Pineoblastoma en el adulto. A propósito de un caso

Fundamento: Los pineoblastomas son tumores cerebrales infrecuentes dentro del grupo de los tumores primitivos neuroectodérmicos. La presentación clínica por lo general está relacionada con la obstrucción del acueducto de Silvio, lo que ocasiona hidrocefalia e hipertensión intracraneal. Objetivo: Describir las características clínicas e imagenológicas de un paciente adulto con diagnóstico de pineoblastoma. Presentación de caso: Masculino, 33 años, que comenzó con disminución de la agudeza visual que evolucionó a la amaurosis bilateral y trastorno de la marcha. Se diagnosticó hidrocefalia obstructiva triventricular, por lo cual se realizó tercer ventriculostomía endoscópica. Se decidió un abordaje supracerebeloso infratentorial a la lesión tumoral, con apoyo endoscópico en posición semisentado; se logró la resección parcial. En estudio inmunohistoquímico se encontró Ki-67 mayor de 50 % de las células, neurofilamento y sinaptofisina positiva. Se concluyó como pineoblastoma. Recibió radioterapia convencional con Co-60, fraccionada, con un total de 30 dosis diarias de 2 Gy. La evolución del paciente a los 6 meses de operado fue satisfactoria. Conclusiones: El tratamiento combinado de cirugía y radioterapia constituye un esquema terapéutico ideal en este tipo de lesiones tumorales. La endoscopia es una herramienta de gran valor en los abordajes quirúrgicos a la región pineal.

Background: Pineoblastomas are infrequent brain tumors among the neuroectodermal primitive tumors. Clinical presentation is usually related to Silvian aqueduct obstruction, which causes hydrocephalus and intracranial hypertension. Objective: To describe the clinical and imagenological characteristics in an adult patient diagnosed with pineoblastoma. Case presentation: Male, 33 years old, who started with visual acuity decline that evolved to bilateral amaurosis and gait disorder. Triventricular obstructive hydrocephalus was diagnosed, therefore, an endoscopic third ventriculostomy was realized. It was decided to use an infratentorial supracerebellar approach to the tumor lesion, with endoscopic support in semi-seated position; partial resection was achieved. In immunohistochemical study, Ki-67 was found to be higher than 50% of the cells, neurofilament and synaptophysin positive. It was concluded as pineoblastoma. He received fractionated Co-60 conventional radiotherapy, with a total of 30 daily doses, 2 Gy. The evolution of the patient 6 months after surgery was satisfactory. Conclusions: The combined treatment of surgery and radiotherapy constitutes an ideal therapeutic scheme in this type of tumor lesions. Endoscopy is a tool of great value in surgical approaches to the pineal region.

Fonctions de la sensorialité dans la prise en charge thérapeutique de l'autisme infantile / Funções da sensorialidade no manejo terapêutico do autismo infantil / Functions of sensoriality in the therapeutic management of infantile autism / Funciones de la sensorialidad en el manejo terapéutico del autismo infantil

La sensorialité tient plusieurs fonctions dans l'élaboration psychique de l'individu autiste et dans son évolution psychique au cours de sa prise en charge thérapeutique. Nous suivons dans cette recherche l'idée de la transformation d'un usage défensif de la sensorialité en un processus mutatif, d'une construction du moi corporel, ainsi qu'un travail de symbolisation primaire, d'inscription, de représentation et de figurabilité.Avec la psychothérapie d'un enfant autiste en institution, nous explorons les fonctions de la sensorialité sur la base de l'attention particulière portée aux éprouvés corporels dans la dimension transférentielle et contre-transférentielle. Celle-ci permet au thérapeute d'éprouver les angoisses en lien avec des expériences sensorielles primaires. En s'appuyant sur la résonnance contre-transférentielle des différentes angoisses du patient, une sensorialité partagée aide à la métabolisation des éprouvés de catastrophe primitive ayant entravé l'organisation d'un sentiment continu d'exister. Cette dynamique thérapeutique ouvre sur de nouvelles perspectives psychiques et relationnelles.

Resumos A sensorialidade assegura várias funções na elaboração psíquica do indivíduo autista e em seu desenvolvimento psíquico durante os seus cuidados terapêuticos. Nesta pesquisa perseguimos a ideia da transformação de um uso defensivo da sensorialidade em um processo mutativo, de uma construção do eu corporal, bem como de um trabalho de simbolização primária, de inscrição, representação e figurabilidade. Na psicoterapia de uma criança autista em instituição, exploramos as funções da sensorialidade se concentrando mais particularmente nas experiências corporais a partir da dimensão transferencial e contra-transferencial. Esse trabalho permite que o terapeuta experimente angústias ligadas a experiências sensoriais primárias. Com base na ressonância contra-transferencial das diferentes angústias do paciente, uma sensorialidade partilhada ajuda na metabolização das experiências de catástrofe primitiva que impedem a organização de um sentimento contínuo de existência. Esta dinâmica terapêutica abre novas perspectivas psíquicas e relacionais.

