Spontaneous rupture of ovarian cystadenocarcinoma: pre- and post-rupture computed tomography evaluation

AbstractEpithelial ovarian tumors are the most common malignant ovarian neoplasms and, in most cases, eventual rupture of such tumors is associated with a surgical procedure. The authors report the case of a 54-year-old woman who presented with spontaneous rupture of ovarian cystadenocarcinoma documented by computed tomography, both before and after the event. In such cases, a post-rupture staging tends to be less favorable, compromising the prognosis.

Chest magnetic resonance imaging: a protocol suggestion

Abstract In the recent years, with the development of ultrafast sequences, magnetic resonance imaging (MRI) has been established as a valuable diagnostic modality in body imaging. Because of improvements in speed and image quality, MRI is now ready for routine clinical use also in the study of pulmonary diseases. The main advantage of MRI of the lungs is its unique combination of morphological and functional assessment in a single imaging session. In this article, the authors review most technical aspects and suggest a protocol for performing chest MRI. The authors also describe the three major clinical indications for MRI of the lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation.

In vitro multiplication of Tabernaemontana fuchsiaefolia L. (Apocynaceae)

This study describes a simple and promising for in vitro multiplication of Tabernaemontana fuchsiaefolia, a species abundantly found in southern Brazil utilized for medicinal purposes and as a source of compounds that may be used to develop new synthetic drugs. Apical and hypocotyl explants were cultured in MS medium containing different concentrations of the cytokinins benzylaminopurine (BA) and 6-furfurylaminopurine (kinetin), supplemented with phloroglucinol (1, 3, 5-hydroxybenzene) to stimulate growth and shoot proliferation. Cytokinin added to the culture media positively influenced the micropropagation of T. fuchsiaefolia.and kinetin induced more shoots per explant than BA cytokinin. A favorable effect of phloroglucinol on apical and lateral buds from hypocotyls was also achieved in medium containing no kinetin or in all kinetin concentrations tested. Short pulses of auxin 3-indolebutyric acid (IBA) 5.0 mg/l resulted in satisfactory rooting in apical microcuttings. The addition of phloroglucinol to MS medium induced rhizogenesis in 29% of the nodal segments transferred to MS medium in the absence of IBA and in 50% of the nodal segments transferred to MS medium containing 0.5 mg/l IBA and in nodal segments previously submitted to short pulses of IBA.

Micropropagação de Cabralea canjerana

A Cabralea canjerana (Vell.) Mart. (Meliaceae) (canjarana) é uma espécie arbórea nativa brasileira importante para fornecimento de madeira de boa qualidade. As sementes desta espécie não podem ser armazenadas por muito tempo e, por tanto, existe a necessidade do desenvolvimento de técnicas alternativas de propagação como a micropropagação. Neste trabalho, foram realizados experimentos de multiplicação utilizando segmentos nodais, retirados de plantas germinadas in vitro. Os segmentos foram inoculados em meio de cultura MS ou WPM, adicionado de 6-benzilaminopurina (BAP) e, ou, 2-isopenteniladenina (2-iP) nas concentrações de 2,5 ou 5 µM. Microestacas de rebrotas foram colocadas em meio de cultura MS/2, com a metade da concentração dos sais do meio MS, adicionado de ácido indol 3-butírico (AIB) (0, 2,5 e 5 µM). Após sete dias, foram transferidas para meio MS/2 sem auxina e na luz. Na fase de multiplicação, o meio de cultura MS foi mais adequado que o meio WPM. O segmento nodal, em presença de 2,5 µM de BAP, propiciou um dos melhores resultados, com uma taxa de multiplicação de 1,77 por mês, em meio de cultura MS. O enraizamento das microestacas oriundas de rebrotas foi de 87,5% em presença de 5 µM de AIB durante sete dias. A aclimatização foi realizada em casa de vegetação e proporcionou 90% de sobrevivência das mudas após 30 dias. A micropropagação da canjarana a partir de segmentos nodais de mudas cultivadas in vitro é viável para a multiplicação dessa espécie.

