Fibroma mole gigante vulvar: relato de caso / Giant soft vulvar fibroma: case report

Fibroma mole, ou pólipo fibroepitelial, é uma lesão de proporções geralmente reduzidas, de cor hiperpigmentada ou igual à da pele, localizando-se frequentemente na face, pescoço, tronco e regiões intertriginosas. É um tumor classificado como benigno e pode acometer tanto homens quanto mulheres em idade reprodutiva e depois da quarta década de vida. Ocorre principalmente em obesos, diabéticos e durante a gestação. Com menor frequência, podem alcançar dimensões que excedem 5 cm. Seu crescimento pode ser lento ou rápido e comumente são assintomáticos, mas podem promover sangramentos por conta de ulcerações decorrentes de traumas repetidos. Apresentamos neste relato um fibroma mole, gigante, de localização vulvar, com 11 cm de comprimento, 11 cm de largura e 5 cm de espessura, pesando 500 g.

Giant soft vulvar fibroma is a fibroepithelial polyp lesion with generally reduced proportions, with a hyperpigmented color or similar to that of the skin, frequently located on the face, neck, trunk and intertriginous regions. It is a tumor classified as benign, can affect both men and women, of reproductive age and after the fourth decade, mainly obese, diabetic and during pregnancy. However, less frequently, they can reach dimensions that exceed 5 cm, may have a slow or accelerated evolution. They are commonly asymptomatic, but bleeding may be present due to ulcerations resulting from repeated trauma. In the current study, we describe a giant soft fibroma with a vulvar location measuring 11 cm in length, 11 cm in width, 5 cm in thickness and weighing 500 grams.

Are both distinct epithelial and stromal cells molecular analysis from phyllodes tumors versus fibroadenoma components affected in breast fibroepithelial progression?

Purpose: To determine molecular events involved in the tumorigenesis of phyllodes tumors (PT) and the role of each stromal (SC) and epithelial (EC) cell. Methods: Frozen breast samples enriched with epithelial and stromal cells from three fibroadenomas and 14 PT were retrieved and laser microdissected. Sanger and polymerase chain reaction-based sequencing of exon 2 MED12 and TERT promoter hotspot mutations were performed; 44K microarray platform was used to analyze gene expression. Results: All three fibroadenomas (FAs) presented mutations in MED12, but not in TERT, whose mutation was observed in five of the 14 PTs. EC and SC of each affected tumor displayed identical alterations. Of the total differentially expressed genes (DEG) (EC = 1,543 and SC = 850), 984 were EC-eDEGs and 291 were SC-eDEGs. We found a high similarity of diseases and functions enriched by both cell types, but dissimilarity in the number of enriched canonical pathways. Three signaling canonical pathways overlapping with EC and SC were predicted to be activated in one cell type and inactivated in the other, while no overlap in eDEGs was assigned to them. We also identified 13 EC-eDEGs and five SC-eDEGs enriched networks, in which the SC-eDEGs were able to segregate FA from PT samples. Conclusions: Identical TERT mutations from both SC and ES origins might affect the PTs tumorigenesis. Gene expression differences suggest coordinated molecular processes between these components with determinant differences acquired by SC, able to fully distinguish PTs from FAs lesions.

An easy and practical prognostic parameter: tumor-stroma ratio in Luminal, Her2, and triple-negative breast cancers

SUMMARY OBJECTIVE: The stroma surrounding the tumor cells is important in tumor progression and treatment resistance, besides the properties of tumor cells. Studies on the tumor stroma characteristics will contribute to the knowledge for new treatment approaches. METHODS: A total of 363 breast cancer patients were evaluated for the tumor-stroma ratio. The percentage of stroma was visually assessed on hematoxylin-eosin stained slides. The cases of tumor-stroma ratio more than 50% were categorized as tumor-stroma ratio high, and those less than 50% and below were categorized as tumor-stroma ratio low. RESULTS: Tumor-stroma ratio-high tumors had shorter overall survival (p=0.002). Disease-free survival tended to be shorter in tumor-stroma ratio-high tumors (p=0.082) compared with tumor-stroma ratio-low tumors. Tumor-stroma ratio was an independent prognostic parameter for the total group of patients (p=0.003) and also axillary lymph node metastasis and tumor-stroma ratio was statistically associated (p=0.004). Also, tumor-stroma ratio was an independent prognostic parameter in node-positive Luminal A and B subgroups for overall survival (p<0.001). CONCLUSION: Tumor-stroma ratio is an independent prognostic parameter that can be evaluated quite easily in all molecular subtypes of all breast cancers and does not require extra cost and time to evaluate.

