WHICH LESIONS ARE AT HIGHER RISK OF DEVELOPING COLORECTAL CARCINOMAS: SUPERFICIALLY ELEVATED SERRATED LESIONS OR DEPRESSED LESIONS?

BACKGROUND: There are lesions that are still being missed in colonoscopy. Many of those could be superficially elevated serrated lesions or depressed ones. AIMS: The aim of this study was to compare the histopathological characteristics of these lesions and their risks for submucosal carcinoma. METHODS: This is a retrospective, cross-sectional, and observational study comparing 217 superficially elevated serrated lesions larger than 5 mm resected by colonoscopies (G1) with 558 depressed lesions (G2). RESULTS: In G1, 217 lesions were found in 12,653 (1.7%) colonoscopies; in G2, 558 lesions were found in 36,174 (1.5%) colonoscopies. In G1, 63.4% were women and in G2, there was no gender predominance. The average size of G1 was 16.2 mm and G2 was 9.2 mm (p<0.001). G1 predominated on the proximal colon and G2 on the distal and rectum (p<0.001). In G1, there were 214 (98.6%) low-grade intramucosal neoplasia and 3 (1.4%) high-grade intramucosal neoplasia. Excluding 126 hyperplastic polyps and considering 91 sessile serrated adenomas in G1, we observed 88 (96.7%) low-grade intramucosal neoplasia and 3 (3.3%) high-grade intramucosal neoplasia; in G2, we observed 417 (74.7%) low-grade intramucosal neoplasia, 113 (20.3%) high-grade intramucosal neoplasia, and 28 (5.0%) submucosal adenocarcinomas (p<0.001). CONCLUSION: Depressed lesions significantly had more high-grade intramucosal neoplasia and more invasive carcinomas in the submucosal layer than superficially elevated serrated lesions and more than superficially elevated sessile serrated adenomas.

Which lesions are at higher risk of developing colorectal carcinomas: superficially elevated serrated lesions or depressed lesions? / Quais lesões apresentam maior risco de evolução para carcinomas colorretais: as serrilhadas superficialmente elevadas ou as deprimidas?

ABSTRACT BACKGROUND: There are lesions that are still being missed in colonoscopy. Many of those could be superficially elevated serrated lesions or depressed ones. AIMS: The aim of this study was to compare the histopathological characteristics of these lesions and their risks for submucosal carcinoma. METHODS: This is a retrospective, cross-sectional, and observational study comparing 217 superficially elevated serrated lesions larger than 5 mm resected by colonoscopies (G1) with 558 depressed lesions (G2). RESULTS: In G1, 217 lesions were found in 12,653 (1.7%) colonoscopies; in G2, 558 lesions were found in 36,174 (1.5%) colonoscopies. In G1, 63.4% were women and in G2, there was no gender predominance. The average size of G1 was 16.2 mm and G2 was 9.2 mm (p<0.001). G1 predominated on the proximal colon and G2 on the distal and rectum (p<0.001). In G1, there were 214 (98.6%) low-grade intramucosal neoplasia and 3 (1.4%) high-grade intramucosal neoplasia. Excluding 126 hyperplastic polyps and considering 91 sessile serrated adenomas in G1, we observed 88 (96.7%) low-grade intramucosal neoplasia and 3 (3.3%) high-grade intramucosal neoplasia; in G2, we observed 417 (74.7%) low-grade intramucosal neoplasia, 113 (20.3%) high-grade intramucosal neoplasia, and 28 (5.0%) submucosal adenocarcinomas (p<0.001). CONCLUSION: Depressed lesions significantly had more high-grade intramucosal neoplasia and more invasive carcinomas in the submucosal layer than superficially elevated serrated lesions and more than superficially elevated sessile serrated adenomas.

