Paulo Guilherme de Oliveira Salles

Kidney carcinoma associated with Xp11.2 translocation / TFE3 (ASPL-TFE3) gene fusion

We report the case of a 58-year old patient, showing a solid image in the right kidney, who underwent radical nephrectomy that revealed neoplasia, whose pathological study led to the diagnosis of kidney carcinoma associated with Xp11.2 translocation / TFE3 (ASPL-TFE3) gene fusion. The authors discuss aspects related to this lesion, such as frequency, pathogenesis, clinical presentation, histopathology and outcome, as observed in the literature.

Interobserver agreement of gleason score and modified gleason score in needle biopsy and in surgical specimen of prostate cancer

INTRODUCTION Gleason score, which has a high interobserver variability, is used to classify prostate cancer. The most recent consensus valued the tertiary Gleason pattern and recommended its use in the final score of needle biopsies (modified Gleason score). This pattern is considered to be of high prognostic value in surgical specimens. This study emphasized the evaluation of the modified score agreement in needle biopsies and in surgical specimen, as well as the interobserver variability of this score. MATERIALS AND METHODS Three pathologists evaluated the slides of needle biopsies and surgical specimens of 110 patients, reporting primary, secondary and tertiary Gleason patterns and after that, traditional and modified Gleason scores were calculated. Kappa test (K) assessed the interobserver agreement and the agreement between the traditional and modified scores of the biopsy and of the surgical specimen. RESULTS Interobserver agreement in the biopsy was K = 0.36 and K = 0.35, and in the surgical specimen it was K = 0.46 and K = 0.36, for the traditional and modified scores, respectively. The tertiary Gleason grade was found in 8%, 0% and 2% of the biopsies and in 8%, 0% and 13% of the surgical specimens, according to observers 1, 2 and 3, respectively. When evaluating the agreement of the traditional and modified Gleason scores in needle biopsy with both scores of the surgical specimen, a similar agreement was found through Kappa. CONCLUSION Contrary to what was expected, the modified Gleason score was not superior in the agreement between the biopsy score and the specimen, or in interobserver reproducibility, in this study.

Prevalência da esquistossomose mansoni e de parasitoses intestinais em escolares da área rural do Município de Jaboticatubas, MG, 1992-1993

Students from a Rural Boarding house of UFMG School of Medicine performed a survey of prevalence of schistosomiasis mansoni and other intestinal parasites in 20 rural schools in Jaboticatubas, MG. An evaluation of house and sanitation conditions was made and stool parasitological examinations were realised in all school children. It was noticed that 15.43% of the children presented S. mansonis ova in stool - that was the most prevalent parasite. From the examinations we verify 13.76% positive cases for G. lamblia; 12.89% for S. stercoralis; 11.13% for A. lumbricoides; 9.96% for hookworms; 9.57% for E. histolytica. The other parasites appeared with lower prevalence. All the children that presented parasites ova in stool received treatment. The result that was found shows that schistosomiasis mansoni is a very serious problem of public health and basic sanitation actions are necessary to the endemic control.

Metaplasia intestinal e carcinoma gástrico: correlação com os subtipos histológicos da neoplasia

Background: The role of intestinal metaplasia (IM) as a precancerous lesion is not fully understood. Objetives: To analyze IM type and distribution in relationship with gastric carcinoma (GC) histotypes. Material and methods: 71 gastrectomy surgical specimens of gastrectomy were analyzed. Samples taken from the tumor and the mucosa (along the lesser and greater curvatures), were processed routinely and stained by HE and histochemical methods for IM classification. IM intensity, topography and type were correlated with the histological subtype of the tumor. Results: 42 (59%) intestinal-type GC (IGC), 17 (24%) diffuse-type (DGC) and 12 (17%) unclassified tumors were observed. CAG and IM were more marked in IGC than in DGC (p = 0,02; p = 0,004). Foci of IM types I, II and III were observed in 21 IGC (50%), whereas foci of IM types I and II were seen in 5/17 (29%) DGC. Type III IM was diagnosed in 21 IGC (50%) and 6 DGC (35%) (p = 0,04); in peritumoral areas type II IM was detected in 13/34 (38%) IGC and 3/10 (30%) DGC. Type III IM was directly related with the lesions intensity (p = 0,005) and was observed predominantly in cases with moderate to marked IM. Conclusions: Type III IM may be considered a marker of IM intensity. Its presence in only 50% of IGC cases limits its role as a precancerous lesion and favors the hypothesis of several pathways in gastric carcinogenesis.

