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Unfortunately, one of the author name was wrongly published in the original publication. The complete correct name should read as follows "Beatriz Camargo Azevedo". The original article was updated.
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BACKGROUND: Neoadjuvant chemoradiation therapy (nCRT) for rectal cancer may lead to cure. As we currently lack reliable methods to clinically confirm the absence of disease, some patients undergo radical resection and have pathological complete response (pCR) still undergo surgery. Furthermore, it is uncertain if conventional one-level histopathological analysis is accurate enough to determine complete response. Confirming pCR is essential to determine the prognosis and to consider the patient's inclusion in trials of adjuvant therapy. The aim of this study was to determine whether the current 1-level approach is sufficient to confirm pCR. METHODS: Four hundred and thirty-five patients with rectal cancer who received nCRT followed by radical resection were analyzed. All cases identified as pCR by 1-level step section histological evaluation were reassessed with 3-level step sections and immunohistochemical analysis to verify the presence of residual disease. RESULTS: Out of 435 patients, 75 (17.2%) were staged as ypT0. Of these, 6 had lymph node involvement and 1 had distant metastasis, leaving 68 (15.6%) who had pCR. After the additional step sections, residual tumor was detected in 12 (17.6%) of these 68. The final pCR rate was 12.9%. Distant recurrence was detected in 7.1% of real-pCR patients compared to 16.7% in the false-pCR group (p = 0.291). Sensitivity of clinical assessment for detecting pCR was 35.7%, and the accuracy of 1-section histological evaluation to identify pCR was 82.4%. CONCLUSIONS: Histopathological analysis with 1-level step section is insufficient to determine complete tumor eradication. The 3-level sections methodology revealed residual tumor cells in patients initially classified as ypT0. Further studies with larger sample size are required to verify the clinical relevance of these residual tumor cells. Caution should continue to be applied to watch and wait strategies following nCRT.
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Quimiorradioterapia Adjuvante/métodos , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/diagnóstico , Neoplasia Residual/diagnóstico , Neoplasias Retais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasia Residual/patologia , Prognóstico , Estudos Prospectivos , Neoplasias Retais/terapia , Reto/patologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
In order to assess further biological evidence for similarities among the "diagnostic classes" of cervical lesions, which are now a matter of international discussion in the search for a uniform classification, the purpose of this study was to characterize the immunoexpression of cell proliferation markers (proliferating cell nuclear antigen, PCNA and Ki-67) and protein p53. Each marker was individually quantified in basal, intermediate, and superficial epithelial compartments presenting chronic cervicitis (CC) accompanied by the cytopathic effects of infection by human papillomavirus (CCHPV) or not (CC), as well as in cervical intraepithelial neoplasia (CIN) grades I, II, and III. A total of 100 patients were evaluated and the positive nuclei were counted separately, including all extensions of the available epithelium. The percentage of PCNA- and Ki-67-positive cells increased with increasing grade of the cervical lesions, although PCNA immunoreactivity was always greater than the immunoreactivity observed with Ki-67 antigen. The immunoexpression of p53 protein was found to be weak, with no remarkable behavior in any specific "diagnostic class". The differences in cell proliferation markers found herein further emphasize the progressive loss of epithelial layer organization in the course of the development of preneoplastic changes in cervical squamous epithelium. Furthermore, difficulties in morphologically distinguishing "borderline lesions" persist when cell cycle markers are studied, further supporting the suggestion to consider the lesions of CCHPV and CIN I together as only one diagnostic class. Conversely, the different immune profile found between CIN II and III further supports the validity of the subdivision of CIN into three groups.
