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Background: Solid pseudopapillary neoplasm, or Frantz-Gruber tumor, is a diagnostic challenge for the surgical pathologist. It is classified by the WHO as a malignant epithelial tumor of the pancreas, its prevalence is low, it occurs in only 1 to 2% of all malignant tumors of the pancreas, it usually affects mainly young women, its origin is still unclear, it is generally It presents as a solitary, encapsulated lesion, without invasion of peripancreatic tissues with rare cases of metastasis, which is why it is considered a low-grade malignant tumor by the WHO. The objective of this article is to present three clinical cases and to evaluate the epidemiology, clinical manifestations, morphology and immunohistochemical expression of the tumor in a review of the bibliography, as well as to compare it with the cases already reported on the subject. Clinical case: Three cases of Frantz tumor were diagnosed by the pathology department of a tertiary hospital are presented, which correspond to two women aged 17 and 34, as well as a 52-year-old man whose presentation by age and sex is rare. Conclusions: After the bibliographical review and the analysis of the cases presented, we verified the difficulty to make a correct diagnosis, since its presence is rare in the daily practice of the surgical pathologist. The morphological patterns of the solid pseudopapillary tumor are varied and can often be reminiscent of neuroendocrine tumors of the pancreas, whose presentation rate is higher.
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Neoplasias Pancreáticas , Masculino , Humanos , Femenino , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico , PáncreasRESUMEN
Introdução: A descrição do linfoma anaplásico de células T e o recente aumento das cirurgias de explante resultou na elevação do número de exames anatomopatológicos nas cirurgias de retirada de implantes mamários de silicone. O objetivo desta pesquisa é analisar a qualidade e quantidade de dados contidos na requisição do exame histopatológico. Métodos: Foram estudados 251 casos. Os seguintes dados foram analisados: sexo, idade, localização anatômica e espacial, lateralidade, história clínica, sinais e sintomas, quimioterapia e radioterapia prévia, hipótese diagnóstica, cirurgias prévias, tipo e marca do implante, exames de imagem prévios e número e características dos espécimes enviados. Resultados: A idade média foi de 43 anos. A lateralidade não foi mencionada em 16 (0,84%). A localização anatômica foi citada em 15 casos. O tipo de cirurgia foi mencionado por 40 (15,94%). O número de contêineres variou de 1 a 5, com mediana de 2. A cápsula foi enviada em 242 casos, em 161 de forma isolada, tecido mamário em conjunto com cápsula em 27, tecido mamário e cápsula em contêineres diferentes em 54 casos. A história clínica foi incluída em 19,12%, sinais e sintomas em 13,94%, em que a contratura foi o único termo inserido em 64. Em 27 requisições foi citado linfoma. Em 15 pacientes a presença de seroma foi referida e destes nove foram enviados. O tipo e marca do implante não foi citado. Conclusão: Os dados são escassos. Recomenda-se a criação de protocolos na retirada da cápsula e tecido adjacente, incluindo a orientação anatômica e espacial.
Introduction: The description of the Anaplastic Large Cell Lymphoma and the explantation surgery resulted in an increase of histopathological exams in breast implant removing surgery. Methods: 251 pathology requests were studied. The following data from the medical requests were analyzed: gender, age, type of surgery, number of specimens containers sent, laterality, anatomical and spatial location, clinical history, signs and symptoms, previous radiotherapy, previous chemotherapy, diagnostic hypothesis, previous surgeries, and reference to previous breast exams. Results: The mean age was 43 years old. Laterality was not mentioned in 16 requests. The surgery performed was mentioned in 15.94% requests. The number of containers varies from 1 to 5, with a median of 2. The containers include capsules in 242 cases, 161 as isolated capsule, 27 mammary tissue, and capsule in the same specimen, 54 mammary tissues sent in a separate container, anatomical and spatial location was mentioned in 6.33% cases. The detailed clinical data was included in 19.12%, signs and symptoms 13.94%, contracture as the only item mention in 64 of them. In 27 requests, lymphoma evaluation was requested. 15 included seroma and from nine of those, liquid was sent with a request for immunohistochemical and cytology analysis. None of the requests had any data on implant type or brand. Conclusion: The amount of information contained in the medical request forms is minimal. The authors recommend the need for a protocol to standardize the surgical removal of the capsule and the adjacent mammary tissue. Surgical specimens should be spatially oriented.
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Cervical thymic cysts are relatively rare benign cystic lesions that tend to be diagnosed clinically as branchial cysts, which usually present as painless, enlarging neck masses. They can occur anywhere along the normal path of descent of thymic primordia from the angle of the mandible to the sternal notch, with mediastinal extension observed in approximately 50% of cases. They are usually seen in the first decade of life on the left side with a male predominance. Here we report a case of a 15-year-old boy who presented to the hospital with left-sided neck swelling for about 2 months. The neck's contrast-enhanced computed tomography (CECT) revealed a large, well-defined cystic swelling in the left neck region, showing peripheral enhancement, seen from the submandibular region to the superior mediastinum extending into the retrosternal region. Direct fine needle aspiration (FNA) was done, which showed a benign lesion with inflammatory and cystic characteristics, leading to the possibility of a branchial cyst. The cyst was completely excised surgically. Histopathology showed a thymic cyst with parathyroid tissue. The presence of thymic tissue with Hassall's corpuscles is essential for the diagnosis. Knowledge of the clinical presentation, cyto-histological findings, and differential diagnosis of cystic cervical lesions in the pediatric population is important to diagnose this rare entity. Hence, though uncommon, when one comes across a cystic cervical region mass in children, a diagnosis of cervical thymic cyst should be kept in mind. Nonetheless, a definitive diagnosis depends on imaging findings as well as intraoperative findings and histopathological examination.
