Roberto Souza Camargo

End results of a prospective trial on elective lateral neck dissection vs type III modified radical neck dissection in the management of supraglottic and transglottic carcinomas

Either modified type III radical neck dissection (MRND) or lateral neck dissections (LNDs) are considered valid treatments for patients with laryngeal carcinoma with clinically negative neck findings (N0). The object of this prospective study was to compare complications, neck recurrences, and survival results of elective MRND and LND on the management of laryngeal cancer patients.

Aspectos fundamentais da experimentação animal - aplicações em cirurgia experimental

This study aimed to present the general principles for experiments performed on laboratory animals as required by international and national ethical committees on animal welfare. Compliance to these principles is a prerequisite for publication in international journals. Details of genetic, sanitary and environmental standards, transportation, acclimation, environmental enrichment, appropriate education and training of all those involved in handling of live animals, information management strategy, biossecurity, diet, anesthesia, analgesia, postoperative care and euthanasia for Mus musculus (mice), Rattus norvegicus (rat), Oryctolagus cuniculus (rabbit) and Sus scropha domesticus (pig) combined with well planned biomedical research are fundamental to increase the accuracy, reproducibility and precision of the experimental results.

Lymphatic Vessel Density and VEGF-C Expression are Significantly Different Among Benign and Malignant Thyroid Lesions

Thyroid cancer is the most frequent endocrine neoplasia worldwide. The route for metastasis and loco-regional invasion preferentially occurs by lymphatic vessels. For this reason, the assessment of lymphatic vessel density (LVD) is supposed to represent both a prognostic parameter and also a potential therapeutic target. In order to evaluate the value of LVD in benign and malignant thyroid lesions, we analyzed 110 thyroidectomy specimens using D2-40, a specific marker for lymphatic vessels and vascular endothelial growth factor C (VEGF-C), the most potent molecule of lymphatic proliferation. LVD was significantly different between papillary and follicular carcinomas in total (p = 0.045) and peritumoral area (p = 0.042). Follicular adenoma and follicular carcinoma showed an important difference of intra- (p = 0.019) and peritumoral (p = 0.033) LVD. VEGF-C was more markedly expressed in malignancies than in benignant lesions (p = 0.0001). Almost all cancers with high positive VEGF-C expression also exhibited increased peritumoral LVD (p = 0.049) when compared with the benignant lesions. Indeed, the high peritumoral LVD of malignant thyroid lesions is an important finding for surgery planning and supports the practice of total thyroidectomy in malignant thyroid neoplasm’s since the lymphatic peritumoral vessels definitely are an escape path for tumor cells.

DNA image cytometric analysis of differentiated thyroid adenocarcinoma specimens

A total of 117 differentiated thyroid adenocarcinomas that had been removed by total thyroidectomy were studied. Seventy (60%) were papillary, 36 (30%) were follicular, and 11 (10%) were Hürthle cell adenocarcinomas. The mean length of follow-up was 57.7 months. Adverse prognostic factors according to multivariate analysis were adjacent tissue infiltration (p = 0.0004), histologic type (p = 0.0049), and patient age (p = 0.033). The nuclear DNA content of tumor cells and of morphologically normal adjacent tissue was assessed by image cytometry, and correlations between nuclear DNA content and prognostic factors were examined. Fifty-four (75%) adenocarcinomas were classified as aneuploid, 9 (13%) as diploid, and 9 (12%) as borderline. Thirty-four (60%) specimens of morphologically normal adjacent tissue were classified as aneuploid, 18 (32%) as diploid, and 5 (8%) as borderline. The correlation between tumor ploidy and selected prognostic factors was statistically significant for patient age (p = 0.004) and histologic type (p = 0.033). Despite the fact that ploidy could not be identified as a prognostic factor, we suggest that, because of its correlation with age and histologic type, it might prove prognostic if the number of patients were increased. We also emphasize the importance of evaluating morphologically normal adjacent tissue because of the high rates of aneuploidy in these areas.

Radiographic aspects and angioarchitectural arrangements in corrosion casts of the blood supply to the human sternocleidomastoid muscle by the sternocleidomastoid branch of the occipital artery

The contribution of the sternocleidomastoid branch of the occipital artery (superior arterial pedicle-SAP) to the irrigation of the sternocleidomastoid muscle (SCM) was evaluated in fresh human cadavers by injecting radiological dye and a resin for microvasculature corrosion casts. From its insertion in the mastoid process of the temporal bone, the SCM was divided into superior, medium, and inferior thirds. In most of the SCM, The SAP are formed by two longitudinal parallel branches. In all specimens, the radiological dye injected into the SAP reached or trespassed the middle part of the studied SCM. The SAP was poorly distributed in the lowermost region of the inferior third of the SCM, suggesting the contribution of other arteries or pedicles. The corrosion casts of the microvasculature showed a profuse network of microscopic vessels in those levels where the SAP was detected.

