Aqueous extract of pummelo pulp (Citrus maxima) improves the biochemical profile and reduces the inflammation process in Wistar rats with non-alcoholic fatty liver disease.

This study investigated the effect of pummelo extract (Citrus maxima) on biochemical, inflammatory, antioxidant and histological changes in NAFLD rats. Forty male Wistar rats divided into four groups were used: (1) control group; (2) fructose associated with high-fat diet - DHF; (3) normal diet + pummelo extract (50 mg/kg); and (4) FHD + pummelo extract. This was administered at dose of 50 mg/kg of the animal's weight, by gavage, for 45 days. Significant improvement in lipid profile, liver and kidney function, inflammation, oxidative stress markers was identified in group 4 compared to group 2. Regarding TNF-α and IL-1ß, group 2 showed higher values (respectively 142, 5 ± 0.7 and 560.5 ± 2.7 pg/mg protein) compared to group 4 (respectively 91.4 ± 0.9 and 402.1.4 ± 0.9 pg/mg protein), p < 0.05. Significant increases were found in SOD and CAT activities, respectively 0.10 ± 0.06 and 8.62 ± 1.67 U/mg protein for group 2 and respectively 0.28 ± 0.08 and 21.52 ± 2.28 U/mg of protein for group 4. Decreases in triglycerides, hepatic cholesterol and fat droplets in hepatic tissue were observed in group 4 compared to group 2. Results highlight that pummelo extract may be useful for prevent the development of NAFLD.

Real-World Prevalence of PD-L1 Expression Among Tumor Samples From Patients With Non-Small-Cell Lung Cancer.

INTRODUCTION: We analyzed the prevalence of non-small-cell lung cancer (NSCLC) with a programmed cell death ligand 1 (PD-L1) tumor proportion score (TPS) of ≥ 50% and compared the results with the existing data from clinical trials and databases from other countries. MATERIALS AND METHODS: The Latin American Cooperative Oncology Group and Grupo Brasileiro de Oncologia Torácica performed a retrospective, cross-sectional study from August 2017 to April 2018. PD-L1 expression was collected from pathology reports from 5 laboratories in Brazil. All tests were sponsored by the pharmaceutical industry on request from the treating medical oncologist. PD-L1 expression was assessed by immunohistochemistry. The variables were summarized as absolute and relative frequencies or the median and interquartile range. Pearson's χ2 test was used to compare the TPS categories stratified by sex, age, and histologic type. All analyses were performed with SAS, version 9.4, and were deemed statistically significant at P < .05. RESULTS: A total of 1512 patients were included in the present study. Their median age was 66 years. Most patients were men (56.02%), and the most common histologic type was adenocarcinoma (58.04%); 109 tumors (11.31%) had EGFR mutations and 34 (3.64%) had ALK gene rearrangements. Overall, 56.54% had a PD-L1 TPS < 1%, 25.63% a TPS of 1% to 49%, and 17.83% a TPS of ≥ 50%. The factors associated with PD-L1 expression were histologic type (with adenocarcinoma samples having a greater proportion of TPS < 1%) and the laboratory that performed the test. CONCLUSION: The prevalence of high PD-L1 expression among the Brazilian NSCLC samples was lower than previously described in other countries, which could affect the number of patients who might be candidates for immunotherapy alone.

Un melanoma amelanótico con metástasis a la glándula tiroides. Descripción clinico-patológica de un caso / Amelanotic anorectal melanoma metastatic to the thyroid gland. A case report

A pesar de su rico aporte vascular, las metástasis en la glándula tiroides son eventos raros. Los carcinomas renales, colorectales, de pulmón y mama son las fuentes más frecuentes de metástasis. Presentamos el caso de una mujer de 75 años de edad, con el antecedente de un melanoma anorrectal amelanótico avanzado, operado un año antes, que se presentó con un crecimiento nodular rápido de la glándula tiroides, por lo que fue sometida a una tiroidectomía parcial. Histopatológicamente, el lóbulo tiroideo mostró una infiltración difusa por melanoma amelánico. Aunque se han publicado algunos casos de metástasis de melanoma en la glándula tiroides, la mayoría de ellos son de origen cutáneo por lo que, a nuestro entender, nosotros presentamos el primer caso de un melanoma anorrectal con metástasis a la glándula tiroide (AU)

