Analytical and quantitative cytology and histology / the International Academy of Cytology [and] American Society of Cytology, 2003
To characterize, by morphometric and chromatin texture analysis, a series of rectal carcinomas cl... more To characterize, by morphometric and chromatin texture analysis, a series of rectal carcinomas classified according to Dukes staging. High-resolution imagery of 6,001 nuclei from 51 specimens of rectal carcinoma and 22 specimens of normal rectal tissue was digitally recorded. A set of 93 features descriptive of the spatial and statistical distribution of nuclear chromatin was computed for each nucleus to form a characteristic signature. Rectal carcinomas were significantly different from normal rectum in their digital signature. Eleven karyometric features, such as nuclear area and total optical density, were clearly different between the groups, with significant differences found in analysis of 8 of those features. The most distinctive pattern in lesion signatures in comparison with normal rectal tissue was observed at Dukes' stage D. However, the highest average signature values were seen at Dukes' stage B. The lesion signatures and total optical density observed in cancer...
Analytical and quantitative cytology and histology / the International Academy of Cytology [and] American Society of Cytology, 2003
To investigate the prognostic value of nuclear features in rectal carcinoma. High-resolution imag... more To investigate the prognostic value of nuclear features in rectal carcinoma. High-resolution imagery of 3,635 nuclei from 51 patients operated on for rectal cancer at various Dukes' stages was digitally recorded. A set of 93 features descriptive of the spatial and statistical distribution of nuclear chromatin was computed for each nucleus to derive a digital signature. Karyometric features were analyzed for correlation with progression of disease and death. Multivariate analysis of main karyometric features in comparison with cancer staging demonstrated that total optical density and clumpness, as well as average nuclear signature, had significant prognostic value in predicting cancer-related death. Digital signature seems to have a role as prognostic factor in rectal cancer. The method could be a useful parameter in deciding whether to perform adjuvant therapy in particular subgroups of patients, independently of tumor staging. However, these observations need to be substantiat...
A disseminação metastática endotraqueal e endobrônquica do câncer de cólon é um evento raro. Os a... more A disseminação metastática endotraqueal e endobrônquica do câncer de cólon é um evento raro. Os autores relatam o caso de um paciente com manifestação aguda de doença metastática endotraqueal e endobrônquica, 10 anos após o tratamento do tumor primário.
In this letter, we report a case of a 57-year-old woman referred to our Coloproctology Division w... more In this letter, we report a case of a 57-year-old woman referred to our Coloproctology Division with symptoms of progressive constipation and a colonoscopy showing a rigid stenosis of the sigmoid colon, without any mucosal lesion. She had a history of a radical hysterectomy, performed 5 years earlier, due to a well-differentiated villoglandular cervical adenocarcinoma (Fig 1a). After a preoperative workup without additional findings, she underwent a sigmoid resection. Histopathologic examination of the surgical specimen revealed a well-differentiated glandular malignant tumor (3 9 3 cm) within the intestinal wall (Fig. 1b), without extension to the mucosal layer, but showing tumor emboli within subserosal vessels (Fig 1c). This glandular pattern was very similar to that previously seen in the cervical adenocarcinoma. Immunohistochemical analysis of the tumor confirmed the diagnosis of adenocarcinoma originating in the cervix. The immunohistochemical profile was as follows: strong intensity staining for CEA, CA125 and CK7 in 100 % of the tumor cells; strong staining for CK20 in 70 % of the cells; and negative staining for p53, k-ras and progesterone receptor. Considering the well-known etiological correlation of human papillomavirus (HPV) and cervical cancer, we decided to analyze tumor tissues through MY/GP-nested polymerase chain reaction (PCR) and through GP5?/ GP6? auto-nested PCR. Specific primer sets targeting the E6/E7 region of the HPVs 16, 18, 33, 45 were used for typing. The molecular analyses revealed the presence of HPV18 in both the primary cervical adenocarcinoma and the metastatic tumor. Metastatic lesions involving the colon are rare, being usually related to carcinomas of the breast and kidney or to melanoma. Colonic metastases of cervical cancers are exceedingly rare. To date, there are only 9 cases reported in the literature (eight squamous carcinomas) [1–5]. There is only one report of a cervical adenocarcinoma metastasizing to the large bowel, which also involved the sigmoid colon with extension to the subserosa [5]. HPV has been definitely implicated in the process of cervical carcinogenesis. Its role in development of primary colorectal cancer has also been demonstrated [6]. Some authors have reported the identification of HPV deoxyribonucleic acid (DNA) in bone, lung, liver and lymph node metastasis from squamous cell carcinoma of the cervix [4]. However, to the best of our knowledge, the present article is the first to report the detection of HPV within a metastastic adenocarcinoma of the cervix involving the colon. Our findings confirm the importance of HPV in cervical carcinogenesis and reinforce prior data indicating that viral integration into host cell DNA represents a crucial step for development of the malignant phenotype and tumor dissemination. A. P. Damin G. Agnes Laboratory of Molecular Biology, Federal University of Health Science of Porto Alegre, Porto Alegre, Brazil
