ABSTRACT
We present the case of a 75-year-old patient diagnosed with malaria, a native of Zaragoza, Spain, despite having no travel history to malaria-endemic regions. Following an extensive investigation, transfusion emerged as the most probable mode of transmission.
ABSTRACT
Immune checkpoint blockade (ICB) is a promising cancer therapy; however, resistance often develops. To learn more about ICB resistance mechanisms, we developed IRIS (Immunotherapy Resistance cell-cell Interaction Scanner), a machine learning model aimed at identifying candidate ligand-receptor interactions (LRI) that are likely to mediate ICB resistance in the tumor microenvironment (TME). We developed and applied IRIS to identify resistance-mediating cell-type-specific ligand-receptor interactions by analyzing deconvolved transcriptomics data of the five largest melanoma ICB therapy cohorts. This analysis identifies a set of specific ligand-receptor pairs that are deactivated as tumors develop resistance, which we refer to as resistance deactivated interactions (RDI). Quite strikingly, the activity of these RDIs in pre-treatment samples offers a markedly stronger predictive signal for ICB therapy response compared to those that are activated as tumors develop resistance. Their predictive accuracy surpasses the state-of-the-art published transcriptomics biomarker signatures across an array of melanoma ICB datasets. Many of these RDIs are involved in chemokine signaling. Indeed, we further validate on an independent large melanoma patient cohort that their activity is associated with CD8+ T cell infiltration and enriched in hot/brisk tumors. Taken together, this study presents a new strongly predictive ICB response biomarker signature, showing that following ICB treatment resistant tumors turn inhibit lymphocyte infiltration by deactivating specific key ligand-receptor interactions.
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Pathologists need to compare histopathological images of normal and diseased tissues between different samples, cases, and species. We have designed an interactive system, termed Comparative Pathology Workbench (CPW), which allows direct and dynamic comparison of images at a variety of magnifications, selected regions of interest, as well as the results of image analysis or other data analyses such as scRNA-seq. This allows pathologists to indicate key diagnostic features, with a mechanism to allow discussion threads amongst expert groups of pathologists and other disciplines. The data and associated discussions can be accessed online from anywhere in the world. The Comparative Pathology Workbench (CPW) is a web-browser-based visual analytics platform providing shared access to an interactive "spreadsheet" style presentation of image and associated analysis data. The CPW provides a grid layout of rows and columns so that images that correspond to matching data can be organised in the form of an image-enabled "spreadsheet". An individual workbench can be shared with other users with read-only or full edit access as required. In addition, each workbench element or the whole bench itself has an associated discussion thread to allow collaborative analysis and consensual interpretation of the data. The CPW is a Django-based web-application that hosts the workbench data, manages users, and user-preferences. All image data are hosted by other resource applications such as OMERO or the Digital Slide Archive. Further resources can be added as required. The discussion threads are managed using WordPress and include additional graphical and image data. The CPW has been developed to allow integration of image analysis outputs from systems such as QuPath or ImageJ. All software is open-source and available from a GitHub repository.
ABSTRACT
BACKGROUND: In humans, muscle-invasive bladder cancer (MIBC) is highly aggressive and associated with a poor prognosis. With a high mutation load and large number of altered genes, strategies to delineate key driver events are necessary. Dogs and cats develop urothelial carcinoma (UC) with histological and clinical similarities to human MIBC. Cattle that graze on bracken fern also develop UC, associated with exposure to the carcinogen ptaquiloside. These species may represent relevant animal models of spontaneous and carcinogen-induced UC that can provide insight into human MIBC. RESULTS: Whole-exome sequencing of domestic canine (n = 87) and feline (n = 23) UC, and comparative analysis with human MIBC reveals a lower mutation rate in animal cases and the absence of APOBEC mutational signatures. A convergence of driver genes (ARID1A, KDM6A, TP53, FAT1, and NRAS) is discovered, along with common focally amplified and deleted genes involved in regulation of the cell cycle and chromatin remodelling. We identify mismatch repair deficiency in a subset of canine and feline UCs with biallelic inactivation of MSH2. Bovine UC (n = 8) is distinctly different; we identify novel mutational signatures which are recapitulated in vitro in human urinary bladder UC cells treated with bracken fern extracts or purified ptaquiloside. CONCLUSION: Canine and feline urinary bladder UC represent relevant models of MIBC in humans, and cross-species analysis can identify evolutionarily conserved driver genes. We characterize mutational signatures in bovine UC associated with bracken fern and ptaquiloside exposure, a human-linked cancer exposure. Our work demonstrates the relevance of cross-species comparative analysis in understanding both human and animal UC.
