Solitary plantar basal cell carcinoma.

Basal cell carcinoma is the most frequent skin cancer, generally located in hair-bearing, sunlight-exposed areas. Basal cell carcinoma usually occurs on the head and neck, but very rarely on extra-facial locations. We report a case of a 65-year-old woman presenting with a solitary non-healing ulcer on the sole of the right foot for two years. Histopathological examination showed a typical nodular basal cell carcinoma, confirmed by positivity to Ber-EP4 on immunohistochemistry. There was no history of trauma, exposure to noxious agents, basal cell nevus syndrome, or xeroderma pigmentosum.

Solitary plantar basal cell carcinoma

Abstract: Basal cell carcinoma is the most frequent skin cancer, generally located in hair-bearing, sunlight-exposed areas. Basal cell carcinoma usually occurs on the head and neck, but very rarely on extra-facial locations. We report a case of a 65-year-old woman presenting with a solitary non-healing ulcer on the sole of the right foot for two years. Histopathological examination showed a typical nodular basal cell carcinoma, confirmed by positivity to Ber-EP4 on immunohistochemistry. There was no history of trauma, exposure to noxious agents, basal cell nevus syndrome, or xeroderma pigmentosum.

Disseminated toxoplasmosis in a patient with advanced acquired immunodeficiency syndrome.

Extracerebral toxoplasmosis, with pulmonary involvement and shock, is a rare form of toxoplasmosis in patients with advanced AIDS. It can mimic pneumocystosis, histoplasmosis, and disseminated tuberculosis, and should be considered in the differential diagnosis of causes of respiratory failure and fulminant disease in this group of individuals, especially in areas where the Toxoplasma gondii infection is highly prevalent and in those without proper use of antimicrobial prophylaxis. We report the case of a 46-year-old male patient who presented to the emergency department with uremia, requiring urgent dialysis. During the laboratorial investigation, the patient had confirmed HIV infection, with a low CD4+ peripheral T-cell count (74 cells/µL). During hospitalization, the patient presented drug-induced hepatitis due to trimethoprim/sulfamethoxazole in a prophylactic dose, requiring interruption of this medication. On the 55th day of hospitalization, the patient developed refractory shock and died. At the autopsy, disseminated toxoplasmosis with encephalitis and severe necrotizing pneumonia were diagnosed, with numerous tachyzoites in the areas of pulmonary necrosis.

Disseminated toxoplasmosis in a patient with advanced acquired immunodeficiency syndrome

Extracerebral toxoplasmosis, with pulmonary involvement and shock, is a rare form of toxoplasmosis in patients with advanced AIDS. It can mimic pneumocystosis, histoplasmosis, and disseminated tuberculosis, and should be considered in the differential diagnosis of causes of respiratory failure and fulminant disease in this group of individuals, especially in areas where the Toxoplasma gondii infection is highly prevalent and in those without proper use of antimicrobial prophylaxis. We report the case of a 46-year-old male patient who presented to the emergency department with uremia, requiring urgent dialysis. During the laboratorial investigation, the patient had confirmed HIV infection, with a low CD4+ peripheral T-cell count (74 cells/µL). During hospitalization, the patient presented drug-induced hepatitis due to trimethoprim/sulfamethoxazole in a prophylactic dose, requiring interruption of this medication. On the 55th day of hospitalization, the patient developed refractory shock and died. At the autopsy, disseminated toxoplasmosis with encephalitis and severe necrotizing pneumonia were diagnosed, with numerous tachyzoites in the areas of pulmonary necrosis.

