Teratoma mesentérico maduro en una mujer adulta: reporte de caso y revisión de la literatura / Mature mesenteric teratoma in an adult women: Case report and literature

Introducción. Los teratomas son neoplasias que surgen a partir de células germinales pluripotenciales y derivan de dos o más capas de células. Se clasifican en tumores maduros, que contienen tejidos bien diferenciados, o inmaduros, que contienen estructuras inmaduras y embrionarias. Su localización más frecuente son las gónadas; la ubicación mesentérica es infrecuente y se han descrito aproximadamente 40 casos en la literatura mundial. Dentro del abordaje diagnóstico y terapéutico, se emplea la tomografía computarizada y la resonancia magnética nuclear para caracterizar la lesión, evaluar la extensión intraabdominal y la relación con otras estructuras. El diagnóstico debe confirmarse mediante el examen histopatológico. Caso clínico. Paciente femenina de 56 años, con antecedente de carcinoma ductal infiltrante de mama izquierda en remisión, en estudios de seguimiento con hallazgo incidental en tomografía de abdomen de lesión abdominopélvica dependiente del mesenterio, contornos lisos y nivel grasa-líquido. Estudios de extensión con marcadores tumorales negativos. Resultados. Por la alta sospecha clínica e imagenológica de teratoma, fue llevada a resección quirúrgica de la lesión. El examen histopatológico confirmó el diagnóstico de teratoma quístico maduro del mesenterio. Conclusión. El teratoma mesentérico es una entidad clínica rara, que debe ser considerado como uno de los diagnósticos diferenciales de una masa abdominal con efecto compresivo. El diagnóstico se basa principalmente en el examen clínico y los hallazgos imagenológicos. La escisión quirúrgica temprana es el pilar del tratamiento; el abordaje laparoscópico o abierto depende de las características clínicas y la experiencia del cirujano.

Background. Teratomas are neoplasms that arise from pluripotent germ cells, derived from two or more layers of germ cells. They are classified as mature tumors (cystic or solid), which contain well-differentiated tissues, or as immature tumors, which contain immature and embryonic structures. Its most frequent location is the female and male gonads; the mesenteric location is rare and approximately 40 cases have been described in the world literature. Within the diagnostic and therapeutic approach, computed tomography and magnetic resonance imaging are used to characterize the lesion, assess intra-abdominal extension and the relationship with other structures. The diagnosis must be confirmed by histopathological examination. Clinical case. A 56-year-old female patient with a history of infiltrating ductal carcinoma of the left breast in remission. In follow-up studies, incidental abdominal tomography finding of an abdominopelvic lesion dependent on the mesentery at the level of the mesogastrium, smooth contours with fat-liquid level. Extension studies with negative tumor markers. Results. Due to high clinical and imaging suspicion of teratoma, the patient was taken to resection of the lesion. Histopathological examination confirmed the diagnosis of mature cystic teratoma of the mesentery. Conclusion. Mesenteric teratoma is a rare clinical entity and is considered one of the differential diagnoses of an abdominal mass with a compressive effect. Diagnosis is mainly based on clinical examination and imaging findings. Early surgical excision is the mainstay of treatment; laparoscopic or open approach depends on the clinical characteristics and the experience of the surgeon.

Presentación atípica de teratoma quístico maduro gigante en una paciente adolescente: a propósito de un caso / Atypical presentation of a giant mature cystic teratoma in an adolescent patient: A case report

Introducción: El teratoma quístico maduro es un tipo de tumor derivado de las células germinales que aparece en pacientes en edad fértil. La edad más frecuente de aparición de este tipo de tumores es entre los 20 y40 años.Caso clínico: Se presenta el caso de una paciente adolescente de 18 años con masa abdominal gigante de crecimiento abrupto cuya presentación fue atípica dado el tamaño de esta, el cual se manifestó con dolor abdominal agudo.Tratamiento: Se realiza resección de la masa la cual confirma el diagnóstico histopatológico de teratoma quístico maduro.Conclusión: Este tipo de patologías rara vez se presentan con un crecimiento tan exagerado como el caso de la paciente en mención, y la resolución quirúrgica sigue siendo el gold estándar en cuanto al tratamiento.Palabras clave:DeCS: Teratoma, Células germinativas embrionarias, Adolescente, Neoplasias

Introduction: Mature cystic teratoma is a type of tumor derived from germ cells that appears in patients of childbearing age. The most common age at which this type of tumor appearsis 20 to40.Clinical case: The case of an 18-year-old adolescent patient with a giant abdominal mass of abrupt growth is presented, whose presentation was atypical given its size, which manifested with acute abdominal pain Treatment: Amass resection confirmedthehistopathological diagnosis of mature cystic ter-atoma.Conclusion: This type of pathology rarely presents with growth as exaggerated as in the case of the patient mentioned. Surgicalresolution continues to be the gold standard in terms of treatment

Hallazgos incidentales en cirugía abdominal: masas y sarcomas retroperitoneales / Incidental findings in abdominal surgery: Retroperitoneal masses and sarcomas

