Linfoma anaplásico de células grandes associado a implante mamários: um desafio diagnóstico / Breast implant-associated anaplastic large cell lymphoma: a diagnostic challenge

O linfoma anaplásico de células grandes associado a implante mamário (BIA-ALCL ) é uma entidade provisória com características morfológicas e imunofenotípicas indistinguíveis do linfoma anaplásico de células grandes (ALCL) ALK negativo. Ao contrário do ALCL, o BIA-ALCL surge principalmente em associação ao implante mamário. A confirmação diagnóstica do BIA-ALCL pode ser difícil e a associação de características morfológicas e patológicas com citometria de fluxo e imuno-histoquímica pode auxiliar no diagnóstico. O objetivo deste relatório é descrever um caso de BIA-ALCL no qual a análise citológica e imunofenotipológica utilizando citometria de fluxo sugeriu a presença de grandes células positivas para CD30 no líquido de derrame.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a provisional entity with morphological and immunophenotypic characteristics indistinguishable from ALKnegative anaplastic large cell lymphoma (ALCL). Unlike ALCL, BIA-ALCL arises mainly in association with breast implantation. Diagnostic confirmation of BIA-ALCL can be difficult and associating morphological and pathological hallmarks with flow cytometry and immunohistochemistry can assist in the diagnosis. The objective of this report is to describe a case of BIA-ALCL in which cytological and immunophenotypological analysis using flow cytometry suggested the presence of large CD30-positive cells in the effusion fluid.

Sebaceous carcinoma in a mature teratoma of the ovary

The finding of a sebaceous carcinoma in a mature teratoma is rare in human pathology, with fewer than 10 cases currently reported in the literature. In this article, we report a case of sebaceous carcinoma in a mature teratoma of the ovary in a 59-year-old patient and discuss its histological findings.

Furosemide-induced pseudoporphyria in a patient with chronic kidney disease: case report / Pseudoporfiria induzida por furosemida em paciente com doença renal crônica: relato de caso

ABSTRACT Introduction: Pseudoporphyria is a rare photodermatosis with characteristics similar to those of porphyria cutanea tarda, without, however, presenting abnormalities in porphyrin metabolism. Its etiology is related to chronic kidney disease, ultraviolet radiation and certain medications. The aim of the present study is to describe a case of furosemide-related pseudoporphyria in a patient with chronic kidney disease. Case description: A 76-year-old male patient with stage 4 chronic kidney disease and in continuous use of furosemide presented ulcerated lesions with peripheral erythema and central hematic crust in the legs. On a skin infection suspicion, treatment with quinolone and neomycin sulfate was initiated, without improvement. A biopsy of the lesion was performed, with histopathological examination demonstrating findings compatible with porphyria, although the patient did not present high porphyrin levels. The diagnosis of furosemide-induced pseudoporphyria was then established, with medication suspension, and there was a significant improvement of the lesions. Discussion: There are few cases of pseudoporphyria described, but it is believed that this condition is underdiagnosed, especially in patients with chronic kidney disease. Both clinical and histopathological findings closely resemble porphyria, differentiating it from normal levels of porphyrin in plasma, urine, or feces. Conclusions: Although the lesions are mostly benign, they may increase the morbidity and mortality of these patients, so a proper diagnosis and early treatment are extremely important.

RESUMO Introdução: A pseudoporfiria é uma fotodermatose rara com características semelhantes às da porfiria cutânea tardia, sem, no entanto, apresentar anormalidades no metabolismo da porfirina. Sua etiologia está relacionada a doença renal crônica, radiação ultravioleta e determinados medicamentos. O objetivo do presente trabalho é descrever um caso de pseudoporfiria relacionada a furosemida em paciente portador de doença renal crônica. Descrição do caso: Paciente masculino, 76 anos, com doença renal crônica estágio 4 e em uso contínuo de furosemida, apresentou lesões ulceradas com eritema periférico e crosta hemática central nas pernas. Por suspeita de infecção de pele, foi iniciado tratamento com quinolona e sulfato de neomicina, sem melhora. Foi realizada então biópsia da lesão, com exame histopatológico demonstrando achados compatíveis com porfiria, sem, no entanto, o paciente apresentar níveis elevados de porfirinas. Foi então estabelecido o diagnóstico de pseudoporfiria induzida por furosemida, com suspensão de medicação , e houve melhora significativa das lesões. Discussão: Há poucos casos de pseudoporfiria descritos, mas acredita-se que essa condição seja subdiagnosticada, principalmente em pacientes com doença renal crônica. Tanto achados clínicos quanto histopatológicos se assemelham muito à porfiria, diferenciando desta por níveis normais de porfirina no plasma, na urina ou nas fezes. Conclusões: Embora as lesões sejam majoritariamente benignas, podem aumentar a morbimortalidade desses pacientes, por isso um diagnóstico adequado e tratamento precoce são de extrema importância.

