Plasmin and plasminogen prevent sepsis severity by reducing neutrophil extracellular traps and systemic inflammation.

Sepsis is a lethal syndrome characterized by systemic inflammation and abnormal coagulation. Despite therapeutic advances, sepsis mortality remains substantially high. Herein, we investigated the role of the plasminogen/plasmin (Plg/Pla) system during sepsis. Plasma levels of Plg were significantly lower in mice subjected to severe compared with nonsevere sepsis, whereas systemic levels of IL-6, a marker of sepsis severity, were higher in severe sepsis. Plg levels correlated negatively with IL-6 in both septic mice and patients, whereas plasminogen activator inhibitor-1 levels correlated positively with IL-6. Plg deficiency render mice susceptible to nonsevere sepsis induced by cecal ligation and puncture (CLP), resulting in greater numbers of neutrophils and M1 macrophages, liver fibrin(ogen) deposition, lower efferocytosis, and increased IL-6 and neutrophil extracellular trap (NET) release associated with organ damage. Conversely, inflammatory features, fibrin(ogen), and organ damage were substantially reduced, and efferocytosis was increased by exogenous Pla given during CLP- and LPS-induced endotoxemia. Plg or Pla protected mice from sepsis-induced lethality and enhanced the protective effect of antibiotics. Mechanistically, Plg/Pla-afforded protection was associated with regulation of NET release, requiring Pla-protease activity and lysine binding sites. Plg/Pla are important host-protective players during sepsis, controlling local and systemic inflammation and collateral organ damage.

Angiotensin-(1-7)/MasR axis promotes migration of monocytes/macrophages with a regulatory phenotype to perform phagocytosis and efferocytosis.

Nonphlogistic migration of macrophages contributes to the clearance of pathogens and apoptotic cells, a critical step for the resolution of inflammation and return to homeostasis. Angiotensin-(1-7) [Ang-(1-7)] is a heptapeptide of the renin-angiotensin system that acts through Mas receptor (MasR). Ang-(1-7) has recently emerged as a novel proresolving mediator, yet Ang-(1-7) resolution mechanisms are not fully determined. Herein, Ang-(1-7) stimulated migration of human and murine monocytes/macrophages in a MasR-, CCR2-, and MEK/ERK1/2-dependent manner. Pleural injection of Ang-(1-7) promoted nonphlogistic mononuclear cell influx alongside increased levels of CCL2, IL-10, and macrophage polarization toward a regulatory phenotype. Ang-(1-7) induction of CCL2 and mononuclear cell migration was also dependent on MasR and MEK/ERK. Of note, MasR was upregulated during the resolution phase of inflammation, and its pharmacological inhibition or genetic deficiency impaired mononuclear cell recruitment during self-resolving models of LPS pleurisy and E. coli peritonitis. Inhibition/absence of MasR was associated with reduced CCL2 levels, impaired phagocytosis of bacteria, efferocytosis, and delayed resolution of inflammation. In summary, we have uncovered a potentially novel proresolving feature of Ang-(1-7), namely the recruitment of mononuclear cells favoring efferocytosis, phagocytosis, and resolution of inflammation. Mechanistically, cell migration was dependent on MasR, CCR2, and the MEK/ERK pathway.

Exercise Training Improved Pulmonary Gas Exchange Abnormalities in Pulmonary Hypertension due to Heart Failure: A Case Report

Abstract Heart failure (HF) is the most common cause of pulmonary hypertension (PH), and reduced exercise capacity and exertional dyspnea are the most frequent concerns in patients with PH-HF. Indeed, carbon dioxide end-tidal partial pressure (PETCO 2 ) during exercise is a well-established noninvasive marker of ventilation/perfusion ratio in PH. We aimed to evaluate the effect of aerobic exercise training on PETCO 2 response during exercise in a 59-year-old woman with PH secondary to idiopathic dilated cardiomyopathy. The patient with chronic fatigue and dyspnea at mild-to-moderate efforts was admitted to a cardiorespiratory rehabilitation program and had her cardiorespiratory response to exercise assessed during a cardiopulmonary exercise testing performed before and after three months of a thrice-weekly aerobic exercise training program. Improvements in aerobic capacity (23.9%) and endurance time (37.5%) and reduction in ventilatory inefficiency (-20.2%) was found after intervention. Post-intervention improvements in PETCO 2 at ventilatory anaerobic threshold (23.3%) and change in PETCO 2 kinetics pattern, with progressive increases from rest to peak of exercise, were also found. Patient also improved breathing pattern and timing of ventilation. This case report demonstrated for the first time that aerobic exercise training might be able to improve PETCO 2 response during exercise in a patient with PH-HF.

