Carcinomas de glândulas salivares são raros e seu tratamento de escolha é cirúrgico, seguido ou não de radioterapia. Até 50% dos casos apresentam recorrências neoplásicas e a maioria delas é local. O único tratamento de resgate com potencial curativo é o cirúrgico. No entanto, poucos estudos abordam o tema. O objetivo deste estudo é avaliar a ocorrência de complicações cirúrgicas e os fatores prognósticos clínicos e anatomopatológicos em pacientes portadores de carcinoma de glândulas salivares recidivado, submetidos à cirurgia de resgate. Foram avaliados 59 pacientes que preenchiam os critérios de elegibilidade do estudo: diagnóstico comprovado da recidiva de carcinoma de glândulas salivares e cirurgia de resgate realizada com intenção curativa. Trinta e 5 pacientes desta série (59,3%) foram tratados previamente em outra instituição. A cirurgia de resgate de todos os pacientes foi realizada no Hospital A. C. Camargo, em São Paulo, entre os anos de 1957 a 2000. O local do tumor primário foi parótida em 34 casos (57,6%); cavidade oral, em 13 (22,1%) e glândula submandibular, em 12 (20,3%). O tipo histológico mais freqüente foi o carcinoma adenocístico em 23 casos (39%), seguido pelo carcinoma mucoepidermóide, em 14 (23,7%). O tratamento prévio foi somente cirurgia em 47 casos, cirurgia e radioterapia adjuvante em 11 casos e cirurgia e quimioterapia em apenas um caso. A maioria dos pacientes apresentou recorrência local (39; 66%), em sete casos a recorrência foi regional (11,9%) e em treze foi locorregional (22,1%). O estádio clínico da recorrência foi inicial (rEC I e II) em 15 casos (25,5%) e avançado (rEC III e IV), em 44 (74,5%). O tratamento cirúrgico da recorrência foi ressecção local em 39 casos (66,1%), esvaziamento cervical isolado em 7 (11,9%) e cirurgias em monobloco (ressecção local associada a esvaziamento cervical) em 13 casos (22%). Em 5 pacientes foi realizada parotidectomia ampliada com temporalectomia. A taxa global de complicações cirúrgicas foi de 32,2%. A complicação mais comum foi a infecção da ferida operatória. Não houve mortalidade pós-operatória. Houve nova recorrência em 36 pacientes (61%). A recorrência mais freqüente foi a distância, em 16 casos (27%), sendo o pulmão o sítio mais acometido. Em 10 casos (17%) houve falha no controle local; em 5 (8,5%), falha locorregional e em 5, falha regional (8,5%). A sobrevida atuarial global, após a cirurgia de resgate, foi de 61,3% em 5 anos e 42% em 10 anos. O sexo, o tipo histológico, a topografia, o estadiamento clínico e a conservação do nervo facial (tumores parotídeos) não apresentaram associação com a sobrevida global. Em análise univariada a idade maior que 60 anos foi associada a pior prognóstico. Este estudo demonstra que o prognóstico de pacientes com carcinomas de glândulas salivares recidivados, selecionados para serem submetidos à cirurgia de resgate é aceitável. As taxas de complicações cirúrgicas foram geralmente locais e não houve mortalidade pós-operatória nesta série. / Salivary gland carcinomas are rare and the main treatment option is surgery with or without postoperative radiotherapy. Almost half of the cases present recurrences of tumors and the majority are local. The only potentially curative treatment for recurrent tumors is salvage surgery. However, few papers were published on this subject. The aim of this study is evaluate the surgical complications and clinical and pathologic prognostic factors in patients with recurrent salivary gland carcinoma submitted to salvage surgery. We reviewed the medical charts of 59 patients that fulfilled the eligibility critera of the study: proven diagnosis of locorregionally recurrent salivary gland carcinoma and surgery with curative intention. Thirty five patients (59,3%) had been previously treated at another institution. The salvage surgery in all the patients was performed at the A. C. Camargo Hospital in São Paulo, Brazil from 1957 to 2000. The site of the primary tumor was the parotid in 34 cases, the oral cavity in 13 and submandibular gland in 12 cases. The most frequent histopathologic type was adenoid cystic carcinoma (23 cases; 39%) and mucoepidermoid carcinoma (14 cases ;23.7%). The prior treatment was surgery alone in 47 cases, surgery with adjuvant radiotherapy in 11 cases and surgery and adjuvant chemotherapy in only one case. The majority of the patients presented local recurrence (39; 66%), in seven cases the recurrence was regional (11.9%) and in thirteen cases it was locorregional (22.1%). The clinical stage of the recurrences were initial (rCS I/II) in 15 patients (25.5%) and advanced (rCS III/IV) in 44 patients (74.5%). The surgical treatment of the recurrence was local ressection in 39 cases (66.1%), en bloc surgeries (local ressection and neck dissection) in thirteen cases (22%) and neck dissection alone in seven cases (11.9%). Wide parotidectomy with temporal bone ressection was performed in five cases. The overall rate of surgical complications was 32.2%. The most frequent complication was wound infection. There was no post-operative deaths. There was a new recurrence in 61% of the patients, and the majority were distant metastases (16 cases; 27%). The lung was the most frequent involved site. In ten cases (17%) the recurrence was local, in five cases it was locorregional (8.5%). The actuarial overall survival were 61.3% in 5 years and 42% in ten years and in five cases it was regional (8.5%). Gender, histopathology, site of the primary tumor, facial nerve preservation (parotid tumors), were not associated with overall survival. In the univariate analysis, only age older than 60 years was associate with a poor prognosis. This study shows that the prognosis of patients with recurrent salivary gland carcinoma treated to salvage surgery is acceptable. The rates of surgical complications are local and there was no post-operative mortality in this series.

