Carcinoma de células de Merkel: múltiplas lesões cutâneas primárias no membro inferior / Merkel cell carcinoma: multiple primary skin lesions in the lower limb

Carcinoma de células de Merkel é um tumor neuroendócrino raro e agressivo de pele que usualmente apresenta-se como lesão única na região de cabeça ou pescoço. Relata-se um caso de topografia e apresentação atípicas, com presença de múltiplos e simultâneos tumores na perna esquerda de rápida evolução, associados à linfonodomegalia inguinal palpável, com diagnóstico confirmado por meio de histopatologia e imuno-histoquímica. Realizada exérese de linfonodo inguinal esquerdo e das lesões cutâneas com margem de segurança

Merkel cell carcinoma is a rare and aggressive neuroendocrine skin tumor usually presenting as a single lesion in the head or neck region. We report a case of atypical topography and presentation, with multiple and simultaneous tumors on the left leg of rapid progression associated with palpable inguinal lymphadenopathy and diagnostic confirmation by histopathology and immunohistochemistry. Exeresis of the left inguinal lymph node and skin lesions with a safety margin was performed

Metaplastic breast carcinoma: series of cases and literature review

Introduction: Metaplastic breast carcinoma is a heterogeneous group of infrequent invasive carcinomas with aggressive behavior. It presents differentiation from the neoplastic ductal epithelium to squamous and/or sarcomatous mesenchymal component, through the epithelial-mesenchymal transition process, and may present morphology of epithelioid and fusiform cells, with possible cartilage, bone, lipomatous, fibromatous, smooth muscle or skeletal muscle differentiation, among others. Most of the cases present the triple-negative immunohistochemical profile. Objective: To report three cases of metaplastic carcinomas, with an emphasis on clinical and pathological aspects, in addition to conducting a literature review on this topic. Methods: The three cases were registered in the internal search system for reference services in breast pathology in São Paulo, between 2012 and 2019. For literature review, the keywords metaplastic carcinoma, breast, cancer, review, breast cancer subtype and pathological and clinical outcomes were used in PubMed. We found 154 articles, of which 42 were selected for full reading, based on the abstract and established inclusion criteria. After this initial selection, these articles were read and reviewed; nine articles that did not meet the inclusion criteria were excluded. Discussion: Three cases of metaplastic carcinoma with similar immunohistochemical characteristics have been reported. The first case is that of a 40-year-old patient with the diagnosis of metaplastic carcinoma producing a chondroid matrix with liposarcomatous and osteosarcomatous differentiation. The second case is that of a 50-year-old patient who presented with the final diagnosis for a fusocellular metaplastic carcinoma with lymph node metastasis. Finally, the third case described is that of a 59-year-old patient, who presented metaplastic carcinoma with chondroid differentiation. Conclusion: Metaplastic carcinoma is a rare and aggressive type of breast cancer, in which most of the patients have shorter survival and worse prognosis in relation to the other subtypes. More studies are needed in order to determine a gold standard treatment for this disease.

Cervical squamous intraepithelial lesions grades 1 and 2: value of an alternative morphological classification and of p16 immunohistochemistry in the prediction of clinical outcome / Lesões intraepiteliais escamosas cervicais graus 1 e 2: valor de uma classificação morfológica alternativa e do estudo imuno-histoquímico com p16 na predição do desfecho clínico

ABSTRACT Introduction: Diagnostic reproducibility and determination of prognostic factors in cervical intraepithelial neoplasias grades 1 and 2 are still relevant problems in the daily practice of gynecological histopathology. Objective: To correlate the value of morphological reclassification and of p16 immunoexpression in cervical intraepithelial neoplasias grades 1 and 2 with clinical outcome. Materials and methods: Sixty-six patients were included (34 with cervical intraepithelial neoplasia grade 1, and 32 with grade 2); an immunohistochemical study with p16 and reclassification according to the Lower Anogenital Squamous Terminology (LAST) Consensus and by the alternative proposal of Herfs and Crum were done; unfavorable outcome was defined as a subsequent histologic diagnosis of cervical intraepithelial neoplasia grade 3 or invasive squamous cell carcinoma. Results: We observed superior performance of the alternative morphological classification (p = 0.002) to determine unfavorable outcome. We also detected superior performance of p16 in the same determination (p = 0.002). Conclusion: The use of an alternative morphological classification is promising; in the context of the use of immunohistochemical antibodies as biomarkers, p16 showed good sensitivity and negative predictive value in the determination of cases in which the outcome was unfavorable.

RESUMO Introdução: A reproducibilidade diagnóstica e a determinação de fatores prognósticos em neoplasias intraepiteliais cervicais graus 1 e 2 ainda são problemas relevantes na prática diária da histopatologia ginecológica. Objetivo: Correlacionar o valor da reclassificação morfológica e da imunoexpressão do marcador p16 em neoplasias intraepiteliais cervicais graus 1 e 2 com o desfecho clínico. Materiais e métodos: Incluídas 66 pacientes (34 com neoplasia intraepitelial cervical grau 1 e 32 com grau 2); realizou-se estudo imuno-histoquímico com p16 e reclassificação segundo o Consenso Lower Anogenital Squamous Terminology (LAST) e a proposta alternativa de Herfs e Crum; desfecho desfavorável foi definido como diagnóstico histológico subsequente de neoplasia intraepitelial cervical grau 3 ou carcinoma de células escamosas invasivo. Resultados: Observamos performance superior da classificação morfológica alternativa (p = 0,002) para determinação de desfecho desfavorável. Também detectamos performance superior do marcador p16 na mesma determinação (p = 0,002). Conclusão: A utilização de uma classificação morfológica alternativa é promissora. No âmbito da utilização dos anticorpos imuno-histoquímicos como biomarcadores, o p16 apresentou boa sensibilidade e valor preditivo negativo na determinação dos casos em que o desfecho foi desfavorável.