Subject(s)
Carcinoma, Transitional Cell , Cat Diseases , Dog Diseases , Urinary Bladder Neoplasms , Humans , Animals , Cats , Cattle , Dogs , Urinary Bladder Neoplasms/genetics , Carcinogens , MusclesABSTRACT
Primary cutaneous and mucosal melanoma shows a wide histological spectrum. The correct diagnosis depends upon the demonstration of melanocytic differentiation by recognition of an associated in-situ component or immunohistochemical evidence of a melanocytic phenotype using conventional melanocytic markers, such as S-100, SOX10, Melan-A and HMB-45. Exceptionally, melanomas lose their melanocytic phenotype, at least focally, and show differentiation towards other lineages. Review of the literature shows that de- and trans-differentiation in melanoma is rare but probably under-recognised and under-reported. These often large and frequently ulcerated tumours affect adults and show a wide anatomical distribution, including mucosal sites, although there is a predilection for sun-damaged skin of the head and neck. Histologically, the tumours are biphasic and contain a pre-existing conventional melanoma. The de-differentiated component closely resembles atypical fibroxanthoma, both morphologically and immunohistochemically. Trans-differentiated melanoma may show rhabdomyosarcomatous or spindle cell carcinomatous features. Undifferentiated melanomas are similar tumours in which the conventional melanoma component is absent. Their diagnosis depends entirely upon the clinical context and identification of a classical melanoma driver gene mutation, i.e. BRAF V600E. The diagnosis of these rare and unusual tumours is challenging, and requires thorough tumour sampling and recognition of the background of a pre-existing but often focal conventional melanoma together with molecular analysis.
Subject(s)
Cell Dedifferentiation/physiology , Cell Differentiation/physiology , Melanoma/pathology , Skin Neoplasms/pathology , Skin/pathology , Biomarkers, Tumor/genetics , Biomarkers, Tumor/metabolism , Humans , Melanoma/genetics , Melanoma/metabolism , Mutation , Skin/metabolism , Skin Neoplasms/genetics , Skin Neoplasms/metabolismABSTRACT
Introdução: A cirurgia bariátrica é atualmente o tratamento indicado para a obesidade mórbida e a técnica do bypass gástrico em Y de Roux (BGYR) largamente utilizada em todo o mundo, mesmo para pacientes superobesos. No Brasil, o BGYR é a técnica de escolha da maioria dos cirurgiões bariátricos. As deiscências de anastomose ou da linha de grampeamento estão entre as complicações cirúrgicas mais temidas. Relato de Caso: Paciente com fístula da anastomose gastrojejunal após bypass gástrico em Y de Roux comunicando com a ferida operatória, foi tratado com sucesso com tratamento endoscópico conservador. Após o diagnóstico, o paciente foi submetido à endoscopia digestiva alta em ambiente de centro cirúrgico com passagem de sonda nasoenteral. Onze dias após, foi realizada uma segunda endoscopia com dilatação da anastomose gastrojejunal com vela de Savary-Gillard. A fístula fechou em 21 contando da data de seu diagnóstico. Conclusão: A partir desse relato, conclui-se que a abordagem conservadora de fístulas pós-BGYR em pacientes estáveis com auxílio endoscópico para o posicionamento da sonda nasoenteral e dilatação com vela pode reservar bons resultados terapêuticos para a condução dessa complicação e evitar intervenções cirúrgicas mais complexas.
