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    Vacuum-assisted biopsy in the era of low-risk ductal carcinoma in situ active monitoring: real world data and implications
    (2025) Couto, Henrique Lima; Neves, Carolina Nazareth Valadares; Soares, Aleida Nazareth; Ricardo, Bernardo Ferreira de Paula; Toppa, Paola Hartung; Coelho, Bertha Andrade; Pessoa, Eduardo Carvalho; Resende, Vivian; Oliveira, Tereza Cristina Ferreira de; Mattar, Andre; Amorim, Andressa Gonçalves; Clarke, Paula; Freitas Junior, Ruffo de; Rahal, Rosemar Macedo Sousa
    Background: The short-term oncological safe of active monitoring for ductal carcinoma in situ (DCIS) with low risk (LR-DCIS) of progression to invasive cancers (IC) has been demonstrated. This study evaluates vacuum assisted biopsy (VAB) as diagnostic test for LR-DCIS active monitoring (AM) in real-world clinical practice.Methods: Database analysis of 116 cancers [both invasive breast cancers (IC) and ductal carcinoma in situ (DCIS)] diagnosed by VAB submitted to standard surgical treatment with complete histological data from VAB and surgery from 04/13/2017 to 11/28/2020. The VAB results matched the surgical pathology, considered the gold standard, and AM criteria. The pathological diagnoses were grouped into malignancies requiring guideline surgical treatment [DCIS with high risk (HR-DCIS) of progression to IC or IC] versus those eligible to alternative AM (LR-DCIS). HR-DCIS/IC were considered positive while LR-DCIS negative results. VAB sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were obtained.Results: Mean age 55.6 [± 12.27]; mean IC size 7.14 [± 5.17]mm and 12.6 [± 11.63]mm for DCIS. Out of 116 malignancies diagnosed by VAB, 15 (12.9%) resulted LR-DCIS in the biopsy, 10 (8.6%) confirmed LR-DCIS in surgery, and 5 (4.3%) upgraded to HR-DCIS/IC in surgery. VAB showed 95.28% (89.3–98.5; 95% CI) sensitivity, 100% (69.2–100; 95% CI) specificity, PPV was 100% (96.4–100; 95% CI), and NPV 66.67% (38.4–88.2; 95% CI). VAB LR-DCIS AM was 6.9% (8/116) and underdiagnoses 2.6% (2 pT1a-bN0 hormone receptor positive and 1 HR-DCIS).Conclusion: VAB LR-DCIS AM would lead to a moderate (6.9%) overall reduction of short-term breast cancer surgical overtreatment counterbalanced by a low rate (2.6%) of underdiagnosed HR-DCIS/IC potentially treatable by adjuvant hormone therapy.
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    Nonulcerated lesion with hardening of the tongue: sarcoma or squamous cell carcinoma?
    (2025) Biokino, Filipe Moreira; Santos, Andrezza do Carmo; Siqueira, Nara Rúbia Pereira de; Arantes, Diego Antonio Costa; Mendonça, Elismauro Francisco de; Moreira, Victor Hugo Lopes de Oliveira; Rotta, Rejane Faria Ribeiro
    Nonulcerated tumors located in the tongue region, with movement limitation, are frequently associated with malignant tumors of mesenchymal tissues, with rhabdomyosarcoma being the most common. A 44-year-old female presented a symptomatic mass located on the right ventral surface of the tongue, firm on palpation, limiting it´s movement, without lymphadenopathy. The main clinical hypothesis was sarcoma. The magnetic resonance imaging revealed an invasive and infiltrative lesion, compromising the whole base of the tongue and extending to the floor of the mouth. The patient underwent an incisional biopsy, and the trans-surgical hypothesis was squamous cell carcinoma (SCC), considering its color and hardness aspects. The histopathologic analysis reported invasive islands and cords of malignant squamous epithelial cells, immunohistochemical panels were positive for cytokeratin, p63, p40, CAM 5.2 and Ki-67. The final diagnosis was poorly differentiated SCC, and the patient was referred to the local cancer hospital
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    Screening of erythematous petechiae and macules as indicators of systemic diseases: a case report
    (2025) Siqueira, Nara Rúbia Pereira de; Biokino, Filipe Moreira; Milani, Vanessa; Goulart, Douglas Rangel; Arantes, Diego Antonio Costa; Mendonça, Elismauro Francisco de; Rotta, Rejane Faria Ribeiro
    Oral mucosa alterations can be part of screening for various diseases. A 39-year-old white woman, with lower lip erythematous macules for 5 years, worsting in 2 months with bleeding upon minimal trauma and healing delay. History of 10 years of working sun overexposure, treated anemia, no chronic medication. Current blood tests are within normal limits. Labial mucosa, gingiva, dorsum of the tongue, buccal mucosa, and fingertips presented erythematous petechiae. Lower lip incisional biopsy reported capillary hemangioma. Clinical diagnosis pointed toward hereditary hemorrhagic telangiectasia, as the patient reported recurrent spontaneous epistaxis and her 18-year-old daughter exhibited similar symptoms. Differential diagnosis was considered for CREST syndrome. She was referred to a physician to investigate possible arteriovenous malformations involving the lungs, liver, or central nervous system. Lip lesions were successfully treated with ethanolamine. The dentist can play a decisive role in the diagnosis of systemic diseases if he thoroughly explores the whole patient's history.
