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Sotelo M, Muñoz-Unceta N, Matorras A, Jara P, Castro C, Cacho D, Caramelo B, Azueta A, Durán I. Outcomes with atezolizumab in metastatic urothelial cancer: real-world data from a single institution. Clin Transl Oncol 2024; 26:682-688. [PMID: 37537512 DOI: 10.1007/s12094-023-03288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/17/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Immune checkpoint inhibitors (ICIs) have been incorporated in the treatment of metastatic urothelial carcinoma (mUC) upon platinum-based chemotherapy according to the positive results of large clinical trials. Nevertheless, results from unselected populations reflecting real-world data (RWD) are highly informative to the clinician. We reviewed daily clinical practice outcomes in patients with mUC who received atezolizumab in our institution. METHODS Here we evaluated the clinical activity and safety of atezolizumab in an unselected population of mUC patients who received atezolizumab between 2018 and 2022 reflecting RWD. Efficacy and safety information were retrospectively collected. RESULTS A total of 63 patients were included. The mean age was 68 years and the objective response rate was 14.3%. The median progression-free survival was 3 months and the median overall survival 6 months. At 1 year, 42% of the patients were alive. ECOG (0 vs 1) and neutrophil-lymphocytes ratio < 2 at the start of ICI were positive prognostic factors that discriminated between long vs short survivors. Overall tolerance was good with no new safety signals. Five patients (17%) had treatment-related adverse events grade ≥ 2 that required corticosteroids. CONCLUSION In this retrospective study, atezolizumab was an effective and tolerable treatment option for patients with mUC after progression to platinum-based chemotherapy. Yet, patient selection remains critical to improve outcomes.
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Affiliation(s)
- Marta Sotelo
- Medical Oncology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Nerea Muñoz-Unceta
- Medical Oncology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | - Pablo Jara
- Medical Oncology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Clara Castro
- Medical Oncology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Diego Cacho
- Medical Oncology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Belén Caramelo
- Medical Oncology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Ainara Azueta
- Pathology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Ignacio Durán
- Medical Oncology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain.
- Instituto de Investigación Valdecilla, IDIVAL, Santander, Spain.
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Serrano M, Muñoz-Unceta N, Alonso LA, Azueta A, Gutiérrez Baños JL, Ferreira L, Domínguez M, Torres Zurita A, Ballestero R, Cacho D, López-Brea M, Sotelo M, Campos-Juanatey F, Ramos Barseló E, Duran I. Neoadjuvant chemotherapy with dose-dense MVAC in muscle-invasive bladder cancer: a tertiary center experience. Clin Transl Oncol 2024; 26:549-553. [PMID: 37566343 DOI: 10.1007/s12094-023-03277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/04/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Neoadjuvant chemotherapy in muscle-invasive bladder cancer (MIBC) patients has proven beneficial in overall survival. However, the optimal regimen is still a matter of debate. MATERIALS AND METHODS In this retrospective analysis, we evaluate the results obtained in 42 patients treated in our center with 4 cycles of neoadjuvant dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) followed by radical cystectomy from August 2015 to October 2020. All patients had cT2 or higher non-metastatic MIBC. Clinical and pathological outcomes are reported. RESULTS Of the 42 patients, 90.5% were men (n = 38) and the mean age was 65 years. All of them had ECOG 0-1 at diagnosis and most tumors had an initial clinical stage T2N0 (76%). Thirty-six patients (85.7%) completed 4 cycles of neoadjuvant treatment, and 21.4% required a dose reduction. The most frequent adverse event (AE) was grade 1-2 asthenia (81%), while neutropenia was the most frequent grade 3 or higher AE (38%). Complete pathological response (ypT0, ypN0) was achieved in 50% of patients (n = 21), and down-staging was observed in 57.1% (n = 24). Only one patient presented radiological progressive disease during neoadjuvant treatment (2.4%), and after a mean follow-up time of 31.5 months, 33.3% of patients experienced disease recurrence. CONCLUSIONS Neoadjuvant chemotherapy with 4 cycles of dd-MVAC is an effective regimen with high rates of pathological complete responses and down-staging along with an acceptable toxicity profile. DD-MVAC should be considered as an alternative to cisplatin and gemcitabine in patients with good clinical performance status.
