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This communication reports the second known case of oral phaeohyphomycosis in a patient with squamocellular carcinoma of the lip. The patient, an 82-year-old black woman, a former smoker (for more than 30 years), suffering from an ulcerous vegetative lesion in the middle third of the lower lip for approximately 12 months. The result of the histopathological analysis indicated carcinoma, with well-differentiated keratinized squamous cells and the presence of septate mycelial filaments. In the direct mycological examination, thick and dematiaceous septate mycelial filaments were observed. After the resection surgery, the patient did not need to use an antifungal drug to treat the phaeohyphomycosis, and no follow-up radiotherapy was needed to treat the squamocellular carcinoma. We stress that the presence of the squamocellular lesion of the lip was a possible contributing factor to the infection.

INTRODUCTION: The choice for having mastectomy with preservation of the nipple-areolar complex (NAC), with better esthetic results, depends on the abscence of neoplastic invasion of the NAC. OBJECTIVE: To identify the predictive factors related to neoplastic NAC invasion. METHODS: We carried out a retrospective, analytical and clinical-pathologic study comprising 48 mastectomy specimens of breast carcinoma from patients treated at Cancer Institute of Paraiba - Napoleao Laureano Foundation (Hospital de Câncer da Paraiba - Fundacao Napoleao Laureano) from April 2007 to January 2008. The mean age was 52.69 ± 10.72. The NAC complex was sectioned separately and perpendicular and parallel cuts were performed from the papilla extending 2 cm deep into the retroareolar tissue (including collecting ducts, lactiferous sinuses and segmental ducts), followed by transverse cuts toward the deep margin. RESULTS: The frequency of NAC involvement by invasive carcinoma was 14.58%. The following characteristics were associated with a higher risk of NAC involvement (p < 0.05): younger patients (mean age 42.3 ± 4.7 years), distance between the tumor and the areola/nipple < 2 cm, size of the areola < 3 cm, histological type (invasive ductal carcinoma associated with comedo type ductal carcinoma in situ), status of axillary lymph nodes (mainly with metastasis in 10 or more lymph nodes), presence of lymphovascular and perineural invasion, and inflammatory infiltrate of intra/peritumoral stroma. Smaller areolas correlated significantly with decreased breast weights (p < 0.0016), which demonstrated that the breast size had a greater impact on NAC involvement in comparison with the tumor diameter. CONCLUSION: The results of this study enabled us to identify factors associated with an increased risk of neoplastic NAC invasion.

Recentemente a core biopsy estereotática tem sido proposta como método alternativo na avaliação inicial de lesões mamárias impalpáveis. OBJETIVO: Os autores propõem-se a analisar a acurácia do diagnóstico histopatológico em material de core biopsy estereotática. Discutem a aplicabilidade de testes usados para variáveis nominais como sensibilidade e especificidade na avaliação de gradações de qualidade, tais como, benigno, borderline e maligno. MATERIAL E MÉTODOS: De um total de 700 biópsias, selecionou-se para o estudo as 567 primeiras (obtidas até maio de 1996), com acompanhamento de no mínimo seis e no máximo trinta meses. Foi feita a comparação do diagnóstico dado na core com os achados da peça cirúrgica ou do acompanhamento clínico-mamográfico subseqüente. RESULTADOS: A sensibilidade foi de 90,72% e a especificidade de 98,36%. O teste de correlação de Spearman foi 0,92 (máximo 1). CONCLUSÃO: Os dados são semelhantes aos da literatura e demonstram uma boa acurácia da core biopsy no diagnóstico histopatológico de lesões impalpáveis da mama. BACKGROUND: Recently the stereotaxic core biopsy has been proposed as an alternative method for the initial evaluation of non palpable breast lesions. The authors verify the accuracy of core biopsy in diagnosis and discuss the applicability of tests used for nominal variables, like sensibility and specificity, to evaluate grading of quality such as benign, borderline and malignant. MATERIAL AND METHODS: Among 700 stereotaxic core biopsies of the breast the authors selected the first 567 cases, examined from May, 1993 to May, 1996 to check the accuracy of the histopathologic diagnosis. These cases were followed-up for a minimum of six months and a maximum of thirty months. For the evaluation, the diagnosis by core biopsies was compared with the findings of the surgical ressection specimens for the malignant and atypical hyperplasia cases, and mammographic/ clinical examinations for the cases not submited to surgery. RESULTS: The sensibility and specificity were respectively 90.72% e 98.36% and the Spearman correlation test was 0.92. CONCLUSIONS: The stereotaxic core biopsy is an accurate method for the evaluation of breast non- palpable lesions. These results are similar to others in the literature.

