O objetivo deste trabalho é aplicar técnicas de inteligência artificial ao apoio ao processo de tomada de decisão em diagnose de lesões ósseas malignas. Com vistas à obtenção de um produto portátil e de baixo custo este trabalho foi direcionado para a linha IBM-PC. Trata se de yn sistema especialista, denominado PATHO, desenvolvido com o suporte da ferramenta VP-EXPERT específica para a construção de sistema desta natureza. O conhecimento adquirido de especialistas e da literatura da área, for armazenado sob a forma de regras tipo IF-THEN e abrange diagnósticos diferenciais de lesões ósseas tumorais malignas. O motor de inferência do VP-EXPERT é ativado a partir de informações, fornecidas pelo usuário, sobre o estado clínico do paciente, radiografias, exames laboratoriais e biópsia. A base de conhecimento, então, é processada, através de uma estratégia de busca top-down, são geradas resultados, sob a forma de diagnósticos prováveis, listados em ordem decrescente de fatores de certeza. A avaliação de desempenho do PATHO foi auxiliada pelo SAAD - Sistema de Avaliação Automática de Desempenho, que foi desenvolvido, como parte deste trabalho, para facilitar a árdua tarefa de refinar a base de conhecimento.

A família de Tumores de Ewing pode ser compreendida como um espectro de neoplasias de células neuroectodérmicas primitivas, dentre eles se inclui uma classe menos diferenciada chamada Sarcoma de Ewing (SE), no qual o diagnóstico é mais frequente entre 11 e 20 anos. O índice de sobrevida pode chegar em 70%; todavia, estima-se que apenas 55% dos pacientes recebam um tratamento efetivo. Alguns estudos sugerem relevância do receptor do fator de crescimento epidérmico (EGFR) no processo de tumorigênese e metátase em cânceres de cabeça e pescoço, pulmão e colorretal. Algumas vias de sinalização que poderiam explicar a relação do EGFR a estes processos incluem a MAPK/ERK e PI3K/AKT. No entanto, estes complexos de sinalização podem ser ativados por outras cascatas de transdução de sinal como do sistema BDNF/TrkB. As neurotrofinas, mais recentemente, estão sendo relacionadas ao processo tumoral. O presente trabalho tem por objetivo avaliar a importância de EGF/EGFR na progressão tumoral do Sarcoma de Ewing, bem como o crosstalking entre este sistema e neurotrofinas. Linhagens celulares foram expostas a EGF ou ao inibidor da fosforilação do respectivo receptor (AG1478). A viabilidade e proliferação celular foram avaliadas em hemocitômetro. A análise do ensaio clonogênico foi feita em software ImageJ®. Para análise do ciclo celular, após exposição ao AG1478, realizou-se a avaliação por citometria de fluxo e uma provável indução de senescência foi analisada com X-Gal. Western Blotting foi padronizado para avaliação das vias MEK/ERK, PI3K/AKT, Ciclina D1, p53 e BDNF quando da exposição ao AG1478. Análises de viabilidade celular também foram feitas usando inibidores de MEK ou PI3K em combinação ao AG1478 ou não. A exposição das linhagens SK-ES-1 E RD-ES ao EGF afeta positivamente a taxa de proliferação destas e, quando essas são tratadas com o inibidor AG1478, existe um decréscimo desta taxa além de um impacto da razão de viabilidade. O índice de citotoxicidade (IC50) resultante é de 12,8uM e 9,8uM para SK-ES-1 e RD-ES, respectivamente. Foi observado que a inibição de EGFR reduziu o número e tamanho de colônias, e que a sua ativação reflete em um aumento dos parâmetros. Alterações das porcentagens populacionais nas fases do ciclo celular foram observadas. O ensaio colorimétrico mostrou aumento da percentagem de células senescentes e sugere-se envolvimento da via da ERK; AKT; Ciclinas, P53 e BDNF no efeito mediante exposição ao AG1478. A exposição ao EGF, portanto, aumenta a proliferação e a clonogenicidade de células de SE, bem como a diminuição destas quando da inibição do receptor. Também, a inibição de EGFR resulta em alterações no ciclo celular, senescência e morte celular. / The family of Ewing's tumors may be