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Diagnostic criteria for intracapsular carcinoma ex pleomorphic adenoma (CXPA) are subjective and vary among authors. Biomarker analysis, which could provide more objective evaluation of these tumors, has rarely been studied in intracapsular CXPA. Immunohistochemical evaluation of c-erbB-2, p53 protein, bcl-2, and Ki-67 was performed in 8 cases of CXPA at an early phase of malignant transformation (4 intracapsular and 4 minimally invasive) and in 17 pleomorphic adenomas (PA). In all cases of CXPA, p53 and Ki-67 were demonstrated predominantly in luminal cells of benign and malignant areas, significantly more in the latter. Few benign myoepithelial cells were p53 positive. c-erbB-2 reactivity was strongly associated with atypical luminal cells. Bcl-2 expression was weak and focal in malignant areas from 2 cases. In conclusion, both p53 and c-erbB-2 proteins appear to be involved at an early stage of malignization of PA. In PA with atypical cells, evaluation of the expression of these 2 markers provides more objective criteria for the diagnosis of intracapsular CXPA.

Aims : To characterize the cellular component in pleomorphic adenoma (PA) that undergoes malignant transformation in carcinoma ex pleomorphic adenoma (CXPA). Methods and results : A panel of antibodies against cytoskeletal proteins was applied in 16 cases of CXPA: intracapsular carcinoma (five cases), minimally invasive (four cases) and frankly invasive (seven cases). The CXPAs were classified into two main groups according to their predominant cellular component as detected by the panel of antibodies: (i) carcinomas with only epithelial differentiation (75% of the cases), and (ii) carcinomas with a myoepithelial component (25%). CXPA with only epithelial differentiation showed two types of malignant areas in the part of the tumour that was confined by the PA capsule: (i) intraductal carcinoma areas characterized by ductal structures containing both benign myoepithelial cells positive for α-smooth muscle actin (α-SMA), vimentin and cytokeratin (CK)14 and proliferating atypical luminal cells reactive for CK7, CK8 and CK19, and (ii) carcinoma areas composed only of epithelial cells reactive for CK7, CK8 and CK19. In the latter, the cells presented morphological and immunohistochemical characteristics similar to those found in areas of invasive carcinoma outside the PA capsule. CXPAs with a myoepithelial component were composed mainly or exclusively of cells that expressed vimentin and α-SMA. In this group, ductal structures reminiscent of PA filled by malignant cells were not identified. Conclusion : Most CXPAs consist only of epithelial cells that have an immunoprofile comparable to ductal luminal cells of PA. These malignant luminal cells arise in the duct-like structures as intraductal carcinoma and probably only at this early stage of development should the lesion be considered as a non-invasive carcinoma.

Introduction Carcinoma ex-pleomorphic adenoma (CXPA) is a rare and aggressive malignancy of the salivary glands that arises from a previous PA. CXPA present different histological subtypes and grade of invasiveness, leading to variable clinical behavior. Objective Determine the proliferative index of 36 cases of CXPA, considering the histological subtypes and invasiveness phase. Material and methods It was included on this study 36 each of CXPA and PA, and 22 areas of PA in CXPA. All cases of CXPA were classified according to invasiveness (early and frankly invasive phase) and histological subtype. Proliferative index was determined by Ki-67, and the data were statistically analyzed by Wilcoxon’s, Mann–Whitney and Kruskal–Wallis’ tests. Results CXPA included 14 cases classified as early invasive and 22 as frankly invasive phases. Fifteen cases corresponded to salivary duct carcinoma, 7 adenocarcinoma NOS, 7 myoepithelial carcinoma, 5 epithelial-myoepithelial carcinoma, one each squamous cell carcinoma and sarcomatoid carcinoma. The Ki-67 mean index of PA and residual PA were 6.7 ± 2.5 and 6.9 ± 8.2, respectively, significantly lower than CXPA (49.3 ± 21.7). Early invasive carcinoma (44.3 ± 23.0) showed smaller proliferative index than frankly invasive (52.5 ± 20.8). Considering the subtypes of CXPA, there was not a statistic difference among them. Conclusion Ki-67 is a useful marker in the differential diagnosis of PA and CXPA, even when in the early invasive phase. Ki67 index varies according to the histological subtype of CXPA, but are not statistically significant.

