RESUMO
Carcinosarcoma is a rare malignant disease with aggressive behaviour rarely producing oral manifestations. This article reports a case of an intraoral carcinosarcoma affecting a 71-year-old black male; the diagnosis was made by histopathological and immunohistochemical analyses. Computed tomography scanning showed metastatic masses in the lungs. The patient was underwent a chemotherapy protocol regimen, but died as a consequence of the disease within 10 months of diagnosis. Distinctive characteristics of this presentation were the location of the lesion (floor of the mouth) and its clinical features resembling a benign lesion. A brief review of intraoral carcinosarcoma cases in the literature is also presented.
Assuntos
Carcinossarcoma/diagnóstico , Granuloma Piogênico/diagnóstico , Doenças da Boca/diagnóstico , Soalho Bucal/patologia , Neoplasias Bucais/diagnóstico , Idoso , Antineoplásicos/uso terapêutico , Carcinossarcoma/patologia , Carcinossarcoma/secundário , Diagnóstico Diferencial , Células Epiteliais/patologia , Evolução Fatal , Humanos , Queratina-3/análise , Neoplasias Pulmonares/secundário , Masculino , Mesoderma/patologia , Neoplasias Bucais/patologia , Tomografia Computadorizada por Raios X/métodos , Vimentina/análiseRESUMO
Hobnail hemangioma (HH) is a rare benign vascular neoplasm reported as a distinctive small benign, solitary vascular neoplasm of the superficial and mid-dermis occurring on the face, trunk, or extremities of young or middle-aged adults. The oral manifestations are quite uncommon, with only three cases reported in the English language literature. The following case refers to a 38-year-old woman with a small nodule on the hard palatal mucosa. Histological findings showed a biphasic growth pattern of irregularly dilated vascular structures in the superficial mucosa, lined by epithelioid endothelial cells with a hobnail appearance, with neoplastic vessels observed in deeper parts of the lesion. In the oral cavity, the differential diagnosis includes hemangioma, melanoma, and Kaposi's sarcoma, whose clinical and histological features may be confused with those of HH.
Assuntos
Hemangioma/patologia , Mucosa Bucal/patologia , Neoplasias Palatinas/patologia , Palato Duro/patologia , Adulto , Diagnóstico Diferencial , Feminino , Hemangioma/diagnóstico , Hemangioma/cirurgia , Humanos , Linfangioma/diagnóstico , Melanoma/diagnóstico , Mucosa Bucal/cirurgia , Neoplasias Palatinas/diagnóstico , Neoplasias Palatinas/cirurgia , Palato Duro/cirurgia , Sarcoma de Kaposi/diagnósticoRESUMO
Renal abnormalities have been reported in Ankylosing Spondylitis (AS) patients. Possible mechanisms include the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), an increased incidence of glomerulonephritis, particularly the ones associated with deposition of IgA-containing immune complexes and the renal deposition of amyloid. These observations prompted us to evaluate in detail the frequency and severity of renal dysfunction in 40 AS patients, consecutively selected attending the rheumatology disease unit outpatient clinic at Escola Paulista de Medicina, using sensitive tests of glomerular and tubular function. Fourteen of the 40 patients presented one or more signs of renal involvement: microscopic hematuria (9 patients), microalbuminuria (4 patients), decreased renal function assessed by serum creatinine (2 patients), and creatinine clearance (4 patients). None of the patients presented increased urinary excretion of retinol binding protein (RBP). The finding of renal abnormalities in 35% of our patients suggests that in this illness evidence of renal involvement should be actively investigated.
Assuntos
Rim/fisiopatologia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/fisiopatologia , Adolescente , Adulto , Idoso , Albuminúria/etiologia , Anti-Inflamatórios não Esteroides/efeitos adversos , Creatinina/sangue , Creatinina/urina , Feminino , Hematúria/etiologia , Humanos , Rim/patologia , Nefropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Espondilite Anquilosante/patologiaRESUMO
OBJECTIVE: To evaluate the sensitivity and specificity of the ESSG criteria when applied to Brazilian patients with SpA and control patients with other rheumatic diseases. METHODS: Seventy patients with spondylarthropathies and 62 patients with other rheumatic diseases were interviewed, examined and had their charts reviewed. The diagnoses of the diseases were based on published diagnostic guidelines or classification criteria. Data were also collected according to the ESSG criteria. RESULTS: The sensitivity and specificity of the ESSG classification criteria were 98.5% and 88.7%, respectively. The sensitivities of the criteria in the different subgroups of SpA ranged from a low of 97.7% in AS to a high of 100% in other SpA studied. CONCLUSION: Despite differences in the socio-cultural and geographic characteristics and in individual disease frequencies, the ESSG preliminary classification criteria performed well when applied to Brazilian patients.
Assuntos
Guias de Prática Clínica como Assunto , Doenças da Coluna Vertebral/classificação , Brasil , Europa (Continente) , Feminino , Humanos , Masculino , Doenças Reumáticas/classificação , Sensibilidade e EspecificidadeRESUMO
The purpose of this study was to develop some of the focus group discussion (FGD) potentialities in order to provide information on patients' understanding of the origin and management of their medical condition. Fifteen ankylosing spondylitis (AS) patients (mean age = 32.6 yr and mean disease duration = 13.4 yr) were selected from the Rheumatic Disease Unit (RDU) out-patient clinic at Escola Paulista de Medicina, São Paulo, Brazil, to take part in this study. The FGD constituted two sessions, with eight patients in the first and seven in the second. The moderator raised specific questions about the patients' understanding of the pathology, the treatment and how the illness affected their quality of life. It was observed through the FGD that patients believed that their illness onset was due to some physical trauma. Clinicians should inquire about this tissue to be sure that their individual patients do not have this false belief. Also, it is necessary to improve the methods for early diagnosis and to develop further studies to determine and assess the parameters of disease activity. And finally, FGD may be of use in establishing a self-help group for individuals with chronic diseases, such as AS. In conclusion the FGD is an available technique that should be used more frequently in medicine to gather global qualitative data.