Carlos Augusto Rodrigues Véo

Study on the prevalence of human papillomavirus in the anal canal of women with cervical intraepithelial neoplasia grade III

OBJECTIVE The objective was to evaluate the prevalence of human papillomavirus (HPV) in the anal canal of women with cervical intraepithelial neoplasia (CIN) grade III. STUDY DESIGN Two groups were compared. In group I (study group), 40 women who had undergone cervical biopsy with a histopathological result indicating CIN III were evaluated. Group II (control) consisted of 40 women with normal results from colposcopic examination and colpocytological tests. The women in group I who presented high-grade neoplasia in colpocytological tests underwent collection of material from the uterine cervix and anal canal for investigating HPV DNA using the Hybrid Capture II technique. Colposcopy and cervical biopsy were then performed. If CIN III was confirmed, HPV DNA was investigated in the material collected. In group II, colpocytological tests and colposcopy were performed and, if normal, the procedure was similar to that followed for group I, except that no biopsy was performed. RESULTS In group I, 39 women (97.5%) were positive for HPV in the uterine cervix and 14 women (35%) in the anal canal. In group II, only four women (10%) had a positive HPV test, for both the uterine cervix and the anal canal. CONCLUSIONS The prevalence of HPV in the anal canal of the women with CIN III was greater than in the women without CIN III.

Characterization of topoisomerase II α and minichromosome maintenance protein 2 expression in anal carcinoma

The present study aimed to ascertain the significance of topoisomerase II α (TOP2A) and minichromosome maintenance protein (MCM) 2 expression in anal carcinoma. A total of 75 anal lesions were retrieved from the files of the Department of Pathology of Barretos Cancer Hospital (Barretos, Brazil) in order to verify the human papillomavirus (HPV) statuses of these lesions and characterize the immunohistochemical expression levels of TOP2A and MCM2 in anal carcinoma, as these are important markers for cervical HPV-induced lesions; their expression was also compared with respect to p16 and Ki-67. The vast majority of the cases tested positive for HPV16 (84%); 1 case tested positive for both HPV16 and HPV18. Positive HPV16 status was more frequent in early stages than in advanced stages (P=0.008). Positive immunohistochemical reactivity for MCM2 and TOP2A protein was observed in 71.6 and 100% of cases, respectively. Positive reactivity for p16 was significantly associated (P=0.001) with histological grade, and was more commonly expressed in squamous cell carcinoma than adenocarcinomas. HPV16 was strongly associated with positive p16 protein expression (76.6%). However, the high expression of Ki-67 combined with the high expression of p16 was predominantly observed in Stage III-IV cases. MCM2, TOP2A, p16 and Ki-67 exhibited intense positive staining in the anal lesions, indicating that these markers were significantly and constantly expressed in anal carcinoma.

Laparoscopic mobilization for resection of the transverse colon for cancer: a simple, reproducible method.

Laparoscopic resection for colorectal cancer by appropriately skilled surgeons is now accepted as safe and oncologically sound. Much of the contemporary debate in this area is regarding appropriate training of surgeons, as there is a steep learning curve. Arguably, the most difficult aspect of laparoscopic colon resection is mobilization of the transverse colon, with division of the middle colic artery. Mobilizing the transverse colon is necessary for many colonic resections, including “introductory” procedures. Our department has a consistent, sequential method for mobilization of the transverse colon with proximal isolation and ligation of the middle colic artery as indicated. This involves using the head, or distal body, of the pancreas as a landmark, for right-sided and left-sided resections, respectively. We believe that this particular methodology is easy to learn and surgically efficient. We also discuss some particular intraoperative problems and scenarios, with suggested solutions.

Inborn-like errors of metabolism are determinants of breast cancer risk, clinical response and survival: a study of human biochemical individuality

Breast cancer remains a leading cause of morbidity and mortality worldwide yet methods for early detection remain elusive. We describe the discovery and validation of biochemical signatures measured by mass spectrometry, performed upon blood samples from patients and controls that accurately identify (>95%) the presence of clinical breast cancer. Targeted quantitative MS/MS conducted upon 1225 individuals, including patients with breast and other cancers, normal controls as well as individuals with a variety of metabolic disorders provide a biochemical phenotype that accurately identifies the presence of breast cancer and predicts response and survival following the administration of neoadjuvant chemotherapy. The metabolic changes identified are consistent with inborn-like errors of metabolism and define a continuum from normal controls to elevated risk to invasive breast cancer. Similar results were observed in other adenocarcinomas but were not found in squamous cell cancers or hematologic neoplasms. The findings describe a new early detection platform for breast cancer and support a role for pre-existing, inborn-like errors of metabolism in the process of breast carcinogenesis that may also extend to other glandular malignancies. Statement of Significance: Findings provide a powerful tool for early detection and the assessment of prognosis in breast cancer and define a novel concept of breast carcinogenesis that characterizes malignant transformation as the clinical manifestation of underlying metabolic insufficiencies.

