Metástase pulmonar de tumor de células gigantes benigno: relato de caso

O tumor de células gigantes é a sexta neoplasia óssea primária mais comum. Acomete a metáfise de ossos longos, sendo mais comum em adultos jovens. Na radiologia mostra-se como lesão lítica, excêntrica e de limites definidos. Os autores relatam um caso de tumor de células gigantes benigno em paciente que apresentou metástases pulmonares cinco anos após a retirada do tumor primário.

Expressão Imuno-histoquímica da triptase em mastócitos nos Fibromas de Células Gigantes e Hiperplasias Fibrosas de Mucosa Oral

The giant cell fibroma is a benign neoplasm characterized by the presence of mono, bi or multinucleate cells, which can have a connection to the presence of mast cells. This research aims to analyze, descriptively and comparatively, the immunohystochemistry expression of the tryptase in mast cells of the giant cell f ibroma, f ibrous hyperplasia and samples of the normal oral mucosa. Thirty cases of giant cell fibroma, ten cases of fibrous hyperplasia and ten cases of normal oral mucosa were selected for the analysis of the immunohistochemistry expression, determination of the number of present mast cells, as well as their location and shape. It could be stated that there was a statistically signif icant difference (p<0,001) in relation to the quantity of mast cells among other samples analyzed where the giant cell f ibroma presented lesser quantity of mast cell and the hyperplasia showed higher concentration of this cellular type. Although the oral mucosa has presented a higher quantity of mast cells when compared to the giant cells fibroma, these were found in usual locations in the connective tissue in normal tissues. There could be noticed a statistically significant difference in relation to the number of non-granulated mast cells (p<0,001). On the areas of fibrosis, we could observe a statistically signif icant difference (p<0,006) among the samples. In relation to the present mast cells in perivascular location, no statistically signif icant difference was found. On the morphological analysis there was a predominance of oval mast cells. It was concluded that despite of the fact there was a lesser quantity of mast cells present in cases of giant cell f ibroma, they appeared to have a stronger relation to the present giant fibroblasts in this lesions, around 59,62%, being also evidenced a strong relation between these cells and the fibrosis areas in both cases of giant cell f ibroma and f ibrous hyperplasias and samples of normal oral mucosa, used as control group in our study, confirming, this way, the role of the mast cells as fibrinogenous inductor

Expressão imuno-histoquímica das proteínas MMP-9, VEGF e FVW em lesões centrais e periféricas de células gigantes

Central giant cell lesion (CGCL) and peripheral giant cell lesion (PGCL) of the jaws have a distinct clinical behavior, although they share histopathologic features. It is still unclear whether these clinical differences are supported by a distinct pattern of immunoexpression of markers for multinucleated giant cells (GC) and mononuclear cells (MC). The purpose of this study was to compare the immunohistochemical expression of VEGF, MMP-9 in CG and MC and measure the vascularization by vWF to check whether there are differences in expression of these biomarkers between CGCL and PGCL. Paraffin wax blocks of 20 cases of LCCG and 20 LPCG were retrieved. MMP-9 immunoreactivity was greater in the CM of PGCL compared to VEGF (p<0.05). VEGF expression was greater in the CM of CGCL compared to PGCL (p<0.05) and it was greater in the overall expression of CGCL compared to PGCL (p<0.05). Vascularity was quantified by microvascular counting (MVC). MVC was greater in the PGCL compared CGCL (p<0.05). MMP-9 showed a greater tendency of expression in CGCL, though was not significant (p>0.05). We tested correlation between the proteins studied in each group and found a significant negative correlation between VEGF and vWF in CGCL (p<0.05). These results suggest that there are differences in the expression of VEGF in CM and overall expression between the lesions, although no statistically significant difference in the overall expression of the MMP-9. Then, there was a trend in increased expression of MMP-9 and VEGF in CGCL, possibly by the involvement of both proteins in osteoclastogenesis. Additionally, the results of this study indicate a higher degree of vascularization in PGCL compared to CGCL, fact that can be directly linked to the reactive nature of the PGCL, where the inflammatory process with its rich angiogenesis contributes significantly to these findings.

