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Disseminated cryptococcosis, commonly linked to immunocompromised conditions like HIV infection, is exceedingly rare in immunocompetent individuals. This case report presents a rare case of disseminated cryptococcosis in an immunocompetent patient, who manifested with fever, weight loss, neurological manifestations, and distinct verrucous skin lesions. Mycological cultures and histopathological assessments were conducted, leading to the identification of Cryptococcus neoformans var. gattii within both lung and skin biopsies. This case highlights the significance of considering this yeast infection within immunocompetent individuals and the necessity for promptly initiating appropriate antifungal therapy to enhance patient outcomes.

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BACKGROUND: Dopamine Responsive Dystonia (DRD) and Juvenile Parkinsonism (JP) are two diseases commonly presenting with parkinsonian symptoms in young patients. Current clinical guidelines offer a diagnostic approach based on molecular analysis. However, developing countries have limitations in terms of accessibility to these tests. We aimed to assess the utility of imaging equipment, usually more available worldwide, to help diagnose and improve patients' quality of life with these diseases. METHODS: We performed a systematic literature review in English using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and meta-analysis of observational studies in epidemiology (MOOSE) protocols. We only used human clinical trials about dopamine responsive dystonia and juvenile parkinsonism patients in which a fluorodopa (FD) positron emission tomography (PET) scan was performed to identify its use in these diseases. RESULTS: We included six studies that fulfilled our criteria. We found a clear pattern of decreased uptake in the putamen and caudate nucleus in JP cases. At the same time, the results in DRD were comparable to normal subjects, with only a slightly decreased marker uptake in the previously mentioned regions by the FD PET scan. CONCLUSIONS: We found a distinctive pattern for each of these diseases. Identifying these findings with FD PET scans can shorten the delay in making a definitive diagnosis when genetic testing is unavailable, a common scenario in developing countries.

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Resumen ANTECEDENTES: Los tumores malignos de células germinales de ovario constituyen un grupo heterogéneo de neoplasias de rápida evolución a la malignización, que suelen aparecer durante las dos primeras décadas de la vida. La prevalencia en México es de 3.4% de los tumores ováricos. El 10% de las pacientes afectadas padece dolor abdominal agudo por distención capsular, necrosis, hemorragia, rotura o torsión. CASO CLÍNICO: Paciente de 17 años, acudió al servicio de Urgencias por dolor pélvico de inicio súbito. En la laparotomía se encontró una torsión ovárica secundaria a una tumoración anexial derecha; por eso se le efectuó la salpingooferectomía. Se detectó elevada concentración de alfa-fetoproteína (10,702 ng/mL); el servicio de Oncología pediátrica indicó quimioterapia durante dos años; sin embargo, después de suspender el tratamiento persistió elevada su concentración. El ultrasonido y PET-SCAN no evidenciaron enfermedad activa. En la laparoscopia diagnóstica se observaron múltiples implantes tumorales. El reporte histopatológico fue de tumoración de senos endodérmicos. La paciente se envió, nuevamente, a Oncología pediátrica para continuar con quimioterapia y radioterapia. En la actualidad permanece estable, con descenso de la concentración de alfa-fetoproteína (última determinación: 1200 ng/mL). CONCLUSIÓN: La importancia de la laparoscopia toma relevancia en este tipo de casos, cuando existe discordancia entre los estudios bioquímicos y de imagen (ultrasonido y PET-SCAN); además, orienta hacia un diagnóstico más certero, mediante la visualización y obtención de biopsias directas, con la finalidad de establecer el tratamiento específico.

