Study of the upper pole after subtotal splenectomy in rats.

PURPOSE: To evaluate macro/microscopic viability of the upper pole (UP) in rats after 80 days of subtotal splenectomy preserving the upper pole (SSPUP). METHODS: Twenty-five male Wistar rats were submitted to SSPUP. After 80 days, the rats were euthanized, and the remaining UP was evaluated macroscopically regarding appearance, color, consistency, length, width, thickness, and presence of fibrosis/necrosis; and microscopically regarding presence of red and white pulp, fibrosis/necrosis. RESULTS: Two rats died during surgery and were removed from the statistical analysis. There was statistically significant increase in length and width between the pre and postoperative in the experimental group, with no significant difference in thickness. In the manipulation group, the macroscopic appearance of the spleen was normal in pre and postoperative, with viability preserved. In the experimental group, two UP of the spleen were not found during the second surgery. Macroscopically, it was observed absence of fibrosis and necrosis in all cases. Microscopically, the white and red pulp were intact in both groups. Two spleens of rats in the manipulation group presented areas with fibrosis and necrosis focus, which were not enough to be considered inviable. CONCLUSIONS: The UP of the spleen remained viable in 91.3% of the cases.

Macro and microscopic comparison of the upper pole of the spleen with the lower pole in partial splenectomy.

PURPOSE: To evaluate the viability of the upper (UP) and lower pole (LP) of the spleen from a macro and microscopic point of view, after subtotal splenectomy with preservation (SSP) of the UP and the LP. METHODS: Seventeen male Wistar rats, two months old, were submitted to SSPUP and SSPLP and 5 to simulated operation (SG). After 80 days, the rats were euthanized, and the remaining LP and UP and intact spleens were evaluated macroscopically and microscopically. RESULTS: Two rats died during the operation. Macroscopic analysis showed that in 15 LP, one of them was not viable and in 15 UP and in 5 spleens in the SG, all were viable. In the statistical analysis, there was no difference in relation to viability. The LP and UP analyzed showed variation. As for the length, the UP increased significantly; however, in relation to the width, there was a significant increase in the LP in relation to the UP. In addition, the weight of the UP was significantly greater than that of the LP. Microscopic analysis attested viability of the splenic remnants. CONCLUSION: There was no significant difference regarding the viability of UP and LP, in macroscopy and microscopy.

Melanotic schwannoma of the lumbar spine: a case report and literature review / Schwannoma melanocítico da coluna lombar: relato de caso e revisão de literatura / Schwannoma melanótico de la columna lumbar: reporte de un caso y revisión de la literatura

Schwannomas are benign tumors, usually solitary, encapsulated, slow-growing, which have their origin in differentiated neoplastic Schwann cells with extramedullary intradural usual development related to nerve roots. The melanotic schwannoma is a variant of these tumors whose location in almost one third of cases is on the posterior spinal nerve root, with a nonspecific clinical presentation. Magnetic resonance imaging is the most widely used test for the diagnosis, revealing hyperintense T1-weighted sequences and hypointense T2-weighted sequences. Diagnostic confirmation is obtained by histological and immunohistochemical studies, in which there is intense cytoplasmatic pigmentation. There are two distinct types of melanotic schwannomas: sporadic and psammomatous, the latter related to the called Carney complex, a form of multiple endocrine neoplasm with familiar character. In literature we found few cases of these neoplasms, the largest series consisting of five cases. The objective of this study is to report a rare case of melanotic schwannoma of the lumbar spine of the sporadic type of extramedullary location. We also present a brief review of the literature containing the main characteristics of the tumor, including its different forms, differential diagnoses, data from histological and immunohistochemical studies as well as the currently recommended approach in order to contribute to a better understanding of this neoplasm.

Os schwannomas são tumores benignos, geralmente solitários, encapsulados e de crescimento lento, que têm sua origem nas células de Schwann neoplásicas diferenciadas, com desenvolvimento habitual extramedular intradural relacionado com as raízes nervosas. O schwannoma melanocítico é uma variante dessas neoplasias cuja localização em quase um terço dos casos está na raiz nervosa posterior, com apresentação clínica inespecífica. A ressonância magnética é o exame de imagem mais utilizado no diagnóstico, revelando imagens hiperintensas em T1 e hipointensas em T2. A confirmação diagnóstica é obtida através do estudo histológico e imuno-histoquímico, em que se observa intensa pigmentação citoplasmática. Existem dois tipos distintos de schwannomas melanocíticos: o esporádico e o psamomatoso, este último relacionado ao chamado complexo de Carney, uma forma de neoplasia endócrina múltipla de caráter familiar. Na literatura, encontramos poucos casos dessas neoplasias, sendo a maior série composta por cinco casos. Assim, o objetivo deste trabalho é relatar um raro caso de schwannoma melanocítico da coluna lombar do tipo esporádico de localização extramedular. Apresentamos ainda uma breve revisão de literatura contendo as principais características do tumor, incluindo suas diferentes formas, diagnósticos diferenciais, dados do estudo histológico e imuno-histoquímico, bem como a abordagem atualmente preconizada, a fim de colaborar para o melhor entendimento desta neoplasia.

