No abstract

Despite recent advances in molecular genetics, the pituitary adenoma initiation, development, progress, and the molecular basis of their unique features are still poorly understood. In this sense, it is proposed that stem cell could be involved in pituitary adenoma tumorigenesis. It is suggested that TP63 has important functions in stem cells, and it may have interplay of TP63 and Notch and its ligand Jagged in this process. This study aimed to evaluate the distinct expression of TP63 isoforms (TAp63 and ΔNp63), as well as its correlation with Notch3 receptor and its ligand Jagged1 in human pituitary adenomas at the messenger RNA (mRNA) level. We included 77 pituitary adenoma tumor samples from patients who underwent surgical resection. The expression levels of TP63 isoforms (TAp63 and ΔNp63) and Notch3 and its ligand Jagged1 were evaluated by qRT-PCR using isoform-specific primers. We also evaluated proliferation index immunohistochemically using KI-67 antibody. The expression levels were associated with clinical outcomes, as age, gender, tumor size, and tumor subtype. In summary, we found that mRNA expression of both TP63 isoforms decreased in pituitary adenomas compared with normal pituitary control. On the other hand, there was an increase of relative Notch3 and Jagged1 mRNA expression in the majority of examined samples. The mRNA expression of three genes evaluated was correlated and statistically significantly. There was no significant association between gene expression and the analyzed clinical data. The current study has provided the first time evidence that Tap63 and ΔNp63 isoforms are underexpressed in most pituitary adenomas. These results are correlated with Notch3 and its ligand Jagged1 overexpression, corroborating previous studies pointing its antagonistic interactions.

SUMMARY BACKGROUND: Asymmetric or heteropagus conjoined twins is a rare occurrence, with an incidence of one case in 1-2 million. Conjoined twins are classified according to their symmetry, place of fusion, and grade of duplication. METHODS: We report here an extremely rare presentation of parasitic twins not described before. We describe macro and micro anatomic alterations and discuss the aspects of this peculiar presentation and the importance of prenatal diagnosis. RESULTS: The case of a twenty-three-year-old patient, with monochorionic, monoamniotic asymmetrically-conjoined twin pregnancy, discovered at 29 weeks of gestational age. We believe that this report calls attention to this presentation and the importance of prenatal care and management. The twins were delivered vaginally without life. The twins’ combined weight was 1.300 gr. They were bonded in the left cervical region. CONCLUSION: This report may help to find strategies for clinical decisions in future cases. Antepartum diagnosis is important to the management, preoperative planning, and outcomes. Prenatal imaging exams like echocardiography, CT, MRI, and ultrasonography are feasible and can provide relevant information about malformation severity and prognosis.

Background  Mycobacterial infections are a serious public health problem worldwide. Involvement of the anal canal and perineum is very rare, but constitute an important differential diagnosis with other equally serious pathologies that may affect the region, such as malignant neoplasms and Crohn’s disease. Objectives  To conduct a literature review on mycobacterial infections of the perianal region considering the most recent information for diagnostic and therapeutic guidance of this disease. Methods  Research was performed on the PUBMED and LILACS databases with the expressions Mycobacterium, Anal, Infection and Tuberculosis. We reviewed articles referring to series of treated cases, clinical reports and literature review published since 2005. Results  Information was compiled on the epidemiology of mycobacterial infections; the clinical behavior of affected individuals; diagnostic options and their validity in clinical practice; and, finally, therapeutic options. Conclusions  Mycobacterial infections of the anus and perineum are rare. The most common clinical presentations are the presence of ulceration and fistulization. The diagnosis involves more than one procedure for identifying the bacilli and should consider the presence of manifestations in more than one organ. The treatment is based on pharmacological intervention. Surgery is recommended for acute complications or chronic sequelae of the disease.

Vulvar angiomyolipoma is a rare, benign mixed mesenchymal pathology, composed of smooth muscle, vascular and mature adipose tissue in varying proportions. It may stand for an incidental diagnosis; and the treatment can be conservative or surgical by enucleation. The definitive diagnosis is made by anatomopathological and immunohistochemical examination. The authors report a case of angiomyolipoma located in the labrum vulvar major and conduct a mini review.

