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OBJECTIVE: To review the pathological diagnosis of possible cases and/or hidden cases of malignant mesothelioma (MM) between 2000 and 2012 using the Hospital-Based Cancer Registry database in the state of São Paulo, Brazil. METHODS: Possible cases were retrieved by assessing the database. Inclusion criteria were being older than 30 years of age and having ICD-O-3 topography and morphology codes related to MM. A board of expert pathologists reviewed the pathology reports and requested paraffin blocks in cases that demanded revision. After staining with calretinin, D2-40, WT-1 (as positive MM markers) and Ber-EP4 and MOC31 (as negative MM markers), cases were divided and studied independently by a pair of pathologists to confirm or discard the diagnosis of MM. RESULTS: Our sample comprised 482 cases from 25 hospitals, and 130 needed further histological revision. We received 73 paraffin blocks with adequate material. After board analysis, there were 9 cases with a definitive diagnosis of MM, improving the diagnostic rate in 12%. Two cases of previously diagnosed MM were discarded by review. CONCLUSIONS: Our results confirm that part of MM underdiagnosis and underreporting in Brazil is due to incomplete or mistaken pathological diagnosis.
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Neoplasias Pulmonares , Mesotelioma Maligno , Mesotelioma , Sistema de Registros , Humanos , Brasil/epidemiologia , Mesotelioma/patologia , Mesotelioma/epidemiologia , Mesotelioma/diagnóstico , Mesotelioma Maligno/patologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/epidemiologia , Adulto , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Neoplasias Pleurais/patologia , Neoplasias Pleurais/epidemiologia , Neoplasias Pleurais/diagnósticoRESUMO
ABSTRACT Objective: To review the pathological diagnosis of possible cases and/or hidden cases of malignant mesothelioma (MM) between 2000 and 2012 using the Hospital-Based Cancer Registry database in the state of São Paulo, Brazil. Methods: Possible cases were retrieved by assessing the database. Inclusion criteria were being older than 30 years of age and having ICD-O-3 topography and morphology codes related to MM. A board of expert pathologists reviewed the pathology reports and requested paraffin blocks in cases that demanded revision. After staining with calretinin, D2-40, WT-1 (as positive MM markers) and Ber-EP4 and MOC31 (as negative MM markers), cases were divided and studied independently by a pair of pathologists to confirm or discard the diagnosis of MM. Results: Our sample comprised 482 cases from 25 hospitals, and 130 needed further histological revision. We received 73 paraffin blocks with adequate material. After board analysis, there were 9 cases with a definitive diagnosis of MM, improving the diagnostic rate in 12%. Two cases of previously diagnosed MM were discarded by review. Conclusions: Our results confirm that part of MM underdiagnosis and underreporting in Brazil is due to incomplete or mistaken pathological diagnosis.
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Malignant pleural mesothelioma (MPM) is an aggressive neoplasm that originates from hyperplasia and metaplasia of the mesothelial cells that cover the pleural cavity. Previous exposure to asbestos is the main risk factor. Since MPM is often diagnosed at an advanced stage with rapid evolution and resistance to treatment, it is associated with an unfavorable outcome. Mesothelioma in situ (MIS) has been postulated as a preinvasive phase of MPM; however, its diagnostic criteria have been defined only recently. Diagnosis of MIS may represent an opportunity for early therapies with better results, but the optimal approach has not been defined thus far. Here, we report on a case of a 74-year-old man with right-sided pleural effusion and a previous history of occupational exposure to asbestos for 9 years who was diagnosed with MIS after a latency of 36 years. During follow-up, spontaneous disease regression was observed 5 months after the initial diagnosis; however, it recurred in the form of invasive epithelioid MPM. There is a paucity of literature on MIS and its evolution; however, our case provides relevant knowledge of this unusual behavior, which is important to define follow-up and therapeutic strategies for future cases.
