Highly aggressive squamous cell carcinoma in an HIV-infected patient

Unusually aggressive forms of cutaneous squamous cell carcinoma are being increasingly recognized as a complication of HIV infection. We report the case of a 59-year-old male patient with advanced HIV infection who presented with a highly aggressive SCC lesion over the scalp area with destruction of the underlying parietal bone and fulminant clinical progression.

Infecções pelos vírus das hepatites B e C e o carcinoma hepatocelular na Amazônia oriental

Com o objetivo de contribuir para um melhor conhecimento do envolvimento das infecções pelos vírus das hepatites B e C, na etioepidemiologia do CHC na Amazônia Oriental, estudou-se 36 pacientes em Belém-PA. Foram avaliados marcadores sorológicos e a pesquisa do HBV-DNA e HCV-RNA pela reação em cadeia da polimerase. Observou-se etilismo em 33,3% e cirrose em 83,3%. Marcadores sorológicos das infecções pelo HBV e HCV foram encontrados respectivamente em 88,9% e 8,3%. O HBsAg foi encontrado em 58,3%; anti-HBc em 86%; anti-HBe em 85,7; HBeAg em 9,5%; anti-HBc IgM em 57,1%. O HBV-DNA foi detectado em 37,7% e em 65% dos HBsAg positivos; o HCV-RNA em 8,5% e em 100% dos anti-HCV positivos. AFP esteve alterada em 88,9% e acima de 400ng/ml em 75% dos casos. Conclui-se que a infecção pelo HBV parece ter importância na etiologia do CHC e ressalta-se a importância de implementar programas de vacinação e detecção precoce do tumor.

Analysis of molecular biology techniques for the diagnosis of human papillomavirus infection and cervical cancer prevention

The objective of the present study was to evaluate the usefulness of molecular methodologies to access human papillomavirus genome in the genital tract. Samples from 136 women aged 17 to 52 years old obtained from the Dr. Sérgio Franco Laboratories between 2000 and 2001, were analyzed by the hybrid capture assay and amplified by PCR with generic primers MY09/MY11 and specific primers for types 16, 18, 31, 33, 35, 58. Viral genome was detected in 71.3% of the samples by hybrid capture and 75% by amplification. When cytopathology was used as a reference method for screening lesions, hybrid capture (p=0) and amplification (p=0.002) presented positive association. The 3 methods showed absolute agreement when cytopathology confirmed papillomavirus infection and high grade intraepithelial lesion. Disagreements occurred for 10 cases: seven inflammatory cases positive by PCR and negative for hybrid capture and 3 low squamous intraepithelial lesions positive for hybrid capture but negative for amplification. In conclusion, hybrid capture was shown to be sensitive and specific enough for use in clinical routines. Moreover, the evaluation of viral load values obtained by this method were shown to be related to the severity of the lesion and merit further studies to analyze the possible association with risk of progression to malignancy.

Linfócitos CD4, CD8 e células NK no estroma da cérvice uterina de mulheres infectadas pelo papilomavírus humano

INTRODUÇÃO: A resposta imune pode ser um elemento chave para a progressão ou remissão da infecção pelo papilomavírus humano (HPV) no estroma da cérvice uterina. Este estudo objetivou quantificar no estroma cervical a presença de linfócitos T CD4, CD8 e células NK, por imunohistoquímica, em lesões de alto e baixo grau em pacientes infectadas por HPV MÉTODOS: Utilizou-se 56 amostras de biópsia da estroma cervical, sendo 43 amostras positivas para DNA de HPV de alto risco oncogênico e com diagnóstico histopatológico de neoplasia intraepitelial cervical (NIC) de alto e baixo grau, ou negativa para lesão intraepitelial e malignidade (NILM), e 13 amostras de pacientes negativas para DNA de HPV com diagnóstico histopatológico NILM RESULTADOS: Maior quantidade de linfócitos T CD4 foi observada em amostras NIC II/III, carcinoma e NILM (p=0,04) e naquelas cuja carga viral esteve entre 10 e 1,000 RLU/PCB. O predomínio de linfócitos T CD8 ocorreu em maior proporção nas amostras NIC II/III (p=0,02) e em amostras com carga viral entre 100 e 1.000 RLU/PCB. As células NK prevaleceram nas amostras com lesões de baixo grau e com baixa carga viral CONCLUSÕES: Este estudo comprovou que nas fases iniciais da infecção, onde não há ainda alterações celulares de alto grau, não temos a presença de células que possam desencadear a fase efetora da resposta imune.

