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BACKGROUND: Cancer is a public health problem, especially in developing countries. In order to establish effective measures for the cancer control, there is a need for quality information, thus enabling a better understanding of the disease and its determinants, formulation of causal hypotheses, evaluation of the technological advances applied to prevention and treatment as well as the effectiveness of health care. The objective of the study was to investigate the prevalence of solid neoplasms diagnosed between the years 2011 to 2016 and treated at the Oncology Department of the University Hospital of Santa Maria and the existing oncological context. METHODS: This is an observational cross-sectional study. The target population was comprised of adult patients (18 years of age or older) and elderly people (60 years of age or older) diagnosed with solid cancer by anatomico-pathological examination between 2011 and 2016, who started oncological treatment, according to high complexity procedure authorization (APAC)/Oncology. RESULTS: A total of 2,757 patients were selected, of which 1,493 patients were female (54.2%) and 1,264 male (45.8%). The mean age at the time of initiation of treatment was 59.94 years for both sexes, with the 95% confidence interval (59.44 - 60.44). The majority of patients were aged 61 - 70 years, totaling 747 patients, followed by 718 patients between 51 - 60 years. In all 31 primary sites identified the most prevalent one of neoplasms are breast, prostate, colorectal and lung; and most cases were stage IV (1,039 cases). A percentage of the number of cases of breast and esophageal cancer was higher than expected, and in contrast to a low percentage of hepatocarcinoma, kidney cancer and central nervous system tumors. The patients came from the entire area of the fourth Health Coordinating Area, where 100% of the municipalities referred to the institution, as well as other nine locations belonging to other coordinators. CONCLUSION: Most of the data obtained are consistent with the Brazilian reality, not identifying any peculiar characteristic of this region of the study worthy of note, except for the difference in the prevalence of some types of cancer, a fact that deserves further studies. There were also no discrepancies in a regional analysis. Along with this work, it was possible to demonstrate the cancer situation and the profile of oncology patients attended at a reference center for 41 municipalities, mainly in the central region of Rio Grande do Sul state, which may be useful in the elaboration of public policies to modify the profile identified, and serve as the basis for further studies in this region.
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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a minimally invasive tool with excellent diagnostic accuracy and low risk of complications in the diagnosis of thoracic diseases, including lung cancers and primary mediastinal lesions. Occasionally, EBUS-TBNA may be useful in identifying thoracic metastasis from distant tumors. Here we report an interesting and rare case of mediastinal metastasis of ovarian carcinoma diagnosed by EBUS-TBNA.
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INTRODUCTION: Gastroesophageal reflux disease (GERD) is a pathology with a wide range of clinical and endoscopic manifestations. Epidermal growth factor receptor (EGFR), found in the epithelium of the digestive tract, plays an important role in epithelial repair and shows increased expression in different neoplasms, including esophageal tumors. OBJECTIVES: The purpose of this study was to evaluate EGFR expression using immunohistochemistry in esophageal biopsies obtained from patients with GERD, Barrett's esophagus, and adenocarcinoma of the esophagus. METHODS: EGFR expression was immunohistochemically determined in biopsies from 194 patients with symptoms suggestive of GERD or adenocarcinoma of the esophagus, seen at two Brazilian university hospitals between January 2003 and December 2008. Based on histopathological analysis, patients were divided into three groups: GERD, Barrett's esophagus and adenocarcinoma of the esophagus. EGFR expression was considered positive when staining was detected in the membrane. RESULTS: Mean age was 55.25 years (range 30-90). Patients with GERD (n = 127) accounted for 65.5% of the sample, compared with 12.4% (n = 24) of patients with Barrett's esophagus and 22.2% (n = 43) of patients with esophageal adenocarcinoma. Immunohistochemical analysis was positive for EGFR in 19.1% of the patients (37/194), divided as follows: 8.7% (11/127) in the GERD group, 25% (6/24) in the Barrett's esophagus group, and 46.5% (20/43) in the esophageal adenocarcinoma group. Statistical analysis revealed significant differences between the three groups (p = 0.0001). CONCLUSIONS: GERD patients showed lower levels of EGFR expression than patients with Barrett's esophagus or patients with adenocarcinoma of the esophagus, suggesting a direct relationship between EGFR expression and disease progression.