OBJECTIVE: To describe a case of kaposiform hemangioendothelioma, the only malignant tumor of vascular origin specific of childhood.METHODS: We report a case of a 40-days-old girl who presented with a giant hemangioma of the face. Rapid enlargement of the tumor lead to laryngeal compression with severe respiratory distress. She had also a consumptive thrombocytopenic coagulopathy (Kasabach-Merritt syndrome).RESULTS: She was admitted to the pediatric intensive care unit of the Hospital das Clinicas da Universidade Estadual de Campinas and mechanical ventilation was introduced. A ten day course of dexamethasone was only partially effective. We then started alpha-2a interferon at a dose of 1.8 million units/m(2)/day by subcutaneous route, but she died four days after the onset of this therapy. The microscopic features showed a kaposiform hemangioendothelioma.CONCLUSION: We discuss this unusual fatal evolution of a rapidly growing hemangioma and its hematological complications.

Paracoccidioidomycosis (PCM) is a deep mycosis caused by Paracoccidioides brasiliensis, with high incidence in Brazil. In order to examine the immune response in lesional tissue from patients with PCM, we analyzed cytokines as well as the phenotype of the cell infiltrate. Paraffin-embedded tissue from the oral mucosa of eight patients with the localized adult form (AF) of PCM and from the lymph nodes of 10 patients with the juvenile form (JF) of PCM was analyzed by immunohistochemistry to detect tumor necrosis factor-alpha (TNF-alpha), inducible nitric oxide synthase (iNOS), transforming growth factor-beta (TGF-beta) and interleukin-10 (IL-10). Most of the inflammatory cells in the lymph nodes were CD68+ (macrophages, epithelioid and giant cells), while a mixed infiltrate with macrophages, plasma cells and neutrophils was detected in the oral mucosa. TNF-alpha as well as iNOS expression was similar in lymph nodes and oral mucosa, whereas TGF-beta and IL-10 were observed in a larger number of macrophages, epithelioid and giant cells in the lymph nodes, where numerous yeast cells were visualized. The higher expression of anti-inflammatory cytokines (IL-10 and TGF-beta) in lesions of patients with the JF of PCM (lymph nodes) may represent a mechanism by which the fungus evades the host immune response, contributing to a more severe and disseminated form of the disease.

CONTEXT: Undifferentiated head and neck and skull base tumors are not unusual. They can arise in mucosa as well as in salivary glands, soft tissues or lymph nodes. Suitable therapy and prognosis for each case depends upon precise histopathological diagnosis. OBJECTIVE: To evaluate the role of immunohistochemical techniques in determining the conclusive diagnosis. The occurrence of these tumors in our service and the way in which they were distributed according to cell pattern, patient's age and tumor location was also evaluated. TYPE OF STUDY: Cross-sectional study. SETTING: Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. PARTICIPANTS: 43 biopsies performed between January 1990 and December 1997, diagnosed as undifferentiated head and neck tumors. PROCEDURES: We applied an immunohistochemical panel in accordance with the avidin-biotin-peroxidase complex method. The final diagnosis was achieved after new analysis in conjunction with biopsies stained using the hematoxylin-eosin technique. MAIN MEASUREMENTS: This study evaluated undifferentiated tumors in head and neck, and the way in which they were distributed, according to cell pattern, patient's age and tumor location. RESULTS: The most frequent locations for undifferentiated tumors were the lymph nodes, 20.9%; pharynx and neck, 16.3%; paranasal sinus, 14%; and nose, 11.6%. They were most prevalent during the seventh decade of life (34.9%), and twice as prevalent in men as in women. The immunohistochemical technique allowed conclusive diagnosis for 60.5% of the tumors and was suggestive for 20.9% of the biopsies. The most prevalent cell pattern was round cells (51.2%), followed by epithelioid cells (20.9%), spindle cells (16.3%), myxoid pattern (9.3%) and pleomorphic cells (2.3%). CONCLUSION: Our results demonstrate the fundamental role of the immunohistochemical technique for conclusive diagnosis of undifferentiated tumors.

