Resumo Schwannomas são tumores benignos oriundos de células da bainha neural cuja apresentação intraóssea é rara. Estima-se que os schwannomas intraósseos representem 0,2% de todos os tumores ósseos. Schwannomas podem acometer diferentes ossos do esqueleto, como a mandíbula, o sacro, corpos vertebrais, a ulna, o úmero, o fêmur, a tíbia, a patela, a escápula, costelas e ossos da mão. Apenas quatro casos que acometeram o calcâneo foram descritos na literatura. No presente trabalho, os autores relatam o caso de um paciente masculino de 49 anos com dor no retropé direito e com exames de imagem que evidenciaram lesão osteolítica no calcâneo. O estudo histopatológico confirmou o diagnóstico de Schwannoma intraósseo. O tratamento de escolha foi ressecção intralesional com adjuvância local e substituição por polimetilmetacrilato e fixação com parafusos canulados. O paciente evoluiu de forma satisfatória no pós-operatório e, após 1 ano de evolução, encontra-se assintomático, com boa resposta funcional e sem evidência de doença. Com esse relato, os autores desejam chamar atenção para essa patologia rara, sua apresentação clínica, radiológica e patológica, além de reiterar a importância de incluir o schwannoma intraósseo dentre os diagnósticos diferenciais das lesões osteolíticas do calcâneo.

Abstract Schwannoma is a benign neural sheath tumor of the soft tissue, and its intraosseous presentation is very rare. It is estimated that intraosseous schwannomas represent 0.2% of all bone tumors. The tumor may affect any site of the skeleton, including the mandible, the sacrum, vertebral bodies, the ulna, the humerus, the femur, the tibia, the patella, the scapula, the ribs, and small bones of the hand. The involvement of the calcaneus has only been reported four times in the literature. The present study reports the case of a 49-year-old male with right hindfoot pain and a radiological finding of an osteolytic bone lesion in the calcaneus. The diagnosis was confirmed by histopathological study. The treatment of choice was an intralesional resection with adjuvant local control, and bone defect substitution with polymethylmethacrylate and fixation with two cannulated screws. The patient had a satisfactory postoperative evolution; after 1 year, he is asymptomatic, with good functional response and no evidence of disease. The present case report shows the clinical, radiological, and pathological features of a rare benign bone neoplasm. Moreover, intraosseous schwannoma should be included in the differential diagnosis of osteolytic calcaneal lesions.

RESUMO Objetivo: Analisar os determinantes do prognóstico em pacientes com tumores carcinoides brônquicos tratados cirurgicamente e possível segunda neoplasia primária concomitante. Métodos: Trata-se de uma análise retrospectiva de 51 tumores carcinoides brônquicos tratados cirurgicamente entre 2007 e 2016. A sobrevida livre de doença (SLD) foi calculada pelo método de Kaplan-Meier, e os determinantes do prognóstico foram avaliados. As neoplasias primárias concomitantes aos tumores carcinoides brônquicos foram identificadas por meio da análise dos prontuários dos pacientes. Resultados: A mediana de idade foi de 51,2 anos, 58,8% dos pacientes eram do sexo feminino e 52,9% eram assintomáticos. A classificação histológica mais comum foi carcinoide típico (em 80,4%). A SLD em cinco anos foi de 89,8%. A expressão de Ki-67 foi determinada em 27 pacientes, e a SLD em cinco anos foi melhor nos pacientes nos quais a expressão de Ki-67 foi ≤ 5% do que naqueles nos quais a expressão de Ki-67 foi > 5% (100% vs. 47,6%; p = 0,01). Neoplasias primárias concomitantes foram observadas em 14 (27,4%) dos 51 casos. Entre as neoplasias primárias malignas concomitantes, a mais comum foi o adenocarcinoma pulmonar, observado em 3 casos. Neoplasias primárias concomitantes foram mais comuns em pacientes assintomáticos e naqueles com tumores pequenos. Conclusões: A resseção cirúrgica é o principal tratamento de tumores carcinoides broncopulmonares e propicia um bom prognóstico. É provável que tumores carcinoides brônquicos se relacionem com segunda neoplasia primária.

ABSTRACT Objective: To analyze determinants of prognosis in patients with bronchial carcinoid tumors treated surgically and the potential concomitance of such tumors with second primary neoplasms. Methods: This was a retrospective analysis of 51 bronchial carcinoid tumors treated surgically between 2007 and 2016. Disease-free survival (DFS) was calculated by the Kaplan-Meier method, and determinants of prognosis were evaluated. Primary neoplasms that were concomitant with the bronchial carcinoid tumors were identified by reviewing patient charts. Results: The median age was 51.2 years, 58.8% of the patients were female, and 52.9% were asymptomatic. The most common histology was typical carcinoid (in 80.4%). Five-year DFS was 89.8%. Ki-67 expression was determined in 27 patients, and five-year DFS was better among the patients in whom Ki-67 expression was ≤ 5% than among those in whom it was > 5% (100% vs. 47.6%; p = 0.01). Concomitant primary neoplasms were observed in 14 (27.4%) of the 51 cases. Among the concomitant primary neoplasms that were malignant, the most common was lung adenocarcinoma, which was observed in 3 cases. Concomitant primary neoplasms were more common in patients who were asymptomatic and in those with small tumors. Conclusions: Surgical resection is the mainstay treatment of bronchopulmonary carcinoid tumors and confers a good prognosis. Bronchial carcinoid tumors are likely to be accompanied by second primary neoplasms.