Introduction: Bariatric surgery is currently the indicated treatment for morbid obesity and the Roux-en-Y gastric bypass (RYGB) technique is widely used worldwide, even for super obese patients. In Brazil, RYGB is the most chosen technique of bariatric surgeons. Although, anastomosis or stapling line dehiscences are one of the most feared surgical complications. Case Report: A patient with gastrojejunal anastomosis fistula after Rouxen-Y gastric bypass communicating with the surgical wound was successfully treated with conservative endoscopic treatment. After diagnosis, the patient underwent upper digestive endoscopy in operating room with introduction of a nasoenteral tube. Eleven days later, a second endoscopy was performed with dilation of the gastrojejunal anastomosis with a Savary-Gilliard bougie. The fistula closed at the day 21 counting from the date of his diagnosis. Conclusion: From this report, it's concluded that the conservative approach of post-RYGB fistulas in stable patients with endoscopic aid for positioning the nasoenteral tube and dilation with a bougie can reserve good therapeutic results for the management of this complication and avoid more surgical interventions complex.
Subject(s)
Humans , Male , Adult , Obesity, Morbid , Gastric Bypass , Anastomotic Leak , Endoscopy, Gastrointestinal , Bariatric Surgery , Conservative TreatmentABSTRACT
Acral melanoma (AM) is a malignant cutaneous melanocytic tumour specifically located on the palms, soles, and nail apparatus, which are areas of glabrous (hairless) skin. Acral lentiginous melanoma, a subtype of AM, represents a histopathological subtype diagnosis of cutaneous melanoma with unique morphological and structural features. Despite clear definitions, the misuse of these terms and the inconsistency in reporting the histopathological features of AM cases have become a major obstacle to the study of the disease. In this review, we discuss the epidemiology, histopathological features, prognosis, and genetic profile of AM, highlighting the differences observed when histopathological subtypes are considered. The increasing global effort to characterise AM cases from ethnically diverse populations would benefit greatly from a more consistent classification of the disease.
Subject(s)
Melanoma , Skin Neoplasms , Animals , Biomarkers, Tumor/genetics , Foot/pathology , Hand/pathology , Humans , Melanoma/epidemiology , Melanoma/genetics , Melanoma/pathology , Nails/pathology , Prognosis , Skin Neoplasms/epidemiology , Skin Neoplasms/genetics , Skin Neoplasms/pathologyABSTRACT
Dedifferentiation and transdifferentiation are rare and only poorly understood phenomena in cutaneous melanoma. To study this disease more comprehensively we have retrieved 11 primary cutaneous melanomas from our pathology archives showing biphasic features characterized by a conventional melanoma and additional areas of de-/trans-differentiation as defined by a lack of immunohistochemical expression of all conventional melanocytic markers (S-100 protein, SOX10, Melan-A, and HMB-45). The clinical, histologic, and immunohistochemical findings were recorded and follow-up was obtained. The patients were mostly elderly (median: 81 years; range: 42-86 years) without significant gender predilection, and the sun-exposed skin of the head and neck area was most commonly affected. The tumors were deeply invasive with a mean depth of 7 mm (range: 4-80 mm). The dedifferentiated component showed atypical fibroxanthoma-like features in the majority of cases (7), while additional rhabdomyosarcomatous and epithelial transdifferentiation was noted histologically and/or immunohistochemically in two tumors each. The background conventional melanoma component was of desmoplastic (4), superficial spreading (3), nodular (2), lentigo maligna (1), or spindle cell (1) types. For the seven patients with available follow-up data (median follow-up period of 25 months; range: 8-36 months), two died from their disease, and three developed metastases. Next-generation sequencing of the cohort revealed somatic mutations of established melanoma drivers including mainly NF1 mutations (5) in the conventional component, which was also detected in the corresponding de-/trans-differentiated component. In summary, the diagnosis of primary cutaneous de-/trans-differentiated melanoma is challenging and depends on the morphologic identification of conventional melanoma. Molecular analysis is diagnostically helpful as the mutated gene profile is shared between the conventional and de-/trans-differentiated components. Importantly, de-/trans-differentiation does not appear to confer a more aggressive behavior.
