High constant incidence rates of second primary neoplasms

The incidence of contralateral breast cancer is high and constant with age, around five per 1000 women who had a primary breast cancer. For other neoplasms, the pattern of incidence of second primary neoplasms with age is less known, particularly as for only a few neoplasms the site of origin is not totally removed, and hence remains at risk of a second primary. Using the dataset from the Cancer Registry of the Swiss Canton of Vaud, we show that the incidence of second neoplasms is constant with age also after oral and pharyngeal, colorectal cancers, cutaneous malignant melanoma (CMM) and basal cell carcinoma. The incidence of first primary oral and pharyngeal cancer increased 20-fold between age 30-39 and 70-89 years, whereas the incidence of second neoplasms did not increase with age. Rates of second colorectal cancer remained relatively constant with age, between 2.5 per 1000 at age 40-59 years and 3.8 per 1000 at 70 years and above. Likewise, for CMM, the age-specific incidence rates of second primary CMM did not vary, ranging between 1 and 2.5 per 1000 in various subsequent age groups. The pattern of incidence for second basal cell carcinoma was similar, with no clear rise with age. These patterns are compatible with the occurrence of a single mutational event in a population of susceptible individuals. A possible implication of these observations is that a variable, but potentially large, proportion of cancers arise in very high-risk individuals and the incidence, on average, increases at a high constant level at a predetermined age.

Rehabilitation of orbital cavity after total orbital exenteration using oculofacial prostheses anchored by osseointegrated dental implants posed as a one-step surgical procedure

BACKGROUND: Total orbital exenteration is a radical surgical procedure, which typically involves the removal of the entire contents of the orbit including the periorbita, leaving the patient with a deep orbital deformity and results in devastating cosmetic, functional, and psychological consequences requiring difficult and challenging procedures for oculoplastic surgeons. Oculofacial prostheses retained by endosseous dental implants present an attractive and viable alternative when aesthetic and functional demands are beyond the capacity of local reconstructive efforts. PATIENTS AND METHODS: A 72-year-old woman presenting a malignant melanoma of the right eyelids and a 77-year-old man presenting a sebaceous carcinoma of the left upper eyelid underwent a total exenteration followed by positioning of endosseous implants (Straumann system Dental implants) as an integrated one-step combined surgical procedure. The oculofacial prosthesis was placed after epithelialization of the orbital cavity. RESULTS: The implants were perfectly osseointegrated without any complications, providing sufficient retention of the prostheses. A satisfactory aesthetic outcome has been achieved for both patients. CONCLUSIONS: Oculofacial prostheses anchored by osseointegrated dental implants placed as one-step surgical procedure ensure an adequate aesthetic result as well as a considerably decreased rehabilitation time and present a satisfactory solution when reconstruction is not a suitable option.

Réparation par excision de nucléotides des dommages induits par rayons ultraviolets dans les mélanomes humains