Effect of the period of extrinsic mechanical compression following sclerotherapy in veins in rabbit ears

PURPOSE Research whether a post-sclerotherapy venous compression period of up to 120 hours is sufficient to avoid reperfusion in treated veins; whether there is a relationship between the inflammatory intensity in venous walls and adjacent tissue and the size of venous thrombosis; whether the intensity of the post-sclerotherapy inflammation varies with the period of compression; whether there is a relationship between the presence of hemosiderin in the tissues adjacent to the sclerosing blood vessels and venous blood clots. METHODS Twenty eight rabbits, all male, were utilized, distributed into four groups (0, 24, 72 and 120). All the animals were administered with 0.25 ml of 1% polidoconal solution and, as a control, 0.25 ml of 0.9% sodium chloride solution in the marginal dorsal vein of the right and left ears, respectively. Mechanical compression was applied to the perfused stretch of the vein, except for the animals in group 0. The period of compression varied from 0 to 120 hours in the groups. An anatomopathological examination of the section of the right and left marginal dorsal veins of all the animals was conducted. RESULTS There was no significant difference among the various compression periods, both in terms of the degree of vein thrombosis and in the inflammatory intensity in both ears of the various groups. A positive and significant correlation was observed between the inflammatory intensity and the size of the thrombus and in the occurrence of thrombi and hemosiderin. CONCLUSIONS A compression period of up to 120 hours is not sufficient to prevent reperfusion in sclerosing blood vessels. The intensity of tissue inflammation is related to the size of the thrombus, but not to the compression period. The presence of hemosiderin in the tissues adjacent to the vessels subjected to sclerosis is related to the presence of venous coagulation.

Recidiva local nos sarcomas de tecidos moles: fatores prognósticos

OBJECTIVE To determinate the prognostic factors associated with the local relapse in patients treated for soft tissue sarcoma in extremities. METHODS Retrospectively, 30 patients were evaluated after being treated with surgical resection of soft tissue sarcoma located in extremities, with a outcome of 36,5 +/- 12,2 months. The prognostic factors evaluated were: age, sex, location, depth, location in the anatomic compartments, size, tumor previous manipulation, surgical margins, grade of histological malignance, presence of histological necrosis or histological vascular invasion. These factors were correlated with the local relapse of the tumor with a univariated and multivariated analysis with significance when p = 0,05. RESULTS Local relapse presented significant correlation in univariated and multivariated analysis with extra-compartimental location (p = 0,001) and with high grade histological malignance (p = 0,001). There was no significant association with age (p = 1,000), sex (p = 1,000), body location (p = 0,544), depth (p = 0,288), size (p = 0,694), surgical margins (p = 0,384), previous manipulation (p = 0,461), necrosis (p = 0,461) or with the presence of vascular invasion (p = 1,000). CONCLUSION Local relapse presents correlation with extra-compartimental location and with high grade malignancy tumors.

Invasão do duodeno por carcinoma do terço distal do estômago: estudo histopatológico e revisão da literatura

