Magíster en Bioquímica área de Especialización en Bioquímica Clínica y memoria para optar al Título de Bioquímico / Autor no autoriza el acceso a texto completo de su documento hasta enero 2017 / El Carcinoma Basocelular Cutáneo (BCC), un tipo de cáncer de piel, es una de las neoplasias más frecuentes en el ser humano. Es causado por una desregulación de la vía Sonic Hedgehog/Gli (Shh/Gli), cuya señalización juega un rol importante en la proliferación y mantenimiento de nichos celulares troncales. Comúnmente el BCC se caracteriza por ser poco metastático, sin embargo es capaz de dañar significativamente el tejido y existen subtipos de gran agresividad y recurrencia. Por esto se hace necesario entender mejor esta patología y buscar nuevos blancos terapéuticos y/o marcadores tumorales que ayuden a mejorar la prognosis y tratamiento de esta enfermedad. Recientemente se reportó que la proteína Neogenina-1 (NEO1) es un blanco transcripcional de la vía Shh/Gli. NEO1 es un receptor transmembrana de Netrinas y RGM con funciones contexto y ligando dependientes. Se ha postulado que NEO1 pertenece a la familia de receptores de dependencia, entre otras funciones. La habilidad de estos receptores de gatillar apoptosis en ausencia de ligando se ha propuesto como un mecanismo de supresión tumoral, implicado tanto en proliferación como sobrevida de células tumorales. Diversos antecedentes indican que la expresión de NEO1 varía en distintos tipos de cáncer, relacionándose con su grado de proliferación, indiferenciación, agresividad y sobrevida. Estos antecedentes junto a un estudio piloto desarrollado en el laboratorio de la Dra. Palma que indica la presencia de NEO1 en muestras de BCC, permiten postular que: “Los niveles de expresión receptor de dependencia NEO1 y su(s) ligando(s) varían en la progresión del BCC ligado a la sobre-activación de la vía de señalización SHH/GLI”. Para comprobar esta hipótesis se analizó la expresión de mRNA de NEO1 y sus ligandos por PCR cuantitativo y por inmunotinciones en muestras de pacientes con BCC y muestras de piel sana correlacionándolos con la actividad de la vía SHH/GLI; se evaluó la relación entre los niveles de NEO1 y sus ligandos con la agresividad tumoral; y por último se analizaron las variaciones de este receptor, sus ligandos y reporteros la vía Shh/Gli en un modelo murino de BCC. Como principales resultados se observó la presencia de NEO1 y sus ligandos en piel sana y en BCC y se comprobó que los niveles de NEO1 y sus ligandos NTN1 y RGMA se correlacionan positivamente con los niveles de GLI1, un conocido reportero de la vía SHH/GLI. La inhibición de la vía SHH/GLI ex vivo produce una disminución de los niveles de mRNA de estos genes. Notablemente, los niveles de expresión de NEO1, RGMA y GLI1 son menores en las muestras correspondientes a subtipos más agresivos; en la progresión tumoral del BCC murino, dichos niveles disminuyen conforme avanza la enfermedad. El aumento de NEO1 y sus ligandos en las muestras de BCC indolentes podría guardar relación con su rol de receptor de dependencia, promoviendo la proliferación de las células tumorales. En tanto la disminución de NEO1 en subtipos agresivos, guarda relación a lo observado con otros blancos transcripcionales de la vía Shh/Gli y podría estar relacionado con eventos tumorigénicos adicionales. Se concluye que NEO1 y sus ligandos se encuentran aumentados en BCC en correlación con la actividad de la vía SHH/GLI. NEO1 disminuye en casos agresivos de BCC lo que lo podría postular como un potencial marcador prognóstico tumoral / Basal Cell Carcinoma of the skin (BCC), a type of skin cancer, is one of the most common cancers in humans. It is mainly caused by a deregulation of Sonic Hedgehog/ Gli (Shh/Gli) pathway, which plays an important role in proliferation and maintenance of stem cell niches. Commonly, BCC is rarely metastatic, nevertheless it can cause large tissue damage and some aggressive subtypes with great recurrence are known. Therefore a deeper knowledge of this disease is required combined with the search for new therapeutic targets and/or tumor markers that might contribute to improve prognosis and treatment of this pathology. Recently it has been reported that Neogenin-1 (NEO1), a transmembrane receptor, is a transcriptional target of Shh/Gli pathway. NEO1 is a receptor of Netrin and RGM ligands and has both context and ligand dependent functions. NEO1 has been postulated as a death dependence receptor. In the absence of ligand interaction this kind of receptors can trigger apoptosis; process that has been proposed as a tumor suppression mechanism that could be altered in cancer promoting either proliferation or survival of tumor cells. NEO1 and ligand