Estratégias para o fortalecimento de redes sociais comunitárias: a experiência dos bairros Tupi e Lajedo em Belo Horizonte/MG / Strategies for strengthening community social networks: the experience of the Tupi and Lajedo neighborhoods in Belo Horizonte/MG / Estrategias para el fortalecimiento de redes sociales comunitarias: la experiencia de los barrios Tupi y Lajedo en Belo Horizonte/MG

A pesquisa objetivou sistematizar estratégias para o fortalecimento de uma rede comunitária localizada em Belo Horizonte, desmobilizada em decorrência de conflitos existentes entre suas lideranças e pela forte presença de viés político-partidário nas relações comunitárias. Buscou-se elucidar os fatores que influenciavam no engajamento, motivação e participação política da comunidade nas ações em rede para, a partir daí, propor estratégias para o seu fortalecimento. Foi utilizada a pesquisa participante como método, tendo sido realizada observação participante e um grupo focal como instrumentos de coleta de dados. Repensar a própria rede, seus objetivos e funcionamento, e realizar ações que digam respeito à comunidade e sua história, para que os moradores se identifiquem e estabeleçam uma relação de afeto com o território, foram algumas das estratégias propostas para a reconfiguração da rede comunitária, com vistas ao aumento da sua força de mobilização e à participação efetiva de seus membros.

The main objective of our research was to systematize strategies for strengthening a community network located in Belo Horizonte, demobilized as a consequence of conflicts between their leaders and by the strong presence of partisan political bias in their community relations. We tried to elucidate the factors influencing the engagement, motivation and political participation of the community in the networked actions in order to, from there, propose strategies for community strengthening. Method used was the participatory survey, with participatory observation and focal group chosen as data collection instruments. Some of the proposed strategies for reconfiguration of community network were to rethink the actual network, its objectives and operation, and to make actions related to the community and its history, in order to make the dwellers identify themselves and establish an emotional/affective relationship with the territory, towards the increase of the mobilization force and the effective participation of the community members.

La investigación objetivó sistematizar estrategias para el fortalecimiento de una red comunitaria ubicada en Belo Horizonte, desmovilizada como consecuencia de conflictos existentes entre sus líderes y por la fuerte presencia de sesgo político-partidario en las relaciones comunitarias. Se buscó elucidar los factores que influían el compromiso, motivación y participación política de la comunidad en las acciones en red para, a partir de ahí, proponer estrategias para su fortalecimiento. Se utilizó la investigación participante como método, habiendo sido realizada observación participante y grupo focal como instrumentos de recolección de datos. Repensar la propia red, sus objetivos y funcionamiento, y realizar acciones que afecten a la comunidad y su historia, para que los habitantes se identifiquen y establezcan una relación de afecto con el territorio, fueron algunas estrategias propuestas para la reconfiguración de la red comunitaria, con vistas al aumento de su fuerza de movilización ya la participación efectiva de sus miembros.

Atorvastatin Inhibited ROS Generation and Increased IL-1ß And IL-6 Release by Mononuclear Cells from Diabetic Patients.

BACKGROUND: Atorvastatin (ATV) inhibits the conversion of 3-Hydroxy-3-Methylglutaryl Coenzyme A (HMG-CoA) to mevalonate formation and promotes lowering of the LDL cholesterol fraction. However, ATV exhibits pleiotropic metabolic actions beyond cholesterol-lowering properties. OBJECTIVE: We aimed to evaluate the effect of ATV on oxidizing species generation and cytokine secretion in Peripheral Blood Mononuclear Cells (PBMNC) of Type 2 Diabetes Mellitus (T2DM) patients in comparison to healthy control. METHODS: Both NADPH-oxidase-dependent and mitochondrial ROS generation were assessed by chemoluminescence luminol-dependent assay and fluorometric experiment, using Dichlorofluorescein Assay (DCFH-DA), respectively. IL-1ß and IL-6 were quantified by classical ELISA. RESULTS: ATV inhibited NADPH-oxidase dependent ROS generation, but showed no effect on mitochondrial ROS generation and activated IL-1ß and IL-6 secretions in PBMNC from control and T2DM patients. ROS generation and cytokine secretion in the presence of an inhibitor of Protein Kinase Cß (iPKCß) and ATV led to similar results. The secretion of IL-1ß, PDB-induced in the presence of iPKCß, but not ATV, was increased. ATV and iPKCß exacerbated PDB-induced IL-6 secretion. LPS activated the secretion of IL-1ß and IL-6 which was potentiated by ATV. CONCLUSION: ATV inhibited ROS generation and activated IL-1 ß/IL-6 secretion in PBMNC of diabetes patients. Its effect was not affected by the hyperglycemia.

