Vitrectomy and tumor endoresection for the diagnosis and treatment of focal nodular retinal gliosis.

We report the case of a 60-year-old woman who presented with metamorphopsia and progressive vision loss in the right eye. Fundus examination revealed an elevated, white-yellow mass in the peripheral inferotemporal retina, with massive retinal exudation, proliferative vitreoretinopathy, and retinal detachment. Pars plana vitrectomy with tumor endoresection was performed, and a complete excisional biopsy of the lesion was obtained by removing the tumor through the anterior chamber. Histopathological analysis of the specimen confirmed a diagnosis of peripheral, focal, nodular retinal gliosis. Postoperatively, visual function improved greatly, with no recurrence of the disease at 12 months' follow-up. Focal nodular retinal gliosis is a rare, non-neoplastic proliferation of retinal glial cells, with a vascular component. In our case, surgical treatment with pars plana vitrectomy facilitated accurate diagnosis and resulted in effective management of the retinal tumor and associated complications.

XPERT® breast cancer STRAT4 as an alternative method of identifying breast cancer phenotype in Cape Verde (preliminary results).

Introduction: Breast cancer (BC) is a public health problem in developing countries, including Cape Verde. Immunohistochemistry (IHC) is the gold standard technique used for BC phenotypic characterisation to support efficient therapeutic decisions. However, IHC is a demanding technique that requires knowledge, trained technicians, expensive antibodies and reagents, controls, and results validation. The low number of cases in Cape Verde increases the risk of expiring the validity of the antibodies, and manual procedures often jeopardise the quality of the results. Thus, IHC is limited in Cape Verde, and an alternative technically easy solution is needed. A point-of-care messenger RNA (mRNA) STRAT4 BC assay to assess estrogen (ER), progesterone (PR), hormone growth factor 2 receptor (HER2), and Ki67, using the GeneXpert platform, has been recently validated on tissues from internationally accredited laboratories, showing excellent concordance with IHC results.To assess whether this technology can be implemented in Cape Verde to guide BC treatment we decided to study the level of agreement between the findings yielded by BC STRAT4 and the results are the same cases obtained by IHC. Methods: Formalin-fixed and paraffin-embedded (FFPE) tissue samples from 29 Cabo Verdean BC patients diagnosed in Agostinho Neto University Hospital were analysed by applying IHC and BC STRAT4 assay. The time between sample collection and pre-analytic procedures is unknown. All the samples were pre-processed in Cabo Verde (fixed in formalin and embedded in paraffin). IHC studies were performed in referenced laboratories in Portugal. STRAT4 and IHC result concordance was assessed by calculating the percentage of results agreement and Cohen's Kappa (K) statistics. Results: STRAT4 assay failed in 2 out of the 29 analysed samples. Of the 27 successfully analysed samples, STRAT4/IHC results for ER, PR, HER2, and Ki67 were concordant in 25, 24, 25, and 18 cases, respectively. Ki67 was indeterminate in three cases, and PR was indeterminate once.The percentage of agreement between STRAT4 and IHC results for ER, PR, HER2, and Ki67 was 92.59%, 92.31%, 92.59% and 81.82%, respectively. The Cohen's K statistic coefficients for each biomarker were 0.809, 0.845, 0.757 and 0.506, respectively. Conclusions: According to our preliminary results, a point-of-care mRNA STRAT4 BC assay may be an alternative in laboratories unable to provide quality and/or cost-efficient IHC services. However, more data and improvement on sample pre-analytic processes are required to implement this BC STRAT4 Assay in Cape Verde.

Villoglandular Pattern in HPV-associated Endocervical Adenocarcinoma is Associated With Excellent Prognosis: A Reappraisal of 31 Cases Using IECC and Silva Pattern Classification.

Villoglandular adenocarcinoma of the cervix is a rare histologic entity that typically develops in young women, characterized by an association with oral contraceptives and excellent prognosis, though this point is controversial. These tumors have not been studied in the context of the International Endocervical Adenocarcinoma Criteria and Classification (IECC) or Silva Pattern Classification. We analyzed 31 cases that met strict diagnostic criteria, including being completely excised with negative margins. These were categorized according to IECC and Silva Pattern Classification and the association with various pathologic parameters analyzed. Most patients were young with a mean age of 41.1 (range 25-79). There were 14 (45.2%) pattern A, 11 (35.5%) pattern B, and 6 (19.3%) pattern C cases. Only 1 of 22 patients (4.5%) presented with lymph node metastasis at the time of diagnosis (pattern C, stage IB1) and 3 (9.7%) had lymphovascular invasion (2 pattern C, 1 pattern B). Overall survival was 100%, while recurrence-free survival was 96.2% for the entire cohort with only 1 case (3.2%) recurring 25 mo after surgery (IB2, pattern B). Kaplan Meier analysis (log rank test) revealed no significant correlation for recurrence-free survival at 5 and 10 yr associated with depth of invasion, tumor size, Silva pattern, FIGO stage, lymphovascular invasion, or lymph node metastasis. Cox univariate analysis demonstrated no independent prognostic factors predicting recurrence-free survival. These results indicate that completely excised villoglandular adenocarcinoma generally has an excellent prognosis and when Silva Pattern Classification is applied, those tumors that potentially have a higher chance for adverse outcomes can be identified.

Sclerosing Stromal Tumor of the Ovary: A Successful Laparoscopic Approach.

Sclerosing stromal tumors (SSTs) are a rare type of benign tumors of the ovary, representing 6% of sex cord tumors subtype. We report a case of SSTs affecting a young female patient presenting with abdominal pain and a pelvic mass on imaging examination. The patient underwent laparoscopic right salpingo-oophorectomy, and the pathology report confirmed the diagnosis of SSTs. A review of the literature with the typical pathological and imaging features of SSTs as well their management is performed.

Necrotizing infundibulo-hypophysitis: case-report and literature review.

PURPOSE: We describe a rare case of histopathologic-proven necrotizing infundibulo-hypophysitis (NIH). CLINICAL HISTORY: A 40-year-old female presented with coexistence of central diabetes insipidus and hypopituitarism. Imaging disclosed a thickened infundibulum and a diffusely enlarged pituitary mass with gadolinium rim enhancement pattern. Microsurgical endonasal transsphenoidal resection was performed. The presence of extensive liquefactive necrosis, surrounded by lymphoplasmocytic inflammatory infiltrate, allowed for the diagnosis of NIH. Follow-up cranial imaging 10 months after surgery showed no evidence of reappearance of the lesion. There was no progression to panhypopituitarism. CONCLUSION: Surgery and histopathological confirmation are the key diagnostic feature in NIH. The current case is the fifth report of NIH and the first one with an indolent course and without progression to panhypopituitarism so far.

Posterior fossa metastasis of lung carcinoid tumor: case report.

Carcinoid tumors are generally indolent neoplasms. Brain metastases are rare and when present, yield a poor prognosis. We present the case of a 76-year old female surgically treated for an atypical bronchial carcinoid, staged as T2aN0M0G2. Without further adjuvant treatment she remained stable for four years, when she presented with headaches and gait imbalance. Brain MRI revealed a midline, intra-axial infratentorial lesion that was completely removal, of which histolology confirmed a carcinoid metastasis. At 14 months of follow-up, the patient showed no signs of systemic disease or brain recurrence, and thus no adjuvant radiotherapy was prescribed.

Gastrointestinal and renal involvement in systemic vasculitis

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Gastrointestinal and renal involvement in systemic vasculitis.

Vasculitis can also present with GI or solid organ involvement. IgA and ANCA associated vasculitis are more likely to have GI involvement. A 56-year-old female was admitted to the ER due to nausea, vomiting, epigastric pain and fever. The patient had a medical history of acromegaly and chronic kidney disease of an undetermined etiology, elevated C-reactive protein and renal dysfunction. Abdominal-CT revealed duodenal parietal thickening and pancreatic head edema. On esophagogastroduodenoscopy (EGD), duodenal mucosa had a diffusely nodular aspect with ulcerated areas. The following differential diagnosis were made, infectious enteritis, Whipple disease, infiltrative disorder and GI vasculitis. After discussion between a multidisciplinary team of Gastroenterology and Nephrology, they decided to initiate oral glucocorticoids due to worsening of the renal function, which lead to the resolution of digestive symptoms and renal function stabilization. Myeloperoxidase antineutrophilic-cytoplasmic antibodies (MPO-ANCA) were subsequently positive and histology confirmed duodenal involvement by vasculitis. The patient was asymptomatic after 4-weeks, with endoscopic healing and renal function stabilization. GI involvement limited to the duodenum in the setting of ANCA-MPO vasculitis is a rare condition. Moreover, histopathologic confirmation of vasculitis in endoscopic biopsy samples is exceptional.

Neutrophilic eccrine hidradenitis in a patient with FOLFOX chemotherapy.

This case study describes a 37-year-old Caucasian male with pruritic papules and plaques-some with central erosion-on the arms, neck, and trunk that appeared after chemotherapy with FOLFOX (folinic acid, fluorouacil, and oxiliplatin) for colon cancer. A histological examination showed features of neutrophilic eccrine hidradenitis. To the best of our knowledge, this is the first reported case of neutrophilic eccrine hidradenitis due to FOLFOX.

Cerebral Metastasis as First Systemic Event in a Patient with Prostate Adenocarcinoma

Prostate adenocarcinoma (PAC) is the second most common malignant tumor in men, and it is usually diagnosed because of its symptoms and/or because of an increase in the value of the prostate-specific antigen (PSA) in asymptomatic patients. The lymph nodes and the bones are the most common sites in which metastases occur, while the brain is a rare site, with metastases occurring in < 2% of the cases, and usually only after the aforementioned sites have been affected. Considering the brain as the only site where a metastasis can occur, the incidence is of 0.15%. We present the case of a 63-year-old male diagnosed with PAC, with a Gleason score of 7 (3þ4), who underwent radiotherapy and anti-hormonal therapy in 2012. After biochemical recurrence early in 2015 (PSA: 8 ng/mL), he was re-staged, and the bone and node metastases were excluded. The patient then resumed the hormone therapy with bicalutamide. He was admitted in August 2015 to the emergency department of our institution with headache and behavioral changes. The imaging study revealed a single right temporo-parieto-occipital lesion, which was then resected. The histological analysis confirmed it to be a PAC brain metastasis. The patient went through a cycle of brain radiotherapy, and evolved favorably after one year of follow-up.

O adenocarcinoma da próstata (ACP) é a segunda neoplasia maligna mais comum em homens, sendo habitualmente diagnosticada por meio de seus sintomas e/ou pelo aumento do valor do antígeno prostático específico (APE) em doentes assintomáticos. As metastizações óssea e ganglionar são as mais frequentes, sendo o cérebro um local raro de disseminação desta neoplasia, ocorrendo em menos de 2% dos casos, e geralmente surgindo apenas após a disseminação nos locais previamente descritos. Considerando o cérebro como único local de metastização, a incidência é de 0,15%. Os autores apresentam o caso de um homem de 63 anos com diagnóstico de ACP, com pontuação 7 (3 þ 4) na escala de Gleason, submetido a radioterapia e bloqueio hormonal em 2012. Por recidiva bioquímica (APE de 8 ng/mL) no início de 2015, o paciente foi re-estadiado, tendo-se excluído as metastizações óssea e ganglionar. Ele reiniciou a hormonoterapia com bicalutamida. Em agosto de 2015, foi admitido no serviço de urgência de nossa instituição com um quadro de cefaleias associadas a alterações no comportamento. O estudo imagiológico revelou uma lesão cerebral temporo-parieto-occipital direita única, e o paciente foi submetido a uma craniotomia com remoção completa; o diagnóstico histológico revelou tratar-se de metástase de ACP. O paciente foi posteriormente submetido a radioterapia cerebral, apresentando uma evolução favorável após um ano de acompanhamento.

