Burkitt's lymphoma of the duodenum in a patient with AIDS

Non-Hodgkin's lymphoma of B-cell type is the second most common neoplasm after Kaposi's sarcoma, among patients with human immunodeficiency virus infection. Most non-Hodgkin's lymphoma cases that are associated with acquired immunodeficiency syndrome involve extranodal sites, especially the digestive tract and the central nervous system. We report a case of primary lymphoma of the duodenum in a patient with AIDS. Upper gastrointestinal endoscopy revealed pseudopolypoid masses found in the second portion of the duodenum. A complete diagnostic study including histological, immunohistochemical and virological analyses showed high-grade B-cell Burkitt's lymphoma. The Epstein-Barr virus genome was detected in biopsies by immunohistochemical and in situ hybridization.

Müllerian adenosarcoma of the uterus with sarcomatous overgrowth following tamoxifen treatment for breast cancer

Müllerian adenosarcoma with sarcomatous overgrowth presented by a 52-year-old female patient after adjuvant tamoxifen treatment for breast carcinoma is described. The diagnosis was made on histological basis after curettage and complementary total hysterectomy with bilateral salpingo-oophorectomy. The immunohistochemical study showed high expression of estrogen receptors in the epithelial component of the lesion and irregularly positive findings in the stroma. The proliferative activity evaluated by Ki-67 immunoexpression was higher in the stroma than the epithelium. Some of the stromal cells showed rhabdomyoblastic differentiation. The association of tamoxifen use and development of mesenchymal neoplasms is discussed.

Primary rhabdomyosarcoma of the diaphragm: case report and literature review

The authors report a case of primary rhabdomyosarcoma of the diaphragm, an extremely rare presentation with only 14 cases reported in the literature. An 18-year-old male presented 2 spontaneous occurrences of pneumothorax. Computed tomography and magnetic resonance showed a tumoral mass on the right diaphragmatic surface, and after biopsy, the diagnosis was compatible with spindle cell rhabdomyosarcoma. Because the visceral pleura was invaded by the tumoral mass, a right pleuropneumonectomy was performed. The patient received adjuvant chemotherapy, and there was no evidence of disease 15 months after the operation. Based on the Intergroup Rhabdomyosarcoma Study Group (IRSG) criteria, which consider the extent of the disease and its surgical resectability, rhabdomyosarcomas can be classified into 4 groups. In clinical group I, which was the classification of our patient, the tumor is localized and completely resectable, which implies a good prognosis. Rhabdomyosarcoma is a rare tumor, and a good outcome may result if it is completely resected.

Cardiac abnormalities in the acquired immunodeficiency syndrome. A prospective study with a clinical-pathological correlation in twenty-one adult patients

OBJECTIVE - To evaluate the cardiac abnormalities and their evolution during the course of the acquired immunodeficiency syndrome, as well as to correlate clinical and pathological data. METHODS - Twenty-one patients, admitted to the hospital with the diagnosis of acquired immunodeficiency syndrome, were prospectively studied and followed until their death. Age ranged from 19 to 42 years (17 males). ECG and echocardiogram were also obtained every six months. After death, macro- and microscopic examinations were also performed. RESULTS - The most frequent causes of referral to the hospital were: diarrhea or repeated pneumonias, tuberculosis, toxoplasmosis or Kaposi sarcoma. The most frequent findings were acute or chronic pericarditis (42%) and dilated cardiomyopathy (19%). Four patients died of cardiac problems: infective endocarditis, pericarditis with pericardial effusion, bacterial myocarditis and infection by Toxoplasma gondii. CONCLUSION - Severe cardiac abnormalities were the cause of death in some patients. In the majority of the patients, a good correlation existed between clinical and anatomical-pathological data. Cardiac evaluation was important to detect early manifestations and treat them accordingly, even in asymptomatic patients.

