Lucinei Roberto Oliveira

Prognostic factors and survival analysis in a sample of oral squamous cell carcinoma patients.

OBJECTIVES The aims of this report were to describe the 5-year overall survival (OS) in a group of oral squamous cell carcinoma (OSCC) patients and to investigate the effects of age, gender, anatomic localization, tumor evolution time, smoking and alcohol intake, nodal status, tumoral recurrences, histologic classification, p53 and p63 immunoexpression, human papillomavirus DNA presence, and treatment on the prognostic outcome. STUDY DESIGN Survival curves were generated using Kaplan-Meier method, and univariate and multivariate analyses were made using the log rank test and Cox regression, respectively. RESULTS The 5-year OS was 28.6%, and the univariate analysis showed significant results for p53 and p63 immunoexpression, age, and anatomic localization. The Cox regression demonstrated poor OS for tumors with p53 immunoexpression and for patients aged over 60 years. There were also significant differences in survival depending on the anatomic localizations. CONCLUSION These results highlight the influence of p53 immunoexpression, age, and anatomic localization in OSCC evolution.

Cancer stem cell immunophenotypes in oral squamous cell carcinoma.

BACKGROUND The presence of cancer stem cell (CSC) antigens can be evidenced in some human tumors by phenotypic analysis through immunostaining. This study aims to identify a putative CSC immunophenotype in oral squamous cell carcinoma (OSCC) and determine its influence on prognosis. METHODS The following data were retrieved from 157 patents: age, gender, primary anatomic site, smoking and alcohol intake, recurrence, metastases, histologic classification, treatment, disease-free survival (DFS), and overall survival (OS). An immunohistochemical study for CD44 and CD24 was performed in a tissue microarray of 157 paraffin blocks of OSCCs. RESULTS In univariate analysis, the immunostaining pattern showed significant influences in relation to OS for alcohol intake and treatment, as well as for the CD44(+) and CD44(-) /CD24(-) immunophenotypes. The multivariate test confirmed these associations. CONCLUSIONS Based on our results, the CD44 immunostaining and the absence of immunoexpression of these two investigated markers can be used in combination with other clinicopathologic information to improve the assessment of prognosis in OSCC.

Perfil da incidência e da sobrevida de pacientes com carcinoma epidermóide oral em uma população brasileira

BACKGROUND: The buccal cancer incidence in Brazil is one of the highest in the world. OBJECTIVES: To evaluate profile, risk factors and survival in patients with oral squamous cell carcinoma between 1982 and 2002 in a Brazilian population. MATERIAL AND METHOD: Age, gender, tumor site, previous clinical history, tobacco and alcohol consumption, actinic exposure, trauma by dental prosthesis, recurrences, metastases and survival rates were obtained from the medical files. RESULTS: From 340 patients, 84.4% were men and 15.6%, women (5.4:1). The lingual lesions were the most frequent ones (27.9%). Twenty percent of the patients reported trauma by dental prosthesis and in 73.8% of the lesions in lower lip an unprotected actinic exposure was reported. There was no difference between anatomical region and tobacco consumption concerning recurrences and regional or distant metastases. The average time of previous clinical history was 13 months, with significant differences among the anatomical regions. The 5-year-old survival rates were 24%. The survival rate of patients with recurrences and/or metastases varied according to age ( 60), but not to previous medical history or anatomical regions. The man/woman discrepancy found was high, but decreased according to the rise of age. Tobacco and alcohol consumption is elevated in this population, but did not influence recurrences and metastases. The time of evolution of the lesions was long until the search for medical service. CONCLUSIONS: The low survival rates reflect the need of a more careful attention to buccal cancer in this population.