Exprassão imuno-histoquímica dos fatores de reabsorção óssea em lesões centrais e periféricas de células gigantes

The Giant Cell Lesions, both the Central Giant Cells Lesions (CGCL) as the Peripheral Giant Cells Lesions (PGCL), correspond to a group of oral lesions that are histologically similar entities; however they show a variable clinical behaviour. The purpose of this study was to compare the immunohistochemical expression of bone resorption factors RANK (Receptor Activator of Nuclear Factor kappa B), RANKL (Receptor Activator of Nuclear Factor kappa B Ligand) and OPG (Osteoprotegerin) between CGCL and PGCL. Additionally, these bone resorption factors were examined in terms of aggressiveness of these lesions. The sample consisted of 61 cases, 30 cases of PGCL and 31 CGCL (16 non-aggressive and 15 aggressive). The analysis was performed by quantification of mononuclear cells (MO) and giant multinucleated cells (CG) immunopositive to anti-RANK, anti-RANKL and anti-OPG antibodies in 10 fields. Moreover, according to the proportion between the amount of cells positive for RANKL and OPG, the cases were categorized into: RANKL>OPG, OPG>RANKL e RANKL=OPG. CGCL showed a higher amount of MO (p=0.002) and total cells (p=0.003) both positives to RANKL compared with the PGCL. Additionally, the CGCL revealed a significant association with the ratio of RANKL>OPG (p=0.001). Analysis of the bone resorption factors revealed no significant differences between aggressive and non-aggressive CGCL (p>0.05). It was observed a positive correlation between the markers themselves, and a negative correlation between lesion size and quantity of OPG positive MO cells (p=0,004) and total cells (p=0,009). Through these results, we suggest that the greatest CGCL resorptive potential compared to the PGCL, may have occurred to the high expression of RANKL. Furthermore differences in the biological behavior of aggressive and non-aggressive CGCL appear to be related to the expression of these bone resorption factors

Caracterização das fases de desenvolvimento de células gigantes induzidas por Meloidogyne exigua em raiz de seringueira (Hevea brasiliensis Muell. Arg.)

The developmental phases of giant cells induced by root-knot nematodes (Meloidogyne exigua) in rubber plant (Hevea brasiliensis) root were studied in relation to its number and size evaluated in eight sample dates. The results were subject to cluster analysis and principal component analysis. Sample dates were clearly distinct regarding giant cell development. As a result, the nematode infestation cycle was characterized by the following sequential phases: initial, equilibrium, choice and final.

Lesão de células gigantes periférica da cavidade bucal: avaliação da agressividade das lesões por meio dos estudos clínico-radiográfico retrospectivo, histopatológico, histoquímico e imunohistoquímico

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Expressão de recptor de estrógeno, vimentina, TGFbeta, e marcador de macrófagos em tumor ósseo de células gigantes em gatos domésticos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efeito modulador de citocinas sobre a formação e atividade fungicida de células gigantes multinucleadas obtidas de mnóctos humanos estimulados com antígeno de Paracoccidioides brasiliensis

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise comparativa da imunoexpressão de GLUT-1, GLUT-3 e M-CSF em lesão periférica e central de células gigantes