INTRODUÇÃO E OBJETIVO: O adenoma pleomórfico (AP) é o tumor das glândulas salivares mais comum. A parótida é o sítio anatômico mais frequente. Características clínicas e microscópicas são bem conhecidas, entretanto sua patogênese ainda é incerta, como a expressão de oncogenes e fatores que influenciam a transformação maligna. O objetivo deste estudo foi analisar e correlacionar os aspectos histopatológicos indicativos de transformação maligna de AP de glândula salivar maior, com a expressão da proteína p53 nesses tumores. MATERIAL E MÉTODO: Foram avaliados 106 casos de AP por pesquisa retrospectiva nos prontuários clínicos, revisão das preparações histológicas em hematoxilina e eosina (HE) e realização de técnica imuno-histoquímica, pelo método da estreptoavidina-biotina, utilizando o anticorpo primário anti-p53. RESULTADOS: Alterações histopatológicas relacionadas com a transformação maligna foram incomuns: hialinização extensa (5; 4,7%) e necrose (1; 0,9%). Houve positividade para a proteína p53 em 25 dos 106 casos estudados (23,58%). O arranjo histológico das células dos tumores considerados positivos para p53 foi principalmente dos tipos ductal (92%; 23) e cordonal (88%; 22). Não houve associação estatisticamente significante entre a positividade para o p53 e as variáveis histopatológicas, em comparação com os casos negativos: quantidade e tipo de matriz extracelular; alterações teciduais sugestivas de transformação maligna e metaplasia. CONCLUSÃO: Poucos casos que exibiram expressão para p53 apresentaram algum tipo de alteração morfológica sugestiva de malignidade, e a correlação entre a imunoexpressão da proteína p53 e a presença de alteração sugestiva de transformação maligna não foi estatisticamente significante, sugerindo que a expressão dessa proteína nesses tumores independe dessas características. INTRODUCTION AND OBJECTIVE: The pleomorphic adenoma is the most common salivary gland tumor. The parotid gland is the most frequent anatomic site. Its clinical and microscopic features are widely known. However, its pathogenesis is still uncertain as well as the expression of oncogenes and other factors that influence malignant transformation. The objective of this study was to analyze the histopathological features of malignant transformation in pleomorphic adenoma (PA) of major salivary gland and correlate them with p53 protein expression in these tumors. MATERIAL AND METHOD: We evaluated 106 cases of PA by researching clinical records retrospectively, reviewing histological preparations in HE and applying immunohistochemical technique through streptavidin biotin method using primary anti-p53 antibody. RESULTS: Histopathological changes related to malignant transformation were unusual: extensive hyalinization (5; 4.7%) and necrosis (1; 0.9%). There was positivity for p53 protein in 25 out of 106 cases (23.58%). The histological cell arrangement of p53 - positive tumors was mainly the ductal type (92%; 23) and cordonal (88%, 22). There was no statistically significant association between positivity for p53 and histopathological variables in comparison with negative cases: quantity and type of extracellular matrix, tissue changes suggestive of malignant transformation and metaplasia. CONCLUSIONS: A few cases that showed p53 expression had some kind of morphological change suggestive of malignancy and the correlation between p53 immunoexpression and the presence of changes suggestive of malignant transformation was not statistically significant, which suggests that the protein expression in these tumors do not depend on these characteristics.

