Sentinel lymph node biopsy in rats. Comparison between paraffin and frozen section analysis

PURPOSE:To simulate a lymph node metastasis in an animal model using activated carbon, assess their identification in frozen section analysis and compare with histopathological examination in paraffin.METHODS:Thirty two adult female rats were used. They received the carbon injection on its hind legs. Half of the rats was sacrificed on day one, and the other half after 21 days. Thus, 64 lymph nodes were dissected and split longitudinally. One half of the lymph node was sent immediately to frozen section analysis. The other half was fixed in 10% formaldehyde to be cut in paraffin. Slides were divided into quadrants and classified by the presence of carbon in these four quadrants_ They were also classified by the carbon staining intensity.RESULTS:Comparing the slides obtained in the first day and 21 days, there was a tendency of carbon to spread over time, but without statistical significance. The intensity did not alter over time.CONCLUSION:There was no concordance between the two methods of pathological analysis, however the actived carbon was seen in all lymph nodes.UNIFESPUNIFESP Pathology DepartmentUniversidade Federal de São Paulo (UNIFESP) Department of SurgeryUNIFESP, Pathology DepartmentUNIFESP, Department of SurgerySciEL

“Pele Alerta Project”: prevention and early detection of skin cancer aimed at beauty professionals

Introduction: Skin cancer is the most common neoplasm in several countries, including Brazil, and its incidence continues to rise. Early detection and primary prevention are the main ways to reduce morbidity and mortality. Places such as the head, neck and back are difficult to see by the person himself. There is a potential in beauty professionals for the early detection of these lesions and referral for evaluation and medical conduct. Objectives: Develop an online project with tools to educate beauty professionals about skin cancer. Methods: Based on current literature, videos and educational illustrated material were made available on a website. Results: The "Pele Alerta Project" can be accessed at www.projetopelealerta.com; this currently has four topics, each with a video (YouTube) and support material in PDF. Conclusion: The project in question is feasible, easy to execute and allows comprehensive education concerning skin cancer

Equipamento nacional de detecção gama intra-operatória na identificação de linfonodo sentinela

PURPOSE: To investigate a national equipment of intraoperatory gamma detection in the identification of sentinel lymph node. METHODS: Thirty young adult male rats were used. After anesthetized, animals were divided into two groups of 15 animals each. Animals from group A received dextram 500 - Tc99 radiopharmaceutical and patent blue V and those from group B received only patent blue V to map the lymphatic drainage. The presence of radiation in the background area, in the area of injection and of the ex vivo sentinel lymph node of group A were measured. After the exeresis, each lymph node in group A and in group B was mixed forming a new random sequence and the radioactive reading of each lymph node was carried out, using both pieces of equipment. RESULTS: The hottest sentinel lymph node was identified by the national equipment when radiation was measured in the area of limphatic drainage after the Dextran 500 was injected. Also, the ex vivo sentinel lymph node. The national equipment has also detected radiation in the lymph nodes that had not received radiopharmaceutical, leading to false positive, checked by the application of Mann-Whitney tests and Student's paired t-tests. The Cronbach alpha has shown high internal consistency of data 0,9416. CONCLUSIONS: The national equipment of intraoperatory gamma detection identifies the LS and showed false positives LS and needs improvement.OBJETIVO: Investigar o equipamento nacional de detecção gama intra-operatória na identificação de linfonodo sentinela. MÉTODOS: Foram utilizados 30 ratos machos, adultos jovens. Depois de anestesiados, os animais foram distribuidos em dois grupos de 15 animais cada. O grupo A recebeu radiofármaco dextran 500 - Tc99 e azul patente V e o grupo B, somente azul patente V para realização do mapeamento linfático. Foi realizada a medição da captação radioativa da região de fundo, do sítio de injeção e do linfonodo sentinela ex vivo do grupo A. Após a exérese, cada linfonodo do grupo A e do grupo B foram misturados formando uma nova seqüência aleatória e procedeu a leitura da radioatividade de cada linfonodo com os dois equipamentos. RESULTADOS: O linfonodo sentinela hipercaptante foi identificado pelo equipamento nacional durante as medições da captação radioativa na região do sítio de injeção e linfonodo sentinela ex vivo. O equipamento nacional detectou radiação mesmo nos linfonodos que não receberam o radiofármaco, causando falso positivo, verificado na aplicação dos testes de Mann-Whitney e t pareado de Student. O alfa de Cronbach mostrou alta consistência interna dos dados (0,9416). CONCLUSÕES: O equipamento nacional de detecção gama intra-operatória identifica o linfonodo sentinela e mostra falsos positivos e necessita de aprimoramento.UNIFESPUniversidade Federal de São Paulo (UNIFESP) Department of Surgery Division of Plastic SurgeryUniversity of São Paulo Faculty of MedicineUNIFESP, Department of Surgery Division of Plastic SurgerySciEL

