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Background Embryonic stem cell markers, such as SOX2, NANOG, and OCT4, are transcription factors expressed in pluripotent stem cells, involved in the mediation of pluripotency and self-renewal. Especially after the discovery of cancer stem cells, these proteins have been associated with several types of neoplasia, including astrocytomas. In the pediatric population, astrocytomas are the most common solid neoplasia and present the highest mortality rates. Methods Our study evaluated 5 polymorphisms in SOX2, NANOG, and POU5F1 genes in 101 pediatric astrocytoma samples. Results We describe the associations between wild and polymorphic alleles in astrocytomas. Conclusions In our results, the intronic polymorphic G allele in SOX2 rs77677339 [G/A] had a borderline association with low-grade astrocytomas, and the intronic polymorphic T allele in NANOG rs10845877 [C/T] showed a higher frequency in grade 2, compared to grade 1 astrocytomas, thus showing promising results. Impact Our study is relevant because it shows a potential correlation between polymorphic embryonic stem cell marker genes and pediatric astrocytomas.

Central nervous system tumors, especially astrocytomas, are the solid neoplasms with the highest incidence and mortality rates in childhood. The diagnosis is based on histopathological characteristics, but molecular methods have been increasingly used. Translationally controlled tumor protein (TCTP) protein, encoded by the tumor protein, translationally controlled 1 ( TPT1) gene, is a multifunctional protein with an important physiological role in the cell cycle. Expression of this protein has been associated with several neoplasms, including astrocytomas in adults. However, the role of this protein in pediatric astrocytomas is largely unknown. We aim to evaluate in cases of pediatric astrocytomas, the frequency of polymorphisms in the TPT1 gene and other genes associated with its molecular pathways, such as MTOR, MDM2, TP53, and CDKN1A, correlating it with protein expression and clinical variables, in formalin-fixed, paraffin-embedded (FFPE) samples. These samples were submitted to genotyping and immunohistochemistry analyses. The most revealing results refer to the MDM2 gene, rs117039649 [G/C], in which C polymorphic allele was observed only in the glioblastomas ( p = .028). The CDKN1A gene, rs3176334 [T/C] presented a homozygous polymorphic genotype only in high-grade astrocytomas, when infiltrating tumors were compared ( p = .039). The immunohistochemical expression of cytoplasmic MDM2 correlated with better survival rates in patients with glioblastoma ( p = .018). The presence of polymorphisms in the MDM2 and CDKN1A genes, as well as a specific correlation between MDM2 expression, suggests a likely association with risk in pediatric astrocytomas. This study sought the probable role involved in the TCTP pathway, and associated proteins, in the tumorigenesis of pediatric astrocytomas, and some could have potential impact as prognostic markers in these patients.

Parkin, a protein encoded by PRKN, discovered in the context of Parkinson’s disease, controls proteasomal degradation by protein ubiquitination and acts on cell cycle control and mitochondrial homeostasis, among other cellular processes. Parkin has been also implicated in several carcinomas, melanoma and leukemia. In the neoplastic setting, reduced parkin level usually indicates poorer prognosis. Some authors have described the associations between parkin and gliomas. Gliomas are a heterogeneous group of tumors that arise in the central nervous system, astrocytomas being the most common. The aim of this systematic review is to evaluate how parkin behaves in gliomas and the molecular pathways associated in this interaction. A search was conducted in PubMed, EBSCO and Scopus and 8 published articles were identified as eligible studies. The studies were categorized in three groups, according to their main emphasis: PRKN mutation patterns detected in gliomas, parkin effects on tumor growth and survival rates, and molecular interactions between parkin and other proteins. The studies showed higher PRKN mutation rates and lower parkin expression in high grade gliomas. Patients with higher parkin expression had better overall survival. Besides, different molecular pathways associated with parkin were described, some of them regarded as potential therapeutic targets.

Paciente feminina, 24 anos, apresentando, há 9 anos, cefaléia crônica recorrente e crises convulsivas sensíveis ao tratamento clínico com fenitoína e fenobarbital, evoluindo com períodos de amnésia transitória. A tomografia computadorizada (TC) demonstrou lesão cística e superficial em lobo temporal esquerdo, tendo sido submetida à craniotomia temporoparietal, com ressecção parcial da lesão. O exame histopatológico de rotina evidenciou cédulas ora fusiformes de núcleo alongado ora redondas ou ovaladas com núcleo único ou convoluto; pleomorfismo nuclear, células gigantes multinucleadas bizarras, conteúdo lipídico e fibras reticulínicas variáveis foram evidenciados. A análise imunohistoquímica pela técnica da avidina-biotina-peroxidase evidenciou positividade para GFAP, proteína S100 e sinaptofisina, confirmando o diagnóstico de astrocitoma xantopleomórfico. A paciente avoluiu com a melhor das crises tônico-clônicas, contudo, cinco meses após, a TC evidenciou presença de recidiva tumora. A paciente foi submetida à nova ressecção tumoral, não havendo posterior recidiva.

Objective: The history of Anatomical Pathology in the state of Paraná, in southern Brazil, is closely linked with the foundation of the Universidade Federal do Paraná (UFPR). This study identified the first central nervous system (CNS) clinical autopsy performed by the Department of Anatomical Pathology of the UFPR. Methods: This study reviewed the autopsy report archives of the Hospital de Clínicas-UFPR from 1951 onward. The clinical anatomy interpretations of the autopsy report and possible etiologic agents were discussed. Result: The first adult clinical autopsy with CNS study was performed on April 23, 1952 on a 45-year-old man with lobar pneumonia with abscesses complicated by bacterial meningitis. Conclusion: This case was the first CNS clinical autopsy performed in the state of Paraná and, possibly, in southern Brazil. The death was due to an infectious disease, which was the main cause of death in Brazil in the 1950s.

Glioblastomas (GBMs) are resistant to current therapy protocols and identification of molecules that target these tumors is crucial. Interaction of secreted heat-shock protein 70 (Hsp70)-Hsp90-organizing protein (HOP) with cellular prion protein (PrP(C)) triggers a large number of trophic effects in the nervous system. We found that both PrP(C) and HOP are highly expressed in human GBM samples relative to non-tumoral tissue or astrocytoma grades I-III. High levels of PrP(C) and HOP were associated with greater GBM proliferation and lower patient survival. HOP-PrP(C) binding increased GBM proliferation in vitro via phosphatidylinositide 3-kinase and extracellular-signal-regulated kinase pathways, and a HOP peptide mimicking the PrP(C) binding site (HOP230-245) abrogates this effect. PrP(C) knockdown impaired tumor growth and increased survival of mice with tumors. In mice, intratumor delivery of HOP230-245 peptide impaired proliferation and promoted apoptosis of GBM cells. In addition, treatment with HOP230-245 peptide inhibited tumor growth, maintained cognitive performance and improved survival. Thus, together, the present results indicate that interfering with PrP(C)-HOP engagement is a promising approach for GBM therapy.