Background Pleomorphic adenoma (PA) is the most common tumor of the salivary gland, while basal cell adenoma (BCA) is an uncommon neoplasm. Blood and lymphatic vessels are crucial for tumor metabolism. The aim of this study was to compare the blood and lymphatic vascular density and vascular and endothelial growth factor (VEGF) expression in PA and BCA tumors. In addition, cell proliferation was evaluated in these tumors. Methods Blood and lymphatic vessel content, VEGF expression, and cell proliferation were analyzed in 30 cases of PA and 13 cases of BCA by immu-nohistochemistry using antibodies for CD34, CD105, D2-40, VEGF, and Mcm -2. Results Regarding CD34 and CD105 expression, PA demonstrated a high vascularity and a low number of positive vessels, respectively. D2-40-positive lymphatic vessels were mainly located in the tumor capsules, with small intratumoral lymphatic vessels observed occasionally. VEGF expression revealed a remarkably heterogeneous immunoreactivity, alternating from weak or negative to positive or intense. BCA presented significantly higher CD34, CD34, CD105, D2-40, and VEGF expression compared to PA. No significant difference was found in cell proliferation between the tumors. Conclusion Although PA and BCA are considered part of the same spectrum of differentiation, this study showed that the blood and lymphatic vascularization of these tumors is different.

The authors report one case of granulocytic sarcoma infiltrating the larynx and cervical lymph nodes in a 50-year-old smoking patient. At the time of diagnosis there was no clinical and laboratory evidence of acute myeloid leukemia or chronic myeloproliferative disease. Four months after diagnosis, bone marrow morphology was consistent with chronic myeloid leukemia, accelerated phase. Cytogenetic abnormalities (Ph 1 chromosome, t(1; 12) (p36; p13), and trisomy of chromosome 20) were also found in hemopoetic cells. Granulocytic sarcoma preceding installation of chronic myeloid leukemia, as described here, seems to be a rare clinical event.

Recurrent tonsillitis has been the subject of much investigation. Events considered to predispose to or cause recurrent tonsillitis (RT) include the misuse of antibiotic therapy in acute bouts, alterations in the microflora, structural changes in crypt epithelium and certain viral infections. Epstein-Barr Virus (EBV) infection usually occurs in early childhood and can persist in palatine tonsil lymphocytes to induce tonsillitis at a later date. We have examined the presence of EBV in palatine tonsils in order to assess the relationship between this virus and recurrent acute tonsillitis. Tonsils were obtained from 85 patients, 2--14 years old (mean 5.6 years old) who underwent tonsils and adenoid (T&A) removal because of recurrent tonsillitis (RT) or T&A hypertrophy (TH). Tissues specimens were processed for non-isotopic in situ hybridization (ISH) using EBER 1/2 oligonucleotides (EBER RNA). The indications for surgery were RT in 42 patients and TH in 43 patients. In 25 out of 85 cases (29.4%) a positive EBER RNA reaction (15 RT and 33 TH) was found. The chi(2)-test showed no statistically significant difference in frequency of positive results between RT and TH group. We conclude that tonsils of children can be colonized by EBV and that the virus may be implicated in RT and TH.

We examined the presence of human papillomavirus (HPV) DNA in 65 cases of laryngeal squamous dysplasia and carcinomas using in situ hybridization with signal amplification in paraffin sections. Hybridization was performed with biotynilated DNA probes for HPV 6/11, 16/18, 31/33 and wide-spectrum HPV (6, 11, 16, 30, 31, 45, 51 and 52). HPV DNA was found in 7 cases of the total sample (10.7%); it was also found in 4 out of 45 (8.8%) cases of invasive carcinoma and in 5 out of 33 (15.5%) cases of squamous dysplasia. Morphological signs suggestive of HPV infection were observed in 35.5% of our sample but they were not related to HPV DNA positivity. In conclusion, HPV probably plays little, if any, role in laryngeal carcinogenesis among the population studied.

