[Diffuse bone marrow metastasis in cerebellar high-grade astrocytoma. A case report]. / Metastasis difusa de la medula osea en un astrocitoma cerebeloso de alto grado. Un caso clinico.

INTRODUCTION: Cerebellar high-grade astrocytoma is uncommon. Although more prone to present cerebrospinal fluid dissemination, the cerebellar location is not particularly related to the occurrence of extra-cranial metastases, which are also unusual in supratentorial malignant gliomas. CASE REPORT: A 46 year-old man with cerebellar anaplastic astrocytoma who developed pancytopenia due to extensive bone marrow metastases. CONCLUSION: Extraneural metastases of brain gliomas are rare and the spread to the bone marrow confers an extremely poor prognosis for these patients. The expected improvement in glioma patients' survival due to the combination of more efficient therapies may lead to an increased incidence of this uncommon presentation, justifying a more rigorous follow-up of systemic manifestations.

Amerindian women of the Brazilian Amazon and STD.

Papanicolaou tests, PCR for HPV, C. trachomatis, HSV-1/2 and N. gonorrhoea, and Hybrid Capture II were performed for high- and low-risk HPV groups during screening for cervical cancer in 49 women of the Parakana tribe. Cytological diagnoses of HPV were suggested in three samples: PCR showed 12 (22.4%) cases of DNA positive HPV, 16 (1), 18 (2), 58 (3), 39 (1), 61 (1), 33 (1), 35 (1), unknown (2), and HCII analyzed 48 samples: 19 positive (39.58%) for the high-risk group and four (18.33%) for the low-risk group. The prevalence of HPV was 42.85% (p = 0.001) by molecular biology methods. The largest viral load was 1588.11 pg/ml for HPV 39 in a 16-year-old. PCR was positive for C. trachomatis and negative for HSV-1/2 and N. gonorrhoea. Parakana women present a high risk for the development of cervical cancer.

Mild hypothermia reduces polymorphonuclear leukocytes infiltration in induced brain inflammation

Over the last 50 years deep hypothermia (23 degrees C) has demonstrated to be an excellent neuroprotective agent in cerebral ischemic injury. Mild hypothermia (31-33 degrees C) has proven to have the same neuroprotective properties without the detrimental effects of deep hypothermia. Mechanisms of injury that are exaggerated by moderate hyperthermia and ameliorated by hypothermia include, reduction of oxygen radical production, with peroxidase damage to lipids, proteins and DNA, microglial activation and ischemic depolarization, decrease in cerebral metabolic demand for oxygen and reduction of glycerin and excitatory amino acid (EAA) release. Studies have demonstrated that inflammation potentiates cerebral ischemic injury and that hypothermia can reduce neutrophil infiltration in ischemic regions. To further elucidate the mechanisms by which mild hypothermia produces neuroprotection in ischemia by attenuating the inflammatory response, we provoked inflammatory reaction, in brains of rats, dropping a substance that provokes a heavy inflammatory reaction. Two groups of ten animals underwent the same surgical procedure: the skull bone was partially removed, the duramater was opened and an inflammatory substance (5% carrageenin) was topically dropped. The scalp was sutured and, for the group that underwent neuroprotection, an ice bag was placed covering the entire skull surface, in order to maintain the brain temperature between 29.5-31 degrees C during 120 minutes. After three days the animals were sacrificed and their brains were examined. The group protected by hypothermia demonstrated a remarkable reduction of polymorphonuclear leukocytes (PMNL) infiltration, indicating that mild hypothermia can have neuroprotective effects by reducing the inflammatory reaction.

