Prognostic value of the diagnostic criteria distinguishing endometrial stromal sarcoma, low grade from undifferentiated endometrial sarcoma, 2 entities within the invasive endometrial stromal neoplasia family

The World Health Organization (WHO 2003) recognizes 3 endometrial stromal neoplasms: noninvasive endometrial stromal nodule and the 2 invasive neoplasms, endometrial stromal sarcoma (ESS), low grade and undifferentiated endometrial sarcoma (UES). It is important to note that the WHO 2003 does not define moderate atypia (an important differentiating diagnostic criterion for ESS, low grade and UES), nor does it discuss its significance. Moreover, studies on reproducibility and additional prognostic value of other diagnostic features in large are lacking. Using strict definitions, we analyzed the agreement between routine and expert-review necrosis and nuclear atypia in 91 invasive endometrial stromal neoplasias (IESN). The overall 5-year and 10-year recurrence-free survival rate estimates of the 91 IESN patients were 82% and 75%, respectively. Necrosis was well reproducible, and nuclear atypia was reasonably well reproducible. The 10-year recurrence-free survival rates for necrosis absent/inconspicuous versus prominent were 89% and 45% (P<0.001) and those for review-confirmed none/mild, moderate, severe atypia were 90%, 30%, and <20% (P<0.00001). Therefore, cases with moderate/severe atypia should be grouped together. Nuclear atypia and necrosis had independent prognostic values (Cox regression). Once these features were taken into account, no other feature had an independent additional prognostic value, including mitotic count. Using "none/mild atypia, necrosis absent/inconspicuous" as ESS, low grade versus "moderate/severe atypia present or necrosis present" as UES resulted in 68 ESS, low grade and 23 UES cases with disease-specific overall mortality-free survival of 99% versus 48% (P<0.00001, hazard ratio=45.4). When strictly defined microscopic criteria are used, the WHO 2003 diagnoses of ESS, low grade and UES are well reproducible and prognostically strong. © 2012 International Society of Gynecological Pathologists.

Mortalidade por câncer de boca e condição sócio-econômica no Brasil

Chronic non-communicable diseases represent a major public health problem, requiring more effective investigation and control by government agencies. The aim of this study was to correlate the mortality rate for oral cancer in Brazilian State capitals from 1998 to 2002 with socioeconomic factors collected in the 2000 census, using an ecological study design. Data were obtained from the Mortality Information System from 1998 to 2002. Social factors were taken from the Brazilian Human Development Atlases. After data collection, statistical analysis was performed using Pearson's correlation index. The findings included positive and significant correlations among the socioeconomic indicators (Municipal Human Development Index - MHDI, MHDI-income, MHDI-education, MHDI-life expectancy, and per capita income), and negative and significant correlations with the socioeconomic indicators Gini Index and infant mortality. Despite the study’s limitations and probable underreporting in less developed State capitals, the study found significant statistic correlations between the selected socioeconomic indicators and the oral cancer mortality rate___________________________RESUMO As doenças crônico-degenerativas representam um grande problema de saúde pública, necessitando de levantamento e controle mais efetivos destas enfermidades por parte dos órgãos públicos. O objetivo deste estudo foi correlacionar os índices de mortalidade por câncer oral nas capitais do Brasil no período de 1998 a 2002 com indicadores sócio-econômicos do Censo Demográfico de 2000 , por meio de um estudo do tipo ecológico. Os dados foram extraídos do Sistema de Informação de Mortalidade (Ministério da Saúde/DATASUS), para os anos de 1998-2002. Os indicadores sócio-econômicos foram obtidos a partir do Atlas do Desenvolvimento Humano no Brasil. Após coleta dos dados, a análise estatística foi realizada usando-se o índice de correlação de Pearson. Observaram-se corre- lações positivas e significativas entre os indicadores sócio-econômicos (Índice de Desenvolvimento HumanoMunicipal – IDH-M, IDH-M renda, IDH-M educação, IDH-M longevidade e renda per capita), e correlação negativa e significante para os indicadores sócio-econômicos índice de Gini e mortalidade infantil. Apesar das limitações do estudo e da provável problemática de sub-registros nas capitais menos desenvolvidas, o presente trabalho encontrou correlações estatisticamente significantes entre os indicadores sócio-econômicos selecionados e o índice de mortalidade por câncer oral

