16/06/2007 - Ribeirão Preto - Dra. Ierecê Lins Aymoré

DIAGNÓSTICOS

Diagnoses

1. A219-1 – Hospital do Câncer
BA7/3295
 – 51 y/o, woman. Skin lesion in the face. Under treatment for multiple myeloma.
Pharmacodermia? 
Follicular parakeratosis (Keratosis pilaris) (paraneoplastic syndrome associated  with multiple myeloma)
(J Am Acad Dermatol 49:736,2003; Arch Dermatol 126: 509, 1990)

2. A219-2 – Porto
H05/9161
 – 86 y/o man. Large soft tissue tumor in the arm (16 cm in diameter).
Pleomorphic rhabdomyosarcoma (Myogenin, Myo D1, Desmin +; S-100 negative) (EarJ Surg Oncol 30: 1131, 2004)

3. A219-3 – Salomão & Zoppi
IH 106/1119
 – 46 y/o, man. Tumoral mass adherent to a segment of the small intestine. Previous abdominal surgery due to a benign disease.
Heterotopic mesenteric ossification
Intraabdominal ossifying myositis (mesenteritis ossificans
) (Vim, AML, Desmin, Ki-67 positive)

4. A219-4 – AFIP CASE 5
Brazil-5
 – A 40 y/o man was in good general health except for some intermittent partial nasal obstruction that interfered occasionally with nasal breathing. Endoscopic examination of the nasal passages revealed a small nasopharyngeal mass and this was biopsied.
Low grade papillary adenocarcinoma of the nasopharynx (Ck,  EMA +) (Am J Surg Pathol 1988; 12: 946)

5. A219-5 – EPM – UNIFESP
B07/1261
 – 72 y/o woman. Thyroid nodule.
Papillary carcinoma of the thyroid, oncocytic variant (RET-PTC, Bratt test negative) (case seen in consultation by Dr. Sylvia Asa)

6. A219-6 – Pathos
B07/7101
 – 57 y/o man. Thyroid nodule. The thyroidectomy revealed a 3.8 cm in diameter nodule, ill-demarcated, comprised by a whitish-yellowish tissue.
Medullary carcinoma (thyroglobulin, chromogranin, synapth, calcitonin, CK positive)

7. A219-7 – BAURU
HB05/2660 (1), HB05/4723 (2&3) – 76 y/o woman. Vaginal bleeding. Pelvic and endovaginal US: A 20 cm subserosal leiomyoma Thickness of the endometrium in the uterine fundus.
Uterine curettage (Slide #1) followed by pan-histerectomy (Slides # 2, 3). Gross     features: a polypoid, “botrioid”, 4.0 cm in diameter lesion occupying the uterine cavity (Slide # 2 = lesion; Slide # 3: The lesion attached to the endometrium and myometrium).
Müllerian adenosarcoma (focally positive for myogenin)

8. A219-8 – IAMSPE
B06/2771 – A 34 y/o pregnant woman was found to have a 3.0 X 2.0 X 1.0 cm adnexial nodule during a cesarean.
Adnexal tumor of Wolffian origin (FATWO)

9. A219-9 – UNESP Botucatu
B2056/07 – 71 y/o woman. Increase in the abdominal volume and intestinal constipation.
A pan-histerectomy revealed an adnexial mass of 16 x 13 x 5 cm. 
Carcinosarcoma: Mixed müllerian tumor of the ovary (further sections revealed glandular structures)

10. A219-10 – UFMG
BIO96/07
 – 6 y/o boy. Testicular biopsy.
Sertoli-cell nodules (undescended testis) (very likely to be associated with P-J syndrome) (Am J Surg Pathol 2007; 31:827-35)

11. A219-11 – Patocito – Hospital Aliança
AP06/2099 – 35 y/o, mother. Placenta (100g) gestacional age: 26 weeks. Fetus = 650 g; APGAR 1º; 4; 5; 7. 
Intrauterine growth restriction. Fetal hypoxic
Moaternal pre-edampsia Acute ateromatosis.
Thrombosis. Infarcts. Vascular alterations.
Umbelical cord with multiple spirals.
Placental hypofunction

12A219-12 – Suster 
S06/59193 – 57y/o woman. Tumoral mass in the pulmonary left lower lobe (3.0 cm in diameter). 
Poorly differentiated small cell variant of squamous cell carcinoma (not to be confused with small cell neuroendocrine carcinoma of the lung) (p63, CK 5/6, AE1/AE3, MOC 3 positive; chrom, synapth, monoclonal NSE negative) EM did not show neurosecretory granules.

13. A219-13 – Hospital Universitário – USP
B07/920 – 66 y/o, man. Hemorrhage from the upper digestive tract Previous BII gastrectomy 30 years ago (“ulcer”). He underwent gastrectomy due to perfuration related to a post-endoscopic sclerosis of a lesion close to the cardia.
Dieulafoy lesion (Endoscopy 5: 449, 2005)

14. A219-14 – Fleury
AP 2945/07; 12000 11147 – 3 y/ 10 mo old, girl. Voluminous hepatic tumor with impairment of the clinical condition.
Hepatic angiosarcoma (paediatric variant) (CD31, CD34, SMActin (pericytes) positive; AE1-AE3 negative.

15. A219-15 – AFIP CASE 6 
Brazil-6 – 13 y/o, man presents with 1 to 2 week history of generalized swelling, weight gain and shortness of breath. He was noted to have nephrotic syndrome. Past history of renal "problem" with protein in urine at age 10 - Details not available. He also took Naprosyn for sports-related joint pain for the last two weeks. 
Minimal change glomerulopathy (IF – NEGATIVE; EM: podocyte changes)

16. A219-16 – Marília
HC 736/07– 68 y/o, woman. Difficulty to walk and memory failure. Intracranial lesion in the left cerebral hemisphere, measuring 3.6 X 4.2X 5.0 cm.
Intraventicular solitary fibrous tumor (CD34, Bcl-2, Vim positive; EMA, S-100, GFAP negative)

17. A219-17 – USP Ribeirão Preto 
HC 478/06 – 42 y/o man. HIV positive. Disturbance of consciousness and mental status. CT: Hypodense lesions in the white matter Liquor culture: Negative. Empirical treatment for neurotoxoplasmosis and neurotuberculosis, with no response.
Viral encephalitis, HIV associated (foci of desmyelinization; CD68+; NFP↓↓↓; axonal damage) (the co-participation of immune restovation due to HAARF was considered) (the calcification of the vessel walls was considered as an epiphenomenum)