Chagas' disease, a systemic illness endemic to some regions of South America, is caused by the protozoan Trypanosoma cruzi. Transplacental infection may occur during any phase and cause fetal death. This study is the first to characterize the inflammatory cells in chagasic villitis by immunohistochemistry. Paraffin sections of 8 placentas with villitis by T. cruzi (4 live births and 4 stillbirths), as well as 8 control placentas without inflammation, were stained with hematoxylin and eosin, monoclonal antibodies for CD45RO, CD20, CD45RO/OPD4, CD8, HNKI, CD15, MAC387, and CD68 proteins, and a polyclonal antibody for S-100 protein. Quantification of positive cells was performed in 3 different high-power fields. In all cases of chagasic villitis, the inflammatory infiltrate was composed mainly of CD68+ macrophages, T lymphocytes, and a few natural killer cells. Among T cells, CD8+ cells outnumbered CD4+ cells in all placentas (CD4+:CD8+ ratios ranged from 0.04 to 0.38). B cells were absent or rare. In stillbirths, villitis was diffuse and severe with numerous T. cruzi, while in live births it was focal with few parasites. Other features that characterized villitis in stillbirths were 1) frequent trophoblastic necrosis, 2) presence of MAC387+ macrophages and CD15+ granulocytes attached to the sites of trophoblastic necrosis, 3) low CD4+: CD8+ ratios in most cases, 4) increased numbers of S-100 positive cells in the villous stroma. In conclusion, CD68+ macrophages and CD8+ T lymphocytes were the major cell population in villitis caused by T. cruzi. However, the pattern of inflammatory reaction differed between stillbirths and live births and was probably related to the number of parasites in the placental villi.

CONTEXT: Adenoid cystic carcinomas are malignant tumors that occur in both the major and the minor salivary glands. A laryngeal location is rare because of the paucity of accessory salivary glands in this area. Adenoid cystic carcinomas account for less than 1% of all malignant tumors in the larynx, and only about 120 cases have been reported in the literature. These tumors have a slight female predisposition, and their peak incidence is in the fifth and sixth decades of life. In this article, we describe a case of laryngeal adenoid cystic carcinoma and discuss its clinical characteristics and treatment. CASE REPORT: We report on a case of laryngeal adenoid cystic carcinoma in a 55 year-old female patient who presented with dyspnea and hoarseness. Features of the diagnostic and therapeutic evaluation are described and the clinical management of such cases is outlined. The clinical course, definitive treatment strategy and surgical procedure, and also adjuvant treatment with irradiation are discussed. Although the tumor is radiosensitive, it is not radiocurable. CONTEXTO: Carcinoma adenóide cístico (CAC) é um tumor maligno que ocorre tanto nas glândulas salivares maiores quanto nas menores. Localização laríngea é rara devido à paucidade de glândulas salivares acessórias nesta região. O carcinoma adenóide cístico representa menos de 1% das lesões malignas da laringe e apenas 120 casos foram relatados na literatura. O CAC tem freqüência discretamente superior no sexo feminino e seu pico de incidência ocorre entre a quinta e sexta décadas de vida. Neste artigo, descrevemos um caso de CAC laríngeo e discutimos suas características clínicas e seu tratamento. RELATO DE CASO: Relatamos o caso de CAC numa paciente de 55 anos que apresentava disfonia e dispnéia. Características diagnósticas e avaliação terapêutica são descritas e a conduta clínica definida. Evolução clínica, estratégia terapêutica e procedimento cirúrgico são discutidos, bem como o tratamento adjuvante com radioterapia. O tumor, apesar de radiossensível, não é radiocurável.

Introduction and purpose Carcinoma ex-pleomorphic adenoma (CXPA) is a rare tumor with different prevalence rates found among studies. There are few epidemiological studies of large series of CXPAs in developing countries. Objective The aim of the present study is to present a Brazilian retrospective study of 38 patients with CXPA. Material and methods Thirty-eight cases of CXPA from three Brazilian institutions, Sao Paulo State were evaluated. The patients were analyzed according to gender, age, location, clinical stage, histopathological subtype, invasiveness of the tumor, and follow-up information. Results No preferential gender was found, and the mean age of diagnosis was 57.6 years. The most commonly involved site was the parotid (28 cases, 73.7%), followed by the submandibular (six cases, 15.8%), and the minor salivary gland (four cases, 10.5%). At diagnosis, 9 (23.6%) were classified as clinical stage I or II, and 19 (50.1%) as stage III or IV, with 10 (26.3%) having no information. The histological types were: 16 salivary duct carcinomas (42.2%), 8 adenocarcinomas not otherwise specified (21.1%), 7 myoepithelial carcinomas (18.4%), 5 epithelial-myoepithelial carcinomas (13.1%), 1 epidermoid carcinoma (2.6%), and 1 sarcomatoid carcinoma (2.6%). Moreover, according to the invasive phase, 6 (15.8%) were classified as intra-capsular, 9 (23.7%) minimally invasive and 23 (60.5%) frankly invasive. Recurrence was observed in 7 out 24 patients with follow-up information available, which were all invasive cases. Seven out 24 patients died of causes related to the disease. Conclusion The distribution of cases according to age, gender, tumor location and clinical stage was similar to the reported literature. Frankly invasive cases presented worse prognosis.

