Retalho autólogo de grande omento como estrutura cirúrgica de reparo extraperitoneal. Estudo experimental comparativo, pareado e controlado de suas propriedades adaptativas / The autologous greater omental flap as a structure for extraperitoneal surgical repair: a comparative, paired, and controlled experimental study of its adaptive properties

Introdução: O grande omento vem sendo utilizado como estrutura de reparo desde o século XIX e a partir do século XX tem sido descrito, em meio extraperitoneal, para o tratamento de diversas afecções em várias especialidades cirúrgicas. Apesar de amplamente estudado a partir da década de 1960, não há descrição de estudos comparativos sobre o seu retalho em meio extra peritoneal. O objetivo do presente estudo foi analisar as características adaptativas do grande omento em meio extra peritoneal para identificar a real aplicabilidade cirúrgica desta estrutura. Métodos: Estudo experimental comparativo, pareado e controlado de 20 amostras teciduais de ratos (Rattus norvegicus) fêmeas obesas, irmãs da linhagem Sprague- Dawley. De cada animal foram analisados e comparados, macroscopicamente e microscopicamente, através das técnicas de Hematoxilina-eosina (HE) amostras de: (1) omento sem manipulação, (2) omento manipulado intraperitoneal, (3) omento manipulado extraperitoneal e (4) tecido adiposo subcutâneo. Resultados: omento extraperitoneal, macroscopicamente, apresentou uma coloração amarelado mais intenso, semelhante à gordura subcutânea adjacente, com alto grau de contração se comparado ao omento intraperitoneal de controle. Pela técnica de HE, foi identificado alto grau de fibrose e tamanho médio dos adipócitos semelhante ao omento de controle e inferior ao do subcutâneo (p<0,001). Conclusão: O omento extraperitoneal não se mostra capaz de promover regeneração tecidual, uma vez que não foi observado metaplasia à histologia do retalho translocado. Entretanto, pode servir para a correção de pequenas deformidades, para o tratamento de áreas isquêmicas, como estrutura carreadora para a reconstrução cirúrgica e como plataforma germinadora para o desenvolvimento de novos órgãos.

Introduction: The greater omentum was initially used in the repair of gastrointestinal defects in the 19th century; during the 20th century, it has been used extraperitoneally in the treatment of various disorders, in several surgical specialties. Despite the fact that the greater omentum was studies in detail in the 1960s, there are no reported comparative studies concerning the use of omental flaps extraperitoneally. The present study analyzed the adaptive features of the greater omentum in the extraperitoneal space, with the aim of identifying its surgical applicability. Methods: A paired, controlled comparative study was conducted using 20 tissue samples from 5 obese female Sprague-Dawley rats (Rattus norvegicus). The following specimens from each animal were analyzed and compared, macroscopically and microscopically, using the hematoxylin-eosin (HE) technique: (1) omentum without manipulation; (2) intraperitoneally manipulated omentum; (3) extraperitoneally manipulated omentum; and (4) subcutaneous adipose tissue. Results: Macroscopically, the extraperitoneal omentum exhibited a more intense yellowish color and a higher degree of contraction than the control (intraperitoneal) omentum. The extraperitoneal omentum was similar in color to the adjacent subcutaneous adipose tissue. HE staining revealed a high degree of fibrosis and an average adipocyte size, similar to that in the control omentum, but lower than that in subcutaneous adipose tissue (p< 0.001). Conclusion: The results of this study indicate that the extraperitoneal omentum was not able to promote tissue regeneration, as metaplasia of the translocated flap was not observed in the histological analysis. However, this structure may be used to correct small deformities, in the treatment of ischemic areas, as a carrier structure for surgical reconstruction and as a germination platform for the development of new organs.

Immunohistochemical analysis of vascular density and area in colorectal carcinoma using different markers and comparison with clinicopathologic prognostic factors.

Analysis of blood and lymphatic vessel in colorectal cancer is controversial in the literature, possibly due to variations in the methods of analysis. In this study, it was aimed to search for a reliable approach in the quantification of angio- and lymphangiovascular density and area as a prognostic factor and to compare such vessel counts in normal mucosa, adenomas and cancer. A retrospective study was performed on 60 sporadic colorectal cancer, 30 colorectal adenomas, and 10 colorectal non-neoplastic lesions. Archival tissues were submitted to immunohistochemical evaluation using antibodies to CD31, CD34, CD105, VEGF-A, VEGF-C, and D2-40. Microvessel density and total vascular area were determined by computer image analysis and values were compared in the three groups of lesions; the prognostic value of these parameters was evaluated in the group of colorectal cancer. Most markers showed progressive vessel counts from non-neoplastic tissue to carcinoma, both for microvessel density and total vascular area. Only microvessel density determined by CD34 in the central areas of the cancer correlated with recurrence/metastasis (p = 0.04) and survival (p = 0.02). Different methods of quantification (microvessel counting versus estimation of total vascular area), immunohistochemical markers (pan-endothelial marker versus neovessels and lymphatic markers), and areas of analysis (periphery versus inner portions of the lesion) were assessed using image analysis. The results corroborate the increase in vascularization of carcinoma and suggest that microvessel density determined by immunostaining for CD34 in the inner portion of the tumor might represent a prognostically relevant parameter in colorectal cancer.

