High-frequency (22-MHz) ultrasound for assessing the depth of basal cell carcinoma invasion.

BACKGROUND: High-frequency ultrasound (HFUS) has been studied in the diagnosis and therapeutic management of basal cell carcinoma (BCC). The accuracy of this method for location of deep margins remains unknown. This study evaluates HFUS for localization of deep surgical margins in BCC. MATERIALS AND METHODS: Ultrasound images of 83 lesions from 67 patients with clinical and dermoscopic diagnosis of BCC were compared with histopathological findings. Pearson's correlation coefficient was used to assess the relationship between thickness as measured by HFUS and histopathology. RESULTS: A strong correlation between HFUS and histopathological measurements was identified (r = 0.9744, P < .001). HFUS had sensitivity of 96%, specificity of 84%, and accuracy of 91% for measurement of deep tumor margins. Factors affecting tumor measurement on HFUS include marked basophilic degeneration of collagen, presence of peritumoral hypertrophic glands or hair follicles, fibrosis, and dense inflammatory changes related to the tumor itself or to prior procedures. CONCLUSION: High-frequency ultrasound was effective in localizing deep tumor margins in BCC. Therefore, we believe that this diagnostic imaging method is important when selecting a therapeutic approach, considering Mohs micrographic surgery, and evaluating the surgical site.

An unusual cause of tree-in-bud pattern: pulmonary intravascular tumor embolism caused by chondrosarcoma.

We report the case of a 45-year-old man who initially presented with chondrosarcoma of the left femur that was treated surgically. Follow-up chest computed tomography (CT) performed 3 years later showed multiple small nodules with a tree-in-bud branching pattern and larger elongated opacities with beaded contours. These findings raised the suspicion of intravascular tumor embolism. Pulmonary CT angiography demonstrated intravascular thrombosis and dilated and beaded peripheral pulmonary arteries. The tumoral origin of the thrombus was confirmed by lung biopsy.

High-frequency ultrasound associated with dermoscopy in pre-operative evaluation of basal cell carcinoma.

The recent development of high-frequency ultrasound, associated with the improved sensitivity in color Doppler, enabled the identification of various skin structures and layers. In basal cell carcinoma, the 22 MHz frequency ultrasound permits the delimitation of tumor margins, while color Doppler, determines its vascularization. We present two cases in which the association of both exams allowed an in vivo analysis of the tumor's morphology, size, thickness and vascularization, thus contributing to a better pre-operative evaluation.

High-frequency ultrasound associated with dermoscopy in pre-operative evaluation of basal cell carcinoma

The recent development of high-frequency ultrasound, associated with the improved sensitivity in color Doppler, enabled the identification of various skin structures and layers. In basal cell carcinoma, the 22 MHz frequency ultrasound permits the delimitation of tumor margins, while color Doppler, determines its vascularization. We present two cases in which the association of both exams allowed an in vivo analysis of the tumor's morphology, size, thickness and vascularization, thus contributing to a better pre-operative evaluation.

Heparanase expression and localization in different types of human lung cancer.

BACKGROUND: Heparanase is the only known mammalian glycosidase capable of cleaving heparan sulfate chains. The expression of this enzyme has been associated with tumor development because of its ability to degrade extracellular matrix and promote cell invasion. METHODS: We analyzed heparanase expression in lung cancer samples to understand lung tumor progression and malignancy. Of the samples from 37 patients, there were 14 adenocarcinomas, 13 squamous cell carcinomas, 5 large cell carcinomas, and 5 small cell carcinomas. Immunohistochemistry was performed to ascertain the expression and localization of heparanase. RESULTS: All of the tumor types expressed heparanase, which was predominantly localized within the cytoplasm and nucleus. Significant enzyme expression was also observed in cells within the tumor microenvironment, such as fibroblasts, epithelial cells, and inflammatory cells. Adenocarcinomas exhibited the strongest heparanase staining intensity and the most widespread heparanase distribution. Squamous cell carcinomas, large cell carcinomas, and small cell carcinomas had a similar subcellular distribution of heparanase to adenocarcinomas but the distribution was less widespread. Heparanase expression tended to correlate with tumor node metastasis (TNM) staging in non-small cell lung carcinoma. CONCLUSION: In this study, we showed that heparanase was localized to the cytoplasm and nucleus of tumor cells and to cells within the microenvironment in different types of lung cancer. This enzyme exhibited a differential distribution based on the type of lung tumor. General significance Elucidating the heparanase expression patterns in different types of lung cancer increased our understanding of the crucial role of heparanase in lung cancer biology. This article is part of a Special Issue entitled Matrix-mediated cell behaviour and properties.

