ABSTRACT Introduction Penile cancer (PC) occurs less frequently in Europe and in the United States than in South America and parts of Africa. Lymph node (LN) involvement is the most important prognostic factor, and inguinal LN (ILN) dissection can be curative; however, ILN dissection has high morbidity. A nomogram was previously developed based on clinicopathological features of PC to predict ILN metastases. Our objective was to conduct an external validation of the previously developed nomogram based on our population. Materials and methods We included men with cN0 ILNs who underwent ILN dissection for penile carcinoma between 2000 and 2014. We performed external validation of the nomogram considering three different external validation methods: k-fold, leave-one-out, and bootstrap. We also analyzed prognostic variables. Performance was quantified in terms of calibration and discrimination (receiver operator characteristic curve). A logistic regression model for positive ILNs was developed based on clinicopathological features of PC. Results We analyzed 65 men who underwent ILN dissection (cN0). The mean age was 56.8 years. Of 65 men, 24 (36.9%) presented with positive LNs. A median 21 ILNs were removed. Considering the three different methods used, we concluded that the previously developed nomogram was not suitable for our sample. Conclusions In our study, the previously developed nomogram that was applied to our population had low accuracy and low precision for correctly identifying patients with PC who have positive ILNs.

ABSTRACT Cancer related to hereditary syndromes corresponds to approximately 5-10% of all tumors. Among those from the genitourinary system, many tumors had been identified to be related to genetic syndromes in the last years with the advent of new molecular genetic tests. New entities were described or better characterized, especially in kidney cancer such as hereditary leiomyomatosis renal cell carcinoma (HLRCC), succinate dehydrogenase kidney cancer (SDH-RCC), and more recently BAP1 germline mutation related RCC. Among tumors from the bladder or renal pelvis, some studies had reinforced the role of germline mutations in mismatch repair (MMR) genes, especially in young patients. In prostate adenocarcinoma, besides mutations in BRCA1 and BRCA2 genes that are known to increase the incidence of high-risk cancer in young patients, new studies have shown mutation in other gene such as HOXB13 and also polymorphisms in MYC, MSMB, KLK2 and KLK3 that can be related to hereditary prostate cancer. Finally, tumors from testis that showed an increased in 8 - 10-fold in siblings and 4 - 6-fold in sons of germ cell tumors (TGCT) patients, have been related to alteration in X chromosome. Also genome wide association studies GWAS pointed new genes that can also be related to increase of this susceptibility.

RESUMO INTRODUÇÃO: Sarcomas uterinos constituem forma rara de neoplasia maligna, composta por cerca de 3% de todos os tumores malignos do útero, o que representa menos de 1% de todas as neoplasias ginecológicas. Baixa taxa de cura muitas vezes ocorre devido a metástases à distância, geralmente para os pulmões. Agressividade, altas taxas de recorrência local, metástases à distância e prognóstico desfavorável com sobrevida global de dois anos em menos de 50% são características comuns aos sarcomas uterinos. Apesar da baixa prevalência, estes tumores são de grande interesse devido às suas múltiplas características morfológicas e clínicas. OBJETIVO: Este artigo focaliza aspectos gerais dos sarcomas uterinos, etiologia, prognóstico, tratamento e métodos moleculares utilizados em seu estudo. METODOLOGIA: Esta revisão foi realizada utilizando o banco de dados Pubmed para pesquisar artigos publicados que continham as palavras-chaves: sarcoma uterino, características moleculares, fatores prognósticos. RESULTADOS: Pouco se sabe sobre a etiologia dos sarcomas uterinos. Alguns estudos têm demonstrado a associação entre eventos genéticos que envolvem mutações em genes do ciclo celular e apoptose e epigenética em sarcomas ginecológicos. Estudos anteriores mostraram que as translocações cromossômicas foram identificadas, resultando em genes de fusão que são constitutivos e podem envolver a ativação de fatores de transcrição. Os avanços nas técnicas moleculares têm melhorado as possibilidades diagnósticas e permitiu uma melhor compreensão de diversas patologias. CONCLUSÕES: Há vários fatores que dificultam o estudo de sarcomas, pois trata-se de tumores raros e não se sabe a origem celular de cada um de seus tipos histológicos. Assim, o estudo molecular dos fenômenos envolvidos no desenvolvimento dos diferentes tipos de câncer levou a novas estratégias utilizadas no diagnóstico e no tratamento destes tumores.