Perianal leiomyoma / Leiomioma de localização perianal

Abstract Leiomyomas are smooth muscle tumors and may occur in places where these fibers are present, while the anorectal location is rare. They are commonly incidental imaging findings and in most cases, patients are asymptomatic. The therapeutic recommendation is tumor resection and postoperative follow-up. Case report: a 38-year-old Black woman had, one year ago, a swelling in perianal right region, which showed slow and progressive growth. She denied bowel habit alterations, local pain, hematochezia, or tenesmus. Proctologic examination showed a fibroelastic, regular, mobile, painless nodule measuring 10 cm at its largest diameter in the right perianal region, next to the anal verge. The soft tissue ultrasound image identified a solid, hypoechoic, and discreetly vascularized nodule in the perianal, superficial right gluteal region that did not reach the adjacent muscles. A complete resection of perineal tumor was carried out in the ventral position. Histological and immunohistochemical analyses disclosed a leiomyoma with a positive finding for actin smooth muscle and negative for desmin. She is currently asymptomatic and undergoing outpatient follow-up.

Resumo Os leiomiomas são tumores da musculatura lisa podendo ocorrer nos locais onde essas fibras estão presentes, sendo rara a localização anorretal. Na maioria dos casos os pacientes são assintomáticos, sendo comumente achados de exame de imagem. A recomendação terapêutica é a ressecção tumoral e o seguimento pós-operatório. Relato do caso: mulher, 38 anos, negra. Há um ano, apresentou abaulamento em região perianal direita, de crescimento lento e progressivo. Negava alteração do hábito intestinal, dor local, hematoquezia, puxo ou tenesmo. Ao exame proctológico, apresentava nodulação fibroelástica, regular, móvel, indolor, com 10 cm de diâmetro em região perianal à direita, próxima à borda anal. Realizou ultrassonografia de partes moles que identificou imagem nodular, sólida, hipoecogênica e discreta vascularização em parte superficial perianal e glútea direita, não envolvendo musculatura adjacente. Foi submetida à ressecção completa do tumor via perineal, em posição ventral. O laudo histológico e imuno-histoquímico revelou leiomioma, com achado positivo para actina de músculo liso e negativo para desmina. Atualmente está assintomática, em seguimento ambulatorial.

Disseminated neuroendocrine neoplasm with undetected primary tumor.

Since the 19th century, neuroendocrine neoplasms (NEN) have been identified. Right up to the present day, the nomenclature is still under debate reflecting the heterogeneity of these tumors. Although some of them are slow growing, some can be fearfully aggressive and may develop in almost any organ of the abdomen, thorax, neck, skin, and gonads. The most commonly observed sites of NEN are the lung and the gastroenteropancreatic system (GEP), where more than 50 entities have been observed. In case of a NEN of unknown primary tumor, the histopathological diagnostic workup includes immunohistochemistry for chromogranin A and synaptophysin, followed by specific tissue markers. Clinical presentation is very diverse, depending on the primary site and functionality of the tumor. In the case of the GEP-NEN, the main symptoms are abdominal pain, diarrhea, weight loss, gastrointestinal bleeding, or bowel obstruction. The presence of neuropsychiatric symptoms is not insignificant in this group of tumors. The authors report a case of a 51-year-old man who sought medical attention because of a three-month history of a consumptive disease. The diagnostic workup disclosed a diffuse nodular infiltration of the lungs, hypokalemia, and hypercalcemia in a cachectic patient. The clinical investigation could not proceed because of an infectious intercurrence, which led to the fatal outcome. Autopsy findings showed a diffuse metastatic NEN. The primary tumoral site could not be demonstrated with the available immunohistochemical panel.

Resultados do exame anátomo-patológico e "Polymerase Chain Reaction (PCR)" na forma clinica e subclinica da infecção anal pelo Papilomavirus Humano (HPV): estudo em quatro grupos de pacientes / Histopathological and PCR results for clinical and subclinical forms of HPV anal infection: study of four groups of patients