Despite its rich vascular supply, metastases to the thyroid gland are rare. Renal, colorectal, lung and breast carcinomas are the most frequent sources of metastases. We report the case of a 75-year-old woman who presented with a rapid nodular enlargement of the thyroid gland, for which she underwent a partial thyroidectomy. She had a history of advanced amelanotic anorectal melanoma surgically treated one year previously. Histopathologically, the thyroid lobe showed diffuse infiltration by an amelanotic melanoma. Although a few cases of metastases of melanoma to the thyroid gland have been reported, the majority are derived from a cutaneous primary; to the best of our knowledge, this is the first reported case of an anorectal melanoma with metastasis to the thyroid gland (AU)

Alterações citológicas cervicovaginais no Alto Uruguai Gaúcho, Rio Grande do Sul / Cytological cervico-vaginal changes in Alto Uruguai Gaúcho, Rio Grande do Sul

Objetivo: Avaliar a frequência de alterações cervicovaginais que acometem mulheres da região do Alto Uruguai. Métodos: Foram avaliados dados de exames citopatológicos obtidos a partir de um sistema de programa personalizado conhecido como Laudo & Imagem, propriedade de um laboratório de referência da cidade de Erechim, Rio Grande do Sul, no período de 2007 a 2011. Resultados: Dos 62.280 casos avaliados, 2.049 (3,3%) apresentaram alguma alteração citológica; destes, 1.094 (53,4%) corresponderam à lesão escamosa de baixo grau, 179 (8,8%) à lesão escamosa de alto grau, 13 (0,7%) à carcinoma escamoso, 5 (0,2%) à adenocarcinoma e 758 (37%) a atipias de significado indeterminado, que, no seguimento, 360 (47,5%) corresponderam a lesões benignas, 225 (29,7%) a lesões malignas; destas, 220 casos (29,02%) de lesão escamosa intraepitelial de baixo grau, 4 casos (0,53%) de lesão escamosa intraepitelial de alto grau e 1 (0,13%) de carcinoma escamoso. Não tiveram seguimento citopatológico 173 (22,8%) casos. Conclusão: O estudo verificou que os dados encontrados nessa região assemelham-se aos encontrados nacionalmente, o que justifica a importância de incentivo ao rastreamento e à prevenção através dos programas de rastreamento do exame citológico para a detecção precoce do câncer de colo uterino.

Objective: To evaluate the frequency of cervical changes that affects women in Alto Uruguai, Rio Grande do Sul. Methods: We evaluated cytology findings of the National Health System, in a reference laboratory in Erechim, Rio Grande do Sul at the period of 2007 to 2011. Results: From 62,280 cases evaluated, 2,049 (3.2%) showed cytological changes, which in 1,094 (53.4%) corresponded to low-grade squamous intraepithelial lesions, 179 (8.8%) and high grade squamous intraepithelial lesion, 13 (0.7%) squamous carcinomas, 5 (0.2%) adenocarcinomas and the 758 (37%) of atypical squamous cell underteminated significance Of atypical squamous cell underteminated significance, 360 (47.5%) lesions were benign, 225 (29.7%) malignant lesions and of this cases, 220 (29.02%) cases of low-grade squamous intraepithelial lesions, 4 (0.53%) cases of high grade squamous intraepithelial lesion and 1 (0.13%) cases of squamous cell carcinoma. But, 173 patients (22.8%) did not follow the cytopathologic screening. Conclusion: In conclusion the study and found that the data found in this region are similar to those found at the national level, justifying the importance of encouraging screening and prevention through screening programs of cytological cervical early detection of cervical cancer .

Displasia mesenquimática placentaria. Presentación de un caso / Placental mesenchymal dysplasia. A case report

La displasia mesenquimática placentaria es una patología caracterizada por placentomegalia, alteraciones vasculares y vellosidades edematizadas. Frecuentemente se confunde con la mola hidatiforme, pero a diferencia de esta última no tiene potencial de malignización y permite, salvo algunas complicaciones, el desarrollo normal de la gestación. En este artículo informamos un nuevo caso, diagnosticado después del parto, asociado a retardo en el crecimiento intrauterino. Discutimos también la fisiopatología, la utilidad de p57 y el diagnóstico diferencial de esta entidad(AU)

Placental mesenchymal dysplasia (PMD) is characterized by placentomegaly, vascular alterations and oedematous villi and is often confused with hydatidiform mole; however, unlike the latter, it has no malignant potential and normal gestation is possible although complications may occur. We report a case of PMD, diagnosed after delivery, which was associated with intrauterine growth restriction. The pathophysiology, usefulness of p57 and differential diagnosis of PMD is discussed(AU)

Juxtaglomerular cell tumor of the kidney: case report and differential diagnosis with emphasis on pathologic and cytopathologic features.

