Asunto(s)
Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/patología , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/patología , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Diagnóstico Diferencial , Humanos , Metástasis Linfática/diagnóstico , Metástasis Linfática/patología , Invasividad NeoplásicaAsunto(s)
Humanos , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/patología , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/patología , Diagnóstico Diferencial , Metástasis Linfática/diagnóstico , Metástasis Linfática/patología , Invasividad NeoplásicaRESUMEN
PURPOSE: To investigate the immunohistochemical expression (IGF-1, EGFr, EGF, c-erbB-2/HER-2/neu, PDGF-A, PDGF-B, FGF and VEGF) in patients with Graves' ophthalmopathy. METHODS: Twenty-four samples (Graves' ophthalmopathy patients) underwent lateral rectus muscle and surrounding fibrous and adipose tissue biopsy. The control group was obtained by strabismus surgery. Correlation between clinical-ophthalmologic, endocrinological, ultrasonographic findings, and immunohistochemical expression was performed. RESULTS: IGF-1: There were 7 positive cases (29.2%). There was a direct relation with higher CAS (clinical activity score) in all of them and if only CAS equal or higher than 5 was considered, this was 54.5%. FGF: There was expression in 5 cases (20.8%) with a direct relation in all those with higher CAS (>5) (45.4%). VEGF: There were two positive cases (8.3%) for VEGF in endothelial cells, in these cases the patients also presented CAS higher than 5. There was no expressions of all growth factors in the control group. CONCLUSIONS: All patients, except one, with positive expression of FGF, IGF-1 and VEGF showed CAS greater than 5, suggesting in this way an important role of these growth factors in the pathogenesis and severity of Graves' ophthalmopathy. However, statistical analysis revealed only significant association between IGF-1 and male sex (P=0.034). Low ultrasound reflectivity and endocrine status may not correlate directly with disease activity or with immunoexpression of growth factors and c-erbB-2/HER-2/neu.
Asunto(s)
Tejido Conectivo/metabolismo , Factores de Crecimiento de Fibroblastos/análisis , Oftalmopatía de Graves/metabolismo , Factor I del Crecimiento Similar a la Insulina/análisis , Músculos Oculomotores/metabolismo , Factores de Crecimiento Endotelial Vascular/análisis , Tejido Adiposo/metabolismo , Tejido Adiposo/patología , Adulto , Biopsia , Estudios de Casos y Controles , Interpretación Estadística de Datos , Femenino , Oftalmopatía de Graves/etiología , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Músculos Oculomotores/patología , Estrabismo/metabolismo , Estrabismo/cirugíaRESUMEN
PURPOSE: To investigate the immunohistochemical expression (IGF-1, EGFr, EGF, c-erbB-2/HER-2/neu, PDGF-A, PDGF-B, FGF and VEGF) in patients with Graves' ophthalmopathy. METHODS: Twenty-four samples (Graves' ophthalmopathy patients) underwent lateral rectus muscle and surrounding fibrous and adipose tissue biopsy. The control group was obtained by strabismus surgery. Correlation between clinical- ophthalmologic, endocrinological, ultrasonographic findings, and immunohistochemical expression was performed. RESULTS: IGF-1: There were 7 positive cases (29.2 percent). There was a direct relation with higher CAS (clinical activity score) in all of them and if only CAS equal or higher than 5 was considered, this was 54.5 percent. FGF: There was expression in 5 cases (20.8 percent) with a direct relation in all those with higher CAS (>5) (45.4 percent). VEGF: There were two positive cases (8.3 percent) for VEGF in endothelial cells, in these cases the patients also presented CAS higher than 5. There was no expressions of all growth factors in the control group. CONCLUSIONS: All patients, except one, with positive expression of FGF, IGF-1 and VEGF showed CAS greater than 5, suggesting in this way an important role of these growth factors in the pathogenesis and severity of Graves' ophthalmopathy. However, statistical analysis revealed only significant association between IGF-1 and male sex (P=0.034). Low ultrasound reflectivity and endocrine status may not correlate directly with disease activity or with immunoexpression of growth factors and c-erbB-2/HER-2/neu.
