Giant retroperitoneal liposarcoma

<p>Abstract</p> <p>Background</p> <p>Liposarcoma is the most frequent histopathological variety of the retroperitoneum, surgery is the gold standard for treatment.</p> <p>Case presentation</p> <p>We present the case of a 24-year-old male who was diagnosed with a giant retroperitoneal liposarcoma. The patient received palliative treatment due to non-resectability on the basis of chemotherapy. We decided to perform surgery after no benefit was received with systemic treatment. Complete macroscopic resection of the tumor was performed, without multi-organ resection. The patient is currently alive and disease free at 14 months of evolution.</p> <p>Conclusion</p> <p>Retroperitoneal liposarcomas represent a unique situation and require a more aggressive surgical approach including multiple resections for recurrences. Based on the ability of the patient to tolerate the procedure, surgery is suggested to evaluate resectability of the tumor. We must take into consideration whether prolonged survival will be attained and tumor removal will result in palliation of symptoms.</p

Laser resection of liposarcoma of the hypopharynx

Liposarcomas represent between 15 and 18% of all sarcomas with the most common site being the extremities and retroperitoneum. Liposarcomas of the head and neck are rare, with an estimated incidence representing 3 to 5.6% of all liposarcomas. Liposarcomas most commonly present in the soft tissues of the neck. Primary liposarcoma of the hypopharynx (piriform sinus) is extremely rare. The symptoms presented are principally dysphagia, dyspnea, dysphonia, airway obstruction and sensation of a foreign body. Treatment of choice is surgery, and the literature describes the performance of lateral pharyngotomy, simple excision and even total laryngectomy. We present the case of a 23-year-old patient who was diagnosed 7 years prior with liposarcoma of the piriform sinus. The patient underwent surgery using a cervical approach. The tumor recurred 4 years postoperatively and the patient was again surgically intervened using the same approach. He presented to our Institute with 3 months evolution of dysphonia. Nasofibrolaryngoscopy and imaging studies were performed. Surgical treatment was decided upon with CO2 laser using suspension microlaryngoscopy, obtaining excellent results. Some of the advantages of this approach are low morbidity because of the avoidance of performing a tracheostomy, rapid return to oral feeding without necessity of a feeding tube, and reduction in hospitalization days. Disadvantage includes difficulty in evaluating margins

Expression of the metalloproteases MMP-1, MMP-2, MMP-3, MMP-9, MMP-11, TIMP-1 and TIMP-2 in angiocentric midfacial lymphomas

<p>Abstract</p> <p>Background</p> <p>Extranodal T/NK cell lymphomas possess distinctive clinico-pathological characteristics: they are angiocentric, exhibit extensive necrosis. Prognosis is poor in the short term. The objective is to explore the expression of different MMPs in the cells and stroma which are around of the blood vessels damaged and their correlation with clinico-pathological parameters.</p> <p>Patients and methods</p> <p>Twenty cases of this type of lymphomas were studied and collected patient clinical data. The expressions of MMP-1, 2, 3, 9, 11, 13 and TIMP-1, 2 were studied by immunohistochemistry. Ultrastructural studies were performed in two cases. Statistical analysis was done with Fisher's exact test, Chi²test.</p> <p>Results</p> <p>Of the 20 patients, 13 were men with median age of 43 years. In 13 patients the primary tumor was localized in the nasal cavity. Treatment was combined chemotherapy and radiotherapy in 60%. The 55% advanced clinical stages, 70% died from the disease. There were neoplastic cell and peritumoral fibroblasts positivity to MMP-1 and MMP-11 in most of the cases. The MMPs-2, 3 and 9 were expressed in neoplastic cell between 30 to 65%of the cases. TIMP-1 was presented mainly in the epithelium and TIMP-2 was poor expressed of the all cases.</p> <p>Conclusion</p> <p>There were no statistical significance between the different enzymes used and the clinical parameters, besides status and survival of the patients. It is necessary to study more enzymes and focus them to quantify and determine their activity, in order to have a better correlation with histological features in this type of neoplasm.</p

Prognostic factors in patients with breast cancer and brain metastasis as the first site of recurrence

Objective. To evaluate the prognostic factors (clinicalpathological characteristics and treatments) in patients with breast cancer and metastasis to central nervous system (CNS) as the first site of the disease. Materials and methods. Kaplan-Meier method and life tables were used to estimate overall survival time over a retrospective cohort of 125 breast cancer patients treated at the Instituto Nacional de Cancerología (INCan) during 2007-2015, who presented metastasis to the CNS as the first site of extension of the disease. The cox proportional hazards model was used to determine the prognosis factors. Result. The median overall survival time was 14.2 months (IC95%: 11.83-26.93). Patients with triple negative (TN), according to inmunohistochemistry analysis classification, had lower survival times (p=0.0004) and had a risk of dying two times (p=0.037) higher than patients with a different immunophenotype (HR: 2.77. 95%CI: 1.10-6.99). The degree of intermediate SBR increases the risk of dying in patients with metastasis (HR 2.76, 95% CI: 1.17-6.51). Conclusion. CNS metastasis continues to be a poor prognostic factor that reduces survival and affects quality of life. It is recommended to monitor the early presence of clinical neurological manifestations during follow-up for prompt treatment. TN patients have worse prognosis and HER2+ a better control

High resolution human leukocyte antigen (HLA) class I and class II allele typing in Mexican mestizo women with sporadic breast cancer: case-control study