A lesion suspected of melanoma by dermoscopy: we must trust this diagnostic tool.

BACKGROUND: The incidence of cutaneous melanoma is increasing worldwide and early diagnosis is essential since the prognosis is poor in advanced stages of disease. Dermoscopy emerged as an additional and important diagnostic procedure for the early diagnosis of cutaneous melanoma. MAIN OBSERVATION: We report a case of a 52-year-old man, who developed a pigmented lesion in the right pretibial region. Dermoscopy highly suggestive of melanoma. The initial histopathological evaluation suggested a benign lesion. Since dermoscopy was very suspicious, a more extensive histopathological study of the excised skin fragment was performed. This led to a change of diagnosis to a melanoma with partial regression. CONCLUSIONS: The present case shows that occasionally dermoscopy may be more informative for diagnosis of melanoma than an initial histopathology result.

Simultaneous cytomegalovirus and Mycobacterium tuberculosis infection presenting as hemorrhagic colitis 3 years after a kidney transplant.

Cytomegalovirus is an important cause of colonic disease in solid organ transplant recipients. Although several reports have shown that simultaneous infection with other pathogens may aggravate the course of cytomegalovirus colitis, to our knowledge, no case of colitis caused by simultaneous cytomegalovirus and Mycobacterium tuberculosis has been previously reported. We describe a case of hemorrhagic colitis associated with simultaneous cytomegalovirus/ Mycobacterium tuberculosis infection in a 26-year-old woman, 38 months after a kidney transplant. Initial results of histopathologic analyses of gastrointestinal biopsies showed that tuberculosis was the only cause of colitis, as no morphologic alteration suggestive of cytomegalovirus infection was observed on hematoxylin-eosin staining. However, further analysis with immunoperoxidase staining confirmed the clinical suspicion of cytomegalovirus infection. This report shows that cytomegalovirus/tuberculosis coinfection may be a cause of late-onset colitis among solid organ transplant recipients. It also illustrates that coinfection with other pathogens may pose an additional challenge for diagnosing gastrointestinal cytomegalovirus disease.

Paracoccidioidomycosis: high-resolution computed tomography-pathologic correlation.

OBJECTIVE: The purpose of this study was to describe the high-resolution computed tomography (HRCT) features of pulmonary paracoccidioidomycosis and to correlate them with pathologic findings. METHODS: The study included 23 adult patients with pulmonary paracoccidioidomycosis. All patients had undergone HRCT, and the images were retrospectively analyzed by two chest radiologists, who reached decisions by consensus. An experienced lung pathologist reviewed all pathological specimens. The HRCT findings were correlated with histopathologic data. RESULTS: The predominant HRCT findings included areas of ground-glass opacities, nodules, interlobular septal thickening, airspace consolidation, cavitation, and fibrosis. The main pathological features consisted of alveolar and interlobular septal inflammatory infiltration, granulomas, alveolar exudate, cavitation secondary to necrosis, and fibrosis. CONCLUSION: Paracoccidioidomycosis can present different tomography patterns, which can involve both the interstitium and the airspace. These abnormalities can be pathologically correlated with inflammatory infiltration, granulomatous reaction, and fibrosis.

Influenza A (H1N1) virus-associated pneumonia: high-resolution computed tomography-pathologic correlation.

