PATRICIA PICCIARELLI DE LIMA

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 29
  • bookPart
    Desepitelizações corneanas
    (2022) BISSOLI, Leandro Bortolon; LIMA, Patrícia Picciarelli de
  • article 3 Citação(ões) na Scopus
    Hemorrhagic brain lesions in a newly diagnosed HIV-1 infected patient
    (2019) PELLEGRINO, D.; LIMA, Patricia Picciarelli de; OLIVEIRA, Augusto Cesar Penalva de; VIDAL, Jose E.
    We report the case of a previously healthy 29-year-old man who has sex with men who was admitted with sub-acute onset of headache, seizures and altered mental status. Physical examination revealed oral thrush, mental confusion and right hemiparesis. An unenhanced computed tomography of the brain revealed multiple rounded hemorrhages associated with perilesional edema and no enhancement was seen after contrast infusion. A rapid test for HIV-1 was positive and the CD4 T-lymphocyte count was 120 cells/mm(3). Pyrimethamine, sulfadiazine plus folinic acid and dexamethasome were started. After two weeks of treatment, the clinical condition and neuroimaging of the patient remained unaltered. A stereotactic brain biopsy was performed and the histopathologic examination confirmed the diagnosis of hemorrhagic toxoplasmosis. After a longer course of anti-Toxoplasma treatment due to an incomplete clinical and radiological response, the patient was discharged home. Hemorrhagic toxoplasmosis is a rare presentation of cerebral toxoplasmosis and should be considered in the differential diagnosis of hemorrhagic cerebral lesions in HIV-infected patients in order to initiate specific treatment promptly.
  • article 0 Citação(ões) na Scopus
    Relationship between actinic keratosis and malignant skin lesions on the eyelid
    (2023) ROSSATO, Luiz Angelo; CARNEIRO, Rachel Camargo; MACEDO, Erick Marcet Santiago de; LIMA, Patricia Picciarelli de; URBANO, Mariana Ragassi; MATAYOSHI, Suzana
    Purpose: To evaluate the variables possibly related to actinic keratosis and malignant skin lesions on the eyelid. Methods: A prospective study of patients with suspected eyelid malignancy was conducted. The participants underwent a 2-mm punch biopsy at two opposite sites of the lesion for diagnosis, and the results were compared with those of the histopathological study of the surgical excised specimen. The patients with an actinic keratosis component were divided into two groups (actinic keratosis-associated malignancy and actinic keratosis alone), which were compared for the following variables: age, disease duration, largest diameter, tumor area, Fitzpatrick classification, sex, tumor site and margin involvement. A cluster analysis was also performed. Results: We analyzed 174 lesions, of which 50 had an actinic keratosis component. Actinic keratosis was associated with squamous cell carcinoma in 22% of the cases and to basal cell carcinoma in 38%, which shows that both neoplasms may have contiguous actinic keratosis. Statistical analysis revealed no significant difference among the variables. In a cluster analysis, four groups were identified with malignant lesions in the medial canthus with the largest mean diameter and area. All margin involvements on the lower eyelid were related to malignancy, which means that all cases with margin involvement had an almost 100% risk of malignancy. Conclusions: Larger actinic keratosis lesions in the medial canthus and lesions with margin involvement on the lower eyelid have a greater probability of malignant association.
  • bookPart
    Infecções herpéticas
    (2022) KATO, Juliana Mika; LIMA, Patrícia Picciarelli de
  • article 4 Citação(ões) na Scopus
    Orbital retinoblastoma: case report
    (2013) MABTUM, Eduardo Darahem; BONANOMI, Maria Teresa Brizzi Chizzotti; LIMA, Patricia Picciarelli de; ALMEIDA, Maria Tereza Assis de
    We describe the case of a 9-month old boy with unilateral retinoblastoma and bulftalmo. Primary enucleation was the treatment of choice due to the lack of visual prognosis. The histology of the enucleated eye showed massive choroidal invasion by the tumor and the optic nerve free of neoplastic tissue. Therefore, no adjuvant chemotherapy or radiotherapy was indicated. Three months after the enucleation, the patient returned with massive orbital retinoblastoma with exposure of the conjunctiva. Treated with chemotherapy, the patient has been in remission for 12 months. The risk factors for orbital recurrence are discussed.
  • conferenceObject
    The impact of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC): A retrospective study of 828 aspirates with emphasis on the prior ""indeterminate"" category
    (2012) FERREIRA, C.; LIMA, P.; MENTEM, M.; ESPOSITO, J.; WASSERSTEIN, L.; FELIPE-SILVA, A.