Les mélanomes malins (MM) constituent le deuxième type de cancer le plus fréquent chez les jeunes adultes canadiens (entre 20 et 44 ans) ainsi qu’un des rares cancers dont l’incidence augmente annuellement. À moins que les MM ne soient excisés à temps par chirurgie, les chances de survie des patients sont pratiquement nulles puisque ce type de tumeur est très réfractaire aux traitements conventionnels. Il est bien connu que l’exposition aux rayons ultraviolets (UV), induisant des photoproduits génotoxiques, est une déterminante majeure dans l’acquisition de MM. À cet effet, la réparation par excision de nucléotides (NER) est la ligne de défense principale contre le développement des mélanomes puisqu’elle est la voie de réparation prépondérante en ce qui a trait aux dits photoproduits. Malgré cela, la contribution potentielle de défauts de la NER au développement des MM dans la population normale n’est toujours pas bien établie. Notre laboratoire a précédemment développé une méthode basée sur la cytométrie de flux qui permet de mesurer la NER en fonction du cycle cellulaire. Cette méthode a déjà mise en évidence qu’une déficience de l’activité de la protéine ATR peut mener à une déficience de la NER exclusive à la phase S dans des fibroblastes humains. Pareillement, nous avons démontré que plusieurs lignées cellulaires cancéreuses modèles comportent une déficience en NER en phase S, suggérant qu’une telle déficience puisse caractériser certains types de cancers. Nous avons voulu savoir si une déficience en NER en phase S pouvait être associée à une proportion significative de mélanomes et si le tout pouvait être attribuable à une diminution de l’activité d’ATR. Nos objectifs ont donc été de : (i) mesurer l’efficacité de la NER en fonction du cycle cellulaire dans les MM en comparaison avec les mélanocytes primaires, (ii) vérifier si le niveau d’activité d’ATR corrèle avec l’efficacité de la NER en phase S dans les lignées de MM et (iii) voir si un gène fréquemment muté dans les mélanomes (tels PTEN et BRAF) pouvait coopérer avec ATR pour réguler la NER en phase S dans les mélanomes. Nous avons démontré que 13 lignées de MM sur 16 ont une capacité grandement diminuée à réparer les photoproduits induits par UV spécifiquement en phase S. De plus, cette déficience corrèle fortement avec une réduction de l’activation d’ATR et, dans plusieurs lignées de MM, avec une phosphorylation d’Akt plus importante. L’utilisation d’ARN interférent ou d’un inhibiteur du suppresseur de tumeurs PTEN, a permis, en plus d’augmenter la phosphorylation d’Akt, de réduire la réparation des photoproduits et l’activation d’ATR dans les cellules en phase S. En addition, (i) l’expression ectopique de la protéine PTEN sauvage dans des lignées déficientes en PTEN (mais pas d’une protéine PTEN sans activité phosphatase) ou (ii) l’inhibition pharmacologique d’Akt a permis d’augmenter la réparation en phase S ainsi que l’activation d’ATR. En somme, cette étude démontre qu’une signalisation d’ATR dépendante de PTEN/Akt amenant à une réparation déficiente des photoproduits génomiques causés par les UV en phase S peut être déterminante dans le développement des mélanomes induits par UV.

Le rôle d’Akt dans la réponse cellulaire aux dommages à l’ADN induits par les ultraviolets dans les cellules de mélanomes humains

Le mélanome malin est l’un des cancers les plus mortels dont l’incidence continue à augmenter chaque année avec peu de traitement efficace à long terme. Il est causé et initié principalement par l’exposition excessive aux rayons ultraviolets engendrant des photoproduits hautement génotoxiques. Il est bien connu que la cascade de signalisation PI3K/Akt joue un rôle crucial dans la régulation des processus qui sont généralement dérégulés durant le développement tumoral comme la prolifération, le contrôle du cycle cellulaire et l’apoptose. Néanmoins, l’implication de cette voie moléculaire dans la réponse aux dommages à l’ADN est peu caractérisée. Chez les mammifères, trois isoformes de la protéine kinase Akt ont été identifiées: Akt1, Akt2 et Akt3. Bien qu’elles soient très homologues en termes de séquence, plusieurs études ont montré que ces isoformes ont des fonctions biologiques distinctes, et nous suggérons qu’elles puissent contribuer différemment à la régulation de la réponse génotoxique. Les objectifs de ce projet étaient de: (i) évaluer l’activation d’Akt dans les cellules de mélanomes (ii) déterminer l’impact de l’inhibition de cette activité sur la régulation de la réponse cellulaire aux UV (iii) vérifier si la perte d’expression de l’un ou de l’autre des isoformes d’Akt peut réguler la réponse aux UV. Nous avons démontré qu’Akt est transitoirement hyperactivée par phosphorylation suite aux irradiations UV dans les lignées cellulaires de mélanomes. Afin de déterminer l'importance de cette activation dans la réponse cellulaire aux UV, notre approche était de diminuer (i) la phosphorylation d’Akt par l’usage d’inhibiteurs pharmacologiques ou (ii) l’expression de chaque isoforme d’Akt par l’approche des ARN interférents. Nous avons montré que l’inhibition de la phosphorylation d’Akt amène à l’augmentation du taux de l’apoptose induit par les UV d’une manière isoforme spécifique, alors qu’elle n’a aucun effet sur la régulation de la voie de réparation par excision de nucléotides (NER), qui est la seule voie humaine pour éliminer les dommages à l’ADN induits par les UV. En somme, notre étude constitue un nouvel aspect qui permet de mieux comprendre les mécanismes moléculaires du développement de mélanomes malins suites aux irradiations ultraviolettes.

