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ABSTRACT Pseudomyogenic hemangioendothelioma is an ultra-rare vascular sarcoma that most commonly affects young adults, with a male predominance. It is diagnosed using a combination of imaging studies, histopathological examinations, and immunohistochemical staining. Surgical excision is the mainstay of treatment for pseudomyogenic hemangioendothelioma, with the goal of achieving a wide local excision and reducing the risk of recurrence. The role of systemic therapies is not well established because of the rarity of pseudomyogenic hemangioendothelioma, uncertainty regarding its response to currently approved medications, and lack of randomized controlled trials. We describe the case of an 18-year-old male patient diagnosed with multifocal pseudomyogenic hemangioendothelioma of the left lower limb who was treated with everolimus in addition to denosumab, achieving a partial response that was consolidated with resection, radiofrequency ablation, and radiotherapy of multiple local lesions, achieving a long-lasting response. Following subsequent disease progression, the patient responded favorably to pazopanib, with no significant toxicities.

HER2-Low is defined as low levels of HER2 expression, based on a score of 1+ on immunohistochemical (IHC) assay or as an IHC score of 2+ and negative results on in situ hybridization (ISH or FISH). They are a heterogeneous population of breast cancers that vary in prognosis and sensitivity to systemic treatments. The frequency and clinical characteristics of pathogenic germline variants (PGVs) in HER2-Low breast cancer (BC) patients is not defined. We analyzed results from patients with BC who underwent multi-gene panel testing (MGPT) (maximum 145 genes) between 2018–2019. We reclassified HER-2 status accordingly. Relationships between the variables of interest were assessed by adopting the proportional regression Cox models. Of a total of 167 BC patients who underwent MGPT, half were hormone-receptor-positive. The median age was 45 years. About two thirds of the patients were in the earlier stage of BC. A total of 57% of the cases were reclassified as HER-2-negative or -Low. PGVs were found in 19% of the patients overall, as follows: seven BRCA1, four BRCA2, two ATM, one ATR, two CFTR, three CHEK2, one FANCA, one MERTK, one MLH1, three MUTYH, one RAD50, three RAD51C, one RECQL4, and two TP53 mutations. In HER2-Low, 26.5% of the patients had PGVs, and in the overall cohort, this was 19.8%. In conclusion, differences in the prevalence of deleterious germline mutations in HER2-Low BC patients compared to non-HER2-Low BC patients were identified. Similar alterations in BRCA were observed in this group of patients compared to the overall cohort. Germline genetic tests should be evaluated in larger cohorts of patients with HER2-Low status to better address the findings.

ABSTRACT Objective Currently programmed cell death protein 1 (PD-1) inhibitors in combination with other therapies are being evaluated to determine their efficacy in cancer treatment. However, the effect of PD-ligand (L) 1 expression on disease outcomes in stage III (EC III) non-small cell lung cancer is not completely understood. Therefore, this study aimed to assess the influence of PD-L1 expression on the outcomes of EC III non-small cell lung cancer. Methods This study was conducted on patients diagnosed with EC III non-small cell lung cancer who underwent treatment at a tertiary care hospital. PD-L1 expression was determined using immunohistochemical staining, all patients expressed PD-L1. Survival was estimated using the Kaplan-Meier method. Relationships between variables were assessed using Cox proportional regression models. Results A total of 49 patients (median age=69 years) with EC III non-small cell lung cancer and PD-L1 expression were evaluated. More than half of the patients were men, and most were regular smokers. The patients were treated with neoadjuvant chemotherapy, surgery, or sequential or combined chemotherapy and radiotherapy. The median progression-free survival of the entire cohort was 14.2 months, and the median overall survival was 20 months. There was no significant association between PD-L1 expression and disease progression, clinical characteristics, or overall survival. Conclusions PD-L1 expression was not correlated with EC III non-small cell lung cancer outcomes. Whether these findings differ from the association with immune checkpoint inhibitors remains to be addressed in future studies.

