A randomised phase II study of chemoradiotherapy with or without nimotuzumab in locally advanced oesophageal cancer: NICE trial.

PURPOSE: Chemoradiotherapy is the standard treatment for patients with inoperable locally advanced oesophageal cancer. We sought to assess the safety and efficacy of chemoradiation combined with nimotuzumab, a humanised antibody directed against epidermal growth factor receptor (EGFR). PATIENTS AND METHODS: Untreated patients with inoperable locally advanced oesophageal cancer and no distant metastases were randomised to chemoradiotherapy (cisplatin and fluorouracil combined with external beam radiation) alone or in combination with nimotuzumab. The primary end-point was the endoscopic complete response (eCR) rate, and secondary end-points comprised quality of life (QoL) and safety. The combined eCR and pathologic complete response (cEPCR) and overall survival (OS) were also evaluated. RESULTS: We enrolled 107 patients with a mean age of 59 years, and 93% had squamous cell carcinoma. Toxicity was manageable in both arms with no important differences in adverse events (AEs). We performed post-treatment endoscopies in 67 patients, including 60 who had a biopsy. In the intent-to-treat population, the eCR rates with and without nimotuzumab were 47.2% and 33.3% (P = 0.17), respectively, and the cEPCR rates were 62.3% and 37.0% (P = 0.02), respectively. With a median follow-up of 14.7 months, the hazard ratio (HR) for OS was 0.68 (95% confidence interval (CI): 0.44-1.07; P = 0.09) with a median OS of 15.9 months for the nimotuzumab arm and 11.5 months for the control arm. Regarding QoL, a significant difference was observed for the physical subscale score (P = 0.03) with lower values for the control arm. CONCLUSION: Combined chemoradiotherapy plus nimotuzumab is safe for patients with locally advanced oesophageal cancer, it appears to increase the cEPCR rate, and without compromising QoL. CLINICAL TRIALS: Identification number: EF024-201; Trial registry: NCT01249352.

A CLINICAL-PATHOLOGICAL CORRELATION IN THE DIAGNOSIS OF BREAST SARCOMA / Correlação clinicopatológica no diagnóstico de sarcoma de mama

Breast sarcomas are rare tumors that are difficult to diagnose. They are characterized by a mobile and painless mass with accelerated growth. This neoplasm represents less than 1% of all breasts malignancies and less than 5% of all soft tissues sarcomas. The present publication reports the case of a 78 year old patient, who was referred to the Hospital da Cidade de Passo Fundo's Mastology Ambulatory due to a suspicious mass occupying almost the entire right breast (BI-RADS®5). The diagnosis of breast sarcoma was made through the correlation between a clinical evaluation and an anatomopathological exam, and was supplemented by an immunohistochemistry and oncologic evaluation. The patient developed lung and liver metastasis three months after surgery. This paper aimed to report an unusual case of a breast tumor and the difficulty in performing its diagnosis, even after surgery. In the end, a multidisciplinary evaluation was needed.

Sarcomas de mama são tumores raros e de difícil diagnóstico, que se apresentam como uma massa indolor, móvel e de crescimento acelerado. Essa neoplasia representa menos de 1% de todas as malignidades da mama e menos de 5% de todos os sarcomas de tecidos moles. Relata-se nesta publicação o caso de uma paciente de 78 anos, encaminhada ao Ambulatório de Mastologia do Hospital da Cidade de Passo Fundo em razão de uma massa suspeita ocupando quase a totalidade da mama direita (BI-RADS®5), que teve diagnóstico de sarcoma de mama, o qual foi obtido por meio da correlação entre avaliação clínica, exame anatomopatológico complementado por estudo imuno-histoquímico e avaliação oncológica. A paciente evoluiu com metástase pulmonar e hepática três meses após a intervenção cirúrgica. O objetivo deste trabalho foi relatar um caso inusitado de tumor de mama e a dificuldade em realizar o diagnóstico, mesmo após intervenção cirúrgica, tendo sido necessária uma avaliação multidisciplinar.

Marantic endocarditis and adenocarcinoma of unknown primary site.