Sensoriality has several functions in the psychic elaboration of the autistic individual and in his psychic evolution during his therapeutic care. We follow in this research the idea of the transformation of a defensive use of sensoriality into a mutative process, of a construction of the bodily self, as well as a work of primary symbolization, inscription, representation and figurability. With the psychotherapy of an autistic child in an institution, we explore the functions of sensoriality based on the particular attention paid to bodily experiences in the transference and counter-transference dimension. This allows the therapist to experience anxieties related to primary sensory experiences. By relying on the counter-transferential resonance of the patient's various anxieties, a shared sensoriality helps to metabolize the experiences of primitive catastrophe that have hindered the organization of a continuous feeling of existing. This therapeutic dynamic opens up new psychic and relational perspectives.

La sensorialidad tiene varias funciones en la elaboración psíquica del individuo autista y en su evolución psíquica durante la asistencia terapéutica. Seguimos en esta investigación la idea de la transformación de un uso defensivo de la sensorialidad en un proceso mutativo, de una construcción del yo corporal, así como de un trabajo de simbolización primaria, inscripción, representación y figurabilidad. Con la psicoterapia de un niño autista en una institución, exploramos las funciones de la sensorialidad a partir de la particular atención prestada a las experiencias corporales en la dimensión transferencial y contratransferencial. Este trabajo le permite al terapeuta experimentar ansiedades relacionadas con las experiencias sensoriales primarias. Apoyándose en la resonancia contratransferencial de las diversas angustias del paciente, una sensorialidad compartida ayuda a metabolizar las experiencias de catástrofe primitiva que han impedido la organización de un sentimiento continuo de existir. Esta dinámica terapéutica abre nuevas perspectivas psíquicas y relacionales.

Directed differentiation of human induced pluripotent stem cells into midbrain / 南方医科大学学报

OBJECTIVE@#To establish an efficient protocol for directed differentiation of human induced pluripotent stem cells (hiPSCs) into functional midbrain dopaminergic progenitor cells (DAPs) in vitro.@*METHODS@#hiPSCs were induced to differentiate into DAPs in two developmental stages. In the first stage (the first 13 days), hiPSCs were induced into intermediate cells morphologically similar to primitive neuroepithelial cells (NECs) in neural induction medium containing a combination of small molecule compounds. In the second stage, the intermediate cells were further induced in neural differentiation medium until day 28 to obtain DAPs. After CM-DiI staining, the induced DAPs were stereotactically transplanted into the right medial forebrain bundle (MFB) of rat models of Parkinson's disease (PD). Eight weeks after transplantation, the motor behaviors of PD rats was evaluated. Immunofluorescence assay of brain sections of the rats was performed at 2 weeks after transplantation to observe the survival, migration and differentiation of the transplanted cells in the host brain microenvironment.@*RESULTS@#hiPSCs passaged stably on Matrigel showed a normal diploid karyotype, expressed the pluripotency markers OCT4, SOX2, and Nanog, and were positive for alkaline phosphatase. The primitive neuroepithelial cells obtained on day 13 formed dense cell colonies in the form of neural rosettes and expressed the neuroepithelial markers (SOX2, Nestin, and PAX6, 91.3%-92.8%). The DAPs on day 28 highly expressed the specific markers (TH, FOXA2, LMX1A and NURR1, 93.3-96.7%). In rat models of PD, the hiPSCs-DAPs survived and differentiated into TH+, FOXA2+ and Tuj1+ neurons at 2 weeks after transplantation. Eight weeks after transplantation, the motor function of PD rats was significantly improved as shown by water maze test (P < 0.0001) and apomorphine-induced rotation test (P < 0.0001) compared with rats receiving vehicle injection.@*CONCLUSION@#HiPSCs can be effectively induced to differentiate into DAPs capable of differentiating into functional neurons both in vivo and in vitro. In rat models of PD, the transplanted hiPSCs-DAPs can survive for more than 8 weeks in the MFB and differentiate into multiple functional neurocytes to ameliorate neurological deficits of the rats, suggesting the potential value of hiPSCs-DAPs transplantation for treatment of neurological diseases.

Bilineage embryo-like structure from EPS cells can produce live mice with tetraploid trophectoderm

Self-organized blastoids from extended pluripotent stem (EPS) cells possess enormous potential for investigating postimplantation embryo development and related diseases. However, the limited ability of postimplantation development of EPS-blastoids hinders its further application. In this study, single-cell transcriptomic analysis indicated that the "trophectoderm (TE)-like structure" of EPS-blastoids was primarily composed of primitive endoderm (PrE)-related cells instead of TE-related cells. We further identified PrE-like cells in EPS cell culture that contribute to the blastoid formation with TE-like structure. Inhibition of PrE cell differentiation by inhibiting MEK signaling or knockout of Gata6 in EPS cells markedly suppressed EPS-blastoid formation. Furthermore, we demonstrated that blastocyst-like structures reconstituted by combining the EPS-derived bilineage embryo-like structure (BLES) with either tetraploid embryos or tetraploid TE cells could implant normally and develop into live fetuses. In summary, our study reveals that TE improvement is critical for constructing a functional embryo using stem cells in vitro.