The peripheral giant cell lesion ( PG CL ) and the central giant cell lesion ( CGC L) are lesions histologically similar affecting the head and neck region . The study aimed to analyze the immunohistochemical expression of markers GLUT - 1 , GLUT - 3 and M - CSF in a series of cases of PGCL and CGCL , in trying to understand the different biological behavior of these pathologies . The sample consisted of 20 tissue specimens of PGCL 20 central lesion of not aggressive giant cell ( CLNAGC) and 20 central lesi on of aggressive giant cell ( CLAGC), coming from the Pathology Unit of Oral Pathology of the Department of Dentistry of UFRN . W as performed the s emi - quantitative and qualitative analysis of immunohistochemical expression of the markers in giant cells and m ononuclear cells . In relation to the GLUT - 1, it was found a statistically significant difference (p < 0.05) in the number of mononuclear cells immunomarked between the PGCL and the CLNAGC and between the PGCL and CLAGC . Regarding the intensity of staining w as also observed a statistically significant difference both at the mononuclear cells as in giant cells between PL and CLNAGC and between PGCL and CLAGC , at the giant cells there was also a statistically significant difference between the CLNAGC and CLAGC . In relation to GLUT - 3 , was found a statistically significant difference between PGCL and CLAGC and between CLAGC and CLNAGC in amount of mononuclear cells immunomarked . Regarding the intensity of labeling for such protein was found a statistically signifi cant difference at the giant cells between PL and CLAGC . To the M - CSF was observed only a statistically significant difference in the intensity of labeling at the mononuclear cells between PGCL and CLNAGC and between PGCL and CLAGC . Based on these results, we can conclude the participation of GLUT - 1, GLUT - 3 and M - CSF in the pathogenesis of the lesions studied. The bigger immunostaining of these proteins in mononuclear cells show that these cells perform a higher metabolic activity and osteoclastogenic, espe cially in CLAGC . It was found that the mononuclear cells were more related to the pathogenesis of the studied lesions than properly the giant s cell s.

Isquemia Crítica dos Membros Superiores. Manifestação Inicial de Arterite de Células Gigantes - Caso Clínico

Introdução: A arterite de células gigantes (ACG), de etiologia desconhecida, é a vasculite sistémica mais comum nos adultos e pode ter uma ampla variedade de apresentações clínicas. Atinge mais frequentemente os ramos extracranianos da artéria carótida mas, em 10-15% dos casos, pode ocorrer o envolvimento das artérias subclávia, axilar e braquial. Caso clínico: Tratava-se de uma doente do sexo feminino, de 80 anos, com antecedentes de HTA e doença cerebrovascular. Foi observada no serviço de urgência por arrefecimento e dor em repouso nos membros superiores, com evidências de cianose digital distal bilateral. As queixas tinham tido início 2 meses antes e agravamento progressivo desde então. Realizou um angio-TC que mostrou a existência de oclusão de ambas as artérias axilares/braquiais proximais e imagens sugestivas de vasculite ao nível de ambas as artérias subclávias, aorta e artérias femorais comuns. Foi medicada com corticoterapia; contudo, por não apresentar melhoria significativa após 5 dias, optou-se por realizar um bypass carotídeo-umeral bilateral. Após a cirurgia, ocorreu resolução completa das queixas e a doente apresentava pulso radial palpável bilateralmente. Seis meses após a cirurgia, a doente encontrava-se assintomática e os bypasses permeáveis. Conclusão: O presente trabalho pretende expor o caso de uma doente com o diagnóstico inaugural e ACG,que se apresentou com isquemia crítica bilateral e simultânea. Este quadro clínico exigiu a realização de um procedimento de revascularização raro.

Annular erythematous papules in the neckline.

A 45-year-old woman with personal history of hypertension presented with an erythematous lesion in the neckline for a year and with a progressive growth. A physical examination revealed an annular lesion with erythematous papules in the edge. Histological exam showed phagocytosis of elastic fibers by multinucleated cells compatible with annular elastolytic giant-cell granuloma. The patient did not present any other associated systemic manifestation. Treatment with tacrolimus 0.1 percent ointment was prescribed with a very good response after two months.