Resultados del tratamiento de nevos melanocíticos con láser

Introducción A pesar de que los nevos melanocíticos son un motivo de consulta frecuente en nuestra población no existen estudios a nivel de Colombia acerca de su tratamiento, a nivel mundial existe muy poca literatura al respecto por lo que hay un vacío conceptual en este campo. Objetivos Evaluar los cambios en cuanto a la presencia de pigmento y cicatrización, en los nevos melanocíticos adquiridos tratados con láser, basados en la experiencia de un solo centro en Bogotá. Materiales y métodos Es un estudio observacional de antes y después, en una cohorte histórica, de 90 casos de nevos melanocíticos adquiridos, tratados con láser en Uniláser Medica, en los que se evaluó la presencia de pigmento, cicatrización, y otras variables, con un control realizado a no menos de 3 meses de la intervención. Resultados Se encontró un rango de edad entre los 18 -51 años, promedio 27,59 años; fototipo de III-V; en el 32% de los casos, solo fue requerida una sesión de láser de Co2 y Erbio, para el aclaramiento completo de la misma. La duración del eritema en el 54,4% los casos fue de 1 a 3 meses. En un 64,4% quedó pigmento residual al control, pero de éstos casos el 48,2% fue entre un 5 a un 10% del inicial. El 58,9% hizo cicatriz, de éstos el 63% fue estética. La satisfacción por parte de los pacientes es alta a pesar de la persistencia pigmentaria y/o la presencia de cicatriz. Discusión El tratamiento de nevos melanocíticos adquiridos con láser es una opción terapéutica que genera cambios estadísticamente significativos en cuanto a pigmento, cicatriz estética y alta satisfacción por parte de los pacientes. Se requieren estudios, analíticos, para determinar eficacia del tratamiento.

Paraben esters: review of recent studies of endocrine toxicity, absorption, esterase and human exposure, and discussion of potential human health risks

This toxicology update reviews research over the past four years since publication in 2004 of the first measurement of intact esters of p-hydroxybenzoic acid (parabens) in human breast cancer tissues, and the suggestion that their presence in the human body might originate from topical application of bodycare cosmetics. The presence of intact paraben esters in human body tissues has now been confirmed by independent measurements in human urine, and the ability of parabens to penetrate human skin intact without breakdown by esterases and to be absorbed systemically has been demonstrated through studies not only in vitro but also in vivo using healthy human subjects. Using a wide variety of assay systems in vitro and in vivo, the oestrogen agonist properties of parabens together with their common metabolite (p-hydroxybenzoic acid) have been extensively documented, and, in addition, the parabens have now also been shown to possess androgen antagonist activity, to act as inhibitors of sulfotransferase enzymes and to possess genotoxic activity. With the continued use of parabens in the majority of bodycare cosmetics, there is a need to carry out detailed evaluation of the potential for parabens, together with other oestrogenic and genotoxic co-formulants of bodycare cosmetics, to increase female breast cancer incidence, to interfere with male reproductive functions and to influence development of malignant melanoma which has also recently been shown to be influenced by oestrogenic stimulation. Copyright (C) 2008 John Wiley & Sons, Ltd.

MARCKS functions as a novel growth/tumour suppressor in cells of melanocyte origin