INTRODUCTION: Uterine sarcomas are rare forms of malignant neoplasm, comprising about 3% of all malignant uterine tumors, representing less than 1% of all gynecologic malignancies. Low cure rates often occur due mainly to distant metastases, usually to the lungs. Aggressiveness, high rates of local recurrence, distant metastasis and poor prognosis with overall two-year survival less than 50% are common features of uterine sarcomas. Despite the low prevalence, these tumors are of great interest because of their multiple morphological and clinical features. OBJECTIVE: This article will be focused on the uterine sarcomas general aspects, etiology, prognosis, treatment and molecular features. METHOD: This review was performed using the Pubmed database to search for published articles. RESULTS: Little is known about the etiology of uterine sarcomas. Some studies have demonstrated the association between genetic events involving mutations in genes of the cell cycle and apoptosis and epigenetic in gynecologic sarcomas. Previous studies showed that chromosomal translocations have been identified, resulting in fusion genes that are constitutive and might involve the activation of transcription factors. Advances in molecular techniques have improved the diagnostic possibilities and allowed an improved understanding of the various pathologies. CONCLUSIONS: There are several factors that make the study of sarcomas a challenging issue, since those tumors are rare and the cell origin of each histologic type is nor well known Thus, molecular study of the events involved in the development of different types of cancer may lead to new strategies used in the diagnosis and treatment of these tumors.

Introduction Positive surgical margins (PSMs) are an adverse factor that may predict a worse outcome in patients submitted to radical prostatectomy (RP). However, not all of these cases will evolve to biochemical (BCR) or clinical (CR) recurrence, therefore relationship between PSMs and these recurrent events has to be correlated with other clinical and pathologic findings to indicate complementary treatment for selected patients. Materials and Methods Of 1250 patients submitted to open retropubic radical prostatectomy (RRP), between March 1991 and June 2008, the outcome of 161 patients with PSMs and of 67 without PSMs as a control group, comprising a total of 228 cases were retrospectively reviewed. A minimum follow-up time of 2 years after surgery was considered. BCR was determined when PSA ≥ 0.2ng/mL. CR was determined whenever there was clinical evidence of tumor. Chi-square test was used to correlate clinical and pathologic variables with PSMs. Time interval to biochemical recurrence was analyzed by the Kaplan-Meier product limit analysis using the log-rank test for comparison between groups. Univariate and multivariate Cox stepwise logistic regression models were used to identify significant predictors of risk of shorter intervals to BCR. Results Prostate circumference margin was the most common site with 78 cases (48.44%). Regarding the outcome of 228 cases from both groups, BCR occurred in 68 patients (29.82%), and CR in 10 (4.38%). Univariate analysis showed statistically significant associations (p < 0.001) between presence of PSMs with BCR, but not with CR (p = 0.05). At follow-up of the 161 patients with PSMs, only 61(37.8%) presented BCR, while 100 (62.8%) did not. BCR correlated with pathologic stage; Gleason score; preoperative PSA; tumor volume in the specimen; capsular and perineural invasion; presence and number of PSMs. CR correlated only with angiolymphatic invasion and Gleason score. Considering univariate analysis of clinical and pathologic factors predicting progression-free survival at 5 years, prostate weight; preoperative PSA; Gleason score; pathologic stage; tumor volume; PSMs; capsular and perineural invasion were correlated with BCR. At multivariate analysis, only Gleason score and percentage of tumor volume correlated as significant independent predictors of BCR. Conclusion At univariate analysis, presence, number and location of PSMs have consistent correlation with BCR after RRP, but at follow-up BCR occurred only in 37.8% of patients with PSMs. However at multivariate analysis, the significant risk factors for BCR were percentage of tumor volume (p = 0.022) and Gleason score (p < 0.005) in the surgical specimen. Angiolymphatic invasion and Gleason score were significantly correlated with CR.