Introducción. El retroperitoneo es una estructura que se extiende desde el diafragma hasta la pelvis, está delimitado adelante por el peritoneo parietal, atrás y a los lados por la fascia transversalis y se divide en 9 compartimientos. Se pueden encontrar lesiones primarias o secundarias, cuya evolución clínica varía desde un curso indolente hasta rápidamente progresivo, tanto local como a distancia. Su enfoque, desde el hallazgo hasta el tratamiento, es fundamental para el desenlace oncológico. Objetivo. Analizar la evaluación, el diagnóstico y el tratamiento de las masas retroperitoneales halladas incidentalmente y brindar un algoritmo de manejo. Métodos. Se hizo búsqueda en bases de datos como PubMed y MedicalKey de literatura referentes a tumores retroperitoneales, su diagnóstico y enfoque terapéutico, con el fin de presentar una revisión sobre el abordaje de las masas retroperitoneales y dar nuestras opiniones. Resultados. Se revisaron 43 referencias bibliográficas internacionales y nacionales, y se seleccionaron 20 de ellas, de donde se obtuvieron datos actualizados, recomendaciones de guías internacionales y experiencias nacionales, con lo cual se estructuró este manuscrito. Conclusiones. Las masas retroperitoneales abarcan un espectro de patologías que establecen un reto diagnóstico por su origen embriológico, localización y baja frecuencia. El diagnostico histológico es de vital importancia desde el inicio, para conocer la evolución natural de la enfermedad, y el manejo multidisciplinario en centros de referencia es fundamental para impactar en los desenlaces oncológicos. Existen variadas modalidades terapéuticas, como quimioterapia, radioterapia y resección quirúrgica con estándares oncológicos

Introduction. The retroperitoneum is an structure that extends from the diaphragm to the pelvis, bounded anteriorly by the parietal peritoneum, posteriorly and laterally by the transversalis fascia, and it is divided into 9 compartments. We can find primary or secondary lesions whose clinical evolution varies from an indolent course to a rapidly progressive one, both local and distant. Its approach from discovery to diagnosis and treatment is essential for the oncological outcomes. Objective. To analyze the evaluation, diagnosis and treatment of incidental retroperitoneal masses according to their origin and to provide a management algorithm. Methods. An updated literature search was carried out in databases such as PubMed and Medical Key on retroperitoneal tumors, therapeutic approach and diagnosis, obtaining national and international information to carry out a review article on the approach to retroperitoneal masses.Results. Forty-three international and national bibliographic references were reviewed, based on 20 updated data, recommendations from international guidelines and national experiences were obtained, with which a review and opinion manuscript was structured.Conclusions. Retroperitoneal masses cover a spectrum of pathologies that establish a diagnostic challenge due to their embryological origin, location and low frequency. Histological diagnosis is of vital importance from the beginning to know the natural evolution of the disease and multidisciplinary management in reference centers is essential to impact oncological outcomes. There are many therapeutic modalities from chemotherapy, radiotherapy and surgical resection with oncological standards

Sobrecrecimiento lateral aislado - caracterización auxológica y clínico-radiológica de una cohorte de 76 casos de un único centro / Isolated lateralized overgrowth: clinical, radiological, and auxological characteristics of a single-site cohort of 76 cases

Introducción. El sobrecrecimiento lateral aislado (SLA), antes denominado hemihiperplasia/ hemihipertrofia, se refiere al sobrecrecimiento corporal lateral en ausencia de un patrón reconocible de malformaciones o síndromes genéticos. El objetivo fue analizar el crecimiento y las características clínico-radiológicas de pacientes con SLA en seguimiento en un hospital de tercer nivel en Argentina entre 1993 y 2020. Población y métodos. Estudio retrospectivo, observacional, de una cohorte de pacientes con SLA. Resultados. Se incluyeron 76 casos, 41 varones. Mediana de años de seguimiento: 5,85 (rango intercuartílico [RIC] 2,60-10,96), máximo 15,76 años. Cuarenta y ocho de 76 pacientes presentaron sobrecrecimiento en más de un segmento corporal (SLA complejo). El puntaje Z promedio de peso al nacer de niñas de término con SLA complejo fue +0,51 (desviación estándar [DE] 0,91) (p 0,022). El crecimiento en estatura de la mayoría de los niños se ubicó entre los centilos 50 y 97 de la población de referencia. La mediana de asimetría de longitud de miembros inferiores fue 1,5 cm (RIC 1,01-2,2) en pacientes con tratamiento médico y 3,70 cm (RIC 2,953,98 cm) en aquellos que requiriero epifisiodesis. El 75 % mostró una progresión de la asimetría menor o igual a 2 cm. Ocho casos presentaron asimetría renal mayor o igual a 1 cm; 2 casos presentaron nefroblastoma: edad promedio al diagnóstico 0,75 años. Conclusiones. El crecimiento prenatal de niños con SLA es normal, excepto en niñas con SLA complejo en quienes tiende a estar aumentado. La estatura promedio se ubica en centilos altos con crecimiento normal. Se recomienda realizar cribado de tumores embrionarios en este grupo de niños.

Introduction. Isolated lateralized overgrowth (ILO), formerly referred to as hemihyperplasia/hemihypertrophy, is the overgrowth of one-half of the body to its contralateral in the absence of a recognizable pattern of malformations or genetic syndromes. Our objective was to analyze the growth clinical and radiological characteristics of patients with ILO under follow-up in a tertiary care hospital in Argentina between 1993 and 2020. Population and methods. Retrospective, observational, single cohort study of patients with ILO. Results. A total of 76 cases were included; 41 were males. Median years of follow-up: 5.85 (interquartile range [IQR]: 2.60­10.96), maximum: 15.76 years. Forty-eight of 76 patients had overgrowth compromising more than 1 body segment (complex ILO). The mean birth weight Z-score of term girls with complex ILO was +0.51 (standard deviation [SD]: 0.91) (p 0.022). Most children grew between the 50th and 97th centile of the Argentinian population height reference. The median leg length discrepancy was 1.5 cm (IQR: 1.01­2.2) in patients receiving medical treatment and 3.70 cm (IQR: 2.95­3.98 cm) in those who required epiphysiodesis. Progression of discrepancy ≤ 2 cm was observed in 75% of cases. Renal asymmetry ≥ 1 cm was observed in 8 cases; Wilms tumor was noted in 2 cases: mean age at diagnosis: 0.75 years. Conclusions. Prenatal growth of children with ILO is normal, except in girls with complex ILO, in whom it tends to be increased. The average height of boys and girls tends to be located in high centiles with normal growth over time. Embryonal tumor screening is recommended in this group of children.

