RESUMO Contexto: O câncer colorretal é mundialmente, a terceira causa de câncer e um quarto destes estão localizados no reto. O oncogene DEK está envolvido em vários processos nucleares e pode acelerar a tumorigênese. Objetivo: Este estudo tem como objetivo avaliar a imunoexpressão das proteínas DEK e Fosfo-P38 antes da terapia neoadjuvante em pacientes com adenocarcinoma de reto e correlacioná-la com resposta clínica e sobrevida. Métodos: Foram incluídos pacientes com adenocarcinoma de reto médio e baixo submetidos à quimio e radioterapia seguida de ressecção cirúrgica do tumor. A expressão e quantificação foram estudadas por imuno-histoquímica nos tecidos de biópsia tumoral utilizando um sistema HScore. Escores ≥4 foram considerados positivos e aqueles com <4 negativos. Resultados: Foram incluídos 22 pacientes com média de idade de 63,55 anos (DP: ±13,49). O estágio clínico antes do tratamento era T3 em 72,7%, T4 em 18,2%, 31,8% eram N1, 50% N0 e todos M0. Após a quimio e radioterapia, 54,6% eram T3; 22,7% eram T2; 9,1% eram T1 e 13,6% T0. Entre os tumores, 22,7% foram positivos para DEK e 63,6% positivos para Phospho-P38. Houve uma correlação positiva para a imunoexpressão da proteína DEK e o estágio pTNM (P=0,011). A proteína fosfo-P38 não apresentou correlação com esses parâmetros. Pacientes com HScore negativo para DEK tiveram sobrevida média de 141,33 meses (IC95%: 112,41-170,25) e aqueles com HScore positivo tiveram sobrevida média de 25,10 meses (IC95%: 17,36-32,84) (P<0,001). Conclusão: Observou-se maior expressão de DEK em estágios avançados. Os pacientes que apresentaram expressão de DEK <4 tiveram maior sobrevida, sendo um fator de pior prognóstico.

ABSTRACT Background: Colorectal cancer is the third cause of cancer worldwide and a quarter of them are in the rectum. DEK oncogene is involved in several nuclear processes and can accelerate tumorigenesis. Objective: This study aims to evaluate the immunoexpression of DEK and Phospho-P38 proteins before neoadjuvant therapy in patients with rectum adenocarcinoma and correlate it with a clinical response and survival. Methods: Patients with adenocarcinoma of the middle and low rectum who underwent chemotherapy and radiotherapy followed by surgical tumor resection were included. The expression and quantification were studied by immunohistochemistry in the tumor biopsy tissues using a HScore system. Score ≥4 were considered positive and those with <4 negative. Results: 22 patients were included with a mean age of 63.55 years (SD: ±13.49). The clinical-stage before treatment was T3 on 72.7%, T4 on 18.2%, 31.8% were N1, 50% N0 and all M0. After chemo and radiotherapy, 54.6% were T3; 22.7% were classified as T2; 9.1% as T1, and 13.6% were T0. Among the tumors, 22.7% were positive for DEK and 63.6% positive for Phospho-P38. There was a positive correlation between DEK protein before treatment and pTNM stage (P=0.011). Phospho-P38 protein showed no correlation with these parameters. Patients with a negative HScore had a mean survival of 141.33 months (95%CI: 112.41-170.25) and those with a positive HSscore had a mean survival of 25.10 months (95%CI: 17.36-32.84; P<0.001). Conclusion: A higher expression of DEK was observed in advanced stages. Patients who presented DEK expression <4 had a higher survival, being a factor of worst prognosis.