Intralesional corticosteroid injections in the treatment of central giant cell lesions of the jaws

Objective: The aim of this study was to evaluate the response of treatment of central giant cell lesion to intralesional corticosteroid injections. Study Design: Review of articles indexed in PubMed on the topic between the years 1988 and 2011, and development of a descriptive meta-analysis of the results. Results: Sample of 41 patients primarily treated with intralesional corticosteroid injections was obtained, with a male female ratio of 1:0.95, being 23 aggressive and 18 non-aggressive central giant cell lesions. Triamcinolone acetonide and triamcinolone hexacetonide were the drugs used, and 78.0% cases were considered as good result, 14.6% were considered as moderate response and 7.3% were considered as negative result to treatment. Considering the aggressiveness, 88.9% of non-aggressive lesions presented a good response to treatment, in aggressive central giant cell lesions, 69.6% presented a good response to intralesional corticosteroid injections. Conclusion: In view of the results analyzed, intralesional corticosteroid injections could be considered as first treatment option for central giant cell lesion.

Odontoma em pacientes odontopediátrico: diagnóstico e tratamento. Relato de caso clínico.

Odontoma is a term that refers to a benign tumor of odontogenic and mixed nature, composed of epithelial and mesenchymal components. Histologically, they are compounds of different configurations including dental enamel, dentin, cementum and in some cases the pulp tissue. A slow growing asymptomatic tumor, odontoma is usually discovered through routine radiographic examination. A 3-year old male patient sought care at the School of Dentistry’s Baby Clinic (UNESP-Araçatuba), complaining of “small ball close to the teeth.” During the interview, the mother reported that the lesion was observed soon after a trauma, and evolved in less than one month. An ulcerated lesion with a 0.8 cm diameter was found during intraoral clinical examination. It was located in the inferior and anterior region of the mouth, between teeth 81 and 82, and there was also crown distalization. A radiographic examination showed a radiolucent area and root distance. In the absence of clinical and radiographic characteristics suggesting a case of odontoma, the differential diagnosis was peripheral giant cell lesion and pyogenic granuloma. So the area was punctured. Nonetheless, due to the absence of liquid, the surgical removal of the lesion was performed, followed by histological examination, which showed the definite diagnosis of a suggestive case of emerging odontoma.

Granuloma Actínico. A Propósito de um Caso Clínico

INTRODUÇÃO: O Granuloma Actínico (GA), também conhecido por granuloma anular elastolítico de células gigantes, é uma doença dermatológica rara e caracteriza-se clinicamente por placas anulares de bordos elevados e eritematosos com centro atrófico e hipopigmentado. As lesões são geralmente assintomáticas e localizam-se em zonas cronicamente expostas à radiação solar, nomeadamente, face, pescoço, decote e membros superiores. Há ainda muita controvérsia na classificação do GA, sendo que muitos autores defendem que não se trata de uma entidade nosológica distinta, mas de uma variante do granuloma anular que surge em zonas de exposição solar. No entanto, as características histopatológicas, nomeadamente, a presença de células gigantes multinucleadas com elastofagocitose e elastólise, bem como, a ausência de necrobiose ou deposição de mucina, permitem identificar o GA como entidade distinta. CASO CLÍNICO: Mulher de 77 anos, caucasiana, referenciada à consulta de dermatologia por placa anular de bordos bem definidos, elevados e eritematosos que se localizava na região frontal esquerda. A lesão, com cerca de três anos de evolução, não estava associada a qualquer sintomatologia sistémica. A biópsia cutânea revelou elastose solar marcada com infiltrado granulomatoso composto por células gigantes multinucleadas, elastofagocitose e elastólise. Assim, de acordo com a histopatologia, foi estabelecido o diagnóstico de GA. A doente, que já tinha sido tratada pelo seu médico assistente com corticoides tópicos sem melhoria clinica, recusou qualquer terapêutica adicional. Foi aconselhada a evitar exposição solar, além do uso de fotoproteção regular. CONCLUSÃO: O GA é considerado por muitos autores como uma variante do granuloma anular. No entanto, apesar de existirem características clinicas semelhantes, a histologia permite classificar o GA como patologia distinta. Os autores apresentam este caso pela raridade desta patologia e importância da correlação clinico-histológica no estabelecimento de diagnósticos diferenciais.