Estabelecimento, multiplicação e alongamento in vitro de Eucalyptus benthamii Maiden & Cambage x Eucalyptus dunnii Maiden

Neste trabalho foram testadas diferentes concentrações de cloro ativo (NaOCl) na assepsia de explantes para o estabelecimento in vitro, bem como benzilaminopurina (BAP) e ácido naftalenoacético (ANA) para a multiplicação e alongamento de Eucalyptus benthamii x Eucalyptus dunnii. As minicepas fornecedoras de propágulos para introdução in vitro foram conduzidas em minijardim clonal sob sistema semi-hidropônico. Segmentos nodais dos clones H12, H19 e H20 foram desinfestados com 0,5; 1,0; 1,5; e 2,0% (v/v) de cloro ativo durante 10 min e inoculados em meio de cultura MS. Na obtenção de brotações múltiplas, utilizou-se o meio de cultura ½MS suplementado com 0; 0,25; 0,50; 0,75; e 1,0 mg L-1 de BAP. Na fase de alongamento, utilizou-se o meio de cultura ½MS com 0; 0,25; 0,50; 0,75; e 1,0 mg L-1 de ANA. Não houve interação entre os fatores estudados, obtendo-se 45%, 46% e 66% de estabelecimento do clone H12, H19 e H20, respectivamente. A concentração de BAP que resultou na maior proliferação de gemas axilares para o clone H12 aos 60 dias foi estimada na faixa de 0,25 e 0,30 mg L-1. Aos 60 dias, a faixa entre 0,25 e 0,75 mg L-1 de ANA promoveu o maior número de brotações alongadas do clone H12.

Ultrastructural calli analysis of Inga vera Willd. subsp. Affinis (DC.) T.D. Penn

Subcellular changes are relevant to understand plant organogenesis and embryogenesis in the early stages of cell development. The cytology during cell development in tissue culture is however still poorly characterized. This study aimed to characterize the ultrastructural differences related to callogenesis of anthers, ovaries, leaf and nodal segments of Inga vera Willd. subsp. Affinis (DC.) T.D. Penn. Flower buds, nodal segments and leaves were disinfected and inoculated in test tubes containing MS medium with 3% sucrose and 4.5µM 2.4-D, except for leaf callogenesis, where 9µM of this auxin was used, and for the callogenesis of anthers and ovaries, where the culture medium was enriched with 0.25% activated charcoal and 90µM PVP. After 45 days in culture medium, the anther, ovary, leaf and nodal segment calli were fixed in Karnovisky and prepared for visualization by scanning and transmission electron microscopy. Ultrastructural differences were observed among the callus cells of anthers, ovaries, segments and leaves. There was no evidence of somatic embryo formation in the anther, leaf and nodal segment calli, in spite of some embryogenic characteristics in the cells. The ovary calli, with indications of embryo formation, seem to be the most responsive explant source for embryogenesis.

Conduta terapêutica atual no adenocarcinoma da cárdia e da junção esofagogástrica

