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- ItemAcesso aberto (Open Access)Assessment of stage T1 (TNM 1997) for renal cell carcinoma: is recommended the subdivision in T1a and T1b?(Sociedade Brasileira de Urologia, 2003-04-01) Dall Oglio, Marcos Francisco [UNIFESP]; Srougi, Miguel [UNIFESP]; Mangini, Marcelo; Ribeiro, Eduardo [UNIFESP]; Ferraz, Márcio [UNIFESP]; Sañudo, Adriana [UNIFESP]; Leite, Kátia Ramos Moreira [UNIFESP]; Nesrallah, Luciano [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Classification TNM 1997 defines renal cell carcinoma smaller than 7 cm and confined to the kidney as stage T1. Our goal is to discuss if tumors smaller than 4 cm have the same behavior characteristics then tumors between 4 and 7 cm, to compose the same stage of the disease. MATERIALS AND METHODS: Retrospective assessment of 138 patients in stage T1 (TNM - 97), divided into 2 groups; group-1: composed of 65 patients (47%) with tumors < 4 cm, and group-2: composed of 73 patients (53%) with tumors between 4 and 7 cm. The following prognostic factors were assessed in the recurrence of the disease and survival of patients: nuclear degree, microvascular invasion, sarcomatous degeneration, and involved lymph nodes. Statistical evaluation has been accomplished through the log rank test, chi-square test, and Fishers exact text. RESULTS: Average tumor size was 2.5 cm for group-1, and 5.3 cm for group-2. In group-2, there was the predominance of worse prognostic factors, with high-grade tumors (p = 0.01) and presence of microvascular invasion (p = 0.001). Sarcomatous tumors and involvement of lymph nodes did only happen in group-2. Disease-free survival for group-1, analyzed in the median period of 36 months, was 100%, and for group 2, in the median period of 31 months, was 81% (p = 0.008). CONCLUSION: The results obtained allow the conclusion that the present stage T1 for renal cell carcinoma gathers tumors of different evolution, being therefore recommendable the stratification in T1a for tumors smaller than 4 cm, and T1b for tumors between 4 and 7 cm.
- ItemSomente MetadadadosCarcinoma of the papilla of Vater: Are endoscopic appearance and endoscopic biopsy discordant?(Elsevier B.V., 2006-09-01) deOliveira, Michelle Lucinda de [UNIFESP]; Trivino, Tarcisio; Lopes Filho, Gaspar de Jesus; Universidade Federal de São Paulo (UNIFESP)Carcinoma of the papilla of Vater is classified as periampullary cancer representing 5% of all gastrointestinal tract malignancies. Early and accurate diagnosis is important for those patients with a tumor of the papilla, as the prognosis is more favorable than in other periampullary neoplasms. Endoscopically obtained biopsies from suspicious papillae can detect an early tumor, although even for skilled pathologists it is often difficult to differentiate carcinomas from noninvasive lesions on the basis of forceps biopsies. the purpose of this study was to assess the preoperative diagnostic accuracy of duodenoscopy appearance and biopsy in all cases with suspicion of tumor. Thirty patients with suspicion of carcinoma of the papilla of Vater and with final diagnosis established by pancreatoduodenectomy were included in this retrospective study. in each case, a comparison was made between endoscopic biopsy and duodenoscopic appearance. Duodenoscopic appearance sensitivity and accuracy for malignancy were 86% and 83%, respectively, whereas endoscopic biopsy sensitivity and accuracy were 65% and 67%, respectively. Although preoperative diagnosis of carcinoma of the papilla of Vater is useful for making therapeutic decisions, the diagnostic value of the endoscopic appearance was superior to endoscopic biopsy in this series.