We report the case of a 2 month-old patient with a large, probably congenital, posterior fossa tumor. Hematoxylin and eosin staining (HE), reticulin and immunohistochemistry revealed a medulloblastoma with extensive nodularity, showing ganglioglial differentiation, high proliferative index in the primitive neuroectodermal tumor (PNET) area and low proliferative index in the ganglioglial maturation area. Ganglioglial differentiation is a rare event in medulloblastomas and its mechanism is still unknown. Previous surgery, radiation and chemotherapy may contribute to differentiation in astrocytic and nerve cells. In this case, however, the differentiation was already present in the first specimen, prior to any surgical or therapeutic procedure. Paciente de dois meses de idade apresentando grande tumor, provavelmente congênito, de fossa posterior. As colorações de hematoxilina e eosina (HE), reticulina e imuno-histoquímica revelaram meduloblastoma com extensa nodularidade, exibindo diferenciação ganglioglial, alto índice proliferativo na região de tumor neuroectodérmico primitivo e baixo índice proliferativo na área de maturação ganglioglial. Diferenciação ganglioglial é um evento raro em meduloblastomas e seu mecanismo ainda é desconhecido. Cirurgia prévia, radiação e quimioterapia podem contribuir para diferenciação em células astrocitárias e nervosas. Neste caso, entretanto, a diferenciação já estava presente no primeiro espécime, antes de cirurgias prévias ou procedimentos terapêuticos.

Neurocysticercosis (NCC) is a common central nervous system (CNS) infection caused by Taenia solium metacestodes. The objective of this study is to describe the incidence of cysticercosis diagnosed at autopsies and describe the epidemiological and clinical characteristics of NCC. Retrospective study analyzing 6,500 reports of autopsies between 1977 and 1994 from a school hospital in Curitiba, PR, southern of Brazil. The following data was obtained, age, gender, site of cysticercosis, NCC as cause of death. The diagnosis of cysticercosis was established in 52 (0.8%) autopsies. From 1977 to 1987 (0.7%) and from 1988 to 1994 (1.1%). In the autopsies with cysticercosis 75% were male; age (mean ± SD) was 43 ± 20. NCC was present in 96% of cases, and seizures was the most frequent clinical manifestation. Asymptomatic cases in 54%. These data classify our area as hiperendemic, according with OMS criteria. The present study reinforces the necessity to develop adequate control programs.

INTRODUCTION AND OBJECTIVE: The aim of the present study is the immunohistochemical assessment of tumor progression markers (E-cadherin, β-catenin, CEACAM-1 and PTEN) in primary cutaneous melanomas and their correlation with prognostic factors. METHOD: Primary lesions in patients with cutaneous melanoma were recorded as to clinical data (age, gender, location and metastases) and anatomopathologic data (Breslow, Clark level, margins, histological type, mitosis, ulceration, regression, satellitosis and TIL type). It was made a comparison between immunohistochemical expression of the markers and prognostic and anatomopathologic factors. RESULTS: Breslow thickness was > 1 mm (thick) in 21 patients (48.83%) and < 1 mm (thin) in 22 (51.16%). There was a higher CEACAM-1 positive expression in thick melanomas than in thin ones (p = 0.002). There was a more frequent E-cadherin (p = 0.008), b-catenin (p = 0.001) and PTEN (p = 0.005) positive expression in thin melanomas than in thick ones. There was a more frequent CEACAM-1 positive expression in superficial (p = 0.003) and deep (p = 0.002) samples of thick melanomas than in thin ones. No statistically significant differences between clinical and histopathological data were found when comparing patients with (n = 6) and without metastasis (n = 15). DISCUSSION AND CONCLUSION: There was a higher positivity for E-cadherin, b-catenin and PTEN in thin melanomas, whereas there was a higher positivity for CEACAM-1 in thick melanomas.INTRODUÇÃO E OBJETIVO: O objetivo do presente estudo está na avaliação imuno-histoquímica de marcadores de progressão tumoral (E-caderina, β-catenina, CEACAM-1 e PTEN) em melanomas cutâneos primários e sua correlação com fatores prognósticos. MÉTODO: Lesões primárias de pacientes portadores de melanoma cutâneo foram tabuladas quanto a dados clínicos (idade, sexo, localização e metástases) e anatomopatológicos (Breslow, nível de Clark, margens, tipo histológico, mitoses, ulceração, regressão, satelitose e tipo de TIL). Foi realizada comparação da expressão imuno-histoquímica dos marcadores em estudo com fatores prognósticos clínicos e anatomopatológicos. RESULTADOS: Breslow foi > 1 mm (espesso) em 21 pacientes (48,83%) e ≤ 1 mm (fino) em 22 (51,16%). CEACAM-1 foi mais positivo em melanomas grossos que em finos (p = 0,002). E-caderina (p = 0,008), β-catenina (p = 0,001) e PTEN (p = 0,005) foram mais frequentemente positivos em melanomas finos que em grossos. CEACAM-1 foi mais frequentemente positivo nas porções superficiais (p = 0,003) e profundas (p = 0,002) dos melanomas grossos que nas dos finos. Não houve diferenças estatisticamente significativas entre dados clínicos e histopatológicos quando comparamos os pacientes com (n = 6) e sem (n = 15) metástases. DISCUSSÃO E CONCLUSÃO: Observou-se maior tendência de positividade para E-caderina, b-catenina e PTEN em melanomas finos. Por sua vez, CEACAM-1 demonstrou maior frequência de positividade nos melanomas grossos.

