IMMUNOHISTOCHEMICAL ANALYSIS BY KI67 AND IDH1 IN PATIENTS WITH CHONDROSARCOMA.

Objective: To perform an immunohistochemical evaluation using the IDH1 and Ki67 markers in patients who underwent treatment for chondrosarcoma in a reference service center in Brazil. Methods: Retrospective analytical observational study using medical records of patients diagnosed with chondrosarcoma. Besides the epidemiological and clinical profile, important variables for prognosis and correlation with immunohistochemical analysis results with Ki67 and IDH1 markers were evaluated. Results: Histopathological examinations by immunohistochemistry of 56 patients were analyzed, 52% of which were women, with the age group 20-60 years being more prevalent. Grade 1 and 2 histological subtypes corresponded to most chondrosarcomas. The femur, humerus, and tibia were the most frequent anatomical sites. Most tumors (59%) were larger than 8 cm. Ki67 expression was very low (< 10%) in 98% of patients. The analysis of IDH1 was positive in 43% of the cases. The correlation between IDH1 positivity and tumor size was statistically significant, but regarding survival, we observed no significance. Conclusion: Immunohistochemical analysis using IDH1 and Ki67 markers in patients with conventional chondrosarcoma is not useful for prognostic guidance.Level of Evidence II, Prognostic Assessment, Results of Immunohistochemical Tests and Correlation with Survival.

Objetivo: Fazer uma avaliação imuno-histoquímica usando os marcadores IDH1 e Ki67 em pacientes que fizeram tratamento para condrossarcoma em um serviço de referência no Brasil. Métodos: Estudo retrospectivo, analítico e observacional de prontuários de pacientes com diagnóstico de condrossarcoma. Além do perfil epidemiológico e clínico, foram avaliadas variáveis importantes para o prognóstico e a correlação com os resultados da análise imuno-histoquímica utilizando os marcadores Ki67 e IDH1. Resultados: Foram analisados exames histopatológicos por imuno-histoquímica de 56 pacientes, dos quais 52% eram do sexo feminino. A faixa etária mais prevalente foi entre 20 e 60 anos. Os subtipos histológicos graus 1 e 2 corresponderam à maioria dos casos. Fêmur, úmero e tíbia foram os sítios anatômicos mais frequentes. A maioria dos tumores (59%) tinha tamanho superior a 8 cm. O Ki67 teve expressão muito baixa (< 10%) em 98% dos pacientes. Já a análise do IDH1 foi positiva em 43% dos casos. A correlação entre a positividade do IDH1 e o tamanho do tumor foi estatisticamente significativa; já em relação à sobrevida, não houve significância. Conclusão: A análise imuno-histoquímica por meio dos marcadores IDH1 e Ki67 em pacientes com condrossarcoma convencional não é útil para orientação prognóstica. Nível de Evidência II, Avaliação Prognóstica, Resultados de Exames Imuno-Histoquímicos e Correlação com Sobrevida.

Immunohistochemical analysis by ki67 and idh1 in patients with chondrosarcoma / Análise imuno-histoquímica por meio de ki67 e idh1 em pacientes com condrossarcoma

ABSTRACT Objective: To perform an immunohistochemical evaluation using the IDH1 and Ki67 markers in patients who underwent treatment for chondrosarcoma in a reference service center in Brazil. Methods: Retrospective analytical observational study using medical records of patients diagnosed with chondrosarcoma. Besides the epidemiological and clinical profile, important variables for prognosis and correlation with immunohistochemical analysis results with Ki67 and IDH1 markers were evaluated. Results: Histopathological examinations by immunohistochemistry of 56 patients were analyzed, 52% of which were women, with the age group 20-60 years being more prevalent. Grade 1 and 2 histological subtypes corresponded to most chondrosarcomas. The femur, humerus, and tibia were the most frequent anatomical sites. Most tumors (59%) were larger than 8 cm. Ki67 expression was very low (< 10%) in 98% of patients. The analysis of IDH1 was positive in 43% of the cases. The correlation between IDH1 positivity and tumor size was statistically significant, but regarding survival, we observed no significance. Conclusion: Immunohistochemical analysis using IDH1 and Ki67 markers in patients with conventional chondrosarcoma is not useful for prognostic guidance. Level of Evidence II, Prognostic Assessment, Results of Immunohistochemical Tests and Correlation with Survival.

