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Neuroparacoccidiodimycosis (NPDM) is an uncommon granulomatous disease, which more frequently affects immunocompromised male patients over 30 years of age in the course of chronic lung disease. Paracoccidioides brasiliensis (PB) is an endemic fungus in Brazil, and grows as thick-walled yeast (with round to oval bodies) measuring 10 µm to 60 µm in diameter. Neuroparacoccidiodimycosi may develop many years after transmission and/or primary lung involvement. The authors describe a case of NPDM affecting a male patient, 52 years of age, farmer, heavy smoker, with clinical complaint of headache, asthenia, seizures, and prostration in the previous nine months. Upon physical examination, the patient presented regular general condition, without other relevant physical alterations. Computed tomography (CT) showed multiple bilateral pulmonary nodules associated to enlargement of the mediastinal lymph node. Magnetic resonance imaging (MRI) and CT scans of the central nervous system showed six heterogeneous nodular lesions compromising the frontal and parietal lobes, the largest one measuring 3.8 × 3.2 × 3.2 cm. The hypothesis of a neoplastic process compromising the lung and brain was considered. A biopsy of the mediastinal lymph node showed epithelioid granulomas, which exhibited round, thin-walled fungal structures in Grocott silver stain. The stereotactic biopsy of the frontal lesion was constituted by necrotic tissue admixed with some round to oval, thin-walled fungi measuring 10 µm to 60 µm, compatible with PB (identified on Grocott silver stain/confirmed in culture). The diagnosis of NPDM was then established. The employed therapeutic regimen was intravenous amphotericin B, itraconazole, and sulfamethoxazole-trimetropin. After ninety days of clinical follow-up, no episodes of seizures/neurological deficits were identified, and a marked decrease in the number and size of the lung and brain lesions were found.

Introduction According to the World Health Organization (WHO) classification, invasive breast carcinoma (IBC) of no special type (IBC-NST) is the second most common primary site of central nervous system metastases, affecting 15% to 30% of patients. Brain metastasis originating from IBC is associated with patient age, tumor size, and axillary lymph node status. Loss of expression of hormone receptors and c-erbB-2 amplification are frequent findings in patients who develop brain metastasis. Radiological studies of the central nervous system are carried out only in patients presenting with neurological signs or symptoms during the clinical follow-up. Objective To evaluate the associations of clinical and pathological findings with brain metastasis in breast cancer. Materials and Methods The sample comprised 73 patients with breast cancer who underwent mastectomy with lymph node resection. The following variables were evaluated: tumor size, histological grade, nodal state, expression of estrogen and progesterone receptors and c-erbB-2, and presence of brain metastasis. Results The histopathological findings associated with brain metastasis in patients with IBC were tumor size (p = 0.03), presence of nodal metastasis (p = 0.045), and c-erbB-2 expression (p = 0.012). Conclusion The assessment of specific pathological findings in breast carcinoma can help identify risk factors and/or clinical parameters associated with the development of brain metastasis.