Primary neoplasms of the heart. Clinical and histological presentation of 50 cases

OBJECTIVE: To analyze clinical and histologic findings of 50 patients with primary neoplams of the heart in a tertiary referral center. METHODS: From 1980 to 1998, we retrospectively analyzed 50 patients, 32 of whom were females, whose ages ranged from 9 to 73 years (mean age = 44.16±18 years). RESULTS: Most tumors were located in the left side of the heart (72%), myxoma being the most common (84%) histologic type. The other histologic types found were as follows: fibroma (4%), lipoma (2%), rhabdomyosarcoma (2%), hemangioma (2%), sarcoma (2%), angiosarcoma (2%), and lymphoma (2%). Diagnosis was established by echocardiography in 94% of the cases. Clinical findings were as follows: dyspnea (36%), weight loss (20%), palpitations (18%), chest pain (16%), fever (8%), and arthralgia (6%). All patients with thromboembolic phenomena (10%) had left atrial myxoma. Approximately 20% of the patients were asymptomatic at the initial clinical assessment. CONCLUSION: Primary cardiac tumors are a rare entity with diverse clinical and histologic findings, requiring, therefore, a high level of clinical suspicion.

Experimental Model of Gene Transfection in Healthy Canine Myocardium: Perspectives of Gene Therapy for Ischemic Heart Disease

OBJECTIVE: To assess the transfection of the gene that encodes green fluorescent protein (GFP) through direct intramyocardial injection. METHODS: The pREGFP plasmid vector was used. The EGFP gene was inserted downstream from the constitutive promoter of the Rous sarcoma virus. Five male dogs were used (mean weight 13.5 kg), in which 0.5 mL of saline solution (n=1) or 0.5 mL of plasmid solution containing 0.5 µg of pREGFP/dog (n=4) were injected into the myocardium of the left ventricular lateral wall. The dogs were euthanized 1 week later, and cardiac biopsies were obtained. RESULTS: Fluorescence microscopy showed differences between the cells transfected and not transfected with pREGFP plasmid. Mild fluorescence was observed in the cardiac fibers that received saline solution; however, the myocardial cells transfected with pREGFP had overt EGFP expression. CONCLUSION: Transfection with the EGFP gene in healthy canine myocardium was effective. The reproduction of this efficacy using vascular endothelial growth factor (VEGF) instead of EGFP aims at developing gene therapy for ischemic heart disease.

Avaliação por ressonância magnética de massas cardíacas

FUNDAMENTO: Tumores cardíacos são extremamente raros; no entanto, quando há suspeita clínica, é necessária a correta avaliação diagnóstica, para planejar o tratamento mais adequado. Nesse contexto, a ressonância magnética cardiovascular tem um papel importante, permitindo uma abrangente caracterização de tais lesões. OBJETIVO: Revisar os casos encaminhados a um Serviço de Ressonância Magnética para investigação de massas cardíacas e paracardíacas. Descrever a série de casos positivos, juntamente de uma breve revisão da literatura para cada tipo de lesão e sobre o papel da ressonância magnética cardiovascular em sua avaliação. MÉTODOS: Entre agosto de 2008 e dezembro de 2011, foram revistos todos os casos de pacientes encaminhados a ressonância magnética com suspeita de neoplasia envolvendo o coração. Foram selecionados aqueles com confirmação histopatológica, evolução ou resposta terapêutica compatíveis com a suspeita clínica e achados de imagem. RESULTADOS: Entre os 13 pacientes incluídos neste estudo, oito (62%) tiveram confirmação histopatológica. Foram descritas cinco neoplasias benignas (mixomas, rabdomioma e fibromas), cinco neoplasias malignas (sarcoma, linfoma, síndrome de Richter cardíaca e doença metastática) e três lesões não neoplásicas (cisto pericárdico, trombo intracardíaco e vegetação infecciosa). CONCLUSÃO: A informação disponível sobre essa questão é escassa. Estudos prospectivos adicionais são necessários para elucidar o papel desses nutrientes no risco cardiovascular de pacientes com diabetes.