Organoides: fundamentos, presente y futuro / Organoids: fundamentals, present and future

RESUMEN Los organoides son estructuras miniaturizadas, generadas principalmente a partir de células madre pluripotentes inducidas, que se cultivan en el laboratorio conservando sus características innatas o adquiridas. Tienen el potencial de reproducir procesos de desarrollo biológico, modelar procesos patológicos que permitirán el descubrimiento de nuevos fármacos y propicien la medicina regenerativa. Sin embargo, estas experiencias requieren perfeccionamiento constante porque pueden haberse realizado variaciones en la constitución de estos órganos. Por ello, el presente artículo tiene como objetivo revisar la información actualizada sobre organoides y sus procesos experimentales básicos y recientes, empezando por la gastrulación, para tratar de imitar, en lo posible, la formación de las tres capas: ectodermo, mesodermo y endodermo, incluyendo los factores que intervienen en la inducción, diferenciación y maduración en la generación de estos organoides. Asimismo, el diseño y preparación de medios de cultivo altamente especializados que permitan obtener el órgano seleccionado con la mayor precisión y seguridad. Se realizó una búsqueda de artículos originales y de revisión publicados en PubMed, Nature y Science. Los artículos se seleccionaron por sus resúmenes y por su texto completo. Las conclusiones de este articulo destacan las ventajas futuras en el uso y aplicaciones de los organoides.

ABSTRACT Organoids are tiny structures, mainly generated from induced pluripotent stem cells, which are cultured in the laboratory while retaining their innate or acquired characteristics. They have the potential to reproduce biological development processes, model pathological processes that will enable the discovery of new drugs and promote regenerative medicine. However, these processes require constant improvement because variations may have occurred in the constitution of the organs. Therefore, this article aims to review updated information on organoids and their basic and recent experimental processes, starting with gastrulation, in an attempt to mimic, as much as possible, the formation of the three layers: ectoderm, mesoderm and endoderm; as well as the information regarding the factors involved in the induction, differentiation and maturation during the generation of organoids. Likewise, the design and preparation of highly specialized culture media that allow obtaining the selected organ with the highest precision and safety. We searched for original and review articles published in PubMed, Nature and Science. Articles were selected for their abstracts and full text. The conclusions of this article highlight the future advantages in the use and applications of organoids.

Sacrococcygeal teratoma: evaluation of its approach, treatment and follow-up in two reference children cancer centers in Brazil / Rio de Janeiro / Teratoma sacrococcígeo: avaliação de abordagem, tratamento e seguimento em dois centros de referência do estado do Rio de Janeiro

ABSTRACT Introduction: sacrococcygeal teratoma (TSC) is the most common tumor of the neonatal period. Alphafetoprotein is an important tumor marker and is used in the follow-up period as a marker of malignancy. The complete surgical resection of the tumor associated with coccygectomy is the standard treatment and chemotherapy in different stages are necessary. Follow-up consists of serial exam: tumor markers, imaging searching to possible metastasis sites, in addition to a complete physical examination. Methodology: a descriptive, retrospective, study was carried out by analyzing a chart of 25 patients of two different reference children cancer center; with TSC in the State of Rio de Janeiro from 2004 to 2019. The clinical and epidemiological data collected were described and a comparison was made between these two centers studied. Results: the sociodemographic characteristics found were similar to those described in the medical literature. Data related to treatment and follow-up, such as the use of chemotherapy, use of specific imaging tests, digital rectal examination, and outpatient follow-up, differed between the two centers studied. There was a 25% loss of follow-up. Conclusion: the characteristic of being a non-cancer center can interfere with the full application of the current protocol for the treatment of sacrococcygeal teratoma. The knowledge of the data of the studied cases can allow the optimization of the approach of the patients with this pathology and generate discussions about the integral application of the specific therapeutic protocol in the medical centers that are qualified for such treatment.

RESUMO Introdução: teratoma sacrococcígeo é o tumor neonatal mais comum. Alfafetoproteína é um marcador tumoral importante e é utilizado no período de seguimento como um marcador de malignidade. A ressecção cirúrgica completa do tumor associado a coccigectomia é o tratamento padrão, associado a quimioterapia em determinados estadiamentos. Exames de seguimento consistem em avaliação de marcadores tumorais, investigação de sítios de metástases, além de um completo exame físico. Metodologia: foi realizado um estudo retrospectivo descritivo, através da análise de 25 pacientes em dois centros de referência em tratamento oncológico infantil, com teratoma sacrococcígeo no Estado do Rio de Janeiro, entre 2004 e 2019. Os dados clínicos e epidemiológicos foram descritos, comparando-se os dois centros. Resultados: as características socio-demográficas foram similares ao descrito na literatura médica. Os dados relativos ao tratamento e seguimento, como o uso de quimioterapia, uso de testes de imagem específicos, exame de toque e retal e seguimento ambulatorial, foi diferente entre os dois centros. Tivemos uma perda de seguimento de 25%. Conclusão: a característica de ser um centro não oncológico pode interferir com a aplicação do protocolo de tratamento de teratoma sacrococcígeo. O conhecimento dos dados estudados pode permitir a otimização da abordagem dos pacientes com esta patologia e gerar discussões sobre a aplicação integral dos protocolos terapêuticos em centros médicos que são qualificados para tal tratamento.