Gastric carcinoma with duodenal invasion is reported in 11% to 33.3% of surgical specimens. In spite of this high frequency, it is not easily recognised during the surgical proceeding or at gross examination. The study of risk factors like histological type, tumor stage and extension of duodenal invasion can be useful in establishing the best surgical approach in order to diminish the risk of local recurrence. We report 50 cases of distal gastric carcinoma in which we analysed the tumor extension in the different layers of the duodenal wall; duodenal invasion was correlated with histological type, level of infiltration in the gastric wall and presence of vascular invasion. Duodenal invasion was observed in 27 cases (54%), 17/32 of intestinal type (53%), 9/10 of diffuse type (90%) e 1/8 of non-classifiable tumours (12.5%). Diffuse type carcinoma was the most important risk factor for invasion (OR = 11; CI 95%: 1.20 to 254.16; P < 0.01). Most of the cases (21/27, 77%) were stage III or IV. The submucosal layer was the most frequent (22/27 cases, 81%) and also most extensively (8.21 +/- 9.75 mm) invaded. We conclude that the risk of duodenal invasion is higher in diffuse type tumours and in stage III or IV. Distal surgical resection should be wider in these cases and determined by frozen section biopsy specimen at the point of transection.A invasao do duodeno pelo carcinoma gastrico e relatada em 11% a 33,3% dos exames de pecas cirurgicas. Apesar dessa alta frequencia, e dificilmente reconhecida durante o ato cirurgico ou no exame macroscopico da peca. A identificacao de fatores de risco de invasao do duodeno, como tipo histologico e estadio da neoplasia, bem como a analise da extensao media de invasao poderao ser uteis na adocao de condutas cirurgicas que diminuam o risco de recidiva local do tumor. Foram estudados 50 casos de carcinoma do terco distal do estomago, com o objetivo de quantificar a extensao da infiltracao neoplasica nas diversas camadas da parede duodenal e de correlaciona-la com caracteristicas do tumor como tipo histologico, nivel de infiltracao do tumor na parede gastrica e invasao vascular, procurando-se estabelecer fatores prognosticos para a invasao do duodeno. Observou-se invasao em 27 casos (54%), 17/32 de tipo intestinal (53%), 9/10 de tipo difuso (90%) e 1/8 dos casos nao-classificaveis histologicamente (12,5%). O tipo histologico difuso constituiu o principal fator de risco (RC = 11; IC 95%: 1,20 a 254,16; P < 0,01) para a invasao do duodeno. A maioria dos casos (21/27, 77%) encontrava-se em estadios III ou IV. A submucosa duodenal foi a camada mais frequentemente invadida (22/27 casos, 81%) e em maior extensao (8,21 ± 9,75 mm). Conclui-se que o risco de invasao duodenal e maior nos tumores difusos e em estadios III e IV; a resseccao cirurgica duodenal deve ser ampliada nessas neoplasias e o exame peroperatorio pode ser util na determinacao da margem de resseccao.

CHOLESTEATOMA OF THE UPPER URINARY TRACT

We report the case of a 57-year old patient with complex cystic image in right kidney. Following radical nephrectomy, the pathological study established the diagnosis of renal cholesteatoma. We discuss the frequency, pathogenesis, clinical presentation, propedeutics, histological findings and proposes for intervention observed in the literature.

Associação de leishmaniose visceral e hepatite B de curso fulminante: relato de um caso

The case of a 20-year-old man with hepatoesplenomegaly, fever and severe hepatic insufficiency is reported. Histopathological and immunohistochemical studies of tissue specimens obtained at autopsy led to diagnosis of visceral leishmaniasis and fulminant hepatitis B. The authors pointed out a possible influence of immunological response related with visceral leishmaniasis in development of severe hepatic involvement by hepatitis B virus.

18F-FDG PET/CT as a prognostic factor in penile cancer

PurposePenile cancer (PC) is a rare neoplasm with an aggressive behavior and variable prognosis. Lymph node (LN) involvement and pathological features of the primary lesion have been proven to be the most important survival factors. Positron emission tomography/computed tomography with fluorodeoxyglucose labelled with fluorine-18 (18F-FDG PET/CT) provides information on tumor staging and works as a prognostic factor, with promising results in other carcinomas. The aim of the present study is to evaluate PET/CT as a prognostic factor in PC.MethodsFifty-five patients (mean age 56.6 y) diagnosed with penile squamous cell carcinoma were prospectively evaluated from 2012 to 2014. All subjects underwent 18F-FDG PET/CT before treatment and were regularly followed after surgery.ResultsOut of the 53 patients selected, 17 (32.1%) had localized disease (cT1–2) and 24 (45.3%) had palpable nodes (cN+). Partial penile amputation was performed in 38 patients (71.7%) and inguinal lymphadenectomy (LND) in 30 (56.6%). From the LND group, 16 (53.3%) presented with positive neoplastic cells (pN+). Patients with more aggressive disease had a significantly (p = 0.019) higher 18F-FDG tumor uptake (pSUVmax), while inguinal LN uptake (nSUVmax) was able to recognize metastatic LN (p = 0.039). Some pathological prognostic features, when presented, have shown significant changes in pSUVmax values. Receiver operating characteristic (ROC) curves were performed and specific cutoff values of pSUVmax were evaluated to determine sensitivity and specificity. Regarding regional LNs, PET/CT presented a 76.2% accuracy in cN+ patients. After a 39-month follow up, pSUVmax of 16.6 (p = 0.0001) and nSUVmax of 6.5 (p = 0.019) were established as the ideal values to predict cancer-specific survival. The multivariate analysis confirmed nSUVmax as a predictor for LN metastasis (p = 0.043) and pSUVmax as a mean to estimate survival rate (p = 0.05).ConclusionThis study showed promising results on the use of 18F-FDG PET/CT as a prognostic tool for PC, using specific cutoff values of pSUVmax and nSUVmax.