Los schwannomas son tumores benignos, generalmente solitarios, encapsulados y de crecimiento lento, que tienen su origen en las células de Schwann neoplásicas diferenciadas con desarrollo habitual intradural extramedular relacionado con las raíces nerviosas. El schwannoma melanótico es una variante de estos tumores cuya localización en casi un tercio de los casos se encuentra en la raíz nerviosa posterior, con presentación clínica no específica. La resonancia magnética es el examen más ampliamente utilizado en el diagnóstico, con hiperintensidad en secuencias T1 e hiposeñal en T2. La confirmación del diagnóstico se obtiene por el estudio histológico e inmunohistoquímico, en el que existe una intensa pigmentación citoplásmica. Hay dos tipos distintos de schwannoma melanótico: el esporádico y el psamomatoso, este último relacionado con el llamado complejo de Carney, una forma de neoplasia endocrina múltiple de carácter familiar. En la literatura encontramos pocos casos de estos tumores, la serie más grande consta de cinco casos. El objetivo de este trabajo es presentar un caso raro de schwannoma melanótico lumbar del tipo esporádico y de localización extramedular. También presentamos una breve revisión de la literatura que contiene las principales características del tumor, incluyendo sus diferentes formas, los diagnósticos diferenciales, los datos del estudio histológico e inmunohistoquímico, así como el tratamiento recomendado actualmente, a fin de contribuir a una mejor comprensión de esta neoplasia.

Schwannoma melanocítico da coluna lombar: relato de caso e revisão de literatura / Melanotic schwannoma of the lumbar spine: a case report and literature review

Os schwannomas são tumores benignos, geralmente solitários, encapsulados e de crescimento lento, que têm sua origem nas células de Schwann neoplásicas diferenciadas, com desenvolvimento habitual extramedular intradural relacionado a raízes nervosas. O schwannoma melanocítico é variante dessas neoplasias cuja localização em quase um terço dos casos está na raiz nervosa posterior, com apresentação clínica inespecífica. A ressonância magnética é o exame de imagem mais utilizado em seu diagnóstico, revelando imagens hiperintensas em T1 e hipointensas em T2. A confirmação diagnóstica é obtida a partir do estudo histológico e imuno-histoquímico, em que se observa intensa pigmentação citoplasmática. Existem dois tipos distintos de schwannomas melanocíticos: o esporádico e o psammomatoso, este último relacionado ao chamadocomplexo de Carney, uma forma de neoplasia endócrina múltipla de caráter familiar. Existem poucos relatos dessas neoplasias, sendo a maior série composta de cinco casos. O objetivo deste relato é descrever um raro caso de schwannoma melanocítico da coluna lombar do tipo esporádico de localização extramedular. Apresenta-se breve revisão de literatura contendo as principais características do tumor, incluindo suasdiferentes formas, diagnósticos diferenciais, estudo histológico e imuno-histoquímico, bem como a abordagem atualmente preconizada, a fim de colaborar para o melhor entendimento dessa neoplasia.

Schwannomas are benign, usually solitary, encapsulated and of slow growth tumors,which have their origin in differentiated neoplastic Schwann cells, with extramedullaryintradural usual development related to nerve roots. The melanocytic schwannomais a variant of these tumors whose location is on the posterior nerve root, witha nonspecific clinical presentation in almost a third of cases. MRI is the most commonlyused imaging test in the diagnosis, revealing hyperintense images in T1 andhypointense in T2. The diagnostic confirmation is obtained from the histological andimmunohistochemical study where intense cytoplasmic pigmentation is observed.There are two distinct types of melanocytic schwannomas: sporadic and psammomatous;the latter related to the called Carney complex, a form of multiple endocrineneoplasias with a familial character. There are few reports of these neoplasms; thegreatest series is composed of five cases. The objective of this report is to describea rare case of melanocytic schwannoma of the lumbar spine of the sporadic typeand extramedullary location. A brief review of the literature containing the maintumor characteristics is presented, including its different forms, differential diagnosis, histological and immunohistochemical study, and thecurrently recommended approach in order to contributeto a better understanding of this neoplasia.