Furosemide-induced pseudoporphyria in a patient with chronic kidney disease: case report.

INTRODUCTION: Pseudoporphyria is a rare photodermatosis with characteristics similar to those of porphyria cutanea tarda, without, however, presenting abnormalities in porphyrin metabolism. Its etiology is related to chronic kidney disease, ultraviolet radiation and certain medications. The aim of the present study is to describe a case of furosemide-related pseudoporphyria in a patient with chronic kidney disease. CASE DESCRIPTION: A 76-year-old male patient with stage 4 chronic kidney disease and in continuous use of furosemide presented ulcerated lesions with peripheral erythema and central hematic crust in the legs. On a skin infection suspicion, treatment with quinolone and neomycin sulfate was initiated, without improvement. A biopsy of the lesion was performed, with histopathological examination demonstrating findings compatible with porphyria, although the patient did not present high porphyrin levels. The diagnosis of furosemide-induced pseudoporphyria was then established, with medication suspension, and there was a significant improvement of the lesions. DISCUSSION: There are few cases of pseudoporphyria described, but it is believed that this condition is underdiagnosed, especially in patients with chronic kidney disease. Both clinical and histopathological findings closely resemble porphyria, differentiating it from normal levels of porphyrin in plasma, urine, or feces. CONCLUSIONS: Although the lesions are mostly benign, they may increase the morbidity and mortality of these patients, so a proper diagnosis and early treatment are extremely important.

Reduced immunohistochemical expression of CCN3 in vitiligo.

BACKGROUND: Defective adhesion seems to be involved in the chronic loss of melanocytes observed in vitiligo. Recent findings showed an association of genetic variants of an adhesion gene with vitiligo and reduced immunohistochemical expression of some adhesion molecules in vitiligo skin. AIMS: To compare CCN3 immunohistochemical expression in lesional and non-lesional epidermis of individuals with vitiligo. METHODS: A total of 66 skin specimens from 33 volunteers with vitiligo were analyzed by immunohistochemistry using anti-CCN3 antibodies. Absence of topical or systemic treatment for vitiligo over the previous 30 days and availability of an area of non-lesional skin for biopsy at least 15 cm away from any vitiliginous macules were the main inclusion criteria. RESULTS: A significant reduction of CCN3 expression was observed in lesional skin as compared to non-lesional skin (P = 0.001). LIMITATIONS: Paraffin embedded skin samples do not allow investigation by molecular biology methods. Not all samples allowed analysis due to the lamina preparation technique. Complete clinical data was not available for all patients. CONCLUSION: Our results support the hypothesis of impaired cell adhesion in vitiligo suggested by genetic studies. The pattern of immunohistochemical expression suggests that vitiligo might be an epithelial disease and not just a melanocyte disorder.

Sebaceous carcinoma in a mature teratoma of the ovary.

The finding of a sebaceous carcinoma in a mature teratoma is rare in human pathology, with fewer than 10 cases currently reported in the literature. In this article, we report a case of sebaceous carcinoma in a mature teratoma of the ovary in a 59-year-old patient and discuss its histological findings.

Inflammatory Myofibroblastic Tumor: Rare Manifestation in Face.

Inflammatory myofibroblastic tumor, also known as inflammatory pseudotumor and plasma cell granuloma, is a tumor that occurs most often in the lungs, abdomen, skin, soft tissue, genital system, and mediastinal. Before surgery, the diagnosis is difficult to establish because of its diverse manifestations. In the head and neck, manifestation is rare and may occur in the upper respiratory tract, soft tissues, orbits, and skull base. This article aims to report a rare manifestation of the disease in the face, highlighting the importance of a correct diagnosis to determine the most appropriate form of treatment, in male patient, leucoderma, 22 years old, with complain of a painless unilateral growth in the left cheek, beginning 2 months before and with progressive growth.

