Correlação entre ressonância magnética, expressão do Ki-67 e p53, e prognóstico em astrocitomas / Correlation between Magnetic Ressonance Image, Expression of Ki-67 and p53, and Prognosis in Astrocytomas

Objetivos Avaliar a correlação entre a expressão do Ki-67 e do p53 em astrocitomas graus II a IV, as características da RM e seu prognóstico. Métodos e Resultados Este é um estudo longitudinal retrospectivo do tipo coorte histórico que avaliou 45 pacientes. O prognóstico foi avaliado mediante revisão dos prontuários. A avaliação imuno-histoquímica foi realizada no Serviço de Patologia do HB. A avaliação das imagens de RMfoi feita no Serviço de Radiologia. A sobrevidamédia dos pacientes foi de 581,4 dias no grau IV; 1.704,8 dias no grau III; e 1.044,8 dias no grau II. Para cada grau, os seguintes percentuais de células positivas de Ki-67 e p53 tiveram respectivamente: 97,8 e 80% de positividade no grau IV; 72,7 e 73,4% de positividade no grau III; e 70 e 80% de positividade no grau II. Observou-se diferença estatística na expressão de Ki-67 entre os graus III e IV (P » 0,014). A RM mostrou especificidade de 64% e sensibilidade de 100% para a presença de necrose tumoral. Conclusão Concluímos que a análise da positividade do Ki-67 e do p53 não permite sua correlação com a sobrevida dos pacientes, apesar de ambos terem sua frequência distribuída de maneira semelhante. A RM tem especificidade moderada em relação ao exame patológico.rada em relação ao exame patológico.

Objectives To evaluate the correlation between the expression of Ki -67 and p53 in astrocytomas grades II to IV, the characteristics of MRI and its prognosis. Methods This was a retrospective longitudinal cohort study of its kind that evaluated 45 patients. Prognosis was assessed by review of medical records. The immunohistochemical evaluation was performed at the Pathology Service of HB. The evaluation of MRI images was taken in the Radiology Department. The median survival of patients was 581.4 days in grade IV; 1704.8 days in grade III; 1044.8 days in grade II. For each grade, the following percentages of cells positive for Ki -67 and p53 , respectively : 97.8% and 80% had a positive grade IV ; 72.7% and 73.4% positivity in grade III ; 70% and 80% in stage II positivity . There was statistical difference in Ki -67 between grades III and IV (P » 0.014).MRI showed 64% specificity and 100% sensitivity for the presence of tumor necrosis Conclusion We conclude that the analysis of the positivity of Ki -67 and p53 expression does not allow correlation with patient survival, although both their frequency distributed similarly. MRI hasmoderate specificity in relation to pathological examination.

[Subcutaneous panniculitis-like T-cell lymphoma]. / Linfoma subcutâneo de células T paniculite-símile.

Subcutaneous panniculitis-like T-cell lymphoma is extremely rare and has recently been recognized as a clinicopathological entity. Young female, 17 years old, has complained of subcutaneous nodules and plaques in the limbs and abdomen for three years, accompanied of mild weight loss without other constitutional symptoms. Nodal, visceral and bone marrow involvement was absent, and subcutaneous CD3/CD8 atypical lymphocyte infiltration was observed in the skin sample. Chemotherapy interrupted the onset of new lesions and led to remission in the 8-month follow-up. Immunophenotypic and molecular aspects were relevant to the diagnosis and as prognosis makers.

[Tzanck smears: an old but useful diagnostic tool]. / Citologia de Tzanck: redescobrindo uma antiga ferramenta diagnóstica.

Tzanck smears can be used for the diagnosis of cutaneous infections, autoimmune disorders and cutaneous tumors. To exemplify its use, we report a case of a female patient with pemphigus vulgaris whose diagnosis was confirmed by positive direct immunofluorescence and conventional cytology using smears obtained by scraping the cheek mucosa.