Subject(s)
Genomics , Melanoma/pathology , Neurofibromin 1/genetics , Skin Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor/metabolism , Cell Differentiation , DNA, Neoplasm/genetics , Diagnosis, Differential , Female , High-Throughput Nucleotide Sequencing , Humans , Male , Melanoma/genetics , Melanoma/metabolism , Middle Aged , Neoplasm Proteins/metabolism , Skin Neoplasms/genetics , Skin Neoplasms/metabolismABSTRACT
Melanoma represents ~5% of all cutaneous malignancies, yet accounts for the majority of skin cancer deaths due to its propensity to metastasise. To develop new therapies, novel target molecules must to be identified and the accessibility of cell surface proteins makes them attractive targets. Using CRISPR activation technology, we screened a library of guide RNAs targeting membrane protein-encoding genes to identify cell surface molecules whose upregulation enhances the metastatic pulmonary colonisation capabilities of tumour cells in vivo. We show that upregulated expression of the cell surface protein LRRN4CL led to increased pulmonary metastases in mice. Critically, LRRN4CL expression was elevated in melanoma patient samples, with high expression levels correlating with decreased survival. Collectively, our findings uncover an unappreciated role for LRRN4CL in the outcome of melanoma patients and identifies a potential therapeutic target and biomarker.
Subject(s)
Biomarkers, Tumor/metabolism , CRISPR-Cas Systems , Lung Neoplasms/metabolism , Melanoma, Experimental/metabolism , Membrane Proteins/metabolism , Skin Neoplasms/metabolism , Animals , Biomarkers, Tumor/genetics , Cell Line, Tumor , Cell Movement , Female , Gene Expression Regulation, Neoplastic , Humans , Lung Neoplasms/genetics , Lung Neoplasms/secondary , Male , Melanoma, Experimental/genetics , Melanoma, Experimental/secondary , Membrane Proteins/genetics , Mice , Mice, Inbred C57BL , Mice, Inbred NOD , Mice, Knockout , Neoplasm Invasiveness , Skin Neoplasms/genetics , Skin Neoplasms/pathology , Up-RegulationABSTRACT
Adenomatoid tumors are benign tumors of mesothelial origin that are usually encountered in the genital tract. Although they have been observed in other organs, the skin appears to be a very rare location, with only one case reported in the literature to our knowledge. We report a second case of an adenomatoid tumor, arising in the umbilicus of a 44-year-old woman. The patient presented with an 8-month-old erythematous and firm plaque under the umbilicus. A skin biopsy showed numerous microcystic spaces dissecting a fibrous stroma and lined by flattened to cuboidal cells with focal intraluminal papillary formation. This little-known diagnosis constitutes a diagnostic pitfall for dermatopathologists and dermatologists, and could be misdiagnosed as other benign or malignant entities. Through this case report, a practical approach and diagnostic keys have been devised to avoid misdiagnosis and overtreatment.
Subject(s)
Adenomatoid Tumor/diagnosis , Adenomatoid Tumor/pathology , Skin Neoplasms/pathology , Umbilicus/pathology , Adult , Diagnosis, Differential , Female , Humans , Skin Neoplasms/diagnosisABSTRACT
Introdução: A graduação em Medicina tem passado por diversas mudanças curriculares, com transferência gradativa do ensino tradicional para metodologias ativas, as quais preconizam a aprendizagem significativa e a participação ativa dos discentes. Orientado pelas Diretrizes Curriculares Nacionais vigentes, o curso de graduação em Medicina da Universidade Federal do Pampa (UNIPAMPA), contempla essa nova perspectiva formativa. Apresenta como foco as construções de competências médicas, desenvolvidas desde etapas iniciais do curso, com ênfase no vínculo entre teoria e prática. Método: O presente estudo aborda um relato de experiência e tem por objetivo refletir acerca da implementação da disciplina "Introdução à Psicologia e Habilidades Médicas" (IPHM). Resultados: Por meio das atividades do referido componente curricular, é ofertado desde o primeiro semestre o contato dos discentes com a entrevista médica, com ênfase na construção da anamnese e na compreensão dos aspectos relacionais e comunicacionais englobados. Ainda que outras instituições desenvolvam a construção de aspectos relacionados à anamnese médica em fases iniciais, o curso de Medicina da Unipampa apresenta inovações na forma como conduz esse trabalho, com emprego de metodologias ativas associadas às situações clínicas simuladas (Role-play), com foco tanto na redação, como nas relações interpessoais e qualidade da comunicação na relação médico-paciente. Conclusões: Por meio da abordagem dos desafios e potencialidades do processo de implementação do referido componente curricular, cumpre reconhecer a adequação e a pertinência da experiência, no sentido de estabelecer um espaço de construção de competências profissionais para a entrevista médica, em momento inicial da formação acadêmica.
