Metástase cervical de carcinoma epidermóide com tumor primário desconhecido

Revisamos nossa experiência com carcinoma epidermóide metastático (CEM) para o pescoço com tumor primário desconhecido com a intenção de evidenciar quando o tratamento radioterápico exclusivo ou o tratamento cirúrgico seguido de radioterapia teriam impacto positivo sobre a sobrevida. Este é um estudo retrospectivo de 54 pacientes com CEM tratados na Seção de Cirurgia de Cabeça e Pescoço do Hospital do Câncer/INCa entre 1986 e 1992. Quarenta e oito pacientes (89%) eram do sexo masculino, a idade média foi de 54 anos. Quarenta pacientes tinham metástase para linfonodos cervicais da cadeia jugular interna alta (nível 2). Utilizamos a classificação TNM da UICC de 1992 para estagiar os pacientes, onde oito pacientes foram classificados como N1, vinte como N2, 22 como N3, sendo que quatro pacientes permaneceram não classificados. Todos foram submetidos a endoscopia do trato aerodigestivo superior e raio X de tórax. Trinta e cinco pacientes foram submetidos a biópsia de aspiração com agulha fina. Trinta e oito pacientes tiveram tratamento com intenção curativa e 1.6 tiveram tratamento paliativo com radioterapia. Dos pacientes tratados com intenção curativa, dez foram submetidos a esvaziamento cervical e 28 tiveram tratamento exclusivo com radioterapia. Os 16 pacientes tratados com intenção paliativa foram excluídos dos cálculos de sobrevida e análise das recidivas. As recidivas cervicais foram analisadas usando o método do qui-quadrado, e as curvas de sobrevida foram comparadas usando-se o teste de Wilcoxon. A biópsia aspirativa com agulha fina alcançou o diagnóstico em 85% dos casos. Oito pacientes (15%) apresentaram metástase à distância. O tumor primário foi identificado subseqüentemente em 9% dos pacientes. Dezoito pacientes (64%) tratados com radioterapia exclusiva tiveram recidivas no pescoço, e três pacientes (33%) tratados com cirurgia + radioterapia tiveram recidivas no pescoço. (p=0,05) Os pacientes classificados como N2/N3 tratados com cirurgia + radioterapia tiveram melhores resultados do que os tratados com radioterapia exclusiva (respectivamente p=0,05 e p=0,09). Os pacientes Nl tiveram melhor sobrevida livre de doença do que os pacientes N2/N3 (respectivamente p=0,007 e p=0,OO7). A sobrevida livre de doença em cinco anos foi de 69% para os pacientes Nl, 11 % para os pacientes N2 e 15% para os pacientes N3. A sobrevida livre de doença para todos os estágios foi de 28%. A biópsia aspirativa com agulha fina é um bom meio para diagnóstico e deve ser usada rotineiramente.

Metástase cervical de tumor primário oculto: estudo de 107 casos

Foram avaliados retrospectivamente 107 pacientes com metástases cervicais de tumor primário oculto, atendidos entre 1977 e 1995 no Hospital Heliópolis. Considerou-se a influência de fatores epidemiológicos e características clínicas na recorrência da doença e sobrevida. O carcinoma epidermóide foi o tipo histológico mais freqüente, acometendo predominantemente as cadeias júgulo-carotídeas alta e média (níveis II e III). Noventa e três por cento dos pacientes apresentavam doença avançada (estadiamento N2 ou N3). A sobrevida livre de doença (SLD) aos 5 anos foi de 24%, sendo 40% para os pacientes com 55 anos ou menos e 8% para aqueles com mais de 55 anos (p = 0,01). Todos os pacientes com doença na cadeia júgulo-carotídea baixa (nível IV) apresentaram recidiva nos primeiros 12 meses após o tratamento. Os tumores indiferenciados apresentaram recidiva mais precocemente. Na análise multivariada os fatores idade, tipo de tratamento e estadiamento foram significativos (p<0,05).

