Surgical lung biopsy in onco-hematological patients with diffuse pulmonary infiltrates and mechanical ventilation in the ICU.

Among onco-hematological patients with acute respiratory failure (ARpF), surgical lung biopsy (SLB) could contribute to the medical management, by guiding initiation, maintenance or discontinuation of diagnostic and therapeutic interventions. The aim of the present study was to evaluate the results of SLB in these patients in an oncological center from a medium-income country, as well as analyze if this procedure is clinically useful in this context, and its impact on complications and mortality. This observational retrospective study analyzed onco-hematological patients with ARpF in the Intensive Care Unit (ICU) of a cancer center in southern Brazil between 2010-2016, who required mechanical ventilation and were submitted to open SLB. Among the studied population (n=17), the most commonly found etiology was infectious, present in ~50% of the biopsies, followed by unspecific inflammatory infiltrate acute respiratory distress syndrome and interstitial fibrosis, alveolar hemorrhage, neoplastic infiltrate and pulmonary embolism. Biopsy has led to a change of management in 63.3% of patients that were alive when results were available; however, 35% of patients succumbed prior to the pathological result. There was no requirement for re-operation or mortality attributable to the procedure. However, ICU mortality was elevated (88%). SLB in onco-hematological patients mechanically ventilated in the ICU is a safe procedure with few severe complications and that contributes for diagnosis and management in the majority of cases. Due to the high mortality of this population, controlled trials may be required to establish its benefit in mortality and ICU outcomes.

Histopathological grading systems analysis of oral squamous cell carcinomas of young patients

BACKGROUND: To analyze the clinicopathological profile of young patients (ˇÜ 40 years) with oral SCC and correlate with a control group (ˇÝ 50 years) by means of histopathological grading systems. MATERIAL AND METHODS: 14 young patients and 14 control patients were selected with similar clinical stage and tumor location. Demographic and clinical data were obtained from patient records and histological sections were evaluated according to four histopathological grading systems. Associations between categories of demographic and clinical data were performed through Chi-square test and Exact Fisher test. The survival analyzes were performed according to the Kaplan-Meier method. RESULTS: The comparison between groups showed a greater association of treatment modalities in younger patients (p = 0.022), they had a higher incidence of local recurrence and regional metastasis (p = 0.018) and lower disease free survival in 5 years (p = 0.069). There was no difference in 5-year overall survival among the studied groups. There was no difference in histological grading between studied groups according to the four used systems. CONCLUSIONS: This study showed that, despite tumors had similar histological grade and more therapeutic modalities were used in the young group, tumors in young patients had a higher incidence of recurrence/metastasis, showing tendency to a more aggressive behavior

Clinicopathologic analysis of 493 cases of salivary gland tumors in a Southern Brazilian population.

OBJECTIVE: The aim of this study was to determine the distribution and demographic features of salivary gland tumors (SGTs) in a large Brazilian population. STUDY DESIGN: A total of 493 cases of SGTs diagnosed between 2001 and 2011 from a general pathology laboratory and an oral pathology service were reviewed with respect to their clinicopathologic features. RESULTS: A total of 369 tumors were benign and 124 were malignant. The mean age of patients with benign tumors was 46.3 years and that of patients with malignancies was 54.0 years. The parotid gland was the most common location (42.3%). Pleomorphic adenoma (PA) and Warthin's tumor were the most common benign neoplasias, whereas mucoepidermoid carcinoma (MEC) and adenocarcinoma, not otherwise specified, were the most frequent malignancies. CONCLUSIONS: The present data confirm that PA and MEC are the most common benign and malignant SGTs. However, it is important to consider that differences in tumor types may be influenced by whether a tumor derives from a medical or a dental service.

Concomitant loss of heterozygosity at the BRCA1 and FHIT genes as a prognostic factor in sporadic breast cancer.

Previous studies have shown loss of heterozygosity (LOH) at the BRCA1 and FHIT genes in sporadic primary breast cancer. The aim of this study was to evaluate concomitant LOH at the BRCA1 and FHIT genes in sporadic breast cancer and investigate its influence on patient survival. Loss of heterozygosity was determined using microsatellite markers. The analysis on the informative cases (n = 72) indicated LOH at both the BRCA1 and FHIT loci in 25 cases (35%), the absence of LOH at both loci in 23 cases (32%), and the presence of LOH at one of the loci in 24 cases (33%). The concomitant LOH was associated with poor prognostic factors, such as large tumors (P = 0.01), axillary nodal involvement (P < 0.01), histologic grade III (P < 0.01), vascular invasion (P = 0.01), and negative hormone receptor (P = 0.02). After a median follow-up period of 48 months, the concomitant LOH group had the shortest survival (P < 0.02 by log-rank test; P < 0.05 by Cox model; hazard ratio of 4.87), compared with patients without LOH. These data suggest that concomitant allelic losses of the BRCA1 and FHIT genes are associated with more aggressive breast tumors.