Brooke-Spiegler Syndrome - an underrecognized cause of multiple familial scalp tumors: report of a new germline mutation

BACKGROUND: Brooke-Spiegler syndrome (BSS) is probably an underdiagnosed genodermatosis that predisposes for the development of cylindromas, spiradenomas and trichoepitheliomas mainly of the head and neck. Wide phenotypic variability regarding the number and type of lesions can be observed within a family. Mutations of the CYLD gene are identified in the vast majority of cases and play a key role in BSS pathogenesis. MAIN OBSERVATIONS: Two first degree relatives with numerous erythematous telangiectatic nodules of the scalp present for decades, with recurring tendency regardless the multiple previous excisions. Histopathological review of the lesions revealed predominantly "spiradenocylindromas" in the proband and cylindromas in her sister. The suspicion of BSS was confirmed after detection of a new nonsense germline mutation of CYLD (c.1783C>T pGln 595*) in the proband. CONCLUSIONS: BSS diagnosis can be challenging and is based on clinical-pathological correlation, positive familial association and identification of CYLD mutations. CYLD exerts antineoplastic effects by downregulating intracellular NF-κB signalling pathways. The reported mutation affecting the ubiquitin-specific protease domain leads to a truncated and catalytically inactive enzyme. Despite the expanding list of CYLD mutations no firm genotype-phenotype correlation is known so far. Early recognition and treatment of BSS avoid disfiguring changes like "turban tumor".

Cancer diagnosis disclosure from Portuguese physicians

OBJECTIVE: Doctor-patient communication in oncology, particularly concerning diagnostic disclosure, is a crucial factor related to the quality of the doctor-patient relationship and the psychological state of the patient. The aims of our study were to investigate physicians' opinions and practice with respect to disclosure of a cancer diagnosis and to explore potential related factors. METHOD: A self-report questionnaire developed for our study was responded to by 120 physicians from Coimbra University Hospital Centre and its primary healthcare units. RESULTS: Some 91.7% of physician respondents generally disclosed a diagnosis, and 94.2% were of the opinion that the patient knowing the truth about a diagnosis had a positive effect on the doctor-patient relationship. A need for training about communicating with oncology patients was reported by 85.8% of participants. The main factors determining what information to provide to patients were: (1) patient intellectual and cultural level, (2) patient desire to know the truth, and (3) the existence of family. SIGNIFICANCE OF RESULTS: Our results point to a paradigm shift in communication with cancer patients where disclosure of the diagnosis should be made part of general clinical practice. Nevertheless, physicians still experience difficulties in revealing cancer diagnoses to patients and often lack the skills to deal with a patient's emotional responses, which suggests that more attention needs to be focused on communication skills training programs.

NOD2 mutations and colorectal cancer - Where do we stand?

Due to the overwhelming burden of colorectal cancer (CRC), great effort has been placed on identifying genetic mutations that contribute to disease development and progression. One of the most studied polymorphisms that could potentially increase susceptibility to CRC involves the nucleotide-binding and oligomerization-domain containing 2 (NOD2) gene. There is growing evidence that the biological activity of NOD2 is far greater than previously thought and a link with intestinal microbiota and mucosal immunity is increasingly sought after. In fact, microbial composition may be an important contributor not only to inflammatory bowel diseases (IBD) but also to CRC. Recent studies have showed that deficient NOD2 function confers a communicable risk of colitis and CRC. Despite the evidence from experimental models, population-based studies that tried to link certain NOD2 polymorphisms and an increase in CRC risk have been described as conflicting. Significant geographic discrepancies in the frequency of such polymorphisms and different interpretations of the results may have limited the conclusions of those studies. Since being first associated to IBD and CRC, our understanding of the role of this gene has come a long way, and it is tempting to postulate that it may contribute to identify individuals with susceptible genetic background that may benefit from early CRC screening programs or in predicting response to current therapeutic tools. The aim of this review is to clarify the status quo of NOD2 mutations as genetic risk factors to chronic inflammation and ultimately to CRC. The use of NOD2 as a predictor of certain phenotypic characteristics of the disease will be analyzed as well.

