ABSTRACT
As neoplasias astrocitárias correspondem a 60 por cento dos tumores do sistema nervoso central, sendo o estudo da biologia molecular um importante passo para a compreensão da gênese e comportamento biológico destas doenças. As proteínas Ki-67, que é um marcador de proliferação celular, e p53, que é o produto do gene supressor de tumor de mesmo nome, são importantes marcadores tumorais. O objetivo deste estudo foi identificar e quantificar as proteínas Ki-67 e produto do gene supressor de tumor TP53 em diferentes graus de malignidade das neoplasias astrocitárias, bem como analisar suas relações com idade e sexo. Foram estudadas por imuno-histoquímica as proteínas Ki-67 e p53 em 47 pacientes com neoplasias astrocitárias ressecadas cirurgicamente, classificadas previamente e revisadas quanto ao grau de malignidade, de acordo com o proposto pela Organização Mundial da Saúde. Os núcleos celulares imunomarcados foram quantificados no programa Imagelab-softium pela razão paramétrica absoluta entre os núcleos de células positivas e o número total de células tumorais, sendo contadas 1000 células. O delineamento utilizado foi transversal não controlado. Para análise estatística as variáveis foram divididas em grupos, que para a Ki-67 foram ausente, <5 por cento e >5 por cento e para a p53 foram ausente (0), <25 por cento (1+), entre 25 e 50 por cento (2+), entre 50 e 75 por cento (3+) e maior que 75 por cento (4+). Ki-67 esteve presente em 37 casos (78,72 por cento) expressando correlação com maior grau de malignidade (p<0,001) . A p53 esteve presente em 14 casos (35,13 por cento) tendo maior correlação com astrocitoma grau IV (p=0,59). Não houve correlação estatisticamente significativa entre p53 e Ki-67, bem com entre estas variáveis, idade e sexo. Concluiu-se que a hipótese de maior presença de Ki-67 e p53 em neoplasias astrocitárias de maior grau de malignidade, com exceção da correlação entre grau III e p53, é corroborada pelos resultados deste estudo.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Astrocytoma/chemistry , Central Nervous System Neoplasms/chemistry , /analysis , /analysis , Cross-Sectional Studies , Immunohistochemistry , Retrospective Studies , /geneticsABSTRACT
We present a case of a severe head injured 23 year-old male patient. The initial CT scan disclosed bilateral epidural hematoma, isodense with the brain, thus being a pitfall in diagnosis. Brief case report, image and literature review are presented.
Apresentamos o caso de um homem de 23 anos com traumatismo craniano grave. A TC de crânio demonstrou um volumoso hematoma epidural bilateral, isodenso com o cérebro, sendo uma armadilha ao diagnóstico. São apresentados um breve relato, estudo da imagem tomográfica e revisão da literatura.
Subject(s)
Humans , Adult , Male , Brain , Hematoma, Epidural, Cranial , Skull Fractures , Glasgow Coma Scale , Tomography, X-Ray ComputedABSTRACT
The astrocytic neoplasms respond by 60% of the central nervous system tumors, being the study of the molecular biology an important step for the understanding of the genesis and biological behavior of these diseases. The Ki-67 proteins, which are markers of the cellular proliferation, and p53, which is the product of the tumor suppressor gene TP53, are both important tumoral markers. This study intends to identify and quantify the Ki-67 and p53 proteins in astrocytic tumors of different grades of malignancy, as well as to analyze their relations with age and gender. Ki-67 and p53 proteins in 47 patients with surgically resected astrocytic neoplasms were studied through immunohistochemistry. They have been previously classified and reviewed concerning their histological grade, as suggested by the World Health Organization. The immunomarked cellular nuclei were quantified by the program Imagelab-softium for the absolute parametric reason between the nuclei of the positive cells and the total amount of tumoral cells, being counted 1000 cells. The lineation used has been transversal not controlled. For the statistical analysis the variables were divided into groups. For the Ki-67 they were absent, <5% and >5% and for p53 they were absent (0), <25% (1+), between 25 and 50% (2+), between 50 and 75% (3+), and higher than 75% (4+). Ki-67 was present in 37 cases (78.72%) evidencing a correlation with a higher malignancy degree (p<0,001). p53 was present in 14 cases (35.13%) with a higher correlation with astrocytoma grade IV (p=0.59). There has not been a statistically significant correlation between p53 and Ki-67, as well as among these variables, age and gender. The hypotheses of a greater presence of Ki-67 and p53 in astrocytic neoplasms with a higher degree of malignancy, except for the correlation between grade III and p53, is corroborated by the results of this study.
Subject(s)
Astrocytoma/chemistry , Central Nervous System Neoplasms/chemistry , Ki-67 Antigen/analysis , Tumor Suppressor Protein p53/analysis , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Immunohistochemistry , Male , Middle Aged , Retrospective Studies , Tumor Suppressor Protein p53/geneticsABSTRACT
The purpose of this article is to describe the clinical and pathological features of metastatic angiosarcoma in the central nervous system. Only a few cases of cerebral metastasis from angiosarcoma of the heart have been recorded in the literature; particularly related to intracerebral hemorrhage. A case of secondary cerebral angiosarcoma of the heart in a 33 years old man is presented. The initial symptoms were headache, vomiting, lethargy and aphasia. There was a mass in the left temporal lobe with hemorrhage and edema on the computerized tomography (CT). After 24 hours the neurological status worsened and another CT scan showed rebleeding on the tumor area. He underwent an emergency craniotomy but died two days after. Considering the longer survival of sarcoma patients with new modalities of treatment, the incidence of brain metastasis may increase, demanding a better preventive and more aggressive approach. Besides, due to the hemorrhagic nature of such lesions, we suggest the immediate surgery to prevent a fast and lethal evolution because rebleeding.
Subject(s)
Brain Neoplasms/secondary , Cerebral Hemorrhage/etiology , Heart Neoplasms/pathology , Hemangiosarcoma/secondary , Adult , Brain Neoplasms/diagnostic imaging , Fatal Outcome , Hemangiosarcoma/diagnostic imaging , Humans , Male , Temporal Lobe/diagnostic imaging , Temporal Lobe/pathology , Tomography, X-Ray ComputedABSTRACT
We report the case of a 32 years old male patient with carotid-cavernous fistula caused by head injury who died from massive epistaxis. Treatment assessment of this case is faced with the literature.
Subject(s)
Carotid-Cavernous Sinus Fistula/etiology , Craniocerebral Trauma/complications , Epistaxis/etiology , Adult , Carotid-Cavernous Sinus Fistula/diagnostic imaging , Carotid-Cavernous Sinus Fistula/therapy , Embolization, Therapeutic/adverse effects , Epistaxis/therapy , Fatal Outcome , Humans , Male , Radiography , Treatment FailureABSTRACT
The cavernous sinus is most frequently involved by septic thrombosis. The common sites of primary infection are the medial face, orbits, tonsils, soft palate, sphenoid and ethmoid sinuses. The usual clinical presentation begins with fever and periorbital edema followed by headache, ptosis and ocular muscles palsy. The diagnosis is usually made on clinical grounds. Treatment consists of eradication of the primary source of infection and the administration of antibiotics and anticoagulants. We report six cases of septic thrombosis of cavernous sinus.
