Osseous metaplasia in gliosarcoma: an unusual histologic finding. Case report

Gliosarcoma (GS) is a malignant neoplasm of the central nervous system that has coexisting glial and mesenchymal components. GSs are rarely related to osseous metaplasia. The authors report a case of GS in a male patient presenting apathy and catatonia. Computed tomography/magnetic resonance imaging showed an expansive process affecting the left frontal lobe. At microscopy, a malignant glioma constituted by highly atypical glial cells intermingled with spindle-shaped cells was identified. The lesion showed areas of necrosis with pseudopalisading formation, focus of osseous metaplasia, and positive immunoexpression of S100, CD99 and vimentin in both elements. Only the sarcomatous component exhibited negative immunoexpression of glial fibrillary acidic protein (GFAP). The diagnosis of GS was then established

Angiossarcoma metastático intra-axial do sistema nervoso central associado a anemia, tuberculose pulmonar e sobrevivência curta

Introduction: Angiosarcoma (AG) is a malignant mesenchymal neoplasm that pre- dominantly affects the soft tissues and, to variable degrees, expresses the morphological and functional characteristics of the endothelium. The incidence of sarcomas of the central nervous system (CNS) is low (0.5% to 2.7%), and AGs involving the brain are even rarer. Case Description A 45-year-old male patient presented with complaints of headache, nausea, and vomiting. An examination showed bilateral papilledema and a right lung pleurotomy. The patient’s previous history included drug addiction, pulmonary tuberculosis, lung abscess, pleural empyema, and pulmonary artery embolization for severe hemoptysis. Computed tomography/magnetic resonance imaging scans revealed a large intra-axial lesion extending into the right parietal and temporal lobes, with hemorrhagic zones. The patient underwent surgical resection of the lesion. Microscopy showed a poorly-differentiated, high-grade malignant tumor composed of plump/epithelioid cells forming small vascular spaces and solid nests, compatible with AG.In the postoperative period, the patient developed recurrent hemoptysis. A biopsy of the tissues adjacent to the pleurotomy determined the diagnosis of pulmonary AG. At 30 days after the resection, the patient died from hemoptysis, hemothorax, lung atelectasis, and intracranial hypertension related to the recurrence of the brain tumor. Conclusion: Angiosarcoma is a rare neoplasia related to short survival due to the high proliferative index, which must be considered in patients presenting hemorrhagic tumors. No specific genetic abnormalities have been described for this neoplasia.Introdução: O angiossarcoma (AG) é uma neoplasia mesenquimal maligna que afeta predominantemente os tecidos moles e, em graus variáveis, recapitula as características morfológicas e funcionais do endotélio. A incidência de sarcomas do sistema nervoso central (SNC) é baixa (0,5% a 2,7%), e os AGs envolvendo o cérebro são ainda mais raros. Descrição do Caso Paciente masculino, 45 anos, apresentou queixa de dor de cabeça, náusea e vômitos. O exame físico mostrou papiledema bilateral e pleurostomia à direita. A história prévia incluía drogadição, tuberculose pulmonar, abscesso pulmonar, empiema pleural e embolização da artéria pulmonar por hemoptise grave. A tomografia computadorizada / ressonância magnética revelou uma grande lesão intra-axial com zonas hemorrágicas que se estendia para os lobos parietal e temporal direitos. O paciente foi submetido à ressecção cirúrgica da lesão. A microscopia mostrou um tumor maligno de alto grau, pouco diferenciado, composto por células fusiformes / epitelioides, formando pequenos espaços vasculares e ninhos sólidos, compatíveis com AG. No pós-operatório, o paciente desenvolveu hemoptise recorrente. A biópsia dos tecidos adjacentes à pleurostomia determinou o diagnóstico de AG pulmonar. Após 30 dias da ressecção, o paciente faleceu por hemoptise, hemotórax, atelectasia pulmonar e hipertensão intracraniana relacionada à recorrência do tumor cerebral. Conclusão: A AG é uma neoplasia rara relacionada à curta sobrevida devido ao alto índice proliferativo, que deve ser considerada em pacientes com tumores hemorrágicos. Nenhuma anormalidade genética específica foi descrita para esta neoplasia

Neuroparacoccidioidomicose multifocal de forma pseudotumoral em paciente imunocompetente : uma revisão clinicopatológica baseada em um relato de caso