Protein kinase C (PKC) plays a pivotal role in modulating the growth of melanocytic cells in culture. We have shown previously that a major physiological substrate of PKC, the 80 kDa myristoylated alanine-rich C-kinase substrate (MARCKS), can be phosphorylated in quiescent, non-tumorigenic melanocytes exposed transiently to a biologically active phorbol ester, but cannot be phosphorylated in phorbol ester-treated, syngeneic malignant melanoma cells. Despite its ubiquitous distribution, the function of MARCKS in cell growth and transformation remains to be demonstrated clearly. We report here that MARCKS mRNA and protein levels are down-regulated significantly in the spontaneously derived murine B16 melanoma cell line compared with syngeneic normal Mel-ab melanocytes. In contrast, the tumourigenic v-Ha-ras-transfonned melan-ocytic line, LTR Ras 2, showed a high basal level of MARCKS phosphorylation which was not enhanced by treatment of cells with phorbol ester. Furthermore, protein levels of MARCKS in LTR Ras 2 cells were similar to those expressed in Mel-ab melanocytes. However, in four out of six murine tumour cell lines investigated, levels of MARCKS protein were barely detectable. Transfection of B16 cells with a plasmid containing the MARCKS cDNA in the sense orientation produced two neomycin-resistant clones displaying reduced proliferative capacity and decreased anchorage-independent growth compared with control cells. In contrast, transfection with the antisense MARCKS construct produced many colonies which displayed enhanced growth and transforming potential compared with control cells. Thus, MARCKS appears to act as a novel growth suppressor in the spontaneous transformation of cells of melanocyte origin and may play a more general role in the tumour progression of other carcinomas.

Intrinsically Multivariate Predictive Genes

Canalizing genes possess such broad regulatory power, and their action sweeps across a such a wide swath of processes that the full set of affected genes are not highly correlated under normal conditions. When not active, the controlling gene will not be predictable to any significant degree by its subject genes, either alone or in groups, since their behavior will be highly varied relative to the inactive controlling gene. When the controlling gene is active, its behavior is not well predicted by any one of its targets, but can be very well predicted by groups of genes under its control. To investigate this question, we introduce in this paper the concept of intrinsically multivariate predictive (IMP) genes, and present a mathematical study of IMP in the context of binary genes with respect to the coefficient of determination (CoD), which measures the predictive power of a set of genes with respect to a target gene. A set of predictor genes is said to be IMP for a target gene if all properly contained subsets of the predictor set are bad predictors of the target but the full predictor set predicts the target with great accuracy. We show that logic of prediction, predictive power, covariance between predictors, and the entropy of the joint probability distribution of the predictors jointly affect the appearance of IMP genes. In particular, we show that high-predictive power, small covariance among predictors, a large entropy of the joint probability distribution of predictors, and certain logics, such as XOR in the 2-predictor case, are factors that favor the appearance of IMP. The IMP concept is applied to characterize the behavior of the gene DUSP1, which exhibits control over a central, process-integrating signaling pathway, thereby providing preliminary evidence that IMP can be used as a criterion for discovery of canalizing genes.

Estudo da precocidade diagnóstica dos melanomas cutâneos primários em Porto Alegre por análise de imagem computadorizada

Fundamentos: A literatura tem demonstrado que a detecção precoce e a remoção cirúrgica em fases iniciais reduz a mortalidade do melanoma e que, em conseqüência, a identificação do melanoma em fases curáveis deve ser encorajada. Objetivos: O interesse principal do estudo foi conhecer se os melanomas cutâneos, no meio, estão sendo diagnosticados em fases iniciais, através de método reprodutível e armazenável. Metodologia: Foi realizado um estudo transversal com os casos de melanomas cutâneos primários, analisados nos laboratórios de patologia de Porto Alegre, de 1° de janeiro de 1994 a 30 de junho de 1995, a fim de avaliar se os diagnósticos foram realizados em estágios precoces. Os casos foram revisados por três dermatopatologistas, que classificaram quanto ao tipo histológico e quanto ao nível de invasão de Clark. Foi realizado um consenso com pelo menos duas concordâncias. A espessura de Breslow foi considerada fator prognóstico determinante e foi medida através de um sistema de análise de imagem computadorizada, por dois membros da equipe. Resultados: Do total de 279 casos que preencheram os critérios de inclusão, 2,15% eram intraepiteliais. Dos melanomas invasivos, 52% tinham espessura ≤ 1,5 mm. Quando agrupado por sexo e procedência, as mulheres de Porto Alegre, capital do estado do Rio Grande do Sul, tiveram a mais alta taxa de diagnóstico precoce (75% ≤ 1,5 mm). O tronco foi o sítio predominante no homem e freqüente na mulher. O melanoma de espalhamento superficial foi o tipo histológico mais freqüente (80,9%), seguido pelo nodular (10,1%). Para definir os determinantes do diagnóstico precoce, foram realizados cruzamentos simples, dos melanomas intraepiteliais somados aos de espessura <0,76 mm, com o sexo, a idade, a procedência, a situação previdenciária, a região anatômica e o tipo histológico. A análise de variáveis múltiplas demonstrou que apenas o sexo (feminino), o sítio anatômico (outras regiões exceto membros inferiores) e a procedência (Porto Alegre) mostraram-se variáveis independentes para determinar um diagnóstico precoce. A idade ≥ 40 anos apresentou significância próxima ao limite. O tipo histológico foi excluído do modelo, uma vez que gerou instabilidade estatística. Conclusão: Embora o número de casos fosse pequeno, o diagnóstico do melanoma ainda é tardio (52% com até 1,5 mm de espessura). Entretanto, existe um subgrupo de diagnóstico precoce que são mulheres, sobretudo de Porto Alegre, possivelmente por estarem mais atentas e informadas sobre os riscos do melanoma. As mudanças no estilo de vida, nas últimas décadas, provavelmente são responsáveis pela maior incidência no tronco e pela alta freqüência de melanoma de espalhamento superficial encontrada. A análise da espessura tumoral por projeção em tela de computador mostrou-se um recurso auxiliar vantajoso.

