which 85 (85%) were male. Twenty-five patients were of Asian and 75 of Caucasian origin. HER2 status was positive in 36% (95% CI: 26.6-46.2) of cases. Median time from initial diagnosis to the development of brain metastases (BMets) or leptomeningeal carcinomatosis (LC) was 9.9 months (95% CI: 8.5-15.0). Median overall survival from diagnosis was 16.9 months (95% CI: 14.0-20.7) and was not related to the HER2 status. E-cadherin loss was observed in 9% of cases and loss of expression in at least one DNA MMR proteins in 6%. CONCLUSIONS: The proportion of a positive HER2 status in patients with gastro-oesophageal adenocarcinoma and CNS involvement was higher than expected. The impact of anti-HER2 therapies should be studied prospectively.


Assuntos
Adenocarcinoma/metabolismo , Neoplasias Encefálicas/metabolismo , Neoplasias Esofágicas/metabolismo , Receptor ErbB-2/metabolismo , Neoplasias Gástricas/metabolismo , Adenocarcinoma/mortalidade , Adenocarcinoma/secundário , Idoso , Antígenos CD , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/secundário , Caderinas/metabolismo , Reparo do DNA , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia
6.
Pathologe ; 35(4): 314-21, 2014 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-24916775

RESUMO

Because of different patterns of molecular changes, a dualistic model of serous tumors is now assumed with serous borderline tumors (SBT) and low-grade serous carcinomas (LGSC) on one side and high-grade serous carcinomas (HGSC) on the other. The clinical course and the type of treatment of SBT and LGSC depend crucially on whether they are associated with extraovarian manifestations. So-called invasive implants of SBT correspond morphologically to LGSC. The MD Anderson grading system has become established for the distinction between LGSC and HGSC, HGSC shows a wide range of growth patterns, including a transitional epithelial-like type. Carcinosarcomas can be interpreted as HGSC variants. Considering the new theory that all serous neoplasms of the ovary, peritoneum and fallopian tubes are derived from the tubal fimbria, the term "ovarian carcinoma" seems no longer appropriate.


Assuntos
Cistadenocarcinoma Seroso/patologia , Neoplasias Ovarianas/patologia , Cistadenocarcinoma Seroso/classificação , Cistoadenofibroma/classificação , Cistoadenofibroma/patologia , Diagnóstico Diferencial , Tubas Uterinas/patologia , Feminino , Humanos , Gradação de Tumores , Invasividade Neoplásica , Neoplasias Ovarianas/classificação , Ovário/patologia , Peritônio/patologia , Prognóstico , Terminologia como Assunto
7.
Virchows Arch ; 462(1): 39-46, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23242173

RESUMO

KRAS mutation testing is mandatory for patients with metastatic colorectal cancer who are eligible for treatment with an epidermal growth factor receptor targeting agent, since tumors with a mutation are not sensitive to the drug. Several methods for mutation testing are in use and the need for external quality assurance has been demonstrated. An often little addressed but important issue in external quality assurance schemes is a low percentage of tumor cells in the test samples, where the analytical sensitivity of most tests becomes critical. Using artificial samples based on a mixture of cell lines with known mutation status of the KRAS gene, we assessed the reliability of a series of commonly used methods (Sanger sequencing, high resolution melting, pyrosequencing, and amplification refractory mutation system-polymerase chain reaction) on samples with 0, 2.5, 5, 10, and 15 % mutated cells. Nine laboratories throughout Europe participated and submitted a total of ten data sets. The limit of detection of each method differed, ranging from >15-5 % tumor cells. All methods showed a decreasing correct mutation call rate proportionally with decreasing percentage of tumor cells. Our findings indicate that laboratories and clinicians need to be aware of the decrease in correct mutation call rate proportionally with decreasing percentage of tumor cells and that external quality assurance schemes need to address the issue of low tumor cell percentage in the test samples.