ABSTRACT Purpose To compare tissue inflammatory response, foreign body reaction, fibroplasia, and proportion of type I/III collagen between closure of abdominal wall aponeurosis using polyglactin suture and intraperitoneal implant of polypropylene, polypropylene/polyglecaprone, and polyester/porcine collagen meshes to repair defects in the abdominal wall of rats. Methods Forty Wistar rats were placed in four groups, ten animals each, for the intraperitoneal implant of polypropylene, polypropylene/polyglecaprone, and polyester/porcine collagen meshes or suture with polyglactin (sham) after creation of defect in the abdominal wall. Twenty-one days later, histological analysis was performed after staining with hematoxylin-eosin and picrosirius red. Results The groups with meshes had a higher inflammation score (p < 0.05) and higher number of gigantocytes (p < 0.05) than the sham group, which had a better fibroplasia with a higher proportion of type I/III collagen than the tissue separating meshes (p < 0.05). There were no statistically significant differences between the three groups with meshes. Conclusions The intraperitoneal implant of polypropylene/polyglecaprone and polyester/porcine collagen meshes determined a more intense tissue inflammatory response with exuberant foreign body reaction, immature fibroplasia and low tissue proportion of type I/III collagen compared to suture with polyglactin of abdominal aponeurosis. However, there were no significant differences in relation to the polypropylene mesh group.

Abstract Purpose: To compare four types of mesh regarding visceral adhesions, inflammatory response and incorporation. Methods: Sixty Wistar rats were divided into four groups, with different meshes implanted intraperitoneally: polytetrafluoroethylene (ePTFE group); polypropylene with polydioxanone and oxidized cellulose (PCD); polypropylene (PM) and polypropylene with silicone (PMS). The variables analyzed were: area covered by adhesions, incorporation of the mesh and inflammatory reaction (evaluated histologically and by COX2 immunochemistry). Results: The PMS group had the lowest adhesion area (63.1%) and grade 1 adhesions. The ePTFE and PM groups presented almost the total area of their surface covered by adherences (99.8% and 97.7% respectively) The group ePTFE had the highest percentage of area without incorporation (42%; p <0.001) with no difference between the other meshes. The PMS group had the best incorporation rate. And the histological analysis revealed that the inflammation scores were significantly different. Conclusions: The PM mesh had higher density of adherences, larger area of adherences, adherences to organs and percentage of incorporation. ePTFE had the higher area of adherences and lower incorporation. The PMS mesh performed best in the inflammation score, had a higher incorporation and lower area of adherences, and it was considered the best type of mesh.

ABSTRACT BACKGROUND: Serological tests are practical, with low cost, but no noninvasive tests are available for diagnosing Helicobacter pylori (H. pylori) infection in Brazil. The aim here was to develop and validate enzyme-linked immunosorbent assay (ELISA) serological tests to detect anti-H. pylori immunoglobulin G antibodies, based on cultured strains from Brazilian patients. DESIGN AND SETTING: Cross-sectional, diagnostic accuracy study comparing a locally developed and validated ELISA and invasive tests among dyspeptic patients at two public hospitals in São Paulo, Brazil. METHODS: An ELISA test was prepared using whole-cell antigen from 56 strains. After genotypic characterization, it was standardized and optical density (OD) cutoffs were determined based on the serum antibody response of 100 H. pylori-negative samples, compared with 82 H. pylori-positive samples. Validation was performed on 174 symptomatic patients. RESULTS: The optimal OD cutoffs established (for monoclonal and polyclonal tests, respectively) were 0.167 and 0.164; overall ELISA sensitivity: 84.3%, 78.9%; specificity: 88.6%, 90.6%; positive predictive value (PPV): 75.4%, 80%; negative predictive value (NPV): 93.1%, 81.8%; accuracy: 87.3%, 86.2%; child and adolescent ELISA sensitivity: 74.2%, 81.8%; specificity: 90.8%, 86.7%; PPV: 66.6%, 84.3%; NPV: 95.8%, 84.8%; accuracy: 88.5%, 84.6; adult ELISA sensitivity: 84.4%, 75%; specificity: 86.9%, 93%; PPV: 81.8%, 78.3%; NPV: 88.9%, 91.8%; accuracy: 85.9%, 88.5%. CONCLUSION: The polyclonal serological test developed using local strains presented better diagnostic performance among children and adolescents, while the monoclonal test was better among adults. The results from both tests suggest that these in-house serological tests could be used to detect anti-H. pylori antibodies in our population, for screening purposes.

