Siderosis idiopática del sistema nervioso central y asociación con atrofia óptica e infarto cerebral. Caso clínico / Superficial siderosis of the central nervous system. Report of one case

Superficial siderosis of the central nervous system is produced by the deposit of hemosiderin within the subpial layers of the central nervous system and central parts of the cranial nerves, leading to progressive degeneration. We report a 55-year-old male who consulted for hearing loss and long-standing progressive decrease in visual acuity, associated with sudden onset of left hemiparesis. A brain CAT scan showed subacute ischemic lesions in the territory of the right posterior cerebral artery (thalamus and right subcortical temporal regions), old ischemic lesions in the right subcortical occipital regions and cerebellar atrophy. A magnetic resonance confirmed the lesions and the presence of superficial diffuse siderosis. A cerebrospinal fluid analysis showed slight xanthochromia, 26 leukocytes/mm3, glucose 51 mg/dL and proteins 1.23 g/L. He was managed with aspirin in low doses and statins. His motor function improved and was discharged two weeks after admission.

Importancia de los macrófagos cargados con hemosiderina en el diagnóstico de la hemorragia alveolar difusa / Importance of hemosiderin-loaded macrophages in diagnosis of diffuse alveolar hemorrhage / A importância dos macrófagos carregados com hemosiderina no diagnóstico de hemorragia alveolar difusa / Reconocimiento a la trayectoria del Prof. Dr. Juan Miguel Castagnino†

Resumen La hemorragia alveolar difusa (HAD) es un síndrome clínico con una alta mortalidad que compromete la función respiratoria. Su diagnóstico se basa en pruebas clínicas, radiológicas y citológicas. El objetivo del trabajo fue ratificar el valor de referencia de hemosiderófagos en lavados broncoalveolares (BAL) (hemosiderófagos ≥20%), correlacionar con la etiología y definir las condiciones preanalíticas para que la reacción de Perls alcance valores elevados de sensibilidad. De 109 muestras de pacientes con sospecha de HAD, se analizaron 90 por cumplir los criterios de inclusión; 36 resultaron positivas para HAD, 3 falsamente negativas y 51 resultaron negativas. La sensibilidad fue de 92% y la especificidad de 100%. La mediana de hemosiderófagos para muestras con diagnóstico de HAD fue de 70%. Se agruparon según la etiología: procesos infecciosos puros (PI), enfermedades autoinmunes puras (EA), enfermedades neoplásicas puras (EN), enfermedades autoinmunes más procesos infecciosos (EA+PI), enfermedades neoplásicas más procesos infecciosos (EN+PI), misceláneas (MI). La mediana de hemosiderófagos para cada grupo fue: PI (n=7) 50%, EA (n=15) 58%, EN (n=6) 73%, EA+PI (n=5) 80%, EN+PI (n=4) 80%, MI (n=2) 45% (p=0,57). El porcentaje de pacientes fallecidos fue de 49% (n=19), con una mediana de hemosiderófagos de 70%, en comparación con la de pacientes no fallecidos de 64% (p=0,25). Se ratificó el valor de referencia para establecer el diagnóstico de HAD en muestras de BAL obtenidas luego de las 36 h de comenzados los síntomas utilizando la reacción de Perls, la cual demuestra una alta sensibilidad y especificidad para dicho diagnóstico.

Abstract Difusse alveolar hemorrhage (DAH) is a clinical syndrome with high mortality. Its diagnosis is based on clinical, radiological and cytological tests. The objective of this study was to ratify the reference value of hemosiderophages in bronchoalveolar lavages (BAL) (hemosiderophagues ≥20%), to correlate with the etiology and define the pre-analytical conditions for the Perls reaction to reach high sensitivity values. Out of the 109 samples from patients with suspected ADH, 90 were analysed for meeting the inclusion criteria; 36 were positive for HAD, 3 were false negatives, and 51 were negative (sensitivity 92%; specificity 100%). The median number of hemosiderophagues for samples with a diagnosis of ADH was 70%; they were grouped according to etiology: pure infectious processes (PI), pure autoimmune diseases (AD), pure neoplastic diseases (ND), autoimmune diseases plus infectious processes (AD + PI), and miscellaneous (MI). The median number of hemosiderophagues for each group was: PI (n=7) 50%, AD (n=15) 58%, ND (n=6) 73%, AD + PI (n=5) 80%, ND + PI (n=4) 80%, MI (n=2) 45% (p=0.57). The percentage of deceased patients was 49% (n=19), with a median hemosiderophague of 70%, compared with 64% of non-deceased patients (p=0.25). The reference value to establish the diagnosis of ADH in BAL simples obtained 36 hours after the beginning of symptoms using the Perls reaction was ratified, which shows a high sensitivity and specificity to make the diagnosis of ADH.