Reduced immunohistochemical expression of adhesion molecules in vitiligo skin biopsies.

Because defects in adhesion impairment seem to be involved in the etiopathogenesis of vitiligo, this study aimed to compare the immunohistochemical expression of several adhesion molecules in the epidermis of vitiligo and non lesional vitiligo skin. Sixty-six specimens of lesional and non lesional skin from 33 volunteers with vitiligo were evaluated by immunohistochemistry using anti-beta-catenin, anti-E-cadherin, anti-laminin, anti-beta1 integrin, anti-collagen IV, anti-ICAM-1 and anti-VCAM-1 antibodies. Biopsies of vitiligo skin demonstrated a significant reduction in the expression of laminin and integrin. The average value of the immunohistochemically positive reaction area of the vitiligo specimens was 3053.2µm2, compared with the observed value of 3431.8µm2 in non vitiligo skin (p=0.003) for laminin. The immuno-positive area was 7174.6µm2 (vitiligo) and 8966.7µm2 (non lesional skin) for integrin (p=0.042). A reduction in ICAM-1 and VCAM-1 expression in the basal layer of the epidermis in vitiligo samples was also observed (p=0.001 and p<0.001, respectively). However, no significant differences were observed with respect to the expression of beta-catenin, E-cadherin, and collagen IV between vitiligo and non lesional skin. Our results suggest that an impairment in adhesion exists in vitiligo skin, which is supported by the diminished immunohistochemical expression of laminin, beta1 integrin, ICAM-1 and VCAM-1.

Core needle biopsy in the diagnosis of head and neck lesions: a retrospective study of 3 years.

The management of head and neck tumors is guided by its nature, location and extension. Despite CNB accuracy and efficiency being widely described in the literature, there are few studies that evaluate the diagnostic utility of the technique performed in an outpatient setting, in the diagnosis of head and neck tumors. The aim of this study is to present the experience, sensitivity, specificity and accuracy of the CNB performed in an outpatient setting, free handed, in an important oncology school-hospital. A total of 2007 patients with tumors in the head and neck treated for a period of 3 years were evaluated. A retrospective chart review was performed in 36 of these patients, who underwent core needle biopsy for diagnosis. All samples collected were subjected to histopathological analysis. Values of accuracy, sensitivity and specificity were 94, 92 and 100 %, respectively. In our service, held in an outpatient setting and without the aid of imaging tests, the core needle biopsy proved to be a test with high accuracy values, sensitivity and specificity, easy of application, low morbidity and high predictability, with great use in diagnosing tumors in head and neck.

The role of P16ink4a and P53 immunostaining in predicting recurrence of HG-CIN after conization treatment.

OBJECTIVE: Io evaluate the expression of p16INK4a and p53 biomarkers in conization specimens from patients with high grade cervical intraepithelial neoplasia (HG-CIN), correlating them with the ability to predict the recurrence. METHODS: we conducted a retrospective study of patients with HG-CIN in cervical biopsy treated with conization between January 1999 and January 2006 who had a minimum follow-up of 18 months. The expression of the p16 and p53 was assessed by tissue microarrays and correlated with disease recurrence. For analysis, we used the test of proportions (chi-square), considering value p<0.05, 95% CI and calculations of sensitivity, specificity and accuracy of these immunomarkers in predicting recurrence. RESULTS: the series comprised 83 patients aged between 16 and 86 years (35±11.7), divided into two groups: 30 with HG-CIN recurrence (study group) and 53 without recurrence (control group). Mean age, parity, smoking and conization technique were similar in both groups. The p53 expression was present in 43% of the study group and 57% of the control group, and the p16 was present in 43% of the study group and in 57% of the control group (p>0.05). p53 had a positive predictive value (PPV) of 42% and negative predictive value (NPV) of 73%, sensitivity 70%, specificity of 47% and accuracy of 59%. The p16, PPV 42%, NPV 72%, sensitivity 66%, specificity of 49% and accuracy of 56%. CONCLUSION: immunohistochemistry expression of p53 and p16 showed low sensitivity and low specificity as predictors of HG-CIN recurrence after conization treatment.