Abstract BACKGROUND: Malignant germ cell tumors of the ovary constitute a heterogeneous group of highly malignant and rapidly progressive neoplasms that usually appear during the first two decades of life. Its frequency in Mexico is 3.4% on ovarian tumors. Approximately 10% of affected patients report acute abdominal pain due to capsular distension, necrosis, hemorrhage, rupture or torsion. CLINICAL CASE: A 17 years-old patient, who went to the Emergency Department for pelvic pain of sudden onset. It was decided to perform a laparotomy and ovarian torsion was found secondary to a right adnexal tumor, so salpingo-ophorectomy was performed. High alpha-fetoprotein concentration (10.702 ng/mL) was detected; the Pediatric Oncology Service indicated chemotherapy for two years; however, after stopping the treatment, its concentration persisted. The ultrasound and PET-SCAN did not show active disease, so it was sent to the gynecological endoscopy service, where they performed diagnostic laparoscopy, observing multiple tumor implants. The histopathological results was endodermal sinus tumor. The patient was sent, again, to Pediatric Oncology to continue with chemotherapy and radiotherapy. It is currently stable, with a decrease in values of alpha-fetoprotein (last determination: 1200 ng/mL). CONCLUSION: The importance of diagnostic laparoscopy is especially relevant in this type of cases when there is disagreement between biochemical and imaging studies (ultrasound and PET-SCAN), which through laparoscopy guides us towards a more accurate diagnosis through visualization and direct biopsy taking sample and give a directed management.

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Introdução: A avaliação da resposta à quimioterapia de indução (QI) com regimes triplos, incluindo taxane, cisplatina e 5 fluorouracil (TPF) em carcinoma de células escamosas de cabeça e pescoço localmente avançado (CECCPLA) é geralmente realizada após 2 ciclos de quimioterapia usando critérios morfológicos. Preocupações em relação ao perfil de toxicidade do TPF sugerem um benefício potencial de uma abordagem de avaliação de resposta precoce. Objetivo: o objetivo deste estudo é avaliar a utilidade de se avaliar precocemente a resposta tumoral por método funcional e morfológico com uso do PET-SCAN em pacientes portadores de CECCPLA tratados com QI seguido de radioteapia após o primeiro ciclo de QI. Métodos: Pacientes com CECCPLA que se submeteram ao QI com TPF foram avaliados prospectivamente. Os procedimentos de estadiamento incluíram imagem locorregional e de tórax, exame endoscópico e PET-SCAN. Pacientes foram avaliados para resposta tumoral após o segundo ciclo da QI e ao término do tratamento, conforme conduta estabelecida para a prática clínica. No dia 14 do primeiro ciclo, um segundo PET- SCAN foi realizado e os médicos e pacientes foram cegados para os seus resultados. Todos os pacientes assinaram consentimento para participação do estudo. Resultados: Entre fevereiro de 2010 e julho de 2013, 49 pacientes portadores de CECCPLA estádio III / IVA-B CECCPLA foram recrutados. Após um seguimento mediano de 44,3 meses, pacientes cujos achados de PET-SCAN não registraram aumento no Stardard Uptake Value (SUV) máximo dos linfonodos regionais apresentaram melhor sobrevida livre de recidiva (HR = 0,18; IC95% 0,056-0,585; p = 0,004) e sobrevida global (HR = 0,14, IC 95% 0,040-0,498; p = 0,002) e foram considerados respondedores. Neste subgrupo, os pacientes que atingiram pelo menos 45% de redução no SUV máximo do tumor primário apresentaram melhor sobrevida livre de progressão tumoral (HR = 0,23, IC 95% 0,062-0,854; p = 0,028) e sobrevida global (HR = 0,11, IC 95% 0,013 -0,96; p = 0,046). Conclusão: Estes resultados sugerem um potencial papel da avaliação da resposta tumoral precoce com PET-SCAN em pacientes com CECCPLA submetidos a QI. Aumento no SUV máximo do linfonodo regional e diminuição insuficiente na captação do tumor primário predizem pior evolução clínica (AU)

