RESUMO
Apocrine gland anal sac adenocarcinoma is an aggressive neoplasm, and surgery remains the treatment of choice, although it is controversial in advanced cases. The prognostic factors are not well established. Human Epidermal Growth Factor Receptor 2 (HER2) is a membrane protein related to tumorigenesis, whereas Ki67 is a nuclear protein related to cell proliferation. Both are potential prognostic markers and therapeutic targets. This study aimed to evaluate the expression of HER2 and Ki67 markers in canine apocrine gland anal sac adenocarcinoma. The tumor samples were divided into four groups: largest tumor diameter less than 2.5 cm, largest tumor diameter greater than 2.5 cm, metastatic lymph nodes, and control group of non-neoplastic anal sacs. Each contained 10 samples. Immunohistochemistry was performed to verify the expression of HER2 and Ki67 markers. Positive HER2 staining was observed in 45% of the neoplastic cases and negative HER2 staining in 100% of the control group. The Ki67 expression had a median of 25% in all groups, except for the control group, which had a median of 8%. The HER2 and Ki67 expression was present in apocrine gland anal sac adenocarcinoma, making them potential therapeutic targets. However, it was not possible to determine the clinical value of either marker.
Assuntos
Adenocarcinoma , Sacos Anais , Glândulas Apócrinas , Biomarcadores Tumorais , Imuno-Histoquímica , Antígeno Ki-67 , Receptor ErbB-2 , Antígeno Ki-67/metabolismo , Antígeno Ki-67/genética , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Receptor ErbB-2/metabolismo , Glândulas Apócrinas/metabolismo , Glândulas Apócrinas/patologia , Humanos , Biomarcadores Tumorais/metabolismo , Animais , Sacos Anais/metabolismo , Sacos Anais/patologia , Cães , Feminino , Masculino , Neoplasias das Glândulas Anais/metabolismo , Neoplasias das Glândulas Anais/patologiaRESUMO
Mast cell tumors (MCTs) are the most common malignant cutaneous tumors in dogs, and they present extremely variable biological behavior. The interaction between RANK, RANK-L, and immune checkpoints is frequently detected in the tumor microenvironment, and, together, they participate in every stage of cancer development. Thus, the aim of this study was to characterize the molecular profiles of PD-L1, CTLA-4, RANK/RANK-L signaling pathway, and IFN-γ in primary tumors and lymph node metastases. Formalin-fixed, paraffin-embedded slides of MCTs and metastatic lymph nodes of ten dogs were submitted to immunohistochemical investigations. The results demonstrated that the tumor microenvironment of the high-grade mast cell tumors showed moderate or intense immunolabeling of all proteins, and the lymph node metastases also showed moderate or intense immunolabeling of checkpoint proteins. In addition, MCTs larger than 3 cm were associated with intensified PD-L1 (p = 0.03) in metastatic lymph nodes and RANK-L (p = 0.049) immunoreactivity in the tumor. Furthermore, dogs with a survival time of less than 6 months showed higher PD-L1 immunoreactivity (p = 0.042). In conclusion, high-grade MCT is associated with an immunosuppressive microenvironment that exhibits elevated RANK/RANK-L signaling and enhanced immune checkpoint immunoreactivity, potentially facilitating intratumorally immune escape. These biomarkers show promise as clinical indicators of disease progression and might response to immunotherapy in dogs with high-grade MCTs, thus emphasizing their importance for guiding treatment decisions and improving outcomes.
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Hemangiosarcoma is a mesenchymal neoplasm originating in the endothelial cells of blood vessels; they can be classified as non-visceral and visceral types. Non-visceral hemangiosarcomas can affect the skin, subcutaneous tissues, and muscle tissues; visceral hemangiosarcomas can affect the spleen, liver, heart, lungs, kidneys, oral cavity, bones, bladder, uterus, tongue, and retroperitoneum. Among domestic species, dogs are most affected by cutaneous HSA. Cutaneous HSA represents approximately 14% of all HSA diagnosed in this species and less than 5% of dermal tumors, according to North American studies. However, Brazilian epidemiological data demonstrate a higher prevalence, which may represent 27 to 80% of all canine HSAs and 13.9% of all skin neoplasms diagnosed in this species. Cutaneous HSA most commonly affects middle-aged to elderly dogs (between 8 and 15 years old), with no gender predisposition for either the actinic or non-actinic forms. The higher prevalence of cutaneous HSA in some canine breeds is related to lower protection from solar radiation, as low skin pigmentation and hair coverage lead to greater sun exposure. Actinic changes, such as solar dermatosis, are frequent in these patients, confirming the influence of solar radiation on the development of this neoplasm. There are multiple clinical manifestations of hemangiosarcoma in canines. The diagnostic approach and staging classification of cutaneous HSAs are similar between the different subtypes. The definitive diagnosis is obtained through histopathological analysis of incisional or excisional biopsies. Cytology can be used as a presurgical screening test; however, it has little diagnostic utility in cases of HSA because there is a high risk of blood contamination and sample hemodilution. Surgery is generally the treatment of choice for dogs with localized non-visceral HSA without evidence of metastatic disease. Recently, electrochemotherapy (ECT) has emerged as an alternative therapy for the local ablative treatment of different neoplastic types; the use of radiotherapy for the treatment of dogs with cutaneous HSA is uncommon. There is greater consensus in the literature regarding the indications for adjuvant chemotherapy in subcutaneous and muscular HSA; doxorubicin is the most frequently used antineoplastic agent for subcutaneous and muscular subtypes and can be administered alone or in combination with other drugs. Other therapies include antiangiogenic therapy, photodynamic therapy, the association of chemotherapy with the metronomic dose, targeted therapies, and natural products. The benefits of these therapies are presented and discussed. In general, the prognosis of splenic and cardiac HSA is unfavorable. As a challenging neoplasm, studies of new protocols and treatment modalities are necessary to control this aggressive disease.
