Ricardo Schwingel

Linfoma do sistema nervoso central: ensaio iconográfico

Ilustramos este ensaio iconografico de linfoma do sistema nervoso central com imagens de ressonância magnetica obtidas em nosso servico nos ultimos 13 anos e discutimos algumas das principais caracteristicas radiologicas deste tipo de linfoma, primario e secundario. O linfoma sistema nervoso central e um tumor relativamente infrequente, mas alguns achados na ressonância magnetica podem sugerir este diagnostico.

Publicação de trabalhos científicos apresentados em Congresso de Trauma no Brasil

OBJECTIVE: to assess the proportion of papers presented at the XXI Panamerican Congress of Trauma, VIII Congress of the Brazilian Society of Integrated Assistance to the Traumatized (SBAIT) and X Brazilian Congress of Trauma Leagues (CoLT) that were published in full. METHODS: In the events cited, based in Campinas in 2008, 347 papers abstracts of were presented and published. To evaluate the proportion of complete published works a retrospective observational study was conducted, reviewing the biomedical databases PubMed and SciELO, with support from Google, from the title of the abstracts and list of authors. RESULTS: Of 347 papers considered, 25 (7.3%) were from foreign services and 322 (92.7%) national. Ten (2.9%) papers were published, of which six (1.7%) of nursing and four (1.2%) medical. Among these, four thesis publications were identified and only one international work has been published. CONCLUSION: Despite a large number of papers presented at trauma conferences in Brazil, the publications in this area are rare. The academy and the societies of surgery need to encourage the submission of scientific papers even before the presentation in Congresses in order for them to be evaluated for publication in indexed journals.

Central nervous system lymphoma: magnetic resonance imaging features at presentation

OBJECTIVE This paper aimed at studying presentations of the central nervous system (CNS) lymphoma using structural images obtained by magnetic resonance imaging (MRI). METHODS The MRI features at presentation of 15 patients diagnosed with CNS lymphoma in a university hospital, between January 1999 and March 2011, were analyzed by frequency and cross tabulation. RESULTS All patients had supratentorial lesions; and four had infra- and supratentorial lesions. The signal intensity on T1 and T2 weighted images was predominantly hypo- or isointense. In the T2 weighted images, single lesions were associated with a hypointense signal component. Six patients presented necrosis, all of them showed perilesional abnormal white matter, nine had meningeal involvement, and five had subependymal spread. Subependymal spread and meningeal involvement tended to occur in younger patients. CONCLUSION Presentations of lymphoma are very pleomorphic, but some of them should point to this diagnostic possibility.

Primary dural lymphoma: a rare subtype of primary central nervous system lymphoma (PCNSL)

MD, PhD, Department of Radiology of the Clinics Hospital of the State University of Campinas, Faculty of Medical Sciences, Campinas SP, Brazil; Medical Student, Department of Pathology of the Clinics Hospital of the State University of Campinas, Faculty of Medical Sciences, Campinas SP, Brazil; MD, PhD, Department of Pathology of the Clinics Hospital of the State University of Campinas, Faculty of Medical Sciences, Campinas SP, Brazil. A 56-year-old female with left VI nerve palsy. Diagnostic imaging demonstrated a left cavernous sinus lesion, with a pattern which may be associated to meningioma, lymphoma, inflammatory pseudotumor, tuberculosis or sarcoidosis (Fig 1). Histological analysis confirmed the diagnosis of marginal zone B-cell lymphoma. Signal intensity and marked enhancement are due to dense cellularity (with high nucleus/cytoplasm ratios) and absence of necrosis (Fig 2).

Supratentorial tanycytic ependymoma: an uncommon fibrillary ependymoma variant

A 6-year-old boy with focal seizures and headache. Diagnostic imaging demonstrated a right subcortical pa -rietooccipital heterogeous expansive lesion, with growth into the adjacent ventricular system (Fig 1). Histological analysis led to the diagnosis of tanycytic ependymoma, as tumor cells have features resembling tanycytes (Fig 2).More than half of these tumors occur in the spinal cord. Supratentorial location is very rare, and may arise, as in this case, around the ventricle or from subcortical white matter

The scientific production in trauma of an emerging country

BackgroundThe study aims to examine whether the end of specialty in trauma surgery in 2003 influenced the scientific productivity of the area in Brazil.MethodsWe identified and classified the manuscripts and their authors, from databases such as PubMed, Scielo and Plataforma Lattes and sites like Google, in addition to the list of members of SBAIT, the sole society in Brazil to congregate surgeons involved in trauma care in the country. We applied statistical tests to compare the periods of 1997-2003 and 2004-2010. We also analyzed the following variables: impact factor of journals in which manuscripts were published, journals, regional origin of authors, time since graduation, and conducting post-doctorate abroad.ResultsWe observed a significant increase in publication rates of the analyzed groups over the years. There was a predominance of quantitative studies from the Southeast (especially the state of São Paulo). More time elapsed after graduation and the realization of postdoctoral studies abroad influenced the individual scientific productivity.ConclusionThe number of articles published by authors from the area of trauma has been growing over the past 14 years in Brazil. The end of the specialty in trauma surgery in the country did not influence the scientific productivity in the area.

