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INTRODUCTION: There are several factors predicting evolution in carcinoid tumors (CT) to date including the Ki67 role. AIMS: The aim of this study is to identify a KI67 cut-off point for a population of CT and determine its prognostic implication in global and disease-free survival. METHODS: Hematoxylin-eosin slides of 102 CT were revised. The percentage of cells expressing Ki 67 was determined manually. STATISTICAL ANALYSIS: The variables were compared with the t-test or the Wilcoxon test according to their distribution, the categorical ones with Chi-square or Fisher's test. The best cut-off point was established by constructing receiver operating characteristic curves, then using that value as a dichotomous variable. RESULTS: 72 typical carcinoids (TC) and 30 atypical carcinoids (AC) were analyzed; 66% were female. Median age (TC 38 vs. AC 51, P = 0.001), Ki67 expression (TC 0.63 vs. AC 2, P = 0.003), tumor size (TC 2.5 vs. AC 2.6, P = 0.001), the percentage relapse (TC 3.4% vs. AC 23%, P = 0.006), and the number of deaths (TC 1 vs. AC 4, P = 0.042) were significantly higher in the AC subgroup. The best cut-off point for Ki 67 was 0.755 (area under the curve AUC 0.564, 95% confidence interval 0.270-0.857), with no significant differences found in the disease-free and overall survival curves when considering values < or ≥ at the established cut-off point. The best cut-off point of the Ki-67 when exclusively analyzing AC was 1.18. When using this value as a predictive variable, a marginal statistical association was observed between Ki-67 expression, mortality (P = 0.077), and the frequency of relapses (P = 0.054). CONCLUSIONS: Histological type is the best predictor of prognosis in the carcinoid tumor group. In the AC subgroup, the marginal association between mortality, frequency of relapses and Ki values 67 ≥ 1.18 has clinical relevance future analyses are required to determine the real predictive value of this variable.
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Placental transmogrification of the lung is an extremely rare lesion, associated with giant bullous emphysema and considered by some authors to be a histological variant of unilateral giant bullous emphysema. Its etiology is still unknown and represents a challenge for both clinical and pathological diagnosis. We present the case of a young patient, who consults with dyspnea of one year of evolution, and whose postoperative diagnosis includes this rare entity.
La transmogrificación placentaria del pulmón es una lesión extremadamente infrecuente, asociada al enfisema bulloso gigante y considerada por algunos autores una variante histológica del enfisema bulloso gigante unilateral. Su etiología aún es desconocida y representa un desafío tanto para el diagnóstico clínico como anatomopatológico. Presentamos el caso de un paciente joven, que consulta con disnea de un año de evolución, y cuyo diagnóstico postoperatorio incluye esta rara entidad.
Asunto(s)
Enfisema , Placenta , Enfisema Pulmonar/diagnóstico por imagen , Disnea , Femenino , Humanos , Pulmón/diagnóstico por imagen , Embarazo , Enfisema Pulmonar/cirugíaRESUMEN
Resumen La transmogrificación placentaria del pulmón es una lesión extremadamente infrecuente, asociada al enfisema bulloso gigante y considerada por algunos autores una variante histológica del enfisema bulloso gigante unilateral. Su etiología aún es desconocida y representa un desafío tanto para el diagnóstico clínico como anatomopatológico. Presentamos el caso de un paciente joven, que consulta con disnea de un año de evolución, y cuyo diagnóstico postoperatorio incluye esta rara entidad.
Abstract Placental transmogrification of the lung is an extremely rare lesion, associated with giant bullous emphysema and considered by some authors to be a histological variant of unilateral giant bullous emphysema. Its etiology is still unknown and represents a challenge for both clinical and pathological diagnosis. We present the case of a young patient, who consults with dyspnea of one year of evolution, and whose postoperative diagnosis includes this rare entity.