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Affiliation(s)
- Marina Serrano
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Nerea Muñoz-Unceta
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Lucía Andrea Alonso
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Ainara Azueta
- Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Laura Ferreira
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Mario Domínguez
- Urology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Albero Torres Zurita
- Medical Oncology Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Roberto Ballestero
- Urology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Diego Cacho
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Marta López-Brea
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Marta Sotelo
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | | | - Ignacio Duran
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
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3
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Freire J, García-Berbel P, Caramelo B, García-Berbel L, Ovejero VJ, Cadenas N, Azueta A, Gómez-Román J. Usefulness of COL11A1 as a Prognostic Marker of Tumor Infiltration. Biomedicines 2023; 11:2496. [PMID: 37760937 PMCID: PMC10526338 DOI: 10.3390/biomedicines11092496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Determining the infiltration of carcinomas is essential for the proper follow-up and treatment of cancer patients. However, it continues to be a diagnostic challenge for pathologists in multiple types of tumors. In previous studies (carried out in surgical specimens), the protein COL11A1 has been postulated as an infiltration marker mainly expressed in the extracellular matrix (ECM). We hypothesized that a differential expression of COL11A1 may exist in the peritumoral stroma of tumors that have acquired infiltrating properties and that it may be detected in the small biopsies usually available in normal clinical practice. MATERIAL AND METHODS In our study, we performed immunohistochemical staining in more than 350 invasive and noninvasive small samples obtained via core needle biopsy (CNB), colonoscopy, or transurethral resection of bladder tumor (TURBT) of breast, colorectal, bladder, and ovarian cancer. RESULTS Our results revealed that COL11A1 immunostaining had a sensitivity to classify the samples into infiltrative vs. noninfiltrative tumors of 94% (breast), 97% (colorectal), >90% (bladder), and 74% (ovarian); and a specificity of 97% (breast), 100% (colorectal), and >90% (bladder). In ovarian cancer, the negative predictive value (0.59) did not present improvement over the usual histopathological markers. In all samples tested, the cumulative sensitivity was 86% and the specificity 96% (p < 0.0001). CONCLUSIONS COL11A1-positive immunostaining in small biopsies of breast, colon, bladder and ovarian cancer is an accurate predictive marker of tumor infiltration that can be easily implemented in daily clinical practice.
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Affiliation(s)
- Javier Freire
- Pathology Department, University Hospital Marques de Valdecilla, Avda. Marqués de Valdecilla s/n, 39008 Santander, Spain
| | - Pilar García-Berbel
- Pathology and Molecular Pathology Unit, IDIVAL, Avenida Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - Belén Caramelo
- Pathology and Molecular Pathology Unit, IDIVAL, Avenida Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - Lucía García-Berbel
- Breast Unit, Gynecology Department, University Hospital Puerta del Mar. Av. Ana de Viya, 21, 11009 Cádiz, Spain
| | - Victor J. Ovejero
- Surgery Department, University Hospital Marques de Valdecilla, Avda. Marqués de Valdecilla s/n, 39008 Santander, Spain
| | - Nuria Cadenas
- El Alisal Health Center, Cantabrian Health Service, C. los Ciruelos, 48, 39011 Santander, Spain
| | - Ainara Azueta
- Pathology Department, University Hospital Marques de Valdecilla, Avda. Marqués de Valdecilla s/n, 39008 Santander, Spain
| | - Javier Gómez-Román
- Pathology Department, University Hospital Marques de Valdecilla, Avda. Marqués de Valdecilla s/n, 39008 Santander, Spain
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Alvarez-Dominguez C, Azueta A, Muñoz Unceta N, Gutierrez-Baños JL, Teran H, Ocejo-Viñals J, Gonzalez-Lopez E, Caramelo B, Marcos-Gonzalez S, Salcines-Cuevas D, Dominguez M, Madureira-Rivero R, Campos-Juanatey F, Sotelo M, Zeoli A, Revuelta L, Duran I. Immune characterization of urothelial bladder carcinoma integrating transurethral resection of bladder tumor (TURBT) samples and serum: A feasibility study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
