Fas-ligand and caspase-3 positivity in three cases of histiocytic sarcoma: a different etiopathogenic pathway?

Histiocytic sarcoma (HS) is a rare malignant neoplasia of hematopoietic origin and unknown etiology. We studied three patients with histiocytic sarcoma reviewing the morphological and immunohistochemical aspects. We evaluated in particular, if apoptosis may be unbalanced in this disease. All cases have morphological and immunohistochemical features consistent with the diagnosis of histiocytic sarcoma. The markers CD163, CD68, vimentin, lysozyme, and S-100 were positive in all cases. Similarly, the three samples were positive for Fas-ligand and Caspase-3. It is well-known that neoplasms may induce increased levels of Fas-ligand with the blockade of the apoptosis process. In the context of HS, the increased Fas-ligand expression represents a new area for research. Indeed, it is linked to proinflammatory stimulus and, maybe with the association of an infection

Dicephalus dipus dibrachius twins: report of an autopsy case

Dicephalus dipus dibrachius twins are a rare form of conjoined twins. An autopsy of conjoined dicephalus twins is reported. The diagnosis was performed during the pregnancy and the family received a judicial authorization for termination of pregnancy. The preterm newborn progressed to cardiac arrest and died following a court order to terminate the pregnancy. The conceptus presented two arms, two legs, a trunk, two heads, and a single umbilical cord. The two spinal columns presented vertebral fusion in the sacral region. The heart exhibited complex malformations. The external genitalia were female; and cytogenetic analysis confirmed female sex (46, XX). This analysis also corroborated the etiopathogenic hypotheses described for this abnormality, which proposes failures in embryonic formation rather than specific chromosomal alterations. Current identification of cases by ultrasound permits medical management and multidisciplinary action with the family, enabling the legal termination of pregnancy

Absence of Wharton’s jelly: case report

There are few reports in the literature of the absence of Wharton's Jelly. Here we report the seventh case in a primigravida, 22 years old, admitted after vaginal delivery of stillborn. The umbilical cord have a long segment with disruption of cord structures and the three blood vessels were completely separated from each other, with a minimum amount of Wharton's jelly remaining around each vessel. The absence of Wharton' jelly is associated with fetal distress, intrauterine growth restriction, and fetal death. Quantitative/qualitative studies of Wharton's jelly represent an open field of research for possible correlations with obstetric conditions and fetal deaths

Case Report Meningitis and pneumococcal pyomyositis in a child with intramuscular hemangiomas: an autopsy case report

Abstract: Pyomyositis is the bacterial infection of skeletal muscle, usually accompanied by abscesses. The main etiologic agent is Staphylococcus aureus. There are rare cases attributed to Streptococcus pneumoniae. This paper presents an autopsy of a four year old child with multiple congenital intramuscular hemangiomas that developed pneumococcal pyomyositis associated with meningitis. The authors propose the hypothesis that patients with hemangiomas, mainly the intramuscular type, may also represent a risk group for pyomyositis. The possibility of respiratory/meningeal co-infection, might also be considered even if the clinical picture is restricted to the muscular system

Emphysematous pyelonephritis in a transplanted kidney

Emphysematous pyelonephritis is a rare infection characterized by necrosis and gas accumulation in the renal parenchyma, adjacent tissues, and/or urinary collecting system. This entity is rarely reported in transplanted kidneys. Computed tomography imaging is necessary for diagnosis and risk classification. The authors described the case of a 58-year-old man who underwent a kidney transplant and presented sepsis from a urinary tract infection. An abdominal tomography showed some characteristics of emphysematous pyelonephritis associated with an abscess. A graft biopsy, performed 45 days after the transplant, failed to show signs of infection, and tubule-interstitial and vascular rejection were ruled out. The patient had a poor outcome, and a nephrectomy was needed, the pathological analysis of which yielded the diagnosis of chronic pyelonephritis with necrotizing papillitis. The patient became hemodynamically unstable and died. The authors highlight the current tomographic criteria for the diagnosis and treatment of emphysematous pyelonephritis and question the validity of accepting the same standards used to guide the treatment of patients without transplants, and call attention to the importance of the clinical status for the indication of nephrectomy in cases of emphysematous pyelonephriti

Fas-ligand and caspase-3 positivity in three cases of histiocytic sarcoma: a different etiopathogenic pathway?