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Surgical excision of solid tumors is required for local control of neoplasms. However, surgical trauma can stimulate the release of proangiogenic growth factors, suppressing cell-mediated immunity and favoring the development of micrometastases and progression of residual disease. The present study aimed to evaluate the intensity of the metabolic response to trauma induced via unilateral mastectomy in bitches with mammary neoplasia, the consequences of its joint performance with ovariohysterectomy, and their respective effects on the organic response. Two groups of animals were evaluated in seven perioperative moments, namely, unilateral mastectomy (G1) and unilateral mastectomy associated with ovariohysterectomy (G2). Thirty-two female dogs were selected, ten clinically healthy, and twenty-two diagnosed with mammary neoplasia. Surgical trauma reduced serum concentrations of albumin and interleukin-2 but increased blood levels of glucose and interleukin-6 in the postoperative of G1 and G2 patients. Moreover, serum cortisol levels increased after unilateral mastectomy associated with ovariohysterectomy. Our findings allowed us to conclude that unilateral mastectomy induces significant metabolic alterations in female dogs with mammary neoplasms and its joint performance with ovariohysterectomy increases the organic response to trauma.
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Background: Hepatic tumors of primary origin account for 0.6% to 2.9% of cases in canine species, less common than hepatic metastases. The hepatic tumors are divided into hepatocellular tumors, neuroendocrine tumors, bile duct tumors or cholangiocarcinomas, and mesenchymal tumors. Cholangiocarcinomas, are classified according to their origin, being intrahepatic, extrahepatic, or gallbladder type. Cholangiocarcinomas are considered rare in dogs and cats with a ratio of 29% to 71% compared to hepatocellular carcinomas, accounting for 9% of the hepatic tumors. The present study aims to describe a case of cholangiocarcinoma in a bitch, focusing on the diagnostic approach. Case: A 10-year-old castrated bitch Poodle was attended presenting hypoglycemia and seizure crisis. The patient had previous exams of hemogram and serum biochemical profile, showing a discrete increase of the hepatic enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST), besides hypoglycemia. Previous ultrasound exam revealed the presence of a hepatic mass located between the right and square lobes, immeasurable, and significant splenomegaly. Abdominal palpation revealed the presence of immeasurable abdominal formation of undetermined origin. Abdominal computerized tomography (CT), glycemic curve, and insulin dosage were requested. Tomography exam showed an increase in hepatic volume with the presence of a heterogeneous formation in the right lateral lobe topography; increase in spleen dimensions and the presence of multiple nodules; and the presence of a nodule in the right lung, at the caudal thoracic region. The glycemic curve showed acute variations, and insulin dosage was between normal values. The animal was referred for surgery, as in abdominocentesis, it was observed the presence of hemorrhagic fluid, confirming active bleeding by ultrasonography. The owners chose for euthanasia. In the post-mortem evaluation the main lesion was confirmed of hepatic origin, with a massive, irregular, cavitary presentation, involving multiple hepatic lobes, and a single nodule was observed in the right caudal lobe of the right lung. Histopathological evaluation was considered inconclusive. Immunohistochemistry was performed and the association of the immunohistochemical profile with the morphological characteristics indicated diagnosis of cholangiocarcinoma. Discussion: The related symptomatology, in hepatic neoplasms, is generally considered non-specific, with reports of lethargy, vomiting, dyspnea, anorexia and weight loss, however, the dog in this study presented a unique manifestation of hypoglycemia and one episode of convulsive crisis resulting from it. The clinical manifestation observed was extremely unspecific making initial diagnosis difficult. The ultrasonographic examination was effective in evidencing the abdominal mass. In addition, abdominal CT was also performed, which confirmed the hepatic origin, detailing the macroscopic aspect. Biochemical analyses of ALT and AST showed a discrete increase. Biochemical changes may occur in dogs with hepatic neoplasms, although they are not specific. Functional pancreatic beta-cell tumors producing insulin are the most common cause of paraneoplastic hypoglycemia, although in the case the insulin dosage was within normal limits. In cases of nonislet cell tumor the mechanism is frequently associated with the production of insulin-like growth factor (IGF). In most cases the definitive diagnosis of cholangiocarcinoma can be obtained by histopathological examination, although in the present report the result obtained was inconclusive, requiring an immunohistochemical examination. Due to the aggressive and metastatic character of this neoplastic type, early detection becomes extremely important in order to maximize therapeutic chances, however, diagnosis may be difficult.
Assuntos
Animais , Feminino , Cães , Ductos Biliares/patologia , Carcinoma/veterinária , Colangiocarcinoma/diagnóstico , Imuno-Histoquímica/veterináriaRESUMO
Canine transmissible venereal tumor (TVTC) is a highly casuistic transmissible neoplasm in Brazil. Chemotherapy with vincristine sulfate is considered the treatment of choice, but the need for weekly applications and hematological monitoring, in addition to costs, are obstacles to owners' adhesion to the treatment. Lomustine is an alkylating class antineoplastic agent, and because it is administered orally, it is a more practical and less costly treatment option for the owners of animals with neoplasms sensitive to the drug. This study evaluated the therapeutic efficacy of lomustine in dogs affected by TVTC. Twelve dogs with cytopathological diagnosis of natural genital TVTC were selected. The dogs were submitted to the experimental protocol with lomustine administration at doses of 70 to 85 mg/m2 orally every 21 days, totaling a maximum of two administration cycles. The animals were reevaluated every 7 days until a maximum of +49 days after the first dose of lomustine, to monitor the regression of neoplastic lesions through measurements. Among the 12 dogs submitted to the lomustine protocol, 8/12 achieved complete remission of the neoplasm and were considered cured (66.6%), 1/12 had partial response to treatment (8.33%) and 3/12 had stable disease (25%). Important adverse effects such as severe neutrophilic leukopenia were detected in 3/12 dogs (25%). The clinical study indicated that lomustine may be a treatment option for TVTC.
O tumor venéreo transmissível canino (TVTC) é uma neoplasia transmissível de elevada casuística no Brasil. A quimioterapia com sulfato de vincristina é considerada o tratamento de escolha, mas a necessidade de aplicações semanais e acompanhamento hematológico, além dos custos, são obstáculos à adesão dos proprietários ao tratamento. A lomustina é um antineoplásico da classe dos agentes alquilantes e, por ser administrado por via oral, representa um opção de tratamento mais prática e menos onerosa para os proprietários de animais com neoplasias. O objetivo deste estudo foi avaliar a eficácia terapêutica da lomustina em cães acometidos por TVTC. Foram selecionados 12 cães com diagnóstico citopatológico de TVTC genital de ocorrência natural. Os cães foram submetidos ao protocolo experimental com administração de lomustina nas doses de 70 a 85 mg/m2 por via oral a cada 21 dias, totalizando no máximo dois ciclos de administração. Os animais foram reavaliados a cada sete dias até um máximo de +49 dias após a primeira dose de lomustina, para monitorar a regressão das lesões neoplásicas por meio de mensuração das lesões. Entre os 12 cães submetidos ao protocolo, 8/12 obtiveram remissão completa da neoplasia e foram considerados curados (66,6%), 1/12 tiveram resposta parcial ao tratamento (8,33%) e 3/12 tiveram doença estável (25%). Efeitos adversos importantes, como leucopenia neutrofílica grave, foram detectados em 3/12 cães (25%). O estudo clínico indicou que a lomustina pode ser uma opção de tratamento para TVTC.