CONTEXTO E OBJETIVO: Cordoma é um tumor raro e com alto risco de recidiva locorregional. O objetivo deste estudo foi analisar os resultados a longo prazo do tratamento dessa doença.TIPO DE ESTUDO E LOCAL: Estudo de coorte realizado em um único hospital em São Paulo, Brasil.MÉTODOS: Estudo de coorte retrospectivo com 42 pacientes com cordoma tratados de 1980 e 2006 no Hospital A. C. Camargo. Os prontuários foram revistos e foi realizada a análise descritiva das variáveis clínicas e patológicas. As curvas de sobrevida foram estimadas pelo método de Kaplan-Meier e a comparação entre elas, pelo teste de log-rank.RESULTADOS: Dezenove pacientes eram homens e 23, mulheres. Vinte e cinco tumores (59,5%) estavam localizados no sacro, 11 (26,2%) na base do crânio e 6 (14,3%), na coluna móvel. A cirurgia foi realizada em 28 pacientes (66,7%). A ressecção foi considerada como tendo margens negativas em 14 casos e margens comprometidas em 14 pacientes. A sobrevida global (SG) em 5 anos foi de 45,4%. Para os pacientes cirúrgicos, a SG em 5 anos foi de 64,3% (82,2% para as margens negativas e 51,9% de margens positivas). No grupo inoperável, a SG em 24 meses foi de 37,7% e 0% em 5 anos.CONCLUSÃO: A ressecção completa está relacionada com o controle local e, definitivamente, tem impacto positivo na sobrevida a longo prazo.

CONTEXT AND OBJECTIVE: Chordoma is a rare tumor with a high risk of locoregional recurrences. The aim of this study was analyze the long-term results from treating this pathological condition.DESIGN AND SETTING: Cohort study in a single hospital in São Paulo, Brazil.METHODS: This was a retrospective cohort study on 42 patients with chordoma who were treated at Hospital A. C. Camargo between 1980 and 2006. The hospital records were reviewed and a descriptive analysis was performed on the clinical-pathological variables. Survival curves were estimated using the Kaplan-Meier method and these were compared using the log-rank test.RESULTS: Nineteen patients were men and 23 were women. Twenty-five tumors (59.5%) were located in the sacrum, eleven (26.2%) in the skull base and six (14.3%) in the mobile spine. Surgery was performed on 28 patients (66.7%). The resection was considered to have negative margins in 14 cases and positive margins in 14 cases. The five-year overall survival (OS) was 45.4%. For surgical patients, the five-year OS was 64.3% (82.2% for negative margins and 51.9% for positive margins). In the inoperable group, OS was 37.7% at 24 months and 0% at five years.CONCLUSION: Complete resection is related to local control and definitively has a positive impact on long-term survival.

A síndrome de Bannayan-Riley-Ruvalcaba é afecção rara, causada por mutações no gene PTEN. Apresenta associação de múltiplos lipomas, macrocefalia, hemangiomas, polipose hamartomatosa intestinal, atraso do desenvolvimento e máculas salpicadas na genitália masculina. Relatamos o caso de um menino de nove meses com lesões tumorais de crescimento rápido e progressivo em três meses de evolução, macrocefalia e lentigos no pênis. Exames de imagem demonstraram extensa lipomatose com invasão da musculatura paraespinhal, alargamento do canal vertebral e compressão medular. Depois da excisão cirúrgica da massa, o anatomopatológico foi compatível com lipoma. A análise do cariótipo em cultura de adipócitos demonstrou mutação do PTEN. Apresentamos este caso por sua exuberância e raridade.

