Is Immediate Breast Reconstruction With a Latissimus Dorsi Myocutaneous Flap Safe for Starting Adjuvant Chemotherapy in Patients With Breast Cancer?

INTRODUCTION: Immediate breast reconstruction following mastectomy reduces perceptions of mutilation and femininity issues in oncological patients, but surgical complications should not delay chemotherapy. This study evaluated postsurgical complications in patients who underwent radical breast surgery followed by immediate reconstruction with latissimus dorsi myocutaneous flaps and silicone implants, along with resulting impacts in delaying chemotherapy. MATERIALS AND METHODS: This retrospective study utilized a prospectively maintained database. Clinical, surgical, and oncological data from 196 women were collected according to the operated side. Patients were grouped according to the time elapsed between surgery and the first cycle of adjuvant chemotherapy: ≤ 60 days (group 1), 61 to 90 days (group 2), or > 90 days (group 3). RESULTS: A total of 198 immediate reconstructions were performed on 196 patients between August 1, 2010 and March 31, 2020; after surgery, 47.4% had minor complications and 7.1% had major complications. Ninety-six patients (48.5%) received adjuvant chemotherapy. The mean time elapsed between surgery and the first chemotherapy cycle was 65.4 days (median: 59), with 52.7% of the patients assigned to group 1, 37.4% to group 2, and 9.9% to group 3. The occurrence of major postoperative complications significantly affected the start of chemotherapy (64.0 vs. 94.5 days; P = .044). Additionally, patients with 2 or more comorbidities were more likely to experience major complications (OR: 3.35; 95% CI: 1.03-10.95; P = .045) than those with 1 or 0. CONCLUSION: Major postoperative complications significantly delayed initiation of adjuvant chemotherapy in oncological patients who underwent radical breast surgery followed by immediate reconstruction with a latissimus dorsi myocutaneous flap and silicone implants.

Neoadjuvant chemotherapy impact on outcomes in immediate breast reconstruction with latissimus dorsi flap and silicone implant.

BACKGROUND AND OBJECTIVES: Neoadjuvant chemotherapy (NCH) has demonstrated efficacy in downsizing tumors and facilitating less extensive surgery. However, immediate breast reconstruction (IBR) after NCH has raised concerns regarding higher complication rates. This study evaluates the impact of NCH on outcomes following IBR with a latissimus dorsi flap and implant (LDI) after mastectomy. METHODS: Cases from a prospective maintained database were reviewed, and patients classified according to whether or not they received NCH. Risk factors and major and minor complications in both groups were then analyzed. RESULTS: Among the 196 patients who underwent 198 IBR procedures, 38.4% received NCH and 66.1% did not. The overall complication rate was 46.7% in the non-NCH group and 53.3% in the NCH group (p = 0.650). The presence of comorbidities increased the likelihood of any complication (odds ratio [OR]: 3.46; 95% confidence interval [CI]: 1.38-8.66; p = 0.008) as well as major complications (OR: 3.35; 95% CI: 1.03-10.95; p = 0.045). Although patients in the NCH group experienced more major complications (10.5% vs. 4.9%; p = 0.134) and early loss of breast reconstruction (3.9% vs. 0.8%; p = 0.128), these findings were not statistically significant. CONCLUSION: This study found no statistically significant association between NCH and higher risk of complications or loss of IBR with LDI after mastectomy.

Teleoncology Orientation of Low-Income Breast Cancer Patients during the COVID-19 Pandemic: Feasibility and Patient Satisfaction.