Mortalidade por câncer de boca e condição sócio-econômica no Brasil

BORGES,D. M. L.et al. Mortalidade por câncer de boca e condição sócio-econômica no Brasil.Cad. Saúde Pública, Rio de Janeiro, v.25,n.2, p.321-327, fev, 2009

Reacções adversas a fármacos com manifestações na mucosa oral

Existe uma grande quantidade de fármacos que provocam reacções adversas na mucosa oral. Os efeitos que causam são variados, nomeadamente angioedema, língua pilosa nigra, bruxismo, síndrome da boca ardente, candidose, queilite, xerostomia, eritema multiforme, hiperplasia gengival, glossite, halitose, hiperpigmentação das mucosas, hipersalivação, reações liquenóides, lupóides, penfigóides e tipo pênfigo, osteonecrose, tumefação das glandulas salivares, alterações do paladar, ulcerações, mucosite e lesões potencialmente malignas, entre outras. Com o presente trabalho pretende-se criar uma base de dados que facilite a pesquisa dos diferentes efeitos adversos e relação com a terapêutica prescrita ao paciente, de modo a auxiliar a vida ao Médico Dentista no contexto da prestação de serviços aos seus Utentes.

Generation and Characterisation of a Canine EGFP-HMGA2 Prostate Cancer In Vitro Model

The architectural transcription factor HMGA2 is abundantly expressed during embryonic development. In several malignant neoplasias including prostate cancer, high re-expression of HMGA2 is correlated with malignancy and poor prognosis. The let-7 miRNA family is described to regulate HMGA2 negatively. The balance of let-7 and HMGA2 is discussed to play a major role in tumour aetiology. To further analyse the role of HMGA2 in prostate cancer a stable and highly reproducible in vitro model system is precondition. Herein we established a canine CT1258-EGFP-HMGA2 prostate cancer cell line stably overexpressing HMGA2 linked to EGFP and in addition the reference cell line CT1258-EGFP expressing solely EGFP to exclude EGFP-induced effects. Both recombinant cell lines were characterised by fluorescence microscopy, flow cytometry and immunocytochemistry. The proliferative effect of ectopically overexpressed HMGA2 was determined via BrdU assays. Comparative karyotyping of the derived and the initial CT1258 cell lines was performed to analyse chromosome consistency. The impact of the ectopic HMGA2 expression on its regulator let-7a was analysed by quantitative real-time PCR. Fluorescence microscopy and immunocytochemistry detected successful expression of the EGFP-HMGA2 fusion protein exclusively accumulating in the nucleus. Gene expression analyses confirmed HMGA2 overexpression in CT1258-EGFP-HMGA2 in comparison to CT1258-EGFP and native cells. Significantly higher let-7a expression levels were found in CT1258-EGFP-HMGA2 and CT1258-EGFP. The BrdU assays detected an increased proliferation of CT1258-HMGA2-EGFP cells compared to CT1258-EGFP and native CT1258. The cytogenetic analyses of CT1258-EGFP and CT1258-EGFP-HMGA2 resulted in a comparable hyperdiploid karyotype as described for native CT1258 cells. To further investigate the impact of recombinant overexpressed HMGA2 on CT1258 cells, other selected targets described to underlie HMGA2 regulation were screened in addition. The new fluorescent CT1258-EGFP-HMGA2 cell line is a stable tool enabling in vitro and in vivo analyses of the HMGA2-mediated effects on cells and the development and pathogenesis of prostate cancer.