Mesenchymal stromal cells represent a therapeutic option for systemic sclerosis patients / Células estromales mesenquimales representan una opción terapéutica en pacientes con esclerosis sistémica

ABSTRACT The mesenchymal stromal cells (MSCs) are hematopoietic stem cells with high capacity of differentiation to other cellular lineages, depending on the microenvironment in which they live as well as on the interaction and signaling pathways they establish with the extracellular matrix. Several properties have been described in these cells: proangiogenic, antifibrotic and immunomodulatory. These properties are being studied as a therapeutic approach for autoimmune diseases such as cutaneous systemic sclerosis (SSc). SSc is a systemic chronic disease, with an approximate prevalence of 35.6 cases per 100,000 inhabitants in North America and of 0.02% in Colombia in 2018. There are two different clinical variants, diffuse and localized. In both variants an important skin involvement and a rapidly deterioration of organs is present, which can overshadow the clinical prognosis and increase the mortality. Options for the treatment of advanced diffuse SSc are scarce mainly targeting symptomatic control with little impact on the progression and mortality. Therefore, there is an increasing interest in new therapies like advanced cellular therapy with hematopoietic stem cells and stromal mesenchymal cells. This article reviews the information related to the use of stromal mesenchymal cells in patients with this disease.

RESUMEN Las células mesenquimales estromales son células madre no hematopoyéticas pluripotenciales con alta capacidad de derivación a diferentes linajes celulares, dependiendo tanto del microambiente en el que se encuentren, como de la interacción y señalización que establezcan con la matriz extracelular del entorno, esto ha permitido describir un potencial proangiogénico, antifibrótico e inmunomodulador, que ha sido blanco de investigación en enfermedades autoinmunes como la esclerosis sistêmica cutánea. Considerando que la esclerosis sistêmica cutánea es una enfermedad inflamatoria crónica, con una prevalencia estimada de 35,6 casos por cada 100.000 habitantes en Norte América y de 0,02% en nuestro país para el 2018, se caracteriza por presentar dos variables clínicas principalmente; una variante limitada y una variante difusa, presentando en ambas un compromiso extenso de piel y órganos que puede ser rápidamente progresivo y deteriorar el pronóstico de los pacientes que la padecen aumentando su mortalidad. Debido a que las opciones terapéuticas en esta entidad son limitadas y buscan únicamente el control de síntomas, pero con poco impacto en progresión y mortalidad, terapias celulares avanzadas han surgido como nuevas opciones terapéuticas incluyendo el trasplante de células madre hematopoyéticas y las células mesenquimales estromales. A continuación, se revisará acerca de la utilidad y evidencia de células mesenquimales estromales en pacientes con esta enfermedad.

Expression of stromal elements of prostatic adenocarcinoma in different gleason scores

Abstract Purpose: To quantify and compare the expression of stromal elements in prostate adenocarcinoma of different Gleason scores with non-tumor area (control). Methods: We obtained 132 specimens from samples of prostate peripheral and transition zone. We analyzed the following elements of the extracellular matrix: collagen fibers, elastic system, smooth muscle fibers and blood vessels. The tumor area and non-tumor area (control) of the TMA (tissue microarray) were photographed and analyzed using the ImageJ software. Results: The comparison between the tumor area and the non-tumor area showed significant differences between stromal prostate elements. There was an increase of collagen fibers in the tumor area, mainly in Gleason 7. Elastic system fibers showed similar result, also from the Gleason 7. Blood vessels showed a significant increase occurred in all analyzed groups. The muscle fibers exhibited a different behavior, with a decrease in relation to the tumor area. Conclusions: There is a significant difference between the extracellular matrix in prostate cancer compared to the non-tumor area (control) especially in Gleason 7. Important modifications of the prostatic stromal elements strongly correlate with different Gleason scores and can contribute to predict the pathological staging of prostate cancer.

Prostate specific antigen and acinar density: a new dimension, the "Prostatocrit"

ABSTRACT Background Prostate-specific antigen densities have limited success in diagnosing prostate cancer. We emphasise the importance of the peripheral zone when considered with its cellular constituents, the “prostatocrit”. Objective Using zonal volumes and asymmetry of glandular acini, we generate a peripheral zone acinar volume and density. With the ratio to the whole gland, we can better predict high grade and all grade cancer. We can model the gland into its acinar and stromal elements. This new “prostatocrit” model could offer more accurate nomograms for biopsy. Materials and Methods 674 patients underwent TRUS and biopsy. Whole gland and zonal volumes were recorded. We compared ratio and acinar volumes when added to a “clinic” model using traditional PSA density. Univariate logistic regression was used to find significant predictors for all and high grade cancer. Backwards multiple logistic regression was used to generate ROC curves comparing the new model to conventional density and PSA alone. Outcome and results Prediction of all grades of prostate cancer: significant variables revealed four significant “prostatocrit” parameters: log peripheral zone acinar density; peripheral zone acinar volume/whole gland acinar volume; peripheral zone acinar density/whole gland volume; peripheral zone acinar density. Acinar model (AUC 0.774), clinic model (AUC 0.745) (P=0.0105). Prediction of high grade prostate cancer: peripheral zone acinar density (“prostatocrit”) was the only significant density predictor. Acinar model (AUC 0.811), clinic model (AUC 0.769) (P=0.0005). Conclusion There is renewed use for ratio and “prostatocrit” density of the peripheral zone in predicting cancer. This outperforms all traditional density measurements.