OBJECTIVE: The present study aims to assess the feasibility and patient satisfaction of teleoncology orientation in a vulnerable population of breast cancer patients assessed in a government health system during the coronavirus pandemic in 2020. METHODS: Eligible patients received an invitation to receive remote care to minimize exposure to an environment in which the risk of respiratory infection was present. The means of communication was telephone through an application that allows free conversation with no charge. An anonymous-response questionnaire based on a Likert-type scale was sent through a cell phone application or e-mail directly to each patient or close relative of the patient immediately after teleconsultation. Responses to the questions, which addressed utility, facility, interface quality, interaction quality, reliability, satisfaction, and interest in future evaluation, were compiled and analyzed. RESULTS: A total of 176 eligible patients scheduled for consultation were evaluated and 98 were included. Seventy (71.4%) successfully undertook the teleorientation. The questionnaire was submitted by 43 (61.4%) patients. The overall teleoncology orientation was classified as very positive by 41 (95.3%) patients. Specifically, regarding the questionnaire items, 43 (100%) patients scored 4 or 5 (agreed that the teleconsultation was beneficial) concerning the facility, followed by 42 (97.2%) for the interface quality, 41 (95.3%) for both utility and interaction quality, 40 (93%) for satisfaction and interest in future evaluation, and, finally, 39 (90.6%) for reliability. CONCLUSION: Teleoncology orientation of low-income breast cancer patients is most feasible and leads to high patient satisfaction.

OBJETIVO: O presente estudo teve como objetivo avaliar a viabilidade e satisfação em relação à orientação teleoncológica realizada em população vulnerável de pacientes com câncer de mama e provenientes do sistema público de saúde durante a pandemia do coronavírus em 2020. MéTODOS: Pacientes elegíveis foram agendados para atendimento remoto visando minimizar exposição a ambientes com risco de infecção respiratória. O meio de comunicação foi o telefone, pois permite conversa sem custos. Um questionário anônimo com base na escala Likert foi enviado através de aplicativo de telefone celular ou e-mail para paciente ou familiares, logo após a teleconsulta. As respostas, que abordavam utilidade, facilidade, qualidade da interface, qualidade da interação, confiabilidade, satisfação e interesse em avaliações futuras, foram compiladas e analisadas. RESULTADOS: Um total de 176 pacientes elegíveis para teleconsulta foram avaliados e 98 foram incluídos. Setenta (71,4%) realizaram a teleorientação com sucesso. O questionário foi respondido por 43 (61,4%) pacientes. De maneira geral, a teleorientação foi classificada como muito positiva por 41 (95,3%) pacientes. Em relação aos itens avaliados, 43 (100%) pacientes pontuaram 4 ou 5 (concordaram que a teleconsulta era benéfica) em relação à facilidade do serviço, seguido por 42 (97,2%) para a qualidade da interface, 41 (95,3%) tanto para a utilidade quanto para a qualidade da interação, 40 (93%) para satisfação e interesse em avaliação futura e 39 (90,6%) para confiabilidade em relação ao método. CONCLUSãO: A orientação teleoncológica em pacientes de baixa renda e com câncer de mama mostrou ser viável e com altas taxas de satisfação.

Teleoncology Orientation of Low-Income Breast Cancer Patients during the COVID-19 Pandemic: Feasibility and Patient Satisfaction / Orientação teleoncológica de pacientes de baixa renda com câncer de mama durante a pandemia de COVID-19: Viabilidade e satisfação do paciente

Abstract Objective The present study aims to assess the feasibility and patient satisfaction of teleoncology orientation in a vulnerable population of breast cancer patients assessed in a government health system during the coronavirus pandemic in 2020. Methods Eligible patients received an invitation to receive remote care to minimize exposure to an environment in which the risk of respiratory infection was present. The means of communication was telephone through an application that allows free conversation with no charge. An anonymous-response questionnaire based on a Likert-type scale was sent through a cell phone application or e-mail directly to each patient or close relative of the patient immediately after teleconsultation. Responses to the questions, which addressed utility, facility, interface quality, interaction quality, reliability, satisfaction, and interest in future evaluation, were compiled and analyzed. Results A total of 176 eligible patients scheduled for consultation were evaluated and 98 were included. Seventy (71.4%) successfully undertook the teleorientation. The questionnaire was submitted by 43 (61.4%) patients. The overall teleoncology orientation was classified as very positive by 41 (95.3%) patients. Specifically, regarding the questionnaire items, 43 (100%) patients scored 4 or 5 (agreed that the teleconsultation was beneficial) concerning the facility, followed by 42 (97.2%) for the interface quality, 41 (95.3%) for both utility and interaction quality, 40 (93%) for satisfaction and interest in future evaluation, and, finally, 39 (90.6%) for reliability. Conclusion Teleoncology orientation of low-income breast cancer patients is most feasible and leads to high patient satisfaction.