Disgerminoma ovariano na gestação: relato de caso / Ovarian dysgerminoma in pregnancy: a case report

Os disgerminomas são tumores malignos de células germinativas ovarianas, são raros, geralmente acometem mulheres em idade fértil e têm bom prognóstico e sobrevida elevada. Paciente de 20 anos, primigesta com 26 semanas de gestação, foi admitida no centro obstétrico da Fundação Hospitalar Santo Antônio em Blumenau- SC com quadro de dor abdominal intensa refratária à analgesia e desconforto respiratório. Ressonância magnética demonstrou derrame pleural, moderada ascite e volumosa lesão expansiva de aspecto sólido-cístico em anexo direito. Foram realizadas salpingo-oforectomia à direita e omentectomia parcial e coletado lavado peritoneal. Anatomopatológico evidenciou disgerminoma. A paciente seguiu acompanhamento gestacional nos serviços de pré-natal de alto risco e oncologia. Devido à imaturidade fetal, manteve-se conduta expectante e, após o parto normal com 37 semanas, foi realizado estadiamento e iniciada quimioterapia adjuvante. Devido à baixa incidência e à raridade de tumores de células malignas ovarianas, relatos de casos como este são importantes para discutir as melhores estratégias de manejo clínico.(AU)

Dysgerminomas are rare malignant ovarian germ cell tumors that generally affect adolescence and early adulthood, have a good prognosis and high survival. Patient 20 years old, gestation 1, at 26 weeks of gestation, was hospitalized at the obstetric center of Fundação Hospitalar Santo Antônio in Blumenau-SC, with severe abdominal pain refractory to analgesia and respiratory discomfort. Magnetic resonance showed pleural effusion, moderate ascites and a massive expansive lesion with a solid cystic aspect in the right ovary. Right salpingoophorectomy, partial omentectomy and peritoneal lavage were collected. Anatomopathological evidence showed dysgerminoma. Patient followed gestational follow-up at high-risk prenatal and oncology services. Due to fetal immaturity, expectant management was maintained and after vaginal delivery at 37 weeks, staging was performed and adjuvant chemotherapy was started. Due to the low incidence and rarity of ovarian malignant cell tumors, case reports such as this one are important to discuss the best clinical management strategies.(AU)

Ética en el ámbito de la investigación en medicina regenerativa / Ethics in the field of regenerative medicine research

Introducción: La medicina regenerativa se basa en la sustitución o regeneración de células humanas, tejidos u órganos con la finalidad de restablecer una función normal. Es una terapia basada en el tratamiento con células madre. Las estrategias terapéuticas basadas en la terapia celular permiten su empleo en diferentes enfermedades que no resuelven o tardan más en resolver por tratamientos médicos convencionales. Objetivos: Analizar aspectos éticos de la investigación que contribuyen a la reflexión cognitiva y ética de la ciencia en el ámbito de la medicina regenerativa. Métodos: Se realizó una revisión que consideró artículos originales y de corte experimental publicados en la última década, en algunas bases de datos de la Biblioteca Virtual de Salud (BVS) de Cuba. Se emplearon los descriptores del Medical Subject Headings y de Ciencias de la Salud. Análisis y síntesis de la información: Se abordan las aplicaciones y generalidades relacionadas con las células madre y los avances en la medicina regenerativa, así como los procedimientos y tratamientos con células madre para diferentes enfermedades con la aplicación de los conocimientos destinados al beneficio social del ser humano. Conclusiones: Se señala la importancia de una postura ética en la medicina regenerativa para la valoración adecuada de los avances en el tratamiento de diversas enfermedades, el impacto de la adquisición de nuevos conocimientos, así como una actitud más responsable y el desarrollo de valores sociales que forman parte de la humanidad(AU)

Introduction: regenerative medicine is based on the replacement or regeneration of human cells, tissues or organs in order to restore normal function; it is a therapy based on stem cell treatment. Therapeutic strategies based on cell therapy allow their use in different diseases that do not resolve or take longer to resolve by conventional medical treatments. Objectives: to address ethical aspects of research those contribute to cognitive and ethical reflection of science in the field of regenerative medicine research. Methods: A review was carried out that considered original and experimental articles published in the last decade, in some databases of the Virtual Health Library (VHL) of Cuba. The descriptors of the Medical Subject Headings and Descriptors in Health Sciences were used. Analysis and synthesis of the information: Applications and generalities related to stem cells and advances in regenerative medicine are summarized, as well as procedures and treatments with stem cells for different diseases with the application of knowledge aimed at the social benefit of the human being. Conclusions: the importance of an ethical posture in regenerative medicine was pointed out for the adequate assessment of the advances in the treatment of various diseases, the impact of the acquisition of new knowledge, as well as a more responsible attitude and the development of social values that they are part of humanity(AU)

Tumor del saco vitelino primario de vagina en una niña. A propósito de un caso / Primary vaginal yolk sac tumor in a girl. Case report