Histiocytic sarcoma (HS) is a rare malignant neoplasia of hematopoietic origin and unknown etiology. We studied three patients with histiocytic sarcoma reviewing the morphological and immunohistochemical aspects. We evaluated in particular, if apoptosis may be unbalanced in this disease. All cases have morphological and immunohistochemical features consistent with the diagnosis of histiocytic sarcoma. The markers CD163, CD68, vimentin, lysozyme, and S-100 were positive in all cases. Similarly, the three samples were positive for Fas-ligand and Caspase-3. It is well-known that neoplasms may induce increased levels of Fas-ligand with the blockade of the apoptosis process. In the context of HS, the increased Fas-ligand expression represents a new area for research. Indeed, it is linked to proinflammatory stimulus and, maybe with the association of an infection

Evolucao de pacientes com AIDS pos cART: evolucao clinica e laboratorial de pacientes com AIDS apos 48 semanas de tratamento antirretroviral

SUMMARY Combination Antiretroviral Therapy (cART) aims to inhibit viral replication, delay immunodeficiency progression and improve survival in AIDS patients. The objective of this study was to compare two different schemes of cART, based on plasma viral load (VL) and CD4+ T lymphocyte count, during 48 weeks of treatment. For this purpose, 472 medical charts of a Specialized Outpatient Service were reviewed from 1998 to 2005. Out of these, 58 AIDS patients who had received a triple drug scheme as the initial treatment were included in the study and two groups were formed: Group 1 (G1): 47 individuals treated with two nucleoside reverse-transcriptase inhibitors (NRTI) and one non-nucleoside reverse-transcriptase inhibitor; Group 2 (G2): 11 patients treated with two NRTI and one protease inhibitor. In G1 and G2, 53.2% and 81.8% respectively were patients with an AIDS-defining disease. The T CD4+ lymphocyte count increased progressively up until the 24th week of treatment in all patients, while VL became undetectable in 68.1% of G1 and in 63.6% of G2. The study concluded that the evolutions of laboratory tests were similar in the two treatment groups and that both presented a favorable clinical evolution.RESUMO A terapia antirretroviral na aids visa inibir a replicação viral, retardar a progressão da imunodeficiência e melhorar a sobrevida do paciente. O objetivo do estudo foi comparar dois esquemas de tratamentos antirretrovirais, quanto à carga viral plasmática (CV) e contagem de linfócitos T CD4+, durante 48 semanas de tratamento, pela revisão de 472 prontuários no período de 1998 a 2005, em um Serviço de Ambulatórios Especializados. Foram incluídos para o estudo 58 pacientes que receberam esquema tríplice como terapêutica inicial, os quais formaram dois grupos: Grupo 1 (G1): 47 indivíduos em tratamento com dois inibidores de transcriptase reversa análogos de nucleosídeos (ITRN) e um inibidor de transcriptase reversa não análogo de nucleosídeo; Grupo 2 (G2): 11 pacientes em tratamento com dois ITRN e um inibidor de protease. Entre os pacientes de G1 e G2, 53.2% e 81.8%, respectivamente, foram classificados como portadores de aids com doença definidora. A contagem de linfócitos T CD4+ aumentou progressivamente até a 24ª semana de tratamento, em todos os doentes e, a CV tornou-se indetectável em 68,1% dos casos de G1 e em 63,6%, do G2. O estudo concluiu que, em ambos os grupos de tratamento, houve evolução laboratorial semelhante e essa observação foi compatível com evolução clínica favorável dos pacientes estudados

Endobronchial solitary fibrous tumor

Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that appears primarily in the pleura and rarely in intrapulmonary or endobronchial topography. The authors report the case of a 47-year-old woman who presented obstructive respiratory symptoms for 4 years. The chest computed tomography and bronchoscopy showed an obstructive polypoid lesion located between the trachea and the left main bronchus associated with distal atelectasis of the left lung. A resection of the lesion was performed and, macroscopically, the mass was oval, encapsulated, and firm, measuring 2.3 × 1.7 × 1.5 cm. Histology revealed low-grade mesenchymal spindle cell neoplasm, with alternating cellularity, myxoid areas, and mature adipose tissue outbreaks, as well as blood vessels with irregular walls. The immunohistochemical study was positive for CD34, CD99, and BCL2. The diagnosis was SFT in an unusual topography. The patient’s symptoms remitted after tumor excision, and no systemic problems were evident. SFTs primarily affect adults and often follow a benign course; however, their behavior is unpredictable. The presence of necrosis and mitotic activity may portend a poor prognosis. Endobronchial SFTs are rare but should be evaluated and monitored similar to SFTs at other sites, with a long-term follow-u