Resumo Objetivo O presente estudo teve como objetivo avaliar a viabilidade e satisfação em relação à orientação teleoncológica realizada em população vulnerável de pacientes com câncer de mama e provenientes do sistema público de saúde durante a pandemia do coronavírus em 2020. Métodos Pacientes elegíveis foram agendados para atendimento remoto visando minimizar exposição a ambientes com risco de infecção respiratória. O meio de comunicação foi o telefone, pois permite conversa sem custos. Um questionário anônimo com base na escala Likert foi enviado através de aplicativo de telefone celular ou e-mail para paciente ou familiares, logo após a teleconsulta. As respostas, que abordavam utilidade, facilidade, qualidade da interface, qualidade da interação, confiabilidade, satisfação e interesse em avaliações futuras, foram compiladas e analisadas. Resultados Um total de 176 pacientes elegíveis para teleconsulta foram avaliados e 98 foram incluídos. Setenta (71,4%) realizaram a teleorientação com sucesso. O questionário foi respondido por 43 (61,4%) pacientes. De maneira geral, a teleorientação foi classificada como muito positiva por 41 (95,3%) pacientes. Em relação aos itens avaliados, 43 (100%) pacientes pontuaram 4 ou 5 (concordaram que a teleconsulta era benéfica) em relação à facilidade do serviço, seguido por 42 (97,2%) para a qualidade da interface, 41 (95,3%) tanto para a utilidade quanto para a qualidade da interação, 40 (93%) para satisfação e interesse em avaliação futura e 39 (90,6%) para confiabilidade em relação ao método. Conclusão A orientação teleoncológica empacientes de baixa renda e com câncer de mama mostrou ser viável e com altas taxas de satisfação.

The Breast Tumor Microenvironment: Could Silicone Breast Implant Elicit Breast Carcinoma?

Complications related to breast implants have received much attention recently. Breast implant-associated anaplastic large cell lymphoma, silicone-induced granuloma of breast implant capsule, and breast implant illness are the main complications reported in the medical literature. However, the literature contains limited evidence regarding the possibility of silicone implants eliciting breast carcinoma. In this manuscript, we propose a theory in which the immune response to silicone breast implant gel bleeding acts as a triggering point for tumor oncogenesis in breast tissue. This hypothesis is derived from our findings of a case of invasive and undifferentiated medullary carcinoma in a patient with a silicone breast implant. The following concepts have been used to support this theory: 1) silicone bleeding from intact breast implants; 2) metaplasia: an adaptation to injury and precursor to dysplasia and cancer; 3) T-cell dysfunction in cancer immunity; 4) inhibitory cells in the tumor microenvironment (TME); 5) morphogenesis and bauplan; and 6) concepts underlying medullary carcinoma. We propose that the inflammatory process in response to silicone particles in the pericapsular glandular tissue favors the development of cellular mutations in specialized epithelial cells. This reverse morphogenesis could have resulted in breast carcinoma of the medullary type in the present case.

Mamoplastia redutora modificada para otimização de abordagem oncológica: resultados iniciais e revisão da literatura / Modified reduction mammoplasty for optimization of oncological approach: initial results and literature review