This study presents a case of juxtaglomerular cell tumor (JCT) in a 12-year-old girl with hypertension. Fine needle aspirate (FNA) cytology demonstrated a neoplasm with features of a papillary carcinoma, prompting a right radical nephrectomy. Histological examination revealed solid sheets of round epithelioid cells with eosinophilic granular cytoplasm, and distinct cell borders in a background of widespread hemorrhage. Electron microscopy revealed cytoplasmic renin granules. The differential diagnosis of a renal mass in a young patient with hypertension includes JCT, Wilm's tumor, and renal cell carcinoma, which may produce renin. The renin granules detected by electron microscopy are characteristic of JCT, and the diagnosis is confirmed by ultrastructural study. FNA cytology is not sensitive enough for the diagnosis of JCT and its results must be carefully interpreted.

Thyroid involvement in disseminated zygomycosis by Cunninghamella bertholletiae: 2 cases and literature review.

Thyroid involvement is very rare in disseminated zygomycosis. We describe two cases of thyroiditis due to Cunninghamella bertholletiae diagnosed though a necropsy study and the only five previous cases of thyroid zygomycosis reported in the literature are revised.

Infección múltiple fúngica en un paciente diabético / Mixed fungal infection in a diabetic patient

Antecedentes. Las infecciones mixtas de origen fúngico, aunque poco valoradas, puede que sean más habituales de lo referido en la literatura médica. Dichas infecciones tienen, en general, un peor pronóstico para el paciente. Objetivos. Presentar un caso clínico inusual en un paciente de 61 años, diabético descompensado, que en 2001 debutó con zigomicosis rinoorbitosinusal. Se trató con amplia resección quirúrgica y anfotericina B liposomal, mejorando su cuadro clínico. Años después presentó un cuadro de similares características, realizándose otra vez el diagnóstico de zigomicosis rinoorbitocerebral. Métodos. En ambas ocasiones se realizó un estudio histopatológico de las lesiones de senos, y se colorearon con tinción de hematoxilina y eosina, Giemsa, ácido periódico de Schiff y plata metenamina modificada de Grocott, además de cultivos específicos para hongos. Resultados. En la última recidiva los estudios histopatológicos mostraron una infección mixta de bacterias, actinomicetos y hongos con cuatro morfologías diferentes. A pesar del rápido diagnóstico, el paciente falleció por diseminación fúngica al sistema nervioso central. Conclusiones. La infección múltiple por hongos es muy infrecuente, pero dado el gran aumento del número de pacientes con alteraciones inmunitarias puede acontecer con mayor frecuencia. Alertamos de esta posibilidad y, si se detecta, debe ser valorada como una micosis más agresiva y de peor pronóstico(AU)

Background. Mixed fungal infections although undervalued, are more common than mentioned in the scientific literature. These infections have a poor prognosis for the patient. Objectives. We present an unusual case of a 61-year-old diabetic male who had a rhino-orbito-sinusal zygomycosis in 2001. After surgical debridement of the infected parts, along with antifungal therapy with liposomal amphotericin B, the patient started improving. Several years later the patient was hospitalized due to a similar problem and was diagnosed of rhino-orbito-cerebral zygomycosis. Methods. In both episodes, a histopathological examination and cultures were performed on the sinus lesions. Tissue sections were stained with haematoxylin and eosin, Giemsa, periodic acid-Schiff (PAS) and Grocott's methenamine silver, and cultures specific for fungi were performed. Results. The histopathology studies revealed the presence of bacteria, actinomyces and a mixed infection by at least four different fungi, all of them well differentiated by their morphology. Despite the rapid diagnosis the patient died due to spreading to the central nervous system. Conclusions. Mixed infections by fungi are rare, but due to the high incidence of immunodeficiencies they could occur more often than reported. We would like to alert on the possibility of acquired mixed infection by fungi which have shown to be high aggressive and have a worse prognostic in patients with underlying diseases (AU)

[Mixed fungal infection in a diabetic patient]. / Infección múltiple fúngica en un paciente diabético.

