RESUMO
We report a case of follicular dendritic cell sarcoma (FDCS) in a 60-year-old Ugandan female who presented with a 6-year history of a progressive left sided tonsillary mass. General systemic examination was unrevealing and the patient underwent left tonsillectomy. She was subsequently lost to follow-up. Grossly, the mass measured 6 cm in diameter and had a mottled appearance due to tissue microhaemorrhages. Markers specific for follicular dendritic cell differentiation (CD21, CD35 and CD23), p53 and EGFR were expressed on immunohistochemical analysis. Review of all of the 49 published reports of tonsil FDCS showed that this entity tended to occur at younger age (mean: 44.5 yrs) in women than in men (mean: 49.4 yrs). Tumour size ranged from 0.8 to 5 cm in maximum dimension (mean 2.9 cm). Only 12.2% of the patients presented with metastatic disease at initial diagnosis, all localised in the cervical lymph nodes. Local or distant recurrences occurred after a mean period of 72.5 months. In conclusion, although the pertinent literature suggests that FDCS should be considered at least of intermediate grade, our review indicates that FDCS of the tonsil region behaves as a low-grade sarcoma.
Assuntos
Sarcoma de Células Dendríticas Foliculares/patologia , Neoplasias Tonsilares/patologia , Biomarcadores Tumorais , Sarcoma de Células Dendríticas Foliculares/diagnóstico , Sarcoma de Células Dendríticas Foliculares/terapia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Tonsila Palatina , Neoplasias Tonsilares/diagnóstico , Neoplasias Tonsilares/terapiaAssuntos
Neurofibromatose 1/complicações , Sarcoma/complicações , Sarcoma/diagnóstico , Neoplasias Vulvares/complicações , Neoplasias Vulvares/diagnóstico , Adulto , Antineoplásicos/uso terapêutico , Evolução Fatal , Feminino , Humanos , Sarcoma/tratamento farmacológico , Sarcoma/cirurgia , Fatores de Tempo , Neoplasias Vulvares/tratamento farmacológico , Neoplasias Vulvares/cirurgiaRESUMO
Schwannoma, also referred to as neurilemmoma or peripheral neurinoma, is an unusual orbital benign tumour that may pose diagnostic challenges. Awareness of the clinical features that may be associated with the tumour and prompt surgical excision with histopathologic examination enable correct diagnosis. The authors describe a progressively increasing inferolateral orbital mass in a 32-year-old patient that was demonstrated to be an orbital ancient schwannoma.
Assuntos
Neurilemoma/patologia , Neoplasias Orbitárias/patologia , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Neurilemoma/cirurgia , Neoplasias Orbitárias/cirurgiaRESUMO
In the project of active research of occupational diseases was conducted a study on 45 welders in the engineering companies, with particular attention to the hazards of exposure to the optical radiation. The protocol used involved the execution of Breack Up test, Schirmer test, corneal staining and scraping cytology. It revealed that more than half of the welders had ocular lesions referable to their work activity as well as some permanent functional damages with the characters of dry eye syndrome. None of these diseases, which could alert for medical-legal and insurance, was highlighted by the occupational health physician.
Assuntos
Síndromes do Olho Seco/epidemiologia , Engenharia , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Soldagem , Adulto , Humanos , Inquéritos e QuestionáriosRESUMO
Studies to define the optimal upper limits of tumor size and number as predictors of outcome after orthotopic liver transplantation (OLT) have yielded conflicting results. We analyzed 72 patients with cirrhosis and hepatocellular carcinoma (HCC) who underwent OLT over a 12-year period in a single center. Predictive factors for survival and tumor recurrence, according to the Milan criteria, were also examined. Our cohort included 60 men and 12 women of mean age 54 +/- 8 years and mean follow-up of 40 +/- 39 months. Origin of cirrhosis was postviral in 70% and Child class B or C in two thirds of patients. HCC was multifocal in 61%; about one fifth of patients had micro- or macrovascular involvement or positive nodes upon histologic examination. The cumulative size of the lesions was <3 cm in 17 patients; >3 to < or =5 cm in 28 patients; >5 to < or =8 cm in 14 patients; and >8 cm in 13 patients. According to the number and size of tumor nodules, 49 patients met the Milan criteria. During follow-up 25 patients died, 13 due to tumor recurrence. The 1- and 2-year survivals were 90% and 85% for patients who met the Milan criteria versus 57% and 51% for patients exceeding those limits (P = .006). A cumulative tumor size >8 cm was predictive of survival and tumor recurrence upon multivariate analysis. The adoption of Milan criteria for selection of cirrhotic patients has improved survival and reduced the rate of tumor recurrence. The evaluation of cumulative tumor size might further improve patient selection.
