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Acute pulmonary embolism (PE) can be fatal if left untreated. Long-term prognosis of acute PE in the 21st century has not been fully reported. We aimed to determine the long-term prognosis of patients hospitalized with acute PE and compare survivalof patients with idiopathic and secondary PE.We retrospectively analysed a cohort of hospitalized patients with acute PE between 2006 and 2013.18 years, venous embolism of non-pulmonary veins, chronic thromboembolic pulmonary hypertension, and presumptive diagnosis without image confirmation. Only patients with a first PE episode were included. End-point: all-cause mortality. Patients were compared according to PE aetiology: idiopathic, secondary to neoplastic conditions and secondary to non-neoplastic conditions. A Cox-regression analysis was used to study the prognostic impact of PE aetiology.We studied 872 hospitalized acute PE patients. Median age 70 years, 56.9% were women. PE was idiopathic in 376 (43.1%), secondary to a neoplastic condition in 284 (32.6%) and secondary to a condition other than neoplasia in 212 (24.3%). Patients were followed for a median 25 months period and 508 (58.3%) died. Patients with PE attributed to a neoplastic condition had the worst survival. Patients with idiopathic PE had a multivariate-adjusted HR of mortality of 1.46 (1.08-1.99) during the over 2-year follow-up period when compared to those with acute PE attributed to a non-neoplastic condition.Patients with idiopathic acute PE have an almost 50% higher death risk in a median 2-year follow-up period than those with acute PE secondary to a condition other than neoplasia.

Background: On March 11, 2020, COVID-19 was declared a global pandemic Caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this infection may remain asymptomatic The European Society of Medical Oncology and the Portuguese Health Authority recommended both a symptomatic survey and laboratory testing in all cancer patients (pts) undergoing immunosuppressive treatment (IT) The impact of this measure is still unknown We report our experience in a Portuguese center Methods: Since March 2020, a symptomatic survey has been performed at our institution before each hospital visit From April 6 through May 8, 2020, reverse-transcriptase polymerase chain reaction (RT-PCR) SARS-CoV-2 testing was added on cancer pts before undergoing IT The impact of this intervention was evaluated comparing the hospitalization rate of cancer pts due to COVID-19, before and after the introduction of RT-PCR testing Retrospective analysis of clinical data was performed Results: 444 tests were carried out on 244 pts and laboratory SARS-CoV-2 infection was confirmed in 11 (5%);5 were male, with a median age of 65 years [34-76] Breast and colorectal cancer were prevalent;2 pts had lung cancer;6 advanced disease Ongoing IT in these pts was temporarily suspended: 9 pts under chemotherapy, 1 atezolizumab and 1 rituximab Only 1 patient was symptomatic (9%) and previously hospitalized No admission due to COVID-19 was registered in this group Since March 7, 179 pts were admitted due to COVID-19 at our center: 12 were active cancer pts (6 7%) of which 4 were under IT 6 of the oncological pts passed away, all of them had advanced diseases, 1 was under IT Of the dead pts, lung and breast tumors were prevalent Among all COVID-19 hospitalizations, the prevalence of pts under IT was similar before and after the implementation of the RT-PCR testing (2 2% vs 2 4%) Conclusions: We found a significant percentage of active cancer pts diagnosed with asymptomatic COVID-19 Due to the small sample size of COVID-19 pts under IT, it is difficult to evaluate the impact of RT-PCR testing However, on a long-term analysis, this intervention may reduce the risk of severe complications related to COVID-19 in cancer pts Health education and dynamic organization are also important measures Legal entity responsible for the study: The authors Funding: Has not received any funding Disclosure: All authors have declared no conflicts of interest