BACKGROUND: Mixed fungal infections although undervalued, are more common than mentioned in the scientific literature. These infections have a poor prognosis for the patient. OBJECTIVES: We present an unusual case of a 61-year-old diabetic male who had a rhino-orbito-sinusal zygomycosis in 2001. After surgical debridement of the infected parts, along with antifungal therapy with liposomal amphotericin B, the patient started improving. Several years later the patient was hospitalized due to a similar problem and was diagnosed of rhino-orbito-cerebral zygomycosis. METHODS: In both episodes, a histopathological examination and cultures were performed on the sinus lesions. Tissue sections were stained with haematoxylin and eosin, Giemsa, periodic acid-Schiff (PAS) and Grocott's methenamine silver, and cultures specific for fungi were performed. RESULTS: The histopathology studies revealed the presence of bacteria, actinomyces and a mixed infection by at least four different fungi, all of them well differentiated by their morphology. Despite the rapid diagnosis the patient died due to spreading to the central nervous system. CONCLUSIONS: Mixed infections by fungi are rare, but due to the high incidence of immunodeficiencies they could occur more often than reported. We would like to alert on the possibility of acquired mixed infection by fungi which have shown to be high aggressive and have a worse prognostic in patients with underlying diseases.

Prostate melanosis associated with acinar adenocarcinoma.

Prostate melanosis is an uncommon lesion of uncertain etiology where melanin deposition is seen in the epithelium, in the stroma, or in the form of a blue nevus. There are three reports in the literature of melanosis seen in association with prostatic adenocarcinoma. This is the fourth report of this association.

Histopathological aspects of neurocryptococcosis in HIV-infected patients: autopsy report of 45 patients.

The authors describe the histopathological necropsy findings of 45 human immunodeficiency virus (HIV)-infected patients with neurocryptococcosis. Systemic cryptococcosis with involvement of multiple organs such as spleen, liver, and lungs was present in all patients. Predominant diffuse meningoencephalitis predominantly in the basal ganglia, thalamus, and mid-brain, with minimal inflammatory infiltrate was seen in 30 AIDS patients (70%). We frequently observed in those patients the presence of multiple gelatinous pseudocysts with abundant Cryptococcus neoformans in the Virchow-Robin spaces and adjacent brain caused by the dissemination of the meningeal infection along the perivascular spaces. Isolated meningeal and cerebral involvement with minimal inflammatory infiltrate with numerous fungal organisms, and occasionally with granulomatous reaction and necrosis, was seen in 15 patients (30%). In addition to involvement of multiple organs by C. neoformans, HIV-infected patients with clinical manifestations of neurocryptococcosis frequently present a widespread involvement of the brain.

Web conferencing systems: Skype and MSN in telepathology.

Virtual pathology is a very important tool that can be used in several ways, including interconsultations with specialists in many areas and for frozen sections. We considered in this work the use of Windows Live Messenger and Skype for image transmission. The conference was made through wide broad internet using Nikon E 200 microscope and Digital Samsung Colour SCC-131 camera. Internet speed for transmission varied from 400 Kb to 2.0 Mb. Both programs allow voice transmission concomitant to image, so the communication between the involved pathologists was possible using microphones and speakers. A live image could be seen by the receptor pathologist who was able to ask for moving the field or increase/diminish the augmentation. No phone call or typing required. The programs MSN and Skype can be used in many ways and with different operational systems installed in the computer. The capture system is simple and relatively cheap, what proves the viability of the system to be used in developing countries and in cities where do not exist pathologists. With the improvement of software and the improvement of digital image quality, associated to the use of the high speed broad band Internet this will be able to become a new modality in surgical pathology.

Ossificacao endometrial: relato de caso / Endometrial ossification: case report

Os autores relatam o caso de uma paciente feminina, 37 anos, que durante a investigacao para infertilidade apresentou o diagnostico de ossificacao endometrial. A etiologia, patogenese e diagnosticos diferenciais de ossificacao endometrial sao...

Development of secondary resistance to fluconazole in Cryptococcus neoformans isolated from a patient with AIDS

Relatamos um caso de meningite por Cryptococcus neoformans em paciente com Sindrome de Imunodeficiencia Adquirida (SIDA). A terapia de manutencao com fluconazol nao evidenciou melhora clinica e micologica, ao mesmo tempo em que o teste de suscetibilidade in vitro revelou aumento progressivo da concentracao inibitoria minima (CIM). Estes resultados sugerem o desenvolvimento de resistencia secundaria ao fluconazol, todavia, resistencia cruzada com outros derivados azolicos nao foi constatada