RESUMEN
Rosai-Dorfman Disease (RDD) is an idiopathic histiocytic proliferation affecting lymph nodes. Although extranodal involvement has been reported in diverse sites, manifestation in the central nervous system (CNS) is extremely rare, particularly in the brain parenchyma. A 39-year-old male presented with an isolated well-circumscribed brain mass in the right temporal lobe, preoperatively thought to be a meningioma. Histology and immunohistochemistry confirmed that the lesion was RDD. The intraparenchymal brain location of RDD appears to have a benign course. Although the adjuvant therapy is a treatment of choice, surgical resection seems to be the appropriate treatment modality. From the clinical point of view RDD might be an important intracerebral entity because it may mimic other lesions, particularly other histiocytic disorders.
Asunto(s)
Encefalopatías/diagnóstico por imagen , Histiocitosis Sinusal/diagnóstico por imagen , Adulto , Encefalopatías/patología , Encefalopatías/cirugía , Histiocitosis Sinusal/patología , Histiocitosis Sinusal/cirugía , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: Most cases of granulosa cell tumors (GCT) of the ovary are characterized by a relatively good outcome. However, some tumors behave aggressively and some tend to recur many years after the initial diagnosis. Tumor growth depends on cell proliferation and angiogenesis. Thus, proliferative indices and microvessel density were studied to determine possible valuable methods to assess the GCT patient's outcome. METHODS AND STUDY DESIGN: Paraffin-embedded tissue blocks were available for 60 patients with primary GCT and were investigated by immunostaining with monoclonal antibodies against PCNA, Ki-67 and factor VIII-related antigen. The follow-up was available for 51 patients and ranged from 25 to 206 months. A clinical follow-up distribution of patients was made: 8 patients with recurrence (group I); 6 patients who lived with no evidence of recurrence for 100 months or more (group II), and 37 patients alive with no evidence of recurrence in the follow-up period of less than 100 months (group III). RESULTS: There was a statistical correlation between PCNA and Ki-67 proliferative indices. A significant increase (P <0.05) of mean PCNA and Ki-67 proliferative indices and mean tumor size was seen in patients of Group I compared to those of Group II. The mean PCNA proliferative index positively correlated with the mean Ki-67 proliferative index for Groups I and II. Mean microvessel density showed a positive correlation with mean PCNA and Ki-67 proliferative indices and with mean tumor size for Group I, whereas it was negatively correlated with PCNA proliferative index and tumor size for Group II. A positive correlation was found between mean mitotic count and both proliferative indices only for Group II. The following features were indicative of a relatively poor prognosis: GCT measuring >9 cm in diameter, PCNA >4.0%, Ki-67 >1.2%, and diffuse, insular and sarcomatoid histologic patterns. CONCLUSIONS: The findings support the importance of proliferative factors, tumor size and histologic patterns as possible prognostic indicators for estimating the biologic behavior of patients with GCT. Unfortunately, angiogenesis did not seem to be a useful determinant parameter of a possible aggressive behavior. However, a longer follow-up period with larger series may be required to assess the value of the parameters in prediction of patient survival.
Asunto(s)
Tumor de Células de la Granulosa/irrigación sanguínea , Tumor de Células de la Granulosa/patología , Neovascularización Patológica , Neoplasias Ováricas/irrigación sanguínea , Neoplasias Ováricas/patología , Adulto , Anciano , División Celular , Femenino , Tumor de Células de la Granulosa/inmunología , Humanos , Inmunohistoquímica , Antígeno Ki-67/análisis , Microcirculación , Persona de Mediana Edad , Neoplasias Ováricas/inmunología , Antígeno Nuclear de Célula en Proliferación/análisisRESUMEN
Cavernous angioma of the optic chiasm or optic nerve is extremely rare. We report the case of a 58-year-old woman with cavernous angioma of the optic chiasm. The lesion was totally removed through the eyebrow keyhole approach, which allowed appropriate intraoperative exploration of the optic chiasm and related structures. The present case confirms that a cavernous angioma located in the optic chiasm can be totally resected without further impairment of visual function.
Asunto(s)
Hemangioma Cavernoso del Sistema Nervioso Central/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Neuroquirúrgicos/métodos , Quiasma Óptico/cirugía , Cejas/cirugía , Femenino , Hemangioma Cavernoso del Sistema Nervioso Central/patología , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Quiasma Óptico/patología , Resultado del TratamientoRESUMEN
Immunohistochemical analysis of the distribution of the lipid peroxidation product 4-hydroxynonenal (HNE) in the brain of baboons exposed to experimental hemorrhagic traumatic shock or sepsis showed that systemic oxidative stress and the thereby generated HNE affect the blood:brain barrier and the regulation of cerebral blood flow determining secondary brain damage. Similarly, HNE was determined during ischemia in the brain blood vessels of rats exposed to ischemia/reperfusion injury of the brain. After reperfusion, HNE disappeared from the blood vessels but remained in neurones and in glial cells. Since HNE modulates cell proliferation and differentiation (including proto-oncogene expression), it is postulated that HNE might have prominent local and systemic effects that are not only harmful but beneficial, too, determining the outcome of various pathophysiological conditions based on oxidative stress.