Introdução: O câncer de mama é a segunda neoplasia mais comum entre as mulheres. A constante evolução científica tem permitido abordagens cirúrgicas cada vez menos invasivas, diminuindo a morbidade relacionada ao tratamento sem prejuízo oncológico. O objetivo deste artigo é mostrar os resultados cirúrgicos e a versatilidade da mamoplastia redutora com a técnica de Pitanguy modificada, para otimização da reconstrução imediata associada à cirurgia oncológica. Métodos: Apresentamos os casos de três pacientes submetidas à técnica proposta. A marcação da mama com diagnóstico de câncer é planejada seguindo os princípios da mamoplastia redutora descrita por Pitanguy. Porém, o triângulo de ressecção inferolateral é transposto para a área supratumoral. Ele pode ser posicionado da junção dos quadrantes laterais (JQL) até o quadrante superolateral (QSL) da mama oncológica. Resultados: As três pacientes foram submetidas à técnica descrita associada à mamoplastia de simetrização contralateral com a técnica de Pitanguy. Todas realizaram radioterapia adjuvante, associada ou não à quimioterapia. Duas pacientes evoluíram sem intercorrências e uma apresentou pequena necrose de 1x1cm na junção inferior dos retalhos na mama com câncer, que foi tratada de maneira conservadora sem atrasar o tratamento adjuvante. Todas seguem satisfeitas com o resultado estético. Conclusão: A técnica descrita mostrou-se uma boa alternativa para tumores localizados entre a JQL e o QSL da mama oncológica, proporcionando ressecções mais amplas e dessa forma ampliando a indicação de cirurgia conservadora e reduzindo a necessidade de cirurgia radical, com melhores resultados estéticos sem prejuízo do desfecho oncológico.

Introduction: Breast cancer is the second most common cancer among women. Constant scientific evolution has allowed increasingly less invasive surgical approaches, reducing treatment-related morbidity without cancer damage. The objective of this article is to show the surgical results and the versatility of reduction mammoplasty with the modified Pitanguy technique to optimize the immediate reconstruction associated with cancer surgery. Methods: We present the cases of three patients who underwent the proposed technique. Marking of the breast diagnosed with cancer is planned following the principles of reduction mammoplasty described by Pitanguy. However, the inferolateral resection triangle is transposed into the supratumoral area. It can be placed from the junction of the lateral quadrants (JLQ) to the superolateral quadrant (SLQ) of the oncological breast. Results: the three patients underwent the described technique associated with contralateral symmetrization mammoplasty with the Pitanguy technique. All were submitted to adjuvant radiation therapy, associated or not with chemotherapy. Two patients progressed without incident and one had a small necrosis of 1x1 cm at the flaps lower junction in the breast with cancer, which was treated conservatively without delaying the adjuvant treatment. All were satisfied with the aesthetic result. Conclusion: The described technique proved to be a good alternative for tumors located between the JLQ and the SLQ of the oncological breast. It provides broader resections and thus expands the indication for conservative surgery and reduces the need for radical surgery, with better aesthetic results without impairment of the cancer outcome

Silicone-Induced Granuloma of Breast Implant Capsule (SIGBIC): Histopathology and Radiological Correlation.

Currently, attention has been given to complications related to breast implants, especially due to the presence of anaplastic large cell lymphoma (ALCL) related to silicone implants. Many manuscripts attempt to associate silicone presence with clinical complaints reported by patients, while others try to demonstrate the mechanisms of silicone bleeding by permeability loss of breast implant surfaces. There also are reports of foreign body type reactions from implant fibrous capsule to silicone corpuscles. However, there seems to be no study that correlates the clinical, radiological, and histological correlations of these lesions. The objective of this review is to correlate radiological findings of silicone-induced granuloma of breast implant capsule (SIGBIC) from breast MRI (BMRI) scans and complementary findings of ultrasound (US) and positron emission tomography (PET) scan, and its histology originated from surgical breast implant capsulectomy. To make this correlation possible, we divided SIGBIC into three radiological findings: (1) intracapsular SIGBIC, (2) SIGBIC with extracapsular extension, and (3) mixed SIGBIC associated with seroma. Our experience demonstrates histological-radiological correlation in SIGBIC diagnosis. Knowledge of these findings may demonstrate its real importance in terms of public health and patient management. We believe that SIGBIC is currently underdiagnosed by lack of training, guidance, and management in our clinical practice.