Mortality and Embolic Potential of Cardiac Tumors

Background: Cardiac tumors are rare, mostly benign with high embolic potential. Objectives: To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery. Methods: Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%). The diagnosis was established by echocardiography, magnetic resonance and histological examination. Results: Most tumors were located in the left side of the heart. Myxoma was the most common (72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001). The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%) and two recurrences 1 and 11 years after the operation, to the same cavity. Conclusion: Most tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event.

Introdução à família Tarsonemidae Kramer, 1877 (Acarina) no estado de São Paulo

No presente trabalho é dada uma introdução à família Tarsonemidae e são relatadas as seguintes espécies: Polyphagotarsus latus (Banks, 1904) Beer & Nucifora, 1965; Tarsonemus setifer Ewing, 1939; Steneotarsonemus ananas (Tryon, 1898) Beer, 1954; S. pallidus (Banks, 1901) Beer, 1954; S. hyaleos Beer, 1954 e Rhynohotarsonemus sp. Uma chave para a separação dos gêneros e outra para a separação das espécies de Steneotarsonemus é apresentada.

Geographic variation in ectoparasitic mites diversity in Tadarida Brasiliensis (Chiroptera, Molossidae)

Tadarida brasiliensis (Geoffroy, 1824), the Brazilian free-tailed bat, is an insectivorous bat that occurs from southern United States of America to southern South America. In this study we present the first data on diversity of ectoparasitic mites of T. brasiliensis in Brazil. A compilation and analysis of the studies of mite diversity conducted in different points the geographic distribution this bat species are provided. The mites were collected from March 2010 to November 2011 on 160 T. brasiliensis adult bats captured in southern Brazil. Four species of mites have been found: Chiroptonyssus robustipes (Ewing, 1925), Ewingana longa (Ewing, 1938), Ewingana inaequalis (Radford, 1948), and specimens of Cheyletidae. Chiroptonyssus robustipes was the most prevalent species (100%), followed by E. longa (20%), E. inaequalis (10%), and specimens of Cheyletidae (1.25%). The data currently available show that C. robustipes parasitizes T. brasiliensis throughout its region of occurrence, and this mite is highly prevalent and abundant. The two species of Ewingana accompany the geographical distribution of T. brasiliensis, but with much lower prevalence and abundance.

Reticulo-endotheliomatose maligna

A spindle-cell sarcoma (fig. 5) apparently originating from the dura (fig. 4) was found at the autopsy of a male, mulato, 17 years of age. The bones of the skull (occipital and both parietals) were penetrated and destroyed (fig. 1 and 2). The nervous tissue was not penetrated, the only change in the brain being a depressed area where the tumor was included. Metastatic nodules were found in the liver (fig. 3),hepatic lymphnodes (fig. 14), spleen (fig. 12) and suprarenal bodies (fig. 15). The structure, however, in all those different locations was that of a typical endothelioma (figs. 8, 11 and 13). The cells are of large and moderate size, of polyhedral form, with vesicular nuclei, diminutive nucleoli and clear cytoplasm. (Figs. 6 and 8). They are arranged about a central lumen which represents a rudimentary vessel (figs. 9 and 13). Other areas are composed of cells without concentric arrangement (figs. 4 and 10). In small areas, the colums of liver cells are marginated in one side by typical sinusoids, while in the other side tumor cells arranged about a narrow lumen are seen suggesting a pathological (neoplastic) sinusoid (figs. 7 and 9). The case is considered as a multiple diffuse endothelioma. The origin of the tumor is referred to the reticulo-endothelial apparatus of the liver, the spleen, the suprarenal bodies and the lymph nodes, the structure being rather uniform in those organs. In the dura, the endothelioma reproduces the structure and presents the general character of a fibroblastic sarcoma; in some places, however, the structure of endothelioma could be found (fig.6). It corresponds to the reticulo-endotheliomatosis maligna according to Puhr's grouping of progressive changes in the reticulo-endothelial apparatus which is a follows: 1. HYPERPLASTIC - 1. Mnnocytic leukemia. 2. a) Aleukemic reticulosis (Goldschmid and Isaac). b) Idiopathic sarcoma of skin (Kaposi). c) Cutaneous sarcoid (Spiegler). 3. Secretory reticulosis. a) Gaucher's disease. b) Generalized xanthomatosis. c) Spleno-hepatomegaly with lipoidic cells (Pick). II. BLASTOMATOSUS OR NEOPLASTIC - 1. Benign - a) Circumscribed tumors. a) Epulis sarcomatosa; b) Benign giant-cells sarcoma of the bone - marrow of long bones. b) Generalized brown tumors of osteitis fibrosa. 2. Malignant - a) Circumscribed haemangio - endothelioma (reticulo- endothelioma (maligum). of {liver, spleen, bone-marrow. b) Generalized haemangio-endotheliomatosis (reticulo-endotheliomatosis maligna) (Grabowski).

