ESTHESIONEUROBLASTOMA: ENDOSCOPIC APPROACH IN A KADISH C PATIENT

Introdução: Esthesioneuroblastoma (EBN) é uma neoplasia maligna rara do epitélio olfativo. Devido à sua raridade, há varias controvérsias quanto ao seu tratamento, sendo os avanços endoscópicos uma nova opção terapêutica. Objetivo: descrever o caso de um jovem masculino diagnosticado com EBN, a dificuldade diagnóstica e opções terapêuticas. Relato de Caso: masculino, 21 anos, apresentava há 2 meses dificuldade respiratória e hiposmia após ser submetido a cauterização de veia nasal devido a epistaxe recorrente. Ao exame foi confirmado massa nasal obstruindo narina esquerda. Ressonância magnética de face demostrou massa em septo nasal infiltrando orofaringe, palato, placa cribiforme e lâmina orbital do osso etmoide. Realizada embolização endovascular seguida de excisão cirúrgica endoscópica transesfenoidal. Anátomopatologia e imunohistoquímica confirmaram o diagnóstico de EBN. RNM pósoperatória demostrou lesão residual. Realizada craniotomia aberta em associação com radio e quimioterapia. Conclusão: EBN é um tumor maligno incomum da cavidade nasal superior. Por isso, não há consenso em relação à melhor abordagem cirúrgica de tratamento. Ressecção endoscópica transesfenoidal deve ser reservada apenas para estágios iniciais e seu uso em doença avançada ainda não foi profundamente estudado.Introduction: Esthesioneuroblastoma (EBN) is a rare and malignant tumor of olfactory epithelium. Due to its infrequency, there are several controversies regarding its treatment, being the endoscopic approach a new option. Objective: describe a young male case of EBN, its challenging diagnosis and options of treatment. Case report: 21 year old man who presented with a two month history of difficulty breathing and hyposmia after undergoing nasal vein cauterization for recurrent epistaxis. Physical examination confirmed a mucosal mass obstructing his left nostril. Magnetic Resonance Imaging of the face demonstrated a mass within the nasal septum infiltrating the oropharynx, hard palate, cribriform plaque and orbital lamina of the ethmoid bone. Endovascular embolization was performed followed by transsphenoidal endoscopic surgical excision. Anatomopathological and immunohistochemistry analysis confirmed the diagnosis of EBN. Repeat MRI-face showed a residual lesion requiring open craniotomy in addition to radio-chemotherapy. Conclusion: EBN is an uncommon malignant tumour arising in the superior aspect of nasal cavity. There is no consensus regarding optimal treatment strategies. Endoscopic transsphenoidal resection is reserved to early stages only and its use on advanced disease has been poorly explored

The Role of Histone Methyltransferases and Long Non-coding RNAs in the Regulation of T Cell Fate Decisions

T cell lineage decisions are critical for the development of proper immune responses to pathogens as well as important for the resolution of inflammatory responses. This differentiation process relies on a combination of intrinsic and extrinsic factors converging upon epigenetic regulation of transcriptional networks relevant to specific T cell lineages. As these biochemical modifications represent therapeutic opportunities in cancer biology and autoimmunity, implications of writers and readers of epigenetic marks to immune cell differentiation and function are highly relevant. Given the ready adoption of histone methyltransferase inhibitors in the clinic, we focus this review on the role of three histone modifying complexes: PRC-1, PRC-2, and G9A in modulating T cell fate decisions. Furthermore, we explore the role of long non-coding RNAs in regulating these processes, and discuss recent advances and challenges of implementing epigenetic therapies into clinical practice