Caso clínico atípico de tumor sólido pseudopapilar de pâncreas (TSPPP) acometendo paciente do sexo masculino, 37 anos, com quadro inicial de dor abdominal aguda. Após cirurgia e exame anatomopatológico com imuno-histoquímica, demonstrou padrão condizente com TSPPP e forte positividade para β-catenina. Dois anos após a cirurgia o paciente encontra-se livre de recidiva. O TSPPP é mais comum em mulheres jovens com quadro clínico de massa ou desconforto abdominal, podendo alguns casos ser assintomáticos. Apresenta crescimento lento e baixo potencial de malignidade, sendo a ressecção cirúrgica o tratamento de escolha com altos índices de cura.Atypical clinical case of solid pseudopapillary tumor (SPPT) of the pancreas in a 37 year-old man with acute abdominal pain. After surgery, anatomopathologic investigation with immunohistochemistry showed pattern in keeping with SPPT and strong positivity for β-catenin. Two years post-surgery the patient does not present recurrence. The SPPT normally occurs in young women with a history of mass or abdominal discomfort, although in some cases it can be asymptomatic. The tumor has slow growth, low potential for malignancy and surgical resection yields high cure rates.

The sentinel lymph node (SLN) is considered to be the first axillary node that contains malignant cells in metastatic breast tumors, and its positivity is currently used in clinical practice as an indication for axillary lymph node dissection. Therefore, accurate evaluation of the SLN for the presence of breast metastatic cells is essential. The main aim of our study is to characterize the genomic changes present in the SLN metastatic samples with the ultimate goal of improving the predictive value of SLN evaluation. Twenty paired samples of SLN metastases and their corresponding primary breast tumors (PBT) were investigated for DNA copy number changes using comparative genomic hybridization (CGH). Non-random DNA copy number changes were observed in all the lesions analyzed, with gains being more common than losses. In 75% of the cases there was at least one change common to both PBT and SLN. The most frequent changes detected in both lesions were gains of 1pter→p32, 16, 17, 19, and 20 and losses of 6q13→q23 and 13q13→q32. In the PBT group, alterations on chromosomes 1, 16, and 20 were the most frequent, whereas chromosomes 1, 6, and 19 were the ones with the highest number of changes in the SLN metastatic group. A positive correlation was found between the DNA copy number changes per chromosome in each of the groups. Our findings indicate the presence of significant DNA copy number changes in the SLN metastatic lesions that could be used in the future as additional markers to improve the predictive value of SLN biopsy procedure.

BACKGROUND: We compare neuropathological abnormalities in children and adults after bone marrow transplantation (BMT) by means of autopsy in the Department of Medical Pathology, Universidade Federal do Paraná (UFPR), Brazil. METHODS: Autopsy reports of 180 patients were reviewed. They were divided in two groups: patients under 15 years old and those 15 or older. Age, gender, clinical diagnosis at time of BMT, survival time, neuropathological abnormalities and cause of death were analyzed. RESULTS: In children (26.6% of total) and in the adult group (73.4% of total), the main clinical diagnoses prior to BMT were, respectively, severe aplastic anemia (31.2%) and chronic myeloid leukemia (36.3%). The mean survival time for children was 102.6 days and for adults, 185.9 days after BMT. Brain lesions were considered cause of death in 20.8% of pediatric cases and 11.3% of the adult group. Neuropathological abnormalities were morphologically similar in children and adults, with the following respectively prevalence: cerebrovascular diseases in 58.3 and 56% (p = 0.8655), neurotoxoplasmosis in 6.2% and 3% (p = 0.3856) and infections in 27 and 25.7% (p = 0.8489). CONCLUSIONS: The pediatric patients had shorter survival than adults, with increasing prevalence of neurotoxoplasmosis, and brain lesions were considered cause of death in twice as many as compared to adult patients.

Genetic heterogeneity is high in breast cancer, and hence it is difficult to link a specific chromosome alteration to a specific clinicopathologic feature. We examined clonal chromosome alterations in 45 breast carcinomas and statistically correlated the findings with clinical-histopathological parameters of the patients. The most common abnormalities were losses of chromosomes 19, 22, 21, X, and 17 and gains of chromosomes 9 and 18. A statistically significant correlation was found between clonal aberrations in chromosomes 17, 20, and 21 and positive lymph node involvement (LN+) and between clonal aberrations in chromosomes X and 6 and negative involvement (LN-). The average number of chromosome abnormalities was the same for both LN- and LN+ groups, and numerical and structural alterations were equally distributed. The mean number of chromosome aberrations did not differ significantly among tumor grades, but when aberrations were analyzed as monosomies, trisomies, and structural aberrations, a heterogeneous distribution was observed. Further cytogenetic investigation of breast tumors and their variable pathological features is undoubtedly necessary. The recognition and ultimately the molecular understanding of these abnormalities may improve breast cancer taxonomy and provide important prognostic information for both the patient and clinician.

Background Medulloblastoma is a malignant, invasive embryonal tumor of the cerebellum and accounts for 20% of intracranial tumors in children. QSOX1, whose functions include formation of disulphide bridges, which are needed for correct protein folding and stability, formation of the extracellular matrix, regulation of the redox status and cell cycle control, appears to be involved in apoptosis in pathological states such as cancer. Thus, the aim of this study was to investigate the immunohistochemical expression of QSOX1 in medulloblastomas and nonneoplastic cerebellum. Methods Histology blocks of pediatric medulloblastomas were separated and two representative areas of the tumors and non-neoplastic cerebellum samples were used to construct tissue microarrays (TMAs) that were stained with an anti-QSOX1 antibody, and the slides were read using image analysis software. Results QSOX1 immunoexpression was observed in the non-neoplastic cerebellum samples and the medulloblastoma samples. There was no statistically significant relationship between QSOX1 immunopositivity in the medulloblastoma samples and the clinical and pathological variables. Conclusions Although QSOX1 did not prove useful for stratifying patients into risk groups, tumor cells and the fibrillar extracellular matrix were positive for this marker, indicating that this enzyme may be involved in the pathogenesis of medulloblastoma. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1822040654139436

