Alberto Domingues Vianna

Pulmonary involvement in Kaposi sarcoma: correlation between imaging and pathology

Kaposi sarcoma is a low-grade mesenchymal tumor involving blood and lymphatic vessels. There are four variants of this disease, each presenting a different clinical manifestation: classic or sporadic, African or endemic, organ transplant-related or iatrogenic, and AIDS-related or epidemic. Kaposi sarcoma is the most common tumor among patients with HIV infection, occurring predominantly in homosexual or bisexual men. The pulmonary involvement in Kaposi sarcoma occurs commonly in critically immunosupressed patients who commonly have had preceding mucocutaneous or digestive involvement.The etiology of Kaposi sarcoma is not precisely established; genetic, hormonal, and immune factors, as well as infectious agents, have all been implicated. There is evidence from epidemiologic, serologic, and molecular studies that Kaposi sarcoma is associated with human herpes virus type 8 infection. The disease starts as a reactive polyclonal angioproliferative response towards this virus, in which polyclonal cells change to form oligoclonal cell populations that expand and undergo malignant transformation.The diagnosis of pulmonary involvement in Kaposi sarcoma usually can be made by a combination of clinical, radiographic, and laboratory findings, together with the results of bronchoscopy and transbronchial biopsy. Chest high-resolution computed tomography scans commonly reveal peribronchovascular and interlobular septal thickening, bilateral and symmetric ill-defined nodules in a peribronchovascular distribution, fissural nodularity, mediastinal adenopathies, and pleural effusions. Correlation between the high-resolution computed tomography findings and the pathology revealed by histopathological analysis demonstrate that the areas of central peribronchovascular infiltration represent tumor growth involving the bronchovascular bundles, with nodules corresponding to proliferations of neoplastic cells into the pulmonary parenchyma. The interlobular septal thickening may represent edema or tumor infiltration, and areas of ground-glass attenuation correspond to edema and the filling of air spaces with blood. These findings are a result of the propensity of Kaposi sarcoma to grow in the peribronchial and perivascular axial interstitial spaces, often as continuous sheets of tumor tissue.In conclusion, radiological findings can play a major role in the diagnosis of pulmonary Kaposi sarcoma since characteristic patterns may be observed. The presence of these patterns in patients with AIDS is highly suggestive of Kaposi sarcoma.

Pulmonary hemorrhage syndrome associated with dengue fever, High-resolution computed tomography findings: a case report

Dengue hemorrhagic fever is an acute infectious disease caused by dengue virus. We described the high-resolution CT findings in a 70-year-old male with the disease, which was diagnosed by clinical examination and confirmed by serological methods. High-resolution CT demonstrated bilateral areas of consolidation with air bronchogram and ground glass opacities, as well as small bilateral pleural effusions. Dengue hemorrhagic fever should be considered in the differential diagnosis of diffuse pulmonary hemorrhage.

Cancerização de lóbulos: correlação de achados mamográficos e histológicos

OBJETIVO: Caracterizar os aspectos mamograficos de cancerizacao de lobulos associados a carcinoma ductal in situ (CDIS), por meio de correlacao entre achados de imagem e histologicos. MATERIAIS E METODOS: O presente estudo retrospectivo foi baseado em uma revisao de laudos histopatologicos de 135 pacientes submetidas a biopsia de mama. O diagnostico de cancerizacao de lobulos associada a CDIS foi confirmado em 12 das pacientes. Dois casos foram excluidos porque os cortes histopatologicos nao estavam disponiveis para correlacao da patologia com a mamografia. Todas as imagens mamograficas foram retrospectivamente analisadas as cegas quanto aos resultados histologicos e classificados por dois experientes radiologistas especializados em mama. RESULTADOS: Nove casos (90%) apresentavam microcalcificacoes redondas agrupadas e um (10%) apresentava calcificacoes lineares. A distribuicao das calcificacoes foi definida como lobular em todos os casos. A analise histopatologica demonstrou quatro casos de CDIS cribriforme, dois casos de comedocarcinoma, um caso de CDIS solido, um caso de CDIS cribriforme associado com solido e um caso de CDIS cribriforme associado com solido e comedocarcinoma. No caso em que havia calcificacoes redondas e lineares, o subtipo histologico era de CDIS cribriforme. Com relacao ao numero de microcalcificacoes, nove casos apresentavam mais do que 20 e apenas um caso apresentava menos do que 10 microcalcificacoes. CONCLUSAO: Na presente coorte, a avaliacao mamografica de pacientes com CDIS apresentando cancerizacao de lobulos demonstrou agrupamentos de microcalcificacoes redondas com distribuicao lobular. Embora agrupamentos de calcificacoes redondas sejam normalmente associados a um processo benigno, a cancerizacao de lobulos por CDIS pode produzir um padrao similar, mimetizando, assim, uma condicao benigna.

Tuberous sclerosis with pulmonary lymphangioleiomyomatosis and renal angiomyolipomas. Computed tomographic findings: a case report

The authors describe a case of a 31-year-old female with tuberous sclerosis, a genetic, rare, variably expressed disease. Clinical symptoms were chest pain, and progressive dyspnea. Computed tomography scan of the chest showed bilateral, diffuse, small thin-walled cysts scattered throughout the lungs characteristic for pulmonary lymphangioleiomyomatosis. Computed tomography scan of the abdomen revealed enlarged, heterogeneous kidneys, with low density tumors corresponding to angiomyolipomas. Pulmonary lymphangioleiomyomatosis and bilateral renal angiomyolipomas are some presentations of tuberous sclerosis and the coexistence of both conditions may cause devastating morbidity and mortality.