Metástase tardia múltipla de carcinoma renal de células claras: relato de caso / Late multiple metastasis from clear renal cell carcinoma: case report

Metástases para o pâncreas são raras, podendo ocorrer a partir do carcinoma renal de células claras. Apresentamos um caso demetástase pancreática, envolvendo suprarrenal e hilo esplênico, em uma mulher de 49 anos, que teve carcinoma renal de células clarassete anos atrás. Em seguimento após nefrectomia, a paciente teve o diagnóstico de metástase em pâncreas, suprarrenal e hiloesplênico. Tratada com cirurgia e interferon. Imunohistoquímica para gp200 e CD-10, foi positiva. Tomografia computadorizada mostroumetástase para o estômago oito anos após a nefrectomia, estando a paciente em uso de interferon atualmente. Carcinoma de célulasrenais pode recidivar anos após a nefrectomia. Identificação e tratamento cirúrgico podem proporcionar suporte paliativo e sobrevidaem longo prazo.

Metastasis to the pancreas is uncommon; however, it may occur from clear renal cell carcinomas. We present a case of pancreaticmetastasis involving adrenal and splenic hilum in a 49 year-old woman that had clear renal cell carcinoma seven years ago. The patientin post nephrectomy follow-up presented a diagnosis of metastasis in the pancreas, adrenal and splenic hilus. The patients was treatedby surgery and interferon. Immunohistochemistry for gp200 and CD-10 was positive and computed tomography showed metastasis inthe stomach eight years after surgery. She is currently treated with interferon. Renal cell carcinoma can reappear years afternephrectomy, therefore, recognition and surgical treatment can provide palliation and long-term survival.

Ruptura de angiomiolipoma renal gigante: relato de caso / Break giant renal angiomyolipoma: case report

Introdução: Angiomiolipoma renal é uma neoplasia beigna formada por vasos sanguíneos, adipócitos e fibras de músculos lisos. Pode se associar à esclerose tuberosa ou ser esporádico. Geralmente é assintomático e diagnosticado incidentalmente. Ruptura espontânea é rara, porém pode se constituir numa complicação severa e potencialmente fatal. Relatamos um caso de ruptura de angiomiolipoma gigante tratado cirurgicamente. Relato de caso: Uma paciente de 51 anos, branca, foi admitida com dor de início súbito em flanco e região lombar. Tomografia computadorizada mostrou um tumor adiposo renal com hematoma retroperitoneal. Tratada cirurgicamente por drenagem do hematoma e tumorectomia, sendo feito o diagnóstico de angiomiolipoma, apresentando excelente evolução. Conclusão: Descrevemos o caso de uma ruptura de angiomiolipoma gigante esporádico que foi tratado por cirurgia e teve uma boa recuperação.

Introduction: Renal Angiomyolipoma is a beign tumor formed by blood vessels, adipocytes and smooth muscle fibers. May be associated with tuberous sclerosis or be sporadic. It is usually asymptomatic and diagnosed incidentally. Spontaneous rupture is rare but can constitute a severe and potentially fatal complication. A case of ruptured giant angiomyolipoma treated surgically. Case report: A patient of 51 years, White was admitted with sudden pain in the flank and lumbar region. A CT scan showed a fatty tumor renal retroperitoneal hematoma. Treated surgically by lumpectomy and drainage of the hematoma, and the diagnosis of angiomyolipoma, showing excellent progress. Conclusion: We describe a case of a ruptured giant sporadic angiomyolipoma that was treated by surgery and had a good recovery.

Metástase renal bilateral de um carcinoma de esôfago / Bilateral renal metastases from an esophageal carcinoma

Metástases renais de carcinoma primário de esôfago são pouco diagnosticadas, sendo muitas vezes relatadas como achados em estudos de necrópsia.Relatamos um caso que evoluiu para óbito por uremia devido à infiltração renal bilateral. Paciente de 37 anos, branco, sexo masculino, foi admitido comhistória de disfagia. Investigação revelou carcinoma espinocelular de esôfago pouco diferenciado grau III. Tratado com radioterapia. Oito meses depois o paciente procurou serviço médico com queixa de dor lombar, sendo diagnosticada metástase renal bilateral. Evoluiu com uremia e óbito 10 dias após a biópsia.