expression have been reported to vary in different types of cancer, in relation to the degree of tumor proliferation, differentiation, aggressiveness and survival. In addition, a pilot study developed in Dra. Palma’s laboratory shows presence of NEO1 in BCC samples. These findings lead us to propose that: “Neogenin-1 and ligand levels of expression vary in BCC tumor progression, relating with SHH/GLI pathway overactivation”. To test this hypothesis both NEO1 and ligand mRNA levels where quantified by qPCR and assessed by immunostaining on human BCC and healthy skin samples, correlating these results with SHH/GLI pathway activity; correlation between NEO1 and ligand levels with aggressiveness was assessed; and finally, variations in NEO1, ligand and SHH/GLI readouts levels were assessed in a BCC mouse model. As key results, presence of NEO1 and ligand was detected in healthy skin and in BCC. NEO1 and ligands (NTN1 and RGMA) mRNA levels presented a positive correlation with GLI1 levels, a classical SHH/GLI readout. Pharmacological inhibition of SHH/GLI pathway ex vivo decreased mRNA levels of these genes. Noteworthy, NEO1, RGMA and GLI1 levels where found to be significantly lower in aggressive subtypes of BCC and, in addition, a decrease their levels with tumor progression was observed. The increase of NEO1 and ligand in BCC samples could be related with its role as a death dependence receptor, promoting tumor cell proliferation. Meanwhile the decrease of NEO1 in aggressiveness could be related with additional tumorigenic events similar to what has been reported for other SHH/GLI transcriptional targets. In conclusion, NEO1 and it ligand are upregulated in BCC in relation to deregulation of the SHH/GLI pathway. NEO1 is decreased in aggressive BCC subtypes; therefore it is possible to evaluate NEO1 as a potential prognosis marker / Conicyt

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science. Johannesburg, 2012 / Cell-extracellular matrix (ECM) detachment triggers a cell survival mechanism known as autophagy. A link between attachment and autophagy suggests a form of adhesion-based regulation, involving mechanotransduction of extracellular-originating signals to the cellular machinery controlling autophagy induction. This implies a role for integrin-linked kinase (ILK), which transmits mechanical stimuli to the mammalian target of rapamycin (mTOR) signalling pathway. Cells with a propensity for metastasis may negate these adhesive signals, inducing autophagy inappropriately. Metastasis is a hallmark of transformation frequently associated with human oesophageal squamous cell carcinoma (HOSCC). Additionally, hyperactive mTOR/mTORC1 signalling correlates increasingly with HOSCC. Therefore, the protein expression of significant signal transduction pathway intermediates was investigated in response to both soluble and ECM-originating stimuli. Measurements by SDS-PAGE and western-blotting coupled to semi-quantitative densitometry, during standard tissue culture conditions, revealed that HOSCC’s expressed moderate-to-high levels of mTOR, p-RPS6(Ser 235/236) and mATG-13; indicating elevated levels of autophagy induction despite aberrant signalling through mTOR/mTORC1. Additionally, an 80 kDa mTORβ isoform was identified in HOSCC cells with lower mTOR abundance, presumably to maintain aberrant mTORC1 signalling. A canonical role for the PI3K/PKB pathway was also identified; where autophagy induction accompanied diminished mTORC1 signalling in response to specific PI3K inhibition with LY294002 and serum withdrawal. However, autophagy induction varied in response to a dose-dependent decrease in mTORC1 signalling after exposure of HOSCC cells to rapamycin. Moreover, specific inhibition of p90RSK with BI-D1870, suggests that mTORC1 phosphorylates RPS6(Ser 235/236) in the absence of MAPK signals. Furthermore, ectopic ILK expression indicated an enhanced potential for adhesion-based signalling. Correspondingly, HOSCC cells commonly increased mTOR and p-RPS6(Ser 235/236) expression following growth on fibronectin or collagen. However, co-immunoprecipitation analysis revealed that signals transduction to mTOR precludes a direct interaction with ILK or FAK. Rather, ECM-modulation of mTOR occurs in a integrin-triggered, but PI3K-depedant manner; since specific inhibition of PI3K negated fibronectin-induced increases of mTOR concentration and RPS6(Ser 235/236) phosphorylation. Thus, these data strongly suggest mTOR is a target for adhesion-based signal transduction, where the ECM influences cell survival through mTORC1. Moreover, exploitation of autophagy induction post cell-ECM detachment in HOSCC may promote the survival of metastases during dissemination.