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Amianto , Mesotelioma Maligno , Mesotelioma , Derrame Pleural Maligno , Neoplasias Pleurais , Idoso , Amianto/toxicidade , Humanos , Masculino , Mesotelioma/etiologia , Derrame Pleural Maligno/complicações , Neoplasias Pleurais/etiologiaRESUMO
Resumo: Introdução: A patologia é uma disciplina básica que exerce o link entre ciclos básicos e clínico-cirúrgicos. A partir do início de 2020, com a pandemia provocada pela síndrome respiratória aguda grave do coronavírus 2 (severe acute respiratory syndrome coronavirus 2 - Sars-CoV-2) e a implantação do ensino remoto emergencial (ERE), o curso de patologia em nossa instituição sofreu alterações e adaptações. O presente trabalho tem como objetivos relatar as atividades desenvolvidas em nossa faculdade para o ensino da patologia geral, dentro do contexto do ERE, e discutir como parte dessas estratégias poderá ser incorporada após o término da pandemia. Relato de experiência: Para o ensino das alterações macroscópicas, utilizamos discussões com peças cirúrgicas filmadas, enquanto as alterações microscópicas foram desenvolvidas no chamado "Projeto Atlas". Discussão: Nosso projeto foi bem dinâmico com grande aceitação por parte dos alunos que tiveram atitudes mais proativas, principalmente em relação ao estudo dos casos de microscopia. As estratégias também se prestaram muito bem como forma de avaliação formativa. Conclusão: Muitas das estratégias que têm sido desenvolvidas por diferentes grupos de professores neste momento da pandemia trouxeram alternativas muito interessantes que devem ser incorporadas ao curso mesmo quando ele voltar a ser presencial. Peças filmadas contemplaram o estudo da macroscopia durante esse período de restrições e podem ser incorporadas à rotina presencial, intercalando com as técnicas utilizadas anteriormente. Já o "Projeto Atlas" foi uma experiência positiva, ressaltando o papel do aluno como protagonista do seu processo de ensino/aprendizagem e o trabalho em pequenos grupos como pontos principais.
Abstract: Introduction: Pathology is a basic discipline that acts as a link between basic and clinical-surgical cycles. Since the beginning of 2020, with the pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SarsCoV-2) and the implementation of emergency remote education (ERE), the pathology course in our institution has undergone changes and adaptations. This paper aims to report the activities developed in our college for the teaching of general pathology, within the context of ERE and discuss how part of these strategies may be incorporated after the end of the pandemic. Experience report: For teaching macroscopic changes we used discussions with filmed surgical specimens while microscopic changes were developed in the so-called "Atlas Project". Discussion: Our project was very dynamic and widely accepted by students with a more proactive attitudes, especially regarding the study of microscopic cases. The strategies also lent themselves very well as a formative form of evaluation. Conclusion: Many of the strategies that have been developed by different groups of teachers during this pandemic have brought very interesting alternatives that should be incorporated into the course even when face-to-face classes are resumed. The filmed pieces include the study of macroscopy during this period of restrictions and can be incorporated into the classroom routine, interspersed with the techniques used previously. The Atlas Project was a positive experience, highlighting the role of the student as the protagonist of his teaching/learning process and work in small groups as main points.
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OBJECTIVE: To evaluate the value of EBUS-TBNA in the diagnosis of lung and mediastinal lesions. METHODS: Prospective cohort study that included 52 patients during a 2-year period (2016 to 2018) who underwent EBUS-TBNA. RESULTS: Among the 52 individuals submitted to the procedure, 22 (42.31%) patients were diagnosed with locally advanced lung cancer (N2 or N3 lymph node involvement). EBUS-TBNA confirmed the diagnosis of metastases from other extrathoracic tumors in the mediastinum or lung in 5 patients (9.61%), confirmed small cell lung cancer in 3 patients (5.76%), mediastinal sarcoidosis in 1 patient (1.92%), and reactive mediastinal lymph node in 8 patients (15.38%); insufficient results were found for 3 patients (5.76%). Based on these results, EBUS-TBNA avoided further subsequent surgical procedures in 39 of 52 patients (75%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86%, 100%, 100%, 77%, and 90%, respectively. No major complications were observed. CONCLUSIONS: EBUS-TBNA is a safe, effective, and valuable method. This technique can significantly reduce the rate of subsequent surgical procedures required for the diagnosis of lung and mediastinal lesions.