PURPOSE: To evaluate the role of Losartan in skin healing repair. METHODS: One hundred and eleven male Wistar rats were distributed into four groups, at random. Group I (n=31) underwent a laparotomy to induce hypertension by stenosis of the left renal artery, and 48 hours later it received Losartan (10 mg/Kg) daily. Group II (n=30) went through the same procedure and received isotonic saline solution. Group III (n=30) underwent a simulated laparotomy. Group IV (n=20) to confirm the induced hypertension method. Ketamine and Xylazin anesthesia was used in every painful/stressful procedure. After 15 days, skin healing repair was studied by a dorsal midline skin incision and second layer-skin incision in groups I, II and III, that was sutured in one layer with 4-0 nylon suture. Samples of the dorsal wall scar were taken 4, 7 and 14 days after the last procedure, and sent to strength and displacement analysis and histological preparation. RESULTS: By the 4th and 7th days of the analysis, group II scars showed to be less resistant than group III scars (pOBJETIVO: Avaliar a influência do Losartan na reparação de feridas da pele. MÉTODOS: Cento e onze ratos Wistar, machos, foram distribuídos aleatoriamente em quatro grupos. Grupo I (n=31), submetidos à laparotomia com indução de hipertensão pela estenose da artéria renal esquerda e que após 48 horas receberam Losartan (10 mg/Kg) diariamente. Grupo II (n=30) submetidos ao mesmo procedimento e que receberam solução salina isotônica. Grupo III (n=30) submetidos à laparotomia sem indução de hipertensão. Grupo IV (n=20) animais que serviram para a confirmação do método de indução da hipertensão. Anestesia com quetamina e xilazina foi utilizada para todos os procedimentos com dor ou estresse. Após 15 dias, a cicatrização da pele foi estudada fazendo-se uma incisão medial, no dorso, seguida de síntese com sutura de náilon 4.0, nos animais dos grupos I, II e III. As avaliações foram realizadas após 4, 7 e 14 dias verificando-se a resistência e analizando-se as preparações histológicas. RESULTADOS: No 4.º e no 7.º dia as cicatrizes dos animais do grupo I eram menos resistentes do que as do grupo III (p

FUNDAMENTOS: A biópsia por punch é de grande auxílio no diagnóstico das doenças do couro cabeludo quando avaliada por patologista experiente. O conhecimento das estruturas encontradas no couro cabeludo normal facilita o diagnóstico histopatológico nessa área tão complexa da dermatopatologia. OBJETIVO: Determinar dados quantitativos normais do couro cabeludo de adultos brancos. MÉTODOS: Em 20 necrópsias, 80 fragmentos de couro cabeludo clinicamente normal foram obtidos por punch 4mm. As amostras foram avaliadas em cortes transversais. RESULTADOS: Em fragmentos obtidos de adultos brancos, com idade variando entre 21 e 78 anos, foi possível observar (medianas): 16,5 (12-23) folículos totais; oito (6-9) unidades foliculares; 15 (10-20) folículos terminais; um (0-2) folículo velo; um (0-2,5) trato fibroso; 92,2% de folículos anágenos; 1,6% de catágenos e 6,2% de telógenos. CONCLUSÃO: Além dos resultados apresentados, observaram-se ainda nos indivíduos do sexo masculino: menor número de unidades foliculares, folículos totais e folículos telógenos; e ainda, nas regiões frontal e vértex, maior número de folículos e tratos fibrosos.BACKGROUND - Punch-biopsy is a great tool for the diagnosis of scalp disorders, however experience is required for the dermatopathologist. Recognizing the standard structures found in normal scalp is very helpful in this aspect. OBJECTIVE - The goal of this study was to determine quantitative data considering normal structures on the scalp of white adults. METHODS - Twenty necropsies were followed by eighty 4mm-punch biopsies of clinically normal scalp. Samples were evaluated by transverse sections. RESULTS - Scalp fragments from white adults, age 21 to 78, demonstrated (medians): 16.5 (12.0-23.0) total follicles; 8.0 (6.0-9.0) follicular units; 15.0 (10.0-20.0) terminal follicles; 1.0 (0.0-2.0) vellus follicle; and 1.0 (0.0-2.5) fibrous tract. Considering the hair cycle phase: 92.2% were in anagen; 1.6% in catagen and 6.2% in telogen. CONCLUSION - Comparing the results, male samples demonstrated fewer follicular units, total and telogen follicles, and higher number of total follicles and fibrous tracts on frontal and vertex area.

FUNDAMENTOS: A biópsia por punch é de grande auxílio no diagnóstico das doenças do couro cabeludo quando avaliada por patologista experiente. O conhecimento das estruturas encontradas no couro cabeludo normal facilita o diagnóstico histopatológico nessa área tão complexa da dermatopatologia. OBJETIVO: Determinar dados quantitativos normais do couro cabeludo de adultos brancos. MÉTODOS: Em 20 necrópsias, 80 fragmentos de couro cabeludo clinicamente normal foram obtidos por punch 4mm. As amostras foram avaliadas em cortes transversais. RESULTADOS: Em fragmentos obtidos de adultos brancos, com idade variando entre 21 e 78 anos, foi possível observar (medianas): 16,5 (12-23) folículos totais; oito (6-9) unidades foliculares; 15 (10-20) folículos terminais; um (0-2) folículo velo; um (0-2,5) trato fibroso; 92,2% de folículos anágenos; 1,6% de catágenos e 6,2% de telógenos. CONCLUSÃO: Além dos resultados apresentados, observaram-se ainda nos indivíduos do sexo masculino: menor número de unidades foliculares, folículos totais e folículos telógenos; e ainda, nas regiões frontal e vértex, maior número de folículos e tratos fibrosos. BACKGROUND - Punch-biopsy is a great tool for the diagnosis of scalp disorders, however experience is required for the dermatopathologist. Recognizing the standard structures found in normal scalp is very helpful in this aspect. OBJECTIVE - The goal of this study was to determine quantitative data considering normal structures on the scalp of white adults. METHODS - Twenty necropsies were followed by eighty 4mm-punch biopsies of clinically normal scalp. Samples were evaluated by transverse sections. RESULTS - Scalp fragments from white adults, age 21 to 78, demonstrated (medians): 16.5 (12.0-23.0) total follicles; 8.0 (6.0-9.0) follicular units; 15.0 (10.0-20.0) terminal follicles; 1.0 (0.0-2.0) vellus follicle; and 1.0 (0.0-2.5) fibrous tract. Considering the hair cycle phase: 92.2% were in anagen; 1.6% in catagen and 6.2% in telogen. CONCLUSION - Comparing the results, male samples demonstrated fewer follicular units, total and telogen follicles, and higher number of total follicles and fibrous tracts on frontal and vertex area.

