Luiz Gonzaga Porto Pinheiro

Hemosiderin: a new marker for sentinel lymph node identification.

PURPOSE To evaluate and present our initial results of a new marker (hemosiderin) for mammary sentinel lymph node identification in an experimental model. METHODS Skins mapped like a lymphatic duct draining to the axilla in patients submitted to breast biopsy, in our mastology service, stimulated us to try it in an animal model (female dogs). Our theory was that some blood derivate (hemosiderin) was captured by macrophages and accessed the lymphatic ducts in direction to the axilla. Six female dogs of no defined race were studied. We injected 0,2 ml of technetium on both superior mammary glands. After ten minutes, a 2,5 ml solution of hemolized blood (hemosiderin) from the own animal was injected in the subareolar lymphatic plexus on the left superior mammary gland and 2,5 ml of patent blue concomitantly and equally on the contralateral gland. Ten minutes after, incisions on both axillae were made to search, through the lymphatic mapping and a gamma probe, the sentinel lymph nodes. RESULTS Seven brown sentinel lymph nodes were identified and also radiomarked on the left axilla. Six blue sentinel lymph nodes were identified and also radiomarked on the right axilla. CONCLUSION Preliminary studies of a potential new dye for sentinel lymph node identification are presented. It may be the change of the current use of the blue dyes and their severe side-effects on patients submitted to sentinel lymph node biopsies.

Estudo experimental de linfonodo sentinela na mama da cadela com azul patente e Tecnécio Tc99m

The sentinel lymph node research (SLN) has been effective in the evaluation of nodal status in patients with breast cancer. A negative SLN makes an axillary lymphadenectomy unnecessary. PURPOSE: To identify the SLN of the subareolar region in female dog breasts using blue dye (BD), Technetium (Tc99m) or the association of both techniques and to compare their sensibility in the detection of the SLN. METHODS: Seventeen female dogs were studied. 55 breasts were analyzed. DB and/or Tc99m were used for the identification of SLN. Tc99m was introduced two hours before the experiment. BD was introduced some minutes before the procedure. Once the SLN was localized its dissection was performed. RESULTS: From all 44 lymph nodes in which BD was used, 40 were colored (90,90%). Tc99m was used in 48 lymph nodes and 47 of them were radioactive (97,91%) (BD vs Tc99m: p=0.18; k= - 0.067). BD and Tc99mwere associated in 37 lymph nodes, although 02 lymph nodes were not colored, all of them were radioactive (100%)(BD vs BD+Tc99m: p=0.12; k=0.083; Tc99m vs BD+ Tc99m: p=1.0; k=0.018). CONCLUSION: Tc99mand BD isolated or in association, were effective in the identification of the SLN in the female dog breasts studied.

Histological study of rat ovaries cryopreserved by vitrification or slow freezing and reimplanted in the early or late postmenopausal stage

PURPOSE To compare two rat ovary cryopreservation techniques (vitrification vs. slow freezing) and two postmenopausal stages (early vs. late) with regard to graft take. METHODS Thirty-three Wistar rats were submitted to bilateral oophorectomy. One ovary was submitted to histological analysis while the other was cryopreserved by slow freezing or vitrification. The cryopreserved ovary was thawed and reimplanted in the greater omentum one week (early menopause) or one month (late menopause) after oophorectomy. One month after ovary reimplantation, the graft take was evaluated macroscopically and histologically. RESULTS Six of the animals were used ascontrols and seven died. The histological findings of 20 animals included atretic follicles (n=4), primordial follicles (n=2), and corpus luteum with primordial follicles (n=3). No ovarian tissue was found in 11 animals. Vitrification resulted in a higher graft take rate than slow freezing (50% vs. 38.5%), but the difference was not statistically significant. However, the graft take rate was 9.3 times higher in the early than in the late postmenopausal stage (61.5% vs. 14.3%) (p=0.043). CONCLUSION Vitrification was superior to slow freezing as ovarian cryopreservation technique, and grafting was significantly more successful when the ovary was reimplanted in the late postmenopausal stage.