Nos últimos 50 anos, a hipotermia tem demonstrado ser um excelente agente neuroprotetor nas lesões isquêmicas encefálicas. A hipotermia moderada (310 C - 330 C) provou também apresentar as mesmas propriedades protetoras, sem os efeitos deletérios da hipotermia profunda. Dentre alguns mecanismos de lesão que são melhorados pela hipotermia e piorados pela hipertermia moderada, podemos citar a diminuição da demanda de oxigênio pelo encéfalo e a redução da glicina e aminoácidos excitatórios, evitando a produção de radicais de oxigênio, com aumento da peroxidase e conseqüente lesão aos lípides, proteínas e DNA, assim como pela ativação microglial e despolarização isquêmica. Alguns estudos demonstraram que a inflamação potencializa a lesão isquêmica e que a hipotermia pode reduzir a infiltração leucocitária nas áreas isquêmicas. Para melhor elucidar os mecanismos pelos quais a hipotermia apresenta efeito neuroprotetor através da redução da inflamação, no processo isquêmico, escolhemos o método utilizando a indução de uma reação inflamatória com a utilização de uma substância com capacidade promover intensa reação inflamatória em encéfalos de ratos. Dois grupos de dez animais foram submetidos a um mesmo procedimento cirúrgico: a calota craniana foi parcialmente removida, a duramáter aberta e uma substância com potente efeito inflamatório (carragenina a 5%) foi gotejada. A pele foi suturada e, para o grupo com neuroproteção, uma bolsa de gelo foi colocada, cobrindo toda a superfície craniana, de modo a manter a temperatura encefálica entre 29,50 C e 310 C durante 120 minutos. Três dias após, os animais foram sacrificados e os encéfalos examinados. O grupo protegido pela hipotermia apresentou considerável redução na infiltração leucocitária, demonstrando que a hipotermia pode apresentar função neuroprotetora por meio de uma redução no processo inflamatório.

MRI of medulloblastoma in adults.

Medulloblastoma has variable appearances on MRI in both children and adults. Adults are more likely to have heterogeneous cerebellar hemisphere tumours, and this is thought to be related to the greater prevalence of desmoplastic tumours in adulthood. Few studies have addressed the MRI features of adult medulloblastoma and the specific characteristics of desmoplastic and classic tumours have not been analysed. Our aim was to analyse the imaging characteristics of desmoplastic (DM) and classic (CM) medulloblastomas in adult. We retrospectively studied preoperative MRI of six men and three women, median age 33 years, range 23-53 years, with pathologically proved medulloblastomas. There were six (67%) with DM. The tumour was in the cerebellar hemisphere in eight patients (89%), including the three with CM, one of which was bilateral. All tumours were heterogeneous, giving predominantly low or isointense signal on T1- and isointense signal on T2-weighted images. Cystic or necrotic areas in all patients were particularly visible on T2-weighted images. Contrast enhancement was absent in one DM and varied from slight to intense in eight (three CM), homogeneous in one DM and patchy in seven. All tumours extended to the surface of the cerebellum and two had well-defined margins. MRI does not allow a clear distinction between DM and CM in adults.

P27 expression in normal epithelium and condylomas of the vulva in HIV positive and negative women.

PURPOSE: The objective of the present study was to evaluate the expression of the p27 protein in the normal epithelium and vulvar condylomas in human immunodeficiency (HIV) positive and negative patients. METHODS: Eight samples of normal vulvar epithelium were evaluated (Group A), ten of the HIV negative vulvar condyloma patients (Group B) and another eight of the vulvar condyloma HIV positive patients (Group C). The DNA of human papillomavirus (HPV) was identified by means of polymerase chain reaction (PCR). Immunohistochemistry was the method used to evaluate the expression of p27 using monoclonal mouse antibody (Monoclonal Mouse, anti-human p27, Clone Sx 53 G8). The immunoexpression was evaluated at a magnification of 400x, counting a minimum of 1,000 cells per slide. RESULTS: The results obtained were the following: a) comparing groups A and B and groups A and C there was a significant difference in relation to the expression of the p27 protein which was 63.32% in group A and only 13.35% and 18.89% in groups B and C, respectively; b) comparing groups B and C among them, there was no significant difference. CONCLUSION: We concluded that in normal vulvar tissue the p27 protein is present in a large number of cells and that in vulval condylomas its expression is very much lowered both in HIV positive and negative cases.

[Fraction of gemistocytic astrocytes and immunoexpression of p53 protein in astrocytomas grade II and III (WHO)]. / Indice de astrócitos gemistocíticos e imuno-expressão da proteína p53 em astrocitomas, grau II e III OMS.

Twenty-two patients with astrocytomas, grade II or III WHO, were studied from 1990 to 1998. In all cases, histopathology showed that the astrocytomas had a gemistocytic component. The aims of this study were to establish the fraction of gemistocytic astrocytes, to investigate p53 protein immunoexpression and to evaluate correlations between these two parameters with the tumour outcome. Tumor cells were quantified at high-power magnification (x400). At least 1000 neoplastic cells (small neoplastic astrocytes plus gemistocytes) were counted in each specimen. The percentage of gemistocytes was defined as the gemistocytic index. Nuclear expression of p53 protein was evaluated in neoplastic astrocytes and gemistocytes. Both the frequency (7/22) as well the p53 immunoexpression indices in gemistocytes, regardless of the grade of the astrocytomas, were inferior from those reported in the literature. No correlation was found between the gemistocytic indices and the p53 immunoexpression.