Las neoplasias ginecológicas en niñas son raras. Representan menos del 5 % de todos los cánceres en pediatría. No existen estadísticas sobre la incidencia de tumores de vagina en esta etapa de la vida. Se presenta el caso de una niña de 9 meses con sangrado por genitales. La ecografía evidencia una masa sólida en vagina, y la vaginoscopia, un tumor friable. Presenta valores de α-fetoproteína elevados, por lo que se diagnostica tumor de saco vitelino, confirmado por biopsia. Se realiza tratamiento quimioterápico. A menos de 1 año del diagnóstico, se encuentra en remisión completa. Este caso resulta de interés no solo por la rareza, sino también porque el diagnóstico rápido de tumor de saco vitelino permite mejorar los resultados y la sobrevida de las pacientes

Gynecological neoplasms in girls are rare and represent only less than 5 % of all childhood tumors. There are no statistics on the incidence of vaginal tumors at this stage in life. We present a 9-month-old girl evaluated for genital bleeding. Ultrasound reveals a vaginal solid mass and vaginoscopy reports a friable tumor. AFP is elevated. A yolk sac tumor is confirmed by biopsy she receives chemotherapy. Within a year after diagnosis, she remains tumor-free. This is a case of interest, not only because of its rarity, but also because a rapid diagnosis of a yolk sac tumor improves outcomes and patient's survival rates.

Analysis on the prokaryotic microbiome in females and embryonic cell cultures of Rhipicephalus sanguineus tropical and temperate lineages from two specific localities in Brazil / Análise do microbioma procarionte de fêmeas e cultura celular embrionária de Rhipicephalus sanguineus linhagens tropical e temperada de duas localidades no Brasil

Abstract Two lineages of Rhipicephalus sanguineus are known in Brazil: the temperate or southern and the tropical or northern populations. The distribution patterns of both lineages of R. sanguineus have epidemiological implications that can affect vectorial competence concerning Ehrlichia canis, the agent of canine monocytic ehrlichiosis. Intending to identify the microbiomes of both lineages and compare microorganisms in R. sanguineus, we used the 16S rRNA (V4-V5 region) gene-based metataxonomic approach, through NGS sequencing on the MiSeq Illumina platform. We selected specimens of females from the environment and samples of primary embryonic cell cultures, from both lineages, and this was the first study to investigate the prokaryotic microbiome in tick cell cultures. The results showed that many bacterial taxa detected in the samples were typical members of the host environment. A significant diversity of microorganisms in R. sanguineus females and in embryonic cell cultures from both lineages was found, with emphasis on the presence of Coxiella in all samples, albeit in different proportions. The Coxiella species present in the two lineages of ticks may be different and may have co-evolved with them, thus driving different patterns of interactions between ticks and the pathogens that they can harbor or transmit to vertebrate hosts.

Resumo Duas linhagens de Rhipicephalus sanguineus são conhecidas no Brasil: populações da linhagem temperada ou do sul, e tropical ou do norte. Os padrões de distribuição de ambas as linhagens de R. sanguineus têm implicações epidemiológicas, podendo afetar a competência vetorial de Ehrlichia canis, o agente etiológico da erliquiose monocítica canina. Com a intenção de identificar os microbiomas de ambas as linhagens e comparar microrganismos de R. sanguineus, foi utilizada a metataxonomia, baseada no gene 16S rRNA (região V4-V5), por meio do sequenciamento de nova geração na plataforma MiSeq Illumina. Foram selecionadas amostras de fêmeas do ambiente e cultivo primário de células embrionárias, considerando-se as duas linhagens conhecidas do Brasil. Este é o primeiro estudo que investiga o microbioma procariótico de células de cultura de carrapato. Os resultados mostram que muitos grupos de bactérias detectadas nas amostras são membros típicos do ambiente do hospedeiro. Uma diversidade significativa de microrganismos em fêmeas e cultura de células embrionárias nas duas linhagens de R. sanguineus foi encontrada, com ênfase na presença de Coxiella em todas as amostras, ainda que em diferentes proporções. Possivelmente, as espécies de Coxiella presentes nas duas linhagens de carrapatos são diferentes e co-evoluíram com essas linhagens, conduzindo a diferentes padrões de interação entre carrapatos e patógenos que podem abrigar ou transmitir aos hospedeiros vertebrados.

Síndrome de teratoma creciente: reporte de caso y revisión de la literatura / Growing ovarian teratoma syndrome: Case report and literature review / Growing ovarian teratoma syndrome: Case report and literature review

RESUMEN El síndrome de teratoma creciente (STC) es una condición infrecuente en la que se evidencia aumento de tamaño de los tumores de células germinales o la aparición de nuevas lesiones, durante o después del tratamiento con quimioterapia. Lo más característico de este tumor es la presencia exclusiva de componentes de teratoma maduro, así como valores de marcadores tumorales que negativizan durante la quimioterapia, y se mantienen negativos durante el seguimiento. Se presenta el caso de una mujer de 28 años con un tumor de ovario de células germinales mixtas sometida a cirugía y luego quimioterapia. Durante el seguimiento, desarrolló múltiples tumores pélvicos que correspondieron a teratomas maduros. En esta paciente, fue crucial identificar el síndrome de teratoma creciente para evitar tratamiento adicional con quimioterapia.

