Carcinoma e leucemia da glândula lacrimal: a raridade num caso clinico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Malformações branquiais : revisão bibliográfica

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Amiloidose pulmonar nodular localizada : uma revisão teórica a propósito de um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

QUALIDADE DE VIDA E ESTRATÉGIAS DE ENFRENTAMENTO DE MULHERES COM E SEM LINFEDEMA APÓS CÂNCER DE MAMA

O linfedema no membro superior é uma complicação inerente ao tratamento de câncer de mama. Caracterizado pelo aumento do volume do membro, leva às limitações físicas e funcionais, e impacto negativo no âmbito psicológico e social. O objetivo deste estudo foi investigar a qualidade de vida e seus domínios, as estratégias de enfrentamento frente ao câncer de mama, e a correlação entre essas variáveis. Este estudo foi realizado em um centro de saúde dedicado às mulheres, por quatro meses. Os instrumentos de avaliação foram: questionário de caracterização geral e específico do câncer de mama, perimetria dos membros superiores; questionários de qualidade de vida da Organização Européia de Pesquisa e Tratamento do Câncer, EORTC QLQ-30 e BR-23; e Inventário de Estratégias de Coping. Foram entrevistadas 82 mulheres, idade média de 57,4 anos (DV12,3), submetidas a tratamento cirúrgico de mama unilateral e esvaziamento axilar, sem metástase. O linfedema apresentou-se em 39,03% (32) e parece não interferir muito na qualidade de vida das mulheres pós-câncer de mama, sendo a função social a mais prejudicada. Sintomas relacionados à quimioterapia e a mama incomodam as mulheres de ambos grupos, porém os sintomas relacionados aos braços foram estatisticamente maiores nas portadoras de linfedema. As estratégias mais utilizadas pelas entrevistadas para enfrentar o câncer foram a reavaliação, resolução de problemas, fuga, suporte social e autocontrole, somente o autocontrole foi estatisticamente maior nas mulheres com linfedema. As estratégias de resolução de problemas, autocontrole e baixo suporte social podem ter colaborado para o desencadeamento do linfedema. Conclui-se que o uso de estratégias ativas e positivas para enfrentar o câncer de mama parece resultar na boa adaptação psicossocial

Análise da imunoexpressão da podoplanina e da triptase em carcinoma epidermóide de língua e sua relação com parâmetros clinicopatológicos

Oral tongue squamous cell carcinoma (OTSCC) has an aggressive biological behavior, with a high propensity for the development of lymph node metastases. In this context, lymphangiogenesis is considered an important phenomenon for the spread of tumor cells and may be influenced by microenvironmental stimuli. Mast cells have been implicated in tumor progression, although their influence in the formation of lymphatic vessels is not well established. The aim of this study was to analyze, in a case series of OTSCC (n=50), possible correlations between lymphatic vessel density (LVD), mast cell count and clinicopathological features, including tumor-node-metastasis (TNM) stage, histological grade of malignancy (Bryne, 1998), and nodal metastasis. LVD was established as the mean number of lymphatic vessels immunostained by anti-podoplanin (D2-40) antibody, identified in five microscopic fields (200x). For the analysis of mast cells, tryptase-immunoreactive cells were quantified in five fields (400x). Both immunostainings were analyzed in the tumor center and invasion front. Intratumoral lymphatic density (ILD) was higher in cases in advanced clinical stages (III-IV), compared to those in initial stages (I-II), as well as in metastatic cases in respect of non-metastatic (p<0,05). There were no statistically significant differences between low-grade and high-grade malignancy cases with respect to ILD (p>0,05). Peritumoral lymphatic density (PLD) and mast cell counts showed no significant relations with any of the clinicopathological parameters evaluated (p>0,05). Also there were no significant correlations between LVD and mast cell counts, whether in intratumoral (r = -0,004; p=0,977) or peritumoral region (r = -0,154; p=0,285). The results of the present study suggest that intratumoral lymphatic vessels may contribute in part to the progression of OTSCC, although PLD may be insufficient to justify differences in biological behavior. This supports the hypothesis of involvement of other mechanisms in metastatic spread of malignant cells, which could complement the effects of lymphangiogenesis. Although mast cells perform several pro- and antitumoral functions, they do not appear to directly influence aggressiveness of OTSCC. In addition, the quantity of these cells may not be essential for lymphatic vessel formation.