Linfoma subcutâneo de células T paniculite-símile: [relato de caso] / Subcutaneous panniculitis-like T-cell lymphoma: [case report]

Linfoma subcutâneo de células T paniculite-símile foi recentemente reconhecido como entidade clínico-patológica. Paciente do sexo feminino, 17 anos, relatou nodosidades eritêmato-violáceas e depressões nos membros e abdome há três anos e discreta perda ponderal, sem outros sintomas gerais. Adenomegalia, visceromegalias e infiltração da medula óssea estavam ausentes, e a histopatologia da pele mostrou densa infiltração de linfócitos atípicos CD3/CD8 no subcutâneo. A quimioterapia interrompeu o surgimento de novas lesões com remissão das pré-existentes no seguimento de oito meses. Aspectos imunofenotípicos e moleculares são relevantes para elucidação diagnóstica e avaliação do prognóstico.

Subcutaneous panniculitis-like T-cell lymphoma is extremely rare and has recently been recognized as a clinicopathological entity. Young female, 17 years old, has complained of subcutaneous nodules and plaques in the limbs and abdomen for three years, accompanied of mild weight loss without other constitutional symptoms. Nodal, visceral and bone marrow involvement was absent, and subcutaneous CD3/CD8 atypical lymphocyte infiltration was observed in the skin sample. Chemotherapy interrupted the onset of new lesions and led to remission in the 8-month follow-up. Immunophenotypic and molecular aspects were relevant to the diagnosis and as prognosis makers.

Citologia de Tzanck: redescobrindo uma antiga ferramenta diagnóstica / Tzanck smears: an old but useful diagnostic tool

A citologia de Tzanck consiste em método simples e confiável para o diagnóstico de dermatoses virais, parasitárias, autoimunes e tumorais. Para exemplificar o emprego do teste de Tzanck em lesões vésico-bolhosas, um caso de pênfigo vulgar é descrito, cuja citologia e imunofluorescência direta, utilizando-se esfregaço coletado de lesão oral, confirmaram o diagnóstico de forma rápida e fácil.

Tzanck smears can be used for the diagnosis of cutaneous infections, autoimmune disorders and cutaneous tumors. To exemplify its use, we report a case of a female patient with pemphigus vulgaris whose diagnosis was confirmed by positive direct immunofluorescence and conventional cytology using smears obtained by scraping the cheek mucosa.

Polyploidy in atypical grade II choroid plexus papilloma of the posterior fossa.

Cytogenetic studies of choroid plexus tumors, particularly for atypical choroid plexus papillomas, have been rarely described. In the present report, the cytogenetic investigation of an atypical choroid plexus papilloma occurring at the posterior fossa of a 16-year-old male is described. Comparative genome hybridization analysis demonstrated gains of genetic material from almost all chromosomes. Chromosome losses involved 19p, regional losses at chromosome X and loss of chromosome Y. The presence of polyploid cells was confirmed by fluorescence in situ hybridization analysis with probes directed to centromeric regions. Furthermore, the microscopic analysis of cultures showed nuclear buds, nucleoplasmic bridges, and micronuclei in 23% of tumor cells suggesting the presence of complex chromosomal abnormalities. Previous cytogenetic studies on choroid plexus papillomas showed either normal, hypodiploid or hyperdiploid karyotypes. To the best of our knowledge, this is the first report of polyploidy in choroid plexus papilloma of intermediate malignancy grade. Although the mechanisms beneath such genome duplication remain to be elucidated, the observed abnormal nuclear shapes indicate constant restructuring of the tumor's genome and deserves further investigation.

Leprosy-specific oral lesions: a report of three cases.

Leprosy is a chronic infection caused by Mycobacterium leprae, a bacillus that presents a peculiar tropism for the skin and peripheral nerves. The clinical spectrum of leprosy ranges from the tuberculoid form (TT) to the disseminative and progressive lepromatous form (LL). Oral lesions are rare but, when present, occur in the lepromatous form. This article describes the clinical and microscopic findings of three cases of LL with oral manifestations. All patients had the lepromatous form and their leprosy-specific oral lesions occurred in the palate. The diagnosis was based on clinical, serological and histopathological findings, and multidrug therapy for multibacillary leprosy was started and continued for 24 months. All patients completed treatment, but developed reaction episodes which were treated with prednisone and/or thalidomide. The authors emphasize the importance of oral mucosa evaluation by a dental health professional during patient care since oral lesions may act as a source of infection.

