Diagnostico histologico e expressão dos marcadores p53, c-erbB-2, Ki-67, PCNA e CD34 em pacientes portadoras de tumor de celulas da granulosa do ovario

Orientadores : Sophie Françoise Mauricette Derchain, Liliana Ap. Lucci de Angelo AndradeDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Objetivo: investigar em tumores de células da granulosa do ovário (TCGO) a credibilidade de seu diagnóstico com coloração H&E e a expressão do p53 mutante, do c-erbB-2, Ki-67, PCNA e a atividade angiogênica (CD34), bem como as correlações destes marcadores com características clínicas e histológicas. Sujeitos e método: Três patologistas (A,B e C) reavaliaram os 22 casos de TCGO tratados no CAISM/UNICAMP nos últimos 12 anos, sendo os marcadores detectados através de imuno-histoquímicas em cortes histológicos preparados a partir de blocos de parafina. Foram calculados os coeficientes kappa para avaliação da concordância interobservador entre os patologistas. A análise de associação entre as variáveis categóricas foi realizada com o teste exato de Fisher e entre variáveis categóricas e contínuas, com teste de Mann- Whitney. Resultados: Vinte e um casos foram confirmados como TCGO. Quatro casos foram diagnosticados como TCGO, mesmo sem unanimidade entre os patologistas devido à imunorreatividade para a inibina. Os coeficientes kappa foram de 0,42 (IC95%: -0,05; 0,88); 0,50 (IC95%: 0,13; 0,86); 0,24 (IC95%: -0,14 a 0,61), respectivamente para as duplas de patologistas A/B, A/C e B/C. A IHQ para os marcadores foi realizada em 18 pacientes. Nove (50%) pacientes apresentaram tumores <10cm. Treze (72%) pacientes apresentaram algum componente sólido difuso/sarcomatóide. Em 12 (66%) casos a atipia celular era ausente/leve e em 6 (33%) casos, moderada/intensa. A contagem mitótica foi < 2/10 CMA em 14 (78%) casos. Seis (33%) pacientes apresentaram extensão extra-ovariana da doença (estádios III/IV). O seguimento médio foi de 45,3 meses (0,7 a 128,8). Uma, zero e 11 pacientes apresentaram expressão para o p53 mutante, c-erbB-2 e Ki-67 (focal), respectivamente. Quatorze (78%) casos foram classificados como de alto índice de proliferação, quando avaliados pelo PCNA. A densidade microvascular média foi de 29,0/mm2 (CI95%: 21,8 a 36,1). Apenas o Ki-67, PCNA e o CD34 foram expressos em níveis adequados para uma adequada correlação com outras variáveis. Não houve associação estatisticamente significante entre o índice de proliferação dos tumores (avaliada pelo PCNA), ou Ki-67 ou densidade microvascular com o tamanho do tumor, extensão extra-ovariana da doença, atividade mitótica, atipia celular e padrão histológico. Conclusão: Em nossa casuística, o estudo dos TCGO através da IHQ revelou neoplasias cujo mecanismo de desenvolvimento aparentemente não envolve mutações do p53 e nem expressão aumentada do c-erbB-2; apresentaram resultados conflitantes no que diz respeito ao índice de proliferação celular conforme foram avaliados pelo Ki-67 ou PCNA e, finalmente, são pouco angiogênicos quando avaliados pelo CD34Abstract: The purpose of this study was to investigate the credibility of diagnosis of granulosa cell tumor of ovary (GCTO) through the morphological evaluation employing only H&E staining. We also evaluated the expression of mutant p53, c-erbB-2, Ki-67, PCNA as well as angiogenic activity (CD34) and the correlation of these variables with clinical and histological characteristics. Three well trained pathologists (A, B, and C) reevaluated the slides of 22 GCTO patients that had been treated and followed at the CAISM/UNICAMP in the last 12 years. The interobserver agreement was studied calculating kappa coefficient. We employed the Fisher Exact test to assess the correlation between categorical variables and the Mann-Whitney test for the correlation between categorical and continuous variables. Twenty one cases were deemed GCTO after evaluation. Four cases received the diagnosis of GCTO due to positive reaction to inhibin, despite the divergent opinion of one the pathologist. The kappa coefficients were 0.42 (IC95%: -0.05; 0.88); 0.50 (IC95%: 0.13; 0.86); and 0.24 (IC95%: -0.14 a 0.61), for pairs A/B, A/C and B/C observers, respectively. We performed immunohistochemistry for the biological markers in 18 cases. Concerning the clinical and histological variables: 9 (50%) patients presented tumor size <10cm; 13 (72%) patients presented some solid diffuse/sarcomatoid pattern; 12 (66%) cases presented no/slight atypia and 6 (33%) cases presented moderate/strong atypia; 14 cases presented < 2 mitoses/10 HPF; 6 (33%) patients presented extraovarian extension of the disease (stage III/IV). The mean follow-up was 45.3 months (range: 0.7 to 128.8). One, 0 and 11 cases presented positive expression for mutant p53, c-erbB-2 e Ki-67 (focal), respectively. Fourteen (78%) cases were classified as high proliferating index when evaluated by PCNA. The mean microvascular density was 29,0/mm2(IC95%: 21,8 to 36,1). Only Ki-67, PCNA and CD34 were expressed at adequate levels for further correlation with other variables. There was no statistically significant link between either the PCNA proliferating index or the Ki-67 expression or microvascular density with tumor size, extraovarian extension of disease, mitotic activity, cellular atypia and histological pattern. We concluded that the diagnosis of GCTO is difficult in some cases, suggesting the evaluation be complemented with a panel of markers such as inhibin. We also verified that GCTO is a neoplasm that apparently did not involve mutations of p53 nor overexpression/amplification of c-erbB-2; presented conflictings results concerning the proliferating activity when evaluated by PCNA and Ki-67; and finally presented a low angiogenic activity when evaluated by CD34MestradoTocoginecologiaMestre em Tocoginecologi