FUNDAMENTOS: A caracterização histológica do folículo piloso normal em humanos é escassa na literatura, considerando que o reconhecimento da arquitetura folicular normal e suas variações nas diversas áreas do couro cabeludo é fundamental para o estudo das doenças do couro cabeludo. OBJETIVOS: Analisar fragmentos do couro cabeludo normal em indivíduos de raça branca quanto à área, os diâmetros máximo e mínimo dos folículos anágenos terminais. MÉTODOS: Vinte necrópsias de indivíduos de raça branca, com idade variando de 20 a 78 anos, foram acompanhadas da coleta de biópsias por punch de 4mm de diâmetro em quatro áreas do couro cabeludo. Os casos foram divididos conforme o sexo em dois grupos, com 10 casos cada. A área e os diâmetros máximo e mínimo dos folículos anágenos terminais foram determinados por análise computadorizada das imagens de cortes transversais da microscopia óptica. Os resultados obtidos foram comparados entre os sexos e os locais de coleta. RESULTADOS: Os resultados numéricos das áreas e diâmetro máximo e mínimo são expostos e comparados. CONCLUSÃO: Não houve diferença estatisticamente significativa entre o diâmetro máximo e a área folicular nas diversas regiões do couro cabeludo; entretanto, foram evidenciadas dimensões de folículos anágenos terminais maiores no sexo masculino do que no feminino.

OBJETIVO: avaliar o motivo para indicação e analisar o grau de auxílio da imuno-histoquímica (IHQ) para o diagnóstico de neoplasias e lesões pseudoneoplásicas. MATERIAL E MÉTODO: avaliação retrospectiva observacional e descritiva de 4.459 casos submetidos a análise no laboratório de IHQ do Departamento de Patologia do Jackson Memorial Hospital, Universidade de Miami, Estados Unidos, em 1999. RESULTADOS: 3.706 casos possuíam dados suficientes para o desenvolvimento dos objetivos propostos. Em 19% dos casos a IHQ foi utilizada para determinar fatores prognósticos ou índices proliferativos; em 17% dos casos teve como objetivo identificar microrganismos, células, estruturas ou materiais; e em 64% dos casos teve aplicação diagnóstica propriamente dita. Em 835 casos desta última categoria a IHQ contribuiu para um diagnóstico específico em 83% das vezes e diminuiu o número de diagnósticos diferenciais em 12%. Em 5% das vezes a IHQ não auxiliou o patologista devido a exigüidade de algumas amostras, presença de necrose extensa ou indiferenciação extrema de algumas neoplasias. Os principais problemas de diagnóstico diferencial para os quais a IHQ foi utilizada foram: determinar o local de origem de carcinomas e adenocarcinomas e diferenciar entre hiperplasia mesotelial reacional, mesotelioma e adenocarcinoma, entre outros. Foram utilizados 4,1 anticorpos por caso, em média. CONCLUSÕES: Quando bem indicada e aplicada, a imuno-histoquímica é um método diagnóstico complementar útil em 95% dos casos e muitas vezes contribui fundamentalmente para as condutas cirúrgica e terapêutica. Amostras muito exíguas ou necróticas e neoplasias extremamente indiferenciadas são situações que comprometem o exame imuno-histoquímico e seus resultados. Quando utilizada de maneira direcionada aos principais diagnósticos diferenciais, a técnica apresenta uma relação custo/benefício alta. BACKGROUND: Immunohistochemistry (IHC) is a valuable tool in diagnostic surgical pathology. We evaluated the frequency of IHC use and its contribution to the final diagnosis of tumors and pseudotumors. METHODS: A retrospective study of the 4,459 cases received in 1999 for immunoperoxidase study at the Immunohistochemistry Laboratory, Department of Pathology, University of Miami/Jackson Memorial Hospital, USA, was performed. RESULTS: 3,706 cases yielded all data necessary for the study. In 19% of cases IHC was used for localization of predictive tumor markers or evaluation of proliferation indicators; 17% of cases performed IHC to identify organisms or acellular structures and in 64% of cases IHC examination was to aid the pathologists in differential diagnosis of tumors. In 835 cases of the latter category, IHC helped the pathologists to render a specific diagnosis in 83% of instances. In 12% IHC narrowed down the diagnostic possibilities to two or three entities. In the remaining 5% of cases, IHC had no contribution to the final diagnosis due to limited diagnostic material, extensive necrosis or lack of tumor differentiation. The main differential diagnosis dilemmas included determination of the site of origin of carcinomas, differentiation between reactive mesothelial hyperplasia, mesothelioma and adenocarcinoma, and demonstration of cell phenotype in undifferentiated neoplasms. The average of antibodies per case was 4.1. CONCLUSIONS: Immunohistochemistry is a valuable tool in diagnostic surgical pathology capable of delineating the nature of disease in 95% of cases. In some instances, IHC is essential for the treatment decision-making. On the other hand, limited diagnostic material, extensive necrosis or lack of tumor differentiation can interfere in IHC performance. A well-designed differential diagnosis-driven utilization of the technique is extremely cost-effective.

Primary meningiomas of the jugular foramen are extremely rare. There is controversy regarding the management of these tumors. The objective of this article is to analyze the treatment and results in a series of ten cases. From a series of 107 patients that had been operated on for jugular foramen tumors between 1987 and 2005, ten had meningiomas. The clinical, histological and imaging findings, as well as the outcome of these cases, were reviewed. A high incidence of malignant or aggressive tumors (six cases) was found. Gross total resection (Simpson I and II) was achieved in five patients. Four patients with meningotheliomatous meningiomas are alive, with a mean follow-up time of 71.8 months (6.5 years). Two patients (one with anaplastic type and one with papillary type) died in the immediate postoperative period. Four patients (two with papillary type, one with microcystic type and one with anaplastic type) died because of disease progression, with a mean survival time of 35 months. Radical removal of benign jugular foramen meningiomas is possible. The incidence of postoperative deficit of cranial nerves is higher than in other benign tumors of the jugular foramen. A high incidence of aggressive (malignant) tumors was observed in this series.

O acometimento cerebral pela histoplasmose é raro, ocorrendo mais comumente sob a forma de doença disseminada. Raramente, a doença pode ocorrer sob a forma de histoplasmomas, que simulam tumores do sistema nervoso central. Mais raro ainda é a ocorrência de histoplasmomas em pacientes imunocompetentes como única manifestação desta infecção. Neste relato é apresentado um paciente masculino de 13 anos com cefaléia, vômitos, redução da acuidade visual e auditiva à esquerda e hemiparesia à direita. A ressonância magnética mostrou lesão expansiva com impregnação anelar de contraste, localizada na região talâmica, hipotalâmica e quiasmática à esquerda. Foi realizada biópsia estereotáxica e a avaliação histológica do material definiu o diagnóstico de histoplamose. Iniciou-se tratamento com fluconazol, com melhora clínica importante após 6 meses do início do tratamento.