Assuntos
Animais , Cães , Tumores Venéreos Veterinários/terapia , Doenças do Cão , Lomustina/uso terapêutico , Neoplasias/veterináriaRESUMO
Canine transmissible venereal tumors (TVT) have a high incidence in Brazil. This is partly due to the large population of stray dogs and the ineffectiveness of epidemiological control programs. This study aimed to describe the epidemiological data, clinical manifestations, and treatments used in dogs affected by TVT. Data were retrospectively collected from the 2015-2020 records of the Veterinary Hospital of the Federal Rural University of Rio de Janeiro. A total of 252 dogs were diagnosed with TVT during the study period. Of these, 81.3% were mixed-breed, 50.4% were males, and 88.9% were young or adult animals. The genital region only was affected in 77.3% of cases. Exclusively extragenital lesions were observed in 22.6% of cases. Among the animals seen, 40.1% received no treatment. Of those treated, 99.3% underwent a vincristine sulfate protocol, and in 77.2%, the treatment resulted in total remission of the neoplasm after 4 to 6 chemotherapy sessions. It was concluded that TVT is a neoplasm most often seen in mixed-breed dogs and located in the genital region, with hemorrhagic secretion being the main clinical sign reported by owners. Vincristine sulfate is currently the most used therapy, with high efficacy. However, despite the good prognosis, there was a high rate of non-adherence or abandonment of treatment, and this is an important factor to be considered and addressed by veterinarians.
O tumor venéreo transmissível (TVT) apresenta elevada incidência no Brasil, relacionada a elevada população de caninos errantes e a ineficácia dos programas de controle epidemiológicos. O objetivo do estudo foi descrever dados epidemiológicos, manifestação clínica e o tratamento empregado em cães acometidos pelo TVT no Hospital Veterinário da Universidade Federal Rural do Rio de Janeiro entre os anos de 2015 e 2020. Foram diagnosticados 252 cães com TVT durante o período do estudo, sendo 81,3% cães sem raça definida, 50,4% machos e 49,6% fêmeas, e com 88,9% animais jovens ou adultos. A região genital foi acometida em 77,3% dos casos. Lesões exclusivamente extragenitais foram observadas em 22,6% dos casos. Quanto ao tratamento, 40,1% dos cães não receberam tratamento. Entre os animais tratados, 99,3% utilizaram protocolo com sulfato de vincristina e em 77,2% o tratamento resultou em remissão total da neoplasia, com a realização de 4 a 6 sessões do quimioterápico. Conclui-se que o TVT é uma neoplasia frequentemente relacionada a cães sem raça definida, localizados na região genital, com secreção hemorrágica sendo o principal sinal clínico reportado pelos proprietários. O sulfato de vincristina é a terapia mais empregada, com alta eficácia. Entretanto, apesar de ser uma neoplasia com bom prognóstico, o alto índice de não adesão ou abandono ao tratamento representa um importante fator a ser considerado e trabalhado pelos médicos veterinários.
Assuntos
Animais , Cães , Tumores Venéreos Veterinários/diagnóstico , Tumores Venéreos Veterinários/patologia , Tumores Venéreos Veterinários/tratamento farmacológico , Tumores Venéreos Veterinários/epidemiologia , Doenças do Cão , Vincristina/uso terapêutico , Brasil/epidemiologia , CãesRESUMO
Anal sac neoplasms are common in companion animals, and the epidemiological profile has been extensively described in international studies; however, national data are still lacking. Data on the Brazilian reality of anal sac carcinoma cases' diagnosis and treatment are also scarce. The purpose of this study was to retrospectively evaluate cases of canine anal sac carcinoma and assess the profile of involvement, tumor size, and lymphatic invasion at the time of diagnosis. Information was obtained from Vetpat laboratory database, from 260 cases spanning a 12-year period (2010-2021). In histopathological evaluation at the time of diagnosis, data on sex, age, and race were described, as well as tumor size and lymphatic invasion. The presence of metastasis was also assessed in cases where lymph nodes were sampled. Simple descriptive statistical analysis was used to evaluate the data. Adult and elderly, female, and mixed-breed animals were more involved, indicating differences from international studies that can be attributed to sociocultural factors. In terms of tumor size, it was observed that 93% of the cases had the largest diameter above 2.5cm. Only 7% of the cases had the largest diameter below 2.5cm, demonstrating the often late diagnosis and the importance of rectal palpation examination during the general physical assessment of canine patients, particularly at an advanced age. Regarding lymphatic invasion and affected lymph nodes, 50% of the cases had lymphatic invasion described in the histopathological examination. However, only 5% of the lymph nodes were sent along with the primary tumor, indicating the disease's aggressive behavior but with possible metastases underdiagnosed.
As neoplasias de saco anal possuem incidência importante nos animais de companhia, tendo o seu perfil epidemiológico de acometimento amplamente descrito em estudos internacionais, entretanto dados nacionais ainda são escassos. De modo semelhante, dados acerca da realidade brasileira, associados ao diagnóstico e conduta desses casos, são inexistentes. O objetivo do presente trabalho foi avaliar, de forma retrospectiva, os casos de carcinoma de saco anal canino, avaliando o perfil de acometimento, o tamanho tumoral e a invasão linfática no momento do diagnóstico. Foi obtido informações de 260 casos, respectivo a um período de 12 anos (2010-2021), proveniente do banco de dados do laboratório Vetpat. Foram descritos os dados acerca do sexo, idade e raça, bem como o tamanho tumoral e presença de invasão linfática em avaliação histopatológica no momento do diagnóstico. Os casos que cursavam com envio dos linfonodos também foram avaliados quanto a presença de metástase. Os dados foram avaliados mediante análise estatística descritiva simples. Foi encontrado um maior acometimento em animais adultos a idosos, do sexo feminino e sem raça definida, evidenciando diferenças em relação a estudos internacionais, que podem ser atribuídas a fatores socioculturais. Em relação ao tamanho tumoral, observou-se que 93% dos casos apresentavam o maior diâmetro acima de 2,5cm e apenas 7% dos casos apresentavam o maior diâmetro abaixo de 2,5cm, evidenciando o diagnostico frequentemente tardio, bem como a importância do exame de palpação retal durante a avaliação física geral de pacientes caninos, principalmente em idade avançada. Quanto a avaliação da invasão linfática e linfonodos acometidos, 50% dos casos cursavam com invasão linfática descrita em exame histopatológico, entretanto em apenas 5% dos casos os linfonodos foram enviados junto ao tumor primário, evidenciando o comportamento agressivo da doença, porém com metástases possivelmente subdiagnosticadas.