Tumor neuroectodérmico primitivo periférico de riñón, reporte de caso

Introducción: El tumor neuroectodérmico primitivo periférico de riñón (PNETk) es una enfermedad rara muy agresivo que afecta mayormente a varones jóvenes. Reporte de caso: paciente varón de 19 años con cuadro clínico dolor abdominal, hematuria y masa palpable, en la tomografía se evidencia una enorme tumoración renal izquierda, Se le realiza nefrectomía radical convencional y se envía a estudio patológico más histoquímica resultando de PNETk. Luego paciente siguió su manejo por oncología para quimiterapia inicialmente. Conclusión: El PNETk que describimos representa el primer caso reportado en nuestro país, constituye una entidad clínica única por su rareza siendo un reto hacer diagnóstico y su comportamiento y manejo se sigue basando a reportes de casos debido a su poca frecuencia.

Introduction: Peripheral primitive neuroectodermal tumor of the kidney (PNETk) is a very aggressive rare disease that mainly affects young men. Case report: A 19-year-old male patient with symptoms of abdominal pain, hematuria and a palpable mass, the tomography shows a large left renal tumor. Conventional radical nephrectomy was performed and sent for pathology study plus histochemistry, resulting in PNETk. The patient then continued his oncology management for chemotherapy initially. Conclusion: The PNETk that we describe represents the first case reported in our country, it constitutes a unique clinical entity due to its rarity, being a challenge to make a diagnosis and its behavior and management is still based on case reports due to its infrequency.

Ewing sarcoma arising in colon and ovary––Two rare sites of presentation

Ewing sarcoma is a rare aggressive malignant round cell tumor, primarily presenting in bone and soft tissues. This study presents two cases of this tumor in unusual locations, one in right colon which presented with intussusception and other in ovary which presented clinically as carcinoma ovary. Both the cases showed histomorphology of primitive round cell tumor with characteristic immunohistochemical profile and was confirmed on molecular analysis. We aim to highlight the importance of considering Ewing sarcoma in the differential diagnoses in these locations as they have dismal prognosis with no standard treatment modality.

Sacrococcygeal teratoma: A case report

Sacrococcygeal teratomas (SCTs) are the most common extragonadal germ cell tumors, comprised different types of tissues that come from at least two of three germ cell layers. Depending on the tissues that are included, they are divided into mature, immature, and malignant. The incidence of SCT in infants and children is 1 in 35,000–40,000 live births. We are reporting a case of type I SCT. The patient was gravida 3, para 1, and abortion 1, which was diagnosed during antenatal ultrasound examination at 22 weeks of gestation and the termination was done after counseling the parents. A female fetus with a tumor in the sacrococcygeal region, weighing 800 g was delivered. The baby was sent to the department of anatomy. SCTs develop at the base of the coccyx and are thought to be derived from Henson’s node a rounded and elevated area at the cranial end of the primitive streak. This primitive streak consists of totipotent cells, which are able to transform into any type of cells.

Tumor neuroectodérmico primitivo primario de ovario

El tumor neuroectodérmico primitivo del ovario es un sarcoma de tejido blando de células redondas pequeñas, raro y agresivo, de origen neural que generalmente se asocia con una alta morbilidad y mortalidad. La inmunohistoquímica es un complemento útil en el diagnóstico diferencial. Se describe un caso de tumor neuroectodérmico primitivo del ovario en paciente nulípara de 21 años que refería dolor y aumento de la circunferencia abdominal. La ecografía mostró tumoración de contenido heterogéneo sólido-quística que aparentemente se originaba del anexo izquierdo. La resonancia magnética confirmó la presencia de tumoración que se extendía hacia la fosa iliaca izquierda sin afectación de órganos locales ni metástasis regionales o a distancia. Los marcadores tumorales estaban todos dentro del rango normal. Durante la laparotomía se observó tumoración de ovario izquierdo con ovario derecho normal. Se realizó salpingoforectomía izquierda debido al tamaño del tumor, resección en cuña de ovario derecho, linfadenectomía pélvica y omentectomía. El examen histopatológico reveló tumor compuesto por láminas de células redondas. Las células tumorales fueron positivas para cromogranina A, sinatrofisina, vimentina y enolasa específica de neuronas, lo que confirmó el diagnóstico de tumor neuroendocrino primitivo de ovario izquierdo, que se originaba de teratoma quístico inmaduro. La paciente rechazó la quimioterapia postoperatoria.

Primitive neuroectodermal tumor of the ovary is a rare and aggressive small round cell soft tissue sarcoma of neural origin that is usually associated with high morbidity and mortality. Immunohistochemistry is a useful adjunct in the differential diagnosis. We describe a case of a primitive neuroectodermal tumor of the ovary in a 21-yearold nulliparous patient who reported pain and increased abdominal circumference. Ultrasonography showed a solid-cystic heterogeneous tumor apparently originating from the left adnexa. Magnetic resonance imaging confirmed the presence of a tumor extending into the left iliac fossa without local organ involvement or regional or distant metastases. Tumor markers were all within the normal range. During laparotomy, a left ovarian tumor was observed with a normal right ovary. Left salpingo-oophorectomy was performed due the size of the tumor, right ovarian wedge resection, pelvic lymphadenectomy and omentectomy. Histopathologic examination revealed tumor composed of sheets of round cells. The tumor cells were positive for chromogranin A, synaptophysin, vimentin and neuron-specific enolase, which confirmed the diagnosis of a primitive neuroendocrine tumor of the left ovary originating from immature cystic teratoma. The patient refused postoperative chemotherapy.