<p>Abstract</p> <p>Background</p> <p>The development of breast cancer is multifactorial. Hormonal, environmental factors and genetic predisposition, among others, could interact in the presentation of breast carcinoma. Human leukocyte antigen (HLA) alleles play an important role in immunity (cellular immunity) and may be important genetic traits. HLAAllele-specific interaction has not been well established. Recently, several studies had been conducted in order to do so, but the results are controversial and in some instances contradictory.</p> <p>Methods</p> <p>We designed a case-control study to quantify the association of HLA class I and II genes and breast cancer. HLA typing was performed by high resolution sequence-specific oligotyping after DNA amplification (PCR-SSOP) of 100 breast cancer Mexican mestizo patients and 99 matched healthy controls.</p> <p>Results</p> <p>HLA-A frequencies that we were able to observe that there was no difference between both groups from the statistical viewpoint. HLA-B*1501 was found three times more common in the case group (OR, 3.714; <it>p </it>= 0.031). HLA-Cw is not a marker neither for risk, nor protection for the disease, because we did not find significant statistical differences between the two groups. DRB1*1301, which is expressed in seven cases and in only one control, observing an risk increase of up to seven times and DRB1*1602, which behaves similarly in being present solely in the cases (OR, 16.701; 95% CI, 0.947 – 294.670). DQ*0301-allele expression, which is much more common in the control group and could be protective for the presentation of the disease (OR, 0.078; 95% CI, 0.027–0.223, <it>p </it>= 0.00001).</p> <p>Conclusion</p> <p>Our results reveal the role of the MHC genes in the pathophysiology of breast cancer, suggesting that in the development of breast cancer exists a disorder of immune regulation. The triggering factor seems to be restricted to certain ethnic groups and certain geographical regions since the relevant MHC alleles are highly diverse. This is the first study in Mexican population where high resolutions HLA typing has been performed in order to try to establish an association with malignancy.</p

Cancer burden in Mexico: urgent challenges to be met

Primary prevention of cancer was initiated with the introduction of Hepatitis B vaccine in the 80’s. However, in primary prevention of cancer at the worldwide level has been relatively recent. Intervention-action initiatives began at the global level in 2003 with the WHO Framework Convention on Tobacco Control, which was the first treaty negotiated under WHO guidance and as of today includes 168 countries. This negotiation, although innovative, was somewhat overdue, considering that the causal association between exposure to tobacco and elevated cancer incidence was established over 65 years ago. Vaccines against hepatitis and more recently human papilloma virus are other noteworthy developments in primary cancer prevention. As for secondary prevention, it has focused on early detection of cancer, especially among women, first with screening based on the Pap test and later other strategies for cervical cancer detection. For breast cancer, early detection strategies such as mammograms and clinical breast examination have been used for many years. However, today their impact on mortality for this cancer has come into question. In this context, in Mexico we face enormous challenges to provide an efficient organized social response to cancer prevention and control. This issue of Salud Pública de México on “Cancer burden in Mexico: urgent challenges to be met” is an effort to estimate in epidemiological terms the breadth and depth of the problem faced in Latin America and particularly in Mexico. The authors do this by describing the enormous population-level and clinical challenges which need to be faced in the short term.   DOI: http://dx.doi.org/10.21149/spm.v58i2.777

Integrated oncology and palliative care: five years experience at the National Cancer Institute of Mexico

Under the national plan for addressing cancer, prevention and detection play important roles. However, the cost of treatments and late diagnosis represent a significant burden on health services. At the National Cancer Institute, more than half of patients present with tumors in advanced stages, and approximately 10% of patients seen for the first time exhibit terminal-stage malignancies, where there are no feasible cancer treatment options, and the patients are instead admitted to the hospital exclusively for palliative symptomatic management. In 2010, the National Cancer Plan began implementing a model of integrative management of palliative care in oncology that has gradually come to include symptomatic palliative care, involving ambulatory, distant and hospitalized management of patients with cancer, in its final stages and, more recently, in earlier stages. DOI: http://dx.doi.org/10.21149/spm.v58i2.780

In situ and invasive carcinoma identified through an opportunistic screening mammography in asymptomatic women of Mexico City.

Objective. To describe the mammographic findings and carcinoma detection rate in asymptomatic women of Mexico City, that participated in an opportunistic screening program. Materials and methods. 39 491 participants were included, with mammograms performed and interpreted in the National Cancer Institute, from 2008 to 2011. The mammographic findings, type of lesion and true positives (TP), are described by age groups. We calculated the crude effect of age on the classification BIRADS (Breast Imaging Reporting and Data System) 0 and the type of lesion. Results. The median age was 50 (45-57) years. 80.5% were classified as BIRADS 2, 11.4%(0), 4.1%(1), 3.5%(3), 0.5%(4) y 0.1%(5). Malignant lesions were detected in 1.3 and 3.3 per 1000 and the proportion of true positives (TP) was 8.2% and 20.6%, in women of 41-50 and 51-70 years, respectively. Conclusions. Although some cases are detected in women 40 to 50 years, in women over 50 years the screening by mammography is more efficient, with a higher proportion of cases detected and fewer false positives

The importance of registries in cancer control

Cancer is one of the major causes of morbidity and mortality in the world, with 14.1 million new cases and 8.2 million deaths annually. A marked disparity exists between developed countries and developing countries, with 57% of new cases and 65% of deaths in 2012 occurring in developing countries. This global picture can only be obtained because of data obtained from population-based cancer registries, which allow cancer estimations for different geographic areas. Our objective is to perform a review of different types of registries and their role in the control of cancer. These types of registries are lacking in developing countries. In Central and South America, only 6% of the population is included in cancer registries versus 83% in North America. It is necessary to increase the coverage of cancer registries to obtain more reliable data that will more appropriately guide control programs. DOI: http://dx.doi.org/10.21149/spm.v58i2.780