Adenocarcinomas of the cardia and gastroesophageal junction are peculiar entities with three different origins, which differ somewhat from other adenocarcinomas of the stomach in their clinical presentation and pathogenesis, and have a poorer prognosis. In this article the authors reviewed definitions, incidence and epidemiology, etiologic factors, genetic implications, clinical presentation, diagnosis, staging and treatment, with emphasis on the surgical approach, discussing the current management of these cancers. The prognostic factors related specifically to the cardia cancers are: esophageal invasion greater than 3cm, microscopic residual tumor and wall penetration (>T2). Preoperative workup should include computed tomography, and endoscopic ultrasonography and laparoscopy when available. Preoperative recognition of T3/ T4/N2 lesions should indicate inclusion in neo-adjuvant protocols whenever possible. The authors present the results of 46 resected cases of adenocarcinomas of the cardia and GE junction of the Instituto Nacional do Câncer- Brazil (1981-1995). Cure was intended in 29 and palliation in 17 patients. The most common type of resection was total gastrectomy with abdominal esophagectomy (28 cases). Morbidity (major and minor) occurred in 50% of the patients. The main causes were of respiratory origin and fistulas (19.6% each). Death occurred in 44% of the patients with fistula. Postoperative death until the 30th day occurred in 17.24% of the curative cases and in 23.52% of the palliative ones. The median survival time was 68.5 months for stage I, 25 months for stage II, 31 months for stage III and 12.5 months for stage IV diseases. The median survival time was 8 months for palliation and 28.5 months for cure. No long-term survival was obtained with the palliative group, whereas 25% survived five years of more in the curative group. The authors conclude that the surgical approach should be the one the surgeon feels more comfortable with. Complete removal of the disease proved by frozen section, splenectomy and D2 lymphadenectomy should be the standard therapy with curative intent.

Papiloduodenectomia como alternativa terapêutica para tumores papilares

The papiloduodenectomy is a procedure that, although accomplished rarely, has its validity in selected cases of papillary tumors. It is included in this group the patients with important diseases that doesn't have conditions of supporting the surgery of Whipple, the standard procedure for these pathologies. The authors review its experience with four patient carriers of malign neoplasia of the duodenal papila submitted to papiloduodenectomy. All the patients came jaundiced to the admission. The age varied of 62 to 82 years. The ultrassonography, the computed tomography and the endoscopy with biopsy were used for diagnosis and staging, and all the patients presented with initial stages (TI or T2). Two patients were classified as ASA3 and the other two as ASA4, according to the American Society of Anesthesiology. All the diagnoses were proven by the pathological exam of the surgical piece. It is ended that this procedure facilitates to obtain appropriate margins and satisfactory results when indicated of appropriate way.

Pseudotumor de pâncreas por corpo estranho

The diagnosis of pancreatic masses represents a great challenger for imaging studies. However the occurrence of pancreatic masses have been reported more frequently in the last years due to advances in imaging diagnostic methods. During the last decade, the surgical approach of pancreatic masses was limited to an attempt of establishing histological diagnosis, staging and evaluation of resection of these masses. Recently, the approach and staging of pancreatic masses was facilitated by sophisticated methods of diagnosis, especially, ultrasound, dynamic computerized tomography, magnetic resonance imaging (/RM), angiography, endoscopic retrograde cholangiopancreatography (CPRE), endoscopic ultrasound, laparoscopy and biochemical tumors markers. The present paper reports a case of a pancreatic mass due to foreign body in which the imaging study helped to determine out this rare etiological agent that has not been previouly described in literature.

Descoberta simultânea de carcinomatose disseminada e carcinoma de cólon, após colecistectomia laparoscópica

A particularly rapid and fatal outcome has been noted in cases of malignant soft-tissue metastases occurring after cancer surgery. Abdominal wall metastases occurring in scars after laparotomy for cancer resection show a similar poor outcome. On the other hand, neoplasm seeding at trocar sites after laparoscopy has been reported with an increasing frequency. A case is presented of a 68-years-old woman with metastatic seeding of non-diagnosed colon cancer at the umbilical trocar site used for a laparoscopic cholecystectomy. The gallbladder was extracted through the umbilical incision. Pathological examination confirmed chronic cholecystitis. Eight months latter, the patient was seen with a tender umbilical mass protruded through a 4,5 cm the umbilical incision site. Biopsies of this tissue were taken and histopathological examination showed metastatic adenocarcinoma, probably of a gastrointestinal origin. A colonoscopy performed at the same time revealed a 2-cm lesion at the hepatic flexur which was shown to be a differentiated adenocarcinoma. An 8.0 x 6.0 x 6.0-cm pelvic mass without signs of liver metastases was identified by computerised tomography. Diagnostic laparoscopy showed a diffuse peritoneal carcinomatosis. The pelvis could not be approached, except for simple biopsy, and no surgical procedure was performed. It is presumed that the primary colon cancer existed prior to cholecystectomy. Laparoscopy is the procedure of choice to perform cholecystectomy and fundoplication. It has also been increasingly used to diagnose, resect and perform the staging of malignant tumours. As in any relatively new technique, questions arising about its safety and risk of complications must be extensively studied. Many questions about the specific features of laparoscopy promoting cancer growth remain unanswered.