Assuntos
Carcinoma Hepatocelular/cirurgia , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/fisiologia , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Neoplasias Hepáticas/patologia , Transplante de Fígado/mortalidade , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
A 58-year-old man developed psoriatic arthritis and, after 6 months, persistent watery diarrhoea. Biopsies from the colorectal mucosa showed thickened subepithelial collagen consistent with collagenous colitis. There also was an inflammatory cell infiltration (mainly lymphocytes and monocytes) in the chorion. These findings and the parallel course of articular and bowel complaints suggest a clinicopathologic correlation between arthritis and colic involvement.
Assuntos
Artrite Psoriásica/complicações , Colite/complicações , Colágeno/metabolismo , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Psoriásica/metabolismo , Artrite Psoriásica/patologia , Artrografia , Colite/metabolismo , Colite/patologia , Quimioterapia Combinada , Humanos , Mucosa Intestinal/metabolismo , Mucosa Intestinal/ultraestrutura , Articulações/patologia , Cetoprofeno/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Microscopia Eletrônica , Pessoa de Meia-Idade , Sulfassalazina/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Oxalato de Cálcio/análise , Transplante de Rim , Rim/química , Adolescente , Adulto , Idoso , Criança , Cristalização , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
AIMS: To study ocular pathology and systemic correlations in a series of 73 postmortem eyes from British patients who died from AIDS before the introduction of a HAART regimen. METHODS: The eyes were studied with conventional histology, special histochemical stainings, and immunohistochemistry. RESULTS: 72.6% of the cases showed chronic uveal inflammation, caused by opportunistic agents in 37.7% of them (cytomegalovirus (CMV) in 30.1%, C neoformans in 5.6%, and Gram positive bacteria in 1.8%). Cytoid bodies were noted in 10/73 eyes, three linked to CMV retinitis. Six retinal haemorrhages, four of which were secondary to CMV, were found. 14 specimens (19. 1%) showed foci of calcification, and a further 11 (15%) calcium oxalate deposits. In no cases were the calcific deposits suspected clinically. Six eyes (8.2%) did not show any abnormality. CONCLUSIONS: CMV retinitis is the most common (28.7%, 21/73) ocular infection in this series and may occur either during or in the absence of systemic dissemination. Conversely, ocular cryptococcosis appears to be an epiphenomenon of systemic and CNS disease. No other opportunistic ocular infections were present in this series. Interesting findings were the presence of intraocular precipitates of calcium oxalate and calcium phosphate or carbonate in a significant number of cases (15% and 19%, respectively), and the high prevalence of idiopathic uveal inflammation (43.8%).