Reconstrução mamária imediata com retalho do músculo grande dorsal e implante de silicone / Immediate breast reconstruction with latissimus dorsi flap and silicone implant

Introdução: O primeiro tratamento eficaz para o câncer de mama foi descrito em 1894. A partir das décadas de 60 e 70, cirurgias menos agressivas foram desenvolvidas, sem prejuízos oncológicos. Com evolução histórica semelhante, o retalho do músculo grande dorsal (RMGD) foi introduzido em 1906. Contudo, apenas 70 anos após sua primeira descrição, ele ganhou popularidade como uma opção para as reconstruções mamárias. Método: Estudo clínico retrospectivo realizado por meio da coleta de dados de 22 pacientes submetidas à reconstrução mamária imediata com emprego do RMGD associado a implante de silicone durante o período de fevereiro de 2012 a dezembro de 2013. Resultados: Não houve necrose do retalho de grande dorsal ou perda da reconstrução mamária nos casos estudados. Foram observados 10 casos (45%) de seroma em região dorsal, 3 casos (14%) de necrose parcial da pele da mastectomia e 3 casos (14%) de deiscência parcial da ferida operatória. Não foram evidenciados fatores de risco com significância estatística para as complicações apresentadas. Ocorreram 4 casos (18,18%) de alterações de cobertura do implante, com atrofia muscular e cutânea, e 2 casos (9,09%) de contratura capsular. Apenas um caso não foi associado à radioterapia. Contudo, não houve significância estatística em relação à radioterapia adjuvante e às complicações tardias apresentadas (p = 0,635). Conclusão: O RMGD associado ao implante de silicone é uma opção segura e confiável para a reconstrução mamária imediata após mastectomias.

Introduction: The first effective breast cancer treatment was described in 1894. Less aggressive surgeries were developed in the 1960s and 70s, without increased mortality due to cancer. With similar historical evolution, the latissimus dorsi muscle flap (LDMF) procedure was introduced in 1906. Seventy years after its first description, LDMF gained popularity as an option for breast reconstruction. Method: A retrospective clinical study was conducted using data obtained from 22 patients undergoing immediate breast reconstruction with LDMF and silicone implants between February 2012 and December 2013. Results: No latissimus dorsi flap necrosis or breast reconstruction losses were observed in this study. Ten cases (45%) of seroma were detected in the dorsal region, three cases (14%) of partial necrosis of the mastectomized skin, and three cases (14%) of partial surgical wound dehiscence. Statistical significant risk factors for the complications observed have not been emphasized. There were four cases (18.18%) of muscle and skin atrophy associated with implants, and two cases (9.09%) of capsular contracture. Only one case was not associated with radiotherapy. However, there were no statistically significant differences in adjuvant radiotherapy and late complications (p = 0.635). Conclusion: LDMF associated with silicone implants is a safe and reliable option for immediate breast reconstruction after mastectomies.

Reconstrução da porção medial da pálpebra inferior com retalho de Imre / Reconstruction of medial portion of inferior eyelid using the Imre flap

Introdução: A reconstrução da pálpebra inferior se constitui em um importante capitulo de reconstruçãofacial, tanto por seu aspecto estético quanto por sua importância funcional, evitandocomprometimentos oculares mais graves. Dissertamos neste artigo sobre uma excelente opçãoterapêutica para esse tipo de reconstrução, especialmente em casos de defeitos extensos da pálpebra.Relato dos casos: Foram operados dois pacientes, em junho de 2008, que apresentavamdefeitos da pálpebra inferior entre 50% e 75% da mesma após ressecção de tumores de pele.Esses pacientes foram submetidos à reconstrução com retalho de Imre, descrito, em 1903, pelocirurgião Joseph Imre, seguindo sua marcação original, evoluindo com resultado efetivo quantoa sua importância funcional e estética. Os casos operados apresentaram bom posicionamento daspálpebras inferiores, sem ectrópio, apresentando apenas uma leve esclera aparente, porém semrepercussão funcional em um dos casos operados. As cicatrizes resultantes localizaram-se nossulcos naturais da face. Discussão: Consideramos que a técnica proposta por Imre se adequaàs necessidades da reconstrução palpebral inferior, proporcionando bom resultado funcionale estético, com pouca morbidade de área doadora. Conclusão: O retalho de Imre se constituiem mais uma opção para reconstrução da porção medial da pálpebra inferior, sendo de fácilexecução e reprodutível, mesmo em grandes defeitos da mesma.