Resumo A hemorragia alveolar difusa (HAD) é uma síndrome clínica com alta mortalidade que compromete a função respiratória. Seu diagnóstico se baseia em testes clínicos, radiológicos e citológicos. O objetivo do trabalho foi ratificar o valor de referência de hemossiderófagos em lavagens broncoalveolares (LBA) (hemossiderófagos ≥20%), relacioná-los com a etiologia e definir as condições pré-analíticas para que a reação de Perls alcance valores elevados de sensibilidade. De 109 amostras de pacientes com suspeita de HAD, 90 foram analisadas para cumprir com os critérios de inclusão; 36 resultaram positivas para HAD, 3 foram falsos negativos e 51 resultaram negativas. A sensibilidade foi de 92% e a especificidade de 100%. A média de hemossiderófagos para amostras com diagnóstico de HAD foi de 70%, eles foram agrupados de acordo com a etiologia: processos infecciosos puros (PI), doenças autoimunes puras (DA), doenças neoplásicas puras (DN), doenças autoimunes mais processos infecciosos (DA+PI), doenças neoplásicas mais processos infecciosos (DN+PI), miscelâneas (MI). A média de hemossiderófagos para cada grupo foi: PI (n=7) 50%, DA (n=15) 58%, DN (n=6) 73%, DA+PI (n=5) 80%, DN+PI (n=4) 80%, MI (n = 2) 45% (p= 0,57). A porcentagem de pacientes falecidos foi de 49% (n=19), com uma média de hemossiderófagos de 70%, em comparação com 64% de pacientes não falecidos (p=0,25). Foi ratificado o valor de referência para estabelecer o diagnóstico de HAD em amostras LBA obtidas 36 horas após o início dos sintomas através da reação de Perls, que apresenta alta sensibilidade e especificidade para esse diagnóstico.

Predictive factors and prognosis of post-stroke seizures / 中华行为医学与脑科学杂志

Objective:To assess the predictive factors and prognosis of post-stroke seizures.Methods:A total of 315 inpatients with acute anterior circulation cerebral infarction from January 2018 to December 2018 were retrospectively collected, including 95 patients with PSS as observation group and 220 patients without PSS as control group.Clinical characteristics of the patients were recorded, including gender, age, lesion specificity, imaging features, past history, and the time and type of seizures.The Alberta stroke program early CT score (ASPECTS) was used to assess the extent of infarction, the national institutes of health stroke scale (NIHSS) and the modified rankin scale (MRS) were used to assess the severity and prognosis of cerebral infarction.The hemorrhage transformation of cerebral infarction was graded according to the European cooperative acute stroke study Ⅲ(ECASS Ⅲ) classification system.SPSS 21.0 software was used for data analysis.Chi-square test was used for categorical variables and t-test or non-parametric test was used for continuous variables. Results:The observation group had lower ASPECTS scores compared with the control group (5(4, 7), 7 (5, 8)), the presence of atrial fibrillation, hemorrhage transformation, laminar necrosis(LN) and hemosiderin deposition (31.6%, 45.3%, 24.2%, 26.3%) were higher than those of control group (20.9%, 28.2%, 9.1%, 16.4%), and the differences were statistically significant (all P<0.05). In multivariate analysis, ASPECTS score ( OR=0.658, 95% CI=0.556-0.778, P<0.001), hemorrhage transformation ( OR=2.307, 95% CI=1.311-4.059, P=0.004), LN ( OR=2.530, 95% CI=1.250-5.123, P=0.010) and hemosiderin deposition ( OR=2.308, 95% CI=1.201-4.436, P=0.012) were the influencing factors of PSS.Partial secondary generalized seizures was the most common type of seizures, and in this group it accounted for 42.1% (40/95), simple partial seizures and complex partial seizures accounted for 12.6% (12/95)respectively, and generalized seizures accounted for 32.6% (31/95). The mean follow-up time of the two groups was 24.1 months and 24.6 months, respectively.The scores of MRS at the last follow-up and discharge (3(2, 4), 2(1, 4)) of the observation group were better than those of the control group (2(1, 3), 1(1, 3)), and the differences were statistically significant(both P<0.05). Conclusions:PSS after cerebral infarction can affect the prognosis of patients, and the large infarction scope, hemorrhage transformation, LN and hemosiderin deposition are the high risk factors of PSS.

Hemosiderosis pulmonar idiopática: seguimiento de pacientes durante 25 años (1995-2019) / Idiopathic pulmonary hemosiderosis: follow-up of patients for 25 years (1995-2019)

La hemosiderosis pulmonar idiopática (HPI) es una causa de hemorragia alveolar difusa. OBJETIVO: describir la evolución de niños con HPI en nuestra institución. Se realizó una revisión retrospectiva con protocolo de seguimiento. Se reclutaron 13 pacientes, 7 hombres. Procedentes de una zona agrícola (6/13). No todos presentaron la tríada diagnóstica completa: infiltrados algodonosos (9/13), anemia (11/13), hemoptisis (9/13). Todos evidenciaron un recuento de hemosiderófagos sobre 30% en el lavado broncoalveolar. Tomografía computada de tórax: normal (5/13), patrón intersticial (5/13), vidrio esmerilado (2/13) y fibrosis (1/13). Espirometría: normal (7/13), restrictiva (4/13), obstructiva (1/13) y no efectuada (1/13). Tratamiento durante la fase aguda: bolos de metilprednisolona (7/13) o prednisona (6/13) o hidrocortisona (1/13). En la fase de mantención se administró: prednisona (13/13) más un inmunosupresor, azathioprina (12/13), hidroxicloroquina (1/13), micofenolato (1/13), más budesonida MDI (13/13). Ocho pacientes detuvieron los sangrados. Dos pacientes fallecieron y hubo cinco embarazos de curso fisiológico en 3 adolescentes. Se observó: a) diferentes modalidades de presentación que retrasaron el diagnóstico; b) gran exposición a pesticidas; c) mejor pronóstico si el diagnóstico y el tratamiento eran precoces, también en niñas adolescentes; d) la mayoría detuvo los episodios de sangrado.

