João Goes

Association between intratumoral lymphatic microvessel density (LMVD) and clinicopathologic features in endometrial cancer: a retrospective cohort study

BackgroundLymph node metastasis in endometrial cancer significantly decreases survival rate. Few data on the influence of intratumoral lymphatic microvessel density (LMVD) on survival in endometrial cancer are available. Our aim was to assess the intratumoral LMVD of endometrial carcinomas and to investigate its association with classical pathological factors, lymph node metastasis and survival.MethodsFifty-seven patients with endometrial carcinoma diagnosed between 2000 and 2008 underwent complete surgical staging and evaluation of intratumoral LMVD and other histologic variables. Lymphatic microvessels were identified by immunohistochemical staining using monoclonal antibody against human podoplanin (clone D2-40) and evaluated by counting the number of immunostained lymphatic vessels in 10 hot spot areas at 400× magnification. The LMVD was expressed by the mean number of vessels in these 10 hot spot microscopic fields. We next investigated the association of LMVD with the clinicopathologic findings and prognosis.ResultsThe mean number of lymphatic vessels counted in all cases ranged between 0 and 4.7. The median value of mean LMVD was 0.5, and defined the cut-off for low and high LMVD. We identified low intratumoral LMVD in 27 (47.4%) patients and high LMVD in 30 (52.6%) patients. High intratumoral LMVD was associated with lesser miometrial and adnaexal infiltration, lesser cervical and peritoneal involvement, and fewer fatal cases. Although there was lower lymph node involvement among cases with high LMVD, the difference did not reach significance. No association was seen between LMVD and FIGO staging, histological type, or vascular invasion. On the other hand, low intratumoral LMVD was associated with poor outcome. Seventy-five percent of deaths occurred in patients with low intratumoral LMVD.ConclusionOur results show association of high intratumoral LMVD with features related to more localized disease and better outcome. We discuss the role of lymphangiogenesis as an early event in the endometrial carcinogenesis.

Intratumoral lymphatic vessel density and clinicopathologic features of patients with early-stage cervical cancer after radical hysterectomy.

Introduction: Lymphangiogenesis plays a key role in tumor growth, progression, and metastasis, yet few studies have investigated lymphatic vessel density (LVD) in cases of cervical cancer. The aim of this retrospective study was to evaluate intratumoral LVD, in addition to other histologic variables, in relation to lymph node metastases and survival of patients with stage IB to IIA cervical cancer after radical hysterectomy. Methods: Between 2000 and 2008, 144 patients had a diagnosis of cervical uterine cancer and underwent radical hysterectomy. Tumor stages for these patients were identified according to the criteria of the International Federation of Gynecology and Obstetrics and included 84 stage IB1, 44 stage IB2, and 16 stage IIA cases. With an antibody directed against human podoplanin (D2-40), immunohistochemical staining was used to measure LVD. The correlation between LVD and clinicopathologic features of the resected tumors was analyzed. Results: Lymphatic vessel density was significantly higher in tumors less than 2 cm in diameter (P = 0.001) and in tumors with 1.0-cm-or-less depth of invasion (P = 0.007), with early stage (P = 0.001), and with negative lymph nodes (P = 0.05). After multivariate analysis, the predictive factors associated with lymph node metastases were depth of infiltration (P = 0.027), lymphovascular space invasion (P < 0.001), and parametrial involvement (P = 0.01). For patient death, the predictive factors were International Federation of Gynecology and Obstetrics stage (P = 0.017), histologic type (P = 0.010), lymph node status (P = 0.031), and histologic grade (P = 0.041). Lymphatic vessel density was not a predictive variable for lymph node metastasis or death. Conclusions: Intratumoral LVD was greater in early cervical cancer (ie, smaller tumors, early clinical stage, and negative lymph nodes), and no relationship between LVD and lymph node metastases or survival was observed.

Intratumoral lymphatic vessel density in vulvar squamous cell carcinomas: a possible association with favorable prognosis.

Lymphatic vessels serve as major routes for regional dissemination, and therefore, lymph node status is a key indicator of prognosis. To predict lymph node metastasis, tumor lymphatic density and lymphangiogenesis-related molecules have been studied in various tumor types. To our knowledge, no previous studies have evaluated the role of intratumoral lymphatic vessel density (LVD) in the behavior of vulvar carcinomas. The aim of this study was to analyze intratumoral LVD in relation to patient survival and well-characterized prognostic factors for cancer. Thirty-five patients with vulvar squamous cell carcinoma underwent vulvectomy and dissection of regional lymph nodes. Clinical records were reviewed, in addition to histological grade, peritumoral lymphatic invasion, and depth of infiltration for each case. Tissue microarray paraffin blocks were created, and lymphatic vessels were detected using immunohistochemical staining of podoplanin (D2-40 antibody). Intratumoral LVD was quantified by counting the number of stained vessels. Higher values for intratumoral LVD were associated with low-grade and low-stage tumors, and with tumors without lymphatic invasion and reduced stromal infiltration. In a univariate analysis, high intratumoral LVD was associated with a higher rate of overall survival and a lower rate of lymph node metastasis. Our results suggest that increased intratumoral LVD is associated with favorable prognosis in vulvar squamous carcinomas.

