Absence of multinucleated giant cell reaction as an indicator of tumor progression in oral tongue squamous cell carcinoma.

PURPOSE: The aim of this study was to evaluate the presence and distribution of multinucleated giant cell (MGC) reactions in 61 cases of OTSCC and to verify the association of this microscopic finding with clinicopathological parameters (gender, age, tumor size/extent, regional lymph node metastasis, distant metastasis, clinical stage, and histopathological grade of malignancy). METHODS: Clinical data were collected from medical records and the histopathological grade of malignancy of OTSCCs was evaluated using the World Health Organization (WHO) grading system. The presence and distribution of MGC reaction in high power fields (HPFs) were evaluated in hematoxylin-eosin-stained histological sections. In all cases containing MGCs, immunohistochemical analysis for CD68 was performed in order to confirm the histiocytic nature of these cells. RESULTS: Twenty-one (34.4%) cases had MGC reactions, with a higher frequency of the focal distribution pattern (57.1%). All MGCs were immunohistochemically positive for CD68. The absence of MGC reaction was significantly associated with regional lymph node metastasis (PR: 2.75; 95% CI 1.05-7.20; p = 0.027), advanced clinical stage (PR: 3.37; 95% CI 1.28-8.85; p = 0.006), and moderately/poorly differentiated tumors (PR: 3.36; 95% CI 1.51-7.48; p = 0.001). No significant associations were observed between the distribution of MGCs and clinicopathological parameters (p > 0.05). CONCLUSION: Taken together, the results of this study suggest that the absence of MGC reaction may represent an indicator of tumor progression in OTSCCs.

Dedifferentiated liposarcoma of the gallbladder: first reported case.

BACKGROUND: Liposarcoma of the gallbladder is an extremely rare sarcoma, with only five cases reported in the literature according to our knowledge. CASE PRESENTATION: A 71-year-old woman was referred to the Surgical Oncology Division of Napoleão Laureano Hospital (João Pessoa, PB, Brazil) due to a solid mass at the right side of the abdomen and fever, with no signs of jaundice. Abdominal ultrasonography and computed tomography (CT) evidenced an extensive gallbladder lobular formation adhered to the inferior border of the right hepatic lobe and cholelithiasis. The CT report suggested gallbladder liposarcoma. A cholecystectomy associated with resection of segments IV-B and V of the liver were performed. Intraoperative frozen sections were compatible with gallbladder sarcoma. Anatomopathological examination and immunohistochemistry confirmed dedifferentiated liposarcoma with foci of heterologous leiomyosarcomatous differentiation and undifferentiated fusocellular areas of high histological grade. CONCLUSION: This is the first case of dedifferentiated liposarcoma of the gallbladder to be reported.

Clear Cell Papillary Renal Cell Tumors: A Study of 42 Tumors with Emphasis on the Fibrous Capsule, Cystic Component, and GATA3 Immunohistochemistry.

Clear cell papillary renal cell tumor is a common and sometimes underdiagnosed renal cell neoplasm. Its proper recognition is important because its diagnosis implies a remarkably high probability of indolent behavior. This study aimed to evaluate the frequency of a fibrous capsule, a cystic component, and a GATA3 expression in clear cell papillary renal cell tumors. We assessed 419 renal cell neoplasms from three institutions located in northeastern Brazil and identified 42 clear cell papillary renal cell tumors (from 39 patients), which were the fourth most common renal cell neoplasm. These tumors commonly exhibited fibrous capsules (all showed complete or partial capsules) and cystic component (93%). Eighteen out of 42 tumors (43%) showed some expression of GATA3, and weak and focal staining was common among the positive tumors. Clear cell papillary renal cell tumor must always be included in the differential diagnosis of predominantly cystic renal cell neoplasms. As GATA3 is inconsistently expressed in clear cell papillary renal cell tumors, it is not useful in this diagnosis.

Isopropyl Caffeate: A Caffeic Acid Derivative-Antioxidant Potential and Toxicity.