Familial cancer: depressed NK-cell cytotoxicity in healthy and cancer affected members

Este estudo se reporta às funções de células natural killer (NK), como adesão, lise e citotoxicidade e de subpopulações de células T em uma família com alta prevalência de pacientes com câncer e que apresentaram: glioblastoma, leucemia mielóide crônica, osteoblastoma, melanoma e carcinomas gástrico, pancreático e cólon retal. Quinze membros dessa família foram estudados, sendo 13 sadios, acompanhados por 5 anos e dois com câncer: glioblastoma e leucemia mielóide crônica. Duas pessoas sadias, no momento da avaliação, desenvolveram posteriormente osteoblastoma mandibular ou melanoma maligno. Como controle, foram avaliados 19 indivíduos saudáveis de faixa etária equivalente. A determinação de linfócitos T CD3+ e de suas subpopulações CD4+ e CD8+ foi realizada empregando-se anticorpos monoclonais e a atividade citotóxica de células NK, avaliada pelo teste de single-cell contra células alvo da linhagem eritroleucêmica K562. Os resultados mostraram que as percentagens de células T totais (CD3+), da subpopulação CD4+ e da relação CD4/CD8 foram significativamente menores nos indivíduos da família estudada em comparação aos valores observados no grupo controle. em todos os membros dessa família a percentagem de formação de conjugados entre células NK-células alvo foi inferior ao valor mínimo observado nos controles. Essa alteração poderia estar relacionada a defeito na expressão de moléculas de adesão, presentes na membrana de células NK, como provável causa das alterações funcionais dessas células. A herança dos mecanismos determinantes desta deficiência pode ser um fator de risco, com valor prognóstico para o desenvolvimento de cancer.

HMB-45 - A review

HMB-45, named for the immunogen used (human melanoma, black) is a monoclonal antibody developed 10 years ago by Gown and colleagues to a whole-cell extract of a human melanoma. Over the years, it has been demonstrated that HMB-45 is a highly sensitive and specific reagent for the identification of melanoma. More recently, it has been found that HMB-45 reacts with a protein designated gp100-cl, which is apparently related to the pmel 17 gene product. Because gp100-cl is a melanosomal matrix protein, HMB-45 is more correctly identified as an organelle-specific rather than tumor-specific reagent. HMB-45 immunoreactivity is seen in normal fetal and neonatal melanocytes but not in adult resting melanocytes. Reactive or proliferating melanocytes present in inflamed adult skin or in skin overlying certain dermal neoplasms, can also ''re-express'' the HMB-45-defined antigen. Whereas the vast majority of melanomas are HMB-45-positive, one important exception is desmoplastic malignant melanoma, which consistently demonstrates a much lower rate of expression of the HMB-45-defined antigen compared with other types of melanoma. In recent years there have been scattered reports of HMB-45 immunoreactivity in nonmelanomatous tumors, such as breast and other carcinomas, but virtually all these reports employed commercial ascites fluid preparations of HMB-45 antibody that were subsequently shown to be contaminated with nonspecific antibodies. Thus, for most practical purposes, a positive reaction with HMB-45 indicates active melanosome formation and, therefore, melanocytic differentiation. There is also a set of HMB-45-positive tumors that consistently manifest HMB-45 immunoreactivity but do not display obvious pigmentation: clear cell ''sugar'' tumor of the lung, angiomyolipoma, and lymphangiomyomatosis. Nonetheless, these lesions are all unified by recent ultrastructural studies that confirm the presence premelanosomes. Curiously, all three lesions also manifest evidence for simultaneous smooth-muscle differentiation. HMB-45 remains, therefore, a reliable marker of melanoma but may also provide insights into a rare group of tumors.

