Danilo Toshio Kanno

Beta-catenin and E-cadherin tissue "content" as prognostic markers in left-side colorectal cancer

AIM To investigate the relationship between beta-catenin and E-cadherin tissue quantitative expression (content) in tumors and clinical prognostic factors in patients with left colon cancer. MATERIAL AND METHODS Twenty nine patients with colon adenocarcinoma located distal to the splenic flexure were studied. Diagnosis and histological variables related to adenocarcinoma prognosis were evaluated using hematoxylin-eosin. Beta-catenin and E-cadherin were analysed by immunohistochemistry with specific anti-beta-catenin and anti-E-cadherin monoclonal antibodies. Tissue quantitative expression (content) was determined by computer assisted image analysis method. Results were analysed with statistical tests, adopting a significance level of 5%. RESULTS There are correlations between beta-catenin and TNM stage (p< 0.01). There are progressively greater amounts of beta-catenin in patients with deeper invasion of the tumor in colon layers (p=0.03), progressive lymph node involvement (p=0.05), as well as in patients with distant metastasis (p=0.04). Worse histological grades are related to lower expression of E-cadherin in tumor tissue (p=0.01). CONCLUSIONS E-cadherin can be used as an indicator of tumor differentiation degree, whereas beta-catenin can be used as a predictor of invasion depth and spread of distal colorectal cancer.

Claudin-3 and occludin content in the glands of colonic mucosa devoid from fecal stream submitted to topical intervention with oil extract of Curcuma longa

Purpose: To evaluate the inflammatory intensity and measure the tissue content of the proteins claudin-3 and occludin in the colonic mucosa without fecal stream submit to intervention with curcumin. Methods: Thirty-six rats were submitted to a proximal colostomy and a distal mucous fistula and divided into two groups according to sacrifice to be performed two or four weeks. Each group was divided into three subgroups according daily application of enemas containing saline, curcumin at 50 mg/kg/day or 200 mg/kg/day. Colitis was diagnosed by histological analysis. Claudin-3 and occludin were determined by immunohistochemistry. The tissue content of claudin-3 and occludin were quantified by computer-assisted image analysis. Mann-Whitney, Student t and ANOVA tests were used to analyze the results establishing the level of significance of 5% for both (p<0.05). Results: Curcumin at both concentrations reduces the inflammation and preserves the tissue content of the proteins claudin-3 and occludin, which was related to the concentration used and to the time of the intervention. Conclusion: The application of enemas with curcumin reduces inflammation and preserves the tissue content of the proteins claudin-3 and occludin in the colonic mucosa devoid from the fecal stream.

TISSUE EXPRESION OF THE GENES MUTYH AND OGG1 IN PATIENTS WITH SPORADIC COLORECTAL CANCER

ABSTRACT Background: MTUYH and OGG1 genes have importance in the base excision repair systems of oxidized DNA bases. Modification of the tissue expression of these genes is related to the increased risk of developing colorectal cancer. Aim: To evaluate the tissue expression of MUTYH and OGG1 comparing normal and neoplastic tissues of patients with sporadic colorectal cancer and to correlate it with clinical and histopathological variables. Method: MUTYH and OGG1 tissue expression was quantified by RT-PCR in patients with colorectal cancer and the values were compared in normal and neoplastic tissues. MUTYH and OGG1 expression was measured and normalized to the constitutive 18S gene. The level of expression of both genes was correlated with the variables: age, gender, tumor location, size of the tumor, histological type, degree of cell differentiation, invasion depth in the intestinal wall, angiolymphatic infiltration, lymph node involvement and TNM staging. Results: Was found downregulation of both genes in neoplastic when compared to normal tissue. There was downregulation of the MUTYH in larger tumors and in patients with angiolymphatic invasion. Tumors with more advanced TNM stages (III and IV) presented downregulation of both genes when compared to those with earlier stages (I and II). Conclusion: The MUTYH and OGG1 genes present downregulation in the more advanced stages of colorectal cancer.