Assuntos
Adenocarcinoma/genética , Neoplasias Colorretais/genética , Genes ras , Mutação , Proteínas Proto-Oncogênicas/genética , Garantia da Qualidade dos Cuidados de Saúde/métodos , Proteínas ras/genética , Adenocarcinoma/patologia , Contagem de Células , Linhagem Celular Tumoral , Neoplasias Colorretais/patologia , Análise Mutacional de DNA/métodos , Análise Mutacional de DNA/normas , DNA de Neoplasias/análise , Humanos , Limite de Detecção , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/normas , Reação em Cadeia da Polimerase/métodos , Reação em Cadeia da Polimerase/normas , Proteínas Proto-Oncogênicas p21(ras) , Garantia da Qualidade dos Cuidados de Saúde/normas , Reprodutibilidade dos Testes
9.
Histol Histopathol ; 25(9): 1139-47, 2010 09.
Artigo em Inglês | MEDLINE | ID: mdl-20607656

RESUMO

The differential diagnosis of malignant melanomas and atypical melanocytic nevi is still a diagnostic challenge. The currently accepted morphologic criteria show substantial interobserver variability, likewise immunohistochemical studies are often not able to discriminate these lesions reliably. Techniques that support diagnostic accuracy are of the greatest importance considering the growing incidence of malignant melanomas and their increase in younger patients. In this study we analyzed the feasibility of fluorescence in situ hybridization (FISH) analysis for the discrimination of malignant and benign melanocytic tumors. A panel of DNA probes was used to detect chromosomal aberrations of chromosomes 6 and 11. On a series of 5 clearly malignant and benign melanocytic tumors we confirmed the applicability of the test. Then we focused on examination of ambiguous melanocytic lesions, where atypical cells are often difficult to relocalize in the 4',6-Diamidino-2-phenylindol (DAPI)-fluorescence stain. FISH analyses were conducted on destained H&E-stained slides. By comparison of the DAPI-image with photos taken from the H&E stain, unambiguous assignment of the FISH results to the conspicuous groups of cells was possible. The results of FISH analysis were consistent with the conventional diagnosis in 11 of 14 small ambiguous lesions. Of the remaining 3 cases, 2 showed FISH-results close to the cut-off level. Comparison of FISH results on thin and thick sections revealed that the cut-off values have to be adapted for 2 microm destained sections. In conclusion, FISH analysis is a useful and applicable tool for assessment of even smallest melanocytic neoplasms, although there will remain unclear cases that cannot be solved even after additional FISH evaluation.


Assuntos
Hibridização in Situ Fluorescente , Melanoma/diagnóstico , Melanoma/genética , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Cromossomos Humanos Par 6/genética , Feminino , Dosagem de Genes , Humanos , Masculino , Pessoa de Meia-Idade , Nevo/diagnóstico , Nevo/genética , Adulto Jovem
11.
Br J Cancer ; 102(1): 151-61, 2010 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-19935791

RESUMO

BACKGROUND: Our aim was to investigate the prognostic and predictive value of the oncogenic MAPKK-like protein T-cell-originated protein kinase (TOPK) stratified by KRAS and BRAF mutations in patients with sporadic, hereditary and metastatic colorectal cancer (CRC) treated with anti-EGFR therapy. METHODS: Immunohistochemistry (IHC) for TOPK was performed on four study groups. Group 1 included two subgroups of 543 and 501 sporadic CRC patients used to test the reliability of TOPK expression by IHC. In Group 2, representing an additional 222 sporadic CRCs, the prognostic effect of TOPK stratified by KRAS and BRAF was assessed. The prognostic effect of TOPK was further analysed in Group 3, representing 71 hereditary Lynch syndrome-associated CRC patients. In Group 4, the predictive and prognostic value of TOPK was analysed on 45 metastatic patients treated with cetuximab or panitumumab stratified by KRAS and BRAF gene status. RESULTS: In both sporadic CRC subgroups (Group 1), associations of diffuse TOPK expression with clinicopathological features were reproducible. Molecular analysis of sporadic CRCs in Group 2 showed that diffuse TOPK expression was associated with KRAS and BRAF mutations (p<0.001) and with poor outcome in patients with either mutation in univariate and multivariate analysis (P=0.017). In hereditary patients (Group 3), diffuse TOPK was linked to advanced pT stage. In metastatic patients treated with anti-EGFR therapy (Group 4), diffuse TOPK expression was linked to dismal outcome despite objective response to treatment (P=0.01). CONCLUSIONS: TOPK expression is an unfavourable prognostic indicator in sporadic patients with KRAS or BRAF mutations and also in patients with metastatic disease experiencing a response to anti-EGFR therapies. The inhibition of TOPK, which could benefit 30-40% of CRC patients, may represent a new avenue of investigation for targeted therapy.