Abstract Purpose: To evaluate the effect of remote ischemic preconditioning (r-IPC) administered to pregnant rats, in the ileum of newborn rats subjected to hypoxia and reoxygenation. Methods: We used three pregnant rats and their newborn rats distributed in three groups: 1) Control (C) - Newborn rats born from a pregnant rat which did not undergo any intervention; 2) Hypoxia-Reoxygenation (H/R) - Newborn rats born from a pregnant rat which did not undergo any intervention, and were subjected to hypoxia-reoxygenation; 3) Remote Ischemic Preconditioning (r-IPC) - newborn rats born from a pregnant rat which was subjected to remote ischemic preconditioning twenty-four hours before giving birth and the newborn rats were subjected to hypoxia-reoxygenation. Segments of ileum were prepared for histological analysis by HE and immunohistochemistry by the Ki67 to evaluate cell proliferation, crypt depth and villus height and evaluation of apoptosis by cleaved caspase-3. Results: The intensity of the lesions was lower in the r-IPC than in the H/R group, showing significant difference (p<0.01). The r-IPC group showed a higher proliferative activity compared to the H/R group (p<0.01), with deeper crypts (r-IPC > H/R - p < 0.05), and higher villi, showing significant difference (r-IPC > H/R - (p <0.01). The occurrence of apoptosis in the H/R group was lower in comparison to groups C and r-IPC, with significant difference (H/R < r-IPC; p<0.05). Conclusion: The remote ischemic preconditioning applied to the pregnant rat protected the ileum of newborn rats subjected to hypoxia and reoxygenation, with decreased intensity of the lesions in the ileum mucosa and preservation of proliferative activity, keeping the villus height and crypt depth similar to group C.

RESUMO Contexto - O receptor 2 do fator de crescimento epidermal humano (EGFR2/HER2/ErbB2) é um receptor transmembrana que estimula a proliferação celular quando ativado. A expressão de HER2 foi estudada em diversas neoplasias, como câncer gástrico. No entanto, sua relação com a sobrevida dos pacientes com câncer gástrico metastático permanece desconhecida. Além disso, há falta de informação sobre este assunto na população brasileira. Objetivo - Avaliar a proporção de pacientes cujas células tumorais expressam HER2 e correlacionar essa característica com aspectos clínicos e também com os desfechos do tratamento. Métodos - Este é um estudo retrospectivo. Foram incluídos pacientes adultos com câncer gástrico metastático tratados em um Hospital Geral Universitário entre 2011 e 2015. Nenhum paciente recebeu terapia anti-HER2. A expressão do receptor foi avaliada por imuno-histoquímica. Fatores de risco para a sobrevida foram avaliados com regressão de Cox univariada e valor P<0,05 foi considerado estatisticamente significativo. Resultados - Quarenta e nove pacientes foram incluídos neste estudo. No entanto, 32 tiveram amostras avaliadas para expressão de HER2. Cinco (16%) pacientes foram positivos. Entre os pacientes HER2 negativos: a idade média foi de 54 anos, 44% receberam um protocolo com três drogas, 70% apresentavam um score de status performance 0-1, 41% tinham histologia bem ou moderada diferenciada. Entre os pacientes HER2 positivos: a média de idade foi de 58 anos, 40% receberam três drogas, 100% apresentavam um score de status performance de 0-1, 67% tinham histologia bem ou moderada diferenciada. A taxa de resposta foi avaliada em 28 casos e não houve diferença entre os grupos (HER2 negativo 52% e HER2 positivo de 40%; P=0,62). A sobrevida foi menor entre pacientes HER2 positivos. As medianas de Sobrevida Livre de Progressão foram 8,3 meses e 10,6 meses, respectivamente (HR 1,61; IC 95%: 0,59-4,38). As medianas de Sobrevida Global foram 14,8 meses e 16,9 meses, respectivamente (HR 1,52; IC 95%: 0,50-4,66). Conclusão - A expressão tumoral de HER2 pode ser um fator de pior prognóstico para pacientes portadores de câncer gástrico metastático e uma validação futura desses achados se faz necessária.

