A case report: primary melanoma of the nasal cavity / Un reporte de caso: melanoma primario de la cavidad nasal

We report a rare case of sinonasal mucosal malignant melanoma in the nasal cavity. The patient had respiratory difficulty, continuous epistaxis and nasal pain. We identified a malignant tumour which is a rare pathology with detailed physical examination, anterior rhinoscopy, computed tomography (CT) scan, magnetic resonance imaging (MRI) and histopathologic examination. The patient did not accept surgical procedures and was referred for chemotherapy or immunotherapy. Continued follow-up of this is necessary.

Reportamos un caso raro de melanoma maligno de la mucosa del tracto nasosinusal. El paciente tenía dificultad respiratoria, epistaxis continua, y dolor nasal. Identificamos un tumor maligno que es una patología, con examen físico detallado, rinoscopia anterior, tomografía computarizada (TC), resonancia magnética (MRI) y examen histopatológico. El paciente no aceptaba los procedimientos quirúrgicos y fue remitido para quimioterapia o inmunoterapia. Es necesario realizar un seguimiento continuo.

É o exame anatomopatológico de rotina indispensável em cirurgias orificiais / Is the histopathologic examination essential in orificial sugeries

Introdução: O exame anatomopatológico é feito rotineiramente em cirurgias orificiais e é importante para diagnosticar doenças anais concomitantes, lesões malignas e doenças sexualmente transmissíveis não previstas anteriormente no exame clínico. O gasto com estes exames é bastante significativo para o serviço público o que evidencia a necessidade de avaliar o custo/benefício da sua utilização rotineira. Objetivos: Avaliar o tempo decorrido entre a entrega do material e a emissão do laudo, o nível de concordância entre a impressão diagnóstica e a conclusão do anatomopatológico, a importância clínica das patologias diagnosticadas secundariamente, o custo de realização dos exames e a relação custo/benefício dos mesmos. Metodologia: Estudo descritivo e retrospectivo de 173 exames anatomopatológicos de pacientes do Hospital Universitário de Aracaju realizados de 2005 a 2007, que foram submetidos à cirurgias orificiais. Resultados: O nível de concordância entre a impressão diagnóstica e a conclusão do anatomopatológico foi elevada e, dos laudos discordantes, poucos apresentaram relevância clínica, havendo somente um caso de neoplasia anorretal. Houve um atraso significativo na emissão dos laudos, sugerindo sobrecarga do serviço e o custo/benefício para realização dos exames foi desfavorável. Conclusão: Sugerimos triagem para um uso racional e criterioso do exame anatomopatológico em cirurgias orificiais baseada na história clínica e fatores de risco do paciente.

Introduction: The histopathologic examination is repeatedly done in orificial surgeries and it's important to diagnose anal diseases associated, malign lesions and sexually transmitted diseases that weren't previously predicted on the clinic examination. The cost of the histopathologic examinations is very significant to the public health service, which shows the need to do a cost-benefit analysis of their routine use. Objectives: Evaluate the time between the surgical specimen's delivery and the emission of the histopathologic examination's report, the concordance level between the clinic impression and the histopathologic examination's report, the clinical relevance of the diseases secondarily diagnosed, the cost of the histopathologic examinations and the cost-benefit analysis of them. Methods: Descriptive and retrospective study of 173 histopathologic examinations from patients of the Hospital Universitário de Aracaju made from 2005 to 2007, that were submitted to orificial surgeries. Results: High concordance level between the clinic impression and the histopathologic examination's report; from the discordants reports, a few had clinical relevance and was only one case of anal cancer. There was a significant delay on the reports' emission, which suggests that the pathology service is overloaded; and the cost-benefit analysis was unfavorable. Conclusions: We suggest screening to a rational and judicious use of the histopathologic examination in orificial surgeries based on the patient's clinical history and risk factors.

A Comparative Study of KOH Preparation, Fungal Culture, Histopathologic Examination and Polymerase Chain Reaction for Diagnosis in Onychomycosis / 대한의진균학회지

BACKGROUND: Onychomycosis is one of the most common nail disorders, and it is necessary of mycologic confirmation to treat correctly. It has been reported that histopathologic evaluation and polymerase chain reaction (PCR) of the nail plate by nail clipping might be a useful supportive method for identification of causative fungi showing higher detection rates. Objective: This study was designed to compare diagnostic efficacy of KOH preparation, fungal culture, histopathologic examination and PCR in onychomycosis. METHODS: Using 60 nail samples from 60 patients with clinically suspected onychomycosis, KOH preparation and fungal culture with nail and subungual tissue was performed. And histopathologic examination with PAS staining and PCR with DNA extracted from paraffin block was performed. RESULTS: The results are summarized as follows: 1. The positive rates of conventional KOH preparation, fungal culture, histopathologic examination and PCR were 87.5%, 8.9%, 87.5% and 83.9%. 2. In histopathologic examination, fungi were distinguished as 3 groups based on Kim and Cho's classification (1997): dermatophytes, Candida sp. and non-dermatophytic mold (NDM). Fifteen of 49 samples are dermatophytes, 1 is Candida sp., and 7 are NDM, 8 are dermatophytes and Candida sp. mixed infections, 18 are dermatophytes and NDM mixed infections. 3. In PCR, 1 of 47 samples is Trichophyton rubrum, 4 are Candida sp. and 39 samples are NDM. CONCLUSION: Histopathologic examination in onychomycosis is considered to be an useful supportive method in diagnosis and identification of causative fungi in onychomycosis.