Immunoexpression of proliferating cell nuclear antigen (PCNA) in spleen of splenectomized rats with preservation of inferior pole, submitted to hyperbaric oxygenation.

PURPOSE: To analyze PCNA immunoexpression on the inferior pole of the spleen of splenectomized rats submitted to hyperbaric oxygenation (HBO). METHODS: Were analyzed fragments of the inferior pole of the spleen of 20 male Wistar rats submitted to splenectomy with preservation of the inferior pole. The rats were divided in two groups: group A (n=10) without HBO and group B (n=10) submitted to HBO at 2, 5 atmospheres per 120 minutes, twice a day for three days and once a day for seven days. The groups were then subdivided in four subgroups: A15 (n=5), with euthanasia on the 15th day; A45 (n=5), with euthanasia on the 45th day; B15 (n=5) with euthanasia on the 15th day and B45 with euthanasia on the 45th day. Respectively on these days, fragments of the inferior pole of the spleen of all animals were collected and analyzed with the immunohistochemistry technique in order to evaluate PCNA expression. RESULTS: There was an expressive increase in PCNA immunoreactivity in the group B. The 45 day postoperative period resulted in a higher level of positivity than the 15 day postoperative period (p<0.01). CONCLUSION: The quantitative analysis of proliferating cell nuclear antigen positive suggests that hyperbaric oxygenation increases cellular proliferation, contributing to splenic regeneration.

Immunoexpression of proliferating cell nuclear antigen (PCNA) in spleen of splenectomized rats with preservation of inferior pole, submitted to hyperbaric oxygenation

PURPOSE: To analyze PCNA immunoexpression on the inferior pole of the spleen of splenectomized rats submitted to hyperbaric oxygenation (HBO). METHODS: Were analyzed fragments of the inferior pole of the spleen of 20 male Wistar rats submitted to splenectomy with preservation of the inferior pole. The rats were divided in two groups: group A (n=10) without HBO and group B (n=10) submitted to HBO at 2, 5 atmospheres per 120 minutes, twice a day for three days and once a day for seven days. The groups were then subdivided in four subgroups: A15 (n=5), with euthanasia on the 15th day; A45 (n=5), with euthanasia on the 45th day; B15 (n=5) with euthanasia on the 15th day and B45 with euthanasia on the 45th day. Respectively on these days, fragments of the inferior pole of the spleen of all animals were collected and analyzed with the immunohistochemistry technique in order to evaluate PCNA expression. RESULTS: There was an expressive increase in PCNA immunoreactivity in the group B. The 45 day postoperative period resulted in a higher level of positivity than the 15 day postoperative period (p<0.01). CONCLUSION: The quantitative analysis of proliferating cell nuclear antigen positive suggests that hyperbaric oxygenation increases cellular proliferation, contributing to splenic regeneration.

Histological profile and age at diagnosis of breast and ovarian tumors: A register-based study in Espirito Santo, Brazil.

Breast and ovarian cancers are important public health problems in Brazil. However, in various locations in the Brazilian territory these types of cancer remain poorly characterized. Therefore, this study aimed to compare data collected from the Pathology Services of two Oncology Reference Hospitals in Espirito Santo state (Brazil) with the data in previous Brazilian studies. Histological type frequency and age at diagnosis of breast and ovarian tumors between 2001-2004 and 2009-2010 were analyzed. Tumor size, histological grade, lymph node status, hormone receptor status [estrogen (ER) and progesterone receptors (PR)] as well as HER2 and Ki-67 marker status were obtained for the cases of infiltrating ductal carcinomas of the breast during the period 2009-2010. Categorical variables were described by their absolute and/or relative frequencies, while quantitative variables were expressed as the mean ± standard deviation and median, using 95% confidence intervals. Chi-square tests were performed to examine whether or not the studied variables differed by age at the time of diagnosis. Malignant breast tumors (1,758) and 119 malignant ovarian tumors were examined. Mean ages for malignant breast and ovarian tumors were 53.59 and 52.98 years, respectively. An increased tumor frequency in the age group of ≤35 years was observed for other malignant tumors of the breast during the period of 2009-2010, compared to 2001-2004. When considering only infiltrating ductal carcinomas with immunohistochemistry records available, there were 82.1% (133 cases) of ER+/PR+ tumors, 1.9% (3 cases) of ER-/PR-/HER2 3+ and 16.04% (26 cases) of ER-/PR-/HER2- tumors. The findings of this study demonstrated detailed information concerning breast and ovarian tumor behavior in the Espirito Santo state (Brazil), allowing for a precise comparison with other populations (Brazilian or international), which may be helpful in the planning of prevention and treatment strategies.

