SAP - Serviço de Anatomia Patológica
Permanent URI for this community
Browse
Browsing SAP - Serviço de Anatomia Patológica by Title
Now showing 1 - 10 of 40
Results Per Page
Sort Options
- 17-Week Delay Surgery after Chemoradiation in Rectal Cancer with Complete Pathological ResponsePublication . Santos, M.; Gomes, M.; Moreno, F.; Rocha, A.; Lopes, C.Neoadjuvant chemoradiation (CRT) followed by curative surgery still remains the standard of care for locally advanced rectal cancer (LARC). The main purpose of this multimodal treatment is to achieve a complete pathological tumor response (ypCR), with better survival. The surgery delay after CRT completion seems to increase tumor response and ypCR rate. Usually, time intervals range from 8 to 12 weeks, but the maximum tumor regression may not be seen in rectal adenocarcinomas until several months after CRT. About this issue, we report a case of a 52-year-old man with LARC treated with neoadjuvant CRT who developed, one month after RT completion, an acute myocardial infarction. The need to increase the interval between CRT and surgery for 17 weeks allowed a curative surgery without morbidity and an unexpected complete tumor response in the resected specimen (given the parameters presented in pelvic magnetic resonance imaging (MRI) performed 11 weeks after radiotherapy completion).
- Abdominal Actinomycosis misdiagnosed as liposarcomaPublication . Vieira E Monteiro, Eunice; Gaspar, Joana; Paiva, Cláudia; Correia, Raquel; Valente, Vítor; Coelho, André; Lamas, Nuno JorgeActinomycosis is an uncommon, endogenous, and chronic infection with varied and nonspecific clinical features such as abdominal, pelvic or cervical masses, ulcerative lesions, abscesses, draining fistula, fibrosis, and constitutional symptoms. The disease ensues when the bacteria disrupt the mucosal barrier, invade, and spread throughout interfascial planes. Currently, the diagnosis of actinomycosis is challenging because of its very low frequency and depending on the clinical presentation it may masquerade malignancies. Therapy consists initially in intravenous penicillin, followed by an oral regimen that may be extended until a year of treatment. A timely diagnosis is crucial to avoid extensive therapeutic attempt as surgery. However, a biopsy or drainage of abscesses and fistula's tract may be required not only as a diagnostic procedure as part of the therapy. We report the case of a 72-year-old woman with an abdominal mass initially misdiagnosed as a liposarcoma. A second biopsy of a skin lesion of the abdominal wall made the diagnosis of actinomycosis, avoiding a major surgical procedure. The patient was treated with a long-term course of antibiotics with favorable outcome. Liposarcoma was ruled out after the patient's full recovery with antibiotics and the misdiagnosis was credit to the overconfidence on the immunohistochemical positivity to MDM2.
- Acute kidney injury with active urinary sediment analysis, a positive ANCA test and hypocomplememtemia: A tough situationPublication . Campos, A.; Vizcaíno, J.; Coelho, A.; Freitas, C.; Rocha, G.
- Adult blaschkolinear acquired inflammatory skin eruption (BLAISE) with simultaneous features of lichen striatus and blaschkitisPublication . Raposo, I.; Mota, F.; Fernandes, I.; Canelhas, Á.; Selores, M.Blaschkitis and lichen striatus are generally distinguished in the literature by the age of onset, lesion distribution, and histopathology. However, there is currently no clear consensus among authors about whether to consider blaschkitis and lichen striatus different clinical entities or a spectrum ofthe same disease. We present a case of adult BLAISE with features of both lichen striatus and blaschkitis, which seems to support the theory that these clinical entities may in fact represent a spectrum of the same pathological process.