Tumor estromal gastrointestinal de intestino delgado

Stromal tumors of the gastrointestinal tract (gists) represent relatively rare lesions that arise from connective tissue elements located along the entire length of the gut. They were initially identified by immunohistochemical investigation, proving their origin from nondifferentiated mesenchymal cells. Only a minority of this lesions, mainly those confined to the esophagus and rectum, have been shown to correspond to mature, well-differentiated types of neoplasms such as leiomyoma or leiomyosarcoma. The majority of gists corresponds to a heterogeneous group of lesions that have as their common denominator an immature proliferation of epithelioid or spindle cells arising from its muscle layers, or between them, showing partial or incomplete myoide, neural, ganglionic, or mixed features of differentiation. This case report intends to show a gist of small bowel in a male, 46 years old, with a two-year of evolution.

Tumor carcinóide do reto

The rectum is the second most common location of the carcinoid tumors of the gastrointestinal tract. It represents approximately one or two per cent of the rectal neoplasms. Metastases are less frequent and it presents a better prognosis than carcinoid tumors found in the digestive tract. Treatment is surgical and the technique to be used depends fundamentally on the size of the tumor and the degree of in the intestinal wall penetration. Lesions which are greater than one centimeter have been treated with local excision, while the ones greater than two centimeters have been submitted to a radical resection. This article presents a case of rectal carcinoid diagnosed and treated initially as adenocarcinoma by abdominal rectossigmoidectomy. There were no signs of recurrence after a period of five years and six months of post-surgical follow-up. Nowadays the validity of radical resection in the treatment of rectal carcinoids has been much questioned due to the fact that it has not shown a significant raise in survival rate when compared with patients who were submitted to a local resection.

Reatividade linfonodal com metástase cervical de tumor primário oculto: estudo de 24 pacientes

OBJETIVO: Avaliar a reatividade linfonodal em pacientes com metástase cervical de tumor primário oculto. MÉTODO: Foram avaliados retrospectivamente 24 pacientes submetidos a esvaziamento cervical entre 1983 e 1995 devido à metástase de tumor primário oculto. Os cortes histológicos dos 601 linfonodos resultantes foram corados pela hematoxilina-eosina e avaliados à microscopia óptica. A reatividade linfonodal considerou a presença de hiperplasia paracortical, hiperplasia de centro germinativo e hiperplasia sinusal. Foram avaliadas a relação da reatividade linfonodal, ruptura capsular, necrose e desmoplasia com a recidiva da doença. A análise estatística foi feita com Teste de Fisher com erro inferior a 5%. RESULTADOS: Setenta e sete por cento (77%) dos linfonodos se mostraram reativos. Cinqüenta e cinco por cento (55%) dos pacientes com hiperplasia paracortical ou mista e dezesseis por cento (16%) dos pacientes com hiperplasia de centro germinativo ou linfonodos não reativos estavam assintomáticos por ocasião do último retorno ambulatorial (p=0,11). A presença de necrose tumoral mostrou associação significativa com a presença de desmoplasia (p=0,02). CONCLUSÕES: A reatividade linfonodal é freqüente na maioria das metástases cervicais em tumor primário oculto e a necrose tumoral está diretamente ligada à presença de desmoplasia.

Tumor do apêndice vermiforme

Appendiceal tumors are rare and usually presented as acute appendicitis. They are incidentally discovered at an emergency surgery, in which case the decision-making is very difficult. The purpose of this report is discuss to the most appropriate management for appendiceal tumors. A retrospective analysis of one case treated at HU-UEL was undertaken and the literature was reviewed. The conclusion is that frozen section should be done whenever the appendiceal findings are atypical. For appendiceal carcinoids greater than 2 cm and adenocarcinomas, a right hemicolectomy is recommended. Appendectomy is apropriate for patients whose carcinoid tumors are 1 cm in diameter or less and for carcinoid tumors between 1 cm and 2 cm without extensive lymphatic permeation and mesenteric invasion. Every case should be searched for synchronous tumors.

Tumor estromal do trato gastrintestinal primário da papila duodenal

The majority gastrointestinal wall tumors previously considered leiomyomas or leiomyosarcomas were reclassified into Gastrointestinal Stromal Tumours because of typical imunohistochemic, genetic and biologic behaviors findings. We present a case report of Gastrointestinal Stromal Tumor primary of the duodenal papilla causing digestive haemorrage that was submitted to surgical treatment.