Census of Cnidaria (Medusozoa) and Ctenophora from South American marine waters.

We have compiled available records in the literature for medusozoan cnidarians and ctenophores of South America. New records of species are also included. Each entry (i.e., identified species or still as yet not determined species referred to as "sp." in the literature) includes a synonymy list for South America, taxonomical remarks, notes on habit, and information on geographical occurrence. We have listed 800 unique determined species, in 958 morphotype entries: 5 cubozoans, 905 hydrozoans, 25 scyphozoans, 3 staurozoans, and 20 ctenophores. Concerning nomenclatural and taxonomical decisions, two authors of this census (Miranda, T.P. & Marques, A.C.) propose Podocoryna quitus as a nomen novum for the junior homonym Hydractinia reticulata (Fraser, 1938a); Euphysa monotentaculata Zamponi, 1983b as a new junior synonym of Euphysa aurata Forbes, 1848; and Plumularia spiralis Milstein, 1976 as a new junior synonym of Plumularia setacea (Linnaeus, 1758). Finally, we also reassign Plumularia oligopyxis Kirchenpauer, 1876 as Kirchenpaueria oligopyxis (Kirchenpauer, 1876) and Sertularella margaritacea Allman, 1885 as Symplectoscyphus margaritaceus (Allman, 1885).

Status of the names of some hydroid species (Cnidaria, Hydrozoa), described from the Atlantic coast of Patagonia.

Thirty new species of benthic leptothecate hydroids were described and named from Patagonia in a 1991 PhD dissertation by Mohamed El Beshbeeshy. Although constituting nomina nuda under provisions of the International Code of Zoological Nomenclature (ICZN), the names of some species were used in several scientific publications between 1991 and 2011. In 2011, the dissertation of El Beshbeeshy was published in accordance with Article 8 of the ICZN. Several species-group names appearing in that work nevertheless fail to fully comply with certain articles of the code. The goal of this contribution is to review the nomenclatural availability of the names of those 30 new taxa, and to clearly establish the current status of El Beshbeeshy's material. Two of them were made available in 1999 as part of studies other than those of El Beshbeeshy, and correct authorship and date is here noted. Twenty-one of the nomina nuda were made available in a work published by El Beshbeeshy in 2011, although some constitute junior synonyms. Six of the new species-group names appearing in both the 1991 and 2011 works, established following a literature review of Patagonian species, were proposed without re-description, or designation of name-bearing types, or locations of such types. Most of them do not meet criteria of availability and remain nomina nuda. The status of each is discussed to avoid additional nomenclatural errors and continued taxonomic confusion.

Direct communication between the left circumflex and the right coronary arteries: a very rare coronary anomaly circulation.

Coronary artery anomalies (CAA) are congenital changes in their origin, course, and/or structure. Intercoronary communication (ICC) is a very rare subset with uni- or bidirectional blood flow between two or more coronary arteries. We present the case of a 58-year-old man with an acute coronary syndrome whose coronary angiography incidentally showed a surprising and very rare communication between the right coronary and left circumflex arteries.

Towards a phylogenetic classification of Leptothecata (Cnidaria, Hydrozoa).

Leptothecata are hydrozoans whose hydranths are covered by perisarc and gonophores and whose medusae bear gonads on their radial canals. They develop complex polypoid colonies and exhibit considerable morphological variation among species with respect to growth, defensive structures and mode of development. For instance, several lineages within this order have lost the medusa stage. Depending on the author, traditional taxonomy in hydrozoans may be either polyp- or medusa-oriented. Therefore, the absence of the latter stage in some lineages may lead to very different classification schemes. Molecular data have proved useful in elucidating this taxonomic challenge. We analyzed a super matrix of new and published rRNA gene sequences (16S, 18S and 28S), employing newly proposed methods to measure branch support and improve phylogenetic signal. Our analysis recovered new clades not recognized by traditional taxonomy and corroborated some recently proposed taxa. We offer a thorough taxonomic revision of the Leptothecata, erecting new orders, suborders, infraorders and families. We also discuss the origination and diversification dynamics of the group from a macroevolutionary perspective.

