Carmen Etxezarraga

Basaloid Squamous Cell Carcinoma of the Head and Neck: A Clinicopathological and Follow-Up Study of 40 Cases and Review of the Literature

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of cancer that mainly arises in the upper aerodigestive tract. This study reviews the clinico-pathological features and follow-up of a series of cases occurring in the head and neck. During a 32-year period (1974–2005), a total of 40 BSCCs have been diagnosed in the head and neck in our Institution. Males predominated in the series (35M/5F). The average age was 60.2xa0years (range, 40–85). Tobacco and alcohol consumption was found in more than 80% of the cases. Topographic distribution was as follows: larynx and hypopharynx, 22 cases (55%); oropharynx, 12 cases (30%); and oral cavity 6 cases (15%). The basaloid component predominated in 29 cases (72.5%). Vasculo-lymphatic invasion was detected in 5 cases (12.5%). Lymph node metastases were seen in 25 cases (62.5%, levels II and III in the neck dissection). Local recurrences appeared in 11 cases (27.5%) and distant metastases in 6 (15%). In 7 cases (17.5%) a second primary tumour was detected. The 2002 TNM staging was as follows: Stage I, 5 cases (12.5%); Stage II, 7 cases (17.5%); Stage III, 8 cases (20%), and Stage IV, 20 cases (50%). On follow-up, 21 cases (52.5%) are alive and 19 (47.5%) died of disease. Three- and 5-year overall survival was 50% and 38.5%, respectively. A significant shorter survival was detected in node positive patients (P<0.05).

Increased prolyl endopeptidase activity in human neoplasia.

Prolyl endopeptidase (EC 3.4.21.26) (PEP) is a serine peptidase that converts several biologically active peptides. This enzyme has been linked to several neurological, digestive, cardiovascular and infectous disorders. However, little is known about its involvement in neoplastic processes. This study analyzes fluorimetrically cytosolic and membrane-bound PEP activity in a large series (n=122) of normal and neoplastic tissues from the kidney, colon, oral cavity, larynx, thyroid gland and testis. Cytosolic PEP activity significantly increased in clear cell renal cell carcinoma, urothelial carcinoma of the renal pelvis and head and neck squamous cell carcinoma. Both cytosolic and membrane-bound PEP activity were also increased in colorectal adenomatous polyps. These data suggest the involvement of PEP in some mechanisms that underlie neoplastic processes.

The combination of millimetres of cancer and Gleason index in core biopsy is a predictor of extraprostatic disease.

Aims:u2002 The Gleason index (GI) is related to several pathological endpoints in radical prostatectomy (RP) specimens, including the risk of extraprostatic disease (ED). The amount of tumour (TM) in core biopsy (CB) specimens also correlates with staging. The aim was to determine whether the sum of the relative statistical weights of GI and TM in CBs strengthens the prediction of ED in RPs.

Clinical impact of aspartyl aminopeptidase expression and activity in colorectal cancer.

Aspartyl aminopeptidase (ASP; EC 3.4.11.21) is a widely distributed and abundant cytosolic enzyme that regulates bioactive peptides such as angiotensin II. It has been demonstrated that the expression and activity of this enzyme is modified in tissue and serum of patients with several types of cancer. However, the involvement of ASP in the neoplastic development and survival of patients with colorectal cancer (CRC) has not been analyzed to date. The activity and messenger RNA expression of ASP in tumor tissue (nxa0=xa071) and plasma (nxa0=xa040) of patients with CRC was analyzed prospectively using fluorometric and quantitative real-time polymerase chain reaction methods. Data obtained from tumor tissue were compared with those from the surrounding normal mucosa. Classic pathologic parameters (grade, stage, nodal invasion, distant metastases and perineural, lymphatic, and vascular invasion) were stratified following ASP data and analyzed for 5-year survival. ASP was upregulated in CRC tissues, and greater activity correlated significantly with the absence of lymph node metastases and with better overall survival. Inversely, greater plasmatic ASP activity was associated with worse overall and disease-free survival. Data suggest that ASP is involved in colorectal neoplasia and point to this enzyme as a potential useful diagnostic tool in clinical practice.

El adenocarcinoma diminuto en la biopsia transrectal de la próstata. Correlación con los hallazgos en la prostatectomía radical en 46 casos

SUMMARY Background: Minute carcinoma is a common finding in prostate core biopsies. Its exact significance remains controversial to the urologists because it does not necessarily imply low Gleason Index or organ confined disease. Methods: Over an 8-year period (1998-2005), 46 radical prostatectomies with a diagnosis of minute carcinoma on previous core biopsies were identified. It represents 12.67% of cases in our material. Minute carcinoma was defined as one focus of cancer 0.5 mm in length or less in the biopsy material. This finding was morphologically characterized in core biopsies and its presence correlated with T category, Gleason index, status of the surgical margins at the apex, high grade PIN, perineurial invasion, and extraprostatic extension on radical prostatectomies. Results: Gleason index ≤7 (43/46), nuclear enlargement (41/46), infiltrative pattern (41/46), nucleoli (41/46), high grade PIN (27/46), intraglandular secretions (26/46), crystalloids (22/46), were the most consistent findings in core biopsies. Correlations of minute carcinoma with organ confined disease category and with Gleason index were evident. In addition, positive margins, and apex and perineurial invasions were variably found. Conclusions: Minute carcinoma is a common finding in core biopsies and may be associated to some parameters of bad prognosis in radical prostatectomies.

La cuantificación del volumen tumoral en las biopsias transrectales de próstata

Resumen Esta comunmente aceptado en la literatura medica que la cantidad de tumor en la biopsia transrectal de prostata se correlaciona con el estadio tumoral y con otros parametros de importancia pronostica en el cancer de prostata. En este trabajo se correlacionan los hallazgos histologicos con impacto pronostico que se han observado en 363 prostatectomias radicales y en sus respectivas biopsias previas, tratando de evaluar que sistema de medicion del volumen tumoral (milimetros totales de cancer, numero de focos tumorales, y porcentaje de tumor en la biopsia) es el mas apropiado en la practica diaria. Los resultados demuestran que todos ellos se correlacionan con el estadio (pT), con el indice de Gleason, y con la invasion perineural. Ademas, hemos encontrado que mas de 22 milimetros de cancer en la biopsia predice extension extraprostatica en el 100% de los casos. En conclusion, aunque los 3 metodos pueden ser validos, pensamos que la determinacion de los milimetros totales de cancer es el sistema de eleccion para cuantificar el volumen tumoral en las biopsias transrectales debido a su reproductibilidad y fiabilidad.

El adenocarcinoma de próstata en los años 1999 y 2006. Diferencias en el estudio comparativo de biopsias transrectales y de prostatectomías radicales

SUMMARY Background: The increase in number of prostate cancer diagnoses in the last decade is accompanied by a similar increase in the number of radical prostatectomy specimens. We analyse the histological differences between patients treated with radical surgery in 1999 and in 2006. The evolution in the indications for surgery is also evaluated. Methods: Histological data in core biopsies and radical prostatectomies of cases diagnosed in 1999 and 2006 have been compared. Only cases with complete histological information have been included in the study. Bi/unilateral tumour invasion, number of tumour foci, total millimetres of cancer, high-grade PIN, Gleason index, and perineurial invasion have been evaluated in core biopsies. Pathological staging, Gleason index, high-grade PIN, margin status, apex invasion, perineurial and vascular permeation, extraprostatic extension and seminal vesicle invasion have been analysed in radical prostatectomies. The statistical study included χ2 , Student’s t, and Mann-Whitney test. Results: The study includes 24 radical prostatectomies in 1999 and 50 in 2006. The pathological staging is significantly lower in 2006 than in 1999 (p=0.032). Similarly, organ-confined disease is more frequent in 2006 (p=0.034). Extraprostatic extension and seminal vesicle invasion by prostate adenocarcinoma are significantly lower in 2006 (p=0.090 y p=0.011, respectively). Conclusions: Prostate adenocarcinoma patients treated with radical surgery in 2006 are at a lower stage compared with 1999 cases.

Adenocarcinomas renales sincrónicos, de células claras y de células cromófobas

Resumen Caso clinico Se presenta el caso de un paciente de 78 anos de edad al que se descubren dos neoplasias epiteliales independientes y sincronicas en el mismo rinon El tumor dominante, el que llevo al paciente al medico y por el cual se realizo la nefrectomia corresponde a un carcinoma de celulas claras tipico. El tumor secundario, localizado a 4 cm. del tumor principal, fue detectado en el estudio macroscopico de la pieza quirurgica y corresponde a un carcinoma de celulas cromofobas. El patron de inmunohistoquimica es el caracteristico y esperado en cada tumor, y confirma la especificidad de cada uno de ellos. Discusion Se revisa y se discute la literatura actual relacionada con la coexistencia de diversos tumores de la misma o de distinta estirpe histologica en el rinon.