ABSTRACT Objective: Follicular and mantle cell lymphoma are low-grade B-cell malignancies that lack good responses to chemoimmunotherapy. This study aimed to assess retrospectively clinicopathological features and to determine independent prognostic factors for follicular and mantle cell lymphoma patients treated at two Brazilian medical centers: the Hematology and Hemotherapy Center of the Universidade Estadual de Campinas (Unicamp), a public university hospital, and AC. Camargo Cancer Center, a specialized cancer center. Methods: Two hundred and twenty-seven follicular and 112 mantle cell lymphoma cases were diagnosed between 1999 and 2016. Archived paraffin blocks were retrieved and reviewed. Corresponding demographics and clinical data were recovered from medical charts. Outcome analyses considered both overall and event-free survival. Results: For follicular lymphoma treated with the R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, prednisone) and R-CVP (rituximab, cyclophosphamide, vincristine sulfate, prednisone) regimens, both B-symptoms (p-value < 0.01 for overall and event-free survival) and high-risk Follicular Lymphoma International Prognostic Index (p-value < 0.01 for overall survival) were independently associated to worse prognosis. Maintenance with rituximab improved the prognosis (p-value < 0.01 for overall survival). For mantle cell lymphoma, B-symptoms (p-value = 0.03 for overall survival and event-free survival) and bone marrow infiltration (p-value = 0.01 for overall survival) independently predicted reduced survival, and rituximab at induction increased both event-free and overall survival (p-value < 0.01 in both analyses). Combinations of these deleterious features could identify extremely poor prognostic subgroups. The administration of rituximab was more frequent in the AC. Camargo Cancer Center, which was the institution associated with better overall survival for both neoplasias. Conclusion: This study represents the largest cohort of follicular and mantle cell lymphoma in South America thus far. Some easily assessable clinical variables were able to predict prognosis and should be considered in low-income centers. In addition, the underuse of rituximab in the Brazilian public health system should be reconsidered in future health policies.

RESUMO O angiossarcoma ósseo (AO) é uma patologia rara de comportamento biológico variável e com prognóstico reservado. Pouco se conhece sobre o seu tratamento oncológico e sua etiologia ainda é desconhecida. Os autores apresentam um caso de lesão lítica em fêmur proximal que se disseminou para outros ossos (tais como coluna e crânio), pulmão e sistema nervoso central. Foi instituído tratamento ortopédico, com vistas a uma melhoria da qualidade de vida e ao conforto do paciente. O diagnóstico de AO maligno de alto grau foi confirmado pelo espécime cirúrgico. Apesar disso e do tratamento oncológico feito, o paciente apresentou uma evolução rápida e agressiva com desfecho desfavorável.

ABSTRACT Primary osseous angiosarcoma is a rare entity with variable biological behavior and poor prognosis. Little is known about the oncologic treatment and its etiology is still unknown. This study presents a case of lytic lesion in the right femur with dissemination to other bones, such as the vertebral column and skull, and to the lungs and central nervous system. Orthopedic surgery was performed in order to improve quality of life. Surgical specimen confirmed the diagnosis of high-grade malignant osseous angiosarcoma. Despite oncologic and orthopedic treatment, the patient had rapid and aggressive progression with a poor outcome.

PURPOSE: To investigate the copaiba oil on the hepatic damage induced by acetaminophen, comparing against corn oil. METHODS: Fifty four rats were distributed into nine study groups (N=6): control group, that didn't receive the acetaminophen; Acetaminophen Group, that only received the acetaminophen; Prophylactic Copaiba Group 1, that received copaiba oil two hours before the acetaminophen; Prophylactic Copaiba Group 7, that received copaiba oil seven days, once by day, before the acetaminophen; Therapy Copaiba Group, that received the copaiba oil two hours after the acetaminophen, the corn's groups were similar than copaiba oil groups; and N-Acetyl-Cysteine Group, that received the N-Acetyl-Cysteine two hours after the acetaminophen. Euthanasia was performed after 24 hours. The serum levels transaminases, bilirubin and canalicular enzymes were analyzed. RESULTS: The prophylactic copaiba group 7, therapy copaiba group and N-Acetyl-Cysteine Group showed amounts of AST and ALT similar to the control group; and the prophylactic copaiba group 1 and corn's groups showed similar levels to the acetaminophen group. There was no significant difference between the groups regarding the amount of alkaline phosphatase and ɤ GT (p>0.05). The therapy copaiba group showed the highest levels of total bilirubin and was statistically different from the other groups (p<0.01). CONCLUSIONS: Copaiba oil administered prophylactically for seven days and therapeutically 2 hours after the acetaminophen acute intoxication offered a potential hepato protection against paracetamol-induced hepatic damage, normalizing the biochemical parameters similarly to N-Acetyl-Cysteine, and the treatment with corn oil shows no effect on the liver damage.