Age-related changes in the N-methyl-D-aspartate receptor binding sites within the human basal ganglia.

The present study examined the regional differences in dopamine transporter binding sites and NMDA receptor complex binding based on autoradiographic images obtained in postmortem sections of human normal brain tissues. In middle-aged control tissues, high and comparable levels of [(3)H]CFT binding were observed in the caudate nucleus, putamen, and accumbens nucleus without significant alteration along the rostrocaudal axis and ventral and dorsal parts of these nuclei. In aging normal brain tissues, dopamine binding sites for [(3)H]CFT were significantly reduced in the caudate nucleus, putamen, and accumbens nucleus. l-[(3)H]Glutamate, [(3)H]MK-801, and [(3)H]glycine binding to the NMDA receptor complex was lower in aging brain tissues than in middle-aged controls. Significant correlation did occur between age and [(3)H]CFT binding and between age and l-[(3)H]glutamate, [(3)H]MK-801, and [(3)H]glycine binding sites. These results demonstrate that the basal ganglia have age-associated reductions in dopamine transporter uptake and NMDA receptors. These data support hypoactive activity of the NMDA receptor complex system with advancing age. The dopamine transporter uptake and NMDA receptors appear to be vulnerable to the aging process in the basal ganglia.

Ultrasonographic and morphological studies of the postmenopausal endometrium using unopposed estrogen replacement therapy with regular pause: a prospective preliminary study.

UNLABELLED: Hormone replacement therapy with progestogen is known to have severe side effects or complications in certain patients. OBJECTIVE: The goal of this study is to evaluate the safety and efficacy of an alternative treatment regimen with a mensal pause using both transvaginal sonography (TVS) and endometrial biopsy to follow patients. METHODS: A total of 30 postmenopausal women were treated with unopposed estrogen for 21 days each month followed by a regular pause of 9-10 days, and were studied prospectively for 18 months. The TVS measurements of endometrial thickness and biopsy of the endometrium were done on the 21st day of treatment and the 7th day of the pause at 6-month intervals throughout the study. RESULTS: There was a significant decrease of proliferative activity at all three time points during the study (6, 12 and 18 months) when tested on the 7th pause day (PD7). The percentage of patients with hyperplasia without nuclear atypia and endometrial thickness > or =8mm was 32% at 6 months, but decreased to 22 and 19% at 12 and 18 months, respectively. All cases of hyperplasia regressed after the hormonal pause throughout the treatment period. CONCLUSIONS: This study presents an alternative treatment regimen for select patients having side effects or complications from progestogen administration; however, studies evaluating the safety and efficacy of this regimen over longer time periods are necessary.

[Multiple gliomas. Illustrative cases of 4 different presentations]. / Gliomas múltiplos: casos ilustrativos de quatro formas de apresentação.

Multiple gliomas are uncommon and may be classified according to: a) the time of presentation in early (at diagnosis) or late (during treatment); b) the characteristics of computed tomography or magnetic resonance imaging (CT/MRI) in multifocal (with evidence of spread) and multicentric (without evidence of spread). From 212 patients with histopathologic diagnosis of glioma evaluated from March/90 to September/99, 15 (7%) had multiple lesions. We describe 4 patients: early multicentric, late multicentric, early multifocal and late multifocal, with emphasis on characteristics of CT/MRI and possible differential diagnosis. The differential diagnosis of multiple lesions in the central nervous system includes mainly infectious/inflammatory diseases and metastasis, however multiple gliomas should always be considered, even in patients with known systemic cancer, as described by others. Considering that CT/MRI features are not definite, the diagnosis should always be confirmed by histopathologic examination.

[Cervical cancer screening among indigenous women in the Xingu Indian Reservation, central Brazil]. / Rastreamento do câncer de colo uterino em índias do Parque Indígena do Xingu, Brasil central.

