FERNANDO PEREIRA FRASSETTO
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- Oncocytic Meningioma: Case Report of a Rare Meningioma Variant(2023) CASAL, Yuri Reis; TEIXEIRA, Livia Porto; BANDEIRA, Gabriela Alencar; PORCEBAN, Matheus Moreli; PAIVA, Wellingson Silva; GODOY, Luis Filipe de Souza; YAMAKI, Vitor Nagai; LUCATO, Leandro Tavares; ALVES, Venancio Avancini Ferreira; FRASSETTO, Fernando PereiraOncocytic meningioma has been first identified in 1997 as a rare meningioma variant, composed predominantly of large meningothelial cells with abundant intracytoplasmic mitochondria. Here, we describe a 34-year-old male patient presenting with 2 weeks of progressive holocranial headache. Brain magnetic resonance imaging (MRI) revealed an extra axial solid-cystic expansive lesion in the left parieto-occipital parasagittal region, with intense vascularization. Histological and immunohistochemical analysis established the diagnosis. We also review briefly the pathological and radiological findings of this rare variant of meningioma as described in the literature.
- Survivin: A Potential Marker of Resistance to Somatostatin Receptor Ligands(2023) HERKENHOFF, Clarissa G. Borba; TRARBACH, Ericka B.; BATISTA, Rafael Loch; SOARES, Ibere Cauduro; FRASSETTO, Fernando Pereira; NASCIMENTO, Felipe Barjud Pereira do; GRANDE, Isabella Pacetti Pajaro; SILVA, Paula P. B.; DUARTE, Felipe H. G.; BRONSTEIN, Marcello D.; JALLAD, Raquel S.Context Invasive and somatostatin receptor ligand (SRL)-resistant pituitary tumors represent a challenge in the clinical practice of endocrinologists. Efforts have been made to elucidate reliable makers for both. Survivin and eukaryotic translation initiation factor-binding protein 1 (4EBP1) are upregulated in several cancers and involved in apoptosis and cell proliferation. Objective We explored the role of these markers in somatotropinomas. Methods Immunostains for survivin and 4EBP1, and also for somatostatin receptor type 2 (SSTR2), Ki-67, and cytokeratin 18, were analyzed in tissue microarrays containing 52 somatotropinoma samples. Tumor invasiveness was evaluated in all samples while drug resistance was evaluated in 34 patients who received SRL treatment. All these parameters were correlated with first-generation SRL (fg-SRL) responsiveness and tumor invasiveness. Results Low survivin expression (P = 0.04), hyperintense signal on T2 weighted image (T2WI) (P = 0.01), younger age (P = 0.01), sparsely granular adenomas (SGA) (P = 0.04), high postoperative growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels (P = 0.049 and P < 0.001, respectively), and large postoperative tumor size (P = 0.02) were associated with resistance to fg-SRL. Low survivin and SSTR2 expression and high 4EBP1 expression were associated with SGA (P = 0.04, P = 0.01, and P = 0.001, respectively). Younger age (P = 0.03), large tumor pre- and postoperative (P = 0.04 and P = 0.006, respectively), low SSTR2 expression (P = 0.03), and high baseline GH and IGF-1 (P = 0.01 and P = 0.02, respectively) were associated with tumor invasiveness. However, survivin, 4EBP1, Ki-67, and granulation patterns were not associated with tumor invasion. Conclusion This study suggests that low survivin expression is predictive of resistance to fg-SRL in somatotropinomas, but not of tumor invasiveness.