The role of P16ink4a and P53 immunostaining in predicting recurrence of HG-CIN after conization treatment / O papel da expressão imunoistoquímica do P16ink4a e do P53 na predição da recorrência da nic-ag após tratamento por conização

Objective: Io evaluate the expression of p16INK4a and p53 biomarkers in conization specimens from patients with high grade cervical intraepithelial neoplasia (HG-CIN), correlating them with the ability to predict the recurrence. Methods : we conducted a retrospective study of patients with HG-CIN in cervical biopsy treated with conization between January 1999 and January 2006 who had a minimum follow-up of 18 months. The expression of the p16 and p53 was assessed by tissue microarrays and correlated with disease recurrence. For analysis, we used the test of proportions (chi-square), considering value p<0.05, 95% CI and calculations of sensitivity, specificity and accuracy of these immunomarkers in predicting recurrence. Results : the series comprised 83 patients aged between 16 and 86 years (35±11.7), divided into two groups: 30 with HG-CIN recurrence (study group) and 53 without recurrence (control group). Mean age, parity, smoking and conization technique were similar in both groups. The p53 expression was present in 43% of the study group and 57% of the control group, and the p16 was present in 43% of the study group and in 57% of the control group (p>0.05). p53 had a positive predictive value (PPV) of 42% and negative predictive value (NPV) of 73%, sensitivity 70%, specificity of 47% and accuracy of 59%. The p16, PPV 42%, NPV 72%, sensitivity 66%, specificity of 49% and accuracy of 56%. Conclusion : immunohistochemistry expression of p53 and p16 showed low sensitivity and low specificity as predictors of HG-CIN recurrence after conization treatment.

Objetivo : avaliar a expressão dos biomarcadores p16INK4a e p53, nas peças de conização de pacientes com neoplasia intraepitelial cervical de alto grau (NIC-AG), correlacionando com a capacidade de predizer o risco de recorrência. Métodos : estudo retrospectivo de pacientes com NIC-AG em biópsia de colo uterino, tratadas por conização, entre janeiro de 1999 e janeiro de 2006 e seguimento mínimo de 18 meses. A expressão dos biomarcadores p16 e p53 foi avaliada através de técnica de microarranjos teciduais e correlacionada com a recorrência da doença. Para análise utilizou-se o teste das proporções (qui-quadrado), considerando valor p<0,05, IC95% e cálculos de sensibilidade, especificidade e acurácia destes imunomarcadores na predição de recorrência. Resultados : oitenta e três pacientes, idade entre 16 e 86 anos (35±11,7), divididas em dois grupos: 30 com recorrência da NIC-AG (grupo estudo) e 53 sem recorrência (grupo controle). A média de idade, paridade, hábito de fumar e técnica de conização foram semelhantes nos dois grupos. A expressão do p53 esteve presente em 43% do grupo estudo e 57% do grupo controle e para o p16 esteve presente em 43% do grupo estudo e 57% do grupo controle (p>0,05). O p53 apresentou valor preditivo positivo (VPP) de 42% e valor preditivo negativo (VPN) de 73%, sensibilidade de 70%, especificidade de 47% e acurácia de 59%. O p16, VPP de 42% e VPN de 72%, sensibilidade de 66%, especificidade de 49% e acurácia de 56%. Conclusão : a expressão imunoistoquiímica do p53 e do p16 apresentaram baixa sensibilidade e baixa especificidade como marcadores capazes de predizer a recorrência da NIC-AG tratada por conização.

Unusual presentation of oral amyloidosis.

Amyloidosis is a rare disease of difficult diagnosis that occurs due accumulation of amyloid substance localized or systemic. The oral cavity is an unusual site and can be related to both localized and systemic forms and for that reason a full investigation is necessary to determine the extent of the disease. This study reports a case of a 58-year-old melanoderm male patient referred to the Department of Oral and Maxillofacial Surgery with white plaques on the tongue and multiple nodules in the region of the buccal mucosa and labial commissure, with 6 months of evolution and painful symptoms. An incisional biopsy was performed on both sites and histological examination indicated the presence of eosinophilic amorphous material within the connective tissue, positive for crystal violet staining, consistent with amyloidosis. At the present time, there is no consensus on the management of local amyloidosis. Surgical treatment of localized forms is indicated in some cases to reduce the functional prejudice. Moreover, follow-up is mandatory, both to manage recurrences and to monitor the possible evolution of the disease to the systemic form.