Although the literature presents worrisome data regarding the incidence of cervical cancer among indigenous populations, in Brazil there is very little information regarding the occurrence of this type of cancer among indigenous peoples. Therefore, the objective of the present descriptive study was to assess the prevalence of cervical cancer and of cervical and vaginal infections among 423 indigenous women living in the Xingu Indian Reservation, in the state of Mato Grosso, Brazil. These women were or had been sexually active. Data were collected between 1989 and 1996. Clinical and gynecological examinations were carried out prior to the collection of cervical specimens and to the performance of cytologic analyses. Upon detection of abnormalities, a colposcopy and a biopsy were also performed. Our results show that 1% of the women studied presented invasive carcinoma and that 3% presented premalignant lesions. In addition, 84% presented inflammatory atypia, resulting from sexually transmitted genital infections. The present findings are in accordance with the results of other international reports regarding the high prevalence of cervical conditions among indigenous populations, and they underscore the need to extend to the indigenous peoples of Brazil programs aiming at the control of sexually transmitted diseases and at the early detection and treatment of cervical cancer.

[Image guided stereotactic approach of central nervous system lesions: accuracy, morbidity, mortality]. / Abordagem estereotáxica guiada por imagem de lesões do sistema nervoso central. Precisão diagnóstica, morbidade, mortalidade.

We studied seventy-five patients with brain lesions biopsied by stereotaxis from March 1993 to December 1998 at Universidade Federal de São Paulo-Escola Paulista de Medicina. The three most frequent lesions were: metastasis, low grade astrocytomas and glioblastoma multiforme. The morbidity rate was 2.66% due to: one case of scalp infection in a patient with thalamic cyst; and a partial seizure during surgery in a patient with lymphoma. The mortality rate was 1.33% due to increasing of cerebral edema after biopsy and the patient died after one week. The diagnostic accuracy was 89.33%.

Hemorrhagic cerebral metastasis as a first manifestation of a hepatocellular carcinoma. Case report.

We report herein a rare instance in which a patient presented with a hemorrhagic cerebral metastasis as the initial manifestation of a hepatocellular carcinoma (HCC). A few cases of cerebral metastasis from HCC have been reported in the literature, mainly from eastern countries. This is the first report from South America of a cerebral metastasis from hepatocellular carcinoma.

[Germinoma of the basal ganglia and thalamus with brain stem invasion: case report]. / Germinoma localizado nos núcleos da base e tálamo com invasão do tronco cerebral. Relato de caso.

We report an unusual case of germinoma arising from the basal ganglia and thalamus with brain stem invasion, with emphasis on computed tomography and magnetic resonance findings. Diagnosis was confirmed by histopathologic examination. Early detection of this tumor is important due to its potential response to treatment.

Isolated angiitis of central nervous system with pleocytosis in the cerebrospinal fluid.

We report the case of a 32-year-old woman with isolated angiitis of the central nervous system. This case shows that high levels of pleocytosis may not rule out isolated angiitis of the central nervous system if this diagnosis can be considered on clinical grounds.

Transvaginal ultrasonography and the progestogen challenge test in postmenopausal endometrial evaluation.

OBJECTIVE: To analyze the morphologic and ultrasonographic aspects of the endometrium of postmenopausal women according to the progestogen challenge test. METHODS: The study was conducted on 150 postmenopausal women. Each patient was submitted to transvaginal ultrasonography for measurement of endometrial echo thickness and to endometrial biopsies, followed by the progestogen challenge test. RESULTS: Women with a negative test presented atrophic endometrium in 94% of cases. The other 6% have shown active endometrium, but none had hyperplasia. However, 56% of the patients with a positive test had atrophic endometrium. There was a correlation between endometrial thickness less than 5 mm and endometrial atrophy in patients with either positive or negative tests. CONCLUSION: Because the progestogen challenge test is cheap and easy to deal with, it can be done as a primary screening method in asymptomatic postmenopausal women. If the test is positive, ultrasonography is required in order to determine who needs a more accurate examination of the endometrium. If the test is negative, ultrasonography is not required due to the great number of women who have atrophic endometrium.

Importance of peniscopy, oncologic cytology and histopathology in the diagnosis of penile infection by human papillomavirus.