Being a dissertation presented in fulfilment of the requirements governing the degree of Masters of Science in the Faoulty of Medicine, University of the Witwatersrand / Recent investigations have shown enhanced or aberrant expression of major histocompatibility system (MHC) antigens on cells lines derived from human hepatocellular carcinoma (HCC) in vitro and HCC in vivo. ( Abbreviation abstract ) / AC2017

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine / Medical Oncology. Johannesburg 1st September 2014 / Introduction: Tyrosine kinase inhibitors and EGFR mutations has changed the treatment approach to lung cancer globally. This retrospective study will look at factors associated with EGFR mutations and define the EGFR mutation rate in South Africa. Methods: Retrospective record review from NSCLC patients in South Africa who were tested for EGFR mutations at Lancet Laboratories during 1st September 2009 to 30th June 2012. Chi-squared test was used to determine association with categorical variables. Kaplan- Meier survival analysis was done for OS and PFS between EGFR mutation positive and negative patients. Cox proportional hazards were used for subgroup analysis. Treatment practices and response were described. Results: 170 lung cancer samples were evaluable for EGFR mutation and 37 were EGFR mutation positive (21.8%). There were 22 (59.5%) exon 19 deletions, 11 (29.7%) L858R mutations, two G719X mutations, one S768I mutation and one exon 20 insertion. The median age was 63 (range 27-85). There were more females (55.6%) than males (44.4%) sent for mutation testing. Most patients were whites (71%), followed by blacks (18.3%), and other race (10.7%). 85% of all NSCLC samples tested were adenocarcinoma. None of the squamous cell carcinoma tested was positive for EGFR mutation. Smoking status was inversely proportional to EGFR mutation status (p<0.001). Over 60% patients received chemotherapy first and second line and responses decreased with each line of chemotherapy. Median PFS and OS were not different between the EGFR mutation positive and negative groups (6.85 versus 6.8 months; HR 1.6; 95% CI 0.70-3.65; p=0.2543 and 11.5 versus 12.9 months; HR 0.70; 95% CI 0.28-1.75; p=0.44, respectively). On multivariate analysis, only non-white race was associated with decrease in OS (HR 6.66; 95% CI 2.31-19.19; p=0.0004). Conclusion: EGFR mutation rate in South African lung cancer patients was 21.8%. 89% of all EGFR mutations were either exon 19 deletions or L858R point mutations. Most EGFR mutations were associated with adenocarcinoma of the lung in non-smokers. These findings were consistent with current literature in western countries. Treatment practice remained chemotherapy based, with few patients receiving EGFR TKIs. Efforts should be made to prioritized targeted treatment approach in lung cancer in South Africa.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Radiation Oncology Johannesburg, 2016 / Purpose: To assess the improvement in swallowing status, overall survival and treatment related complications in patients with Carcinoma of the Oesophagus treated with palliative radiotherapy. Methods: A retrospective analysis of patients with advanced squamous cell carcinoma of the oesophagus who were treated for palliation from May 2007 to June 2012 at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) was done. Ninety- nine patients received palliative radiation therapy during this period, 63% were male and 37% female with a mean age of 60, 6 years. The predominant site of lesion was middle 3rd (56%) and 86, 9% of patients had lesions more than 5cm in length. Patients received palliative External beam irradiation (EBRT) with or without High dose rate brachytherapy (HDRBT) as per the CMJAH, Department of Radiation Oncology protocol. Results: There was an overall significant improvement in swallowing status (p<0,001). Eighty –four patients (85%) had an improvement in swallowing score after treatment. The effect of treatment was not significant in the relationship between the change in swallowing status and treatment group. Overall mean time to progression was 3, 7 months. The median overall survival was 7, 7 months. The type of treatment did not affect survival significantly, unadjusted (p=0, 31) or adjusted for prognostic parameters (age, sex, length of lesion, site of lesion, and pre-treatment swallowing status) (p=0.29). There were treatment related complications in 32% of cases, consisting of ulcerations (24%), tracheo- oesophageal fistula (5%) and strictures (3%). Conclusion: In patients with advanced squamous cell oesophageal carcinoma, palliative radiotherapy is an effective modality in improving a patient’s dysphagia and thus quality of life. / MT2016