RESUMO RACIONAL: Há ainda lesões que podem ser perdidas nas colonoscopias. Muitas delas poderiam ser serrilhadas superficialmente elevadas ou deprimidas. OBJETIVO: Comparar as características histopatológicas destas lesões e seus riscos para carcinoma invasivo para a submucosa. MÉTODO: Estudo retrospectivo, transversal, observacional comparando 217 lesões serrilhadas superficialmente elevadas com mais de 5 mm e ressecadas por colonoscopias (G1) com 558 lesões deprimidas (G2). RESULTADOS: As 217 lesões do G1 foram encontradas em 12.653 colonoscopias (1,7%) enquanto as 558 do G2 ocorreram dentre 36.174 colonoscopias (1,5%). No G1, 63,4% eram mulheres e no G2 não houve predominância de gênero. O tamanho médio foi no G1, 16,2 mm e no G2, 9,2 mm (p<0,001). G1 predominaram no cólon proximal e G2, no distal e reto (p<0,001). No G1, ocorreram 214 (98,6%) neoplasias mucosas de baixo grau e três de alto grau (1,4%). Excluídos 126 pólipos hiperplásicos e considerados os 91 adenomas sésseis serrilhados, no G1 observou- se 88 (96,7%) neoplasias mucosas de baixo grau e três (3,3%) de alto grau, e no G2, 417 (74,7%) neoplasias mucosas de baixo grau 113 (20,3%) de alto grau e 28 (5,0%) adenocarcinomas invadindo a submucosa (p<0,001). CONCLUSÕES: As lesões deprimidas apresentaram significativamente mais neoplasias mucosas de alto grau e carcinomas invasivos para a submucosa do que as serrilhadas superficialmente elevadas e mais do que os adenomas sésseis serrilhados superficialmente elevados.

Pre-malignant signs of gastric MALT lymphoma.

Mucosa-associated lymphoid tissue (MALT) lymphoma is the most common type of extra-nodal non-Hodgkin lymphoma, which mostly involves the stomach. The clinical suspicion and diagnosis are often challenging because of the lack of specific symptoms and conventional endoscopic findings. Three magnifying endoscopic signs of the gastric mucosa have been described as highly specific to the diagnosis of MALT lymphoma, such as (i) tree-like appearance of the microvessels; (ii) non-structural area; and (iii) ballooning crypt pattern. We report the case of a middle-aged woman in which these signs appeared chronologically over a period of 2 years, showing the association of the sequence of the endoscopic findings and the final histological diagnosis of gastric MALT lymphoma.

Descrição de casos de nefroblastoma diagnosticados em um laboratório de anatomia patológica da cidade de São Paulo, Brasil / Description of Nephroblastoma Cases Diagnosed in a Laboratory of Pathologylocated at Sao Paulo City, Brazil / Descripción de los Casos de Nefroblastoma Diagnosticados en un Laboratorio dePatología de la Ciudad de São Paulo, Brasil

Introdução: As neoplasias renais correspondem a 2% dos tumores malignos nos seres humanos. Entre os tumores renais de maior prevalência, o nefroblastoma, também conhecido como tumor de Wilms, é a neoplasia maligna sólida mais comum em crianças. Objetivo: Descrever 15 casos de nefroblastoma (tumor de Wilms) diagnosticados em um laboratório especializado em Anatomia Patológica, localizado na região central da cidade de São Paulo, no período de abril de 2003 a agosto de 2011. Método: Estudo descritivo, retrospectivo, no qual foram avaliados prontuários de pacientes que realizaram exames para diagnóstico de doenças renais. Foram levantados laudos de amostras renais obtidas por nefrectomia ou biópsia, diagnóstico anatomopatológico macro e microscópico, sexo e idade dos indivíduos acometidos, visando a caracterizar a população portadora de tumor de Wilms. Resultados: Em uma amostra de 2.277 pacientes, 15 tiveram seu diagnóstico positivo para nefroblastoma (tumor de Wilms), sendo a maior porcentagem, 67% dos casos, de indivíduos do sexo masculino. Em 46,67% dos casos, o tumor foi classificado com estadiamento I.Conclusão: Conhecer a população normalmente acometida pelo nefroblastoma pode contribuir para um diagnóstico precoce e, consequentemente, melhorar o prognóstico do indivíduo acometido.

Mucin pattern reflects the origin of the adenocarcinoma in Barrett's esophagus: a retrospective clinical and laboratorial study.