Assuntos
Adenocarcinoma/química , Neoplasias Colorretais/química , Proteínas Serina-Treonina Quinases/análise , Proteínas Proto-Oncogênicas B-raf/genética , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/epidemiologia , Adenocarcinoma/genética , Adenocarcinoma/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/farmacologia , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Cetuximab , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Neoplasias Colorretais Hereditárias sem Polipose/química , Neoplasias Colorretais Hereditárias sem Polipose/epidemiologia , Neoplasias Colorretais Hereditárias sem Polipose/genética , Neoplasias Colorretais Hereditárias sem Polipose/patologia , Receptores ErbB/antagonistas & inibidores , Receptores ErbB/imunologia , Feminino , Seguimentos , Regulação Neoplásica da Expressão Gênica , Genes ras , Humanos , Masculino , Pessoa de Meia-Idade , Quinases de Proteína Quinase Ativadas por Mitógeno , Variações Dependentes do Observador , Panitumumabe , Valor Preditivo dos Testes , Prognóstico , Inibidores de Proteínas Quinases/farmacologia , Inibidores de Proteínas Quinases/uso terapêutico , Distribuição Aleatória , Reprodutibilidade dos Testes , Transdução de Sinais/genética
12.
J Clin Pathol ; 62(11): 970-7, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19861557

RESUMO

There is a need for predictive biomarkers that identify non-small-cell lung cancer (NSCLC) patients most likely to respond to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) treatment. There are numerous potential candidates, although none has been proven in prospective clinical trials. The EGFR gene copy number evaluated by fluorescence in situ hybridisation (FISH) has been highlighted as one of the most effective markers for sensitivity to EGFR TKIs in large phase III, randomised placebo-controlled trials and has been used in clinical settings to assist physicians in defining the therapeutic regimen. The EGFR FISH assay has technical challenges and it is critical that detailed guidelines are provided to help clinical laboratories in performing and interpreting the test. Excellent assay reproducibility and portability rates among laboratories are crucial to guarantee that accurate clinical decisions can be made for patients with NSCLC. This article discusses the consensus outcomes of a global workshop convened to discuss key technical issues and standardise reading strategies for the EGFR FISH assay of NSCLC tumour tissue.


Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Receptores ErbB/metabolismo , Neoplasias Pulmonares/diagnóstico , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Ensaios Clínicos Fase III como Assunto , Receptores ErbB/antagonistas & inibidores , Humanos , Hibridização in Situ Fluorescente/métodos , Neoplasias Pulmonares/tratamento farmacológico , Proteínas de Neoplasias/metabolismo , Guias de Prática Clínica como Assunto , Inibidores de Proteínas Quinases/uso terapêutico
13.
J Clin Pathol ; 62(4): 357-60, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19329714

RESUMO

AIMS: PCR has been shown previously to be the most sensitive technique to detect a clonal population in marrow aspirates (MAs), and the clinical standard for evaluation of bone marrow lymphoma involvement today is bone marrow trephine biopsy (BMTB). The goal of this study was to compare morphological evaluation of B cell neoplasm in BMTB (histology and immunohistochemistry) and PCR analysis in MA, with both specimens obtained at the same time, in patients with a known molecular marker of the disease. METHODS: This was a retrospective evaluation of 98 consecutive BMTB specimens from 60 patients with a known B-cell neoplasm and a previous PCR marker of the disease (BCL2 and/or IGH). RESULTS: Considering the IGH PCR cases alone, a B cell clone was detected in 85% and 39% of the morphology (M) positive and negative groups, respectively. Five M(+), IGH(-) cases were found, including two cases of follicular lymphoma (FL), one case of diffuse large B cell lymphoma, and two cases of mantle cell lymphoma. The FLs had about 20% and 50% of BMTB involvement each. All other cases had minimal lymphoma localisation. The two FLs were also BCL2-MBR(+). Use of BCL2-MBR detected all M(+) cases and 66% of M(-) cases whenever it was an initial marker of disease. CONCLUSIONS: IGH PCR alone is not good enough for BMTB assessment, especially in FL. On the other hand, the PCR study for BCL2 is more sensitive than morphology, without any false negative results in this series, suggesting that BCL2-MBR PCR on MA can be used as an alternative and more sensitive examination for disease evaluation, providing that there is careful analysis of data, adequate knowledge of PCR pitfalls and absence of other haematological disorders.