Generation and Characterization of Knockout Mice and Analysis of Patient Material Demonstrates a Role for Tissue Inhibitor of Metalloproteinases 4 (Timp4) in the Cardiovascular System and Tumor Metastasis

This thesis focuses on tissue inhibitor of metalloproteinases 4 (TIMP4) which is the newest member of a small gene and protein family of four closely related endogenous inhibitors of extracellular matrix (ECM) degrading enzymes. Existing data on TIMP4 suggested that it exhibits a more restricted expression pattern than the other TIMPs with high expression levels in heart, brain, ovary and skeletal muscle. These observations and the fact that the ECM is of special importance to provide the cardiovascular system with structural strength combined with elasticity and distensibility, prompted the present molecular biologic investigation on TIMP4. In the first part of the study the murine Timp4 gene was cloned and characterized in detail. The structure of murine Timp4 genomic locus resembles that in other species and of the other Timps. The highest Timp4 expression was detected in heart, ovary and brain. As the expression pattern of Timp4 gives only limited information about its role in physiology and pathology, Timp4 knockout mice were generated next. The analysis of Timp4 knockout mice revealed that Timp4 deficiency has no obvious effect on the development, growth or fertility of mice. Therefore, Timp4 deficient mice were challenged using available cardiovascular models, i.e. experimental cardiac pressure overload and myocardial infarction. In the former model, Timp4 deficiency was found to be compensated by Timp2 overexpression, whereas in the myocardial infarct model, Timp4 deficiency resulted in increased mortality due to increased susceptibility for cardiac rupture. In the wound healing model, Timp4 deficiency was shown to result in transient retardation of re-epithelialization of cutaneous wounds. Melanoma tumor growth was similar in Timp4 deficient and control mice. Despite of this, lung metastasis of melanoma cells was significantly increased in Timp4 null mice. In an attempt to translate the current findings to patient material, TIMP4 expression was studied in human specimens representing different inflammatory cardiovascular pathologies, i.e. giant cell arteritis, atherosclerotic coronary arteries and heart allografts exhibiting signs of chronic rejection. The results showed that cardiovascular expression of TIMP4 is elevated particularly in areas exhibiting inflammation. The results of the present studies suggest that TIMP4 has a special role in the regulation of tissue repair processes in the heart, and also in healing wounds and metastases. Furthermore, evidence is provided suggesting the usefulness of TIMP4 as a novel systemic marker for vascular inflammation.

A biologia molecular no prognóstico do carcinoma da tireóide

This overview examines some selected genetic mechanisms of cancer development. Strong evidence has been accumulated suggesting that alteration in either the struture or activity of proto-oncogene contributes to the development and for the maintenance of the malignant phenotype. Many factors are known to interfere with both normal and pathological controls of growth and differentiation of thyroid cells. Among them, some are oncogenes, like those encoding g-proteins (ras, gsp, TSH-R), encoding thyrosino kinases receptors (RET, trk, c-met, c-erb, BRAF) and encoding nuclear proteins (c-myc, e-fós). Others are anti-oncogenes (p53, p15, RB), by loss of the growth suppression ativity of the suppressive gene. Cancer cell invasion and metastasis are the major causes of morbidity and mortality in cancer patients. Many genes are involved in the mechanism of invasion and metastasis of thyroid tumors, like Nis, b-catenina, E-caderina, galectina-3, GLUT, telomerase, VEGT, nm-23. All these oncogenes, antioncogenes and tumor invasion and metastasis-related genes are analysed. Several clinical and prognostic factors have been proposed to identify patients at risk for the development of metastasis and death. The role of molecular genetics in this issue is discussed. However, other studies are needed to validate molecular alterations as an independent prognostic factor in thyroid cancer.

Ablação de tumor de canal anal tratado com laser de diodo: seguimento após 17 meses

The Nd:YAG laser is used as the palliative treatment of obstructive and/or hemorrhagic intestinal lesions with an effective but temporary symptomatic relief, with symptoms and signs recurrence after six to eight weeks. This report describes the treatment of a patient bearing a low rectal adenocarcinoma through diode laser ablation and the result after 17 months.

