Difficulty in positive diagnosis of ascites and in differential diagnosis of a pulmonary tumor.

Ascites is the most frequent complication of cirrhosis and occurs only when the portal hypertension has already installed but ascites is caused by neoplasms, heart failure, tuberculosis, pancreatic illnesses, as well as other kind of affections. We describe the case of a 67-year-old patient, a retired person, without significant personal or familial history, nonsmoker, infrequent alcohol and coffee consumer with following chief complaints at onset: loss of appetite, weight loss, serious physical asthenia, delayed intestinal transit, diffuse abdominal pain and increase of abdominal circumference. Initially was misdiagnosed with liver cirrhosis. After discharged from our Clinic, suspicion of diagnosis was mesothelioma as well as after first thoracoscopy and pleural biopsy performed in a Clinic of Thoracic Surgery. Several pleural fragments collected by biopsy were sampled for the histopathological exam. The stainings used were Hematoxylin-Eosin (HE) and Periodic Acid-Schiff (PAS) for the mucopolysaccharides. For the immunohistochemistry was used the labeled Streptavidin-Biotin (LSAB)-Horseradish peroxidase (HRP) method, as well as the antibodies: cytokeratin (CK) cocktail (AE1÷AE3), vimentin, calretinin, CK7, CK5÷6, CK20, epithelial specific antigen/epithelial cell adhesion molecule (Ep-CAM) (BerEP4), thyroid transcription factor-1 (TTF-1), E-cadherin, CDX2, carcinoembryonic antigen (CEA) and the Hector Battifora mesothelial antigen-1 (HBME-1). The aspect at immunohistochemistry establishes a positive diagnostic of poorly differentiated mucinous pulmonary adenocarcinoma, with "signet ring" cells. The rapid and accurate determination of the diagnostics will allow not only for a decrease in the expenses for inefficient treatments, but also for the guidance of the patients towards clinics or centers able to provide and supervise these treatments.

Hepatocellular carcinoma and metabolic diseases - histological perspectives from a series of 14 cases.

Hepatocellular carcinoma (HCC) represents a major health burden, as curative methods only apply to a select small portion of the affected population. Screening programs are ineffective in the absence of established underlying conditions such as viral hepatitis or alcohol abuse resulting in liver cirrhosis. Thus, overweight or obese, diabetic patients as well as non-alcoholic fatty liver disease (NAFLD) cases are often overlooked as potential candidates for HCC development. Current diagnostic methods for HCC are restricted to non-invasive imaging tests; however, the need for accurate predictive or therapeutic markers make histological studies a necessity; the latest guidelines and recommendations demand an increased effort in obtaining pertinent data from immunohistochemical investigations. Our aim was to retrospectively evaluate a series of patients with common symptoms and manifestations of metabolic syndrome who underwent liver biopsy after imaging revealed suspicious liver masses. We describe the major findings of both common histological evaluation and microvessel density evaluated by positive CD34 immunostaining.