Purpose Carcinoma ex-pleomorphic adenoma (CXPA) is a malignant salivary gland tumor that arises rarely in the minor salivary glands. Although the etiology of CXPA remains unclear, the role of some tumor suppressor genes and oncogenes in CXPA is well known, however other genes still need to be studied. Material and methods An uncommon case of CXPA involving the upper lip is presented, which was analyzed by a panel of genes (the most are tumor suppressor) by multiplex ligation dependent-probe amplification (MLPA). Results A 69-year-old male was submitted to surgical resection of a mass in the mucous of the upper lip histologically diagnosed as CXPA. The patient is free of disease after 30 months postoperatively. From all of the genes investigated in this study, a loss of copy number was detected for BCL2, CASP8, CD44, CDH1, DAPK1, ESR1, RASSF1, and TP73. Immunohistochemical reactions for the validation of some of these results showed negativity for CD44, Bcl-2, RASSF1 and p73. Conclusion A loss of copy number of the genes CD44, BCL-2, RASSF1, and TP73, may contribute with the formations of CXPAs. The genomic findings this case may be compared to malignant tumors of other sites aiming a better understanding of the carcinogenesis process.

Hemorrhagic endovasculitis (HEV) of the placenta involves damage to or destruction of chorionic vessels and fetal erythrocytes. We evaluated the frequency and extension of the HEV and clinical events and morphologic changes associated with it in placentas from liveborn and stillborn infants. Two hundred sixty four placentas were examined: 214 from livebirths and 50 from stillbirths. The livebirths were subdivided according to the time of intrauterine retention (IUR). HEV occurred in 8.8% of placentas from livebirths and in 32% from stillbirths. In the livebirths the lesion affected small number of villi, was frequently associated with villitis (73.6% of the cases), but there was no significant association with maternal disease or birth weight. In the stillbirths, HEV was strongly associated with the time of IUR. In stillbirths with 1 day of IUR, HEV occurred in frequency similar to the livebirths (9.5%), but in stillbirths with 2-7 days of IUR the frequency was high (71.4%) and numerous vessels were involved. In those over 7 days the lesion was less extensive and frequent (20%) and it had the appearance of end stage of organization. We conclude that HEV, in livebirths and fresh stillbirths is frequently a small lesion of little significance, while in macerated stillbirths it is an artifact of maceration.

Villitis of unknown etiology (VUE) is a common placental lesion and complement-fixing immune complexes is one of the mechanisms proposed for its development. We examined 16 placentas with VUE and 16 without VUE by immunofluorescence in order to compare the distribution and amount of C1q, C3d, IgG and IgM in the chorionic villi between the two groups. We found both in cases with and without VUE a distribution of the complement components and immunoglobulins similar to that described in normal placentas. The amount of deposit was also not significantly different in the two groups. Only the inflamed villi showed an abnormal distribution of C1q which was present diffusely in the stroma of these villi.