- ItemAcesso aberto (Open Access)Carcinoma papilífero da tireoide associado à tireoidite de Hashimoto(Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2012-12-01) Campos, Luiz Alexandre Albuquerque Freixo; Picado, Sílvia Miguéis; Guimarães, André Vicente; Ribeiro, Daniel Araki [UNIFESP]; Dedivitis, Rogério Aparecido [UNIFESP]; Hospital Ana Costa; Hospital Regional do Vale do Paraíba; Hospital Ana Costa Serviço de Cirurgia de Cabeça e Pescoço; Universidade Federal de São Paulo (UNIFESP); Fundação Lusíada UNILUSThere is controversy in the literature regarding the association between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT) and as to what would be the etiological relationship between them. OBJECTIVE: To establish the proportion of cases among patients with TH and CPT, correlating it with histomorphological aspects. METHOD: A retrospective study of patients undergoing partial or total thyroidectomy for PTC between 2007 and 2009, a total of 41 cases. RESULTS: Regarding the association of HT and CPT, we found 11 cases (26.8%), all females, but without statistical significance. The mean age was 44.9 years among the patients with coexistent TH and CPT, whereas it was 49.1 years without that association. The average size of tumors in those without TH was 20.53 mm and for those with TH it was 12.72 mm (p = 0.4). Regarding pathology staging, the ratiosbetween those with and those without TH were kept in T1a, T1b and T3. In T2, there were no cases of coexistence of HT and PTC. CONCLUSION: There is a rate of 26.8% of patients with association between TH and CPT, but without differences in relation to tumor size.
- ItemSomente MetadadadosEsophageal carcinoma secondary to a chemical injury in a child(Springer, 1998-09-01) Schettini, S. T.; Ganc, A.; Saba, L.; Universidade Federal de São Paulo (UNIFESP)Twin sisters were clinically and endoscopically followed due to chemical injuries to the esophagus after ingestion of muriatic acid at 10 months of age. One of the girls developed esophageal carcinoma 10 years later and died after esophagectomy because of progression of the disease. Her twin sister has a severe stenosis at the distal esophagus and is waiting for surgical treatment. Malignization of a chemical injury to the esophagus in a child has not yet been described in the literature, emphasizing the role of endoscopic follow-up with periodic biopsies.
- ItemAcesso aberto (Open Access)Esvaziamento cervical no carcinoma epidermoide de laringe: indicação de esvaziamento eletivo contralateral(Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2012-04-01) Amar, Ali [UNIFESP]; Chedid, Helma Maria; Franzi, Sergio Altino; Rapoport, Abrão [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Heliópolis; Universidade de São Paulo (USP)Unilateral or bilateral neck dissection must be considered in the treatment of laryngeal cancer AIM: To evaluate the prevalence of contralateral metastases in larynx cancer and distribution of these metastases according to lymph node levels in the neck. METHOD: Retrospective longitudinal study of 272 charts from patients with squamous cell cancer of the larynx treated between 1996 and 2004; and we selected 104 surgical cases submitted to neck dissection. We evaluated the incidence of bilateral or contralateral metastases, according to the location and extension of the primary tumor, considering the anatomical sub-sites and the midline. RESULTS: Contralateral metastases in lateral tumors were observed in 3.5% of glottic lesions and in 26% of supraglottic lesions. Contralateral metastases were uncommon in N0 patients. Lymph nodes levels IIa and III were the most commonly involved in the neck. CONCLUSION: In lateral glottic tumors there is no need for elective contralateral neck dissection. In supraglottic lesions without ipsilateral metastases, the incidence of hidden metastasis does not justify elective contralateral dissection. The midline is not a reliable indicator of the risk of contralateral laryngeal tumors.