Cells with characteristics of embryonic stem cells, and cancer stem cells are at the basis of both embryo development and the cancer process. At the same time, they share signaling pathways, such as the hedgehog, Notch, Wnt, TGF beta, among others. This knowledge is important for understanding the pulmonary regeneration process and for the development of new target therapies.

SOJ SurgeryOpen Access Case Report that polyp size increased to 1.0 × 0.5 cm, for which the patient underwent laparoscopic cholecystectomy. Family history showed that the patient's 80-year-old father and 54-year-old sister died of pancreatic and colon cancers, respectively. The pathology report described the presence of ectopic pancreas in the gallbladder wall [ Figure 1] and polyp cholesterolosis. DiscussionThe presence of heterotopic pancreas has been described in the stomach, duodenum, jejunum, and spleen; it is rarely found in the ileum, liver, gallbladder, bile ducts, mesentery, lungs, mediastinum, and fallopian tubes [1,3,[6][7][8][9]. Approximately 90% of the cases are located in the upper gastrointestinal tract [2]. The stomach is the most frequent site (25-38% of cases), followed by the duodenum (30%) and the jejunum (15%). In the ileum, the heterotopic pancreas may be associated with Meckel's diverticulum, intestinal obstruction, or intussusception [4]. Only 33 cases of ectopic pancreas in the gallbladder have been described until 2013 [7].A review of 212 cases of ectopic pancreatic tissue in the Mayo Clinic found only one instance in the gallbladder [6].Heterotopic pancreas can be diagnosed at all ages, being more frequent in men; however, a higher incidence of heterotopic pancreas in the gallbladder is found in women [8]. This condition can occur in all age groups, but 50% of cases are diagnosed between the fourth and sixth decades of life [4,6]. AbstractEctopic or heterotopic pancreas is an abnormality of embryological origin and is defined as the presence of pancreatic tissue histologically identified outside the normal topography without any anatomical, vascular, or neural connection with the gland. Is a rare pathologic condition, but with the potential to cause severe symptoms sometimes attributed to idiopathic causes.The authors present an asymptomatic patient who underwent laparoscopic cholecystectomy for polyps, and the pathology report describes the presence of associated pancreatic tissue. A brief review of the literature is also presented.

Small cell lung carcinoma (SCSL) is a rare malignancy whose treatment is palliative. The knowledge of its biology is important for the development of new therapies. The expression of delta like 3 protein (DLL3) is involved in the regulation tumorigenic in SCSL. The aim of this study was to evaluate the expression of DLL3 in small cells lung carcinoma (SCLC) and its correlation with clinical data, survival and association with other biomarkers. Methods: a cohort retrospective of 56 patients from institution in Southern Brazil was analyzed. The expression of DLL3 was positive when present in 5% or more of the membranes and cytoplasm of neoplastic cells. PDL -1 and EGFR were positive when expressed in 1% or more of the membranes, ciclin D1 and KI 67 by the percentage of stained nucleus. Synaptophysin, chromogranin and CD56 were tabulated with 1 positive and zero for negative. DLL 3 expression was evaluated as mean, standard deviation and quartiles. Clinical-demographic and death data were analyzed using Fisher's exact test and Pearson's test. Cox regression and the Kaplan-Meier curve were used for survival. Results: Of 56 individuals, 16 were excluded because there was no tumor available and 13 patients (32.5%) had positive DLL 3. EGFR expression was 46.2% (HR 2.4), PDL-1 30.8% (HR 3.56) cyclin D1 53.8% (HR 2.77) and chromogranin A 30.8% (HR 0.3) All patients positive for chromogranin A were negative for anti-DLL3 (p> 0.17). The overall survival for positive DLL3 was slightly higher (p = 0.711) as well as for chromogranin A negative (p 0.299) Conclusion: The DLL3 mutation acts on SCLC tumorigenesis. The study of its expression may be useful for the development of new therapies. The inverse correlation between DLL3 and chromogranin .A may represented a protective factor, but it needs to be better studied in a larger cohort.