ABSTRACT Background - Human epidermal growth factor receptor 2 (EGFR2/HER2/ErbB2) is a transmembrane receptor that stimulates cell proliferation when activated. The correlation of HER2 expression with prognosis has been studied in many cancer types. However, its relationship with survival of patients with metastatic gastric cancer remains unknown. Moreover, there is a lack of information on this issue in a Brazilian population. Objective - To assess the proportion of patients whose tumor cells express HER2 and correlate this with clinical characteristics as well as treatment outcomes. Methods - This was a retrospective study. We included adult patients with metastatic gastric cancer treated at an University Hospital between 2011 and 2015. Patients did not receive anti-HER2 therapy. Receptor expression was evaluated by immunohistochemistry. Survival risk factors were assessed individually with univariate Cox regression, and a P value <0.05 was considered statistically significant. Results - Forty-nine patients were included in this study. However, only 32 had samples assessed for HER2 expression. Five (16%) patients were positive. Among HER2-negative patients, the average age was 54 years, 44% received a treatment protocol with three drugs, 70% had a performance status score 0-1, and 41% had well or moderately differentiated histology. Among HER2-positive patients, the average age was 58 years, 40% received three drugs, 100% had a performance status score 0-1, and 67% had well or moderately differentiated histology. Response rate was evaluated in 28 cases, and there was no difference between the groups (HER2-negative 52% vs. HER2-positive 40%; P=0.62). Survival outcomes were numerically worse among HER2-positive patients. Median progression-free survival was 8.3 months for HER2-positive patients and 10.6 months for HER2-negative patients (HR 1.61, 95% CI: 0.59-4.38); median overall survival was 14.8 months and 16.9 months for HER2-positive and HER2-negative patients, respectively (HR 1.52, 95% CI: 0.50-4.66). Conclusion - HER2 overexpression in metastatic gastric cancer patients may be a predictor of poor prognosis and further validation is warranted.

RESUMO Contexto O tratamento da obesidade mórbida através da gastroplastia vertical com derivação gastrojejunal em Y de Roux inicialmente utilizou o anel de contenção. No entanto, essa técnica pode criar condições para o desenvolvimento de alterações potencialmente malignas na mucosa gástrica. Apesar de eficaz e realizada anteriormente em grande escala, essa técnica precisa ser melhor avaliada em estudos de longo prazo em relação às alterações causadas na mucosa gástrica. Objetivo Analisar os achados endoscópicos, histológicos e da proliferação celular na mucosa do antro e corpo gástricos no pré-operatório e no pós-operatório de pacientes submetidos à derivação gastrojejunal em Y de Roux com anel de contenção. Métodos Avaliamos retrospectivamente todos os pacientes submetidos à derivação gastrojejunal em Y de Roux com anel de contenção e mais de 60 meses de seguimento pós-operatório. Comparamos os achados endoscópicos da mucosa gástrica, o índice de proliferação celular e a prevalência do H. pylori no pré-operatório (antro e corpo gástricos) e no pós-operatório (bolsa gástrica). Avaliamos a proliferação celular pela expressão imuno-histoquímica do anticorpo Ki67. Resultados No período do estudo, 33 pacientes foram operados com a derivação gastrojejunal em Y de Roux usando anel de contenção. Encontramos a taxa de gastrite crônica de 69,7% no período pré-operatório (antro e corpo gástrico) e 84,8% no pós-operatório (bolsa gástrica). O H. pyloriestava presente em 18,2% dos pacientes no período pré-operatório (antro e corpo gástrico) e em 57,5% no pós-operatório (bolsa gástrica). O índice de proliferação celular pré-operatório foi de 18,1% no antro gástrico e 16,2% no corpo gástrico, e de 23,8% na bolsa gástrica no pós-operatório. O índice de proliferação celular pós-operatório na bolsa gástrica foi significantemente maior (P=0,001) do que no antro e corpo gástrico no pré-operatório. O maior índice de proliferação celular e a intensidade da gastrite crônica na bolsa gástrica associaram-se significantemente à presença do H. pylori(P=0,001 e P=0,02, respectivamente). Conclusão Após a derivação gastrojejunal em Y de Roux com anel de contenção, houve maior incidência de gastrite crônica e maior índice de proliferação celular na bolsa gástrica do que no antro e corpo gástricos no pré-operatório. A intensidade da inflamação da mucosa e o índice de proliferação celular encontrados na bolsa gástrica no pós-operatório associaram-se à presença doH. pylori e foram maiores do que os encontrados na mucosa gástrica do antro e corpo gástricos no pré-operatório.