- ItemAcesso aberto (Open Access)Fístula faringocutânea após laringectomia total(Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2012-12-01) Aires, Felipe Toyama; Dedivitis, Rogério Aparecido [UNIFESP]; Castro, Mario Augusto Ferrari de; Ribeiro, Daniel Araki [UNIFESP]; Cernea, Claudio Roberto; Brandão, Lenine Garcia; Centro Universitário Lusíada; Universidade de São Paulo (USP); Santa Casa da Misericórdia de Santos Hospital Ana Costa Serviços de Cirurgia de Cabeça e Pescoço; Universidade Federal de São Paulo (UNIFESP)Pharyngocutaneous fistula (PCF) is the most common complication after total laryngectomy. OBJECTIVES: To establish the incidence of this complication and to analyze the predisposing factors. METHOD: This is a cross-sectional study of a historical cohort including 94 patients who underwent total laryngectomy. The following aspects were correlated to the occurrence of PCF: gender, age, tumor site, TNM staging, type of neck dissection, previous radiation therapy, previous tracheotomy, and use of stapler for pharyngeal closure. The following were considered in PCF cases: the day into postoperative care when the fistula was diagnosed, duration of occurrence, and proposed treatment. RESULTS: Twenty (21.3%) patients had PCF. The incidence of PCF was statistically higher in T4 tumors when compared to T2 and T3 neoplasms (p = 0.03). The other analyzed correlations were not statistically significant. However, 40.9% of the patients submitted to tracheostomy previously had fistulae, against 21.1% of the patients not submitted to this procedure. CONCLUSION: Advanced primary tumor staging is correlated with higher incidences of PCF.
- ItemSomente MetadadadosLow clinical stage renal cell carcinoma: Relevance of microvascular tumor invasion as a prognostic parameter(Lippincott Williams & Wilkins, 2004-08-01) Goncalves, P. D.; Srougi, M.; Dall'Oglio, M. F.; Leite, KRM; Ortiz, V; Hering, F.; Universidade Federal de São Paulo (UNIFESP); Hosp Sirio LibanesPurpose: Renal cell carcinoma is a tumor with unpredictable behavior and defining reliable prognostic factors would be extremely valuable in the clinical setting. Tumor stage, nuclear grade and tumor cell type are the main prognostic clinical parameters available. in this study we evaluated the role of microvascular involvement in the primary lesion for predicting tumor behavior in patients with low stage clinical disease.Materials and Methods: A total of 95 patients with clinically localized renal cell carcinoma (stages T-1-T-2 N-x M-0) underwent radical nephrectomy and/or nephron sparing surgery, and were followed for a median of 45 months. the impact of microvascular tumor invasion on disease progression and its correlation with known pathological outcomes (tumor size, nuclear grade and cell type) were studied.Results: Microvascular tumor invasion was observed in 24 patients (25%), of whom 50% had disease recurrence. of the 71 patients without microvascular invasion only 4 (6%) showed tumor recurrence. When microvascular invasion was correlated with other histological parameters, a significant statistical association was noted with tumor diameter, perirenal fat invasion, macroscopic extension to the renal vein, nuclear grade, lymph node metastasis and sarcomatous elements in the tumor. Multivariate analysis showed that microvascular invasion and the involvement of regional lymph nodes were independent predictors of disease recurrence. Concerning cancer specific survival, microvascular invasion and perirenal fat infiltration were the only factors related to death.Conclusions: Microvascular invasion is an independent and relevant clinical prognostic parameter for low clinical stage renal cell carcinoma.