Unusual orofacial manifestations of histoplasmosis in renal transplanted patient.

Histoplasmosis is a fungal infection caused by the Histoplasma capsulatum. Mucosal manifestations are uncommon, but, when present, they are usually associated with pulmonary or chronic disseminated infection. The course of the disease is often related to the host immune response. The purpose of this article is to describe the clinical and microscopic findings of unusual involvement of nasal cartilage and septal destruction, and oral lesions of histoplasmosis in an immunosuppressed patient who presented an unusual form of the disease.

Lymphomatoid papulosis in a patient with Waldenström's macroglobulinemia.

Lymphomatoid papulosis (LyP) is a rare skin disease with a benign course but a malignant histologic appearance based on atypical lymphocytes. Waldenström's macroglobulinemia (WM) is a diffuse infiltration of the bone marrow by cells that synthesize IgM immunoglobulins. A 46-year-old female presented with a two year history of weakness, fatigue, anemia, and recurring multiple erythematous papules and nodules in the skin. The skin biopsy showed pleomorphic lymphoid cells with atypical mitoses permeated by a diffuse dermal infiltrate of normal appearing lymphocytes. The neoplastic cells were positive for CD30, CD3, and CD5 but negative for CD20 and EMA. The bone marrow was hypercellular due to a diffuse infiltration by lymphocytes, plasma cells, and plasmacytoid lymphocytes. LyP is a lymphoproliferative disorder of CD30-positive T cells that may be associated with other lymphoid malignancies, particularly Hodgkin's disease, mycosis fungoides, and anaplastic T cell lymphomas. To our knowledge, this is the first report of a LyP appearing in a patient with WM.

Disseminated mucocutaneous leishmaniasis resulting from chronic use of corticosteroid.

Mucocutaneous leishmaniasis is a granulomatous disease clinically characterized by ulcerated skin and mucosal lesions whose clinical manifestations can regress spontaneously, but with possible long subclinical evolution. The course of the disease is often related to the host immune response. The purpose of this article is to describe the clinical and microscopic findings of cutaneous and mucosal lesions of mucocutaneous leishmaniasis in a patient who presented an unusual form of the disease associated with an immunosuppressive state.

Matriz extra-celular: fibronectina / Extracellular matrix: fibronectine

A fibronectina é uma glicoproteína presente no plasma sangüíneo e nos tecidos. Tem propriedade de ligar-se a si mesma e a várias outras substâncias diferentes, tais como a fibrina, a heparina, bactérias, colágeno, fibroblastos, e outras células. Por esta propriedade ligante, desempenha funções fisiológicas múltiplas e tem participação importante em diversos processos patológicos, tanto em sua forma intacta como pela presença de seus isômeros e fragmentos. Fisiologicamente, a fibronectina é responsável pela orientação da migração celular na embriogênese e participa na homeostase e a coagulação sangüínea e na condrogênese. A fibronectina está envolvida em processos osteoartríticos, na produção de anomalias nos membros e em condições patológicas que afetam a mucosa oral humana

Idade do paciente, hiperplasia nodular e adenocarcinoma de próstata: estudo estatístico / Patient age, nodular hyperplasia and prostate adenocarcinoma: a statistical study

A próstata humama é constituída por estroma e ácinos, distribuídos em dois lobos laterais e um central e pode apresentar três importantes lesoes: inflamatória, hiperplasia nodular e câncer. No presente trabalho investigamos a faixa etária em que ocorrem a hiperplasia nodular e o câncer. Verificamos, estatisticamente, que ambas as patologias ocorrem na mesma faixa etária, com maior incidência de ambas entre 65 e 69 anos.