ABSTRACT Background Morbid obesity treatment through vertical gastroplasty Roux-en-Y gastric bypass initially used a contention ring. However, this technique may create conditions to the development of potentially malign alterations in the gastric mucosa. Although effective and previously performed in large scale, this technique needs to be better evaluated in long-term studies regarding alterations caused in the gastric mucosa. Objective To analyze the preoperative and postoperative endoscopic, histological and cell proliferation findings in the gastric antrum and body mucosa of patients submitted to the Roux-en-Y gastric bypass with a contention ring. Methods We retrospectively evaluated all patients submitted to Roux-en-Y gastric bypass with a contention ring with more than 60 months of postoperative follow-up. We compared the preoperative (gastric antrum and body) and postoperative (gastric pouch) gastric mucosa endoscopic findings, cell proliferation index and H. pylori prevalence. We evaluated cell proliferation through Ki-67 antibody immunohistochemical expression. Results In the study period, 33 patients were operated with the Roux-en-Y gastric bypass using a contention ring. We found a chronic gastritis rate of 69.7% in the preoperative period (gastric antrum and body) and 84.8% in the postoperative (gastric pouch). H. pylori was present in 18.2% of patients in the preoperative period (gastric antrum and body) and in 57.5% in the postoperative (gastric pouch). Preoperative cell proliferation index was 18.1% in the gastric antrum and 16.2% in the gastric body, and 23.8% in the postoperative gastric pouch. The postoperative cell proliferation index in the gastric pouch was significantly higher (P=0.001) than in the preoperative gastric antrum and body. Higher cell proliferation index and chronic gastritis intensity were significantly associated to H. pylori presence (P=0.001 and P=0.02, respectively). Conclusion After Roux-en-Y gastric bypass with contention ring, there was a higher chronic gastritis incidence and higher cell proliferation index in the gastric pouch than in the preoperative gastric antrum and body. Mucosa inflammation intensity and cell proliferation index in the postoperative gastric pouch were associated to H. pylori presence and were higher than those found in the preoperative gastric antrum and body mucosa.

PURPOSE: To evaluate the effects of maternal remote ischemic preconditioning (IPCr) in the colonic mucosa of newborn rats subjected to hypoxia and reoxygenation.METHODS:Newborn Wistar rats were divided into three groups. Control Group (CG), Hypoxia and Reoxygenation Group (HRG) and Remote Ischemic Preconditioning Group (IPCrG). Hypoxia and reoxygenation was performed 2x per day, with an interval of 6 hours, on the 1st, 2nd and 3rd days of life, with 10 minutes of CO2 at 100%, followed by 10 minutes O2 at 100%(HRG/IPCrG). The maternal IPCr was performed 24 hours before delivery by applying a rubber band tourniquet to the left hind limb (IPCrG). Segments of the colon underwent histological (HE) and immunohistochemical analysis for caspase-3 and COX - 2.RESULTS: The histological findings showed no intestinal mucosal damage in the CG group and severe lesions in HRG that was attenuated in the IPCrG (p<0.05). The expression of the apoptotic cells was lower in the HRG group than in the CG and IPCrG. The COX-2 expression was intense in HRG and attenuated in the IPCrG (p<0.05).CONCLUSIONS: Maternal IPCr protected the colonic mucosa of newborn rats subjected to hypoxia and reoxygenation, reducing the morphological alterations and inflammatory response. It ameliorates the occurrence of apoptosis, keeping the physiological process of renewal and regeneration in the epithelial lining of the colonic mucosa.