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    Low and high-intensity water-based training equally improve disability and functional performance in women with multiple sclerosis but has no effects on IL10, IL17, and S100 protein biomarkers
    (2025) Askari, Roya; Jafari, Maryam; Kakhki, Seyed Alireza Hosseini; Etemadifar, Masoud; Azarnive, Marzie Sadat; Gentil, Paulo Roberto Viana; Khademosharie, Mitra; Shekarchizadeh, Parivash
    Purpose: Multiple sclerosis (MS) is a demyelinating neurodegenerative disease of the central nervous system that involves a wide range of symptoms including loss of physical function. This study investigated the effects of eight weeks of water exercise training with two different intensities on Interleukin 10 (IL10), Interleukin 17 (IL17), and low molecular-weight calcium-binding proteins (S100), disability, and functional performance in women with MS. Methods: Forty-five relapsing-remitting women with MS and an Expanded Disability Status Scale (EDSS) score 3.5 were randomly divided into three groups: water-based low-intensity aerobic training (LIT), water-based high-intensity aerobic training (HIT), and a control group (CON). After eight weeks of water-based exercises, blood samples were collected 24 hours before the first session and 48 hours after the last training session. Physical performance was evaluated using a 30-second sit-to-stand test, the total number of elbow flexions performed with 2.5 kg dumbbells, 2-minute walking distances, and a timed up-and-go test (TUG). Results: There were no significant differences within or between groups in IL10, IL17, and S100 indices (p > 0.05). A significant difference was observed in the disability and functional indices after eight weeks, with higher values for the LIT and HIT groups compared to the CON group (p < 0.01), with no difference between them. Conclusions: Eight weeks of water-based exercises improve functional disability in patients with MS despite no changes in inflammatory biomarkers.
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    Association of genetic variants with the progression of COVID-19 symptoms in diabetic patients: a systematic review and in silico protein interaction analysis
    (2025) Silveira, Luciana Carvalho; Santos, Kamilla de Faria; Campos, Jessica da Silva; Assunção, Leandro do Prado; Santos, Rodrigo da Silva; Reis, Angela Adamski da Silva
    Diabetes mellitus is a global public health issue and, at the onset of the COVID-19 pandemic, was identified as a risk factor associated with high morbidity and mortality in cases of acute respiratory infection caused by the SARS CoV-2 coronavirus. This study investigated genetic variants in diabetic patients with COVID-19 through a systematic analysis of the PubMed/NCBI, EMBASE, Web of Science, SCOPUS, and Virtual Health Library databases, with the protocol registered on the PROSPERO platform (registration number CRD42020181311). Fifteen genetic variants were associated with five specific genes in symptomatic diabetic patients with COVID-19. Inheritance models, diabetic individuals carrying the heterozygous genotype TC (VDR rs4516035) showed ~10–15-fold higher odds of symptomatic COVID-19. Protein-protein interaction (PPI) analysis showed that the proteins ACE, ACE2, IL-6, and IL-17 exhibited strong predicted interactions with each other, as well as with insulin and the TMPRSS2 protease. Limitations include small number of eligible studies, heterogeneity in populations and outcome definitions. These preliminary findings highlight the need for further studies to understand better the relationship between the identified genetic variants and the progression of COVID-19 in diabetic patients.