INTRODUCTION: Male genital infection by human papillomavirus is of particular importance since it is often asymptomatic. The patient generally presents no clinical lesion. Therefore, men represent an important reservoir of virus, playing a special role in the transmission and perpetuation of the disease. PATIENTS AND METHODS: In the present prospective clinical trial study, 190 sex partners of women with genital infection by human papillomavirus, associated or not with cervical intraepithelial neoplasia, were investigated. All patients were unaware of or denied the presence of a genital lesion. RESULTS: Cytologic examination revealed koilocytosis in 9 cases (4.7%) in the urethra and in 3 cases (1.6%) in the corona of the glans and the distal prepuce. Peniscopy with the previous use of 5% acetic acid revealed white lesions in 97.9% of the patients. Toluidine blue stained most of the lesions. At least one fragment revealed koilocytosis in the histopathologic study of 97 cases (51.05%). CONCLUSION: The three methods complement one another, allowing a more precise diagnosis of the infection in men.

[Secretory meningioma. Report of two cases]. / Meningioma secretório. Relato de dois casos.

Two surgically removed meningotheliomatous meningiomas with hyaline inclusions or pseudopsammoma bodies were studied. Both meningiomas showed expression of carcinoembryonic antigen and cytokeratin in the cells surrounding the hyaline bodies. There was widespread vimentin and epithelial membrane antigen except in the cells with hyaline inclusions. Clinically both had a severe cerebral edema. One of the cases showed multiple tumors, probably meningiomas. It is important not to misinterpret this variant of meningioma as metastatic neoplasm which may result in palliative treatment of a potentially curable tumor.

[Glucagonoma: case report and literature review]. / Glucagonoma: relato de caso e revisão de literatura.

Glucagonoma is a neuroendocrine tumor of pancreatic alpha cells manifested by necrolytic migratory erythema, hyperglucagonemia, glucose intolerance, weight loss, anemia and hypopaminoacidemia. We report a case of glucagonoma in a 38 years-old patient diagnosed by the presence of a pancreatic tumor, liver metastasis, weight loss, glucose intolerance, necrolytic migratory erythema, hyperglucagonemia (1400 pg/ml; normal < 200 pg/ml) and histologic demonstration of glucagon and neurospecific enolase by immunocytochemical reaction. Actual therapeutic of glucagonoma includes surgery, chemotherapy, somatostatin or octreotide for control of the symptoms, and more recently alpha-interferon was suggested.

Histologic and biomolecular aspects of papillomatosis of the vulvar vestibule in relation to human papillomavirus.

OBJECTIVE: To determine whether human papillomavirus (HPV) plays a role in the genesis of papillomatosis of the vulvar vestibule. METHODS: We conducted a study based on molecular hybridization and histology of biopsy material obtained from the inner surface of the labia minora of 25 women with papillomatosis of the vulvar vestibule who presented no abnormal clinical, cytologic, or colposcopic changes in the cervix or vagina. These women were compared with 24 women with condyloma acuminatum of the vulvar vestibule and with ten women with normal vulvar epithelium and no cervicovaginal changes. All patients included in the study were 35 years or younger, and none was pregnant. RESULTS: Papillomatosis of the vulvar vestibule was rarely found to be HPV positive by molecular hybridization (one of 25, 4%, by dot blot hybridization and one of 15, 6.67%, by polymerase chain reaction [PCR]). This result did not differ significantly from that obtained for the group with normal vulvar epithelium (none of 10 by dot blot and none of six by PCR), but did differ (P = .001) from the result obtained for the group with condyloma acuminatum of the vestibule (12 of 24, 50%, by dot blot and six of six, 100%, by PCR). The biomolecular study of vestibular papillomatosis showed that focal koilocytosis was not correlated with HPV infection. CONCLUSION: Papillomatosis of the vulvar vestibule is not associated with HPV and should be considered a paraphysiologic formation of the vulvar epithelium. The diagnosis of vulvar HPV infection should be avoided in the absence of more explicit clinical-histologic evidence, with no need for biopsies or unnecessary treatments.

[Supratentorial primitive neuroectodermal tumor. Study of 4 cases]. / Tumor neuroectodérmico primitivo supratentorial. Estudo de quatro casos.

The clinicopathological and immunohistochemical features of four cases of primitive neuroectodermal tumors of the central nervous system were investigated. Three patients died. All cases showed vimentin-positive cells with the morphology of neoplastic cells and one case showed glial fibrillary acidic protein, neuron-specific enolase and neurofilament protein-positive cell. The present study indicates that this group of tumors have bad prognostics and may show immunocytochemical features indicating glial and/or neuronal differentiation.