This study was conducted to assess the feasibility of the sentinel lymph node procedure in patien... more This study was conducted to assess the feasibility of the sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal. Between February 2001 and November 2002, 14 patients with epidermoid carcinoma of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel lymph node procedure consisted of a combination of preoperative lymphoscintigraphy with technetium 99m dextran 500 injected around the tumor and intraoperative detection of the sentinel node with a gamma probe. Patent blue V dye was also injected at the periphery of the tumor to facilitate direct identification of the blue-stained lymph node. After removal, the sentinel node was studied by hematoxylin and eosin staining and immunohistochemistry for pancytokeratins (antigen A1 and A3). Detection and removal of sentinel lymph nodes was possible in all patients. There was no correlation between tumor size and pattern of lymphatic drainage to the groin. Tumors located in the midline of the anal canal gave rise to bilateral sentinel nodes in eight of nine cases. In total, 23 sentinel lymph nodes were removed. One patient (7.1 percent) had a node identified as positive for metastatic carcinoma on immunohistochemical staining. Surgical complications were minimal. The standardized technique was safe and highly effective in sampling inguinal sentinel lymph nodes in carcinoma of the anal canal. It also proved to be useful as an instrument to detect micrometastatic deposits in clinically normal nodes. Our early results suggest the sentinel lymph node procedure may have a role in guiding a more selective approach for patients with anal cancer. Additional studies in a larger patient population to determine the sensitivity and specificity of this method are warranted.
Analytical and quantitative cytology and histology / the International Academy of Cytology [and] American Society of Cytology, 2003
To characterize, by morphometric and chromatin texture analysis, a series of rectal carcinomas cl... more To characterize, by morphometric and chromatin texture analysis, a series of rectal carcinomas classified according to Dukes staging. High-resolution imagery of 6,001 nuclei from 51 specimens of rectal carcinoma and 22 specimens of normal rectal tissue was digitally recorded. A set of 93 features descriptive of the spatial and statistical distribution of nuclear chromatin was computed for each nucleus to form a characteristic signature. Rectal carcinomas were significantly different from normal rectum in their digital signature. Eleven karyometric features, such as nuclear area and total optical density, were clearly different between the groups, with significant differences found in analysis of 8 of those features. The most distinctive pattern in lesion signatures in comparison with normal rectal tissue was observed at Dukes' stage D. However, the highest average signature values were seen at Dukes' stage B. The lesion signatures and total optical density observed in cancer...
Analytical and quantitative cytology and histology / the International Academy of Cytology [and] American Society of Cytology, 2003
To investigate the prognostic value of nuclear features in rectal carcinoma. High-resolution imag... more To investigate the prognostic value of nuclear features in rectal carcinoma. High-resolution imagery of 3,635 nuclei from 51 patients operated on for rectal cancer at various Dukes' stages was digitally recorded. A set of 93 features descriptive of the spatial and statistical distribution of nuclear chromatin was computed for each nucleus to derive a digital signature. Karyometric features were analyzed for correlation with progression of disease and death. Multivariate analysis of main karyometric features in comparison with cancer staging demonstrated that total optical density and clumpness, as well as average nuclear signature, had significant prognostic value in predicting cancer-related death. Digital signature seems to have a role as prognostic factor in rectal cancer. The method could be a useful parameter in deciding whether to perform adjuvant therapy in particular subgroups of patients, independently of tumor staging. However, these observations need to be substantiat...
A disseminação metastática endotraqueal e endobrônquica do câncer de cólon é um evento raro. Os a... more A disseminação metastática endotraqueal e endobrônquica do câncer de cólon é um evento raro. Os autores relatam o caso de um paciente com manifestação aguda de doença metastática endotraqueal e endobrônquica, 10 anos após o tratamento do tumor primário.