Edema agudo hemorrágico da infância: relato de três casos / Acute hemorrhagic edema of infancy: report of three cases

O Edema Agudo Hemorrágico da Infância é uma vasculite leucocitoclástica pouco frequente, que ocorre, quase exclusivamente, em crianças entre 4 meses e 2 anos de idade. Caracteriza-se, clinicamente, pela tríade febre, lesões purpúricas na face, pavilhões auriculares e extremidades e edema. Embora os achados cutâneos sejam dramáticos e de surgimento rápido, o prognóstico é favorável, com resolução espontânea dentro de 1 a 3 semanas. Descrevem-se três casos cujos achados clínicos e histopatológicos são característicos de edema agudo hemorrágico da infância.

Acute Hemorrhagic Edema of Infancy is an infrequent leukocytoclastic vasculitis which occurs almost exclusively in children between 4 months and 2 years of age. It is clinically characterized by the triad fever, purpuric lesions on the face, auricular pinna and extremities, and edema. Although the cutaneous findings are dramatic and of rapid onset, the prognosis is favorable, with spontaneous resolution within 1 to 3 weeks. Three cases are described in which clinical and histopathological findings are characteristic of acute hemorrhagic edema of infancy.

Síndrome carcinoide: relato de caso / Carcinoid syndrome: case report

JUSTIFICATIVA E OBJETIVOS: O tumor carcinoide é uma neoplasia rara, com prevalência de apenas 2,47 a 4,48 casos para cada 100.000 habitantes/ano, sendo a síndrome carcinoide ainda mais rara, estando presente em apenas 5% a 7% dessas neoplasias.Na imensa maioria das vezes, só se detecta o tumor quandoo paciente já apresenta sintomas da síndrome, tais como: flushing, diarreia, dor abdominal, telangiectasia, alterações cardíacas, broncoespasmo e pelagra. O objetivo deste estudo foi o de alertar para se incluir a suspeita de síndrome carcinoide como diagnóstico diferencial com outras condições que podem se apresentar com sintomas similares, como climatério, feocromocitoma, anafilaxia, uso de certos medicamentos, ingestão alcoólica e até mesmo a febre. RELATO DO CASO: Paciente do sexo feminino, 42 anos, apresenta há seis anos quadro de flushing na face, pescoço, tronco e membros superiores, evoluindo com eritema telangectásico e há um ano diarreia. Suspeitou-se de síndrome carcinoide, que se confirmou por meio da dosagem do ácido 5-hidroxindolacético na urina de 24h. A investigação prosseguiu com colonoscopia em que se encontrou lesão tumoral em íleo terminal, cuja histopatologia confirmou tumor carcinoide. Foi realizado tratamento com doses mensais de análogos da somatostatina de ação prolongada e programada cirurgia de ressecção tumoral. CONCLUSÃO: A síndrome carcinoide é uma manifestação rara e tardia do tumor, mas é fundamental que o clínico saiba identificá-la, pois apesar do prognóstico já ser desfavorável nessa fase, é possível ainda proporcionar melhor qualidade de vida ao paciente, com bom controle dos sintomas.

BACKGROUND AND OBJECTIVES: Carcinoid tumors are rare with a prevalence of only 2.47 to 4.48 cases per 100.000 inhabitants/year and the carcinoid syndrome is even rarer, present in 5% to 7% of the cases. In most patients, the neoplasm is detectedonly when the syndrome symptoms turn evident - flushing, diarrhea, abdominal pain, telangiectasia, cardiac manifestations, bronchospasm and pellagra. This case report objective was to alert for the importance of including carcinoid syndrome as a differential diagnosis of other conditions that could present similar symptoms like climacterium, pheochromocytoma, anaphylaxis, use of some medications, alcohol ingestion and also fever. CASE REPORT: Female patient, 42 years, has been presentingfor six years flushing episodes on face, neck, trunk and arms.Lately, could be observed telangiectasia and diarrhea. Carcinoid syndrome was suspected and the measurement of 24 hour urine5-hydroxyindoleacetic acid confirmed the diagnosis. The investigation proceeded with a colonoscopy which evidenced a tumoral lesion on the terminal ileum and the histopathology confirmed carcinoid tumor. Treatment was based on mensal doses of longacting somatostatin analogue for posterior tumor resection. CONCLUSION: Carcinoid syndrome is a rare and late tumor manifestation but it is fundamental for the clinician to knowhow to identify the symptoms because although the prognosisis already disfavorable at this stage, it is still possible to providequality of life and good symptoms control.