Fibroma uterino en una hembra canina cruzada de 12 años en Veterinaria Vida, Noviembre Managua, Nicaragua 2013

Se analizó un estudio de caso atendido en la Clínica “VIDA ” el 21 de noviembre del 2013. Inicialmente se procedió a la valoración de su estado físico y de salud considerando la edad de la paciente. A partir de la inspección clínica y anamnesis se procedió a brindar un diagnóstico de la patología que presentaba, para fundamentar las principales causas y consecuencia que gen eran las patologías reproductivas en la especie canina. El estudio de caso es una investigación cualitativa de tipo participativa, cuya base es la descripción de sucesos ocurridos en un momento determinado el cual consistía en el análisis de un estudio de caso que no pueden duplicarse por las condiciones individuales del sujeto y de su entorno en particular . El paciente era una perra de 12 años , llamada princesa que t enía completo su programa de vacunación y desparasitación. Después del último celo tuvo descargas vaginal es hemorrágicas , durante 6 días el cual alarmó a la dueña, ya que no mostró síntomas característicos de postraciones . Era alimentada con concentrado, su estro era normal . Se le brindó atención ambulatoria y s e le realizaron exámenes clínicos , realizando la anamnesis , sin mostrar dolor a la palpación, no se detectaron masas abdominales, no se realizó exploración vagina l debido a que la paciente no habí a sido incorporada para reproducción. Se determinó como piómetra en diagnostico presu ntivo, aplicándole vit. K p or tres días y al cuarto día una dosis de medroxiprogesterona para detener el sangrado. A l no haber efecto en el sangrado, se optó por la extirpación quirúrgica del útero el cual se real izó sin problemas, encontrándose: cuernos uterinos y útero hiperplásicos , endometrio con fibromas y pequeñas neoplasias. Se identificó neoplasia uterina causada por quistes ováricos, estrés, trastorno psicológico de adaptabilidad a la ausencia de la dueña, creando un desorde n en las estructuras de cascada del sistema endocrino, viéndose afectado por la relació n de la edad de la paciente. Terminada la cirugía se le entregó la mascota a su dueña junto con las indicaciones postoperatoria pero ya en su casa la paciente murió por complicaciones post quirúrgica no identificadas .

Quercetin in Cancer Treatment, Alone or in Combination with Conventional Therapeutics?

Cancer is a problem of global importance, since the incidence is increasing worldwide and therapeutic options are generally limited. Thus, it becomes imperative to find new therapeutic targets as well as new molecules with therapeutic potential for tumors. Flavonoids are polyphenolic compounds that may be potential therapeutic agents. Several studies have shown that these compounds have a higher anticancer potential. Among the flavonoids in the human diet, quercetin is one of the most important. In the last decades, several anticancer properties of quercetin have been described, such as cell signaling, pro-apoptotic, anti-proliferative and anti-oxidant effects, growth suppression. In fact, it is now well known that quercetin has diverse biological effects, inhibiting multiple enzymes involved in cell proliferation, as well as, in signal transduction pathways. On the other hand, there are also studies reporting potential synergistic effects when combined quercetin with chemotherapeutic agents or radiotherapy. In fact, several studies which aim to explore the anticancer potential of these combined treatments have already been published, the majority with promising results. Actually it is well known that quercetin can act on the chemosensitization and radiosensitization but also as chemoprotective and radioprotective, protecting normal cells of the side effects that results from chemotherapy and radiotherapy, which obviously provides notable advantages in their use in anticancer treatment. Thus, all these data indicate that quercetin may have a key role in anticancer treatment. In this context, this review is focused on the relationship between flavonoids and cancer, with special emphasis on the role of quercetin.

