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PURPOSE: This study aimed to validate the classification of breast cancer (BC) patients in progression risk groups based on total tumor load (TTL) value to predict lymph node (LN) affectation after neo-adjuvant systemic therapy (NAST) obtained in the NEOVATTL study. METHODS/PATIENTS: This was an observational, retrospective, international, multicenter study including patients with infiltrating BC who received NAST followed by sentinel lymph node biopsy (SLNB) analyzed with one-step nucleic acid amplification (OSNA) from nine Spanish and two Italian hospitals. Patients were classified into three groups according to the progression risk, measured as disease-free survival (DFS), based on TTL values (> 250, 250-25,000, and > 25,000 copies/µL). The previous (NEOVATTL study) Cox regression model for prognosis was validated using prognostic index (PI) and Log ratio test (LRT) analyses; the value of TTL for axillary non-SLN affectation was assessed using receiver operating characteristic (ROC) curves. RESULTS: We included 263 patients with a mean age of 51.4 (± SD 10.5) years. Patients with TTL > 25,000 copies/µL had a shorter DFS (HR 3.561 [95% CI 1.693-7.489], p = 0.0008 vs. TTL ≤ 25,000). PI and LRT analyses showed no differences between the two cohorts (p = 0.2553 and p = 0.226, respectively). ROC analysis showed concordance between TTL and non-SLN involvement (area under the curve 0.828), with 95.7% sensitivity and 92.9% specificity at a TTL cut-off of > 15,000 copies/µL. CONCLUSIONS: In BC patients who had received NAST and underwent SLNB analysis using OSNA, a TTL value of > 25,000 copies/µL was associated with a higher progression risk and > 15,000 copies/µL was predictive of non-SLN involvement.

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El sarcoma de Ewing o también llamado tumor neuroectodérmico primitivo es una entidad muy rara, cuyo diagnóstico se realiza con la utilización de estudios de inmunohistoquímica, su comportamiento es muy agresivo con una supervivencia limitada. Se presenta el caso de un paciente masculino de 18 años de edad que consultó por presentar un tumor renal, se le realizó nefrectomía radical con diagnóstico definitivo de sarcoma de Ewing extra esquelético. Esta es una patología quirúrgica poco frecuente, lo que nos motivó a su presentación y a la revisión de la literatura.

The Ewing sarcoma is also denominated primitive neuroectodermic tumor and is considered how a rare entity, the diagnostic is realize with the utilization of immunohistochemestry study’s, his clinical curse is very aggressive with a limite superlife. We presented and study a clinical case of a sex male patient of 18 years old which consult us for present a renal tumor. He underwent a radical nefrectomy with a definitive diagnostic of extra osseous Ewing sarcoma. This is a less frequent surgical pathology, we motive us to present and review the literature.

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OBJECTIVE: Phyllodes tumor of the prostate is a rare neoplasm. We report the clinical, histopathological, and immunohistochemical features of a low grade phyllodes tumor of the prostate with lung metastases. METHODS: A 68-year-old man presented acute urinary obstruction. Suprapubic prostatectomy was performed, and one month later he developed acute urinary obstruction, shortness of breath and cough. RESULTS: Microscopically, the prostatic tumor showed elongated ducts and cellular stroma. Lung biopsy was composed of stromal cells with enlarged, hyperchromatic nuclei. CONCLUSION: This case represents a typical low grade prostatic phyllodes tumor to lung. Grading of these neoplasm is not always of value to predict patient prognosis.

