Adma Silva de Lima

Linfangiomatose pulmonar: relato de dois casos

Lymphangiomatosis, a rare diseases of controversial origin, occurs in individuals of any age, regardless of gender, but is predominantly seen in younger individuals. It often presents with thoracic involvement, although, the bones, spleen and liver can also be affected. Histologically, the pulmonary involvement includes proliferation, complex anastomoses and secondary dilatation of the lymphatic vessels. Clinically, the presentation is variable. Although radiographic findings can be suggestive of the disease, the final diagnosis is made histologically. We report two cases of lymphangiomatosis, both in females: one was oligosymptomatic and is being treated for the disease; the other had a more progressive form, was diagnosed quite late and ultimately died of the disease.

Furuncular myiasis: dermoscopic features using a cross-polarized device without contact.

DERMOSCOPIC APPEARANCE Eight nodular, indurated lesions were detected. Direct dermoscopic examination was performed with a Dermlite II Hybrid dermoscope (3Gen, Inc, San Juan Capistrano, CA) without skin contact or the use of any fluid. The lesions had a squamous collarette and dilated blood vessels surrounding a central orifice with serosanguineous discharge, less prominent in the scalp. In each orifice, a yellowwormwith a central white and luminescent ring-like structure was seen (Fig 1). A cylindrical, ringworm structure pointing in and out was also noticed (Fig 2). In addition, a luminescent, central ring-like structure was visualized at the posterior end of the maggot, which might correspond to its posterior spiracles (feature yet to be proved). The lesions were covered with occlusive dressings and the larvae were extracted after a few hours. Eight white larvae with black spines and a thin cylinder posterior structure were removed surgically.

Epidemiology of Melanoma in the South of Brazil: study of a city in the Vale do Itajaí from 1999 to 2013

BACKGROUND Cutaneous melanoma is a highly aggressive malignancy with increasing incidence worldwide. The southern Brazilian state of Santa Catarina has one of the highest incidence rates of melanoma in the country. OBJECTIVE To evaluate the epidemiological profile of melanoma patients in a southern city of Brazil. METHODS a cross-sectional retrospective study was conducted, aiming to detect the clinical and histopathological characteristics of cutaneous melanoma diagnosed in the city of Brusque - SC, between 1999 and 2013. RESULTS A total of 213 cases in 212 individuals were studied. More than 50% of the patients were females (p< 0.05). The trunk was the most commonly affected site (p< 0.05), followed by the upper limbs. Nodular and superficial spreading melanomas were the most commonly detected in histological analyses. They did not differ statistically in frequency, but were more prevalent than other histopathological subtypes (p< 0.05). There was no statistically significant difference between invasive and noninvasive melanomas (p= 0.2441). Among the invasive melanomas, those with Breslow thicknesses < 1 mm and between 1-2mm were more prevalent (p< 0.05). CONCLUSIONS In this study we found a higher frequency of melanomas in female patients and patients aged over 51. The trunk was the most commonly affected site. Nodular and superficial spreading melanomas prevailed. Among invasive melanomas, those with Breslow thicknesses < 2 mm were the most frequent. This paper highlights the epidemiological profile of melanoma patients in the city and may help to identify and aid in the follow-up of those who are most likely to present the disease.

Acute pancreatitis associated with acute viral hepatitis: case report and review of literature

This case report, along with the review presented, describes a patient diagnosed with acute viral hepatitis, who developed a framework of intense abdominal pain and laboratorial alterations compatible with acute pancreatitis. The association of acute pancreatitis complicating fulminant and non-fulminant acute hepatitis virus (AHV) has been reported and several mechanisms have been proposed for this complication, but so far none is clearly involved. As acute hepatitis is a common disease, it is important to stimulate the development of other studies in order to determine local incidence and profile of patients presenting this association in our environment.