AVALIAÇÃO DA EXPRESSÃO FENOTÍPICA DE 18 PORTADORES DE POLIPOSE ADENOMATOSA FAMILIAR

Introdução: Os tumores estromais gastrointestinais (GIST) representam menos de 1% de todas as neoplasias malignas porém são as neoplasias mesenquimais mais comuns do trato gastrointestinal. Surgem da parede do trato gastrointestinal, provavelmente das células intersticiais de Cajal, que regular a motilidade do trato, e o marcador histoquímico mais importante é a proteína cKIT CD117, expresso em 95% dos casos. Mais raramente, neoplasias de características semelhantes podem originar-se fora do TGI, o qual denominamos de tumor estromal extragastrointestinal (EGIST), sendo o retroperitônio o local mais incomum de aparecimento. Caso: Paciente masculino, 73 anos, admitido em hospital terciário de Salvador (BA) com sangramento retal intermitente há 4 meses, de piora progressiva, associado a retenção urinária há 2 meses. Realizou colonoscopia evidenciando abaulamento importante junto à linha pectínea, de aspecto extra colônico. Submetido à Ressonância Magnética de Pelve evidenciando volumosa formação pré sacral de contornos bem definidos, hiperintensa em T2 e com numerosas áreas de degeneração hemorrágicas internas em íntimo contato e indissociável com parede posterior do reto (volume de 921 cm3); Fígado com 4 lesões focais de realce em meio ao contraste. Ao exame físico observava-se abaulamento com compressão extrínseca de lúmen de canal anal há 2 cm de borda anal. Submetido a amputação abdominoperineal de reto, em maio/2017, com resultado anátomopatológico de Neoplasia Fusocelular e estudo Imunohistoquímico conclusivo de GIST de alto grau histológico (pT4N0) com positividade para os anticorpos monoclonais desmin, CD34, cKIT CD117 e Smooth muscle actin. Encontra-se em tratamento quimioterápico com Mesilato de Imatinibe (Gleevec). Discussão: EGISTs são um grupo de tumores com histologia e imunoquimica idênticas aos GISTs. Entretanto a patogênese, incidência, fatores clínicos associados e prognóstico dos EGISTs não foram completamente elucidados. Localização, tamanho, celularidade, atividade mitótica e necrose são os preditores mais precisos de um desfecho desfavorável desses tumores. Eles crescem silenciosamente sendo descobertos causando sintomas de compressão. Conclusão: Relatamos aqui um caso de EGIST primário de retroperitônio tratado cirurgicamente. Trata-se de um caso singular onde a revisão da literatura demonstra que a correta relação clinicoradiológica é importante no diagnóstico diferencial para GIST e seu posterior tratamento imunossupressor/quimioterápico.

A Proliferating Trichilemmal Cyst in the Perianal Region: A Case Report

Highlights • Proliferating trichilemmal cyst is a rare benign neoplasms from the hair follicles.• There are no reports of proliferating trichilemmal cyst in the perianal region.• The treatment for trichilemmal cyst is surgical excision with normal tissue margins.• The differential diagnosis of trichilemmal cyst include squamous cell carcinoma.

Rare perianal extramammary Paget disease successfully treated using topical Imiquimod therapy

BackgroundPerianal Paget’s disease (PPD) is a rare intraepithelial adenocarcinoma of the anal margin. Primary PPD likely represents intra-epithelial neoplasm from an apocrine source, whereas secondary disease may represent “pagetoid” spread from an anorectal malignancy.Case presentationHistologic CDX-2 and CK20 are hallmark markers for colorectal-derived Paget’s cells. Interestingly, our primary PPD patient presented both positive and no internal malignancy was identified. In addition, a negative CK7 marker was observed in our case in contrast with previously reported. Surgical excision is the standard treatment; however, previous studies have demonstrated good response with Imiquimod 5% cream in patients with vulval extramammary Paget disease (EMPD). The efficiency of Imiquimod treatment for PPD has not been well described. Our PPD patient was successfully treated using Imiquimod 5% cream.ConclusionsThis study describes a primary cutaneous PPD patient CDX-2+/CK20+/CK7- without invasion of the dermis and no associated colorectal carcinoma effectively treated using topical Imiquimod therapy, suggesting that Imiquimod might potentially be considered as a first-line treatment for PPD.

CISTO TRIQUILEMAL PROLIFERANTE LOCALIZADO NA REGIÃO PERIANAL: UM ACHADO EXCEPCIONAL

A. total de exames FOBT efetuados: 5.732. B. total de FOBT positivos: 289 (5,04%) (b/a) = 289/5.732. C. total de positivos para câncer nas colonoscopias feitas:15 (0,26%) (c/a) = 15/5.732. D. colonoscopias feitas em FOBT + : 185. Doenças benignas ou exame normal: 68 (36,75%) (68/185); adenomas (baixo grau ou serrilhado): 101 (64,66%) (101/185); câncer: 15 (8,1%) (15/185). Câncer intramucoso ou adenomas de alto grau de atipia: oito (tratados por via endoscópica). Câncer invasivo: sete (tratamento cirúrgico:1 e ESD:1). Pacientes FOBT + que aguardam colonoscopia: 59; recusaram colonoscopia: 45.