Can a sentinel node mapping algorithm detect all positive lymph nodes in cervical cancer?

OBJECTIVES: The aims of this study were to determine the sensitivity and negative predictive value (NPV) of sentinel lymph node (SLN) detection in cervical cancer using a combination technique, and to test the SLN algorithm that was proposed by the Memorial Sloan Kettering Cancer Center (MSKCC). METHODS: The study included 57 FIGO stage IA2-IIA patients who were treated at the Erasto Gaertner Hospital, Curitiba, from 2008 to 2010. The patients underwent SLN mapping by technetium lymphoscintigraphy and patent blue dye injection. Following SLN detection, standard radical hysterectomy, including parametrectomy and systematic bilateral pelvic lymphadenectomy, was performed. The SLNs were examined by immunohistochemistry (IHC) when the hematoxylin and eosin results were negative. RESULTS: The median age of patients was 42 years (range 24-71), the median SLN count was 2 (range 1-4), and the median total lymph node (LN) count was 19 (range 11-28). At least one SLN was detected in 48 (84.2 %) patients, while bilateral pelvic detection of SLNs was noted in 28 (58.3 %) cases-one case had bilateral pelvic SLNs and a para-aortic SLN, 19 (39.6 %) had unilateral pelvic LNs, and one (2.1 %) had an SLN in the para-aortic area. Metastatic LNs were found in 9 of 57 (15.8 %) patients. Eight of nine patients with LN metastasis had a positive SLN, yielding an overall sensitivity of 88.9 % and NPV of 97.5 %. Of the 75 sides that were mapped, the SLN detection method predicted LN involvement in 74 (98.6 %) hemi-pelvises. A total of ten hemi-pelvises had LN metastasis, nine of which involved the SLN, resulting in a sensitivity of 90 %, NPV of 98.5 %, and a false negative (FN) of 10 %. In two cases (4.2 %), the SLN was positive only after IHC. CONCLUSIONS: Our SLN procedure is a safe and accurate technique that increases metastatic nodal detection rates by 4.2 % after IHC. The SLN method performed better when analyzing each side; however, one FN occurred, even after applying the MSKCC algorithm.

Significance of p16 positive expression in oropharyngeal cancers.

BACKGROUND: The involvement of HPV in oral and oropharyngeal carcinogenesis was first proposed in 2004, based on epithelial HPV tropism and detection of HPV genotypes in oral squamous cell carcinoma samples. While 60-70% of oropharynx tumors may be HPV-positive, only 10 to 19% of tumors of the oral cavity, larynx and hypopharynx appear to have HPV infection. The aim of the study was to evaluate HPV infection associated with oropharyngeal cancer. MATERIALS AND METHODS: Seventy-eight cases were selected for p16 immunoexpression reactions, and demographic data were collected for comparisons. RESULTS: Most patients were over 60 years old, and 64.1% were smokers. Immunohistochemistry results showed that 86.3% of cases stained positive for p16 protein. CONCLUSION: The oropharyngeal cancer profile at Erasto Gaertner Hospital presented a high index of smokers over 60 years as well a high number of p16+ tumors, for what we can not determinate the main etiologic factor, but can be aware of the number of patients that presented HPV infection. Since prevention is still the best way to deal with cancer disease, it is important to analyze the interaction of these two etiologic factors and how to detect lesions at an early stage.

Immunohistochemical assessment of HER2 expression in gastric cancer in a cohort of 118 Brazilian patients / Avaliação da expressão imuno-histoquímica do HER2 em câncer gástrico em uma coorte de 118 pacientes brasileiros

INTRODUCTION: Recent studies indicate a role of human epidermal growth factor receptor type 2 (HER2) in the development of numerous types of human cancer, including gastric cancer, and its overexpression correlates with poor prognosis and increased aggressiveness of this neoplasm. OBJECTIVES: Identify and evaluate the immunohistochemical expression of HER2 in gastric cancer from biopsies, surgical resection specimens, lymph node metastasis and distant metastasis, and evaluate their correlation with currently known clinical and histopathological prognostic factors. METHODS: Samples from 118 patients of both sexes and all age groups diagnosed with gastric cancer were analyzed. Immunohistochemistry (IHQ) was performed using the HER2 antibody, and its evaluation was made according to the modified gastric cancer testing protocol, taking into account incomplete basolateral staining or only lateral staining. RESULTS: HER2 expression did not correlate with any histological prognostic factors or clinical outcome, except for the N stage. By comparing the HER2 expression in biopsies, surgical specimen, lymph node and metastasis, 88.1% were in agreement. CONCLUSION: As anti-HER2 therapies are becoming the standard of care in gastric cancer, currently available data indicate that IHQ should be used as the screening test, and the pathologist has an important role to ensure an accurate testing of HER2 status in these tumors. In addition, the HER2 status can be tested using the available samples from biopsies, surgical specimens, nodal and extranodal metastatic disease.