Importancia clínica del diagnóstico de neoplasia intraepitelial prostática de alto grado y del de proliferación microglandular atípica en biopsias transrectales

Resumen Antecedentes La neoplasia intraepitelial prostatica de alto grado (PIN-AG) y el foco de microglandulas atipicas (ASAP) son dos hallazgos histologicos estrechamente relacionados con el cancer de prostata. En este trabajo se analiza una serie amplia de ambos diagnosticos como unico dato resenable en la primera biopsia y su relacion con el adenocarcinoma de prostata aparecido en biopsias subsiguientes. Metodos Se analizan histologicamente 125 PIN-AG sin adenocarcinoma concomitante y 45 ASAP diagnosticados entre un total de 4.770 biopsias transrectales durante un periodo de 8 anos (1998-2005). Se analizan todas las rebiopsias de cada uno de los casos y las caracteristicas propias de los carcinomas aparecidos en algunas de estas. Resultados El porcentaje de cancer en la muestra general es del 30,3%. Sin embargo, entre los casos previamente diagnosticados de PIN-AG se detecto cancer en 21 (16,8%) y entre los diagnosticados de ASAP, en 12 (26,7%). La demora media entre ambos diagnosticos y el cancer fue de 12,3 y 12,7 meses, respectivamente. El numero de rebiopsias necesarias hasta la aparicion de cancer fue de 1 a 4 en el PIN-AG y de 1 a 3 en el ASAP. Se observa una correlacion significativa entre el PIN-AG y varios parametros histologicos del cancer en la biopsia [numero de focos de cancer (p=0,003), milimetros totales de cancer (p=0,000), bilateralidad (p=0,024), Indice de Gleason (p=0,011), invasion perineural (p=0,015)] y en la prostatectomia radical [pT (p=0,010)]. Conclusiones No existe mayor probabilidad de detectar cancer de prostata en aquellos pacientes con diagnostico previo de PIN-AG o ASAP respecto de la poblacion general que se biopsia. En el caso de existir cancer, pueden ser necesarias hasta 4 biopsias repetidas para detectarlo.

Parámetros histológicos predictivos de la invasión de las vesículas seminales en el cáncer de próstata

Resumen Antecedentes La invasion de las vesiculas seminales es un dato histologico de mal pronostico en el cancer de prostata. En la mayor parte de los casos es un hallazgo accidental ya que los pacientes con signos clinicos o histologicos de enfermedad extraprostatica no se tratan mediante cirugia en la mayor parte de protocolos al uso. Nuestra intencion es cuantificar este hallazgo histologico en una serie homogenea de prostatectomias radicales y correlacionarlo con los hallazgos en las biopsias previas. Metodos Durante un periodo de 8 anos (1998-2005), 363 pacientes con cancer de prostata fueron tratados mediante prostatectomia radical en el Hospital de Basurto. Los pacientes fueron seleccionados para la cirugia en funcion de la combinacion de la estadificacion clinica, niveles de PSA serico y datos obtenidos de la biopsia previa. Los datos obtenidos en las prostatectomias se correlacionaron (rho de Spearman) con varios hallazgos histologicos procedentes de las biopsias. Resultados Se detecto invasion seminal en 37 pacientes (10,2%). La invasion microscopica de las vesiculas seminales se correlaciono con los milimetros totales de cancer (media 20 mm, ρ=0,397), con el numero de focos de tumor (media 3,8, ρ=0,383), con la invasion de ambos lados prostaticos (ρ=0,256), con el indice de Gleason >7 (ρ=0,306), con la invasion perineural (ρ=0,318), y con el PIN de alto grado (ρ=0,142) en las biopsias, y con el indice de Gleason >7 (ρ=0,357), con el PIN de alto grado (ρ=0,211), con la extension extraprostatica (ρ=0,480), y con la invasion de margenes quirurgicos (ρ=0,287), invasion perineural (ρ=0,847), y afectacion del apex (ρ=0,307), en las prostatectomias. Conclusiones La invasion de las vesiculas seminales es un hallazgo frecuente en las piezas de prostatectomia radical, incluso despues de una seleccion correcta de pacientes para cirugia. Este hallazgo histologico se correlaciona con parametros de volumen tumoral, con la invasion bilateral, y con otros parametros de mal pronostico en el cancer de prostata.