A comparative study between conventional and liquid-based cytology in screening for anal intraepithelial lesions in HIV-positive patients.

Anal intraepithelial neoplasia (AIN) is associated with HPV infection and can be detected by cytological screening. While conventional exfoliative cytology (CC) is a low-cost and nonaggressive method, liquid-based cytology (LBC) tends to give clearer readings. Although studies of the efficacy of anal cancer screening methods would be of great importance for groups at high risk for AIN, few such studies have been conducted. The aim of the present study was to assess the concordance of CC and LBC in diagnosing anal pre-neoplastic lesions, and to compare cytological results with anoscopy, histopathological, and molecular biology findings. Comparative study involving 33 HIV-positive patients, who underwent anoscopy and biopsy of suspected lesions. Concordance between the two cytology methods was calculated, as were the associations between cytology results and findings from other screening methods. A total of 54.5% of cases were considered AIN-negative by CC and LBC, and concordance between the two methods was statistically significant (P < 0.05). Anoscopy was negative in 15 of the 18 CC- and LBC-negative cases. CC identified 75% of patients with positive biopsy, while LBC identified 85.71% of these patients. Molecular biology results showed that patients with LSIL tested positive for the highest number of HPV subtypes. The associations between positive biopsy and high grade HPV, HPV 16, and multiple HPV infections were not statistically significant. Conventional and liquid-based cytology are equally effective in screening for anal preneoplastic lesions.

Hybrid capture II and PapilloCheck® tests for detection of anal high-risk human papillomavirus.

INTRODUCTION: This study evaluated the level of concordance between hybrid capture II (HCII) and PapilloCheck® for the detection of high-risk human papillomavirus (HPV) in anal samples. METHODS: Anal cell samples collected from 42 human immunodeficiency virus (HIV)+ patients were analyzed. RESULTS: Considering only the 13 high-risk HPV types that are detectable by both tests, HCII was positive for 52.3% of the samples, and PapilloCheck® was positive for 52.3%. The level of concordance was 80.9% (Kappa = 0.61). CONCLUSIONS: Good concordance was observed between the tests for the detection of high-risk HPV.

Value of human papillomavirus typing for detection of anal cytological abnormalities.

PURPOSE: The objective of this study was to evaluate anal cytology and human papillomavirus (HPV) typing in patients with human immunodeficiency virus infection. MATERIALS AND METHODS: Anal samples were collected from 61 patients (44 men and 17 women) and analyzed by PapilloCheck test and conventional cytology. RESULTS: Of all anal samples, 37.7% had cytological abnormalities, 47.54% were negative and 14.75% were unsatisfactory. High-risk HPV, multiple high-risk HPV and HPV 16 infection was detected in 91.13%, 78.26% and 47.82% of the samples with cytological abnormalities and in 47.54%, 6.89% and 3.44% of the negative samples, respectively. High-risk HPV infection was significantly more frequent in anal samples with cytological abnormalities than in negative samples (P = 0.0005, Fisher's test), particularly multiple high-risk HPV infection (P < 0.0001) and HPV 16 infection (P = 0.0002). CONCLUSIONS: High-risk HPV, multiple high-risk HPV and HPV 16 infections are significantly associated with anal cytological abnormalities. Furthermore, the frequency of HPV infection in anal cytological samples suggests that high-risk HPV detection has high sensitivity, but low specificity for detection of anal cytological abnormalities, but multiple high-risk HPV typing and HPV 16 typing have a lower sensitivity and high specificity. Results suggest that HPV typing may be useful as an adjunct to cytology to screen patients for high-resolution anoscopy and biopsy.

Chronic myelopathy associated to intramedullary cysticercosis.

STUDY DESIGN: Case report. OBJECTIVE: Discuss an isolated intramedullary neurocysticercosis (NCC) case in an adult patient with chronic progressive onset myelopathic symptomatology with clinical, radiologic, and pathologic correlation. SUMMARY OF BACKGROUND DATA: NCC is the most common parasitic infection in the central nervous system. Spinal NCC belongs to the group of extraparenchymal forms of NCC and it is considered an extremely rare form characterized by a distinct clinical entity due to mass effect on the spinal cord. METHODS: Description of a 62-year-old male patient case who presented with chronic but progressive low cord myelopathy who underwent radiologic investigation through magnetic resonance imaging depicting a thoracic intramedullary cystic lesion at level T11. RESULTS: Surgical excision of the intramedullary lesion was preformed and pathologic study confirmed a cysticercus. There was complete resolution of the neurologic symptoms and follow-up monitoring was unremarkable. CONCLUSION: Although intramedullary is a rare NCC location, it should be considered in the differential diagnosis in high-risk populations especially when cord compression and myelopathy symptoms are present. Magnetic resonance imaging remains the investigative and follow-up modality of choice, and promptly lesion recognition is fundamental for surgical planning and to improve the patient outcome.

Lobomycosis: diagnosis and management of relapsed and multifocal lesions.

We report a case of lobomycosis in the left leg of a patient that had traveled to the endemic Brazilian Amazon region. After surgical resection of the lesion, there was relapse with local dissemination of the disease and the treatment was successfully performed by oral itraconazole and cryosurgery.

Extramedullary plasmocytoma associated with a massive deposit of amyloid in the duodenum.