OBJECTIVE: The purpose of this study was to describe the high-resolution computed tomography (HRCT) features of fatal cases of Influenza A (H1N1) virus-associated pneumonia and to correlate them with pathologic findings. METHODS: The study included six adult patients who died following Influenza A (H1N1) virus-associated pneumonia. All patients had undergone HRCT, and the images were retrospectively analyzed by two chest radiologists, who reached decisions by consensus. Two experienced lung pathologists reviewed all pathological specimens. The HRCT findings were correlated with the histopathologic data. RESULTS: The predominant HRCT findings included areas of airspace consolidation (n=6) and ground-glass opacities (n=3). The main pathological features consisted of diffuse alveolar damage with hyaline membrane formation (n=5), associated with various degrees of pulmonary congestion, edema, hemorrhage, inflammatory infiltration and bronchiolitis. A patient who survived longer showed findings of organizing pneumonia. CONCLUSION: Fatal cases of Influenza A (H1N1) virus-associated pneumonia can present as areas of consolidation on CT, with or without ground-glass opacities. These abnormalities can be pathologically correlated with diffuse alveolar damage. Patients with longer survival may present with findings of organizing pneumonia.

AIDS-related Kaposi sarcoma of the lung presenting with a "crazy-paving" pattern on high-resolution CT: imaging and pathologic findings.

Kaposi sarcoma (KS) is a fulminate and disseminated form of acquired immunodeficiency syndrome (AIDS)-defining neoplasm, usually presenting pulmonary involvement. We report a 40-year-old woman with AIDS and biopsy-proven KS showing unusual high-resolution computed tomography (HRCT) findings. HRCT showed areas of ground-glass attenuation with superimposed septal thickening ("crazy-paving" pattern). CT-pathologic correlation revealed that crazy-paving pattern in this case was due to accompanying pulmonary edema and hemorrhage in addition to tumor cell infiltration into the peribronchovascular interstitium, interlobular and alveolar septa. The authors suggest the inclusion of KS in the differential diagnosis of lung diseases in patients with AIDS presenting with crazy-paving pattern on the HRCT.

Granulomas hialinizantes pulmonares: aspectos na tomografia computadorizada: relato de caso / Computed tomography findings in patients with pulmonary hyalinizing granulomas: a case report

Granulomas hialinizantes são lesões fibrosantes benignas que em geral se apresentam radiologicamente sob a forma de nódulos múltiplos, freqüentemente escavados e/ou calcificados. Neste trabalho é relatado o caso de uma paciente de 28 anos de idade que apresentou a doença provavelmente secundária a infecção tuberculosa prévia. Ressalta-se a necessidade da inclusão deste diagnóstico diferencial frente ao quadro radiológico de múltiplas lesões nodulares.

Hyalinizing granulomas are benign fibrotic lesions that generally present multiple nodules seen on radiological examinations, which are frequently cavitary and/or calcified lesions. We report a case of a 28 year-old-woman with hyalinizing granulomas probably secondary to a previous tuberculosis infection. Hyalinizing granulomas should be included in the differential diagnosis of patients with multiple pulmonary nodules.

Nódulos com sinal do halo na aspergilose pulmonar angioinvasiva: correlação da tomografia computadorizada de alta resolução com a anatomopatologia / Halo sign nodules in angioinvasive pulmonary aspergillosis: correlation of high-resolution computed tomography findings with anatomopathology

O objetivo do trabalho é apresentar os achados precoces da aspergilose angioinvasiva na tomografia computadorizada de alta resolução e correlacioná-los com a anatomopatologia. Foram analisadas as tomografias computadorizadas de alta resolução de dois pacientes com aspergilose angioinvasiva, ambos com leucemia, e feita a correlação com os achados de necropsia. Os nódulos corresponderam a infartos hemorrágicos, com necrose de coagulação, permeados por hifas dos fungos. O halo em vidro fosco correspondeu a hemorragia intra-alveolar. Os nódulos com sinal do halo observados na tomografia computadorizada de alta resolução de pacientes com aspergilose angioinvasiva apresentaram estreita correlação com os aspectos anatomopatológicos. As alterações dos nódulos com sinal do halo demonstradas à anatomia patológica explicam claramente as características da lesão à tomografia computadorizada de alta resolução.