understood as a spectrum of primitive neuroectodermal cell neoplasms, including a less differentiated class called Ewing's sarcoma (ES), wherein the diagnosis is most common between 11 and 20 years. The survival rate can reach 70%; however, it is estimated que only 55% of Patients receive effective treatment. Some published studies suggest relevance of epidermal growth factor receptor (EGFR) in tumorigenesis and metastatic process in head and neck, lung and colorectal tumors. Some signaling pathways, which could explain its relation with these processes, include MAPK / ERK and PI3K / AKT. However, other signal transduction cascades such as BDNF / TrkB system may activate these signaling complexes, the neurotrophins being related to the tumoral process. This study aims to assess the importance of EGF / EGFR in Ewing's Sarcoma tumor progression, and the crosstalking between this system and neurotrophins. Cell lines were exposed to EGF or the inhibitor of phosphorylation of its receptor (AG1478). The viability and cell proliferation were evaluated in hemocytometer. The analysis of the clonogenic assay was performed in ImageJ® software. For cell cycle analysis after exposure AG1478, the evaluation was performed by flow cytometry and a probable induction senescence was analyzed with X-Gal. Western Blott was standardized to evaluate the pathways MEK / ERK, PI3K / AKT, cyclin D1 and P53 when exposure to AG1478. Cell viability analyzes were also performed on exposure to MEK and PI3K inhibitor in combination or not with AG1478. Exposure of SK-ES-1 and RD-ES lines to EGF positively affects the rate of proliferation and when these are treated with the inhibitor AG1478, there is a decrease in this rate as well as an impact reason viability. The cytotoxicity index (IC50) is 12,8uM resulting 9,8uM and SK-ES-1 and RD-ES, respectively. We observed that inhibition of EGFR reduced the number and size of colonies, and their activation reflects an increase in the parameters. Changes in population percentages in the cell cycle phases were observed. The colorimetric assay showed an increased percentage of senescent cells and it is suggested involvement of the ERK pathway; AKT; Cyclin P53 and the effect upon exposure AG1478. Therefore, the EGF exposure increases the proliferation and clonogenicity of ES cells, as well as the reduction is observed when these receptor inhibited. Also, inhibition of EGFR results in changes in the cell cycle, senescence and cell death.

by Au Kwong Keung. / Thesis (Ph.D.)--chinese University of Hong Kong, 1998. / Includes bibliographical references (p. 212-227). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Orientador: Andrigo Barboza De Nardi / Resumo: A medicina comparativa torna-se cada vez mais importante para obtenção de estudos aprofundados em diversas áreas incluindo a oncologia, possibilitando melhor conhecimento da genética do câncer e desenvolvimentos de novas terapias. A expressão do IGF2BP-1 tem sido correlacionada com lesões pré-neoplásicas e neoplasias de maior agressividade, além de estar correlacionada com mau prognóstico em pacientes oncológicos com melanomas, sarcomas e carcinomas. A proposta geral desta pesquisa é identificar a expressão do IGF2BP-1 em linhagens celulares de osteossarcoma (OSA) canino e murino, bem como correlacionar sua expressão com o comportamento celular e avaliar a intensidade de marcação desta proteína através de imuno-histoquímica em amostras de OSA canino. Os resultados deste ensaio demonstraram que o IGF2BP-1 reduziu o potencial de formação de colônias, aumentou o potencial de invasão e migração celular e gerou aumento da expressão dos genes ABCG2, AXIN2, BTrCP, VEGF, CD133 e C-MYC em células de OSA murinho. A expressão deste gene em células de cão aumentou a formação de colônias, reduziu o potencial de invasão e migração celular e o silenciamento parcial do IGF2BP-1 gerou redução da expressão dos genes CCND1, CD133, CMYC e FZD6 em células de OSA canino. O silenciamento parcial do IGF2BP-1 gerou aumento dos genes AXIN-2 e VEGF em células de OSA canino. A imuno-histoquímica é um método eficaz para detecção do IGF2BP-1 em amostras de OSA canino evidenciando marcação citoplasmática f... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