Introduction: Evaluation of induction chemotherapy (IC) response with triplet taxane, cisplatin and 5 fluorouracil containing regimen (TPF) in locally advanced head and neck squamous cell carcinoma (LASCCHN) is usually performed after 2 cycles of chemotherapy using morphological criteria. Concerns regarding the TPF toxicity profile suggest a potential benefit of an early tumor response assessment approach. Objective: The objective of this study is to evaluate the usefulness of early evaluation of tumor response by functional and morphological method using PET-SCAN patients with LASCCHN treated with IC followed by radiotherapy after the first IC cycle. Methods: Patients with LASCCHN who underwent IC with TPF were prospectively evaluated. Staging procedures included standard primary neck tumor and chest imaging, endoscopic examination and PET-SCAN. Patients were evaluated for tumor response after the second cycle of IC and at the end of treatment, according to established practice guidelines. On day 14 of the first cycle, a second PET-SCAN was performed and physicians and patients were blinded to their exam findings. Results: Between February 2010 and July 2013, 49 patients staged AJCC III / IVA-B LASCCHN were recruited. After a median follow-up of 44.3 months, patients with no increase in the regional maximum lymph node SUV had better relapse-free survival (HR = 0.18, 95% CI 0.056-0.585, p = 0.004) and overall survival (HR = 0.14, 95% CI 0.040-0.498, p = 0.002) and were considered responders. Among cases considered responders, patients who achieved at least 45% reduction of SUV in the primary tumor presented improvement in progression-free (HR = 0.23, 95% CI 0.062-0.854, p = 0.028) and overall survival (HR = 0.11, 95% CI 0.013 -0.96, p = 0.046). All patients provided informed consent for study participation. Conclusion: These results suggest an important role of the evaluation of the early response with PET-SCAN in patients with LASCCHN undergoing IC. Increase in the regional SUV maximum and insufficient decrease in primary tumor uptake predict worse clinical outcome (AU)

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Introduction Parotid gland incidentalomas (PGIs) are unexpected hypermetabolic foci in the parotid region that can be found when scanning with whole-body positron emission/computed tomography (PET/CT). These deposits are most commonly due to benign lesions such as Warthin tumor. Objective The aim of this study was to determine the prevalence of PGIs identified in PET/CT scans and to assess the role of smoking in their etiology. Methods We retrospectively reviewed all PET/CT scans performed at our center in search of PGIs and identified smoking status and standardized uptake value (SUVmax) in each case. We also analyzed the database of parotidectomies performed in our department in the previous 10 years and focused on the pathologic diagnosis and the presence or absence of smoking in each case. Results Sixteen cases of PGIs were found in 4,250 PET/CT scans, accounting for 0.4% . The average SUVmax was 6.5 (range 2.8 to 16). Cytology was performed in five patients; it was benign in four cases and inconclusive in one case. Thirteen patients had a history of smoking. Of the parotidectomies performed in our center with a diagnosis of Warthin tumor, we identified a history of smoking in 93.8% of those patients. Conclusions The prevalence of PGIs on PET/CT was similar to that reported by other authors. Warthin tumor is frequently diagnosed among PGIs on PET/CT, and it has a strong relationship with smoking. We suggest that a diagnosis other than Warthin tumor should be considered for PGIs in nonsmokers. .

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Introduction Parotid gland incidentalomas (PGIs) are unexpected hypermetabolic foci in the parotid region that can be found when scanning with whole-body positron emission/computed tomography (PET/CT). These deposits are most commonly due to benign lesions such as Warthin tumor. Objective The aim of this study was to determine the prevalence of PGIs identified in PET/CT scans and to assess the role of smoking in their etiology. Methods We retrospectively reviewed all PET/CT scans performed at our center in search of PGIs and identified smoking status and standardized uptake value (SUVmax) in each case. We also analyzed the database of parotidectomies performed in our department in the previous 10 years and focused on the pathologic diagnosis and the presence or absence of smoking in each case. Results Sixteen cases of PGIs were found in 4,250 PET/CT scans, accounting for 0.4%. The average SUVmax was 6.5 (range 2.8 to 16). Cytology was performed in five patients; it was benign in four cases and inconclusive in one case. Thirteen patients had a history of smoking. Of the parotidectomies performed in our center with a diagnosis of Warthin tumor, we identified a history of smoking in 93.8% of those patients. Conclusions The prevalence of PGIs on PET/CT was similar to that reported by other authors. Warthin tumor is frequently diagnosed among PGIs on PET/CT, and it has a strong relationship with smoking. We suggest that a diagnosis other than Warthin tumor should be considered for PGIs in nonsmokers.