Areas of endemism in the Southwestern Atlantic Ocean based on the distribution of benthic hydroids (Cnidaria: Hydrozoa).

Geographic distributions of 130 species of benthic hydroids were used to infer areas of endemism in the Southwestern Atlantic Ocean (SWAO, between 22°S and 55°S). Endemicity Analysis (EA) was carried out with the software NDM VNDM, using a 2° x 2° grid with different values of F (F = 0.5 and F = 1.0) for inferred presence. Hypothesized areas of endemism (16 with F = 0.5 and 13 with F = 1.0) formed three generalized patterns: (1) Tropical, (2) Subtropical, and (3) disjunctions along Tropical and Subtropical areas. Areas of endemism estimated here were compared with provinces, ecoregions and areas of endemism previously defined (but not based on algorithmic analysis) in the literature. Ecological and historical aspects that are potentially relevant for the SWAO realm were contrasted, related and discussed to areas of endemism. This is the first study to apply NDM VNDM to the marine realm and one of the few that focuses on the SWAO.

Analysis of heparanase isoforms and cathepsin B in the plasma of patients with gastrointestinal carcinomas: analytical cross-sectional study / Análises das isoformas de heparanase e da catepsina B em plasma de pacientes com carcinomas gastrointestinais: estudo transversal analítico

CONTEXT AND OBJECTIVE: Heparanase-1 degrades heparan sulfate and has been correlated with tumor progression. Although the isoform heparanase-2 has no catalytic activity, it seems to be important for modulating heparanase-1 activity. Cathepsin B is a proteinase involved in tumor metastasis. The aim of this study was to analyze heparanase isoform expression and cathepsin B activity in plasma samples from patients with gastrointestinal carcinomas, compared with healthy individuals (control group). DESIGN AND SETTING: This was an analytical cross-sectional study. Peripheral blood samples were collected at a Brazilian public hospital, from 21 patients with histopathological diagnoses of gastrointestinal carcinomas and from 43 healthy individuals. The analyses were performed in two Brazilian medical schools. METHODS: Heparanase isoforms were identified and quantified in plasma samples by means of Western blot. The enzymatic activities of heparanase-1 and cathepsin B were also measured. RESULTS: The results demonstrated that the expression of both heparanase isoforms was significantly greater in plasma samples from gastrointestinal carcinoma patients, compared with the control group. Logistic regression analysis showed that increased heparanase-1 and heparanase-2 expression was exclusively dependent on the ...

CONTEXTO E OBJETIVO: A heparanase-1 degrada heparam sulfato e está relacionada à progressão de tumor. Apesar de a isoforma heparanase-2 não possuir atividade catalítica, parece ser importante para modular a atividade da heparanase-1. A catepsina B é uma proteinase envolvida na metástase de tumores. O objetivo deste estudo foi analisar a expressão das isoformas de heparanase e atividade da catepsina B em amostras de plasma de pacientes com carcinomas gastrointestinais, comparando-se com indivíduos saudáveis (grupo controle). TIPO DE ESTUDO E LOCAL: Este é um estudo transversal analítico. Foram coletadas amostras de sangue periférico, em hospital público brasileiro, de 21 pacientes com diagnóstico histopatológico de carcinoma gastrointestinal e 43 indivíduos saudáveis. As análises foram realizadas em duas faculdades de medicina brasileiras. MÉTODOS: As isoformas da heparanase foram identificadas e quantificadas em amostras de plasma por Western blot. As atividades enzimáticas de heparanase-1 e catepsina B foram também mensuradas. RESULTADOS: Os resultados demonstraram que as expressões das isoformas de heparanase foram significativamente maiores nas amostras de plasma de pacientes com carcinoma gastrointestinal em comparação com ...

Analysis of heparanase isoforms and cathepsin B in the plasma of patients with gastrointestinal carcinomas: analytical cross-sectional study.