In this letter, we report a case of a 57-year-old woman referred to our Coloproctology Division w... more In this letter, we report a case of a 57-year-old woman referred to our Coloproctology Division with symptoms of progressive constipation and a colonoscopy showing a rigid stenosis of the sigmoid colon, without any mucosal lesion. She had a history of a radical hysterectomy, performed 5 years earlier, due to a well-differentiated villoglandular cervical adenocarcinoma (Fig 1a). After a preoperative workup without additional findings, she underwent a sigmoid resection. Histopathologic examination of the surgical specimen revealed a well-differentiated glandular malignant tumor (3 9 3 cm) within the intestinal wall (Fig. 1b), without extension to the mucosal layer, but showing tumor emboli within subserosal vessels (Fig 1c). This glandular pattern was very similar to that previously seen in the cervical adenocarcinoma. Immunohistochemical analysis of the tumor confirmed the diagnosis of adenocarcinoma originating in the cervix. The immunohistochemical profile was as follows: strong intensity staining for CEA, CA125 and CK7 in 100 % of the tumor cells; strong staining for CK20 in 70 % of the cells; and negative staining for p53, k-ras and progesterone receptor. Considering the well-known etiological correlation of human papillomavirus (HPV) and cervical cancer, we decided to analyze tumor tissues through MY/GP-nested polymerase chain reaction (PCR) and through GP5?/ GP6? auto-nested PCR. Specific primer sets targeting the E6/E7 region of the HPVs 16, 18, 33, 45 were used for typing. The molecular analyses revealed the presence of HPV18 in both the primary cervical adenocarcinoma and the metastatic tumor. Metastatic lesions involving the colon are rare, being usually related to carcinomas of the breast and kidney or to melanoma. Colonic metastases of cervical cancers are exceedingly rare. To date, there are only 9 cases reported in the literature (eight squamous carcinomas) [1–5]. There is only one report of a cervical adenocarcinoma metastasizing to the large bowel, which also involved the sigmoid colon with extension to the subserosa [5]. HPV has been definitely implicated in the process of cervical carcinogenesis. Its role in development of primary colorectal cancer has also been demonstrated [6]. Some authors have reported the identification of HPV deoxyribonucleic acid (DNA) in bone, lung, liver and lymph node metastasis from squamous cell carcinoma of the cervix [4]. However, to the best of our knowledge, the present article is the first to report the detection of HPV within a metastastic adenocarcinoma of the cervix involving the colon. Our findings confirm the importance of HPV in cervical carcinogenesis and reinforce prior data indicating that viral integration into host cell DNA represents a crucial step for development of the malignant phenotype and tumor dissemination. A. P. Damin G. Agnes Laboratory of Molecular Biology, Federal University of Health Science of Porto Alegre, Porto Alegre, Brazil
This study was conducted to assess the feasibility of the sentinel lymph node procedure in patien... more This study was conducted to assess the feasibility of the sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal. Between February 2001 and November 2002, 14 patients with epidermoid carcinoma of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel lymph node procedure consisted of a combination of preoperative lymphoscintigraphy with technetium 99m dextran 500 injected around the tumor and intraoperative detection of the sentinel node with a gamma probe. Patent blue V dye was also injected at the periphery of the tumor to facilitate direct identification of the blue-stained lymph node. After removal, the sentinel node was studied by hematoxylin and eosin staining and immunohistochemistry for pancytokeratins (antigen A1 and A3). Detection and removal of sentinel lymph nodes was possible in all patients. There was no correlation between tumor size and pattern of lymphatic drainage to the groin. Tumors located in the midline of the anal canal gave rise to bilateral sentinel nodes in eight of nine cases. In total, 23 sentinel lymph nodes were removed. One patient (7.1 percent) had a node identified as positive for metastatic carcinoma on immunohistochemical staining. Surgical complications were minimal. The standardized technique was safe and highly effective in sampling inguinal sentinel lymph nodes in carcinoma of the anal canal. It also proved to be useful as an instrument to detect micrometastatic deposits in clinically normal nodes. Our early results suggest the sentinel lymph node procedure may have a role in guiding a more selective approach for patients with anal cancer. Additional studies in a larger patient population to determine the sensitivity and specificity of this method are warranted.
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Papers by Daniel Damin