Differential expression of HIF-1α in CD44+CD24-/low breast ductal carcinomas

BackgroundCancer stem cell (CSC) hypothesis postulates that tumors are maintained by a self-renewing CSC population that is also capable of differentiating into non-self-renewing cell populations that constitute the bulk of tumor. Stem cells renewal and differentiation can be directly influenced by the oxygen levels of determined tissues, probably by the reduction of oxidative DNA damage in hypoxic regions, thus leading to a friendlier microenvironment, regarding to clonal expansion and for resistance to chemotherapeutic regimens. Furthermore, there have been strong data indicating a pivotal role of hypoxic niche in cancer stem cells development. There are evidence that hypoxia could drive the maintenance of CSC, via HIF-1α expression, but it still to be determined whether hypoxia markers are expressed in breast tumors presenting CD44+CD24-/low immunophenotype.MethodsImmunohistochemical analysis of CD44+CD24-/low expression and its relationship with hypoxia markers and clinical outcome were evaluated in 253 samples of breast ductal carcinomas. Double-immunolabeling was performed using EnVision Doublestain System (Dako, Carpinteria, CA, USA). Slides were then scanned into high-resolution images using Aperio ScanScope XT and then, visualized in the software Image Scope (Aperio, Vista, CA, USA).ResultsIn univariate analysis, CD44+CD24-/low expression showed association with death due to breast cancer (p = 0.035). Breast tumors expressing CD44+CD24-/low immunophenotype showed relationship with HIF-1α (p = 0.039) and negativity for HER-2 (p = 0.013).ConclusionConsidering that there are strong evidences that the fraction of a tumour considered to be cancer stem cells is plastic depending upon microenvironmental signals, our findings provide further evidence that hypoxia might be related to the worse prognosis found in CD44+CD24-/low positive breast tumors.

CD44/CD24 immunophenotypes on clinicopathologic features of salivary glands malignant neoplasms

BackgroundSalivary Glands Malignant Neoplasms (SGMNs) account for 3-6% of head and neck cancers and 0.3% of all cancers. Tumor cells that express CD44 and CD24 exhibit a stem-cell-like behavior. CD44 is the binding site for hyaluronic acid, and CD24 is a receptor that interacts with P-selectin to induce metastasis and tumor progression. The present study aims to evaluate the expression of CD44 and CD24 on SGMNs and correlated these data with several clinicopathologic features.MethodsImmunohistochemical stains for CD44 and CD24 were performed on tissue microarrays containing SGMN samples from 69 patients. The CD44, CD24 and CD44/CD24 expression phenotypes were correlated to patient clinicopathologic features and outcome.ResultsCD44 expression was associated with the primary site of neoplasm (p = 0.046). CD24 was associated with clinical stage III/IV (p = 0.008), T stage (p = 0,27) and lymph node (p = 0,001). The CD44/CD24 profiles were associated with the primary site of injury (p = 0.005), lymph node (p = 0.011) and T stage (p = 0.023). Univariate analysis showed a significant relationship between clinical staging and disease- free survival (p = 0.009), and the overall survival presents relation with male gender (p = 0.011) and metastasis (p = 0.027).ConclusionIn summary, our investigation confirms that the clinical stage, in accordance with the literature, is the main prognostic factor for SGMN. Additionally, we have presented some evidence that the analysis of isolated CD44 and CD24 immunoexpression or the two combined markers could give prognostic information associated to clinicopathologic features in SGMN.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1284611098470676.

Significance of topoisomerase IIIβ expression in breast ductal carcinomas: strong associations with disease-specific survival and metastasis.

Topoisomerases are ubiquitous nuclear enzymes that regulate DNA structure in eukaryotic cells. The role of topoisomerase IIIβ, the newest member of the topoisomerase family, in the clinical outcome of breast cancer is still poorly understood. This study aims to investigate the immunoexpression of topoisomerase IIIβ in breast cancer and its relationships with clinicopathologic features and immunohistochemical markers of prognostic significance in breast pathology. Using tissue microarrays containing 171 cases of primary invasive breast cancer, we analyzed the immunoexpression of topoisomerase IIIβ, estrogen receptor, progesterone receptor, HER-2, BRCA-1, p53, and Ki67. Immunostaining for topoisomerase IIIβ was found in 33.9% of breast carcinomas, and immunopositivity was correlated with distant metastasis (P = .036) and death (P = .006). Decreased expression of topoisomerase IIIβ correlated with low expression of Ki67 (P < .001) and negativity for HER-2 (P < .001), BRCA-1 (P = .001), and p53 (P < .001). In the multivariate analysis, topoisomerase IIIβ expression was a significant predictor of survival (hazard ratio, 3.006 [95% confidence interval, 1.582-5.715]; P = .001). In conclusion, topoisomerase IIIβ expression can be a useful marker in assessing the prognosis of patients with breast cancer and is an independent predictor of survival.