Epidermal growth factor receptor (EGFR) is a transmembrane receptor tyrosine kinase which activates, upon EGFR binding, a number of signaling pathways including the mitogenic protein kinase pathway (MAPK) and phosphatidylinositol 3-kinase cascade (PI3K). Over expression of EGFR is a common feature in variety of human cancers including lung, colorectal, breast, pancreatic and oesophageal cancers and results in autonomous cell growth, enhanced metastatic potential, tissue invasion and increased resistance to current cancer therapeutics. Thus EGFR has been identified as a potential target in cancer therapeutics. Using the RNA interference (RNAi) pathway, the aim was to specifically knockdown expression levels of endogeneous EGFR in human oesophageal squamous carcinoma cell (HOSCC) lines. The RNAi pathway was initiated through the transfection of three specifically designed short hairpin RNAs (shRNAs) against human EGFR. The shRNAs were specifically designed using bioinformatics tools and their individual knockdown efficacy determined through the introduction of an exogeneous based target reporter systems, psiCHECK and pcieGFP. Expression levels of EGFR were determined using Western blot analysis followed by densitometry. Knockdown of EGFR was achieved by all three EGFR shRNAs in the three HOSCC cell lines (WHCO1, WHCO5 and WHCO6) despite low transfection levels of ~10%. Greastest knockdown of EGFR (85%) was achieved by EGFR sh2 in WHCO5. EGFR sh2 and sh1 resulted in average knockdown of EGFR of ~ 65% in WHCO1 and WHCO5 respectively. Weakest knockdown of EGFR (~ 20%) was obtained by all three EGFR shRNAs following transfection of WHCO6. RNAi-based approaches therefore show substantial potential for the specific and efficient targeting of EGFR in human cancer cells.

ABSTRACT MUC1, a mucin-like transmembrane glycoprotein, is highly overexpressed and aberrantly localized in several invasive carcinomas. MUC1 is proposed to play numerous roles in the transformed behaviour of cells in which it is expressed. A number of these roles are facilitated by the interaction of MUC1 with β-catenin, a protein that is central to both cellular adhesion as well as Wnt-responsive gene transcription. The aim of this study was to investigate MUC1 expression, localization, and interaction with β-catenin, as a means of providing insight into the behaviour of human oesophageal squamous cell carcinoma. This cancer-type is exceptionally aggressive and is a major cause of cancer-related morbidity and mortality in South Africa. MUC1 is expressed and aberrantly localized in oesophageal squamous cell carcinoma cell lines, as demonstrated by RT-PCR, western blotting and indirect immunofluorescence. Moreover, evidence from coimmunoprecipitation assays shows that the MUC1 cytoplasmic tail and β-catenin form a complex both at the cell membrane and importantly, within the nucleus of these cell lines. This is the first demonstration of such a complex in the nucleus of a carcinoma derived from stratified, as opposed to simple, epithelia. Data presented here further indicates that activation of the epidermal growth factor receptor results in modulation of the association between MUC1 and β-catenin at the cell membrane. MUC1 membrane-localization, and interaction with β-catenin, may modulate cellular adhesion through steric interference of cell surface adhesion molecules as well as through sequestration of β-catenin away from adherens junctions. On the other hand, MUC1 association with β-catenin may enhance β- catenin signalling either through the stabilization of β-catenin, or as an essential functional component of the β-catenin/LEF/TCF transcription factor complex. Furthermore, results presented in this study identify oesophageal squamous cell carcinoma as a prime candidate for MUC1-specific immunotherapy. This finding is of substantial importance considering the ineffectual nature of existing therapies used in the treatment of oesophageal carcinoma.