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La presencia de células tumorales en médula ósea en pacientes con cáncer de mama no metastático ha sido reportada en la literatura internacional, sin embargo, su valor pronóstico no está claro. El presente es el primer estudio nacional dirigido a determinar la incidencia de este hallazgo en nuestros pacientes y establecer su significado al relacionarlo con factores pronósticos conocidos. Se analizó la médula ósea de 40 pacientes con cáncer de mama no metastático que acudieron a la consulta de patología mamaria del Instituto Oncológico “Dr. Luis Razetti” entre enero de 2005 y abril de 2006. Las muestras fueron analizadas con hematoxilina-eosina e inmunohistoquímica con la aplicación de anticuerpos anticitoqueratina y se determinó la relación entre la presencia de células tumorales asiladas en médula ósea y los factores pronósticos conocidos. De las pacientes estudiadas, un 8 por ciento presentaron células tumorales aisladas en médula ósea; y este hallazgo se relacionó desde el punto de vista estadístico con el tamaño tumoral, estadio de la enfermedad, estado de los receptores hormonales. Durante el seguimiento de estas pacientes no se evidenció recaída sistémica. En pacientes con cáncer de mama no metastático es posible detectar células tumorales aisladas en aspirados de médula ósea y este hallazgo parece estar relacionado con factores pronósticos conocidos. Sin embargo, el impacto de este nuevo elemento evaluado en el pronóstico de las pacientes y su utilidad en la toma de decisiones terapéuticas está por definirse.

The presence of isolated tumor cells in non metastatic breast cancer patients has been reported in the international literature, however its prognostic values is actually not clear. The present work is the first national report to determinate these find and his incidence in our patients, the objetive was to determine the relationship between this isolated tumour cells and the knowing prognostic factors. We analyzed the bone marrow of 40 patients with non metastatic breast cancer whom accede to the breast cancer department consult of the “Dr. Luis Razetti” Oncology Institute, between the years January 2005 and April 2006. The specimens were analized with hematoxilin-eosin and an inmunohystochemistry with the application of the anticytokeratin antiboides and the determination of the relationship between the presence of isolated tumor cells and known prognostic factors was established. Of the studied patients the bone marrow study reported isolated tumour cells in 8 % of the patients and this finding was statistically related with the tumour size, the pathological stage and the hormonal receptors status. During the following time no systemic recurrence was reported in our patients. In patients with non metastatic breast cancer it is possible to detect isolated tumor cells in bone marrow and this finding seems to be related with some known prognostic factos, however the impact of this new element in the prognosis of the patients and its utility in the therapeutic decisions making needs to be defined.

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La endometriosis pélvica se refiere a implantes endometriósicos en las trompas de Falopio, ovarios peritoneo pélvico; la extrapélvica a otras áreas del cuerpo, incluyendo vagina, vulva, cuello uterino, periné, canal inguinal, sistema urinario, tracto gastrointestinal, pulmones, extremidades, piel, sistema nervioso central. El tejido endometriósico raramente sufre transformación maligna, ocurriendo en 0,7 por ciento - 1 por ciento de casos, está frecuentemente asociado a patología ovárica. Presentamos el caso de paciente 41 años, antecedente de episiotomía durante el parto y miomectomía a los 31 años. Refería desde 1 año previo a consultar, aumento de volumen, dolor en región perineal y glútea derecha, progresivo; y sangrado genital cíclico. La biopsia con aguja gruesa confirmó el diagnóstico prequirúrgico de lesión perineal. Ingresa al servicio de ginecología del Hospital Vargas de Caracas con los diagnósticos: 1. Tumor pélvico: hematometra vs. tumor de ovario, 2. Tumor sólido de fosa isquiorrectal derecha: Adenocarcinoma endometrioide moderadamente diferenciado. La laparotomía ginecológica reportó: Útero ausente, ovario izquierdo: quiste endometriósico, ovario derecho: quiste folicular, apéndice con focos de endometriosis. La evolución fue tórpida presentando a los 6 meses metástasis hepática falleciendo a los 8 meses del posoperatorio. Los criterios que definen una neoplasia de origen endometriósico son: endometriosis íntimamente asociada con el cáncer, histología del cáncer compatible con origen del tejido endometrial, ausencia de otra neoplasia primaria. La transformación maligna en endometriosis extraovárica es rara (60 casos informados hasta 1990), 90 por ciento de carcinomas son de tipo endometrioide.