RESUMO Objetivo: Fazer uma avaliação imuno-histoquímica usando os marcadores IDH1 e Ki67 em pacientes que fizeram tratamento para condrossarcoma em um serviço de referência no Brasil. Métodos: Estudo retrospectivo, analítico e observacional de prontuários de pacientes com diagnóstico de condrossarcoma. Além do perfil epidemiológico e clínico, foram avaliadas variáveis importantes para o prognóstico e a correlação com os resultados da análise imuno-histoquímica utilizando os marcadores Ki67 e IDH1. Resultados: Foram analisados exames histopatológicos por imuno-histoquímica de 56 pacientes, dos quais 52% eram do sexo feminino. A faixa etária mais prevalente foi entre 20 e 60 anos. Os subtipos histológicos graus 1 e 2 corresponderam à maioria dos casos. Fêmur, úmero e tíbia foram os sítios anatômicos mais frequentes. A maioria dos tumores (59%) tinha tamanho superior a 8 cm. O Ki67 teve expressão muito baixa (< 10%) em 98% dos pacientes. Já a análise do IDH1 foi positiva em 43% dos casos. A correlação entre a positividade do IDH1 e o tamanho do tumor foi estatisticamente significativa; já em relação à sobrevida, não houve significância. Conclusão: A análise imuno-histoquímica por meio dos marcadores IDH1 e Ki67 em pacientes com condrossarcoma convencional não é útil para orientação prognóstica. Nível de Evidência II, Avaliação Prognóstica, Resultados de Exames Imuno-Histoquímicos e Correlação com Sobrevida.

Evaluation of vitamin D receptor expression in uterine leiomyoma and nonneoplastic myometrial tissue: a cross-sectional controlled study.

BACKGROUND: Uterine myomas are the most frequent benign solid pelvic tumors in women of reproductive age. At present, uterine myomas are the most common indication for hysterectomy because of the morbidity they cause, including intense bleeding, compression of adjacent organs, pain, and infertility. Some studies show that vitamin D receptor (VDR) expression is correlated with the etiology of uterine leiomyomas. This study aimed to assess the expression of VDR in uterine leiomyoma and nonneoplastic myometrial tissue. METHODS: A controlled cross-sectional study involving 40 women who underwent abdominal hysterectomy the Department of Gynecology of the Getúlio Vargas Hospital of Federal University of Piauí, Brazil, was performed to compare the immunohistochemical expression of VDR in samples of uterine leiomyoma tissue with adjacent nonneoplastic myometrial tissue. The mean percetages of stained nuclei in the two groups was compared by Student's t teste, with significance established at p < 0.05. RESULTS: The percentage of cells with nuclei stained by anti-VDR in the myometrial and leiomyoma tissue was 79.52 % (± 4.32) and 60.22 % (± 7.24), respectively (p < 0.0001). CONCLUSIONS: The mean percentage of nuclei expressing VDR was significantly lower in the uterine leiomyoma than in nonneoplastic myometrial tissue.

Radiation-induced angiosarcoma: case report.