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Animais , Masculino , Feminino , Cães , Adenocarcinoma/veterinária , Doenças do Cão , Neoplasias das Glândulas Anais/diagnóstico , Neoplasias das Glândulas Anais/epidemiologia , Sacos Anais/patologia , LinfonodosRESUMO
Mast cell tumors, which are neoplasms with variable behavior, from less aggressive to highly metastatic tumors, account for 16%21% of cutaneous neoplasms in dogs. The diagnosis and grading of mast cell tumors are based on cytological analysis and histological evaluation, which facilitate appropriate planning for surgical and chemotherapeutic treatment. Surgical resection with safety margins of 23 cm is considered the best therapeutic option; however, postoperative complications, such as delayed healing, necrosis, suture dehiscence, and occurrence of seroma, are reported. It is essential to understand the biology of mast cell tumors because prognostic factors directly influence the efficacy of the treatment and the quality of life of the patient. Here, we conducted a retrospective study of dogs submitted to surgical resection of cutaneous mast cell tumors, and analyzed the prognostic factors and occurrence of postoperative complications. The results showed that low grade mast cell tumors were associated with a lower occurrence of ulceration, metastasis, recurrence, lack of need for adjuvant therapy, and occurrence of paraneoplastic syndrome compared to those of a higher grade. We also compared the association between demanding or compromised margins with the presence of postoperative complications. The results showed that high grade mast cell tumors have a greater metastatic potential and that the presence of neoplastic cells in the adjacent tissues leads to a greater malignancy and postoperative complications
Mastocitomas representam de 16 a 21% das neoplasias cutâneas em cães. São neoplasmas com comportamentos variáveis, de tumores pouco agressivos até altamente metastáticos. Seu diagnóstico é baseado na análise citológica e avaliação histológica para determinação da graduação, sendo possível realizar o adequado planejamento do tratamento cirúrgico e qui-mioterápico. A ressecção cirúrgica com margens de segurança de 2 a 3 cm é considerada a melhor opção terapêutica, entretanto, são relatadas complicações no pós-operatório como retardado na cicatrização, necrose, deiscência de sutura e ocorrência de seroma. É indispensável o entendimento da biologia do tumor, pois fatores prognósticos implicam diretamente na eficácia do tratamento e na qualidade de vida do paciente. O presente trabalho objetivou a realização de estudo retrospectivo de cães submetidos à ressecção cirúrgica de mastocitoma cutâneo, com análise dos fatores prognósticos e da ocorrência de complicações pós-operatórias. Foi possível observar que os mastocitomas de baixo grau apresentam menor ocorrência de ulceração, metástase, recidiva, ausência de necessidade de terapia adjuvante e ocorrência síndrome paraneoplásica comparativamente aos de maior grau. Foi possível ainda, a comparação da associação entre margens exíguas ou comprometidas com a presença de complicações pós-operatórias. Os resultados demonstraram que mastocitomas de alto grau tem maior potencial metastático e a presença de células neoplásicas nos tecidos adjacentes acarretam em comportamento de maior malignidade e complicações pós-operatórias
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Animais , Cães , Mastocitoma Cutâneo/cirurgia , Mastocitoma Cutâneo/veterinária , Mastócitos/patologia , Neoplasias Cutâneas/veterinária , Estudos RetrospectivosRESUMO
Lymphomas, malignant neoplasms that originate in the lymphocytes, have a high incidence in domestic animals. This paper aimed to describe the clinical and epidemiological findings of 200 cases of canine lymphoma evaluated over nine years (20112019) at the Oncology Service of the Veterinary Hospital at The Federal Rural University of Rio de Janeiro. A majority of mixed-breed canines (84/200-42%) were observed, followed by the Labrador Retriever, Pitbull, and Rottweiler with similar incidence (15/200-7.5%). The average age was 7.7 years and the most affected canines were aged approximately 3 and 11 years old (146/200-73%). As for the anatomical classification, the cases classified as multicentric (131/200-65,5%) were the most common, followed by cases of the cutaneous form (44/200-22%), alimentary form (7/200 - 3.5%), mediastinal form (5/200-2.5%), and extranodal form (16/200-6,5%). Among extranodal cases were described cases of ocular involvement (5/200-2.5%), oral cavity involvement (4/200-2%), cardiac involvement (3/200-1.5%), and pulmonary involvement (1/200-0.5%). The clinical manifestation observed was related to the affected region in the different anatomical forms. More studies of this nature are needed to profile the disease presentation and contribute to clinical identification and diagnosis
Os linfomas são neoplasias malignas que se originam nos linfócitos, apresentando alta incidência em animais domés-ticos. Este trabalho teve como objetivo descrever os achados clínicos e epidemiológicos de 200 casos de linfoma canino avalia-dos ao longo de nove anos (2011-2019) no Serviço de Oncologia do Hospital Veterinário da Universidade Federal Rural do Rio de Janeiro. A maioria dos cães foi classificada como sem raça definida (84/200-42%), seguida pelo Labrador Retriever, Pitbull e Rottweiler com incidência semelhante (15/200-7,5%). A idade média foi de 7,7 anos e os caninos mais acometidos tinham aproximadamente 3 e 11 anos (146/200-73%). Quanto à classificação anatômica, os casos classificados como multicêntricos (131/200-65,5%) foram os mais comuns, seguidos pelos casos da forma cutânea (44/200-22%), forma alimentar (7/200 - 3,5 %), forma mediastinal (5/200-2,5%) e forma extranodal (16/200-6,5%). Entre os casos extranodais foram descritos casos de envolvimento ocular (5/200-2,5%), envolvimento da cavidade oral (4/200-2%), envolvimento cardíaco (3/200-1,5%) e envolvimento pulmonar (1/200-0,5 %). A manifestação clínica observada foi relacionada à região acometida nas diferentes formas anatômicas. Mais estudos dessa natureza são necessários para traçar o perfil de apresentação da doença e contribuir para a identificação e diagnóstico clínico
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Animais , Cães , Linfoma não Hodgkin/veterinária , Linfoma/veterinária , Linfoma/epidemiologia , Estudos RetrospectivosRESUMO
