Sarcoma granulocítico multicêntrico como recidiva de leucemia mieloide aguda / Multicentric granulocytic sarcoma as relapse of acute myelogenous leukemia

Sarcoma granulocítico (SG) é um tumor sólido extramedular, constituído por células precursoras de granulócitos. É geralmente associado a leucemia mieloide aguda ou raramente a outras desordens mieloproliferativas. O tumor geralmente ocorre precedendo uma leucemia mieloide aguda, durante o seu curso ou após a remissão ter sido alcançada. O prognóstico é pobre e tem como principais modalidades terapêuticas a quimioterapia e a radioterapia. Relata- se um caso de SG multicêntrico, de evolução rápida, com acometimento difuso de pele, mamas, gânglios linfáticos, tecido celular subcutâneo e líquor, em mulher de 45 anos, fora de tratamento para leucemia mieloide aguda e em remissão hematológica há 18 meses. A paciente apresentava dor intensa em membro inferior direito há uma semana e estava em anticoagulação oral há seis meses por trombose venosa profunda neste membro. Diagnosticado o SG, a paciente foi tratada com radioterapia e quimioterapia com boa resposta. Após três meses de seguimento, em vigência do tratamento quimioterápico, evoluiu com recidiva do SG neste membro, associado ao acometimento das mamas e posteriormente do sistema nervoso central, evoluindo para óbito em aplasia e sepses.

Granulocytic sarcoma is an extramedullary solid tumor consisting of immature granulocytic cells. It is often associated with acute myelogenous leukemia and more rarely with other myeloproliferative disorders. The tumor generally occurs before acute myeloid leukemia, during its course or after disease remission. It has a poor prognosis with the main therapeutic options being chemotherapy and radiotherapy. A multicentric accelerated case of granulocytic sarcoma of a 45- year- old woman with diffuse skin, breast, lymphatic ganglia and subcutaneous tissue presentations no longer undergoing treatment for acute myeloid leukemia and in hematologic remission for 18 months is reported. The patient presented with severe pain of right lower limb for a week and was undergoing oral anticoagulation for 6 months due to deep venous thrombosis. After diagnosis of granulocytic sarcoma she received radiotherapy and chemotherapy with good response. After a 3- month follow- up, under chemotherapy, she presented relapse of granulocytic sarcoma in the limb followed by breast and central nervous system presentations leading to death in aplasia and sepsis.

Megacolon in Chagas disease: a study of inflammatory cells, enteric nerves, and glial cells.

After acute infestation with the Chagas disease parasite, Trypanosoma cruzi, some patients who are serologically positive develop chronic megacolon and megaesophagus, whereas others are symptom-free. Chagas disease with gastrointestinal involvement involves an inflammatory invasion of the enteric plexuses and degeneration of enteric neurons. It is known that glial cells can be involved in enteric inflammatory responses. The aims were to determine the nature of any difference in lymphocytic invasion, enteric neurons, and enteric glial cells in seropositive individuals with and without megacolon. We have compared colonic tissue from serologically positive individuals with and without symptoms and from seronegative controls. Subjects with megacolon had significantly more CD-57 natural killer cells and TIA-1 cytotoxic lymphocytes within enteric ganglia, but numbers of CD-3 and CD-20 immunoreactive cells were not significantly elevated. The innervation of the muscle was substantially reduced to about 20% in megacolon, but asymptomatic seropositive subjects were not different to seronegative controls. Glial cell loss occurred equally in symptomatic and unaffected seropositive subjects, although the proportion with glial fibrillary acidic protein was greater in seropositive, nonsymptomatic subjects. Development of megacolon after acute infection with T cruzi is associated with maintained invasion of enteric ganglia with cytotoxic T cells and loss of muscle innervation, but changes in glial cell numbers are not associated with progression of enteric neuropathy.

Frequency of infectious agents for vaginitis in non- and hysterectomized women.

The frequency of infectious agents for vaginitis has shown varying results. Bacterial vaginosis and candidiasis are infections related to vaginal pH alteration. Vaginal pH is related to endocervical pH in pre- and post-menopaused women, and vaginal pH in hysterectomized women is more acidic than in non-hysterectomized women. The aim of this paper is to verify differences in Papanicolaou smear diagnoses of infectious agents in hysterectomized women. A retrospective study was conducted at Faculdade de Medicina do Triângulo Mineiro (public tertiary referral centre). A total of 1,579 Papanicolaou reports for each group (hysterectomized and non-hysterectomized) was analysed. Clue cells, Candida sp., Trichomonas vaginalis, cytolysis, coccobacilli and lactobacilli were diagnosed by cytological criteria (Papanicolaou's method), statistical methods: the chi2 test and linear regression (significance level < 0.05). Clue cells decrease with the age in both the groups and are more frequent in non-hysterectomized women with > 59 years. There is an increased frequency of Coccobacilli and a decrease of lactobacillus as the age of women increases. The frequency of T. vaginalis is not influenced by hysterectomy but there is a decreased frequency between 40 years and 49 years old. Cytolysis was more frequent in women below 40 years old and between 50 years and 59 years old in both groups (P < 0.009). Candida sp. is a less common finding between 40 years and 49 years old in both groups and more frequent in hysterectomized women with > 60 years old (P = 0.002). Our results showed that the presence of infectious agents for vaginitis in Papanicolaou findings is associated with age. The frequency of finding of Candida sp. in women above 60 years old may be influenced by hysterectomy.