Colecistectomia videolaparoscópica experimental em cadáver humano: 70 casos

OBJETIVO: Apresentar, descrever e propor como metodo de treinamento e/ou aperfeicoamento em colecistectomia videolaparoscopica, um modelo desenvolvido em cadaver de feto humano. METODO: No Departamento de Morfologia da Faculdade de Medicina da Universidade Federal do Ceara foram utilizados 70 cadaveres de fetos humanos, de ambos sexos, frescos-congelados, com tamanhos entre 39 e 54 centimetros (media = 49cm) e pesos entre 1.210 e 3.900 gramas (media = 2.900g). Foi empregado, ainda, todo o arsenal de equipamentos e instrumentais de cirurgia videolaparoscopica. Cada feto foi submetido a videocolecistectomia experimental e os dados referentes aos aspectos tecnicos e anatomicos registrados em fitas de video e em protocolo para analise posterior. A tecnica cirurgica utilizada seguiu todos as etapas operatorias da videocolecistectomia in vivo. RESULTADOS: Foi possivel manter um pneumoperitonio eficiente, em torno de 18mmHg, em todos os casos. A adequada clipagem do ducto cistico foi possivel em 66 dos 68 casos operados, e da arteria cistica em 62 casos. A vesicula foi extirpada satisfatoriamente em 67 fetos. O tempo cirurgico medio foi de 70 minutos. Observou-se que o metodo proposto permite ao cirurgiao adquirir, a partir de um treinamento adequado, habilidades tecnicas, bem como seguranca na execucao de manobras necessarias para a pratica desta modalidade cirurgica. CONCLUSAO: A videocolecistectomia em cadaver de feto humano representa um metodo factivel, de grande importância, que pode ser aplicado no treinamento e/ou aperfeicoamento de cirurgioes videolaparoscopicos.

Sentinel lymph node biopsy in patients with locally advanced breast cancer after neoadjuvant chemotherapy

PURPOSE To check the rate of sentinel lymph node (SLN) identification in patients with locally advanced breast cancer who underwent neoadjuvant chemotherapy comparing intraoperative contact cytology (imprint) and embedded in paraffin and validation of methods. METHODS A cross-sectional validation of diagnostic test involving 34 patients from the outpatient clinic of the Maternity School Assis Chateaubriand. The patients had locally advanced breast cancer and were treated with neoadjuvant chemotherapy. Those with clinically negative axilla underwent SLN biopsy, studied by imprint and histopathology in paraffin. All patients underwent axillary dissection and its histopathological study. RESULTS The SLN identification rate was 85.3% (29/34). The sensitivity of imprint associated with paraffin on detection of metastasis compared to histopathology of the axillary content was 84.62% and specificity of 100% with false-negative rate of 12.01% and an accuracy of 92.77%. CONCLUSION The search for metastases in the SLN by imprint and histopathological analysis in paraffin compared to the gold standard (axillary dissection) had a low sensitivity with high rate of false negatives in our sample.

The impact of previous para-areolar incision in the upper outer quadrant of the breast on the localization of the sentinel lymph node in a canine model

OBJECTIVES: This paper discusses the influence of a para-areolar incision in the upper outer quadrant of the breast on the location of the sentinel lymph node in a canine model. METHODS: The sentinel lymph node was marked with technetium-99, which was injected into the subareolar skin of the cranial breast. After the marker had migrated to the axilla, an arcuate para-areolar incision was performed 2 cm from the nipple in the upper outer quadrant. Patent blue dye was then injected above the upper border of the incision. At the marked site, an axillary incision was made, and the sentinel lymph node was identified by gamma probe and/or by direct visualization of the dye. The agreement between the two injection sites and the two sentinel lymph node identification methods was determined. Our sample group consisted of 40 cranial breasts of 23 adult females of the species Canis familiaris. The data were analyzed by using the McNemar test and by determining the kappa agreement coefficient. RESULT: Our findings showed that in 95% of the breasts, the sentinel lymph node was identified by the injection of technetium-99 m into the subareolar region, and in 82% of the cases, the sentinel lymph node was identified by the injection of patent blue dye above the upper border of the incision. The methods agreed 82% of the time. CONCLUSIONS: Previous para-areolar incisions in the upper outer quadrant did not interfere significantly with the biopsy when the dye was injected above the upper border of the incision.

Ductal carcinoma of the breast: morphological aspects according to the age

Introduction:Breast cancer is the most common cancer in women worldwide, and its morphological characteristics, despite the current molecular classification, also provide important information about the pattern of this disease.Objective:To analyze the morphological characteristics of invasive ductal breast carcinoma among women older and younger than 50 years.Method:302 cases of invasive ductal carcinoma patients treated at the Division of Mastology of the Universidade Federal do Ceara, in the period 2005-2014, aged ≤ 50 years and older. The following morphological characteristics were analyzed: larger tumor diameter (TD), lymph node metastasis (MX), and histological grade (HG).Results:The mean age of patients was 55.6 years. The average tumor size was 3.4 cm, 40% of tumors have diameter ≤ 2 cm and 60% > 2 cm. As for the histological grade, 23.7% were grade 1, 32.1% grade 2, and 42% grade 3. Axillary metastasis were present in 66% of the cases and 34% did not. Women aged ≤ 50 years had fewer tumors grade 1 (p = 0.002), compared with grades 2 and 3. Women older than 50 years had more grade 3 tumors (p = 0.002), and more tumors larger than 2 cm diameter (p < 0.001). The presence of metastasis predominated in both age groups when analyzed separately (p < 0.001).Conclusion:Women older than 50 years had larger and more morphologically undifferentiated tumors. Women aged ≤ 50 years had less well-differentiated tumors. There were no differences in morphology between these two age groups when compared each other.