Gastrointestinal stromal tumors treated at a Brazilian Cancer Center: evaluation of clinical, epidemiological, and therapeutic profiles

Background: Gastrointestinal stromal tumors (GISTs) originate as precursor cells of the interstitial cells of Cajal in the myenteric plexus and generally have a mutation in the tyrosine kinase receptor, C-KIT (CD117). The objective is to evaluate the clinical, epidemiological, and therapeutic profiles of GIST cases available from a hospital specializing in cancer treatment. Methods: A retrospective, longitudinal study of 85 GIST cases in a Cancer Center (São Paulo, Brazil) was conducted. Results: The cases identified involved 40 men and 45 women and the average age at diagnosis was 55.7 ± 14. 8 years (median, 57). The symptoms present at diagnosis depended on the location and dimensions of each lesion. In 49 cases (57.6%), the tumors had a gastric location and the mean dimensions were 7.2 ± 2.3 cm (median, 3.4 cm). Recurrent metastatic disease presented in 27 cases (with the liver mainly affected). Locoregional recurrence was detected in 16 cases. C-KIT was positive in 79/81 (97.5%) of the cases examined. Most of the tumors were initially treated with surgery, while clinical treatment was applied to the recurrent cases. The overall survival rate was 76.4% 162 months after diagnosis. Conclusions: The GISTs examined most commonly originated in the stomach, while the liver was the main site affected by metastatic lesions. Most of the lesions appeared to be slow-growing neoplasms that were positive for C-KIT (CD117). Complications, as well as death, mostly affected the elderly patients that had comorbidities or more aggressive forms of the disease (AU)

Adipose tissue stromal vascular fraction in the treatment of full thickness burns in rats

ABSTRACT PURPOSE: To analyze the healing effects of stromal vascular fraction (SVF) application compared to wound dressing with 2% silver sulfadiazine in full thickness burn wounds in rats. METHODS: Animals were divided into two groups: 2% silver sulfadiazine group and SVF group. Both groups received occlusive bandages while the first one was treated with 2% silver sulfadiazine and the latter was treated with injections of SVF prepared from adipose tissue extracted from an animal donor. The animals were accompanied through 3, 7 and 30 days for evaluation of macroscopic, microscopic and morphometric aspects. RESULTS: On day three, a significant increase (p<0.05) of infiltration of polymorphonuclear, fibrin formation and fibroblasts migration in SVF group was observed. On the 7th day the mononuclear infiltrate, angiogenesis, collagen and fibroblasts were significantly increased in the SVF group (p<0.05). At 30 days significantly increased collagen deposition was observed in the SVF group (p<0.05) . CONCLUSION: Adipose tissue derived stromal vascular fraction injections promotes better wound repair than 2% silver sulfadiazine in the treatment of full thickness burn in rats during the evaluated experimental period.

Criopreservación de células estromales derivadas del tejido adiposo: comparación de diferentes medios de criopreservación / Cryopreservation of adipose derived stromal cells: comparison of different cryopreservation media

Objetivo Obtener células estromales derivadas del tejido adiposo, medir y comparar las tasas de viabilidad antes e inmediatamente después un ciclo de criopreservación con diferentes combinaciones de criopreservantes de manera de obtener el mejor medio de criopreservación. Material y método Medición de la tasa de viabilidad poscriopreservación de células estromales derivadas del tejido adiposo obtenidas de 5 pacientes utilizando medios definidos (DMEM/Ham F12) libres de suero bovino y suplementados con una de los siguientes combinaciones de compuestos: dimetilsulfóxido (DMSO) 10%; DMSO 10% + trehalosa 7,6%; DMSO 10% + albúmina humana 10% y DMSO 10% + trehalosa 7,6% + albúmina humana 10%, mediante citometría de flujo con ioduro de propidio. Resultados No existen diferencias estadísticamente significativas en las tasas de viabilidad de las células estromales posterior a un ciclo de criopreservación. Sin embargo, se observa una tendencia a mejorar la tasa de recuperación de células vitales al agregar albúmina humana. Conclusiones No se observaron diferencias significativas entre las condiciones estudiadas, sugiriendo que ninguna es superior a las demás en cuanto a rendimiento. Es así como podemos afirmar que la criopreservación de las células estromales derivadas del tejido adiposo en un medio que combine DMEM/F12 con DMSO 10% + trehalosa 7,6% + albúmina humana 10% no logra una tasa de recuperación de células vitales significativamente mayor que las congeladas solo con DMSO 10%.