ABSTRACT The growing teratoma syndrome (GTS) is a rare condition in which patients with germ cell tumors present an increase in tumor size or the appearance of new lesions, during or after chemotherapy. The hallmark of this tumor is the unique presence of mature teratoma components, as well as tumor marker values that become negative with chemotherapy, and remain low thereafter. We report the case of a 28-yearold female who presented a mixed germ cell tumor of the ovary, for which she underwent surgery and subsequent chemotherapy. Later, she developed multiple pelvic tumors that corresponded to mature teratoma. It was crucial in this patient to identify the syndrome to avoid additional treatment with chemotherapy.

Clinical studies using stem cells for treatment of retinal diseases: state of the art / Estudos clínicos com uso de células-tronco para tratamento de doenças da retina: estado da arte

ABSTRACT Degenerative retinal diseases such as retinitis pigmentosa, Stargardt's macular dystrophy, and age-related macular degeneration are characterized by irreversible loss of vision due to direct or indirect photoreceptor damage. No effective treatments exist, but stem cell studies have shown promising results. Our aim with this review was to describe the types of stem cells that are under study, their effects, and the main clinical trials involving them.

RESUMO As doenças degenerativas da retina, como retinose pigmentar, distrofia macular de Stargardt e degeneração macular relaciona à idade, são caracterizadas por perda irre versível da visão devido a danos diretos ou indiretos aos fotorreceptores. Não existem tratamentos eficazes, porém os estudos com células-tronco mostraram resultados promissores. Nosso objetivo com esta revisão foi descrever os tipos de células-tronco em estudo, seus efeitos e os principais ensaios clínicos que as envolvem.

Tumor de células germinales primario de mediastino (seminoma de mediastino) / Cell Germ primary tumor of mediastinum (seminoma of mediastinum)

RESUMEN Fundamento: el tumor de células germinales de mediastino anterior, es una formación de células neoplásicas localizada en mediastino. Se forman por defectos congénitos en la etapa embrionaria por migración de la célula germinal primordial y derivan de células que están dentro de las gónadas (germinales), pueden migrar y localizarse fuera de estas (extra gonadal) como el caso que se presentó, y situarse en mediastino anterior (seminoma). La localización más reportada de los extra gonadales es en mediastino anterior. Objetivo: describir un enfermo con tumor primario de células germinales del mediastino anterior. Caso clínico: paciente de 23 años de edad, masculino, con antecedentes de asma bronquial, acudió al cuerpo de guardia con tos seca y frecuente, pérdida de peso de 7 kg en un mes y fiebre de 38˚C hace dos días. Al examen físico, ligera palidez cutáneo mucosa, murmullo vesicular abolido en hemitórax derecho sin estertores. Después de estudios analíticos, radiografía de tórax, tomografía axial computarizada de pulmón y estudio histológico, se concluyó como neoplasia de células germinales primitiva extra gonadal de mediastino anterior. Conclusiones: la localización más frecuente de los tumores de células germinales de mediastino, extragonadal, es mediastino anterior. Son los tumores sólidos de mediastino más frecuentes en varones y afecta entre los 20 y 40 años de edad, hecho infrecuente en la práctica clínica.

ABSTRACT Background: the anterior mediastinal germ cell tumor is a formation of neoplastic cells located in the mediastinum. They are formed by congenital defects in the embryonic stage by migration of the primordial germ cell and dermal cells that are within the gonads (germinal), being able to migrate and localize outside of these (extra gonadal) as the case presented, and to be located in the anterior mediastinum (Seminoma). The most reported location of the extra gonadal is in the anterior mediastinum. Objective: to describe a patient with primary tumor of germ cell of the anterior mediastinum. Clinical case: a 23-year-old male patient with a history of bronchial asthma attended the emergency room with a dry, frequent cough, weight loss of 7 kg in one month and fever of 38˚C for 2 days. At physical examination, slight mucous skin pallor, vesicular murmur abolished in right hemi-thorax without rales. After analytical studies, chest x-ray, computerized lung tomography and histological study, it was concluded as primitive extra-gonadal germ cell neoplastic of anterior mediastinum. Conclusions: the most frequent location of mediastinal germ cell tumors, extra-gonadal, is anterior mediastinum. They are the most frequent mediastinal solid tumors in men and affect between 20 and 40 years of age; being the case that occupies a male patient of 23 years, uncommon in clinical practice.

Developmental stages and viability of Toxocara canis eggs outside the host / Desarrollo y viabilidad de huevos de Toxocara canis

ABSTRACT Introduction: Toxocariasis is a soil-transmitted zoonotic disease caused mainly by ingestion of larvated eggs of Toxocara canis. Objectives: To study the morphology of the intraovular developmental stages of Toxocara canis in culture, characterize non-viable eggs and the sequences of larval molting and compare the viability of eggs at the early stages of division and at reaching full maturation. Material and methods: Observation of developing embryos and characterization of non-viable eggs were done using light microscope. The proportions of viable eggs during embryonation were compared to the proportions of viable mature eggs. Results: Cell division commenced after 24 hours of cultivation. Early stages were found to be present over a period of 3-5 days. The developmental stages identified were eggs with: One cell, two cells, three cells, four cells, early morula, late morula, blastula, gastrula, tadpole, pre-larva, first, second and third stage larva. Two larval molts occurred. Non-viable eggs had degenerated cytoplasm, thin or collapsed shell and the larvae did not move after exposure to light. No significant differences were found between the proportions of viable eggs from day five to day 21 as compared to viability of fully mature eggs (30 days). Conclusion: Developing embryos in the environment may be considered as a potential threat to the public health. The precise identification of developmental stages and the clear differentiation of viable and non-viable eggs can help in determining an accurate baseline rate of development that could be used in studies of ovicidal compounds.