Embryonal tumor with multilayered rosettes in a teenager

ABSTRACT Background Embryonal tumor with multilayered rosettes (ETMR), NOS/C19MC- altered, is a rare and recently classified highly aggressive malignant brain tumor in the 2021 World Health Organization (WHO) classification of tumors of the central nervous system 5th edition. They are mostly diagnosed in children before the age of three years. Most of them are located in the supratentorial region. Prior to the reclassification of ETMR as a single entity, three distinct tumors, namely, embryonal tumor with abundant neuropil and true rosettes (ETANTR), ependymoblastoma (EBL) and medulloepithelioma (MEPL) were recognized. Recent studies showed that all the three entities have multilayered rosettes on morphology, sharing a common amplification of the C19MC locus at the chromosome 19q13.42 by fluorescence in situ hybridization, and highly specific immunohistochemical staining for LIN28A rendered their reclassification as a single entity. Report: A 13-year-old girl was rushed to the emergency room unconscious, with no return of spontaneous circulation after cardiopulmonary resuscitation. Autopsy revealed a left cerebellar hemisphere hemorrhagic tumor which histopathological examination revealed a multilayered ependymoblastic rosettes with abundant neuropil. The multilayered rosettes showed reactivity for vimentin but non-reactivity for pan-cytokeratin, the zones with abundant neuropil were reactive for synaptophysin consistent with a diagnosis of embryonal tumor with abundant neuropil and true rosettes now ETMR, NOS (WHO Grade 4) due to the lack of genetic testing for amplification of C19MC. Conclusion: ETMR is a highly aggressive CNS embryonal tumor with extremely poor prognosis. It should be considered in the differential diagnosis of pediatric brain tumors. Multilayered rosettes are a useful clue to histologic diagnosis.

Cancers primitifs de l'intestin grêle: épidémiologie, diagnostic et traitement dans un contexte de ressources limitées / Primitive Cancers of small Intestine: Epidemiology, diagnosis and treatment in a context of limited resources

Contexte et objectif. Le but de cette étude était d'étudier les aspects épidémiologiques, histologiques et thérapeutiques des cancers primitifs du grêle. Méthodes. Il s'est agi d'uneétude transversale à visée descriptive sur 10 ans et incluant tous les patients traités pour cancers primitifs de l'intestin grêle. La collecte des données a été rétrospective. Le test de Khi 2 a été utilisé pour la comparaison des données avec un seuil de signifi cation de 5%. Résultats. Cinquante-quatre dossiers de patients ont inclus dans l'étude dont 33 patients de sexe féminin (61,1%). L'âge moyen était de 34,3 ans. Trente-deux patients (59,3 %) ont été admis dans un tableau d'urgence chirurgicale, soit 24 occlusions intestinales aiguës et 8 péritonites aiguës généralisées. Les autres patients ont été admis dans un contexte de masse abdominale douloureuse. Le cancer était localisé sur l'iléon dans 27 cas (50%), sur le jéjunum dans 11 cas (20,3%) et sur le duodénum dans 16 (29,7%) cas. L'adénocarcinome était le type histologique le plus fréquent (35,2%), suivi des tumeurs endocrines (33,3%). Un envahissement local ou métastatique était noté chez 46 patients (85,2%) au moment du diagnostic. Une résection - anastomose a été réalisée dans 29 cas (53,7%) et une dérivation interne dans 19 cas (35,3%). La survie à 1 an était de 70%. Conclusion. Les cancers primitifs de l'intestin grêle sont souvent des adénocarcinomes.Ils surviennent chez des patients jeunesavec une prédominance des localisations iléales.

Bioinformatics analysis of gene expression profile of central nervous system primitive neuroectodermal tumors / 西安交通大学学报(医学版)

【Objective】 To analyze the gene expression profile of central nervous system primitive neuroectodermal tumors （CNS-PNETs） by bioinformatics methods so as to explore the possible pathogenesis of CNS-PNETs at the molecular level. 【Methods】 The gene expression profile of CNS-PNETs was downloaded from the GEO database， GSE35493 and GSE74195. The differentially expressed genes （DEGs） were screened by the online analysis tool of GEO2R and Venn software， DEGs were analyzed by using the online analysis tools of David database， such as Gene Ontology （GO） and pathway enrichment （KEGG）. The protein interaction network analysis （PPI） of CNS-PNETs was made by using STRING online analysis tool， Cytoscape software and its plug-in cytohubba to find the key genes. 【Results】 We obtained 262 DEGs， including 49 upregulated genes and 213 downregulated genes. The analysis of GO function and KEGG signal pathway enrichment showed that DEG was involved in DNA transcription and mitosis， cell division， synaptic signal transmission and other biological processes， and associated with cell cycle， tumor-related pathway， p53 signal pathway， synapsis-related signal pathway， cAMP signal pathway and calcium ion signal pathway. Ten key genes， namely， CDK1， CDC20， MAD2L1， KIF11， ASPM， TOP2A， TTK， NDC80， NUSAP1 and DLGAP5 were screened out by STRING analysis. 【Conclusion】 Ten key genes including CDK1 may play an important role in the initiation and progression of CNS-PNETs， providing new clues for exploring the pathogenesis of CNS-PNETs.