- Glioneuronal and Neuronal Tumors: Who? When? Where? An Update Based on the 2021 World Health Organization Classification(2023) AYRES, A. S.; BANDEIRA, G. A.; FERRACIOLLI, S. F.; TAKAHASHI, J. T.; MORENO, R. A.; GODOY, L. F. de Souza; CASAL, Y. R.; LIMA, L. G. C. A. de; FRASSETO, F. P.; LUCATO, L. T.Neuronal and glioneuronal tumors usually have a benign course and may have typical imaging characteristics, allowing their diagnosis based on MR imaging findings. The most common lesions are dysembryoplastic neuroepithelial tumors and gangliogliomas, which have typical imaging characteristics. The fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System, recently published in 2021, places greater emphasis on molecular markers to classify tumors of the CNS, leading to extensive changes in the classification of tumors, including neuronal and glioneuronal tumors. The 2021 revision included 3 new tumors types: multinodular and vacuolating neuronal tumor, diffuse glioneuronal tumor with oligodendroglioma-like features and nuclear clusters (a provisional type), and myxoid glioneuronal tumor. Following these recent changes in the World Health Organization classification, we aimed to review the main imaging features of these lesions in relation to their histopathologic and molecular features. Learning Objectives: To list the neuronal and glioneuronal tumors; recognize the main imaging findings and histologic characteristics of neuronal and glioneuronal tumors; know the typical location of each neuronal and glioneuronal tumor; and become familiar with the main molecular alterations of neuronal and glioneuronal tumors to better understand their behavior
- Neuropathology of yellow fever autopsy cases(2023) FRASSETTO, Fernando Pereira; ROSEMBERG, SergioBackgroundYellow fever is a viral hemorrhagic fever caused by yellow fever virus, a mosquito-borne flavivirus. Despite an effective vaccine, major outbreaks continue to occur around the world. Even though it is not a proven neurotropic virus, neurological symptoms in more severe clinical forms are frequent. The understanding of this apparent paradox is still rarely addressed in literature.MethodsThe brains of thirty-eight patients with yellow fever confirmed by RT-PCR, who underwent autopsy, were analyzed morphologically to identify and characterize neuropathological changes. The data were compared with brains collected from individuals without the disease, as a control group. Both cases and controls were subdivided according to the presence or absence of co-concurrent septic shock, to exclude changes of the sepsis associated encephalopathy. To verify possible morphological differences between the yellow fever cases groups, between the control groups, and between the cases and the controls, we applied the statistical tests Fisher's exact test and chi-square, with p values < 0.05 considered statistically significant.ResultsAll cases and controls presented, at least focally, neuropathological changes, which included edema, meningeal and parenchymal inflammatory infiltrate and hemorrhages, and perivascular inflammatory infiltrate. We did not find an unequivocal aspect of encephalitis. The only parameter that, after statistical analysis, can be attributed to yellow fever was the perivascular inflammatory infiltrate.ConclusionsThe neuropathological findings are sufficient to justify the multiple clinical neurologic disturbances detected in the YF cases. Since most of the parameters evaluated did not show statistically significant difference between cases and controls, an explanation for most of the neuropathological findings may be the vascular changes, consequent to shock induced endotheliopathy, associated with stimulation of the immune system inherent to systemic infectious processes. The statistical difference obtained in yellow fever cases regarding perivascular infiltrate can be can be explained by the immune activation inherent to the condition.
- Brain tuberculoma in pediatric heart transplant recipient(2023) OLIVEIRA, Pedro Carpini de; CORBI, Maria Julia de Aro Braz; SIQUEIRA, Adailson Wagner da Silva; NAVAJASEGARAN, Joshua; MESQUITA, Ana Sofia Silva; FRASSETTO, Fernando Pereira; JATENE, Marcelo Bisceglli; IKARI, Nana Miura; AZEKA, EstelaIntroductionHeart transplantation is the standard treatment for end-stage heart disease. Despite advances in the field, patients remain under risk of developing complications, including opportunistic infections, such as tuberculosis. We present the unprecedented case of cerebral tuberculoma in a 9-year-old heart transplant recipient. Case ScenarioA 9-year-old female child, who underwent heart transplantation in December 2020, was admitted to the emergency department in September 2021 due to headache and vomiting. She had normal vital signs and a mild left hemiparesis. Laboratory findings included lymphopenia and a low C Reactive Protein and brain images showed expansive lesions. A biopsy of the intracranial lesion was performed and anatomopathological analysis was compatible with tuberculoma. After the diagnosis was established, treatment protocol for neurotuberculosis was initiated, the patient had a satisfactory clinical evolution and was discharged 22 days after admission. DiscussionClinical manifestation of tuberculosis usually occurs up to 6 months after transplantation, the findings are commonly atypical and symptoms may be mild. We could not find in medical literature any description of the disease in a heart transplant recipient as young as the one presented in this case report. We documented great response to treatment, even though conventional antituberculosis therapy may interfere with immunosuppression. ConclusionPatients in the postoperative period following heart transplantation are at high risk for developing opportunistic infections such as tuberculosis, which may present with atypical symptoms. Therefore the clinician must have a high index of suspicion in order to make the correct diagnosis and promptly start treatment.