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ABSTRACT - BACKGROUND: At least 12 lymph nodes (LNs) should be examined following surgical resection of colon cancer. As it is difficult to find small LNs, fat clearing fixatives have been proposed, but there is no consensus about the best option. AIM: The objective of this study was to verify if Carnoy's solution (CS) increases the LN count in left colon cancer specimens. METHODS: A prospective randomized trial (clinicaltrials.gov registration: NCT02629315) with 60 patients with left colon adenocarcinoma who underwent rectosigmoidectomy. Specimens were randomized for fixation with CS or 10% neutral buffered formalin (NBF). After dissection, the pericolic fat from the NBF group was immersed in CS and re-dissected (Revision). The primary endpoint was the total number of LNs retrieved. RESULTS: Mean LN count was 36.6 and 26.8 for CS and NBF groups, respectively (p=0.004). The number of cases with <12 LNs was 0 (CS) and 3 (NBF, p=0.237). The duration of dissection was similar. LNs were retrieved in all cases during the revision (mean: 19, range: 4-37), accounting for nearly 40% of the LNs of this arm of the study. After the revision, no case was found in the NBF arm with <12 LNs. Two patients had metastatic LNs during the revision (no upstaging occurred). CONCLUSION: Compared to NBF, CS increases LN count in colon cancer specimens. After conventional pathologic analysis, fixing the pericolic fat with CS and performing a second dissection substantially increased the number of LNs.
RESUMO - RACIONAL: Pelo menos 12 linfonodos (LNs) devem ser examinados após a ressecção cirúrgica do câncer de cólon. Como é difícil encontrar LNs pequenos, fixadores de clareadores de gordura foram propostos, mas não há consenso sobre a melhor opção. OBJETIVO: Verificar se a solução de Carnoy (SC) aumenta o número de LNs obtidos em espécimes de câncer de cólon esquerdo. MÉTODOS: Ensaio prospectivo randomizado (clinictrials.gov: NCT02629315) com 60 pacientes com adenocarcinoma de cólon esquerdo submetidos à retossigmoidectomia. As amostras foram randomizadas para fixação com SC ou formalina tamponada neutra a 10% (NBF). Após a dissecção, a gordura pericólica do grupo NBF foi imersa em SC e redissecada (Revisão). O endpoint primário foi o número total de LNs recuperados. RESULTADOS: O número médio de LNs foi de 36,6 e 26,8 para os grupos CS e NBF, respectivamente (p=0,004). O número de casos com <12 LNs foi 0 (CS) e 3 (NBF, p=0,237). A duração da dissecção foi semelhante. LNs foram recuperados em todos os casos durante a revisão (média de 19, intervalo: 4-37), representando quase 40% dos LNs deste braço do estudo. Após a revisão, nenhum caso no braço NBF permaneceu com <12 LNs. Dois pacientes tiveram LNs metastáticos encontrados durante a revisão (não ocorreu upstaging). CONCLUSÃO: Em comparação com NBF, a SC aumenta a contagem de LNs em espécimes de câncer de cólon. Após a análise patológica convencional, a fixação da gordura pericólica com SC e a realização de uma segunda dissecção aumentaram o número de LNs.
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Cervical thymic cysts are relatively rare benign cystic lesions that tend to be diagnosed clinically as branchial cysts, which usually present as painless, enlarging neck masses. They can occur anywhere along the normal path of descent of thymic primordia from the angle of the mandible to the sternal notch, with mediastinal extension observed in approximately 50% of cases. They are usually seen in the first decade of life on the left side with a male predominance. Here we report a case of a 15-year-old boy who presented to the hospital with left-sided neck swelling for about 2 months. The neck's contrast-enhanced computed tomography (CECT) revealed a large, well-defined cystic swelling in the left neck region, showing peripheral enhancement, seen from the submandibular region to the superior mediastinum extending into the retrosternal region. Direct fine needle aspiration (FNA) was done, which showed a benign lesion with inflammatory and cystic characteristics, leading to the possibility of a branchial cyst. The cyst was completely excised surgically. Histopathology showed a thymic cyst with parathyroid tissue. The presence of thymic tissue with Hassall's corpuscles is essential for the diagnosis. Knowledge of the clinical presentation, cyto-histological findings, and differential diagnosis of cystic cervical lesions in the pediatric population is important to diagnose this rare entity. Hence, though uncommon, when one comes across a cystic cervical region mass in children, a diagnosis of cervical thymic cyst should be kept in mind. Nonetheless, a definitive diagnosis depends on imaging findings as well as intraoperative findings and histopathological examination.
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Humanos , Masculino , Adolescente , Neoplasias de Cabeza y Cuello/patología , Quiste Mediastínico/patología , Tomografía Computarizada por Rayos X , Biopsia con Aguja Fina , Diagnóstico DiferencialRESUMEN
Bone and soft tissue sarcomas consist of a heterogeneous group of malignant tumors of mesenchymal origin that can affect patients from any age. The precise staging of these lesions determines the best therapeutic strategies and prognosis estimates. Two staging systems are the most frequently used: the system proposed by the University of Florida group, led by Dr. William F. Enneking (1980) and adopted by the Musculoskeletal Tumor Society (MSTS), and the system developed by the American Joint Committee on Cancer (AJCC) (1977), currently in its 8 th edition (2017). This paper updates the reader on the staging of bone and soft tissue sarcomas affecting the musculoskeletal system.