A hantavirose é uma zoonose de distribuição mundial que utiliza como vetores roedores, musaranhos, toupeiras e morcegos. Os sintomas da infecção pelo hantavírus assemelham-se aos de diversas doenças, por isso o diagnóstico laboratorial é crucial para o tratamento precoce. Objetivo: Realizar uma revisão da literatura sobre as características e diagnóstico laboratorial da hantavirose. Métodos: Trata-se de uma revisão integrativa da literatura com base no modelo PRISMA, com seleção de estudos nas bases de dados Portal de Periódicos da Capes, PubMed/Medline, SciELO, ScienceDirect e Biblioteca Virtual em Saúde (BVS). Foram empregados os descritores: hantavírus, diagnóstico laboratorial, exames e zoonose, em português e inglês, no período de 2015 a 2022, sendo selecionados 19 artigos científicos em atendimento aos critérios de inclusão. Resultados e Discussão: Diversas técnicas diagnósticas podem ser empregadas em casos de hantavirose, sendo a biologia molecular a mais empregada, conjuntamente com a imunologia. Há outros recursos utilizados para monitoramento e evolução da doença, como a bioquímica, a hematologia e a imagenologia. Para a ocorrência de hantavirose é necessário um ambiente propício, clima específico e contato com hospedeiro suscetível, podendo evoluir para quadros assintomáticos ou sintomáticos com complicações graves. Conclusão: O diagnóstico dessa doença é desafiador e requer investigação detalhada que inclua a sintomatologia do paciente, o histórico de exposição a animais reservatórios e os resultados de exames laboratoriais. Como desfechos negativos da hantavirose incluem-se a febre hemorrágica com síndrome renal, a síndrome pulmonar por hantavírus e o óbito
Hantavirus is a worldwide distributed zoonosis that uses rodents, shrews, moles and bats as vectors. The symptoms of hantavirus infection resemble those of many diseases, so laboratory diagnosis is crucial for early treatment. Objective: The present study aimed to conduct a literature review on the characteristics and laboratory diagnosis of hantavirus. Methods: This is an integrative literature review based on the PRISMA model, with a selection of studies in the Capes Portal de Periódicos, PubMed/Medline, SciELO, ScienceDirect and Virtual Health Library databases, using the descriptors: hantavirus, laboratory diagnosis, exams, and zoonosis, in portuguese and english, from 2015 to 2022, and nineteen scientific articles that met the inclusion criteria were selected. Results and Discussion: Several techniques can be used in cases of hantavirus, with molecular biology being the most evidenced along with immunology. There are other parameters that are used for monitoring and evolution of the disease, such as biochemistry, hematology, and imaging. For the hantavirus disease, an adequate environment, specific climate and contact with a susceptible host are necessary, which may lead to asymptomatic conditions or symptoms with more serious complications. Conclusion: The diagnosis of this disease is challenging and requires detailed investigation that includes the patient's symptoms, the history of exposure to reservoir animals and the results of laboratory tests. Negative outcomes of hantavirus infection include hemorrhagic fever with renal syndrome, hantavirus pulmonary syndrome, and death
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Humanos , Masculino , Feminino , Infecções por Hantavirus/diagnóstico , Técnicas de Laboratório Clínico , Argentina , Suíça , Turquia , Estados Unidos , Bélgica , Bolívia , Brasil , Canadá , Ensaio de Imunoadsorção Enzimática , Chile , China , Reação em Cadeia da Polimerase , Cazaquistão , Febre Hemorrágica com Síndrome RenalRESUMO
There is no consensus on the role of electromyographic analysis in detecting and characterizing the asymmetries of jaw muscle excitation in patients with temporomandibular disorders (TMD). To analyze the TMD patients (n = 72) in comparison with the healthy controls (n = 30), the surface electromyography (sEMG) of the temporalis anterior muscle (TA) and masseter muscle (M) was recorded while a maximal biting task was performed. The differences in the asymmetry of the relationship between the masseter muscles were assessed in a module to determine the sensitivity (Sn) of binomial logistic models, based on the dominance of the TA or the M muscle, in accurately predicting the presence of TMD. All assumptions were met, and comparisons between the groups showed significant differences for the TA muscle ratio (p = 0.007), but not for the M muscle ratio (p = 0.13). The left side was predominant over the right side in the TMD group for both the TA (p = 0.02) and M muscles (p = 0.001), while the non-TMD group had a higher frequency of the right side. Binary logistic regression showed a significant model (χ2 = 9.53; p = 0.002) for the TA muscle with Sn = 0.843. The model for the M muscle also showed significance (χ2 = 8.03; p = 0.005) with Sn = 0.837. The TMD patients showed an increased TA muscle ratio and asymmetry of left dominance, compared to the healthy subjects. Both of the binomial logistic models, based on muscle dominance TA or M, were moderately sensitive for predicting the presence of TMD.
Assuntos
Músculo Temporal , Transtornos da Articulação Temporomandibular , Eletromiografia , Feminino , Humanos , Músculo Masseter/fisiologia , Músculo Temporal/fisiologiaRESUMO
Os efeitos do trauma cirúrgico no organismo, os quais são amplamente estudados pela medicina humana e veterinária, resultam em uma complexa resposta neuroendócrina e imunológica, desencadeadas para restabelecer a homeostase e preservar a vida. A resposta metabólica ao trauma é caracterizada pelo aumento da secreção de hormônios hipofisários, ativação do sistema nervoso simpático e secreção de citocinas pró-inflamatórias. Essa resposta tem por objetivo manter a perfusão tecidual, controlar a proliferação de microrganismos e mobilizar substratos para garantir a integridade das funções celulares e promover reparação tecidual. Diferentes fatores podem influenciar a intensidade da resposta do organismo ao trauma, incluindo magnitude e duração dos estímulos, enfermidades ou eventos traumáticos pré-existentes, protocolos anestésicos e técnicas cirúrgicas utilizadas. Respostas metabólicas exacerbadas ocasionam complicações pós-operatórias, tempo prolongado de recuperação dos pacientes e óbito. Através da identificação dos principais eventos relacionados à resposta metabólica ao trauma cirúrgico, é possível atuar de forma a reduzir os danos associados, melhorando a qualidade e minimizando os riscos do período pós-operatório. Sendo assim, este trabalho tem como objetivo apresentar uma revisão descrevendo a fisiopatologia e as consequências da resposta metabólica ao trauma cirúrgico, em suas diferentes formas e origens, no período perioperatório.