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Endossonografia , Mediastino , Humanos , Mediastino/diagnóstico por imagem , Estadiamento de Neoplasias , Estudos Prospectivos , Ultrassonografia de IntervençãoRESUMO
SUMMARY OBJECTIVE: To evaluate the value of EBUS-TBNA in the diagnosis of lung and mediastinal lesions. METHODS: Prospective cohort study that included 52 patients during a 2-year period (2016 to 2018) who underwent EBUS-TBNA. RESULTS: Among the 52 individuals submitted to the procedure, 22 (42.31%) patients were diagnosed with locally advanced lung cancer (N2 or N3 lymph node involvement). EBUS-TBNA confirmed the diagnosis of metastases from other extrathoracic tumors in the mediastinum or lung in 5 patients (9.61%), confirmed small cell lung cancer in 3 patients (5.76%), mediastinal sarcoidosis in 1 patient (1.92%), and reactive mediastinal lymph node in 8 patients (15.38%); insufficient results were found for 3 patients (5.76%). Based on these results, EBUS-TBNA avoided further subsequent surgical procedures in 39 of 52 patients (75%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86%, 100%, 100%, 77%, and 90%, respectively. No major complications were observed. CONCLUSIONS: EBUS-TBNA is a safe, effective, and valuable method. This technique can significantly reduce the rate of subsequent surgical procedures required for the diagnosis of lung and mediastinal lesions.
RESUMO OBJETIVO: Avaliar a importância da ecoendoscopia endobrônquica com punção por agulha fina (Ebus-TBNA) no diagnóstico das lesões pulmonares e mediastinais. MÉTODOS: Estudo prospectivo e do tipo coorte, no qual foram incluídos 52 pacientes, durante o período de dois anos (2016 a 2018), submetidos ao procedimento de Ebus-TBNA. RESULTADOS: Do total de 52 indivíduos submetidos ao procedimento, 22 (42,31%) pacientes foram diagnosticados com neoplasia pulmonar localmente avançada (N2 ou N3). O método confirmou o diagnóstico de metástases de outros tumores extratorácicos no mediastino ou pulmão em cinco pacientes (9,61%), três pacientes (5,76%) com carcinoma de pequenas células, um paciente (1,92%) com sarcoidose, oito pacientes (15,38%) com linfonodomegalias reacionais/inflamatórias e resultado insuficiente em três pacientes (5,76%). O Ebus-TBNA evitou a realização de outros procedimentos cirúrgicos subsequentes em 39 de 52 (75%) pacientes. Foram calculados os valores de sensibilidade de 86%, especificidade de 100%, valor preditivo positivo de 100%, valor preditivo negativo de 77% e acurácia de 90%. Não foram observadas complicações maiores pelo método neste estudo. CONCLUSÃO: O Ebus-TBNA é um método seguro, eficaz e de relevante importância. Este exame pode reduzir significativamente o número de procedimentos invasivos subsequentes necessários para o diagnóstico das lesões pulmonares e mediastinais.
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Humanos , Endossonografia , Mediastino/diagnóstico por imagem , Estudos Prospectivos , Ultrassonografia de Intervenção , Estadiamento de NeoplasiasRESUMO
We describe cases of donor-derived transmission of Cryptococcus deuterogattii in 2 kidney transplant recipients in Brazil and published information on other cases. Prompt reduction of immunosuppression and initiation of antifungal therapy was required to successfully control the fungal infections and preserve engraftment.