Orientador: Albina Messias de Almeida Milani Altemani / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T00:26:10Z (GMT). No. of bitstreams: 1 Neves_CatarinadeOliveira_D.pdf: 1050550 bytes, checksum: fc3ca7c67f2a52e8450896158a67f0d6 (MD5) Previous issue date: 2009 / Resumo: CD10 e Podoplanina (D2-40), além de expressos nas células mioepiteliais, estão envolvidos na progressão tumoral e podem ser utilizados como marcadores prognósticos. Em 79 neoplasias salivares com diferenciação mioepitelial (44 malignas e 35 benignas), analisamos a expressão dessas proteínas nas células neoplásicas, na reação desmoplásica tumoral e, nos carcinomas adenóides císticos (CAC), verificamos possível correlação com fatores prognósticos. CD10 foi negativo nas células epiteliais em 100% dos casos. Nas mioepiteliais, foi positivo em 25,71% das lesões benignas e em 27,27% das malignas, sendo esses resultados significantemente inferiores àqueles da a-SMA (60% e 88,64%, respectivamente). CD10 foi positivo em 83,33%, 30%, 27,7% e 40% dos carcinomas epiteliais-mioepiteliais (CEME), adenomas pleomórficos, mioepiteliomas e carcinomas mioepiteliais, respectivamente, e negativo em 100% dos CAC, adenocarcinomas polimórficos de baixo grau (APBG) e adenomas de células basais. No estroma tumoral, a expressão do CD10 (38,64%) foi significantemente maior (p=0.007) que a da a-SMA (11,36%). Entretanto, a expressão do CD10 não apresentou correlação com os fatores prognósticos do CAC. O D2-40 foi negativo, nas células epiteliais e estromais, e positivo nas mioepiteliais em 59% dos carcinomas e em 42,86% das lesões benignas. Concluímos que, ao contrário do D2-40, o CD10 tem pouca utilidade para identificar células mioepiteliais malignas, exceto no CEME onde pode ser útil no diagnóstico diferencial com a variante tubular do CAC. Sua expressão estromal ocorre em células de fenótipo distinto dos miofibroblastos, está associada com invasão tumoral e não se correlaciona com fatores prognósticos do CAC. / AbstrAct: CD10 and Podoplanin (D2-40) are expressed in myoepithelial cells and, in addition, are involved in tumoral progression and can be utilized as prognostic markers. In a series of 79 salivary neoplasias with myoepithelial differentiation (44 malignant and 35 benign), the expression of these proteins was analyzed in tumor cells as well as in tumor-associated stromal cells and it was correlated with prognostic factors in a select group of lesions (adenoid cystic carcinomas). In epithelial cells, CD10 was negative in 100% of the cases. In myoepithelial cells, CD10 was positive in 25.71% of the benign neoplasias and in 27.27% of the malignant ones and this expressions was significantly lower in comparison to that of a-smooth muscle actin (a-SMA) (60% and 88.64%, respectively). In neoplasias classified according to histological subtype, CD10 was positive in 83.33%, 30%, 27.27% and 40% of epithelial-myoepithelial carcinomas (EMC), pleomorphic adenomas, myoepitheliomas and myoepithelial carcinomas, respectively and negative in 100% of adenoid cystic carcinomas (ACC), polymorphic low-grade adenocarcinomas (PLGA) and basal adenomas. In tumor-associated stromal cells, CD10 expression was significantly higher (p=0.007) than that of a-SMA (38.64% versus 11.36%). However, no correlation was detected between CD10 expression and prognostic factors in ACC. D2-40 was negative in epithelial cells and in tumorassociated stromal cells as well and positive in myoepithelial cells of carcinomas (59%) and benign lesions (42.86%). This reactivity in myoepithelial cells did not differ significantly of that using a-SMA as a marker, except for PLGA where D2-40 was negative. In conclusion, CD10 differs of D2-40 once it shows low utility to detect neoplastic myoepithelial cells. However, EMC is an exception and in this tumor, CD10 could be useful to separate this lesion from tubular variant of ACC. In the tumor-associated stroma, CD10 expression in non-myofibroblast cells seems to be associated with tumor invasion but it does not show correlation with prognostic factors in ACC. / Doutorado / Anatomia Patologica / Doutor em Ciências Médicas