Estudo comparativo das inclusões do alastrim e da variola vera

Resulta das descripções e documentos examinados que as inclusões cytoplasmaticas da variola vera, no material humano examinado, apresentam caracteres geraes que poderão ser assim resumidos: 1. intensa coloração pela safranina nos preparados pelo methodo de Unna modificado (Fig. 42), mostrando a inclusão matiz semelhante ao dos nucleolos da mesma cellula. 2. reacção predominantemente acidophila nos preparados pela hematoxylina-eosina, traduzida pela tonalidade rosea ou vermelha de coloração (Figs. 27, 29, 30, 31 e 31). 3. frequente multiplicidade de inclusões de fórma e dimensões variadas na mesma cellula (Figs. 29 e 30), as maiores inclusões (Figs. 29 e 32), sendo menores que as grandes inclusões cytoplasmaticas solitarias do alastrim (Figs. 15, 16 e 18). É a regra, ainda, observar-se desapparecimento de qualquer estructura no cytoplasma das cellulas com inclusões em zona muito extensa, tornando-se difficil explicar tal aspecto unicamente pela retracção das inclusões no acto da fixação (Figs. 31 e 32). Quanto ás inclusões intranucleares, ellas se apresentam sob tres aspectos, dois dos quaes bem reconhecidos por Luger e Lauda (1926). Em um primeiro aspecto, o nucleo conserva, em parte, o reticulo de linina e encerra uma massa irregular (Fig. 35) ou, então, pequenas massas e granulos de dimensões variaveis (Figs. 33 e 34) constituidos por material acidophilo que ali não existe em condições normaes. A membrana nuclear tem espessura visinha do normal. Em um segundo aspecto, a inclusão occupa a totalidade do nucleoplasma (Fig. 3), apenas separado da membrana nuclear, em alguns casos (Fig. 38), por um estreito espaço claro (zona de retracção). Por vezes apresenta um aspecto homogeneo (Fig. 37); outras vezes a inclusão mostra pequenas areas chromophobas ( Fig. 38). A hyperchromatose da membrana nuclear é accentuada, tanto neste como no aspecto seguinte. No terceiro aspecto (aspecto corpuscular) (Figs. 39, 40, 48 e 50), a inclusão intranuiclear é formada por um ou mais corpusculos acidophilos, de contornos muito nitidos e fórma regular, ora ovoide, ora espherica. No interior de cada corpusculo, apparecem zonas chromophobas multiplas, sendo ordinariamente uma maior que as outras (Figs. 39, 40, 48 e 50). Fóra desses corpusculos, o nucleoplasma contem, por vezes material menos intensamente corado pelo eosina ou pela safranina (Figs. 40). O reticulo de linina, porém, acha-se completamente desapparecido, e não raro se observa, em torno dos corpusculos acidophilos, uma zona algum tanto extensa de nucleoplasma sem nenhuma estructura apparente (Fig. 48, á direita). Frisamos o modo peculiar de se comportar o nucleolo nas cellulas epidermicas com inclusões intranucleares da variola. Recalcado, a principio, de encontro á membrana nuclear (Fig. 36), elle em seguida é englobado pela propria membrana nuclear, parecendo incluso nessa estructura (Figs. 37, 35, 38 e 48, á direita). A « marginação » do nucleolo, e o seu englobamento ou inclusão na membrana nuclear, bem como o terceiro aspecto que descrevemos, de corpusculos intranucleares esphericos ou ovoides com zonas chromophobas, são caracteres que differenciam, de modo nitido, as inclusões intranucleares da variola vera da das demais inclusões das doenças de virus. Nem sempre, porém, os aspectos encontrados podem ser incluidos, com facilidade, em um dos tres grupos atraz mencionados, o que indica a existencia de phases de transição entre elles. Tal como assignalou Ewing, as cellulas epidermicas com inclusões intranucleares são geralmente as attingidas pela « ballonierende Degeneration ». Em geral taes elementos revestem o fundo da vesicula, ás vezes formando uma unica camada, e representando tudo o que resta da epiderme. Comtudo, em nosso material, conseguimos encontrar inclusões intranucleares em cellulas espinhosas do corpo mucoso de Malpighi que ainda conservaram relações normaes com os elementos contiguos e não eram attingidas pela « ballonierende Degeneration ». Em taes inclusões é que, de preferencia, observamos o aspecto de granulos mencionado no grupo I (Fig. 34). A hyperchromatose da membrana nuclear é, então, pouco notavel, constratando como o grau pronunciado que apresenta nos dois outros aspectos. Existiam, ellas em «lambeaux » epitheliaes, presos em certos pontos, por extreito pediculo, á camada basal, no fundo da vesicula.