CONTEXT AND OBJECTIVE: Heparanase-1 degrades heparan sulfate and has been correlated with tumor progression. Although the isoform heparanase-2 has no catalytic activity, it seems to be important for modulating heparanase-1 activity. Cathepsin B is a proteinase involved in tumor metastasis. The aim of this study was to analyze heparanase isoform expression and cathepsin B activity in plasma samples from patients with gastrointestinal carcinomas, compared with healthy individuals (control group). DESIGN AND SETTING: This was an analytical cross-sectional study. Peripheral blood samples were collected at a Brazilian public hospital, from 21 patients with histopathological diagnoses of gastrointestinal carcinomas and from 43 healthy individuals. The analyses were performed in two Brazilian medical schools. METHODS: Heparanase isoforms were identified and quantified in plasma samples by means of Western blot. The enzymatic activities of heparanase-1 and cathepsin B were also measured. RESULTS: The results demonstrated that the expression of both heparanase isoforms was significantly greater in plasma samples from gastrointestinal carcinoma patients, compared with the control group. Logistic regression analysis showed that increased heparanase-1 and heparanase-2 expression was exclusively dependent on the tumor. There was a significant increase in heparanase-1 and cathepsin B activity in the patients' plasma. CONCLUSION: Overexpression of heparanase-1 and heparanase-2, along with increased heparanase-1 and cathepsin B activity in plasma, is associated with the diagnosis of gastrointestinal carcinoma. These findings provide support for using non-invasive assays (plasma samples) as an auxiliary method for diagnosing gastrointestinal tumors.

Influence of exposure time to saliva and antioxidant treatment on bond strength to enamel after tooth bleaching: an in situ study

Objectives: This study evaluated the influence of different exposure times to saliva in situ in comparison with an antioxidant treatment on composite resin bond strength to human enamel restored after tooth bleaching. Material and Methods: Forty human teeth specimens measuring 5x5 mm were prepared and randomly allocated into 5 groups with 8 specimens each: Gct (control group, restored on unbleached enamel); Gbl (restored immediately after bleaching); Gsa (bleached, treated with 10% sodium ascorbate gel for 60 min and restored); G7d (bleached, exposed to saliva in situ for 7 days and restored); and G14d (bleached, exposed to saliva in situ for 14 days and restored). Restored samples were cut into 0.8 mm2 sticks that were tested in microtensile. Specimens were microscopically analyzed and failure modes were classified as adhesive, cohesive, or mixed. Pretest and cohesive failures were not considered in the statistical analysis, which was performed with one-way ANOVA and Tukey's post-hoc test (α=0.05), with the dental specimen considered as the experimental unit. Results: Mean bond strength results found for Gbl in comparison with Gct indicated that bleaching significantly reduced enamel adhesiveness (P<0.01). However, no statistically significant differences were found between Gct, Gsa and G7d (P>0.05). Bond strength found for G14d was significantly higher than for Gsa (P<0.01). Fractures modes were predominantly of a mixed type. Conclusions: Bonding strength to bleached enamel was immediately restored with the application of sodium ascorbate and exposure to human saliva in situ for at least 7 days. Best results were obtained with exposure to human saliva in situ for 14 days. Treatment with sodium ascorbate gel for 60 min may be recommended in cases patients cannot wait for at least 7 days for adhesive techniques to be performed. .

Influence of exposure time to saliva and antioxidant treatment on bond strength to enamel after tooth bleaching: an in situ study.

OBJECTIVES: This study evaluated the influence of different exposure times to saliva in situ in comparison with an antioxidant treatment on composite resin bond strength to human enamel restored after tooth bleaching. MATERIAL AND METHODS: Forty human teeth specimens measuring 5x5 mm were prepared and randomly allocated into 5 groups with 8 specimens each: Gct (control group, restored on unbleached enamel); Gbl (restored immediately after bleaching); Gsa (bleached, treated with 10% sodium ascorbate gel for 60 min and restored); G7d (bleached, exposed to saliva in situ for 7 days and restored); and G14d (bleached, exposed to saliva in situ for 14 days and restored). Restored samples were cut into 0.8 mm2 sticks that were tested in microtensile. Specimens were microscopically analyzed and failure modes were classified as adhesive, cohesive, or mixed. Pretest and cohesive failures were not considered in the statistical analysis, which was performed with one-way ANOVA and Tukey's post-hoc test (α=0.05), with the dental specimen considered as the experimental unit. RESULTS: Mean bond strength results found for Gbl in comparison with Gct indicated that bleaching significantly reduced enamel adhesiveness (P<0.01). However, no statistically significant differences were found between Gct, Gsa and G7d (P>0.05). Bond strength found for G14d was significantly higher than for Gsa (P<0.01). Fractures modes were predominantly of a mixed type. CONCLUSIONS: Bonding strength to bleached enamel was immediately restored with the application of sodium ascorbate and exposure to human saliva in situ for at least 7 days. Best results were obtained with exposure to human saliva in situ for 14 days. Treatment with sodium ascorbate gel for 60 min may be recommended in cases patients cannot wait for at least 7 days for adhesive techniques to be performed.