Pneumonia intersticial linfocítica: correlação da tomografia computadorizada de alta resolução com a anatomopatologia / Lymphocytic interstitial pneumonia: correlation of high-resolution computed tomography findings with anatomopathology

A proposta do trabalho é apresentar os achados radiológicos observados na tomografia computadorizada de alta resolução do tórax de dois pacientes com pneumonia intersticial linfocítica e correlacioná-los com os aspectos anatomopatológicos, obtidos a partir de biópsias a céu aberto. Um dos pacientes mostrou, na tomografia, basicamente opacidades em vidro fosco difusas, e o outro tinha infiltração ao longo das bainhas conjuntivas peribroncovasculares. Na anatomopatologia o padrão predominante foi o de infiltração intersticial, especialmente ao longo dos septos alveolares, por linfócitos policlonais. O estudo mostrou estreita correlação entre os achados anatomopatológicos e aqueles observados na tomografia computadorizada de alta resolução do tórax.

Presença da proteína p53 com prognóstico de recidiva/progressão de neoplasia intra-epitelial vulvar III / p53 protein overexpression as a prognostic marker for vulvar intraepithelial neoplasia III recurrence/progression

Objetivo: avaliar o valor da presença da proteína p53 nos casos de recidiva/progressão da neoplasia intra-epitelial vulvar (VIN) III. Métodos: foram selecionadas 20 pacientes com VIN III indiferenciada, seguidas semestralmente por período de até quatro anos, divididas em dois grupos: quatorze sem e seis com recidiva/progressão da lesão. Os casos de recidiva/progressão foram distribuídos da seguinte forma: em três pacientes a recidiva ocorreu uma única vez, em duas, houve dupla recorrência e apenas uma evoluiu para carcinoma escamoso. Em ambos os grupos foram avaliados o sítio vulvar acometido e a presença da proteína p53 com análise do padrão de marcação imunohistoquímica. Estudo semelhante foi realizado nos casos de recidiva/progressão além da análise do intervalo de tempo para o surgimento de recidiva/progressão. Resultados: observou-se recidiva da VIN III em 25 por cento dos casos e, em 5 por cento, progressão para carcinoma. O tempo médio de recidiva foi de 24,5 meses. A localização multifocal da lesão primária foi a mais freqüente (50 por cento) em ambos os grupos. Na maioria dos casos (87,5 por cento), a recidiva/progressão ocorreu na mesma localização da lesão vulvar primária. A presença da proteína p53 mostrou-se positiva em 50 por cento das lesões primárias de VIN III e em 75 por cento dos casos de recidiva/progressão. Conclusões: a presença da proteína p53 parece desempenhar papel importante na gênese e na predição do curso clínico das VIN III. As recidivas/progressão das VIN III tendem a ocorrer na mesma área da doença inicial, sugerindo a presença de campo molecular alterado.

Linfangite carcinomatosa: correlaçäo da tomografia computadorizada de alta resoluçäo com a anatomopatologia / Lymphangitis carcinomatosis: correlation between high resolution computed tomography and anatomopathological findings

Neste trabalho säo apresentados os aspectos observados nas tomografias computadorizadas de alta resoluçäo (TCAR) de oito pacientes com linfangite carcinomatosa e correlacionados com os achados anatomopatológicos em biópsias cirúrgicas e necrópsias de cinco destes pacientes. O aspecto mais freqüentemente observado foi o espessamento dos septos interlobulares e das bainhas broncovasculares, liso ou nodular, correspondendo ao acúmulo de células neoplásicas dentro dos vasos linfáticos. Outros achados comuns foram nódulos distribuídos ao longo dos compartimentos linfáticos (superfície pleural, bainhas broncovasculares, septos interlobulares e regiäo centrolobular) e derrame pleural