O Papilomavírus Humano tem alta incidência na população. O objetivo deste trabalho é o estudo dos resultados encontrados no exame anatomo-patológico e no PCR das formas clínica e subclínica da infecção anal por HPV em quatro grupos de pacientes. MÉTODO: Foram estudados 10 pacientes com prurido anal idiopático, seis com infecção genital pelo HPV, tratada, seis com condiloma anal tratado e oito com condiloma anal. As verrugas foram biopsiadas nos oito pacientes com condiloma e feito exame de anuscopia de alta resolução com biópsia dirigida nos outros 22 pacientes. O material foi encaminhado para exame anátomo-patológico e depois, a partir do mesmo bloco de parafina, foi feito o exame de PCR. Resultados: O anátomo-patológico foi positivo para HPV em todos os pacientes, sendo que nos oito com condiloma confirmou-se a forma clínica e em 22 diagnosticou-se a subclínica com 13 casos de neoplasia intraepitelial associada. O PCR foi positivo em 91,9 por cento dos 22 pacientes da forma subclínica ao anátomo-patológico e em 87,5 por cento dos oito pacientes da forma clínica. O tipo predominante nos casos de HPV anal subclínico foi o 16 e o predominante nas verrugas foi o 11. CONCLUSÕES: O exame anátomo-patológico foi positivo para HPV em todos os pacientes, propiciando também o diagnóstico de 13 casos de neoplasia intraepitelial, sendo dois de carcinoma "in situ". O PCR foi positivo em 91,9 por cento dos pacientes da forma subclínica ao anátomo-patológico e em 87,5 por cento da forma clínica ao anátomo-patológico. O tipo predominante da forma subclinica foi o 16 e das verrugas foi o 11.

The purpose of this study is to analyze the results found in the pathological examination and PCR test for clinical and subclinical HPV anal infections in four groups of patients. Methods: The four groups studied were: ten patients with idiopathic anal pruritus, six with treated HPV genital infection, six with treated anal condyloma, and eight with anal condyloma. Eight patients with condyloma underwent wart biopsy, and high-resolution anoscopy with directed biopsy was performed in the remaining 22 patients. Paraffin wax embedded biopsy specimens were sent to pathological analysis, and later PCR was carried out on the same samples. Results: Through the pathological examination, the presence of HPV is positive in all patients studied: clinically in the eight patients with condyloma, and subclinically in the others 22. Thirteen of these 22 patients presented and associated intraepithelial neoplasia. PCR was positive in 91,9 percent of the 22 patients those who presented the subclinical infection at pathology examination and 87,5 percent of the eight patients that presented the clinical infection the most common type of anal subclinical HPV infection was HPV-16 and HPV-11 when warts were presented. Conclusions: Pathological findings related to HPV were presented in all patients studied, and 13 cases were diagnosed two of them were carcinoma in situ. PCR was positive in 91,9 percent of patients presenting the subclinical infection, and in 87,5 percent with the clinical infection was HPV-16, and for warts HPV-11.

A importância da anuscopia de alta resolução para o diagnóstico do papilomavírus humano anorretal na forma subclínica, das lesões anais intraepiteliais e do carcinoma "in situ"anal / Importance of High Resolution Anuscopy for the Diagnosis of Subclinical Anorectal Human Papillomavirus, Anal Intraepithelial Neoplasia and Anal Carcinoma