Febre do viajante associada com adenite cervical e sororreatividade para Bartonella sp em paciente brasileira, após retorno da África do Sul

Um grande número de viajantes visita anualmente, por estudo, turismo ou trabalho o continente africano. Um caso de adenomegalia cervical e hepatoesplenomegalia associado à febre de duas semanas de duração com teste sorológico positivo para Bartonella sp em uma paciente de 22 anos do sexo feminino que retornou da África do Sul após realização de trabalho de campo com primatas em área silvestre é apresentado.

Hepatitis virus and hepatocellular carcinoma in Brazil: a report from the State of Espírito Santo

IntroductionFew studies have examined hepatocellular carcinoma (HCC) in Brazil, and the incidence and risk factors for this type of malignancy vary greatly geographically. In this paper, we report several risk factors associated with HCC diagnosed at the University Hospital in Vitória, ES, Brazil.MethodsWe reviewed 274 cases of HCC (January 1993 to December 2011) in which hepatitis B (HBV) and C (HCV) virus infection and chronic alcoholism were investigated. A diagnosis of hepatocellular carcinoma was confirmed by histology or by the presence of a characteristic pattern on imaging.ResultsHCC with associated liver cirrhosis was noted in 85.4% of cases. The mean ages of men and women were 56.6 years and 57.5 years, respectively. The male-to-female ratio was 5.8:1. Associated risk factors included the following: HBV, 37.6% (alone, 23.4%; associated with chronic alcoholism, 14.2%); HCV, 22.6% (alone, 13.5%; associated with chronic alcoholism, 9.1%), chronic alcoholism, 17.1%, non-alcoholic steatohepatitis, 2.6% and cryptogenic, 19.3%. The male-to-female ratio was higher in cases associated with HBV or chronic alcoholism compared with HCV-associated or cryptogenic cases. In 40 cases without associated cirrhosis, the male-to-female ratio and mean age were lower than those in cirrhosis-associated cases.ConclusionsThese results demonstrate that the main risk factor associated with HCC in the State of Espírito Santo is HBV. Chronic alcoholism is an important etiological factor, alone or in association with HBV or HCV infection.

Prostate carcinoma with neuroendocrine differentiation: case report and literature review

Neuroendocrine differentiation in prostatic carcinomas generally confers a more aggressive clinical behavior and less favorable prognosis than usual prostatic carcinomas. In this manuscript, we report a case of a 58-year-old man with prostatic carcinoma who died 1 year after initial diagnosis. Autopsy showed a disseminated prostatic carcinoma with neuroendocrine differentiation. There were metastasis to the spleen, an organ infrequently involved by disseminated epithelial neoplasms. Neuroendocrine differentiation was demonstrated by immunohistochemical studies in the biopsy and autopsy material.

Prognostic factors influencing morbidity and mortality in esophageal carcinoma

PURPOSE: In 1980, operative mortality for esophageal resection was 29%. Over the last 15 years, technical and critical care improvements contributed to the reduction of postoperative mortality rate to 8%. The aim of this study is to analyze retrospectively the role of different factors (surgical procedure, stage of the disease, and anesthetic risk) on the postoperative mortality of 63 patients that underwent esophagectomy with gastric interposition for cancer. METHODS: Seventy-two patients underwent esophagectomy. The stomach was the esophageal substitute in 63 cases. Surgical procedures included transthoracic esophagectomy in 49 patients and transhiatal esophagectomy in 14 cases. Among the 49 transthoracic esophagectomy patients, there were 18 patients with a high anesthetic risk (ASA III). Among the patients that underwent transhiatal esophagectomy, there were 10 patients with a high anesthetic risk (ASA III). RESULTS: The operative mortality rate was 14% (2/14) in transhiatal esophagectomy group and 22% (11/49) in transthoracic esophagectomy group (P = ns). The postoperative mortality of patients with a high anesthetic risk (ASA III) was 47% (8/17) after transthoracic esophagectomy and 10% (1/10) after transhiatal esophagectomy (P <0.05). DISCUSSION: In our experience, the operative mortality was nearly 18% (16.6% after transhiatal esophagectomy and 20.8% after transthoracic esophagectomy). Among the patients with a high anesthetic risk (ASA III) that underwent surgery, the postoperative mortality was significantly lower after transhiatal esophagectomy (10%) compared to transthoracic esophagectomy (47%) (P <0.05).