Sentinel lymph node in children with melanoma: case report

Objective: to present a case of a child who was subjected to sentinel lymph node biopsy for cutaneous melanoma. Description: a 12 year-old child with Dysplastic Nevus Syndrome developed melanoma on the lumbar region. The excision biopsy revealed a melanoma with depth of 1.5 mm. The patient was submitted to amplification of the margins 2 cm in all directions and the sentinel node was also excised. The histopathological exam did not show residual disease. Sentinel on exam did not show metastases either under hematoxylin-eosin stain or immunohistochemistry (S-100 and HMB45). Therefore, RT-PCR for tyrosinase mRNA was positive. The patient has been followed for twelve months without evidence of recurrence. Comments: childhood melanoma is rare, corresponding to less than 1% of malignant tumors in children. Data point to a worldwide increase in its incidence. Melanoma occurs in melanocytic lesions in 70% and in the remaining 30% it occurs de novo. Melanoma is very aggressive, so the survival depends on an early diagnosis. Sentinel lymph node biopsy has selected patients to complete lymphadenectomy. Some authors have been using this technique in childhood melanoma.Objetivo: apresentar um caso de melanoma cutâneo na infância, submetido à biópsia de linfonodo sentinela. Descrição: criança de 12 anos de idade, portadora da síndrome do nevo displásico, desenvolveu melanoma em dorso. A biópsia excisional revelou melanoma (Breslow = 1,5 mm), sendo submetida a tratamento cirúrgico da lesão, com ampliação de margem de 2cm e biópsia de linfonodo sentinela. O exame anatomopatológico não mostrou doença residual. O exame do linfonodo sentinela não mostrou metástases ao exame histopatológico por hematoxilina eosina, nem à imunohistoquímica (S100 e HMB45). No entanto, a pesquisa de RNA mensageiro da tirosinase por RT-PCR se mostrou positiva. A paciente não mostrou sinais de metástase ou recidiva local nestes doze meses iniciais de seguimento. Comentários: o melanoma é raro em crianças, corresponde a menos de 1% dos tumores da infância. Inúmeros trabalhos mostram o aumento da incidência mundial do melanoma. Em cerca de 70%, se originam de nevos melanocíticos pré-existentes, e nos 30% restantes, eles surgem de novo. Dada a agressividade do melanoma, a sobrevida depende do diagnóstico precoce. A biópsia do linfonodo sentinela tem contribuído na decisão de se realizar ou não a linfadenectomia completa, e alguns autores já estão utilizando a mesma em crianças.Escola Paulista de Medicina Programa de Pós-graduação em Cirurgia PlásticaUniversidade Federal de São Paulo (UNIFESP) Disciplina de Cirurgia PlásticaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PatologiaUNIFESP, EPM, Programa de Pós-graduação em Cirurgia PlásticaEPM, Disciplina de Cirurgia PlásticaEPM, Escola Paulista de Medicina Depto. de PatologiaSciEL

Is intra-operative gamma probe detection really necessary for inguinal sentinel lymph node biopsy?

