Histopathological findings and diagnosis of cutaneous leishmaniasis, confirmed by PCR, in an endemic region of Brazil.

INTRODUCTION: Diagnosis of cutaneous leishmaniasis (CL) is difficult, and the correct use of histopathological criteria can be useful in clinical practice. The present study evaluates the association between histopathological findings and the results of polymerase chain reaction (PCR) in clinically suspected cases of CL. METHODOLOGY: Skin samples were received in a laboratory from an endemic region of Brazil for over nine years. Associations were analyzed by means of the Chi square test with a 5% level of significance. RESULTS: Of the 222 examined samples, 190 (85.6%) tested positive by PCR. All 25 cases identified by microscopic examination also tested positive by PCR. Except for the more intense inflammatory infiltrate, all other evaluated histological variables (ulceration, epidermal hyperplasia, hyperkeratosis, presence of granuloma, neutrophils, histiocytes, lymphocytes, plasmocytes, and necrosis) were not significantly associated with PCR positivity. CONCLUSIONS: The intensity of the inflammatory infiltrate is a good indicator of the occurrence of CL. Histopathological aspects are useful to increase the predictive values of CL diagnoses, but PCR is still necessary to confirm or exclude the disease.

Macroscopic tumor dimension, sentinel lymph node outcome, and survival analysis among cutaneous melanoma.

BACKGROUND: Cutaneous melanoma is characterized by a high risk of metastasis to distant organs and a substantial mortality rate. For planning treatment and assessing outcomes, the Breslow micrometric measurement is critical. The tumor macroscopic dimension is not considered a prognostic parameter in cutaneous melanoma, although there are studies showing that tumor size is an independent prognostic factor for melanoma-specific survival. Therefore, this study aimed to evaluate the macroscopic dimension of melanoma and other known prognostic factors (i.e., Breslow index, mitoses, regression, and ulceration) as predictors of sentinel lymph node outcome and survival outcome. METHODS: We performed a retrospective cross-sectional study of 227 melanoma lesions subjected to sentinel lymph node biopsy at two Brazilian referral centers. RESULTS: On univariate analysis, there was a statistically significant correlation between the largest macroscopic tumor dimension and the sentinel lymph node result (P = 0.001); however, on multivariate analysis considering all evaluated parameters, there was no significant difference between the sentinel lymph node result and the tumor macroscopic dimension (P = 0.2689). Regarding melanoma-specific survival, the macroscopic dimension showed no significant correlation (P = 0.4632) in contrast to Breslow's dimension (P < 0.0001). CONCLUSION: The Breslow thickness was the only significant factor related to both the sentinel lymph node outcome and melanoma specific survival among the evaluated variables.

Bilateral intra-lymph node Warthin's tumor as a potential diagnostic pitfall mimicking metastatic carcinoma.

Warthin's tumor (WT) is a benign and frequent salivary gland tumor primarily affecting the parotid gland. In some cases, this tumor can involve the extra parotid region and affect cervical lymph nodes. Fine-needle aspiration can be the first step in the diagnostic approach to lymphadenopathy; however, specimens from intra-nodal WT can present a potential pitfall, leading to a misdiagnosis of metastasis. Here, we report an unusual case of a patient with bilateral WT in parotid lymph nodes misdiagnosed as metastases. In addition, we highlight the cytopathological aspects of WT to alert cytopathologists about this challenging diagnosis.

Thyroid FNA performed by cytopathologists accompanied by radiologists guiding the ultrasound provide high-level quality results: A retrospective observational study.

BACKGROUND: On thyroid cytology, false negative and false positive rates are considered parameters for quality control. Nevertheless, there are few studies about medical professional involved in this procedure. We conducted a 4-year cytohistological correlation of thyroid specimens in a single institution. To describe cytological and histological correlation where radiologists guide the ultrasound (US) and cytopathologists perform the thyroid fine needle aspiration (FNA). METHODS: Retrospective observational study of thyroid specimens in a Brazilian countryside setting. The ultrasound was performed by radiologists, and the FNA was performed by pathologists. All cases were reviewed by two pathologists following the Bethesda Reporting System for Reporting Thyroid Cytopathology and the World Health Organization's Classification of Tumours of Endocrine Organs. Clinical information, such as sex, age, location, and ultrasound data, was collected from our reports. RESULTS: From a total of 3265 patients, 3703 nodules (391 patients showed more than one nodule) were submitted to FNA. For correlation, there were 168 surgical thyroidectomy specimens. The risk of malignancy for the Bethesda system categories were: nondiagnostic/unsatisfactory = 0/4 (0%); benign = 1/38 (2.6%); atypia of undetermined significance or follicular lesion of undetermined significance = 2/20 (10.0%); follicular neoplasm or suspicious for follicular neoplasm = 3/16 (18.7%); suspicious for malignancy = 63/67 (94.0%); and malignant = 22/23 (95.6%). CONCLUSION: High-level quality results can be accomplished with cooperation between cytopathologists performing thyroid FNA accompanied by radiologists guiding the ultrasound.