O Sarcoma Sinovial revela consistentemente t(X;18) resultando em SS18- SSX1, SS18-SSX2 e raramente SS18-SSX4. Dos 328 casos incluídos neste estudo, Sarcoma Sinovial foi considerado a primeira possibilidade diagnóstica ou um importante diagnóstico diferencial em 134 casos: destes, cDNA de qualidade foi obtido em 131. A fusão SS18-SSX foi identificada em 126 (96%) casos (74 SS18-SSX1, 52 SS18-SSX2) através de qRT-PCR e 120 (92%) por RT-PCR convencional. 101 casos no array de tecidos, analisados por FISH, revelaram que 87 (86%) mostraram rearranjo do SS18. Quatro casos positivos por RT-PCR mostraram perda de um sinal spectrum green e 15 casos revelaram cópias múltiplas de SS18: ambos os achados são potencialmente problemáticos na interpretação de resultados. Um dos 3 casos não analisados por RT-PCR por não ter gerado cDNA de qualidade, foi positivo por FISH. A fusão SS18-SSX1 foi demonstrada em 56 SS monofásicos e 18 SS bifásicos. SS18-SSX2 foi detectada em 41 monofásicos e 11 bifásicos. Áreas pouco diferenciadas foram identificadas em 44 casos (31%). Não houve correlação estatisticamente significante entre os subtipos bifásico, monofásico e o tipo de fusão. Cinco casos foram negativos através dos três métodos utilizados, três de localização pleural. Após correlação clínica, o diagnóstico de mesotelioma foi favorecido em um caso, tumor fibroso solitário em outro e o diagnóstico de sarcoma sem outras especificações no terceiro. A possibilidade do diagnóstico de TMBNP não pode ser excluída nos outros dois casos. Nós concluímos que os métodos moleculares são ferramentas auxiliares importantes para o diagnóstico de SS com 95% de sensibilidade e 100% de especificidade, mas os resultados devem ser interpretados à luz de características clínicas e dados imunohistoquímicos. / Synovial Sarcoma consistently harbors t(X;18) resulting in SS18-SSX1, SS18-SSX2 and rarely SS18-SSX4 fusion transcripts. Of 328 cases included in our study, synovial sarcoma was either the primary diagnosis or was very high in the differential diagnosis in 134 cases: of these, amplifiable cDNA was obtained from 131. SS18-SSX fusion products were found in 126 (96%) cases, (74 SS18-SSX1, 52 SS18-SSX2), using quantitative and 120 by conventional RT-PCR. 101 cases in a tissue microarray, analyzed by FISH, revealed that 87 (86%) showed SS18 rearrangement: 4 reverse transcriptase polymerase chain reaction positive cases, reported as negative for FISH, showed loss of one spectrum green signal, and 15 cases had multiple copies of the SS18 gene: both findings are potentially problematic when interpreting results. One of 3 cases, not analyzed by RT PCR due to poor quality RNA, was positive by FISH. SS18-SSX1 was present in 56 monophasic and 18 biphasic synovial sarcoma: SS18-SSX2 was detected in 41 monophasic and 11 biphasic synovial sarcoma. Poorly differentiated areas were identified in 44 cases (31%). There was no statistically significant association between biphasic, monophasic and fusion type. Five cases were negative for SS18 rearrangement by all methods, 3 of which were pleural-sited neoplasms. Following clinical input, a diagnosis of mesothelioma was favored in one case, a sarcoma, not-otherwise specified in another and a solitary fibrous tumor in the third case. The possibility of a malignant peripheral nerve sheath tumor could not be excluded in the other 2 cases. We concluded that the employment of a combination of molecular approaches is a powerful aid to diagnosing synovial sarcoma giving at least 96% sensitivity and 100% specificity but results must be interpreted in the light of other modalities such as clinical findings and immunohistochemical data.