CONTEXT: Sentinel node (SN) biopsy has changed the surgical treatment of malignant melanoma. The literature has emphasized the importance of gamma probe detection (GPD) of the SN. OBJECTIVE: Our objective was to evaluate the efficacy of patent blue dye (PBD) and GPD for SN biopsy in different lymphatic basins. DESIGN: Patients with cutaneous malignant melanoma in stages I and II were submitted to biopsy of the SN, identified by PBD and GPD, as part of a research project. SETTING: Patients were seen at Hospital São Paulo by a multidisciplinary group (Plastic Surgery Tumor Branch, Nuclear Medicine and Pathology). PATIENTS: 64 patients with localized malignant melanoma were studied. The median age was 46.5 years. The primary tumor was located in the neck, trunk or extremities. INTERVENTIONS: Preoperative lymphoscintigraphy, lymphatic mapping with PBD and intraoperative GPD was performed on all patients. The SN was examined by conventional and immunohistochemical staining. If the SN was not found or contained micrometastases, only complete lymphadenectomy was performed. MAIN MEASUREMENTS: The SN was identified by PBD if it was blue-stained, and by GPD if demonstrated activity five times greater than the adipose tissue of the neighborhood. RESULTS: Seventy lymphatic basins were explored. Lymphoscintigraphy showed ambiguous drainage in 7 patients. GPD identified the SN in 68 basins (97%) and PBD in 53 (76%). PBD and GPD identified SN in 100% of the inguinal basins. For the remaining basins both techniques were complementary. A metastatic SN was found in 10 basins. Three patients with negative SN had recurrence (median follow-up = 11 months). CONCLUSION: Although both GPD and PBD are useful and complementary, PBD alone identified the SN in 100% of the inguinal lymphatic basins.CONTEXTO: A biópsia de linfonodo sentinela (LS) mudou a abordagem cirúrgica do melanoma maligno. A literatura tem enfatizado a importância da detecção gama intra-operatória (DG) do LS. OBJETIVO: Nosso objetivo é avaliar a eficácia do corante azul patente (AP) e da DG na biópsia de LS em diferentes bases linfáticas. TIPO DE ESTUDO: Pacientes portadores de melanoma maligno cutâneo foram submetidos à biópsia do LS, usando AP e DG como parte de um projeto de pesquisa. LOCAL: Hospital São Paulo, grupo multidisciplinar (cirurgião oncológico, médico nuclear e patologista). PACIENTES: Foram estudados 64 pacientes portadores de melanoma maligno localizado, com idade mediana de 46,5 anos. O sítio primário estava localizado no pescoço, tronco e nos membros. INTERVENÇÕES: Linfocintilografia pré-operatória, mapeamento linfático com AP e DG foram realizados em todos os pacientes. O LS foi examinado por histopatologia convencional e imunohistoquímica. Quando o LS não foi encontrado ou continha micrometástases, linfadenectomia completa da base linfática foi realizada. VARIÁVEIS ESTUDADAS: O LS foi considerado como identificado pelo AP se corado em azul e pela DG quando demonstrou pelo menos 5 vezes mais atividade do que o tecido gorduroso vizinho. RESULTADOS: Foram exploradas 70 bases linfáticas. A linfocintilografia mostrou drenagem ambígua em 7 pacientes. DG identificou o LS em 68 bases linfáticas (97%) e o AP o fez em 53 bases (76%). Os dois métodos identificaram separadamente 100% dos LS inguinais. Nas demais bases, as técnicas foram complementares. O LS estava invadido por células tumorais em 10 bases. Três pacientes com LS negativo apresentaram recorrência (seguimento mediano de 11 meses). CONCLUSÃO: Embora o emprego de AP e GP na pesquisa de LS sejam complementares, o AP demonstrou ser um método suficiente para a localização do LS inguinal.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Discipline of Plastic Surgery/Tumor branchUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of DermatologyUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Nuclear MedicineUNIFESP, EPM, Discipline of Plastic Surgery/Tumor branchUNIFESP, EPM, Department of DermatologyUNIFESP, EPM, Department of Nuclear MedicineSciEL

Breast augmentation via the abdominoplasty incision approach: a prospective study of 100 cases

INTRODUCTION: Pregnancy and obesity cause distension of the abdominal wall and produce changes in the shape and size of the breasts. Thus, the need of aesthetic improvement of the abdominal area is not uncommon, coinciding with the desire for breast augmentation. Performing mammoplasty via the abdominoplasty incision approach was first described in 1976. Because of the lack of prospective studies using this approach, we performed a series of dermolipectomy procedures using the abdominal incision to insert a pair of silicone gel breast implants. METHODS: In total, 100 consecutive patients were selected, with a mean age of 33 ± 2 years. Classic abdominoplasty was performed, and 2 tunnels were then made in the right and left hypochondria. After implant placement, the mammary fold was reconstructed using simple sutures with absorbable threads to attach the subcutaneous tissue to the aponeurosis. RESULTS: None of the following complications were observed: deep-vein thrombosis, cardiorespiratory or anesthetic complications, skin necrosis, visible bleeding, hematoma, or clinically detectable infection. The volume of the implants ranged from 280 to 450 mL (median, 350 mL). The mean operation time was 116 minutes. Reoperation was not necessary in any of the cases. The monitoring period ranged from 9 to 84 months (mean, 36 months). CONCLUSIONS: Breast augmentation via the abdominoplasty incision approach was demonstrated to be a reliable and simple technique, providing a new, scar-free alternative to mammary surgical procedures.INTRODUÇÃO: A gravidez e a obesidade causam distensão da parede abdominal e também produzem mudanças na forma e no tamanho das mamas. Assim, não é incomum a necessidade de melhoria estética da área abdominal, coincidindo com o desejo de aumento de mama. A mamoplastia utilizando a mesma incisão da abdominoplastia foi descrita pela primeira vez em 1976. Em decorrência da falta de estudos prospectivos empregando essa abordagem, os autores realizaram uma série de dermolipectomias usando a incisão abdominal para inserir o par de implantes mamários de silicone gel. MÉTODO: Cem pacientes consecutivas foram selecionadas, com média de idade de 33 ± 2 anos. A abdominoplastia clássica foi realizada e, em seguida, confeccionados 2 túneis sobre os hipocôndrios direito e esquerdo. Após colocação dos implantes, foi realizada reconstrução do sulco mamário com pontos simples usando fios absorvíveis, fixando o subcutâneo à aponeurose. RESULTADOS: Não houve nenhuma das seguintes complicações: trombose venosa profunda, complicações cardiorrespiratórias ou anestésicas, necrose de pele, sangramento visível, e hematoma ou infecção detectáveis clinicamente. O volume dos implantes variou de 280 ml a 450 ml (mediana de 350 ml). O tempo médio de operação foi de 116 minutos. Em nenhum caso foi necessária reoperação. O período de acompanhamento mínimo foi de 9 meses e máximo, de 84 meses (média de 36 meses). CONCLUSÕES: A técnica de aumento mamário por meio da incisão da abdominoplastia se mostrou confiável e simples, constituindo uma nova opção para a cirurgia mamária sem cicatriz nas mamas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP-EPMUniversidade Cidade de São PauloUNIFESP, EPMSciEL

