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Histoplasmosis occurs in 5-10% of HIV-infected patients in endemic areas and evolves to severe and disseminated infection with mortality rates over 50% in some regions. This report presents epidemiological, clinical and outcome data from HIV-infected patients with histoplasmosis confirmed by culture and/or at necropsy who were admitted to a Brazilian teaching hospital. Data from 65 patients were obtained from their respective medical and necropsy records. From 2005 to 2018, 36 HIV-infected patients were diagnosed with histoplasmosis confirmed by culture. At admission, most of these patients presented disseminated fungal infection, whereas 15 (41.7%) were simultaneously diagnosed with both HIV infection and histoplasmosis. Fever, weight loss, hepatosplenomegaly, respiratory and digestive symptoms were present in 86.2%, 50%, 44.4% and 41.7% of the patients, respectively. At admission, 24 patients had low CD4 T-cell count and high viral load values. Among the 30 patients who received antifungals, 16 (53.3%) were cured, 13 (43.3%) died, and one was lost to follow-up. Six patients died prior to therapy. From 1990 to 2018, 63 necropsies of patients with Histoplasma capsulatum infection were performed. Of these patients, 29 (46.0%) were HIV-infected individuals, including 21 (72.4%) who presented disseminated histoplasmosis and 21 (72.4%) who were diagnosed with histoplasmosis at necropsy. The epidemiological, clinical and outcome profiles presented herein are similar to those described elsewhere and reinforce the difficulties that are still present in limited-resource settings where advanced immunodeficiency, combined with severe fungal infection and late patient admissions, is related to poor outcomes.

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OBJECTIVE: To assess the percent agreement between diagnostic imaging modalities for the evaluation of lymphadenopathies in HIV-infected/AIDS patients. MATERIALS AND METHODS: This was an open, comparative, prospective study of diagnostic imaging methods for lymphadenopathy evaluation. We evaluated 30 patients (19 men and 11 women). All underwent ultrasound and computed tomography (CT). Twenty of the patients also underwent magnetic resonance imaging (MRI). We determined the percent agreement between two examiners using the various imaging methods to evaluate lymphadenopathies. RESULTS: CT had the highest percent agreement, at 93.3%, with a kappa coefficient of 0.85, corresponding to 28 of the 30 examinations. When we compared the percent agreement between the two examiners and between CT and ultrasound, examiner 1 had an observed rate of 80.0%, with a kappa of 0.49, corresponding to 24 of the 30 examinations, whereas examiner 2 had a rate of 70.0%, with a kappa of 0.31, corresponding to 21 of the 30 examinations. Between MRI and CT, the percent agreement for examiner 1 was 50.0%, with a kappa of -0.18, corresponding to 10 of the 20 examinations, whereas that for examiner 2 was 85.0%, with a kappa of 0.69, corresponding to 17 of the 20 examinations. For MRI and ultrasound, examiner 1 had a percent agreement of 70.0%, with a kappa of 0.20, corresponding to 14 of the 20 examinations, and examiner 2 had a percent agreement of 75.0%, with a kappa of 0.38, corresponding to 15 of the 20 examinations. CONCLUSION: This study indicates that intermethod agreement is highly dependent on the way in which the research is conducted, rather than on the level of experience of the examiner.

OBJETIVO: Avaliar a porcentagem de concordância entre métodos de diagnóstico por imagem na avaliação de linfonodomegalias em pacientes HIV(+)/AIDS. MATERIAIS E MÉTODOS: Foi realizado estudo aberto, comparativo e prospectivo dos métodos de diagnóstico por imagem na avaliação de linfonodomegalias. Foram avaliados 30 pacientes (19 homens e 11 mulheres). Todos foram submetidos a ultrassonografia e tomografia computadorizada (TC) e 20 também foram submetidos a ressonância magnética (RM). Foi determinado o grau de concordância entre dois examinadores usando-se métodos de diagnóstico por imagem. RESULTADOS: A TC obteve o maior grau de concordância, com taxa de 28/30 (93,3%) e coeficiente kappa de 0,85. Quando comparado o grau de concordância para linfonodomegalias entre dois examinadores e entre TC e ultrassonografia, o examinador 1 teve taxa de 24/30 (80,0%) e kappa de 0,49, e o examinador 2 teve taxa de 21/30 (70,0%) e kappa de 0,31. Entre RM e TC, o examinador 1 teve taxa de 10/20 (50,0%) e kappa de -0,18, e o examinador 2 teve taxa de 17/20 (85,0%) e kappa de 0,69. Entre RM e ultrassonografia, o examinador 1 teve taxa de 14/20 (70,0%) e kappa de 0,20, e o examinador 2 teve taxa de 15/20 (75,0%) e kappa de 0,38. CONCLUSÃO: Este estudo indica que a concordância entre métodos depende fortemente da forma como a pesquisa é conduzida e não da capacidade do examinador.

