Usefulness of a clinicopathological classification in predicting treatment-related outcomes and multimodal therapeutic approaches in pituitary adenoma patients: retrospective analysis on a Portuguese cohort of 129 patients from a tertiary pituitary center.

PURPOSE: A clinicopathological classification has been designed to predict recurrence/progression in patients with pituitary adenomas (PAs). We aimed to study its usefulness in predicting PAs that will have a challenging disease course and may require more often complex multimodal and multiple therapeutic approaches. METHODS: Retrospective analysis of 129 patients with PAs operated in our institution between 2001 and 2020 (84 non-clinically functioning PAs, 32 acromegaly, 9 Cushing's disease, 2 prolactinomas and 2 thyrotropinomas). Grading was based on invasion and proliferation: 1a (non-invasive, non-proliferative; n = 59), 1b (non-invasive, proliferative; n = 17), 2a (invasive, non-proliferative; n = 38), and 2b (invasive, proliferative; n = 15). RESULTS: Of the 129 patients, 68 (52.7%) were females, and the mean age at diagnosis was 53.7 ± 15.4 years. The mean follow-up duration was 93.1 ± 61.8 months. Grade 2b PAs when compared to other grades (2b-2a-1b-1a) had significantly higher rates of persistent tumor remnant within 1-year after operation (93-78-18-30%; p < 0.001), active disease at last follow-up (40-27-12-10%; p = 0.004), re-operation (27-16-0-5%; p = 0.023), irradiation (53-38-12-7%; p < 0.001), multimodal treatment (67-49-18-25%; p = 0.003), multiple treatment (33-27-6-9%; p = 0.017). Patients with grade 2b PAs also required a higher mean number of treatments (2.6-2.1-1.2-1.4; p < 0.001). CONCLUSIONS: This clinicopathological classification appears to be a useful grading system to identify PAs that may be more refractory and more often require complex multimodal and multiple therapeutic approaches. Invasive PAs, especially grade 2b tumors, may be more likely to need complex treatment approach, including radiotherapy, and may display higher rates of active disease at last follow-up, despite receiving higher number of treatments.

Choristoma: a very rare cause of thyroid nodule. Case report and literature review.

BACKGROUND: Choristoma is a well-defined benign lesion formed by histologically normal tissue in an unusual location. Diagnosis is confirmed after surgical removal of the mass. To our knowledge, to date there has been only one case of thyroid choristoma described in the literature. PATIENT FINDINGS: A 70-year-old man with a history of non-Hodgkin lymphoma presented with sudden cervical enlargement. Cervical CT scan showed a 47mm hypodense nodule on the right thyroid lobe. Fine-needle aspiration revealed follicular lesion of undetermined significance. During the following weeks there was noticeable thyroid enlargement. Reassessment with thyroid ultrasound showed a 73mm nodule. The patient underwent total thyroidectomy. Histopathological examination revealed a choristoma composed of squamous epithelium lined cysts, smooth muscle, adipose tissue, connective tissue, foci of ossification and extramedullary hematopoiesis. No cytological atypia or tumoral necrosis were found. Thyroid choristomas are an exceedingly rare cause of a thyroid nodule.

Criatividade: opinião de alunos e professores sobre a utilização dessa competência na formação de enfermeiros / Creativity: students and teachers opinion about the use of such skill in nurses training / Creatividad: opinión de estudiantes y profesores en el uso de tales conocimientos en la formación de enfermeras

Objetivo: descrever a opinião de alunos e professores de um Curso de Graduação em Enfermagem sobre a utilização da criatividade na formação de enfermeiros. Método: estudo descritivo, transversal, com análise quantitativa realizado com 112 alunos e sete professores. Os dados foram coletados em agosto e setembro de 2012 por meio de questionários. A análise ocorreu de forma descritiva. O projeto foi aprovado pelo Comitê de Ética e Pesquisa, protocolo nº 20120110. Resultados: observou-se que os professores da instituição utilizam a criatividade, sobretudo nos aspectos relacionados ao incentivo a novas ideias e à criação de um clima para a expressão dessas. Conclusão: apesar disso, torna-se oportuno o incentivo ao aprofundamento de discussões sobre essa temática no ambiente investigado, com pautas em reuniões do colegiado e do núcleo docente estruturante do curso, a fim de que as discordâncias citadas sejam analisadas e revertidas.(AU)

Objective: describing the opinion of students and teachers of a Graduate Nursing Course about the use of creativity in nursing education. Method: a descriptive, cross-sectional study with a quantitative analysis conducted with 112 students and seven teachers. Data were collected in August and September 2012 through questionnaires. The analysis was descriptively. The project was approved by the Research Ethics Committee, Protocol nº 20120110. Results: it was observed that the institution's teachers use creativity, especially in aspects related to encouraging new ideas and the creation of an environment for the expression of these. Conclusion: nevertheless, it is opportune to encourage the deepening of discussions on this topic in the investigated environment, with agendas at meetings of the college and the structuring teaching core of the course, so that the said disagreements are reviewed and reversed.(AU)

Objetivo: describir la opinión de los estudiantes y profesores de un curso de grado en enfermería en el uso de la creatividad en la educación de enfermería. Método: es un estudio descriptivo, transversal, con el análisis cuantitativo conducido con 112 alumnos y siete profesores. Los datos fueron recolectados en agosto y septiembre de 2012 a través de cuestionarios. El análisis fue descriptivo. El proyecto fue aprobado por el Comité de Ética en la Investigación, Protocolo nº 20120110. Resultados: se observó que los docentes de la institución utilizan la creatividad, sobre todo en los aspectos relacionados con el fomento de nuevas ideas y la creación de un entorno para la expresión de estos. Conclusión: no obstante, es oportuno fomentar la profundización de las discusiones sobre este tema en el ambiente investigado con agendas en las reuniones de la universidad y la enseñanza básica de estructuración del curso, por lo que dichos desacuerdos se revisan y se invierten.(AU)