Lobular panniculitis of the thigh as the only cutaneous manifestation of reactivation of Chagas disease in a renal transplant patient: a case report.

Reactivation of chronic Trypanosoma cruzi infection in solid organ transplant recipients (SOTRs) has been reported. The patient presented with a 2-week history of two painful erythematous, infiltrated plaques with central ulceration and necrotic crust on the left thigh. She had a history of chronic indeterminate Chagas disease (CD) and had received a kidney transplant before 2 months. Skin biopsies revealed lobular panniculitis with intracellular amastigote forms of T. cruzi. The patient was diagnosed with CD reactivation. Treatment with benznidazole significantly improved her condition. CD reactivation should be suspected in SOTRs living in endemic areas with clinical polymorphism of skin lesions.

Synovial sarcoma of the extremities: prognostic factors for 20 nonmetastatic cases and a new histologic grading system with prognostic significance.

PURPOSE: To evaluate 20 cases of nonmetastatic synovial sarcoma of the extremities regarding prognostic factors, and to propose a histologic grading system with prognostic significance. METHODS: The cases of 20 patients (14 females and 6 males) with nonmetastatic synovial sarcomas of the extremities treated between 1985 and 1998, were retrospectively evaluated regarding prognostic factors. A histologic grading system with prognostic significance is proposed. RESULTS: The mean follow-up period was 48.4 months (range, 16-116 months). There was local recurrence in 3 cases (15%), microscopic surgical margin being the only prognostic factor identified. Seven patients (35%) died of the disease in a mean postoperative period of 31.7 months (range, 16-53 months), all with pulmonary or brain metastasis. The survival rate was 65% in 48.4 months of follow-up. CONCLUSION: The unfavorable prognostic factors identified regarding survival were high histologic grade, tumors proximal to the knee or elbow, and spontaneous tumor necrosis over 25%. Local recurrence did not have influence on survival in this study. The presence of mast cells appears to have a positive influence on survival, although statistical significance was not reached (P = 0.07). The oncologic and functional result was good in 6 cases (30%), regular in 7 (35%), and poor in 7 cases (35%).

Lobular panniculitis of the thigh as the only cutaneous manifestation of reactivation of Chagas disease in a renal transplant patient: a case report

Abstract Reactivation of chronic Trypanosoma cruzi infection in solid organ transplant recipients (SOTRs) has been reported. The patient presented with a 2-week history of two painful erythematous, infiltrated plaques with central ulceration and necrotic crust on the left thigh. She had a history of chronic indeterminate Chagas disease (CD) and had received a kidney transplant before 2 months. Skin biopsies revealed lobular panniculitis with intracellular amastigote forms of T. cruzi. The patient was diagnosed with CD reactivation. Treatment with benznidazole significantly improved her condition. CD reactivation should be suspected in SOTRs living in endemic areas with clinical polymorphism of skin lesions.

Medullary carcinoma of the thyroid metastatic to the breast: a case report and literature review.

Breast malignancies, apart from skin cancer, are the leading cause of cancer from cancer among the female population. Unlike the high prevalence of primary mammary malignancies, metastases to the breast are uncommon, and account for only 0.2-2.7% of all malignancies affecting this organ. We report the case of a 35-year-old woman who sought medical care because of a breast lump. A mammogram suggested a breast tumor, which was biopsied. The histopathological workup resulted in the diagnosis of a metastasis from a medullary thyroid cancer. The authors review the most useful clinical, radiological, histological, and immunohistochemical features concerning extramammary malignancy to the breast.

Primary bone lymphoma in 24 patients treated between 1955 and 1999.