The effects of surgical trauma on the organism, which are widely studied by human and veterinary medicine, result in a complex neuroendocrine and immune responses triggered to restore homeostasis and preserve life. The metabolic response to trauma is characterized by increased secretion of hypophyseal hormones, activation of the sympathetic nervous system, and secretion of pro-inflammatory cytokines. This response aims to maintain tissue perfusion, control the proliferation of microorganisms, and mobilize substrates to ensure the integrity of cellular functions and promote tissue repair. Different factors can influence the intensity of the organism's response to trauma, including magnitude and duration of stimuli, pre-existing infirmities or traumas, anaesthetic protocols, and surgical techniques applied. Exacerbated metabolic responses can cause post-operative complications, prolonged recovery time, and death. By identifying the main events related to the metabolic response to surgical trauma, it is possible to act to reduce the associated damages, improving quality and minimizing the risks of the postoperative period. Thus, the present paper aims to present a review describing the physiopathology and the consequences of the metabolic response to surgical trauma, in its different forms and origins, in the perioperative period.
Assuntos
Humanos , Animais , Complicações Pós-Operatórias/metabolismo , Inflamação/metabolismo , Complicações Intraoperatórias/metabolismo , Metabolismo/fisiologiaRESUMO
Mast cell tumors (MCTs) are hematopoietic neoplasms composed of mast cells. It is highly common in dogs and is extremely important in the veterinary oncology field. It represents the third most common tumor subtype, and is the most common malignant skin tumor in dogs, corresponding to 11% of skin cancer cases. The objective of this critical review was to present the report of the 2nd Consensus meeting on the Diagnosis, Prognosis, and Treatment of Canine Cutaneous and Subcutaneous Mast Cell Tumors, which was organized by the Brazilian Association of Veterinary Oncology (ABROVET) in August 2021. The most recent information on cutaneous and subcutaneous mast cell tumors in dogs is presented and discussed.
Assuntos
Doenças do Cão , Transtornos Mieloproliferativos , Neoplasias Cutâneas , Animais , Doenças do Cão/diagnóstico , Doenças do Cão/terapia , Cães , Mastócitos/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Neoplasias Cutâneas/veterinária , Tela Subcutânea/patologiaRESUMO
Cutaneous horn is a skin disease with low incidence and few citations in the literature. This report describes a dog with multiple cutaneous lesions of papillomatosis and one giant cutaneous horn on the face. Two sessions of cryotherapy achieved complete remission of the lesions.
La corne cutanée est une maladie de la peau à faible incidence et peu citée dans la littérature. Cet article décrit un chien avec de multiples lésions cutanées de papillomatose et une corne cutanée géante sur la face. Deux séances de cryothérapie ont permis d'obtenir une rémission complète des lésions.
Los cuernos cutáneos son una lesion patológica de baja incidencia y con escasas menciones en la literatura. Este artículo describe un caso de un perro con multiples lesiones cutáneas de papilomatosis y un cuerno cutáneo gigante en la cara. Dos sesiones de crioterapia consiguieron una remisión completa de las lesiones.
O corno cutâneo é uma doença cutânea com baixa incidência e poucas citações na literatura. Este relato descreve um cão com múltiplas lesões cutâneas características de papilomatose e um corno cutâneo gigante na face. Houve remissão completa das lesões após duas sessões de crioterapia.
Assuntos
Doenças do Cão , Ceratose , Papiloma , Dermatopatias , Animais , Crioterapia/veterinária , Doenças do Cão/patologia , Doenças do Cão/cirurgia , Cães , Ceratose/veterinária , Papiloma/cirurgia , Papiloma/veterinária , Pele/patologia , Dermatopatias/patologia , Dermatopatias/terapia , Dermatopatias/veterináriaRESUMO
Background: Canine transmissible venereal tumor (TVT) is one of the most common canine neoplasms in Brazil. Lesions develop mainly in the genital tissue and less frequently in other areas, in the extragenital form. Metastasis is rare, and the disease progression depends on the patients immune status. The treatment of choice is chemotherapy with vincristine sulfate, considered an effective and safe modality. The present work describes the first case of extragenital TVT in the larynx with pulmonary metastasis at the time of diagnosis. Case: An approximately 4-month-old mixed-breed bitch was attended manifesting acute clinical respiratory signs. The patient had been rescued from the street 2 months beforehand. Physical examination revealed pale mucous membranes and crackling pulmonary auscultation. Thoracic radiography was performed in 3 projections, showing multiple nodules in the lung parenchyma, followed by cytopathological examination using fine needle puncture guided by thoracic ultrasound, confirming the diagnosis of TVT. Considering the cytological finding and the absence of primary tumor lesions in the genital, oral, cutaneous or nasal regions, endoscopy was performed in order to locate a possible primary focus. The exam revealed a small erythematous tumor with smooth and regular surface, measuring approximately 2.5 cm, located in the larynx, between the arytenoid cartilages. Chemotherapy was performed with vincristine sulfate with radiographic follow-up throughout the treatment. Full remission of the pulmonary and laryngeal nodules was achieved at the end of the protocol. The animal remained in complete remission for a period of 2 years. Discussion: TVT is more frequently observed in animals of active reproductive age, and rarely in animals under 1 year of age, as in the case...