Orientadores: Albina Messias De Almeida Milani Altemani, Elizabeth Ferreira Martinez / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T03:06:25Z (GMT). No. of bitstreams: 1 Montalli_VictorAngeloMartins_D.pdf: 4723030 bytes, checksum: 1764455ec3666d02c7e74ee7c326caed (MD5) Previous issue date: 2014 / Resumo: As lesões salivares tumorais compostas por dupla população celular (epitelial e mioepitelial) são consideradas originárias do ducto intercalado e estas lesões são subdivididas em diversas entidades que apresentam sobreposição morfológica, com delimitações entre elas nem sempre nítidas. Entre as neoplasias benignas estão o adenoma pleomórfico (AP) e o adenoma de células basais (ACB). Recentemente foi descrita uma nova entidade tumoral benigna, com composição epitelial e mioepitelial, denominada de lesão do ducto intercalado (LDI). Diante disso, o nosso primeiro objetivo foi analisar os perfis morfológicos e imuno-histoquímicos de LDIs e ACBs classificados em tubulares (ACB-T) e não tubulares (ACB-NT) para verificar se as LDIs e ACB-Ts representam entidades distintas. Ainda, dado o papel crítico da célula mioepitelial na morfogênese das lesões tumorais salivares histogeneticamente relacionadas ao ducto intercalado, nosso segundo objetivo foi avaliar in vitro a influência de fatores do microambiente tumoral (proteínas da matriz extracelular e fatores de crescimento) sobre a morfologia, viabilidade e proliferação de células mioepiteliais advindas de AP. Para a análise morfológica e imuno-histoquímica, foram estudados oito casos de LDIs, nove ACBs-T e 19 ACBs-NT. Todos os ACB-T continham áreas LDI-like, enquanto nos ACB-NT estas eram raras e escassas. As células luminais das LDIs e ACBs-T exibiram positividade para CK7, lisozima, S100 e DOG1. No grupo ACB-NT, poucas células luminais mostraram tal expressão, sendo principalmente positivas para CK14. As células mioepiteliais das LDIs, ACB-T e ACB-NT foram positivas para CK14, calponina, AML e p63, mas essas eram mais numerosas nos ACBs. No estudo in vitro, a morfologia e diferenciação das células mioepiteliais foram avaliadas qualitativamente por imunofluorescência indireta (expressão da vimentina e AML, respectivamente). As células mioepiteliais exibiram morfologia poliédrica em todas as matrizes, independentemente da suplementação do fator de crescimento. AML foi imunoexpressa de forma heterogênea nas células mioepiteliais, porém houve aumento da expressão desta proteína quando acrescentado o TGF- ?1, independentemente do tipo de matriz usada. TGF- ?1 também aumentou significantemente a viabilidade das células mioepiteliais cultivadas na matriz fibronectina. Conclusões: as LDI, ACB-T e ACB-NT formam um continuum de lesões onde as LDIs estão estreitamente relacionadas com o ACB-T, visto que em ambos o imunofenótipo das células luminais e mioepiteliais é semelhante àquele observado nos ductos intercalados. A principal diferença entre LDI e ACB-T é a quantidade de células mioepiteliais, que é maior no último. Além disso, nossos resultados indicam que pelo menos alguns ACBs podem surgir via LDI. Os estudos em cultura de células sugerem que as diferentes matrizes celulares não influenciam a morfologia e diferenciação da célula mioepitelial. Dentre os fatores de crescimento estudados apenas TGF- ?1 associou-se com aumento da expressão de AML (diferenciação celular) e aumentou significantemente a viabilidade celular associado à matriz fibronectina / Abstract: Salivary tumor lesions composed of dual cell population (epithelial and myoepithelial) are considered to originate from the intercalated duct. These lesions are subdivided into several entities that share morphological features. Among the benign tumors are pleomorphic adenomas (PA) and basal cell adenoma (BCA). Recently, a new entity was described that is a benign tumor with epithelial and myoepithelial composition, called intercalated duct lesion (IDL). Our first objective was to analyze the morphological and immunohistochemical profiles of IDLs and BCAs classified into tubular (T-BCA) and non-tubular subtypes (NT-BCA), to determine whether or not IDL and tubular BCA represent distinct entities. Also, given the critical role of myoepithelial cells in the morphogenesis of the salivary tumor lesions histogenetically related to the intercalated duct, our second objective was to evaluate in vitro the influence of tumor microenvironment factors (extracellular matrix proteins and growth factors) on the morphology, viability and proliferation of myoepithelial cells arisen from PA . Eight IDLs, nine tubular BCAs and 19 non-tubular BCAs were studied by immunohistochemical technique. All tubular BCAs contained IDL-like areas, which represented 20-70% of the tumor. In non-tubular BCA, IDL-like areas were occasional and small (<5%). One patient presented IDLs, tubular BCAs and IDL/tubular BCA combined lesions. Luminal ductal cells of IDLs and tubular BCAs exhibited positivity for CK7, lysozyme, S100 and DOG1. In the non-tubular BCA group, few luminal cells exhibited such immunoprofile; they were mainly CK14-positive. Basal/myoepithelial cells of IDLs, tubular BCAs and non-tubular BCAs were positive for CK14, calponin, ?-SMA and p63; they were more numerous in BCA lesions. The in vitro study analyzed morphology and differentiation of myoepithelial cells by vimentin and SMA expressions, respectively, which were qualitatively assessed using indirect immunofluorescence. Myoepithelial cells showed polyhedral morphology in all extra cellular matrixes regardless of the supplementation of growth factors. These cells expressed SMA heterogeneously but when TGF- ?1 was added such expression increased. This modification did not show relationship with the type of extracellular matix. The viability of myoepithelial cells cultured on fibronectin matrix increased significantly with addition of TGF - ?1. Conclusions: IDL, tubular BCA and non-tubular BCA form a continuum of lesions in which IDLs are related closely to tubular BCA. In both, the immunoprofile of luminal and myoepithelial cells recapitulates the normal intercalated duct. The difference between the adenoma-like subset of IDLs and tubular BCA rests mainly on the larger numbers of myoepithelial cells in the latter. Our findings indicate that at least some BCAs can arise via IDLs. The cell culture studies suggest that the different matrixes do not influence the morphology and differentiation of myoepithelial cells. Among the growth factors studied, only TGF - ?1 was associated with an increased expression of SMA (cell differentiation) and a significant increase of the cellular viability associated with the fibronectin matrix / Doutorado / Ciencias Biomedicas / Doutor em Ciências Médicas

Orientador: Pablo Agustin Vargas / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-26T11:33:31Z (GMT). No. of bitstreams: 1 Fonseca_FelipePaiva_D.pdf: 1634857 bytes, checksum: 43da6be9627bec5197103495826aa6d6 (MD5) Previous issue date: 2015 / Resumo: Tumores de glândulas salivares correspondem a aproximadamente 3% de todas as neoplasias de cabeça e pescoço e as neoplasias malignas derivadas destas estruturas anatômicas ainda representam um grande desafio para a oncologia de cabeça e pescoço devido a sua difícil abordagem cirúrgica e pobre resposta às outras abordagens terapêuticas. Um melhor entendimento do seu perfil molecular contribuiria significativamente para um melhor manejo terapêutico futuro e o estudo do potencial angiogênico dos tumores de glândulas salivares representa um interessante alvo de investigação. Tem sido demonstrado que as semaforinas induzem a apoptose de células tumorais, modulam a migração celular neoplásica e inibem a angiogênese em diferentes neoplasias humanas, competindo com o fator de crescimento endotelial vascular (VEGF) pela ligação aos seus principais receptores, as neuropilinas-1 e -2, desta forma inibindo os efeitos mitogênicos e pró-angiogênicos de VEGF. Assim, o objetivo deste estudo é investigar a expressão das semaforinas de classe 3 A e B (Sema3A e Sema3B), e dos seus receptores neuropilinas-1 e -2 (Np-1 e Np-2) em tumores de glândulas salivares, determinando seus significados clínicos. Duzentos e quarenta e oito tumores benignos e malignos de glândulas salivares selecionados de quatro instituições brasileiras foram organizados em blocos de parafina em microarranjo tecidual em matriz e submetidos a reações de imunoistoquímica contra CD34, Sema3A, Sema3B, Np-1 e Np-2. As imunoreações foram quantificadas utilizando algoritmos digitais e os resultados foram correlacionados com parâmetros clinicopatológicos e índices de sobrevida. Tumores malignos apresentaram uma maior densidade vascular, porém uma menor área vascular do que sua contraparte benigna. Em glândulas salivares normais a expressão de Np-1 e -2 esteve restrita às células ductais, enquanto que Sema3A e Sema3B estiveram principalmente no componente acinar. Tumores benignos e malignos revelaram uma expressão similar de todos os marcadores e a co-expressão de Np-1/Np-2 correlacionou-se significativamente com a ocorrência de parestesias e estágios mais avançados dos tumores. Apesar de não ser estatisticamente significativa, a sobre-expressão simultânea de ambos os receptores também indicou uma menor taxa de sobrevida. Desta forma, Sema3A, Sema3B, Np-1 e Np-2 devem estar envolvidas no desenvolvimento das glândulas salivares normais e na patogênese das neoplasias benignas e malignas derivadas destas estruturas; entretanto, a expressão destas proteínas não apresentou um potencial prognóstico estatisticamente significativo no presente estudo / Abstract: Salivary gland tumors correspond to approximately 3% of all head and neck neoplasms and the malignant neoplasias derived from these anatomic structures still represent a major pitfall in head and neck oncology because of their difficult surgical approach and poor response to other therapies. A better understanding of their molecular basis would significantly aid to an improved future management and the study of salivary gland tumors angiogenic potential represents an interesting target of investigation. It has been shown that semaphorins induce tumor cell apoptosis, modulate tumor cell migration and inhibit angiogenesis in different human neoplasms, competing with vascular endothelial growth factor (VEGF) for biding to their main receptors, the neuropilins-1 and -2, thereby inhibiting mitogenic and pro-angiogenic effects of VEGF. Hence, the objective of this study is to investigate the expression of class 3 Semaphorins A and B, and their receptors neuropilins-1 and -2 in salivary gland tumors, determining their clinical significance. Two hundred and forty eight benign and malignant salivary gland tumors selected from four Brazilian institutions were organized in tissue microarray paraffin blocks and submitted to immunohistochemical reactions against CD34, Sema3A, Sema3B, Np-1 and Np-2. The immunoreactions were quantified using digital algorithms and the results were correlated with clinicopathological parameters and survival rates. Malignant tumors presented an increased vascular density but a lower vascular area than their benign counterparts. In normal salivary glands Np-1 and Np-2 expression was restricted to ductal cells, whereas Sema3A and Sema3B were positive mainly in serous acinar compartment. Benign and malignant tumors revealed a similar expression of all markers and the co-expression of Np-1/Np-2 significantly correlated with the occurrence of paresthesia and higher stages of the tumors. In addition, although not statistically significant, simultaneous overexpression of both receptors also indicated an inferior survival rate. Hence, these results suggest that Sema3A, Sema3B, Np-1 and Np-2 may be involved in the development of normal salivary glands and in the pathogenesis of benign and malignant neoplasms derived from these structures; however, the expression of these proteins did not present a statistically significant prognostic potential in the current study / Doutorado / Patologia / Doutor em Estomatopatologia

We hypothesized that lymph node involvement in minor salivary gland cancers is associated with clinical and pathological factors commonly available to the clinician after a typical initial workup. Our aim was to identify these factors using a dataset that allowed us to compile the largest series of minor salivary gland cancers in the published literature. Using this dataset we also aimed to characterize the distribution of histological types by primary site, identify the predictors of the use of external beam radiation therapy and neck dissection, and examine the effect of lymph node involvement on survival. Using the SEER database, we identified 2667 minor salivary gland cancers with known lymph node status from 1988 to 2004. Univariate and multivariate analyses were conducted to identify factors associated with the use of neck dissection, the use of external beam radiation therapy, and the presence of cervical lymph node metastases. Kaplan Meier survival curves were constructed to examine the effect of lymph node involvement on survival. 426 (16.0%) patients had neck nodal involvement. Factors associated with neck nodal involvement on univariate analysis included increasing age, male gender, increasing tumor size, high tumor grade, T3-T4 stage, adenocarcinoma or mucoepidermoid carcinomas, and pharyngeal site of primary malignancy. On multivariate analysis, four statistically significant factors were identified, which included male gender, T3-T4 stage, pharyngeal site of primary malignancy, and high-grade adenocarcinoma or high-grade mucoepidermoid carcinomas. The proportions (and 95% confidence intervals) of patients with lymph node involvement for those with 0, 1, 2, 3 and 4 of these prognostic factors were 0.02 (0.01-0.03), 0.09 (0.07-0.11), 0.17 (0.14-0.21), 0.41 (0.33-0.49), and 0.70 (0.54-0.85) respectively. Grade was a significant predictor of metastasis for adenocarcinoma and mucoepidermoid carcinoma but not for adenoid cystic carcinoma. Overall survival was significantly worse at 5, 10, and 15 years for patients with lymph node involvement on presentation. A prognostic index using the four clinicopathological factors listed above can effectively differentiate patients into risk groups of nodal metastasis. The precision of this index is subject to the limitations of SEER data and it should be validated in further clinical studies.