The authors present their experience in the treatment of 24 patients with primary bone lymphoma. Eighty-one patients treated between 1955 and 1999 were evaluated, and 57 were excluded because of misdiagnosis. The male to female ratio was 7:5 and the median age was 38.5 years (range, 18-69 years). Two patients had human immunodeficiency virus. Seventeen patients had intermediate-grade lymphomas (Working Formulation), nine patients had centroblastic subtype (Kiel), and 22 patients had B immunophenotype. Nine patients had combined treatment with chemotherapy and radiation therapy, and nine patients had chemotherapy alone. The mean followup was 13.2 years (range, 1.5-37.3 years). Three patients had surgery, two because of subtrochanteric fractures (one patient had closed reduction and internal fixation and the other patient had resection and endoprosthesis reconstruction). The third patient presented with myelocompression at the thoracic level, and he had decompression surgery. Only one patient had radiation therapy and two patients had no treatment. There have been no local recurrences in 17 patients (70.8%). Seven patients (29.2%) died with evidence of disease within a followup of 11 months. The results of the current study showed that patients with primary bone lymphoma have a good prognosis when they are treated with chemotherapy, regardless of whether radiation therapy was given. Surgery usually is appropriate for patients with fractures.

Synovial sarcoma of the extremities: prognostic factors for 20 nonmetastatic cases and a new histologic grading system with prognostic significance

PURPOSE: To evaluate 20 cases of nonmetastatic synovial sarcoma of the extremities regarding prognostic factors, and to propose a histologic grading system with prognostic significance. METHODS: The cases of 20 patients (14 females and 6 males) with nonmetastatic synovial sarcomas of the extremities treated between 1985 and 1998, were retrospectively evaluated regarding prognostic factors. A histologic grading system with prognostic significance is proposed. RESULTS: The mean follow-up period was 48.4 months (range, 16-116 months). There was local recurrence in 3 cases (15 percent), microscopic surgical margin being the only prognostic factor identified. Seven patients (35 percent) died of the disease in a mean postoperative period of 31.7 months (range, 16-53 months), all with pulmonary or brain metastasis. The survival rate was 65 percent in 48.4 months of follow-up. CONCLUSION: The unfavorable prognostic factors identified regarding survival were high histologic grade, tumors proximal to the knee or elbow, and spontaneous tumor necrosis over 25 percent. Local recurrence did not have influence on survival in this study. The presence of mast cells appears to have a positive influence on survival, although statistical significance was not reached (P = 0.07). The oncologic and functional result was good in 6 cases (30 percent), regular in 7 (35 percent), and poor in 7 cases (35 percent).

OBJETIVO: Avaliar casos de sarcoma sinovial não-metastático das extremidades no que se refere a fatores prognósticos, e propor um sistema histológico de pontuação com significado prognóstico. MATERIAL E MÉTODO: Vinte casos (14 do sexo feminino e 6 do sexo masculino) de sarcomas sinoviais não-metastáticos das extremidades tratados entre 1985 e 1998 no departamento de Ortopedia foram avaliados retrospectivamente no que se refere a fatores prognósticos e está sendo proposto um sistema de pontuação histológico com significado prognóstico. RESULTADOS: A média dos períodos de acompanhamento foi 48,4 meses (mínimo 16 meses, máximo 116). Houve recorrência localizada em 3 casos (15 por cento), sendo a margem cirúrgica microscópica o único fator prognóstico identificado. Sete pacientes (35 por cento) morreram da doença, todos em período pós-operatório médio de 31,7 meses (mínimo 16 meses, máximo 53), todos com metástase pulmonar ou cerebral. A sobrevida foi de 65 por cento em 48,4 meses de acompanhamento. CONCLUSÃO: Os fatores prognósticos desfavoráveis identificados referentes à sobrevida foram: grau histológico alto, tumores proximais de joelho ou cotovelo e necrose espontânea de tumor acima de 25 por cento. Neste estudo, a recorrência localizada não influiu na sobrevida. Parece que a presença de mastócitos influi positivamente na sobrevida, porém não obtivemos significado estatístico (p=0,07). O resultado oncológico e funcional foi bom em seis casos (30 por cento), regular em sete (35 por cento) e insatisfatório em sete (35 por cento).