Assuntos
Feminino , Animais , Cães , Metástase Neoplásica , Neoplasias Laríngeas/veterinária , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/veterinária , Tumores Venéreos Veterinários/diagnóstico , Tumores Venéreos Veterinários/tratamento farmacológico , Vincristina/uso terapêuticoRESUMO
Objetivo: Evaluar los resultados funcionales de tres protocolos distintos de tratamiento conservador en pacientes con capsulitis adhesiva del hombro. Materiales y Métodos: Se revisaron las historias clínicas de los pacientes tratados por capsulitis adhesiva en nuestra institución, entre enero de 2016 y enero de 2019. Se compararon tres protocolos diferentes de tratamiento: grupo 1, bloqueo del nervio supraescapular con un anestésico local y corticoide, analgésicos y fisioterapia después del alivio del dolor; grupo 2, bloqueo del nervio supraescapular con anestésico local sin corticoide, analgésicos y fisioterapia; grupo 3, analgésicos y fisioterapia, sin bloqueo del nervio supraescapular. Se determinaron los resultados funcionales con la escala ASES y el resultado subjetivo con el SSV. Resultados: Se dividió en tres grupos a 46 pacientes tratados por capsulitis adhesiva. Los pacientes del grupo 3 tuvieron, en promedio, más sesiones de fisioterapia (30,31 ± 21,07). Los del grupo 2 recibieron la mayor cantidad promedio de bloqueos del nervio supraescapular (3,27 ± 1,22). Los resultados de los puntajes funcionales fueron: grupo 1 (15 pacientes): media 84 ASES y 84 SSV; grupo 2 (15 pacientes): media 93,40 ASES y 91,67 SSV; grupo 3 (16 pacientes): media 79,4 ASES y 80,63 SSV. Conclusiones: Las distintas formas de tratamiento conservador para la capsulitis adhesiva logran excelentes resultados. La analgesia mediante bloqueos seriados del nervio supraescapular con un anestésico y corticoide logró mejores resultados funcionales y subjetivos, y disminuyó la necesidad de administrar analgésicos y de sesiones de fisioterapia (grupo 1). Nivel de Evidencia: IV
Objective: To evaluate the functional outcomes of three different conservative treatment protocols in patients with adhesive capsulitis of the shoulder. Materials and Methods: Reviews of medical records were carried out on patients treated at the institution for adhesive capsulitis in the period between January 2016 and January 2019. 3 different treatment protocols were compared. Group 1; Suprascapular nerve block (SSNB) with local anesthetic and corticosteroid, analgesics, and physiotherapy after pain reduction. Group 2: SSNB with local anesthetic without corticosteroids, analgesics, and physiotherapy, and group 3: analgesics and physiotherapy, without SSNB. The functional outcomes were determined with the ASES scale and the subjective results were assessed with the SSV. Results:A total of 46 patients treated for adhesive capsulitis were divided into 3 groups. Group 3 presented a higher mean number of physiotherapy sessions (30.31±21.07). Group 2 had the highest mean number of SSN blocks (3.27±1.22). The results of the functional scores were: group 1 (15 patients): mean ASES 84 and mean SSV 84; group 2 (15 patients): mean ASES 93.40 and mean SSV 91.67; group 3 (16 patients): mean ASES 79.4 and mean SSV 80.63. Conclusion: The various forms of conservative treatment for adhesive capsulitis achieve excellent outcomes. Analgesia through serial blocks of the suprascapular nerve with an anesthetic and corticosteroid achieved better functional and subjective outcomes and decreased the need to administer analgesics and physiotherapy sessions (group 1). Level of Evidence: IV
Assuntos
Ombro , Bursite , Resultado do TratamentoRESUMO
Background: Urethral tumors are uncommon in canines, represented predominantly by transitional cell carcinoma, marked by aggressive behavior associated with short life expectancy. Definitive diagnosis is achieved by histopathological analysis. Surgery associated with chemotherapy is the main therapeutic alternative. The aim of this paper is to report a case of primary transitional cell carcinoma of the urethra in a bitch, submitted to surgical treatment associated with conventional adjuvant chemotherapy and metronomic chemotherapy, achieving survival of 21 months, to date. Case: A 12-year-old bitch mixed breed was admitted at the Veterinary Hospital of Federal Rural University of Rio de Janeiro (UFRRJ), manifesting hematuria and urinary incontinence for one month. Physical examination indicated that vital parameters were within normal limits. Laboratory tests of blood count and serum biochemistry, urinalysis, culture, urinary antibiogram, and abdominal ultrasound were performed. The ultrasound image suggested a neoplastic urethral process. Because of the suspicion of neoplasm, a thoracic X-ray was performed, showing no evidence of metastasis. Computed tomography (CT) of the abdominal region was performed, revealing an expansive lesion in the urethra with loss of definition of the walls and urethral lumen extending to the level of the pelvic floor, measuring about 2.9 x 1.4 x 1.2 cm. After preanesthetic exams, the animal underwent resection and surgical anastomosis of the affected urethral region. The sectioned tissue was sent for histopathological analysis, with diagnosis of transitional cell carcinoma. Adjuvant chemotherapy was performed using carboplatin at a dose of 250 mg/m², intravenously, every 21 days for 6 sessions. After completing the protocol, abdominal ultrasonography was performed again, which showed a cicatricial process in the urethral region of the surgical excision, with no sign of tumor recurrence. A metronomic chemotherapy protocol was then started with cyclophosphamide at a dose of 15 mg/m², daily for 6 months, with periodic oncological follow-up. At the end of the period, the animal remained under periodic follow-up with ultrasound exams performed at 2-month intervals, and has been free from recurrence for 21 months until now. Discussion: Urethral neoplasms account for 0.5 - 2% of all canine tumors, and are represented mostly by transitional cell carcinomas. Clinical signs of urinary obstruction and hematuria are the most common, as reported in the patient in question. The definitive diagnosis is by histopathological examination. However, imaging tests such as computed tomography are important in the initial investigation and surgical planning. The indicated treatment is surgical resection of the mass with subsequent adjuvant chemotherapy or radiotherapy. The chemotherapy protocol associating cisplatin and piroxicam can achieve remission rates of 70%, but this association has a high nephrotoxic effect. In the present case, cisplatin was replaced by carboplatin in order to reduce the nephrotoxic effects of chemotherapy. The metronomic protocol using cyclophosphamide was used as maintenance therapy, at the end of the conventional chemotherapy protocol. Survival achieved was longer than that described in the literature in cases of transitional cell carcinomas in the urethral region. Therefore, multimodal therapy using surgery associated with conventional and metronomic chemotherapy, is an option in canines with urethral carcinoma.