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Abstract Bone and soft tissue sarcomas consist of a heterogeneous group of malignant tumors of mesenchymal origin that can affect patients from any age. The precise staging of these lesions determines the best therapeutic strategies and prognosis estimates. Two staging systems are the most frequently used: the system proposed by the University of Florida group, led by Dr. William F. Enneking (1980) and adopted by the Musculoskeletal Tumor Society (MSTS), and the system developed by the American Joint Committee on Cancer (AJCC) (1977), currently in its 8th edition (2017). This paper updates the reader on the staging of bone and soft tissue sarcomas affecting the musculoskeletal system.
Resumo Os sarcomas ósseos e das partes moles consistem em grupo heterogêneo de neoplasias malignas de origem mesenquimal que podem ocorrer em qualquer faixa etária. O estadiamento preciso destas lesões determina as melhores estratégias terapêuticas e estimativas de prognóstico. Dois sistemas de estadiamento são os mais frequentemente empregados no manejo destas neoplasias: o sistema proposto pelo grupo da Universidade da Flórida, liderado pelo Dr. William F. Enneking (1980), adotado pela Musculoskeletal Tumor Society (MSTS) e o sistema desenvolvido pela American Joint Committee on Cancer (AJCC) (1977) que se encontra em sua 8a edição (2017). O presente artigo busca atualizar o leitor a respeito do estadiamento dos sarcomas ósseos e das partes moles que acometem o sistema musculoesquelético.
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Humanos , Patología Quirúrgica , Sarcoma , Diagnóstico por Imagen , Neoplasias de Tejido Óseo , Estadificación de Neoplasias , Neoplasias de Tejido ConjuntivoRESUMEN
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of non-Hodgkin T-cell lymphoma, recently defined in the 2016 World Health Organization (WHO) classification of lymphoid neoplasms. It occurs more commonly when textured implants are used and appears clinically as a late seroma. Cytologically, these lesions are composed of large atypical cells with pleomorphic nucleus and an immunophenotype positive for T cell markers and CD30, and negative for ALK1. We report a 56-years-old woman with breast implants who developed a periprosthetic seroma three years after surgery. A fine needle aspiration of the lesion was carried out. Cytology and the immunocytochemical study revealed cells compatible with BIA-ALCL. The flow cytometric study was negative. Excisional biopsy of the capsule was performed, observing that the neoplastic cells were confined to the inner surface of the capsule. Imaging studies did not find evidence of disseminated disease. The present case demonstrates the importance of the study of any late periprosthetic effusion, which can be performed using fine needle aspiration.
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Femenino , Humanos , Persona de Mediana Edad , Neoplasias de la Mama , Linfoma Anaplásico de Células Grandes , Implantes de Mama , Implantación de Mama , Neoplasias de la Mama/cirugía , Linfoma Anaplásico de Células Grandes/cirugía , Linfoma Anaplásico de Células Grandes/diagnóstico , Linfoma Anaplásico de Células Grandes/etiología , Implantes de Mama/efectos adversos , Implantación de Mama/efectos adversos , Biopsia con Aguja Fina , Seroma/etiologíaRESUMEN
AIMS: L1 cell adhesion molecule (L1CAM) has been shown to be correlated with tumour progression, attributed to its possible association with epithelial-mesenchymal transition (EMT), characterised by the expression of vimentin and loss of e-cadherin. Herein, we investigate the associations between L1CAM and clinicopathological parameters, as well as the expression of vimentin and e-cadherin, in carcinomas restricted to the cervix. METHODS: The study was retrospective observational and included 45 squamous cell carcinomas (63.4%) and 26 adenocarcinomas (36.6%) submitted to primary surgical treatment. Patient age, FIGO (International Federation of Gynecology and Obstetrics) stage, tumour size and follow-up were obtained from the medical records. All the slides were revised to evaluate histological differentiation, lymphovascular space invasion, depth of infiltration, disease-free cervical wall thickness, pattern of invasion front, Silva pattern (for adenocarcinomas) and the percentage of tumour-infiltrating lymphocytes. Tissue microarrays were constructed for immunohistochemical staining for L1CAM, e-cadherin and vimentin. RESULTS: Adenocarcinomas were associated with lower disease-free and overall survival. L1CAM and vimentin expressions were more frequent among adenocarcinomas, although loss of e-cadherin expression was more common among squamous carcinomas. L1CAM expression was associated with larger tumours, vimentin expression and lower disease-free survival. No association was observed between the expression of either L1CAM or vimentin and loss of e-cadherin. High levels of tumour-infiltrating lymphocytes were more frequent in squamous cell carcinoma, high-grade tumours, destructive pattern at front of invasion and loss of e-cadherin expression. CONCLUSIONS: Our results confirm the prognostic role of L1CAM in cervical carcinomas, but suggest a role for mechanisms other than EMT.
