Giovana Tavares dos Santos

Fatores clínicos e anatomopatológicos que influenciam a sobrevida de pacientes com câncer de mama e derrame pleural neoplásico

OBJECTIVE: The objective of this study was to identify the clinical and pathological factors that can influence the prognosis of breast cancer patients with clinical symptoms of malignant pleural effusion. METHODS: This was a clinical cohort study, in which we analyzed the medical charts of patients diagnosed with malignant pleural effusion between 2006 and 2010. By examining the charts, we identified the female patients with a history of breast cancer. For those patients, we collected pathology data related to the primary tumor and cytopathology data related to the pleural metastasis. RESULTS: We evaluated 145 patients, 87 (60%) of whom had tested positive for malignant cells in the pleural fluid. Ductal histology was observed in 119 (82%). The triple-negative breast cancer phenotype was seen in 25 cases (17%). Those patients had the worst prognosis (with a sharp decline in the survival curve), and 20 of the 25 (80%) died during the follow-up period (through June of 2011). The mean survival after the identification of malignant pleural effusion was 6 months. CONCLUSIONS: In patients with triple-negative breast cancer who test positive for malignant cells in the pleural fluid, the prognosis is poor and survival is reduced.

The Role of Urine Cytology for ‘Decoy Cells’ as a Screening Tool in Renal Transplant Recipients

Objective: To determine the role of urine cytology for ‘decoy cells’ as a screening tool for polyomavirus type BK (BKV) infection in renal transplant recipients. Study Design: This was a prospective cohort study of patients undergoing renal transplantation between 2006 and 2010. Results: A total of 442 patients underwent urine cytology for decoy cells, 27.8% underwent 1 examination only and 72.2% more than one. Of the 1,713 examinations reviewed, 426 (24.9%) were positive and 785 (45.8%) were negative for ‘decoy’ cells, 380 (22.2%) showed degenerated tubular cells and 122 (7.1%) were unsatisfactory for analysis. Urine cytology was found to have a specificity of 68.5%, a sensitivity of 84.6%, a positive predictive value of 21.2%, a negative predictive value of 97.8% and an overall accuracy of 69.9%. The incidence of polyomavirus nephropathy among the patients investigated was 11.8%. Of the 442 patients, 32 (7.2%) had graft loss, which was attributed to BKV nephropathy in 2 (6.2% of the 32). Conclusions: Urine cytology is an effective screening method for monitoring renal transplant patients, with high sensitivity and a high negative predictive value, and can therefore be used routinely in the follow-up of renal transplant patients.

Erratum to “Evaluation of the Expression of C-Kit (CD117) in Ependymomas and Oligodendrogliomas”

We came through this erratum and declare that we are aware that the author Ligia Maria Barbosa Coutinho, Professor at the Graduate Program in Pathology of Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), Brazil, was a part of the implementation of this paper, and, by our mistake, was absent from the list of authors. We would like to add Ligia Maria Barbosa Coutinho as a coauthor.

Evaluation of the expression of C-kit (CD117) in ependymomas and oligodendrogliomas

C-kit is a proto-oncogene located on the long arm of chromosome 4. Its product, CD117, is a specific immunohistochemical (IHQ) marker that is associated with response to a potent tyrosine kinase inhibitor therapy with STI-571 (Gleevec®) in chronic myelogenous leukemia and GISTs. In our study, we aimed to evaluate the expression of CD117 in glial tumors as this finding may guide therapeutic approaches for these brain tumors. Ependymomas and oligodendrogliomas, in formalin fixed and paraffin embedded blocks were assayed for CD117 immunoreactivity using anti-c-kit (CD117, DAKO). GISTs were used as positive control. We observed immunoreactivity of CD117 protein in 25.5% of tumors in both histological types. In oligodendrogliomas, there was an association between older age at diagnosis and positivity for CD117 (P = 0.039). In addition, we observed an association between higher tumor grade (grade III) and positivity for CD117 (P = 0.007). No clinical association was observed in ependymomas (P > 0.05). This study encourages further investigations, considering that CD117 may be a possible oncogenic factor in some glial tumors. In this case, tumors that express this marker may eventually benefit from a therapy with selective inhibitors of receptor kinases.