538 Background: Urothelial bladder cancer (UBC) is characterized by high immunogenicity. Multiple immunotherapies both in the perioperative and advanced setting are being developed. However, we lack good predictive biomarkers of response to immunotherapy in UBC. We aimed to characterize the immune profile of UBC patients using TURBT and serum samples. Methods: 13 UBC biopsies from TURBT samples were analyzed along with sera of these patients. Biopsy samples were divided in two equal parts. One part was formalin-fixed paraffin embedded and stained for immune histochemistry [IHC] for the following markers (CD3, CD4, CD8, CD20, CD68 and PD-L1 using SP142 antibody) and results expressed in percentages. The other part was homogenized and processed for immune cell isolation (human tumor isolation Miltenyi Kit). Tumor cells were stained with PHK and double positive CD8 and PHK were isolated using a MACSTM procedure. Different immune cell populations were analyzed by flow cytometry for the following markers (CD3, CD4, CD8, CD20 and CD68) and results expressed in percentages. Cytokines were examined in sera using the Luminex multiparametric procedure and results were expressed as pg/mL. Results: IHC and flow cytometry data were comparable and identified three groups according to the immune cells associated with the tumors (Table). Groups 1 and 2 showed high and moderate levels of tumor activated CD8+ T cells (1-4%) along with a higher expression of PD-L1 (40-20%). Group 3 lacked tumor activated CD8+ T cells and show lower expression of PD-L1 (15%). All groups showed significant levels of Th2 cytokines (IL-4, IL-6 or IL-10) while very low or lack of Th1 cytokines (IFN or IL-2) was observed except in group 2. Conclusions: TURBT biopsies and serum analysis of cytokines could represent a valid approach to further evaluate potential predictive biomarkers of response to immunotherapy in UBC. Different immune populations subgroups were identified in our series and could potentially predict for diverse responses to treatment. Further prospective validation in larger series is ongoing to confirm these results.[Table: see text]
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Affiliation(s)
| | - Ainara Azueta
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | | | | | | | | | - Belen Caramelo
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | | | - Mario Dominguez
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | | | - Marta Sotelo
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | | | - Ignacio Duran
- Hospital Universitario Marques de Valdecilla, Santander, Spain
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5
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Freire-Salinas J, Benito R, Azueta A, Gil J, Mendoza C, Nicolás M, García-Berbel P, Algarate S, Gómez-Román J. Genotype Distribution Change After Human Papillomavirus Vaccination in Two Autonomous Communities in Spain. Front Cell Infect Microbiol 2021; 11:633162. [PMID: 34631594 PMCID: PMC8493034 DOI: 10.3389/fcimb.2021.633162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
Context It has been more than 10 years since the human papillomavirus (HPV) vaccination program was initiated in most advanced countries. Thus, it seems necessary to change the uterine cervical cancer screening strategy. Molecular-based tests are considered essential in this scenario. Objective We aimed to review the distribution of the HPV genotypes after the introduction of the vaccination program with Cervarix® and Gardasil 4® in two autonomous communities in Spain, looking for possible changes in distribution and the occurrence of a herd effect. Design A cross-sectional study was performed in 45,362 samples that were processed in the Cantabria and Aragon communities during the period from 2002 to 2016. We compared the genotype distribution before and after the vaccination program was initiated. Results Genotypes HPV6 and HPV11 have decreased significantly after the introduction of the vaccine. HPV16 has had a decrease, but not a significant one in the statistical analysis. However, HPV31, HPV52, and HPV45 have increased in percentage. A replacement phenomenon with other genotypes not included in the vaccine has been observed in our population. Conclusions Continued surveillance is needed to provide further indication of any changes over time in the genotypes in circulation. This will be facilitated by monitoring the genotyping results from the new model of cervical screening using primary HPV DNA testing.