Idiopathic pulmonary hemosiderosis (IPH) is a cause of diffuse alveolar hemorrhage. OBJECTIVE: to describe the evolution of children with IPH in our institution. Retrospective monitoring with a follow-up protocol was carried out. 13 patients, seven males, were recruited. From an agricultural area (6/13). Not all of patients had the complete diagnostic triad: cotton infiltrates (9/13), anemia (11/13), hemoptysis (9/13). Hemosiderin-laden macrophages counting in the bronchoalveolar lavage fluid was over 30% in all the patients. Computed chest tomography was informed as normal (5/13), interstitial pattern (5/13), ground glass (2/13) and fibrosis (1/13). Spirometry: normal (7/13), restrictive (4/13), obstructive (1/13) and not performed (1/13). Treatment during the acute phase: bolus of methylprednisolone (7/13) or prednisone (6/13) or hydrocortisone (1/13). In the maintenance phase: prednisone (13/13) plus an immunosuppressant, azathioprine (12/13), hydroxychloroquine (1/13), mycophenolate (1/13), plus budesonide MDI (13/13). Eight patients stopped the bleeding episodes. Two patients died and there were five physiological pregnancies in 3 adolescents. It was observed:(a) different modes of IPH presentation that delayed its diagnosis; (b) large exposure to pesticides; (c) prognosis improved if diagnosis and treatment were early, also in adolescent girls; (d) most of the patients stopped the bleeding episodes.

First report of hemosiderotic adenodermatofibroma in Brazil / Primeiro relato de adenodermatofibroma hemossiderótico no Brasil

ABSTRACT Hemosiderotic adenodermatofibroma is a recently recognized lesion, characterized by a dermal nodule with cystic structures of an apocrine gland, surrounded by a dermatofibroma-like stroma with hemosiderotic macrophages. We present the first case report of this entity in Brazil together with representative images, in addition to a review on the subject and discussion about the apocrine origin of this lesion.

RESUMEN El dermatoadenofibroma hemosiderótico es una lesión recientemente descrita, caracterizada por un nódulo dérmico con estructuras quísticas de una glándula apocrina, rodeado por un estroma del tipo dermatofibroma con macrófagos hemosideróticos. Presentamos el primer reporte de caso de esa entidad en Brasil, junto a imágenes representativas, además de una revisión del tema y discusiones acerca del origen apocrina de esa lesión.

RESUMO Adenodermatofibroma hemossiderótico é uma lesão recentemente conhecida, caracterizada por um nódulo dérmico com estruturas císticas de uma glândula apócrina, circundado por um estroma do tipo dermatofibroma com macrófagos hemossideróticos. Apresentamos o primeiro relato de caso dessa entidade no Brasil junto a imagens representativas, além de uma revisão do assunto e discussões sobre a origem apócrina dessa lesão.

Avaliação pré-clínica dos efeitos profiláticos do extrato de Pinus pinaster (Pycnogenol®) sobre a deposição cutânea de hemossiderina / Pre-clinical evaluation of the profilatic effects of Pinus pinaster extract (Pycnogenol®) on skin hemosiderin deposits

Introdução: A escleroterapia é o método mais utilizado para o tratamento de varizes dos membros inferiores tendo como complicação mais comum o aparecimento de manchas hipercrômicas na região tratada. O Pycnogenol® é conhecido há muito tempo como um flebotônico, anti-inflamatório e despigmentante da pele. Estudos já comprovaram a eficácia deste fármaco na prevenção e no tratamento da hiperpigmentação pós-inflamatória. Objetivo: Avaliar a eficácia do extrato de Pinus pinaster (Pycnogenol®; EPP) na prevenção de depósitos de hemossiderina em cultura de pele humana submetida a estresse inflamatório. Métodos: Fragmentos de pele humana foram estimulados com interleucina 1 alfa (IL-1a) para indução de uma resposta inflamatória e, concomitantemente, tratados com EPP para posterior avaliação histológica e semi-quantificação de hemossiderina. Resultados: A avaliação histológica dos fragmentos de pele expostos à IL-1alfa; revelaram uma densidade de hemossiderina 26,6% maior em comparação ao grupo controle. Por outro lado, os fragmentos de pele incubados concomitantemente com EPP mostraram reduções significativas na deposição de hemossiderina quando comparados ao grupo somente expostos ao microambiente inflamatório. Conclusões: Os resultados apresentados neste estudo apontam para um importante efeito do EPP (Pycnogenol®) na prevenção do acúmulo de hemossiderina originado pelo estresse inflamatório semelhante ao processo pós escleroterapia.