Fauna de hidroides (Cnidaria, Hydrozoa) da região de Bombinhas, Santa Catarina, Brasil / Hydroid fauna (Cnidaria, Hydrozoa) from the region of Bombinhas, Santa Catarina, Brazil

A fauna de hidroides bentônicos do infralitoral raso, de seis locais do município de Bombinhas (Santa Catarina, Brasil), foi pesquisada e analisada com base na morfologia. O cnidoma foi examinado quando necessário para a identificação específica. Foram encontradas 25 espécies, das quais cinco (20 por cento) são registradas pela primeira vez para o estado de Santa Catarina e três (12 por cento) são registradas pela primeira vez para a região sul do Brasil. Houve um acréscimo de 12 por cento e 5,5 por cento nos registros de espécies de hidroides para Santa Catarina e litoral sul brasileiro, respectivamente.

The benthic hydroid fauna from shallow subtidal zone of six localities in the municipality of Bombinhas (state of Santa Catarina, Brazil) was surveyed and its morphology analysed. Cnidome was also examined when it was necessary for species identification. Twenty five morphospecies were found, from which five (20 percent) were recorded for the first time in Santa Catarina State and three (12 percent) were recorded for the first time in the south region of Brazil. There was a 12 percent and 5.5 percent increase in the records of benthic hydroid species for Santa Catarina and southern Brazilian coast, respectively.

Cancer de mama na mulher idosa: a visão do geriatra / Breast cancer in elderly women: perspective of geriatricians

O câncer de mama é uma das neoplasias mais incidentes e prevalentes nas mulheres na maior parte do mundo. Mulheres em faixa etária mais avançada são freqüentemente excluídas de estudos clínicos e poucos dados prospectivos são colhidos a seu respeito. No presente trabalho, revisamos alguns aspectos do câncer de mama nesta população. Embora pacientes idosas sejam freqüentemente poupadas de tratamentos potencialmente tóxicos, temos dados que indicam haver benefício significativamente maior quando a terapia em doses normais consegue ser tolerada. Esta revisão sugere que a idade cronológica, quando analisada isoladamente, não deve ser uma barreira para a indicação de quimioterapia. Devido à heterogeneidade inerente da população idosa, faz-se necessária a realização de estudos prospectivos dirigidos, que incluam aspectos da avaliação geriátrica global.

Sarcoma sinovial primário da orofaringe: relato de caso / Primary synovial sarcoma of the oropharinx: a case report

O sarcoma sinovial primário da cabeça e pescoço é um tumor raro. Em torno de 90 casos foram descritos na literatura. Relatamos um caso adicional ocorrido em um paciente jovem do sexo masculino comprometendo a orofaringe. O tumor apresentou típico crescimento bifásico, fibrossarcomatoso e epitelial, com estruturas pseudo-glandulares. O diagnóstico final foi obtido pelo exame da peça cirúrgica com preparaçöes histológicas de rotina e análise imunohistoquímica

Carcinoma de pequenas células do estômago: relato de caso / Small cell carcinoma of the stomach: case report

O carcinoma indiferenciado de pequenas células é uma neoplasia rara no estômago, morfologicamente análoga ao carcinoma avenocelular do pulmão. Caracteriza-se por apresentar curso clínico muito agressivo e aspecto macroscópico indistinguível do adenocarcinoma gástrico. Os autores apresentam um caso adicional ocorrido em uma mulher de 64 anos de idade. Foram revisados os principais aspectos clínico-paatológicos, imunosisstoquímicos e levamtadas algumas considerações sobre sua histogênese. A maioria dos achados foi semelhante àqueles descritos na literatura