Assuntos
Exame de Medula Óssea/métodos , Linfoma de Células B/diagnóstico , Biópsia , Medula Óssea/patologia , Genes bcl-2 , Humanos , Cadeias Pesadas de Imunoglobulinas/genética , Linfoma de Células B/genética , Linfoma de Células B/patologia , Reação em Cadeia da Polimerase/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos
14.
Anaesthesist ; 58(2): 156-62, 2009 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-18958432

RESUMO

Local anaesthetic agents (LA) in clinical concentrations have the potential for tissue toxicity, although this is rarely observed in clinical practice. The case of a 74-year-old female patient (BMI 16.8 kg/m(2)) with a metastasising bronchial carcinoma is reported, who suffered from severe back pain due to tumour infiltration. For pain management a tunnelled continuous thoracic peridural catheter (PC) was placed and a mixture of bupivacaine 0.49%, morphine 0.0036% and clonidine 0.0001% was infused at 3 ml/h. After 8 weeks of continuous infusion an ulcer developed in the soft tissue close to the thoracic spine containing whitish crystalline material (CM). A computed tomography examination revealed a subcutaneously displaced PC with extensive fluid collection reaching down to the sacrospinalis muscle. Histologically an unreactive necrosis with enclosed CM of unknown etiology was found. The result of the chemical analysis of the deposits demonstrated bupivacaine, morphine and sodium chloride. It is concluded that the soft tissue ulcer was probably caused by precipitation of the LA mixture.


Assuntos
Anestesia Epidural/efeitos adversos , Úlcera/etiologia , Idoso , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Neoplasias Brônquicas/complicações , Neoplasias Brônquicas/cirurgia , Bupivacaína/administração & dosagem , Bupivacaína/uso terapêutico , Espaço Epidural/patologia , Feminino , Humanos , Assistência de Longa Duração , Morfina/administração & dosagem , Morfina/uso terapêutico , Dor/complicações , Dor/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/patologia , Tomografia Computadorizada por Raios X , Úlcera/microbiologia , Úlcera/patologia
15.
Pathologe ; 29 Suppl 2: 363-9, 2008 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-18807040

RESUMO

AIMS: The aim of the present study was to evaluate the prognostic impact of basal and myoepithelial phenotype in breast carcinomas (BBC and MBC) in the palliative situation. METHODS: Paraffin-embedded material from 244 primary breast carcinomas of patients with subsequent metastatic disease was stained immunohistochemically for CK 5/6, CK14, smooth-muscle actin, p63, estrogen receptor and progesterone receptor. BBC was defined as positive for CK5/6 and/or CK14 and MBC as positive for SMA and/or p63. Clinical and pathological data were available for all patients and follow-up data for 96.3% (range 5 days-151 months). RESULTS: Until the end of the follow-up period 90.2% of patients died and 6.1% are still alive. Of the tumours 28.7% could be classified as BBC and 8.2% as MBC. Kaplan Meier analysis revealed a trend for reduced survival after first diagnosis of metastasis (OASM) for BBC and MBC. Differences in survival were significant for BBC (log-rank =5.0; p=0.025), but not for MBC. CK5/6+ and CK14+ double positive tumours (n=18; 7.4%) were identified as a subgroup of BBC associated with reduced OASM (log-rank=8,6; p=0.003). This subgroup, but not BBC or MBC was an independent negative prognostic factor in a multivariate analysis including age, typing, tumour size, grading, axillary nodes, HR, Her2/neu, site of first metastasis and disease-free interval. CONCLUSION: The association of BBC and MBC with reduced OASM in metastatic breast carcinomas is not independent from established prognostic factors. CK5/6+ CK14+ double positive tumours may be a subgroup of BBC with particularly unfavourable outcome.


