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Endobronchial myxoma: Case report
Get PDFINTRODUCTION: Pulmonary myxoma is an extremely rare benign neoplasm. It is mostly parenchymal but may occasionally occur within the tracheobronchial tree. There are very few reports of endobronchial myxoma.
CASE REPORT: We describe a case of endobronchial myxoma in a 40-year-old female patient with a history of asthma and repeated right-sided pneumonia. Thoracic computed tomography (CT) showed medium lobe atelectasis. Fiber optic bronchoscopy revealed a polypoid, well-circumscribed tumor, causing total obstruction of the medium lobe bronchus. Biopsy of the mass was non-diagnostic. Further study included a positron emission tomography (PET) which demonstrated low metabolic activity of the tumor and no evidence of neoplasia in other location. The patient was submitted to a medium lobectomy and microscopic examination of the tumor revealed myxoid stroma with lobulated pattern, elongated and stellate cells, compatible with myxoma.
CONCLUSION: Pulmonary myxoma is extraordinary rare and endobronchial location is very few reported in medical literature
linical challenges in Crohn s disease
Get PDFIntroduction: Crohn s disease is a chronic inflammatory disease from gastrointestinal tract. The increase in incidence and heterogeneity of this pathology, with different presentations and prognostics leads to a constant concern in developing and improving its classification and treatment.
Objectives: To establish recommendations (based on level of evidence and recommendation grades) to 5 questions considered as the clinical challenges of the therapeutic approach in Crohn s disease.
Methods: The methodology adopted by the working group DC2 (Desafios Clínicos na Doença de Crohn) was based on the selection of 5 questions, by voting, and establishing recommendations to each question proposed to each subgroup. Discussion and approval of reflexions and final recommendations was carried out in a consensus meeting.
Conclusion: It has been possible to base conclusions about the questions under study on evidence, being recommended: 1) having Crohn s disease under 40 years old, structuring phenotype disease and anal disease are predictive factors of bad prognostic; 2) it is possible to consider suspension of biologics in patients with endoscopic remission and normal biomarkers; 3) patients with biochemical markers of disease activity (CRP and calprotectina) have more probability of relapse; 4) in failure of biologics it is essential to assure that treatment with the first drug was optimized: with infliximab it s demonstrated that either reduction of the administration range or increasing the dose allows to recover the response in the majority of patients; as for adalimumab, patients should change from bimonthly to weekly administrations; 5) in case of Crohn s disease with intestinal surgery, use of therapeutic to reduce postoperative recurrence is indicated, particularly immunosupressors and biologics
Diabetes e hiperglicemia: factores de prognóstico na pneumonia adquirida na comunidade – estudo retrospectivo em doentes admitidos no Hospital de Braga
Get PDFRare variants of malignant melanoma – a clinical and histopathological challenge
Get PDFIntroduction: Malignant melanoma may present a great variety of histopathological patterns. Besides
the classic forms of melanoma, there are a number of variants that have been described, such as polypoid, verrucous,
desmoplastic, myxoid, chondroid, balloon-cell, rhabdoid, animal-type, amelanotic, spitzoid, nevoid. The aim of this
study was to characterize the rare histopathologic variants of malignant melanoma observed in a Dermatopathology
Laboratory in a period of 15 years (1995-2009). Material and Methods: Analized data included: patient age and sex,
clinical diagnosis, melanoma location, Breslow and Clark level, presence of ulceration and follow-up. These variants
were grouped according to architectural, cytologic and/or stromal changes. Results: Eighty-seven rare histopathologic
variants of melanoma were observed, corresponding to 6,5% of all melanomas. We have found predominance of females
in spitzoid and of males in animal-type melanoma. There were some preferential locations: face in animal type,trunk in polypoid, limbs in verrucous, and subungual in chondroid melanoma. We identified ulceration in 73% of polypoid,
in 60% of verrucous and 50% of amelanotic melanomas. A higher mortality rate was documented in mixed variant
(polypoid/animal-type), desmoplastic, polypoid and animal-type. Conclusions: The recognition of these variants is important,
not only by the clinical and histopathological challenge in the differential diagnosis with other skin tumors, but
also because of the possible implication of some of these variants, with peculiar biological behavior, in the prognosis
“From Side Effect to Major Concern” – Case Report
Get PDFPain control in rheumatological disorders is a true clinical challenge because of its multiple presentations.
Unsuccessful pain control attempts, add extra difficulty to its management.
Osteoarticular chronic symptoms, especially in an advanced phase, are strongly incapacitating but often
undervalued despite its functional impact in patient’s life quality.
Treatment options are frequently limited by its side effects, being these one of the major problems when
handling different pharmacological groups.
We report the case of a patient with an enteropathic arthropathy presenting with difficult persisting pain control.
It reflects the importance of a correct and rigorous clinical evaluation leading to therapeutic success
Cortical maturation in fetuses referred for ‘isolated’ mild ventriculomegaly: a longitudinal ultrasound assessment
Get PDFOBJECTIVES:
To compare cortical maturation between fetuses with isolated mild ventriculomegaly (IMV) and healthy fetuses, and to explore its potential prognostic value in IMV.