Cervical Primary Ewing's Sarcoma:Report of One Case / 中国医学科学院学报

Ewing's sarcoma in the cervix is characterized by extremely rare occurrence,high degree of malignancy,and rapid progression.The diagnosis of this disease is based on pathology and immunohistochemistry. The main image of the case reported in this paper showed the cervical cyst with solid mass,large volume,and uneven density and signal,and the solid part can be strengthened in enhanced scanning.Because of the rapid growth,the lesion is prone to liquefaction necrosis and bleeding.Since the metastasis occurs early,timely diagnosis is essential.

Regressões em análise: contribuições de Ferenczi e Balint para a técnica psicanalítica / Regressions in psychoanalysis: Ferenczi's and Balint's contributions to the psychoanalytic technique / Regresiones en análisis: contribuciones de Ferenczi y Balint a la técnica psicoanalítica

Na clínica psicanalítica contemporânea temos nos defrontado, cada vez mais, com impasses técnicos que nos exigem repensar a teoria sobre a técnica psicanalítica. Essa revisão teórica se justifica a partir de uma maior incidência de quadros clínicos cujo dinamismo psíquico não se encontra balizado hegemonicamente pela lógica do recalque, mas pela predominância de outros mecanismos defensivos, como a clivagem/splitting do eu, e formas de expressão não verbais como passagens ao ato e acting outs. Diante da necessidade de reconfigurar alguns parâmetros da técnica psicanalítica, delimitamos como objetivo deste artigo a investigação do tema do manejo clínico das regressões em análise a partir das contribuições teórico-clínicas de Sándor Ferenczi e de seus desdobramentos e avanços propostos Michael Balint. Assim, pretendemos extrair das modificações no dispositivo analítico propostas por esses autores, elementos que nos ajudem a pensar o manejo clínico com pacientes cujo sofrimento remete às falhas traumáticas dos primórdios da constituição subjetiva.

In contemporary psychoanalytic clinic we have faced increasingly technical deadlocks that require to rethink the psychoanalytic technique theory. This situation requires a revision of psychoanalysis technical theory. This theoretical revision is justified by a higher incidence of clinical conditions whose psychic dynamic is not hegemonic marked by the logic of repression, but the predominance of other defensive mechanisms, e.g. splitting, and non-verbal forms of expression such as acting out. Given the need to reconfigure some parameters of the psychoanalytic technique, we set as the objective of this article the investigation of clinical management of regressions under analysis from the theoretical and clinical contributions of Sándor Ferenczi and from developments and advances by Michael Balint. Therefore, from the changes proposed by these authors, we will attempt to extract elements that will help us think different clinical management of patients whose suffering refers to traumatic failures in the early stages of development, in an analytical setting.

En la clínica psicoanalítica contemporánea nos hemos enfrentado, cada vez más, con impases técnicos que nos obligan a repensar la teoría sobre la técnica psicoanalítica. Esta revisión teórica se justifica por una mayor incidencia de cuadros clínicos cuyo dinamismo psíquico no responde a la lógica de la represión, sino por el predominio de otros mecanismos defensivos, como el clivaje / escisión del yo, y formas de expresión no verbal como pasajes al acto y "acting outs". Ante la necesidad de reconfigurar algunos parámetros de la técnica psicoanalítica, el objetivo de este artículo es delinear la investigación del tema del manejo clínico de las regresiones en análisis, a partir de las contribuciones teórico-clínicas de Sándor Ferenczi y sus desdoblamientos y avances en la teoría de Michael Balint. Así, pretendemos extraer, de las modificaciones en el dispositivo analítico propuestas por esos autores, elementos que nos ayuden a pensar sobre el manejo clínico con pacientes cuyo sufrimiento remite a los fracasos traumáticas de los primordios de la constitución subjetiva.

Linfoma cutáneo primario de células B. Presentación de un caso / Primary skin lymphoma of cells B. Presentation of a case / Linfoma de células da pele primária B. Apresentação de um caso

RESUMEN Introducción: el Linfoma cutáneo primario del centro folicular es indolente; la supervivencia es de 95% a cinco años; es el más común de los LCCB (35%). Tiene predilección por varones adultos mayores. Se manifiesta con pápulas, placas y tumores solitarios o agrupados principalmente en la piel cabelluda, la frente y el tronco. El objetivo de este trabajo es la presentación del caso por lo inusual de aparición en esta localización y ser el 1ero en nuestro servicio y provincia. Caso clínico: paciente JVL de 58 años de edad, que se interconsulta con los médicos del servicio de Dermatología por presentar lesiones en cuero cabelludo de 3 meses de evolución. Examen físico: Presenta lesiones localizadas en el cuero cabelludo, tumorales en número de 4 redondeadas eritemato violáceas de centro ulcerado con secreción serohemáticas y telangiectasias en su superficie las cuales eran dolorosas. Adenopatías múltiples, pequeñas, movibles en región cervical bilaterales. Se le realizó estudio histopatológico de los tumores para confirmar el diagnóstico clínico planteado. Discusión: los linfomas son tumores malignos del sistema linforreticular, representan un 25% del total de los LCP. Esta neoplasia aparece fundamentalmente entre los 40 y 60 años y es 2,2 veces más frecuente en el sexo masculino que en el femenino, en nuestro caso la paciente tenía 58 años de edad. Si bien es cierto que esta patología es infrecuente, en nuestro caso aparece en mujer con lesiones en cuero cabelludo en una de las localizaciones menos reportada, pero con las lesiones clásicas de los linfomas cutáneos primarios de células B, la tendencia a las ulceraciones se pueden encontrar en la forma centro folicular y en los linfomas difuso de células B como en nuestro caso. Conclusiones: realizamos esta presentación de linfoma cutáneo primario de células B enfermedad infrecuente que se ve mayormente en sexo masculino sin embargo en su variedad difuso se observa más frecuente en mujer en cuero cabelludo de forma ulcerada como apareció en nuestro caso y por ser el primero diagnosticado nuestra provincia.

