Artificial Intelligence Improves the Accuracy in Histologic Classification of Breast Lesions.

OBJECTIVES: This study evaluated the usefulness of artificial intelligence (AI) algorithms as tools in improving the accuracy of histologic classification of breast tissue. METHODS: Overall, 100 microscopic photographs (test A) and 152 regions of interest in whole-slide images (test B) of breast tissue were classified into 4 classes: normal, benign, carcinoma in situ (CIS), and invasive carcinoma. The accuracy of 4 pathologists and 3 pathology residents were evaluated without and with the assistance of algorithms. RESULTS: In test A, algorithm A had accuracy of 0.87, with the lowest accuracy in the benign class (0.72). The observers had average accuracy of 0.80, and most clinically relevant discordances occurred in distinguishing benign from CIS (7.1% of classifications). With the assistance of algorithm A, the observers significantly increased their average accuracy to 0.88. In test B, algorithm B had accuracy of 0.49, with the lowest accuracy in the CIS class (0.06). The observers had average accuracy of 0.86, and most clinically relevant discordances occurred in distinguishing benign from CIS (6.3% of classifications). With the assistance of algorithm B, the observers maintained their average accuracy. CONCLUSIONS: AI tools can increase the classification accuracy of pathologists in the setting of breast lesions.

Liposclerosing myxofibrous tumor: A series of 9 cases and review of the literature.

BACKGROUND: Liposclerosing myxofibrous primary bone tumor is a rare benign bone lesion that was characterized by complex mixture of various histological elements. METHODS: We have studied the radiological, clinical and pathological features of nine patients with this disorder. Pain and limping were the main symptoms. RESULTS: Radiographic images typically showed a geographic lytic lesion with thick sclerotic margin, reflecting a pattern of slow growth. Histological sections revealed a polymorphic neoplasia characterized by predominant proliferation of stellate and fusiform cells aimed the myxoid matrix. CONCLUSIONS: These features suggest that the lesion may represent a variant of fibrous dysplasia with a high risk of malignant transformation.

Infantile Cortical Hyperostosis: Report of a Case with Observations on Clinical Manifestations, Radiology, and Pathology with a Late Follow-Up of Eight Years.

Purpose. The purpose of our study was to investigate clinical manifestations, roentgen images, histopathological studies, and evolution of the disease in patient displaying infantile cortical hyperostosis. Methods. Roentgenograms were made to evaluate a neonatal patient presenting multiple soft-tissue swellings. The initial radiographs insinuated that the disease had been present for some time in utero. Bone puncture biopsy of the tibia for histopathological observation and diagnosis conclusions was performed. Results. The disease was demonstrated radiographically by massive cortical diaphyseal thickening and also extensive periosteal new bone formation surrounding several bones. Results in blood count were as follows: discrete anemia, moderate leukocytosis, and elevated sedimentation rate. Histological pattern of tissue removed from tibia showed lamellar cortical bones and hyperplasia. Biopsy studies disclosed no evidence of neoplasia as well as of bacterial infection. Comments. Clinical manifestations in a neonatal patient displaying infantile cortical hyperostosis have gradually decreased. Radiograph findings have demonstrated complete recovery of bones manifested by the disease. The pathologic findings are in accordance with previous microscopic examination summarized by the literature. Total patient cure, without sequels, could be demonstrated.

[Presence of riziform bodies in a patient with juvenile idiopathic arthritis: case report and literature review.] / Presença de corpos riziformes em paciente com artrite idiopática juvenil: relato de caso e revisão de literatura.

Riziform bodies are structures formed by fibrin and cells that can be found in the synovial fluid or attached to the synovium, and have this denomination due to its rice grain-like appearance. They have already been described in several diseases such as tuberculous arthritis, rheumatoid arthritis, and rarely in juvenile idiopathic arthritis (JIA). This is the case of a boy with a 4-month course of chronic monoarthritis of the left knee, with family history of sarcoidosis in which diagnostic investigation showed the presence of these riziform bodies in the synovial biopsy. Diagnostic investigation ruled out sarcoidosis, tuberculosis and malignancies, establishing the diagnosis of JIA. Our objective was to describe what we believe is the 9th case reported on the presence of riziform bodies in JIA, which are probably underdiagnosed, and should be considered mainly in cases of severe arthritis of difficult medical treatment.