Loss of Raf kinase inhibitor protein expression is associated with human papillomavirus 16 infection in anal tumors

There has been an increase in the incidence of anal cancer in the past two decades, with squamous cell carcinoma (SCC) being the most frequent histological type identified. Among the risk factors, high-risk human papillomavirus (HPV) infection is the most pervasive. Raf kinase inhibitor protein (RKIP) is expressed in a number of normal human tissues and previous studies have demonstrated the prognostic value of the loss of RKIP expression in several gastrointestinal tumors. Therefore, the present study aimed to evaluate the clinical implications of RKIP expression in a series of neoplastic lesions of the anal canal. The resected tumors of 48 patients [8 high-grade intraepithelial lesions (HSILs), 14 adenocarcinomas and 26 squamous cell carcinomas (SCCs)] were immunohistochemically evaluated for RKIP expression, and the results were correlated with clinicopathological data. The results identified a decreased 5-year overall survival rate in patients with adenocarcinoma (40.8%) compared with patients with SCC (76.7%), and a decreased 5-year disease-free survival rate in patients at clinical stages III/IV (37.3 vs. 62.5 and 82.6% for clinical stages 0 and I/II, respectively). Low RKIP expression was revealed in 62.5% of HSILs, 88.5% of SCCs and 100.0% of the adenocarcinomas. High RKIP expression was associated with patient ethnicity (37.5% in non-Caucasians vs. 7.5% in Caucasians) and patient age (33.3% in younger patients vs. 0.0% in older patients). Finally, high RKIP expression was correlated with HPV16 infection status (40% in HPV- vs. 5.3% in HPV+ patients). A correlation was identified between high RKIP expression and lesions with a generally improved prognosis, such as those diagnosed in younger patients, in situ lesions and lesions of lower clinical grades; there was also a negative correlation between high RKIP expression and HPV16 positivity in patients.

RECONSTRUÇÃO DE TRÂNSITO INTESTINAL VIDEOLAPAROSCÓPICA POR SINGLE‐PORT ASSOCIADO A MAPEAMENTO VASCULAR COM VERDE DE INDOCIANINA: RELATO DE CASO

Introdução: O uso de verde de indocianina endovenosa como indicador de adequada perfusão sanguínea intraoperatória já é estabelecido, permitindo uma adequada tática cirúrgica em ressecções ou reconstruções do trânsito intestinal. Relato de caso: F.C.M. 69 anos, sexo masculino, submetido a colectomia total com ileostomia terminal videolaparoscópica por Hemorragia Digestiva Baixa (DDC pancolônica) sem instabilidade hemodinâmica. Após 90 dias submeteu-se a reconstrução de trânsito intestinal (ileorreto anastomose ao nível do promontório sacral) por videolaparoscopia e single port (local da ileostomia). Apresentou boa evolução pós-operatória com alta no 3 dia após a cirurgia. Discussão: Neste vídeo demonstra-se a aplicabilidade do verde de indocianina na viabilidade vascular de dois segmentos intestinais a serem anastomosados, procurando identificar áreas isquêmicas não visíveis a olho nu que poderiam comprometer a vascularização da anastomose. Conclusão: O verde de indocianina se mostrou eficaz em reconstrução de trânsito intestinal por videolaparoscopia através de técnica single-port.

APLICABILIDADE DO VERDE DE INDOCIANINA NA EXCISÃO TOTAL DO MESORRETO EM AMPUTAÇÃO ABDOMINOPERINEAL DO RETO: RELATO DE CASO

Introdução: A identificação de determinadas estruturas anatômicas no intraoperatório pode se tornar trabalhosa em determinadas situações. Existem diversos métodos de mapeamento intraoperatório para utilização em cirurgias convencionais e cirurgias minimamente invasivas, notadamente o verde de indocianina, já disponível para uso em cirurgias minimamente invasivas. Relato de caso: B.F.S.A., 62 anos, sexo feminino, ASA I, diagnosticada com adenocarcinoma moderadamente diferenciado de reto baixo à 2 cm da margem anal. Submetida a neoadjuvância (5FU-LV + radioterapia com dose de 54 Gy) com término em 03/04/2018. Apresentou resposta parcial na invasão de canal anal e músculo elevador do ânus. Submetida a Amputação abdominoperineal do reto videolaparoscópica com auxílio de verde de indocianina intratumoral pré-operatória. Discussão: o mapeamento intraoperatório com verde de indocianina permitiu a correta identificação de linfonodos mesorretais e a completa excisão do mesorreto, não evidenciando captação em linfonodos pélvicos laterais ou em outros sítios abdominais. Conclusão: O uso de verde de indocianina auxiliou na correta identificação de planos anatômicos corretos em amputação de reto videolaparoscópica.

