21/06/2008 - Bauru

DIAGNÓSTICOS

1.  Hospital Aliança
AP 149/08 – 
77 y/o, woman. A tumor in the parotid.
– Pleomorphic adenoma with abundant “schwannomatous” stromal component (case seen in consultation by Dra. Isabel Fonseca – Lisboa, Portugal)
(AE1-AE3, Ck7, Ck5/6, Ck14, 34BE12, p63, EMA, Vim, Calponin, HHF-35, GFAP positive, focal).

2. Pathos 
B08/13481 
– 33 y/o, woman. A 4 mo. history of dry coughing. Chest X-Ray: A 2 cm pulmonary nodule close to the visceral pleura.
– Bronchioloalveolar carcinoma, non-mucinous subtype (Ck7, TTF-1 positive; Ki67-5%; Ck20 negative)
OBS: At gross inspection, it had a very mucinous apperance. Dr. Saul Suster suggested the diagnosis of “Mucin-rich tumor of the lung-mucinous cystic neoplasm: Adv Anat Pathol 2:229-305, 1995).

3. Case Porto – Case # 2
H06/1325 
– 66y/o, woman. A cerebral expansive lesion (several fragments   weighing 1g and measuring up to 4.0 mm).    
– Gliosarcoma with a component of chondroid metaplasia (GFAP, Ki67 positive).

4. Patologia – FMB – UNESP 
– 70 y/o, woman. A 3 mo. history of diarrhea and hematemesis. CT: a pelvic mass in the left ovary (15 x 14 x 5 cm; 300 g), encapsulated, comprised by a soft, white yellowish tissue.
– Poorly differentiated (undifferentiated) carcinoma primary of the ovary (15 cm; 331g; invasive up to the uterus)
(AE1-AE3, Ck7, Ca 125, WT1, EMA, CEA positive; Ck20 negative).           

5. Hospital do Câncer-Barretos
    E08/4540 – 
59 y/o, woman. A ruptured left ovarian tumor.
– Granulosa cell tumor, adult type, with hepatocytic differentiation.
(Polyclonal CEA, CK and HepPar positive)

6. Esther Oliva Case
MS/30490 – 
25 y/o, woman. A cystic ovarian tumor: 30.0 x 30.0 x 30.0 cm; 5.0 kg. The cyst is opened to reveal one dominant cyst and solid components. 
– Carcinoid tumor of the ovary
(Inhibin, negative; chromogranin, synaptophysin positive) 

7. Case Marília
B07/4480; 08/1821 
– 24 y/o, woman. Virilization, weight loss and ascites.
– Leydig – Sertoli cell tumor (first diagnosed in September, 2007; it recurred in 2008, with retiform features and heterologous  components) 

8.  EPM Case 
B07/28169 
– 56 y/o, man with a left testicular tumor: 3.5 x 3.0 x 2.5 cm, made  up by a whitish, firm, solid tissue.
– Sertoli-cell tumor of the testis, sclerosing pattern. (J Clin Pathol 2007; 60: 866-880)

9. Ribeirão Preto  – USP
– 48 y/o, woman presented with a 3-month-history of ocular proptosis, more intense in the left side. Image analysis: Neurilemoma? In the follow up: Blindness, retroperitoneal fibrosis, chronic renal insufficiency, bilateral hydronephrosis.
The patient was admitted to the Hospital with acute heart insufficiency, atrial flutter and died.
Autopsy Findings: Bilateral peri-orbital xanthomas; a diffuse infiltrating lesion in both orbits; similar lesions in the retroperitoneum, peri-aortic tissue, heart, Girota fascia (bilateral), dura mater and transverse sinus. 
– Erdheim-Chester disease
(CD68 positive) (The case will be presented and discussed in the next meeting) 

10. Hosp. Santa Rita – Vitória - ES
B465/08
 – 8 y/o, girl. A Tumor attached to the ulnar extensor tendon of the   carpus. Surgical specimen: an irregular, 2.8 x 2.0 x 1.0 cm whitish, elastic fragment of tissue. 
– Calcifying aponeurotic fibroma         

11. Porto Case # 1
H 569/00 – 
24 y/o, woman.
Tumor in the posterior mediastinum: 11 cm in diameter: 504 g. Made up by a solid, fasciculated, white-yellowish tissue, with cystic degeneration and foci of necrosis.
– Monophasic fibrous variant of synovial sarcoma
(Vim, EMA, Cam 5.2 positive)     

12. Salomão & Zoppi Case
AP/108/23981
 – 51 y/o, man. A multinodular, firm-elastic, soft tissue mass located in the left gluteal region.
– Silicon granuloma
(J. Cut Pathol. 2007; 34:281-3)  

13. Bauru Case
IB08/1328 
– A 31 y/o, woman presented with a cystic nodule (2.0 cm in diameter) in the vagina in the beginning of a pregnancy. After two months, the nodule grew rapidly and became ulcerated and hemorrhagic.
The excised non-encapsulated mass measured 18.0 in diameter, weighed 900 g and was comprised by a myxoid, homogenous, focally hemorrhagic tissue. 
– Agressive angiomyxoma
(Vim, Desmin, 1A4, HHF35, Hormonal receptor: Estrogen and progestone, positives; Ki-67 negative)
(Korean J Radiol 2008; 9:91-3; Med Gen Med 2007, 9: 16  Review. Association with pregnancy)