Concomitant detection of hematological neoplasm and carcinoma: report on seven cases.

CONTEXT: The presence of multiple neoplasms in one patient is an uncommon event. Its occurrence ranges from 1.2% to 4.5% of cancer patients in autopsy and clinical studies. In the present article, cases of synchronous diagnoses of carcinoma and lymphoid neoplasms are reported. The intention of this report was to alert clinicians and pathologists to the possibility of the existence of concomitant neoplasms, in order to prevent inaccurate or delayed diagnosis and staging. CASES: Seven patients (four female and three male) with a median age of 61.4 years were diagnosed as having concomitant epithelial and hematological neoplasms. DISCUSSION AND CONCLUSION: Lymph nodes should be carefully examined when searching for metastases, because of the possibility of a second hematological malignancy. Whenever uncommon suspicious morphological features are seen in such neoplasms, an immunohistochemical analysis is essential.

Concomitant detection of hematological neoplasm and carcinoma: report on seven cases / Detecção concomitante de neoplasia hematológica e carcinoma: relato de sete casos

CONTEXT: The presence of multiple neoplasms in one patient is an uncommon event. Its occurrence ranges from 1.2 percent to 4.5 percent of cancer patients in autopsy and clinical studies. In the present article, cases of synchronous diagnoses of carcinoma and lymphoid neoplasms are reported. The intention of this report was to alert clinicians and pathologists to the possibility of the existence of concomitant neoplasms, in order to prevent inaccurate or delayed diagnosis and staging. CASES:Seven patients (four female and three male) with a median age of 61.4 years were diagnosed as having concomitant epithelial and hematological neoplasms. DISCUSSION AND CONCLUSION: Lymph nodes should be carefully examined when searching for metastases, because of the possibility of a second hematological malignancy. Whenever uncommon suspicious morphological features are seen in such neoplasms, an immunohistochemical analysis is essential.

CONTEXTO: A presença de múltiplas neoplasias em um mesmo paciente é evento infreqüente, correspondendo a 1,2 por cento-4,5 por cento dos pacientes com câncer em estudos clínicos e de autópsias. Neste artigo, os autores relatam casos de diagnósticos sincrônicos de carcinomas e neoplasias linfóides. Ao apresentar estes casos, tenciona-se alertar clínicos e patologistas para a possibilidade da ocorrência de neoplasias concomitantes, para evitar atrasos ou erros diagnósticos ou de estadiamento da doença. SÉRIE DE CASOS:Sete pacientes, quatro mulheres e três homens, com média de idade de 61,4 anos, foram diagnosticados com neoplasias epitelial e hematológica concomitantes. DISCUSSÃO E CONCLUSÃO: Os linfonodos devem ser cuidadosamente examinados quando se buscam metástases, dada a possibilidade de uma neoplasia hematológica concomitante. Sempre que aspectos morfológicos suspeitos forem detectados, um estudo imunoistoquímico faz-se necessário.

Síndrome de Letterer-Siwe mimetizando broncopneumonia em criança de 11 meses / Letterer-Siwe Syndrome imitating bronchopneumonia in an 11-months-aged child

A Síndrome de Letterer-Siwe é uma doença de acometimento sistêmico, de causa desconhecida, consistindo na proliferaçäo de histiócitos maturos e imaturos. No pulmäo, a doença é marcada pela inflamaçäo das pequenas vias aéreas e vênulas pulmonares, evoluindo para fibrose e destruiçäo dos tabiques. É de rara ocorrência (1 para cada dez mil habitantes) e de difícil diagnóstico, sendo importante a manifestaçäo sistêmica, muitas vezes inespecífica. Será apresentado o caso de uma criança de 11 meses de idade, com pneumopatia, que recebeu tratamento para broncopneumonia, vindo a falecer, e em cuja necrópsia diagnosticou-se Síndrome de Letterer-Siwe.