Granular cell tumor (GCT) usually occurs as a solitary, small, nodular tumor and rarely grows to a sufficient size to present symptoms. The tumor is more prevalent in female adults. The authors report a case of an 8-year-old boy with GCT of the neurohypophysis presenting with central precocious puberty. Few cases of symptomatic GCT have been reported in the literature, none of them in a patient in the first decade of life. Clinical picture, histopathological features, and histogenesis of GCT of neurohypophysis are discussed.

Gliosarcoma (GSa) is a rare primary central nervous system neoplasm (CNS) characterized by biphasic histological pattern with both glial and sarcomatous components. Our objective is to describe the clinical, morphological and immunohistochemical features of four cases of GSa and to discuss its pathogenetic mechanisms. The male:female ratio was 3:1. The mean age was 39 years, ranging from 19 to 48. Headache was the commonest clinical symptom. All patients underwent craniotomy with microsurgery and total resection of the tumor. Diagnosis was suspected due to microscopic architecture and confirmed by detection of reticulin fibers through histochemical techniques. Immunohistochemical analysis was positive for p53 in both glial and sarcomatous cells in all four cases. EGFR was focally positive in glial cells in one case. Our findings support monoclonal origin of GSa involving the TP53 tumor-suppressor gene. However, alternative pathways cannot be ruled out.Gliossarcoma (GSa) é uma neoplasia primária rara do sistema nervoso central, caracterizada por padrão histológico bifásico incluindo componentes tanto glial como sarcomatoso. São discutidos os aspectos clínicos, morfológicos e imunohistoquímicos de quatro casos de GSa e seus mecanismos patogêneticos. A relação masculino/feminino foi 3:1. A média de idade foi 39 anos, variando de 19 a 48. Cefaléia foi a manifestação predominante. Todos os pacientes foram submetidos a craniotomia com microcirurgia e ressecção total do tumor. O diagnostico foi suspeitado devido à arquitetura microscópica e foi confirmada por presença de fibras de reticulina através de técnicas de histoquímica. A análise imuno-histoquímica foi positiva para p53 tanto em células gliais como em células sarcomatosas nos quatro casos. EGFR foi localmente positivo em células gliais em apenas um caso. Esses achados apoiam uma origem monoclonal do GSa relacionada com alteração no Tp53, gene supressor de tumor. No entanto, outras vias alternativas na gênese desses tumores não podem ser afastadas.

The impact of specimen adequacy on the diagnosis of cervical cytology is not fully understood. Virtually, the greatest impact of smear quality limitation factors is on the diagnosis of atypical squamous cells of undetermined significance (ASCUS) because this category is more susceptible to interpretation mistake due to its criteria subjectivity. This study aims to evaluate the impact of smear quality impairing factors on the diagnosis of ASCUS. The 1,507 cases of ASCUS studied were obtained from the Cervical Cancer Screening Program of Parana (CCSPP). The cases were reviewed by expert cytopathologists and the results were correlated to the specimen adequacy. The results showed that the presence of obscuring blood impairs the correct diagnosis and leads the pathologist to overdiagnose negative smears as ASCUS. The presence of adequate endocervical sampling contributes to a higher rate of correct ASCUS diagnoses but did not influence the pathologist to over- or underestimate the cytological findings.

The authors report a case of an 11-year-old boy with Fanconi anemia presenting with squamous cell carcinoma of the tongue 763 days after bone marrow transplantation. Few cases have been reported in the literature, usually involving mucosal membranes in adult patients. The factors related to the development of malignancies after bone marrow transplantation are discussed and the early presentation is highlighted, once a high index of suspicion is required for the early identification of this kind of lesion in children.Os autores relatam o caso de um menino de 11 anos de idade com anemia de Fanconi que foi submetido a transplante de medula óssea. Com 763 dias de evolução, foi detectada uma lesão ulcerada na língua, compatível com carcinoma de células escamosas. Poucos casos semelhantes foram reportados na literatura, geralmente envolvendo as membranas mucosas em pacientes adultos. Os fatores relacionados ao desenvolvimento de neoplasias secundárias em transplante de medula óssea são discutidos e a idade precoce de apresentação do paciente enfatiza a necessidade de um alto índice de suspeição, mesmo em pacientes muito jovens, para que se faça o diagnóstico da lesão em fase inicial.

Gliosarcoma (GSa) is a rare primary central nervous system neoplasm (CNS) characterized by biphasic histological pattern with both glial and sarcomatous components. Our objective is to describe the clinical, morphological and immunohistochemical features of four cases of GSa and to discuss its pathogenetic mechanisms. The male:female ratio was 3:1. The mean age was 39 years, ranging from 19 to 48. Headache was the commonest clinical symptom. All patients underwent craniotomy with microsurgery and total resection of the tumor. Diagnosis was suspected due to microscopic architecture and confirmed by detection of reticulin fibers through histochemical techniques. Immunohistochemical analysis was positive for p53 in both glial and sarcomatous cells in all four cases. EGFR was focally positive in glial cells in one case. Our findings support monoclonal origin of GSa involving the TP53 tumor-suppressor gene. However, alternative pathways cannot be ruled out.

Tumores derivados do plexo coróide são neoplasias raras do sistema nervoso central que acometem principalmente crianças. Este estudo apresenta uma série de 38 pacientes com tumores de origem neuroectodérmica, dentre os quais 24 possuem diagnóstico histológico e/ou imunoistoquímico de Carcinoma do Plexo Coróide (CPC). Destes, 16 eram do gênero masculino. O local predominantemente acometido foi o ventrículo lateral esquerdo. As manifestações clínicas mais freqüentes foram hidrocefalia, hipertensão intracraniana e crises convulsivas. Todos os pacientes foram submetidos a tratamento cirúrgico. Houve um óbito no per-operatório e outro no pós-operatório imediato. Nove pacientes tiveram recidiva, evoluindo a óbito em tempo médio de 12,3 meses. Sete estão vivos. Os demais casos não apresentavam dados disponíveis. Em Curitiba, o CPC tem uma alta prevalência em relação a outros tumores do plexo coróide, podendo estar relacionado a algum agente patogênico.