Renal metastases from esophageal carcinomas are very uncommon and frequently reported as a necropsy finding. We described a case who died in renal failure in consequence a bilateral infiltration of kidneys. A 37-year-old man was admitted with dysphagia. Investigation revealed an esophageal espinocellular carcinoma. He was managed with radiotherapy. Eight months later, the patient had lumbar pain, and the diagnosis of bilateral renal metastases was done.He developed renal failure and died ten days later.

Evolução incomum de provável histoplasmose de sistema nervoso central: de leptomeningite para granuloma da fossa posterior: Relato de caso com imagens por ressonância magnética / Uncommon evolution of probable central nervous system histoplasmosis: from leptomeningitis to posterior fossa granuloma: A case report with magnetic resonance images

Um caso de jovem paciente imunocompetente com provável histoplasmose do sistema nervoso central é aqui reportado, com ênfase nos aspectos evoluktivos muito peculiares de neuroimagem por ressonncia magnética que foram encontrados. Inicialmente foi observado espessamento leptomeníngeo, que, posteriormente, acabou organizando-se em granuloma de fossa posterior. O diagnóstico da infecção fúngica só foi obtido através do estudo histopatológico e o tratamento empregado baseou-se no uso do fluconazol em terapia de longo prazo, com boa resposta inicial.

We report a case of a young immunocompetent patient with probable central nervous system histoplasmosis with evolutive peculiar findings seen on magnetic resonance imaging. Leptomeningeal thickening was initially observed which subsequently became a posterior fossa granuloma. The diagnosis of fungal infection was only reached by histopathological study and the treatment was based on long term therapy with fluconazole with good initial response.

Carcinoma de células renais em rim transplantado: relato de caso / Renal cell carcinoma in a transplanted kidney: case report

Carcinoma de células renais no enxerto tem sido raramente relatado. Apresentamos um caso diagnosticado oito anos após o transplante renal em ecografiade rotina, tratado com tumorectomia e manutenção do enxerto. Relato do caso: Paciente de 42 anos, branco, sexo masculino, história de hipertensão delonga data evoluindo com insuficiência renal crônica terminal, tendo sido submetido à hemodiálise durante dois anos, e a um transplante renal com doadorvivo haploidêntico há oito anos, recebendo azatioprina e prednisona como terapia imunossupressora. Durante exame ecográfico de rotina, constatadaimagem nodular de 2,2 x 1,7 cm de diâmetro em enxerto renal. Tratado com tumorectomia e manutenção do enxerto. Após dois anos a função renal, mantém-se estável e não há evidência de metástases. Discussão: Carcinoma de células renais é raro em rim transplantado, havendo controvérsia sobre o tipode tratamento cirúrgico, tumorectomia com manutenção do enxerto ou transplantectomia e retorno à diálise. Apresentamos um caso submetido à tumorectomiaque mantém função renal estável dois anos após a cirurgia.

Peritonite espontânea em paciente lúpica: relato de caso / Spontaneous peritonitis in a SLE patient: case report

Mulher de 21 anos com diagnóstico de lúpus eritematoso sistêmico havia oito anos foi admitida em pronto-socorro com dor intensa e distensão abdominal. Após tratamento clínico com pulsoterapia corticóide não houve melhora e, diante da gravidade do quadro de dor abdominal incontrolável, foi realizada laparotomia exploradora. O ato cirúrgico revelou peritonite não bacteriana com ascite e edema de alças intestinais. Não foi observada perfuração ou outras complicações cirúrgicas. Algumas horas após a cirurgia evoluiu para óbito. Freqüentemente, é difícil diferenciar se a dor abdominal é decorrente de peritonite lúpica ou de causas cirúrgicas. Quando a avaliação clínica é realizada e a condição cirúrgica não pode ser excluída, a laparotomia exploradora deve ser realizada sem demora.

Evaluation of the efficacy of triple therapy regimen for Helicobacter pylori eradication in gastrectomized patients with gastric adenocarcinoma.

BACKGROUND: The cause of cancer in the gastric stump is multifactorial, and Helicobacter pylori is one of these factors. Its eradication has been recommended; however, there are few studies about of H. pylori eradication in gastrectomized patients. METHODS: Twenty gastrectomized patients with gastric adenocarcinoma and Roux-en-Y reconstruction (study group) infected by H. pylori were compared with nongastrectomized patients (control group) also infected by H. pylori. The presence of H. pylori was determined by the ultra-quick urease test and from a histological sample obtained by endoscopy. Both groups received the same triple therapy regimen. RESULTS: The rate of eradication of H. pylori in the study group was 90% and in the control group, it was 85%. Sex, age, and postoperative time did not influence the rate of eradication. CONCLUSION: There were no differences in the efficacy of H. pylori eradication between the two groups; therefore, the triple therapy regimen is effective for the eradication of H. pylori in gastrectomized patients with a Roux-en-Y reconstruction.