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Adenocarcinoma/diagnóstico , Biomarcadores de Tumor/metabolismo , Carcinoma de Células Escamosas/diagnóstico , Molécula L1 de Adhesión de Célula Nerviosa/metabolismo , Neoplasias del Cuello Uterino/diagnóstico , Adenocarcinoma/metabolismo , Adenocarcinoma/patología , Antígenos CD/metabolismo , Cadherinas/metabolismo , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patología , Cuello del Útero/metabolismo , Cuello del Útero/patología , Estudios de Cohortes , Transición Epitelial-Mesenquimal , Femenino , Humanos , Inmunohistoquímica , Molécula L1 de Adhesión de Célula Nerviosa/genética , Pronóstico , Neoplasias del Cuello Uterino/metabolismo , Neoplasias del Cuello Uterino/patología , Vimentina/genética , Vimentina/metabolismoRESUMEN
Apresentou-se à consulta um paciente masculino de 74 anos, portador de uma mancha hiperpigmentada junto à borda palpebral inferior esquerda, com cores variadas, entre diferentes matizes de marrom; a biópsia confirmou o diagnóstico de lentigo maligno. A sua localização na borda palpebral é rara. Há alguma divergência na literatura quanto ao melhor método para seu tratamento. Opções terapêuticas não cirúrgicas, como o imiquimode, têm sido apresentadas bem como diferentes variantes no manejo cirúrgico e nas margens requeridas. No caso descrito, optou-se por manejo com margens conservadoras, preservando-se a funcionalidade da área.
74-year-old male patient came to medical consultation presenting a hyperpigmented stain near the lower left eyelid edge, with varying colors, between different shades of brown; the biopsy confirmed the diagnosis of lentigo maligna. Its location on the eyelid edge is rare. There is some divergence in the literature regarding the best method for its treatment. Non-surgical therapeutic options, such as imiquimod, have been suggested, as well as different variants in surgical management and required margins. In the case described, it was chosen to manage with conservative margins, preserving, the functionality of the area.
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Neoplasias de los PárpadosRESUMEN
ABSTRACT Purpose: The 8th edition of the TNM has been updated and improved in order to ensure a high degree of clinical relevance. A major change in prostate includes pathologically organ - confined disease to be considered pT2 and no longer subclassified by extent of involvement or laterality. The aim of this study was to validate this major change. Materials and Methods: Prostates were step - sectioned from 196 patients submitted to radical prostatectomy with organ confined disease (pT2) and negative surgical margins. Tumor extent was evaluated by a semiquantitative point count method. The dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer from the quadrants. Laterality was considered as either total tumor extent (Group 1) or index tumor extent (Group 2). Time to biochemical recurrence was analyzed with the Kaplan - Meier product limit analysis and prediction of shorter time to biochemical recurrence with Cox proportional hazards model. Results: In Group 1, 43 / 196 (21.9%) tumors were unilateral and 153 / 196 (78.1%) bilateral and in Group 2, 156 / 196 (79.6%) tumors were unilateral and 40 / 196 (20.4%) bilateral. In both groups, comparing unilateral vs bilateral tumors, there was no significant clinicopathological difference, and no significant association with time as well as prediction of shorter time to biochemical recurrence following surgery. Conclusions: Pathologic sub - staging of organ confined disease does not convey prognostic information either considering laterality as total tumor extent or index tumor extent. Furthermore, no correlation exists between digital rectal examination and pathologic stage.
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Humanos , Masculino , Prostatectomía/métodos , Neoplasias de la Próstata/patología , Tacto Rectal , Estadificación de Neoplasias/normas , Pronóstico , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/química , Estudios Retrospectivos , Estudios de Seguimiento , Antígeno Prostático Específico , Clasificación del Tumor , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias/métodos , Neoplasias/clasificaciónRESUMEN
PURPOSE: The 8th edition of the TNM has been updated and improved in order to ensure a high degree of clinical relevance. A major change in prostate includes pathologically organ - confined disease to be considered pT2 and no longer subclassified by extent of involvement or laterality. The aim of this study was to validate this major change. MATERIALS AND METHODS: Prostates were step - sectioned from 196 patients submitted to radical prostatectomy with organ confined disease (pT2) and negative surgical margins. Tumor extent was evaluated by a semiquantitative point count method. The dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer from the quadrants. Laterality was considered as either total tumor extent (Group 1) or index tumor extent (Group 2). Time to biochemical recurrence was analyzed with the Kaplan - Meier product limit analysis and prediction of shorter time to biochemical recurrence with Cox proportional hazards model. RESULTS: In Group 1, 43 / 196 (21.9%) tumors were unilateral and 153 / 196 (78.1%) bilateral and in Group 2, 156 / 196 (79.6%) tumors were unilateral and 40 / 196 (20.4%) bilateral. In both groups, comparing unilateral vs bilateral tumors, there was no significant clinicopathological difference, and no significant association with time as well as prediction of shorter time to biochemical recurrence following surgery. CONCLUSIONS: Pathologic sub - staging of organ confined disease does not convey prognostic information either considering laterality as total tumor extent or index tumor extent. Furthermore, no correlation exists between digital rectal examination and pathologic stage.
