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AimWe aim to evaluate the prognostic effect of Epstein-Barr virus (EBV) infection on overall survival (OS) in Peruvian women with cervical cancer.MethodsWe conducted a retrospective cohort study. Polymerase chain reaction technique was used in paraffin-embedded tumor tissue for the detection of EBNA-1 and LMP-1. We used a multiple Cox proportional-hazard regression to estimate adjusted hazard ratios (aHR) for death and 95% confidence intervals (95% CI). In order to model continuous variables without categorization, we used a multivariable fractional polynomial approach. We performed a stability analysis using bootstrapping for internal validation.ResultsA total of 99 patients with cervical cancer were included. The prevalence of EBV in cervical cancer specimens was 22.2% (n=22). The 1-year and 5-year OS rates were 81.8% (95% CI 58.5-92.8) and 45% (95% CI 23.9-64.1) in the EBV-positive group compared to 78.8% (95% CI 67.7-86.4) and 37.8% (95% CI 25.7-49.8) in the EBV-negative group, respectively. In the multivariate analysis, positive EBV status was an independent prognostic factor for improved OS (aHR: 0.32; 95% CI 0.16 to 0.67; p=0.002) compared to negative EBV status.ConclusionsEBV status is an independent prognostic factor for OS in cervical cancer. Evaluation of EBV status could be used as a clinical prognostic biomarker and to improve currently available prognostic models such as the FIGO system. Future prospective studies will be needed to validate these theories.

Breast cancer (BC) is a heterogeneous disease composed of four main subtypes with distinct clinical and epidemiological features. Although several reports have described the distribution of BC subtypes in Latin America, the majority of them have not included the cellular marker, Ki-67, in the immunohistochemical (IHC) panel. The aim of the present study was to describe the distribution of BC subtypes in a cohort of Latin American women using an IHC panel with Ki-67. A prospective cohort of 580 patients in three centers of Peru (the Hospital Nacional Edgardo Rebagliatti Martins, the Hospital Nacional Guillermo Almenara Irigoyen, the Hospital Nacional Alberto Sabogal, Lima) and one in Uruguay (Instituto Nacional del Cáncer, Montevideo) were evaluated. BC phenotypes were classified according to an IHC panel: Estrogen receptor (ER), progesterone receptor (PgR), HER2 and Ki-67. Silver in situ hybridization was used when the HER2 status, as determined by IHC, was equivocal. The associations between the BC phenotypes and their clinicopathological features were evaluated. ER was positive in 65% of the cases (n=377), and PgR in 50% (n=203). In total, 79.1% (n=459) were HER2-negative, 19.8% (n=115) were HER2-positive and 1% (n=6) had an equivocal status. With respect to Ki-67, 44.7% of the patients exhibited staining in >14% of the tumor cells (n=259). The distribution of subtypes was as follows: Luminal A, 31.9% (n=183); luminal B, 35% (n=201); HER2, 12.1% (n=70); and triple-negative, 20.9% (n=120). When Ki-67 was not included in the panel, the frequency of luminal A was 41.1% and luminal B, 25.8% (9.2% of the cases were misclassified). Ki-67 was most highly expressed in triple-negative and HER2 tumors. Inclusion of Ki-67 in the IHC panel to assign subtypes revealed a higher frequency of luminal B tumors than was reported previously for Latin American women with BC, whereas the distribution of triple-negative and HER2 tumors were similar to that previously reported. In conclusion, these results demonstrated that excluding Ki-67 from the panel of IHC markers may lead to an underestimation of the rates of luminal B tumors.

Primary cardiac neoplasms are rare. However, among them, cardiac myxoma is the most common tumor. In contrast, primary cardiac lymphoma within a cardiac myxoma is extremely rare and might be difficult to diagnose because of non-specific clinical manifestations. We report the case of a previously healthy 52-year-old man who presented with acute onset of transient dysarthria and left hemiplegia. A transthoracic echocardiography showed a 6×2.5-cm solid mass in the left atrium, which was subsequently resected. Histological, immunohistochemical, and molecular analyses revealed an EBV-associated CD30-positive large B-cell lymphoma with anaplastic morphology within a cardiac myxoma and fibrinous material. Staging studies showed no evidence of lymphoma elsewhere. The patient achieved complete remission and is alive 42 months after diagnosis, and did not receive chemotherapy. We discuss the clinical and pathologic features of lymphoma arising in cardiac myxoma or in intra-atrial fibrinoid mass and the potential role of IL-6 in its pathogenesis.