Assuntos
Animais , Feminino , Cães , Uretra/patologia , Carcinoma de Células de Transição/terapia , Carcinoma de Células de Transição/veterinária , Carboplatina/administração & dosagem , Neoplasias Uretrais/veterinária , Administração Metronômica/veterináriaRESUMO
This study aimed to evaluate the serum concentration of vitamin D (25-Hydroxyvitamin D) and acute phase proteins (APPs; alpha-1 acid glycoprotein, haptoglobin, transferrin, ceruloplasmin, albumin, IgA, IgG and alpha-1 - antitrypsin) as potential biomarkers for prognostic and therapy response in dogs with multicentric lymphoma submitted to the CHOP (Cyclophosphamide, Doxorubicin, Vincristine and Prednisone) chemotherapy protocol. Thirteen dogs with multicentric lymphoma classified as high grade by cytology were included in the treatment group (GL), while ten healthy dogs were included in the control group (GC). Serum was collected in the weeks T0, T5 and T10 of CHOP chemotherapy protocol, for the GL group, and in a single collection, for the GC group. All the collected samples were evaluated for the APPs and vitamin D concentrations through electrophoresis and chemiluminescence methods, respectively. Diagnostic and staging tests were performed for all the dogs in the GL group, and included cytopathology, histopathology and immunohistochemistry of the affected lymph node. Of these dogs, 9 achieved a complete response and 4 a partial response to the treatment. Data analysis was performed with the R software. The results demonstrated that serum concentrations of IgA, haptoglobin and α1-acid glycoprotein were significantly different between the groups and also between the different chemotherapy times analyzed (p<0.05), indicating that these proteins can be considered as sensitive biomarkers for lymphoma in dogs. Furthermore, the α1-acid glycoprotein showed prognostic value for the disease, with 63% specificity. However, vitamin D concentration was not correlated with prognosis of the dogs with lymphoma.
Objetivou-se caracterizar a concentração sérica da vitamina D e das PFAs (Proteínas de Fase Aguda) (alfa-1 glicoproteína ácida, haptoglobina, transferrina, ceruloplasmina, albumina, IgA, IgG e alfa-1 antitripsina) em cães com linfoma multicêntrico, submetidos ao tratamento quimioterápico com protocolo CHOP (Ciclofosfamida, Doxorrubicina, Vincristina e Prednisona), determinando o valor prognóstico desses marcadores para a doença. Foram avaliadas as concentrações séricas das PFAs, através do método da eletroforese e as concentrações da vitamina D, através da quimioluminescência em dois grupos experimentais, um grupo de 13 cães com linfoma multicêntrico classificados como alto grau pela citologia (GL) durante as semanas T0, T5 e T10 do tratamento com protocolo quimioterápico antineoplásico e em um grupo de 10 animais saudáveis para compor o grupo controle (GC), em coleta única. Para isso, foi realizado o diagnóstico, estadiamento e avaliação de resposta terapêutica dos 13 pacientes com linfoma multicêntrico através de técnicas de citopatologia, histopatologia, imuno-histoquímica do linfonodo periférico acometido. Foi observado que 9 pacientes tiveram resposta completa e 4 pacientes tiveram resposta parcial ao tratamento. Os dados foram analisados através do software R. Os resultados indicam que as diferenças entre as variáveis IgA, haptoglobina e α1-glicoproteína ácida foram significativas entre os grupos, e entre os diferentes momentos da quimioterapia (p< 0,05), indicando que podem ser marcadores sensíveis ao linfoma em cães. A α1-glicoproteína ácida apresentou valor prognóstico para o linfoma, com 63% de especificidade. Porém a vitamina D não apresentou valor prognóstico para o linfoma multicêntrico em cães.
Assuntos
Animais , Cães , Biomarcadores , Doenças do Cão , Linfoma/tratamento farmacológico , Linfoma/veterinária , Vitamina D/imunologia , Proteínas de Fase Aguda/imunologia , Reação de Fase Aguda/veterinária , CãesRESUMO
The canine transmissible venereal tumor (TVTC) is a neoplasm transmitted mainly through copulation and with a high incidence in stray dogs in Brazil. In the process of tumor evolution of TVTC, the progression, stationary and regression phases are recognized. The host immunity is related to the disease's biological behavior, however, spontaneous regression observation in cases of naturally occurring TVTC is uncommon. A canine patient was attended, after beeing rescued from the street, due to an ulcerated mass in the external genitália and tick infestation. Cytopathological examination, which diagnosed TVTC, and laboratory tests that showed mild anemia and severe thrombocytopenia were performed. In view of the impossibility of carrying out other exams, it was made the presumptive diagnosis of canine monocytic ehrlichiosis (CME), and treatment was instituted. During follow-up it was observed quick improvement in clinical signs and laboratory changes, as well as a reduction in tumor mass. A new cytopathological evaluation was carried out, and was verified increase in mature lymphocytes and plasmocytes in the midst of the tumor cells, finding compatible with the stationary phase of the disease. From that moment on, it was decided to perform only clinical and cytopathological follow-up. In the following evaluations, continuous clinical remission and cytopathological findings compatible with those described in the regression phase were observed, until its complete remission. It is considered that the improvement in the general health of the patient after the treatment of CME is related to the spontaneous regression of TVTC, and that simultaneous performance of serial clinical and cytopathological exams may be feasible and useful for monitoring the stages of evolution of TVTC.
O tumor venéreo transmissível canino (TVTC) é uma neoplasia transmitida principalmente através da cópula, com elevada incidência em cães errantes no Brasil. No processo de evolução tumoral do TVTC, são reconhecidas as fases de progressão, estacionária e de regressão. O estado imunológico do hospedeiro está relacionado ao comportamento biológico da doença, contudo, a observação de regressão espontânea em casos de TVTC de ocorrência natural é incomum. Foi atendida uma paciente canina, resgatada da rua, por apresentar massa ulcerada na genitália externa e infestação por carrapatos. Foram realizados exame citopatológico, que diagnosticou TVTC, e exames laboratoriais que evidenciaram anemia discreta e grave trombocitopenia. Com isso e diante da impossibilidade de realizar outros exames, foi também estabelecido o diagnóstico presuntivo de erlichiose monocítica canina (EMC) e instituído tratamento para a hemoparasitose. Durante o acompanhamento, foi observada rápida melhora dos sinais clínicos e das alterações laboratoriais, bem como a redução espontânea da massa tumoral. Em sequência, foi realizada nova avaliação citopatológica do TVTC e verificado o aumento quantitativo de linfócitos maduros e plasmócitos, em meio as células tumorais, achado compatível com a fase estacionária da doença. A partir desse momento, optou-se por realizar apenas acompanhamento clínico e avaliação citopatológica da neoplasia. Foram observados contínua remissão clínica e achados microscópicos compatíveis com a fase de regressão do tumor, até sua remissão completa. Pondera-se que a melhora na saúde geral da paciente após o tratamento da EMC esteja relacionada à regressão espontânea do TVTC, e que realização simultânea de exames clínico e citopatológico seriados pode ser viável e útil ao acompanhamento das fases de evolução do TVTC.