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Adenocarcinoma/metabolismo , Esôfago de Barrett/metabolismo , Fator de Crescimento Epidérmico/metabolismo , Neoplasias Esofágicas/metabolismo , Refluxo Gastroesofágico/metabolismo , Regulação da Expressão Gênica , Adulto , Idoso , Idoso de 80 Anos ou mais , Fator de Crescimento Epidérmico/genética , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Diverticular disease of the colon is a very common condition, present in most of the elderly population. However, the occurrence of rectal diverticula is extremely unusual. It is typically an incidental finding at colonoscopy. OBJECTIVE: Describe epidemiological, clinical, surgical and endoscopic characteristics of a case series of rectal diverticula in Brazil. METHODS: Four patients with rectal diverticula were analyzed in terms of symptomatology, associated conditions and colonoscopy findings. Endoscopic findings were discussed individually. RESULTS: The prevalence of rectal diverticula at our endoscopy unit was 0.15% of all colonoscopies, affecting 0.74% of patients with colonic diverticulosis. The endoscopic analysis showed the diverticulum ostium with mean size of 2.3 cm, depth of 2.8 cm and anal margin distance of 6.8 cm. Colonoscopy also demonstrated simple rectal diverticulum in all patients. Diverticula were located in the anterior, right lateral and posterior walls of the rectum. One patient developed diverticulitis as complication and underwent to diverticulectomy. CONCLUSIONS: Rectal diverticulum is an incidental finding at colonoscopy and associated with diverticulosis. Its rarity and specific colonoscopic characteristics make it a unique entity. Asymptomatic in most cases, it rarely needs intervention. Surgery is reserved for complicated cases. (AU)
INTRODUÇÃO: Diverticulose é uma condição muito comum, presente em grande parte da população idosa. Divertículo retal, entretanto, é condição rara. Geralmente é um achado incidental em colonoscopias. OBJETIVO: Descrever as características epidemiológicas, clínicas, cirúrgicas e, especialmente, endoscópicas de uma série de casos de divertículos retais no Brasil. MÉTODOS: Quatro pacientes com divertículos retais são analisados em relação a sintomatologia, condições associadas e colonoscopias. Os achados endoscópicos são discutidos especificamente. RESULTADOS: Em nosso Serviço de Endoscopia, a prevalência de divertículos retais foi de 0,15% de todas as colonoscopias realizadas e de 0,74% em pacientes portadores de diverticulose. Análise endoscópica revelou tamanho médio do óstio do divertículo de 2,3 cm, profundidade de 2,8 cm e distância da margem anal de 6,8 cm. Colonoscopia demonstrou presença de divertículo retal único em todos pacientes, os quais se localizaram nas paredes anterior, lateral-direita e posterior do reto. Um dos pacientes apresentou diverticulite como complicação, sendo submetido à cirurgia de diverticulectomia. CONCLUSÕES: Divertículo retal é um achado incidental em colonoscopias, estando associado à diverticulose. Sua raridade e seus aspectos endoscópicos específicos tornam importante o reconhecimento como uma entidade única. Assintomático na maioria dos casos, raramente necessita intervenção. Cirurgia está reservada para os casos em que ocorrem complicações. (AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Reto , Diverticulite , Colonoscopia , Doença Diverticular do ColoRESUMO
