Adriano Rodrigues

GLUT expression and 18F-FDG uptake in breast cancer cell lines

Positron emission tomography (PET) using the radiolabeled glucose analogue 18F-FDG allows uncovering glycolysis processes within cancer cells and reveals high value in diagnosis, staging, relapse and therapeutic response evaluation in several malignancies. Breast cancer presents considerable variability when it comes to 18F-FDG uptake, which results in different sensitivity and specificity values related to this technique. 18F-FDG enters the cells through glucose transporters (GLUTs). Therefore, this study aims to determine the pattern of 18F-FDG uptake in various breast cancer cell lines with different hormonal and HER2 receptor’s expressions, and to set a correlation with the expression of GLUT’s 1 and 3. The studies were performed in three different human breast cancer cell lines, MCF-7, HCC1806 and HCC1954. MCF-7 express estrogen and progesterone receptors (ER and PR), HCC1806 cells are triple negative and HCC1954 are negative for hormonal receptors, but overexpress HER2/neu. GLUT-1 and GLUT-3 expressions were assessed by flow cytometry. Our results show that, besides HCC1806 and HCC1954 cells present higher GLUT-1 and GLUT-3 levels than MCF-7, we observe a higher 18F-FDG uptake in HCC1954 cells. In fact, HCC1806 cells show the lower 18F-FDG uptake comparing with other cell lines. These results suggest that despite the dependability of GLUT-1 and GLUT-3 isoforms’ overexpression for 18F-FDG uptake, these receptors do not seem to be the unique responsible. Considering the absence of correlation between GLUT’s expression and 18F-FDG uptake, ER, PR and principally HER2/neu gains an apparent relevance in this process.

Hepatoid Adenocarcinoma of the Lung

We present the case of an 80-year-old patient hospitalized for the study of a lower limb bone lesion. The biopsy of this lesion was suggestive of liver cancer metastasis. However, the study of the liver did not present any local lesion. In the event of an hepatoid tumor, a study of the digestive tract was performed, without detection of neoplasia. By recurrent respiratory infections, it was hypothesized a tumoral lesion at this level, which was confirmed by later thorax CT and biopsy.

Low Back Pain: A Pain That May Not Be Harmless

Abdominal aortic aneurysms are defined as vascular dilatations greater than 50% of the normal proximal segment or those that have a maximum diameter above 3 cm. Risk factors include male gender, age over 75 years, history of vascular pathology, hypertension and arteriosclerosis. The Authors describe a case of a 74-year-old man, evaluated in an emergency setting for right lumbar pain lasting 4 days. The pain did not respond to analgesia and became progressively worse. Due to the severity of symptoms, CT angiography was performed, which showed an active rupture of a partially contained aneurysm associated with aortic dissection. Early diagnosis and timely management of aortic aneurysms are essential in preventing complications, namely rupture (50–83% patients die after rupture and before receiving medical care). Acute aortic dissection is a surgical emergency and the risk of rupture is proportional to the size of the aneurysm and its rate of growth. LEARNING POINTS This article shows how difficult it is sometimes to make the right diagnosis in an emergency department. Although a very common symptom, low back pain should not be regarded as harmless.

A Case Report of Pseudomembranous Colitis Resulting from Clostridium difficile Infection Successfully Treated with Fidaxomicin

Pseudomembranous colitis (PMC) is a serious condition caused by Clostridium difficile , often arising after antibiotic therapy in the healthcare setting. We describe the complex case of an elderly patient with recurrent PMC and comorbid conditions who was successfully treated with fidaxomicin after metronidazole and vancomycin failure, with no further recurrences. J Med Cases. 2016;7(10):451-454 doi: http://dx.doi.org/10.14740/jmc2632w

Caracterização de metástases ósseas em neoplasias ocultas e neoplasias previamente diagnosticadas

Introducao: A metastizacao ossea associa-se, geralmente, a mau prognostico, com evidencia de doenca neoplasica avancada. Este estudo caracteriza uma amostra de doentes com metastizacao ossea e neoplasia primaria conhecida, comparando com doentes sem neoplasia diagnosticada previamente. Material e metodos: Estudo observacional retrospectivo, onde foram incluidos doentes com diagnostico de “neoplasia ossea secundaria” ou “metastases osseas”, admitidos no nosso hospital, de 2009 a 2013. Analisados os dados de doentes com metastases osseas com neoplasia primaria conhecida ou oculta. Resultados: Incluidos 94 doentes, media de idades de 69±12. 66anos, 68% do sexo masculino. Os sintomas apresentados eram principalmente dorso-lombalgia (34%) e defice de forca muscular dos membros (15%). Eam 42% dos doentes, existia previamente o diagnostico de neoplasia. A coluna vertebral constituiu o principal local de metastizacao. Em 22% dos doentes nao se identificou a neoplasia primaria. A taxa de mortalidade durante o internamento foi de 14%, e no follow-up apos um ano de 31%. Discussao: No estudo efectuado, verifica-se que a mortalidade a data de alta do internamento em doentes com neoplasia conhecida e superior a dos doentes com neoplasia indeterminada, o que nao se verifica no follow-up a 1 ano. Pode considerar-se que os doentes com neoplasia previamente conhecida podem apresentar metastizacao ossea mais tardia, e assim, com pior prognostico. Conclusao: A disseminacao tumoral com expressao atraves da metastizacao relaciona-se com um agravamento do prognostico no follow-up.