Background The immune checkpoint inhibitors (ICI) in non-small cell lung cancer (NSCLC) had shown to increase progression-free survival (PFS) and overall survival (OS). The prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) are biomarkers easy to measure by blood tests and they had been studied as possible prognostic predictors in patients (pts) with various types of cancer treated with ICI. This study intends to analyze the impact of the NLR and PNI in pts with NSCLC treated with ICI. Methods Thirty-four pts with stage IV NSCLC that had started ICI in 1st and subsequent lines between 03/2016 and 06/2019 were retrospectively analyzed. The pre-treatment NLR and PNI were calculated and the cut-off 5 and 50 were respectively considered. The Kaplan-Meier method and Log Rank test and the Cox regression were used in survival analysis. Results Twenty-seven (79%) were male, with a median age of 67 (34-79) years; ECOG 0-1 (n = 30; 88%); stage IVA (n = 14; 41%); PD-L1 ≥50% (n = 18; 53%); NLR ≥5 (n = 13; 38%); PNI ≥50 (n = 14; 41%). Eleven pts (32%) were submitted to ICI in 1st line. The median follow-up time was 19,3 months (mo.). The median PFS was 6,1 mo. (95%CI 1,94-10,26) and median OS was 9,3 mo. (95%CI 0,31-18,29) - 16,5 mo. in 1st line vs 8,6 mo. in subsequent lines. The median PFS was superior in patients with PNI ≥50 (7,0 vs 2,1 mo., p = 0,039), but there weren’t differences considering the NLR. The median OS was also superior when PNI ≥50 (16,8 vs 6,7 mo., p = 0,019). In multivariate analysis (sex, age, 1st line, PD-L1, stage, ECOG, NLR and PNI), the mortality probability was superior in pts with ≥70 years [HR 6,14 (95%CI 1,49-25,39)]. Moreover, PD-L1 ≥50% [HR 0,09 (95%CI 0,01-0,52)], male sex [HR 0,03 (95%CI 0,004-0,24)], stage IVA [HR 0,26 (95%CI 0,07-0,997)] and PNI ≥50 [HR 0,15 (95%CI 0,03-0,69)] were associated to a reduced mortality risk. Conclusion PNI ≥50 was predictive of a better PFS and OS and the NLR wasnt a predictor of survival. Regarding OS, PNI ≥50 was an independent survival prognostic factor. In order to understand the impact of this biomarker in NSCLC treated with ICI, it is important to evaluate it in more studies with a larger population and prolonged follow-up time. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Hand-Schuller-Christian disease is a multifocal variant of eosinophilic granuloma, characterised by the classical triad of bony lesions, exophtamos and diabetes insipidus. This case relates recurrent Langerhan's cell histiocytisis lesions presented as destruction of periodontal support associated with diabetis in a 10-year–old patient. Medical history suggests that the case represents a case of Hand- Schuller Christian disease.

No presente trabalho, os autores relatam o caso de uma criança com neuroblastoma intrarenal, que foi, inicialmente, diagnosticado como tumor de Wilms. Pré-escolar, sexo feminino, com um ano e três meses, apresentava uma tumoração endurecida que ocupava o hipocôndrio esquerdo e se estendia até a região do mesogástrio, acompanhada de febre e palidez. O ultra-som do abdome total revelou massa intrarenal. A biópsia por agulha fina, em vários pontos de acesso tumoral, revelou um tumor de Wilms. Entretanto, não foi possível naquele momento realizar a imunohistoquímica (IHQ), face à escassez de material. Diante da gravidade da paciente, foi iniciado o protocolo SIOP por quatro semanas. Como não houve resposta clínica, foi indicada uma laparotomia exploradora, com ressecção parcial do tumor, sendo também, nesse momento, realizada punção aspirativa de medula óssea (MO). O exame histopatológico revelou neoplasia maligna de pequenas células mal diferenciadas. A IHQ foi negativa para WT-1 e positiva para NB-84, cromogranina e sinaptofisina. A biologia molecular revelou amplificação de N-myc. O mielograma identificou infiltração medular por pequenas células redondas. O neuroblastoma intrarenal é um tumor raro que se assemelha clínica e radiologicamente ao tumor de Wilms. Esse trabalho procura enfatizar a importância do emprego de análises imunohistoquímica e moleculares para o diagnóstico do neuroblastoma intrarenal.

We report on a 7-year-old girl with Ewing's Sarcoma (ES) who developed a poorly differentiated acute myeloid leukemia (AML-M0) 20 months after beginning the EW92 protocol for the treatment of the primary tumor. She received a total dose of 1500 mg of etoposide, a tumor cumulative radiation dose of 35Gy and granulocyte colony-stimulating factor (G-CSF) was as predicted in the protocol regimen. At onset of secondary malignancy her laboratorial analysis revealed immature blast cells characterized by CD34+/CD33-/a-MPO+ and a t(4;11)(q21;q23) abnormality. This serious complication of ES treatment, which associates etoposide, irradiation and G-CSF schedule, should be weighed against its therapeutic benefits.

1. Cat retinal ganglion cells projecting to the superior colliculus (SC) were detected in flat whole-mounts of Nissl-stained retinas by means of unilateral intracollicular injections of horseradish peroxidase (HRP). 2. With the purpose of drawing a comparison between HRP-labeled ganglion cells and the remaining population of unlabeled ganglion cells, the latter were classified according to their perikaryal characteristics into three groups: large, medium and small ganglion cells. Measurements of perikaryal sizes of ganglion cells distributed from the central area to the periphery of the retina showed that large cells ranged from 20 to 44 μm, medium cells from 15 to 30 μm and small cells from 8 to 17 μm. 3. Peroxidase-labeled retinal ganglion cells (HRP-cells) occurred among representatives of each of the three groups into which retinal ganglion cells had been classified. Small HRP-cells clearly constituted the majority of the HRP-cell population. When the injection site was restricted to the superior colliculus, medium HRP-cells as large as 19 μm were only occasionally observed, the 15 to 18 μm range being predominant over the medium cell population. 4. Medium HRP-cells larger than 20 μm were a common finding only when the injection site involved the pretectal nuclei and were never observed when the injection site was restricted to superior colliculus. 5. Possibility of a correspondence between the large, medium and small HRP-cells of the present study with, respectively, the physiological types Y-, X- and W- of cat retinal ganglion cells is discussed.