Introduction: Graduation in Medicine has experienced several changes in the training curriculum, by changing from the traditional way of teaching to active methodologies, providing meaningful learning and active participation by students. Guided by the National Curriculum Guidelines, the undergraduate course in Medicine, from the Federal University of Pampa (Unipampa), contemplates this new formative perspective, through curricular innovations in the methodological and organizational fields. It focuses on the construction of medical skills, developed since the initial stages of the course, with emphasis on the link between theory and practice. Method: This study is an experience report, with a qualitative approach and aims to reflect on the implementation of the IPHM discipline. Results: Through the activities of this curricular component, student´s contact with the medical interview is offered in the first semester, emphasis on the construction off the anamnesis and the knowlegment of its relational and communicational aspects. Although other academies develop the construction of aspects related to medical anamnesis in early stages, the Unipampa's Medicine course introduced a inovation in the way that conducts it's work, using active methodologies associated with simulated clinical situations (Roleplay), focusing both writing, interpersonal relationship and quality of communication between doctor and patient. Conclusions: Through addressing the challenges and potentialities of the implementation process of the said curricular component, it is important to recognize the adequacy and relevance of the experience, in order to establish a space for the construction of professional skills for the medical interview, at the beginning of academic training.
Subject(s)
Humans , Professional Competence , Education, Medical , Physician-Patient Relations , Materia Medica Study Methods , Creativity , Curriculum , Education, Medical, Undergraduate , Medical History TakingABSTRACT
Ochratoxin A (OTA) is a mycotoxin found in grape products and oxidative stress has been reported as an important mechanism involved in its toxicity, classified as possible carcinogenic to humans. Conversely, phenolics are known bioactive compounds in grapes and display great antioxidant properties. However, the biological effects of the concomitant presence of phenolic compounds and OTA remains unclear. The aim of this study was to evaluate, for the first time, the effect of OTA presence in Cabernet Sauvignon wine on antioxidant activity in vitro and on oxidative stress markers in vivo. In addition, the phenolic composition of wine was evaluated by LC-DAD-MS/MS. In vitro assays were based on spectrophotometric methods, while in vivo assays were performed evaluating oxidative stress markers in the nematode Caenorhabditis elegans, an alternative model to animal testing. A total of 23 phenolic compounds were identified in the Cabernet sauvignon red wine, including the anthocyanins delphinidin-3-O-glicoside and malvidin-3-O-glicoside, the flavonol quercetin-3-O-glucuronide and the phenolic acids caffeic, verbascoside and caftaric. Trans-resveratrol and trans-piceid were the only stilbenes found in the samples. OTA presence in the red wine was accompanied by reduction in GSH content and increase in hydroxyl radical generation in vitro. The presence of OTA in wine also increased lipoperoxidation and induced overexpression of the antioxidant enzymes superoxide dismutase and catalase in vivo. This study demonstrates that OTA presence in red wine can reduce its antioxidant potential in vitro and induces oxidative stress in vivo, without affecting the phenolic compounds levels in the samples. Thus, this work provides insights into the negative effects of the presence of OTA in wine, not only by its known toxicity, but also by prejudicing the antioxidant potential of wine. It is important to be aware of these effects when developing a complete description of OTA toxicity in humans.