Introduction: Sclerotherapy is the most widely used method for the treatment of varicose veins of the lower limbs. The most common complication is the appearance of hyperchromic spots in the treated region. Pycnogenol® has long been known as a phlebotonic, anti-inflammatory and skin depigmenting drug. Studies have already proven the efficacy of this drug in the prevention and treatment of post inflammatory hyperpigmentation. Objective: To evaluate the effectiveness of Pinus pinaster extract (Pycnogenol®; PPE) in the prevention of hemosiderin deposits in human skin culture submitted to inflammatory stress. Methods: Fragments of human skin were stimulated with interleukin 1 alpha (IL-1 a) to induce an inflammatory response and, concurrently, treated with PPE for further histological evaluation and hemosiderin semi-quantification. Results: The histological evaluation of skin fragments exposed to IL-1 alpha revealed a 26.6% higher hemosiderin density compared with the control group. Moreover, skin fragments incubated concomitantly with PPE showed significant reductions in hemosiderin deposits when compared with the group only exposed to the inflammatory microenvironment. Conclusions: The results presented in this study showed an important effect of PPE (Pycnogenol®) in the prevention of hemosiderin accumulation caused by inflammatory stress similar to the post-sclerotherapy process.

Comparative morphometric evaluation of hepatic hemosiderosis in wild Magellanic penguins (Spheniscus magellanicus) infected with different Plasmodium spp. subgenera / Avaliação morfométrica comparativa da hemossiderose hepática em pinguins-de-Magalhães (Spheniscus magellanicus) de vida livre infectados por diferentes subgêneros de Plasmodium spp

Abstract Avian malaria is one of the most important diseases of captive penguins. We employed morphometric techniques to evaluate hepatic hemosiderosis in rehabilitating wild Magellanic penguins (Spheniscus magellanicus) that were negative (n = 9) or naturally infected by different subgenera of Plasmodium spp. (n = 24), according with: Plasmodium subgenera (Haemamoeba, Huffia, Other lineages, and Unidentified lineages), severity of Plasmodium histopathological lesions, and concurrent diseases, age class (juvenile or adult plumage), sex (male, female or not determined), body score (emaciated, thin, good, excellent, not available), molt, presence or absence of oil contamination upon admission, iron supplementation, and rehabilitation center. The percentage of the area occupied by hemosiderin was called 'Index of Hepatic Hemosiderosis (IHH)'. Plasmodium-positive females presented significantly higher IHH values (17.53 ± 12.95%) than males (7.20 ± 4.25%; p = 0.041). We observed higher levels of congestion (p = 0.0182) and pneumonia (p = 0.0250) severity between Unidentified lineages vs. Huffia. We believe that the hepatic hemosiderosis observed in this study was multifactorial, the result of pathological processes caused by malaria, molting, hemoglobin and myoglobin catabolism during migration, anemia, concomitant diseases, and iron supplementation, all possibly potentiated by decreased liver mass. Further studies are needed to clarify the mechanisms of these hypotheses.

Resumo Malária aviária é uma das mais relevantes doenças em pinguins cativos. Foram aplicadas técnicas morfométricas para avaliar a hemossiderose hepática em pinguins-de-Magalhães (Spheniscus magellanicus ) de vida livre em reabilitação negativos (n = 9) e naturalmente infectados por diferentes subgêneros de Plasmodium spp. (n = 24), quanto a: subgênero de Plasmodium (Haemamoeba , Huffia, Outras Linhagens, e Linhagens não identificadas), severidade das lesões histopatológicas causadas por Plasmodium e doenças concomitantes, faixa etária (plumagem juvenil ou adulta), sexo (macho, fêmea, indeterminado), condição corporal (emaciado, magro, bom, excelente, indisponível), muda, presença/ausência de óleo a admissão, suplementação de ferro, e centro de reabilitação. A porcentagem da área ocupada por hemossiderina foi denominada "Índice de Hemossiderose Hepática (IHH)". Fêmeas Plasmodium -positivas apresentaram IHH significativamente mais elevado que machos, respectivamente, 17,53 ± 12,95% e 7,20 ± 4,25% (p = 0,041). Níveis mais elevados de congestão (p = 0,0182) e pneumonia (p = 0,0250) foram observados entre Linhagens não identificadas vs. Huffia. Possivelmente, a hemossiderose hepática observada nesse estudo seja multifatorial, resultado de processos patológicos causados por malária, muda, catabolismo de hemoglobina e mioglobina durante a migração, anemia, doenças concomitantes e suplementação de ferro, potencialmente intensificados por massa hepática reduzida. Estudos complementares são necessários para esclarecer os mecanismos de tais hipóteses.

Dermoscopy of granuloma faciale: a description of a new finding

Abstract: Granuloma faciale is a rare, chronic dermatologic disorder, which mainly affects the face. Recently, dermoscopy has been demonstrated as an important ancillary tool on the clinical diagnosis of facial dermatoses. We report two cases of granuloma faciale with yellow areas on dermoscopy that was not yet described in the literature, corresponding to abundant hemosiderin on histopathological examination.

