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BACKGROUND: The energy metabolism of drug-resistant tumor cells can provide a survival advantage during therapy, and treatment itself may influence metabolic reprogramming. Petiveria alliacea (Traditional name: Anamu) could inhibit glycolysis and OXPHOX modulating tumor metabolism, making it a potential treatment for tumors with altered metabolism. This clinical study aims to evaluate the safety and efficacy of a standardized Anamu phytomedicine called Esperanza in treating gastric tumors and acute leukemias. METHODS: This is a prospective, open label, phase I/ randomized, double-blind single-center phase II study designed to evaluate the safety and efficacy of Esperanza extract in patients with metastatic gastrointestinal tumors and acute leukemias. In stage 1, the study will determine the MTD and assess safety. In stage 2, safety at the MTD will be evaluated, and the efficacy of Esperanza extract will be explored in both metastatic gastric tumors and acute leukemias. Quality of life improvement will be the primary outcome in the gastric tumor group, while different efficacy outcomes will be assessed in the acute leukemia group. A placebo group will be used for comparison in the gastric tumor group, and a historical control group will be used in the acute leukemia arm. DISCUSSION: This clinical trial aims to evaluate the safety profile of the Esperanza extract in patients with metastatic gastrointestinal tumors and acute leukemias, while exploring its potential efficacy in conjunction with standard treatment for these pathologies. TRIAL REGISTRATION: This trial was registered in the US National Library of Medicine with identifier NCT05587088. Registered October 19th, 2022.
Assuntos
Leucemia , Phytolaccaceae , Neoplasias Gástricas , Estados Unidos , Humanos , Neoplasias Gástricas/tratamento farmacológico , Estudos Prospectivos , Qualidade de Vida , Leucemia/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Ensaios Clínicos Fase I como Assunto , Ensaios Clínicos Fase II como AssuntoRESUMO
Abstract Introduction: Among the sub-types of lymphoma, mantle cell lymphoma, or what was previously known as intermediate lymphocytic lymphoma, accounts for 3-10% of B-cell non-Hodgkin lymphomas. Treatment is directed according to the patient's classification, age, functional status and comorbidities, and is directly related to the ability to receive intensive treatment or transplantation. It is important to homogenize treatments to offer the best alternatives in the Colombian context, as there are different diagnostic and therapeutic options today, most of which are financed by the Colombian healthcare system. Objective: To structure a series of considerations for the diagnosis and treatment of MCL within the Colombian context. Methods: A formal, mixed (Delphi/nominal) expert consensus was developed. The options for each question were scored in two masked rounds and an open nominal session. The information was consolidated in Excel and analyzed using STATA 13. Results: 25 considerations were developed for the diagnosis and treatment of MCL. Twenty-two specialists participated: 16 hematologists and hematologist-oncologists, four hematopathologists, one radiation therapist and one nuclear medicine specialist from Bogotá, Medellín and Cali, with an average of 10.5 years' of practical experience and who were members of the Asociación Colombiana de Hematología y Oncología [Colombian Association of Hematology and Oncology]. Conclusions: The consensus established 26 considerations for the diagnosis and treatment of MCL, according to the Colombian context, aimed at healthcare professionals with a direct relationship with this disease. It is expected that clinical management will be homogenized by a consideration of this consensus and the referenced literature. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2606).
Resumen Introducción: Dentro de los subtipos de linfoma, el linfoma de células del manto o anteriormente denominado linfoma linfocítico intermedio corresponde a 3-10% de los linfoma no Hodgkin de células B. El tratamiento se enfoca según la clasificación del paciente, edad, estado funcional y comorbilidades, lo cual está directamente relacionado con la capacidad de recibir un tratamiento intensivo o trasplante. Es importante homogeneizar conductas con el fin de ofrecer las mejores alternativas bajo el contexto colombiano, pues actualmente existen diferentes opciones diagnósticas y terapéuticas, financiadas en su mayoría por el sistema de salud colombiano. Objetivo: Estructurar una serie de consideraciones para el diagnóstico y tratamiento para LCM, en el contexto colombiano. Métodos: Se llevó a cabo un consenso formal de expertos, tipo mixto (Delphi/ Nominal). Se calificaron las opciones de cada pregunta en dos rondas enmascaradas y una sesión abierta nominal. La información fue consolidada en Excel y analizada en STATA 13. Resultados: Se elaboraron 25 consideraciones para el diagnóstico y tratamiento de LCM. Participaron 22 médicos especialistas: 16 hematólogos y hemato-oncólogos, cuatro hemato-patólogos, un radioterapeuta y un especialista en medicina nuclear de Bogotá, Medellín y Cali, con experticia en la práctica de 10.5 años en promedio y quienes forman parte de la Asociación Colombiana de Hematología y Oncología. Conclusiones: El consenso definió 26 consideraciones para el diagnóstico y tratamiento de LCM, según el contexto colombiano, dirigidas a profesionales de la salud con relación directa a esta patología. Se espera homogeneizar las conductas clínicas teniendo en cuenta este consenso y la literatura referida. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2606).