Tumor de células gigantes: evolução histórica do seu diagnóstico e tratamento junto ao Instituto de Ortopedia e Traumatologia da FMUSP / Giant cells tumor: diagnosis and treatment history evolution in Instituto de Ortopedia e Traumatologia from FMUSP

O tumor de células gigantes (TGC) é uma neoplasia óssea benigna agressiva de comportamento biológico incerto, constituído histologicamente por células gigantes multinucleadas dispersas pelo tecido tumoral, cujo núcleo apresenta as mesmas características das células ovóides e fusiformes que formam o seu estroma. A graduação anatomopatológica é dada pelo seu estroma e não pelas células gigantes, que podem estar presentes também em outras lesões tumorais e pseudotumorais como o tumor marrom do hiperparatireoidismo, o cisto ósseo aneurismático, o condroblastoma epifisário, o osteoblastoma e o fibroma não osteogênico. Os aspectos radiográficos clássicos do TGC o definem como uma lesão epifisiometafisária, lítica, insuflativa, excêntrica, com afinamento ou erosão da cortical, em adulto jovem na faixa dos 20 aos 35 anos de idade, localizado mais freqüentemente no fêmur distal e na tíbia proximal, podendo ocorrer em outras patologias, destacando-se pela sua gravidade o osteossarcoma telangectásico e o fibrohistiocitoma ósseo maligno. Dentre as lesões benignas, notadamente o cisto ósseo aneurismático e o condroblastoma epifisário fazem o diagnóstico diferencial com o TGC. Com menor freqüência, pode estar localizado no úmero proximal, rádio distal, fêmur proximal, coluna dorsal e sacro. Clinicamente, seu comportamento é agressivo (estadiamento B3 de ENNEKING), com crescimento rápido, às vezes em semanas, apesar do oligossintomático, levando ao afinamento e ruptura da cortical óssea, com invasão das partes moles adjacentes, sem entretanto invadir e ulcerar a pele e o tecido celular subcutâneo.

Carcinoma baso-adenoide do colo uterino: descricao de 3 casos e revisao da literatura / Adenoid basal carcinoma of the uterine cervix: report of 3 cases and review of the literature

Descrevemos 3 casos de carcinoma baso-adenoide do colo uterino em pacientes com 66, 70 e 83 anos. Em todos os casos o diagnostico foi incidental. A primeira paciente, ARO, 66, teve o diagnostico em material de biopsia, associado a NIC 3. A segunda paciente, AMO, 70, teve o diagnostico em produto de histerectomia total realizada em conjunto com anexectomia bilateral indicada por teratoma maduro cistico do ovario. No caso mais recente, ARJ, 83, o diagnostico foi...

Emprego de grampeadores para anastomose intestinal em cirurgia colorretal / Employment of intestinal staplers in colorrectal surgery

Grampeadores sao instrumentos utilizados na pratica cirurgica, onde grampos colocados em cartuchos sao forcados mecanicamente a assumir a conformacao em B, unindo duas estruturas. Depois de experimentos na Europa Oriental, houve um grande desenvolvimento na Russia, onde nasceram os principais grampeadores que ate hoje utilizamos. Coube aos americanos a divulgacao e padronizacao das tecnicas. O uso dos grampeadores deve obedecer as mesmas premissas empregadas nas suturas manuais. A anastomose deve ser confeccionada com tecnica adequada, sem tensao e tecidos desvitalizados e com boa irrigacao das bordas a serem anastomosadas. Diversos procedimentos cirurgicos em coloproctologia sao descritos com a utilizacao dos grampeadores, sendo que as resseccoes anteriores do reto e as anastomoses ileo-retais com reservatorio ileal sao para nos as indicacoes mais apropriadas. Os diversos estudos realizados mostram que nao ha diferenca entre os indices de complicacao das suturas mecanicas e os das suturas manuais...