Superficial Siderosis with Peripheral Dizziness: Report of 2 Cases / 대한평형의학회지

Superficial siderosis (SS) of the central nervous system is a rare disease, which is caused by the accumulation of iron from the hemoglobin in the superficial layer of the brain, spinal cord, and central parts of cranial nerves. The etiology of SS is the accumulation of hemosiderin in the subarachnoid space due to chronic or repeated hemorrhage resulting in progressive and irreversible neurological dysfunction. The cause of the disease is aneurysm, trauma, tumor, and vascular malformation. In most cases, the cause of bleeding is unknown. Clinical features include sensorineural hearing loss, cerebellar ataxia, and myelopathy. Until now, magnetic resonance imaging (MRI) has only been diagnosed and there is no standardized treatment. We will investigate clinical features and MRI findings of SS disease in the central nervous system using 2 patient cases.

CT spectral imaging assessment of synovial hemosiderin deposition in knee joint in patients with hemophilic arthropathy / 中国医学影像技术

Objective To observe the value of CT spectral imaging in assessment of synovial hemosiderin deposition (SHD) in the knee joint in patients with hemophilic arthropathy (HA).Methods Twenty-five HA patients (40 assessable knees) underwent CT spectral imaging and MR scanning.According to the MRI international prophylaxis study group (IPSG) score of SHD,the knees were divided into mild group and severe group.CT value,iron (water) concentration (FeC),water (iron) concentration (WC),effective atomic number (Eff-Z) and average spectral curve slope (aSCS) of SHD area were measured and calculated,respectively.Meanwhile,the adjacent semi-membrane muscles in the same slice were taken as controls.The spectral parameters of CT were compared with One-Way ANOVA,and ROC curves were plotted to obtain the spectral parameters and the optical diagnostic threshold of SHD.Results CT value,FeC,and aSCS of SHD area were statistically significant among three groups (F=148.08,307.88,7.80,364.62 and 261.50,P＜0.01),and the differences of parameters between any two groups except WC were statistically significant (all P＜0.05).The area under ROC curve of SHD evaluated with aSCS was the largest,and the thresholds for the diagnosis of severe and mild SHD of aSCS was 1.84 and 0.42,respectively.Conclusion Multiple parameter analysis of CT spectral imaging is of great value for assessment of the severity of SHD in the knee joint in HA patients,therefore having important clinical significance.

Estimation on Formation Time of Thrombus / 法医学杂志

OBJECTIVES@#To observe the changes of the formation time of venous thrombus in rats, and to provide new ideas and methods for the estimation on thrombus formation time of the forensic cases died from thrombosis.@*METHODS@#Totally 80 rats were randomly divided into 10 groups （0 h, 3 h, 6 h, 12 h, 1 d, 3 d, 1 week, 2 weeks, 3 weeks and 4 weeks after operation）. A vein thrombosis model was established by the "narrow" method. The processes of thrombosis, organization, recanalization and the features of change on hemosiderin and calcium salt were observed by HE stain, Perls stain and Von Kossa stain. The expression changes of CD61, α-SMA and CD34 were observed by immunohistochemical staining technique.@*RESULTS@#Platelets adhered to the exposed blood vessel intima 3 h after operation, and platelet trabeculae were formed by the repeated accumulation of platelets 1 d after operation. The thrombus organization formed through the fibroblasts from vessel wall that grew into the interior of the thrombus 3 d after operation. Endothelial cells covered the surface of thrombus and then the new blood vessels were reformed, and the vessels were reconstructed. The expression of CD61 upregulated at the stages of the thrombus formation （3 h） and thrombus reformation （4 weeks）, and reached the peak 1 d after thrombus formation. The release of hemosiderin and the initial expression of α-SMA were detected 3 d later. Calcium deposit and expression of CD34 were observed 1 week later.@*CONCLUSIONS@#The hemosiderin, calcium salt, CD61, α-SMA and CD34 show time-dependent changing characteristics, which is expected to provide a reference for the estimation on thrombus formation time of the forensic cases died from thrombosis.

Identification of the sentinel lymph node using hemosiderin in locally advanced breast cancer / Identificação do linfonodo sentinela utilizando hemossiderina em casos de câncer de mama localmente avançado

ABSTRACT Objective: to verify the agreement rate in the identification of sentinel lymph node using an autologous marker rich in hemosiderin and 99 Technetium (Tc99) in patients with locally advanced breast cancer. Methods: clinical trial phase 1, prospective, non-randomized, of 18 patients with breast cancer and clinically negative axilla stages T2=4cm, T3 and T4. Patients were submitted to sub-areolar injection of hemosiderin 48 hours prior to sentinel biopsy surgery, and the identification rate was compared at intraoperative period to the gold standard marker Tc99. Agreement between methods was determined by Kappa index. Results: identification rate of sentinel lymph node was 88.9%, with a medium of two sentinel lymph nodes per patients. The study identified sentinel lymph nodes stained by hemosiderin in 83.3% patients (n=15), and, compared to Tc99 identification, the agreement rate was 94.4%. Conclusion: autologous marker rich in hemosiderin was effective to identify sentinel lymph nodes in locally advanced breast cancer patients.