BACKGROUND AND STUDY AIMS: Patients with gastroesophageal reflux disease and Barrett esophagus have an increased risk of developing adenocarcinoma of the esophagus. It is uncertain whether molecular or proliferative alterations are present in the early stages of disease. METHODS: One hundred thirty-eight patients with gastroesophageal reflux disease symptoms were subjected to upper gastrointestinal endoscopy with biopsies of the esophageal mucosa. p53 protein expression and the Ki-67 proliferation index were determined by immunohistochemical studies. Patients were divided into 4 groups according to histopathologic diagnosis: G1, normal epithelium (n=58); G2, mild esophagitis (n=42); G3, moderate esophagitis (n=23), and G4, severe esophagitis (n=15). RESULTS: p53 overexpression was detected in 7% of G1, 21.4% of G2, 52.2% of G3, and 60% of G4 patients. There were significant differences between G1 and G3 or G4 (P<0.001) and between G2 and G4 (P<0.05). The Ki-67 index was 21.3+/-19.5% in G1, 30.8+/-23.4% in G2, 47.1+/-23.2% in G3, and 48.3+/-25.7% in G4. Significant differences in the Ki-67 index were found between groups: G1 x G3 (P<0.001), G1 x G4 (P<0.001), G2 x G3 (P=0.026), and G2 x G4 (P=0.046). p53 and Ki-67 overexpression were correlated with the severity of esophagitis (P<0.001). CONCLUSIONS: p53 overexpression and the Ki-67 (MIB-1) index were correlated with histologic findings of inflammation in the esophageal mucosa, particularly in the moderate and severe forms of chronic esophagitis.
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Refluxo Gastroesofágico/diagnóstico , Mucosa Intestinal/metabolismo , Antígeno Ki-67/metabolismo , Proteína Supressora de Tumor p53/metabolismo , Biópsia , Progressão da Doença , Endoscopia Gastrointestinal , Esofagite/complicações , Esofagite/diagnóstico , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/metabolismo , Refluxo Gastroesofágico/patologia , Refluxo Gastroesofágico/fisiopatologia , Humanos , Imuno-Histoquímica , Mucosa Intestinal/patologia , Antígeno Ki-67/imunologia , Proteína Supressora de Tumor p53/imunologiaRESUMO
RACIONAL: O tratamento cirúrgico do divertículo de Zenker inclui na maioria dos casos a cricomiotomia do músculo cricofaríngeo, a qual pode ser associada à diverticulopexia ou diverticulectomia. A escolha destas opções cirúrgicas ainda é controversa. OBJETIVO: Avaliar os resultados de dois tratamentos cirúrgicos (diverticulopexia ou diverticulectomia, ambos associados à cricomiotomia) em uma série de casos. MÉTODOS: Estudo retrospectivo em período de 10 anos de 26 pacientes submetidos ao tratamento cirúrgico do divertículo de Zenker. Para análise estatística, os pacientes foram divididos em dois grupos: Grupo 1 - diverticulectomia (n=17) e Grupo 2 - diverticulopexia (n=9). Em todos realizou-se miotomia. Foram avaliadas as variáveis: tempo cirúrgico, de internação e de início da alimentação via oral, complicações gerais, ocorrência de fístulas, recidiva dos sintomas e mortalidade. Consideraram-se diferenças significativas quando P<0.05. RESULTADOS: A idade média dos pacientes foi de 64 anos. Sintomas pré-operatórios principais: disfagia (91 por cento) e regurgitação (46 por cento). Todos foram investigados com estudo radiográfico contrastado de faringe-esôfago-estômago e 58 por cento dos casos com endoscopia digestiva alta. Não houve diferença significativa entre os Grupos 1 e 2 em relação ao tempo operatório (96 x 99 min), tempo de internação (5,5 x 5 dias), início da alimentação via oral (7,5 x 4 dias), ocorrência de fístulas esôfago-cutâneas (35 x 22 por cento), recidiva da disfagia (6 x 11 por cento), complicações pós-operatórias em geral (41 x 33 por cento) e tempo de seguimento (7,5 x 9 meses). A mortalidade foi nula. CONCLUSÃO: O tratamento cirúrgico do divertículo de Zenker é método terapêutico relativamente seguro, com morbidade aceitável e seus resultados independem da opção por ressecção ou pexia do divertículo.