BACKGROUND: Mucin immunoexpression in adenocarcinoma arising in Barrett's esophagus (BE) may indicate the carcinogenesis pathway. The aim of this study was to evaluate resected specimens of adenocarcinoma in BE for the pattern of mucins and to correlate to the histologic classification. METHODS: Specimens were retrospectively collected from thirteen patients who underwent esophageal resection due to adenocarcinoma in BE. Sections were scored for the grade of intestinal metaplasia. The tissues were examined by immunohistochemistry for MUC2 and MUC5AC antibodies. RESULTS: Eleven patients were men. The mean age was 61 years old (varied from 40 to 75 years old). The tumor size had a mean of 4.7 +/- 2.3 cm, and the extension of BE had a mean of 7.7 +/- 1.5 cm. Specialized epithelium with intestinal metaplasia was present in all adjacent mucosas. Immunohistochemistry for MUC2 showed immunoreactivity in goblet cells, while MUC5AC was extensively expressed in the columnar gastric cells, localizing to the surface epithelium and extending to a variable degree into the glandular structures in BE. Tumors were classified according to the mucins in gastric type in 7/13 (MUC5AC positive) and intestinal type in 4/13 (MUC2 positive). Two tumors did not express MUC2 or MUC5AC proteins. The pattern of mucin predominantly expressed in the adjacent epithelium was associated to the mucin expression profile in the tumors, p = 0.047. CONCLUSION: Barrett's esophagus adenocarcinoma shows either gastric or intestinal type pattern of mucin expression. The two types of tumors developed in Barrett's esophagus may reflect the original cell type involved in the malignant transformation.

Lugol staining and histological evaluation of esophageal mucosa in achalasia.

BACKGROUND/AIMS: Esophageal cancer in achalasia is often diagnosed in the advanced stage, which makes for a poor prognosis. Therefore, the aim of this study was to evaluate the macroscopic and histological features of the esophageal mucosa in order to improve the early detection of cancer. METHODOLOGY: We studied the macroscopic features of esophageal mucosa using Lugol's solution and compared them with histological analysis of the entire mucosa in 20 esophagectomy specimens resected for achalasia. Intraepithelial neoplasia, when detected, was selected for DNA ploidy analysis through static cytometry. RESULTS: Macroscopically, the mucosa showed opacification and/or diffuse irregularities in 19 specimens. Advanced squamous cell carcinoma was diagnosed in 2 cases. Using Lugol, the esophageal mucosa acquired irregular brownish color. Clear unstained areas were circumscribed in 5 esophagi. They were macroscopically defined as ulcer, neoplasia (2 cases) and mucosal irregularities (2 cases). The histological analysis showed ulcer, squamous cell carcinoma (2 cases), Barrett's esophagus and esophagitis, respectively. The histological study of the stained mucosa revealed minute foci of DNA aneuploid intraepithelial neoplasia in 4 cases. CONCLUSIONS: Macroscopic examination using Lugol failed to identify minute foci of early carcinoma. The stained mucosa does not exclude the esophageal cancer risk in achalasia.

Valor diagnóstico do conteúdo celular de DNA (ploidia) e da atividade proliferativa tumoral no câncer colorretal: comparaçäo com as variáveis clínico-patológicas convencionais / Prognostic value of cellular content of DNA (Ploidy) and proliferative activity tumor in colorectal cancer: comparison with conventional clinical pathologic variables

O presente estudo objetivou analisar os resultados e o valor prognóstico da ploidia do DNA e da atividade proliferativa tumoral (AP) no câncer colorretal (CCR) pela técnica da citometria digital de DNA (CD) através da comparaçäo entre estas duas variáveis e variáveis clínico-patológicas convencionais. Foram estudados prospectivamente 50 doentes submetidos a tratamento cirúrgico do CCR. As variáveis clínico-patológicas foram: sexo, idade, localizaçäo do tumor, tipo histológico, grau de diferenciaçäo, margem invasora, acometimento linfonodal e estadiamento (Dukes e Jass). Em todos os casos foi possível determinar a ploidia do DNA e a AP.A frequência de aneuploidia foi de 68 por cento e a AP tumoral média foi de 12,34 por cento. A correlaçäo entre as variáveis estudadas e a sobrevida foi realizada por análise uni e multivariada. Conclui-se que a CD é eficaz na determinaçäo do conteúdo celular de DNA e da AP tumoral no CCR. A ploidia do DNA e a AP näo estäo associadas às variáveis Clínico-patológicas estudadas. Näo foi possível demonstrar valor prognóstico da ploidia do DNA ou da AP tumoral. A padronizaçäo das técnicas de citometria e da estimativa do valor prognóstico constituem medidas necessárias à produçäo de resultados mais precisos sobre o papel da ploidia e da AP tumoral no prognóstico do CCR

Aspergillosis in the frontal sinus with intracranial extension: report of 1 case and analysis of the literature