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Affiliation(s)
- Javier Freire-Salinas
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Rafael Benito
- Servicio de Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Ainara Azueta
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Joaquina Gil
- Servicio de Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Claudia Mendoza
- Servicio de Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Montserrat Nicolás
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Pilar García-Berbel
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Sonia Algarate
- Servicio de Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Javier Gómez-Román
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
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Rivera DH, Duran I, Marcos Kovandzic L, Puente J, Mellado B, Grande E, Virizuela JA, Rodriguez-Moreno JF, Azueta A, Alonso Buznego LA, Luque R, Garrigos C. Single nucleotide polymorphisms (SNPs) as predictors of efficacy of cabazitaxel in patients with metastatic castration-resistant prostate cancer (mCRPC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e17582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17582 Background: Cabazitaxel is a semi-synthetic derivative of a natural taxoid approved for the treatment of mCRPC patients (pts) after failure to docetaxel. Despite its proven efficacy, there is variability in the response, progression-free survival (PFS) and overall survival (OS) of pts. Changes in the genetic constitution of the individual such as the SNPs could explain this variability. The aim of this study was to evaluate the impact of certain SNPs in cabazitaxel activity. Methods: Clinical data from 67 mCRPC pts treated with cabazitaxel between March 2011 and October 2016 were collected. DNA was isolated from formalin fixed paraffin-embedded tumor samples. 56 SNPs in 5 genes related with metabolism and/or mechanism of action of cabazitaxel (CYP3A4, CYP3A5, ABCB1, TUBB1, CYP2C8) were chosen based on their Minor Allele Frequency, linkage disequilibrium and information from dbSNP and analyzed by TaqMan OpenArray (Lifetech). The presence/absence of mutant alleles of the selected SNPs was correlated with clinical features, progression free survival (PFS) and overall survival (OS) of prostate cancer. Chi-square test and Kaplan-Meier with log-rank test were used for statistical analyses. Results: The median age was 61 years (range 44-82). 56.7% (n = 38) had a Gleason score ≥8 and 94% had received docetaxel in first line. Type of response to cabazitaxel was associated with median OS (Partial response = 24.35 months, Stable disease = 11.16 months, Progression disease = 5.8 months; p= 0.045). Univariate analysis, showed worsed OS at 1 year for wild type status of SNP rs151352 (OR = 4, 95%CI 1.27-12.58, p= 0.029). In addition, two SNPs (rs11773597, rs1202186) were associated with radiological response to cabazitaxel ( p= 0.031 and p= 0.030 respectively). Other 7 SNPs (rs11773597, rs2235040, rs1045642, rs1419745, rs1202170, rs6949448, rs11572093) were associated ( p<0.05) with Gleason score, pain, PSA doubling time, febrile neutropenia and asthenia. Conclusions: A particular SNP profile could be predictive of efficacy and related with toxicity in mCRPC population treated with cabazitaxel after progression to docetaxel. These outcomes become particularly relevant in patient selection given the recent results of the CARD trial.
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Affiliation(s)
| | - Ignacio Duran
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Javier Puente
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Begona Mellado
- Translational Genomics and Targeted Therapeutics in Solid Tumours Lab, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | | | | | | | - Raquel Luque
- Medical Oncology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Carmen Garrigos
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
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7
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Martín‐Penagos L, Benito‐Hernández A, San Segundo D, Sango C, Azueta A, Gómez‐Román J, Fernández‐Fresnedo G, López‐Hoyos M, Ruiz JC, Rodrigo E. A proliferation‐inducing ligand increase precedes IgA nephropathy recurrence in kidney transplant recipients. Clin Transplant 2019; 33:e13502. [DOI: 10.1111/ctr.13502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Luis Martín‐Penagos
- Nephrology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Adalberto Benito‐Hernández
- Nephrology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - David San Segundo
- Immunology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Cristina Sango
- Nephrology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Ainara Azueta
- Pathology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Javier Gómez‐Román
- Pathology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Gema Fernández‐Fresnedo
- Nephrology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Marcos López‐Hoyos
- Immunology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Juan C. Ruiz
- Nephrology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Emilio Rodrigo
- Nephrology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
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Mora Cuesta VM, Iturbe D, González L, Díaz T, Fernández S, Martínez A, Sangrador A, Gómez J, Azueta A, Sánchez L, Naranjo S, Álvarez C, Carbajo M, Mons R, Alonso R, Pérez V, De Pablo A, Cifrián JM. Basiliximab induction reduces the incidence of acute rejection in lung transplant patients. Transplantation 2018. [DOI: 10.1183/13993003.congress-2018.pa2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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9
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González-Castro A, Ortiz-Lasa M, García-Reyero J, Azueta A. [Wünderlich syndrome due to a ruptured iliac vein secondary to deep venous thrombosis]. Rev Esp Patol 2018; 51:197-202. [PMID: 30012315 DOI: 10.1016/j.patol.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 06/08/2023]
Abstract
Wünderlich syndrome, or spontaneous retroperitoneal hematoma, secondary to spontaneous rupture of the iliac vein is a rare clinical entity and a medical emergency. Often the aetiology is difficult to identify and different hypotheses have been proposed, such as the presence of hormonal, inflammatory and/or mechanical factors. It may be important to assess the presence of a factor that triggered the deep vein thrombosis and secondary rupture of the iliac vein and retroperitoneal hematoma. We present a case where venous thrombosis could have caused rupture of the iliac vein and we discuss the entity in light of the current literature.