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Tacto Rectal , Estadificación de Neoplasias/normas , Prostatectomía/métodos , Neoplasias de la Próstata/patología , Estudios de Seguimiento , Humanos , Masculino , Clasificación del Tumor , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias/métodos , Neoplasias/clasificación , Pronóstico , Antígeno Prostático Específico , Neoplasias de la Próstata/química , Neoplasias de la Próstata/cirugía , Estudios RetrospectivosRESUMEN
Introdução: O ceratoacantoma é uma neoplasia epitelial de rápido crescimento, mais frequente em áreas de exposição solar. Habitualmente, apresenta-se como lesão única, arredondada, com depressão central preenchida de queratina. As semelhanças clínicas e histopatológicas com o carcinoma de células escamosas, frequentemente, dificultam o diagnóstico diferencial. A biópsia excisional é a abordagem de escolha, permitindo diagnóstico e tratamento. Método: O presente estudo é observacional e retrospectivo, com dados de 162 pacientes tratados de 2005 a 2013, no Hospital Felício Rocho, em Belo Horizonte, MG. Todos os pacientes submeteram-se à excisão cirúrgica dos tumores. Foram estudados: sexo, idade, número de lesões, localização, tamanho do tumor e diagnóstico pré-operatório. Resultados: Dos 162 pacientes, totalizando 173 lesões, 154 (95,06%) apresentavam ceratoacantoma único. Noventa e dois eram do gênero masculino (56,80%) e 70 do feminino (43,20%). A idade dos pacientes variou de 11 a 96 anos, com média de 71,23 anos. As lesões localizavam-se predominantemente nos membros superiores (43,64%), na face (28,48%) e nos membros inferiores (17,58%). Nas hipóteses diagnósticas formuladas pelos cirurgiões, no pedido do exame anatomopatológico, houve diagnóstico correto em 63,13%. Conclusão: O ceratoacantoma é uma neoplasia epitelial de características morfológicas semelhantes ao carcinoma de células escamosas, o que, por muitas vezes, dificulta o diagnóstico. Torna-se necessária, portanto, a excisão cirúrgica completa das lesões suspeitas para diagnóstico e tratamento corretos.
Introduction: Keratoacanthoma is an epithelial neoplasm of rapid growth, more frequent in areas of sun exposure, and usually appears as a single, rounded lesion with a central depression filled with keratin. Clinical and histopathological similarities with squamous cell carcinoma often make differential diagnosis difficult. Excisional biopsy is the approach of choice, allowing diagnosis and treatment. Method: This is an observational and retrospective study, in which data of 162 patients treated at the Hospital Felício Rocho from 2005 to 2013, in Belo Horizonte, MG, were analyzed. All patients underwent surgical excision of tumors. Data on sex, age, number of lesions, location, tumor size, and preoperative diagnosis were studied. Results: Of the 162 patients, with a total of 173 lesions, only 154 (95.06%) had keratoacanthoma. There were 92 male (56.80%) and 70 female (43.20%) patients. The age of patients ranged from 11 to 96 years, with an average of 71.23 years. The lesions were located predominantly in the upper limbs (43.64%), face (28.48%), and lower limbs (17.58%). In the diagnostic hypotheses formulated by surgeons at the request of the pathology, the diagnosis was correct in 63.13%. Conclusion: Keratoacanthoma is an epithelial tumor with morphological characteristics similar to those of squamous cell carcinoma, which often complicates the diagnosis. Therefore, the complete excision of the suspicious lesions is necessary for correct diagnosis and treatment.
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Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Neoplasias Cutáneas/cirugía , Procedimientos Quirúrgicos Operativos/métodos , Biopsia/métodos , Procedimientos de Cirugía Plástica/métodos , Células Epiteliales/patología , Epitelio/cirugía , Complicaciones Intraoperatorias/cirugía , Queratoacantoma/cirugía , Queratoacantoma/patología , Proliferación Celular , QueratoacantomaRESUMEN
Background: Preoperative assessment of tumor size is important in breast cancer treatment planning, especially in breast conservation surgeries. The use of the Magnetic Resonance Imaging (MRI) is increasing among patients with newly diagnosed breast cancers. However, some pathological features can overestimate the measurement of tumor size by MRI, increasing mastectomy rates. The objective is to evaluate which pathological features may affect the agreement between MRI and pathologic tumor size on invasive breast carcinomas. Methods: Eighty seven patients with breast cancer who underwent preoperative breast MRI were retrospectively evaluated. The main tumor size measured by MRI was compared with pathology (gold standard) and concordance was defined as a greater diameter difference of less than 10 mm. Results: There was MRI-pathology concordance in 60 cases (69.0%), MRI overestimated tumor size in 21 (24.1%) and underestimated in 6 (6.9%). After multivariate analysis, only associated ductal carcinoma in situ (DCIS) remained significantly related to overestimation of tumor size on MRI (OR: 9.00; 95% IC:1.13-71.87; p = 0.038). Conclusion: There was good correlation between tumor size evaluation on MRI and pathology. The presence of associated DCIS was the only pathological parameter associated with size overestimation on MRI
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Humanos , Neoplasias de la Mama , Cuidados Preoperatorios , Imagen por Resonancia Magnética , Mastectomía SegmentariaRESUMEN
Objetivo: Estabelecer o grau histológico das metástases axilares em casos de câncer de mama do tipo ductal invasor e comparar com os achados do tumor primário. Métodos: Estudo transversal de envolvendo 69 casos de câncer de mama do tipo ductal invasivo, oriundos do serviço de Mastologia da Maternidade Escola Assis Chateaubriand, Ceará, Brasil, com suas respectivas metástases axilares. Os tumores primários da mama e os linfonodos metastáticos foram submetidos ao processamento histológico e, em seguida, foram determinados os graus histológico (GH), tubular (GT), nuclear (GN) e índice mitótico (IM) na mama e na axila pela classificação de Scarff-Bloom-Richadson. Resultados: Os GH mais elevados predominaram entre os tumores primários, sendo 52,2% classificados como GH 3. Quando comparadas ao tumor primário, as metástases axilares evidenciaram uma frequência maior de GH 3 (66,7%), GT 3 (85,5%), GN 3 (58%) e GM 2 (58%). A formação tubular foi menor nas metástases axilares (p=0,04). Conclusão: Os implantes axilares apresentaram morfologia tecidual mais desorganizada formando menos túbulos quando comparados aos tumores primários da mama. Entretanto, não houve diferença significativa do GH entre o tumor primário e a metástase axilar em nossa amostra.