METHODS:
This prospective study quantified cortical maturation by ultrasound in 24 fetuses with IMV and 46 healthy fetuses. Depth and grading the developmental pattern of the parieto-occipital fissure (POF), calcarine fissure (CF) and sylvian fissure, and grading the Sylvian fissure operculization at 23-25, 27-28 and 31-32 weeks gestation were determined.
RESULTS:
At 23-25 and 27-28 gestational weeks, POF and CF mean depths were statistically lower in the IMV group. The POF and CF depth distribution had a normal distribution in the control group but displayed a bimodal distribution in the IMV group. IMV with progression of ventricular dilatation showed mean depth of CF lower than IMV in which ventriculomegaly regressed or remained stable. The sensitivity, specificity, positive predictive value and negative predictive value of a CF depth below the fifth percentile to predict progression of ventricular dilatation were, at 28 weeks, 100%, 88%, 67% and 100%, respectively.
CONCLUSIONS:
Cortical fissure assessment by ultrasound allowed the differentiation of a subgroup of IMV fetuses with a higher risk of progression of ventricular dilatation
Role of the RAD51 G172T polymorphism in the clinical outcome of cervical cancer patients under concomitant chemoradiotherapy
Get PDFINTRODUCTION:
Cervical cancer is one of the most common cancers diagnosed in women worldwide. Mammalian cells are constantly exposed to a wide variety of genotoxic agents from both endogenous and exogenous sources. The RAD51 protein is required for meiotic and mitotic recombination and plays a central role in homology-dependent recombinational repair of double-strand breaks (DSBs). Given the functional relevance of the DNA repair system on carcinogenesis, potential associations between genetic polymorphisms of DNA repair genes, cancer risk and response to therapy have been intensively evaluated. This is the first study evaluating the role of the RAD51 G172T genetic variants in cancer prognosis and clinical outcome of cervical cancer patients.
MATERIAL AND METHODS:
We analyzed RAD51 G172T polymorphism genotypes in cervical cancer patients who underwent a platinum-based chemotherapy in combination with radiotherapy. Genotyping was performed by Taqman™ Allelic Discrimination methodology.
RESULTS AND DISCUSSION:
Concerning the overall survival rates found using Kaplan-Meier method and Log Rank Test, we observed that the mean survival rates were statistically different according to the patients RAD51 genotypes. The group of patients carrying the T allele present a higher mean survival rate than the other patients (102.3months vs. 86.4months, P=0.020). Using the Cox regression analysis, we found an increased overall survival time for T-carrier patients, when compared with GG genotype, with tumor stage, age and presence of lymph nodes as covariates [hazard ratio (HR), 0.373; 95% CI, 0.181-0.770; P=0.008]. Among patients (n=193), RAD51 genotype frequency distributions were not under the influence of clinicopathologic characteristics, namely, treatment response (P=0.508), recurrence (P=0.150) and tumor stage (P=0.250).
CONCLUSIONS:
This is the first study evaluating the role of the RAD51 G172T genetic variants in cancer prognosis and clinical outcome of cervical cancer patients. Our results indicate an influence of the RAD51 genetic variants in overall survival of cervical cancer. Thereby, RAD51 G172T genotypes may provide additional prognostic information in cervical cancer patients who underwent cisplatin-based chemotherapy in combination with radiotherapy
A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions
Get PDFBACKGROUND AND STUDY AIM:
The reliability and external validity of narrow band imaging (NBI) in the stomach have not been described consistently. The aim of the current study was to describe and estimate the accuracy and reliability of a simplified classification system for NBI in the diagnosis of gastric lesions.
METHODS:
Consecutive patients undergoing NBI endoscopy at two reference centers (n=85, 33% with dysplasia) were included in two studies. In total, 224 different areas were biopsied and recorded onto video. In the derivation study, previously described NBI features were analyzed in order to develop a simplified classification. In the validation study the accuracy and reliability of this classification were estimated among three groups of endoscopists with different levels of expertise in NBI.
RESULTS:
The reliability/accuracy results from the derivation study allowed the creation of a simplified NBI classification. In the validation study, "regular vessels with circular mucosa" (pattern A) was associated with normal histology (accuracy 83%; 95% confidence interval [CI] 75 %-90%); "tubulo-villous mucosa" (pattern B) was associated with intestinal metaplasia (accuracy 84%; 95CI 77%-91%; positive likelihood ratio [LR+]=4.75); and "irregular vessels and mucosa" (pattern C) was associated with dysplasia (accuracy 95%; 95CI 90%-99%; LR+=44.33). The reproducibility of these patterns was high (k=0.62). "Light-blue crest" was moderately reliable (k=0.49) but specific (87%) for intestinal metaplasia. A variable vascular density (additional pattern+) was the best feature for Helicobacter pylori gastritis (accuracy 70%; 95CI 59%-80%) but showed only fair reliability (k=0.38). Non-experienced endoscopists presented lower agreement (k=0.6 vs. k=0.75) and accuracy (74% vs. 86%) than international experts/experienced endoscopists.
CONCLUSION:
A simplified NBI classification is accurate and reliable for the diagnosis of intestinal metaplasia and dysplasia. The classification should be further assessed and validated on a per-patient assessment of NBI, and by comparing NBI with other imaging technologies