Impact of cell arrangement of pleural effusion in survival of patients with breast cancer.

Objective: This study was performed to evaluate the potential influence of cytological differences between pleural effusions on the survival of women with metastatic breast cancer during 30 months of follow-up. Study Design: A hospital-based cohort study was performed. Pleural fluid cytology slides from patients with breast cancer were examined. Cases were grouped according to the pattern of tumor cells (spheroid and isolated), in order to access their prognostic value. Results: The study comprised 87 patients. An isolated cell pattern was associated with higher mortality 30 months after the pleural effusion when compared to a spheroid pattern (p = 0.038). Patients with an isolated cell pattern showed higher risk of dying than patients with spheroid formations. The relative risk after adjustment of intervening variables was 5.336 (95% CI 1.054-27.020). The presence of a triple-negative immunohistochemical pattern significantly increased the risk of mortality before 30 months. Conclusion: Pleural effusion with isolated malignant cells is associated with worse prognosis after 30 months of follow-up.

Impact of Her-2 Overexpression on Survival of Patients with Metastatic Breast Cancer

Introduction: Breast cancer is a complex and heterogeneous disease which is increasingly important as a public health problem. In Brazil, 57,960 new cases have been estimated to be the burden in 2016 and 2017. Despite advances in early diagnosis and therapy, approximately 20-30% of patients, even with early stage lesions, will develop distant metastatic disease. Tumors with similar clinical and pathological presentations may have differing behavior, so it is important to understand specific biological characteristics. Objective: To investigate tumor markers of primary tumors featuring pleural metastasis to identify organ-specific characteristics of metastatic breast cancer. Methods: In a historical cohort study, immunohistochemistry was performed on cell blocks of neoplastic pleural effusions and results were compared with clinicopathological data. Results: The median survival time with Her-2 overexpression in malignant pleural effusions was 2.2 months, whereas cases without overexpression survived, on average, for seven months (p = 0.02). Conclusions: We emphasize that metastases may behave independently of primary tumors, but the present results indicate that therapeutic agents targeting Her-2 overexpression could increase survival in metastatic breast cancer cases.

In Memoriam - A Tribute to Alexander Meisels (1926-2014)

awards, among them the Goldblatt Award of the IAC (1975), the Papanicolaou Award of the ASC (1982) and the membership in the Order of Canada (2000). All members of the Executive Council and the entire membership of the IAC pay tribute to this great man and express their feelings of loss and sadness. Alex will be sadly missed. Volker Schneider, Freiburg i.B. Dr. Alexander Meisels died peacefully in September 2014 at the age of 88 years. His service to the International Academy of Cytology is legendary as he was a member of the Executive Council of the IAC for 39 years. He served as Secretary-Treasurer from 1971 to 1986 and continued subsequently as President, Treasurer and Member until 2010. He was responsible as Secretary or President for six International Congresses of Cytology organized by the IAC (Miami 1974, Tokyo 1977, Munich 1980, Montreal 1983, Brussels 1986 and Buenos Aires 1989). His contributions to the field of cytopathology were decisive and manifold. He considered his discovery of the relationship between the infection by human papillomavirus and the development of cervical carcinoma to be his most significant contribution, of which he was understandably proud. In 1976, he postulated that the koilocytotic changes in cervical epithelial cells represent an expression of viral infection and the initial step of carcinogenesis [1] , a hypothesis which was then controversially debated and is now common knowledge. Born in Berlin, he had to flee Germany with his parents and received his early schooling in Paris, France. He later attended the National University of Mexico, where he obtained his BSc and MD in 1951. In 1960 he moved to Quebec, Canada, where he worked until his retirement at the St. Sacrement Hospital and Laval University as Director of the Department of Pathology and the School of Cytotechnology. He educated numerous cytotechnologists, residents of pathology and foreign guests, who subsequently spread around the world. He was fluent in four languages, was an eloquent and gifted speaker, and travelled widely. He was particularly interested in the Spanish-speaking world and spread the cytologic gospel throughout Latin America. He received numerous Published online: October 29, 2014