Objective: To establish the histological grade of the axillary metastases in invasive ductal breast cancer cases and to compare it with the findings from the primary tumor. Methods: Cross-sectional study involving 69 cases of invasive ductal breast cancer from the mastology service of Assis Chateaubriand Maternity School, Ceará, Brazil, and their respective axillary metastases. The breast primary tumors and metastatic lymph nodes were subjected to histological processing and the histological grade (HG), tubular grade (TG), nuclear grade (NG) and mitotic index (MI) of the breast and axilla were subsequently determined by the Scarff-Bloom-Richardson grading system. Results: The highest HG prevailed among the primary tumors, with 52,2% classified as HG 3. When compared to the primary tumor, the axillary metastases showed a higher frequency of HG 3 (66,7%), TG 3 (85,5%), NG 3 (58%) and MI 2 (58%). Conclusion: The axillary implants revealed a more disorganized tissue morphology, which formed a lower number of tubules when compared to the breast primary tumors. However, there was no significant difference in the HG between the primary tumor and axillary metastasis in this sample.
RESUMEN
Surgical pathology is the medical specialty in charge of cancer diagnosis. Although very important since oncology development, its link with overdiagnosis and overtreatment remains understudied. Despite big mediatisation, molecular biology has not brought much progress to tumour classifications. On the contrary, the silent apparition of immunohistochemistry at the end of the 1980's improved much of tumour classifications so significantly that it could cast doubts in some trials' results of that period. This article discusses how the booming and abuse of immunohistochemistry might have led to overdiagnosis. It also highlights that the ISO 15189 standardization, as well as the tumour classification complexity, might function to induce overtreatment. In summary, critical reading and understanding of pathology reports by general practitioners are essential. Therefore, family doctors should not hesitate to discuss the cancer diagnosis with the pathologist, and in some cases also question the oncologist decision. This approach can be considered a quaternary prevention action which can prevent overtreatment.
A anatomia patológica é a especialidade médica responsável pelo diagnóstico de câncer. Apesar de muito importante, a partir do desenvolvimento da oncologia, sua ligação com o sobrediagnóstico e sobretratamento permanece ainda pouco estudada. Apesar de grande midiatização, a biologia molecular não trouxe muito progresso para a classificação dos tumores. Ao contrário, a aparição silenciosa de imunohistoquímica, no final da década de 1980, foi o que melhorou significativamente as classificações tumorais, a ponto de ser possível lançar dúvidas sobre os resultados de alguns ensaios clínicos desse período. Este artigo discute como o auge e o abuso da imunohistoquímica pode ter levado ao sobrediagnóstico. Ele também destaca que a padronização ISO 15189, assim como a complexidade de classificação tumoral, podem também contribuir para a indução do sobretratamento. Em suma, a leitura crítica e a compreensão dos laudos de patologia por parte dos médicos de família são essenciais. Portanto, os médicos de família não deveriam hesitar em discutir o diagnóstico de câncer com o patologista e, em alguns casos, também questionar a decisão do oncologista. Essa abordagem pode ser considerada uma ação de prevenção quaternária que pode prevenir o sobretratamento.
La patología quirúrgica es la especialidad médica encargada del diagnóstico de cáncer. Aunque es muy importante, desde el desarrollo de la oncología, su vínculo con el sobrediagnóstico y sobretratamiento sigue pendiente de estudio. A pesar de gran mediatización, la biología molecular no ha traído mucho progreso para las clasificaciones tumorales. Por el contrario, la aparición silenciosa de la inmunohistoquímica, en el final de la década de 1980, mejoró mucho las clasificaciones tumorales, a punto de que sea posible plantear dudas sobre los resultados de algunos ensayos clínicos en ese período. Este artículo describe cómo el auge y el abuso de la inmunohistoquímica puede tener llevado al sobrediagnóstico. También destaca que la estandarización ISO 15189, así como la complejidad de la clasificación tumoral, pueden también contribuir para la inducción del sobretratamiento. En suma, la lectura crítica y la comprensión de los informes de patología por los médicos familiares son esenciales. Portanto, los médicos de familia no deberían vacilar en discutir el diagnóstico de cáncer con el patólogo y, en algunos casos, también cuestionar la decisión del oncólogo. Este enfoque puede ser considerado una acción de prevención cuaternaria que puede prevenir el sobretratamiento.