Phenolic compounds, among them isopropyl caffeate, possess antioxidant potential, but not without toxicity and/or adverse effects. The present study aimed to evaluate the antioxidant activity and toxicity of isopropyl caffeate through in silico, in vitro and in vivo testing. The results showed that isopropyl caffeate presents no significant theoretical risk of toxicity, with likely moderate bioactivity: GPCR binding, ion channel modulation, nuclear receptor binding, and enzyme inhibition. Isopropyl caffeate induced hemolysis only at the concentrations of 500 and 1000 µg/ml. We observed types A and O erythrocyte protection from osmotic stress, no oxidation of erythrocytes, and even sequestrator and antioxidant behavior. However, moderate toxicity, according to the classification of GHS, was demonstrated through depressant effects on the central nervous system, though there was no influence on water and food consumption or on weight gain, and it did present possible hepatoprotection. We conclude that the effects induced by isopropyl caffeate are due to its antioxidant activity, capable of preventing production of free radicals and oxidative stress, a promising molecule with pharmacological potential.

Embryonal rhabdomyosarcoma in the maxillary sinus with orbital involvement in a pediatric patient: Case report.

This report presents a case of embryonal rhabdomyosarcoma (eRMS) located in the left maxillary sinus and invading the orbital cavity in a ten-year-old male patient who was treated at a referral hospital. The images provided from the computed tomography showed a heterogeneous mass with soft-tissue density, occupying part of the left half of the face inside the maxillary sinus, and infiltrating and destroying the bone structure of the maxillary sinus, left orbit, ethmoidal cells, nasal cavity, and sphenoid sinus. An analysis of the histological sections revealed an undifferentiated malignant neoplasm infiltrating the skeletal muscle tissue. The immunohistochemical analysis was positive for the antigens: MyoD1, myogenin, desmin, and Ki67 (100% positivity in neoplastic cells), allowing the identification of the tumour as an eRMS. The treatment protocol included initial chemotherapy followed by radiotherapy and finally surgery. The total time of the treatment was nine months, and in 18-mo of follow-up period did not show no local recurrences and a lack of visual impairment.

Deep Vein Thrombosis as Initial Manifestation of Whipple Disease.

INTRODUCTION: Wipple disease (WD) is a rare chronic disease caused by the bacillus Tropheryma whipplei. Constitutive, rheumatologic, gastrointestinal, cardiac, cerebral, lymphatic, cutaneous, and ophthalmological signs are possible systemic symptoms. However, thrombotic manifestations are rarely described as "stroke-like syndrome" or arterial thrombosis. Diagnosis is based on clinical manifestations and pathological examination. Laboratory findings may include anemia, leukocytosis, and thrombocytosis. OBJECTIVE: We report a case of venous thrombosis as initial manifestation of WD. CASE REPORT: We describe the case of a 53-year-old male with iliofemoral vein thrombosis followed by intermittent diarrhea, loss of appetite, abdominal distension, and bloating. A mild malnutrition state with a weight loss of 13 kg, pallor (+/4 +), presence of lower-limb edema (+/4 +), and hypertympanic distended abdomen occurred. Laboratory tests on admission revealed anemia, positive inflammatory activity tests, and normal coagulation. Endoscopic examination showed villous edema with white dotted infiltrates in the second duodenal portion and intestinal lymphangiectasia in the terminal ileum. Pathological examination revealed numerous macrophages with positive periodic acid-Schiff inclusions. Venous Doppler ultrasound showed extensive deep thrombosis on the left lower limb and recanalization of the femoral vein in the right lower limb. The patient was treated with ceftriaxone and enoxaparin sodium, which led to an improvement of gastrointestinal and thrombosis symptoms. COMMENTS: Hypercoagulability, endothelial damage, vasculitis, and blood stasis are present in T. whipplei infection, which are associated with the activation of inflammatory mechanisms as well as procoagulant and thromboembolic events. WD should be part of the differential diagnosis of diseases that cause venous thrombosis of unknown origin.