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Abstract Objective: To assess the percent agreement between diagnostic imaging modalities for the evaluation of lymphadenopathies in HIV-infected/AIDS patients. Materials and Methods: This was an open, comparative, prospective study of diagnostic imaging methods for lymphadenopathy evaluation. We evaluated 30 patients (19 men and 11 women). All underwent ultrasound and computed tomography (CT). Twenty of the patients also underwent magnetic resonance imaging (MRI). We determined the percent agreement between two examiners using the various imaging methods to evaluate lymphadenopathies. Results: CT had the highest percent agreement, at 93.3%, with a kappa coefficient of 0.85, corresponding to 28 of the 30 examinations. When we compared the percent agreement between the two examiners and between CT and ultrasound, examiner 1 had an observed rate of 80.0%, with a kappa of 0.49, corresponding to 24 of the 30 examinations, whereas examiner 2 had a rate of 70.0%, with a kappa of 0.31, corresponding to 21 of the 30 examinations. Between MRI and CT, the percent agreement for examiner 1 was 50.0%, with a kappa of −0.18, corresponding to 10 of the 20 examinations, whereas that for examiner 2 was 85.0%, with a kappa of 0.69, corresponding to 17 of the 20 examinations. For MRI and ultrasound, examiner 1 had a percent agreement of 70.0%, with a kappa of 0.20, corresponding to 14 of the 20 examinations, and examiner 2 had a percent agreement of 75.0%, with a kappa of 0.38, corresponding to 15 of the 20 examinations. Conclusion: This study indicates that intermethod agreement is highly dependent on the way in which the research is conducted, rather than on the level of experience of the examiner.

Resumo Objetivo: Avaliar a porcentagem de concordância entre métodos de diagnóstico por imagem na avaliação de linfonodomegalias em pacientes HIV(+)/AIDS. Materiais e Métodos: Foi realizado estudo aberto, comparativo e prospectivo dos métodos de diagnóstico por imagem na avaliação de linfonodomegalias. Foram avaliados 30 pacientes (19 homens e 11 mulheres). Todos foram submetidos a ultrassonografia e tomografia computadorizada (TC) e 20 também foram submetidos a ressonância magnética (RM). Foi determinado o grau de concordância entre dois examinadores usando-se métodos de diagnóstico por imagem. Resultados: A TC obteve o maior grau de concordância, com taxa de 28/30 (93,3%) e coeficiente kappa de 0,85. Quando comparado o grau de concordância para linfonodomegalias entre dois examinadores e entre TC e ultrassonografia, o examinador 1 teve taxa de 24/30 (80,0%) e kappa de 0,49, e o examinador 2 teve taxa de 21/30 (70,0%) e kappa de 0,31. Entre RM e TC, o examinador 1 teve taxa de 10/20 (50,0%) e kappa de -0,18, e o examinador 2 teve taxa de 17/20 (85,0%) e kappa de 0,69. Entre RM e ultrassonografia, o examinador 1 teve taxa de 14/20 (70,0%) e kappa de 0,20, e o examinador 2 teve taxa de 15/20 (75,0%) e kappa de 0,38. Conclusão: Este estudo indica que a concordância entre métodos depende fortemente da forma como a pesquisa é conduzida e não da capacidade do examinador.

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High-grade endometrial carcinomas are aggressive neoplasms of difficult histological classification. Neuroendocrine differentiation in endometrial carcinomas is rare. This is the report of an endometrial large cell neuroendocrine carcinoma with foci of melanocytic differentiation in a 75-year-old woman with abnormal post-menopausal uterine bleeding for 2 years. Two initial biopsies were inconclusive. Histopathological examination of the uterus revealed large cell neuroendocrine carcinoma associated with endometrioid carcinoma and foci of melanocytic differentiation, pT3a (FIGO IIIA). There were metastases in the rectum serosa and lungs. After 8 months of diagnosis and surgical treatment, the patient is on chemotherapy and radiotherapy. We highlight the morphological characteristics and criteria that allow the definitive anatomopathological diagnosis, including immunohistochemical markers used to identify the cell types present in this unprecedented association.

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High-grade endometrial carcinomas are aggressive neoplasms of difficult histological classification. Neuroendocrine differentiation in endometrial carcinomas is rare. This is the report of an endometrial large cell neuroendocrine carcinoma with foci of melanocytic differentiation in a 75-year-old woman with abnormal post-menopausal uterine bleeding for 2 years. Two initial biopsies were inconclusive. Histopathological examination of the uterus revealed large cell neuroendocrine carcinoma associated with endometrioid carcinoma and foci of melanocytic differentiation, pT3a (FIGO IIIA). There were metastases in the rectum serosa and lungs. After 8 months of diagnosis and surgical treatment, the patient is on chemotherapy and radiotherapy. We highlight the morphological characteristics and criteria that allow the definitive anatomopathological diagnosis, including immunohistochemical markers used to identify the cell types present in this unprecedented association.