Asunto(s)
Humanos , Femenino , Patología QuirúrgicaRESUMEN
Introdução: No Brasil o melanoma maligno segue tendência mundial de aumento da incidência com redução da gravidade dos casos ao diagnóstico. Objetivo: Utilizar os critérios prognósticos do Grupo Multicêntrico e Multidisciplinar Brasileiro para Estudo do Melanoma aliados a características clínicas para elaborar um perfil clínico e histopatológico dos casos de melanoma. Métodos: Trata-se de estudo transversal e descritivo com análise retrospectiva de prontuários dos pacientes diagnosticados com melanoma em unidade terciária de referência em dermatologia na cidade de Bauru (SP) entre janeiro de 2007 e julho de 2014. Resultados: O sexo feminino correspondeu a 56,2%, a idade variou de 27 a 95 anos com média de 61,4 anos, e em 36% dos casos a lesão foi detectada no exame físico. A maior incidência de acometimento foi nos membros inferiores (23,5%), e o tipo extensivo superficial correspondeu a 79,6% das biópsias. A espessura média do Breslow foi de 2,9mm, e em 28,1% dos casos a lesão era in situ. Conclusões: Delineou-se o seguinte perfil: mulheres, 61 anos, com lesões localizadas em membros inferiores, subtipo extensivo superficial e com indícios de bom prognóstico. Estudos como este adquirem importância por fornecer subsídios para o delineamento de estratégias de abordagens populacionais.
Introduction: The trends of malignant melanoma in Brazil are aligned with those worldwide: increasing incidence with reduced degree of severity at diagnosis. Objective: To use the prognostic criteria of the Grupo Multicêntrico e Multidisciplinar Brasileiro para Estudo do Melanoma (Brazilian Multicenter and Multidisciplinary Group for the Study of Melanoma) combined with clinical characteristics aimed at developing a clinical and histopathological profile of melanoma cases. Methods: A cross-sectional descriptive study was carried out, with the retrospective analysis of medical records of patients diagnosed with melanoma at a tertiary dermatology reference unit in the city of Bauru, in the Brazilian southeast State of São Paulo, between January 2007 and July 2014. Results: Female patients accounted for 56.2%, with ages ranging from 27 to 95 years (Mean = 61.4 years), with a lesion having been detected on physical examination in 36% of cases. The highest incidence of the disease was in the lower limbs (23.5%), with the superficial spreading subtype corresponding to 79.6% of biopsies. The average Breslow thickness was 2.9 mm, and in 28.1% of cases, the lesion was in situ. Conclusions: The following profile emerged: women, 61-years-old, with lesions in the lower limbs, superficial spreading subtype and with evidence of good prognostic. Studies like this are important due to the fact they provide subsidies for the design of strategies to treat the population.
Asunto(s)
Humanos , Masculino , Femenino , Neoplasias Cutáneas/diagnóstico , Melanoma/diagnóstico , Patología Quirúrgica , Estudios Epidemiológicos , Registros Médicos , Estudios RetrospectivosRESUMEN
As pacientes com carcinoma de mama localmente avançado da mama são candidatas à quimioterapianeoadjuvante. A grande maioria delas apresenta resposta parcial ao tratamento, isto é, redução dadimensão do tumor. Entretanto, a taxa de resposta patológica completa é de apenas 24%, mesmo nosesquemas mais efetivos, como na associação de antraciclina com taxano. Um dos benefícios da quimioterapianeoadjuvante é a possibilidade da cirurgia conservadora da mama, e um dos desafios é avaliarcom exatidão o grau de resposta tumoral ao tratamento. A resposta clínica é determinada por meiode exames físicos e de imagem, os quais não são suficientes para predizer com acurácia o tamanho dotumor ou a resposta patológica completa em relação ao exame padrão-ouro, que é o histopatológico dapeça cirúrgica. Além disso, é necessário considerar que após a quimioterapia neoadjuvante pode ocorrerfragmentação do tumor, originando-se lesões residuais multifocais, de difícil detecção aos métodosde imagem. Em estudos sobre a quimioterapia neoadjuvante, observou-se que não há uniformidadeno tipo de exame utilizado para a avaliação clinicopatológica da resposta tumoral; não há descriçãoexata sobre a metodologia utilizada na marcação pré-operatória do tumor, e nem sempre toda a áreatumoral pré-quimioterapia neoadjuvante é ressecada, fato que dificulta a avaliação exata da resposta aeste tipo de quimioterapia. Portanto, resta a dúvida: em quais circunstâncias a cirurgia conservadorada mama após a quimioterapia neoadjuvante está bem indicada? Neste artigo, discute-se as diferentesformas de marcação do tumor, a avaliação da resposta patológica e sua importância, principalmentequando se pretende realizar a cirurgia conservadora no carcinoma de mama localmente avançado.
Patients with locally advanced breast carcinoma are candidates for the neoadjuvant chemotherapy.The majority of them have partial response to treatment, i.e., reduction in tumor size; however, therate of pathological complete response is of only 24%, even with the association of anthracycline and taxane. One benefit of the neoadjuvant chemotherapy is the possibility of breast-conserving surgery, and the challenge is the accurate assessment of the tumor response degree to treatment. Clinical response is determined by physical exam and imaging studies, which are not sufficient to predict accurately the tumor size or the pathological complete response in relation to the golden-standard test, which is the surgical histopathology. Moreover, it is necessary to consider that after the neoadjuvant chemotherapy there may be tumor fragmentation, originating multifocal lesions, which are difficult to be detected by imaging methods. In studies regarding neoadjuvant chemotherapy, there is no uniformity in the type of test used for clinical and pathological assessments of tumor response, and there is no exact description of the methodology used in the preoperative markup of the tumor bed, which is not always resected after the neoadjuvant chemotherapy. This is a fact that hinders the accurate assessment of response to the neoadjuvant chemotherapy. Therefore, the question is: under which circumstances a breast-conserving surgery after neoadjuvant chemotherapy is well indicated? This article has discussed the different ways of tumor marking, the evaluation of pathological response and its importance, especially considering breast-conserving treatment of locally advanced breast carcinoma.