Palliation with a multimodality treatment including hypoxic pelvic perfusion for unresectable recurrent rectal cancer: outcomes based on a retrospective study

Patients with unresectable recurrent rectal cancer that progresses after systemic chemotherapy and radiotherapy are candidates for palliation with hypoxic pelvic perfusion (HPP). The aim of this observational retrospective study was to evaluate if a multimodality treatment including HPP and targeted-therapy may be useful to prolong clinical responses and survival of these patients. From a cohort of 77 patients with unresectable recurrent rectal cancer in progression after standard treatments and submitted to HPP, 21 patients underwent repeat HPP using mitomycin C (MMC) at the dose of 25&nbsp;mg/m2. After the last HPP, 7 patients received a targeted-therapy with cetuximab according to overexpression of epidermal growth factor receptor in recurrence cancer cells. The median overall survival of these 21 patients from the diagnosis of unresectable recurrent rectal cancer was 23&nbsp;months (iqr 18-24). After the first HPP, the median survival of the 21 patients until death or end of follow-up was 10&nbsp;months (iqr 9-13). The 1-year and 2-year survival rates were 71.4%, and 4.8%, respectively. From the first HPP, age\u2009&gt;\u200960&nbsp;years, a recurrence shrinkage of at least 30% (partial response), and the addition of a post-HPP targeted-therapy with cetuximab significantly affected survival (P\u2009&lt;\u20090.04). In conclusion, repeated MMC-HPP followed by targeted-therapy seems to be an effective palliative treatment for patients with unresectable recurrent rectal cancer in progression after systemic chemotherapy and radiation but the results of this study have to be confirmed by a larger phase III trial

The Delphi and GRADE methodology used in the PSOGI 2018 consensus statement on Pseudomyxoma Peritonei and Peritoneal Mesothelioma

Pseudomyxoma Peritonei (PMP) and Peritoneal Mesothelioma (PM) are both rare peritoneal malignancies. Currently, affected patients may be treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy offering long-term survival or even cure in selected patients. However, many issues regarding the optimal treatment strategy are currently under debate. To aid physicians involved in the treatment of these patients in clinical decision making, the PSOGI executive committee proposed to create a consensus statement on PMP and PM. This manuscript describes the methodology of the consensus process. The Delphi technique is a reliable method for attaining consensus on a topic that lacks scientific evidence through multiple voting rounds which feeds back responses to the participants in between rounds. The GRADE system provides a structured framework for presenting and grading the available evidence. Separate questionnaires were created for PMP and PM and sent during two voting rounds to 80 and 38 experts, respectively. A consensus threshold of 51.0% was chosen. After the second round, consensus was reached on 92.9%–100.0% of the questions. The results were presented and discussed in the plenary session at the PSOGI 2018 international meeting in Paris. A third round for the remaining issues is currently in progress. In conclusion, using the Delphi technique and GRADE methodology, consensus was reached in many issues regarding the treatment of PM and PMP amongst an international panel of experts. The main results will be published in the near future

Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colorectal cancer at high risk for the development of peritoneal metastases. A matched case-control study

n/

Associação dos variantes dos genes bGH e Pit-1 com características de produção leiteira em touros Gir leiteiro

The objective of this study was to obtain genetic marker information in the Gyr breed by analyzing bGH and Pit-1 gene polymorphisms and to verify their association with milk production traits. One sample including 40 Gyr bulls were genotyped at two bGH gene restriction sites (bGH- AluI and bGH-MspI) and at one restriction site in the Pit-1 gene (Pit-1 HinfI). The bGH-MspI(-) allele was favorable for fat milk percentage. The heterozigous Pit-1 HinfI (+/-) bulls were superior for fat milk production, in relation to homozigous Pit-1 HinfI (+/+). The Pit-1 and bGH genes are strong candidates in the dairy cattle QTL search, and zebuine populations are promising samples for this purpose.O objetivo deste estudo foi obter informações dos marcadores genéticos na raça Gir pela análise dos polimorfismos nos genes bGH e Pit-1, e verificar suas associações com características de produção leiteira. Uma amostra de 40 touros da raça Gir foi genotipada, nos dois sítios de restrição no gene bGH (bGH-AluI e bGH-MspI) e em um sítio de restrição no gene Pit-1 (Pit-1 HinfI). O alelo bGH-MspI(-) favoreceu a porcentagem de gordura no leite. Os touros heterozigotos Pit-1 HinfI (+/-) foram superiores quanto à produção de gordura no leite, em relação aos homozigotos Pit-1 HinfI (+/+). Os genes Pit-1 e bGH são fortes candidatos à pesquisa de QTLs em raças leiteiras e populações zebuínas representam uma amostra promissora para esse propósito

Colorectal Cancer with Peritoneal Metastases: The Impact of the Results of PROPHYLOCHIP, COLOPEC, and PRODIGE 7 Trials on Peritoneal Disease Management

HIPEC is a potentially useful locoregional treatment combined with cytoreduction in patients with peritoneal colorectal metastases. Despite being widely used in several cancer centers around the world, its role had never been investigated before the results of three important RCTs appeared on this topic. The PRODIGE 7 trial clarified the role of oxaliplatin-based HIPEC in patients treated with radical surgery. Conversely, the PROPHYLOCHIP and the COLOPEC were designed to chair the role of HIPEC in patients at high risk of developing peritoneal metastases. Although all three trials demonstrated the relative ineffectiveness of HIPEC for treating or preventing peritoneal metastases, these results are not sufficient to abandon this technique. In addition to some criticisms relating to the design of the trials and their statistical value, the oxaliplatin-based HIPEC was found to be ineffective in preventing or treating peritoneal colorectal metastases, especially in patients already treated with systemic platinum-based chemotherapy. Several studies are ongoing investigating further HIPEC drugs and regimens. The review deeply discussed all the aspects and relapses of this new evidence

Diagnostic and Therapeutic Pathway in Diffuse Malignant Peritoneal Mesothelioma

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare form of mesothelioma that carries a very poor prognosis. The 5-year overall survival is about 20% (±5.9). Survival is optimal for patients suitable for cytoreductive surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), with a median OS ranging from 34 to 92 months. However, selecting patients for surgery remains a complex task and requires a careful preoperative workup, rational analysis of prognostic profiles, and risk prediction models. Systemic chemotherapy could be offered: (1) in the adjuvant setting for high-risk patients; (2) for patients not eligible for CRS; and (3) for those with recurrent disease. It mainly includes the combination of Platin compound with Pemetrexed or immunotherapy. The biology of DMPM is still largely unknown. However, progress has been made on some fronts, such as telomere maintenance mechanisms, deregulation of apoptosis, tyrosine kinase pathways, and mutation of BRCA1-associated protein 1 (BAP1). Future perspectives should include translational research to improve our understanding of the disease biology to identify druggable targets. We should also clear the role of immune checkpoint inhibitors and investigate new locoregional technologies, such as pressurized intraperitoneal aerosol chemotherapy (PIPAC) or normothermic intraperitoneal chemotherapy (NIPEC)