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Linfoma de celulas grandes T anaplásico: experiencia de 10 años en el Instituto Nacional de Enfermedades Neoplásicas, Lima - Perú
No full textIntroduction: Anaplastic Large T cells Lymphoma is a rare pathology, determined by expression of CD30 and differences in presentation and aggressiveness according to the ALK expression. Objectives: This study seeks to determine the epidemiological, clinicopathological and prognosis of patients with Anaplastic Large T-cell Lymphoma. Methods: The clinical records of patients diagnosed with Anaplastic Large T cells Lymphoma from the National Institute of Neoplastic Diseases in Lima-Peru were analyzed between years 2006 to 2016. Results: Of 86 patients, 57% were male, 21.9% were positive for ALK, 48 patients were found in clinical stage I and II and 36 between stages III and IV. 57 patients had low or low intermediate risk while 26 patients were between high and high intermediate risk. The estimated overall survival was 40.8% at 5 years. In patients with positive ALK group was 67.4% and in the group with negative ALK was estimated at 30.2%. Conclusions: Anaplastic Large T Cells Lymphoma is an important aggressive disease with heterogeneous distribution for age and slightly more common in males, with the expression of ALK and international prognostic index as important prognostic factors
Dasatinib Induced Pulmonary Arterial Hypertension in a Patient from the Peruvian Andes at 3660 m
No full textLa hipertensión arterial pulmonar (HAP) tiene una incidencia que oscila entre 1,5 y 32 pacientes por mi�llón; es una entidad de mal pronóstico, con una tasa de mortalidad estandarizada en EE.UU. entre 4,5 y 12,3 por 100 00 habitantes, y una supervivencia a cinco años del 56%. (1) La HAP se define cuando la presión sistólica pulmonar supera los 30 mmHg o la presión arterial pulmonar (PAP) media es ≥25 mmHg; las etiologías son muy variadas, e incluyen la secundaria a fármacos (grupo 1 de la clasificación clínica del 6° Sim�posio Mundial de HAP: inducida por drogas/toxinas)
Chip-based digital Polymerase Chain Reaction as quantitative technique for the detection of PIK3CA mutations in breast cancer patients
No full textBackground: PIK3CA is a gene frequently mutated in breast cancer. With the FDA approval of alpelisib, the evaluation of PIK3CA for activating mutations is becoming routinely. Novel platforms for gene analysis as digital PCR (dPCR) are emerging as a potential replacement for the traditional Sanger sequencing. However, there are still few studies on chip-based dPCR to detect mutations in tumor samples. Thus, this cross-sectional study aimed to assess the sensibility of a chip-based dPCR to detect and quantify PIK3CA mutations and compare its performance with Sanger sequencing. Materials and Methods: Tumor samples from 57 breast cancer patients (22 pre-treatment samples, 32 tumors after neoadjuvant chemotherapy, and three lymph nodes) were collected and analyzed by Sanger sequencing and dPCR for the three PIK3CA most relevant mutations (p.E545K, p. H1047R, and p. H1047L). Digital PCR sensitivity, specificity, and overall performance were estimated by contingency tables, receptor operator characteristic (ROC), and area under the curve (AUC). Association of PIK3CA mutations with clinicopathological variables was conducted. Results: Sanger sequencing identified PIK3CA mutations in six patients (10.5%), two with p. H1047R, and four with p. E545K. Digital PCR confirmed those mutations and identified 19 additional patients with at least one mutation. Comparison between dPCR and Sanger sequencing showed a sensitivity of 100% (95% CI 53–100%), and a specificity of 84.2% (95% CI 83–84.2%). Besides, p. H1047R mutation detected by dPCR showed a significant association with breast cancer phenotype (p = 0.019) and lymphatic nodes infiltration (p = 0.046). Conclusions: Digital PCR showed a high sensitivity to detect mutations in tumor samples and it might be capable to detect low-rate mutations and tumor subpopulations not detected by Sanger sequencing. © 2022 The Author(s
Evaluation of Three Models of Follow-up of Patients with Cervical Cytological Abnormalities in a Peruvian’s Largest Teaching Women’s Hospital
No full textIntroduction: The follow-up of squamous intraepithelial lesions (SIL) allows us to understand their progression and regression, however squamous cell atypia (ASC) can generate confusing follow-up results. We aimed to describe the evolution of ASC and SIL during cyto-histopathological follow-up in a tertiary-care hospital. Materials and methods: we conducted a retrospective study during 2016 in 156 Papanicolaou test (PAP) results under three models: 1) with ≥1 PAP and biopsies, 2) 1 PAP followed by ≥1 biopsy, and 3) ≥1 PAP and a confirmatory biopsy. Progression was defined as ASCUS to low-grade SIL (LSIL) or higher, and LSIL to high-grade SIL (HSIL) or higher and regression as HSIL to LSIL or lower and LSIL to ASCUS or lower. Results: In PAP, 57 (36.5%) cases were ASC and in histopathology 56 (39.9%) cases of grade 1 cervical intraepithelial neoplasia. Twenty-nine (18.6%) results were followed: 8 (27.6%), 17 (58.6%), and 4 (13.8%) with models 1, 2, and 3, respectively. The progression of the lesions was reported in ~50% for models 2 and 3. ASCUS was the main cytological finding that indicated biopsies, and for all models, the mean progression and regression time was 4 and 3.1 months, respectively. Conclusions: The follow-up of cytological alterations in three models showed progression of lesions in half of the cases analyzed with a time of four months of evolution ASCUS was the main finding that indicated histopathological study