Angiosarcoma of the breast accounts for less than 1% of breast tumors. This tumor may be primary or secondary to previous radiation therapy and it is also named "radiogenic angiosarcoma of the breast", which is still a rare entity with a poor prognosis. So far, there are only 307 cases reported about these tumors in the literature. We present a case of a 73-year-old woman with a prior history of breast-conserving treatment of right breast cancer, exhibiting mild pinkish skin changes in the ipsilateral breast. Her mammography was consistent with benign alterations (BI-RADS 2). On incisional biopsy specimens, hematoxylin-eosin showed atypical vascular lesion and suggested immunohistochemisty for diagnostic elucidation. Resection of the lesions was performed and histology showed radiogenic angiosarcoma. The patient underwent simple mastectomy. Immunohistochemistry was positive for antigens related to CD31 and CD34, and C-MYC oncogene amplification, confirming the diagnosis of angiosarcoma induced by breast irradiation. A delayed diagnosis is an important concern. Initial skin changes in radiogenic angiosarcoma are subtle, therefore, these alterations may be confused with other benign skin conditions such as telangiectasia. We highlight this case clinical aspects with the intention of alerting to the possibility of angiosarcoma of the breast in patients with a previous history of adjuvant radiation therapy for breast cancer treatment. Sixteen months after the surgery the patient remains asymptomatic.

Radiation-induced angiosarcoma: case report / Angiossarcoma induzido por radiação: relato de caso

ABSTRACT Angiosarcoma of the breast accounts for less than 1% of breast tumors. This tumor may be primary or secondary to previous radiation therapy and it is also named "radiogenic angiosarcoma of the breast", which is still a rare entity with a poor prognosis. So far, there are only 307 cases reported about these tumors in the literature. We present a case of a 73-year-old woman with a prior history of breast-conserving treatment of right breast cancer, exhibiting mild pinkish skin changes in the ipsilateral breast. Her mammography was consistent with benign alterations (BI-RADS 2). On incisional biopsy specimens, hematoxylin-eosin showed atypical vascular lesion and suggested immunohistochemisty for diagnostic elucidation. Resection of the lesions was performed and histology showed radiogenic angiosarcoma. The patient underwent simple mastectomy. Immunohistochemistry was positive for antigens related to CD31 and CD34, and C-MYC oncogene amplification, confirming the diagnosis of angiosarcoma induced by breast irradiation. A delayed diagnosis is an important concern. Initial skin changes in radiogenic angiosarcoma are subtle, therefore, these alterations may be confused with other benign skin conditions such as telangiectasia. We highlight this case clinical aspects with the intention of alerting to the possibility of angiosarcoma of the breast in patients with a previous history of adjuvant radiation therapy for breast cancer treatment. Sixteen months after the surgery the patient remains asymptomatic.

RESUMO Os angiossarcomas de mama representam menos de 1% dos tumores da mama e podem ser primários ou secundários à radioterapia prévia. Tais tumores são chamados de "angiossarcomas radiogênicos da mama" e representam uma entidade mais rara ainda e de prognóstico ruim. Atualmente, na literatura, são encontrados apenas 307 casos desses tumores. Relatamos o caso de uma mulher de 73 anos, com história prévia de tratamento conservador de câncer de mama direita, apresentando alteração rósea discreta em pele da mama homolateral. A mamografia demostrou resultado compatível com alterações benignas (BI-RADS 2). No material de biópsia incisional, a hematoxilina-eosina demonstrou lesão vascular atípica e sugeriu imuno-histoquímica para elucidação diagnóstica. A paciente foi submetida à ressecção de lesões, e a histologia demonstrou angiossarcoma radiogênico. Em seguida, mastectomia simples foi realizada. A imuno-histoquímica demonstrou positividade para os antígenos relacionados a CD31 e CD34, e a amplificação do oncogene C-MYC confirmou o diagnóstico de angiossarcoma induzido por radiação mamária. O atraso no diagnóstico constitui questão importante. Considerando que as alterações iniciais da pele do angiossarcoma radiogênico são sutis e podem ser confundidas com outras condições benignas da pele, como telangiectasias, neste relato destacamos os aspectos clínicos, no intuito de alertar sobre a possibilidade de angiossarcoma de mama em pacientes com história prévia de radioterapia adjuvante para tratamento de câncer de mama. A paciente permaneceu assintomática 16 meses após a cirurgia.

