Hematoma de bainha dos retos / Hematoma of the rectus abdominis sheaths

Os autores relatam sua experiência com 4 casos de hematoma de bainha dos retos, analisando o diagóstico e a conduta terapêutica

Flow cytometric analysis of primary and metastatic bladder cancer.

A total of 22 patients with high grade P2-4N+ transitional cell carcinoma of the bladder underwent flow cytometric analysis of nuclei obtained from paraffin embedded specimens from the primary (bladder) and metastatic (lymph node) sites. Tumor heterogeneity was defined as polyclonal aneuploidy of the primary tumor (not identified in the population studied) or as a difference in the deoxyribonucleic acid index of the primary and metastatic sites of 0.20 or more (8 patients). With these criteria 8 patients (36%) had heterogeneous tumors and 14 (64%) had homogeneous tumors. The median survival of 14 patients with aneuploid and 8 with diploid primary tumors was 17.5 and 8.0 months, respectively (p equals 0.08, Lee-Desu test). When patient survival was compared to the ploidy of the metastatic site, or in patients with diploid primary and metastatic lesions versus deoxyribonucleic acid aneuploidy at either the primary and/or metastatic site, the aneuploid tumors had a longer survival but this difference was not significant (p equals 0.13 and 0.23, respectively). Our study demonstrates the value of flow cytometry to identify primary metastatic tumor heterogeneity. It also suggests that the presence of metastasis may be a more important factor to define the biological potential of transitional cell carcinoma than is deoxyribonucleic acid ploidy.

Anti-endomysial antibodies. A serologic marker of dermatitis herpetiformis.

Direct immunofluorescence (IF) studies of skin biopsies are of value in the diagnosis of most, but not all, cases of dermatitis herpetiformis (DH). Similarly, histologic studies are of help but may be questionable or completely nonspecific. Serologic studies for the presence of IgA-class anti-endomysial antibodies are very specific and are found in 70% of patients with DH and in all untreated patients with celiac disease. The titers of these antibodies are directly associated with the degree of gut disease in these patients. Thus, the presence of these antibodies even in the absence of classic direct IF and histologic findings are diagnostically important. We encountered three cases in which both direct IF and histologic studies were equivocal toward confirming the clinical diagnosis of DH. Serologic studies for the presence of IgA-class anti-endomysial antibodies provided evidence for the diagnosis of DH, and, in each case, results were confirmed by further direct IF studies. Since these antibodies are disease specific for DH and celiac disease and are found in most active cases of DH, they may be considered an adjunct to the direct IF and histologic studies of the skin.

Mucoepidermoid carcinoma of salivary glands.

We reviewed the pathologic slides and clinical data of 44 patients with mucoepidermoid carcinomas of major and minor salivary glands. There were 14 well-differentiated, 20 intermediate, and ten poorly differentiated tumors. Two tumors appeared to have only expansive growth. All of the others were invasive, and we identified two patterns of invasion: broad pushing borders and infiltrative permeation. Infiltrative permeation was seen in 13 of 34 well-differentiated and intermediate tumors of which four (31%) metastasized, and in eight of ten poorly differentiated tumors of which five (63%) metastasized. Six of the nine patients with metastases died of carcinoma. Three patients who died with well-differentiated or intermediate tumors survived 10.5 years after diagnosis. Three patients died of poorly differentiated carcinoma less than one year after diagnosis. No patient died of local disease only, and no tumor with a broad pushing border metastasized. Size of tumor, site of origin, tumor cell mitotic rate, and age and sex of the patient had little, if any, effect on prognosis. A combination of tumor differentiation and pattern of invasion were the most useful factors in predicting carcinoma behavior.

Adenosquamous carcinoma of prostate.

A case is reported of metastatic adenosquamous carcinoma that developed in a patient one year after diagnosis of adenocarcinoma of the prostate by transurethral resection of the prostate (TURP). Prostatic origin of the neoplasm was proved by immunoperoxidase staining for prostatic acid phosphatase in the metastases as well as demonstration of both glandular and squamous differentiation in tumor within the prostate on repeat TURP. This change in tumor differentiation occurred despite the fact that the patient had received no estrogen or radiation. The metastases showed remarkable response when the patient later began diethylstilbestrol (DES) therapy.

Concurrent renal tuberculosis and contralateral transitional cell carcinoma of the renal pelvis: a case report.

We report a case of 2 concurrent serious renal problems in opposite kidneys. The patient presented with gross hematuria, which resulted in a diagnosis of transitional cell carcinoma of the renal pelvis and tuberculosis of the contralateral kidney. Intraoperative nephroscopy allowed for appropriate diagnosis and surgical therapy.