Introduction: The inferior eyelid reconstruction is one of the important issues about facialreconstruction. Besides its aesthetical importance, there is its functional one, avoiding ocularproblems. In this article we present an excellent option of eyelid reconstruction - the Imreflap - especially in defects greater than 50% of extension. Cases report: In July 2008, twopatients were gone under surgery because skin cancer on inferior eyelid. The ejelid defectswere about 50 to 75% of the extension of them. The Imre flap was described first by JosephImre, in 1903. His original technique was followed and the results were functional and aestheticaleffective. Discussion: We considered that the Imre flap is applicable and useful toreconstruct the inferior eyelid, with little morbidity of the donor area and a great final result.Conclusion: The Imre flap is one more option to reconstruct the inferior eyelid portion. It’sa reproducible and an easy technique available to reconstruct large defects of inferior eyelid.

Lipoma intermuscular gigante: relato de caso / Giant intermuscular lipoma: case report

Introdução: Contrastando com o fato de que os lipomas são tumores mesenquimais muito comuns, a variante subfascial é bastante rara. Esta é subdividida em intermuscular eintramuscular. O tipo intermuscular é o menos comum. Os lipomas gigantes também são raramente encontrados e são caracterizados por medir, no mínimo, 10 centímetros em uma dasdimensões ou pesar ao menos 1000 gramas. Relato do caso: No presente artigo, relatamos o caso de uma paciente apresentando um lipoma intermuscular gigante localizado na coxa.

Introduction: Despite the fact that lipomas are very common mesenchymal tumors, the subfascial variant is quite rare. It is subdivided into intermuscular and intramuscular. The intermuscular type is less common. Giant lipomas are also rarely found and are characterizedby measuring at least 10 centimeters in one dimension or weigh at least 1000 grams. Case report: In this article, we describe the case of a patient presenting a giant intermuscular lipoma located in the thigh.

Tratamento da orelha em ponto de interrogação / Question mark ear treatment

As deformidades congênitas uni ou bilaterais da orelhaexterna com atrofia do segmento médio da concha e da escafa sãocoloquialmente chamadas de orelha em ponto de interrogação,devido ao hipodesenvolvimento deste segmento e pelo formatocaracterístico. Diversos autores publicaram suas experiências paraa correção deste tipo de deformidade congênita. Nossa experiênciabaseia-se na reconstrução de três casos, mediante a combinaçãode retalho de deslizamento e da ressecção de um triângulo decompensação na concha, ambos do tipo condro-cutâneo, natentativa de evitar ao máximo a redução do eixo maior da orelhae manter o seu contorno o mais natural possível. Método: Foramoperadas três pacientes do sexo feminino, com 17, 19 e 20 anos,sendo que na paciente de menor idade a deformidade era unilaterale nas outras duas, bilateral. Os procedimentos cirúrgicosobedeceram a mesma sistematização. Em todos os casos, o maioreixo da orelha foi medido antes e após a cirurgia, assim como otamanho do defeito a ser corrigido, para avaliações comparativas.Resultados: Os detalhes cirúrgicos descritos foram basicamentesimilares, porém as deformidades encontradas não apresentaramum padrão idêntico, mesmo numa mesma pessoa com problemabilateralmente. A extensão sendo variável determinou ressecçõesmaiores ou menores, linhas de sutura diversas na posição e naextensão, tendo como parâmetro o retalho de deslizamento e aressecção de um triângulo de compensação. Conclusões: Osprocedimentos descritos são de fácil execução, sob anestesia local,condições ambulatoriais e realizados num único tempo operatório.