A Case of Small-cell Prostate Cancer with a Metastasis to the Scalp

A previously healthy 60-year-old Caucasian male, born in southern Brazil, noticed a rapidly growing lesion on the right side of the scalp during a few weeks. On physical examination, there was a firm, erythematous-violaceous ulcerated mass in the right parietal area with prominent vessels on the surface (Fig. 1). The computed tomography (CT) scan of the skull showed a mass on the right temporal area, adhering to the soft tissue but not invading to the bone (Fig. 2). The patient had no urological symptoms, but he underwent a measurement of serum prostate-specific antigen (PSA) level as a routine examination. The result revealed an elevation of PSA to 18 ng/ml (reference range 0–4 ng/ml). Subsequently, biopsies of both the scalp lesion and the prostate were carried out. The pathological findings of the two separate lesions were very similar, and a diagnosis of small-cell prostate cancer metastasizing to the scalp was made (Figs 3 and 4, skin and prostate lesions, respectively). Small-cell prostate cancer is a rare disorder completely different from the more common variant of adenocarcinoma, and represents a very aggressive disease with a poor prognosis. It is also classified as a high-grade neuroendocrine carcinoma. The immunohistochemistry assay of the scalp lesion showed positivity for cytokeratins 40, 48, 50 and 50.6 kDa, and chromogranin A, indicating epithelial origin of the tumor cells and neuroendocrine differentiation, respectively. It was negative for S100, p53 and cytokeratin 20, and the last character ruled out the possibility for the lesion to be a primary cutaneous neuroendocrine carcinoma (Merkel cell carcinoma). The whole-body CT scan and scintigraphy revealed the lung, liver and bone metastases. The first-line chemotherapy with cisplatin and etoposide, and the second-line treatment were both ineffective, and the patient succumbed to the disease 4 months after the initial presentation.

Exogenous pigmentation of skin and nail caused by a millipede in a patient with plantar psoriasis

filled bulla on the left lower abdomen. He had just administered six of his seven injections in his ninth cycle of azacitidine. The lesion on the abdomen corresponded with the site of the azacitidine injection. His past medical history included a previous diagnosis of classic Sweet syndrome to which he was responding to a course of prednisolone (15 mg mane) and dapsone (25 mg mane). Despite broad spectrum antibiotic therapy, he experienced ongoing fevers and over the next 2 days the lesion on his left abdomen become haemorrhagic with concentric rings (Fig. 4). Histopathology demonstrated a florid neutrophilic infiltrate in the epidermis, dermis and subcutis, with spongiosis and pustule formation, and without evidence of vasculitis, necrosis or infection. His dose of prednisolone was increased, and the azacitidine was withheld, with a rapid resolution of his fever. One week later, he, too, was left with only residual bruising. Azacitidine is an antineoplastic agent used in the treatment of high-risk myelodysplastic syndromes, chronic myelomonocytic leukaemia and acute myeloid leukaemia. There are 13 reports of azacitidine-induced Sweet syndrome in the literature (Table S1). In two cases there are reports of disease activity at the injection site, with one patient reporting associated widespread disease and the other reporting oedema of the affected limb. None, apart from the two we present here, report localised haemorrhagic concentric rings at the site of the injection. It has been well documented that pathergy and surgery can precipitate Sweet syndrome. However, in the above patients there was an absence of lesions at other sites of trauma, implicating azacitidine as the causative agent.

Nailfold capillaroscopy in leprosy

Due to mounting evidences of interaction between Hansens bacilli with endothelial cells and the paucity of studies addressing the presence of nailfold capillaroscopic alterations in patients with Hansens disease, a study was carried out in order to verify the presence of capillaroscopic alterations in patients with leprosy in its various forms and its correlation with clinical parameters. Ten patients were evaluated at a specialized university service. Sixty percent of those had some capillaroscopic change, such as micro-hemorrhages, ectatic, bushy and corkscrew capillaries. Such changes were unspecific, which suggests there is not a specific pattern for this disease.

Melanoma patterns of distant relapse: a study of 108 cases from a South Brazilian center

Background: The incidence of cutaneous melanoma has increased over the last decades. Recurrences occur most frequently within the first 2-3 years after diagnosis but patients carry a lifelong risk of relapse. Nevertheless, there is no consensus in the literature on what screening tests patients should undergo. Objectives: To evaluate the most common melanoma metastasis sites among a South Brazilian population from a city with one of the highest melanoma rates, and establish the best screening method for these patients. Methods: A cross-sectional retrospective study of 108 consecutive melanoma patients followed up at a center from 2009 to 2013. Data were collected on demographic and tumoral characteristics, as well as the site of the first diagnosed metastasis. Results: Patients were divided into 3 groups for analytical purposes: Non-visceral metastases (48% of patients), visceral metastasis (39%) and brain metastasis (13%). We tried to correlate age, gender, mean Breslow thickness, mitosis and death rates with the aforementioned groups but none showed any statistically significant association. Conclusion: Melanoma patients must be monitored to detect early relapse and subsequent effective treatment but the best follow-up strategy remains to be established.

Leprosy in a University Hospital in Southern Brazil

BACKGROUND Leprosy is an infectious disease that may lead to irreversible nerve damage, compromising patients quality of life and leading to loss of working years. OBJECTIVES To evaluate the epidemiological profile of patients followed at a University Hospital. MATERIALS AND METHODS This is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010. RESULTS The mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension. CONCLUSIONS This study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication.