Juan Carlos Roa S

Carcinoma incipiente de la vesícula biliar. Estudio clínico-patólogico y pronóstico de 196 casos

Background: There is little information about the behavior of early gallbladder carcinoma. Aim: To report the clinical and pathological features of 196 patients with early gallbladder carcinoma. Material and methods: All patients with gallbladder cancer diagnosed between 1988 and 1997 were reviewed. In 703 of 829 patients, there was information about clinical features and follow up, and were included in this study. All gallbladders were subjected to a complete mapping. When neoplastic cells involved only the mucosa or muscular layer, the tumors were considered as early. Results: One hundred ninety six patients had an early carcinoma (161 women, aged 57.5 years and 35 male, aged 63.4 years). One hundred twenty eight tumors were located in the mucosa and 68 in the muscular layer. Patients with tumors involving the mucosa were younger than those with tumors involving the muscular layer. All tumors were adenocarcinomas, 66% were well differentiated and 32% moderately differentiated. Tumors were not visible macroscopically in 132 cases. Five and 10 years survival was 92%. Subjects of less than 40 years old had a 100% survival at 5 years. A hepatic and lymph node resection was done in 12 patients with tumors infiltrating the muscular layer but in only one, the tumor infiltrated the liver. No difference in survival was observed when a simple cholecystectomy or radical surgery was done. Conclusions: Nearly 25% of gallbladder carcinomas can be classified as early and its diagnosis requires a directed study

Pólipos y adenomas de la vesícula biliar: consideraciones clínico-patológicas

: In a period of 10 years, 21.412 gall-bladders were processed. Among these, 884 carcinomas were diagnosed and in 219 cases (1%)a polyp was found. One hundred and eighty three patients were females (mean age 49.3 years)and 36 males (mean age 53.4 years). The preoperative diagnosis of gallbladder polyp was doneonly in 26 cases (12%). Eighty five percent of polyps were non-neoplastic (metaplastic in 32%,cholesterol in 29%, hyperplastic in 22% and inflammatory in 2%). The remaining 15% wereadenomas. Seventy five percent of non-neoplastic polyps were located in the proximal half of thegallbladder and 88% of adenomas in the distal half. Ninety five percent of non-neoplastic pol-yps measured less than 10 mm. Among adenomas, 47% measured less than 5 mm and 28%more than 10 mm. Smaller polyps were of cholesterol and larger polyps were adenomas. Eightadenomas were associated with an adenocarcinoma, two had less than 5 mm lenght. Mean ageof patients with adenomas associated to cancer was higher than patients with pure adenomas(64.6 and 44.3 years respectively, p >0.001).

Tipificación del virus papiloma humano (VPH) en lesiones preneoplásicas y carcinoma del cuello uterino en mujeres de la IX Región-Chile

: Detection of HPV was 40% in cases without histologicallesion, 88% in low grade lesions, 89% in high grade lesions (HGL) and 93.5% in invasive carcino-ma. Of all HPV positive cases, 89.5% were classified as high risk and only a 4.9% of HPV caseswere of low risk type. Six percent of cases had multiple infections. Distribution of viral genotypesaccording to RFLP was: HPV33 (25.3%), 16 (18.7%), 52 (13.3%), 31 (12%), 35 (6.6%), 18(2.7%).

Quimiorradioterapia de neoadyuvancia en cáncer de vesÍcula biliar

Twenty three gallbladder cancer patients were prospectively treated between June1993 and September 1999 in the Temuco Regional Hospital. Eighteen (82%) patients had subse-rosal infiltration, while three (13%) had serosal and two (9%) adipose tissue infiltration. Che-motherapy was done with 5-fluorouracil in continuous infusion during 5 days at day 1 and 28of treatment. Radiotherapy consisted in a total dose of 4500 cGy, divided in 25 sessions. Pa-tients’ survival was compared with a series of 19 patients not subjected to chemoradiation, for-merly treated at the institution.