O Sarcoma Sinovial revela consistentemente t(X;18) resultando em SS18- SSX1, SS18-SSX2 e raramente SS18-SSX4. Dos 328 casos incluídos neste estudo, Sarcoma Sinovial foi considerado a primeira possibilidade diagnóstica ou um importante diagnóstico diferencial em 134 casos: destes, cDNA de qualidade foi obtido em 131. A fusão SS18-SSX foi identificada em 126 (96%) casos (74 SS18-SSX1, 52 SS18-SSX2) através de qRT-PCR e 120 (92%) por RT-PCR convencional. 101 casos no array de tecidos, analisados por FISH, revelaram que 87 (86%) mostraram rearranjo do SS18. Quatro casos positivos por RT-PCR mostraram perda de um sinal spectrum green e 15 casos revelaram cópias múltiplas de SS18: ambos os achados são potencialmente problemáticos na interpretação de resultados. Um dos 3 casos não analisados por RT-PCR por não ter gerado cDNA de qualidade, foi positivo por FISH. A fusão SS18-SSX1 foi demonstrada em 56 SS monofásicos e 18 SS bifásicos. SS18-SSX2 foi detectada em 41 monofásicos e 11 bifásicos. Áreas pouco diferenciadas foram identificadas em 44 casos (31%). Não houve correlação estatisticamente significante entre os subtipos bifásico, monofásico e o tipo de fusão. Cinco casos foram negativos através dos três métodos utilizados, três de localização pleural. Após correlação clínica, o diagnóstico de mesotelioma foi favorecido em um caso, tumor fibroso solitário em outro e o diagnóstico de sarcoma sem outras especificações no terceiro. A possibilidade do diagnóstico de TMBNP não pode ser excluída nos outros dois casos. Nós concluímos que os métodos moleculares são ferramentas auxiliares importantes para o diagnóstico de SS com 95% de sensibilidade e 100% de especificidade, mas os resultados devem ser interpretados à luz de características clínicas e dados imunohistoquímicos. / Synovial Sarcoma consistently harbors t(X;18) resulting in SS18-SSX1, SS18-SSX2 and rarely SS18-SSX4 fusion transcripts. Of 328 cases included in our study, synovial sarcoma was either the primary diagnosis or was very high in the differential diagnosis in 134 cases: of these, amplifiable cDNA was obtained from 131. SS18-SSX fusion products were found in 126 (96%) cases, (74 SS18-SSX1, 52 SS18-SSX2), using quantitative and 120 by conventional RT-PCR. 101 cases in a tissue microarray, analyzed by FISH, revealed that 87 (86%) showed SS18 rearrangement: 4 reverse transcriptase polymerase chain reaction positive cases, reported as negative for FISH, showed loss of one spectrum green signal, and 15 cases had multiple copies of the SS18 gene: both findings are potentially problematic when interpreting results. One of 3 cases, not analyzed by RT PCR due to poor quality RNA, was positive by FISH. SS18-SSX1 was present in 56 monophasic and 18 biphasic synovial sarcoma: SS18-SSX2 was detected in 41 monophasic and 11 biphasic synovial sarcoma. Poorly differentiated areas were identified in 44 cases (31%). There was no statistically significant association between biphasic, monophasic and fusion type. Five cases were negative for SS18 rearrangement by all methods, 3 of which were pleural-sited neoplasms. Following clinical input, a diagnosis of mesothelioma was favored in one case, a sarcoma, not-otherwise specified in another and a solitary fibrous tumor in the third case. The possibility of a malignant peripheral nerve sheath tumor could not be excluded in the other 2 cases. We concluded that the employment of a combination of molecular approaches is a powerful aid to diagnosing synovial sarcoma giving at least 96% sensitivity and 100% specificity but results must be interpreted in the light of other modalities such as clinical findings and immunohistochemical data.

Les cellules souche cancéreuses contribuent au développement des sarcomes, mais le manque de marqueurs spécifiques empêche leur caractérisation et la possibilité de cibler ce type de cellules. Nous avons utilisé la séquence régulatrice de la calpaïne-6 dans des systèmes rapporteurs pour identifier les cellules exprimant la calpaïne-6. Ces cellules étaient des cellules initiatrices de tumeurs et se comportaient comme des cellules souche, au sommet de la hiérarchie cellulaire. L'expression de la calpaïne-6 dépend d’un programme génique de cellules souche qui implique Oct4, Nanog et Sox2 et est activée par l'hypoxie. L’inhibition de la calpaïne-6 a bloqué le développement tumoral et a induit la diminution du nombre de cellules souche cancéreuses dans les sarcomes osseux. L’expression de la calpaïne-6 était inversement corrélée à l'expression de marqueurs de sénescence mais était associé à un flux autophagique dynamique. L’inhibition de la calpaïne-6 a induit l'entrée des cellules en sénescence et a supprimé le flux autophagique. Nos résultats révèlent que le calpaïne-6 identifie les cellules souche des sarcomes et joue un rôle important dans le maintien des cellules souche cancéreuses en contrôlant les processus d’autophagie et de sénescence. La calpaïne-6 semble être une cible thérapeutique prometteuse pour éradiquer les cellules souche dans les sarcomes / Cancer stem cells contribute to sarcoma development, but lack of specific markers prevents their characterization and the possibility of targeting. We used the regulatory sequence of calpain-6 in reporter constructions to identify calpain-6–expressing cells. These cells were tumor-initiating cells and behaved like stem cells at the apex of the cellular hierarchy. Calpain-6 expression depended on the stem-cell transcription network that involves Oct4, Nanog, and Sox2 and was activated by hypoxia. Calpain-6 knockdown blocked tumor development and induced depletion of sarcoma stem cells. Calpain-6 was inversely associated with expression of senescence markers but was associated with a dynamic autophagy flux. Calpain-6 knockdown induced cell entry into senescence and suppressed autophagy flux. Our results reveal that calpain-6 identifies sarcoma stem-cell and plays an important role as a regulator of cancer cell fate driving a switch between autophagy and senescence. Calpain-6 may be a promising therapeutic target to eradicate sarcoma stem cells.