Bullous Pemphigoid-like Skin Eruption during Treatment with Rivaroxaban: A Clinical Case Study.

Little has been documented about hypersensitivity reactions caused by treatment with rivaroxaban. This paper reports a bullous pemphigoid-like skin eruption that occurred in a 76-year-old female patient during rivaroxaban treatment. This case highlights the vigilance required by healthcare workers in recognising potential adverse effects of newly marketed drugs and in making medication changes when necessary. A bullous pemphigoid-like eruption due to treatment with rivaroxaban has not, to the best of the Authors' knowledge, been reported previously in the literature. LEARNING POINTS: Rivaroxaban can cause a bullous eruption apparently similar to epithelial toxic necrolysis (or to Stevens-Johnson syndrome).There is an apparent similarity between skin adverse events caused by the different anticoagulants.The anticoagulant responsible for the skin side-effects can be identified on clinical grounds by the correct differential diagnosis.

A case of a mixed adenoneuroendocrine tumor of the colon

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A case of a mixed adenoneuroendocrine tumor of the colon.

Neuroendocrine cells often coexist with exocrine neoplasms of the gut and each component is normally present in a variable range. Despite this frequent association, mixed exocrine-neuroendocrine carcinomas are rare. This entity is known as adenoneuroendocrine carcinoma (MANEC) and each of its malignant components represents at least 30%. In contrast, there are only a few reports of another rare association of an adenoma and a well differentiated neuroendocrine tumor (NET) in the colon and rectum. The term mixed adenoneuroendocrine tumor (MANET) was suggested due to its indolent behavior and distinct morphological characteristics with mild to moderate nuclear atypia and low number of mitoses1. However, it is not included in the recent World Health Organization (WHO) classification of tumors of the digestive system.

Cytomegalovirus duodenitis in immunocompetent patients: what else should we look for?

Cytomegalovirus (CMV) infection is a well-recognised complication of immunodeficiency, although the burden of CMV disease in immunocompetent adults is still unknown. We present the case of a 54-year-old male patient admitted due to severe diarrhoea, epigastric pain and fever. Initial diagnostic workup revealed pericardial and pleural effusion, enlarged abdominal lymph nodes and mild elevation of liver enzymes. CMV serology was IgM positive, and upper endoscopy revealed proximal enteritis. Histology and immunohistochemistry of duodenal samples confirmed CMV disease. An extensive investigation of possible immunodeficiency was conducted with positron emission tomography (PET) scan revealing an abnormal hypermetabolic pulmonary nodule. The patient underwent a right superior lobectomy which, on analysis, confirmed an atypical bronchopulmonary carcinoid tumour. We report this case to reinforce the importance of considering CMV infection as a differential diagnosis in apparent immunocompetent patients and to emphasise the importance of looking for any condition that may cause any degree of immune dysfunction.

Giant left middle fossa VII nerve schwannoma associated with amnesia.

The facial nerve is the third most frequent location of intracranial schwannomas, with facial paresis the most common sign.(1,2) A 77-year-old woman presented with amnesia; the Mini-Mental State Examination score was 26, with normal cranial nerve function. A giant multicystic VII nerve schwannoma was identified in the left middle fossa, with components of the tumor in the temporal bone facial canal, geniculate ganglion, and internal auditory canal (figure). Compression of the hippocampus may have accounted for the clinical presentation. The middle fossa component of the tumor was resected for mass effect relief, with iatrogenic facial palsy.