The accumulation of genetic and epigenetic changes plays a pivotal role in tumor development and progression. In this study, we investigated these changes using comparative genomic hybridization and bisulfite polymerase chain reaction analysis for CpG island hypermethylation of the following genes: TP16, THBS2, E-Cadherin (ECAD), RARbeta2, MINT1, MINT2, and MINT31 in six paired primary breast tumors and their matched sentinel lymph nodes (SLN). The most frequent chromosomal alterations observed were the following: losses of 6q13 approximately q23 and 13q13 approximately q32 and gains of 9q31 approximately qter, 11p15 approximately q21, 12q23 approximately qter, and 20q12 approximately qter. Gain of 6p21 approximately pter was observed in the SLN but in none of the primary tumors. Overall, 71% (30/42) of the methylation measurements were identical between the primary tumors and the SLN. Of the six cases, two showed no differences between the primary tumors and SLN, one tumor with 4 of 7 genes hypermethylated in the primary tumor showed loss of all four hypermethylation events in the SLN, and the remaining three tumors showed loss of one methylation event and simultaneous gain of one to two methylation changes in the SLN. This is the first study reporting genetic and epigenetic alterations in breast sentinel lymph nodes compared to their corresponding primary tumors. Characterization of such alterations may lead to identification of initial events associated with the metastatic dissemination process.

The purpose of this study is to report the organization of a cost-effective screening program for cervical cancer in a developing country such as Brazil. The Cervical Cancer Screening Program of Parana (CCSPP) was launched in October 1997 and was the result of a joint collaboration between the government of Parana (Secretary of Health of the State of Parana), scientific societies (pathologists, gynecologists, and nurses), and a non governmental organization called the Women's Popular Forum of Parana. The main goal of the program was to enhance the Papanicolaou (Pap) smear screening to coverage up to 85% of female adult population with a 3-yr interval between examinations, as well as to reduce the incidence and mortality from cervical cancer in the state of Parana, a Southern state of Brazil. The cytological findings in all Pap smears recorded in a central computer-based register during 5 yr of the program (October 1997-October 2002) are discussed. During that period, 2,244,158 Pap smears were performed in women included in the program from the 398 cities of the state of Parana. The cytological smears were analyzed according to the Bethesda System. The previous year, before the program was launched, a Pap smear was taken from 43% of women of Parana. At the end of 5 yr, coverage was increased to around 86%. The great majority of examinations had a negative result (98%). Only 2% of examinations had cytological abnormalities (n = 44,621). Low-grade lesions predominated in women aged 15-30 yr, and the high-grade lesions were more common in women aged 25-45 yr. Patients older than 40 yr had the greatest incidence of invasive cancer. Although the program is only 5 yr old, a decrease in the mortality from cervical cancer in women from Parana is clearly apparent: in 1998, 297 women died of cervical cancer, as compared with 188 as of September 2002.

The purpose of this report is to describe the unique cytological findings of a new recently characterized type of meningioma that has extensive noncalcifying collagenous whorls and glial fibrillary acid protein (GFAP) expression. This new entity, described by Haberler and colleagues, was named whorling sclerosing variant of meningioma. The patient was a 34-yr-old white man with a large tumor in the brainstem. Intraoperative smear preparations showed a tumor with a large number of solid hyaline masses in a loose background and in focal areas tumor cells formed cohesive nests with a somewhat whorling appearance. The histological sections showed a neoplasia composed of innumerable eosinophilic, collagenous, noncalcified round deposits, cuffed by scattered meningothelial tumor cells. The neoplastic cells showed diffuse cytoplasmic reactivity for EMA and vimentin, as well as positivity to GFAP. This is the first cytological description of this new entity in the literature.

We report a case of a 44-years-old woman with relapsing-remitting and secondarily progressive form of multiple sclerosis (MS) since aged 24 years, who developed an anaplastic astrocytoma. The neurological manifestations of the tumor were misinterpreted as resulting from MS. Sequential MRI examination and seizures raised the possibility of another nature of her symptoms, besides MS. Her initial good response to high doses corticosteroids led to the initial assumption her symptoms were only exclusively due to the demyelinating process. She underwent craniotomy with radical excision of the lesion. Pathological examination disclosed anaplastic astrocytoma. Other cases of coincidental MS and primary CNS tumors are reviewed, as well as their possible relation.Relatamos o caso de uma paciente de 44 anos, portadora de esclerose múltipla forma surto-remissão e progressiva secundária, que na evolução desenvolveu um astrocitoma anaplásico. Os sintomas do tumor se confundiram com os da esclerose múltipla e com a repetição de ressonâncias magnéticas foi possível suspeitar do diagnóstico. Além dos sinais neurológicos, também apresentava crises convulsivas. A melhora com os cursos de pulsoterapia mascaravam os sintomas do tumor. Submetida a craniotomia e retirado tumor com características histológicas e histoquímicas de astrocitoma anaplásico, ao lado de áreas de desmielinização típicas de esclerose múltipla. São discutidos os aspectos radiológicos, incidência e mecanismos da concomitância das duas doenças.

We report a case of a 44-years-old woman with relapsing-remitting and secondarily progressive form of multiple sclerosis (MS) since aged 24 years, who developed an anaplastic astrocytoma. The neurological manifestations of the tumor were misinterpreted as resulting from MS. Sequential MRI examination and seizures raised the possibility of another nature of her symptoms, besides MS. Her initial good response to high doses corticosteroids led to the initial assumption her symptoms were only exclusively due to the demyelinating process. She underwent craniotomy with radical excision of the lesion. Pathological examination disclosed anaplastic astrocytoma. Other cases of coincidental MS and primary CNS tumors are reviewed, as well as their possible relation.

The present study sought possible factors leading to the cytological diagnosis of atypical squamous cells of uncertain significance (ASCUS) in cases of high-grade squamous intraepithelial lesions (HSIL). Based on retrospective histopathological analysis of loop electrical excision procedure (LEEP) products that diagnosed HSIL, two study groups were randomly selected. The first was consisted of cases with two consecutive Papanicolaou (Pap) smears with the diagnosis of ASCUS. The second (control) group was represented by cases diagnosed as HSIL by cytology. From the Pap smears diagnosed as ASCUS, the sampling limitations was different from control group (P < 0.05). The median size of the largest lesion in each case with ASCUS was 2.66 mm (± 1.71 mm). In the control group, the median size of the largest lesion was 5.15 mm (±2.58 mm) (P < 0.05). The size of the lesion and sample limitations led patients with cervical intraepithelial neoplasms to be diagnosed as ASCUS for two consecutive times, after a 6-mo period. Diagn. Cytopathol. 2002;26:15–18. © 2002 Wiley-Liss, Inc.