OBJETIVO: Investigar a expressão imuno-histoquímica de IGF-1, EGFr, EGF, c-erbB-2/HER-2/neu, PDGF-A, PDGF-B, FGF e VEGF na oftalmopatia de Graves. MÉTODOS: Vinte e dois pacientes (oftalmopatia de Graves) foram submetidos à biópsia do músculo reto lateral e tecido fibroso e adiposo adjacente. O grupo controle foi de pacientes de cirurgia de estrabismo. Foi feita correlação entre achados clínico-oftalmológicos, endocrinológicos, ultra-sonográficos e da expressão imuno-histoquímica dos fatores de crescimento. RESULTADOS: IGF-1: Houve 7 casos positivos (29,2 por cento). Houve correlação direta com o CAS (clinical activity score) elevado em todos os casos e em que consideramos CAS apenas acima de 5, em 54,5 por cento. FGF: Houve expressão em 5 casos (20,8 por cento) com relação direta com CAS elevado em todos os casos e em que consideramos CAS maior que 5 (45,4 por cento). VEGF: Houve dois casos positivos (8,3 por cento) para VEGF nas células endoteliais e estes casos também apresentavam CAS maior que 5. A imunorreatividade foi negativa em todo grupo controle. CONCLUSÃO: Todos os pacientes, com exceção de um, com expressão positiva para FGF, IGF-1 e VEGF mostraram CAS maior que 5, sugerindo importante papel destes fatores de crescimento na patogênese e gravidade da oftalmopatia de Graves. Entretanto, a análise estatística demonstrou associação significativa entre IGF-1 e o sexo masculino (P=0,034). Baixa refletividade ao ultra-som e condição endócrina não estiveram correlacionadas.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tejido Conectivo/metabolismo , Factores de Crecimiento de Fibroblastos/análisis , Oftalmopatía de Graves/metabolismo , Factor I del Crecimiento Similar a la Insulina/análisis , Músculos Oculomotores/metabolismo , Factores de Crecimiento Endotelial Vascular/análisis , Tejido Adiposo/metabolismo , Tejido Adiposo/patología , Biopsia , Estudios de Casos y Controles , Interpretación Estadística de Datos , Oftalmopatía de Graves/etiología , Inmunohistoquímica , Músculos Oculomotores/patología , Estrabismo/metabolismo , Estrabismo/cirugíaRESUMEN
Adenomas clinicamente não-funcionantes de hipófise, não produzem clínica de hipersecreção hormonal. Por esse motivo, seus sinais e sintomas dependem de seu efeito de massa no sistema nervoso central. A sua etiopatogenia é complexa com vários fatores provavelmente influenciando seu desenvolvimento como os hormônios hipotalâmicos (GHRH), fatores de crescimento (FGF), fatores de proliferação (PCNA, e KI-67), proteína P53 e proto-oncogene c-erb-B2. OBJETIVOS: 1) Determinar as características clínicas da população de 117 pacientes tratados com adenoma clinicamente não-funcionante de hipófise (idade, sexo, tamanho do tumor, número de procedimento cirúrgico, desenvolvimento de deficiência hormonal e hiperprolactinemia). 2) Identificar, após a caracterização clínica desses pacientes, aqueles com adenoma clinicamente não-funcionante que apresentam imunoistoquímica positiva para os hormônios hipofisários PRL LH, FSH, GH, TSH e ACTH. 3) Precisar nessa população a positividade imunoistoquímica para o fator de proliferação celular Ki-67, para a proteína P53 e para a proteína C-erb-B2 correlacionando a sua positividade com o tamanho e invasão tumoral. Dessa forma avaliando o valor prognóstico desses fatores de proliferação. 4) Confrontar os resultados da imunoistoquímica realizada através do bloco padrão com os resultados da imunoistoquímica obtidos através do tissue micro-array. MÉTODO: Estudo das características clínicas de 117 pacientes com adenoma clinicamente não-funcionate de hipófise (idade, sexo, tamanho do tumor, número de procedimento cirúrgico, desenvolvimento de deficiência hormonal e hiperprolactinemia). Estudo imunoistoquímico (H&E) de 39 pacientes para hormônios hipofisários, para a proteína P53, proteína C-erb-B2, Ki-67 e sua correlação com crescimento tumoral. A seguir, também foi realizado o tissue micro-array dos 39 casos, estudados anteriormente, com imunoistoquímica para os hormônios hipofisários, para a proteína P 53, proteína C-erb-B2, Ki-67 e sua correlação com o crescimento tumoral. RESULTADOS: Não houve diferença estatisticamente significante entre os sexos masculino e feminino com relação à idade, tamanho tumoral e número de procedimentos cirúrgicos (p=0,279, p=0,813, p=0,139 respectivamente)...