Subject(s)
Antioxidants/pharmacology , Ochratoxins/pharmacology , Vitis/chemistry , Wine/analysis , Antioxidants/analysis , Catalase/genetics , Catalase/metabolism , Chromatography, Liquid , Ochratoxins/analysis , Oxidative Stress/drug effects , Superoxide Dismutase/genetics , Superoxide Dismutase/metabolism , Tandem Mass SpectrometryABSTRACT
Metastatic melanoma carries a poor prognosis despite modern systemic therapies. Understanding the evolution of the disease could help inform patient management. Through whole-genome sequencing of 13 melanoma metastases sampled at autopsy from a treatment naïve patient and by leveraging the analytical power of multi-sample analyses, we reveal evidence of diversification among metastatic lineages. UV-induced mutations dominate the trunk, whereas APOBEC-associated mutations are found in the branches of the evolutionary tree. Multi-sample analyses from a further seven patients confirmed that lineage diversification was pervasive, representing an important mode of melanoma dissemination. Our analyses demonstrate that joint analysis of cancer cell fraction estimates across multiple metastases can uncover previously unrecognised levels of tumour heterogeneity and highlight the limitations of inferring heterogeneity from a single biopsy.
Subject(s)
Clonal Evolution , Genetic Heterogeneity , Melanoma/genetics , Skin Neoplasms/genetics , Aged , Biopsy , DNA Mutational Analysis , Humans , Male , Melanoma/secondary , Prospective Studies , Skin/pathology , Skin Neoplasms/pathology , Whole Genome SequencingABSTRACT
Cutaneous sebaceous neoplasms show a predilection for the head and neck area of adults and include tumours with benign behaviour, sebaceous adenoma and sebaceoma, and sebaceous carcinoma with potential for an aggressive disease course at the malignant end of the spectrum. The majority of tumours are solitary and sporadic, but a subset of tumours may be associated with Lynch syndrome, also known as hereditary non-polyposis colon cancer (HNPCC) and previously referred to as Muir-Torre syndrome (now known to be part of Lynch syndrome). This review provides an overview of the clinical and histological features of cutaneous sebaceous neoplasia with an emphasis on differentiating features and differential diagnosis. It also offers insights into the recently described molecular pathways involved in the development of sebaceous tumours and their association with Lynch syndrome.
Subject(s)
Sebaceous Gland Neoplasms/diagnosis , Sebaceous Gland Neoplasms/genetics , Sebaceous Gland Neoplasms/pathology , HumansABSTRACT
Spiradenoma and cylindroma are distinctive skin adnexal tumors with sweat gland differentiation and potential for malignant transformation and aggressive behaviour. We present the genomic analysis of 75 samples from 57 representative patients including 15 cylindromas, 17 spiradenomas, 2 cylindroma-spiradenoma hybrid tumors, and 24 low- and high-grade spiradenocarcinoma cases, together with morphologically benign precursor regions of these cancers. We reveal somatic or germline alterations of the CYLD gene in 15/15 cylindromas and 5/17 spiradenomas, yet only 2/24 spiradenocarcinomas. Notably, we find a recurrent missense mutation in the kinase domain of the ALPK1 gene in spiradenomas and spiradenocarcinomas, which is mutually exclusive from mutation of CYLD and can activate the NF-κB pathway in reporter assays. In addition, we show that high-grade spiradenocarcinomas carry loss-of-function TP53 mutations, while cylindromas may have disruptive mutations in DNMT3A. Thus, we reveal the genomic landscape of adnexal tumors and therapeutic targets.
Subject(s)
Carcinoma, Adenoid Cystic/genetics , Deubiquitinating Enzyme CYLD/genetics , Protein Kinases/genetics , Sweat Gland Neoplasms/genetics , Adult , Aged , Aged, 80 and over , Carcinoma, Adenoid Cystic/pathology , Cohort Studies , DNA (Cytosine-5-)-Methyltransferases/genetics , DNA Methyltransferase 3A , DNA Mutational Analysis , Female , Humans , Loss of Function Mutation , Male , Middle Aged , Mutation, Missense , Protein Domains/genetics , Sweat Gland Neoplasms/pathology , Sweat Glands/pathology , Tumor Suppressor Protein p53/genetics , Exome SequencingABSTRACT
We herein report the case of a 3-year-old girl with atypical congenital right upper limb lymphedema who developed an angiosarcoma. Only a few cases have been reported following congenital form of lymphedema and only 4 in such a young child. We also summarize all cases of angiosarcoma associated with congenital lymphedema reported in the literature.