OBJETIVO: Avaliar a expressão imunoistoquímica de p16, Ki-67, p53 e Bcl-2 proteínas em tumores gastrointestinais estromais (GIST); determinar a possível associação entre essas variáveis e fatores clínicos e histopatológicos de câncer, e para verificar o valor prognóstico destas variáveis (sobrevivência e recorrência). MÉTODOS: Uma amostra de 55 pacientes tratados cirurgicamente para GIST em três hospitais foi estudada. Os tumores extirpados cirurgicamente foram confirmados como GIST por KIT, vimentina, proteína desmina S100, CD117, 1A4 e avaliação de CD34 em blocos de parafina. RESULTADOS: Apenas nove (16%) casos de GIST foram positivos para p53, p16 foi positiva em 43,6%, 80% dos GIST apresentaram coloração para Bcl-2. O índice proliferativo (expresso como a proporção de células positivas), avaliado pela expressão imunoistoquímica de Ki-67, foi elevado em 49% dos casos. Escores de Ki-67 elevados foram associados com alto grau histológico (p=0,0026) e índice de mitose, MI (p=0,0001). Alto índice de Ki-67 foi associado à morte. Expressão da p53, p16 e Bcl-2 não se correlacionou com as variáveis morfológicas ou clínicas. CONCLUSÕES: A avaliação imunoistoquímica de Ki-67 deve ser incluída na avaliação pré-operatória de biópsias ou peças cirúrgicas de GIST como uma ferramenta prognóstica para o estadiamento clínico, e todas as outras proteínas estudadas (Bcl-2, p53 e p16) não desempenharam um papel no processo metabólico ou carcinogênico em GIST, mantendo-se sem valor prognóstico.

PURPOSE: To evaluate the immunohistochemical expression of p16, Ki-67, p53 and Bcl-2 proteins in gastrointestinal stromal tumors (GIST); to assess the possible association between these variables and clinical and histopathological factors of cancer; and to check for prognostic value of these variables (survival and recurrence). METHODS: A sample of 55 patients treated surgically for GIST in three hospitals was studied. The surgically excised tumors were confirmed as GIST by KIT, vimentin, desmin S100 protein, CD117, 1A4 and CD34 assessment in paraffin blocks. RESULTS: Only 9 (16%) cases of GIST were positive for p53, p16 was positive among 43.6%; 80% of GISTs showed staining for Bcl-2. The proliferative index (expressed as the proportion of positive cells) assessed by immunohistochemical expression of Ki-67 was high in 49% of cases. Elevated Ki-67 scores were associated to high histological grade (p=0.0026) and mitosis index, MI (p=0.0001). High Ki-67 index was associated to death. Expression of p53, p16 and Bcl-2 did not correlate to morphological or clinical variables. CONCLUSIONS: Ki-67 immunohistochemical evaluation should be included in preoperative evaluation of GIST biopsies or surgical specimens as a prognostic tool for clinical staging; and all other proteins studied (Bcl-2, p53 and p16) did not play a role in GIST metabolic or carcinogenic process, remaining without prognostic value.

INTRODUÇÃO: A expressão reduzida de CD10 pode estar relacionada com prognóstico desfavorável de doentes com carcinoma colorretal. Analisou-se a imunoexpressão tecidual da proteína CD10 no carcinoma colorretal e sua relação com os aspectos clinicopatológicos. MÉTODO: Em 130 doentes operados por carcinoma colorretal, um bloco de tissue microarray foi obtido do tecido neoplásico e da mucosa não neoplásica adjacente e submetido ao estudo imuno-histoquímico com anticorpo monoclonal CD10. Avaliou-se a imunoexpressão por método semiquantitativo, com contagem do percentual de células coradas. Os resultados foram relacionados com a localização, aspectos anatomopatológicos, presença de metástases linfonodais e hepáticas e estadiamento TNM da neoplasia. O estudo estatístico foi realizado com os testes de Mann-Whitney, Kruskal-Wallis e exato de Fisher. RESULTADOS: A expressão do marcador CD10 foi maior no tecido do carcinoma colorretal do que na mucosa não neoplásica adjacente (p<0,0001) e foi maior nas lesões exofíticas (p=0,04). A expressão da proteína CD10 não apresentou relação com os demais aspetos clínicos e patológicos da neoplasia colorretal. CONCLUSÕES: A expressão da proteína CD10 foi mais intensa no tecido neoplásico do carcinoma colorretal do que na mucosa não neoplásica adjacente e relacionou-se com o aspecto exofítico do tumor.