Asunto(s)
Femenino , Humanos , Masculino , Adenoma/metabolismo , Neoplasias Hipofisarias/metabolismo , Biomarcadores de Tumor/metabolismo , Adenoma/patología , Adenoma/cirugía , Inmunohistoquímica/métodos , /sangre , /metabolismo , Pronóstico , Hormonas Hipofisarias/sangre , Hormonas Hipofisarias/metabolismo , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/cirugía , /sangre , /metabolismo , Índice de Severidad de la Enfermedad , Biomarcadores de Tumor/sangre , /sangre , /metabolismoRESUMEN
UNLABELLED: Clinically non-functioning pituitary adenomas do not produce clinical signs of hormonal hypersecretion. Therefore, signs and symptoms will depend on the mass effect of these adenomas over the central nervous system. Their etiopathogeny is complex and their development is probably influenced by several factors, such as hypothalamic hormones (GHRH), growth factors (FGF), proliferation factors (PCNA, and KI-67), protein P53 and the proto-oncogene c-erb-B2. OBJECTIVE: 1) Determining the clinical features of a population of 117 patients treated for clinically non-functioning pituitary adenoma (age, sex, tumor size, number of surgical procedures, development of hormonal deficiency and hyperprolactinemia). 2) Identifying, after the patients had been clinically characterized, those with clinically non-functioning adenomas with positive immunohistochemistry for hypophyseal hormones (PRL, LH, FSH, GH, TSH and ACTH). 3) Determining if the immunohistochemistry of this population was positive for the cellular proliferation factor Ki-67, protein P53 and protein C-erb-B2 and establishing a correlation with tumor size and tumor invasiveness. This will help in the evaluation of the prognostic value of these proliferation factors. 4) Confronting the results of immunohistochemistry using a standard block with the results of immunohistochemistry using a tissue micro-array. METHOD: Study of the clinical features of 117 patients with clinically non-functioning pituitary adenoma (age, sex, tumor size, number of surgical procedures, development of hormonal deficiency and hyperprolactinemia). Immunohistochemical study (H&E) of 39 patients for hypophyseal hormones, protein P53, protein C-erb-B2, Ki-67 to establish their correlation to tumor growth. The next step was a tissue micro-array of the 39 previously studied cases, using immunohistochemistry for hypophyseal hormones, protein P 53, protein C-erb-B2, Ki-67 to establish their correlation to tumor growth. RESULTS: There was no statistically significant difference between males and females with regards to age, tumor size and number of surgical procedures (p=0.279, p=813, p=139 respectively). There is a statistically significant correlation between the size of the tumor, the number of surgical procedures and hormonal deficiency (p=0.032, p=0.223 respectively). There was no statistically significant correlation between a positive immunohistochemistry for protein P53, protein C-erb-B2, Ki-67 and tumor size (r=0.182, p=0.396; r=-0.181, p=0.397; r=0.272, p=0.199, respectively). The tissue micro-array also did not demonstrate a correlation between positive immunohistochemistry for Ki-67 and C-erb-B2 and tumor size, but it showed a statistically significant correlation between a positive immunohistochemistry for p53 and tumor size (r=-0.696; p=001). CONCLUSION: The biological behavior of the clinically non-functioning adenoma is similar for both sexes. The larger the tumor the greater the number of surgical procedures needed. Hormonal deficiency also becomes more significant as the size of the tumor increases. This paper suggests that a positive immunohistochemistry for p53 is negatively correlated to tumor size, thus demonstrating that it has a predictor value. However, a positive immunohistochemistry for Ki-67 and protein C-erb-B2 does not seem to be a prognostic factor for clinically non-functioning pituitary adenomas, as is the case with other neoplasias.