Rhabdomyosarcoma in a congenital pigmented nevus

A 7-month-old boy had a giant pigmented lesion involving the trunk and thighs that exhibited many hyperpigmented hairy and verrucous nevi. One of the nevi ulcerated and on histological examination consisted of pleomorphic rhabdomyosarcoma cells that stained for muscle-specific actin (HHF-35), desmin, and myoglobin. Around the tumor, in the dermis, benign pigmented nevus cells were observed. The occurrence of malignant tumors, other than malignant melanoma, in pigmented nevi is rarely described.

Citologia aspirativa com agulha fina e histopatologia: valor e significado para o diagnóstico e prognóstico do câncer de mama em cadelas

Pós-graduação em Medicina Veterinária - FMVZ

Transmission of clear cell tumor in a graft liver from cadaveric donor: Case report

Neoplasms in children after organ transplantation are related to the type and intensity of immunosuppression and the donorrecipient serostatus, especially in relation to the EpsteinBarr virus. The patient was a two-yr-old female child with biliary atresia who underwent a liver transplantation from a female cadaver donor. Two adults received kidney transplants from the same donor. Nine months after transplantation, one of the adult recipients developed an urothelial tumor in the kidney graft. Imaging tests were repeated monthly in the liver-transplanted child and revealed no abnormalities. However, one yr and two months after the transplantation, the patient developed episodes of fever. At that time, imaging and liver biopsy showed a clear cell tumor of urothelial origin in the graft and the disease was limited to the liver. The patient underwent liver retransplantation, and she is currently free of tumor recurrence. Although rare, the occurrence of tumors in the post-transplant period from cadaver donors, without previously diagnosed tumors, is one of the many problems encountered in the complex world of organ transplantation.

Fotoproteção tópica na infância e na adolescência

OBJETIVO: A exposição à luz solar na infância ocorre, frequentemente, de forma mais intensa do que em muitos adultos. Dados da literatura comprovam de maneira inequívoca a associação desse comportamento social com o risco de desenvolvimento do melanoma maligno e do câncer cutâneo não melanoma mesmo na vida adulta. Além disso, o fotoenvelhecimento cutâneo é semeado já na infância com a exposição solar inadequada. Esta revisão tem como objetivo orientar os pediatras nas medidas adequadas de fotoproteção tópica nas crianças e adolescentes, o que irá alterar de maneira positiva o futuro desses pacientes. FONTES DOS DADOS: Realizou-se uma revisão da literatura indexada na base de dados MEDLINE/PubMed entre os anos de 1999 e 2012 sobre fotoproteção na infância, selecionando-se como fonte os artigos de revisão mais relevantes, do ponto de vista de abrangência do tema fotoproteção em crianças e adolescentes, fotoproteção e vitamina D, fototerapia na neonatologia e impacto no câncer cutâneo, bronzeamento artificial e câncer cutâneo. SÍNTESE DOS DADOS: Crianças e adolescentes devem adotar medidas adequadas de fotoproteção para diminuir o risco de câncer cutâneo melanoma e não melanoma. CONCLUSÕES: Há dados na literatura que suportam a associação de hábitos de exposição solar segura e uso de fotoprotetores tópicos em crianças e adolescentes com a redução da ocorrência do câncer cutâneo.