RESUMO Objetivo: verificar a taxa de concordância na identificação do linfonodo sentinela utilizando um marcador autólogo rico em hemossiderina e o Tecnécio 99 (Tc99) em casos de câncer de mama localmente avançados. Métodos: ensaio clínico fase 1, do tipo prospectivo, não randomizado, em 18 pacientes portadoras de câncer de mama com axila clinicamente negativa em estádio T2=4cm, T3 e T4. As pacientes foram submetidas à injeção subareolar de um marcador autólogo rico em hemossiderina 48 horas antes do procedimento cirúrgico para biópsia do linfonodo sentinela, e sua taxa de identificação foi comparada, no intraoperatório, com o marcador radioativo Tc99 (padrão-ouro). A concordância entre os métodos foi estabelecida pelo índice de Kappa. Resultados: a taxa de identificação do linfonodo sentinela foi de 88,9%, com uma média de dois linfonodos sentinelas por paciente. O estudo identificou os linfonodos sentinelas corados com hemossiderina em 83,3% dos casos (n=15), quando comparados com a taxa de identificação do Tc99, tendo sido observada concordância em 94,4% dos casos estudados. Conclusão: o marcador autólogo rico em hemossiderina se mostrou eficaz na identificação do linfonodo sentinela em casos de câncer de mama localmente avançado.

Sarcomatous transformation of a hemosiderotic fibrohistiocytic lipomatous tumor: a case report / Transformação sarcomatosa de tumor lipomatoso fibro-histiocítico hemossiderótico: relato de caso

ABSTRACT Hemosiderotic fibrohistiocytic lipomatous tumors are rare neoplasms that were first described in 2000. Initially considered a benign lipotamous lesion of the soft tissues, nowadays they are considered to be a locally aggressive tumor. They occur mainly in the foot and ankle of women in their fifth and sixth decades, although they may be found in any place in the lower limbs and, more rarely, in other parts of the body. Histologically, hemosiderotic fibrohistiocytic lipomatous tumors consist of a mixture of mature adipose tissue, fusiform cell fascicles, macrophages that often contain cytoplasmic hemosiderin, mononuclear inflammatory infiltrate, and stroma that may be focally myxoid. Local recurrence is observed in nearly one-third of all cases. There is no consensus in the literature whether this tumor is a part of a spectrum that comprises pleomorphic hyalinizing angiectatic tumors and myxoinflammatory fibroblastic malignant tumors, or if it is an independent entity. The authors report a case of a neoplasia after a diagnosis of a hemosiderotic fibrohistiocytic lipomatous tumor in a 38-year-old woman, with two recurrences and later sarcomatous transformation. An immunohistochemical study indicated myofibroblastic differentiation of a malignant neoplasm. To the best of the authors' knowledge, there are only few reported cases of malignant transformation in hemosiderotic fibrohistiocytic lipomatous tumors.

RESUMO Os tumores lipomatosos fibro-histiocíticos hemossideróticos são neoplasias raras que foram descritas pela primeira vez em 2000. Inicialmente considerada uma lesão lipomatosa benigna dos tecidos moles, atualmente é considerado um tumor localmente agressivo. Essas lesões ocorrem principalmente no pé e no tornozelo das mulheres na quinta e sexta décadas de vida, embora possam ser encontrados em qualquer lugar nos membros inferiores e, mais raramente, em outras partes do corpo. Histologicamente, tumores lipomatosos fibro-histiocíticos hemossideróticos são formados por uma combinação de tecido adiposo maduro, fascículos de células fusiformes, macrófagos que contêm frequentemente hemossiderina citoplasmática, infiltrado inflamatório mononuclear e estroma, que pode ser focalmente mixoide. Há recidiva local em quase um terço dos casos. Não existe consenso na literatura se esse tumor faz parte de um espectro que envolve os tumores angiectásicos hialinizantes pleomórficos e os tumores fibroblásticos mixoinflamatórios malignos ou se configura uma entidade independente. Relatamos um caso de uma neoplasia com diagnóstico inicial de tumor lipomatoso fibro-histiocítico hemossiderótico em uma mulher de 38 anos, com duas recorrências e posterior transformação sarcomatosa. O estudo imuno-histoquímico indicou diferenciação miofibroblástica da neoplasia maligna. Encontramos apenas poucos casos relatados de transformação maligna de tumor lipomatoso fibro-histiocítico hemossiderótico.

Comparação da hemossiderina com o tecnécio-99 na identificação do linfonodo sentinela do câncer de mama. /Paulo Henrique Diógenes Vasques

INTRODUÇÃO E OBJETIVO: Atualmente, a Biopsia do Linfonodo Sentinela (BLS) substitui oesvaziamento axilar no estadiamento do câncer de mama inicial com axila clinicamentenegativa. O tecnécio 99 (Tc99) é o padrão ouro para identificação do Linfonodo Sentinela(LS) da mama. Os corantes azuis são uma opção menos onerosa e mais difundida no Brasil.Estes corantes são responsáveis pelas reações adversas e de hipersensibilidade que, emborararas, podem pôr em risco à vida dos pacientes. Há interesse na descoberta de novassubstâncias equivalentes e com menores efeitos colaterais às usadas na BLS. Aqui se avaliama segurança e a equivalência do uso da hemossiderina, em comparação ao tecnécio 99 (Tc99)na BLS no câncer de mama. A hemossiderina é um derivado da hemoglobina, identificada emestudo pré-clínico, que se mostrou eficaz na BLS da mama da cadela. O objetivo destapesquisa é avaliar a segurança e a potencial equivalência do uso da hemossiderina emcomparação com o Tc99 na BLS da mama humana...

