Meningioma en gestante afecta de endometriosis profunda. A propósito de un caso / Meningioma in pregnant women affected by deep endometriosis. About a case

RESUMEN El siguiente caso clínico trata de una paciente, gestante tras fecundación in vitro, afecta de endometriosis profunda. Dicha paciente debutó durante el embarazo con un síndrome del seno cavernoso con cefalea e hipoestesia facial, siendo diagnosticada tras una exploración neurológica detallada y las pruebas complementarias pertinentes de un meningioma. Por este motivo, tuvo que ser sometida a una cesárea previa al abordaje terapéutico del tumor, dado el empeoramiento clínico progresivo que se estaba produciendo. Dado que en la literatura científica la asociación entre la endometriosis y la aparición de meningiomas ya ha sido descrita, con este caso clínico intentaremos acercarnos a las posibles causas de dicha asociación, como podría ser el ambiente predominantemente estrogénico de las pacientes con endometriosis. De igual modo, abordaremos el manejo del meningioma tanto dentro como fuera del embarazo, sirviéndonos para ello de la bibliografía disponible.

ABSTRACT A pregnancy woman affected by deep endometriosis is presented in this clinical case. A cavernous sinus syndrome was diagnosed during her pregnancy. She started suffering from headache and facial hypoesthesia. After a detailed neurological examination and the relevant complementary tests the patient was diagnosed of a meningioma. Given the progressive clinical worsening that was taking place, she had to undergo a cesarean section prior to the therapeutic approach of the tumor. Through this clinical case we will try to approach the possible causes of the association between endometriosis and meningioma, such as the predominantly estrogenic environment of patients with endometriosis. Similarly, we will address the management of meningioma both inside and outside of pregnancy, using the related available literature.

Bone marrow bi-hypoplasia in a dog with a sertoli cell tumor / Hipoplasia dupla de medula óssea em um cão com tumor de células de sertoli

A 20-year-old unneutered male poodle presented prostration, apathy, staggering gait, lack of appetite and tick infestation. The dog was diagnosed with a Sertoli cell tumor in an undescended testicle by cytological, histopathological and immunohistochemical tests. Pancytopenia with moderate nonregenerative anemia, leukopenia and severe thrombocytopenia were detected in the complete blood count. Cytological and histopathological evaluation of the bone marrow revealed a cellularity of 30%, with erythroid (59%), lymphoid (40%) and mast cells (1%), and an absence of granulocytic, monocytic and megakaryocytic lineage cells. In post-mortem examinations, changes related to hemostatic disorders were found. The absence of microorganisms in molecular tests and an estrogen serum concentration over reference values confirmed hyperestrogenism as a possible cause of pancytopenia. The literature describes a Sertoli cell tumor hyperestrogenism that induced pancytopenia, along with bone marrow hypoplasia of all hematopoietic lineages. In contrast, in the present case, the erythroid precursor cells were preserved in the bone marrow, although there were no reticulocytes circulating in the blood. This case, therefore, should be considered in future investigations of pancytopenia induced by Sertoli cell tumor hyperestrogenism.(AU)

Um cão Poodle, macho, de 20 anos, não castrado, apresentou prostração, apatia, andar cambaleante, falta de apetite e infestação por carrapatos. Nesse animal, foi diagnosticado tumor de células de Sertoli em um testículo não descendente, utilizando-se citologia, histopatologia e imuno-histoquímica. Pancitopenia com anemia moderada não regenerativa, leucopenia e trombocitopenia intensas foram detectadas no hemograma. Na avaliação citológica e histopatológica da medula óssea, havia celularidade de 30%, constituída pelas linhagens eritroide (59%) e linfoide (40%) e por mastócitos (1%), com ausência de células das linhagens granulocítica, monocítica e megacariocítica. Em exames post mortem, mudanças relacionadas à hemostasia foram encontradas. A ausência de micro-organismos nos testes moleculares e a concentração sérica de estrogênio acima dos valores de referência confirmaram hiperestrogenismo como a possível causa da pancitopenia. A literatura descreve hiperestrogenismo em tumores de células de Sertoli induzindo pancitopenia associada com hipoplasia da medula óssea de todas as linhagens hematopoiéticas. Em contraste, no presente caso, as células precursoras eritróides estavam preservadas na medula óssea, embora não houvesse reticulócitos no sangue. Assim, o relato apresentado deve ser considerado em futuras investigações de pancitopenia induzida por hiperestrogenismo em tumor de células de Sertoli.(AU)