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Affiliation(s)
| | - María Ortiz-Lasa
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Julia García-Reyero
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Ainara Azueta
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, España
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10
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Rodríguez-Zarco E, Vallejo-Benítez A, Umbría-Jiménez S, Pereira-Gallardo S, Pabón-Carrasco S, Azueta A, González-Cámpora R, Espinal P, García-Escudero A. Immunohistochemical study of the neural development transcription factors (TTF1, ASCL1 and BRN2) in neuroendocrine prostate tumours. Actas Urol Esp 2017; 41:529-534. [PMID: 28285791 DOI: 10.1016/j.acuro.2016.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Prostatic small-cell neuroendocrine carcinoma is an uncommon malignancy that constitutes 0.5-1% of all prostate malignancies. The median cancer-specific survival of patients with prostatic small-cell neuroendocrine carcinoma is 19 months, and 60.5% of the patients have metastatic disease. Neural development transcription factors are molecules involved in the organogenesis of the central nervous system and of neuroendocrine precursors of various tissues, including the suprarenal gland, thyroid glands, lungs and prostate. MATERIAL AND METHODS We present 3 cases of this uncommon condition, applying the new World Health Organisation criteria. We conducted studies through haematoxylin and eosin staining and analysed the expression of the neural development transcription factors achaete-scute homolog like 1, thyroid transcription factor 1 and the class III/IV POU transcription factors, as a new research line in the carcinogenesis of prostatic neuroendocrine tumours. RESULTS In case 1, there was no TTF1 immunoexpression. Cases 2 and 3 had positive immunostaining for ASCL1, and Case 1 had negative immunostaining. BRN2 immunostaining was negative in case 1 and positive in cases 2 and 3. CONCLUSION The World Health Organisation does not recognise any molecular or genetic marker with prognostic value. ASCL-1 is related to the NOTCH and WNT signalling pathways. ASCL-1, TTF1 and BRN2 could be used for early diagnosis and as prognostic factors and therapeutic targets.
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11
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Velilla G, Carrión CJ, Portillo JA, Truán D, Azueta A, Fuentes J, Herrero E, Gala L. Microcytic carcinoma of the urinary bladder: Experience over 22 years. Actas Urol Esp 2016; 40:195-200. [PMID: 26748843 DOI: 10.1016/j.acuro.2015.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 11/30/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Microcytic carcinoma of the urinary bladder or bladder Small Cell Carcinoma (SCC) is a rare entity, characterised by an aggressive behaviour, with a poor prognosis, elevated metastatic potential, and is commonly found in older patients and in advanced disease stages. Here we present our experiences with the behaviour of the disease and the treatments applied. MATERIAL AND METHOD This was a retrospective study on patients diagnosed with bladder SCC in our hospital between February 1992 and February 2014. We analysed the demographic and clinical characteristics of the tumour, the applied treatments and survival. We performed a descriptive statistical analysis of the median follow-up time, Overall Survival (OS) and Cancer-Specific Survival (CSS), using the SPSS statistical package v. 15.0. RESULTS Over 22 years, 20 patients with an average age of 75 years were diagnosed with bladder SCC (2 female). The predominant symptom was macroscopic haematuria (75%). After the first transurethral resection (TUR) of the bladder and the histological diagnosis, 35% (7 patients) did not receive additional treatment, 15% (3 patients) were treated with chemoradiotherapy (CRT), 10% (2 patients) with TUR, 15% (3 patients) with chemotherapy (QT), 5% (1 patient) with TUR associated to CRT, 5% (1 patient) with radical surgery, 5% (1 patient) with radical surgery treatment followed by adjuvant CRT, 5% (1 patient) with palliative surgery (hypogastric arteriae ligation) followed by adjuvant QT and 5% (1 patient) with hemostatic radiotherapy (RT). With a median follow-up time of 13.8 months, the OS was 14.48 months (95% CI: 6.22 - 22.75) and the CSS 18.04 months (95% CI: 6.51-29.57). Only 10% (2 patients) survived till the end of the study. CONCLUSION Microcytic carcinoma of the urinary bladder is a rare and aggressive entity commonly diagnosed in males of advanced age and in advanced disease stages. It has a poor prognosis and reduced survival. Due to its aggressiveness previous to the initial diagnosis, a cystectomy is only possible in very few cases; therefore multimodal treatment is necessary. This treatment is yet to be defined.