Subject(s)
Hemangiosarcoma/diagnosis , Lymphangiosarcoma/diagnosis , Lymphedema/complications , Antineoplastic Agents/therapeutic use , Child, Preschool , Fatal Outcome , Female , Hemangiosarcoma/therapy , Humans , Infant , Lymphangiosarcoma/therapy , Lymphedema/congenital , Skin/pathology , Upper Extremity/pathologyABSTRACT
AIMS: Spindle cell differentiation is not an uncommon finding in common acquired naevi, and may represent a form of neurotisation with Schwannian differentiation of melanocytes. Perineurial differentiation in this context appears to be very rare, and is only poorly documented in the literature. We therefore aimed to study this rare form of neurotisation in melanocytic naevi more comprehensively. METHODS AND RESULTS: We have identified six melanocytic tumours showing spindle cell morphology and perineurial differentiation from routine and referral material. Clinical data and follow-up were obtained, and the histological and immunohistochemical features were analysed. The tumours affected middle-aged adults (median, 48 years; range, 26-74 years), with a wide anatomical distribution and benign follow-up (median, 13 months; range, 6-48 months). All tumours were nodular and circumscribed but asymmetrical, with extension into the deep dermis and superficial subcutis. A characteristic finding was a biphasic growth pattern with a lentiginous compound naevus in the superficial aspect and abrupt transition to a prominent nodular spindle cell proliferation in the deeper reaches. Spindle cells were bland and uniform, and arranged singly and in short fascicles in a loose fibromyxoid stroma. In areas, a whorled arrangement of slender spindle cells with wavy nuclei was seen. Distinctive intratumoral hypocellular nodules and peripheral lymphoid aggregates were additional features. By immunohistochemistry, the spindle cells were mainly S100-positive melanocytes. In areas, S100-negative/epithelial membrane antigen-positive spindle cells showing coexpression of Glut-1 and claudin-1 were closely admixed. CONCLUSION: This perineurial differentiation probably represents a rare and unusual form of neurotisation. The tumours are benign but may be mistaken for desmoplastic melanoma. Awareness of and careful attention to the clinicopathological and immunohistochemical features allow reliable separation.
Subject(s)
Melanoma/pathology , Nevus, Pigmented/pathology , Skin Neoplasms/pathology , Adult , Aged , Biomarkers, Tumor/analysis , Cell Differentiation , Diagnosis, Differential , Female , Humans , Male , Melanoma/diagnosis , Middle Aged , Nevus, Pigmented/diagnosis , Skin Neoplasms/diagnosis , Melanoma, Cutaneous MalignantABSTRACT
Resumo A literatura refere que, embora a matrícula e permanência de todo e qualquer aluno seja assegurada por inúmeros dispositivos jurídicos, verificam-se, no contexto brasileiro, atrasos e desafios para alcançar uma inclusão escolar satisfatória. Observa-se, muitas vezes, a inserção de crianças com necessidades educacionais especiais sem que a escola desenvolva condições físicas e de apoio favoráveis para recebê-las ou sem que objetive potencializar as habilidades destas crianças. Frente ao exposto, considerou-se pertinente analisar concepções e práticas de psicólogos escolares e docentes da cidade de João Pessoa acerca da inclusão escolar. Para tanto, realizaram-se entrevistas semiestruturadas, baseadas na literatura da área escolar, com quinze psicólogos e quinze docentes de escolas públicas. Os resultados revelaram que, embora a maioria dos docentes e psicólogos mostre-se favorável à inclusão escolar, suas ações ainda se encontram distantes da perspectiva inclusiva defendida por pesquisadores e profissionais que se debruçam sobre esta questão....(AU)
Abstract Literature refers that, although enrollment and permanence in school are assured by many legal devices to all and any student, the Brazilian context is still dealing with delays and challenges to achieve a satisfactory school inclusion. It is often observed the insertion of children with special educational needs without the development, by schools, of favorable physical and supportive conditions to receive them, or without a real aim to potentiate their abilities. Based on the exposed, it was considered pertinent to analyze conceptions and practices of João Pessoas’s school psychologists and teachers. For that, were realized semi structured interviews, based on School Psychology’s literature, with fifteen school psychologists and fifteen teachers of public institutions. The results reveled that, although most teachers and psychologists show themselves favorable to school inclusion, their practices still distant of the inclusive perspective defended by researchers and professionals who have studied this question....(AU)