Aim To obtain stromal cells derived from adipose tissue, to measure and compare viability rates before and immediately after cryopreservation cycle, using different combinations of cryoprotective agents in order to identify the best cryopreservation medium. Material and method Viability rate after cryopreservation of stromal cells derived from adipose tissue were assessed by flow cytometry with propidium iodide. Samples of stromal cells obtained from 5 patients were kept defined, bovine serum-free media (DMEM/Ham-F12), supplemented with one of the following combinations of compounds: 10% dymethylsulfoxide (DMSO); Trehalose 10% DMSO + 7.6%; 10% DMSO + 10% human albumin and 10% DMSO + 7.6% Trehalose + 10% human albumin. Results No statistically significant differences were observed in the viability rates of stromal cells derived from adipose tissue after a cryopreservation cycle. However, we observed a tendency towards improvement of recovery rate when human albumin was added to the medium. Conclusions None of the studied conditions proved superior to others in terms of cell vitality after a cryopreservation cycle. Hence, we conclude that the cryopreservation of stromal cells derived from adipose tissue in an environment that combines DMEM/F12 with 10% DMSO + 7.6% Trehalose + human albumin 10% does not achieve a significantly higher recovery rate than only frozen solely with DMSO 10%.

Expression of CD90 and P75NTR stem cell markers in ameloblastomas: a possible role in their biological behavior

Abstract Multicystic and unicystic ameloblastomas are benign odontogenic tumors that present distinct biological behavior. The investigation of stem cells has become an important branch of tumor biology, with several studies addressing the possible role of these cells in tumor growth, angiogenesis, progression, infiltration and invasiveness. This study evaluated the immunohistochemical expression of CD90(Thy-1) and P75NTR stem cell markers in multicystic and unicystic ameloblastomas. Seventeen (17) samples of ameloblastomas (multicystic, n = 10; unicystic, n = 7) were submitted to immunohistochemical reactions and graded semi-quantitatively. The Kolmogorov-Smirnov test was used to verify possible differences in CD90 and P75NTR expressions between multicystic and unicystic ameloblastomas (p < 0.05). CD90 immunostaining was observed in all multicystic ameloblastoma specimens (n = 10), in the cytoplasm of the fibroblasts and vascular endothelial cells of the tumor stroma, near the neoplastic odontogenic epithelia. The staining of stromal CD90 was significantly higher in multicystic than in unicystic ameloblastomas (p = 0.003). Nuclear P75NTR immunostaining was observed in all ameloblastoma specimens. A significant difference was seen in the epithelial staining of P75NTR between multicystic and unicystic types (p = 0.007). The increased expression of CD90 and P75NTR found in multicystic ameloblastomas suggests a behavioral biological difference between multicystic and unicystic ameloblastomas, as well as a difference in ameloblastoma development.

Evaluación de la fibroína de seda como biomaterial de soporte para el crecimiento de células mesenquimales estromales de pulpa dental / Evaluation of silk fibroin as a support biomaterial for the growth of stromal mesenchymal cells of dental pulp

La regeneración de tejidos usando células, factores de crecimiento y soportes constituyen una alternativa en la Medicina Regenerativa. La fibroína de seda es un excelente biosoporte, sus propiedades mecánicas únicas le permiten soportar procesos de adhesión y crecimiento celular. Objetivo. Evaluar la fibroína de la seda obtenida del gusano de seda Bombyx mori L como material de soporte para el crecimiento de células mesenquimales estromales de pulpa dental (CMPD). Métodos. La fibroína obtenida a partir de capullos de gusanos de seda Bombyx mori L criados en la Granja El Pílamo, propiedad de la Universidad Tecnológica de Pereira, se empleó para la fabricación de películas de fibroína íntegras y resistentes a condiciones de cultivo. Las CMPD fueron obtenidas a partir de un donante de diente premolar, la pieza dental se cortó con disco de diamante para la obtención de la pulpa que fue sometida a disgregación enzimática. Las células obtenidas se subcultivaron hasta el segundo pase, para posteriormente transferirse a cajas de cultivo que contenían películas de fibroína, se sometieron a condiciones inherentes al proceso de incubación siguiendo su crecimiento y viabilidad celular durante 27 días. Resultados. Al final del periodo de incubación, se observaron películas integras, estables y resistentes que permitieron el crecimiento celular. Conclusión. Se plantea el uso de fibroína como un biopolímero natural que brinda un soporte mecánico, un microambiente óptimo y un mimetismo de la estructura organizacional de los tejidos, postulándose como un potencial biomaterial para procesos de crecimiento celular en Medicina Regenerativa e Ingeniería de Tejidos.(AU)

Tissue regeneration using cells, growth factors and supports are an alternative in Regenerative Medicine. Silk fibroin is an excellent biosupport, its unique mechanical properties allow it to support processes of cell adhesion and growth. Objective: Evaluating the obtained silk´s fibroin from silkworm (Bombyx mori L) as a scaffold material for growth of dental pulp mesenchymal stromal cells (CMPD). Methods: The fibroin was obtained from silkworm (Bombyx mori L) cocoons reared at "The Pilamo" Farm, owned by the Universidad Tecnológica de Pereira. Procedures for obtaining full and resistant fibroin films to culture conditions were performed. The CMPD were obtained from a premolar tooth, the tooth was cut with a diamond blade to obtain the pulp which was subjected to enzymatic digestion. The cells obtained were subcultured until the second pass, and then, transferred to culture dishes containing fibroin films. This cells were cultured in standard conditions and tracking incubation with cell viability and growth for 27 days. Results: At the end of the incubation period, we realize that the fibroin films were intact and also this fibroin films allows cell growth.Conclusion: The use of fibroin as a natural biopolymer provides mechanical support, also an optimal microenvironment and mimic the organizational structure of tissues, so we postulated fibroin as a potential biomaterial for cell growth to be used in regenerative medicine and tissue engineering.(AU)