RESUMEN Introducción. La toxocariasis es una enfermedad zoonótica transmitida por contacto con el suelo contaminado y causada principalmente por la ingestión de huevos larvados de Toxocara canis. Objetivos. Estudiar la morfología de los estadios intraovulares en desarrollo de T. canis en cultivo, caracterizar los huevos no viables y las secuencias de las mudas larvarias, y comparar la viabilidad de los huevos en las etapas tempranas de división y al alcanzar la maduración completa. Materiales y métodos. Se observó el desarrollo de los embriones y se caracterizaron los huevos no viables, mediante microscopía de luz. Se comparó la proporción de huevos viables con embrión con la de huevos maduros viables. Resultados. La división celular comenzó 24 horas después de iniciado el cultivo. Los estadios tempranos estuvieron presentes por un periodo de tres a cinco días. Los estadios de desarrollo identificados fueron: huevos con una célula, con dos células, con tres células y con cuatro células;mórula temprana, mórula tardía, blástula, gástrula, renacuajo, prelarva, primer, segundo y tercer estado larvario. Se presentaron dos mudas larvarias. Los huevos no viables tenían el citoplasma degradado, cubierta exterior delgada o colapsada, y su larva no se movía al exponerla a la luz. No se encontraron diferencias significativas entre la proporción de huevos viables del día 5 al día 21, al compararla con la viabilidad de los huevos completamente maduros (30 días). Conclusión. Los embriones en desarrollo en el medio ambiente pueden considerarse como un riesgo potencial para la salud pública. La identificación precisa de los estadios de desarrollo y la clara diferenciación de huevos viables y no viables, pueden ayudar a determinar con exactitud una tasa basal de desarrollo, la cual sería útil en el estudio de compuestos ovicidas.

Embrioteca: espacio para la investigación científica y la docencia en la universidad médica villaclareña / Embrioteca: space for scientific research and teaching at the medical university of Villa Clara

Las embriotecas humanas son valiosas colecciones de material embrionario humano que honran las instituciones que las poseen. Entre las más citadas actualmente están prestigiosas embriotecas en España, Estados Unidos y Argentina. Resultan de un laborioso trabajo de recolección y procesamiento de delicadas muestras embrionarias con potencialidades de uso docente e investigativo. Han sido múltiples las aportaciones al conocimiento científico a partir del estudio de sus series, además del inestimable valor didáctico de las imágenes que atesoran. La Universidad de Ciencias Médicas de Villa Clara presenta la modesta colección que posee, abierta a nuevas contribuciones y a los interesados en su consulta. El objetivo de esta revisión es exponer su relevancia científica y docente en un contexto de revisión histórica y actualidad.

Human embryos are valuable collections of human embryonic material that honor the institutions that own them. Among the most cited are currently prestigious embryos in Spain, the United States and Argentina. They result from a laborious work of collection and processing of delicate embryonic samples with potential for teaching and research use. There have been many contributions to scientific knowledge from the study of their series, in addition to the invaluable didactic value of the images they treasure. The University of Medical Sciences of Villa Clara presents the modest collection that it has, open to new contributions and to those interested in its consultation. The objective of this review is to expose its scientific and teaching relevance in a context of historical review and current affairs.

Yolk sac primary tumor of mediastino: a rare case in a young adult / Tumor de saco vitelínico primário do mediastino: raro caso em um adulto jovem

ABSTRACT Germ cell tumors are rare neoplasms that mostly occur in the gonads, although they can also affect other body sites, especially the anterior mediastinum (50 to 70% of all extragonadal germ cell tumors). We report a case of a primary mediastinal yolk sac tumor, a rare and aggressive germ cell tumors subtype. This was a 38-year-old man who was admitted to Hospital do Servidor Público Estadual "Francisco Morato de Oliveira", complaining about dyspnea and dry cough for 1 year. The computed tomography scan of his chest revealed a large mass in the anterior mediastinum with heterogeneous enhancement to the contrast associated with pleural effusion. There were also high serum levels of alpha-fetoprotein. After neoadjuvant chemotherapy, the patient underwent surgical resection of the mass, followed by pathological examination, which confirmed a primary mediastinal yolk sac tumor, a nonseminomatous subtype of germ cell tumors. Primary mediastinal yolk sac tumors have poor prognosis, despite advances in therapy with surgical resection and cisplatin-based chemotherapy. This poor prognosis is due to the degree of invasion and unresectability in most patients by the time of the diagnosis.

RESUMO Os tumores de células germinativas são neoplasias raras que acometem mais frequentemente as gônadas, embora possam também ocorrer em outras localizações do corpo, destacando-se o mediastino anterior (50 a 70% de todos os tumores de células germinativas extragonadais). No presente artigo, relatamos um caso de tumor de saco vitelínico mediastinal primário, de subtipo raro e agressivo de tumor de células germinativas. Tratava-se de um homem, 38 anos, admitido no Hospital do Servidor Público Estadual "Francisco Morato de Oliveira", com quadro de dispneia e tosse seca há 1 ano. Na investigação clínica, foi solicitada tomografia computadorizada de tórax, que mostrou volumosa massa no mediastino anterior com realce heterogêneo ao meio de contraste associada a derrame pleural. Havia ainda aumento dos níveis séricos da alfafetoproteína. Após quimioterapia neoadjuvante pré-operatória, o paciente foi submetido à ressecção cirúrgica, seguida de estudo anatomopatológico da peça, no qual demonstrou tratar-se de um tumor de saco vitelínico primário do mediastino. Os tumores de saco vitelínicos primários do mediastino têm prognóstico reservado, apesar do avanço na terapêutica com a ressecção cirúrgica e a quimioterapia à base de cisplatina. Isto se deve ao grau de invasão e de irressecabilidade na maioria dos pacientes no momento do diagnóstico.