Nonbacterial thrombotic endocarditis (NBTE) is a disease characterized by deposition of thrombi and fibrin on normal or degenerated cardiac valves in the absence of microorganisms. This condition is more commonly seen in chronic inflammatory states, and is associated with higher incidence of thromboembolic events than infective endocarditis. We report the case of a 63-year old male patient with adenocarcinoma of unknown primary site and systemic embolism.

Endocardite marântica e adenocarcinoma de sítio primário oculto / Marantic endocarditis and adenocarcinoma of unknown primary site / Endocarditis marántica y adenocarcinoma de sitio primario desconocido

A endocardite trombótica não bacteriana é caracterizada pela deposição de trombos e fibrina sobre valvas cardíacas normais ou degeneradas na ausência de germes. A patologia está relacionada a estados inflamatórios crônicos, com maior incidência de fenômenos embólicos quando comparada à endocardite infecciosa. Os autores relatam o caso de um paciente masculino, 63 anos, com adenocarcinoma de sítio primário oculto e embolia sistêmica.

Nonbacterial thrombotic endocarditis (NBTE) is a disease characterized by deposition of thrombi and fibrin on normal or degenerated cardiac valves in the absence of microorganisms. This condition is more commonly seen in chronic inflammatory states, and is associated with higher incidence of thromboembolic events than infective endocarditis. We report the case of a 63-year old male patient with adenocarcinoma of unknown primary site and systemic embolism.

La endocarditis trombótica no bacteriana se caracteriza por el depósito de trombos de fibrina en las válvulas cardíacas normales o degenerados en ausencia de gérmenes. La patología se relaciona con estados inflamatorios crónicos, con una mayor incidencia de fenómenos embólicos cuando comparada a endocarditis infecciosa. Los autores refieren el caso de un paciente varón, de 63 años con adenocarcinoma de sitio primario desconocido y la embolia sistémica.

Carcinoma vesical de pequenas células / Small cell carcinoma of the bladder

O carcinoma neuroendócrino de pequenas células usualmente tem como sítio primário o pulmão e a sua origem na bexiga é rara. O diagnóstico dos tumores localizados na bexiga é realizado pela biópsia através da cistoscopia ou biópsia transuretral, com posterior análise histológica e imunohistoquímica. O prognóstico é sombrio, com sobrevida média de 8% em 5 anos. O objetivo do presente trabalho é relatar um caso de carcinoma de pequenas células com sítio primário na bexiga em paciente do sexo feminino

The small cell neuroendocrine carcinoma usually has as a primary site the lung, and its origin in the bladder is rare. The diagnosis of tumors in bladder is made through biopsy by cystoscopy or transurethral biopsy with subsequent histological and immunohistochemical analyses. The prognosis is bleak, with mean survival of 8% in 5 years. Here we report a case of small cell carcinoma with primary site in the bladder in a female patient

True adrenal cyst mimicking renal cancer in a young woman: a case report.

The adrenal cyst is a rare disease that represents approximately 5% of discovered adrenal lesions, which are usually discovered incidentally. True adrenal cysts originate to cells from mesothelium. The potential of cyst adrenal to become malignant has been reported to be 7% and a radical excision of a potentially malignant mass are indicate. We report a case of a 48 year old woman that presented with pain in left hypochondrium and epigastrium, nausea, vomiting, weight loss and microscopic hematuria. After the diagnosis suspicion surgery was performed with a monoblock resection of left kidney and left adrenal gland because of kidney cancer diagnosis as considered. The microscopically analysis of surgical specimen, diagnosed a true epithelial cyst of adrenal gland.

Cordoma sacral / Sacral chordomas

Cordomas são neoplasias raras que se originam dos remanescentes da notocorda primitiva 50% dos casos têm localização sacral, sendo mais frequente ao nível de S4/S5. Nós descrevemos um caso de cordoma sacral ao nível de S1 e discutimos a apresentação clínica, achados de imagem, tratamento cirúrgico e evolução.

Chordomas are rare neoplasias originating from the remaining primitive notochord. 50% of the cases have sacral localization, being more frequent at levels S4/S5. Here we report a case of sacral chordoma at level S1 and discuss its clinical presentation, imaging findings, surgical treatment, and progress.