We report a rare case of extramedullary plasmocytoma associated with a massive deposit of amyloid in the duodenum. A 72-year-old Japanese man was admitted to our hospital presenting with a 3-mo history of epigastric pain, vomiting and weight loss. On computed tomography (CT) a wall thickening of the fourth part of the duodenum was observed. Multiple biopsies obtained from the lesion showed infiltration of plasma cells and lymphocytes, but they were not conclusive. The patient underwent resection of the lesion and, on histopathological examination, the lesion consisted of a dense and diffuse infiltrate of plasma cells and a few admixed lymphocytes with reactive follicles extending to the muscular propria. An extensive deposition of amyloid was also observed. Immunohistochemical stains revealed that a few plasmacytoid cells showed lambda light chain staining, though most were kappa light chain positive. These cells also were positive for CD138 and CD56 but negative for CD20 and CD79. The findings were consistent with extramedullary plasmocytoma associated with a massive deposit of amyloid in duodenum. A subsequent workup for multiple myeloma was completely negative. The patient showed no signs of local recurrence or dissemination of the disease after 12 mo follow-up. Because of the association of plasmocytoma and amyloidosis, the patient must be followed up because of the possible systemic involvement of the neoplasm and amyloidosis in future.

Condiloma acuminado anal com ovos de Schistosoma mansoni em paciente HIV-positivo / Condilomata acuminata with Schistosoma eggs in HIV-positive patient

Condiloma acuminado e ovos de Schistosoma são freqüentemente encontrados na região anal, mas não há nenhum caso descrito de associação dessas doenças nessa região. No colo uterino a associação de infecção por HPV (vírus do papiloma humano) e ovos de Schistosoma em paciente HIV (vírus da imunodeficiência humana)-positivo já foi relatada e há evidências de que essa associação possa alterar a história natural dessas doenças. Assim como no colo uterino, é possível que essa interação também ocorra na região anal. Nosso objetivo, portanto, é relatar um caso de condiloma anal em paciente HIV-positivo, que foi submetido a ressecção cirúrgica e que apresentou no exame histopatológico numerosos ovos de Schistosoma mansoni.

Condilomata acuminata and Schistosoma eggs are frequently found in the anal region, but there is no report about the association of these diseases in this region. The association of HPV infection and Schistosoma eggs in an HIV-positive patient was found in uterine cervix and there is evidence suggesting that this association can alters the natural history of these diseases. Like in the cervix, it is possible that this interaction also occurs in the anal region. So, we report a case of anal Condilomata acuminata, in an HIV-positive patient, that was ressected and contained on histopathologic examination, multiple Schistosoma eggs.

Sepse por listeria monocytogenes em gestante / Listeria monocytogenes sepsis during pregnancy

Introdução. A Listeria monocytogenes é uma bactéria associada a entidades clínicas neurais, viscerais e reprodutivas, sendo a gestante particularmente susceptível à infecção. O objetivo deste relato é descrever o caso de gestante com sepse por L. monocytogenes e o resultado perinatal.Relato do caso. Gestante com 33 semanas de gestação, admitida em regular estado geral, febril, hipocorada, desidratada, hipotensa, taquicárdica e taquipnéica; batimentos cardiofetais presentes e dinâmica uterina ausente. A cardiotocografia basal mostrou reatividade no traçado e a ultra-sonografia obstétrica foi compatível com restrição de crescimento intra-uterino. Efetuado tratamento empírico com ceftriaxona, houve melhora do estado geral e remissão da febre. No sétimo dia de internação, foi efetuado o parto por alteração no traçado da cardiotocografia,sendo o peso e o índice Apgar do recém-nascido de 1.455 g e 9, no primeiro e no quinto minutos de vida, respectivamente. No segundo dia de puerpério, confirmou-se o diagnóstico de listeriose materna por hemocultura, sendo então substituído o antibiótico em uso por ampicilina. O recém-nascido foi tratado com ampicilina e gentamicina pela prematuridade, e sua hemocultura foi negativa. Mãe e filho estavam em boas condições de saúde na ocasião da alta hospitalar. Conclusão. A listeriose não tratada durante a gestação pode ter mau prognóstico gestacional, incluindo-se graves complicações perinatais. Essas podem ser evitadas pela sua inclusão no diagnóstico diferencial de outras doenças infecciosas e pela instituição de terapêutica apropriada.

Introduction. Lysteria monocytogenes is a bacteria associated with neural, visceral and reproductive clinical entities, and pregnant women are particularly sensitive to its infection. The objective of this report is to describe the case of a pregnant woman with sepsis for L. monocytogenes and the perinatal outcome. Case report. A woman was admitted to the maternity wards at 33-weeks gestation in a regular general condition, febrile, pale, dehydrated, hipotense, tachycardic and tachypneic; cardiofetal beats innalterated and no uterine dynamic. The basal cardiotocography showed reactivity and the obstetric ultrasound was compatible with intrauterine growth restriction. She was started on empirical treatment with ceftriaxone, with improvement of the general state and cessation of the fever. In the seventh day of admission, the baby was delivered by cesarean section because of an alteration in the cardiotocography. The weight and the Apgar score of the newborn were 1455 g and 9 (first and fifth minute of life) respectively. In the second day of puerperium, it was confirmed the diagnosis of mother Lysteriainfection through the hemoculture, so the antibiotic regimen was changed to ampiciline. The newborn was treated with ampiciline and gentamicine because of the prematurity and his hemoculture was negative. Mother and son were in good health conditions when they were discharged from hospital. Conclusion. Lysteriosis when not treated during the gestation can cause bad gestational outcome, includingserious perinatal complications. Those could be avoided by its inclusion in the differential diagnosis of other infectious diseases and by the institution of appropriate therapeutics.