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Introduction: Paraganglioma (PGL) is a rare type of neuroendocrine neoplasm able to secrete neuropeptide and catecholamines. It can occur in any location between the neck and the pelvis. Most of the PGLs are diagnosed in the third to fifth decades and clinical presentation is variable and depends upon catecholamine secretion and tumor location. PGLs occur in the abdomen in 85% of cases. There are no unique imaging characteristics specific for PGLs, consequently, these tumors can be mistaken with other primary abdominal tumors. Clinical-Case: We present the case of a 65-year-old woman with history of hypertension (diagnosis at 40 years) and dyslipidemia. She denied family history of hypertension. In the context of a recent diagnosis of type 2 Diabetes Mellitus, she underwent abdominal ultrasound which revealed a large, heterogeneous nodular formation with partial liquid content, measuring 12x15 cm, adjacent to the left hepatic border. Abdominal CT scan revealed an intra-abdominal mass, with 14cm (largest diameter), showing intimate contact, with no cleavage plan with the posterior wall of the gastric fundus, suggesting Gastrointestinal Stromal Tumor. A left adrenal nodule with 3.3 cm was also present, rounded, hypoechogenic, with regular margins and homogeneous. Echoendoscopy with biopsy of the retro-gastric mass showed a neuroendocrine neoplasia. At this point she was sent to an endocrinologist. When questioned she referred headache, diaphoresis and anxiety complaints for 3 years. At examination, a painless abdominal mass in the epigastrium and left hypochondrium was found. Laboratory evaluation revealed urinary metanephrines 11738 (64-302) ug/day, urinary normetanephrines 5832 (162-527) ug/day, renin 15.5 (1-8.2) pg/mL, aldosterone 28.6 (10-160)ng/dL, cortisol after 1 mg dexamethason 1,18 µg / dl (less than 1,8ug/dl) and chromogranin A 36.6 nmol / L (less than 3nmol/l). MIBG scintigraphy revealed fixation only in the large known retroperitoneal mass. The patient underwent excision of the retroperitoneal mass and of the left adrenal gland without complications. The histological diagnosis revealed, respectively, paraganglioma and adrenal cortical adenoma. Four weeks after surgery laboratory results were normal (urinary metanephrines 202 ug/24h and normetanephrines 382.0 ug /day; Chromogranin A 2.60 nmol/l). The results of the genetic tests including SDHB, SDHD, SDHC, VHL and MAX were negative. Conclusion: This report emphasizes the necessity to include paraganglioma in the differential diagnosis and management of retroperitoneal tumors avoiding the risk of the biopsy in this kind of tumors.

Objetivo: Descrever e comparar o perfil dos pacientes diagnosticados com hanseníase na Paraíba (PB) e no Brasil, entre 2008 e 2012. Metodologia: Trata-se de estudo epidemiológico, quantitativo, realizado por meio da análise de dados secundários obtidos do SINAN, via DATASUS. A variável de investigação correspondeu aos casos de hanseníase notificados na PB e no Brasil, no período definido. As variáveis exploratórias foram: sexo, cor da pele, escolaridade, faixa etária, forma clínica, classificação operacional e esquema terapêutico. Resultados: Foram notificados 207.831 casos de hanseníase no Brasil, sendo 4.069 na PB. Predominaram pacientes do sexo masculino (51,38%) e (56,57%); cor parda (54,67%) e (51,58%); com ensino fundamental incompleto (44,11%) e (49,13%), na PB e Brasil, respectivamente. A forma dimorfa foi a mais prevalente (PB: 25%) e (Brasil: 36%), com a maioria dos pacientes multibacilares: (PB: 52,93%) (Brasil: 62,04%). A poliquimioterapia com 12 doses foi a terapêutica preferencial (52,29%) (61,53%). As maiores incidências foram em 2009, 23,28 casos/100.000 habitantes, na PB e, em 2008, no Brasil: 24,35 casos/100.000 habitantes. Também em 2008 identificou-se maior incidência em menores de 15 anos para ambas as localidades. Conclusão: Constatou-se perfil clínico-epidemiológico semelhante para ambas as localidades, sendo observada a redução da incidência de hanseníase no período estudado. Entretanto, a endemicidade continua alta e alerta para o fortalecimento das ações de controle epidemiológico para esta enfermidade. Estudos como este, que traçam o perfil clínico-epidemiológico dos pacientes, possibilitam o planejamento de estratégias mais direcionadas para realidade encontrada. DESCRITORES: Hanseníase. Epidemiologia. Perfil de Saúde.

Breast cancer epidemiological patterns vary in European countries, which present different incidence rates. Data have suggested that the reduction in breast cancer mortality is not only due to the early detection of the disease, but is, in almost equal part, due to screening and to the advances that have been made in molecular medicine and the development of novel therapies. The aim of the present study is to quantify the actual number of cases of breast cancer present in both of the sexes by calculating the prevalence of silent breast cancer in corpses. To achieve this quantification, bilateral subcutaneous radical mastectomies are performed in corpses of either sex above 40 years of age that lacked any clinical manifestation of the disease, and where the breast cancer or its complications was not the cause of death. Only five publications exist in the international literature based on medico-legal autopsies that were designed to define the ‘natural reservoir’ of the disease. To the best of our knowledge, the present study is the first one to appraise breast tissue via imaging by means of orienting the biopsy incision. In conclusion, to the best of our knowledge, the design of the present study is the first of its type, where image-guided biopsies are used to define the prevalence of silent breast cancer. The study aims to demonstrate that the ‘disease reservoir’ is, in reality, higher than was originally considered to be so. Furthermore, the study aims to contribute towards an improved definition of the disease by determining which tumour profiles potentially do not benefit from aggressive treatments (for example, in case where a high prevalence of low-grade ductal carcinoma in situ is to be detected). According to our pilot study, this analysis represents a feasible protocol.

Granular cell tumours are rare neoplasms that may occur anywhere in the body. The most common locations are the oral cavity, skin and subcutaneous tissue, with only 8% of these tumours occurring at a gastrointestinal site. In the specific case of gastric granular cell tumours, only a few cases have been published until today. Granular cell tumours are usually benign; however, some malignant forms have been reported. Both endoscopic and surgical resection represent the treatment of choice. The authors report a new clinical case of a gastric granular cell tumour, treated with laparoscopic surgical resection, describing some endoscopic, imagiological and anatomopathological features.

Colonoscopy is being widely used since the 1980s and is the leading diagnostic procedure for colorectal cancer. For many colorectal diseases, it is also a therapeutic tool. Like many other procedures in Medicine, it has its drawbacks and complications, some of which if not readily diagnosed can represent a serious risk to the patient's health and well-being. We describe a case of colon perforation during diagnostic colonoscopy in a patient, resulting in exuberant pneumoretroperitoneum, pneumoperitoneum, pneumomediastinum and subcutaneous emphysema, who successfully underwent laparoscopic colonic resection with primary anastomosis. There are only a few cases of combined intraperitoneal and retroperitoneal perforations described in the literature.