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São Paulo, Brazil

Coimbra F.J.,Hospital AC Camargo
Revista da Associação Médica Brasileira (1992)

Colorectal cancer is the 3rd most common malignant neoplasm in the West. About 50% of patients develop liver metastases throughout the course of the disease. Those are responsible for at least two-thirds of deaths. Advances in surgical techniques and improvement in chemotherapy regimens have allowed offering treatment with curative intent to an increasing number of patients. This article reviews recent advances in the treatment of liver metastases, including strategies to increase resection (e.g., portal vein embolization, radiofrequency ablation, two-stage hepatectomy, conversion therapy and reverse treatment strategy) and hepatectomy in the presence of extrahepatic disease. Finally, the results of surgical treatment of liver metastases at the Hospital A.C. Camargo are briefly shown. Source

Kowalski L.P.,Hospital AC Camargo
Brazilian Journal of Otorhinolaryngology

Xerostomia complaint is very commonly associated to radioactive iodine therapy. Alternatives to treat this morbidity can offer better quality of life to patients with thyroid cancer submitted to adjuvant iodine therapy. Aim: to report on the experience with pilocarpine on the treatment of xerostomia in thyroid cancer patients submitted to adjuvant radioactive iodine therapy (RIT). Materials and methods: The five patients who met the inclusion criteria received 5mg of pilocarpine, 3 tid for one week. Side effects of the drug and subjective response to xerostomia complaints after treatment were evaluated. Design: it is a prospective, non-randomized study. Results: Sudoresis was the most frequent side effect of pilocarpine use, followed by fatigue and headache. Two patients reported relief of xerostomia using pilocarpine, but only one patient was able to tolerate the side effects. Conclusions: Pilocarpine seems to relieve xerostomia complaints in thyroid cancer patients because it is able to stimulate salivary flow, but the observed side effects made the patients refuse long-term therapy continuation. Source

Palmero E.I.,International Agency for Research on Cancer | Achatz M.I.,Hospital AC Camargo | Ashton-Prolla P.,Federal University of Rio Grande do Sul | Olivier M.,International Agency for Research on Cancer | Hainaut P.,International Agency for Research on Cancer
Current Opinion in Oncology

Purpose of review Germline TP53 (tumor protein 53) mutations are the molecular basis of a complex cancer predisposition syndrome, the Li-Fraumeni syndrome. The present review discusses the diversity of tumor patterns in TP53 mutation carriers, focusing on molecular factors that may explain familial and individual differences, such as genotype/phenotype correlations, genetic modifiers and genetic anticipation. Recent findings: Initially identified 20 years ago, germline TP53 mutations appear to be associated with an extremely diverse range of cancers. Although no other gene has been found in Li-Fraumeni syndrome, recent results show that the functional effects of particular mutations, polymorphisms in TP53 or in regulators such as MDM2 (murine double minute 2), variations in DNA copy number and variations in telomere length, have a strong impact on individual risk and on tumor patterns. Furthermore, recent studies in large cohorts suggest that TP53 germline mutations may occur in up to 1: 5000 individuals. Summary: Germline TP53 mutations may be responsible for a large fraction (15-20%) of all inherited cancers. Although mutations are detectable by sequencing, counseling and follow-up remain problematic due to the wide variations in disease presentation. Elucidating the molecular mechanisms underlying the predisposition caused by TP53 deficiency may help to develop better, evidence-based and personalized clinical protocols. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

De Brot M.,Federal University of Minas Gerais | Rocha R.M.,Hospital AC Camargo | Soares F.A.,Hospital AC Camargo | Gobbi H.,Federal University of Minas Gerais

Aims: We assessed the expression of ALDH1 and EZH2, cancer stem cell (CSC) related markers, in triple negative and basal-like breast cancers, investigating their association with clinicopathological features and outcome. Methods: Clinicopathological data were obtained from 140 cases of triple negative breast cancer. A tissue microarray was constructed and immunohistochemistry for ER, PR, HER2, ALDH1, EZH2, CK5, CK14, EGFR, p63, caveolin, and p53 was performed. Tumour cell and stromal expression of ALDH1 were evaluated. Multivariate analysis was conducted, including all significant variables. Results: The majority of triple negative breast cancers were invasive ductal carcinomas of no special type (NST) (116/140). Tumour cells exhibited cytoplasmic expression of ALDH1 in 26 of 140 cases, while stromal expression was detected in 117 of 140 cases. Tumour cell expression did not correlate with any of the parameters. Conversely, stromal expression was associated with better overall survival (p=0.044). Assessment by Cox Regression Model showed a HR of 2.80 (HR=1/0.357=2.80; 95%CI 0.178-0.714; p=0.004) for breast cancer death when ALDH1 was not found in the stromal compartment of tumours, independent of age, histological type/grade, nodal status, stage, relapse, and expression of basal markers. High EZH2 expression was noted in 120 of 140 triple negative breast cancers and was not associated with other variables. Basal-like cancers comprised 75% (105/140) of triple negative breast cancers. Interestingly, we found association between EZH2 and CK14 expression (p=0.041). Conclusions: ALDH1 expression is frequent in tumour-associated stromal cells of triple negative breast cancer and is associated with better outcome. Tumour microenvironment should be considered when studying prognostic impact of CSCs in breast cancer. © 2012 Royal College of Pathologists of Australasia. Source

Tessier Cloutier B.,McGill University | Costa F.D.,Hospital AC Camargo | Tazelaar H.D.,Mayo Medical School | Folpe A.L.,Mayo Medical School
Human Pathology

Angiosarcomas (AS) are uncommon endothelial malignancies, usually arising from sun-damaged skin in older adults. Although most AS are readily diagnosed by light microscopy alone, immunohistochemistry (IHC) for endothelial markers such as CD31, CD34, FLI1, and ERG plays a valuable adjunctive role. However, IHC studies of AS must be interpreted with caution, as aberrant expression of markers such as cytokeratins, CD30, and CD117 may be seen. We report 3 cases of AS showing aberrant expression of the neuroendocrine markers synaptophysin and/or chromogranin A, previously unreported phenomena. Cases presented as metastatic lesions in the lung of a 48-year-old woman and as primary tumors of the kidney and neck in a 29-year-old and a 51-year-old woman, respectively. All cases expressed synaptophysin and/or chromogranin A, and various neuroendocrine/endocrine neoplasms were strongly considered as diagnoses by the initial evaluating pathologists. Additional morphological study and confirmatory IHC for CD31, FLI1, and ERG established the diagnosis of AS in all cases. Coexpression of synaptophysin and chromogranin A in 1 case suggests that at least some AS show true neuroendocrine differentiation. Awareness of this potential diagnostic pitfall is important for correct diagnosis and treatment of this rare subset of AS. © 2014 Elsevier Inc. Source

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