Neuroparacoccidiodimycosis (NPDM) is an uncommon granulomatous disease, which more frequently affects immunocompromised male patients over 30 years of age in the course of chronic lung disease. Paracoccidioides brasiliensis (PB) is an endemic fungus in Brazil, and grows as thick-walled yeast (with round to oval bodies) measuring 10 µm to 60 µm in diameter. Neuroparacoccidiodimycosi may develop many years after transmission and/or primary lung involvement. The authors describe a case of NPDM affecting a male patient, 52 years of age, farmer, heavy smoker, with clinical complaint of headache, asthenia, seizures, and prostration in the previous nine months. Upon physical examination, the patient presented regular general condition, without other relevant physical alterations. Computed tomography (CT) showed multiple bilateral pulmonary nodules associated to enlargement of the mediastinal lymph node. Magnetic resonance imaging (MRI) and CT scans of the central nervous system showed six heterogeneous nodular lesions compromising the frontal and parietal lobes, the largest one measuring 3.8 × 3.2 × 3.2 cm. The hypothesis of a neoplastic process compromising the lung and brain was considered. A biopsy of the mediastinal lymph node showed epithelioid granulomas, which exhibited round, thin-walled fungal structures in Grocott silver stain. The stereotactic biopsy of the frontal lesion was constituted by necrotic tissue admixed with some round to oval, thin-walled fungi measuring 10 µm to 60 µm, compatible with PB (identified on Grocott silver stain/confirmed in culture). The diagnosis of NPDM was then established. The employed therapeutic regimen was intravenous amphotericin B, itraconazole, and sulfamethoxazole-trimetropin. After ninety days of clinical follow-up, no episodes of seizures/neurological deficits were identified, and a marked decrease in the number and size of the lung and brain lesions were found.A neuroparacoccidiodimicose (NPDM) é uma doença granulomatosa incomum, que acomete mais freqüentemente pacientes imunocomprometidos do sexo masculino com mais de 30 anos, no curso de doença pulmonar crônica. Paracoccidioides brasiliensis (PB) é um fungo endêmico no Brasil e cresce como levedura de parede espessa (com corpos arredondados a ovais) medindo 10–60 μm de diâmetro. A NPDM pode se desenvolver muitos anos após a transmissão e / ou envolvimento pulmonar primário. Os autores descrevem um caso de NPDM em paciente masculino, 52 anos, agricultor, tabagista pesado, com queixa clínica de cefaleia, astenia, convulsões e prostração nos últimos nove meses. Ao exame físico, o paciente apresentava estado geral regular, sem outras alterações físicas relevantes. A tomografia computadorizada (TC) mostrou múltiplos nódulos pulmonares bilaterais associados a linfonodomegalia mediastinal. A TC / ressonância magnética do sistema nervoso central revelou seis lesões nodulares heterogêneas comprometendo os lobos frontal e parietal, a maior delas medindo 3,8x3,2x3,2 cm. Foi considerada a hipótese do processo neoplásico comprometendo pulmão e cérebro. A biópsia de linfonodo mediastinal mostrou granulomas epitelioides, que exibiam estruturas fúngicas arredondadas e de paredes finas na coloração pela prata de Grocott. A biópsia estereotáxica da lesão frontal era constituída por tecido necrótico entremeado por algumas estruturas fúngicas redondas a ovais e de parede fina, medindo 10–60 μm, compatível com PB (identificado na coloração de prata Grocott / confirmado em cultura). O diagnóstico de NPDM foi então estabelecido. O esquema terapêutico empregado foi anfotericina B intravenosa, itraconazol e sulfametoxazol-trimetropina. Após 90 dias de acompanhamento clínico, nenhum episódio de convulsão / déficit neurológico foi identificado, e uma diminuição acentuada no número e tamanho das lesões pulmonares e cerebrais foi encontrada

Accessory ovary : case report of an incidental finding in a bilateral ovarian tumor resection

Ovários ectópicos estão entre as mais raras anomalias ginecológicas, compreendendo ovários supranumerários e acessórios. Relatamos o caso de um ovário acessório no istmo tubário, encontrado incidentalmente no exame anatomopatológico de uma paciente de 70 anos que foi submetida à anexectomia bilateral por lesão cística volumosa em ovário direito e lesões calcificadas em ovário esquerdo. Aspectos clínicos, diagnósticos e epidemiológicos são discutidos neste estudo.Ectopic ovaries are among the rarest gynecological abnormalities, comprising supernumerary and accessory ovaries. We report the case of an accessory ovary in the tubal isthmus found incidentally in the anatomopathological examination of a 70-year-old female patient who underwent bilateral adnexectomy for a large cystic lesion in the right ovary and calcified lesions in the left ovary. Clinical, diagnostic and epidemiological aspects are discussed in this study

Histopathological evaluation of coronary thrombi in patients with ST-segment elevation myocardial infarction

ABSTRACTBackgroundPrimary percutaneous coronary intervention (primary PCI) is the preferred reperfusion method in patients with ST-segment elevation myocardial infarction (STEMI). Manual aspiration thrombectomy has been increasingly used and enables the analysis of thrombus aspirates.MethodsConsecutive patients undergoing primary PCI were enrolled from December 2009 to June 2011. Clinical, laboratory and angiographic data were prospectively collected and entered in a dedicated database. The decision to perform thromboaspiration was left to the discretion of the operators. One hundred and twelve samples of thrombi were collected, stored in 10% formalin-fixed paraffin, stained with hematoxylin-eosin and analyzed by light microscopy. On histopathological evaluation, the thrombi were classified as recent thrombi or lysed/organized thrombi.ResultsRecent thrombi were identified in 68 patients (61%) and lysed/organized thrombi in 44 patients (39%). Patients with recent thrombi had higher red blood cell infiltration (P=0.03). There were no other statistically significant differences identified for clinical, angiographic, laboratory or clinical outcomes between the two study groups.ConclusionsIn patients with STEMI undergoing primary PCI, two-thirds of thrombus aspirates showed histopathological features of recent thrombi. There were no significant associations between these characteristics and clinical, laboratory and angiographic data in this contemporary sample representative of the real world