IL-13 is produced by tumor cells in breast implant–associated anaplastic large cell lymphoma: implications for pathogenesis

More than 500 women worldwide have developed a CD30+ T-cell lymphoma around breast implants, strongly suggesting a cause-and-effect relationship, and designated as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The mechanism of lymphomagenesis is unknown. Recently, a bacterial biofilm containing gram-negative bacilli was discovered on the surface of breast implants associated with ALCL. We and others have described overexpression of the proto-oncogene JUNB and mutations of JAK1/2, TP53 and STAT3 in BIA-ALCL. Here we report that BIA-ALCL cell lines and anaplastic lymphoma cells in clinical specimens produce IL-13, the signature cytokine of allergic inflammation. Supporting the link of BIA-ALCL to allergic inflammation, lymphoma cells were often surrounded by eosinophils and mast cells, features typically absent in systemic ALCL. Because of the link of IL-13 to allergy, we looked for IgE and found it decorating the surface of mast cells and antigen-presenting follicular dendritic cells in capsules and lymph nodes infiltrated by anaplastic lymphoma cells, but not uninvolved capsules. Plasma cells within capsules and regional lymph nodes were identified as a possible source of IgE. Together, these findings suggest the hypothesis that an amplified immune response with features of a chronic allergic reaction in a susceptible patient underlies the pathogenesis of BIA-ALCL.

Tempo de validade dos exames pré-operatórios normais para uma reintervenção cirúrgica e o impacto nos desfechos pós-operatórios

BACKGROUND AND OBJECTIVE There are few data defining the period of time in which preoperative tests can be considered valid. The purpose of this study was to determine the likelihood of changes in the results of preoperative tests previously normal in relation to time, and the impact of these changes on postoperative outcomes. METHODS A total of 970 patients with normal preoperative tests before the first surgery and who required a new intervention were included. The preoperative tests performed for the first procedure were compared with those performed for the second procedure. The following variables were assessed regarding their potential to induce changes in test results: sex, age, surgical risk, previous chemotherapy or radiotherapy, and presence of comorbidities. In-hospital outcomes were analyzed. RESULTS The median time between procedures was 27 months (6-84). The probability of change in at least one of the preoperative exams was 1.7% (95% CI: 0.5-2.9), 3.6% (95% CI: 1.8-5.4), and 6.4% (95% CI: 3.9-8.9) during the 12, 24, and 36-month intervals, respectively, for patients aged <50 years and 2.1% (95% CI: 0.7-3.5), 9.2% (95% CI: 5.9-12.5), and 13.4% (95% CI: 9.3-17.5), respectively, for patients ≥ 50 years of age. Age (p=0.009), surgical risk (p <0.001), chemotherapy (p=0.001), radiotherapy (p=0.012), and comorbidities (p <0.001) were associated with the likelihood of changes in test results. Test changes were not significantly associated with in-hospital adverse outcomes (p=0.426). CONCLUSION For patients undergoing a second surgical procedure, the probability of change in previously normal preoperative tests is low during the first years after the first surgical intervention, and when changes occurred, they did not adversely affect the in-hospital postoperative outcomes.

PM345 Low Risk Surgery In Women Over Aged 50 Years: Is There Need For Preoperative Tests?

Introduction: Around 200,000 people were displaced from the post-election violence that occurred in Kenya in 2007 and 2008. Objectives: To assess the cardiovascular risk factors of men living in an internally displaced persons camp in Kenya. Methods: Cross sectional survey of 267 men who live in the Shalom Internally Displaced Persons Camp in the Rift Valley in Kenya. Respondent driving sampling technique was used to recruit the men. Data on cardiovascular risk factors was collected using a questionnaire (WHO STEPwise instrument) that asked about tobacco use, alcohol consumption, history of raised blood sugar. Biometric measures were taken of blood pressure, weight and height for BMI and waist hip circumference. Results: Demographic characteristics were: mean age 37 years, 84.5% were of Kikuyu ethnicity, 36% had no schooling or had not completed primary school, over half were married and the average household size was 7 people. Half were employed (predominantly in agriculture) and median monthly household income was 2500 Kenyan Shillings (

Dielectric Study in the Microwave Range for Ceramic Composites Based on Sr2CoNbO6 and TiO2 Mixtures

AUD 31.86). Results for cardiovascular risk factors were: 36% daily smoking, 31% consumed alcohol in past 30 days, 10% had BP 140/90 and a quarter were underweight (< 18.5 BMI). Conclusion: The overcrowded living conditions in the small mud houses in the camp are very basic with inadequate sanitation and access to fresh water. These difficult living conditions which accompany the range of cardiovascular risk factors identified among the men will lead to poor health outcomes unless the health, living conditions and access to health facilities improve. Disclosure of Interest: None Declared