Reticular erythematous mucinosis: Literature review and case report of a 24-year-old patient with systemic erythematosus lupus.

Reticular erythematous mucinosis (REM) was first described 50 years ago, but only around 100 case reports in English have been published. Its relation with other inflammatory skin disorders is still being debated. We report a case of REM, including the clinical and histopathological findings. Also, a systematic review of 94 English-language reported cases is provided. The described criteria for clinical and histopathological diagnosis are highlighted in order to REM can be confidently diagnosed.

Fine-needle aspiration of the Warthin-like variant of papillary thyroid carcinoma: A report of three cases.

In English literature, there are only few reports of Warthin-like papillary thyroid carcinoma. We presented three cases and provided clinical, grossing, cytological, and histological correlation. In our point of view, the diagnosis of Warthin-like papillary thyroid carcinoma is feasible based on cytomorphological aspects. Usually those cases present moderately or highly cellular smears with many atypical Hürthle cells showing obvious papillary thyroid carcinoma nuclear features and without papillary structures, even if the inflammatory background is mild.

Leishmaniose gástrica mimetizando adenocarcinoma: achados endoscópicos / Leishmaniasis gastric adenocarcinoma mimicking: endoscopic findings

Em áreas endêmicas de leishmaniose, as formas atípicas da doença podem ser identificadas. Apresentamos caso de leishmaniose sistêmica, cujo diagnóstico foi realizado pela biópsia endoscópica. Paciente masculino, 45 anos de idade, HIV positivo fora de tratamento devido aos efeitos gástricos da medicação antirretroviral, que vive em Araçatuba ­ SP. O paciente apresentou queixas dispépticas e "clocking" por dois anos. Foi submetido à endoscopia digestiva, tendo sido identificada volumosa lesão ulcerada com bordas sobrelevadas na região da incisura, estando coberta por fibrina e medindo aproximadamente 6cm x 4cm.

High-grade squamous intraepithelial lesions in pregnant and non-pregnant women.

OBJECTIVES: To evaluate if the prevalence of cervical smear results varies between pregnant and non-pregnant women stratified by age group. STUDY DESIGN: Observational analytical study with a total sample of 1,336,180 pregnant and non-pregnant women, aged between 20 and 34 years, who underwent cervical cancer screening in the Primary Health Care of the national health system in the area of Campinas in Brazil during the period of 2005-2009. The source is the information system for cervical cancer screening. Data collected on abnormal cervical smears were analyzed using the Chi-square test and Fisher's exact test and the magnitude of the association between pregnancy and high-grade squamous epithelial lesions was analyzed by odds ratio (OR) and estimated values with confidence intervals (CI) of 95%. RESULTS: 15,190 pregnant women and 395,961 non-pregnant women were analyzed and fulfilled the inclusion criteria. Regardless of age, no statistical differences were observed for high-grade squamous intraepithelial lesion prevalence (OR 0.90; CI 0.66-1.23). Taking into account the five-year age groups, however, low-grade squamous intraepithelial lesion was less prevalent in pregnant women aged 20-24 (OR 0.71; 0.54-0.95) and 25-29 years (OR 0.56; 0.35-0.89); also, atypical squamous cells of undetermined significance was more prevalent in non-pregnant women aged 25-29 years (OR 0.72; 0.54-0.97). CONCLUSION: The study showed that the cytological prevalence of high-grade squamous intraepithelial lesion was similar in pregnant and non-pregnant women, regardless of age. The results indicate that there are no reasons for specific approaches to cervical cancer screening for pregnant women. The examination should be carried out only on pregnant women who have not been tested according to current recommendations.