We present a case with diagnosis of multiple sclerosis done on clinical criteria and proved by autopsy. The morphological aspects of the lesions are well known and often related in the literature. Our objective is to describe the first necropsy among 30500 done at Santa Casa de São Paulo in a patient with the disease. The morphological aspects in the CNS with the characteristic plaques in different grades of activity and the detection of immunoglobulins in these plaques confirm the pathogenic hypothesis about a disease immunologically mediated.
RESUMO -Os tumores do tronco cerebral são raros e geralmente tratados sem diagnóstico histopatológico. Sua incidência varia na literatura entre 1,09% e 17,5% dos tumores cerebrais. O objetivo do trabalho foi relatar a casuísti desses tumores em 28500 necrópsias realizadas de 1952 a 1985 no Departamento de Anatomia Patológica da Santa Casa de São Paulo.Enfatizamos os aspectos neuropatológicos, comparamos nossos casos com os de outras séries e salientamos os tumores mais observados nessa região, com a finalidade de procurar contribuir para melhor abordagem terapêutica.Utilizamos alguns dados clínicos e, através do exame anatomopatológico, localizamos o tumor no tronco cerebral sendo o diagnóstico microscópico estabelecido segundo os critérios da Organização Mundial da Saúde.Dos 428 tumores intracranianos observados, 35 estavam localizados no tronco cerebral.Foram aqui incluídos os tumores próprios do tronco cerebral e as metástases e excluídos os tumores que infiltravam o tronco. A maior incidência ocorreu na primeira década e a causa de óbito predominante foi edema cerebral. A localização preferencial foi a ponte e o tumor mais freqüente foi o glioblas-¬ tomia multiforme (19 casos). As metástases ficaram em segundo lugar na freqüência (9 casos), na maioria dos casos de origem pulmonar.Apesar de alguns autores se posicionarem contra a biópsia de tumor nessa região, baseando-se no alto risco cirúrgico, discordamos dessa opinião, pois acreditamos que, frente ao diagnóstico de glioma, será importante a caracterização ou não de malignidade. Ainda, não devemos deixar de considerar os diagnósticos diferenciais de processo expansivo no tronco.Enfim, com o diagnóstico anatomopatológico de glioma ou de uma das possibilidades aventadas, o procedimento terapêutico poderá ser mais adequado. Brain stem tumors: anatomo-pathologic study of 35 necropsy cases.SUMMARY -Brain stem tumors are rare and are usually treated without histological diagnosis. Its incidence varies in literature between 1.09% and 17.5% of all cerebral tumors. The objective of our study is to present a casuistic of these tumors in 28500 necropsies performed from 1952 till 1985 at the Department of Pathology, Santa Casa Hospital, São Paulo. We emphasize neuropathology aspects, and compare our cases with those of other series.Also, we point out those tumors which are most frequent in this region, with the aim of possibly contributing to a better therapeutic approach.We used some clinical data and pathological diagnosis, and localized the tumor in the brain stem.Its microscopic diagnosis was determined according to the World Health Organization criterion. Among 428 intracranial tumors observed, 35 were localized in the brain stem. Intrinsic tumors and metastasis were included, and excluded those tumors which infiltrated the brain stem.Greatest incidence occured in the first decade and cerebral edema was the predominant cause of death.Preferential topography wasTrabalho realizado no
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