ABSTRACT Introduction: the primary cutaneous lymphoma of the follicular center is indolent; 95% survival over five years; is the most common LCCB (35%). They have a predilection for larger adult males. It manifests with papules, plaques and solitary tumors or grouped mainly in the skinned hair, in front of the trunk. The purpose of this work is the presentation of the case due to the unusual appearance in this location and to be the first in our service and province. Clinical case: JVL patient of 58 years of age, who is consulted with doctors at the Dermatology service for presenting injuries in the hair of 3 months of evolution. Physical examination: There are lesions located in the hair, tumors in the number of 4 rounded violet erythema of the ulcerated center with serohemic secretion and telangiectasias on their surface that are painful. Multiple, small adenopathies, movable in bilateral cervical region. The histopathological study of the tumors was carried out to confirm the planted clinical diagnosis. Discussion: lymphomas are malignant tumors of the lymphorecticular system, representing 25% of the total PCL. This neoplasm appears fundamentally between 40 and 60 years and 2.2 times more often in men than in women, in case the patient had 58 years of age. If I believe that this pathology is unheard of, in one case it appears in many with lesions in the hair in one of the least reported locations, but with the classic lesions of primary cutaneous B-cell lymphomas, the tendency to ulcers is reduced. find in the form of follicular center and diffuse B-cell lymphomas as in this case. Conclusions: we present this presentation of primary cutaneous B-cell lymphoma that is infrequently ill, seen mostly in men, but in a diffuse variety, it is observed more frequently in the hair in an ulcerated form as it appears in our case and because it is the first diagnosed in our province.

RESUMO Introdução: o linfoma cutâneo primário do centro folicular é indolente; a sobrevivência é de 95% em 5 anos; é o mais comum dos LCCBs (35%). Ele tem predileção por homens adultos mais velhos. Manifesta-se na forma de pápulas, placas e tumores, solitários ou agrupados, principalmente no couro cabeludo, testa e tronco. O objetivo deste trabalho é apresentar o caso devido à sua peculiaridade neste local e ser o primeiro em nosso serviço e província. Caso clínico: paciente JVL, 58 anos, que é consultado pelos médicos do serviço de Dermatologia por apresentar lesões no couro cabeludo com 3 meses de evolução. Exame físico: Apresenta lesões localizadas no couro cabeludo, tumores em número de 4 eritematosos violáceos arredondados com centro ulcerado com secreções cerimônicas e telangiectasias dolorosas na superfície. Linfadenopatia múltipla, pequena e móvel na região cervical, bilateral. O estudo histopatológico dos tumores foi realizado para confirmação do diagnóstico clínico. Discussão: linfomas são tumores malignos do sistema reticular linfático, correspondendo a 25% de todos os LCP. Essa neoplasia surge principalmente entre 40 e 60 anos e é 2,2 vezes mais frequente em homens do que em mulheres, em nosso caso o paciente tinha 58 anos. Embora seja verdade que essa patologia não seja frequente, em nosso caso ela aparece em mulheres com lesões no couro cabeludo em uma das localizações menos relatadas, mas com as lesões clássicas dos linfomas cutâneos primários de células B, a tendência à ulceração é pode ser encontrado no centro folicular e nos linfomas difusos de células B, como em nosso caso. Conclusões: apresentamos esta apresentação do linfoma cutâneo primário de células B, uma doença rara observada principalmente no sexo masculino, mas em sua variedade difusa é observada mais frequentemente em mulheres no couro cabeludo de forma ulcerada como apareceu em nosso caso e por seja o primeiro diagnóstico em nossa província.

Pandemia e trabalho psicanalítico, do presencial ao remoto: contato com a vida dos estados primitivos da mente em contexto de viralização de angústias / Pandemic and psychoanalytic work, from face-to-face to remote: contact with primitive states of mind in the context of spread of anxieties / Pandemia y trabajo psicoanalítico, del cara a cara a lo remoto: contacto con la vida de estados primitivos de la mente en el contexto de la viralización de las ansiedades / Pandémie et travail psychanalytique, du face-à-face au télétravail: contact avec la vie des états primitifs de l'esprit dans le contexte de la viralité des angoisses

RESUMO Movimentos da clínica psicanalítica em sua possível plasticidade serão aqui considerados, a partir da convocação de novas modalidades de atendimento além do presencial físico, mobilizadas pela pandemia de 2020. Serão discutidos o trânsito entre diferentes tipos de comunicação, a intensificação do desenvolvimento da associatividade, a presença viva de um repertório em constituição como "corpo-envoltório" do vínculo e a participação dos envolvidos na reconstrução da cena clínica como recurso essencial para o trabalho com o sofrimento psíquico, quando nosso próprio senso de continuidade e integração é posto à prova pela inesperada ruptura do enquadre habitual.