Bannayan-Riley-Ruvalcaba Syndrome is a rare condition caused by mutations in the PTEN gene. It displays association of multiple lipomas, macrocephaly, hemangiomas, hamartomatous intestinal polyposis, developmental delay and speckled pigmented maculae on the male genitalia. We report the case of a nine-month-old boy who had fast growing and progressive tumors for three months, macrocephaly and lentigines on the penis. Imaging tests showed extensive lipomatosis with invasion of paraspinal muscles, enlargement of the spinal canal and spinal cord compression; after surgical excision of the mass, the pathology was consistent with lipoma. Adipocyte culture karyotype demonstrated PTEN mutation. We present this case for its rarity and exuberance.

INTRODUÇÃO: Sabe-se que os níveis de expressão de moléculas envolvidas na regulação da apoptose e da proliferação celular apresentam valor prognóstico em pacientes com neuroblastomas. OBJETIVO: Avaliar a imunoexpressão das proteínas Ki67, B-cell lymphoma 2 (BCL-2), phosphatase and tensin homolog (PTEN), caspase-8 e BCL-2 associated protein X (BAX) em neuroblastomas na tentativa de propor novos biomarcadores prognósticos que poderiam auxiliar na melhor discriminação dos grupos de risco. MATERIAL E MÉTODOS: Amostras de neuroblastoma (n = 23) foram submetidas à técnica tissue microarray e analisadas com imuno-histoquímica. Os pacientes foram classificados de acordo com os fatores prognósticos clínico-patológicos (idade, localização, medula óssea infiltrada ou não, pouco diferenciado ou em diferenciação/ganglioneuroblastoma, rico ou pobre em estroma com células de Schwann, histologia favorável ou desfavorável segundo Shimada, presença ou não da amplificação do MYCN) e com o curso clínico (se em óbito ou vivo, com ou sem lesão residual/recidiva). RESULTADOS: Doze casos eram do sexo feminino; nove tinham idade acima de 18 meses; nove apresentavam tumores extra-abdominais; e nove cursavam com histologia desfavorável. Quinze pacientes foram submetidos à biópsia de medula óssea, sendo quatro com apresentação de metástase. Nove pacientes evoluíram ao óbito. CONCLUSÃO: A imunoexpressão do Ki67 foi mais baixa nos casos ricos em estroma (p = 0,018) e elevada nos casos pouco diferenciados (p = 0,013). O PTEN apresentou-se menos positivo em neuroblastomas ricos em estroma (p = 0,024). A caspase-8 foi mais imunopositiva em casos com medula óssea negativa (p = 0,035). Esses biomarcadores poderiam ser utilizados para auxiliar a discriminar grupos de pacientes de pior prognóstico.

INTRODUCTION: It is widely known that the expression levels of molecules involved in apoptosis regulation and cell proliferation have prognostic value in patients with neuroblastomas. OBJECTIVE: To determine the expression of Ki67, B-cell lymphoma 2 (BCL-2), phosphatase and tensin homolog (PTEN), BCL-2 associated protein X (BAX) and caspase-8 proteins in neuroblastomas and to propose new prognostic biomarkers that could enable a better classification of risk groups. MATERIAL AND METHODS: Formalin fixed paraffin embedded neuroblastoma samples (n = 23) were arranged into tissue microarray blocks and analyzed by immunohistochemistry. The patients were classified according to clinical and pathological prognostic factors (age, site, presence or absence of bone-marrow infiltration, poorly or well differentiated ganglioneuroblastoma, Schwannian stroma rich or poor, favorable or unfavorable Shimada histology, and presence or absence of MYCN oncogene amplification) and clinical course (with or without fatal outcome, with or without relapses/residual lesion). RESULTS: Twelve patients were female; nine children were over 18 months old; nine had extra-abdominal tumors; nine had tumors with unfavorable histology. Fifteen patients underwent bone-marrow biopsy and four were positive for metastasis. Nine patients progressed to fatal outcome. CONCLUSION: Ki67 immunoexpression was lower in cases of Schwannian-stroma rich neuroblastomas (p = 0.018) and higher in poorly differentiated cases (p = 0.013). PTEN was less positive in stroma rich neuroblastomas (p = 0.024). Caspase-8 was more immunopositive in cases of negative bone marrow infiltration (p = 0.035). Therefore, these biomarkers could be applied to discriminate groups with poor prognosis.