Les sarcomes pléomorphes sont des tumeurs mésenchymateuses rares caractérisées par de nombreux remaniements chromosomiques. Leur processus d’oncogenèse reste encore mal compris, aucune altération génétique motrice de l’initiation tumorale n’a pu être identifiée de façon récurrente et spécifique à ce jour. Les travaux que j’ai réalisés durant ma thèse avaient pour but de mieux comprendre la biologie de ces tumeurs, notamment les conséquences transcriptomiques de leur remodelage génomique.Nous avons caractérisé les transcrits de fusion exprimés dans ces tumeurs par séquençage haut-débit (RNA-seq). Ceci nous a amené à identifier l’expression de plusieurs transcrits chimériques impliquant le gène TRIO (5,1% des tumeurs). De plus, cette analyse ainsi que l’identification de variants exprimés nous ont permis d’identifier de fréquentes mutations de gènes suppresseurs de tumeurs tels qu’ATRX (16% des tumeurs) et plus généralement des membres du complexe SWI/SNF (47% des tumeurs). Les altérations de ce complexe majeur de remodelage de la chromatine sont associées à une plus grande instabilité génétique et à un phénotype plus agressif.Dans les sarcomes pléomorphes, l’instabilité génétique est liée à la progression tumorale via l’expression d’une signature transcriptomique pronostique. Cette signature, nommée CINSARC, est impliquée dans le contrôle de la mitose et de la ségrégation chromosomique. Nous avons voulu déterminer l’origine de cette expression via une étude intégrant la génomique et des mécanismes de régulation épigénétique, transcriptionnelle et post-transcriptionnelle. Si ces mécanismes ne semblent pas directement causals de l’expression de CINSARC, d’importantes modifications ont pu être mises en évidences. D’un point de vue clinique, nous avons démontré que l’expression de cette signature est un facteur pronostique universel de l’agressivité tumorale dans de nombreux types de cancers. De plus, CINSARC est un meilleur marqueur pronostique que le grade FNCLCC, actuel standard international d’évaluation du risque métastatique des sarcomes des tissus mous. Nous avons ainsi développé une méthode permettant une application clinique routinière de la signature CINSARC afin d’améliorer la prise en charge thérapeutique de ces tumeurs. / Pleomorphic sarcomas are rare mesenchymal tumors characterized by many chromosomal rearrangements. Their oncogenic process is still poorly understood, no recurrent and specific genetic alteration able to drive the tumor initiation has been identified yet. The work I did during my thesis had the objective to better understand the biology of these tumors, focusing on transcriptomic consequences of their genomic remodeling.We characterized fusion transcripts in these tumors by high-throughput sequencing (RNA-seq). This led us to identify the expression of several chimeric transcripts involving TRIO (5.1% of cases). Moreover, this analysis and the identification of expressed variants allowed us to identify frequent mutations of tumor suppressor genes such as ATRX (16% of cases) and more generally members of the SWI/SNF complex (47% of cases). Alterations of this major complex of chromatin remodeling are associated with higher genetic instability and more aggressive phenotype.In pleomorphic sarcomas, genetic instability is linked to tumor progression through the expression of a prognostic transcriptomic signature. This signature, termed CINSARC, is involved in mitosis control and chromosome segregation pathways. We wanted to determine the origin of such expression by integrating genomics and epigenetics, transcriptional and post-transcriptional regulation mechanisms. Though these mechanisms do not seem to directly regulate CINSARC expression, important changes have been highlighted. From a clinical standpoint, we demonstrated that the signature expression is a global prognostic factor of tumor aggressiveness in numerous cancer types. In addition, CINSARC is a better prognostic marker than the FNCLCC grading system, the current international standard to evaluate the metastatic risk in soft tissue sarcomas. We consequently developed a method allowing a daily clinical application of the CINSARC signature to improve the therapeutic management of these tumors.