Sarcoma epitelióide: aspectos clínicos, fatores prognósticos e sobrevida

OBJETIVO: Descrever os aspectos epidemiológicos, clínicos, o tratamento e o prognóstico dos pacientes com sarcoma epitelióide. MÉTODOS: Revisão do prontuário de 25 pacientes matriculados no INCA com o diagnóstico de sarcoma epitelióide, no período de 05 de junho de 1987 à 15 de julho de 2005. RESULTADOS: A idade mediana foi de 33 anos, variando de 10 à 70 anos. A localização primária mais freqüente foi os membros superiores em doze casos (48%). O tamanho do tumor foi descrito em 19 casos e a mediana foi de 5cm, variando de 1,5 à 15cm. A cirurgia foi realizada em dezessete pacientes com onze amputações. As margens cirúrgicas estavam livres em quinze pacientes, comprometidas em três e em sete não foram relatadas. Seis receberam tratamento com algum tipo de quimioterapia e quatorze receberam tratamento com radioterapia com dose mediana de 46,5Gy. Recidiva local ocorreu em treze casos (52%). Recidiva nodal foi diagnosticada em nove pacientes (36%). Metástase pulmonar foi diagnosticada em sete pacientes (28%). Seis pacientes realizaram o tratamento oncológico na sua totalidade no INCA. Atualmente doze estão vivos sem doença, dois estão vivos com doença e onze pacientes foram a óbito. CONCLUSÃO: O sarcoma epitelióide é um subtipo raro de sarcoma de partes moles que apresenta alta taxa de recidiva local, regional e metástase à distância. Incide principalmente nas extremidades de pacientes jovens. O tratamento cirúrgico consiste em ressecção alargada com margens livres.

Percutaneous core biopsy of palpable breast lesions: accuracy of frozen section histopathological exam in the diagnosis of breast cancer

OBJECTIVE: to evaluate the accuracy of frozen section histopathology from fragments of tissue obtained by percutaneous core needle biopsy of palpable tumors in the diagnosis of breast cancer. METHODS: a cohort study was performed on 57 patients with palpable tumors and suspected breast cancer undergoing percutaneous thick needle core biopsy. The fragments were analyzed by the same pathologist. RESULTS: frozen section diagnosed 16 benign cases (28.6%) and 40 malignant (71.4%), whereas paraffin showed that 15 were benign (26.8%) and 41 malignant (73.2%). Histopathological examinations were concordant in 55 cases and there was one false-negative (6.2%). Statistics rates were: negative predictive value of 93.8%, positive predictive value of 100%, no false-positive (0%), one false negative (6.2%), specificity of 100%, sensitivity of 97 6%; observed agreement = 98.2%; expected agreement = 59.9%, Kappa = 0.955 [ 95% CI = 0.925-0.974, p < 0.01 ]. CONCLUSIONS: frozen section histopathological findings showed excellent correlation with the findings by the technique in paraffin in the fragments of palpable breast tumors obtained by thick needle percutaneous core biopsy (98.2% accuracy). Therefore, in these patients, it was possible to anticipate the diagnosis, staging and the breast cancer treatment planning.