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Criptococose , Cryptococcus gattii , Cryptococcus neoformans , Transplante de Rim , Antifúngicos/uso terapêutico , Brasil , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Cryptococcus gattii/genética , Humanos , Transplante de Rim/efeitos adversos , TransplantadosRESUMO
OBJECTIVE: To report a case of a child with primary immunodeficiency who at eight years developed digestive symptoms, culminating with the diagnosis of a neuroendocrine tumor at ten years of age. CASE DESCRIPTION: One-year-old boy began to present recurrent pneumonias in different pulmonary lobes. At four years of age, an immunological investigation showed a decrease in IgG and IgA serum levels. After the exclusion of other causes of hypogammaglobinemia, he was diagnosed with a Common Variable Immunodeficiency and started to receive monthly replacement of human immunoglobulin. The patient evolved well, but at 8 years of age began with epigastrium pain and, at 10 years, chronic persistent diarrhea and weight loss. After investigation, a neuroendocrine tumor was diagnosed, which had a rapid progressive evolution to death. COMMENTS: Medical literature has highlighted the presence of gastric tumors in adults with Common Variable Immunodeficiency, emphasizing the importance of early diagnosis and the investigation of digestive neoplasms. Up to now there is no description of neuroendocrine tumor in pediatric patients with Common Variable Immunodeficiency. We believe that the hypothesis of digestive neoplasm is important in children with Common Variable Immunodeficiency and with clinical manifestations similar to the case described here in the attempt to improve the prognosis for pediatric patients.
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Imunodeficiência de Variável Comum/complicações , Tumores Neuroendócrinos/diagnóstico , Pneumonia/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Antineoplásicos/uso terapêutico , Criança , Imunodeficiência de Variável Comum/imunologia , Diarreia/diagnóstico , Diarreia/etiologia , Evolução Fatal , Humanos , Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/patologia , Neoplasias Intestinais/cirurgia , Masculino , Metástase Neoplásica/patologia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Pneumonia/etiologia , Recidiva , Redução de PesoRESUMO
ABSTRACT Objective: To report a case of a child with primary immunodeficiency who at eight years developed digestive symptoms, culminating with the diagnosis of a neuroendocrine tumor at ten years of age. Case description: One-year-old boy began to present recurrent pneumonias in different pulmonary lobes. At four years of age, an immunological investigation showed a decrease in IgG and IgA serum levels. After the exclusion of other causes of hypogammaglobinemia, he was diagnosed with a Common Variable Immunodeficiency and started to receive monthly replacement of human immunoglobulin. The patient evolved well, but at 8 years of age began with epigastrium pain and, at 10 years, chronic persistent diarrhea and weight loss. After investigation, a neuroendocrine tumor was diagnosed, which had a rapid progressive evolution to death. Comments: Medical literature has highlighted the presence of gastric tumors in adults with Common Variable Immunodeficiency, emphasizing the importance of early diagnosis and the investigation of digestive neoplasms. Up to now there is no description of neuroendocrine tumor in pediatric patients with Common Variable Immunodeficiency. We believe that the hypothesis of digestive neoplasm is important in children with Common Variable Immunodeficiency and with clinical manifestations similar to the case described here in the attempt to improve the prognosis for pediatric patients.
RESUMO Objetivo: Relatar um caso de criança portadora de imunodeficiência primária que, aos oito anos, desenvolveu sintomas digestivos, culminando com o diagnóstico de tumor neuroendócrino aos dez anos de idade. Descrição do caso: Menino, com um ano de idade, começou a apresentar pneumonias de repetição em diferentes lobos pulmonares. Aos quatro anos, a investigação imunológica mostrou diminuição dos níveis séricos de IgG e IgA. Após exclusão de outras causas de hipogamaglobulinemia, teve diagnóstico de imunodeficiência comum variável, passando a receber reposição mensal de imunoglobulina humana. Evoluiu bem, porém, aos oito anos, começou com epigastralgia e, aos dez anos, diarreia crônica persistente e perda de peso. O quadro culminou com o diagnóstico de tumor neuroendócrino intestinal, de rápida progressão, com óbito do paciente. Comentários: A literatura tem chamado a atenção para tumores gástricos em adultos com imunodeficiência comum variável, alertando para a importância do diagnóstico precoce e da pesquisa de neoplasias digestivas. Até o momento, não há descrição de tumor neuroendócrino em pacientes pediátricos portadores de imunodeficiência comum variável. Acredita-se ser importante a hipótese de neoplasia digestiva diante de crianças com imunodeficiência comum variável e com manifestações clínicas semelhantes ao caso descrito, na tentativa de melhorar o prognóstico para pacientes pediátricos.