Assuntos
Biomarcadores Tumorais/análise , Neoplasias da Mama/patologia , Carcinoma Ductal/patologia , Carcinoma Lobular/patologia , Mioepitelioma/patologia , Neoplasias Hormônio-Dependentes/patologia , Cuidados Paliativos , Receptores de Estrogênio/análise , Receptores de Progesterona/análise , Mama/patologia , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/mortalidade , Carcinoma Ductal/tratamento farmacológico , Carcinoma Ductal/mortalidade , Carcinoma Lobular/tratamento farmacológico , Carcinoma Lobular/mortalidade , Feminino , Humanos , Hibridização in Situ Fluorescente , Queratina-14/análise , Queratina-5/análise , Queratina-6/análise , Metástase Linfática/patologia , Pessoa de Meia-Idade , Mioepitelioma/tratamento farmacológico , Mioepitelioma/mortalidade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Hormônio-Dependentes/tratamento farmacológico , Neoplasias Primárias Múltiplas/tratamento farmacológico , Neoplasias Primárias Múltiplas/mortalidade , Neoplasias Primárias Múltiplas/patologia , Segunda Neoplasia Primária/tratamento farmacológico , Segunda Neoplasia Primária/mortalidade , Segunda Neoplasia Primária/patologia
16.
Histopathology ; 53(3): 299-310, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18643852

RESUMO

AIMS: To report 16 cases of sclerosing angiomatoid nodular transformation (SANT) of the splenic red pulp. METHODS AND RESULTS: Patients were selected in two phases. An initial group of seven patients was diagnosed with SANT based on the presence of angiomatoid nodules. Sheets of inflammatory fibrosis were found in three patients, resembling inflammatory pseudotumour (IPT); nine further cases of IPT were reviewed. Angiomatoid nodules were detected, leading to the diagnosis of SANT in all cases. The splenic mass (10-150 mm in diameter) was polycyclic, composed of multiple small nodules of loose connective tissue comprising myofibroblasts and a dense network of capillaries as well as some remnants of sinuses. Collagenous fibrosis surrounded them. Bands or large sheets of fibrosis, infiltrated by various inflammatory cells, particularly polytypic plasmacytes, resembling IPT, were present in 10 cases. CONCLUSIONS: SANT of the red pulp is a distinct benign pseudotumorous lesion of the spleen characterized by the presence of angiomatoid nodules. We observed such angiomatoid nodules in all our cases of splenic IPT, which were not follicular dendritic cell or myofibroblastic tumours. We therefore recommend careful examination for angiomatoid nodules in all suspected cases of splenic IPT.


Assuntos
Granuloma de Células Plasmáticas/patologia , Histiocitoma Fibroso Benigno/patologia , Baço/patologia , Neoplasias Esplênicas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiomatose/metabolismo , Angiomatose/patologia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Eur J Med Res ; 13(5): 221-8, 2008 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-18559306

RESUMO

Primary adrenal non-Hodgkin's lymphoma (PAL) is a rare neoplastic disease. Clinical symptoms are often related to the presence of lymphoma or adrenal insufficieny. Diagnostic strategies include endocrine evaluation, imaging studies and histopathological examination. In case of suspicious PAL, percutaneous CT or US-guided needle biopsy is recommended to rapidly establish diagnosis before starting chemotherapy. We report about an 84-year-old male who presented with significant weight loss and chronic lumbar pain. Abdominal CT scans revealed bilateral masses highly suggestive of malignancy. After open bilateral adrenalectomy with abdominal lymphadenectomy, histological examination showed bilateral PAL. Five months after surgery, the patient died due to progressive tumor disease.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Linfoma não Hodgkin/diagnóstico , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/terapia , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Diagnóstico Diferencial , Humanos , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/terapia , Masculino , Tomografia Computadorizada por Raios X
18.
Praxis (Bern 1994) ; 96(43): 1667-71, 2007 Oct 24.
Artigo em Alemão | MEDLINE | ID: mdl-18019178