Asunto(s)
Biomarcadores de Tumor , Neoplasias de la Mama/clasificación , Neoplasias de la Mama/patología , Terapia Neoadyuvante , Técnicas de Diagnóstico QuirúrgicoRESUMEN
Estudio descriptivo, analítico, y comparativo, realizado en cadáveres de embriones, fetos y adultos del género masculino, pertenecientes al laboratorio de Anatomía de la Facultad de Medicina. Transcribir los hallazgos embriológicos del descenso testicular normal y darnos cuenta que la gónada masculina fue el asiento de la mayoría de las patologías encontradas en nuestros pacientes y resueltas felizmente por los procedimientos quirúrgicos y médicos correspondientes, que he considerado complemento del estudio primario de las disecciones anatómicas.Ojala, este trabajo el primero de su género en este medio, permita que nuestra Facultad sea conocida fuera del contexto regional.
A descriptive, analytical, and comparative study performed on cadavers of fetuses and adults of the male gender in the Anatomy Laboratory of the Medical School. We inform the embryological findings related with the normal testicular descent and highlight the fact that most pathological entities found in these patients originate in the male gonad, and that they were successfully resolved by means of surgical and medical treatment modalities, considering that this constitutes a complement of the primary study derived from anatomical dissection.We expect that this work, the fist of its kind in our region, will allow a better recognition of our Faculty of Medicine outside its original context.
Asunto(s)
Humanos , Anatomía , Embriología , Histología , Conducto Inguinal , Patología QuirúrgicaRESUMEN
CONTEXT AND OBJECTIVE: Accurate determination of the Gleason score in prostate core biopsy specimens is crucial in selecting the type of prostate cancer treatment, especially for patients with well-differentiated tumors (Gleason score 2 to 4). For such patients, an inaccurate biopsy score may result in a therapeutic intervention that is too conservative. We evaluate the role of Gleason score 2-4 in prostate core-needle biopsies for predicting the final pathological staging following radical prostatectomy. DESIGN AND SETTING: Retrospective study at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. METHODS: We analyzed the medical records of 120 consecutive patients who underwent radical retropubic prostatectomy to treat clinical localized prostate cancer at our institution between December 2001 and July 2006. Thirty-two of these patients presented well-differentiated tumors (Gleason score 2 to 4) in biopsy specimens and were included in the study. The Gleason scores of the core-needle biopsies were compared with the pathological staging of the surgical specimens. RESULTS: Sixteen of the 32 patients (50 percent) presented moderately differentiated tumors (Gleason score 5 to 7) in surgical specimens. Eighteen patients (56 percent) had tumors with involvement of the prostate capsule and ten (31 percent) had involvement of adjacent organs. Evaluating the 16 patients that maintained Gleason scores of 2 to 4 in the pathological staging of the surgical specimens, 11 (68.7 percent) had focal invasion of the prostate capsule and five (31.25 percent) had organ-confined disease. CONCLUSION: Well-differentiated tumors (Gleason score 2 to 4) seen in biopsies are not predictive of organ-confined disease.
CONTEXTO E OBJETIVO: A determinação acurada do escore de Gleason nas biópsias prostáticas é fundamental para seleção do tratamento adequado para o câncer de próstata, especialmente em relação aos tumores bem diferenciados (Gleason 2 a 4), para os quais a abordagem terapêutica pode ser mais conservadora. O objetivo deste trabalho foi avaliar a correlação entre o escore de Gleason 2 a 4 na biópsia de próstata com o estádio patológico final após a prostatectomia radical. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil. MÉTODOS: Foram revisados os prontuários médicos de 120 pacientes submetidos a prostatectomia radical retropúbica para tratamento de câncer de próstata localizado em nossa instituição entre dezembro de 2001 e julho de 2006. Trinta e dois destes pacientes apresentavam diagnóstico de câncer de próstata bem-diferenciado na biópsia prostática com agulha e foram incluídos no estudo. Os resultados das biópsias de próstata com agulha foram comparados com o estadiamento patológico final dos espécimes cirúrgicos obtidos com a prostatectomia radical. RESULTADOS: 16 de 32 pacientes (50 por cento) apresentaram câncer de próstata moderadamente diferenciado (escore de Gleason 5 a 7) na avaliação do espécime cirúrgico. 18 de 32 pacientes (56 por cento) apresentavam acometimento da cápsula prostática pelo tumor, sendo que 10 (31 por cento) destes pacientes apresentavam, em associação, envolvimento de órgãos adjacentes. Avaliando os 16 pacientes que mantiveram escore de Gleason 2 a 4 no estadiamento patológico da peça cirúrgica, 11 (68,7 por cento) destes pacientes apresentavam invasão focal da cápsula prostática e 5 (31,25 por cento) pacientes apresentavam doença confinada à próstata. CONCLUSÃO: Tumores bem diferenciados da próstata na biópsia com agulha (escore de Gleason 2 a 4) não são preditivos de doença órgão-confinada.