OBJETIVO: Avaliar a eficácia da biópsia percutânea por agulha grossa (BPAG) de tumores de partes moles guiada por tomografia computadorizada (TC), em relação ao sucesso na obtenção de amostra para análise, e comparar o diagnóstico da BPAG com o resultado anatomopatológico da peça cirúrgica, quando disponível. MATERIAIS E MÉTODOS: Foram revisados os prontuários e laudos diagnósticos de 262 pacientes com tumores de partes moles submetidos a BPAG guiada por TC em um centro de referência oncológico entre 2003 e 2009. RESULTADOS: Das 262 biópsias realizadas, foi possível a obtenção de amostra adequada em 215 (82,1%). Os tumores mais prevalentes foram os sarcomas (38,6%), carcinomas metastáticos (28,8%), tumores mesenquimais benignos (20,5%) e linfomas (9,3%). Foi possível realizar graduação histológica em 92,8% dos pacientes com sarcoma, sendo a maioria (77,9%) classificada como alto grau. Do total de pacientes, 116 (44,3%) realizaram cirurgia para exérese e confirmação diagnóstica. A BPAG mostrou acurácia de 94,6% na identificação de sarcomas, com sensibilidade de 96,4% e especificidade de 89,5%. A graduação histológica teve concordância significativa entre a BPAG e a peça cirúrgica (p < 0,001; kappa = 0,75). CONCLUSÃO: A BPAG guiada por TC demonstrou elevada acurácia diagnóstica na avaliação de tumores de partes moles e na graduação histológica dos sarcomas, permitindo um adequado planejamento terapêutico.

OBJECTIVE: To evaluate the efficacy of percutaneous computed tomography (CT)-guided core needle biopsy of soft-tissue tumors in obtaining appropriate samples for histological analysis, and compare its diagnosis with the results of the surgical pathology as available. MATERIALS AND METHODS: The authors reviewed medical records, imaging and histological reports of 262 patients with soft-tissue tumors submitted to CT-guided core needle biopsy in an oncologic reference center between 2003 and 2009. RESULTS: Appropriate samples were obtained in 215 (82.1%) out of the 262 patients. The most prevalent tumors were sarcomas (38.6%), metastatic carcinomas (28.8%), benign mesenchymal tumors (20.5%) and lymphomas (9.3%). Histological grading was feasible in 92.8% of sarcoma patients, with the majority of them (77.9%) being classified as high grade tumors. Out of the total sample, 116 patients (44.3%) underwent surgical excision and diagnosis confirmation. Core biopsy demonstrated 94.6% accuracy in the identification of sarcomas, with 96.4% sensitivity and 89.5% specificity. A significant intermethod agreement about histological grading was observed between core biopsy and surgical resection (p < 0.001; kappa = 0.75). CONCLUSION: CT-guided core needle biopsy demonstrated a high diagnostic accuracy in the evaluation of soft tissue tumors as well as in the histological grading of sarcomas, allowing an appropriate therapeutic planning.

PURPOSE: To analyze the immunohistochemical expression of the standard isoform of CD44 (CD44s) adhesion molecule in clear cell renal cell carcinoma (CCRCC) and its impact on clinical outcomes. MATERIALS AND METHODS: Ninety-nine consecutive patients treated surgically for RCC between 1992 and 2009 were selected. A single pathologist reviewed all cases to effect a uniform reclassification and determine the most representative tumor areas for construction of a tissue microarray. The same pathologist, who was blinded to the outcome of the cases, semi-quantitatively scored the staining intensity of CD44s in all specimens. The counting was done using the H-Score algorithm. RESULTS: Of the 99 immunostained RCC specimens, 57(57.7%) showed low expression, and 42(42.4%) showed high expression levels of CD44s. The expression of CD44s was directly associated with tumor size (p = 0.03), clinical stage (p = 0.02) and Fuhrman grade (p = 0.02). Disease specific survival (DSS) rates for patients whose specimens expressed low and high levels of CD44s was 88.1% and 67.5%, respectively (p = 0.009). Progression free survival (PFS) rates in patients with low and high expression of CD44s were 78.8% and 61.7%, respectively (p = 0.05). Classical features such as the presence of metastasis and clinical stage remained isolated predictors of survival. CONCLUSIONS: Immunohistochemical expression of CD44s was associated with important clinical variables such as stage and Fuhrman grade. However, it was not an independent predictor of survival. Therefore, we believe it has a limited role as a prognostic marker in patients with CCRCC.

