Dedifferentiated classic adamantinoma of the tibia: a report of a case with eventual complete revertant mesenchymal phenotype.

Adamantinomas of the long bones are low-grade malignant tumours. They seem to be related to osteofibrous dysplasia with a mesenchymal-to-epithelial transformation. We report a case of an adamantinoma with a revertant sarcomatoid transformation that showed a complete loss of epithelial differentiation. It corresponded to a 41-year-old male presented with an 8-cm multilobated lesion in the centre of the distal tibia. On the en bloc resection specimen, areas of classic adamantinoma were found but most of the tumor corresponded to a high-grade neoplasm with 2 histologic patterns: one made up by epithelial nests with a basaloid arrangement and positive for pankeratins and so-called glandular keratins, and a second sarcomatoid component, negative for these epithelial markers. Five months after surgery the patient had a massive relapse that consisted solely of the second sarcomatous component also negative for epithelial antibodies.Three cases of adamantinomas with sarcomatoid transformation of the epithelial component have been described but the tumours still preserved an epithelial immunophenotype. However, our case represents the extreme end of the sarcomatoid dedifferentiation of a classic adamantinoma with complete sarcomatoid transformation and total loss of epithelial markers. To our knowledge this has not been described previously.

[Different patterns for the 6-minute walk test as a test to measure exercise ability in elderly with and without clinically evident cardiopathy]. / Diferentes padronizações do teste da caminhada de seis minutos como método para mensuração da capacidade de exercício de idosos com e sem cardiopatia clinicamente evidente.

OBJECTIVES: Evaluate the correlation between peak oxygen consumption (VO2peak), from cardiopulmonary test with the distance covered in the six-minute walk test (6MWT) in healthy elderly and with myocardial infarction (MI). METHODS: Thirty individuals were studied, with age range 65-87 years (76.03 +/- 4.75), divided into 2 groups: Group I--14 with clinically evident coronary heart disease (CHD) and Group II--16 without clinically evident CHD. They were submitted to cardiopulmonary test (CPT) and 2 types of 6MWT, standard test 6MWTs. Variables measure at rest and exertion were heart rate (HR) and respiratory rate (RR), blood pressure (BP), distance covered (DC), and Borgs rate subjective perceived exertion (RPE). RESULTS: The study showed significant, strong correlation between distances covered for both 6MWT, and (VO2peak) obtained from cardiopulmonary test (CPT) for all elderly included in the study. When comparing the 6MWT with physiotherapist support (6MWTphy) and without support (6MWTw), statistically significant difference was observed, with higher average values of the DC, of the RH and RR and Borgs RPE in the 6MWTphy, both of the groups. Additionally, the RH reached at final the exertion in 6MWTphy was similar to that obtained in CPT (p<0.05) suggesting that the 6MWT stimulates higher cardiovascular performance. CONCLUSION: 6MWTw, adopted a worldwide, by being submaximal imposes lower cardiovascular overburden as compared to 6MWTphy and is probably safer for elderly who are cardiopaths.

Diferentes padronizações do teste da caminhada de seis minutos como método para mensuração da capacidade de exercício de idosos com e sem cardiopatia clinicamente evidente / Different patterns for the 6-minute walk test as a test to measure exercise ability in elderly with and without clinically evident cardiopathy

OBJETIVOS: Avaliar a correlação do consumo de oxigênio pico (VO2pico), no teste cardiopulmonar, com a distância percorrida no teste da caminhada de seis minutos (TC6) em idosos saudáveis e com infarto do miocárdio (IM). MÉTODOS: Avaliados 30 indivíduos, idade entre 65 e 87 anos (76,03 ± 4,75), divididos em 2 grupos: Grupo I - 14 com doença cardíaca clinicamente evidente (DCCE) Grupo II - 16 sem DCCE. Foram submetidos ao teste cardiopulmonar (TCP) e a 2 tipos de TC6. As variáveis mensuradas foram: a freqüência cardíaca (FC) e respiratória (FR), pressão arterial (PA), distância percorrida (DP), e a percepção subjetiva de esforço de BORG. RESULTADOS: O estudo mostrou uma forte correlação das distâncias percorridas, em ambas as formas do (TC6), com o VO2pico obtido no TCP, em todos idosos incluídos neste estudo. Na comparação entre os TC6, quando aplicado com acompanhamento (TC6ac) e sem acompanhamento (TC6s), foi observada diferença estatisticamente significante, com maiores valores médios da DP, da FC e FR, e da percepção subjetiva de esforço no TC6ac, em ambos os grupos. Além disso, a FC atingida ao final do esforço, no TC6ac, foi semelhante à obtida no TCP máximo (p <0,05), sugerindo que esta forma de padronização do TC6 estimula a um maior desempenho cardiovascular. CONCLUSÃO: O TC6s, por ser submáximo, impõe uma sobrecarga cardiovascular menor do que TC6ac, sendo provavelmente mais seguro em idosos cardiopatas.