Closed head injury in rats: histopathological aspects in an experimental weight drop model.

PURPOSE: To study histopathological findings due to a model of closed head injury by weight loss in rats. METHODS: A platform was used to induce closed cranial lesion controlled by weight loss with a known and predefined energy. 25 male Wistar rats (Rattus novergicus albinus) were divided in five equal groups which received different cranial impact energy levels: G1, G2, G3 and G4 with 0.234J, 0.5J, 0.762J and 1J respectively and G5 (Sham). Under the effect of analgesia, the brain of each group was collected and prepared for histopathological analysis by conventional optic microscopy. RESULTS: It was observed greater number of injured neurons in animals of group 4, however neuronal death also could be noticed in animals of group 5. Intraparenchymal hemorrhages were more frequent in animals of group 4 and the cytotoxic brain swelling and vascular congestion were more intense in this group CONCLUSION: The histopathological analysis of these findings allowed to observe typical cranial trauma alterations and these keep close relation with impact energy.

Closed head injury in rats: histopathological aspects in an experimental weight drop model / Trauma craniano fechado em ratos: aspectos histopatológicos em um modelo experimental de queda de peso

PURPOSE: To study histopathological findings due to a model of closed head injury by weight loss in rats. METHODS: A platform was used to induce closed cranial lesion controlled by weight loss with a known and predefined energy. 25 male Wistar rats (Rattus novergicus albinus) were divided in five equal groups which received different cranial impact energy levels: G1, G2, G3 and G4 with 0.234J, 0.5J, 0.762J and 1J respectively and G5 (Sham). Under the effect of analgesia, the brain of each group was collected and prepared for histopathological analysis by conventional optic microscopy. RESULTS: It was observed greater number of injured neurons in animals of group 4, however neuronal death also could be noticed in animals of group 5. Intraparenchymal hemorrhages were more frequent in animals of group 4 and the cytotoxic brain swelling and vascular congestion were more intense in this group CONCLUSION: The histopathological analysis of these findings allowed to observe typical cranial trauma alterations and these keep close relation with impact energy.

OBJETIVO: Investigar as alterações histopatológicas produzidas por um modelo de trauma craniano fechado por queda de peso em ratos. MÉTODOS: Utilizando uma plataforma para produção de lesão craniana fechada controlada por queda de peso com energia pré-definida e conhecida, 25 ratos Wistar machos (Rattus norvegicus albinus) foram divididos em cinco grupos iguais que receberam níveis diferentes de energia de impacto craniano: G1, G2, G3 e G4 com 0,234J, 0,5J, 0,762J e 1J respectivamente e G5 (Sham). Sob analgesia, cada grupo teve seus encéfalos coletados e processados para análise histopatológica por microscopia óptica convencional. RESULTADOS: Houve maior número de neurônios lesados em animais do grupo 4, mas morte neuronal também pôde ser constatada nos animais do grupo 5. Hemorragias parenquimatosas foram mais frequentes nos animais do grupo 4 e o inchaço cerebral citotóxico e congestão vascular foram mais intensos neste grupo. CONCLUSÃO: Os achados à análise histopatológica permitem observar alterações típicas do trauma craniano e estas guardaram proporção direta com a energia do impacto.

Lesão cerebral traumática: parâmetros clínicos e patológicos em um modelo experimental de queda de peso / Traumatic brain injury: clinical and pathological parameters in an experimental weightdrop model

PURPOSE: To investigate the function of an experimental cranium trauma model in rats. METHODS: The equipment, already described in the literature and under discreet adaptations, is composed by a platform that produces closed head impact controlled by weight drop with pre-defined and known energy. 25 Wistar male rats (Rattus norvegicus albinus) were divided into five equal groups that received different quantities of cranial impact energy: G1, G2, G3 and G4 with 0,234J, 0,5J, 0,762J and 1J respectively and G5 (Sham). Under intense analgesia, each group was evaluated clinically in a sequence of intervals and had their encephalon removed for pathologic analysis. RESULTS: Important clinical alterations (convulsions, bradycardia, bradypnea and abnormal postures) and focal pathologic (hematomas and hemorrhages) kept proportion with the intensity of the impact. No fracture was observed and the group 4 had 80 percent mortality rate. CONCLUSION: The experimental cranium trauma animal model by weight drop is an alternative of low cost and easy reproduction that allows evaluating clinical and pathological alterations in accordance with studies in experimental surgery aims for new traumatic brain injury approach in rats.

OBJETIVO: Investigar o uso de um modelo de trauma craniano experimental em ratos. MÉTODOS: O equipamento, já descrito na literatura e sob discretas adaptações, contitui-se de uma plataforma para produção de lesão craniana fechada controlada por queda de peso com energia pré-definida e conhecida. 25 ratos Wistar machos (Rattus norvegicus albinus) foram divididos em cinco grupos iguais que receberam níveis diferentes de energia de impacto craniano: G1, G2, G3 e G4 com 0,234J, 0,5J, 0, 762J e 1J respectivamente e G5 (Sham). Sob intensa analgesia, cada grupo foi avaliado clinicamente em uma seqüência de intervalos e tiveram seus encéfalos removidos para análise patológica. RESULTADOS: Alterações clínicas importantes (convulsões, bradicardia, bradipnéia e posturas anormais) e patológicas focais (hematomas e hemorragias) guardaram proporção com a intensidade do impacto. Nenhuma fratura foi observada e o grupo 4 teve 80 por cento de mortalidade. CONCLUSÃO: O modelo animal para trauma craniano experimental por queda de peso é uma alternativa de baixo custo e fácil reprodução, gerando alterações clínicas e patológicas compatíveis com os objetivos de estudos em cirurgia experimental para abordagem do trauma craniano em ratos.

Traumatic brain injury: clinical and pathological parameters in an experimental weightdrop model.

PURPOSE: To investigate the function of an experimental cranium trauma model in rats. METHODS: The equipment, already described in the literature and under discreet adaptations, is composed by a platform that produces closed head impact controlled by weight drop with pre-defined and known energy. 25 Wistar male rats (Rattus norvegicus albinus) were divided into five equal groups that received different quantities of cranial impact energy: G1, G2, G3 and G4 with 0,234J, 0,5J, 0,762J and 1J respectively and G5 (Sham). Under intense analgesia, each group was evaluated clinically in a sequence of intervals and had their encephalon removed for pathologic analysis. RESULTS: Important clinical alterations (convulsions, bradycardia, bradypnea and abnormal postures) and focal pathologic (hematomas and hemorrhages) kept proportion with the intensity of the impact. No fracture was observed and the group 4 had 80% mortality rate. CONCLUSION: The experimental cranium trauma animal model by weight drop is an alternative of low cost and easy reproduction that allows evaluating clinical and pathological alterations in accordance with studies in experimental surgery aims for new traumatic brain injury approach in rats.

MONOSTOTIC PAGET'S DISEASE IN LUMBAR VERTEBRAE: AN ATYPICAL LOCATION.

A 41-year-old white female patient with complaints of lumbar pain for more than three years, without irradiation, underwent several radiological examinations. Her condition was diagnosed by means of biopsy, as monostotic Paget' s disease in the third lumbar vertebra. This is an uncommon location.

Doença de Paget óssea monostótica em vértebra lombar: uma localização atípica / Monostotic Paget's disease of the lumbar vertebrae: an atypical location

Paciente do sexo feminino, 41 anos, cor branca, com queixa de dor lombar há mais de três anos, sem irradiações, submetida há vários exames radiográficos sendo diagnosticada, por biópsia, doença de Paget monostótica na terceira vértebra lombar. Trata-se de uma localização incomum.