RESUMO

At the beginning of the 21st century, pathology is dominated by the advent of new molecular techniques. Presently pathology transforms into a clinical discipline at the interface of diagnosis and therapy. In this context many physicians feel that clinical autopsies are out-dated. However, the autopsy has developed into a highly effective and meaningful tool which uses the whole array of contemporary molecular techniques ("molecular autopsy"). For the future one can expect that the clinical autopsy will remain a pivotal instrument for quality management, student teaching and continuous education, epidemiology (e.g. cancer registries) and research (e.g. for neurodegenerative diseases). By endorsing autopsies physicians show that they are open for self-criticism and have an interdisciplinary view of their profession. Since autopsies often reveal unexpected findings, which can be important for both the lives of other patients and for family members of the deceased, relatives saying yes to an autopsy show true compassion and human solidarity.


Assuntos
Autopsia , Patologia , Garantia da Qualidade dos Cuidados de Saúde , Amiloidose/diagnóstico , Amiloidose/patologia , Autopsia/história , Autopsia/métodos , Autopsia/estatística & dados numéricos , Criptococose/diagnóstico , Criptococose/patologia , Diagnóstico Diferencial , Feminino , Alemanha , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/patologia , Masculino , Pessoa de Meia-Idade , Paraproteinemias/diagnóstico , Paraproteinemias/patologia , Patologia/história , Patologia/métodos
19.
Pathologe ; 28(3): 180-6, 2007 May.
Artigo em Alemão | MEDLINE | ID: mdl-17431628

RESUMO

Despite the fact that ovarian carcinomas are phenotypically heterogeneous, they can be divided into two main groups with common pathogenetic mechanisms. Based on clinical, pathological and molecular parameters, a relatively large group of tumors can be distinguished with stepwise development from benign precursors and borderline tumors to invasive carcinomas (type I). Depending on the morphological phenotype, characteristic genetic changes can be observed, such as mutations in KRAS and BRAF in serous borderline tumors and low-grade serous carcinomas. Mutations in KRAS are also frequently detected in mucinous borderline tumors and mucinous carcinomas. The group of endometrioid tumors is characterized by mutations in components of the Wnt-signal transduction pathway and PTEN or microsatellite instability. The second large group of tumors (type II) includes tumors with "de novo" development of highly malignant carcinomas such as the conventional (moderately to poorly differentiated) high-grade serous carcinomas, undifferentiated carcinomas and malignant mixed mesodermal tumors. These tumors are associated with frequent mutations in p53 and complex chromosomal alterations. In the future, the combined analysis of morphological parameters, genetic changes, gene-expression profiling and protein data will reveal possible diagnostic and therapeutic targets for ovarian carcinomas.


Assuntos
Neoplasias Ovarianas/genética , Neoplasias Ovarianas/patologia , Feminino , Genes ras , Genótipo , Humanos , Neoplasias Ovarianas/classificação , Neoplasias Ovarianas/terapia , Fenótipo , Proteínas Proto-Oncogênicas/genética , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas p21(ras) , Proteínas ras/genética
20.
Virchows Arch ; 450(3): 355-8, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17252228

RESUMO

We describe an unusual case of ALK-1-positive primary mediastinal lymphoma with the morphology of an anaplastic large-cell lymphoma (ALCL) of T/NK cell type but expressing CD20. This tumour had T/NK morphology and immunophenotype, as demonstrated by its expression of CD30, EMA, ALK-1, CD7 and TiA-1 and the lack of expression of B-cell markers other than CD20. The significance of such a co-expression of a B cell-associated antigen in a case of ALCL of T/NK cell type is discussed.


Assuntos
Receptores de Activinas Tipo II/metabolismo , Antígenos CD20/metabolismo , Células Matadoras Naturais/patologia , Linfoma Anaplásico de Células Grandes/patologia , Neoplasias do Mediastino/patologia , Linfócitos T/patologia , Biomarcadores Tumorais/metabolismo , Criança , Humanos , Imunofenotipagem , Células Matadoras Naturais/metabolismo , Linfoma Anaplásico de Células Grandes/metabolismo , Masculino , Neoplasias do Mediastino/metabolismo , Linfócitos T/metabolismo
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