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Resumen: El tomógrafo por emisión de positrones (PET, por sus siglas en inglés [positron emission tomography]) es una poderosa herramienta no invasiva para el diagnóstico clínico e investigación in vivo por medio de imágenes empleada en humanos y animales de laboratorio. Se han desarrollado equipos exclusivos para los diversos modelos animales con los beneficios de esta técnica para el estudio de diferentes enfermedades.

Abstract: The positron emission tomography , PET scan (Positron Emission Tomography) is a powerful noninvasive tool for clinical diagnosis and research in vivo by means of images used in humans and laboratory animals. We have developed exclusive equipment for the various animal models with the benefits of this technique for the study of different diseases.

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In an aggressive B16-F10 murine melanoma model, we evaluated the effectiveness and antitumor mechanisms triggered by a surgery adjuvant treatment that combined a local suicide gene therapy (SG) with a subcutaneous genetic vaccine (Vx) composed of B16-F10 cell extracts and lipoplexes carrying the genes of human interleukin-2 and murine granulocyte and macrophage colony stimulating factor. Pre-surgical SG treatment, neither alone nor combined with Vx was able to slow down the fast evolution of this tumor. After surgery, both SG and SG + Vx treatments, significantly prevented (in 50% of mice) or delayed (in the remaining 50%) post-surgical recurrence, as well as significantly prolonged recurrence-free (SG and SG + Vx) and overall median survival (SG + Vx). The treatment induced the generation of a pseudocapsule wrapping and separating the tumor from surrounding host tissue. Both, SG and the subcutaneous Vx, induced this envelope that was absent in the control group. On the other hand, PET scan imaging of the SG + Vx group suggested the development of an effective systemic immunostimulation that enhanced (18)FDG accrual in the thymus, spleen and vertebral column. When combined with surgery, direct intralesional injection of suicide gene plus distal subcutaneous genetic vaccine displayed efficacy and systemic antitumor immune response without host toxicity. This suggests the potential value of the assayed approach for clinical purposes.

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Solitary pulmonary nodule represents 0.2% of incidental findings in routine chest X-ray images. One of the main diagnoses includes lung cancer in which small-cell subtype has a poor survival rate. Recently, a new classification has been proposed including the very limited disease stage (VLD stage) or T1-T2N0M0 with better survival rate, specifically in those patients who are treated with surgery. However, current recommendations postulate that surgery remains controversial as a first-line treatment in this stage. We present the case of a 46-year-old female referred to our hospital with a preoperative diagnosis of a solitary pulmonary nodule. On initial approach, a biopsy revealed a small cell lung cancer. She received multimodal therapy with surgery, chemotherapy, and prophylactic cranial irradiation and is currently alive without recurrence on a 2-year follow-up.

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OBJECTIVE: To analyze glucose transporter 1 expression patterns in malignant tumors of various cell types and evaluate their diagnostic value by immunohistochemistry. INTRODUCTION: Glucose is the major source of energy for cells, and glucose transporter 1 is the most common glucose transporter in humans. Glucose transporter 1 is aberrantly expressed in several tumor types. Studies have implicated glucose transporter 1 expression as a prognostic and diagnostic marker in tumors, primarily in conjunction with positron emission tomography scan data. METHODS: Immunohistochemistry for glucose transporter 1 was performed in tissue microarray slides, comprising 1955 samples of malignant neoplasm from different cell types. RESULTS: Sarcomas, lymphomas, melanomas and hepatoblastomas did not express glucose transporter 1. Fortyseven per cent of prostate adenocarcinomas were positive, as were 29 percent of thyroid, 10 percent of gastric and 5 percent of breast adenocarcinomas. Thirty-six per cent of squamous cell carcinomas of the head and neck were positive, as were 42 percent of uterine cervix squamous cell carcinomas. Glioblastomas and retinoblastomas showed membranous glucose transporter 1 staining in 18.6 percent and 9.4 percent of all cases, respectively. Squamous cell carcinomas displayed membranous expression, whereas adenocarcinomas showed cytoplasmic glucose transporter 1 expression. CONCLUSION: Glucose transporter 1 showed variable expression in various tumor types. Its absence in sarcomas, melanomas, hepatoblastomas and lymphomas suggests that other glucose transporters mediate the glycolytic pathway in these tumors. The data suggest that glucose transporter 1 is a valuable immunohistochemical marker that can be used to identify patients for evaluation by positron emission tomography scan. The function of cytoplasmic glucose transporter 1 in adenocarcinomas must be further examined.