Os autores descrevem o caso de uma mulher branca de 65 anos que apresentava um melanoma amelanótico maligno conjuntival e destacam as características clínicas e patológicas desta entidade rara com crescimento invasivo exclusivo na córnea sem evidência de tumores na conjuntiva além de melanose adquirida primária sem pigmento. A citologia de impressão auxiliou no diagnóstico inicial. A paciente foi submetida a tratamento cirúrgico. A histopatologia e a imuno-histoquímica revelaram um melanoma amelanótico invasivo limitado sobre a córnea exibindo positividade para proteína S-100, Melan A e HMB-45. A ausência de pigmentação retardou sua identificação clínica e seu tratamento precoce. O conhecimento deste melanoma não pigmentado é importante para o reconhecimento precoce e a conduta apropriada.

Here we describe the case of a 65-year-old Caucasian female who presented with an amelanotic malignant conjunctival melanoma and highlight the clinical and pathological features of this rare entity that displayed exclusive corneal invasive growth without evidence of conjunctival tumors other than primary acquired melanosis. Impression cytology aided in the initial diagnosis. The patient underwent surgical treatment. Histopathology and immunohistochemistry revealed an invasive amelanotic melanoma limited to the cornea and exhibiting S-100, Melan A, and HMB-45 positivity. The absence of pigmentation delayed early clinical detection and treatment. Awareness of this nonpigmented melanoma is important for early recognition and appropriate management.

OBJETIVO: Estudar o efeito do óleo de copaíba nas aminotransferases de ratos submetidos à isquemia e reperfusão (IR) hepática, com e sem pré-condicionamento isquêmico (PCI). MÉTODOS: Foram utilizados 24 Rattus norvegicus albinus machos distribuídos em: Grupo padrão (GP), Grupo copaíba (GC), Grupo isquemia-reperfusão (GIR), Grupo isquemia-reperfusão + copaíba (GIRC), Grupo pré-condicionamento isquêmico (GPCI) e Grupo pré-condicionamento isquêmico + copaíba (GPCIC). Foi administrado 0,63ml/kg/dia de copaíba, durante sete dias, por meio de gavagem nos animais do GC, GIRC e GPCIC. A isquemia hepática foi de 30 minutos e, nos animais submetidos ao PCI, realizou-se isquemia de 10 minutos, seguida de reperfusão de 5 minutos e isquemia de 30 minutos com posterior reperfusão. Os animais foram anestesiados via inalatória com éter etílico. O período de reperfusão foi de 24 horas. No 1° DPO foi realizada coleta de sangue venoso e dosagem das aminotransferases. RESULTADOS: Os níveis de AST não se alteraram nos animais submetidos à administração do óleo de copaíba. O óleo estudado não alterou os valores de ALT no GIRC quando comparado com o GIR, entretanto, houve aumento do nível sérico dessa enzima no GPCIC em comparação com o GPCI. CONCLUSÃO: O óleo de copaíba não alterou os níveis de AST nos grupos estudados. Ao se avaliar a ALT, esse óleo não influenciou os valores séricos nos animais submetidos somente à IR hepática, entretanto houve aumento dos níveis dessa enzima no GPCIC em relação ao seu controle. Os valores de ALT não foram diferentes estatisticamente entre os grupos IRC e PCIC.

PURPOSE: To study the copaiba oil effect in rats' aminotrasnferases submited to hepatic ischemic and reperfusion with and without preconditioning. METHODS: 24 male and adults rats (Rattus norvegicus albinus,Wistar) were distributed into six groups: Standard Group (SG); Copaiba Group (CG), Ischemic-reperfusion Group (IRG), Ischemic-reperfusion + Copaiba Group (IRCG), Ischemic Preconditioning Group (IPCG) and Ischemic Preconditioning + Copaiba Group (IPCCG). The animals of CG, IRCG and IPCCG received copaiba oil, 0,63ml/kg/day by gavage, during 7 days. It was realized total hepatic ischemic by 30 minutes and, in animals subbimited to ischemic preconditioning, it was realized 10 minutes of ischemia, following by 5 minutes of reperfusion and other ischemia by 30 minutes. All animals were subbmited to 24 hours of reperfusion. To realalize surgery procedure, animals were anesthezied through ethilic eter breathing. On first post-operating day, blood was collected to dose aminotrasferases. RESULTS: It was not observe alterations in AST level in animals which received copaiba oil. There was no statistic difference between IRCG and IRG ALT levels, however, this enzime was increased in IPCCG when compared with IPCG. CONCLUSION: Copaiba oil did not change AST levels in groups studied. Analysing ALT, this oil did not change its values in animais were realized just hepatic ischemic-reperfusion, however, it had levels increase in IPCCG when compared to IPCG. Between IRCG and IPCCG, ALT levels were not statistical different.