Introdução A Síndrome de Guillan-Barré (SGB) é uma polirradiculoneuropatia inflamatória reportada, geralmente, após uma infecção viral. A SGB foi descrita em relatos de casos como decorrente da Doença do Coronavírus 2019 (COVID-19), embora não haja estudos que comprovem a relação. Com o início da campanha mundial de imunização contra a COVID-19, a SGB também tem sido apontada como um possível efeito adverso pós-vacinal. Descrição do caso Homem, 53 anos, iniciou quadro de paresia de membros inferiores (MMII) associada à parestesia em pés e mão direita. Evoluiu com 3 episódios de queda de própria altura, paresia de membros superiores (MMSS) e dor em queimação na região escapular direita e irradiação para região lombar. Queixou-se de retenção urinária e constipação intestinal. Relatou imunização contra a COVID-19 (BNT162b2/Pfizer) há 20 dias e início dos sintomas há 6 dias. Glasgow 15 na admissão, apresentou: paralisia facial de padrão nuclear em hemiface direita, desvio de rima bucal para a esquerda, disartria grave, força grau 3 em MMSS e grau 2 em MMII e arreflexia tetrassegmentar, orientação e sensibilidade preservadas. A hipótese diagnóstica é de SGB variante Miller-Fisher, com déficit do VII nervo craniano à direita, síndrome disautonômica e síndrome padrão de acometimento de segundo neurônio motor. Comentários Várias descrições já realizadas associam vacinas à patogênese da SGB, como a da Influenza H1N1 e a do pólio. Isto pode ser explicado pela resposta imune anormal às proteínas-alvo específicas contidas nos imunizantes, à semelhança de patógenos virais. Em relação à BNT162b2, poucos relatos são encontrados na literatura e, apesar de não ser possível descartar a hipótese, fatores apontam para baixa probabilidade de associação. Os fatores são: nenhum dos materiais imunogênicos adicionais é conhecido por desencadear SGB; diante da ausência de estudos prospectivos de alta qualidade não foi encontrada associação estatística entre a infecção por Sars-Cov-2 e a SGB; e a não similaridade entre os casos descritos (neste, o paciente de idade adulta média tomou apenas a 1ª dose e não manifestou sintomas infecciosos gastrointestinais ou respiratórios prodrômicos, enquanto outros pacientes pertenciam a diversas faixas etárias, variaram entre 1ª ou 2ª dose e, naqueles que tiveram pródromos, houve detecção de agentes conhecidamente desencadeadores de SGB). Contudo, este é o primeiro caso descrito de SGB variante Miller-Fisher na pós-vacinação por BNT162b2.

Objective:The primary aim is to analyze the endoscopic endonasal surgical results in short-term and two-year follow-ups according to the 11th Acromegaly Consensus statement (2018). Indeed, prognostic factors and complications were analyzed. Subjects and methods: 40 patients who underwent endoscopic endonasal surgery by acromegaly between 2013 to 2020 was analyzed. Patients were considered in remission if an upper limit of normal (ULN) IGF-1 was less than 1.0 at the six-month and two-year follow-ups. Moreover, we assessed the Knosp grade, tumor volumetry, ULN, T2 signal in MRI, reoperation, and complications. Results: The mean age of admission was 46.7 years. Thirty-two patients were in remission after six months of surgery (80%), decreasing to 76.32% at the two-year follow-up. All microadenomas presented remission (n = 6). Regarding the complications, three patients had permanent panhypopituitarism (7.5%); postoperative cerebrospinal fluid (CSF) leaks did not occur in this series. The hyperintense signal on the T2 MRI and a higher tumor volumetry were the single predictor's factors of non-emission in a multivariate regression logistic analysis (p < 0.05). Preoperative hormone levels (GH and IGF-1) were not a prognostic factor for remission. The re-operated patients who presented hypersignal already had a high predictor of clinical-operative failure. Conclusion: The endoscopic endonasal surgery promotes high short-term and two-year remission rates in acromegaly; the tumor's volumetry and the T2 hypersignal were statistically significant prognostic factors in non-remission -the complications presented at similar rates in comparison to the literature. In invasive GH-secreting tumors, we should offer these patients a multi-disciplinary approach to improve acromegalic patients' remission rates.

Background and Aim: Gynecological cancer is one of the most common types of cancer worldwide. Nonetheless, spinal metastasis from gynecological cancer is scarcely reported in the literature. In cases of spinal cord compression, the standard treatment is a decompressive surgery followed by radiotherapy treatment for selected patients. This study aimed to report the overall survival and surgical results in patients presenting with gynecological spinal metastases who underwent spinal cord/nerve root decompression and stabilization. Methods and Materials/Patients: A total of 18 patients were included in this study. The surgical procedures were performed from 2012 to 2019. The evaluation of neurological status, spinal stability, and pain were performed using the American Spinal Injury Association Impairment Scale (ASIA), Spinal Instability Neoplastic Score (SINS), and Visual Analogue Scale (VAS), respectively. Results: The lumbar spine was the most affected location (n=30; 50.0%). Regarding the preoperative neurological deficits, 16 cases (n=16; 88.9%) presented ASIA graded A–D before the surgery, being reduced to five (n=5; 27.8%) after the procedures. The pain level means (pre-and postoperative) were 9.39±0.79 and 2.28±1.44. The overall median survival was 6.1 months (95% Confidence Interval [CI] of 1.10–11.13 months). The mean survival of ambulatory and non-ambulatory patients before the surgery was 7.36 months and 3.2 months, respectively (P=0.007 – Log-rank Mantel–Cox). Conclusion: Decompressive surgery and stabilization promote mechanical pain relief, spinal stability, an improvement of neurological function, and indirectly improving quality of life, despite a dismal overall survival of patients who present with metastatic spinal compression disease.

Introduction/Objectives: Breast cancer is one of the most common malignancies among women, with 10% resulting from genetic predisposition. Li-Fraumeni syndrome is an autosomal dominant disease that predisposes to multiple primary tumors and is responsible for less than 0.1% of breast cancers, being considered in early-onset tumors. The aim of this report was to describe a fast evolution of three primary tumors in a young patient with Li-Fraumeni syndrome, including ductal breast carcinoma. Case Report: In 2017, a 27-year-old female patient was diagnosed with malignant cancer of the right breast, Luminal HER KI67 70%, clinical stage IV (liver and lung), underwent first-line cancer treatment, maintaining endocrinotherapy and Double Block, with a positive genetic panel test for TP53 mutation, inferring SLF. In 2018, screening colonoscopy showed colon adenocarcinoma, pT53pN1, treated with total colectomy with ileal pouch, followed by suspension of endocrinotherapy and maintenance of Double Block and adjuvant FOLFOX. At the end of chemotherapy, endocrinotherapy was adopted again. Reassessment tests showed partial response in the liver, but the primary nodules were unchanged. Biopsy after thoracoscopy described lung adenocarcinoma, pT3pN2, submitted to adjuvant with Gemzar and Navelbine, followed by Double Block and interruption of endocrinotherapy. It evolved with the appearance of nodules in the right breast, suggestive of progression of breast disease, under treatment with Xeloda, Herceptin, and Perjeta, showing good clinical response. Discussion: Breast cancer in young people increases the possibility of heredity, thus raising the need for investigations of genetic syndromes. Although rare, the identification of FHL brings an important implication for the genetic counseling. Early diagnosis is the best form of management, enabling the preventive screening and intervention of multiple malignancies. Conclusion: Cases of breast cancer in young women should raise a suspected diagnosis of Li-Fraumeni syndrome, which can change the therapeutic and investigation of other cancers at an early stage.

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