INTRODUCTION AND OBJECTIVE: Sentinel Lymph Node Biopsy (SLNB) has currently replaced axillary dissection in early - stage breast cancer in clinically tumor - free patients. Technetium - 99 ( 99 Tc) is the gold standard for the identification of Breast Sentinel Ly mph Node (SLN). Blue dyes are a less expensive and widely used option in Brazil. These dyes are responsible for several adverse and hypersensitivity reactions that – although rare – ’ v at risk. There is an interest in the discovery of new equivalent substances with less side effects than those used in SLNB. This research assesses the safety and equivalence of the use of hemosiderin in SLNB in breast cancer compared to technetium - 99 ( 99 Tc). Hemosiderin is a hemoglobin derivate identifie d in a preclinical trial that has proven to be effective in the SLNB f f ’. Th f h h h f y equivalence of the use of hemosiderin in SLNB in human breast compared to the 99 Tc...

Superficial Siderosis of the Central Nervous System Originating from the Thoracic Spine: A Case Report

Superficial siderosis of the central nervous system(SSCNS) is a rare disease characterized by hemosiderin deposition on the surface of the central nervous system. We report a case of SSCNS originating from the thoracic spine, presenting with neurological deficits including, sensorineuronal hearing loss, ataxia, and corticospinal and dorsal column tract signs. The patient underwent dural repair with an artificial dural patch. Clinical findings were elicited by neurological examination, imaging studies, and intraoperative findings, and these were addressed through literature review.

Comparison between hemosiderin and Technetium-99 in sentinel lymph node biopsy in human breast cancer

PURPOSE: To assess the safety and potential equivalence of the use of hemosiderin compared to the Technetium-99 in sentinel lymph node biopsy in human breast cancer. METHODS: Non-random sample of 14 volunteer women diagnosed with breast cancer with primary tumors (T1/T2) and clinically tumor-free axilla were submitted to the identification of sentinel lymph node using hemosiderin obtained from autologous blood injected in the periareolar region 24h before surgery on an outpatient basis. Patients received preoperative subareolar intradermal injection of Technetium-99 in the immediate preoperative period. Patients were submitted to sentinel lymph node biopsy, with incision in the axillary fold guided by Gamma-Probe, dissection by planes until the identification of the point of maximum uptake of Technetium-99, identifying the marked nodes and their colors. All surgical specimens were sent for pathological and immunohistochemical study. RESULTS: The results showed no evidence of side effects and/or allergic and non-allergic reactions in patients submitted to SLNB with hemosiderin. The SLN identification rate per patient was 100%. SLNB identification rate per patient with hemosiderin was the same as that of Technetium, with a concordance rate of 100% between the methods. CONCLUSION: Hemosiderin is a safe dye that is equivalent to Technetium in breast sentinel lymph node biopsy.

Susceptibility weighted imaging: differentiating between calcification and hemosiderin / Imagem ponderada em suscetibilidade magnética: diferenciando calcificação de hemossiderina

Objective: To present a detailed explanation on the processing of magnetic susceptibility weighted imaging (SWI), demonstrating the effects of echo time and sensitive mask on the differentiation between calcification and hemosiderin. Materials and Methods: Computed tomography and magnetic resonance (magnitude and phase) images of six patients (age range 41– 54 years; four men) were retrospectively selected. The SWI images processing was performed using the Matlab’s own routine. Results: Four out of the six patients showed calcifications at computed tomography images and their SWI images demonstrated hyperintense signal at the calcification regions. The other patients did not show any calcifications at computed tomography, and SWI revealed the presence of hemosiderin deposits with hypointense signal. Conclusion: The selection of echo time and of the mask may change all the information on SWI images, and compromise the diagnostic reliability. Amongst the possible masks, the authors highlight that the sigmoid mask allows for contrasting calcifications and hemosiderin on a single SWI image. .

Objetivo: Expor em detalhes o processamento da imagem ponderada em suscetibilidade magnética (susceptibility weighted imaging – SWI), destacando o efeito da escolha do tempo de eco e da máscara sensível à diferenciação de calcificação e hemossiderina simultaneamente. Materiais e Métodos: Imagens de tomografia computadorizada e por ressonância magnética (magnitude e fase) foram selecionadas, retrospectivamente, de seis pacientes (idades entre 41 e 54 anos; quatro homens). O processamento das imagens SWI foi realizado em rotina própria no programa Matlab. Resultados: Dos seis pacientes estudados, quatro apresentaram calcificações nas imagens de tomografia computadorizada. Nestes, as imagens SWI mostraram sinal hiperintenso para as regiões de calcificações. Os outros dois pacientes não apresentaram calcificações nas imagens de tomografia computadorizada e apresentaram depósito de hemossiderina com sinal hipointenso na imagem SWI. Conclusão: A escolha do tempo de eco e da máscara pode alterar toda a informação da imagem SWI e comprometer a confiabilidade diagnóstica. Dentre as possíveis máscaras, destacamos que a máscara sigmoide permite contrastar calcificação e hemossiderina em uma única imagem SWI. .