BACKGROUND: The reduced expression of CD10 may be related to unfavorable prognosis of patients with colorectal carcinoma. The authors analyzed the tissue immunostaining of CD10 protein in colorectal carcinoma and its relationship to clinicopathologic features. METHOD: In 130 patients submitted to colorectal carcinoma surgery, a tissue microarray block was obtained from the tumor and adjacent non-neoplastic mucosa and submitted to immunohistochemistry with monoclonal antibody CD10. The immunostaining was evaluated by semi-quantitative method, with stained cell count in percentage. The results were related to the location, anatomopathological features, presence of lymph node and hepatic metastases and TNM staging of the colorectal neoplasm. The statistical analysis was performed with the Mann-Whitney, Kruskal-Wallis and Fisher exact tests. RESULTS: The expression of CD10 marker was higher in colorectal tumor tissue than in adjacent non-neoplastic mucosa (p<0.0001) and was higher than in exophytic lesions (p=0.04). The expression of CD10 protein was not associated with other clinical and pathological aspects of colorectal neoplasm. CONCLUSIONS: The expression of CD10 protein was more intense in tumor tissue of colorectal carcinoma than in adjacent non-neoplastic mucosa and was related to the exophytic appearance of the tumor.

RESUMO Objetivo: Determinar a expressão de p53, p16 e Ki-67 e sua relevância na sobrevida e diferenciação celular. Métodos: Foram incluídos 15 pacientes submetidos a duodenopancreatectomia. A expressão imunohistoquímica de p53, p16 e Ki-67 foi determinada em blocos tumorais embebidos em parafina. Foi estudada a relação dessas expressões com as variáveis. Resultados: Noventa e três por cento dos tumores apresentaram expressão de p53 e p16. Ki-67 estava expresso em 86,66% dos tumores (índice proliferativo – IP 11,91 ± 9,47). A presença de alterações combinadas não estava relacionada a diferenças significativas no tipo tumoral, no estágio ou na sobrevida; resultados semelhantes foram obtidos com a análise de expressões isoladas. Quando foram criados os grupos de expressões de p16 e Ki-67, a sobrevida mediana não era significativa. Entretanto, havia uma sobrevida discretamente melhor nos pacientes com expressão focal do p16 (sobrevida mediana 20,75 versus 14,34) em comparação com pacientes com expressão difusa. Conclusão: A superexpressão das proteínas p53, p16 e Ki-67 não estava relacionada à sobrevida ou ao grau tumoral quando se compararam as expressões isoladas ou combinadas.

ABSTRACT Objective: To determine the expression of p53, p16 and Ki-67 and its relevance in survival and cell differentiation. Methods: Fifteen duodenopancreatectomized patients were included. Immunohistochemical expression of p53, p16 and Ki-67 was determined in paraffin embedded tumor blocks. The relation of these expressions with different variables was studied. Results: Ninety-three per cent of tumors showed expression of p53 and p16. Ki-67 was expressed in 86.66% of tumors (labeling index – LI 11.91 ± 9.47). The presence of combined alterations was not related to significant differences in tumor type, stage or survival; similar results were obtained analyzing isolated expressions. When groups of p16 and Ki-67 expressions where created, the median survival was not significant. However, there was a slightly better survival in patients with focal expression of p16 (median survival 20.75 versus 14.34), when compared to patients with diffuse expression. Conclusion: The overexpression of p53, p16 and Ki-67 was not related to survival or tumor grade, when comparing isolated or combined expressions.

CONTEXTO E OBJETIVO: A doença de Castleman ou hiperplasia linfonodal gigante é desordem rara dotecido linfóide que causa linfadenomegalia. É considerada afecção benigna em sua forma localizada, porém agressiva no tipo multicêntrico. O diagnóstico definitivo está baseado nas achados anatomopatológicos pós-operatórios. O objetivo foi descrever um caso de doença de Castleman (hiperplasia linfonodal gigante) unicêntrica retroperitoneal localizada no retroperitônio. RELATO DO CASO: Homem, 61 anos, branco, com emagrecimento e adinamia, apresentava hipertensão arterial moderada e leucopenia. A tomografia abdominal revelou massa ovalada de 5 x 4 x 5 cm, hipoatenuante, com calcificação de permeio e intenso realce ao contraste intravenoso, localizado na região retroperitoneal, entre o rim esquerdo e a aorta, no hilo renal. A laparotomia exploradora revelou massa sólida, não pulsátil, ovalada, situada no retroperitônio, próximo ao hilo renal esquerdo e que foi retirada completamente. O exame de congelação mostrou tecido linfonodal benigno e o exame histopatológico da peça cirúrgica revelou hiperplasia linfonodal gigante (doença de Castleman), forma hialina-vascular. O doente obteve alta no 12º dia. Após dois meses da operação, reinternou com quadro de insuficiência cardíaca grave, insuficiência renal e broncopneumonia, evoluindo com insuficiência respiratória aguda, sepse e óbito.