Acute hemorrhagic edema of infancy: report of three cases.

Acute Hemorrhagic Edema of Infancy is an infrequent leukocytoclastic vasculitis which occurs almost exclusively in children between 4 months and 2 years of age. It is clinically characterized by the triad fever, purpuric lesions on the face, auricular pinna and extremities, and edema. Although the cutaneous findings are dramatic and of rapid onset, the prognosis is favorable, with spontaneous resolution within 1 to 3 weeks. Three cases are described in which clinical and histopathological findings are characteristic of acute hemorrhagic edema of infancy.

Coriocarcinoma primário de ovário: relato de um caso em paciente de 10 anos de idade / Primary ovarian choriocarcinoma: case report in a 10-year-old patient

O coriocarcinoma primário de ovário é um tumor raro que se origina de células germinativas, apresentando-se, na maioria das vezes, associado a outros tumores também de origem de células germinativas. Será descrito um caso de coriocarcinoma primário de ovário em uma menina de 10 anos que apresentava um quadro de sangramento vaginal e distensão abdominal. Após serem dosados os marcadores tumorais, que mostraram níveis de beta-HCG (gonadotrofina coriônica humana) e CA-125 altos, e alfafetoproteína normal, e ser realizado ultrassonografia abdominal, a paciente foi submetida a tratamento cirúrgico. O exame histopatológico da peça cirúrgica e a imunohistoquímica foram compatíveis com diagnóstico de coriocarcinoma primário de ovário. Depois da cirurgia, apaciente evoluiu mal, indo a óbito no primeiro dia de pós-operatório devido a uma embolia tumoral pulmonar. Concluiu-se, então, que essa neoplasia é bastante agressiva, causando metástase precoce na maioria dos casos e apresentando prognóstico desfavorável, principalmente em jovens abaixo de 20 anos de idade.

Fibromixoma mamário / Mammary fibromyxoma

O fibromixoma ou mixoma mamário é uma neoplasia mesenquimal benigna, rara, considerada uma forma de fibroma que se diferencia pela capacidade de o fibroblasto produzir mucina. Daí também se denomina mucinose focal. O fibromixoma pode apresentar-se nas formas mucocutânea, cardíaca e mamária. A relação com história familiar é vista em alguns casos e, se associada à neoplasia endócrina múltipla, caracteriza o chamado complexo de Carney ou complexo mixoma. A ocorrência de malignização para mixossarcoma é extremamente rara. O objetivo deste trabalho é relatar um caso clínico de fibromixoma mamário: paciente jovem, 22 anos, que aos 15 anos apresentou um nódulo de cerca de três centímetros na aréola direita, de consistência borrachosa. Submeteu-se à exérese cirúrgica da lesão na Santa Casa de Misericórdia de Vitória. O estudo histopatológico evidenciou fibromixoma mamário. Apresentou recidiva da lesão dois anos após, e esta foi crescendo lentamente. Em 2006, procurou novamente o serviço, com lesão nodular de cerca de quatro centímetros, lobulada, no mesmo local. Não apresentava outras lesões associadas. Submeteu-se a exérese cirúrgica, estudos histopatológico e imunoistoquímico, confirmando a recidiva do fibromixoma e descartando malignização.

The fibromyxomas or mamary myxoma is a rare benign mesenchymal neoplasm which is considered to be a form of fibroma and is characterized by the capacity of the fibroblast to produced mucin. Thus it is also called focal mucinous. The fibromyxoma can appear in mucocutaneous, cardiac, or mammary forms.In some cases, it is a related to family history, and if it is associated with multiple endocrinal neoplasm, it characterizes the so-called Carney complex or myxoma complex. The occurrence of malignancy for a myxosarcoma is extremely rare. This paper aims to relate a clinical case study of mammary fibromyxoma: a young patient, 22 years old, who happened to have a three-centimeter foamy growth in the right areola when she was 15 years. This young patient underwent a surgery at Santa Casa de Misericordia in Vitória, ES, and had the growth extracted. The histopathological study confirmed the presence of a mammary fibromyxoma. After two years, a lesion had reappeared in the same place, and it grew slowly. In 2006 same patient seeked again the service with a nodular lesion of about four centimeters, lobuled, in the same location. No other associated lesions were found. She was submitted to surgical extraction, histopathological and immunohistochemical investigations, confirming the fibromyxoma.recurrence without showing malignancy.