Tumor misto do rim com estrutura de Miosarcoma Mipernefroma e blastema renal em individuo adulto

O A. descreve um caso de turmor misto do rim, em indivíduo do sexo masculino, com 58 anos de idade. A doença teve evolução lenta, somente sendo suspeitada, quando atingiu a fase final. O exame necroscópico revelou a existência de volumoso tumor do rim direito, apresentando forma bosselada, medindo 19 x 10 x 10 cm e pesando 940 g. A massa tumoral destrói quase completamente a estrutura renal, desta pouca restando reconhecivel. Fora do rim, encontra-se tambem tecido blastomatoso no figado, nos gânglios linfáticos mesentéricos, no peritônio e no epiploon. A estrutura do tumor, observada nos cortes histológicos, é variavel conforme o tecido examinado: no rim hipernefroma; fígado, gãnglios linfáticos, nos nódulos do peritônio e do epiploon, sarcoma mioblástico; em alguns gânglios do mesentério, alem da estrutura de sarcoma mioblástico, existe tecido nefrógeno, representado por formações pouco numerosas, constituidas por túbulos epiteliais, reproduzindo a estrutura de túbulo urinífero. casos desta natureza teem sido referidos com particular raridade, muito se aproximando o caso estudado do descrito por CHEVREL-BODIN e MARUELLE.

Hemangio-endoteliosarcoma primário do fígado

Os autores descrevem um caso de tumor raro do fígado, em mulher de 49 anos de idade, o qual apresentou a estrutura de hemângio-endotélio-sarcoma, de acordo com a nomenclatura aconselhada por FOOTE. O fígado pesou 1.700 g e era sede de múltiplas formações de dimensões variaveis, de aspecto comparavel ao de hemangioma cavernoso, emitindo metástases pouco numerosas ao baço. Pelo exame microscópico, pode ser reconhecida a estrutura histológica do hemangioma cavernoso associado à proliferação atípica do endotélio vascular, com a propriedade de reproduzir novos e imperfeitos espaços vasculares. No baço, embora em menor extensão, a estrutura é semelhante à observada no fígado. Analisando-se as várias hipóteses referentes à histogênese do tumor, pode-se admitir a sua origem a custa da transformação anaplásica do hemangioma cavernoso do fígado.

Hemângio-retículo-endotelioma do pericárdio

The author presents a case of primitive hemangio-reticulo-endothelioma of the pericardium. The structure of the tumor is identical to that of cases reported as primitive of the heart, and similar to that of the hemorrhagic sarcoma of KAPOSI, without, however, the typical cutaneous lesion of the disease.