INTRODUÇÃO E OBJETIVOS: Determinar a associação entre alterações mamográficas classificadas na categoria BI-RADS® 5 (lesões altamente suspeitas de malignidade) e diagnóstico histopatológico em material obtido por core biopsy estereotáxica e estabelecer o valor preditivo positivo dessa categoria mamográfica para o diagnóstico de câncer. MÉTODOS: Por meio de estudo retrospectivo, transversal, analítico, de comparação entre métodos diagnósticos, foram analisadas 70 core biopsies de lesões mamárias impalpáveis, classificadas como BI-RADS® 5, de 70 pacientes, atendidas em serviços privados de Anatomia Patológica e Radiologia em Recife, Brasil, entre 2001 e 2006. RESULTADOS: Foram mais acometidos: sexo feminino (97,1%), mama esquerda (60%) e quadrante superior externo (62,9%). Os nódulos irregulares espiculados constituíram 70% da amostra e as microcalcificações estavam presentes em 44,3%. O número médio de fragmentos obtidos foi 6 ± 2. Os diagnósticos histopatológicos foram: carcinoma (59 casos; 84,3%); lesões benignas (sete casos; 10%) e hiperplasia ductal atípica ou lesão suspeita de malignidade (quatro casos; 5,7%). Os nódulos irregulares espiculados corresponderam significantemente a carcinoma invasivo (p = 0,005). O carcinoma ductal in situ (CDIS) padrão comedônico puro associou-se mais frequentemente às microcalcificações na histologia. Os valores preditivos positivos foram: 84,3% para a categoria mamográfica BI-RADS® 5 como um todo; 100% para nódulo irregular espiculado com microcalcificações; 87,8% para nódulo irregular espiculado com ou sem microcalcificações; 84,2% para nódulo irregular espiculado sem microcalcificações; e 75% para microcalcificações sem nódulos. CONCLUSÃO: Lesões mamárias impalpáveis da categoria mamográfica BI-RADS® 5 são de alto valor preditivo para carcinoma, particularmente os nódulos irregulares espiculados com microcalcificações. INTRODUCTION AND OBJECTIVES: To determine the association between mammographic alterations classified as BI-RADS® 5 category (lesions highly suggestive of malignancy) and the corresponding histopathological diagnoses of samples obtained by stereotactic core biopsy; to establish the positive predictive value of this mammographic category for the diagnosis of cancer. METHODS: By means of retrospective cross sectional analytical study comparing diagnostic methods, we investigated seventy stereotactic core biopsies of nonpalpable breast lesions classified as BI-RADS® 5 from 70 patients seen at private Anatomic Pathology and Radiology services in Recife (Pernambuco state, Brazil) from 2001 to 2006. RESULTS: Female patients (97.1%) were predominantly affected. The left breast (60%) and upper outer quadrant (62.9%) were more commonly involved. Irregular spiculated nodules corresponded to 70% of the cases, and microcalcifications to 44.3%. The mean number of core fragments was 6 ± 2. The histopathological diagnoses were: carcinoma (59 cases; 84.3%), benign lesions (seven cases; 10%) and atypical ductal hyperplasia or lesion suspected of malignancy (four cases; 5.7%). Invasive carcinoma was significantly associated with irregular spiculated nodules (p = 0.005). Pure comedo DCIS was more frequently associated with microcalcifications on histology. The positive predictive values were: 84.3% for BI-RADS® 5 category as a whole, 100% for irregular spiculated nodules with microcalcifications, 87.8% for irregular spiculated nodules with or without calcifications, 84.2% for irregular spiculated nodules without microcalcifications and 75% for microcalcifications without nodes. CONCLUSION: Breast lesions classified as BI-RADS® 5 have a high positive predictive value for carcinoma, particularly irregular spiculated nodules with microcalcifications.