Objective To analyze the impact of anterior commissure involvement on rates of local control, recurrence, and laryngeal preservation in patients with early glottic cancer (T1a-T2 lesions, staged according to the TNM staging system) treated with laser microsurgical resection. Design Retrospective review. Setting A tertiary university referral center. Patients Forty-eight patients with early glottic (T1-T2a) cancer. Intervention Laser endoscopic resection of glottic cancer. Main Outcome Measures Evaluation of local control and larynx preservation rates. Results Among 48 patients presenting with early glottic cancer, the anterior commissure was involved in 24 cases. The local control rate was 79% (19 cases), and the larynx preservation rate was 96% (23 cases). In the 24 cases without anterior commissure involvement, the local control rate was 96% (23 cases) and the corresponding larynx preservation rate was 100% (24 cases). The rate of local recurrence with anterior commissure involvement was 21% (5 cases) and was 4% (1 case) when this site was not compromised by the tumor. This difference was not statistically significant ( P = .08). When the anterior commissure was compromised by a lesion, more surgical margins taken from the patient after the completion of surgery (additional margins) were compromised by squamous cell carcinoma (SCC) on permanent section (33% [8 cases]) compared with 0% from patients with anterior commissure involvement ( P = .003), despite the fact that these margins were negative for disease on frozen section. Cases with additional margins compromised by SCC on permanent section ( P = .004) and T1 lesions ( P = .009) had a higher rate of recurrence. Conclusions This study shows the tendency toward greater additional margins compromised by SCC and a higher rate of tumor recurrence in lesions with anterior commissure involvement after laser microsurgery for early glottic carcinoma. Higher recurrence rates were observed in cases with compromised additional margins and in T1 cases.

Carcinoma ex-pleomorphic adenoma (CXPA) accounts for 5% to 15% of all salivary gland malignancies. They are considered high-grade tumors, except when carcinomatous component is enclosed within PA capsule, when a benign behavior is expected. In order to recognize which cellular component of PA develops in carcinoma, and how the progression of the lesion occurs, a panel of antibodies against cytoskeletal proteins (SMA; vimentin, and CK 7, 8, 13, 14, and 19), was applied to 13 cases of CXPA from major and minor glands, using the streptavidin-biotin method of immunohistochemistry. Two major kinds of CXPA were identified: those exhibiting only epithelial differentiation as seen in 10 cases from major glands (positive only to CK 7, 8, and 19) and those presenting myoepithelial component composed either by 2 cell types, luminal and myoepithelial, or with only myoepithelial cells (expressing SMA, vimentin, and CK 7 and 8). In CXPA with only epithelial differentiation, besides the area of PA, 2 other areas could be seen: intraductal carcinoma and/or invasive carcinoma, the latter regardless of being enclosed or not within PA capsule. In intraductal areas myoepithelial cells strongly expressing SMA, vimentin, and CK14 surrounded carcinomatous luminal cells. Invasive areas showed only carcinomatous epithelial cells without myoepithelial cells, indicating no more an intraductal or “in situ” localization of malignant cells. Based on these findings it is clear that the intracapsular CXPA can present in situ and/or in invasive areas. Thus, we recommend that the use of the term “in situ” should be restricted to tumors presenting only intraductal growth.

Villitis of unknown etiology (VUE) is the largest category of the placental villitides and its incidence varies in different countries. The possibility that a higher incidence of intrauterine infection could explain the high frequency of VUE in developing countries led us to determine the incidence of raised IgM levels (a non-specific monitor to intrauterine infections) in cord serum of placentas with VUE. Eighty-six placentas were studied. Of these 67 were from infants with adequate weight for their gestational age (AGA) and 19 from infants small for their gestational age (SGA). IgM level in the cord serum was measured on radial immunodiffusion plates. VUE was found in 36 placentas (41.8%) and it predominated in the SGA group. Raised IgM levels were found in only 13.8% of the placentas with VUE. In spite of our frequency of VUE being high, our incidence of raised IgM levels in placentas with VUE was low and similar to that reported by authors who have low incidence of VUE in their series. We conclude that determination of cord IgM did not help significantly in the investigation of the cause of the high frequency of VUE in our series.