Lymph node metastasis in early gastric cancer

OBJECTIVE: to evaluate the incidence of lymph node metastasis in early gastric cancer, identifying risk factors for its development. METHODS: we conducted a prospective study of patients with gastric cancer admitted to the Section of the Esophago-Gastric Surgery of the Surgery of Service HUCFF-UFRJ, from January 2006 to May 2012. RESULTS: the rate of early gastric cancer was 16.3%. The incidence of nodal metastases was 30.8% and occurred more frequently in patients with tumors with involvement of the submucosa (42.9%), in those poorly differentiated (36.4%), in tumors larger than 2 cm (33.3%) and in type III ulcerated lesions (43.8%). CONCLUSION: the incidence of lymph node metastases in patients was very high and suggests that one should keep the radicality of resection in early gastric cancer, particularly in relation to D2 lymphadenectomy, recommended for advanced gastric cancer. Conservative resections, with lymphadenectomies smaller than D2, should be performed only in selected cases, well-studied as for the risk factors of lymph node metastasis. Despite the small number of cases did not permit to relate the rate of lymph node metastasis to the risk factors considered, we noted a strong tendency for the occurrence of these metastases in the poorly differentiated, type III, larger than 2 cm tumors, and in the Lauren diffuse types.

Evolution in the profile of thyroid cancer cases treated in an oncology reference service: what changed in the last 20 years

Objective: To evaluate the characteristics of thyroid carcinoma cases treated at a reference hospital for cancer between 2008 and 2010.Methods: we studied 807 cases and analyzed the following clinicopathologic variables: symptoms, risk factors, diagnostic tests, staging, histological type, treatment performed and complications.Results: Females were more affected, with 660 cases (82%). The average age at diagnosis was 44.5 years. Prior exposure to ionizing radiation was reported by 22 (3%) patients, a family history of thyroid cancer by 89 (11%), and 289 (36%) individuals reported other types of cancer in the family. The fine needle aspiration biopsy was the main parameter for surgical indication and was suggestive of carcinoma in 463 patients (57%). Papillary carcinoma was the most common histological type, with 780 cases (96.6%). There were 728 (90%) total thyroidectomies, 43 (5.3%) reoperations or partial thyroidectomies followed by totalization, 23 (2.8%) extended thyroidectomies and only 13 (1.6%) partial thyroidectomies (lobectomy with isthmectomy). Neck dissection associated with thyroidectomy was done in 158 patients (19.5%). We observed a predominance of tumors classified as T1 in 602 (74.6%) patients. Transient hypocalcemia was the most frequent complication.Conclusion: The results show that the worldwide increase in the incidence of thyroid cancer has changed the profile of patients seen at a referral service. In addition, there were changes in the type of surgical treatment used, with increased use of total thyroidectomy in relation to partial and subtotal ones, and decreased use of elective neck dissections.

Evaluation of outpatient discharge in patients with cutaneous melanoma

OBJECTIVE: to evaluate discharge in a group of patients with cutaneous melanoma according to recently established criteria. METHODS: we conducted an observational, cross-sectional study with 32 patients at the Hospital Universitário Clementino Fraga Filho (HUCFF) / Universidade Federal do Rio de Janeiro (UFRJ), between 1995 and 2013, in the following stages: IA (17 cases, 53.12%), IB (4 cases, 12.5%), IIA (3 cases, 9.37%), IIC (1 case, 3.12%), IIIB (1 case, 3.12%), IIIC (3 cases, 9.37%), melanomas in situ (2 cases, 6.25%), Tx (1 case, 3.12%). RESULTS: the follow-up time varied from one to 20 years (stage IA), five to 15 years (stage IB), six to 17 years (stage IIA), 20 years (stage IIC), 23 years (stage IIIB) and 14 to 18 years (stage IIIC). One melanoma in situ (subungueal) was discharged in the fourth year of follow-up and the other was promptly discharged. The Tx melanoma was followed for 12 years. We observed no relapses or recurrences in the period. CONCLUSION: although a controversial issue, it was possible to endorse the discharge of the patients since our follow-up time had already exceeded the one recommended by the other authors.