- Advanced Glycation End Products Evolution after Pancreas-Kidney Transplantation: Plasmatic and Cutaneous AssessmentsPublication . Martins, L.; Oliveira, J.; Vizcaíno, J.; Fonseca, R.; Gouveia, C.; Silva, D.; Castro-Henriques, A.; Noronha, I.; Rodrigues, A.Diabetes mellitus leads to increased Advanced Glycation End Products (AGE) production, which has been associated with secondary diabetic complications. Type 1 diabetic patients undergoing pancreas-kidney transplantation (SPKT) can restore normoglycemia and renal function, eventually decreasing AGE accumulation. We aimed to prospectively study AGE evolution after SPKT. Circulating AGE were assessed in 20 patients, at time 0 (T0), 3 months (T3), 6 months (T6), and 12 months (T12) after successful SPKT. Global AGE and carboxymethyllysine (CML) were analyzed, as well as advanced oxidation protein products (AOPP). Skin biopsies were obtained at T0 and T12. Immunohistochemistry with anti-AGE antibody evaluated skin AGE deposition. AGE mean values were 16.8 ± 6.4 μg/mL at T0; 17.1 ± 3.8 μg/mL at T3; 17.5 ± 5.6 μg/mL at T6; and 16.0 ± 5.2 μg/mL at T12. CML mean values were 0.94 ± 0.36 ng/mL at T0; 1.11 ± 0.48 ng/mL at T3; 0.99 ± 0.42 ng/mL at T6; and 0.78 ± 0.38 ng/mL at T12. AOPP mean values were 130.1 ± 76.8 μMol/L at T0; 137.3 ± 110.6 μMol/L at T3; 116.4 ± 51.2 μMol/L at T6; and 106.4 ± 57.9 μMol/L at T12. CML variation was significant (P = 0.022); AOPP variation was nearly significant (P = 0.076). Skin biopsies evolved mostly from a cytoplasmic diffuse to a peripheral interkeratinocytic immunoreaction pattern; in 7 cases, a reduction in AGE immunoreaction intensity was evident at T12. In conclusion, glycoxidation markers decrease, plasmatic and on tissues, may start early after SPKT. Studies with prolonged follow-up may confirm these data.
- Annular elastolytic giant cell granuloma: a "visible" diagnosisPublication . Raposo, I.; Mota, F.; Lobo, I.; Brandão, J.; Selores, M.Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin disease of undetermined cause, characterized by annular plaques with raised erythematous borders in sun-exposed skin. The typical histologic features are dermal infiltration by multinucleated giant cells, elastin degeneration, and elastophagocytosis. The authors describe a clinical case of AEGCG, which exhibited an excellent response to hydroxycloroquine.
- Biópsia Renal Percutânea: experiência de oito anosPublication . Castro, R.; Sequeira, M.; Faria, M.; Belmira, A.; Sampaio, S.; Roquete, P.; Silvestre, F.; Rocha, C.; Morgado, T.A biópsia renal constitui um instrumento fundamental para o diagnóstico e prognóstico de diversas patologias nefrológicas e sistémicas. No nosso Hospital a sua realização iniciou-se em 1994, tendo sido biopsado um doente com Doença de Berger. Até à data foram efectuadas 91 biópsias renais percutâneas com a seguinte distribuição anual: 1994 (n=3), 1995 (n=3), 1996 (n=3), 1997 (n=15), 1998 (n=5), 1999 (n=23), 2000 (n=13), 2001 (n=26) em 57 homens e 34 mulheres. Foi utilizada orientação ecográfica e na maioria dos casos a agulha de Vim Silverman (14G). Apenas em cinco casos se utilizou uma pistola automática BARD. Era nosso objectivo, em cada biópsia, a colheita de pelo menos dois fragmentos, um para microscopia óptica e outro para imunoflurescência. Os grandes síndromas nefrológicos que conduziram a este exame foram: síndroma nefrótico (n=27), anormalidades urinárias assintomáticas (n=25), insuficiência renal aguda ou rápidamente progressiva (n=18), insuficiência renal crónica (n=15), hipertensão arterial (n=4) e glomerulonefrite aguda (n=2). Em 92.3% (84/91) dos casos foi possível efectuar um diagnóstico histológico por microscopia óptica. Se considerarmos, no entanto, sete casos com suspeita clínica de nefropatia IgA em que o fragmento colhido para imunoflurescência não continha glomérulos, a eficácia diminuiu para 84.6% (77/91). O número médio de glomérulos por amostra foi de 18.3 ± 14.2 [0-80]. Os diagnósticos histológico obtidos foram os seguintes: doença de Berger (n=24), diversas formas de síndroma nefrótico primário (n=18), nefrite lúpica (n=8), glomerulonefrite mesangioproliferativa, sem glomérulos na imunoflurescência (n=6), ausência de tecido renal ou de glomérulos nas amostras (n=6), síndroma nefrótico secundário (n=4), nefrite túbulo-intersticial ou necrose tubular aguda (n=4), nefropatia diabética (n=3), rim de mieloma (n=3), glomerulonefrite crescêntica sem depósitos imunes (n=3), nefroangiosclerose hipertensiva (n=2), glomerulonefrite mesangioproliferativa IgM (n=2) e outros (n=8). A hematúria macroscópica revelou-se como a complicação mais frequente (n=9; 9.9%). Apenas em três casos se verificou a existência de hematoma renal ecograficamente (3.3%). A saída de sangue pelo mandril da agulha de biópsia surgiu em quatro casos (4.4%) e foi necessário proceder à transfusão de concentrado de glóbulos rubros em três doentes (3.3%). Registamos uma punção acidental de baço. Em nenhum caso foi necessário efectuar nefrectomia por hemorragia incontrolável. Identificamos, como índices de mau prognóstico relativamente à evolução para insuficiência renal crónica avançada (n=2) ou terminal (n=15), o maior número de glomérulos esclerosados (30% vs 8%; p<0.01) e de lesões túbulo-intersticiais (100% vs 63%; p<0.01). Em conclusão, a biópsia renal efectuada com orientação ecográfica permitiu a obtenção 21 de amostras com valor diagnóstico em 84.6% dos casos. A taxa de complicações foi relativamente baixa comparando com outras séries. Verificamos um progressivo aumento de qualidade das amostras renais colhidas, em relação directa com uma coordenação técnica crescente entre os nefrologistas e radiologistas intervenientes.nephrological and systemic pathologies. At our institution the first patient submitted to this technique, at 1994, showed Berger disease. Until 2002 we have performed 91 renal biopsies (57 men and 34 women) with the following annual distribution: 1994 (n=3), 1995 (n=3), 1996 (n=3), 1997 (n=15), 1998 (n=5), 1999 (n=23), 2000 (n=13) and 2001 (n=26). Ultrasound guidance was always used and in most of cases the technique was performed with Vim-Silverman (14G) needle. BARD automatic system was employed in only five patients. The clinical diagnosis that lead to renal biopsy were: nephrotic syndrome (n=27), asyntomatic urinary abnormalities (n=25), acute or rapidly progressive renal failure (n=18), chronic renal failure (n=15), hypertension (n=4) and acute nephritis (n=2). The efficacy for optic histological diagnosis was 92.3% (84/91). However, if we include seven cases of presumed IgA nephropathy that don’t included fragment for immunofluorescence (IF) analysis the efficacy declined to 84.6% (77/91). The mean number of glomeruli per fragment was 18.3 ± 14.2 [0-80]. Histological diagnosis were the following: Berger disease (n=24), idiopathic nephrotic syndrome (n=18), lupus nephritis (n=8), mesangial proliferative glomerulonephritis without glomeruli in the IF fragment (n=6), without glomeruli (n=6), secondary nephrotic syndrome (n=4), tubulointerstitial nephritis or acute tubular necrosis (n=4), diabetic nephropathy (n=3), myeloma kidney (n=3), pauci-imune and crescentic glomerulonephritis (n=3), hypertensive nephropathy (n=2), IgM mesangial proliferative glomerulonephritis (n=2) and various (n=8). Gross hematuria appeared in 9 patients (9.9%). Only in three of these patients it was showed, by ecography, the existence of kidney haematoma. Bleeding throughout the mandrill in four cases, leaded to transfusion in only three patients. We have registered one accidental spleen puncture. Nephrectomy for incontrollable bleeding was never needed. Higher glomerulosclerosis (30% vs 8%; p<0.01) and also a greater extent of tubulointersticial lesions (100% vs 63%; p<0.01), were predictors of progression into end-stage or advanced renal failure. Concluding, renal biopsy with ultrasound guidance was valuable for diagnosis in 84.6% of our proceedings. Our serie is similar to others concerning serious complications. Nephrologists and radiologists improved progressively their coordination performing this technique, improving the results during this period of 8 years.