Counts of nucleolar regions (NORs) demonstrated by a silver staining technique in paraffin sections, have been used to distinguish benign from malignant lesions. AgNORs were studied in 24 biopsies from oral cavity (5 cases of normal oral mucosa, 5 of pseudocarcinomatous hyperplasia and 14 of squamous cell carcinoma, subdivided according to degree of differentiation: 5 grade 1, 5 grade 2 and 4 grade 3) to find whether they were helpful in distinguishing pseudocarcinomatous hyperplasia due to chronic parasitic infections from squamous cell carcinoma. Two methods of counting AgNORs were used: (A) a simpler one which counts nucleolar clusters (AgNU) and satellite AgNORs and the other (B) counting all individual AgNORs, including those within AgNUs. In both methods the lowest mean values were observed for grade 3 carcinoma, while the highest belonged to grade 2 carcinoma. The simpler method (A) was the most useful because AgNU counts showed significant difference when pseudocarcinomatous hyperplasia was compared with grade 1 and 2 carcinomas, which are the most difficult to discriminate from it. However the overlapping of values render the technique of limited use in individual cases. INTRODUÇÃO E OBJETIVOS: Regiões organizadoras do nucléolo podem ser detectadas através do nitrato de prata em secções de parafina. A contagem de AgNORs tem sido utilizada para distinguir entre lesões benignas e malignas. MATERIAL E MÉTODOS: AgNORs foram contados em 24 biopsias da cavidade oral (5 casos de mucosa oral normal, 5 de hiperplasia pseudocarcinomatosa e 14 de carcinoma epidermóide, subdivididos segundo o grau de diferenciação: 5 grau 1; 5 grau 2 e 4 grau 3) para verificar sua utilidade no diagnóstico diferencial entre hiperplasia pseudocarcinomatosa, secundária a infecções parasitárias crônicas, e carcinoma epidermóide. Foram usados dois métodos de contagem de AgNORs: um mais simples(A), que conta os agregados nucleolares (AgNU) e AgNOR satélites e o outro (B) que conta todos os AgNORs, inclusive aqueles dentro do AgNUs. RESULTADOS E CONCLUSÃO: Em ambos os métodos as médias mais baixas foram do carcinoma grau 3 e as mais altas do carcinoma grau 2. O método mais simples (A) foi o mais útil, pois a contagem de AgNU mostrou valores significantemente diferentes quando comparou-se hiperplasia pseudocarcinomatosa e carcinomas graus 1 e 2, que são os mais difíceis de distinguir da hiperplasia. Entretanto, devido à sobreposição de valores a técnica foi de utilidade limitada em casos individuais.

SummaryIn order to investigate the role of myoepithelial cell and tumor microenvironment in salivary gland neoplasma, we have performed a study towards the effect of different extracellular matrix proteins (basement membrane matrix, type I collagen and fibronectin) on morphology and differentiation of benign myoepithelial cells from pleomorphic adenoma cultured with malignant cell culture medium from squamous cell carcinoma. We have also analyzed the expression of α-smooth muscle actin (α-SMA) and FGF-2 by immunofluorescence and qPCR. Our immunofluorescence results, supported by qPCR analysis, demonstrated that α-SMA and FGF-2 were upregulated in the benign myoepithelial cells from pleomorphic adenoma in all studied conditions on fibronectin substratum. However, the myoepithelial cells on fibronectin substratum did not alter their morphology under malignant conditioned medium stimulation and exhibited a stellate morphology and, occasionally focal adhesions with the substratum. In summary, our data demonstrated that the extracellular matrix exerts an important role in the morphology of the benign myoepithelial cells by the presence of focal adhesions and also inducing increase FGF-2 and α-SMA expression by these cells, especially in the fibronectin substratum.