Assuntos
Retinite por Citomegalovirus/patologia , Infecções Oculares/patologia , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Terapia Antirretroviral de Alta Atividade , Autopsia , Retinite por Citomegalovirus/complicações , Infecções Oculares/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/patologia , Reino Unido/epidemiologiaRESUMO
OBJECTIVES: To compare histological with genome detection methods for diagnosis of herpesvirus infection in eye and brain of HIV infected patients undergoing necropsy and to correlate these findings with both antemortem clinical findings and postmortem evidence of extraocular herpesvirus infection, especially in the CNS. METHODS: A prospective study of 31 consecutive HIV infected patients undergoing necropsy. In life 11 patients had been assessed by an ophthalmologist because of ocular symptoms. Ocular and brain samples were examined for herpesviruses by conventional histological methods and by nested polymerase chain reaction (nPCR) for all eight human herpesviruses; evidence of extraneural herpesvirus infection was sought by histological methods. RESULTS: Although only 12 out of 31 patients (39%) had antemortem clinical evidence of ocular or CNS herpesvirus associated disease, herpesviruses were detected by nPCR in eye and brain from 26 (84%) patients; six patients had more than one herpesvirus infection. There was concordance between ocular and CNS findings in 15 of 19 patients (79%) with CMV infection. 17 of 31 patients (55%) had extraocular or CNS CMV infection at necropsy. Genome detection using nPCR was superior to histological methods for diagnosis of ocular and CNS herpesvirus infection. CONCLUSION: Herpesvirus infection of eye and brain was a frequent finding at necropsy in this group of HIV infected patients; almost a fifth were co-infected by more than one herpesvirus. This was more than twice the incidence predicted from clinical evidence before death. Genome detection using nPCR was superior to histological methods for diagnosis of ocular and CNS herpesvirus infection.
Assuntos
Encefalopatias/diagnóstico , Infecções Oculares Virais/diagnóstico , Infecções por HIV/complicações , Infecções por Herpesviridae/diagnóstico , Adulto , Encefalopatias/virologia , Retinite por Citomegalovirus/diagnóstico , Feminino , Herpesviridae/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase/métodos , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
A large mass in the right orbit, causing proptosis, ptosis of the right upper eyelid, and limitation to eye movements, was surgically removed from a 51-year-old woman suffering from Paget's bone disease (PBD). Histologically, a giant cell tumor of the bone (osteoclastoma) was diagnosed. No bony involvement was apparent either operatively, microscopically, or on preoperative computed tomographic scans. The neoplasm has not recurred in a 3-year follow-up. In addition to the fact that osteoclastoma complicating PBD is rare, the extraskeletal origin of the tumor is a matter of interest and can be tentatively explained by an unusually powerful systemic stimulus acting on circulating osteoclast precursors. HUM PATHOL 31:1527-1531.
Assuntos
Tumor de Células Gigantes do Osso/patologia , Neoplasias Orbitárias/patologia , Osteíte Deformante/patologia , Neoplasias de Tecidos Moles/patologia , Feminino , Tumor de Células Gigantes do Osso/diagnóstico por imagem , Tumor de Células Gigantes do Osso/etiologia , Tumor de Células Gigantes do Osso/cirurgia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/etiologia , Neoplasias Orbitárias/cirurgia , Osteíte Deformante/complicações , Osteíte Deformante/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/etiologia , Neoplasias de Tecidos Moles/cirurgia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: The eyelids of 15 AIDS patients (17 specimens) were examined histologically at postmortem. METHODS: Formalin-fixed, paraffin-embedded and haematoxylin-eosin stained sections were examined by conventional light microscopy. The presence of calcific deposits was confirmed by special stains and elemental analysis (X-ray energy dispersive spectroscopy). RESULTS: 6 cases had abnormal microscopical findings. In two cases deposits of calcium oxalates were observed in the wall of dermal blood vessels and in epithelial cells of sweat and sebaceous glands, respectively. Precipitates of calcium phosphate were observed in the superficial substantia propria of the palpebral conjunctiva in an additional patient. Other histological findings in the remaining three patients included flat warts, an unusual elastotic degeneration of the forniceal palpebral conjunctiva and more common lesions (chalazion, Demodex folliculorum infestation of the eyelashes, trichilemmal cyst). CONCLUSION: The presence of microscopical lesions in nearly half of this small series demonstrates that the eyelids may be affected subclinically in AIDS patients.