- ItemSomente MetadadadosM918V RET mutation causes familial medullary thyroid carcinoma: study of 8 affected kindreds(Bioscientifica Ltd, 2016) Martins-Costa, Maria Cecilia [UNIFESP]; Cunha, Lucas Leite [UNIFESP]; Lindsey, Susan Chow [UNIFESP]; Camacho, Cléber Pinto [UNIFESP]; Dotto, Renata Pires [UNIFESP]; Furuzawa, Gilberto Koiti [UNIFESP]; Sousa, Maria Sharmila Alina de [UNIFESP]; Kasamatsu, Teresa Sayoko [UNIFESP]; Kunii, Ilda Sizue [UNIFESP]; Martins, Marcio Maciel [UNIFESP]; Machado, Alberto L. [UNIFESP]; Martins, João Roberto Maciel [UNIFESP]; Dias-da-Silva, Magnus Régios [UNIFESP]; Maciel, Rui Monteiro de Barros [UNIFESP]Germline mutations in codon 918 of exon 16 of the RET gene (M918T) are classically associated with multiple endocrine neoplasia type 2B ( MEN 2B) with highly aggressive medullary thyroid cancer (MTC), pheochromocytoma and a unique phenotype. The objectives of this study are to describe the rare M918V RET mutation discovered in 8 MTC kindreds from Brazil lacking the MEN 2B phenotype classically observed in M918T patients and to investigate the presence of a founder effect for this germline mutation. Eight apparently sporadic MTC cases were diagnosed with the germline M918V RET mutation. Subsequently, their relatives underwent clinical and genetic assessment (n = 113), and M918V was found in 42 of them. Until today, 20/50 M918V carriers underwent thyroidectomy and all presented MTC/C-cell hyperplasia
- ItemAcesso aberto (Open Access)Sarcomatoid differentiation in renal cell carcinoma: prognostic implications(Sociedade Brasileira de Urologia, 2005-02-01) Dall'Oglio, Marcos Francisco [UNIFESP]; Lieberknecht, Marco [UNIFESP]; Gouveia, Valter [UNIFESP]; Sant'anna, Alexandre C. [UNIFESP]; Leite, Kátia Ramos Moreira [UNIFESP]; Srougi, Miguel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Renal cell carcinoma with sarcomatoid differentiation is a tumor with aggressive behavior that is poorly responsive to immunotherapy. The objective of this study is to report our experience in the treatment of 15 patients with this tumor. MATERIALS AND METHODS: We retrospectively analyzed 15 consecutive cases of renal cell carcinoma with sarcomatoid differentiation diagnosed between 1991 and 2003. The clinical presentation and the pathological stage were assessed, as were the tumor's pathological features, use of adjuvant immunotherapy and survival. The study's primary end-point was to assess survival of these individuals. RESULTS: The sample included 8 women and 7 men with mean age of 63 years (44 - 80); follow-up ranged from 1 to 100 months (mean 34). Upon presentation, 87% were symptomatic and 4 individuals had metastatic disease. Mean tumor size was 9.5 cm (4 - 24) with the following pathological stages: 7% pT1, 7% pT2, 33% pT3, and 53% pT4. The pathological features showed high-grade tumors with tumoral necrosis in 87% of the lesions and 80% of intratumoral microvascular invasion. Disease-free and cancer-specific survival rates were 40 and 46% respectively, with 2 cases responding to adjuvant immunotherapy. CONCLUSIONS: Patients with sarcomatoid tumors of the kidney have a low life expectancy, and sometimes surgical resection associated with immunotherapy can lead to a long-lasting therapeutic response.
- ItemSomente MetadadadosSquamous Cell Carcinoma Derived From Chronic Chromoblastomycosis in Brazil(Oxford Univ Press Inc, 2015-05-15) Azevedo, Conceicao M. P. S.; Marques, Sirlei G.; Santos, Daniel W. C. L. [UNIFESP]; Silva, Raimunda R.; Silva, Nayara F.; Santos, Daniel Assis; Resende-Stoianoff, Maria A.; Univ Fed Maranhao; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Minas Gerais (UFMG)Background. Chromoblastomycosis (CBM) is a chronic fungal infection caused mainly by the melanized fungi Fonsecaea species. the chronic lesions may be predisposed to develop into cancer, the most serious complication of the disease.Methods. in this report, 7 cases of squamous cell carcinoma (SCC) resulting from chronic CBM in patients from Maranhao in the Brazilian Amazon are described.Results. the 7 patients presented with SCC that resulted from chronic CBM, caused by Fonsecaea species >10 years' duration. the malignant lesions occurred independent of the antifungal therapy and all patients underwent curative amputation, except for 1 patient who developed metastases in the inguinal and intra-abdominal lymph nodes and thigh muscles. A majority of previous reports have focused on the malignant transformation of CBM described in only 1 patient each. This is a first report describing a group of patients from a single Brazilian state.Conclusions. Here, we provide new epidemiologic data on malignant CBM lesions, an endemic disease that is seemingly neglected worldwide. We reinforce the idea that typically chronic lesions may be predisposed to turn malignant.