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Humanos , Masculino , Criança , Pneumonia/diagnóstico , Imunodeficiência de Variável Comum/complicações , Tumores Neuroendócrinos/diagnóstico , Pneumonia/etiologia , Recidiva , Redução de Peso , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Imunodeficiência de Variável Comum/imunologia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Evolução Fatal , Diarreia/diagnóstico , Diarreia/etiologia , Neoplasias Intestinais/cirurgia , Neoplasias Intestinais/patologia , Neoplasias Intestinais/diagnóstico por imagem , Metástase Neoplásica/patologia , Antineoplásicos/uso terapêuticoRESUMO
OBJECTIVES: Advancements in non-small cell lung cancer treatment based on targeted therapies have made the differentiation between adenocarcinoma and squamous cell carcinoma increasingly important. Pathologists are challenged to make the correct diagnosis in small specimens. We studied the accuracy of an immunohistochemical panel in subclassifying non-small cell lung cancer in routine small biopsies and compared the results with the diagnosis from resected lung specimens, autopsy samples or biopsied/resected metastases. METHODS: In total, 340 lung cancer biopsies were investigated for the expression of CK5, TTF1, p63 and surfactant. RESULTS: We characterized 166 adenocarcinomas and 124 squamous cell carcinomas. Overall, 85% of cases displayed binary staining (TTF1 positive/p63 negative, and vice versa). The diagnoses of ten cases with a morphology that indicated a specific tumor subtype were changed after immunohistochemistry (IHC). A second specimen was available for 71 patients, and the first diagnosis at biopsy was confirmed in 95% of these cases. Most non-small cell lung cancer cases present a binary immunohistochemical profile in small biopsies, contributing to good diagnostic accuracy with routine markers. In a small proportion of cases, the diagnosis can be changed after IHC even when the morphological aspects indicate one specific tumor subtype. CONCLUSIONS: We recommend that routine small biopsies of lung cancer without classic morphology should be subjected to a minimum immunohistochemical panel to differentiate adenocarcinoma from squamous cell carcinoma.
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Adenocarcinoma/patologia , Biomarcadores Tumorais/análise , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Pulmonares/patologia , Adenocarcinoma/química , Idoso , Biópsia , Carcinoma de Células Escamosas/química , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/química , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Papilloma associated with recurrent respiratory papillomatosis (RRP), caused by human papilloma virus (HPV) infection types 6 and 11, is the most common benign neoplasm of the larynx. The clinical features of RRP vary widely from mild to aggressive forms. RRP in children is known as juvenile-onset recurrent respiratory papillomatosis (JORRP). Its outcome may be poor or even fatal due to the high rate of recurrence and eventual spread to the entire respiratory tract. Pulmonary invasion is reported to occur in 3.3% of patients with RRP, and malignant transformation in 0.5% of patients. We report the case of a 39-year-old female patient with a diagnosis of JORRP from the age of 3 years, with extensive bilateral pulmonary involvement and malignant transformation. Analysis of the papilloma and carcinomatous tissues revealed the presence of HPV type 11, which is associated with rapid and aggressive progression. We discussed the case on the basis of a literature review on pulmonary invasion, malignant transformation, and HPV 11 aggressiveness.
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Humanos , Feminino , Adulto , Carcinoma de Células Escamosas/complicações , Neoplasias Pulmonares/complicações , Infecções por Papillomavirus/complicações , Autopsia , Carcinoma de Células Escamosas/patologia , Evolução Fatal , Papillomavirus Humano 11 , Papiloma/complicaçõesRESUMO
Papilloma associated with recurrent respiratory papillomatosis (RRP), caused by human papilloma virus (HPV) infection types 6 and 11, is the most common benign neoplasm of the larynx. The clinical features of RRP vary widely from mild to aggressive forms. RRP in children is known as juvenile-onset recurrent respiratory papillomatosis (JORRP). Its outcome may be poor or even fatal due to the high rate of recurrence and eventual spread to the entire respiratory tract. Pulmonary invasion is reported to occur in 3.3% of patients with RRP, and malignant transformation in 0.5% of patients. We report the case of a 39-year-old female patient with a diagnosis of JORRP from the age of 3 years, with extensive bilateral pulmonary involvement and malignant transformation. Analysis of the papilloma and carcinomatous tissues revealed the presence of HPV type 11, which is associated with rapid and aggressive progression. We discussed the case on the basis of a literature review on pulmonary invasion, malignant transformation, and HPV 11 aggressiveness.