OBJETIVOS: Estudar variáveis anatomopatológicas relacionadas à progressão tumoral em carcinomas uroteliais primários de bexiga e sua associação com a imunoexpressão de metaloproteinases de matriz (MMPs) - 2, -9 e -14 no epitélio e no estroma dos tumores primários e nas metástases linfonodais. MÉTODOS: Sessenta e um casos de carcinomas uroteliais musculoinvasivos ou localmente avançados primários da bexiga operados no Hospital das Clínicas da Faculdade de Medicina da USP e no Instituto do Câncer do Estado de São Paulo, sendo 34 casos com metástase para linfonodo regional, foram caracterizados quanto ao gênero, idade, tamanho, focalidade, grau histológico, tipo/configuração neoplásica, tipo papilífero da neoplasia, padrão arquitetural de invasão tumoral, grau de atipia nuclear, componente sarcomatoide, diferenciações escamosa e glandular, variante histológica, invasões linfovascular e perineural, carcinoma in situ, estádio do tumor primário, metástase para linfonodo regional, tamanho da metástase e extensão extranodal. Amostras teciduais de 1,0 mm foram dispostas em micromatrizes teciduais (TMA) para pesquisa imuno-histoquímica (IH) das enzimas MMP-2, MMP-9 e MMP-14. A expressão IH das MMPs foi graduada em uma escala semiquantitativa de 0 (ausência de expressão) até 20 (maior expressão). As associações entre a imunoexpressão das MMPs de forma global, no epitélio e estroma do tumor primário e na metástase linfonodal com as variáveis anatomopatológicas foram avaliadas através do teste do qui-quadrado de Pearson, sendo consideradas significativas ao nível de p<0,05. RESULTADOS: Trinta e seis, 57 e 60 casos do tumor primário foram positivos para MMP-2, MMP-9 e MMP-14, respectivamente. Nas metástases linfonodais, 20, 27 e 26 casos foram positivos para MMP-2, MMP-9 e MMP-14, respectivamente. A imunoexpressão global de MMP-2 no tumor primário mostrou-se associada com o padrão arquitetural de invasão (p=0,022) e sua expressão no estroma com o grau de atipia nuclear (p=0,032) e a porcentagem de componente sarcomatoide (p=0,003). A imunoexpressão global de MMP-9 no tumor primário mostrou-se associada com diferenciação escamosa (p=0,033). O padrão arquitetural de invasão relacionou-se com a expressão de MMP-9 no epitélio (p=0,043) e no estroma (p=0,044). A expressão de MMP-9 no estroma mostrou-se associada com o grau de atipia nuclear (p=0,031), componente sarcomatoide (p=0,036) e com a porcentagem desse componente no tumor primário (p=0,013). O estádio tumoral agrupado pT2+pT3 vs pT4 demonstrou associação com a MMP-9 expressa no epitélio (p=0,049). Para a MMP-14, o padrão arquitetural de invasão demonstrou associação significativa com a imunoexpressão global (p=0,022) e no epitélio tumoral (p=0,045). A porcentagem de componente sarcomatoide relacionou-se ainda com a expressão estromal de MMP-14 (p<0,001). Considerando a imunoexpressão de MMPs apenas na metástase linfonodal, houve associação significativa da MMP-9 com o tipo de variante histológica do tumor (p=0,021) e da expressão de MMP-14 com a porcentagem de componente sarcomatoide no tumor primário (p=0,017). CONCLUSÃO: O estudo da imunoexpressão de MMP-2, MMP-9 e MMP-14 em amostras organizadas em TMA, tanto no epitélio como no estroma dos carcinomas uroteliais de bexiga e nas metástases de linfonodos regionais, demonstrou associações estatísticas com características anatomopatológicas reconhecidas como de prognóstico ruim para essas neoplasias, indicando a ação dessas enzimas na transição epitélio-mesênquima e nas etapas de progressão e metástase dos carcinomas uroteliais / OBJECTIVES: To study morphological features related to tumor progression in urothelial carcinoma of the urinary bladder and its association with immunohistochemical (IHC) expression of matrix metalloproteinases (MMPs) -2, -9 and -14 in epithelial and stromal cells of primary tumor and regional lymph node metastases. METHODS: Sixty-one cases of muscle-invasive or locally advanced urothelial carcinomas of the bladder operated on Clinic\'s Hospital of Faculty Medicine Sao Paulo University and the Cancer Institute of the State of Sao Paulo, with 34 cases showing regional lymph nodes metastases, were characterized regarding gender, age, tumor size, multifocality, histological grade, neoplastic type/configuration, papillary type, architectural pattern of invasive tumor, nuclear atypia, sarcomatoid component, squamous and glandular diffentiation, histological variants, lymphovascular and perineural invasion, carcinoma