RCAAP Repository

Portugal is the Western European country with the highest incidence rate of cervical cancer, being the Human Papillomavirus (HPV) infection its main cause. Cervical cytology is the most widely used screening method for the prevention and detection of cervical cancer, either by conventional means or by liquid basis. Conventional cytological preparations have more limitations than liquid-based preparations, however, when dealing with glandular lesions, both conventional and liquid-based cytology have some drawbacks. We report the case of a 31-year-old woman whose results from the screening cytology tests diverge from histological diagnosis. With this study we intend to highlight the limitations of conventional cytology in relation to the liquid-based cytology in the diagnostic of glandular lesions.

Introduction The breast is a glandular organ responsive to hormonal changes, therefore, according to the woman’s reproductive stage, the prevalence of different types of breast diseases varies. Breast cancer is the most prevalent (34,6%) in Portuguese women, its incidence has been rising and is most common in postmenopausal women (75%). However, younger women often present worst prognosis and more aggressive behaviour. Age, histological type and grade, axillary lymph node metastases and molecular subtypes are all important factors for therapeutic selection, patient’s follow-up and prognosis. Purpose The aim of this investigation was to correlate five variables: age, lymph node status, histological type-grade and molecular biomarkers, in women with breast lumps submitted to core biopsy of the breast and fine-needle aspiration cytology of the axillary lymph nodes. Materials and Methods The sample included 41 patients that were submitted to core biopsy of the breast and fine-needle aspiration cytology of the axillary lymph nodes. Breast tissue samples were stained with Hematoxylin-Eosin technique, which allowed the assessment of histological type and grade of the lesion. Besides that, immunohistochemistry techniques were performed, to evaluate the expression of estrogen and/or progesterone receptors, HER-2 and Ki67. In fine-needle aspiration cytology of the axillary lymph node, half of the slides were stained with May-Grünwald-Giemsa technique, and the other half with Papanicolaou technique. Fisher’s Exact Test was used with a confidence level of 95% and a p-value<0.05. Results It was ascertained a correlation between histological grade and molecular subtype (p-value=0.047), and between histological grade and the expression of Ki67 (p-value=0.004). There was no significant association between other variables. Conclusion In conclusion, it was established that there is a correlation between histological grade and the proliferative index and with the molecular subtype of the carcinoma.

Fibroadenoma and phyllodes tumor are the two main prototypes of breast fibroepithelial lesions. Fibroadenoma is the most common benign tumor in the female breast. The phyllodes tumor is rare and may have a benign, borderline or malignant character and in some cases may recur after excision and/or metastasize. Both neoplasms manifest clinically in the form of a breast lump. In their presence, the diagnostic approach currently adopted is the “Diagnostic Triad”, which includes clinical evaluation of the lump, imaging exams and fine needle aspiration. However, the clinical, mammographic, ultrasonographic and cytological features of fibroadenoma and phyllodes tumor may overlap. Due to the different clinical behavior and prognosis associated with these two entities, and consequently, different therapeutic approaches, their differential diagnosis is very important. Thus, it is essential to optimize existing methodologies and / or resort to other diagnostic methodologies in order to differentiate these two entities. This study was carried out with the objective of acquiring a clearer view of how the diagnosis of these two pathologies is performed, as well as highlighting the most relevant cytological and histological features, in addition to addressing other studied methodologies not yet used in the diagnosis

Neuroendocrine tumors of the cervix are extremely rare, so their diagnosis is difficult and sometimes confused with some other neoplastic entities. We present a case of a 43-year-old woman with complaints of uterine bleeding and fibroids, proposed for an elective hysterectomy, diagnosed in routine preoperative cytology, as Adenocarcinoma with no other specification. After a colpocytology with biopsy, a cervix neuroendocrine carcinoma was diagnosed, using complementary immunohystochemistry techniques. The patient experienced several treatments, having died about one year later, with metastatic disease.

Angiomyofibroblastoma-like tumor of male is an extremely rare benign mesenchymal tumor. It commonly occurs in middle-age and is mainly localized in the inguinoscrotal region. It is originated from perivascular stem cells and has the capacity of lipoid and myofibroblastic differentiation that may allow the observation of lipomatous differentiation. We report a case of lipomatous variant of angiomyofibroblastoma-like tumor of male using fine needle aspiration biopsy from the scrotal region of a 53 years-old man. Differential diagnosis could be a real bane for the pathologist in this particular variant. This diagnose should be kept in mind to prevent overlapping with the malignant lipomatous tumors.

Total hysterectomy is a very common surgical technique, that removes the cervix and should eliminate the presence of glandular cells in vaginal smears. However, this fact does not always happen.  In this study, it is related the case of a 49-year-old woman, hysterectomized 6 years before, which control vaginal smear presents ciliated cylindrical cells without atypia. The cytological diagnosis was the presence of ciliated cylindrical cells, which, with the clinical information provided, were suggestive of possible tubal prolapse. Subsequent histological study confirmed the suspected cytological diagnosis.

Metastasis of thyroid carcinoma comprise a low percentage of the total observed in the skullcap. We present a case of a 72-year-old female patient with an osteolytic lesion on the right frontal skullcap, subjected to a fine needle aspiration, whose diagnosis suggested thyroid tissue. On the thyroid ultrasound, a detected nodule was punctured, as well as the osteolytic lesion, whose cellular characteristics were similar, classifying the lesion as a follicular tumor. The patient underwent a total thyroidectomy, and her histological diagnosis was Follicular Carcinoma.

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Com o presente artigo pretende analisar-se os principais elementos de uma futura revisão do sistema de tributação das pessoas coletivas no âmbito da Reforma Tributária em curso em Angola. Considerando que uma reforma duradoura e adequada depende da correta consideração das diversas condicionantes relativas à tributação dos lucros das empresas, é, nesta sede, efetuado um levantamento e análise das melhores práticas internacionais a este respeito e principais critérios de decisão, assim se recolhendo e adaptando os casos de sucesso à situação específica do país. Não obstante a análise levada a cabo, o presente artigo pretende ser, mais do que um ponto de chegada com soluções finais, um elemento dinamizador das discussões a este respeito, fomentando o necessário e enriquecedor debate que nesta fase se pretende.

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