Asunto(s)
Aldehídos/metabolismo , Sistemas de Mensajero Secundario/fisiología , Aldehídos/inmunología , Aldehídos/farmacología , Animales , Anticuerpos Monoclonales , Encéfalo/irrigación sanguínea , Encéfalo/metabolismo , Encéfalo/patología , División Celular/efectos de los fármacos , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/metabolismo , Radicales Libres/metabolismo , Células HeLa , Humanos , Inmunohistoquímica , Ataque Isquémico Transitorio/metabolismo , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patología , Papio , Proto-Oncogenes Mas , Proteínas Proto-Oncogénicas c-fos/metabolismo , Ratas , Ratas Wistar , Sistemas de Mensajero Secundario/inmunología , Sepsis/metabolismo , Choque/complicaciones , Choque/metabolismo , Timidina/metabolismoRESUMEN
AIM: To determine the extent of agreement between clinical and autopsy findings. METHODS: A 14-year retrospective study (1982-1995) of autopsies from the Departments of Internal Medicine and Surgery was performed at the Zagreb University Hospital Center, Croatia. The autopsy findings were compared with the clinical diagnoses. RESULTS: The autopsy rate among hospital deaths ranged between 23% and 33%. The overall rate of major discrepancies was 11.6% for all autopsy reports. The most common cause of death were cardiovascular diseases (40.9%), followed by malignancies (25.2%) and infections (12.9%). Among all cardiovascular diseases, myocardial infarction was the most frequently diagnosed (17.9%) and was misdiagnosed by clinicians in 16.5% of the cases. Incorrectly diagnosed malignancies were found in only 5.7% of the cases; hematological and lymphoid malignancies (48.8%) were the most common neoplasms and were usually confirmed before death. Infections were found in 46.9% of all autopsies. Bacterial pneumonias and peritonitis were overlooked in 67.5% and 23. 5% of the cases, respectively, in which they existed together with another serious condition. CONCLUSIONS: Modern technology has not improved the overall accuracy of clinical diagnoses. When an autopsy should be performed is still a matter of discussion.
Asunto(s)
Autopsia/estadística & datos numéricos , Causas de Muerte , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Croacia/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
This report describes a case of atypical carcinoid of the larynx with metastatic tumor to cervical lymph nodes showing features similar to paraganglioma. Immunohistochemically, both the primary and metastatic tumor were positive for epithelial membrane antigen, cytokeratin, neuron-specific enolase, chromogranin, synaptophysin, calcitonin and carcinoembryonic antigen. The sustentacular cells in pseudo-cell ball ("Zellballen") formations were shown by a positive S-100 marker. Electron microscopic analysis revealed numerous neuroendocrine granules measuring 150-250 nm in diameter. Clinical features, histological appearance, histochemical, immunohistochemical and ultrastructural findings, as well as differential diagnosis are discussed.
Asunto(s)
Tumor Carcinoide/patología , Neoplasias Laríngeas/patología , Metástasis Linfática/patología , Anciano , Calcitonina/análisis , Antígeno Carcinoembrionario/análisis , Tumor Carcinoide/secundario , Cromograninas/análisis , Gránulos Citoplasmáticos/ultraestructura , Diagnóstico Diferencial , Humanos , Inmunohistoquímica , Queratinas/análisis , Masculino , Microscopía Electrónica , Mucina-1/análisis , Cuello , Paraganglioma/diagnóstico , Fosfopiruvato Hidratasa/análisis , Proteínas S100/análisis , Sinaptofisina/análisisRESUMEN
An unusual case of invasive ductal carcinoma of the breast associated with epitheloid granulomas is reported. Multinucleated giant Langhans'-type giant cells were found in the epitheloid granulomas in breast carcinoma, but there were not present in the breast tissue and axillary lymph nodes. Congo-red deposits were found haphazardly in the stroma between tumor cells and granulomas. Numerous mast cells were found surrounding granulomas. The patient lacked any clinical evidence of the systemic granulomatous disease. The presence of epitheloid granulomas, amyloid deposits and numerous mast cells in invasive breast carcinoma could be related to a host immune response towards the tumor.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Granuloma/patología , Anciano , Amiloidosis/patología , Mama/patología , Femenino , Humanos , Ganglios Linfáticos/patologíaRESUMEN
A case of mixed tumor of the vagina or spindle cell epithelioma is presented and the literature on this rare type of tumor is reviewed. Immunohistochemical findings suggest an epithelial origin. Follow-up studies indicate benign behavior. However, recurrent tumors were reported suggesting careful follow-up observation after excision of extended primary tumors.
Asunto(s)
Carcinoma de Células Escamosas/diagnóstico , Tumor Mulleriano Mixto/diagnóstico , Neoplasias Vaginales/diagnóstico , Adulto , Biomarcadores de Tumor/análisis , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Queratinas/análisis , Tumor Mulleriano Mixto/patología , Tumor Mulleriano Mixto/cirugía , Vagina/patología , Vagina/cirugía , Neoplasias Vaginales/patología , Neoplasias Vaginales/cirugíaRESUMEN
Patients with ankylosing spondylitis are susceptible to spinal fractures. In many cases there is no history of associated trauma or only minor trauma. The instability of such fractures and complicating neurologic sequelae are well documented. We describe an unusual complication of ankylosing spondylitis, hemothorax secondary to spinal fracture, that to our knowledge has not been previously reported. Further, we reemphasize that the instability of such fractures may lead to significant paravertebral soft tissue and vascular injuries.