Two Cases of Cavernous Malformation Presenting with Unusual and Large Intracerebral Hemorrhages

Cavernous malformations (CMs), characterized by the presence of a hemosiderin rim and intralesional hemorrhage, are relatively common intracranial vascular malformations. Extralesional hemorrhages arising from CMs are seen in a minority of cases, but most of them show typical CM findings on magnetic resonance imaging. Here, the authors report two cases of pathologically confirmed CM presenting with unusual and large intracerebral hemorrhages, which were not surrounded by the typical hemosiderin rim. CMs presenting with large intracerebral hemorrhage should be considered in the differential diagnosis of massive intracerebral hemorrhages.

Haematology and melanomacrophage centers of Nile tilapia fed supplemented diet with propolis / Hematologia e centros de melanomacrófagos de tilápia do Nilo, alimentada com dieta suplementada com própolis

The objective of this study was to investigate the influence of dietary supplementation with propolis on hematology and number and area of melanomacrophage centers in spleen and kidney of tilapia. After acclimation, fish (24.7 ± 7.4 g mean weight) were distributed in 6 tanks 100 L, 6 fish per tank, in triplicate, at a temperature 24.0 ± 2.8oC, with two treatments: Fish fed 2% propolis supplemented diet and fish fed non-supplemented diet. To monitor the evolution of the effects, two samples were collected: half of the fish from each treatment were used after 15 days and the other half after 21, composing two feeding times. After each feeding time, blood, spleen and kidney were collected. After twenty one days feeding on 2% propolis supplemented diet, fish showed a lower number of total leukocytes and lymphocytes and an increase in the total erythrocytes number. Fish fed supplemented diet presented an increased number of melanomacrophage centers. We observed hemosiderin in all spleen samples. Kidney showed no significant difference on the presence of melanomacrophage centers containing hemosiderin. Despite these changes, the fish health status was not affected. The results showed that propolis supplementation in the diet of Nile tilapia may be physiologically feasible.

O objetivo deste estudo foi avaliar a influência da suplementação de ração com própolis sobre os parâmetros hematológicos e os centros de melanomacrófagos no rim e baço de tilápia do Nilo. Após aclimatação, os animais (peso médio de 24,7 ± 7,4 g) foram distribuídos em seis tanques de 100 L, seis peixes em cada tanque, em triplicata, à temperatura de 24,0 ± 2,8oC e divididos em dois tratamentos: peixes alimentados com ração suplementada com extrato de própolis 2% e peixes alimentados com ração não suplementada. Para observar a evolução dos efeitos foram realizadas duas amostragens. Foi utilizada metade dos peixes de cada tratamento após 15 dias e a outra metade após 21 para coleta de sangue, baço e rim. Após 21 dias de alimentação com ração suplementada, os peixes apresentaram menores números totais de leucócitos e linfócitos e aumento no número de eritrócitos. Aumento no número de centros de melanomacrófagos ocorreu no baço dos peixes alimentados com ração suplementada. Em todos os baços, observou-se presença de hemossiderina. Os rins não apresentaram diferença significativa quanto à presença de centros de melanomacrófagos com hemossiderina. Os resultados mostraram que a própolis é uma possibilidade fisiologicamente viável na suplementação das rações de tilápias.

Microsurgical Treatment and Outcome of Pediatric Supratentorial Cerebral Cavernous Malformation

OBJECTIVE: The purpose of this study was to investigate the clinical features and outcomes of pediatric cavernous malformation (CM) in the central nervous system. METHODS: Twenty-nine pediatric patients with supratentorial CM underwent microsurgical excision. In selected cases, transparent tubular retractor system (TTRS) was used to reduce retraction injury and intraoperative neuromonitoring (IONM) was held to preserve functioning cortex. Patients' demographics and symptoms were reviewed and surgical outcomes were discussed. RESULTS: The main initial clinical manifestations included the following : seizures (n=13, 45%), headache (n=7, 24%), focal neurological deficits (n=3, 10%), and an incidental finding (n=6, 21%). Overt hemorrhage was detected in 7 patients (24%). There were 19 children (66%) with a single CM and 10 (34%) children with multiple CMs. In 7 cases with deep-seated CM, we used a TTRS to minimize retraction. In 9 cases which location of CM was at eloquent area, IONM was taken during surgery. There was no major morbidity or mortality after surgery. In the 29 operated children, the overall long-term results were satisfactory : 25 (86%) patients had no signs or symptoms associated with CMs, 3 had controllable seizures, and 1 had mild weakness. CONCLUSION: With the assistance of neuronavigation systems, intraoperative neuromonitoring, and TTRS, CMs could be targeted more accurately and excised more safely. Based on the satisfactory seizure outcome achieved, complete microsurgical excision in children is recommended for CMs presenting with seizures but removal of hemosiderin-stained areas seems to be unnecessary.