Tumor carcinóide de estômago tipo 1

Gastric carcinoid occurs in less than 1% of gastric neoplasias and around 2% of carcinoids tumors. They are classified into three forms: type 1, associated with atrophic gastritis, type 2, associated with multiple endocrine neoplasia 1 and Zollinger Ellison syndrome, and type 3, a sporadic tumor. This study report a case of gastric carcinoid type 1, which manifested with chronic anemia, dyspeptic symptoms and hypergastrinemia. A 44 years old female patient, presented multiple lesions with diameter between 3 and 20 mm, with lynphonodal metastases. A total gastrectomy was performed associated with lymphnodes ressection and Y Roux reconstruction.

Hemorragia digestiva por tumor estromal gástrico

Gastrointestinal stromal tumors account for 0.1 to 3% of all resected gastric tumors and are the most common submucosal mass found in the stomach. Preoperative diagnosis is often difficult; consequently surgery is the best and only option on most cases. There are studies with different surgery techniques based on tumors location. The reported case led us at literature review with the intent of establishing preoperative diagnosis, therapeutic strategies and prognosis.

Tumor estromal gastrointestinal: análise de fatores relacionados ao prognóstico

OBJETIVO: estudar os critérios morfológicos e imunoistoquímicos relacionados ao prognóstico dos tumores estromais gastrointestinais. MÉTODOS: o estudo foi retrospectivo de 42 casos de tumor estromal gastrointestinal (GIST). Vinte e cinco casos foram obtidos no arquivo do Serviço de Anatomia Patológica do Hospital Universitário Gaffrée e Guinle e os outros dezessete, do Serviço de Anatomia Patológica do Hospital Universitário Clementino Fraga Filho. RESULTADOS: de acordo com a análise univariada os tumores maiores que 5 cm, com número de mitoses maior que 5/50 CGA, presença de necrose, de alto risco, revelaram significância em relação a redução da sobrevida (p= 0,017, 0,010, 0,001 e 0,016, respectivamente). Os outros fatores analisados (subtipo histológico, topografia e imunofenótipo) não mostraram significância. CONCLUSÃO: os resultados confirmam a utilidade do grau de risco, do tamanho tumoral, do índice mitótico e da necrose como fatores preditores do comportamento biológico dos tumores estromais gastrointestinais.

A ultra-sonografia como método de rastreamento populacional de tumor renal

OBJETIVO: Estimar a prevalência dos incidentalomas renais malígnos no Hospital Universitário de Taubaté (HUT), evidenciados pelo ultra-som. MÉTODO: Estudo transversal e retrospectivo de 1559 prontuários de pacientes submetidos a US abdominais, por indicações que não envolviam sinais ou sintomas relacionados ao tumor renal, no período de maio de 1999 a novembro de 2002. Avaliou-se idade, sexo, indicação do exame, característica da lesão. RESULTADOS: Encontrou-se 102 casos de incidentalomas renais, com a prevalência 6,2% de cistos simples e 0,19% de massas malignas do total dos US realizados. CONCLUSÃO: A prevalência do incidentaloma renal maligno no Hospital Universitário foi de 0,19%, sendo menor que a descrita na literatura. O uso de ultra-sonografia como método de rastreamento populacional deve ser mais bem estudado, pois necessita de elevado número de exames para diagnóstico precoce do tumor renal.

Adenocarcinoma e tumor estromal (GIST) sincrônicos no estômago: uma rara ocorrência

A concomitant epithelial and stromal tumor in stomach is unusual in the literature. The purpose of this paper is to report the case and it's therapeutic management. A 72 year old black male patient , which upper digestive endoscopy showed a gastric neoplasm (Borrmann III) at incisura angularis and the biopsy revealed adenocarcinoma. A subtotal gastrectomy with D2 limphadenectomy and Roux-en-Y reconstruction was performed. The histopathology studies confirmed an adenocarcinoma and a gastric stromal tumor, whose immunohistochemical exam was compatible to GIST. Seventeen months after surgery, a computadorized tomography revealed a retrogastric tumor and laparotomy was indicated to remove the lesion.