Myofibroblastoma of the breast is a rare benign neoplasm, which has rarely been reported in association with gynecomastia. We report a case of a 25-year-old male patient with an epithelioid myofibroblastoma arising in a context of bilateral gynecomastia. The lesion was composed of nests and cords of epithelioid cells, with round to oval nuclei, granular chromatin, and distinct nucleoli dispersed in a myxoid to collagenous stroma with marked vascular proliferation. Immunohistochemical profile showed diffuse positivity for vimentin and focal immunoreactivity for desmin, whereas cytokeratins (CAM5.2 and AE1/AE3), EMA, alpha smooth muscle actin, actin HHF35, CEA, S100, factor VIII, neuron-specific enolase, CD31, and CD34 were all negative. We emphasize that this diagnosis is difficult to establish, owing to the rarity of this variant and clinical presentation.
The purpose of this study is to report the organization of a cost-effective screening program for cervical cancer in a developing country such as Brazil. The Cervical Cancer Screening Program of Paraná (CCSPP) was launched in October 1997 and was the result of a joint collaboration between the government of Paraná (Secretary of Health of the State of Paraná), scientific societies (pathologists, gynecologists, and nurses), and a non governmental organization called the Women's Popular Forum of Paraná. The main goal of the program was to enhance the Papanicolaou (Pap) smear screening to coverage up to 85% of female adult population with a 3-yr interval between examinations, as well as to reduce the incidence and mortality from cervical cancer in the state of Paraná, a Southern state of Brazil. The cytological findings in all Pap smears recorded in a central computer-based register during 5 yr of the program (October 1997-October 2002) are discussed. During that period, 2,244,158 Pap smears were performed in women included in the program from the 398 cities of the state of Paraná. The cytological smears were analyzed according to the Bethesda System. The previous year, before the program was launched, a Pap smear was taken from 43% of women of Paraná. At the end of 5 yr, coverage was increased to around 86%. The great majority of examinations had a negative result (98%). Only 2% of examinations had cytological abnormalities (n = 44,621). Low-grade lesions predominated in women aged 15-30 yr, and the high-grade lesions were more common in women aged 25-45 yr. Patients older than 40 yr had the greatest incidence of invasive cancer. Although the program is only 5 yr old, a decrease in the mortality from cervical cancer in women from Paraná is clearly apparent: in 1998, 297 women died of cervical cancer, as compared with 188 as of September 2002.
Introdução: O seguimento e o tratamento adequados das lesões neoplásicas e pré-neoplásicas do colo do útero dependem do diagnostico histopatológico correto. A instauração de mecanismos de controle de qualidade para esse tipo de procedimento diagnóstico é fundamental para garantir precisão aos exames. Objetivo: Comparar o diagnóstico inicial de biópsias e peças cirúrgicas removidas por cirurgia de alta frequência, fornecido por um laboratório da rede de serviço, com o diagnóstico revisado pela unidade de monitoramento de qualidade da Associação Paranaense de Patologia, identificando quais as discrepâncias mais prevalentes. Método: Estudo transversal observacional com revisão do banco de dados da unidade de Controle de Qualidade referente ao ano de 2010 para avaliar o percentual de concordância geral, para cada laboratório e as discrepâncias diagnósticas mais comuns em produtos de biópsias e cirurgias de alta frequência do colo uterino. A concordância foi avaliada através do índice Kappa. Resultados: A compatibilidade entre o diagnóstico inicial e do controle de qualidade foi de 98,6%, variando por laboratório entre 92,9% e 100%. As discrepâncias diagnósticas encontradas foram entre lesão intraepitelial de baixo grau e cervicite (36,3%) e lesão intraepitelial de baixo grau e lesão intraepitelial de alto grau (27,3%). Para todas as categorias diagnósticas estudadas, foi encontrado índice Kappa de 0,99. Conclusão: As discrepâncias diagnósticas mais comuns foram entre lesão intraepitelial de baixo grau e diagnóstico de lesões benignas (supradiagnóstico) e entre lesão intraepitelial de baixo grau e lesão intraepitelial de alto grau (subdiagnóstico). As taxas de concordância encontradas são consideradas excelentes.
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