Characterization of reactive stroma in prostate cancer: involvement of growth factors, metalloproteinase matrix, sexual hormones receptors and prostatic stem cells

ABSTRACT Introduction and Objectives: Reactive Stroma (RStr) is observed in many human cancers and is related to carcinogenesis. The objectives of the present study were to stablish a relationship of the RStr microenvironment with prostate cancer (Pca) through a morphological and molecular characterization, and to identify a possible relationship between RStr with worse prognosis factors and occurrence of malignant prostatic stem cells. Materials and Methods: Forty prostatic samples were selected from men with Pca diagnosis submitted to radical prostatectomy; they were divided in two groups: Group-1 (n=20): samples without reactive stroma; Group-2 (n=20): samples of PCa with intense stroma reaction. Prostatic samples were evaluated for RStr intensity by Masson Trichromic stain and posteriorly submitted to histopathological and immunohistochemistry analysis for antigens: α-actin, vimentin, IGF-1, MMP-2, FGF-2, C-Myc, PSCA, AR, Erα and ERβ. Results: Reactive stroma with intense desmoplastic reactivity was significantly more frequent in intermediate (Gleason 7, 3+4) and high grade tumors (Gleason 7, 4+3). The group with intense stromal reactivity showed significant higher levels of Vimentin, IGF-1, MMP-2, FGF-2, C-Myc, PSCA and ERα. Conclusions: It can be concluded that RStr may be a predictive marker of Pca progression, since it was associated with increase of growth factors, imbalance of androgen and estrogen receptors and presence of malign prostatic stem cells.

Epigenética de la endometriosis y su perspectiva terapéutica en el marco de un sistema integral de atención de la infertilidad: revisión y propuesta de investigación / Epigenetics of endometriosis and its therapeutic perspective in the framework of an integral system for infertility care: A review and research proposal / Epigenética da endometriose e sua perspectiva terapêutica no marco de um sistema integral de atenção da infertilidade: revisão e proposta de investigação

La endometriosis consiste en la presencia ectópica de glándulas endometriales y células estromales fuera de la cavidad uterina (principalmente en ovarios y superficies de órganos internos de la cavidad pélvica). Es uno de los desórdenes ginecológicos benignos más comunes en las mujeres que están en edad reproductiva. Hay diversas teorías para explicar la endometriosis. La más aceptada es la denominada "menstruación retrógrada". Las mujeres con endometriosis presentan dolor en la región pélvica-abdominal, dismenorrea, dispareunia, mucho sangrado en la menstruación, dolor pélvico no-menstrual, dolor al ovular, disquecia, disuria, fatiga crónica y sub-fertilidad. Diversos estudios han relacionado la endometriosis con aparición de cáncer ovárico, con un desarrollo de carcinomas en 5% - 10% de los casos de mujeres con endometriomas ováricos. El desarrollo efectivo de estrategias terapéuticas para el control de la endometriosis depende de una correcta identificación de los patrones epigenéticos y de genes candidatos, que serían el blanco en los tratamientos.

Endometriosis consists in the ectopic presence of endometrial glands and stromal cells outside the uterine cavity (mainly in ovaries and on the surface of internal organs of the pelvic cavity). It is one of the most common benign gynecological disorders in reproductive-age women. There are various theories to explain endometriosis. The most widely accepted theory is known as "retrograde menstruation". Common endometriosis symptoms include pelvic or abdominal pain, dysmenorrhea, dyspareunia, heavy menstrual bleeding, non-menstrual pelvic pain, ovulation pain, dyschezia, dysuria, chornic fatigue syndrome, and fertility problems. Various studies have associated endometriosis with the onset of ovarian cancer, with carcinoma development in 5 to 10% of women with ovarian endometriomas. The successful development of therapeutic strategies to control endometriosis depends on a correct identification of the epigenetic patterns and gene candidates to be targeted by treatment.

A endometriose consiste na presencia ectópica de glândulas endometriais e células estromais fora da cavidade uterina (principalmente em ovários e superfícies de órgãos internos da cavidade pélvica). É um dos desordens ginecológicos benignos mais comuns nas mulheres que estão em idade reprodutiva. Há diversas teorias para explicar a endometriose. A mais aceitada é a denominada "menstruação retrógrada". As mulheres com endometriose apresentam dor na região pélvica-abdominal, dismenorreia, dispareunia, muito sangrado na menstruação, dor pélvico não-menstrual, dor ao ovular, disquesia, disúria, fatiga crónica e subfertilidade. Diversos estudos hão relacionado a endometriose com aparição de câncer ovárico, com um desenvolvimento de carcinomas em 5% - 10% dos casos de mulheres com endometriomas ováricos. O desenvolvimento efetivo de estratégias terapêuticas para o controle da endometriose depende de uma correta identificação dos padrões epigenéticos e de genes candidatos, que seriam o alvo nos tratamentos.