AVALIAÇÃO DO SEGUIMENTO DOS PACIENTES SUBMETIDOS A RETOSSIGMOIDECTOMIA VIDEOLAPAROSCÓPICA COM EXCISÃO TOTAL DO MESORRETO VIA TRANSANAL (TATME)

Objetivo: Avaliar o seguimento dos pacientes submetidos à técnica de retossigmoidectomia videolaparoscópica com excisão total do mesorreto via transanal (TaTme). Método: Análise retrospectiva de prontuários dos pacientes operados submetidos à técnica de excisão total do mesorreto via transanal de 2014 a 2017. Principais resultados: De 26 pacientes operados, a grande maioria era portador de adenocarcinoma e 21 deles foram submetidos a radioterapia e quimioterapia neoadjuvante. Os pacientes tinham entre 31 e 86 anos, com média de 58,72 anos na data em que foram operados, apresentavam IMC entre 16 e 37,9 kg/m2, com uma média de 26,08 kg/m2. Referente ao pós-operatório imediato na UTI, 11,5% (3/26) dos pacientes necessitaram desse apoio. O índice de conversão da cirurgia para laparotomia foi de 7,6% (2/26) e o de complicações 23,7% (6/26), que foram abscesso pélvico, sangramento e deiscência de anastomose, não houve lesões uretrais nesta amostra. A distância da margem distal variou entre exígua a 4,2 cm, o número de linfonodos dissecados ficou entre cinco e 36 e o índice de recidiva até o presente momento do seguimento foi de 11,5% (3/26). Conclusão: A retossigmoidectomia laparoscópica com excisão total do mesorreto por via transanal é uma opção cirúrgica factível para o tratamento do câncer de reto, necessita ainda de uma casuística maior para a comprovação de seus benefícios.

RELATO DE CASO: COLITE POR CITOMEGALOVÍRUS EM PACIENTE IMUNOSSUPRIMIDO POR TRATAMENTO QUIMIOTERÁPICO DE CÂNCER COLORRETAL

Introdução: O citomegalovírus (CMV) é um DNA vírus encapsulado. Os efeitos do citomegalovírus foram primeiramente descritos em 1940 em uma infecção congênita de um recém-nato. É uma infecção que acomete mais comumente pacientes imunossuprimidos. Existe uma gama de sintomas causados por uma infecção pelo CMV, variam até pelo grau de imunossupressão e do sistema envolvido, desde quadro de hepatite, úlceras gastrointestinais, encefalopatias e mononucleose até pneumonite. O quadro de colite por CMV normalmente se apresenta como um quadro de dor abdominal, diarreia de pequeno volume e sangramento retal. Apesar de a frequência desses casos ser incerta, a incidência de casos de infecção gastrointestinal por citomegalovírus foi de 20 a cada 100.000 pacientes um estudo retrospectivo. O número de casos é maior em pacientes portadores de tumores hematológicos em comparação com tumores sólidos, possivelmente devido ao maior grau de imunossupressão no tratamento das patologias hematológicas. Descrição do caso: Paciente masculino, 71 anos, diagnóstico de câncer de reto, fez tratamento com radioterapia e quimioterapia neoadjuvante, seguido de retossigmoidectomia e quimioterapia adjuvante. Após o término do tratamento evoluiu com quadro de diarreia crônica, foi submetido a colonoscopia com biópsia, resultado anatomopatológico evidenciou infecção por CMV e recidiva da doença. Discussão: Colite por CMV não é uma patologia comum, mas pode ser potencialmente grave. Em pacientes com câncer colorretal após quimioterapia, o diagnóstico dessa infecção pode ser desafiador, pela dificuldade de diferenciar de quadros de enterite induzida pelo tratamento oncológico. Conclusão: Colite por CMV é um diagnóstico diferencial importante e deve ser considerada em casos de colite que não respondem ao tratamento convencional.

Estudo da expressão da proteína caderina-E correlacionada com o grau de diferenciação celular e o estadiamento TNM do adenocarcinoma colorretal

OBJECTIVE: To evaluate the relationship of a protein that take part in the same mechanism of cell adhesion with the cell differentiation degree and TNM staging I and IV in CRA. METHODS: One-hundred patients (54 men and 46 women), who have received treatment for CRA, stage I - 44 patients and stage IV - 56 patients, have been studied. Histological cuts of tumor tissue were examined by the immunohistochemical technique as to the expression of E-cadherin proteins. Such histological cuts were classified as positive or negative through the semi-quantitative method. RESULTS: For TNM, the E-cadherin expression for stage I: positive in 72.7% and negative in 35.7%; stage IV: positive in 64.3% and negative in 35.7%. Regarding the cell differentiation degree, the expression of E-cadherin, GI: positive in 70% and negative in 30%; GII: positive in 68.4% and negative in 31.6%; GIII: positive in 63.6% and negative in 36.4%. There was no significant difference among the groups. CONCLUSION: The results of this research come to the conclusion that there is no relationship between the expression of E-cadherin protein with TNM staging (I and IV) and cell differentiation degree in CRA.