Assuntos
Síndrome da Imunodeficiência Adquirida/patologia , Pálpebras/patologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/metabolismo , Adulto , Cadáver , Oxalato de Cálcio/metabolismo , Fosfatos de Cálcio/metabolismo , Túnica Conjuntiva/metabolismo , Túnica Conjuntiva/patologia , Doenças Palpebrais/complicações , Doenças Palpebrais/patologia , Pálpebras/metabolismo , Humanos , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Distribuição Tecidual , Verrugas/complicações , Verrugas/patologiaRESUMO
In a series of 98 consecutive eyeballs enucleated at postmortem from 86 patients dying with AIDS, the incidence of calcium deposits was 14 and 18.6%, respectively, for oxalates and calcium hydroxyapatite. The calcific eyes were examined by scanning electron microscopy (SEM) coupled with energy-dispersive X-ray microanalysis to confirm the elemental nature of the precipitates. Transmission electron microscopy was used in 2 of the cases with oxalosis. Oxalates with a free end exhibited a plate-like shape at SEM and appeared acicular at TEM, due to the reduced thickness of ultrathin sections. Crystals that were embedded in tissues such as the sclera or degenerate detached retinal tissue formed either spherules or plates at SEM. No clear relationship with intracellular structures could be found at TEM, possibly due to postmortem autolysis phenomena. Calcium hydroxyapatite deposits appeared at SEM as fine granules distributed over the collagen fibers of the corneal and conjunctival stroma and the scleral lamellae, but were also present intracellularly, both in the nucleus and cytoplasm of epithelial cells.
Assuntos
Síndrome da Imunodeficiência Adquirida/patologia , Calcinose/patologia , Oxalato de Cálcio/análise , Durapatita/análise , Oftalmopatias/patologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/metabolismo , Adulto , Calcinose/complicações , Calcinose/metabolismo , Microanálise por Sonda Eletrônica , Olho/química , Olho/ultraestrutura , Oftalmopatias/complicações , Oftalmopatias/metabolismo , Feminino , Humanos , Masculino , Microscopia Eletrônica de Varredura , Pessoa de Meia-IdadeRESUMO
The significance of anti-hepatitis C virus (HCV) core immunoglobulin M (IgM) and its relationship with genotypes, alanine aminotransferase abnormality, and histological data were studied for 18 patients who had undergone orthotopic liver transplantation due to HCV-related end-stage disease. During follow-up, IgM response seemed to be associated with the recurrence of HCV infection but did not correlate with abnormal alanine aminotransferase levels and histological data. In addition, the results of this study indicated that the detection of HCV RNA is critical for diagnosis of reinfection in liver transplantation.
Assuntos
Hepacivirus/imunologia , Hepacivirus/isolamento & purificação , Anticorpos Anti-Hepatite C/imunologia , Hepatite C/diagnóstico , Imunoglobulina M/imunologia , Transplante de Fígado/efeitos adversos , Hepatite C/etiologia , Hepatite C/virologia , Anticorpos Anti-Hepatite C/análise , Humanos , Imunoglobulina M/análiseRESUMO
A case of inflammatory pseudotumour of the liver is reported, and evidence is presented for its subsequent evolution into malignant non-Hodgkin's lymphoma. Such postulated malignant transformation challenges the assumption that hepatic inflammatory tumours are entirely benign lesions.