Estudio comparativo de detección del virus papiloma humano (VPH) en muestras citológicas y biopsias de cuello uterino

Background: The DNA quality for the detection and typification of Human Papilloma Virus (HPV) varies according to the type of sample in which it is studied. This may affect the sensitivity and specificity of the method employed. Aim: To study the yield and specificity of HPV detection and typification in uterine cervical samples obtained by cervical brushing fresh frozen and formalin fixed tissue. Material and methods: Cytological, fresh frozen and fixed tissue samples from 44 patients (nine with low grade lesions and 35 with high grade lesions) were studied. Nested polymerase chain reaction for genes E6/E7 was used to typify HPV groups as low risk or high risk. Results: Of all the cytological samples obtained by brushing 84% of fixed samples and 43% of fresh frozen samples were positive for HPV. The yields were significantly different when comparing brushing with fixed tissue or fresh frozen tissue and fixed tissue with fresh frozen tissue (p <0.05). The frequency of high risk HPV fluctuated from 41% in fresh frozen tissue to 98% in cytological samples. Low risk HPV was detected in 16% of fresh frozen tissue and 68% of cytological samples. A mixed infection was detected in 66%, 41% and 14% of cytological, fresh frozen and fixed tissue samples respectively. Conclusions: Cytological samples obtained by brushing had the highest yield for the detection of cervical infection with HPV (Rev Med Chile 2005; 133: 639-44). (Key Words: Cytological techniques; Cytopathology; Papillomavirus, human)

Elementos morfológicos pronósticos en el cáncer de la vesícula biliar

Background: The exact survival rates and prognostic factors of gallbladder cancer are still incompletely known. Aim: To report the actuarial survival of patients with gallbladder cancer. Material and methods: Six hundred thirty seven women, aged 59 years old as a mean and 108 men, aged 64 years old as a mean, with gallbladder cancer are reported. Patients were followed for up to 150 months. Results: Two hundred twenty four patients had an early and 521 had an advanced carcinoma. Overall survival was 38% at ten years. Sex or ethnic origin did not influence survival. Early tumors had a 92% survival at 10 years whereas the survival of advanced tumors was 16% at 5 years. Subserous tumors had a 5 years survival of 32% whereas serous tumors had a 5 years survival of 11%. Well-differentiated advanced tumors had a significantly better survival than moderately or poorly differentiated tumors. Vascular or lymphatic infiltration was also associated to a lower survival. All patients with advanced tumors and vascular infiltration died before 5 years. Conclusions: Tumor infiltration and differentiation degree were the most important prognostic independent factors in gallbladder cancer (Rev Med Chile 2002; 130: 387-395)

Patrón de metilación génico en el cáncer de mama

: We found methylation inat least one of the genes studied in 88% of cases and in 3 or more genes in 40.5% of cases. Thefrequencies of promoter hypermethylation of CDKN2A, hMLH1, APC, CDH1 and FHIT were41.4%, 11.4%, 52.9%, 70% y 42.9%, respectively. We found a relationship between CDKN2A me-thylation and better survival (p=0.002). CDH1 methylation and poor histological differentiation(p=0.007), hMLH1 methylation and non-Mapuche ethnicity (p=0.03), APC methylation and larg-er tumor size (p <0.05), FHIT methylation and lack of estrogen receptor IHC expression (p <0.05).

Mutación del gen p53 en el cáncer de la vesícula biliar

33 formalin fixed paraffin embedded samples of gallbladdercarcinoma (30 women, age range 32-86 years) were selected. Pancreatic cancer tissue with K-ras mutations was used as control. DNA was extracted from the histological section by mean ofmicrodissection and K-ras mutations in codon 12 were detected by polymerase chain reactionand restriction fragment length polymorphism (RFLP), using previously reported technique.

Detección y tipificación de virus papiloma humano en lesiones preneoplásicas del cuello uterino mediante PCR-RFLP

. Los genotiposde HPV que infectan el tracto genital femenino, sehan clasificado en 2 grupos: de bajo riesgo (BR) y dealto riesgo (AR) segun el potencial oncogenico parael desarrollo de lesiones preneoplasicas o neoplasi-cas. Los genotipos de bajo riesgo (BR) mas frecuen-tes son los HPV: 6, 11, 43 y 44 y se asocian concondilomas o neoplasias cervicales intraepitelialesde bajo grado (LBG). En el grupo de alto riesgo (AR)15 tipos de HPV han sido identificados (HPV 16, 18,31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 y 82),detectados principalmente en neoplasia cervicalintraepitelial de alto grado (LAG) y carcinomas

Inactivación del gen CDKN2A (p16) en cáncer de la vesícula biliar

: We analyzed themethylation status of the promoter region of the CDKN2A gene in gallbladder adenocarcinomasusing methylation specific PCR (MSP). We also used microsatellite markers near the CDKN2Agene to detect allelic imbalance (AI) and examined the tumors by immunohistochemistry (IHC)for p16 expression.