Imunoexpressão da proteína endonuclease apurínica/apurimidínica (APE-1) em adenomas pleomórficos e carcinomas ex-adenomas pleomórficos

Introduction: Apurinic/Apyrimidinic Endonuclease 1 (APE-1) is an essential protein for DNA base excision repair (BER) pathway and regulation of redox activities. The ability of malignant cells to recognize and repair DNA damage is an important mechanism for tumor survival, and recent studies suggest that APE-1 overexpression is related to poor prognosis in some tumors. Purpose: To analyze the immunoreactivity of APE-1 in Pleomorphic Adenomas (PA) and Carcinomas Ex Pleomorphic Adenomas (CaExPA) of salivary glands. Materials and Methods: A total of 49 tumors fixed in formalin and embedded in paraffin (33 PA and 16 CaExPA) underwent immunohistochemical study by the immunoperoxidase technique. APE-1 immunoreactivity was evaluated quantitatively by the percentage of immunopositive cells. For statistical analysis a significance level of 5% (p≤ 0.05) was adopted. Results: All cases of PA and CaExPA (n=49) were positive for APE-1, however, there was a higher expression in CaExPA, with statistically significant difference (p<0.001). There was no association between APE-1 expression and tumors of major or minor salivary gland, however, not encapsulated PA (median expression = 54.2%) showed higher expression when compared to encapsulated tumors (p=0.02). APE-1 overexpression was found mainly in cases of CaExAP with lymph node metastasis (median expression = 90.3% - p=0.002) and invasive pattern (median expression = 89.9% - p=0.003), when compared to cases without metastasis and intracapsular pattern. Conclusion: This study suggests that APE-1 is deregulated in the studied tumors. The increased expression of APE-1 is associated with the absence of complete capsule in PA and it is associated with more aggressive behavior in CaExPA.

Imunoexpressão da proteína endonuclease apurínica/apurimidínica (APE-1) em adenomas pleomórficos e carcinomas ex-adenomas pleomórficos

Introduction: Apurinic/Apyrimidinic Endonuclease 1 (APE-1) is an essential protein for DNA base excision repair (BER) pathway and regulation of redox activities. The ability of malignant cells to recognize and repair DNA damage is an important mechanism for tumor survival, and recent studies suggest that APE-1 overexpression is related to poor prognosis in some tumors. Purpose: To analyze the immunoreactivity of APE-1 in Pleomorphic Adenomas (PA) and Carcinomas Ex Pleomorphic Adenomas (CaExPA) of salivary glands. Materials and Methods: A total of 49 tumors fixed in formalin and embedded in paraffin (33 PA and 16 CaExPA) underwent immunohistochemical study by the immunoperoxidase technique. APE-1 immunoreactivity was evaluated quantitatively by the percentage of immunopositive cells. For statistical analysis a significance level of 5% (p≤ 0.05) was adopted. Results: All cases of PA and CaExPA (n=49) were positive for APE-1, however, there was a higher expression in CaExPA, with statistically significant difference (p<0.001). There was no association between APE-1 expression and tumors of major or minor salivary gland, however, not encapsulated PA (median expression = 54.2%) showed higher expression when compared to encapsulated tumors (p=0.02). APE-1 overexpression was found mainly in cases of CaExAP with lymph node metastasis (median expression = 90.3% - p=0.002) and invasive pattern (median expression = 89.9% - p=0.003), when compared to cases without metastasis and intracapsular pattern. Conclusion: This study suggests that APE-1 is deregulated in the studied tumors. The increased expression of APE-1 is associated with the absence of complete capsule in PA and it is associated with more aggressive behavior in CaExPA.

Expressão imuno-histoquímica do ativador de plasminogênio do tipo uroquinase e seu receptor em carcinoma epidermoide de língua oral e sua relação com parâmetros clínico-patológicos

Squamous cell carcinoma (SCC ) is the most common malignancy of the oral cavity (OSCC), with a high mortality rate. Due to this, the discovery of biomarkers that facilitate the understanding of the biological behavior of the tumor and improve treatment is necessary. Urokinase type plasminogen activator (uPA) and its receptor, uPAR, are responsible for the proteolysis of structures of the basement membrana and extracellular matrix, facilitating tumor invasion. This study aims to assess the immuno expression of these proteins in 46 cases of squamous cell carcinoma of the oral tongue (OTSCC). These results were related to the presence of metastasis, clinical TNM staging, locoregional recurrence, outcome of the lesion and histological grading. Immunostaining of each case was evaluated semiquantitatively, in the front of invasion and center of the tumor, in which scores were assigned: 0 (0% of positive cells), 1 (1-10% of positive cells), 2 (11 -50% positive cells) and 3 (more than 50% positive cells). The expression of uPA was observed in 93.5% (n=43) of the cases in the front of invasion, with predominance of score 2 (n=16; 34.8%) and in 67.9% (n=31) of the cases in the center of the tumor, with predominance of score 1 (n=15; 32.6%). Overall, the immunoexpression of uPA was not associated with clinical parameters. Regarding the malignant histological grading, a higher expression of uPA was observed in cases of high-grade malignancy comp ared to low-grade malignancy (p=0.05). Regarding the morphological parameters, increased expression of uPA was observed in the worst mode of invasion (p=0.03 ). The expression of uPAR was observed in 73.9% of cases in the front of invasion, with a predominance of score 1 (n=21; 45.6 %), and in 47.5% (n=21) of the cases in the center of the tumor, with a predominance of score 0 (n=25; 54.4%). Although no statistical differences were observed in relation to lymph node metastasis, clinical TNM staging, outcome, and histological grading, there was a higher expression of uPAR in cases with locoregional recurrence (p=0.04). Regarding the tumor intra -localization, it was observed an increased expression of uPA and uPAR at the front of invasion in relation to the center of the tumor (p<0.001). Regarding the correlation between uPA and uPAR, there was no statistical sign ificance. Based on these results, it is suggested that uPA and uPAR are involved in the progression of CELO, mainly in the deeper region of the tumor.