The congenital external ear deformity withweakening of the medium segment of conch and of scapha isusually denominated question mark ear because of the calledminor development of that segment and by its characteristicshape. Some authors have published their experiences to correctthis kind of deformity. Our experience is based on three patientsusing a sliding flap and a compensatory triangle of the conch tobalance the reduction of the major axis of the ear and supportits shape as natural as possible. Method: Three female patientswere submitted to a surgical procedure. They were 17, 19 and 20years old; the youngest has a unilateral deformity and the others,bilateral. The procedures were systematically done. The majoraxis and the size of the defect were measured before and afterthe surgery to be compared. Results: The surgical procedures werealmost similar, however the deformities were not. They weredifferent even in the same patient. Although the same technicalprinciple of sliding flap and compensatory triangle of the conchhas been used, the extension of the defect determined minor ormajor resection and suture lines different in position and extension.Conclusions: The described procedure is not technically difficult.It can be performed under local anesthesia, ambulatorycondition and in only one operating time.

Primary mucinous adenocarcinoma of the bladder with signet-ring cells: case report.

CONTEXT: Primary adenocarcinomas of the bladder are uncommon and usually occur by contiguity with or hematogenic dissemination of other adenocarcinomas such as colorectal, prostate and gynecological tract carcinomas. Mucinous and signet-ring cell histological patterns are even rarer and it is often difficult to morphologically distinguish them from metastatic colorectal adenocarcinoma. CASE REPORT: We present and discuss a rare case of primary mucinous adenocarcinoma of the bladder with signet-ring cells in a 57-year-old male patient. Other primary sites for the tumor had been excluded and, in the absence of digestive tract tumor and for confirmation that it was a primary bladder tumor, an immunohistochemistry study was performed.

Primary mucinous adenocarcinoma of the bladder with signet-ring cells: case report

CONTEXT: Primary adenocarcinomas of the bladder are uncommon and usually occur by contiguity with or hematogenic dissemination of other adenocarcinomas such as colorectal, prostate and gynecological tract carcinomas. Mucinous and signet-ring cell histological patterns are even rarer and it is often difficult to morphologically distinguish them from metastatic colorectal adenocarcinoma. CASE REPORT: We present and discuss a rare case of primary mucinous adenocarcinoma of the bladder with signet-ring cells in a 57-year-old male patient. Other primary sites for the tumor had been excluded and, in the absence of digestive tract tumor and for confirmation that it was a primary bladder tumor, an immunohistochemistry study was performed.

CONTEXTO: Adenocarcinomas vesicais primários são incomuns, o habitual é o comprometimento por contigüidade ou via hematogênica de outros adenocarcinomas como colorretal, próstata e trato ginecológico. O padrão histológico correspondente ao mucinoso e com células em anel de sinete é mais raro e, muitas vezes, há dificuldade em distingui-lo morfologicamente do adenocarcinoma colorretal metastático. RELATO DE CASO: Apresentamos e discutimos um caso de adenocarcinama mucinoso com células em anel de sinete primário da bexiga em um paciente masculino, de 57 anos. Foram excluídos outros sítios primários do tumor e, na ausência de tumor do trato digestivo e para confirmação de tumor vesical primário realizou-se estudo imunoistoquímico.

Aneurisma de artéria poplítea como manifestação da doença de Behçet descompensada / Popliteal artery aneurysm as a manifestation of decompensated Behçet's disease

A doença de Behçet consiste em uma vasculite sistêmica que acomete veias, artérias e capilares, mas predominantemente pequenos vasos. Raramente há o envolvimento de veias e artérias de médio e grande calibre, sendo as artérias menos acometidas que as veias. No presente trabalho, os autores apresentam um relato de caso de aneurisma da artéria poplítea em um paciente com a doença de Behçet descompensada. Discutem-se os aspectos clínicos e radiológicos e o manejo cirúrgico dos pacientes com essa doença inflamatória sistêmica que apresentam peculiaridades importantes.

Behçet's disease consists of a systemic vasculitis that affects veins, arteries and capillaries, but predominantly small vessels. Veins and medium- and large-caliber arteries are rarely involved; however, arteries are less involved than veins. In this paper the authors present a case of popliteal artery aneurysm in a patient with decompensated Behçet's disease. We discuss clinical, radiological and surgical aspects of patients with this inflammatory systemic disease who present important peculiarities.