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Os linfomas de Hodgkin e não Hodgkin são habitualmente estadiados através da associação do exame físico, exames de imagem, laboratoriais e biópsia de medula óssea (métodos convencionais). A Tomografia computadorizada (CT) dos diferentes segmentos corpóreos é o método de imagem mais utilizado para avaliar a extensão da doença. Com o recente advento do uso de imagens metabólicas do consumo celular de glicose com o FDG-F-18, associadas às imagens anatômicas da Tomografia por Raios X (PET-CT), tornou-se necessária a comparação deste método com os métodos convencionais na definição do estadiamento dos Linfomas, para o futuro entendimento do seu possível impacto no manejo destes pacientes. Objetivos: Avaliar a concordância estatística entre o PET-CT e os métodos convencionais na definição do estadiamento clínico (em estádios I a IV e em grupos de doenças localizada e avançada) dos pacientes com Linfomas, e, também, comparar os resultados quanto ao acometimento nodal, nos diferentes segmentos corpóreos, e extra-nodal, bem como, o número detectado de sítios de lesões. Material e métodos: 57 pacientes, 25 com LH e 32 com LNH, foram prospectivamente estadiados pelo PET-CT e métodos convencionais. Foram calculadas as concordâncias estatísticas entre os estadiamentos clínicos e os resultados dos métodos através da estatística Kappa e a comparação entre o número detectado de sítios de lesões foi feita através do teste de Wilcoxon. Resultados: Observou-se nos LH e LNH concordância estatística nos estádios I a IV. A adição de informações do PET-CT, resultaram em elevação do estadiamento em 24% dos LH e 37,5% nos LNH. Nas doenças localizadas e avançadas, observou-se concordância estatística nos LH, não observada nos LNH. As diferenças resultaram da redução do estadiamento pelo PET-CT em relação ao CT. Observou-se concordância estatística quanto ao acometimento nodal e extra-nodal nos diferentes segmentos corpóreos principalmente, no sentido de exclusão da doença. As discordâncias observadas predominararam no segmento torácico nos LNH deveram-se, à detecção de doença pelo PET-CT nos linfonodos de tamanho habitual. No grupo de LH e LNH o PET-CT detectou maior número de sítios nodais de lesões, mas não foram encontradas diferenças quando comparados segmento corpóreo ou acometimento extra-nodal. Conclusões: Para os LH e LNH observa-se concordância estatística quando utilizamos PET-CT na definição dos estadiamentos clínicos de I a IV e para a detecção do acometimento extra-nodal e acometimento nodal por segmento corpóreo. Nos LH observa-se concordância nos grupos de doenças localizada e avançada, que não é observada nos LNH. Nos LH e LNH o PET-CT detectou maior número de sítios nodais e elevou o estadiamento clínico em mais de um terço dos pacientes com LNH e em cerca de um quarto dos pacientes com LH.