ABSTRACT Movements of the psychoanalytic clinical practice in its possible plasticity will be considered here, from new ways of working beyond the physical face-to-face setting, brought by the 2020 pandemic. The transit between different types of communication will be discussed, as well as the intensification of the development of associativity, the living presence of a repertoire in constitution as a "body-wrap" of the bond and the participation of those involved in the reconstruction of the clinical scene as an essential resource for working with psychic suffering, when our own sense of continuity and integration is challenged by the unexpected rupture of the usual framework.

RESUMEN Los movimientos de la clínica psicoanalítica en su posible plasticidad se considerarán aquí, desde la convocatoria de nuevas modalidades de atención más allá de lo físico presencial, movilizadas por la pandemia de 2020. Se debatirá el tránsito entre diferentes tipos de comunicación, la intensificación del desarrollo de la asociatividad, la presencia viva de un repertorio en la constitución como un "cuerpo-envoltura" del vínculo y la participación de los involucrados en la reconstrucción de la escena clínica como un recurso esencial para trabajar con el sufrimiento psíquico, cuando nuestro propio sentido de continuidad e integración se pone a prueba por la ruptura inesperada del marco habitual.

RÉSUMÉ Les mouvements de la clinique psychanalytique dans sa possible plasticité seront envisagés ici, à partir de la convocation de nouvelles modalités de soins au-delà du face-à-face physique, mobilisées par la pandémie de 2020. Il sera discuté du transit entre les différents types de communication, de l'intensification du développement de l'associativité, la présence vivante d'un répertoire en élaboration comme un « corps-enveloppe ¼, du lien et de la participation des personnes impliquées dans la reconstruction de la scène clinique en tant qu'une ressource essentielle pour travailler la souffrance psychique, lorsque notre propre sens de la continuité et de l'intégration est mis à l'épreuve par la rupture inattendue du cadre habituel.

Desbravando vivências mentais primitivas: uma clínica psicanalítica do terror / Revealing primitive mental experiences: a psychoanalytical clinic of terror / Descubriendo experiencias mentales primitivas: una clínica psicoanalítica de terror / Dévoiler les expériences mentales primitives: une clinique psychanalytique de la terreur

Este trabalho pretende pensar sobre os desafios da psicanálise contemporânea. A análise da parte primitiva da mente, proposta por Bion com base em ideias desenvolvidas por Melanie Klein, traz novas técnicas para a psicanálise. O autor enfatiza que é na análise pessoal do analista, de seus próprios horrores, que se desenvolvem recursos para que seja possível trabalhar e expandir a mente do analisando, com base na contenção e transformação ativa, pela dupla analítica, dessas vivências primitivas de terror.

This work intends to think about the challenges of contemporary psychoanalysis. The analysis of the primitive part of the mind, proposed by Bion based on ideas developed by Melanie Klein, brings new techniques to psychoanalysis. The author emphasizes that personal analysis of the analyst's own horrors is developing resources so that it is possible to work and expand the mind of the analysand, from the contention and active transformation, by the analytical pair, of these primitive experiences of terror.

Este trabajo pretende pensar en los desafíos del psicoanálisis contemporáneo. El análisis de la parte primitiva de la mente, propuesto por Bion a partir de ideas desarrolladas por Melanie Klein, aporta nuevas técnicas al psicoanálisis. El autor enfatiza que es en el análisis personal de los propios horrores del analista que se desarrollan los recursos para que sea posible trabajar y expandir la mente del analizando, a partir de la contención y la transformación activa, por el par analítico, de estas experiencias primitivas de terror.

Ce travail entend réfléchir aux enjeux de la psychanalyse contemporaine. La psychanalyse de la partie primitive de l'esprit, proposée par Bion à partir des idées développées par Mélanie Klein, apporte de nouvelles techniques à la psychanalyse. L'auteur déclare que c'est dans l'analyse personnelle des propres horreurs de l'analyste que les ressources sont développées de sorte qu'il est possible de travailler et d'élargir l'esprit de l'analysant, à partir de la contention et de la transformation active, par le couple analytique, de ces expériences primitives de terreur.

O trauma em Ferenczi e seus desdobramentos nas obras de Balint e Winnicott: regressões em análise e seu manejo clínico / Trauma in Ferenczi and its unfoldings in the works of Balint and Winnicott: regressions under analysis and their clinical handling / El trauma en Ferenczi y sus desdoblamientos en las obras de Balint y Winnicott: regresiones en análisis y su manejo clínico

O objetivo deste artigo é investigar a problemática do trauma a partir das contribuições teórico-clínicas de Sándor Ferenczi e dos seus desdobramentos e avanços nas teorias de Michael Balint e Donald Winnicott. Assim, pretendemos explorar as proximidades e diferenças conceituais entre estes autores, principalmente em relação ao papel do ambiente na experiência traumática, das defesas primitivas que são acionadas neste caso e do aspecto terapêutico das regressões em análise. Além dessa diferenciação, buscaremos extrair das modificações no dispositivo analítico propostas por esses autores elementos que nos ajudem a pensar o manejo clínico com pacientes cujo sofrimento remete às falhas traumáticas dos primórdios da constituição subjetiva.