Paravertebral Mass in a Patient with Hemolytic Anemia: Computed Tomographic Findings

Extramedullary hematopoiesis is characterized by the presence of hematopoietic tissue outside of the bone marrow and is typically associated with chronic hemolytic anemias. Intrathoracic extramedullary hematopoiesis is a rare and usually asymptomatic condition. The authors report a case of a 57-year-old man with intrathoracic extramedullary hematopoiesis and hereditary spherocytosis. Clinical and laboratory evaluation, together with radiological findings, are described. The diagnosis of the disease was confirmed by tissue biopsy.

Computed tomographic findings of tuberous sclerosis with pulmonary lymphangioleiomyomatosis and renal angiomyolipomas: a case report

The authors describe a case of a 31-year-old female with tuberous sclerosis, a genetic, rare, variably expressed disease. Clinical symptoms were chest pain, and progressive dyspnea. Computed tomography scan of the chest showed bilateral, diffuse, small thin-walled cysts scattered throughout the lungs characteristic for pulmonary lymphangioleiomyomatosis. Computed tomography scan of the abdomen revealed enlarged, heterogeneous kidneys, with low density tumors corresponding to angiomyolipomas. Pulmonary lymphangioleiomyomatosis and bilateral renal angiomyolipomas are some presentations of tuberous sclerosis and the coexistence of both conditions may cause devastating morbidity and mortality.

Calcificações malignas da mama: correlação mamografia-anatomia patológica

We carried out 30 comparison studies to establish the relationship between mammography and pathology findings in 29 patients with malignant breast tumors that presented calcifications associated with the lesion on the mammograms. The main purpose of this work was to verify whether the shapes of the calcifications correspond to specific types of tumor, and could be related to the location they originate from. Two objective features of the calcifications observed on the mammograms were studied: shape and distribution. This study showed that carcinomas of the comedo type presented a high frequency of pleomorphic calcifications (95.5%) and a ductal distribution pattern in 66.5% of the cases. Cribriform carcinomas that were not associated to the comedo type presented only round calcifications in 66.5% of the cases, prevailing an undefined distribution pattern (78.5%). Micropapillary tumors that were not associated to the comedo type presented only round calcifications in 66.5% of the cases, prevailing an undefined distribution pattern (66.5%). None of the tumors showed a lobular distribution pattern. Shapeless calcifications in the absence of a tumoral nodule may be suggestive of infiltrative ductal carcinoma. Considering the histological architectural pattern of the 30 tumors, 24 (80%) showed the expected calcification shapes.

Primary pulmonary mucosa-associated lymphoid tissue lymphoma computed tomography findings: a case report

Primary pulmonary non-Hodgkins lymphoma is a very rare neoplasm. It is most frequently represented by the mucosa-associated lymphoid tissue type. We describe a case of a 67-year-old woman who presented with fatigue, mild dyspnea, and consolidation on chest radiograph. The diagnosis of non-Hodgkins lymphoma was established by transbronchial biopsy, and chemotherapy was then started. The patient was treated with 6 cycles of chemotherapy. She had good response to therapy and no progression of the disease was observed during a 4-year follow-up period. The clinical, radiological and histopathological features are described. This entity has an indolent course, good response to therapy and favorable prognosis. However, despite being an incidental radiological finding in a third of cases, this disease remains highly underdiagnosed.

Pulmonary metastases from primary hepatocellular carcinoma in a 26-year-old patient: a case report

Hepatocellular carcinoma is a primary tumor of the liver, which usually develops in the setting of chronic liver disease, particularly viral hepatitis. The diagnosis of hepatocellular carcinoma can be difficult, and often requires the use of serum markers, one or more imaging modalities, and histological confirmation. The authors describe a case of a 26-year-old woman with hepatocellular carcinoma and multiple pulmonary metastases. She presented with hepatomegaly and sporadic fever, and had negative hepatitis serology, normal alkaline phosphatase, and a rising serum alpha-fetoprotein level. The diagnosis was confirmed by histopathology, after percutaneous liver biopsy. Although the patient was in good health condition and had few symptoms, there was no possibility of treatment due to the extension of the liver tumor and the number of pulmonary metastases.

Calcificações arredondadas como único achado mamográfico no carcinoma da mama: correlação mamografia-anatomia patológica

OBJETIVO: Correlacionar os achados da mamografia com os da anatomia patologica nos tumores de mama associados a calcificacoes arredondadas. MATERIAIS E METODOS: Foram avaliados 16 pacientes portadoras de câncer de mama, cujo unico achado mamografico foi o de calcificacoes arredondadas, estudando-se o tipo histologico, o padrao de distribuicao mais frequente e a quantidade de calcificacoes observada. RESULTADOS: O tumor mais frequente foi o carcinoma ductal in situ (CDIS) tipo cribriforme, com 42,9% dos casos, seguido pelo CDIS tipo micropapilar com 23,8%, CDIS tipo comedo com 19% e carcinoma ductal infiltrante com 9,5%. Houve associacao de dois ou mais tipos histologicos em cinco casos, perfazendo um total de 21 tumores. Quanto a distribuicao, 56% dos casos apresentaram padrao indefinido, 31,25% padrao ductal e 12,5% padrao lobular. Em relacao ao numero de calcificacoes, 75% apresentaram mais de 20, 12,5% apresentaram entre 10 e 20 e 12,5% menos de 10 calcificacoes. CONCLUSAO: O carcinoma de mama pode ter como unico achado a presenca de calcificacoes arredondadas, com padrao de distribuicao ductal, lobular ou indefinido.