The heterogeneity of salivary gland neoplasms have made classification and prognostication of these tumours sometimes difficult, and the in­troduction of techniques, such as enzyme and carbohydrate histochemis­try and electron microscopy have only to a certain extent increased our knowledge in these respects. In the present study immunohistochemical methods have been used to identify intermediate filament proteins (IFP) in normal fetal and adult parotid glands, as well as in salivary neo­plasms. The intermediate filaments (IF) make up the cytoskeleton in eucaryotic cells. Epithelial tissue contains IF composed of different cytokeratins (CK 1-19) whilst mesenchymal tissue generally contains IF composed of vimentin, and the IFP pattern is very stable even during cell transformation. It would thus be possible to further clarify the histogenesis of salivary neoplasms by identifying IFP, in addition the IFP pattern would probably be useful in tumour typing. Furthermore, ultrastructural cytochemical studies, microspectorphotometry on nuclear DNA as well as enzyme secretory studies of certain tumour types were carried out, in order to further characterize the biology of salivary neoplasms. The immunohistochemical investigations showed that in normal parotid tissue, the different cell types differed in IFP expression: acinar cells express mainly CK 18 and myoepithelial cells mainly CK 17 and 19, whilst duct cells contained a broad range of CK. Vimentin could in ad­dition to CK be detected in myoepithelial cells and basal cells of ex­cretory ducts. Fetal parotid cells showed a similar CK pattern as mature duct cells. In addition, vimentin could be found in some basal cells of the terminal tubules of the fetal glands. Salivary neoplasms could be divided into three types with regard to their IFP pattern:  Acinic cell carcinomas showed a CK-pattern similar to normal acinar cells but a co-expression of CK and vimentin was present in some cells.  Adenoid cystic carcinomas, mixed tumours and basal cell adenomas showed a CK-pattern of normal duct or myoepithelial cells. The peri­pheral cells were also vimentin positive. 3. Mucoepidermoid carcinomas and adenocarcinomas had a similar CK-pattern as duct cells, and no tu­mour cells contained vimentin. This indicates that typing of IFP may be useful for subgrouping of salivary neoplasms. By stereological measurements, the cells of acinic cell carcinomas were found to be very similar to normal parotid acinar cells. Furthermore, they contained amylase and after stimulation by norepiphrine a secre­tory response was induced, with a rise in intracellular cAMP as well as a release of amylase. By single cell measurements of nuclear DNA con­tent, no difference was found between acinic cell carcinomas with de­finite metastasis and those without recurrence, both in paraffin sec­tions and cytological smears. / digitalisering@umu.se

Orientador: Albina Messias de Almeida Milani Altemani / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T16:39:39Z (GMT). No. of bitstreams: 1 Bonfitto_VeraLuciaLeite_D.pdf: 2371427 bytes, checksum: 9766d47098dc3a0a8725d3d05732303e (MD5) Previous issue date: 2010 / Resumo: A angiogênese induzida pelo tumor é o resultado não somente do balanço entre indutores e inibidores da angiogênese, mas também da demanda metabólica tumoral. Nos carcinomas salivares com diferenciação mioepitelial, a densidade microvascular (DMV) é mais baixa do que nos carcinomas sem tal diferenciação. Apesar do fenótipo antiangiogênico da célula mioepitelial, as razões para essa associação ainda não foram completamente esclarecidas. Com a finalidade de aumentar o conhecimento sobre os fenômenos envolvidos na vascularização de carcinomas salivares, analisamos a DMV em tumores de diferentes tipos e graus histológicos. Além disso, em carcinomas adenóides císticos (CAC) com transformação para alto grau (CAC-TAG) analisamos a expressão de proteínas relacionadas ao metabolismo celular e a DMV entre áreas convencionais e transformadas. Estes achados foram também comparados com aqueles encontrados no CAC clássico. Material e Métodos: Em 42 carcinomas salivares com diferenciação mioepitelial e em 56 sem tal diferenciação, a vascularização tumoral foi avaliada através da DMV em lâminas coradas pelo CD34 (marcador pan-endotelial) e pelo CD105 (marcador de neoangiogênese). Além disso, em 7 casos de CAC-TAG e em 18 CACs foram examinadas as expressões dos marcadores relacionados ao metabolismo celular: transportador de glicose transmembrana (GLUT1) e antígeno mitocondrial (AMT), e do Ki- 67 (para análise do índice de proliferação). Resultados: Somente a DMV-CD105 foi significantemente diferente entre os diferentes subgrupos