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BACKGROUND: Cervicovaginal cytology as a follow-up study in women with a history of a cervical carcinoma treated with chemo-radiotherapy (CRT) plays an important role; however, the cytomorphological characteristics for the diagnosis of high-grade squamous intraepithelial lesions (H-SIL) in post-CRT patients have not been established. The aim of the study is to find the cytomorphological characteristics that support the diagnosis of H-SIL by conventional cytology in these patients. MATERIALS AND METHODS: This is a cross-sectional study from 2009 to 2015, which includes patients with a diagnosis of squamous cell carcinoma treated with CRT, who all have cervix cytology for follow-up and a later biopsy. RESULTS: We identified 82 cases, where the most frequent clinical stage was IIA1 to IIB with 26 cases (61.9%), the most common symptom was transvaginal bleeding (64.29%). The cytological characteristics that were statistically associated with the presence of a positive biopsy were the presence of a hemorrhagic background (45.2% vs. 12.5%, P = .007), high cellularity (45.2% vs. 15%, P < .001), disposition in groups/sheets (69% vs. 22.5%, P < .001), postradiotherapy changes at the background of the smear (73.8 vs. 50%, P < .001) and an increased nuclear/cytoplasmic ratio (100% vs. 22.5%, P < .001). CONCLUSIONS: In patients with CRT, the presence of specific features can help the diagnosis of H-SIL with excellent diagnostic performance.
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Carcinoma de Células Escamosas/patologia , Recidiva Local de Neoplasia/patologia , Lesões Intraepiteliais Escamosas Cervicais/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Colo do Útero/efeitos dos fármacos , Colo do Útero/patologia , Colo do Útero/efeitos da radiação , Quimiorradioterapia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapiaRESUMO
Ovarian mature cystic teratoma (OMCT) is an ovarian benign neoplasm with excellent prognosis presenting components of the three germinal layers. However, transformation into a malignant neoplasm is a rare event (so-called somatic transformation). In most of the cases, the malignant component expresses as epidermoid carcinoma, but occasionally central nervous system tumors occur. Some of the previously reported tumors are astrocytoma, glioblastoma, and ependymoma. Somatic transformation of OMCT into an oligodendroglioma is exceptional. We report a 19-year-old female with a left OMCT with an area of oligonedroglial cells proliferation characterized by immunohistochemical studies with positivity for GFAP and S100, with a low Ki67 index (5%). Additionally, electron microscopy revealed oligodendrocytes with parallel bundles of cytoplasmic intermediate filaments, confirming the oligodendroglial nature of the proliferation. The patient was treated only with left oophorectomy, and three and half years after surgery, there is no evidence of disease.
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Biomarcadores Tumorais/análise , Proliferação de Células , Imuno-Histoquímica , Microscopia Eletrônica , Neoplasias Císticas, Mucinosas e Serosas/diagnóstico , Oligodendroglioma/diagnóstico , Neoplasias Ovarianas/diagnóstico , Teratoma/diagnóstico , Feminino , Humanos , Neoplasias Císticas, Mucinosas e Serosas/química , Neoplasias Císticas, Mucinosas e Serosas/cirurgia , Neoplasias Císticas, Mucinosas e Serosas/ultraestrutura , Oligodendroglioma/química , Oligodendroglioma/cirurgia , Oligodendroglioma/ultraestrutura , Neoplasias Ovarianas/química , Neoplasias Ovarianas/cirurgia , Neoplasias Ovarianas/ultraestrutura , Ovariectomia , Valor Preditivo dos Testes , Salpingectomia , Teratoma/química , Teratoma/cirurgia , Teratoma/ultraestrutura , Resultado do Tratamento , Adulto JovemRESUMO
The Clinco-pathological, immunohistochemical and molecular findings of four cases of Mammary Analogue Secretory Carcinoma (MASC) of salivary glands found in Mexico are described. The cases were extracted from 253 salivary gland tumors from a single institution in Mexico City. The 85 Candidates for initial selection were: low grade mucoepidermoid carcinoma (MEC) (N=70 ), Acinic cell cancinoma (AciCC) (N=14), papillary cystadenocarcinoma (N=1), and adenocarcinoma NOS (N=0). Tumors with some histological features consistent with MASC (N= 17, 6.7%) were studied by immunohistochemistry for mammaglobin, STAT5, and S-100 protein and four cases were positive (1.5%), thus the diagnosis of MASC was established, and these were submitted for molecular studies for ETV6-NTRK3. Fusion gene was demonstrated in three cases, two had been erroneously diagnosed as poorly granulated AciCC, and one as low grade MEC with microcystic pattern. Female gender predominated (3:1); one occurred in the parotid, two in minor salivary glands and one in the submaxillary gland; infiltrating borders, atypical mitosis and lymph node metastases were seen in the parotideal tumor. Two patients with major salivary gland tumors are alive and well at 10 and 20 months respectively, the two patients with minor salivary gland tumors are lost. It can be concluded that is important to think in MASC in poorly granulated AciCC and low grade MEC with microcystic pattern. Immunohistochemisty studies confirm the diagnosis, preferentially supported by molecular studies. MASC may follow aggressive behavior or transform into a high grade neoplasm.