Aggressive angiomyxoma of the vulva: case report / Angiomixoma agressivo da vulva: relato de caso

Female patient, 42-years-old, complaining of difficulty in urinating and swelling in the vulvar area for one year. Her gynecological examination showed extensive injury in the vulvar region and the biopsy done was inconclusive. The removal of the lesion was conducted. After the procedure, the patient remains free of recurrence for 15 months. This case highlights the need to consider angiomyxoma in the differential diagnosis for tumors of unknown cause in the vulvar region.

Paciente do gênero feminino, 42 anos, com queixas de dificuldade ao urinar e aumento de volume na região vulvar há 1 ano. Ao exame ginecológico, apresentava extensa lesão na região vulvar. Biópsia da lesão foi inconclusiva. Realizou-se a exérese da lesão. A paciente permanece livre de recorrências há 15 meses. Este caso destaca a necessidade de considerar o angiomixoma no diagnóstico diferencial de massas de causa desconhecida na região vulvar.

Tissue hyaluronan expression, as reflected in the sputum of lung cancer patients, is an indicator of malignancy

Hyaluronan (HA) shows promise for detecting cancerous change in pleural effusion and urine. However, there is uncertainty about the localization of HA in tumor tissue and its relationship with different histological types and other components of the extracellular matrix, such as angiogenesis. We evaluated the association between HA and degree of malignancy through expression in lung tumor tissue and sputum. Tumoral tissue had significantly increased HA compared to normal tissue. Strong HA staining intensity associated with cancer cells was significant in squamous cell carcinoma compared to adenocarcinoma and large cell carcinoma. A significant direct association was found between tumors with a high percentage of HA and MVD (microvessel density) in tumoral stroma. Similarly significant was the direct association between N1 tumors and high levels of HA in cancer cells. Cox multivariate analysis showed significant association between better survival and low HA. HA increased in sputum from lung cancer patients compared to cancer-free and healthy volunteers and a significant correlation was found between HA in sputum and HA in cancer tissue. Localization of HA in tumor tissue was related to malignancy and reflected in sputum, making this an emerging factor for an important diagnostic procedure in patients suspected to have lung cancer. Further study in additional patients in a randomized prospective trial is required to finalize these results and to validate our quantitative assessment of HA, as well as to couple it to gold standard sputum cytology.

Adiponectin effect on nitric oxide secretion by normal and endometriotic human endometrial stromal cells: in vitro study / Efecto de la adiponectica sobre la secreción de óxido nítrico por células estromales de endometrio humano, normales y con endometriosis: estudio in vitro

Endometriosis is an estrogen-dependent disease in reproductive age women. Adiponectin and Nitric oxide (NO) have an important role in physiologic functions especially in human reproductive system. Levels of NO increased in the endometriosis patients but serum adiponectin levels decreased in woman with endometriosis. The aim of this study was to determine adiponectin effect on nitric oxide secretion by cultured normal and endometriotic human endometrial stromal cells. In this experimental study, normal (n= 10) and endometriotic endometrial biopsies (n= 10) were taken in sterile condition. Stromal cells isolated and cultured in in DMEM/ F12 medium and treated with adiponectin concentrations (0, 10, 100, and 200 ng/ml) for 24 and 48 hours. NO assay was done on their supernatants by Greiss method. Data was analyzed by one way ANOVA and p<0.05 was considered significant. There was significant difference between endometriosis groups in NO secretion in all dose of adiponectin and time (p<0.05). In normal groups there was significant difference in 48 hours (p<0.05) but no significant change in 24 hours (p>0.05). Adiponectin effects nitric oxide secretion of cultured human endometriotic stromal cells.

La endometriosis es una enfermedad dependiente de estrógenos que se presenta en mujeres en edad reproductiva. La adiponectina y el óxido nítrico (ON) tienen un papel importante en las funciones fisiológicas, especialmente en el sistema reproductivo humano. Los niveles de ON aumentan en los pacientes con endometriosis, pero los niveles de adiponectina en suero disminuyen. El objetivo fue determinar el efecto de la adiponectina sobre la secreción de ON por las células estromales de endometrio humano, tanto normales como con endometriosis, en medio de cultivo. En este estudio experimental, las células estromales de endometrio normales (n= 10) y las biopsias de endometrio con endometriosis (n= 10) se tomaron en condiciones de esterilidad. Las células estromales fueron aisladas y cultivadas en un medio DMEM/F12, y se sometieron a distintas concentraciones de adiponectina (0, 10, 100, y 200 ng/ml) durante 24 y 48 horas. El ensayo con ON se realizó a los sobrenadantes obtenidos por el método de Greiss. Los datos recolectados fueron analizados por ANOVA de una vía y un valor p<0,05 se consideró significativo. Entre los grupos con endometriosis, en referencia a la secreción de ON, no hubo diferencia significativa en todas las dosis de adiponectina y los tiempos estipulados (p<0,05). En los grupos normales, hubo diferencia significativa a las 48 horas (p<0,05), pero ningún cambio significativo a las 24 horas (p>0,05). La adiponectina tiene efectos sobre la secreción de óxido nítrico por las células estromales endometriales humanas en cultivo.