Expressão imuno-histoquímica do ativador de plasminogênio do tipo uroquinase e seu receptor em carcinoma epidermoide de língua oral e sua relação com parâmetros clínico-patológicos

Squamous cell carcinoma (SCC ) is the most common malignancy of the oral cavity (OSCC), with a high mortality rate. Due to this, the discovery of biomarkers that facilitate the understanding of the biological behavior of the tumor and improve treatment is necessary. Urokinase type plasminogen activator (uPA) and its receptor, uPAR, are responsible for the proteolysis of structures of the basement membrana and extracellular matrix, facilitating tumor invasion. This study aims to assess the immuno expression of these proteins in 46 cases of squamous cell carcinoma of the oral tongue (OTSCC). These results were related to the presence of metastasis, clinical TNM staging, locoregional recurrence, outcome of the lesion and histological grading. Immunostaining of each case was evaluated semiquantitatively, in the front of invasion and center of the tumor, in which scores were assigned: 0 (0% of positive cells), 1 (1-10% of positive cells), 2 (11 -50% positive cells) and 3 (more than 50% positive cells). The expression of uPA was observed in 93.5% (n=43) of the cases in the front of invasion, with predominance of score 2 (n=16; 34.8%) and in 67.9% (n=31) of the cases in the center of the tumor, with predominance of score 1 (n=15; 32.6%). Overall, the immunoexpression of uPA was not associated with clinical parameters. Regarding the malignant histological grading, a higher expression of uPA was observed in cases of high-grade malignancy comp ared to low-grade malignancy (p=0.05). Regarding the morphological parameters, increased expression of uPA was observed in the worst mode of invasion (p=0.03 ). The expression of uPAR was observed in 73.9% of cases in the front of invasion, with a predominance of score 1 (n=21; 45.6 %), and in 47.5% (n=21) of the cases in the center of the tumor, with a predominance of score 0 (n=25; 54.4%). Although no statistical differences were observed in relation to lymph node metastasis, clinical TNM staging, outcome, and histological grading, there was a higher expression of uPAR in cases with locoregional recurrence (p=0.04). Regarding the tumor intra -localization, it was observed an increased expression of uPA and uPAR at the front of invasion in relation to the center of the tumor (p<0.001). Regarding the correlation between uPA and uPAR, there was no statistical sign ificance. Based on these results, it is suggested that uPA and uPAR are involved in the progression of CELO, mainly in the deeper region of the tumor.

Avaliação da eficácia da radioterapia paliativa no controlo da dor em doentes com metástases ósseas

A Radioterapia é um dos tratamentos disponíveis para tratar o cancro seja com intuito curativo ou paliativo. O objectivo da radioterapia paliativa consiste em controlar os sintomas apresentados pelos doentes com doença avançada, como por exemplo a dor provocada pela presença de metástases ósseas, que é o sintoma em estudo neste trabalho. A Radioterapia deve causar o mínimo de efeitos secundários e o mínimo desconforto possível aos doentes, não devendo aumentar a morbilidade, mas antes proporcionar maior qualidade de vida aos doentes. Recentemente, vários estudos investigaram a utilização da radioterapia em fim de vida, proporcionando uma linha orientadora nesta área, a partir das condições clínicas dos doentes submetidos a radioterapia perto do final da vida. A escolha do tema deste trabalho resulta de uma inquietação sentida no dia-a-dia, aquando da realização dos tratamentos de radioterapia a doentes paliativos com dor óssea e com mau estado geral. Exigindo a radioterapia um posicionamento e imobilização precisos e rigorosos pode, por vezes, causar algum desconforto aos doentes. No caso dos doentes com necessidades paliativas, nomeadamente com dor moderada a forte, é importante inferir acerca do real benefício de um tratamento que ao invés de promover alívio, lhes pode provocar mais dor e desconforto, indo contra às boas práticas preconizadas em cuidados paliativos. Considera-se que o tema é relevante para a melhoria dos cuidados prestados ao doente oncológico a realizar tratamentos de radioterapia, na medida em que permite realizar uma reflexão acerca da eficácia deste tratamento em fim de vida e sua aplicabilidade quando estamos perante doentes com prognóstico de vida limitado. O estudo em causa é um estudo descritivo exploratório, tendo sido realizada uma análise sistemática da informação contida nos processos electrónicos dos doentes, disponíveis na rede hospitalar, de acordo com os critérios de inclusão estabelecidos, no sentido de averiguar a eficácia do tratamento de radioterapia no alívio da dor. O estudo permitiu concluir que a radioterapia é um tratamento eficaz no controlo da dor em doentes com metástases ósseas, não vindo alterar as conclusões avançadas por outros estudos e outros autores internacionais. No entanto, é importante a realização de um prognóstico mais preciso na tomada de decisão terapêutica para que doentes que não vão beneficiar do tratamento de radioterapia possam ser referenciados para cuidados paliativos mais precocemente. Quanto à escolha do esquema terapêutico, o esquema de fracção única deveria ser mais comummente utilizado pela sua demonstrada eficácia, como o comprovam os diversos estudos referenciados neste trabalho.