Reacciones de mujeres frente a la mastectomía : un análisis desde la teoría de la incertidumbre frente a la enfermedad, Chiclayo 2014

La mastectomía es la opción quirúrgica en el tratamiento del cáncer de mama que representa en las mujeres un significativo impacto que ocasiona reacciones frente al sentimiento de mutilación, situación estresante que le genera incertidumbre, experimentando sentimientos de pérdida e identidad femenina. La investigación tuvo como objetivo: Describir y analizar reacciones de las mujeres frente a la mastectomía desde la teoría de la incertidumbre frente a la enfermedad, tomando como base conceptual la teoría de la Mishel Merle. Investigación cualitativa, con abordaje metodológico de estudio de caso. Los sujetos de investigación fueron nueve mujeres mastectomizadas captadas en el servicio de consultorio externo de ginecología del H.N.A.A.A; los datos fueron recolectados mediante la entrevista semi-estructurada, y analizados mediante el análisis de contenido. Obteniéndose las siguientes categorías: I: Antecedentes de la incertidumbre frente a la enfermedad, II: Valoración de la incertidumbre de la enfermedad y III: Afrontando mi enfermedad: Dios y mi familia. En todo momento de la investigación se hizo uso de los criterios de rigor científico y éticos. En conclusión, las mujeres con cáncer de mama y que son mastectomizadas experimentan reacciones: tristeza, miedo, soledad, entre otros, que son valorados por cada mujer de forma distinta para su afrontamiento y que el apoyo familiar y de Dios le permite tener la oportunidad de superar este proceso de enfermedad.

Mesenchymal chondrosarcoma: prognostic factors and outcome in 113 patients. A European Musculoskeletal Oncology Society study

BACKGROUND: Mesenchymal chondrosarcoma (MCS) is a distinct, very rare sarcoma with little evidence supporting treatment recommendations. PATIENTS AND METHODS: Specialist centres collaborated to report prognostic factors and outcome for 113 patients. RESULTS: Median age was 30 years (range: 11-80), male/female ratio 1.1. Primary sites were extremities (40%), trunk (47%) and head and neck (13%), 41 arising primarily in soft tissue. Seventeen patients had metastases at diagnosis. Mean follow-up was 14.9 years (range: 1-34), median overall survival (OS) 17 years (95% confidence interval (CI): 10.3-28.6). Ninety-five of 96 patients with localised disease underwent surgery, 54 additionally received combination chemotherapy. Sixty-five of 95 patients are alive and 45 progression-free (5 local recurrence, 34 distant metastases, 11 combined). Median progression-free survival (PFS) and OS were 7 (95% CI: 3.03-10.96) and 20 (95% CI: 12.63-27.36) years respectively. Chemotherapy administration in patients with localised disease was associated with reduced risk of recurrence (P=0.046; hazard ratio (HR)=0.482 95% CI: 0.213-0.996) and death (P=0.004; HR=0.445 95% CI: 0.256-0.774). Clear resection margins predicted less frequent local recurrence (2% versus 27%; P=0.002). Primary site and origin did not influence survival. The absence of metastases at diagnosis was associated with a significantly better outcome (P<0.0001). Data on radiotherapy indications, dose and fractionation were insufficiently complete, to allow comment of its impact on outcomes. Median OS for patients with metastases at presentation was 3 years (95% CI: 0-4.25). CONCLUSIONS: Prognosis in MCS varies considerably. Metastatic disease at diagnosis has the strongest impact on survival. Complete resection and adjuvant chemotherapy should be considered as standard of care for localised disease.

Cómo evaluar y reducir desigualdades sociales en los programas de cribado de cáncer

Esta nota de campo presenta las conclusiones y recomendaciones elaboradas en el encuentro "¿Cómo reducir las desigualdades sociales en los programas de cribado de cáncer", celebrado en la XXVI Escuela de Salud Pública de Mahón (Menorca). Los participantes elaboraron recomendaciones a partir de las experiencias de los programas de cribado poblacionales de cáncer de mama y colorrectal, y del cribado oportunista de cáncer de cuello uterino. Las conclusiones y recomendaciones se centraron en cuatro grandes áreas (sistemas de información, evaluación y calidad, investigación e intervenciones): incorporar variables sociales individuales en los sistemas de información sanitarios; establecer unos estándares mínimos de recogida de información que permitan conocer las desigualdades en el acceso a los servicios preventivos; realizar acciones en población vulnerable; y promover el intercambio de experiencias y buenas prácticas a través de la Red de Programas de Cribado de Cáncer y de grupos de trabajo de sociedades científicas.