Ameloblastoma: Report of Two Cases and a Brief Literature Review

Ameloblastoma is an uncommon odontogenic neoplasm that accounts for approximately 10% of all tumors originating from gnathic bones. Although its growth is localized, the tumor can also be infiltrative and persistent; however, its behavior is usually benign. The mandible is the most commonly affected site, and ameloblastoma is most frequently diagnosed between the fourth and fifth decades of life. In addition to a brief review of the literature, the present study discusses the clinical, imaging, histopathological and prognostic characteristics of these tumors by presenting two case reports. In these cases, the patients were aged 40 and 66 years, of different sexes and ethnicities and presented with the same complaint regarding localized and asymptomatic swelling. Both cases occurred in the posterior region (but on opposite sides) of the mandible. The patients were initially subjected to clinical examination and imaging of the face, followed by incisional biopsy to confirm (in both cases) the diagnosis of multicystic intraosseous ameloblastoma with a plexiform pattern. Both patients were treated by wide resection of the lesion (with safety margins), and only one patient experienced tumor recurrence. After 42 and 68 months of follow-up, the patients are still alive and show no signs of recurrence. Clinical and imaging findings aid in the differential diagnosis of ameloblastomas; however, histopathological evaluation is essential for its definitive diagnosis. Early diagnosis and precise detection of the borders to provide adequate safety margins during the surgical resection of the tumor are necessary to achieve successful treatment and recurrence-free survival for solid ameloblastomas.

CD44+/CD133+ immunophenotype and matrix metalloproteinase-9: Influence on prognosis in early-stage oral squamous cell carcinoma.

The purpose of this study was to investigate the expression of CD44 and/or CD133 immunophenotypes and the associated effects of matrix metalloproteinase‐9 (MMP‐9) in early‐stage oral squamous cell carcinomas (SCC) to assess their influence on tumor prognosis.

CD441/CD1331 immunophenotype and matrix metalloproteinase-9

The purpose of this study was to investigate the expression of CD44 and/or CD133 immunophenotypes and the associated effects of matrix metalloproteinase‐9 (MMP‐9) in early‐stage oral squamous cell carcinomas (SCC) to assess their influence on tumor prognosis.

Report of a case of solitary fibrous tumour of the orbit

BackgroundSolitary fibrous tumors of the orbit are uncommon lesions, only one relatively large series having been published. Neoplasms, formerly considered as separate entities, including hemangiopericytoma, are presently encompassed as solitary fibrous tumors, a unifying designation. There is a tendency towards recurrence and some cases are malignant. Their rarity justifies the publication of new cases, in order to increase the amount of information about this pathological entity.Case reportA 40-year-old female patient developed swelling in the left lower lid and after slow progression of the symptom during 2 years, presented herself to our elective surgery service. Image exams showed a 20-mm encapsulated tumor. Surgical treatment was performed: complete excision, made difficult by the growth of the lesion amid the inferior rectus and inferior oblique muscles. Histopathological and immunochemical examinations with CD34 positivity, diagnosed a solitary fibrous tumor, without suggestive signs of malignancy. After a follow-up of 40 months, no recurrence has been detected.DiscussionSolitary fibrous tumors, though uncommon, should be considered in the differential diagnosis of orbital expansive lesions. The key point to diagnosis is finding CD34 positivity in immunohistochemical examination. Such tumors have a tendency for recurrence, even after more than 5 years.