Progressive multifocal leukoencephalopathy: a challenging diagnosis established at autopsy

Progressive multifocal leukoencephalopathy (PML) is a feared entity that occurs most frequently in conditions of extreme immunodeficiency. The diagnosis is often made long after the onset of symptoms due to the physicians' unfamiliarity, and the unavailability of diagnostic tests in some medical centers. Although the incidence of PML is decreasing among HIV patients with the advent of highly active antiretroviral therapy (HAART), in Brazil this entity is the fourth highest neurological complication among these patients. The authors present the case of a middle-aged man who tested positive for HIV concomitantly with the presentation of hyposensitivity in the face and the right side of the body, accompanied by mild weakness in the left upper limb. The clinical features worsened rapidly within a couple of weeks. The diagnostic work-up pointed to the working diagnosis of PML after brain magnetic resonance imaging; however, the detection of the John Cunningham virus (JCV) in the cerebral spinal fluid was negative. HAART was started but the patient died after 7 weeks of hospitalization. The autopsy revealed extensive multifocal patchy areas of demyelination in the white matter where the microscopy depicted demyelination, oligodendrocytes alterations, bizarre atypical astrocytes, and perivascular lymphocytic infiltration. The immunohistochemistry was positive for anti-SV40, and the polymerase chain reaction of the brain paraffin-embedded tissue was positive for JCV. The authors highlight the challenges for diagnosing PML, as well as the devastating outcome of PML among HIV patients.

Cararcterização fenotípica dos tumores mucinosos do ovário / Phenotype characterization of the mucinous ovarian tumors

Os tumores mucinosos primários de ovário são classificados como benignos, borderline e malignos, com diferentes fenótipos, recentemente designados como gastrointestinal e seromucinoso. O propósito desse estudo retrospectivo foi analisar os diferentes padrões morfológicos de apresentação dos tumores mucinosos ovarianos e sua associação com o potencial de malignidade e perfil imunoistoquímico. Marcação imunoistoquímica para produtos de gene de mucina (MUC1, MUC2, MUC5AC e MUC6), RE, RP, CK7, CK20, CA19.9 e CA125 foram realizados em tissue microarrays. Os resultados sugerem que os fenótipos pilórico e intestinal puros são diferentes em relação ao potencial de malignidade e perfil imunoistoquímico. Provavelmente os tumores borderline de padrão intestinal, mesmo aqueles sem pseudomixoma peritoneal associado, devem ser considerados como tumores secundários, muitos destes com origem em apêndice cecal...

Primary mucinous ovarian tumors are classified as benign, borderline and malignant, with different phenotypes, recently called as gastrointestinal and seromucinous. The purpose of this retrospective study was to analyze the different morphological patterns of presentation of mucinous ovarian tumors and their association with malignant potential and immunohistochemical profile. Immunohistochemical staining for mucin gene product (MUC1, MUC2, MUC5AC and MUC6), ER, PR, CK7, CK20, CA19.9 and CA125 were performed in tissue microarrays. The results suggest that the pure pyloric and intestinal phenotypes differ regarding malignant potential and immunoprofile. Probably most intestinal borderline tumors, even those without pseudomixoma peritonei, should be considered as secondary tumor, most of them with appendiceal oring...