Kaposi�s sarcoma (KS) is a peculiar vascular neoplasm that occurs mainly in elderly Mediterranean men and patients with acquired immunodeficiency syndrome (AIDS). The current literature indicates that KS is initiated by the human herpes virus 8 (HHV8) as a reactive polyclonal process but with deregulation of oncogene and tumour suppressor genes, it can progress to a true malignancy with monoclonality. Clinically, classical KS often presents as an indolent disease affecting mainly the lower extremities whereas AIDS-related KS has no site predilection and can progress rapidly with systemic involvement. Histologically, KS can be classified into patch, plaque and nodular stages. Interestingly, classical and AIDS-related KS are indistinguishable histologically and this suggests that AIDS-related KS and classical KS might be initiated by a common aetiology but given their different clinical courses, they may progress through different mechanisms. In view of the importance of the cell cycle proteins in the development and progression of many human malignancies, this thesis aims to examine the role of these proteins in the progression of the two main clinical subtypes of KS. The cell cycle protein expressions in a cohort of 47 patients with KS with welldocumented clinical and histological features were studied. Using a monclonal antibody against the latent nuclear antigen-1 molecule of HHV8, HHV8 was detected in 78% of the cases. The more advanced nodular lesions were found to have a higher level of proliferative activity as measured by the proliferation x marker, Ki-67. This suggests it is valid to use the histological specimens as a tumour progression model of KS. The role of the Rb/cyclin D1/p16 pathway was examined. The more advanced nodular stage KS lesions were more likely to be positive for cyclin D1, suggesting that cyclin D1 is important in the progression from patch stage to nodular stage. p16 acts as a tumour suppressor and it has an inhibitory effect on cyclin D1. The p16 expression rate was low in early stage KS but high in the more advanced lesions. It seems that reduced p16 expression occurs early in KS and may be important in its development. The rate of Rb expression, on the other hand, did not differ significantly among the histological subtypes. The results revealed the significant role of the Rb/cyclin D1/p16 pathway in the progression of KS. Of the mitotic cyclins examined, cyclin A expression was correlated with the advanced tumor stage. The rate of p34cdc2 expression was high in the lesions and there was no correlation with histological stage. This suggests that p34cdc2 is important in the early development of the tumour but not necessarily in its progression. Along the p53-apoptotic pathway, mutant p53 expression was significantly more common in the nodular stage. The cyclin G1 (a protooncogene, one of the target genes of p53) expression also paralleled that of mutant p53 with the majority of the KS lesions showing cyclin G1 expression and significant xi correlation between advanced histological stage and increasing rate of cyclin G1 expression. These findings suggest that progression along the p53 pathway may be important in the advanced stage development of KS. On the other hand, expression of the CDK inhibitor, p27, a protein that normally negatively regulates cyclin G1, was reduced in nodular KS. These findings suggest that some KS lesions may progress through a deregulated or abnormal p53 pathway. There were correlations between cyclin D1, cyclin A, cyclin G1, mutant p53 and negative HIV status. The findings suggest that components of both the Rb/cyclin D1/p16 and p53-apoptotic pathways are important in the progression of classical KS. Rb protein was the only cell cycle protein whose rate of expression correlated significantly with HHV8 status in KS. The majority of HHV8 positive lesions were also positive for Rb protein, unlike HHV8 negative lesions. This suggests that some of the HHV8 negative lesions can progress through a defective Rb pathway whereas the role of Rb in the progression may not be as important in the HHV8 positive lesions. This was an unexpected finding given that one of the postulated mechanisms of tumour initiation by the HHV8 virus is via the viral cyclin it produces. The viral cyclin produced by HHV8 acts through the Rb pathway much the same as cyclin D1 and one would have expected that HHV8 positive cases are less likely to be positive for the Rb protein. In summary, the majority of the KS lesions examined in this thesis show HHV8 infection. The Rb/cyclin D1/p16 pathway appears to be important in the progression of the different stages of KS and expression of the proteins involved in the p53 pathway were found to be important in the advanced stages of the development of KS. There were differential expressions of cell cycle proteins between AIDS-related and classical KS, and between HHV8 positive and HHV8 negative lesions. The findings also provided some clues to the possible mechanisms of development in KS lesions that were not initiated by HHV8.