Administración de Citostáticos en el marco de la calidad del cuidado de enfermería oncológica
No full textEn la actualidad a nivel mundial se ha incrementado el número de pacientes que padecen de cáncer, en su mayoría ellos reciben tratamiento con citostáticos. El papel que juega la enfermera especialista en oncología es fundamental para mantener la continuidad del cuidado, educación al paciente y familia para enfrentar los efectos adversos resultantes de la terapéutica. El objetivo general fue evaluar las prácticas de administración de citostáticos y la calidad del cuidado de los enfermeros especializados en oncología de un Hospital Nacional de la ciudad de Lima. Estudio de enfoque cuantitativo, descriptivo, ex post facto, diseño no experimental y de corte transversal. La población estuvo conformada por 30 enfermeras especialistas en oncología que laboran en el servicio de quimioterapia y 120 pacientes que reciben tratamiento con citostáticos. Los resultados mostraron que en su mayoría las enfermeras realizan buenas prácticas en la administración de citostáticos, así también la calidad del cuidado desde la percepción del paciente es buena, lo que genera confianza en el proceso del cuidado. Se concluye que las buenas prácticas de administración de citostáticos promueven un entorno seguro y de confianza para el paciente. Esta situación favorece un mayor nivel de percepción sobre la calidad del cuidado de enfermería lo cual permite sostener la continuidad del tratamiento
Notch Signaling Promotes Mature T-Cell Lymphomagenesis
No full textPeripheral T-cell lymphomas (PTCL) are agressive lymphomas engineered mouse models and spontaneous PTCL models were that develop from mature T cells. The most common PTCLs are used to functionally examine the role of Notch signaling, and genetically, molecularly, and clinically diverse and are generally Notch1/Notch2 blockade and pan-Notch blockade using domiassociated with dismal outcomes. While Notch signaling plays a nant-negative MAML significantly impaired the proliferation of critically important role in both the development of immature T malignant T cells and PTCL progression in these models. Treatment cells and their malignant transformation, its role in PTCL is poorly with DLL1/DLL4 blocking antibodies established that Notch sigunderstood, despite the increasingly appreciated function of Notch naling is ligand-dependent. Together, these findings reveal a role for in regulating the proliferation and differentiation of mature T cells. ligand-dependent Notch signaling in driving peripheral T-cell Here, we demonstrate that Notch receptors and their Delta-like lymphomagenesis. family ligands (DLL1/DLL4) play a pathogenic role in PTCL. Notch1 activation was observed in common PTCL subtypes, includSignificance: This work demonstrates that ligand-dependent ing PTCL-not otherwise specified (NOS). In a large cohort of PTCL-Notch activation promotes the growth and proliferation of mature NOS biopsies, Notch1 activation was significantly associated with T-cell lymphomas, providing new therapeutic strategies for this surrogate markers of proliferation. Complementary genetically group of aggressive lymphomas. 2022 American Association for Cancer Research
Gliomas de alto grado en pacientes pediátricos post - radioterapia: reporte de dos casos en el Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
No full textRadiation therapy-induced high-degree gliomas (RIGs) are a rare complication with an ominous prognosis. Little is known about the underlying biology of RIGs, although some studies have suggested that there are no unique histologic or cytogenetic features to distinguish them from de novo glioblastomas. Two cases that meet the criteria to be considered RIG are reported, and pertinent pieces of literature are discussed. Two patients under 10 years of age, neither of whom had relevant genetic or clinical history, were diagnosed with primary cerebral gliomas at the National Institute of Neoplastic Diseases in Lima and, after radiation therapy cycles, developed high-degree secondary gliomas, confirmed in both patients by a histopathologic analysis. This report emphasizes the need to identify risk factors, molecular mechanisms of tumor development after radiotherapy, and probable therapeutic targets
Human Papillomavirus, Cytomegalovirus Infection and P16 Staining in Breast Tumors from Peruvian Women