Ganglioglioma with anaplastic transformation

A nine year-old male had refractory seizures for four years. Diagnostic imaging (Fig 1A and B) demonstrated a cortico-subcortical focal lesion at the isthmus of the right cingulate gyrus. Biopsy yielded diagnosis of ganglioglioma (Fig 2A). Reoperation one year later showed similar features, but included atypical and multinucleated cells (Fig 2B). At the age of 13, the patient had symptom recurrence. Diagnostic imaging (Fig 1C and D) demonstrated a heterogeneous enhanced lesion in the right parietal region, with necrosis. Histology (Fig 2C to F) revealed a malignant glial tumor with the appearance of glioblastoma multiforme. A few tumor cells were positive for chromogranin. A diagnosis of malignant transformation of ganglioglioma was made. Gangliogliomas are rare tumors predominating in the early decades of life, with strong association with long term intractable epilepsy1-3. They are composed of variable proportions of glial (mainly astrocytic) cells and mature or dysplastic neurons2. Malignant change is a rare, but well recognized, complication. Transformation of the glial component from the low grade to a higher grade is observed in most cases. Also, there is a case of malignant transformation secondary to degeneration of the neuronal component into a neuroblastoma4. Some reports in literature5 suggest that radiation may predispose to malignant degeneration. In this case, the patient did not receive postoperative radiation.

Cerebellar cryptococcoma in a non-HIV patient

A 26-year-old female, immunocompetent, with dys-metria and dysarthria. Diagnostic imaging (Fig 1) dem-onstrated a cerebellar mass, with a pattern which may be associated to a tumor, although multiple hypointense centers surrounded by ring enhancement after gado-linium may suggest the possibility of many types of in-fectious lesions, including cryptococcoma. Histological analysis (Fig 2) confirmed the diagnosis of Cryptococcus neoformans.Central nervous system cryptococcosis is rare in im -munocompetent individuals and is considered an oppor -tunistic pathogen in AIDS patients

Fat necrosis associated with the use of oral anticoagulant therapy: atypical mammographic findings.

Radiol Bras. 2016 Jul/Ago;49(4):267–276 269 http://dx.doi.org/10.1590/0100-3984.2015.0130 left posterior temporal lobe that was distant from the aneurysm and from any subarachnoid cisterns. The case presented here is important because it establishes a mechanism for remote bleeding. In previous reports, a variety of explanations for distant hemorrhage have been proposed, including hypertensive crisis, the formation of jets through subarachnoid cisterns, venous infarction, intraluminal thrombosis, hemorrhagic infarction secondary to vasospasm, and occult vascular anomaly. However, none of those reports provided direct evidence to support any of the proposed mechanisms. In contrast, in our case, we observed definite angiographic evidence of vasospasm in the vessels between the aneurysm and the site of hemorrhage. That constitutes a strong indication that vasospasm-associated hemorrhagic infarction is a mechanism of remote hematoma formation following cerebral aneurysm rupture. In conclusion, we have described a case of ACA aneurysm rupture presenting as remote intraparenchymal hemorrhage in the splenium of the corpus callosum and have demonstrated that vasospasm-induced hemorrhagic infarction is a plausible mechanism for distant bleeding. Neuroradiologists and neurosurgeons should be aware of this rare phenomenon in order to reduce the likelihood of inappropriate treatment.

Creutzfeldt-Jakob dementia

1. Instituto Estadual do Cerebro Paulo Niemeyer, Rio de Janeiro, RJ,Brazil. 2. Hospital Casa de Portugal / 3D Diagnostico por Imagem, Riode Janeiro, RJ, Brazil. 3. Universidade Federal do Rio de Janeiro (UFRJ),Rio de Janeiro, RJ, Brazil. Mailing Address: Dr. Bruno Niemeyer deFreitas Ribeiro. Instituto Estadual do Cerebro Paulo Niemeyer – Ser-vico de Radiologia. Rua do Rezende, 156, Centro. Rio de Janeiro, RJ,Brazil, 20231-092. E-mail: bruno.niemeyer@hotmail.com.