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OBJECTIVES: Advancements in non-small cell lung cancer treatment based on targeted therapies have made the differentiation between adenocarcinoma and squamous cell carcinoma increasingly important. Pathologists are challenged to make the correct diagnosis in small specimens. We studied the accuracy of an immunohistochemical panel in subclassifying non-small cell lung cancer in routine small biopsies and compared the results with the diagnosis from resected lung specimens, autopsy samples or biopsied/resected metastases. METHODS: In total, 340 lung cancer biopsies were investigated for the expression of CK5, TTF1, p63 and surfactant. RESULTS: We characterized 166 adenocarcinomas and 124 squamous cell carcinomas. Overall, 85% of cases displayed binary staining (TTF1 positive/p63 negative, and vice versa). The diagnoses of ten cases with a morphology that indicated a specific tumor subtype were changed after immunohistochemistry (IHC). A second specimen was available for 71 patients, and the first diagnosis at biopsy was confirmed in 95% of these cases. Most non-small cell lung cancer cases present a binary immunohistochemical profile in small biopsies, contributing to good diagnostic accuracy with routine markers. In a small proportion of cases, the diagnosis can be changed after IHC even when the morphological aspects indicate one specific tumor subtype. CONCLUSIONS: We recommend that routine small biopsies of lung cancer without classic morphology should be subjected to a minimum immunohistochemical panel to differentiate adenocarcinoma from squamous cell carcinoma.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Carcinoma de Células Escamosas/patologia , Adenocarcinoma/patologia , Biomarcadores Tumorais/análise , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Biópsia , Imuno-Histoquímica , Carcinoma de Células Escamosas/química , Adenocarcinoma/química , Estudos Retrospectivos , Diagnóstico Diferencial , Neoplasias Pulmonares/químicaRESUMO
OBJECTIVE: To compare the frequency of neuroendocrine tumors in our service with that reported in the literature considering age, gender, location, degree of differentiation and increase in incidence by means of a retrospective study. METHOD: Search of variables from a database of neuroendocrine tumor cases diagnosed at the Department of Pathological Sciences, Hospital da Santa Casa de São Paulo over the past 10 years, relating them to epidemiological data such as gender, age, distribution across organs, most-used immunohistochemical markers and presence or absence of either lymph node or distant metastases. RESULTS: In all, 250 cases were reviewed, 133 involving females, predominantly in the 61-70 age range. The lung was the most frequent site, followed by the stomach. CD56, synaptophysin and chromogranin were the immunohistochemical markers used most often and to a lesser extent Ki67, a marker of cell proliferation that indicates a higher or lower degree of histological malignancy. Metastases, either in lymph nodes and/or distant sites, were found in 44 cases (17.6%). CONCLUSION: The results were largely consistent with those in the literature, including age group, gender and location. Most metastases originated from high-grade tumors, with high Ki67 levels and greater impairment of the liver. However, only 36.4% of the cases had Ki67 index. Reevaluation of the Ki67 proliferative index using image analysis in doubtful cases will allow for a correlation between progression and prognosis.
