Multiple biopsies in bladder urothelial carcinomas: correlation of atypical lesions with histological grade, clinical staging and number of tumors

Twenty-eight cases of transitional cell carcinomas, (19 papillary cell carcinomas, 9 nonpapillary invasive carcinomas) with concomitant mucosal biopses are reported. Multiple biopses were obtained cystoscopically at diagnosis (during ressection or biopsy of the main tumor) or afterwards, during post-operative evaluation. Fifteen patients (53.6%) wre positive for dysplasia, carcinoma "in situ" or micro-invasive carcinoma in the biopsies. These lesions were correlated with the primary neoplasm in regard to: 1) histological grade. Atypical lesions were more frequent the higher the grade (0.01 < p < 0.05); 2) clinical staging. The possibility of finding atypical lesions was higher in cases with more advanced staging (0.01 < < 0.05) and 3) presence of one or more tumors visible cystoscopically. The results were not statistically significant (0.10 < p < 0.50) but there was a trend toward a highr incidence of atypical lesions among patients with more than one tumor at cystoscopy. Performance of multiple mucosal biopsies is the only means of diagnosing for atypical lesions of the bladder because, due to their plane configuration, they are not detected cystoscopically. The presence of these lesions is very important because they influence the prognosis and the therapeutic measures

Síndrome nefrótica por glomerulonefrite membranosa associada a leucemia mielóide crônica / Nephrotic syndrome due to membranous glomerulonephritis associated with chronic myeloid leukemia

Os autores relatam caso de um paciente que apresentou síndrome nefrótica quatro anos após o diagnóstico de leucemia mielóide crônica. A biópsia renal revelou lesöes características da glomerulopatia membranosa. Acreditamos que este represente o primeiro caso relatado na literatura da associaçäo entre leucemia mielóide crônica e glomerulopatia membranosa

Glomerulonefrite granulomatosa com necrose papilar renal em granulomatose de Wegener / Granulomatous glomerulonephritis with renal papillary necrosis in Wegener's granulomatosis

Os autores relatam um caso de granulomatose de Wegener com insuficiência renal rapidamente progressiva que evoluiu para óbito. Os achados histopatológicos evidenciaram glomerulonefrite granulomatosa e necrose papilar renal, achados estes pouco freqüentes na moléstia. Discutem-se os diagnósticos diferenciais da granulomatose de Wegener