BACKGROUND: Surgical treatment of Zenker's Diverticulum comprise in the majority of cases cricopharyngeal miotomy, which may be associated with diverticulopexy or diverticulectomy. The election of these surgical options remains controversial. AIM: To evaluate the results of two surgical treatments (diverticulopexy or diverticulectomy, both associated with miotomy) in a case series. METHODS: Retrospective study comprising a 10-year period of 26 patients submitted to surgical treatment of Zenker's Diverticulum. For statistical analysis, patients were divided in two groups: Group 1 - diverticulectomy (n=17), and Group 2 - diverticulopexy (n=9). All were submitted also to a cricomiotomy. The following variables were evaluated: operative time, in-hospital stay, time to initiate oral feeding, general complications, fistula occurrence, symptom recurrence and mortality. Significant differences considered when P<0.05. RESULTS: Mean age was 64 years. Main pre-operative symptoms were: dysphagia (91 percent) and regurgitation (46 percent). All patients were diagnosed with pre-operative barium esophagram and 58 percent (n=15) did upper gastrointestinal endoscopy. There wasn't significant difference related to mean operative time (96 x 99 min), in-hospital stay (5,5 x 5 days), time to initiate oral feeding (7,5 x 4 days), occurrence of esophagocutaneous fistula (35 x 22 percent), dysphagia recurrence (6 x 11 percent), general post-operative complications (41 x 33 percent) and follow up period ( 7,5 x 9 months). The mortality was null. CONCLUSION: Surgical treatment of Zenker's Diverticulum is a relatively safe therapeutic method, with acceptable morbidity and the results are comparable between diverticulopexy and diverticulectomy.
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BACKGROUND: Nitrosamines are associated with the potential to induce cancer in the digestive tract. Ethanol has also been shown to enhance the effects of nitrosamine-induced carcinogenesis. The aim of this study was to investigate a murine model of the prevalence and types of epithelial lesions induced in the stomach by diethylnitrosamine (DEN), and to evaluate the influence of ethanol and N'-nitrosonornicotine (NNN) as promoters of gastric carcinogenesis. MATERIALS AND METHODS: Two hundred eight (n = 208) mice were distributed into five groups and administered either water (G1), DEN+water (G2), DEN+NNN (G3), DEN+Ethanol (G4), or DEN+NNN+Ethanol (G5) for a period of 180 days. Mice were sacrificed; their stomachs were sectioned and stained with hematoxylin/eosin. Stomachs were analyzed for normal histology; foveolar hyperplasia; gastritis; ulcer; adenoma; metaplasia; dysplasia; squamous-cell cancer (SCC); and adenocarcinoma (ACA). RESULTS: One hundred eighty-four (N = 184) specimens were studied. No statistically significant differences were observed between the average DEN consumption of groups (P > 0.05). Unlike G1, in all four groups exposed to carcinogens, gastric SCC and ACA were induced (P < 0.001). SCC was identified in 91 (49.5%) and ACA in 77 (41.8%) of all mice (including controls). In 47 mice (25.5%), we identified two histological types of carcinoma that occurred simultaneously. The prevalence of ACA in G5 was higher when compared with the other exposed groups (P < 0.001). CONCLUSIONS: We created an optimal murine model for investigation of the development of gastric carcinogenesis, as there was a high rate of development of tumors, but low mortality and morbidity. The coadministration of DEN, ethanol, and NNN induced carcinogenesis to the largest extent compared with the other combinations.