Endocardite infecciosa por Streptococcus bovis em paciente com carcinoma colônico

Descrevemos o caso de uma paciente de 66 anos de idade, com endocardite infecciosa por Streptococcus bovis e adenocarcinoma colônico, que desenvolveu insuficiência aórtica grave aguda. Foi submetida à cirurgia de troca valvar aórtica e posteriormente à ressecção tumoral (hemicolectomia direita). É importante ressaltar a necessidade de complementação do estudo do cólon, mesmo em indivíduos assintomáticos, quando diagnosticamos endocardite infecciosa por S. bovis.

Morfologia externa do adulto de Hemiargus hanno (Lepidoptera, Lycaenidae, Polyommatinae, Polyommatini): II. Região cervical, tórax e abdome

O presente trabalho visa fornecer subsídios para estudos morfológicos comparativos de Lycaenidae neotropicais. Hemiargus hanno (Stoll, 1790) é a primeira espécie neotropical de Polyommatinae a ter sua morfologia detalhada na literatura. Essa borboleta pode ser encontrada em ambientes abertos com vegetação rasteira, desde o sul do Texas até a Argentina. A morfologia da região cervical, do tórax e do abdome de H. hanno foi estudada com auxílio da microscopia óptica e de varredura.

Sobre alguns casos de carcinoma primitivo do pulmão, do bronchio e da trachéa

1-Out of 1531 autopsies at Rio de Janeiro, Brazil, recorded in the Section of Pathology of «Instituto OSWALDO CRUZ», we found three cases of primary carcinoma of the lung, which gives the incidence of 0,195 per cent. They were not associated with tuberculos's and anthracos's was not marked. 2-The gross and microscopical features indicate that they are in reality primary cancers of the larger bronchi arising probably, from the bronchial lining epithelium. There is a striking similarity both macro and microscopical in Cases I and II, where the structure is that of cylindrical cell alveolar carcinoma. Mucus formation was never a prominent feature in these tumors. As in HENRICI's case they apparently invade the lung along the alveolar wall in more or less considerable extension retaining the alveolar septa as stroma. In case III the structure is that of squamous cell carcinoma, and the tumor mass, usually ulcerating, lies in the immediate vicinity of the bronchi, the extension to the lung tissue being not widespread. 3-Cases IV and V are tumors of the lower and median portion of the trachéa, squamous cell carcinoma in structure, which form marked contrast with the tumors originating in the larger bronchi: the tumor process never invades the lung parenchyma by continuous extension. In Case V extension to the mediastinal lymph-nodes is observed, and a tumor of the size of an orange is found in the anterior mediastinum: that tumor mass and the upper lobe of the right lung were only adherent by fibrous tissue of inflammatory origin and the tumor did not extend into the lung tissue.

Carcinoma epidermoide primario do estomago

Os AA. chamam a attenção para a raridade deste typo histologico de tumor do estomago e descrevem um caso verificado pela autopsia, em individuo branco, brasileiro, de 67 annos de edade. O tumor localiza-se na pequena curvatura do estomago, sob o aspecto de uma formação crateriforme de 3,5 cms. de diametro e com adherencias ao pancreas. O esophago e o cardia não são de modo algum comprometidos pelo processo. Foram encontradas metastases no coração, no figado, na capsula do pancrea, no pulmão e glandulas suprarenaes. O exame histologico mostra tratar-se de um carcinoma epidermoide, não só no tumor primitivo, como tambem nos fócos metastaticos. As AA. são inclinados a acreditar que o tumor tenha se originado por intermedio de um processo d metaplasia epidermoide da mucosa gastrica.

Ganglioneuroma da região cervical

A case of ganglioneuroma in the neck of a girl sixteen years old first noticed at the age of fifteen months is reported. The tumor successfully removed at operation has the size of an orange and is in relation by its internal surface with the trachea, oesophagus and vertebral column. Anteriorly it is crossed by the left common carotid and internal jugular vein which are meanwhile dissociated. Although this suggests an origin from the pneumogastric nerve no convincing proof of such an origin was obtained.