Linfonodo sentinela: importância na cirurgia do câncer gástrico e perspectiva da aplicação de um modelo experimental em caninos

INTRODUCAO: A unica perspectiva de cura do câncer gastrico ainda e o tratamento cirurgico - gastrectomia associada com linfadenectomia ampliada -, embora tal procedimento possa levar a alto indice de morbidade ou mortalidade. Atualmente, a pesquisa do linfonodo sentinela para o câncer gastrico inicial (EC T1/T2) apresenta argumentos que podem esta modificando esta conduta. OBJETIVO: Realizar revisao bibliografica atualizada da importância do linfonodo sentinela na cirurgia do câncer gastrico e apresentar modelo experimental, em caninos, que poderia se prestar como treinamento de cirurgioes para o metodo da pesquisa de linfonodo sentinela em estomago. METODO: Revisao da literatura baseaa no Pubmed/Medline, Scielo e Lilacs cruzando os unitermos câncer gastrico, metastase linfatica e biopsia de linfonodo sentinela e apresentacao de metodo experimental para localizacao de nodulo sentinela. CONCLUSOES: As evidencias demonstram que ha muito para se comprovar, entretanto a definicao do tratamento do CaG nos tumores T1 parece ser o maior foco e abre bastante espaco para pesquisa. O modelo experimental em caninos para a pesquisa do LS no estomago, poderia se prestar como treinamento para cirurgioes na aplicacao do metodo.

Transplante de tecido ovariano criopreservado e restauração do metabolismo ósseo em ratas castradas

OBJECTIVES to evaluate estradiol levels and autotransplantation heated ovarian tissue effects, after vitrification, on rats bone metabolism previously oophorectomized bilaterally. METHODS experimental study with 27 rats aged 11 to 12 weeks and weighing 200g to 300g, submitted to bilateral oophorectomy and ovarian tissue cryopreservation for subsequent reimplantation. Animals were divided into two groups, A and B, with 8 and 19 rats, respectively. Autotransplantation occurred in two periods according to castration time: after one week, in group A, and after one month in group B. Serum estradiol measurements and ovary and tibia histological analysis were performed before and after oophorectomy period (early or late) and one month after reimplantation. RESULTS in groups A and B, tibia median cortical thickness was 0.463±0.14mm (mean±SD) at the baseline, 0.360±0.14mm after oophorectomy and 0.445±0.17mm one month after reimplantation p<0.005). Trabecular means were 0.050±0.08mm (mean±SD) at baseline, 0.022±0.08mm after oophorectomy and 0.049±0.032mm one month after replantation (p<0.005). There was no statistical difference in estradiol variation between the two study groups (p=0.819). CONCLUSION cryopreserved ovarian tissue transplantation restored bone parameters, and these results suggest that ovarian reimplantation in women may have the same beneficial effects on bone metabolism.

Identification of the sentinel lymph node using hemosiderin in locally advanced breast cancer

OBJECTIVE to verify the agreement rate in the identification of sentinel lymph node using an autologous marker rich in hemosiderin and 99 Technetium (Tc99) in patients with locally advanced breast cancer. METHODS clinical trial phase 1, prospective, non-randomized, of 18 patients with breast cancer and clinically negative axilla stages T2=4cm, T3 and T4. Patients were submitted to sub-areolar injection of hemosiderin 48 hours prior to sentinel biopsy surgery, and the identification rate was compared at intraoperative period to the gold standard marker Tc99. Agreement between methods was determined by Kappa index. RESULTS identification rate of sentinel lymph node was 88.9%, with a medium of two sentinel lymph nodes per patients. The study identified sentinel lymph nodes stained by hemosiderin in 83.3% patients (n=15), and, compared to Tc99 identification, the agreement rate was 94.4%. CONCLUSION autologous marker rich in hemosiderin was effective to identify sentinel lymph nodes in locally advanced breast cancer patients.