in situ, tumor stage, metastases to regional lymph nodes, metastases size and extranodal extension. Tissue samples of 1.0 mm were arranged in tissue microarrays blocks (TMA) for IHC detection of MMP-2, MMP-9 and MMP-14. The grading of expression of MMPs was determined to a semiquantitative scale from 0 (absence) to 20 (higher expression). The associations between the IHC global expression of MMPs, in epithelium and in stromal cells of the primary tumor and in the lymph node metastases with the morphological features were obtained through Pearson\'s chi-square (significant at p<0.05). RESULTS: Thirty-six, 57 and 60 cases of primary tumor were positive for MMP-2, MMP-9 and MMP-14 respectively. In the lymph nodes metastases, 20, 27 and 26 cases were positive for MMP-2, MMP-9 and MMP-14 respectively. The global IHC expression of MMP-2 in primary tumor has been associated with the architectural pattern of invasion (p=0.022). The expression in stromal cells were correlated with the degree of nuclear atypia (p=0.032) and the percentage of sarcomatoid component (p=0.003). The IHC expression of MMP-9 in primary tumor has been associated with squamous differentiation (p=0.033). The architectural pattern of invasion was related to the expression of MMP-9 in epithelium (p=0.043) and in the stroma (p=0.044). Expression of MMP-9 in the stroma was associated with the degree of nuclear atypia (p=0.031), sarcomatoid component (p=0.036) and the percentage of this component in primary tumor (p=0.013). The grouped tumoral stage pT2+pT3 vs pT4 showed association with MMP-9 expressed in epithelium (p=0.049). For MMP-14, the architectural pattern of invasion showed significant association with global IHC expression (p=0.022) and tumor epithelium (p=0.045). The percentage of sarcomatoid component related to the estromal expression of MMP-14 (p<0.001). Considering the IHC expression of MMPs in lymph nodes metastases, there was a significant association between MMP-9 with the type of histological variants (p=0.021) and the expression of MMP-14 with the percentage of sarcomatoid component in primary tumor (p=0.017). CONCLUSION: The study of IHC expression of MMP-2, MMP-9 and MMP-14 in bladder carcinoma samples arranged in TMA, both in epithelium and in stromal cells and regional lymph nodes metastases, demonstrated significant association with morphological features recognized as prognostically important for these tumors. These findings herald the importance of action of these enzymes in epithelialmesenchymal transition, providing basis for the understanding of tumoral progression and metastases in urothelial carcinoma

Carcinoma de Células Renais (CCR) representa uma família de tumores distintos com evolução clínica imprevisível. Uma variedade de moléculas tem sido avaliada como marcadores prognósticos para CCR. Ciclina D1, uma proteína reguladora do ciclo celular, encontra-se superexpressa em vários tumores primários. Nosso objetivo é avaliar sua expressão como marcador prognóstico em CCR. Antes disso, traçamos um perfil clínico e histopatológico da amostra e verificamos sua relação com os fatores prognósticos considerados clássicos pela literatura. 109 espécimes de pacientes diagnosticados com CCR foram obtidos entre 2005 e 2010 no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto USP e submetidos à análise imunoistoquímica juntamente com 07 amostras de tecido renal normal. A maior parte das características epidemiológicas e clínicas de nossa amostra foi similar àquelas descritas na literatura mundial. Houve predomínio do gênero masculino, da raça branca, com idade próxima a 60 anos, frequência de pacientes assintomáticos em torno de 36% e grande prevalência do CCR de células claras (71,55%). A mortalidade específica da doença foi de 13,76%, sendo o CCR de células claras o tipo mais frequente entre os óbitos e casos metastáticos. Os casos que exibiram má evolução clínica, definida pela ocorrência de metástase e/ou óbito por CCR (22,01%), estiveram associados à presença de sintomas ao diagnóstico, maior tamanho tumoral, grupo de estágio alto (III ou IV), grau nuclear de Fuhrman alto (3 ou 4), presença de necrose e de diferenciação sarcomatóide no tumor, além de outros fatores histológicos desfavoráveis (p < 0,01). Isso indica que as variáveis utilizadas na avaliação de prognóstico em países desenvolvidos podem ser aplicadas aos nossos pacientes. Não houve expressão imunoistoquímica de Ciclina D1 nos casos de tecido renal normal. Observou-se