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Demostrar que existen factores clínicopatológicos para predecir metástasis ganglionares axilares en tumores de mama de más o menos 20 mm, de diámetro y también que la disección axilar es un procedimiento innecesario en la mayoría de estas pacientes, que puede omitirse con seguridad en aquellas pacientes con factores pronósticos favorables. Se realiza un estudio retrospectivo, revisándose los reportes macroscópicos, microscópicos, e inmunohistoquímica en los bloques celulares de pacientes con carcinoma mamario de tamaño hasta 20 mm tratadas en el Instituto Oncológico "Dr. Luis Razzeti", entre enero 2000 y diciembre de 2003, determinándose factores que influyen en la aparición de metástasis axilares, realizándose análisis de uni y multivariables. El trabajo consistió en una población de 121 pacientes, con una edad media de 57 años, 50 (41,32 por ciento) que presentaron metástasis ganglionar axilar; los factores que se relacionaron con ganglios axilares positivos en el análisis de univariables fueron: grado histológico y nuclear, invasión linfovascular, índice mitótico elevado y tumores aneuploides (P< 0,05). En el análisis de multivariables, la invasión linfovascular y el índice mitótico, elevado y la aneuploidía fueron los factores independientes para predecir metástasis axilar (P< 0,001). La invasión linfovascular es el principal factor predictivo de metástasis ganglionar axilar en cáncer de mama clasificado como T1, esto combinado con otros factores como índice mitótico y ploidía tumoral, nos pueden indicar a que pacientes se les puede omitir con seguridad la disección axilar y evitar así las complicaciones.

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OBJECTIVE: Primary extragonadal germ cell tumors are rare and their histogenetic origin is not clear. We describe two cases presenting as primary retroperitoneal germ cell tumors without clinical evidence of testicular tumor. METHODS: A 21 and 18 years-old patients presented retroperitoneal choriocarcinoma and yolk sac tumor, respectively. In both cases, testicular palpation was not suspicious for testicular cancer. Testicular ultrasound founded alterations in right testes. RESULTS: A right orchitectomy were performed and the final diagnostics were mature teratoma associated with intratubular malignant germ cell. CONCLUSION: Adult mature teratoma is infrequent and the retroperitoneal germ cell tumors should be considered to be metastases of a viable or burned-out testicular cancer.

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OBJECTIVE: Ewing's sarcoma/Primitive neuroectodermal tumor (ES/PNET) is an extraordinarily rare primary tumor in the kidney. We re-port herein the clinical, histological, and immunohisto-chemical features of a primary renal ES/PNET. METHODS: A 19-year old male referred a two weeks history of constant, colic, left flank pain, and fever. A left radical nephrectomy was performed. Gross pathologic examination showed pink-tan, lobulated solid tumor, localized at the superior pole. RESULTS: Histologically, the tumor was solid with necrosis. The neoplastic cells showed a small amount of clear cytoplasm, and had vesicular nuclei with small nucleoli. Immunohistochemical studies showed strongly and diffusely positive staining for CD99 in a membranous pattern. CONCLUSIONS: This case represents a typical ES/ PNET affecting a young male patient. Adequate diagnosis is important because this neoplasm has an aggressive behaviour.

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OBJECTIVES: Numerous commercial assays are available for measuring total and free prostate-specific antigen (PSA) levels in serum. These assays can be referenced to different laboratory standards, and interassay variability occurs. Patients and physicians might be affected by the variability between PSA assays that results from the use of different PSA standards. METHODS: We prospectively compared the free and total PSA measurements obtained using two commercially available PSA assays in 103 participants from a prostate cancer screening program in Caracas, Venezuela. We recommended biopsy to men with a total PSA level of 3 to 10 ng/mL and a free/total PSA ratio of 20% or less with either assay. We compared the sensitivity, specificity, and concordance index between the two assays to assess the effects of interassay variability on the cancer detection rate and clinical outcomes. RESULTS: Although the total PSA results were similar between the assays, the free PSA level was significantly greater with one assay. Therefore, the free/total PSA ratio was discordant between the two assays, resulting in different biopsy recommendations and cancer detection rates. CONCLUSIONS: Using a free/total PSA ratio of 20% or less as the threshold for biopsy, the differences in assay sensitivity and specificity for detecting prostate cancer are significant. Commercially available assays for PSA and its derivatives are not necessarily interchangeable, and these differences might lead to different clinical outcomes. When using free and total PSA measurements to make clinical decisions, patients and physicians should be aware of the potential standardization bias and which assay is being used.

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