Hodgkin and non-Hodgkin Lymphomas are usually staged with an association of physical, image and laboratory examinations and bone marrow biopsy (conventional methods). Computed Tomography (CT) is the most widely imaging method used to measure the extent of disease. With the recent advent of metabolic imaging with the 18F-FDG in association with anatomical images of CT (PET-CT), became necessary to compare this method with the conventional methods in the definition of staging of Lymphomas, to the future understanding of the clinical impact in these patients. Purpose: Evaluate the statistical agreement between the PET-CT and conventional methods in definition of clinical staging (stages I to IV) and groups of localized and advanced disease and also compare the results in the detection of nodal and extra nodal sites and lesion number. Material and methods: 57 patients, 25 with HL and 32 with NHL, were prospectively staged with PET-CT and conventional methods. Statistical agreement was calculated with Kappa method and the comparison between the number of lesions sites detected with the Wilcoxon test. Results: Statistical agreement was noted to clinical stages I to IV in LH and LNH, and additional information of PET-CT predominantly resulted in elevation of the staging in HL (24%) and NHL (37.5%). Statistical agreement was present in HL, regarding advanced and localized disease, but it was not observed in NHL. Disagreements were related to the reduction of staging by PET-CT compared to CT. There was statistical agreement regarding the nodal and extra-nodal disease detection, especially in sense of exclusion of the disease. Disagreements were observed principally on the thoracic segment, due to the PET-CT detection of disease in lymph nodes of usual size. Considering the group of HL and NHL, PET-CT detected a larger number of nodal lesions sites than CT, but no differences were found regarding body segments or extra- nodal sites. Conclusions: Statistical agreement is observed to HL and NHL when PETCT is used to define clinical stages I ­ IV and to detect segmental nodal and extra-nodal disease. Statistical agreement is also observed in groups of localized and advanced disease of HL and is not seen in NHL. In HL and NHL PET-CT detected larger number of nodal lesion sites and also upstaged more than one third of patients with NHL and a quarter of the patients with HL.