INTRODUÇÃO: Estudos recentes indicam o papel do human epidermal growth factor receptor type 2 (HER2) no desenvolvimento de vários tipos de câncer, incluindo o gástrico. Sua superexpressão correlaciona-se com pior prognóstico e maior agressividade dessa neoplasia. OBJETIVOS: Identificar e avaliar a expressão imuno-histoquímica de HER2 no câncer gástrico de biópsias, espécimes de ressecção cirúrgica, metástase linfonodal e metástase a distância, bem como analisar sua correlação com fatores prognósticos clínicos e histopatológicos conhecidos atualmente. MÉTODOS: Amostras de 118 pacientes de ambos os sexos e todas as faixas etárias diagnosticados com câncer gástrico foram analisadas. A imuno-histoquímica foi realizada utilizando o anticorpo HER2, e a sua avaliação foi feita de acordo com o protocolo do teste modificado do câncer gástrico, levando em conta a coloração basolateral ou lateral incompleta. RESULTADOS: A expressão do HER2 não apresentou correlação com quaisquer fatores histológicos e prognósticos ou evolução clínica, com exceção do estádio N. Ao comparar a expressão HER2 nas biópsias de peças cirúrgicas, linfonodos e metástases, observou-se que 88,1% dos espécimes apresentaram concordância. CONCLUSÃO: Como as terapias anti-HER2 estão se tornando o padrão para o tratamento do câncer gástrico, os dados atualmente disponíveis indicam que a imuno-histoquímica deve ser usada como teste de rastreamento. O patologista tem um papel importante para determinar a expressão do marcador nesses tumores. Ademais, o status do HER2 pode ser testado usando as amostras disponíveis de biópsias, peças cirúrgicas e doença metastática nodal e extranodal.

Câncer de mama oculto em homem com metástase para tecido celular subcutâneo axilar: relato de caso / Occult breast cancer in man with axillary subcutaneous tissue metastasis: case report

O câncer oculto de mama, que representa menos de 1% de todos os casos de câncer de mama, é definido como doença não identificada durante o exame físico do paciente nem por exames de imagem da mama, mas que apresenta linfadenopatia axilar compatível para câncer por meio de exames imuno-histoquímicos. Apenas 1% dos casos de câncer de mama acomete indivíduos do sexo masculino. Além disso, representa menos de 1% de todos os cânceres em homens, e tal o câncer representa menos de 1% de todos os cânceres em homens. Apresentou-se o caso de um homem de 54 anos com câncer de mama oculto apresentando metástase para tecido subcutâneo axilar, apresentado como nódulo em topografia axilar esquerda. Após a exérese da lesão, o paciente foi submetido à adenomastectomia bilateral e linfadenectomia axilar à esquerda, sendo o exame anatomopatológico das peças negativo para neoplasia. O paciente realizou radioterapia complementar e encontra-se em hormonioterapia com tamoxifeno (cinco anos). No momento, encontra-se em seguimento sem evidência de doença em atividade. Concluiu-se que o câncer de mama oculto em homem é raro e, por isso, ainda existem divergências sobre o tratamento definitivo, não devendo nunca se subestimar queixas mamárias.

Occult breast cancer, which represents less than 1% of all the cases of breast cancer, is defined as axillary metastasis without clinically and/or radiologically evident primary tumor, but the axillary metastasis is compatible with cancer through immunohistochemistry examinations. Only 1% of the cases of breast cancer occurs in men, and breast cancer accounts for less than 1% of all cancers in men. The authors presented a case study of a 54 year old man with occult breast cancer presenting axillary metastasis to subcutaneous tissue in the left axillary node topography. After excision, the patient underwent bilateral adenomastectomy and left axillary lymphadenectomy, with the pathologic diagnosis negative for any trace of malignancy. The patient underwent radiotherapy and is on hormone therapy with tamoxifen for five years. At the moment, he lies in tracking without evidence of active disease. It was concluded that occult breast cancer is rare in men and, due to that, there are still disagreements over the definitive treatment that can be done to this disease. Another important point is that breast complaints should never be underestimate in male patients.