Alimentação de leitoas pré-púberes com dietas contendo zearalenona / Feeding of pre-pubertal gilts with diets containing zearalenone

O desempenho, o peso de alguns órgãos e a morfologia vulvar de leitoas pré-púberes, alimentadas por 28 dias com dietas contendo zearalenona, foram avaliados. O delineamento experimental utilizado foi inteiramente ao acaso, com dois tratamentos, dieta controle (DC) e dieta controle + 2mg kg-1 de zearalenona (DZ), e seis repetições cada. Não houve diferença (P>0,05) entre os tratamentos para consumo médio diário de ração (1,24 x 1,19kg), ganho médio diário de peso (0,68 x 0,71kg), conversão alimentar (1,86 x 1,71) e peso vivo (PV); (30,9 x 30,4kg). A zearalenona não alterou (P>0,05) os pesos absoluto e relativo do coração (137 x 141g e 0,45 x 0,45 por cento PV), fígado (699 x 699g e 2,31 x 2,26 por centoPV), rins (47 x 49g e 0,15 x 0,16 por centoPV) e baço (166 x 171g e 0,55 x 0,55 por centoPV). Houve aumento (P<0,05) no comprimento (17 x 27cm) e no peso (23 x 157g e 0,07 x 0,51 por centoPV) do trato reprodutivo das leitoas do grupo DZ. O volume vulvar ao final do período foi 820 por cento maior (P<0,05) nos animais alimentados com zearalenona (941 x 8658mm³/kgPV0,6). Os resultados indicam que em suínos a zearalenona e seus metabólitos possuem atividade estrogênica, mas não interferem no desempenho dos animais.

The performance, the weights of some organs, and the vulvae morphology in pre-pubertal gilts fed diets containing zearalenone were evaluated during 28 days. The experimental design was completely randomized with two treatments (control diet, ZD - control diet + 2mg kg-1 of zearalenone) and six replications of each were done. No differences (P>0.05) between treatments for daily feed intake (1.24 x 1.19kg), average daily gain (0.68 x 0.71kg), feed conversion ratio (1.86 x 1.71), and live weight (30.9 x 30.4kg) were observed. Zearalenone did not change (P>0.05) the absolute and relative weights of heart (137 x 141g and 0.45 x 0.45 percentBW), liver (699 x 699g and 2.31 x 2.26 percentBW), kidneys (47 x 49g and 0.15 x 0.16 percentBW), and spleen (166 x 171g and 0.55 x 0.55 percent BW). However, zearalenone increased (P<0.05) the length (17 x 27cm) and weight (23 x 157g and 0.07 x 0.51 percentBW) of the reproductive tract. The final vulvae volume was 820 percent larger (P<0.05) in gilts fed diets containing zearalenone than those fed control diet (941 x 8658mm³/kgBW0.6). Results suggested that zearalenone and its metabolites have an estrogenic activity in pigs without changing the animal performance.

Histopathologic Findings & Expression of bcl-2 of the Endometrium Analysis of 1,000 consecutive biopsies of uterine bleeding

We evaluated 1,000 consecutive endometrial curettage samples obtained over a 30 month period. The clinico-pathologic correlation was analysed according to Hendrickson's five criteria based on the practical view. The causes of uterine bleeding in decreasing order of occurrence were as follows: 1) hormonal imbalance lesions (49.2%) encompassing glandular and stromal breakdown suggesting anovulatory bleeding, proliferative phase endometrium, and disordered proliferative endometrium, 2) pregnancy associated lesions (24.2%), 3) organic lesions (13.5%), 4) endometrial hyperplasia (6.9%), and 5) inadequate specimen (6.2%). According to age, pregnancy related lesions were most frequent in the third decade. In the fourth, fifth, and sixth decades, hormonal imbalance lesions were the most common cause. In approximately 30% of the samples, there were two or three morphologic patterns such as anovulatory bleeding with an endometrial polyp, postabortal bleeding with inflammation, and glandular-stromal dissociation with a polyp, which suggested there was a variable histologic morphology in the same disease spectrum. Using immunohistochemical techniques we studied the hormonal dependency of bcl-2 oncoprotein in anovulatory bleeding, endometrial hyperplasia, and proliferative endometrium. 70% of anovulatory bleeding specimens showed weak positivity in the epithelial cytoplasm, and all cases of endometrial hyperplasia and carcinoma showed a strong positivity. These results suggest that there is a estrogenic hormonal dependency of apoptosis in the endometrium.