    Objective: We evaluated the impact of implementing TBSRTC in an academic community hospital. Method: FNAs from Jan/2004 to Dec/2010 were reclassified in TBSRTC: nondiagnostic (ND), benign (B), atypia or follicular lesion of undetermined significance (AUS/FLUS), suspicious for follicular neoplasm (FN), suspicious for malignancy (S) and malignant (M). FLUS and FN were classified according to presence of Hürthle cells as HCLUS and FN-HC. Results: A total of 828 FNAs (480 patients) were obtained: 46 ND (5.55 %), 682 B (82.4 %), 9 S (1.1 %) and 25 M (3.0 %). The 66 (8.0 %) indeterminate categories were reclassified: 1 ND (1.5 %), 8 B (12.1 %), 5 AUS (7.6 %), 34 FLUS (51.5 %), 5 HCLUS (7.6 %), 3 FN (4.5 %), 9 FN-HC (13.6 %) and 1 S (1.5 %). Thyroidectomies were performed in 125 patients (26 %): benign lesions in 83 (66.4 %), 7 (5.6 %) follicular adenoma and 2 (1.6 %) follicular carcinomas, 1 (0.8 %) medullary carcinoma, 21 (16.8 %) papillary carcinomas and 16 (12.8 %) papillary microcarcinomas (PMC). Risk of malignancy (RM) excluding PMC: B 1.4 %, AUS/FLUS/HCLUS 5 %, FN/FN-HC 11.1 %, SM 50 % and M 77.8 %. Conclusion: TBSRTC criteria led to more specific diagnosis. FN/FN-HC category has a two-fold RM when compared to AUS/FLUS/HCLUS.
  • bookPart
    Apresentação
    (2022) CARRICONDO, Pedro Carlos; LEE, Sonia Hae Sun; KATO, Juliana Mika; LIMA, Patrícia Picciarelli de; ALVES, Milton Ruiz
  • conferenceObject
    The Value of Repeated Fine-Needle Aspiration Biopsy in an Academic Community Hospital after the Bethesda System
    (2012) FERREIRA, C. R.; LIMA, P. P.; MENTEM, M. S.; ESPOSITO, J. P.; WASSERSTEIN, L. H.; FELIPE-SILVA, A.
    Background: Follow-up of thyroid nodules with repeated fine-needle aspiration biopsies (rFNA) is recommended in nondiagnostic (ND) samples and in cases of atypia of unknown significance (AUS)/follicular lesions of uncertain significance (FLUS), however, the impact of this approach is generally unexplored. We evaluated the risk of neoplasia (RN) and malignancy (RM) in rFNA. Design: All FNA from Jan/04 to Dec/10 were reclassified according to Bethesda System: ND, benign (B), AUS/FLUS, suspicious for follicular neoplasm (FN), suspicious for malignancy (SM) and malignant (M). Patients with one FNA (1FNA) and with rFNA were compared according to the worst diagnosis in the first FNA (fFNA) or in the rFNA. Surgical pathology (SP) and clinical follow-up were retrieved Results: In 480 patients (F:M=7:1, average age 53), 70 (14.6%) had rFNA. Average number of rFNA was 1.3±0.8. A total of 125 (26%) had a thyroidectomy (21.4% in the rFNA and 26.8% in 1FNA - p=0.3). Diagnoses upon fFNA in rFNA group were ND in 10 (14.3%), B in 49 (70%), AUS/FLUS in 8 (11.4%) and FN/SM in 3 (4.3%). In B group rFNA changed in 3 patients (6.1%) (2 AUS/FLUS, 1 FN) and 11 patients (22.4%) had SP follow-up: 1 follicular adenoma (FA) and 10 benign non-neoplastic lesion (BN), including 1 patient with AUS/FLUS at rFNA. In ND group rFNA changed in all patients: 9 (90%) to B and 1 (10%) to M – SP confirmed papillary carcinoma (PC). In AUS/FLUS group rFNA changed to B in 3 (37.5%) and ND in 1 (12.5%), none with SP. AUS/FLUS rFNA was unchanged in 4 (50%) – SP available in 3: 1 PC, 1 papillary microcarcinoma (PMC) and 1 BN. rFNA changed to B in the 3 patients of FN/MS group, one with BN at SP. Diagnoses in 1FNA group with SP follow-up were ND in 1 (0.9%), B in 60 (54.5%), AUS/FLUS in 15 (13.6%) and FN/SM/M in 34 (30.9%). The 1 ND was BN at SP. In 1FNA B group SP confirmed 7 incidental PMC (11.7%) and 1 FA (1.7%). In 1FNA AUS/FLUS group SP showed 1 FA (6.7%), 1 PC (6.7%) and 1 PMC (6.7%). In 1FNA FN/SFN/M group SP showed 18 PC (52.9%), 6 PMC (17.6%), 1 follicular and 1 medullary carcinoma. RM was 9.1% for all ND FNA. General RN was 9.1% in rFNA B group, 15% in the 1FNA B, 66% in rFNA AUS/FLUS, 20% in 1FNA AUS/FLUS and 82.4% in 1FNA FN/SM/M. Conclusions: Our data support the recommendation of rFNA in ND category. A repeated diagnosis of AUS/FLUS increased the general RN from 20% to 66% (p=0.1). A B fFNA diagnosis had a 4% chance of changing upon rFNA, and a virtually null RM.