Avaliação imunofenotípica das subpopulações de linfócitos no infiltrado linfocitário tumoral em melanomas / Immunophenotypic evaluation of lymphocyte subpopulations in tumor-Infiltrating lymphocytes of melanomas

JUSTIFICATIVA E OBJETIVOS: Estudos com novas terapias utilizando transplante autólogo de infiltrado linfocitário têm mostrado resultados promissores no tratamento de melanomas, justificando pesquisas nesta área. O objetivo deste estudo foi avaliar a expressão fenotípica do infiltrado linfocitário tumoral (TIL), através de marcadores imuno-histoquímicos de moléculas de superfície de células inflamatórias em melanomas cutâneos primários e estudar a sua correlação com outros fatores prognósticos já estabelecidos. MÉTODO: Análise da infiltração linfocitária tumoral em 43 melanomas primários utilizando técnicas de imuno-histoquímica (anticorpos anti-CD3, CD20, CD4, CD8, CD25 e anti-CD57). As variáveis prognósticas foram: clínicas (idade, sexo, localização, metástases e evolução) e anatomopatológicas: Breslow (se fino = < 1 mm = 21 casos ou grosso > 1 mm = 22 casos), nível de Clark, número de mitoses, ulceração, regressão, satelitose e tipo TIL (caso brisk ou nonbrisk). RESULTADOS: Os tumores finos apresentaram maior concentração de linfócitos TCD4+ (p = 0,01) e CD57+ (p = 0,008). Os tumores de cabeça-tronco-pescoço apresentam predomínio de linfócitos TCD8+ e de TCD25+ (p = 0,02). CONCLUSÃO: Tumores centrais, que geralmente são de pior prognóstico, apresentaram maior resposta imune humoral (predomínio de linfócitos CD20+) e são a forma mais prevalente no sexo masculino. Os tumores grossos, que são de pior prognóstico, estavam associados com o padrão nonbrisk de TIL, com maior taxa de mitoses, com maior incidência de satelitoses e com predomínio de ulceração. A presença de ulceração ocorreu em maior número de vezes em pacientes com faixa etária mais elevada. Os tumores finos, que são de melhor prognóstico, apresentaram maior resposta imune celular (predomínio de linfócitos CD4+ e CD57+).

BACKGROUND AND OBJECTIVES: Studies of new therapies that use lymphocytic infiltrate autologous transplantation have shown promising results for the treatment of melanomas, warranting researches in this area. The objective of this study was to assess the phenotypic expression of tumor-infiltrating lymphocytes through immunohistochemical markers of surface molecules of inflammatory cells in primary cutaneous melanomas, and to study its correlation with other established prognostic factors. METHOD: Tumor lymphocytic infiltration analysis in 43 primary melanomas using immunohistochemical techniques (CD3, CD20, CD4, CD8, CD25 and CD57 antibodies). The prognostic variables were: clinical (age, sex, location, metastases and evolution) and anatomopathological variables: Breslow thickness (if thin = < 1 mm = 21 cases or thick > 1 mm = 22 cases), Clark level, number of mitoses, ulceration, regression, satellitosis and type of TIL (if brisk or nonbrisk). RESULTS: The thin tumors showed higher concentration of CD4+ (p = 0.01) and CD57+ (p = 0.008) T lymphocytes. The head-trunk-neck tumors exhibit a predominance of CD8 and CD25 (p = 0.02) T lymphocytes. CONCLUSION: Central tumors, which generally have poorer prognosis, had a higher humoral immune response (CD20 lymphocyte predominance) and are the most prevalent form in males. The thick tumors, which have worse prognosis, were associated with the non-brisk pattern of TIL with a higher rate of mitosis, a higher incidence of satelitoses and ulceration predominance. The presence of ulceration occurred more often in older patients. The thin tumors, which have the best prognosis, had a higher cellular immune response (predominance of CD4+ and CD57+ lymphocytes).