Chemokine Receptor Expression on Normal Blood CD56(+) NK-Cells Elucidates Cell Partners That Comigrate during the Innate and Adaptive Immune Responses and Identifies a Transitional NK-Cell Population

Studies of chemokine receptors (CKR) in natural killer- (NK-) cells have already been published, but only a few gave detailed information on its differential expression on blood NK-cell subsets. We report on the expression of the inflammatory and homeostatic CKR on normal blood CD56(+low) CD16(+) and CD56(+high)  CD16(-/+low) NK-cells. Conventional CD56(+low) and CD56(+high) NK-cells present in the normal PB do express CKR for inflammatory cytokines, although with different patterns CD56(+low) NK-cells are mainly CXCR1/CXCR2(+) and CXCR3/CCR5(-/+), whereas mostly CD56(+high) NK-cells are CXCR1/CXCR2(-) and CXCR3/CCR5(+). Both NK-cell subsets have variable CXCR4 expression and are CCR4(-) and CCR6(-). The CKR repertoire of the CD56(+low) NK-cells approaches to that of neutrophils, whereas the CKR repertoire of the CD56(+high) NK-cells mimics that of Th1(+) T cells, suggesting that these cells are prepared to migrate into inflamed tissues at different phases of the immune response. In addition, we describe a subpopulation of NK-cells with intermediate levels of CD56 expression, which we named CD56(+int) NK-cells. These NK-cells are CXCR3/CCR5(+), they have intermediate levels of expression of CD16, CD62L, CD94, and CD122, and they are CD57(-) and CD158a(-). In view of their phenotypic features, we hypothesize that they correspond to a transitional stage, between the well-known CD56(+high) and CD56(+low) NK-cells populations.

"Da ética e da circunstância do Abjeccionismo"

Estuda-se a metástase portuguesa do surrealismo que se chamou "Abjeccionismo" do ponto de vista da circunstância política da ditadura salazarista.

Melhoria da Atenção ao Câncer de Colo de Útero e Câncer de Mama na Unidade Básica Pereira, Santa Rosa, RS

O Câncer de Colo de Útero é a 4ª causa de doença neoplásica e o Câncer de Mama é a mais frequente neoplasia em mulheres no Brasil. O objetivo deste trabalho foi realizar uma intervenção na Unidade Básica de Saúde Pereira durante três meses para prover melhorias na prevenção e a detecção precoce do câncer de mama e útero a fim de diminuir a morbidade e a mortalidade. Para realização da intervenção foram estabelecidos objetivos, metas, indicadores e ações a serem cumpridas em 4 eixos de atuação: Engajamento Público, Qualificação da Prática Clínica, Organização e Gestão do Serviço, Monitoramento e Avaliação e assim conforme manual do MS como rotina dentro da UBS. Ao final da intervenção no programa de prevenção de câncer de colo de útero foram cadastradas 170 mulheres na faixa-etária de 25-69 anos alcançando o cadastramento de 158 mulheres com percentual de 14,4%. Para o programa de câncer de mama foram cadastradas 68 mulheres totalizando 16,5%. As metas de qualidade dos exames, melhorias dos registros, avaliação dos fatores de risco para câncer de colo de útero e câncer de mama e melhorias na promoção à saúde foram alcançadas em 100%, ou seja, todas as mulheres foram avaliadas em relação a estes indicadores. Não foram encontradas mamografias e citopatológicos alterados, logo não foi realizado a busca ativa. A intervenção permitiu uma melhoria na saúde da mulher, trouxe mais conhecimento à equipe e à população e assim permitiu uma maior reflexão sobre a importância de realizar os exames e fazer a detecção precoce do câncer de colo de útero e câncer de mama e assim diminuir a morbidade e mortalidade por estas patologias.