Resumen La literatura señala que, aunque la matrícula y la retención de todos los alumnos está garantizada por numerosas disposiciones legales, en realidad en el contexto brasileño, persisten retrasos y dificultades para lograr una inclusión escolar satisfactoria. A menudo es observada la inclusión de niños con necesidades educativas especiales sin el desarrollo previo de soporte físico y de condiciones favorables para recibirlos, o sin el propósito de mejorar las habilidades de estos niños, por parte de la escuela. Con base en esto, se consideró oportuno analizar los conceptos y las prácticas de los psicólogos escolares y los maestros de la ciudad de João Pessoa. Para eso, se realizaron entrevistas semiestructuradas, con base la literatura sobre Psicología Escolar, a 15 psicólogos escolares y 15 maestros de escuelas públicas. Los resultados revelaron que aunque la mayoría de los profesores y los psicólogos se muestra a favor de la inclusión escolar, sus acciones están lejos de la perspectiva inclusiva defendida por los investigadores y profesionales que se centran en este tema....(AU)
Subject(s)
Humans , Male , Female , Child , Acting Out , Child , Mainstreaming, Education , School Teachers , Social Skills , TeachingABSTRACT
Resumo A literatura refere que, embora a matrícula e permanência de todo e qualquer aluno seja assegurada por inúmeros dispositivos jurídicos, verificam-se, no contexto brasileiro, atrasos e desafios para alcançar uma inclusão escolar satisfatória. Observa-se, muitas vezes, a inserção de crianças com necessidades educacionais especiais sem que a escola desenvolva condições físicas e de apoio favoráveis para recebê-las ou sem que objetive potencializar as habilidades destas crianças. Frente ao exposto, considerou-se pertinente analisar concepções e práticas de psicólogos escolares e docentes da cidade de João Pessoa acerca da inclusão escolar. Para tanto, realizaram-se entrevistas semiestruturadas, baseadas na literatura da área escolar, com quinze psicólogos e quinze docentes de escolas públicas. Os resultados revelaram que, embora a maioria dos docentes e psicólogos mostre-se favorável à inclusão escolar, suas ações ainda se encontram distantes da perspectiva inclusiva defendida por pesquisadores e profissionais que se debruçam sobre esta questão.(AU)
Abstract Literature refers that, although enrollment and permanence in school are assured by many legal devices to all and any student, the Brazilian context is still dealing with delays and challenges to achieve a satisfactory school inclusion. It is often observed the insertion of children with special educational needs without the development, by schools, of favorable physical and supportive conditions to receive them, or without a real aim to potentiate their abilities. Based on the exposed, it was considered pertinent to analyze conceptions and practices of João Pessoass school psychologists and teachers. For that, were realized semi structured interviews, based on School Psychologys literature, with fifteen school psychologists and fifteen teachers of public institutions. The results reveled that, although most teachers and psychologists show themselves favorable to school inclusion, their practices still distant of the inclusive perspective defended by researchers and professionals who have studied this question.(AU)
Resumen La literatura señala que, aunque la matrícula y la retención de todos los alumnos está garantizada por numerosas disposiciones legales, en realidad en el contexto brasileño, persisten retrasos y dificultades para lograr una inclusión escolar satisfactoria. A menudo es observada la inclusión de niños con necesidades educativas especiales sin el desarrollo previo de soporte físico y de condiciones favorables para recibirlos, o sin el propósito de mejorar las habilidades de estos niños, por parte de la escuela. Con base en esto, se consideró oportuno analizar los conceptos y las prácticas de los psicólogos escolares y los maestros de la ciudad de João Pessoa. Para eso, se realizaron entrevistas semiestructuradas, con base la literatura sobre Psicología Escolar, a 15 psicólogos escolares y 15 maestros de escuelas públicas. Los resultados revelaron que aunque la mayoría de los profesores y los psicólogos se muestra a favor de la inclusión escolar, sus acciones están lejos de la perspectiva inclusiva defendida por los investigadores y profesionales que se centran en este tema.(AU)