Tumores estromales de potencial maligno incierto (STUMP): descripción epidemiológica y manejo durante el período 2004-2013 / Stromal tumors of an uncertain malignant potential (STUMP): epidemiological description and handling during the 2004-2013 period

Los tumores estromales de potencial maligno incierto (STUMP) se enmarcan dentro de las lesiones de células fusadas de la próstata, entidades de relativa infrecuencia en la práctica urológica habitual, contabilizándose entre 0,1-0,2 por ciento 1 de todas los tumores malignos prostáticos. Corresponden a una proliferación no epitelial mesenquimática de células fusadas estromales, que pueden adquirir la capacidad de infiltrar el epitelio glandular prostático. Representan un desafío tanto para el patólogo, por la dificultad diagnóstica, como para el clínico, pues no existe consenso respecto a su manejo. Materiales y métodos: estudio retrospectivo descriptivo. Se filtró la base de datos del servicio de Anatomía Patología del Hospital San Borja Arriarán con los términos clave “STUMP”, “Tumor estromal próstata”, tanto de biopsias transrrectales como de piezas operatorias. De los pacientes con diagnóstico histológico e inmunohistoquímico compatible, se registraron características epidemiológicas, estudio, manejo y sobrevida global. Resultados: se encontraron 3(tres) pacientes con diagnóstico histológico de STUMP. Edad promedio al diagnóstico 66años. Dos de los casos (66,6 ´po0r ciento) correspondieron a hallazgo en biopsia diferida por cirugía benigna prostática, (una por Adenomectomía transvesical y otra por RTU-P). El tercer caso correspondió a un hallazgo en biopsia por punción transrrectal ecodirigida, en contexto de PSA elevado (100ng/mL) y 4 biopsias previas: 3 normales, y una con informe de posible sarcoma prostático. La terapia de elección en 2 casos fue seguimiento y en uno se indicó cirugía radical. En los casos descritos no se registra mortalidad, con seguimiento promedio de 32 meses. Conclusión: Los tumores estromales de potencial maligno incierto son un diagnóstico histológico infrecuente, descrito como hallazgo tanto en la biopsia transrrectal como de pieza quirúrgica. No existen consensos internacionales ni guías de manejo. En nuestra experiencia...

Stromal tumors of uncertain malignant potential (STUMP) are included in the spindle cell lesions of the adult prostate, a very rare diagnostic entity in the clinical practice, accounting no more than 0,1-0,2 percent of all prostate malignancies. STUMP is defined as a non epithelial proliferation of spindle cells, which can acquire the ability of infiltrate the prostate glands. This lesions represent a challenge for both clinical and pathology physician. Material and methods: retrospective cohort study. A research was performed at the San Borja Hospital Pathology Service’s database, using keywords “STUMP”, “Stromal prostate tumor”. From eligible patients we took epidemiology and clinical data. Results: a total of three patients were included. Average age was 66 years. STUMP was founded in two patients in the pathology report after benign prostatic surgery (Simple prostatectomy and TUR-P). A third patient was diagnosed by a needle biopsy (TRUS Biopsy). This patient had an elevated PSA (>100 ng/mL), 4 previous biopsies, three normal and a fourth suspicious of prostate sarcoma. Surveillance was the therapy chosen for those patients diagnosed with STUMP after benign surgery. Radical prostatectomy was offered to the third patient. Average follow up was 32 month Conclusion: STUMP is a rare diagnostic, and is a challenge for both clinical and pathology physician. There are no guidelines for the management. In our series we confirmed the low frequency of this condition, and the management in our service is similar as other series described in literature...

Selenium plasma levels in hemodialysis patients: Comparison between North and Southeast of Brazil / Níveis de selênio plasmático em pacientes em hemodiálise: Comparação entre Norte e Sudeste do Brasil

Introduction: Patients with chronic kidney disease present selenium (Se) plasma deficiency which is an essential trace element with important biological functions and, the best known biological role is attributed to its presence in the antioxidant enzyme, glutathione peroxidase (GPx). The Se content of foods depends on soil and some authors have suggested that Amazon soil (North Brazilian region) has high Se concentrations when compared to other regions of Brazil. Objective: The objective of this work was to compare the Se status in hemodialysis (HD) patients from North and Southeast of Brazil. Methods: Thirty-eight patients from Southeast region (22 men and 16 women, 15% diabetic, 53.5 ± 26.4 yrs) were compared to 40 patients from North region (28 men and 12 women, 22.5% diabetic, 63.5 ± 11.9 yrs). Se in plasma was determined through atomic absorption spectrophotometry with hydride generation. Results: The plasma Se levels in patients from Southeast region were significantly lower (17.5 ± 11.9 μg/L) when compared to patients from the North (37.1 ± 15.8 μg/L) (p < 0.001). However, both patient groups presented low Se plasma levels when compared to recommended values (60- 120 μg/L). There was no correlation between plasma Se levels and analyzed parameters. Conclusion: We concluded that patients from North (Amazon) region present higher plasma Se levels when compared to the patients from Southeast of Brazil. However, independently of the region, HD patients presented Se deficiency. .