IMMUNOHISTOCHEMICAL PROFILE OF BREAST CANCER SUBTYPES IN PATIENTS SEEN AT NAPOLEÃO LAUREANO HOSPITAL, PARAÍBA, BRAZIL / Perfil dos subtipos de câncer de mama baseado no estudo imuno­histoquímico em pacientes do Hospital Napoleão Laureano ­ Paraíba

Objective: To determine the profile of molecular subtypes of invasive breast carcinomas among women who underwent immunohistochemical study from May 2013 to December 2014, at Hospital Napoleon Laureano, Paraiba, Brazil, to characterize the mean age at diagnosis and describe the percentage of the following variables: estrogen and progesterone receptors, human epidermal growth factor 2 and proliferation index (Ki-67). Method: retrospective ecological study using the secondary databases at Hospital Napoleon Laureano Pathology Laboratory. The population consisted of 683 cases of invasive breast carcinoma with immunohistochemical study in this institution between May 2013 and December 2014. Results: Of the 683 patients, 46 were excluded because they presented inconclusive results for human epidermal growth factor 2 (++), totaling 637 recorded cases. Five hundred and fifty-six (87.28%) were 40 or older, and 81 (12.72%) under 40 years old. As for estrogen and progesterone receptor, 452 patients (70.96%) were positive for both receptors, while 185 (29.04%) showed no positivity. Four hundred and sixty-eight women (73.47%) did not show overexpressed human epidermal growth factor 2, while 169 (26.53%) did. The percentage of Ki-67 showed 474 individuals (74.41%) with a high proliferation index and 163 (25.59%) with a low index. The molecular subtypes showed the following prevalence: luminal A (143 cases; 22.45%), luminal B (250 cases; 39.25%), luminal B-enriched (113 cases; 17.84%), HER2 (57 cases; 8.95%) and triple-negative (74 cases; 11.62%). Conclusion: This study supported the notion of regional differences in the profile of breast tumors, since it showed a greater prevalence of triple-positive carcinomas and lower frequency of triple-negative tumors compared to studies of other Brazilian regions.

Objetivo: Determinar o perfil dos subtipos moleculares dos carcinomas invasivos de mama entre mulheres que realizaram o estudo imuno-histoquímico de maio 2013 a dezembro de 2014, no Hospital Napoleão Laureano, Paraíba, além de caracterizar a idade média ao diagnóstico e descrever os percentuais das seguintes variáveis: receptor de estrogênio e de progesterona, fator de crescimento epidérmico humano do tipo 2 e índice mitótico (Ki-67). Método: Estudo retrospectivo, ecológico, a partir da base de dados secundários do Laboratório de Anatomia Patológica do Hospital Napoleão Laureano. A população foi composta de 683 casos de carcinoma invasivo da mama, com estudo imuno-histoquímico realizado nessa instituição entre maio de 2013 e dezembro de 2014. Resultados: Dos 683 pacientes, foram excluídos 46 por apresentarem positividade para fator de crescimento epidérmico humano do tipo 2 inconclusiva (++), totalizando 637 casos contabilizados. Quinhentas e cinqüenta e seis pacientes (87,28%) eram ≥40 anos e 81 (12,72%), <40 anos. Quanto ao estrogênio e à progesterona, 452 pacientes (70,96%) possuíam receptores positivos para ambos, enquanto 185 (29,04%) não apresentaram positividade. Quatrocentas e sessenta e oito mulheres (73,47%) não superexpressaram fator de crescimento epidérmico humano do tipo 2, em contrapartida 169 (26,53%) o fizeram. A porcentagem do Ki-67 evidenciou 474 indivíduos (74,41%) com alto índice mitótico e 163 (25,59%) com baixo índice. Os subtipos moleculares apresentaram as prevalências: luminal A (143 casos; 22,45%), luminal B (250 casos; 39,25%), luminal B amplificado (113 casos; 17,84%), fator de crescimento epidérmico humano 2 (57 casos; 8,95%) e triplo negativo (74 casos; 11,62%). Conclusões: Este artigo ratificou a existência de diferenças regionais quanto ao perfil dos subtipos de tumores mamários, demonstrando maior prevalência de carcinomas triplo-positivos e menor frequência de tumores triplo-negativos quando comparado a outros estudos.