Embryonic death and abortion in goats caused by ingestion of Amorimia septentrionalis / Mortalidade embrionária e abortos em cabras causados pela ingestão de Amorimia septentrionalis

Amorimia spp. are sodium monofluoroacetate (MFA) containing plants causing sudden death in ruminants. In a previous study, Amorimia rigida caused abortion in one of the five pregnant sheep that received the plant suggesting that it may cause reproductive losses. This work aimed to study the embryotoxic and fetotoxic effects of Amorimia septentrionalis in goats in the Brazilian northeastern semi-arid region. The effects of A. septentrionalis on pregnancy were studied in 16 goats, divided into four groups according to their gestational period. In Groups 1, 2 and 3 the administration of A. septentrionalis at the daily dose of 5g of leaves per kg body weight was started on the 18th, 36th and 93th days of gestation, respectively. Goats from Group 4 did not ingest the plant. When the goats presented severe signs of poisoning the administration of the plant was suspended. Groups 1, 2 and 3 ingested the plant for 7.25±2.87, 9.25±2.21 and 12.50±0.57 days, respectively. All the goats recovered 7-12 days after the end of the administration of the plant. In Group 1, all the goats had embryonic death 6.25±3.59 days after the end of the ingestion of the plant. In Group 2, three goats aborted at 53, 54 and 78 days of gestation. Two goats from Group 3 gave birth normally and the other two aborted at 114 and 111 days of gestation. It is concluded that Amorimia septentrionalis is a sodium monofluoracetate-containing plant that causes embryonic deaths and abortions in goats that ingest non-lethal doses of the plant.(AU)

Amorimia spp. são plantas que contém monofluoroacetato de sódio (MFA), responsáveis por causar morte súbita em ruminantes. Em estudo prévio, Amorimia rigida causou aborto em uma de cinco ovelhas prenhas que receberam a planta, sugerindo que pode causar perdas reprodutivas. Este trabalho teve como objetivo estudar os efeitos embriotóxicos e fetotóxicos de Amorimia septentrionalis em caprinos na região semi-árida nordestina brasileira. Os efeitos de A. septentrionalis na prenhez foram estudados em 16 cabras, divididos em quatro grupos de acordo com seu período gestacional. Nos grupos 1, 2 e 3 a administração de A. septentrionalis foi diária, na dose de 5g de folhas por kg de peso corporal, iniciada nos dias 18, 36 e 93 da gestação, respectivamente. As cabras do grupo 4 não ingeriram a planta. Quando as cabras apresentavam sinais severos de intoxicação suspendia-se a administração da planta. Os grupos 1, 2 e 3 ingeriram a planta por 7,25±2,87, 9,25±2,21 e 12,50±0,57 dias, respectivamente. Todas as cabras se recuperaram 7-12 dias após o final da administração da planta. No grupo 1, todas as cabras apresentaram quadros de mortalidade embrionária 6,25±3,59 dias após o término da ingestão da planta. No grupo 2, três cabras abortaram aos 53, 54 e 78 dias de gestação. Duas cabras do Grupo 3 deram à luz normalmente e as outras duas abortaram aos 114 e 111 dias de gestação. Conclui-se que Amorimia septentrionalis é uma planta que contém monofluoroacetato de sódio e pode ocasionar mortes embrionárias e abortos em cabras que ingerem doses não letais da planta.(AU)

Persistencia y repermeabilización del conducto de Cuvier izquierdo / Persistence and restoration of the patency of the left duct of Cuvier

La hepatopatía crónica favorece la redistribución del flujo hacia la circulación sistémica. Si bien es poco frecuente, la repermeabilización de los conductos venosos embrionarios causa el aumento de la presión en la circulación portal. Nuestro objetivo es dar a conocer la persistencia y permeabilidad del conducto venoso de Cuvier izquierdo y su presentación en imágenes

The increased pressure in the portal circulation due to a chronic liver disease favours the redistribution of the flow to the systemic circulation. Although rare, reperfusion of embryonic venous channels may be a possibility. The aim of this article is to determine the persistence and the patency of the ductus venosus, called the left duct of Cuvier, and its presentation in images

Ciencia y ficción en la utilización terapéutica de las células madres / Science and fiction in the therapeutic use of stem cells

En los últimos años ha surgido un fuerte interés en las investigaciones que apuntan a utilizar células madres como fuente de distintos tipos celulares, tejidos y órganos para terapias de reemplazo en distintas enfermedades. Se han identificado distintas fuentes de células madrtes o pñuripotentes, como la médula ósea, la sangre de cordón umbilical, y el embrión. Recientemente se ha demostrado que es posbile reprogramar células adultas de la piel de manera que tengan un potencial similar a las células embrionarias. Sin embargo, a la fecha, sólo se utilizan células de méducla ósea o de sangre de cordón umbilical en el tratamiento de enfermedades hematológicas, y cualquier otro tratamiento se encuentra aún en experimentación. Cada tipo de células madres tiene potencialidades y limitaciones técnicas, que son acompañadas por distintos grados de objeciones éticas. Este trabajo tiene como objetivo describir los tipos de células madres más estudiados hay en día y discutir cuáles son sus fortalezas y sus limitaciones...