No full textObjective: To evaluate the frequency distribution of viral infections in Peruvian Breast Cancer (BC) lesions and its association with clinicopathological features. Additionally, a prospective evaluation of p16 and Tumor-infiltrating lymphocytes (TIL) levels were performed for developing a comprehensive analysis. Methods: Detection of high risk- human papillomavirus (HR- HPV) through qPCR was performed in 447 BC and 79 non-cancer frozen samples. Paired paraffin samples from 238 BC were stained with Human cytomegalovirus (HCMV) and p16 immunohistochemistry. TIL was calculated in 397 BC cases. Results: HCMV was positive in 72.5%. HR- HPV was detected in 2.9% of BC and 1.3% of non-malignant samples. P16+ was found in 28.15% and median TIL percentage was 30. HR- HPV infection was associated with non-ductal histology (p=0.003) and p16+ (p=0.017). Positive P16+ was associated with higher T stage (p=0.022), grade (p=0.009), TIL level (p=0.002), and triple-negative phenotype (p=0.021). Conclusion: HCMV is frequent, but HR- HPV infection is unusual in Peruvian BC. P16+ is associated with HR- PVH infection, high TIL and aggressive features. © 2022. All Rights Reserved.This study was supported by CONCYTEC, under contracts #204-2015-FONDECYT and #198-2015-FONDECYT
Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals
No full textBackground: Pediatric Early Warning Systems (PEWS) reduce clinical deterioration, improve interdisciplinary communication, and provide cost savingshowever, little is known about how these impacts are achieved or related. This study evaluates the multi-level impacts of PEWS in resource-limited pediatric oncology centers. Methods: We conducted 71 semi-structured interviews including physicians (45%), nurses (45%), and administrators (10%) from 5 resource-limited pediatric oncology centers in 4 Latin American countries. Interviews were conducted in Spanish, transcribed, and translated into English. A code book was developed using a priori and inductively derived codes. Transcripts were independently coded by 2 coders, achieving a kappa of 0.8-0.9. Thematic content analysis explored perceived impacts of PEWS at the level of the patient, clinician, healthcare team, and institution. Results: PEWS improved the quality of attention for patients, reducing morbidity and mortality. Clinicians felt more knowledgeable, confident, and empowered providing patient care, resulting in greater job satisfaction. PEWS affected team dynamics by improving interdisciplinary (ward and intensive care unit) and interprofessional (physicians and nurses) relationships and communication. This ultimately led to institutional culture change with emphasis on patient safety, collaboration with other centers, and receipt of institutional awards. Together, these impacts led to hospital-wide support of ongoing PEWS use. Conclusions: In resource-limited hospitals, PEWS use results in multi-level positive impacts on patients, clinicians, teams, and institutions, creating a feedback loop that further supports ongoing PEWS use. These findings can guide advocacy for PEWS to various stakeholders, improve PEWS effectiveness, and inform assessment of other interventions to improve childhood cancer outcomes
The relationship between tumour infiltrating lymphocytes, Epstein–Barr virus and Helicobacter pylori infection in gastric cancer
No full textObjective: Epstein–Barr virus (EBV) and Helicobacter pylori (HP) infections have been extensively recognised as gastric cancer (GC) triggers, and recent publications suggest they could behave as predictive markers for immune-modulating therapies. Tumour-infiltrating lymphocytes (TILs) have also been identified as a predictive biomarker for immunotherapy in different malignancies. This study aimed to investigate the association between EBV and HP infection with TIL levels in GC. Methods: TIL evaluation in haematoxylin-eosin was performed by a pathologist and density of CD3, CD8 and CD163 positive (immunohistochemistry staining) immune cells was calculated with the use of digital pathology software. EBV infection was detected by in situ hybridisation (ISH) and by quantitative polymerase chain reaction (qPCR). Methylation status of EBV-related genes was detected by PCR and a methylome analysis was performed by the Illumina Infinium MethylationEPIC BeadChip. HP status was detected by qPCR. Results: We included 98 resected GC Peruvian cases in our evaluation. Median TIL percentage was 30. The proportion of EBV+ detected by ISH was 24.1%, of EBV+ detected by qPCR was 41.8%, while 70% showed methylation of EBV-related genes, and 58.21% of cases were HP+. Younger age (p = 0.024), early stages (p = 0.001), HP+ (p = 0.036) and low CD8 density (p = 0.046) were associated with longer overall survival (OS). High TIL level was associated with intestinal subtype (p < 0.001), with grade 2 (p < 0.001), with EBV qPCR+ (p = 0.001), and with methylation of EBV-related genes (p = 0.007). Cases with high TIL level and cases that are EBV positive share eight genes with similarly methylated status in the metabolomic analysis. High CD8 density was associated with EBV PCR+ (p = 0.012) and HP− (0.005). Conclusion: Lower CD8 density and HP+ predict longer OS. High TIL level is associated with EBV+ and methylation of EBV-related genes, while lower CD8 density is associated with HP+ GC. Copyright: © the authorslicensee ecancermedicalscience. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Universidad Cientifica del Sur, Consejo Nacional de Ciencia, Tecnologia e Innovacion Tecnologica (under projects #198-2015-FONDECYT and #196-2015-FONDECYT), and INNOVATEPERU (under project #317-PNICP-EC-2014)