Relapsing polychondritis in childhood: three case reports, comparison with adulthood disease and literature review.

Relapsing polychondritis (RP) is a rare autoimmune systemic disease, especially in childhood. To report three new pediatric RP cases, to provide a literature review and to compare with adulthood disease, retrospective data collection from three childhood RP cases was observed in a Brazilian Pediatric Rheumatology Division. A literature review based on a MEDLINE database search was performed. Arthritis and auricular chondritis were present in our three patients. Two cases presented with early and severe laryngotracheal chondritis, besides initial and symptomatic costochondritis. The other case developed prominent epiphyseal plate involvement. Two patients were refractory to corticosteroids and immunosuppressants and required the use of TNF-alpha inhibitors to improve the symptoms, while corticosteroids plus methotrexate induced remission in the other patient. The literature review showed 44 cases of pediatric-onset disease in English language. Arthritis and ear chondritis are the most common initial and cumulative manifestations of RP in children and adults. Nasal and laryngotracheobronchial chondritis are also common manifestations observed during follow-up in childhood. There is also an early severity of respiratory chondritis in childhood, requiring aggressive treatment with corticosteroids, immunosuppressants and biologic agents. The data presented by those 3 children, considered in conjunction with the data from the 44 published cases, may reflect some distinguishing childhood RP features, such as more severe and frequent respiratory tract involvement, symptomatic costochondritis and the atypical pattern of persistent and destructive arthritis with epiphyseal plate involvement. Response to immunosuppressants and biologic agents is anecdotal, but steroids remain the main drug during the flares.

Osteossarcoma parosteal: aspectos na radiologia convencional / Parosteal osteosarcoma: conventional radiology findings

OBJETIVO: Avaliar os achados clínicos mais importantes do osteossarcoma parosteal e descrever os seus aspectos mais comuns na radiologia convencional. MATERIAIS E MÉTODOS: Estudo retrospectivo com 26 pacientes com osteossarcoma parosteal, provenientes do arquivo do Clube do Osso, Rio de Janeiro, RJ, e análise dos principais achados clínicos e aspectos radiológicos. RESULTADOS: A doença predominou em pacientes do sexo feminino e teve idade média de acometimento na terceira década de vida. Os achados clínicos mais freqüentes foram o aumento do volume no local do tumor (77 por cento dos casos) e a dor local (68 por cento dos casos). O local mais comum de tumor foi o oco poplíteo, com 40 por cento dos casos, e houve envolvimento metafisário em 92 por cento dos tumores. O aspecto radiológico mais comumente encontrado foi de lesão bem mineralizada e intimamente justaposta à superfície óssea, com o córtex adjacente irregularmente espessado (92,3 por cento dos casos), observando-se área de adesão a este (88,5 por cento dos casos), além de margens tumorais lobuladas (50 por cento dos casos) ou irregulares (38,5 por cento dos casos). Evidenciaram-se, também, linha radiolucente entre o tumor e o osso adjacente (48 por cento dos casos), padrão de mineralização mais denso na base do que na periferia (42,3 por cento dos casos) e pequena ocorrência de reação periosteal (15,4 por cento dos casos). CONCLUSÃO: Apesar de a tomografia computadorizada e a ressonância magnética serem importantes na identificação de alguns aspectos do osteossarcoma parosteal, a radiologia convencional é altamente sugestiva deste tumor e permite, na maior parte dos casos, o diagnóstico diferencial com outras lesões da superfície óssea.