O termo holoprosencefalia (HPC) é usado para o complexo de deformidades hemisféricas causadas por falha no desenvolvimento da vesícula prosencefálica. Este estudo tem como objetivo relatar o espectro morfológico de 12 casos de HPC, classificá-los e compará-los com a literatura pertinente. Avaliadas 5837 necrópsias realizadas entre 1960 e 1995, 12 apresentavam HPC. Dados como sexo, idade, e presenças de outras malformações associadas foram avaliados e comparados com as demais malformações e com o total de necrópsias. A maioria dos casos era de masculinos (66,66%) e neomortos (75%). A forma de HPC mais frequentemente encontrada foi a lobar (58,3%) e a alteração facial mais frequente foi a ciclopia (25%). Houve tendência estatística de que a HPC possa, dentro das malformações do sistema nervo central (SNC), acometer mais o sexo masculino e de que a neomortalidade seja maior na HPC do que nas outras malformações do SNC. The term holoprosencephaly (HPC) is used to indicate the group of hemispheric deformities caused by a failure in the development of the prosencephalic vesicle. The purpose of this study is to explain the morphologic specter of twelve cases of HPC, qualify them, and compare them to the literature. It was evaluated 5837 pediatrics necropsies, and there were 12 cases of HPC. Data like gender, age and the presence of another associated malformations were evaluated and compared to another malformations and to the total number of necropsies. The majority of the cases was male (66.66%), and stillborns (75%). The most frequently type of HPC found was the lobar type (58.3%), and the most frequently type of facial alteration was the ciclopy (25%). There is a statistic tendency to HPC affect the male sex, in comparison with other neurologic malformations. Besides, the stillborns are more frequently observed in HPC than in other neurologic malformations.

As doenças cerebrovasculares em pacientes entre 15 e 40 anos são pouco estudadas na literatura latino americana, principalmente no que tange aos achados neuropatológicos. Analisamos 47 encéfalos provenientes de necrópsias completas realizadas no período de 1987 a 1997 selecionados com base na faixa etária e alteração neuropatológica básica envolvendo fenômenos vasculares. Destes 47 casos analisados, 26 eram (55,3%) do sexo feminino. Quanto à distribuição etária, 12,8% (n=06) acometeram pacientes entre 15 e 20 anos, 51,1% (n=24) entre 21 e 30 anos, 36,2% (n=17) entre 31 e 40 anos. As doenças básicas que culminaram no óbito foram agrupadas, sendo mais frequentes as doenças cardíacas e hematológicas (19,2%), alterações decorrentes de complicações de gestação (12,8%), doenças infecciosas, doenças dos vasos sanguíneos e doenças neurológicas (10,7%) entre outras. As alterações neuropatológicas incluíram hérnia cerebral e/ou cerebelar (16%), edema cerebral (13,8%), hemorragia subaracnóidea (10%), infarto cerebral recente (9%), hemorragia intraparequimatosa (8%), encefalopatia hipóxico-isquêmica (3%) e eventos menos comuns como a síndrome de Sneddon e vasculite lúpica. Tais achados expressam que os fenômenos cerebrovasculares têm, nesta faixa etária, perfil próprio com estreita relação com a doença de base. Cerebrovascular diseases in patients between 15 and 40 years old are not a frequent subject in Latin-American literature, especially when focusing on neuropathology. We analyzed 47 brains from necropsies performed from 1987 to 1997 and selected on a basis of age and the presence of vascular pathology. From the 47 analyzed brains, 26 belonged to females (55.3%). When distributed among age groups, 12.8% (n=6) affected patients from 15 to 20 yo, 51,1% (n=24) from 21 to 30 yo, 36,2% (n=17) from 31 to 40 yo. The underlying diseases were: cardiac and haemathologic (19.2%), pregnancy complications (12.76%), infections, diseases of blood vessels and neurological (10.1% each) amongst others. The neuropathological abnormalities included cerebral and/or cerebellar herniation (16%), cerebral edema (13.8%), subarachnoid hemorrhage (10%), recent cerebral infarction (9%), intraparenchymatous hemorrhage (8.14%), hypoxic-ischemic encephalopathy (3%) and other events such as Sneddon syndrome and Lupus vasculitis. These findings express that the cerebrovascular phenomena in this age group are unique and closely related with the underlying disease.

O termo holoprosencefalia (HPC) é usado para o complexo de deformidades hemisféricas causadas por falha no desenvolvimento da vesícula prosencefálica. Este estudo tem como objetivo relatar o espectro morfológico de 12 casos de HPC, classificá-los e compará-los com a literatura pertinente. Avaliadas 5837 necrópsias realizadas entre 1960 e 1995, 12 apresentavam HPC. Dados como sexo, idade, e presenças de outras malformações associadas foram avaliados e comparados com as demais malformações e com o total de necrópsias. A maioria dos casos era de masculinos (66,66%) e neomortos (75%). A forma de HPC mais frequentemente encontrada foi a lobar (58,3%) e a alteração facial mais frequente foi a ciclopia (25%). Houve tendência estatística de que a HPC possa, dentro das malformações do sistema nervo central (SNC), acometer mais o sexo masculino e de que a neomortalidade seja maior na HPC do que nas outras malformações do SNC.The term holoprosencephaly (HPC) is used to indicate the group of hemispheric deformities caused by a failure in the development of the prosencephalic vesicle. The purpose of this study is to explain the morphologic specter of twelve cases of HPC, qualify them, and compare them to the literature. It was evaluated 5837 pediatrics necropsies, and there were 12 cases of HPC. Data like gender, age and the presence of another associated malformations were evaluated and compared to another malformations and to the total number of necropsies. The majority of the cases was male (66.66%), and stillborns (75%). The most frequently type of HPC found was the lobar type (58.3%), and the most frequently type of facial alteration was the ciclopy (25%). There is a statistic tendency to HPC affect the male sex, in comparison with other neurologic malformations. Besides, the stillborns are more frequently observed in HPC than in other neurologic malformations.

Invasive zygomycosis is a devastating fungal infection occurring as an opportunistic infection after bone marrow transplantation (BMT). Sinusitis can lead to fungal infection in immunosuppressed patients, and cavernous sinus thrombosis, an uncommon condition in immunocompetent patients, typically follows an infection involving the medial third of the face, nose, or paranasal sinuses. Patients undergoing unrelated-donor BMT (UD-BMT) are prone to develop life-threatening infections because of poor recovery of cellular immunity. Despite adequate clinical evaluation and treatment, the prognosis of patients with invasive fungal infections is dismal, especially when intracerebral structures are affected. We describe a case of a patient who underwent an UD-BMT and developed cavernous sinus thrombosis after sinusitis due to zygomycosis. Moreover, he also had disseminated fungal (Zygomycetes and Aspergillus) and viral (cytomegalovirus and adenovirus) infections.