de tumores. Os tumores de alto grau apresentaram DMV-CD105 significantemente aumentada em relação aos de baixo grau. Os carcinomas com diferenciação mioepitelial e o carcinoma de células acinares mostraram DMV-CD105 semelhantes. Nos CAC-TAG, o componente transformado caracterizava-se pela perda da camada mioepitelial e índice aumentado de Ki-67. As áreas convencionais do CAC-TAG e o CAC clássico foram negativas para GLUT1 na maioria dos casos (83,3% e 81,3%, respectivamente) e exibiam expressão baixa ou ausente de AMT (100% e 66,7% dos casos respectivamente). Em contraste, as áreas transformadas do CAC-TAG exibiam aumento da expressão de GLUT1 (50% dos casos) e de AMT (100%). No CAC-TAG, comparando a DMV entre áreas convencionais e transformadas não se notou alteração significante. Conclusões: Nos carcinomas salivares, as células mioepiteliais não aparentam desempenhar papel crucial na vascularização tumoral, a qual é influenciada por fatores não necessariamente relacionados à demanda metabólica e progressão tumoral. A correlação da neoangiogênese com grau histológico tumoral sugere que a agressividade do carcinoma salivar pode ser um dos fatores indutores, embora por mecanismos ainda não esclarecidos / Abstract: Tumor-induced angiogenesis is not only determined by the net balance between inductors and inhibitors but also by factors related to tumor metabolic demand. Salivary carcinomas with myoepithelial component have been reported to have a lower microvascular density (MVD) than others without such cells. Despite the anti-angiogenic phenotype of the myoepithelial cells, the reasons for this association remain unclear so far. To broaden our understanding of phenomena involved in vascularization of salivary carcinomas we analyzed the MVD in tumors of different histological types and grade. In addition, in adenoid cystic carcinomas (ACC) with high-grade transformation (ACC-HGT), the expression of proteins linked to cellular metabolism as well as MVD was compared between conventional and HGT areas. We also compared the findings with ordinary ACC. Material and Methods: In 42 salivary carcinomas with myoepithelial differentiation and 56 without, tumor vascularization was assessed by measuring MVD in CD34 (pan-endothelial marker) and CD105 (neoangiogenesis marker) stained sections. In addition, in seven cases of ACC-HGT and in 18 ACCs the expressions of GLUT1, mitochondrial antigen (MTA) and Ki-67 (for evaluation of proliferation index) were also examined. Results: Only CD105-MVD was significantly different among the different tumor subgroups. High-grade tumors showed significantly higher CD105-MVD. Carcinomas with myoepithelial differentiation and acinic cell carcinomas exhibited similar CD105-MVD. In ACC-HGT, loss of myoepithelial layer was found only in the HGT component, which also showed higher Ki-67 index. Conventional areas of both ACC-HGT and ACC were negative for GLUT1 in most cases (83.3% and 81.3%, respectively) and exhibited low or no expression of MTA (100% and 66.7% of cases respectively). In contrast, the HGT component presented increased expression of both proteins (GLUT1+ in 50% of cases; MTA+ in 100%). MVD did not differ significantly between conventional and HGT components. Conclusions: In salivary carcinomas, myoepithelial cells do not appear to play a pivotal role in tumor vascularization, which is influenced by factors not necessarily related to metabolic demand and carcinoma progression. The correlation between tumor degree and neoangiogenesis (MVD-CD105) suggests that carcinoma aggressiveness may be one of the inductors but the mechanisms remain to be clarified / Doutorado / Anatomia Patologica / Doutor em Ciências Médicas

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

Made available in DSpace on 2014-12-17T15:32:33Z (GMT). No. of bitstreams: 1 MarciaCCMiguel_tese.pdf: 1534160 bytes, checksum: 1a3ec415bfaf10c088ec1ae5f6224189 (MD5) Previous issue date: 2005-05-27 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Pleomorphic adenoma and adenoid cystic carcinoma (ACC) consist benign and malignant neoplasm from salivary gland, respectively. These neoplasms share some characteristics, such as cellular origin and considerable production of extracellular matrix, however, with distinct biological behavior. The aim of the present study was to compare the expression of D2E1, D3E1 e D5E1 integrins in pleomorphic adenoma from minor and major salivary glands and ACCs. Furthermore, it was investigated possible differences in the expression of these integrins according to histological subtypes of ACC. Fourteen cases of pleomorphic adenoma from major salivary gland, fourteen cases from minor salivary gland and ten