  • article 32 Citação(ões) na Scopus
    Invasive squamous cell carcinomas and precursor lesions on UV-exposed epithelia demonstrate concordant genomic complexity in driver genes
    (2020) VEGA, Lorena Lazo de la; BICK, Nolan; HU, Kevin; RAHRIG, Samantha E.; SILVA, Camilla Duarte; MATAYOSHI, Suzana; PICCIARELLI, Patricia; WANG, Xiaoming; SUGAR, Alan; SOONG, Hunson Kaz; MIAN, Shahzad I.; ROBINSON, Dan R.; CHINNAIYAN, Arul M.; DEMIRCI, Hakan; DANIELS, Anthony B.; WORDEN, Francis; EBERHART, Charles G.; TOMLINS, Scott A.; RAO, Rajesh C.; HARMS, Paul W.
    Although squamous cell carcinomas (SCC) are the most frequent human solid tumor at many anatomic sites, the driving molecular alterations underlying their progression from precursor lesions are poorly understood, especially in the context of photodamage. Therefore, we used high-depth, targeted next-generation sequencing (NGS) of RNA and DNA from routine tissue samples to characterize the progression of both well- (cutaneous) and poorly (ocular) studied SCCs. We assessed 56 formalin-fixed paraffin-embedded (FFPE) cutaneous lesions (n = 8 actinic keratosis,n = 30 carcinoma in situ [CIS],n = 18 invasive) and 43 FFPE ocular surface lesions (n = 2 conjunctival/corneal intraepithelial neoplasia,n = 20 CIS,n = 21 invasive), from institutions in the US and Brazil. An additional seven cases of advanced cutaneous SCC were profiled by hybrid capture-based NGS of >1500 genes. The cutaneous and ocular squamous neoplasms displayed a predominance of UV-signature mutations. Precursor lesions had highly similar somatic genomic landscapes to SCCs, including chromosomal gains of 3q involvingSOX2, and highly recurrent mutations and/or loss of heterozygosity events affecting tumor suppressorsTP53andCDKN2A. Additionally, we identify a novel molecular subclass of CIS withRB1mutations. AmongTP53wild-type tumors, human papillomavirus transcript was detected in one matched pair of cutaneous CIS and SCC. Amplicon-based whole-transcriptome sequencing of select 20 cutaneous lesions demonstrated significant upregulation of pro-invasion genes in cutaneous SCCs relative to precursors, includingMMP1,MMP3,MMP9,LAMC2,LGALS1, andTNFRSF12A. Together, ocular and cutaneous squamous neoplasms demonstrate similar alterations, supporting a common model for neoplasia in UV-exposed epithelia. Treatment modalities useful for cutaneous SCC may also be effective in ocular SCC given the genetic similarity between these tumor types. Importantly, in both systems, precursor lesions possess the full complement of major genetic changes seen in SCC, supporting non-genetic drivers of invasiveness.
  • article 0 Citação(ões) na Scopus
    Blood Flow in Monocular Retinoblastoma Assessed by Color Doppler and Correlations With High-Risk Pathologic Features
    (2018) BONANOMI, Maria Teresa B. C.; SAITO, Osmar C.; LIMA, Patricia Picciarelli de; BONANOMI, Roberta Chizzotti; CHAMMAS, Maria Cristina
    PURPOSE. To use color Doppler to analyze blood flow in the retrobulbar central retinal artery (CRA) and central retinal vein (CRV) in monocular retinoblastoma. METHODS. This prospective study included patients with group D and E retinoblastomas managed with only enucleation. Peak blood velocities were assessed in the CRA and CRV of tumor-containing eyes (CRAv and CRVv, respectively). The resistivity index in the CRA (RIa) and pulse index in the CRV (PIv) were calculated and related to optic nerve invasion (ONi), choroid invasion (mCHi), and tumor volume. RIa and PIv were also calculated for healthy eyes. RESULTS. In total, 25 patients with a mean age of 30.8-months old were included. The means (SD) for CRAv, CRVv, RIa, and PIv were 26.94 (12.32) cm/s, 16.2 (9.56) cm/s, 0.88 (0.12) and 0.79 (0.29), respectively. Tumor volume was significantly correlated with CRAv (P = 0.025) and RIa (P = 0.032). ONi was present in 19 eyes and correlated with a smaller PIv (P < 0.001). A PIv less than 0.935 had a sensitivity of 89.5% and specificity of 83.3% for predicting ONi. mCHi was not correlated with flow values. Healthy eyes had a significantly lower RIa (P < 0.001) and lower PIv than eyes with (P = 0.009) and without (P < 0.001) ONi. CONCLUSIONS. In advanced-stage monocular retinoblastoma, tumor volume was directly correlated with CRAv and RIa, and lower PIv was correlated with optic nerve invasion when a predictive cut-off value of less than 0.935 was applied. Comparisons with healthy eyes showed that tumor-containing eyes were associated with higher RIa and PIv values.