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Tumores Neuroendócrinos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Feminino , Humanos , Imuno-Histoquímica , Antígeno Ki-67/análise , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/secundário , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto JovemRESUMO
Summary Objective: To compare the frequency of neuroendocrine tumors in our service with that reported in the literature considering age, gender, location, degree of differentiation and increase in incidence by means of a retrospective study. Method: Search of variables from a database of neuroendocrine tumor cases diagnosed at the Department of Pathological Sciences, Hospital da Santa Casa de São Paulo over the past 10 years, relating them to epidemiological data such as gender, age, distribution across organs, most-used immunohistochemical markers and presence or absence of either lymph node or distant metastases. Results: In all, 250 cases were reviewed, 133 involving females, predominantly in the 61-70 age range. The lung was the most frequent site, followed by the stomach. CD56, synaptophysin and chromogranin were the immunohistochemical markers used most often and to a lesser extent Ki67, a marker of cell proliferation that indicates a higher or lower degree of histological malignancy. Metastases, either in lymph nodes and/or distant sites, were found in 44 cases (17.6%). Conclusion: The results were largely consistent with those in the literature, including age group, gender and location. Most metastases originated from high-grade tumors, with high Ki67 levels and greater impairment of the liver. However, only 36.4% of the cases had Ki67 index. Reevaluation of the Ki67 proliferative index using image analysis in doubtful cases will allow for a correlation between progression and prognosis.
Resumo Objetivo: Comparar a frequência de tumores neuroendócrinos em nosso serviço com a literatura em relação idade, sexo, localização, grau de diferenciação e aumento da incidência por meio de um estudo retrospectivo. Método: Levantamento em banco de dados de casos de tumores neuroendócrinos diagnosticados no Serviço de Anatomia Patológica do Hospital da Santa Casa de São Paulo nos últimos 10 anos, relacionando com os dados epidemiológicos, como sexo, idade, distribuição pelos diversos órgãos, marcadores imuno-histoquímicos mais utilizados e presença ou não de metástase em linfonodos ou a distância. Resultados: Foram revistos 250 casos, 133 femininos, com faixa etária predominante entre 61 e 70 anos. O pulmão foi o local com maior frequência, seguido do estômago. Os marcadores imuno-histoquímicos mais utilizados foram CD56, sinaptofisina e cromogranina, às vezes complementados pelo Ki67, que permite avaliar o grau de proliferação celular, indicativo de maior ou menor grau de malignidade histológica. Metástases em linfonodos e/ou a distância foram constatadas em 44 casos (17,6%). Conclusão: Os resultados foram em grande parte concordantes com os dados da literatura, como idade, sexo e localização. A maioria das metástases se originou de neoplasias de alto grau, com alto índice do Ki67, com maior comprometimento do fígado. No entanto, o índice proliferativo do Ki67 foi feito em apenas 36,4% dos casos. A reavaliação dos índices proliferativos do Ki67 por meio de análise de imagem, de casos duvidosos, permitirão relacionar com a evolução e o prognóstico dos pacientes.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Tumores Neuroendócrinos/epidemiologia , Brasil/epidemiologia , Imuno-Histoquímica , Estudos Retrospectivos , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/secundário , Antígeno Ki-67/análise , Gradação de Tumores , Centros de Atenção Terciária/estatística & dados numéricos , Pessoa de Meia-Idade , Metástase NeoplásicaRESUMO
INTRODUCTION: Aquaporins and ion channels are membrane proteins that facilitate the rapid movement of water and solutes across biological membranes. Experimental and in vitro studies reported that the function of these channels and pulmonary edema resolution are impaired in acute lung injury (ALI). Although current evidence indicates that alveolar fluid clearance is impaired in patients with ALI/diffuse alveolar damage (DAD), few human studies have addressed the alterations in pulmonary channels in this clinical condition. Additionally, it is not known whether the primary cause of DAD is a relevant variable for the channel dysfunction. METHODS: Autopsied lungs of 43 patients with acute respiratory failure (ARF) due to DAD of three different etiologies, non-pulmonary sepsis, H1N1 viral infection and leptospirosis, were compared to 18 normal lungs. We quantified the expression of aquaporin (AQP) 1, AQP3, AQP5, epithelial Na+ channel (ENaC) and sodium potassium ATPase (Na-K-ATPase) in the alveolar septum using immunohistochemistry and image analysis. RESULTS: The DAD group presented with increased expression of AQP3, AQP5 and Na-K-ATPase and decreased expression of ENaC compared to controls. However, there was no difference in protein expression within the DAD groups of different etiologies. CONCLUSION: Water and ion channels are altered in patients with ARF due to DAD. The cause of DAD does not seem to influence the level of impairment of these channels.