cases of ACC were selected. It was taken into consideration the presence or absence, localization and intensity of integrin immunoexpression. The cases of pleomorphic adenoma were grouped in order to compare the expression between the distinct neoplasms. It was observed a highly significant difference (p<0,0001) in relation to D2E1 integrin between the neoplasms since pleomorphic adenoma showed a pronounced immunostaining. It was not possible to perform statistical tests considering the D2E1 integrin expression; nevertheless, it could be observed a tendency of higher staining in pleomorphic adenoma. For comparative reasons the cases ACCs were divided in two groups: solid and tubular/cribriform. It was not detected significant differences in regard to D2E1 integrin; and statistical analysis could not be realized in relation to D3E1 and D5E integrin expression. However, it was also verified a tendency of absence or reduced expression in the solid subtype. It can be concluded that the reduced D2E1 integrin expression observed in CACs may be related to a lesser degree of cell differentiation in this neoplasm and the reduced D5E1 integrin expression can be associated with aggressive biological behavior. Moreover, the absence and/or reduced expression of the studied integrins in solid ACC suggests a role in pathogenesis and more aggressive biological behavior of this histological subtype / O adenoma pleom?rfico e o carcinoma aden?ide c?stico (CAC) representam neoplasias de gl?ndula salivar benigna e maligna, respectivamente, as quais compartilham algumas caracter?sticas como a mesma origem celular e uma marcante presen?a de matriz extracelular, apresentando, por?m, comportamentos biol?gicos distintos. O prop?sito desta pesquisa consistiu em comparar a express?o das integrinas D2E1, D3E1 e D5E1 em adenomas pleom?rficos de gl?ndula salivar menor e maior e CACs. Al?m disso, procurou investigar se havia diferen?as na express?o destas integrinas entre os subtipos histopatol?gicos do CAC. Foram selecionados 14 casos de adenoma pleom?rfico de gl?ndula salivar maior, 14 casos de gl?ndula salivar menor e 10 casos de CACs. Analisou-se a presen?a ou aus?ncia, localiza??o e intensidade de marca??o das integrinas. Os dois grupos de adenomas pleom?rficos foram reunidos em um s? para fazer a compara??o entre os dois tumores. Verificou-se que houve diferen?a estat?stica altamente significativa (p<0,0001) para a integrina D2E1 entre os dois tumores, apresentando o adenoma pleom?rfico, uma marca??o mais intensa para esta integrina. Em rela??o ? integrina D5E1 n?o foi poss?vel a realiza??o de testes estat?sticos, ficando patente, por?m, que houve uma tend?ncia da referida integrina ser mais intensamente expressa no adenoma pleom?rfico. Para an?lise comparativa, os CACs foram subdivididos em 2 grupos: s?lido e tubular/cribriforme. Para a integrina D2E1 observou-se que n?o houve diferen?a estatisticamente significativa e em rela??o ? D3E1 e D5E1 n?o foi poss?vel a realiza??o do teste estat?stico; no entanto, tamb?m foi verificada uma clara tend?ncia para os casos do subtipo s?lido apresentarem express?o ausente ou reduzida das integrinas avaliadas. Concluiu-se que a reduzida express?o da integrina D2E1 observada nos CACs, pode estar relacionada com a menor diferencia??o das c?lulas deste tumor e ? poss?vel que a reduzida express?o da D5E1, possa estar implicada em seu comportamento mais agressivo. Al?m disso, sugere-se que a aus?ncia e/ou redu??o da express?o das integrinas pesquisadas nos casos do subtipo s?lido, pode desempenhar algum papel na patog?nese e no comportamento biol?gico mais agressivo deste subtipo tumoral

We used flow cytometry in a retrospective study of pleomorphic adenoma and carcinoma arising in pleomorphic adenoma, using paraffin-embedded tissue, to assess the relationship among proliferative activity, ploidy, and recurrence or malignant transformation. Twenty-four specimens obtained from 22 tumors were acceptable for analysis (co-efficient of variation, < or = 7.0), including multiple samples from two tumors. Fourteen tumors (13 benign and one malignant) were diploid. Six tumors were aneuploid: four benign pleomorphic adenomas and two carcinomas arising in pleomorphic adenoma. Two tetraploid tumors were malignant recurrences from the same patient. Of the recurrent tumors (nine benign and four malignant), 54% were aneuploid. The highest S-phase fractions were observed in recurrent and malignant pleomorphic adenomas. Immunostaining with p105, a nuclear proliferation antigen, revealed increased proliferative activity in a majority of pleomorphic adenomas. Increased proliferative activity and aneuploidy occurred in benign pleomorphic adenomas.