Assuntos
Transformação Celular Neoplásica/patologia , Granuloma de Células Plasmáticas/patologia , Hepatopatias/patologia , Linfoma não Hodgkin/patologia , Adulto , Evolução Fatal , Granuloma de Células Plasmáticas/complicações , Granuloma de Células Plasmáticas/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Hepatopatias/complicações , Hepatopatias/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/etiologia , Masculino , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
PURPOSE: Eighty-six post-mortems of AIDS patients were reviewed microscopically and the presence of cytomegalovirus (CMV) infection in the viscera, brain and eye was recorded. METHODS: Immunohistochemical stains and in situ hybridisation with a CMV probe were performed. RESULTS AND CONCLUSION: CMV infection was observed in 63% of the cases. Visceral, cerebral and ocular involvement were overall 49%, 33% and 29%, respectively. The visceral form with no concomitant ocular and/or cerebral infection was the main cause of death (31%) in the 54 CMV-infected patients. Although CMV retinitis occurred mostly (20%) as a component of systemic disease, in 13% of the CMV-infected patients the eyes only were involved, while there were no cases with CMV limited to the brain. In the absence of systemic involvement, 9% of the cases showed concomitant ocular and cerebral infection, but because we failed to observe CMV optic neuritis without ocular involvement, retrograde viral spread from the brain through the optic nerve appears to be an infrequent mechanism of CMV retinitis.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/patologia , Retinite por Citomegalovirus/patologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Autopsia , Encefalopatias/patologia , Encefalopatias/virologia , Estudos de Coortes , Infecções por Citomegalovirus/patologia , Feminino , Humanos , Técnicas Imunoenzimáticas , Hibridização In Situ , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Benign oncocytomas of the accessory lacrimal glands can be found in the lacrimal caruncle, plica semilunaris or conjunctival fornices, but are extremely rare. A series of 15 supposed oncocytomas of the ocular adnexa was reviewed retrospectively, and histological differences were noted with respect to the parotid gland counterpart. Lesions could be divided into three histological groups: (1) tumours composed of tubules lined by tall columnar epithelium with finely granular cytoplasm; the tubules often had dilated lumens containing mucinous secretion; (2) cystic tumours with prominent epithelial tufts projecting from much of the cyst wall; (3) tumours with solid areas composed of variably cuboidal or polygonal cells, largely in trabecular arrangement, and co-existing with the previously described tubular and cystic elements. A striking resemblance to Warthin's tumour without a lymphocytic component, such as may affect the parotid salivary gland, was noted in several tumours.
Assuntos
Adenoma Oxífilo/patologia , Neoplasias Oculares/patologia , Aparelho Lacrimal/patologia , Glândulas Salivares/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Neoplasias Oculares/diagnóstico , Nevo/diagnóstico , Adolescente , Feminino , Humanos , Imuno-HistoquímicaRESUMO
We report the presence of peculiar nonbanded calcification of the cornea in three patients with acquired immunodeficiency syndrome, discovered on postmortem histological examination of the globes. In one patient, multiple calcium salt precipitates also affected other ocular and orbital structures. Calcium deposits were present in the corneal stroma but spared Bowman's layer, as is usually seen in primary and secondary corneal calcification. The calcified areas were positive to von Kossa, alizarin red, alcian blue, and colloidal iron stains. Electron probe analysis of the three cases showed the presence of calcium and phosphorus in a ratio characteristic for hydroxyapatite. No predisposing factors could be found. The possible role of associated alterations in the mucopolysaccharide content or composition in the calcified areas is unclear.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Calcinose/complicações , Oftalmopatias/complicações , Adulto , Calcinose/metabolismo , Calcinose/patologia , Microanálise por Sonda Eletrônica , Oftalmopatias/metabolismo , Oftalmopatias/patologia , Humanos , Masculino , Microscopia Eletrônica de Varredura , Doenças Orbitárias/complicações , Doenças Orbitárias/patologiaRESUMO
Review of a series of 98 eyes removed at autopsy from 86 AIDS patients identified 12 cases (14%) showing varying degrees of microscopic calcium oxalate deposition. The oxalate crystals were birefringent using polarisation microscopy and were stained histochemically by the silver nitrate-rubeanic acid method (Yasue), a stain considered to be specific for calcium oxalate. In two cases, the deposition was extensive and involved the surface of the ciliary processes, ciliary body and pars plana of the retina, the retinal and optic nerve blood vessel wall, a few retinal pigment cells, and the anterior inner sclera. A lesser degree of intraocular involvement was observed in the remaining 10 cases. In all but two eyes, where a peripheral active area of cytomegalovirus retinitis was present, no other significant microscopical abnormality was found. Clinically, these patients were asymptomatic. At autopsy, oxalate deposits were found in the kidney and/or thyroid in seven of the patients.