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Introdução: Uma das características comuns em neoplasias humanas é o aumento do metabolismo glicolítico que serve para que as células neoplásicas se multipliquem. Entre os mecanismos que contribuem para esse fenótipo glicolítco, a expressão das proteínas transportadoras de glicose, especialmente a GLUT-1 e GLUT-3, têm sido encontrada em uma variedade de tumores, incluindo CECP e ovário. Recentemente, a avaliação do metabolismo glicolítico em tumores através do exame de imagem FDG-Pet Scan tem sido usada para identificar tumores particularmente agressivos. O objetivo desse estudo foi analisar a expressão dessas proteínas envolvidas na captação de glicose pela célula, verificar a sua influência nos resultados de Pet Scan e sua associação com variáveis clínico-patológicas e sobrevida dos pacientes portadores de CECP oral. Métodos: As análises retrospectivas da expressão de GLUT-1 e GLUT-3 foram avaliadas em dois grupos distintos de pacientes. O primeiro deles foram àqueles reconhecidos a partir do Departamento de Imagem, Setor de Medicina Nuclear, Hospital A C Camargo, 30 casos de carcinoma epidermóide de cabeça e pescoço e 24 casos de neoplasia ovariana. O segundo foi a partir de série retrospectiva de pacientes portadores de CECP de boca, oriundos do Departamento de Cirurgia de Cabeça e Pescoço do mesmo hospital. Para o primeiro grupo de pacientes foram feitas análises imunoistoquímicas em lâminas convencionais. Para o segundo grupo, confeccionou-se um tissue micro array (TMA) a partir de 151 casos de CECP levantados de nossos arquivos. Esses últimos casos foram analisados em duplicata, contendo 302 cilindros. A análise imunoistoquímica foi realizada pela técnica da estreptavidina-biotina peroxidase. As análises do TMA foram feitas baseadas no local da marcação das células e na quantidade de células positivas. A freqüência de células marcadas foi classificada baseado no nível de corte de 85% de células positivas para o biomarcador. Nos casos de corte convencional, a análise foi baseada num sistema de escore definido pelo produto da intensidade da reação e número de células positivas. Para as análises de associação entre as variáveis consideradas, verificou-se os métodos de &*61539;2 ou teste exato de Fisher. Para as análises de sobrevida global, o cálculo foi realizado pela técnica de Kaplan-Meier e as comparações entre as curvas de sobrevida, pelo teste de Log-rank. A análise multivariada foi feita pelo modelo de riscos proporcionais de Cox. Foi considerado o nível de significância de 5%. Resultados: Nossos resultados em relação ao primeiro grupo de pacientes aqui estudados, mostraram uma expressão positiva para GLUT-1 (91,7%) na membrana das células de tumores CECP. E 16,7% de expressão positiva para GLUT-3 na membrana das células desse tumor. Os resultados mostraram uma boa concordância entre a proteína GLUT-1 e os achados desse exame de imagem. Em relação à proteína GLUT-3, houve uma fraca correspondência. Para os pacientes portadores de neoplasia ovariana, encontramos GLUT-1 expressa na membrana das células (87%). Para a proteína GLUT-3, foi 21,7% de expressão positiva na membrana das células. Houve boa relação entre a proteína GLUT-1 e os resultados do Pet Scan. A proteína GLUT-3, mostrou uma fraca relação com o Pet Scan. Para os pacientes analisados através da técnica de TMA, mostraram uma associação significativamente positiva entre a expressão do padrão de GLUT-1 com o gênero do paciente (p=0,017), consumo de álcool (p=0,004). Nenhuma associação da expressão padrão de GLUT-1 com o estadiamento clínico foi encontrada, nem com a embolização vascular. Foi observada a existência de associação significativa negativamente entre a expressão de GLUT-3 e o estadiamento clínico (p=0,005) e com a embolização vascular (p=0,005). Em relação ao número de células marcadas, foi observada uma forte associação significativa entre GLUT-1 e o gênero do paciente (p=0,001), estadiamento clínico (p=0,028). Não foi observada qualquer associação significativa com a embolização vascular. Houve uma tendência de associação entre a expressão de GLUT-1 e GLUT-3 (p=0,059). Em relação à sobrevida global, foi observada uma associação significativa com a expressão de padrão agrupado (M e MN/N) (p=0,015) e estratificado de GLUT-1(p=0,041) e também com a proteína GLUT-3 (p=0,002). Foi observada uma associação significativa entre a sobrevida livre de doença e a expressão da proteína GLUT-3 (p=0,021). Pela análise multivariada, observou-se que o estadiamento clínico (p=0,006) permaneceu como fator de prognóstico independente para recorrência. A embolização vascular (p=0,003), a expressão de GLUT-1 (M e MN/N) (p=0,006) e a expressão de GLUT-3 (p=0,018) permaneceram como fatores prognósticos independentes para óbito. Conclusão: No presente trabalho, verificamos que o exame de Pet Scan independe da expressão de GLUT-1 e GLUT-3 para a detecção de carcinomas da cabeça e pescoço e de ovário. Em CECP bucal, a presença da expressão nuclear de GLUT-1 se associa com o maior consumo de álcool e pior sobrevida global. A presença da expressão de GLUT-1 ocorre mais freqüentemente em carcinoma epidermóide da boca do que GLUT-3. Pela detecção imunoistquímica de GLUT-3 e através das análises estatísticas, tanto univariada quanto multivariada, ele é um fator de pior sobrevida global assim como GLUT-1 e embolização vascular.

