The authors describe the histopathological necropsy findings of 45 human immunodeficiency virus (HIV)-infected patients with neurocryptococcosis. Systemic cryptococcosis with involvement of multiple organs such as spleen, liver, and lungs was present in all patients. Predominant diffuse meningoencephalitis predominantly in the basal ganglia, thalamus, and mid-brain, with minimal inflammatory infiltrate was seen in 30 AIDS patients (70%). We frequently observed in those patients the presence of multiple gelatinous pseudocysts with abundant Cryptococcus neoformans in the Virchow-Robin spaces and adjacent brain caused by the dissemination of the meningeal infection along the perivascular spaces. Isolated meningeal and cerebral involvement with minimal inflammatory infiltrate with numerous fungal organisms, and occasionally with granulomatous reaction and necrosis, was seen in 15 patients (30%). In addition to involvement of multiple organs by C. neoformans, HIV-infected patients with clinical manifestations of neurocryptococcosis frequently present a widespread involvement of the brain.
Prostate melanosis is an uncommon lesion of uncertain etiology where melanin deposition is seen in the epithelium, in the stroma, or in the form of a blue nevus. There are three reports in the literature of melanosis seen in association with prostatic adenocarcinoma. This is the fourth report of this association.
Virtual pathology is a very important tool that can be used in several ways, including interconsultations with specialists in many areas and for frozen sections. We considered in this work the use of Windows Live Messenger and Skype for image transmission. The conference was made through wide broad internet using Nikon E 200 microscope and Digital Samsung Colour SCC-131 camera. Internet speed for transmission varied from 400 Kb to 2.0 Mb. Both programs allow voice transmission concomitant to image, so the communication between the involved pathologists was possible using microphones and speakers. Alive image could be seen by the receptor pathologist who was able to ask for moving the field or increase/diminish the augmentation. No phone call or typing required. The programs MSN and Skype can be used in many ways and with different operational systems installed in the computer. The capture system is simple and relatively cheap, what proves the viability of the system to be used in developing countries and in cities where do not exist pathologists. With the improvement of software and the improvement of digital image quality, associated to the use of the high speed broad band Internet this will be able to become a new modality in surgical pathology.
This study presents a case of juxtaglomerular cell tumor (JCT) in a 12-year-old girl with hypertension. Fine needle aspirate (FNA) cytology demonstrated a neoplasm with features of a papillary carcinoma, prompting a right radical nephrectomy. Histological examination revealed solid sheets of round epithelioid cells with eosinophilic granular cytoplasm, and distinct cell borders in a background of widespread hemorrhage. Electron microscopy revealed cytoplasmic renin granules. The differential diagnosis of a renal mass in a young patient with hypertension includes JCT, Wilm's tumor, and renal cell carcinoma, which may produce renin. The renin granules detected by electron microscopy are characteristic of JCT, and the diagnosis is confirmed by ultrastructural study. FNA cytology is not sensitive enough for the diagnosis of JCT and its results must be carefully interpreted.
Cryptococcus neoformans is the fifth most common opportunistic agent of infection in patients with AIDS in the USA, exceeded only by Candida species, Pneumocystis carinii, cytomegalovirus and Mycobacterium avium1, 2, 6, 10, 11. In Brazil is the sixth, exceeded by Candida species, P. carinii, Mycobacterium species, Toxoplasma gondii, and herpes simplex virus (AIDS, Boletim Epidemiológico, set/nov 96, Ministério da Saúde, Brasil). During 30 years, the treatment of C. neoformans meningitis was based on the use of amphotericin B with or without flucytosine13. Nowadays, with the immunodepression caused by human immunodeficiency virus (HIV) infection and the availability of new antifungal drugs as the triazoles, the concept related to cure and relapses of cryptococcosis has been altered7, 20. Patients are treated with amphotericin B with or without flucytosine as initial therapy, but maintenance therapy is always necessary in AIDS patients with C. neoformans infections Relatamos um caso de meningite por Cryptococcus neoformans em paciente com Síndrome de Imunodeficiência Adquirida (SIDA). A terapia de manutenção com fluconazol não evidenciou melhora clínica e micológica, ao mesmo tempo em que o teste de suscetibilidade in vitro revelou aumento progressivo da concentração inibitória mínima (CIM). Estes resultados sugerem o desenvolvimento de resistência secundária ao fluconazol, todavia, resistência cruzada com outros derivados azólicos não foi constatad
We report a case of mixed intranasal infection caused by Fusarium solani and a zygomycete, with probable sinus and brain involvement. The patient had chronic myelogenous leukaemia and was treated with chemotherapy. Diagnosis of the infection was established by direct examination of the intranasal eschar and histopathological study of an excisional biopsy. Only F. solani was isolated from both specimens. Difficulties in diagnosis and treatment of these infections are discussed.
Thyroid involvement is very rare in disseminated zygomycosis. We describe two cases of thyroiditis due to Cunninghamella bertholletiae diagnosed though a necropsy study and the only five previous cases of thyroid zygomycosis reported in the literature are revised.
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