heterogeneidade de marcação nuclear intratumoral no total de casos e menor expressão proteica entre os CCR papilífero e cromófobo. Pacientes com tumores com Ciclina D1baixa (até 30% de células positivas) apresentaram má evolução clínica (p = 0,03), maior tamanho tumoral (p = 0,01), presença de sintomas ao diagnóstico (p = 0,04), grau nuclear alto (p = 0,001), presença de necrose (p = 0,004) e de diferenciação sarcomatóide (p = 0,04) no tumor, além de menor sobrevida sem metástase e/ou óbito por CCR (p = 0,03). Após análise multivariada, a expressão de Ciclina D1 não apresentou valor prognóstico independente para má evolução clínica, embora tenha aumentado levemente a acurácia prognóstica do modelo adotado. Em todas as análises realizadas para o CCR de células claras isoladamente, observamos significância estatística semelhante à do total de casos (CCR). Nosso estudo demonstrou que: a proteína Ciclina D1 encontra-se superexpressa em CCR; os tipos de CCR parecem exibir diferentes padrões de marcação imunoistoquímica da Ciclina D1; alta marcação da proteína (acima de 30% de células positivas) esteve associada à boa evolução clínica e à maioria dos fatores prognósticos favoráveis bem estabelecidos na literatura. Novas investigações são necessárias para descobrir que mecanismos levam a seu acúmulo nas células neoplásicas e quais outros eventos podem estar contribuindo para a progressão da doença. / Renal Cell Carcinoma (RCC) is a family of distinct tumors with unpredictable clinical outcome. A variety of molecules have been evaluated as prognostic markers for RCC. Cyclin D1, a cell cycle regulatory protein, is overexpressed in several primary tumors. Our purpose is to evaluate its expression as a prognostic marker in RCC. Before that, we drew a clinical and histopathological profile of the sample and verified its relationship with prognostic factors regarded as classics in literature. 109 specimens from patients diagnosed with RCC were obtained between 2005 and 2010 at Hospital das Clínicas - Ribeirão Preto School of Medicine USP and submitted to immunohistochemical analysis, along with 07 normal kidney tissue samples. Most epidemiological and clinical characteristics of our sample were similar to those described in the literature. There was a predominance of male, Caucasian, aged about 60 years, the frequency of asymptomatic patients around 36%, and high prevalence of clear cell RCC (71.55%). The disease-specific mortality was 13.76%, being the clear cell RCC the most frequent type among deaths and metastatic cases. Cases that exhibited poor clinical outcome, defined by the occurrence of metastasis and/or death by RCC (22.01%), were related to the presence of symptoms at diagnosis, larger tumor size, high stage group (III or IV), high Fuhrman nuclear grade (3 or 4), presence of necrosis and sarcomatoid differentiation in the tumor and other unfavorable histological factors (p < 0.01). This indicates that the variables used in the assessment of prognosis in developed countries can be applied to our patients. There was no immunohistochemical expression of Cyclin D1 in cases of normal kidney tissue. There was intratumoral heterogeneity in nuclear staining in all cases and lower protein expression among papillary and chromophobe RCC. Patients with Cyclin D1low tumors (up to 30% positive cells) showed poor clinical outcome (p = 0.03), larger tumor size (p = 0.01), presence of symptoms at diagnosis (p = 0.04), high nuclear grade (p = 0.001), presence of necrosis (p = 0.004) and sarcomatoid differentiation (p = 0.04) in the tumor and lower survival without metastasis and/or death by RCC (p = 0.03). After multivariate analysis, the expression of Cyclin D1 showed no independent prognostic value for poor clinical outcome, although it has slightly increased the prognostic accuracy of the model adopted. In all analyzes performed for clear cell RCC alone, we observed statistical significance similar to that of the total cases (RCC). Our study showed that: Cyclin D1 protein is overexpressed in RCC; RCC types seem to exhibit different patterns of immunohistochemical staining for Cyclin D1; high protein expression (over 30% positive cells) was related to good clinical outcome and to most favorable prognostic factors well established in the literature. Further investigations are necessary to reveal which mechanisms lead to its accumulation in neoplastic cells and what other events might be contributing to the progression of the disease.