Sarcomas of the female genital tract are rare tumors and account for less than 5% of gynecologic malignancies. Traditionally, gynecologic sarcomas have been divided into different tumor types according to their histopathological features. The most common are leiomyosarcoma (LMS), malignant mixed Müllerian tumors (MMMT), endometrial stromal sarcoma (ESS) and (Müllerian) adenosarcoma. The different tumor types are highly aggressive with early lymphatic and/or hematogenous spread. Treatment is difficult and it is believed that sarcomas have a low radio-and chemosensitivity, and the mainstay in treatment is surgical removal of the tumor. The most important prognostic feature has been tumor stage. Nevertheless, there are some early-stage tumors that run a biological course different from that expected and additional prognostic factors indicating high-risk tumors are desirable. The study cohort consists of 49 uterine LMS, 44 uterine MMMTs, 17 uterine ESS, 11 uterine adenosarcomas and 26 ovarian MMMTs. The tumors were analyzed in a retrospective manner for DNA ploidy, S-phase fraction (SPF), p53 and mdm-2 expression, as well as traditional clinical and pathological prognostic factors, such as tumor stage. grade, atypia and mitotic index. Of the 49 LMS, 36 (86%) were non-diploid and 13 (27%) were p53-positive. Among the 44 uterine MMMTs, 30 (68%) were non-diploid and 27 (61%) had an SPF>10%. Twenty-seven (61%) overexpressed p53 and 11 (25%) were mdm-2 positive. Furthermore, 40 (91%) of the uterine MMMTs had a high mitotic count and 42 (95%) had high grade cytologic atypia. All low-grade ESS were DNA diploid and had a low SPF. Among the four high-grade ESS, three (75%) were DNA aneuploid and three (75%) were p53-positive. Among 1 1 adenosarcomas, eight (73%) were non-diploid. All ovarian MMMTs were non-diploid and all but two had an SPF>10%. 19 (73%) ovarian MMMTs were p53positive. The 5-year survival rate was 33% for LMS, 38% for uterine MMMT, 57% for ESS, 69% for adenosarcoma and 30% for ovarian MMMT. Thirty-five (71%) patients with LMS died of disease and two of intercurrent disease. Stage was found to be the most important factor for survival (p=0.007); in addition DNA ploidy (p=0.045) and SPF (p=0.041) had prognostic significance. Twenty-seven (61%) patients with uterine MMMT died of disease and six (14%) died of intercurrent disease. Stage was the only prognostic factor for survival. Nine (53%) patients with ESS died of disease. There was a significant correlation of survival to tumor grade (p=0.007), DNA ploidy (p=0.026), SPF (p=0.048) and stage (p=0.026). Of the 11 patients with adenosarcoma, four (36%) patients died of disease and three (27%) patients died of intercurrent disease. There were no variables that correlated with survival. Eighteen (69%) patients with ovarian MMMT died of disease and two (8%) patients died of intercurrent disease. In a multivariate analysis, only stage reached independent prognostic significance for survival (p=0.023). In summary, stage represents the most important prognostic factor for survival for uterine and ovarian sarcomas. DNA flow cytometry is useful in gaining additional prognostic information for LMS and ESS. P53-and mdm-2 overexpression had no prognostic value for survival rate. Most of the MMMT overexpressed p53 and were non-diploid. Treatment of sarcomatous neoplasms is difficult and the mainstay remains surgical removal of the tumor. For patients with early stage sarcoma there was a high recurrence rate, which suggests that a large proportion of patients may have systemic micrometastasic disease at the time of diagnosis. Recurrent and metastatic uterine sarcoma remains an incurable disease, and treatment must be considered palliative. / On the day of the public defence the status of the articles III and IV was: Accepted for publication. ; Bild/Image 1=p53/mdm-2 interaction ; Bild/Image 2=Leiomysarcoma stage I ; Bild/Image 3=Survival in uterine sarcoma.