This article aims to investigate the discussion of trauma theory from the theoretical-clinical contributions of Sándor Ferenczi and the developments and advances held by the theories of Michael Balint and Donald Winnicott. Thus, we intend to explore the proximities and the conceptual differences of these authors, especially in relation to the role of the environment in the traumatic experience, the primitive defenses that are put into action and the therapeutic aspect of the regressions under analysis. Besides this differentiation, we will try to extract from the modifications in the analytical setting proposed by these authors, elements that will help us to think about the clinical handling of patients whose suffering refers to traumatic failures in the early stages of development.

El objetivo de este artículo es investigar la problemática del trauma a partir de las contribuciones teórico-clínicas de Sándor Ferenczi y sus desdoblamientos y avances en las teorías de Michael Balint y Donald Winnicott. Así, pretendemos explorar la proximidad y las diferencias conceptuales de estos autores, principalmente, en relación al papel del ambiente en la experiencia traumática, de las defensas primitivas que se accionan y del aspecto terapéutico de las regresiones en análisis. Además de esta diferenciación, buscaremos extraer, de las modificaciones en el dispositivo analítico propuestas por esos autores, elementos que nos ayuden a pensar el manejo clínico con pacientes cuyo sufrimiento remite a los fracasos traumáticas de los primordios de la constitución subjetiva.

Persistent vomiting, an alarm sign in children

Brain tumors, the second common cancer following hematological malignancies account for up to 21% of all malignancies below 14 years of age. Medulloblastoma is a common form of Primitive neuro ectodermal tumor and likely arise from either the external granular layer (e.g., desmoplastic variant) or the subependymal matrix cells of the fourth ventricle (e.g., classic variant), or both. The clinical course of the disease is aggressive in children than in adults. The tumor can invade the CSF through the ventricles or even cause metastases to bones and lymph node. With the emergence of advanced technologies and treatment facilities, the morbidity and mortality of the disease is greatly improved with a five-year survival of up to 75%. However, the presence of disease in children <3 years or evidence of dissemination on diagnosis carries poor prognosis. Here we are discussing a case of 5-year-old girl who presented to OPD with vomiting for 1 month.

Sarcoma de Ewing extraesquelético subcutáneo primario / PNET. Reporte de caso y revisión de la literatura / Primary subcutaneous extraskeletal Ewing's sarcoma (PNET). A case report and literatura review

Resumen La familia de tumores del Sarcoma de Ewing (ES) es un grupo poco habitual de neoplasias malignas que pueden localizarse en regiones: óseas como extraóseas. El tumor neuroectodérmico primitivo (PNET), muestra más diferenciación neuronal que el Sarcoma de Ewing (ES) y rara vez se presenta en piel y tejidos subcutáneos. Ocasionalmente se presenta como un cáncer de piel primario, que tiene como características clínicas: una tumoración superficial, en promedio mide 2-3 cm, de consistencia blanda, móvil y algunas veces dolorosa. Los lugares más afectados son espacios paravertebrales, extremidades inferiores, cabeza, cuello y pelvis. Describimos el caso de un varón de 13 años, con 2 tumores superficiales en cuero cabelludo, el examen histológico presentaba una proliferación de células de pequeño tamaño, basófilas, monomorfas; con perfil inmunohistoquímico FLI1 positivo, compatible con PNET.

Summary Ewing´s sarcomas are a less common malignant neoplasms that can be located both in skeletal and extra skeletal areas. The primitive neuroectodermic tumor (PNET) shows more neuronal differentiation than Ewing´s sarcoma and rarely invades the skin and soft tissues. This tumor occasionally presents as a primary skin cancer which has distinctive features such as a superficial tumor with a 2-3 cm, soft, mobile and eventually painful. Most affected areas of the body are paravertebral spaces, lower limbs, head, neck and pelvis. We report here the case of a 13 year old male presenting with 2 superficial tumors located on the scalp, the histo pathological examination revealed a proliferation of small, basophilic and monomorphic cells that showed FLI1 positive immunohistochemistry pattern compatible with PNET.

Improvement on the methods about the primary culture of rat brain microvascular endothelial cells and identification / 解剖学报

Objective To improve the method about the primary culture of rat brain microvascular endothelial cells in vitro. Methods The SD rats aged from 4 to 6 weeks were chosen as research object. After craniotomy, washing and cutting, sieving, density gradient concentration of BSA, digestion of type II collagenase and collagenase dispersive enzyme twice, the primary culture was carried out. The target cells were indentified by morphological abservation and immunocytochemical staining of facter VI. Results Cultured for 12 to 24 hours,the cells in vitro migrated outward from the microvascular section. The cells appeared polygonal-shaped, and proliferated in a clustered monolayer, the cell growth density reached 70% - 80% of the bottle bottom after 3 days, and arranged like cobbles. The correlation antigen of VI factor was positive, they reached confluence with over purity 99%. Conclusion The method is available that can successfully separate and cultivate microvascular endothelial cells of rat brains in vitro.