OBJETIVO: A doença causada pelo Papilomavírus Humano (HPV) tem alta incidência na população e é considerada pré-neoplásica. O objetivo deste trabalho é estudar um método que detecte o HPV anorretal na sua forma subclínica e suas alterações neoplásicas, a incidência em pessoas com até três parceiros sexuais por ano e o resultado do tratamento com o uso de podofilina, ácido tricloroacético, eletrocauterização e ressecção local. MÉTODO: Vinte e dois pacientes foram submetidos ao exame de anuscopia de alta resolução. Os pacientes foram divididos em três grupos: o primeiro, formado por dez pacientes com prurido anal persistente mesmo após eliminadas causas como diabetes, doenças orificiais, outras doenças sexualmente transmissíveis, verminoses e submetidos a cuidados locais e dietéticos; o segundo e o terceiro, formados por seis pacientes com condiloma anal e seis pacientes com HPV genital respectivamente, ambos com alta do tratamento há mais de seis meses. Nenhum deles apresentava manifestação clínica da doença no momento do exame. Os casos com resultado positivo foram tratados com podofilina 25 por cento e ácido tricloroacético, e os com carcinoma "in situ" com ressecção local e eletrocauterização da lesão. RESULTADOS: O exame de anuscopia de alta resolução proporcionou a colheita dirigida do material nas áreas positivas, cujo resultado anátomo-patológico foi positivo para HPV em 100 por cento dos pacientes, sendo dois deles com carcinoma "in situ" e oito com lesões intraepiteliais concomitantes. Apenas 9 por cento dos pacientes, tinham mais de três parceiros sexuais por ano. Todos os pacientes tratados com podofilina e ácido tricloroacético mantiveram as atipias coilocitóticas no controle após seis meses do início do tratamento. A ressecção local e eletrocauterização nos pacientes com carcinoma "in situ" possibilitou o desaparecimento da neoplasia em todos, mas manteve as atipias coilocitóticas. CONCLUSÕES: O exame de anuscopia de alta...

BACKGROUND: Human Papilloma Virus (HPV) infection has a high incidence in the population and is considered a pre malignant condition. The purpose of this study is to analyze a method of detection of subclinic anorectal HPV and its neoplasic changes; the incidence in people with more than three sexual partners a year and the results of the treatment with podofilin, trichloroacetic acid, electrocauterization and local resection. METHODS: Twenty two patients were divided into three groups, and submitted to high resolution anuscopy. The first group included ten patients with persistent anal pruritus, in whom other causes were eliminated such as diabetes, orificial diseases, other sexual transmitted diseases, verminosis and were instructed about dietary and local care; the second and third groups included six patients treated for anal condylomata and six patients treated for genital HPV, respectively, for at least six months. None of them had clinical manifestations of the disease. Positive cases were treated with podofilin 25 percent and trichloroacetic acid, and carcinoma "in situ" cases were resected and electrocauterized. RESULTS: Anuscopy provided guided biopsies in positive areas, which anatomopathologic results were positive for HPV infection in 100 percent of the patients, including two cases of carcinoma "in situ" and eight associated intraepithelial lesions. Only nine percent of these patients had more than three sexual partners per year. The koilocytotic atypia persisted in all patients treated with podofilin and trichloroacetic acid; local resection and electrocauterization of the carcinoma "in situ" resulted in total remission of the neoplasia but no eradication of the koilocytotic atypia. CONCLUSION: High resolution anuscopy provided diagnosis of subclinical HPV and its neoplastic changes in 100 percent of the patients. Only nine percent had more than three sexual partners per year. Podofilin and trichloroacetic acid treatment...

O Papilomavírus humano (HPV) na forma subclinica como diagnóstico diferencial da etiologia do prurido anal / The human Papillomavirus (HPV) in the subclinic form as a diferencial diagnosis in the ethiology of the pruritus ani

Este trabalho tem por objetivo demonstrar a importância da doença causada pelo HPV subclínico na região anal, como diagnóstico diferencial da etiologia do prurido anal. Dez pacientes com prurido anal persistente foram submetidos ao exame de anuscopia de alta resolução para diagnóstico de HPV subclinico anal. Os casos positivos foram tratados seguindo protocolo estabelecido. A anuscopia de alta resolução proporcionou a colheita dirigida do material cujo exame anátomo-patológico resultou positivo para HPV em 100por cento dos casos. O exame de PCR (polymerase chain reaction) resultou positivo em nove pacientes (90por cento) e negativo em um (10por cento). Após seis meses do inicio do tratamento padronizado, o PCR e o anátomo-patológico mantiveram-se inalterados. Houve melhora do sintoma em três pacientes (30por cento) após este período de tratamento. Os pacientes do grupo não tinham comportamento de risco para doenças sexualmente transmissíveis, todos tinham menos de três parceiros sexuais por ano. Concluiu-se que o HPV anal subclínico pode ser considerado uma possível causa de prurido anal.