INTRODUÇÃO: O adenoma pleomórfico (AP) é o mais comum dos tumores das glândulas salivares. Transformação maligna pode ocorrer após recorrências ou em casos com longo tempo de evolução. OBJETIVO: Analisar os aspectos clinicoepidemiológicos e anatomopatológicos do AP de glândula salivar maior, principalmente os considerados indício de transformação maligna. MATERIAL E MÉTODO: Foram avaliados 106 casos de AP pela pesquisa retrospectiva nos prontuários clínicos e revisão das preparações histológicas. RESULTADOS: A média de idade dos pacientes foi de 39,51 anos, houve predomínio do sexo feminino (69,5%), a glândula parótida foi a mais acometida (86,8%) e o tempo de evolução foi superior a um ano em 76,74% dos casos, com tamanho tumoral de 3,48 cm em média. A avaliação histopatológica demonstrou cápsula tumoral incompleta e delgada em 49% dos casos. Protrusões para a cápsula ou extensão extracapsular foram infreqüentes, 11,32% e 8,49%, respectivamente. A matriz extracelular variou entre mixocondróide (41,5%), mixóide (36,8%), condróide (3,8%) e fibrótica (1,9%), tendo sido observadas associações entre os diversos tipos. O componente epitelial/mioepitelial constituiu 50% ou mais do tumor em 65,1% dos casos e estava disposto em arranjos cordonal (86,8%), ductal (81,1%), sólido (40,6%), cístico (20,7%) e em "paliçada" (8,49%). Metaplasia escamosa ocorreu em 16,04% dos casos. Alterações histopatológicas relacionadas com transformação maligna foram incomuns: hialinização extensa (4,7%) e necrose (0,9%). CONCLUSÕES: confirma-se a diversidade histopatológica do AP. Características associadas a transformação maligna não foram freqüentes na amostra. INTRODUCTION: Pleomorphic adenomas (PA) are the most common histologic type of salivary gland tumors. Malignant transformation may occur in the setting of recurrent or longstanding disease. OBJECTIVE: Evaluate the clinicopathologic characteristics of PA of the major salivary glands, particularly tumors showing signs of malignant transformation. MATERIAL AND METHODS: The clinical and histopathologic characteristics of 106 cases of PA were evaluated retrospectively. RESULTS: The mean patient age was 39.5 years. There was a predominance of female patients (69.5%). The parotid was the most commonly affected gland (86.8%). The tumor had been present for over a year in 76.74% of the cases, with a mean size of 3.48 cm. Histologic examination revealed a thin and incomplete capsule in 49% of the cases; however, protrusions into the capsule or extracapsular extension were infrequent (11.32% and 8.49%, respectively). The extracellular matrix varied from myxochondroid (41.5%), myxoid (36.8%), chondroid (3.8%) and fibrotic (1.9%); coexisting patterns were observed. The myoepithelial-epithelial component corresponded to 50% or more of the tumor in 65.1% of the cases, and was solid (40.6%), cystic (20.7%), arranged in cords (86.8%), ducts (81.1%) and had a palisading configuration (8.49%). Squamous metaplasia was present in 16.04% of the cases. Features associated with malignant transformation were incommon: extensive hyalinization (4,7%) and necrosis (0,9%). CONCLUSION: The histopathologic diversity of PA was confirmed. Features associated to malignant transformation were unfrequent.

BACKGROUND: The increased interest in histological variations of fibroadenomas is due to the diagnostic difficulties found in small biopsies, as well as the slightly increased risk for carcinoma in cases of complex fibroadenoma. GOAL: Determine and compare the distribution of intratumoral epithelial and stromal alterations in young and older women. METHOD: Revision of gross and microscopy of 316 cases of fibroadenomas diagnosed in Department of Pathology at Hospital de Cancer de Pernambuco, from 1997 to 2000 (163 women with 15 to 39 years and 153 with 40 to 79 years). RESULTS: Pericanalicular pattern, normotrophic epithelium, adenosis, apocrine hyperplasia, typical hyperplasia, normo and hypercelular stroma prevailed in the younger group. Intracanalicular pattern, epithelial atrophy, intraductal calcification, stromal hyalinization and calcification were predominant in the older group. There was an association between intracanalicular pattern and myxoid stroma. The larger lesions were more commonly found in younger group as well as in cases showing pericanalicular pattern. These findings were statistically significant. There was no difference in incidence of complex fibroadenomas. DISCUSSION: Morphological elements that indicate lesion activity were more common in younger women, whereas involutive findings were more frequent in older group. CONCLUSION: The occurrence of a continuum of regressive alterations in fibroadenomas is confirmed by decrease in diameter, epithelial atrophy, stromal hyalinization and calcification. The study also suggests there is a progression from pericanalicular to intracanalicular pattern along the years, as well as a larger growth potential for those showing myxoid stroma, which is associated with intracanalicular pattern even in younger women.