Counts of nucleolar regions (NORs) demonstrated by a silver staining technique in paraffin sections, have been used to distinguish between benign and malignant lesions. AgNORs were studied in 24 biopsies from oral cavity (5 cases of normal oral mucosa, 5 of pseudocarcinomatous hyperplasia and 14 of squamous cell carcinoma, subdivided according to degree of differentiation: 5 grade 1, 5 grade 2 and 4 grade 3) to find whether they were helpful in distinguishing pseudocarcinomatous hyperplasia due to chronic parasitic infections from squamous cell carcinoma. Two methods of counting AgNORs were used: (A) a simpler one which counts nucleolar clusters (AgNU) and satellite AgNORs and the other (B) counting all individual AgNORs, including those within AgNUs. In both methods the lowest mean values were observed for grade 3 carcinoma, while the highest belonged to grade 2 carcinoma. The simpler method (A) was the most useful because AgNU counts showed significant difference when pseudocarcinomatous hyperplasia was compared with grade 1 and 2 carcinomas, which are the most difficult to discriminate from it. However the overlapping of values render the technique of limited use in individual cases. Regiões organizadoras do nucléolo podem ser detectadas através do nitrato de prata em seções de parafina. A contagem de AgNORs tem sido utilizada para distinguir entre lesões benignas e malignas. AgNORs foram contados em 24 biópsias da cavidade oral (5 casos de mucosa oral normal, 5 de hiperplasia pseudocarcinomatosa e 14 de carcinoma epidermóide, subdivididos segundo o grau de diferenciação: 5 - grau 1,5 grau 2 e 4 grau 3) para verificar sua utilidade no diagnóstico diferencial entre hiperplasia pseudocarcinomatosa, secundária à infecções parasitárias crônicas, e carcinoma epidermóide. Foram usados dois métodos de contagem de AgNORs: um mais simples(A), que conta os agregados nucleolares (AgNU) e AgNOR satélites e o outro (B) que conta todos os AgNORs, inclusive aqueles dentro do AgNUs. Em ambos os métodos as médias mais baixas foram do carcinoma grau 3 e as mais altas do carcinoma grau 2. 0 método mais simples (A) foi o mais útil, pois a contagem de AgNU mostrou valores significantemente diferentes quando comparou-se hiperplasia pseudocarcinomatosa e carcinomas graus 1 e 2, que são os mais difíceis de distinguir da hiperplasia. Entretanto, devido à sobreposição de valores a técnica foi de utilidade limitada em casos individuais.

An unusual case of congenital generalized fibromatosis in which involvement of the spinal dura mater was accompanied by flaccid paralysis in the lower limbs is presented.

A case of congenital focal glomerular lesions involving crescent formation in only one monozygotic twin is reported. The possible effect of chronic hypotension in the pathogenesis of the lesion is discussed, considering the fact that the affected twin was probably the donor in a feto-fetal transfusion syndrome.

A purified glycoprotein of 43,000 daltons from Paracoccidioides brasiliensis (gp43) was tested as paracoccidioidin in delayed-type hypersensitivity (DTH) tests in both experimental animals (guinea pig and mice) and patients with paracoccidioidomycosis (PCM). The gp43 paracoccidioidin was compared with the traditional Fava Netto antigen (AgFN). In guinea pigs, the intradermal injection of 2 micrograms of gp43 showed a similar response to those obtained with AgFN, showing in histological sections a population of lymphoid cells that participate in DTH. In mice, gp43 at a dose of 3.75 micrograms showed positive DTH response. The use of gp43 as paracoccidioidin in humans showed that this molecule can be used to evaluate the DTH response in patients with PCM. Of 25 PCM patients studied, 48% were positive to gp43 while only 28% were positive to AgFN; 12 PCM patients were completely anergic to both antigens. Considering only those 13 PCM patients who were responsive to gp43 and/or to AgFN, 92.3% reacted against gp43 and 53.8% reacted against AgFN (P < 0.05). Gp43 skin test responses (13.67 +/- 9.56 mm) were significantly larger than those obtained with AgFN (8.43 +/- 3.69 mm). Immunohistochemical study of the human skin showed a perivascular inflammatory response constituted predominantly by T lymphocytes, macrophages and polymorphonuclear leukocytes.

PURPOSE: To develop experimental models to evaluate the effects of hydrochloric acid associated with the pepsin instilled in the mucosa of the upper esophagus and the esophagogastric junction of young male rats Wistar, simulating injury caused by gastroesophageal reflux on the mucosa of aero-digestive tract in humans as well as the action of the risk exposure of mucosa to cigarette smoke. METHODS: Fifty young male Wistar rats divided in 5 groups with 10 animals each one, respectively simulating pharyngo-laryngeal reflux and gastroesophageal reflux, pharyngo-laryngeal reflux and smoking, smoking only, gastroesophageal reflux and control group. RESULTS: The histopathologic studies no recorded neoplasias, only mild changes and no significant alterations. The hemo-oximetry (carboxyhemoglobin and methemoglobim) and CO2 concentration confirm that the animals were submitted to high intensity of exposure to carcinogens in tobacco and its derivatives. CONCLUSION: The experimental models were highly efficient, practical, easy to use and economical and can be employed in other similar studies to determine the harmful effects by smoking and reflux.