Conflict of interest: noneObjective: to analyze female breast cancer mortality trends in Brazil and its regions. Methods: female breast cancer mortality in Brazil and its regions was analyzed using mortality data from the Ministry of Health's Mortality Information System and the National Cancer Institute between 1991 and 2010. The variables analyzed were. proportional mortality from female breast cancer in relation to total deaths in women, mortality rates of the five primary locations of the neoplasms most common in women, and mortality rates for female breast cancer: Linear regression models were estimated to analyze mortality trends: Results: a growth in proportional mortality due to female breast cancer in Brazil and its regions was observed: In relation to the mortality rates for the five primary types of cancer, breast cancer persisted in first place in Brazil and its regions, except the North region, where cervical cancer was the most frequent: Rising female breast cancer mortality rates were observed for Brazil (p = 0.017), Northeastern (p < 0.001), North (p < 0.001) and the Mid-West (p = 0.001), regions, and declining rates for the Southeast region (p = 0.047), and stable rates for the South region. Conclusion: the results emphasize the importance of the disease in terms of public health in the country, reinforcing the need for early detection and appropriate treatment.

No abstract

No abstract

No abstract

BACKGROUNDSarcoidosis is a disease of unknown etiology characterized by the formation of granulomas in various organs. Systemic symptoms such fatigue and weight loss are common. In more than 90% of patients, clinical sarcoidosis is manifested as intrathoracic lymphnode enlargement, pulmonary involvement, skin or ocular signs and symptoms. Approximately, 50 to 65% of patients with sarcoidosis have granulomas on liver biopsy, but only 5 to 15% are symptomatic. Skin involvement is common, occurring in 25 to 35% of patients with sarcoidosis, and includes papular sarcoidosis, lupus pernio, subcutaneous nodules, erythema nodosum and many others skin manifestations. However, panniculitis as an initial presentation is rarely reported. The diagnosis of sarcoidosis requires a compatible clinical picture, the demonstration of noncaseating granulomas on tissue biopsy, and the exclusion of other disorders. Treatment for cutaneous sarcoidosis includes glucocorticoids, methotrexate, hydroxychloroquine and tetracyclines. Tumor necrosis factor alpha inhibitors are indicated in refractory disease. CASE REPORTA 51-year-old female patient with a previous history of obesity, hepatic steatosis, dyslipidemia, and hypertension, reported the appearance of painful subcutaneous nodules, distributed in upper and lower limbs, 2 years ago. In addition, she reported proximal muscle weakness, fever, arthralgias, dyspeptic symptoms, dysphagia for solids, and flank abdominal pain. She also reported coughing, recurrent oral ulcers, bleeding gums, and tooth loss. On physical examination, she had hyperchromic and painful nodular lesions, diffusely distributed over the lower and upper limbs. During hospitalization, laboratory tests showed increased evidence of inflammatory activity and cholestasis, and liver biopsy was indicated. Computed tomography of the chest and abdomen showed multiple pulmonary nodules and mediastinal, hilar, and abdominal lymph node enlargement. Skin and liver biopsies were performed, with the finding of septal panniculitis and non-caseating granulomatous hepatitis, respectively. Clinical, imaging and anatomopathological findings were compatible with the diagnosis of sarcoidosis. She started treatment with prednisone 40 mg/day and methotrexate 10 mg/week during hospitalization, with improvement of the skin lesions. CONCLUSIONWe report a case of sarcoidosis with initial presentation of panniculitis in a 51-year-old female patient.

BACKGROUNDChronic periaortitis is a rare entity characterized by a fibroinflammatory tissue surrounding most commonly abdominal aorta and iliac arteries, which can spread to retroperitoneum, and is of unknown etiology. Other vascular districts which may be involvedalbeit rarely-are the coronary, renal, mesenteric and celiac arteries. Firstly, it was thought to be caused by a local inflammatory reaction to antigens in the atherosclerotic plaques in the aorta, but now it has been considered a primary inflammatory or immune mediated disorder because of its association with immunoregulatory diseases such as systemic lupus erythematosus (SLE), Sjögren's syndrome and systemic vasculitis.

BACKGROUNDRemitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare inflammatory disease of unknown etiology, characterized by edema of the extremities and arthritis, which mainly affects patients over 50 years of age.Rheumatoid factor and anti-CCP are usually negative. The syndrome can be isolated or related with other diseases. There are reports of paraneoplastic association with prostate, lung, lymphoproliferative and gastrointestinal tumors. This patient was diagnosed with gastrointestinal stromal tumor (GIST), for which there are no publications with a direct relation with RS3PE. Patients diagnosed with RS3PE usually present good response to corticosteroids, as was the case of our patient. CASE REPORTA 63-year-old man, previously hypertensive and heavy drinker was admitted for severe COVID-19 infection, needing intubation and hemodialysis. During hospitalization, he developed knee monoarthritis, and an arthrocentesis revealed cloudy synovial fluid, 7,429 leukocytes/µL, with negative gram stain and culture. He was treated as possible septic arthritis due to prolonged hospitalization, multiple infections and use of broad-spectrum antibiotic therapy, with improvement After medical discharge, the patient developed symmetrical polyarthritis of the hands, feet, ankles and knees, prolonged morning stiffness, pitting edema of hands and feet. An extensive investigation was carried out in the outpatient clinic and reactive arthritis, gout, and rheumatoid arthritis were excluded. Investigation of possible associated neoplasia was initiated, due to persistent iron deficiency anemia, weight loss, and melena. Diagnosis of GIST was made by computed tomography of the abdomen and upper digestive endoscopy, and it was surgically resected. The patient was treated with prednisone 10 mg/day and showed improvement in the joint condition.

BACKGROUNDA 27-year-old female patient, complaining of migraine with aura for the least 2 months, developed sudden vertigo, headache, tinnitus, ear fullness with hearing loss, and visual loss. There was no mental confusion. Fundoscopy demonstrated retinal detachment and central retinal artery branches occlusion. CASE REPORTFemale, 27 years old, with a previous history of hypothyroidism, was admitted with hearing and visual loss, headache and vertigo. She denied fever, alopecia, arthritis, rash, livedo or weakness. Ophthalmological investigation showed campimetry with altitudinal deficit to the right, accompanied by ipsilateral visual deficit. Fundoscopy demonstrated retinal detachment and central retinal artery branches occlusion. Audiometry demonstrated sensorineural loss on the right, and with this, the Susac's syndrome triad (encephalopathy, retinal arterial occlusion and sensorineural hearing loss) was confirmed. Cerebrospinal fluid (CSF) examination was unremarkable, echocardiogram did not show vegetations, and carotid Doppler scan was normal. Imaging of central nervous system revealed a typical Susac's syndrome in CNS MRI ("snowball pattern''). CONCLUSIONSusac's syndrome is a rare entity, with less than 400 cases described worldwide. It comprises the triad of encephalopathy, sensorineural hearing loss and retinal artery occlusion. It is an immune-mediated endotheliopathy that affects the microvasculature of the brain, retina and inner ear, with antiendothelial cell antibodies playing an important role in the lesion. It may also present with myalgia, arthralgia, livedo reticularis, livedo racemosa, which makes this diagnosis of importance for the rheumatologist. It can be misdiagnosed as multiple sclerosis, disseminated encephalomyelitis, central nervous system vasculitis, and systemic lupus erythematosus. Treatment requires potent immunosuppression, with pulses of methylprednisolone associated with rituximab, cyclophosphamide or mycophenolate.