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The solid variant of aneurismal bone cysts (ABC) is considered rare. It occurs with greater frequency in pediatric patients and in the tibia, femur, pelvis and humerus. We present a case of a metaphyseal lytic lesion on the distal extremity of the radius in a child whose radiograph was requested after low-energy trauma. The hypothesis of a pathological bone fracture secondary to an aneurysmal bone cyst was suggested. After biopsy, the child underwent intralesional excision without bone grafting and the histopathological findings were compatible with the solid variant of aneurysmal bone cyst.

A variante sólida do cisto ósseo aneurismático (COA) é considerada lesão rara, ocorre com maior frequência nos pacientes pediátricos e nos ossos da tíbia, fêmur, pelve e úmero. Apresentamos o caso de uma lesão lítica metafisária na extremidade distal do rádio de uma criança em que, ao exame radiográfico feito devido a um trauma de baixa energia, foi aventada a hipótese de fratura em um osso patológico secundária a um cisto ósseo aneurismático. Após a biópsia, a criança foi submetida a ressecção intralesional sem interposição de enxerto e o exame histopatológico foi condizente com a variante sólida do cisto ósseo aneurismático.

RESUMO

The solid variant of aneurismal bone cysts (ABC) is considered rare. It occurs with greater frequency in pediatric patients and in the tibia, femur, pelvis and humerus. We present a case of a metaphyseal lytic lesion on the distal extremity of the radius in a child whose radiograph was requested after low-energy trauma. The hypothesis of a pathological bone fracture secondary to an aneurysmal bone cyst was suggested. After biopsy, the child underwent intralesional excision without bone grafting and the histopathological findings were compatible with the solid variant of aneurysmal bone cyst.

A variante sólida do cisto ósseo aneurismático (COA) é considerada lesão rara, ocorre com maior frequência nos pacientes pediátricos e nos ossos da tíbia, fêmur, pelve e úmero. Apresentamos o caso de uma lesão lítica metafisária na extremidade distal do rádio de uma criança em que, ao exame radiográfico feito devido a um trauma de baixa energia, foi aventada a hipótese de fratura em um osso patológico secundária a um cisto ósseo aneurismático. Após a biópsia, a criança foi submetida a ressecção intralesional sem interposição de enxerto e o exame histopatológico foi condizente com a variante sólida do cisto ósseo aneurismático.

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A Pneumonia Intersticial Aguda (PIA) é uma rara e fulminante forma de doença pulmonar difusa descrita por Hamman e Rich em 1935. Pneumonia Intersticial Aguda é classificada como Pneumonia Intersticial Idiopática, e é a mais aguda e agressiva em seu curso. Apresenta-se clinicamente de forma similar a Síndrome da Angústia Respiratória Aguda (SARA), e representa provavelmente uma parte dos casos de síndrome da Angústia Respiratória Aguda idiopática. O caso relatado é de uma paciente de 55 anos, portadora de Obesidade e Esquizofrenia, que apresentou Insuficiência Respiratória Aguda e síndrome da Angústia Respiratória Aguda grave, com piora clínica rápida e evolução para óbito com menos de 3 dias de internação hospitalar. O diagnóstico de Pneumonia Intersticial Aguda foi feito na necropsia. O objetivo deste trabalho é fazer uma breve revisão sobre a Pneumonia Intersticial Aguda e relatar um caso clínico desta doença, que é rara e com pouca descrição na literatura, devendo ser lembrada como diagnóstico diferencial nos casos de Síndrome da Angústia Respiratória Aguda

Acute Interstitial Pneumonia (AIP) is a rare and fulminant diffuse lung disease described by Hamman and Rich in 1935. Acute Interstitial Pneumonia is classified as idiopathic interstitial pneumonia, and is the most aggressive and acute in its course. It is presented as Adult Respiratory Distress Syndrome (ARDS), and it is one of the cases of idiopathic as Adult Respiratory Distress Syndrome. This is a case of a 55 years-old patient, with obesity and schizophrenia who presented with acute respiratory insufficiency and severe as Adult Respiratory Distress Syndrome, with rapid clinical deterioration and progression to death in less than three days of hospitalization. The diagnosis of Acute Interstitial Pneumonia was made at necropsy. The objective of this paper is to briefly review the Acute Interstitial Pneumonia and to report a case of this disease, which is rare with limited description in the literature. It should be included as a differential diagnosis in cases of Adult Respiratory Distress Syndrome

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