OBJECTIVE: To evaluate the most significant features of parosteal osteosarcoma and to describe the most frequent findings on conventional radiology. MATERIALS AND METHODS: A retrospective study was performed including 26 cases of patients with parosteal osteosarcoma from the archives of "Clube do Osso", Rio de Janeiro, RJ, Brazil, with analysis of main clinical and radiological findings. RESULTS: The disease was prevalent in female patients in the third decade of life. Main clinical findings were the increase in volume on the site of the tumor (77 percent of cases) and local pain (68 percent of cases). The most frequent site of tumor was the popliteal fossa (40 percent), and metaphyseal involvement has occurred in 92 percent of cases. The most frequent radiological findings were densely mineralized lesions on juxtacortical locations, and irregularly thickened adjacent host cortex (92.3 percent), with adherence areas being observed in 88.5 percent of cases, besides lobular (50 percent) or irregular (38.5 percent) tumor margins. Also, a radiolucent line between the tumor and the adjacent bone (48 percent), a denser mineralization on the basis than in the periphery of the tumor (42.3 percent), and a small rate of periosteal reaction (15.4 percent) were found. CONCLUSION: Although computed tomography and magnetic resonance imaging are important modalities for identifying some aspects of parosteal osteosarcoma, conventional x-ray is essential in the initial evaluation of this type of lesion, most frequently allowing differential diagnosis with other surface bone lesions.

Case report: Periosteal Ewing's sarcoma: case report and literature review.

Ewing's sarcoma is a round-cell tumor that arises most often in a medullary cavity. This neoplasm is uncommon in a subperiosteal location. We report a new case of a 12-year-old boy with a periosteal Ewing's sarcoma, located in the femur, who was treated by cortical segmental resection associated with chemotherapy. Two years after surgery the patient was free of disease. In reviewing the literature of 29 cases, it seems the prognosis is better in periosteal compared with intramedullary Ewing's sarcoma.

Osteossarcoma parosteal de escápula / Parosteal osteosarcoma of the scapula

O osteossarcoma parosteal (OSP) ocorre, predominantemente, em ossos longos, acometendo o terço distal do fêmur em cerca de 60 por cento dos casos. Relata-se um caso de OSP situado em escápula, sendo este o terceiro publicado na literatura.

Metastatic skeletal leiomyomatosis (leiomyomatosis ossea).

We present a unique case of metastatic leiomyomatosis to the skeleton. The very extensive involvement of the axial and peripheral skeleton with "ring" lesions and associated cyclical premenstrual pain eventually led to the correct diagnosis and total relief with hormonal therapy.

Angiostrongilíase abdominal: relato de possível caso autóctone do Rio de Janeiro / Abdominal angiostrongyliasis: report a probable autocton case from Rio de Janeiro

Apresentamos o primeiro caso de angiotrongilíase abdominal, com possibilidade de ser autóctone, do Rio de Janeiro. Inicialmente o quadro clínico era de febre prolongada e eosinofilia maciça, evoluindo com abdome agudo por perfuraçao de alça, peritonite, sepse e necrose hepática. A histopatologia do segmento ressecado e da biopsia hepática confirmou a presença de verme intra-arterial, arterite e granuloma eosinofílicos. Sao abordados os aspectos clínicos e patológicos desta doença rara e potencialmente grave. É enfatizada a importância de se evitar emprego indiscriminado de anti-helmínticos baseando-se apenas na eosinofilia, sem identificaçao do parasita através de exames de fezes.

Comprometimento hepático na síndrome de imunodeficiência adquirida: valor diagnóstico da biópsia hepática percutânea com correlaçäo clínico-laboratorial / Hepatic involvement in AIDS: diagnostic value of percutaneous hepatic biopy with clinical and laboratorial correlation

As autoras realizaram biópsia hepática percutânea com análise do fragmento de parênquima através de histopatologia associada a técnicas especiais para pesquisa de agentes patógenos (vírus, fungos, micobactérias), em oito pacientes portadores de vírus da imudeficiência humana que cursavam com hepatomegalia e alteraçäo de enzima séricas e provas funcionais hepáticas. Em todos os casos foram observadas alteraçöes, sendo mais freqüênte a esteatose hepática secundária à desnutriçäo protéico-calórica e a associaçäo com hepatite viral. Observamos, paralelamente, lesäo por citomegalovírus e tuberculose. Näo constatamos infiltraçäo neoplásica, mesmo nos casos que cursavam com sarcoma de Kaposi disseminado e linfoma de grandes células

As bases biológicas do envelhecimento / Biological bases of ageing

É apresentada uma análise das bases teóricas do envelhecimento e das modificaçöes dermatológicas, psicológicas e filosóficas que podem ocorrer nas diversas etapas da senectude