Browsing by Author "Fialho, M. Pinto"
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- Cutaneous non-tuberculous mycobacteria infection: a case report and literature reviewPublication . Fialho, M. Pinto; Carvalho, M. M.; Catarino, A. M.; Casanova, S. R.; Sampaio, R.Background & objectives: Non-tuberculous mycobacteria (NTM) are often overlooked as opportunistic agents causing cutaneous infections. While histological findings may resemble cutaneous tuberculosis, treatment and clinical management differ significantly. We present a case of NTM skin infection and a literature review. Methods: A 62-year-old female with autoimmune hepatitis, on immunosuppression, received a corticosteroid injection in the elbow joint. Six months later, she presented with a skin nodule at the injection site, histologically diagnosed as cutaneous tuberculosis. Despite being asymptomatic and lacking epidemiological context or chest X-ray abnormalities, a second adjacent skin nodule developed and was subsequently biopsied. Results: The skin biopsies showed poorly formed epithelioid nonnecrotizing granulomas with neutrophilic microabscesses (suppurative granulomas) and Langhans-type multinucleated giant cells in the reticular dermis and subcutaneous tissue. Gram and Grocott stains were negative, and acid-alcohol-resistant bacilli were observed using the Ziehl-Neelsen stain. As suggested by Song et al., we identified small vessel proliferation with sparse fibroblasts within the lesions. The histological examinations were consistent with NTM skin infection and confirmed by polymerase chain reaction (PCR). Conclusion: The case underscores the diagnostic challenge posed by NTM infections, often mimicking cutaneous tuberculosis. These histopathological findings should help pathologists decide when to suspect an NTM infection, avoiding a delay in diagnosis and a tuberculosis label that could lead to overtest and unnecessary treatments.
- Metaplastic carcinoma of the breast: case series of a single centrePublication . Fialho, M. Pinto; Gonçalves, L.; Ruivo, L.; Gradil, A.; Correia, L.Background & objectives: Metaplastic carcinoma breast cancer (MpBC) is a rare and heterogeneous group of invasive breast carcinomas. Despite some studies and case reports data are currently limited. Our work aims to evaluate the clinicopathological features and the prognosis of MpBC patients. Methods: Retrospective unicentric study of MpBC diagnosed from January 2000 to February 2024. Pathological reports were accessed for specific patterns of MpBC, grouped as monophasic/biphasic tumors and TNM stratified according to WHO Breast Tumours 5th edition and AJCC 8th edition. Time-to-event outcomes were calculated using the Kaplan-Meier method and the log-rank test. Results: We identified 44 patients, 1 male, median age 59 years-old (33-98), 9 metastatic ad-initio. Biphasic-MpBC corresponded to 77%; heterologous-mesenchymal-differentiation was found in 34%, and spindle-cell carcinoma in 6.8%. Ki67 ranged from 20 to 95%. Twenty-seven were triple-negative, eight luminal-B, and six HER2-positive tumors. The median follow-up time was 82.1 months and the median overall survival (mOS) was 32.1 months. Subgroup analysis showed no statistically significant differences between monophasic/biphasic MpBC or histological patterns. Metastatic patients and patients over 60 years had a poorer prognosis (25.1 vs 115.5 months p=0.053; 20.0 months vs mOS have not reached p=0.001, respectively). In luminal-B patients, mOS were not reached (vs 32.1 months -triple-negative and 10.6 months -HER2). Conclusion: MpBC is rare, reported only in up to 2% of all invasive breast cancers. Given its uncommon nature, pathology reports lack uniformity. Establishing protocols is crucial to accurately identifying and reporting patterns to better determine treatment strategies. Our data suggests better outcomes regarding Luminal-B, non-metastatic patients. However, the limited number of patients prevented a statistically significant evaluation of differences between histological subtypes. Multicentric studies are needed to correlate demographic, histological, or immunohistochemistry factors with patients’ outcomes.