Blood supply to the human sternocleidomastoid muscle by the sternocleidomastoid branch of the occipital artery

The contribution of the sternocleidomastoid branch of the occipital artery, superior arterial pedicle (SAP), to the irrigation of the sternocleidomastoid muscle (SCM) was evaluated in fresh human cadavers by injecting Neoprene‐latex for minute dissection. From its insertion in the mastoid process of the temporal bone, the SCM was divided into six levels. The Neoprene‐latex injected into the SAP reached the upper three levels in all SCMs studied, which corresponds to the middle part of the studied SCM. In 43.3% of the SCM, this branch reached level four and in 36.6%, it reached level five. Clin. Anat. 12:412–416, 1999.

Expressão imuno-histoquímica dos marcadores pcna, KI67 e p53 em carcinomas epidermóides do trato aerodigestivo superior

OBJETIVO: Os carcinomas epidermoides do trato aerodigestivo superior sao tumores de comportamento biologico heterogeneo. O objetivo deste trabalho e verificar se a expressao imuno-histoquimica dos marcadores Ki67, PCNA e P53 apresenta correlacoes com parâmetros prognosticos clinico-patologicos. METODOS: Determinacao da expressao imuno-histoquimica dos antigenos Ki67, PCNA e P53 em especimes tumorais fixados e embebidos em parafina de 53 pacientes com carcinoma epidermoide em diferentes sitios primarios do trato aerodigestivo superior. RESULTADOS: Os marcadores tiveram altos indices de expressao imuno-histoquimica, sendo 46,5% para o Ki67, 66,5% para o PCNA e 36,5% para o P53. Nao houve correlacao da expressao do Ki67 e do PCNA com o estadiamento TNM (AJCC), nem com o grau de malignidade. A expressao do Ki67 apresentou correlacao positiva com a expressao do PCNA (p = 0,037). O mesmo aconteceu para o PCNA e o numero de mitoses por campo (p = 0,001). CONCLUSOES: De acordo com estes resultados, concluiu-se que a determinacao da imunorreatividade dos marcadores Ki67 e PCNA e um metodo objetivo e quantificavel para avaliar proliferacao celular que pode subsidiar as informacoes prognosticas.

Pro and Anti-Angiogenic Vascular Endothelial Growth Factors Expression in Benign and Malignant Thyroid Lesions

Vascular endothelial growth factors are the most powerful molecules related to angiogenesis and lymph angiogenesis stimulation and are frequently associated to a worse prognosis in many malignancies. Currently, anti-angiogenic VEGF-A165b has been described and it have been demonstrated to efficiently block the angiogenic sprout. We sought to investigate the VEGF family members expression involved with angiogenesis (including the anti-angiogenic VEGF-A165b) and lymph angiogenesis. The casuistic was composed by 196 cases. The frequencies of thyroid lesions were: 53 (27%) goitres, 16 (8%) thyroiditis, 9 (5%) follicular adenomas, 84 (43%) papillary carcinomas, and 34 (17%) follicular carcinomas. The immunohistochemical reactions for VEGF-A, VEGF-A165b, VEGF-B, VEGF-C and VEGF-D were performed and semi-quantitatively assessed. We observed a widespread positive immunoexpression of VEGF-A and VEGF-A165b in benign and malignant lesions. None of the benign samples of this casuistic had positive immunoexpression of VEGF-B and only a few positive cases were detected in both papillary and follicular carcinomas. The highest levels of VEGF-C and VEGF-D expression were found in papillary carcinomas. There was a relevant association of VEGF-D and a worst tumoral staging (p=0.004) in papillary carcinomas. We also identified a significant association between VEGF-A and vascular invasion (p=0.049) and patient’s age and an increased expression of VEGF-B (p=0.047) in papillary thyroid carcinomas. No association was found for follicular carcinomas.

DNA measurements after radiation-induced tissue structure of thyroid gland of rats

INTRODUCTION: Thyroid gland exposures to radiation induce nuclear chromosomal alteration. Objective: To evaluate the DNA content of thyroid gland submitted to radiation. MATERIALS AND METHODS: We radiated 75 rats while 25 were not radiated to be used as control group. Exposure was conducted by the use of Cobalt-60 radioactive source in the right anterior cervical region in a field of 3-30cm, comprising the second and the sixth tracheal rings with 600-centigray (cGY) doses. The DNA content (ploidy) was obtained with Feulgen-thionin stain and was quantified with CAS 200 quantitative measurement equipment. RESULTS: Diploid pattern was obtained in 88 cases (95.7%), independently of time of exposure: on the other hand, aneuploidy was observed in four cases (4.3%) only in the group sacrificed to the 33 days. Eight cases were excluded due to technical reasons. CONCLUSION: The early aneuploid pattern found in our study certainly corroborated that radiation affects thyroid gland with important consequences in terms of disorders.