Introdução: Pacientes com Doença Renal Crônica apresentam deficiência de selênio (Se), um elemento essencial, com importantes funções biológicas, como a de ser componente da enzima antioxidante glutationa peroxidase (GPx). A concentração de Se nos alimentos depende de sua concentração no solo e autores relatam que o solo da Amazônia possui elevados níveis de Se. Objetivo: O objetivo do trabalho foi comparar o estado nutricional do Se em pacientes em hemodiálise (HD) das regiões Norte e Sudeste do Brasil. Métodos: Trinta e oito pacientes da região Sudeste (22 homens e 16 mulheres, 15% diabéticos, 53,5 ± 26,4 anos) foram comparados com 40 pacientes da região Norte (28 homens e 12 mulheres, 22,5% diabéticos, 63,5 ± 11,9 anos). O Se no plasma foi determinado por espectrofotometria de absorção atômica por geração de hidretos acoplados a cela de quartzo. Resultados: Os níveis de Se dos pacientes em HD da região Sudeste foram significativamente menores (17,5 ± 11,9 μg/L) comparados aos pacientes da região Norte (37,1 ± 15,8 μg/L) (p < 0,001). Entretanto, ambos os grupos apresentaram níveis de Se abaixo da recomendação (60-120 μg/L). Não houve associação entre os níveis de Se e os parâmetros analisados. Conclusão: Com base nos resultados, concluímos que os pacientes da região Norte apresentaram elevados níveis de Se quando comparados com os pacientes da região Sudeste do Brasil. Entretanto, independentemente da região, ambos os grupos apresentaram deficiência com relação ao estado nutricional do Se. .

Immunohistochemical profile of stromal constituents and lymphoid cells over the course of wound healing in murine model

PURPOSE: To assess the evolution profile of the immunohistochemical expression of stromal constituents over the time-course of wound healing in a murine model. METHODS: Surgical wounds were performed in the back of 24 Wistar rats. After three, seven, 14 and 21 days, six rats were euthanized and the wounded histologically processed to assess the immunohistochemical expression of CD3, CD20, CD31, α-SMA and type-I collagen. Non-injured skin samples (NSS) were used as control. Data were subjected to statistical analysis using ANOVA and Tukey test. RESULTS: The mean of CD3 and CD20 positive cells in the wounds was significantly higher than in NSS at seven and 14 days (p<0.001). The blood vessels content was significantly lower than in NSS (p<0.05) at three days, but increased at seven and 14 days (p<0.01). The mean of α-SMA positive cells at seven, 14 and 21 days was higher than in NSS (p<0.05). The relative content of type I collagen increased from three to 21 days, but remained lower than in NSS (p<0.05). CONCLUSIONS: Lymphoid cells, myofibroblasts and microvessels contents varied over the time-course of wound healing, with peak at seven days and progressive reduction until 21 days. The type I collagen content increased over time. .

Hiperplasia pseudoangiomatosa nodular gigante de la mama / Pseudoangiomatous stromal hyperplasia (pash) of the breast

La hiperplasia pseudoangiomatosa (PASH) es una lesión proliferativa benigna de la mama, poco frecuente, caracterizada por la existencia de lagos pseudovasculares embebidos en una gran proliferación del estroma mamario. Probablemente, el desarrollo de la PASH tenga una influencia hormonal, por lo que típicamente se diagnostica en mujeres en edad fértil. La PASH es un hallazgo histopatológico casual en las piezas quirúrgicas y biopsias mamarias realizadas por otra patología. La presentación clínica en forma de masa palpable es poco frecuente. El principal diagnóstico diferencial debe realizarse con el angiosarcoma de bajo grado. El tratamiento de la PASH nodular es una correcta exéresis quirúrgica asegurando borde sano amplio. El pronóstico es excelente, con un mínimo riesgo de recidiva si se realiza una adecuada cirugía. Se presenta el caso de una mujer de 37 años que acude a consulta por un nódulo mamario de crecimiento rápido.

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a rare benign proliferative mesenchymal lesion characterized by the presence of open slit like spaces embedded in a hyalinized fibrous stroma. The development of PASH is probably subject to hormonal influence so it typically affects women in the reproductive age group. Pseudoangiomatous stromal hyperplasia is frequently an incidental histologic finding in breast surgeries or biopsies performed for other injuries. In rare cases, it presents as a localized breast mass. The most important differential diagnosis is low-grade angiosarcoma. Tumorous PASH is treated by local surgical excision with clear margins. The prognosis is excellent, with minimal risk of recurrence after adequate surgery. The presented case was a 37-years-old woman who was admitted with a rapidly growing breast tumor.