A Case of Generalized Nodular Scabies / 대한피부과학회지

Nodular scabies is a clinical variant of classic scabies with uncertain cause. The cutaneous manifestations consist of firm, erythematous nodules focally affecting genitalia, groin and axillae, and no case of generalized involvement has been reported in the literature. On histopathologic examination, mites and excretas were known to be seldom found in the stratum corneum, but if serial sections are studied, they can be seen in as much as 20% of the cases. The dermis shows dense superficial and deep perivascular mixed cell infiltration composed of lymphocytes, histiocytes, plasma cells, eosinophils, and atypical mononuclear cells, which should be distinguished from many types of lymphomas. We herein report a case of nodular scabies that clinically affected whole body and histopathologically revealed mite and eggshells in the stratum corneum and perivascular mixed cell infiltration throughout the dermis.

Comparison of Fungus Culture with Histopathologic Examination in Onychomycosis / 대한의진균학회지

BACKGROUND: Onychomycosis is one of the most common nail disorders, but dermatologists have experienced poor efficacy ol therapy because of incorrect diagnosis. It has been reported that histopathologic evaluation of the nail plate by nail clipping might be a useful supportive method for identification of causative fungi showing higher detection rates. OBJECTIVE: This study was aimed to determine whether histopathologic examination support for identification of causative fungi and whether it increased. The diagnostic sensitivity of onychomycosis even in cases that those fungus culture fail to identify the causative fungi, and to clarify the relative frequency of causative fungi in onychomycosis. METHODS: Histopathologic findings of 218 onychomycotic nail samples, proven by KOH smear, were analyzed and compared with the results of fungus culture. RESULTS: The results were as follows; 1. Histopathologic examination showed higher positive rate (73.9%) than that of fungus culture (35.8%) in identifying the etiologic fungi. 2. The 3 groups of causative fungi confirmed by fungus culture showed morphologically distinguishable characteristics in histopathologic examination: Dermatophytes showed septated long, thin and regular hyphae with or without arthrospores, while Candida sp. showed blastospores, grape-like clusters of regular spores and pseudohyphae. Mold exhibited irregular hyphae with variable width and aggregates of irregular spores. Mixed infections showed the characteristic findings of the corresponding groups at the different sites of the nail samples. 3. Frequency of the causative fungi by fungus culture was 88.5% of dermatophytes, 5.1% of Candida sp. and 6.4% of mold. In histopathologic examination, the frequency was considered as 80.7% of dermatophytes,8.1% of Candida sp.,6.2% of mold and 1.9% of mixed infection. 4. In 42 of 59 samples of T. rubrum and 3 of 10 samples of T. mentagrophytes, hyphae were observed on the ventral and dorsal layer of the nail plate, respectively. In histopathologic sections, 88 of 130 samples of dermatophytes showed fungal element on the ventral layer of the nail plate and all 13 samples of Candida sp. on the subungal keratin layer and ventral layer of the nail plate. CONCLUSION: Histopathologic examination in onychomycosis is considered to be simple, useful supportive method in studying the classification and distribution of causative fungi of onychomycosis and might be included in the routine laboratory tests for making the presumptive diagnosis of causative fungi of onychomycosis. Moreover, we can determine the site of involvement of the fungi in the nail, so we can get useful informations about mixed infections or contaminations

The Effect of Halothane-induced Acidosis on Focal Cerebral Ischemia in Rat

The current study was performed to investigate the influence of acidosis on focal cerebral ischemia in view of morphometric assay and neuropathological examination. The acidosis was induced by increment of halothane concentration and by decreasing respiratory rate. The mean pH were 7.423+/-0.012 in control group and 7.184+/-0.038 in acidosis group. Twenty-four hours after MCA occlusion(MCAO), neutral red staining and perfusion fixation was performed. The ischemic area was measured and morphometric analysis was undertaken. In acidosis group, the infarct area was 25.23+/-4.78% of the total cerebral area;in control group, the infarct area was 27.69+/-4.05%. The histopathological findings were examined under light microscopy, in which the field scanning was carried out from the midline by 0.5mm interval at cortical and basal ganglia levels. These results indicated that although there was no satistically significant difference in infarct area between acidosis and control group, increased acidosis aggravated the extent of histopathologic ischemic neuronal damage.