- Brachyury as a potential modulator of androgen receptor activity and a key player in therapy resistance in prostate cancerPublication . Pinto, F.ilipe; Pértega-Gomes, N.; Vizcaíno, J.; Andrade, R.; Cárcano, F.; Reis, R.Prostate cancer (PCa) is the most commonly diagnosed neoplasm and the second leading cause of cancer-related deaths in men. Acquisition of resistance to conventional therapy is a major problem for PCa patient management. Several mechanisms have been described to promote therapy resistance in PCa, such as androgen receptor (AR) activation, epithelial-to-mesenchymal transition (EMT), acquisition of stem cell properties and neuroendocrine transdifferentiation (NEtD). Recently, we identified Brachyury as a new biomarker of PCa aggressiveness and poor prognosis. In the present study we aimed to assess the role of Brachyury in PCa therapy resistance. We showed that Brachyury overexpression in prostate cancer cells lines increased resistance to docetaxel and cabazitaxel drugs, whereas Brachyury abrogation induced decrease in therapy resistance. Through ChiP-qPCR assays we further demonstrated that Brachyury is a direct regulator of AR expression as well as of the biomarker AMACR and the mesenchymal markers Snail and Fibronectin. Furthermore, in vitro Brachyury was also able to increase EMT and stem properties. By in silico analysis, clinically human Brachyury-positive PCa samples were associated with biomarkers of PCa aggressiveness and therapy resistance, including PTEN loss, and expression of NEtD markers, ERG and Bcl-2. Taken together, our results indicate that Brachyury contributes to tumor chemotherapy resistance, constituting an attractive target for advanced PCa patients.
- Chronic granulomatous disease as a risk factor for cutaneous lupus in childhoodPublication . Carvalho, S.; Machado, S.; Sampaio, R.; Guedes, M.; Vasconcelos, J.; Semedo, D.; Selores, M.Chronic granulomatous disease (CGD) is a primaryimmunodeficiency disorder that affects the phagocyticcells of the innate immune system. It is characterizedby recurrent or persistent infections with granulomaformation. Lupus-like lesions have been reported incarriers of CGD and less frequently, in patients withCGD. Immunological study in these patients areusually negative. We describe the case of an 8-yearoldboy with CGD who developed chronic and acutecutaneous lupus erythematous with angular cheilitis,oral ulcers, Raynaud phenomenon, and positiveserologies for antinuclear, anticentromere, and anti-Saccharomyces cerevisiae antibodies.
- CMV infection of liver transplant recipients: comparison of antigenemia and molecular biology assays.Publication . Amorim, M.; Cabeda, J.; Seca, R.; Mendes, A.; Castro, A.; Amorim, J.Abstract BACKGROUND: CMV is a major clinical problem in transplant recipients. Thus, it is important to use sensitive and specific diagnostic techniques to rapidly and accurately detect CMV infection and identify patients at risk of developing CMV disease. In the present study, CMV infection after liver transplantation was monitored retrospectively by two molecular biology assays - a quantitative PCR assay and a qualitative NASBA assay. The results were compared with those obtained by prospective pp65 antigenemia determinations. MATERIALS AND METHODS: 87 consecutive samples from 10 liver transplanted patients were tested for CMV by pp65 antigenemia, and CMV monitor and NASBA pp67 mRNA assay. RESULTS: CMV infection was detected in all patients by antigenemia and CMV monitor, whereas NASBA assay identified only 8/10 patients with viremia. Furthermore, CMV infection was never detected earlier by molecular biology assays than by antigenemia. Only 5/10 patients with CMV infection developed CMV disease. Using a cut off value of 8 cells/50,000, antigenemia was found to be the assay that better identified patients at risk of developing CMV disease. However, the kinetics of the onset of infection detected by NASBA and CMV monitor seemed to have better identified patients at risk of developing CMV disease. Furthermore, before onset of disease, CMV pp67 mRNA was found to have similar or better negative and positive predictive values for the development of CMV disease. CONCLUSIONS: The present data, suggests that the concomitant use of antigenemia and pp67 mRNA assay gives the best identification of patients at risk of developing CMV disease.