Surgical Treatment of Aggressive Intraosseous Cavernous Hemangioma in Maxilla Through Surgical Resection.

Hemangiomas are benign vascular lesions characterized by endothelial vascular proliferation and may demonstrate aggressive clinical features. Intraosseous hemangiomas are uncommon and the maxillary location rare, with few cases described in the literature. The treatment of these lesions varies, however they have a better prognosis when a surgical treatment through resection is performed. The aim of this study is to report a case of right maxillary cavernous intraosseous hemangioma treated by surgical resection with previous embolization. The diagnosis was made through incisional biopsy and immunohistochemical examination. An aggressive lesion profile was observed through the Ki67 marker. During surgery, a temporary ipsilateral external carotid artery ligation was performed to minimize possible bleeding. Weber-Fergson surgical access was performed and total surgical resection through hemi-maxillectomy. The patient is stable after 30 months of follow-up without relapses. In suspected cases of intraosseous hemangiomas, accurate diagnosis and total surgical resection of the lesion is essential. The use of therapeutic mammoths that minimize sagging during and after the procedure such as embolization and arteriography should always be performed.

Indicação da anuscopia de alta resolução e citologia anal na prevenção de HPV e câncer colorretal em pacientes portadores de HIV / Indication of high resolution anoscopy and anal cytology for prevention of HPV and colorectal cancer in HIV patients

OBJETIVO: Rastreamento do papilomavírus humano (HPV) assim como sua correlação com a neoplasia anorretal nos pacientes portadores do vírus da imunodeficiência humana (HIV) por meio da anuscopia de alta resolução (AAR) e da citologia anal. MÉTODOS: Desenvolvemos um estudo observacional, transversal e duplo-cego em que participaram 31 pacientes portadores do HIV independente de queixas proctológicas. Os pacientes foram submetidos à AAR e citologia anal cujas lâminas foram enviadas ao setor de anatomia patológica para coloração e posterior análise. RESULTADOS: Verificamos 22 pacientes do sexo masculino e 9 do sexo feminino entre 20 e 67 anos. Dos 31 analisados, quatro encontravam-se em estágio de imunodepressão, 23 utilizavam terapia antirretroviral, 16 com passado de sexo anal receptivo e 12 com passado de condiloma acuminado. À AAR 11 pacientes tinham alterações e 7 foram confirmados pela citologia. Verificamos ainda oito pacientes com alterações à citologia os quais possuíam ausência de alterações à AAR. À citologia apresentaram três células escamosas atípicas de significância (Ascus, do inglês atypical squamous cells of undetermined significance), cinco com paraceratose e/ou hiperceratose, seis lesões intraepiteliais de baixo grau e uma lesão intraepitelial de alto grau. CONCLUSÃO: Sugerimos a utilização da AAR aliada à citologia anal para rastreamento nos pacientes portadores do HIV, visto que esses exames complementam-se para a detecção de lesões que estejam relacionadas ao câncer anorretal.

OBJECTIVE: Screening for HPV as well as its correlation with anorectal cancer in patients carrying the human immuno deficiency virus (HIV) through high-resolution anoscopy (HRA) and anal cytology. METHODS: We developed an observational study, double-blind attended by 31 patients with HIV independent proctologic complaints. Patients underwent HRA and anal cytology slides were sent to which sector pathology staining and analysis. RESULTS: We found 22 males and 9 females between 20 and 67 years. Of the 31 tested, 4 were in stage of immunosuppression, 23 were using antiretroviral therapy, 16 with history of receptive anal sex and 12 with a history of condyloma acuminata. In the HRA 11 patients had changes and 7 were confirmed by cytology. We also verified eight patients with abnormal cytology who had no changes to the HRA. In the atypical squamous cells of undetermined significance (Ascus) cytology had three, five with parakeratosis and/or hyperkeratosis, six intraepithelial lesions and a low grade squamous intraepithelial lesion high grade. CONCLUSION: We suggest the use of anoscopy high resolution combined with anal cytology for screening in patients with the HIV, since these examinations are complementary for the detection of lesions that are related to anorectal cancer.