Se reporta un caso de melanoma de vagina, de rara presentación, diagnosticado y tratado en el servicio de Ginecología del Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Se describe la edad de aparición, antecedente ginecológico, clínica, localización, histología, estudios de extensión, tratamiento y evolución.

e12615 Background: Although Ki-67 is important in sub classifying luminal breast cancers, many reports from Latin American Countries does not include the evaluation of this marker in the immunohist...

e20023 Background: Little is known of the status of melanoma in developing countries. Our retrospective study was performed to determine the clinical characteristics and outcome of patients with melanoma in Peru. Methods: All cases with a pathological diagnosis of malignant melanoma from our institution between January 2002 and December 2011 were identified. Clinical data were extracted through retrospective chart review. Patients’ characteristics are presented using descriptive statistics. Survival curves were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were evaluated using log-rank and Cox proportional-hazard regression tests, respectively. Results: A total of 410 cases were evaluated. The median age at presentation was 66 years (range 4-97 years) with a male-to-female ratio was 1.1:1. There were 146 cases (35.6%) of acral lentiginous melanoma, 67 (16.3%) of nodular melanoma, 54 (16.3%) of mucosal melanoma, 39 (9.5%) of superficial spreading melanoma, 55 (13.4%) were lentigo maligno and 49 (12.0%) were unclassifiable. Melanoma of unknown primary occurred in 34 (8.3%) of cases. The proportion of patients with stage I, II, III and IV disease were 24.2%, 24.8%, 21.9% and 7.8%, respectively. Ulceration status of 320 cases of cutaneous melanoma was recorded and 138 (45.1%) had ulceration. The 5-year survival rate of 409 patients was 58.4% with a median survival time of 7.6 years. The 5-year survival rates of patients with stage I, II, III and IV disease were 88.2%, 67.8%, 39.3% and 17.8% respectively (p65 years (p=0.003), male sex (p=0.0001), stage (p

e12047 Background: The aim of this study is to determine differences in clinicopathologic features and outcomes of breast cancer subtypes using immunohistochemical markers. Methods: All invasive breast carcinomas from 2003 to 2005 diagnosed in our institution were included in the study. Evaluation of ER, PR and HER2 was performed by immunohistochemistry in formalin-fixed, paraffin-embedded tumor samples. Subtype definitions were as follows: Luminal A (ER+ and/or PR+, HER2-); Luminal B (ER+ and/or PR+, HER2+); HER2 (ER-, PR-, HER2+); triple negative (ER-, PR-, HER2-). We excluded patients whose inmunohistochemical studies and clinical records were incomplete and those treated with anti-HER2 therapy in the adyuvant and/or metastatic setting. Clinicopathological features and overall survival (OS) were analyzed. Results: Of the 639 invasive breast carcinomas included in this study 64.8% were Luminal A subtype, 7.5% Luminal B, 8.5% HER2 and 19.2% triple negative. No significant differences were found in clinic...

BACKGROUND: Epstein Barr Virus (EBV) positive status is associated with poor survival in Hodgkin lymphoma and T cell NHL. AIM: In order to define the prognostic impact of Epstein Barr Virus (EBV) infection in newly diagnostic nodal diffuse large B cell lymphoma (DLBCL), we investigated the EBV status in Peruvian DLBCL patients. PATIENTS AND METHODS: Between January 2002 and December 2004, seventy-four patients, diagnosed with nodal DLBCL, were included in the analysis. Tissues from patients were analyzed for the presence of EBV encoded RNA (EBER) using the in situ hybridization (ISH) RESULTS: Of the 74 cases, 53 cases (71.6%) were of the non Germinal Center DLBCL type (non GC). This group had a higher IPI than the Germinal Center DLBCL type (GC). Also the non GC DLBCL type had an inferior overall survival compared with GC DLBCL type, but the difference was not significant (p=0.171). Eleven cases (14.9%) were identified as EBER-positive. EBER positive was associated with an advanced age (> 60 years), poorer performance status, more advanced stage, higher IPI and poorer outcome to initial treatment. The EBER+ DLBCL patients demonstrated substantially poorer overall survival (EBER+ vs. EBER−): 1.1 months (95% CI, 0.0–2.6 months) vs. 15.5 months (1.0–30.0 months) respectively, (p=0.001). Most of the cases EBER (+) were of the non GC group. At the multivariable level, EBER status is an independent variable compared with the International Prognostic Index (IPI) (p=0.001) with a 3.2-fold (95% CI, 1.5–7.2) risk for death for positive cases. CONCLUSION: EBV positive status in de novo, nodal DLBCL was present in 11/74 cases and is a powerful prognostic factor in this Peruvian population. EBV positive status correlated with advanced age, poor performance status, more advanced stage, non-GC group and short survival. New therapeutic strategies should be investigated in this poor prognostic subgroup. Figure Figure