Objetivou-se descrever os padrões de sinal nos exames de ressonância magnética (RM) dos carcinomas de células renais (CCR) de células claras e papilares tipos 1 e 2, correlacionando-os com os achados histopatológicos, bem como avaliar o realce dos tumores após a administração intravenosa do meio de contraste paramagnético. Pesquisa no banco de dados da patologia nos últimos 5 anos identificou 49 CCR avaliados com imagens por ressonância magnética (RM), dos quais 37 (17 CCR papilares tipo 1, 4 CCR papilares tipo 2 e 16 CCR de células claras) tinham espécimes patológica disponíveis para avaliação. A intensidade do sinal (IS) dos CCR comparados ao córtex renal, qualitativamente e quantitativamente (IS do tumor/IS do córtex renal x 100), nas imagens por RM ponderadas em T1 e T2, assim como o realce do tumor (qualitativamente e quantitativamente) foram avaliados por 2 radiologistas independentes. Um patologista avaliou as características das células tumorais e achados associados como a presença de hemosiderina, ferritina, sangue fresco, necrose, fibrose e calcificação. Os três subtipos de CCR avaliados tinham padrão diverso nas imagens ponderadas em T1 (p>0.05). Na análise qualitativa das imagens ponderadas em T2, o hiposinal foi observado predominantemente nos CCR papilares tipos 1 e 2, e hipersinal apenas identificado entre os CCR de células claras (p<0.05); dado confirmado na avaliação quantitativa da IS dos tumores (CCR papilares tipo 1: 71% ±16%, CCR papilares tipo 2: 54% ±23% e CCR de células claras: 141% ±44%) (p<0.01). Nas imagens ponderadas em T2, uma IS do tumor de 96% ou menos teve uma sensibilidade de 96% e especificidade de 89% para CCR papilar quando comparado com CCR de células claras e uma IS de 66% ou menos teve uma sensibilidade de 54% e especificidade de 100%. A arquitetura tumoral predominante (papilar para os tumores com hiposinal e em ninho para os tumores com hipersinal) foi o único achado histopatológico que se correlacionou com a IS nas imagens por RM ponderadas em T2 (p<0.05). A maioria dos CCR de células claras apresentou um realce heterogêneo enquanto os CCR papilares tipos 1 e 2 apresentaram um realce variado. Os CCR papilares tipos 1 e 2 realçaram menos do que os CCR de células claras em todas as fases após administração do meio de contraste, sendo essa diferença estatisticamente significativa nas fases córtico-medular e nefrográficas precoce e tardia. Em conclusão, nas imagens ponderadas em T2, o hiposinal foi observado predominantemente nos CCR papilares tipos 1 e 2, e hipersinal apenas identificado entre os CCR de células claras. Houve correlação entre a IS dos tumores e a arquitetura tumoral predominante, papilar para os tumores com hiposinal em T2 e em ninho para os tumores com hipersinal em T2. Os CCR de células claras tiveram um realce mensurado maior que os CCR papilares. / The purpose of this study is to describe magnetic resonance imaging (MRI) tumor signal intensity (SI) of clear cell, and types 1 and 2 papillary renal cell carcinomas (RCC), correlating with histopathologic findings, as well as to evaluate tumor enhancement after intravenous administration of paramagnetic contrast. A query on our pathology database for the past 5 years identified 49 RCC, which were evaluated with MRI. Of these, 37 (17 papillary type 1, 4 papillary type 2, and 16 clear cell) pathology specimens were available for review. Two independent radiologists assessed tumor SI compared to renal cortex, both qualitatively and quantitatively (tumor SI/renal cortex SI x 100), on T1 and T2 weighted MRI, as well as tumor enhancement. A pathologist evaluated tumor cell characteristics and associated findings, such as the presence of hemosiderin, ferritin, fresh blood, necrosis, fibrosis, and calcification. T1 tumor SI varied among RCC subtypes. On T2-weighted images, most types 1 and 2 papillary RCC had hypo signal, whereas hyper signal was only seen among clear cell RCC (p<0.05); which was confirmed with a quantitative assessment (type 1 papillary RCC= 71% ±16%, type 2 papillary RCC= 54% ±23%, and clear cell RCC= 141% ±44%, p<0.01). Tumor T2 SI of 96% or less had a sensitivity of 96% and specificity of 89% for papillary RCC, when compared to clear cell RCC; and tumor SI of 66.2% or less had a sensitivity of 54% and specificity of 100%. Tumor predominant architecture, papillary for tumors with hypo signal and nested for tumors with hyper signal, was the only histopathologic finding to correlate with tumor SI on T2 weighted MRI (p<0.05). Most clear cell RCC had a heterogeneous enhancement, and there was no typical enhancement pattern for both type 1 and type 2 papillary RCC. Types 1 and 2 papillary RCC enhanced less than clear cell RCC on all phases and this difference was statistically significant in the cortico-medullary, as well as early and late nephrographic phases. In summary, on T2-weighted images, most types 1 and 2 papillary RCC had hypo signal, whereas hyper signal was only seen among clear cell RCC. On T1 tumor SI varied among RCC subtypes. There was correlation between tumor predominant architecture and SI on T2 weighted images, papillary for hypo signal and nested for high signal tumors. Clear cell RCC enhanced more than papillary RCC.