O arranjo em matriz de amostras teciduais, ou tissue microarray (TMA), é uma técnica descrita em 1998 por Kononen et al. com ampla aceitação pela literatura mundial. Com um conceito extremamente simples, trata-se de agrupar um grande número de amostras teciduais em um único bloco de parafina, permitindo o estudo de expressão de marcadores moleculares em larga escala com grande aproveitamento do material arquivado, do tempo e dos custos. Discutimos as vantagens e limitações do método, as estratégias e técnica de construção, as aplicações e dificuldades encontradas para a patologia investigativa nos últimos cinco anos de uso no Hospital do Câncer A. C. Camargo.

Tissue microarrays (TMA) is a worldwide well accepted technique described in 1998 by Kononen et al. It uses an extremely simple concept of ordering hundreds of samples in just one paraffin block to evaluate protein expression in large cohorts with great advantages on costs, time and sample saving. We discuss the technique, its advantages and limitations, strategies to construct the receptor block, its usefulness and difficulties experienced in the last five years at Hospital do Cancer A.C. Camargo.

INTRODUÇÃO: O óxido nítrico (NO) é uma molécula mediadora de diversas funções, tais como vasodilatação, neurotransmissão e metabolismo do ferro. Os efeitos do NO na biologia tumoral são ambíguos e complexos. A atividade das sintases do óxido nítrico (NOS) tem sido demonstrada em diversos tumores humanos. OBJETIVO: Pesquisar a expressão das isoformas das NOS em carcinomas gástricos e correlacionar estes achados com características demográficas e histopatológicas destes tumores. MATERIAL E MÉTODOS: O estudo imuno-histoquímico das NOS (NOS-1, NOS-2 e NOS-3) foi realizado em 128 casos de carcinomas gástricos classificados de acordo com o sistema de Lauren. RESULTADOS: A positividade para NOS-1 foi detectada em 92/128 (70%) dos casos, para NOS-2 em 36/128 (30%) e para NOS-3 em 54/128 (42%) dos casos. Na análise estatística observou-se correlação com o tipo intestinal e expressão de NOS-3, e tumores avançados mostraram maior expressão de NOS-2. CONCLUSÃO: Os carcinomas gástricos mostram expressão das três isoformas de NOS, sendo as NOS constitutivas presentes em maior número de casos. A freqüente expressão de NOS induzida nos carcinomas gástricos avançados sugere uma participação de NOS na progressão e na disseminação tumoral na mucosa gástrica.

INTRODUCTION: Nitric oxide is an important bioactive and signaling molecule that mediates a diverse array of actions such as vasodilatation, neurotransmission, and iron metabolism. Also, it can act as a carcinogen. Recent studies have examined the expression and activity of the NOS isoforms in several human cancers. OBJECTIVES: To investigate the expression of nitric oxide synthases in gastric carcinomas and correlate the results. MATERIAL AND METHODS: The immunohistochemistry expression of constitutive and inducible nitric oxide synthases (NOS-1, NOS-2 e NOS-3) were evaluated in 128 cases of gastric cancer classified according to Lauren system. RESULTS: The rate of expression of NOS-1 was 92 (70%) of the 12 cases, NOS-2 was 36 (30%) and NOS-3 was 54 (42%) of the cases. The expression of NOS-3 was associated with the intestinal type of carcinoma and deeply invasive tumors showed high rate of expression of NOS-2. CONCLUSION: There is high expression of all the isoforms of nitric oxide synthases in gastric cancer; the constitutive isoforms show higher expression than the inducible forms. The high expression of the inducible form in deeply invasive tumors is related with tumoral progression and dissemination in the gastric mucosa.