- Modified auramine-rhodamine stain contribution to identify mycobacterium tuberculosisPublication . Ruivo, L.; Fialho, M. Pinto; Santos, H. S.; Tavares, J. A.; Ferreira, C.Background & objectives: Mycobacterium tuberculosis (MT) infection often causes multiple organ granulomatous disease. Suspicious lesions are often biopsied to exclude malignancy. Ziehl-Neelsen (ZN) staining is the histological standard diagnostic tool for MT, although auramine-rhodamine (AR) appears to have better detection ratios. Methods: We evaluated all biopsies with suspected clinical tuberculosis (combined or not with microbiological testing), from January 2022 to September 2023 in a tertiary hospital center, with histological confirmation of granulomatous inflammation and tested with ZN staining. The biopsies were reevaluated using AR staining with a modified protocol in which phenol was replaced by a trident for cell membrane permeabilization. Results: The study comprised 53 cases, 27 females and 26 males. The most frequent biopsy sites were lymph nodes (38% - 20/53) and lung (36% - 19/53). Necrotizing granulomatous inflammation was found in 75% of cases (41/53), 32% of which (13/41) tested positive for ZN stain and were further confirmed with modified AR. From the remaining ZN-negative cases (68% - 28/41), 39% (11/28) tested positive in the microbiological study; from those, 73% (8/11) were positive using modified AR. Conclusion: Although ZN is the histological gold standard method to assess the presence of MT, its evaluation is hampered by the fact that the number of mycobacteria is often below the technique’s detection threshold. AR has greater sensitivity and easier fluorescence visualization, even at lower magnification and with fewer bacilli. Additionally, the proposed modification in the technical protocol for AR, makes it less harmful for the performer and does not compromise the quality of the technique.
- Sebaceous carcinoma in a mature cystic teratoma of the ovaryPublication . Fialho, M. Pinto; Gradil, A.; Ferreira, C.; Lérias, S.Background & objectives: Sebaceous carcinoma originating within an ovarian mature cystic teratoma (MCT) is an extremely rare entity. To the best of our knowledge, less than 14 cases have been reported in the literature. Methods: We report a case of a sebaceous carcinoma arising within a mature teratoma. Results: An 83-year-old female presented with urinary retention symptoms. A pelvic MRI scan revealed a left ovary lesion consistent with MCT. The patient underwent a bilateral adnexectomy. Macroscopically an 18cm ovary cystic mass showed a partially solid appearance intermixed with soft yellow sebaceous material. Histological examination revealed an MCT with a lobular component containing sebocytes surrounded by basaloid cells with focal squamoid features, nuclear pleomorphism, increased mitosis, and associated necrosis. Basaloid cells were immunoreactive to p63 and CK5/6. Sebaceous cells were EMA+ and PRAME+. Mismatch repair protein nuclear expression was intact. A diagnosis of a sebaceous carcinoma arising within an MCT was made. The patient is free of disease at 17 months. Conclusion: Sebaceous carcinoma within an ovarian MCT is a rare entity. Although ocular sebaceous carcinomas are aggressive, the prognosis of extraocular sebaceous carcinoma is thought to be better since local recurrence or metastasis has not yet been described. Given the paucity of data, the management of these patients remains unclear, however identifying tumor microsatellite instability or germline DNA mutations facilitates further cancer screening and treatment (PD1/PD-L1 inhibitors).
- Tumour infiltrating lymphocytes characterization in advanced non-small cell lung cancer with first-line immune checkpoint inhibitors treatmentPublication . Ruivo, L.; Fialho, M. Pinto; Baptista, D.; Filipe, J.Background & objectives: Tumour-infiltrating lymphocytes (TILs) may have an impact on prognosis in non-small cell lung cancer (NSCLC) and may affect the efficacy of treatment. We aim to characterize TILs in advanced NSCLC with PD-L1 score>50%, treated with first-line immune checkpoint inhibitors. Methods: We performed a single-centre retrospective study. Patients diagnosed with advanced NSCLC with PD-L1>50%, from 2017 to 2023, were selected. Medical records and histological slides from the primary tumor specimens before treatment were reviewed. Immunohistochemistry for CD20, CD3, CD8 and PD-1 was performed. Tumour and stromal TILs were scored using 0%, 25% and 50% cut-offs. Results: A total of 34 patients were included. The median age was 64 years and 74% were male. The most prevalent histological type observed was adenocarcinoma (70%). Partial response to therapy was observed in 53% of patients, disease progression was seen in 44% and only 3% had a complete response. All the samples analyzed had a lymphocytic inflammatory infiltrate, with CD3+ T lymphocytes being the most prevalent. The type of inflammatory infiltrate overlapped in all treatment response subgroups. None of the cases showed more than 50% of tumor or stromal PD-1+ inflammatory cells. Conclusion: Despite therapy with immune checkpoint inhibitors, the majority of patients showed a partial response. It seems that the type of inflammatory infiltrate did not influence therapeutic response. Tumour and stromal PD-1+ inflammatory cells were the least prevalent and PD-1 was not relevant in TILs evaluation. Multi-centre randomized studies would provide more accurate data and allow performing statistical analysis regarding the prognostic value of TILs. A second biopsy could show if there are differences in the type of inflammatory infiltrate during treatment.