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Regulação da Expressão Gênica , Antígeno Ki-67/biossíntese , Antígeno Nuclear de Célula em Proliferação/biossíntese , Proteína Supressora de Tumor p53/biossíntese , Doenças do Colo do Útero/metabolismo , Biomarcadores Tumorais , Biópsia , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patologia , Divisão Celular , Núcleo Celular/química , Transformação Celular Neoplásica , Transformação Celular Viral , Doença Crônica , Progressão da Doença , Células Epiteliais/metabolismo , Feminino , Regulação Neoplásica da Expressão Gênica , Genes p53 , Humanos , Antígeno Ki-67/genética , Proteínas de Neoplasias/biossíntese , Proteínas de Neoplasias/genética , Papillomaviridae , Infecções por Papillomavirus/genética , Infecções por Papillomavirus/metabolismo , Infecções por Papillomavirus/patologia , Antígeno Nuclear de Célula em Proliferação/genética , Infecções Tumorais por Vírus/genética , Infecções Tumorais por Vírus/metabolismo , Infecções Tumorais por Vírus/patologia , Doenças do Colo do Útero/classificação , Doenças do Colo do Útero/genética , Doenças do Colo do Útero/patologia , Neoplasias do Colo do Útero/classificação , Neoplasias do Colo do Útero/genética , Neoplasias do Colo do Útero/metabolismo , Neoplasias do Colo do Útero/patologia , Cervicite Uterina/metabolismo , Cervicite Uterina/patologia , Displasia do Colo do Útero/classificação , Displasia do Colo do Útero/genética , Displasia do Colo do Útero/metabolismo , Displasia do Colo do Útero/patologiaRESUMO
OBJECTIVE: To alert the pediatricians about a disease caused by herbal teas considered harmless. METHODS: Report of a case of Hepatic Veno-Occlusive Disease in a child and review of the literature (MEDLINE and LILACS). RESULTS: Description of a case of a sudden beginning portal hypertension, secondary to Hepatic Veno-Occlusive Disease in a 2 year and 5 month-old-patient, coming from Cruz Alta-RS-Brazil, after a chronic consumption of herbal tea called "maria-mole" (Senecio brasiliensis), which contains pyrrolizidine alkaloids, known as hepatotoxic. After an adequate treatment, the patient presented a complete clinical and laboratorial recovery, and nowadays he doesnt show any symptoms anymore. CONCLUSIONS: Prevention of this disease depends on its divulgation among physicians and the general population, and the knowledge of toxic effects of many "innocuous" teas.
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We report a case of mixed intranasal infection caused by Fusarium solani and a zygomycete, with probable sinus and brain involvement. The patient had chronic myelogenous leukaemia and was treated with chemotherapy. Diagnosis of the infection was established by direct examination of the intranasal eschar and histopathological study of an excisional biopsy. Only F. solani was isolated from both specimens. Difficulties in diagnosis and treatment of these infections are discussed.
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Fungos/isolamento & purificação , Fusarium/isolamento & purificação , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Micoses/microbiologia , Cavidade Nasal , Doenças Nasais/microbiologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
We report a case of renal cell carcinoma that metastasized to the pancreas 7 years after the initial excision. The primary and the metastatic tumors were histologically similar. Upper gastrointestinal bleeding was the leading symptom in the present case and the cause of the patient's death.
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Carcinoma de Células Renais/secundário , Neoplasias Renais/patologia , Neoplasias Pancreáticas/secundário , Idoso , Carcinoma de Células Renais/complicações , Hemorragia/etiologia , Hemorragia/mortalidade , Humanos , Masculino , Neoplasias Pancreáticas/complicaçõesRESUMO
Multiple site biopsy specimens from 153 patients were examined retrospectively for the presence of gastritis and Helicobacter-like organisms (HLO). Chronic gastritis was classified as superficial gastritis, diffuse antral gastritis, postgastrectomy (reflux) gastritis, diffuse corporal atrophic gastritis, and multifocal atrophic gastritis. In some cases technical problems did not make possible to define the type of chronic gastritis and we introduce the terms unclassified gastritis and minimal inflammatory changes to name those cases. In our opinion they represent superficial biopsies from cases of diffuse antral gastritis. Diffuse antral gastritis was found in 60% of patients followed by multifocal atrophic gastritis found in 20% of patients. HLO was searched in histological sections stained by a modified Giemsa stain. The typical curved bacilli were seen in the gastric mucus or closely attached to the top of superficial or foveolar epithelial cells in 83% of patients. Although we have noted high correlation between activity of chronic gastritis and infection by HLO such correlation was not possible between the degree of activity and the degree of infection.