Background: Increased glycolitic metabolism has been established as a characteristic of malignant cells. Among the mecanisms that contribute to the glycolytic phenotype, overexpression of glucose transporters, and especially of GLUT-1 and GLUT-3, has been reported for a large variety of tumors, including squamous cell carcinoma of the head and neck (SCCHN) and ovary. Recently, the clinic introduction of positron emission tomography (FDG-PET) provided a means for a noninvasive quantitative assessment of tumor glucose metabolism in vivo. It has been used to identify aggressive tumors. This study was designed initially to measure GLUT-1 and GLUT-3 expression with immunologic techniques involved in the upatke cell glucose in archival specimens of SCCHN and ovary cancer, verifying their influence in the Pet Sacn findings. Also, to study the association with clinicopathological features and survival of the oral SCC patients. Methods: The retrospective anlyses of the GLUT-1 and GLUT-3 expressions were evaluated in two distints groups of patients. The first one, were specimens retrieved from the Image Department of Nuclear Medicine, A C Camargo Hospital, 30 cases of SCCHN and 24 cases of ovarian cancer. The second one, were specimens retrieved from the pathology archives with oral SCC (OSCC), obtened from the Head and Neck Department from the same hospital. For the first group, was submited immunohistochemical analysis in conventional slides. For the second group, was made the tissue micro array (TMA) from 151 cases of oral SCC from our archives. These were analysed in duplicate, incluing 302 cores. The immunohistochemical analysis were achieved by avidin-biotin technique. The criteria for analysis for TMA were based on site of the immunostaning in the cells and also in the frequency of 85% of the positive cells. According to analysis of conventional slides, was based on a score system defined by the product of intensity and frequency of positive cells. Statistical analyses were performed using chi-square or Fisher's tests. Survival curves were constructed according to the method of Kaplan-Meier. For diferences between curves, the P value was calculated using the long rank test. A P value of <0.05 was considered statistically significant. A multivariate COX regression analysis was performed to assess the prognostic significance of different staining patterns and their relationship with other pathological variables. Results: In the first group of patients, 91,7% of the cases were GLUT-1 overexpression in the cell membrane of SCCHN. The positive GLUT-3 expression was seen in 16,7% of the patients in the cell membrane of this tumor. Their relationship with Pet Scan findings in SCCHN, showed a good concordance between GLUT-1. Unlike GLUT-1 protein, the GLUT-3 protein showed low relation with Pet Scan exam. Additionaly, the patients that exhibited ovary cancer were closely related to GLUT-1 overexpression in the membrane of the cells (87%). The GLUT-3 expression was found a low positivity in the membrane of the cells (21,7%). In relation to Pet Scan findings, it was found a good correspondance with GLUT-1. A weak relation was found with GLUT-3 expression and Pet Scan. For the second group of patients, analysed by TMA technique: the pattern of GLUT-1 expression showed significant association with patients gender (p=0,017), showing a strong association with male sex (p=0,008) and alcohol consumption (p=0,004), when in group of pattern expression (M e MN/M) (p=0,042). No statistical association was found neither between GLUT-1 expression and clinical staging, nor vascular embolization. Although, the patients with positive expression of GLUT-3 expression showed negative significance statistical between clinical staging (p=0,005) and vascular embolization (p=0,005). In relation to the proportion of positive cells, was observed a strong association between GLUT-1 and patients gender as well as clinical staging (p=0,028). No statistical association was found between GLUT-1 expression and vascular embolization. There was not significant association between GLUT-1 and GLUT-3 expression, although showed trends to significance. Besides, there was an association between overall survival and GLUT-1 (M e MN/N) (p=0,015), and stratified group (p= 0,041), and also with GLUT-3 (p=0,002). The positive expression of GLUT-3 was associated with free disease survival (p=0,021). In multivariated analysis, only the clinical staging (p=0,006), persisted as independent prognostic marker of relapse. The vascular embolization (p=0,003), GLUT-1 expression (M e MN/N) (p=0,006) and GLUT-3 expression (p=0,018) remaining as independent prognostic markers of overall survival. Conlusion: In the present study, we observed that the detection of recurrent tumor by Pet Scan in SCCHN and ovary cancer no needing of GLUT-1 and GLUT-3 expression. According to our data, the nuclear expression patterns of GLUT-1 is associated with the major alcohol consumption and poor survival as well as GLUT-3 positive expression is a factor of free disease survival, which could be useful prognostic markers. We also demonstrated that the presence of GLUT-1 overexpression occurs more frequently in OSCC than GLUT-3. Furthermore, other clinicopathological parameters like clinical staging indicated that vascular embolization as well as GLUT-1 expression patterns and GLUT-3 expression to be potentials prognostic factors to death that it was noticed by the multivariated analysis.

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