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Aquaporina 1/metabolismo , Aquaporina 5/metabolismo , Canais Epiteliais de Sódio/metabolismo , Alvéolos Pulmonares/metabolismo , ATPase Trocadora de Sódio-Potássio/metabolismo , Lesão Pulmonar Aguda/etiologia , Lesão Pulmonar Aguda/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Aquaporina 3/metabolismo , Autopsia , Feminino , Humanos , Imuno-Histoquímica , Vírus da Influenza A Subtipo H1N1/fisiologia , Influenza Humana/complicações , Influenza Humana/virologia , Leptospirose/complicações , Masculino , Pessoa de Meia-Idade , Alvéolos Pulmonares/patologia , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/metabolismo , Sepse/complicações , Adulto JovemRESUMO
Traqueobronquite aguda é uma forma rara da aspergilose invasiva e geralmente ocorre em pacientes com imunodepressão grave. Relatamos o caso de um paciente no pós-transplante de medula óssea com a manifestação desta doença, dando ênfase aos achados tomográficos encontrados.
Acute tracheobronchitis is a rare manifestation of invasive aspergillosis, generally occurring in severely immunocompromised patients. The authors report the case of a patient presenting with this condition after bone-marrow transplantation, with emphasis on tomographic findings.
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Cardiac angiosarcoma is a rare entity. The incidence through autopsy findings ranges between 0.001% and 0.03%. The disease usually presents with non-specific symptoms, although asymptomatic cases are frequent; therefore, diagnosis is unexpected and consequently delayed. The authors report the case of a middle-aged man with a recent onset cough and dyspnea. He sought medical care several times without receiving a definite diagnosis until a plain chest radiography was taken showing a mediastinal enlargement, which was the reason why he was hospitalized for clinical investigation. During the diagnostic workup, an echodopplercardiogram and a thoracic computed tomography were performed, showing a heterogeneous soft-tissue mass infiltrating the pericardium and the anterior atrial wall. Multiple and scattered pulmonary nodules were also present. A pulmonary nodule was biopsied, which revealed an angiosarcoma. The clinical features added to the radiological and histological findings permitted the diagnosis of right atrial angiosarcoma. The authors highlight the unexpected pattern in the presentation of cardiac tumors.
RESUMO
OBJECTIVES: Pulmonary hypertension is a lethal complication of chronic hepatosplenic schistosomiasis. Little is known of the underlying (immuno-)histopathological characteristics of lung vasculopathy. METHODS: We characterized vasculopathy and inflammation in lung tissue of 10 patients with Schistosomiasis-associated PH (SCH-PH) in comparison to 22 idiopathic pulmonary arterial hypertension (IPAH) patients and 10 normal controls. SCH-PH cases were younger than controls. RESULTS: Plexiform lesions and/or angiomatoid lesions were found in 10/10 SCH-PH, and 19/22 IPAH patients (χ² p = 0.22). Lung granulomas with Schistosoma eggs were found in 2/10 of SCH-PH cases. PAH cases had increased peri-arterial density of CD3+ T cells, chymase+ and tryptase+ mast cells when compared to controls (p ≤ 0.047). SCH-PH showed increased density of CD4+ cells when compared to controls (p = 0.025), paralleled by an increased density of dendritic CD83+ cells when compared to both controls and IPAH patients (p ≤ 0.022). CONCLUSION: Both SCH-PH and IPAH feature plexogenic arteriopathy and increased periarterial T cell and mast cell density. SCH-PH and IPAH differ only with respect to the density of dendritic CD83+ cells. These findings imply ongoing antigenic stimulation in SCH-PH, yet a pattern of pulmonary vasculopathy similar to IPAH, suggestive of a final common pathway in their pathogenesis of PAH.