Cervical stump cancer: a study of 14 cases.

CASE REPORT: This is a report on 14 patients with cervical stump cancer, aged 30 to 68 years old (median = 53 years), seen in a public university hospital. Over a 15-year period, 363 cases of cervical cancer were treated, of which fourteen (3.85%) were in the cervical stump. The time interval between subtotal hysterectomy and the diagnosis of the neoplasm varied from 9 days to 27 years (median = 9.3 years). 28.6% of the patients were in stage I, 42.9% in stage II and 28.6% in stage III. Fibromyoma was the major reason for the subtotal hysterectomy. Three patients underwent Wertheim-Meigs surgery, 1 in association with radiotherapy, and the other 11 patients had radiotherapy alone. The survival ranged from 12 to 120 months (median = 53.3 months). CONCLUSION: Subtotal hysterectomy should be avoided whenever possible in populations with restricted access to screening programs for cancer of the uterine cervix.

Morphometry of submucous and myenteric esophagic plexus of dogs experimentally reinfected with Trypanosoma cruzi

We carried out a morphometric study of the esophagus of cross-bred dogs experimentally infected or consecutively reinfected with Trypanosoma cruzi 147 and SC-1 strains, in order to verify denervation and/or neuronal hypertrophy in the intramural plexus. The animals were sacrificed in the chronic stage, 38 months after the initial infection. Neither nests of amastigotes, nor myositis or ganglionitis, were observed in all third inferior portions of esophageal rings analyzed. No nerve cell was identified in the submucous of this organ. There was no significant difference (p>0.05) between the number, maximum diameter, perimeter, or area and volume of the nerve cells of the myenteric plexus of infected and/or reinfected dogs and of the non-infected ones. In view of these results we may conclude that the 147 and SC-1 strains have little neurotropism and do not determine denervation and/or hypertrophy in the intramural esophageal plexuses in the animals studied, independent of the reinfections

Contribuicao ao estudo da anatomia patologica do megaesofago chagasico / Pathological anatomy of chagasic megaesophagus

Estudo anatomopatologico sistematizado foi feito em 56 esofagos de chagasicos cronicos (17 com e 39 sem mega) e em 26 de nao chagasicos com as seguintes finalidades: 1) avaliar as variacoes de calibre e espessura da parede do orgao; 2) analisar qualitativa e quantitativamente o plexo mienterico, na tentativa de avaliar a eventual relacao entre suas lesoes e o aparecimento de megaesofago (ME); 3) estudar as lesoes das musculares procurando verificar sua contribuicao na genese da visceromegalia; 4) pesquisar formas amastigotas do T. cruzi e sua possivel relacao com o processo inflamatorio; 5) identificar as principais alteracoes da mucosa. Confirmou-se que as lesoes mais intensas localizavam-se na muscular propria e no plexo de Auerbach. Na primeira, as principais alteracoes foram miosite e fibrose e nos ganglios mientericos observou-se inflamacao e despopulacao neuronal, maior nos esofagos dos chagasicos com dilatacao em relacao aos sem dilatacao e destes em relacao aos aos controles. Entretanto, foram vistos esofagos de calibre normal, com intensa denervacao. Conclui-se que parecem ser multiplos os fatores que desencadeiam a esofagopatia, especialmente, o ME. A pesquisa de parasitas em oito esofagos com mega e em oito sem ME foi positiva somente em quatro casos, do primeiro grupo. As lesoes da mucosa e...

Estudo necroscópico de um caso da forma crônica da doença de chagas com eletrocardiograma e raio-x de tórax normais: referência especial ao sistema excito-condutor do coraçäo / Postmortem study of the case of Chagas' disease in chronic form with electrocardiography and x-ray of thorax

Descrevem-se as alteraçöes anatomopatológicas observadas na necrópsia de chagásico crônico, provavelmente, portador da forma indeterminada da doença. O coraçäo mostrou lesöes dos três folhetos e do sistema excito-condutor, traduzidas especialmente por pequenos focos inflamatórios. Havia discreta fibrose do miocárdio contrátil, nódulo átrio-ventricular e origem do ramo esquerdo do feixe de His. Tais alteraçöes, embora de leve intensidade, assemelham-se, qualitativamente, as relatadas nas demais formas crônicas da doença de Chagas e representam lesöes ativas, com potencial evolutivo. No esôfago, observou-se entre outros fatos, despopulaçäo neuronal acentuada

Xenodiagnóstico artificial "post-mortem" em chagásicos crônicos / Post-mortem artificial xenodiagnosis in chronic chagasic patients

A fim de obter metodologias que permitam estabelecer, com segurança, o diagnóstico "post-mortem" da infecçäo chagásica, adaptou-se o xenodiagnóstico artifical a necropsiados com diferentes tempos de óbito. O teste foi positivo em três (30%) de dez chagásicos autopsiados. O tempo decorrido entre o êxito letal e o início do repasto pelos triatomíneos destes chagásicos foi de duas horas, duas horas e quinze minutos e sete horas, respectivamente. Discutem-se os fatores que podem explicar a sobrevivência do Trypanosoma cruzi no hospedeiro morto bem como as aplicaçöes práticas do achado