Abstract Neoadjuvant chemotherapy is considered a new treatment option for potentially resectable pancreatic cancer. However, data are not well established on overall survival and delaying surgery in resectable pancreatic cancer, as well as on those patients that ultimately cannot undergo surgery. We analyzed pancreatic cancer patients treated in a tertiary hospital from January 2016 to December 2020. Patients with resectable stage I and II pancreatic cancer were evaluated regarding surgery, neoadjuvant treatment, and other clinical demographics. The survival function was estimated using the Kaplan–Meier method, and the relationship between the variables of interest and the overall survival (OS) was assessed by adopting the proportional regression Cox models. A total of 216 patients were evaluated. 81 of them with resectable/borderline resectable disease and 135 with unresectable /metastatic disease at diagnosis. Median OS for stage I and II disease were 36 and 28 months, respectively. For resectable pancreatic cancer median OS was 28 months, for borderline resectable pancreatic cancer median OS was 11 months. Median OS for stage III (locally advanced) and stage IV (metastatic) were 10 and 7 months, respectively (p

Immunotherapy (IT) in the form of monoclonal antibodies targeting coreceptors involved in the modulation of the immune synapse represents a standard of care for patients with distinct malignancies. Over the past years, evidences supporting the clinical use of IT both in monotherapy, as well as in combinatorial regimens, grew dramatically, leading to multiple regulatory approvals. With the expanding clinical incorporation of IT, understanding the mechanisms and management of the adverse events (AE) associated with this class of drugs is of utmost importance for professionals involved in patient care. In 2017, the Brazilian Society of Clinical Oncology (SBOC) issued the initial version of the “Brazilian guidelines for the management of immune-related toxicities associated with checkpoint inhibitors”. In this article, we aimed to update general and specific aspects related to immune-related AEs associated with the use of immune-checkpoint inhibitors, including emerging evidences and updated algorithms for the most frequent clinical manifestations.

O objetivo deste trabalho foi analisar as percepções e transformações na implantação do modelo de avaliação progressiva na E. E. M Dr. Brunilo Jacó, do município de Redenção/CE. Buscou-se compreender a percepção de agentes escolares - professores, gestores e estudantes -, assim como observar, comparativamente, as taxas de aprovação, reprovação, transferência e evasão, antes e após a implantação desse modelo avaliativo. As principais referências estudadas foram José Carlos Libâneo, Tomaz Tadeu da Silva, Heloísa Lück, Cipriano Luckesi e Antoni Zabala. Os resultados indicaram que a implantação da avaliação progressiva na escola não teve como consequência direta um maior índice de aprovações, mas facilitou o aprendizado, conforme depoimentos dos professores e estudantes. Esses resultados demonstram que outros aspectos interferem no processo de ensino e aprendizagem, como o aumento do número de alunos por sala. Conclui-se que a gestão escolar precisa continuar repensando os processos de avaliação diante das dinâmicas educacionais. Palavras-chave: avaliação progressiva; ensino médio; escola.

The number of patients requiring admission in intensive care units and prolonged invasive mechanical ventilation (MV) has increased significantly during the coronavirus disease 2019 (COVID-19) pandemic. Tracheoesophageal fistula (TEF) following prolonged invasive MV is a rare condition. Numerous COVID-19 pathophysiological mechanisms and treatment-related effects might support the increase of tracheal complications in this subgroup of patients. We report a case of TEF in a COVID-19 patient submitted to prolonged invasive MV and discuss its diagnosis and management.

OBJECTIVES: To evaluate the efficacy and safety of sorafenib in elderly patients with advanced hepatocellular carcinoma (HCC). METHODS: We analyzed data from a cohort of patients with advanced HCC treated using systemic treatment according to the local institutional protocol. Patients were divided into two groups, Group A, individuals

Abstract Introduction: Vascular access (VA) in hemodialysis (HD) is essential to end-stage renal disease (ESRD) patients survival. Unfortunately, after some years in HD program, a significant number of patients may develop VA failure for many reasons. In this situation, arterial venous fistula (AVF) confection or catheters placement in traditional vascular sites (jugular, femoral or subclavian) are not feasible. In this scenario, translumbar tunneled dialysis catheter (TLDC) may be a salvage option. Objectives: To describe placement technic, complications, and patency of 12 TLDC. Methods: A retrospective study was performed to analyze 12 TLDC placement in an angiography suite using fluoroscopic guidance at the University Hospital of the Rio Grande do Norte Federal University from January 2016 to October 2017. The data collected of the total procedures performed consisted of demographic characteristics, success rates, observed complications, patient survival, and catheter patency. Results: All 12 TLDC were placed with success; there were only 2 significant periprocedure complications (major bleeding and extubation failure); 41.6% of patients presented a catheter-related first infection after 98 ± 72.1 (6-201) days, but catheter withdrawal was not necessary, mean total access patency was 315.5 (range 65 - 631) catheter-days, and catheter patency at 3, 6 and 12 months was 91 %, 75%, and 45%. Conclusion: TLDC is an option for patients with VA failure, improving survival and acting as a bridge for renal transplantation.

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