Female patient, 41 years, Caucasian, with lumbar pain for more than three years, without irradiation, submitted to various radiological exams and diagnosed by biopsy with monostotic Paget's disease of the third lumbar vertebrae, which is an uncommon location.

Meningioma angiomatoso selar tratado por radiocirurgia: relato de caso / Sellar angiomatous meningioma treated by radiosurgery: case report

Os meningiomas são os tumores cerebrais mesodermais,ocorrendo em 13 por cento a 19 por cento de todos os tumores cerebrais.Cerca de 40 por cento deles ocorrem na base do crânio,na região selar, e 10 por cento nas regiões parasselares, incluindo a região da asa do esfenóide,bulbo olfatório,tubérculo e diafragma selares. É relatado o caso de paciente com meningioma angiomatoso selar,submetido previamente à cirurgia transesfenoidal e, posteriormente, tratado por radiocirurgia estereotáxica. A evolução foi satisfatória, com remissão completa das crises de cefaléia e da ptose preexistente.

Changes in pulse oximetry after patent blue dye injection into the uterine cervix.

BACKGROUND: To evaluate changes in pulse oximetry readings in patients with cervical carcinoma after the injection of patent blue dye into the uterine cervix for sentinel lymph node detection. METHODS: Fifty-six patients underwent radical hysterectomy and bilateral pelvic lymphadenectomy for the treatment of International Federation of Gynecology and Obstetrics stage I or II cervical cancer. Four milliliters of patent blue dye were injected into the cervix. On the eve of surgery, all patients also received an injection of Dextran 500 labeled with technetium 99 m (Tc-99 m Dextran, 600 to 800 muCi) into the cervix and subsequently underwent pelvic lymphoscintigraphy. RESULTS: Of the 56 patients, 1 (1.79%) had an anaphylactic reaction, and in 13 (23.22%), pulse oximetry readings were <96%. The lowest median pulse oximetry reading in these patients was 87%. Pulse oximetry readings began to decrease between 2 and 10 minutes after patent blue dye injection into the cervix and lasted for approximately 5 minutes. No changes in blood pressure, heart rate, or electrocardiogram were found during the period in which this alteration was recorded by the pulse oximeter. CONCLUSION: The decrease in pulse oximetry readings after patent blue dye injection into the cervix was associated with larger tumors and tumors that surrounded the external cervical os.

Angiogênese nas lesões pré-malignas e invasoras do colo uterino / Angiogenesis in premalignant lesions and invasive carcinoma of the uterine cervix

Angiogênese é o desenvolvimento de novos vasos sanguíneos a partir de capilares pré-existentes, sendo essencial para o crescimento e progressão dos tumores malignos. A angiogênese também tem sido associada com o prognóstico das neoplasias, apresentando prognóstico pior as neoplasias com alta densidade de microvasos do que aquelas com baixa densidade de microvasos. A maioria dos estudos indicam que a angiogênese tem valor prognóstico em pacientes com carcinoma do colo uterino. Os dados indicam que a mesma pode servir como fator prognóstico em carcinoma do colo uterino. Estes achados podem ter aplicação em futuros estudos terapêuticos com fatores antiangiogênicos

Tuberculose ganglionar periférica / Peripheral ganglionic tuberculosis

A forma extrapulmonar da tuberculose é relativamente freqüente. No entanto o comprometimento axilar é incomum. Os autores apresentam um caso desta entidade e discutem os seus aspectos clínicos, epidemiológicos e terapêuticos, enfatizando a incidência e prevalência da tuberculose.

Gastrosquise: uma abordagem clínica e terapêutica / Gastroschisis: a clinical and therapeutical approach

Gastrosquise é uma anormalidade incomum do desenvolvimento, que se apresenta à época do nascimento como emergência neonatal. Os autores discutem a etiologia, incidência, aspectos clínicos e tratamento desta entidade.