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Affiliation(s)
- G Velilla
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - C J Carrión
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J A Portillo
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - D Truán
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - A Azueta
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J Fuentes
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - E Herrero
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - L Gala
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, España
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Val-Bernal JF, Azueta A, Ballestero R, Fuentes J, Fernández-Flórez A. Incidental bladder lipoma: a case report and review of the literature. Turk Patoloji Derg 2015; 31:64-7. [PMID: 25371024 DOI: 10.5146/tjpath.2014.01284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Conventional lipoma is the most common benign mesenchymal neoplasm in adults. However, bladder lipoma is a rare tumor. We report an incidental 0.5-cm, mucosal, bladder lipoma in a 75-year-old man, successfully treated with endoscopic excision. The tumor was found during the extension study of a high-grade urothelial carcinoma of the renal pelvis. A review of the published cases, including the present report, yielded a total of 16. Conclusions on this review are presented. The case is being reported because its rarity and to highlight the importance of complete workup to clarify associated disorders that may suggest extension of a malignant process.
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Val-Bernal JF, Caballero CI, Lastra P, Azueta A, Gutierrez-Baños JL. Aneurysm of the right renal vein arising from an idiopathic arteriovenous fistula. Cardiovasc Pathol 2014; 23:310-2. [PMID: 24849549 DOI: 10.1016/j.carpath.2014.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 04/10/2014] [Accepted: 04/11/2014] [Indexed: 12/16/2022] Open
Abstract
A renal vein aneurysm is rarely secondary to an arteriovenous fistula. A symptomatic 4.7-cm aneurysm of the right renal vein arising from an idiopathic arteriovenous fistula in a 41-year-old woman is described. Imaging techniques have a critical role in planning the treatment. The 4.7-cm aneurysm showed a venous wall with uneven thickening of the intima, irregular atrophy and architectural disarray of the media, and partial loss of elastic fibers. Potential for rupture supports surgical intervention in a selected patient with a macroaneurysm.
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Affiliation(s)
- José Fernando Val-Bernal
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain.
| | - Clara I Caballero
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain
| | - Pedro Lastra
- Diagnostic Radiology Service, Marqués de Valdecilla University Hospital, Santander Spain
| | - Ainara Azueta
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain
| | - José L Gutierrez-Baños
- Service of Urology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain
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Val-Bernal JF, Azueta A, Ortiz-Rivas LA, Fuentes J, Ballestero R. Incidental lipoma-like hibernoma arising from the adrenal gland: A well-differentiated liposarcoma mimicker. Pathol Res Pract 2013; 209:812-6. [DOI: 10.1016/j.prp.2013.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022]
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Val-Bernal JF, Azueta A, Parra A, Mediavilla E, Zubillaga S. Paratesticular cellular angiofibroma with atypical (bizarre) cells: case report and literature review. Pathol Res Pract 2013; 209:388-92. [PMID: 23582366 DOI: 10.1016/j.prp.2013.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 02/19/2013] [Accepted: 03/08/2013] [Indexed: 12/12/2022]
Abstract
We report the extremely unusual occurrence of a cellular angiofibroma (CAF) with atypical (bizarre) cells in the spermatic cord. We present a 63-year-old man, who was referred to the Urology Service with a six-month history of a slowly growing painless nodule in the right inguino-scrotal area. The clinical impression was that of a lipoma. The mass was locally excised. Gross examination showed a well-circumscribed neoplasm attached to the spermatic cord and measuring 5cm in the greatest dimension. Microscopic examination of the tumor showed the appearance of CAF with scattered severely atypical (bizarre) cells distributed throughout the lesion. By immunohistochemistry, atypical cells showed diffuse expression of p16, CDK-4, CD34 and vimentin. Keratin AE1/AE3, S-100 protein, p53, and epithelial membrane antigen were negative. The patient is free of disease two months after tumor excision. To the best of our knowledge, this is the third case of CAF with atypical (bizarre) cells occurring in the paratesticular area. Pathologists should be aware of this morphological variation of CAF to avoid misdiagnosis and over-treatment.
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Affiliation(s)
- José Fernando Val-Bernal
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IFIMAV, Santander, Spain.