Diagnóstico diferencial no melanoma primário e metastático por espectroscopia FT-Raman

PURPOSE: To qualify the FT-Raman spectral data of primary and metastatic cutaneous melanoma in order to obtain a differential diagnosis. METHODS: Ten normal human skin samples without any clinical or histopathological alterations, ten cutaneous melanoma fragments, and nine lymph node metastasis samples were used; 105, 140 and 126 spectra were obtained respectively. Each sample was divided into 2 or 3 fragments of approximately 2 mm³ and positioned in the Raman spectrometer sample holder in order to obtain the spectra; a monochrome laser light Nd:YAG at 1064 nm was used to excite the inelastic effect. RESULTS: To differentiate the three histopathological groups according to their characteristics extracted from the spectra, data discriminative analysis was undertaken. Phenylalanine, DNA, and Amide-I spectral variables stood out in the differentiation of the three groups. The percentages of correctly classified groups based on Phenylalanine, DNA, and Amide-I spectral features was 93.1%. CONCLUSION: FT-Raman spectroscopy is capable of differentiating melanoma from its metastasis, as well as from normal skin.OBJETIVO: Qualificar os dados espectrais FT-Raman do melanoma cutâneo primário e metastático e assim realizar o diagnóstico diferencial. MÉTODOS: Foram utilizadas amostras de 10 fragmentos de pele sem alterações clínicas ou histopatológicas, 10 de melanomas cutâneos e 9 de metástases linfonodais; 105, 140 and 126 espectros foram obtidos respectivamente. Cada amostra foi dividida em 2 ou 3 frações de 2 mm³ e posicionada no porta amostras do espectrômetro Raman para obtenção dos espectros, por meio da excitação do espalhamento inelástico pelo laser de Nd:YAG em 1064 nm incididos na amostra. RESULTADOS: Para diferenciar os três grupos formados de acordo com as características fornecidas pelos espectros, realizamos a análise discriminante dos dados. As variáveis espectrais Fenilalanina, DNA e Amida-I se destacaram na capacidade de diferenciação dos três grupos histológicos. A porcentagem de classificação correta utilizando estes critérios foi de 93,1%; o que mostra a eficiência da análise realizada. CONCLUSÃO: A espectroscopia FT-Raman é capaz de diferenciar o melanoma de sua metástase, assim como da pele normal.UNIFESPUniversidade Federal de São Paulo (UNIFESP) Department of SurgeryPathology DepartmentPathology Department Federal University of ABC Head of Center for Human and Natural Sciences (CCNH)UNIVAP Institute of Research and Development Head of Biomedical Vibrational Spectroscopy LaboratoryUniversidade Federal de São Paulo (UNIFESP) Department of Surgery Head of Division of Plastic SurgeryUNIFESP, Department of SurgeryUNIFESP, Department of Surgery Head of Division of Plastic SurgerySciEL

Management of complex scalp defects after excision of malignant tumors

Introduction: Scalp reconstruction after cancer resection remains a challenge for surgeons, especially considering the increasing incidence of skin cancer among elderly patients. Dermal matrix (DM) is a heterogeneous group of wound covering materials that aid in wound closure and replace some of the skins functions, either temporarily or permanently. Patients at higher surgical risk can benefit from the use of DM, which help to generate a new dermis, offering great improvements in coverage of complex and extensive defects Methods: It is a retrospective study with analysis of medical records and report of two cases of patients at the A.C.Camargo Cancer Center-SP, Brazil. Results: We report two cases of complex and extensive scalp defects at a single center using DM associated with skin grafting and negative pressure therapy (NPT) in reconstructive surgery after resection of malignant skin neoplasm with satisfactory functional and esthetic results. Conclusions: Extensive lesions of the scalp are a challenge in clinical practice and a multidisciplinary treatment is essential. The results obtained indicate that DM associated with partial skin grafting and NPT have enormous potential to increase the therapeutic options available to the surgeon and possibly benefit patients, especially those who do not have the clinical conditions for extensive coverage surgery with microsurgical flap