CONTEXT AND OBJECTIVE: Castleman's disease, or giant lymph node hyperplasia, is a rare disorder of the lymphoid tissue that causes lymph node enlargement. It is considered benign in its localized form, but aggressive in the multicentric type. The definitive diagnosis is based on postoperative pathological findings. The aim here was to describe a case of retroperitoneal unicentric Castleman's disease in the retroperitoneum. CASE REPORT: A 61-year old white male with weight loss and listlessness presented with moderate arterial hypertension and leukopenia. Abdominal tomography revealed a 5 x 4 x 5 cm oval mass of low attenuation, with inner calcification and intense enhancement on intravenous contrast, located in the retroperitoneal region, between the left kidney and the aorta, at the renal hilus. Exploratory laparotomy revealed a non-pulsatile solid oval mass situated in the retroperitoneum, adjacent to the left renal hilus. The retroperitoneal lesion was removed in its entirety. Examination of frozen samples revealed benign lymph node tissue and histopathological examination of the surgical sample revealed hyaline-vascular giant lymph node hyperplasia (Castleman's disease). The patient was discharged on the 12th day without significant events. Two months after the operation, the patient was readmitted with severe cardiac insufficiency, acute renal failure and bronchopneumonia, which progressed to acute respiratory insufficiency, sepsis and death.

OBJETIVO: Quantificar a intensidade da angiogênese pelo método convencional (densidade microvasal, DMV) e pelo método informatizado, área endothelial (AE) e avaliar a sua correlação com o prognóstico de doentes operados por adenocarcinoma colorretal. MÉTODOS: A angiogênese tumoral foi investigada por meio de técnica imuno-histoquímica, utilizando-se CD-34, em 126 doentes; para quantificar a angiogênese, a microdensidade vascular, definida como o número de microvasos por mm² e a medida da área endotelial, definida como a área ocupada pelo endotélio vascular identificada no campo microscópico foram empregadas. Um programa computadorizado, o IMAGELab foi empregado para a quantificação da área endothelial. RESULTADOS: A media do número de microvasos foi de 128,6 MV/mm ² (d esvio padrão de 44,5). O método do coeficiente de Pearson demonstrou uma baixa correlação entre a DMV e a AE (r=0,429). Nenhuma correlação entre a DMV e AE com o intervalo livre de doença e tempo global de sobrevida foi observada. CONCLUSÃO: A análise histológica da expressão angiogênica em doentes com adenocarcinoma colorretal pode ser realizada tanto da forma informatizada, na quantificação da área endotelial, como pela convencional, na contagem dos microvasos. Ambos métodos não demonstraram relação estatisticamente significante entre estes parâmetros de angiogênese e o intervalo livre de doença e a sobrevida global.

PURPOSE: To quantify the degree of angiogenesis by conventional method (microvessel density, MVD) and computerized method (endothelial area, EA), and to evaluate their relationships with the prognosis of patients operated on for colorectal adenocarcinoma. METHODS: Tumoral angiogenesis was studied by means of an immunohistochemical technique, using CD 34, on 126 patients; to quantify the angiogenesis, MVD (defined as number of microvessels per mm²) and EA measurement (defined as the area occupied by EA in the microscope field). A computerized method, IMAGELab software was utilized to quantify endothelial area. RESULTS: The mean number of microvessels was 128.6 MV/mm² (SD = 44.5) and the mean EA was 4.3% (SD = 2.1). The Pearson method demonstrated a low correlation coefficient between MVD and EA (r = 0.429). No relationship between MVD and EA was observed with regard to relapse-free interval and overall survival. CONCLUSION: The histological analysis of angiogenesis expression in patients with colorectal adenocarcinoma can be performed either by computer-assisted image analysis of endothelial area or by conventional microvessels counting. Both methods did not show any significant relationship between these angiogenesis parameters with relapse-free interval and overall survival.