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Adenocarcinoma/induzido quimicamente , Carcinoma de Células Escamosas/induzido quimicamente , Dietilnitrosamina/efeitos adversos , Neoplasias Gástricas/induzido quimicamente , Adenocarcinoma/patologia , Animais , Carcinógenos/farmacologia , Carcinoma de Células Escamosas/patologia , Dietilnitrosamina/farmacologia , Modelos Animais de Doenças , Epitélio/efeitos dos fármacos , Epitélio/patologia , Etanol/efeitos adversos , Etanol/farmacologia , Feminino , Camundongos , Camundongos Endogâmicos , Nitrosaminas/efeitos adversos , Nitrosaminas/farmacologia , Neoplasias Gástricas/patologiaRESUMO
No mesossalpinge, entre a trompa e o ovário, está situado o paraovário. Os cistos paraovarianos originam-se de estruturas vestigiais de Wolff, do epitélio tubário ou de incluções peritoneais. Raramente atinguem tamanho de cisto do próprio ovário. Os autores relatam um raro caso de cisto paraovariano gigante
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Humanos , Feminino , Mesonefro , Cistos Ovarianos , Mesotelioma Cístico/cirurgiaRESUMO
Apenas 17 por cento - 20 por cento das apendicites agudas ocorrem em pacientes com mais de 40 anos de idade. A apendicite aguda é raramente a primeira manifestação de carci8noma de ceco, como caso relatado pelos autores
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Humanos , Apendicite , Neoplasias do Ceco , ColectomiaRESUMO
O leiomiossarcoma retroperitoneal é patologia rara na prática cirúrgica. O diagnóstico precoce é ocasional, pois não existem sintomas específicos. O tratamento cirúrgico é a modalidade que pode oferecer chance de cura. A radioterapia pode ser útil. Os autores relatam um caso de leiomiossarcoma retroperitoneal manifestado por abdome agudo, uma apresentação atípica
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Humanos , Abdome Agudo , Leiomiossarcoma , Espaço Retroperitoneal/fisiopatologia , Neoplasias RetroperitoneaisRESUMO
Tumores benignos do fígado sao raros. O tumor hepático benigno mais freqüente é o hemangioma cavernoso. Estes sao na maioria pequenos e, excepcionalmente, múltiplos. Usualmente sao assintomáticos, mas podem se manifestar com queixas gastrointestinais inespecíficas e mais raramente como hemorragia espontânea. Os autores relatam um raro caso de hemangioma cavernoso pediculado gigante do fígado complicado por hemorragia intratumoral. Os achados radiológicos nao ajudaram a definir o diagnóstico, optando-se por laparotomia diagnóstica/terapêutica. O follou-up pós-operatório nao mostrou complicaçoes em 14 meses de seguimento.
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Feminino , Adulto , Hemangioma Cavernoso/diagnóstico , Neoplasias Hepáticas/diagnóstico , Seguimentos , Hemangioma Cavernoso/complicações , Hemangioma Cavernoso/cirurgia , Hemorragia/complicações , Laparotomia , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/complicações , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Os autores apresentam um raro caso de enterolitíase em paciente com divertículo de Meckel, a mais comum anomalia congênita do trato gastrintestinal - ocorrendo em 1 por cento a 3 por cento da populaçao. Formaçoes de cálculos no interior dos divertículos sao observaçao muito rara. Discutem os achados clínicos, critérios diagnósticos e o tratamento.
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Humanos , Masculino , Adulto , Cálculos/diagnóstico , Divertículo Ileal/diagnóstico , Enteropatias/diagnóstico , Cálculos/cirurgia , Divertículo Ileal/cirurgia , Divertículo Ileal/patologia , Enteropatias/cirurgiaRESUMO
A doença hidática é patologia parasitária endêmica em várias partes do mundo, tendo alta prevalência no Sul do Brasil. Apesar de o fígado ser o órgao mais comumente afetado, nao é freqüente que o cisto hidático de fígado atinja grandes volumes. Os autores relatam um caso de cisto hidático gigante de fígado.
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Humanos , Masculino , Pessoa de Meia-Idade , Equinococose Hepática/cirurgia , Equinococose Hepática/patologia , PrognósticoRESUMO
Os autores relatam e discutem um caso de adenocarcinoma de jejuno, analisando a apresentaçao clínica, método diagnóstico e tratamento.