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Azueta A, Maiques O, Velasco A, Santacana M, Pallares J, Novell A, Llombart-Cussac A, Gonzalez-Tallada X, Mozos A, Prat J, Pillai R, Mata M, Matias-Guiu X. Gene expression microarray-based assay to determine tumor site of origin in a series of metastatic tumors to the ovary and peritoneal carcinomatosis of suspected gynecologic origin. Hum Pathol 2013; 44:20-8. [DOI: 10.1016/j.humpath.2012.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 04/24/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
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Santacana M, Yeramian A, Velasco A, Bergada L, Gatius S, García V, Azueta A, Palacios J, Dolcet X, Oliva E, Matias-Guiu X. Immunohistochemical features of post-radiation vaginal recurrences of endometrioid carcinomas of the endometrium: role for proteins involved in resistance to apoptosis and hypoxia. Histopathology 2012; 60:460-71. [DOI: 10.1111/j.1365-2559.2011.04106.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Gatius S, Velasco A, Azueta A, Santacana M, Pallares J, Valls J, Dolcet X, Prat J, Matias-Guiu X. FGFR2 alterations in endometrial carcinoma. Mod Pathol 2011; 24:1500-10. [PMID: 21725289 DOI: 10.1038/modpathol.2011.110] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fibroblast growth factor receptor 2 (FGFR2) is a tyrosine kinase receptor involved in many biological processes such as embryogenesis, adult tissue homeostasis and cell proliferation. Mutations in FGFR2 have been reported in up to 10-12% of endometrial carcinomas identical to those found in congenital craniofacial disorders. Inhibition of FGFR2 could be a new therapeutic target in endometrial carcinoma. FGFR2 immunostaining was assessed in three tissue microarrays: one constructed from paraffin-embedded blocks of 60 samples of normal endometrium in different phases of menstrual cycle, and two tissue microarrays containing endometrial carcinoma samples (95 and 62 cases). FGFR2 expression was correlated with stage, histological type and grade as well as with immunostaining of PTEN, RASSF1A, estrogen and progesterone receptors, KI67, Cyclin D1, STAT-3 and SPRY2. FGFR2 mutations were assessed by PCR and direct sequencing, with DNA obtained from 31 paraffin-embedded endometrial carcinoma samples. In normal endometrium, FGFR2 expression was higher in the secretory than in the proliferative phase (P=0.001), with an inverse correlation with Ki67 (P=0.00032), suggesting a tumor-suppressor role for FGFR2 in normal endometrium. Cytoplasmic expression of FGFR2 was higher in endometrial carcinoma when compared with the atrophic endometrium from the same patients (P=0.0283), but was lower in comparison with normal endometrium from women in the menstrual cycle. Interestingly, nuclear staining was observed in some cases, and it was less frequent in endometrial carcinoma when compared with the adjacent atrophic endometrium (P=0.0465). There were no statistical differences when comparing superficial and myoinvasive endometrial carcinoma samples. Endometrioid endometrial carcinomas showed higher expression of FGFR2 than nonendometrioid endometrial carcinomas (fold change 2.56; P=0.0015). Grade III endometrioid endometrial carcinomas showed decreased FGFR2 expression when compared with grade II endometrioid endometrial carcinomas (P=0.0055). No differences were found regarding pathological stage. Two missense mutations of FGFR2 gene were detected in exons 6 and 11 (S252W and N549K, respectively; 6.45%). Results support the hypothesis that FGFR2 has a dual role in the endometrium, by inhibiting cell proliferation in normal endometrium during the menstrual cycle, but acting as an oncogene in endometrial carcinoma.
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Affiliation(s)
- Sonia Gatius
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLLEIDA, Lleida, Spain
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Abstract
Tropical sprue (TS), although endemic in certain tropical regions of the world, is rarely seen in North America and Europe. However, in this era of globalization and worldwide travel, it is important for all clinicians to be aware of the possibility of TS in patients presenting with nonspecific, persistent gastrointestinal complaints like diarrhea and weight loss. The symptoms and histologic findings of TS can resemble and be confused with those of diseases seen more commonly in nontropical climates like celiac disease and small intestine bacterial overgrowth. Therefore, if the usual causes of persistent diarrhea are ruled out, keeping a high index of suspicion for TS in patients who have a travel history to one of the endemic regions is important.
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Affiliation(s)
- Mashal Jatoi Batheja
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Ariz., USA
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