The authors report a case of the 53 year old man carrier of aspergillosis in the both ethmoid and frontal sinus without association with the HIV virus. Aspergillosis in its focal and disseminated form is frequently associated with immune dysfunction, especially with patients carriers of the acquired immunodeficiency syndrome (AIDS), and it constitutes, when present in the central nervous system (CNS), a serious infection with difficult control and high morbidity index. The habitual treatment for these cases consists of the resection of the necrotic tissue and, so much as possible, of the lesions and also the administration and lingering use of liposomal amphotericin B.A lot of times, the invasion of the orbit and of the paranasal sinus can justify an aggressive conduct with extensive cranium-facial surgeries. The patient in subject was submitted to the partial resection of the lesion, which invaded the base of the anterior floor and the base of the frontal lobe to the orbitary cone and mesial face of the orbit. There was as postoperative complication, a liquoric fistula of difficult treatment due to the fragility of the dura mater in the base of the cranium infiltrated by the lesion. It received, for about 12 months, amphotericin in high doses and he comes maintaining himself stable of the clinical-neurological point of view. The authors discuss the etiopathogeny, the diagram of flow of the diagnostic and therapeutics conducts and they point out the need to include aspeergillosis of the SNC as disease of badly prognostic, deserving aggressive therapeutics in its initial phase

Hemangioendotelioma Epitelióde de laringe / Epithelioid Hemangioendothelioma of larynx

O Hemangioendotelioma Epitelióide (HEE) é um tumor vasoformativo de células endoteliais que crescem dentro dos canais vasculares. Pode ocorrer nos tecidos moles superficiais ou profundos. Embora geralmente encontrados na pele, podendo afetar vísceras como baço ou fígado. Sua localizaçäo na regiäo de cabeça e pescoço é rara. Os autores apresentam um caso de Hemangioendotelioma de regiäo sub-glótica, o primeiro relatado detalhadamente na literatura mundial, em um jovem com quadro de disfonia e obstruçäo respiratória gradativa, descrevendo seu quadro clínico, diagnóstico e tratamento, säo descritos com a devida visäo bibliográfica

Sindrome de Peutz-Jeghers associada a carcinoma no intestino grosso: relato de um caso e revisao bibliografica / Peutz-Jeghers syndrome associated with large bowel carcinoma: a case report and review

Os autores relatam a ocorrencia de um caso de adenocarcinoma de ceco associado a polipos hamartomatosos do colon esquerdo e reto em umapaciente de 33 anos que apresentava ainda manchas hipercromaticas em labio inferior. Tal quadro caracteriza sindrome de Peutz-Jeghers associada a um carcinoma colonico, de ocorrencia rara, tendo sido descritos 20 casos ate o momento. Os autores fazem uma ampla revisao bibliografica, enfatizando que os carcinomas associados a sindrome ocorrem numa faixa etaria mais baixa do que a observada na populaçao em geral. Discutem tambem a origem desses carcinomas a partir de polipos hamartomatosos ou de adenomas pre-existentes, fazendo referencia a outros casos jadescritos. A revisao dos casos publicados sugere que os pacientes portadores da SPJ apresentam um risco aumentado, porem pequeno (estimado em 2 a 3//), para desenvolver neoplasias malignas no aparelho digestivo. Esse risco nao justifica, no entanto, a necessidade de realizar-se resseccoes profilaticas de segmentos do intestino delgado ou do intestino grosso envolvidos pela polipose, embora seja necessario um atento seguimento destes pacientes a fim de detectar precocemente o eventual aparecimento de carcinomas digestivos ou em outros locais.

Abdome agudo na infância por angiostrongilíase intestinal: relato de um caso / Acute abdomen due to intestinal angiostrongylus infections: a case report

É apresentado o caso de uma criança de um ano de idade portadora de abdome agudo causado pelo Angiostrongylus costaricensis. O diagnóstico da angiostrongilíase intetinal é feito apenas através de biópsia e identificaçäo de formas do verme na parede intestinal e/ou mesentério. Ovos e larvas do verme ainda näo säo encontrados nas fezes humanas. Até o momento, a única terapêutica comprovadamente eficaz é a ressecçäo cirúrgica das áreas comprometidas. Devido às limitaçöes diagnósticas, esta enfermidade, provavelmente, tem sua prevalência subestimada. O objetivo do presente artigo é chamar a atençäo para est apossibilidade, em nosso meio, no diagnóstico diferencial do abdome agudo na infância

Melanoma maligno da regiao anorretal: apresentaçao de um caso e revisao da literatura / Malignant melanoma: report of a case and review of the literature

Os autores relatam a conduta terapeutica e o seguimento de um paciente portador de melanoma da regiao anorretal e fazem uma revisao da literatura