Comparison of inflammation in the tongue with inflammation of the aorta and coronary arteries: an autopsy study of the histologic features and immunohistochemical markers

Atherosclerosis is an inflammatory disease of the arteries responsible for a high rate of morbidity and mortality worldwide. The objective of this study was to associate the histopathologic and immunohistochemical aspects of tongue inflammation with aortic and coronary atherosclerosis in autopsied humans. A total of 4378 autopsy reports were analyzed, and cases were included in the study if fragments of the individual's tongue, aorta, and coronary artery were available for analysis (N = 16). Morphologic and immunohistochemical evaluations were performed for interleukin 1α (IL-1α), IL-6, tumor necrosis factor α (TNF-α), and interferon γ (IFN-γ). Findings of IL-1α in the aorta were associated with the following parameters evaluated in the tongue: IL-6 (P = 0.031), inflammation in the submucosa (P = 0.042), and spongiosis (P = 0.018). Findings of IL-6 in the tongue were associated with IL-1α (P = 0.031), IL-6 (P = 0.016), and TNF-α (P = 0.016) in the aorta. Tongue exocytosis was associated with IL-6 (P = 0.003) and IFN-γ (P = 0.003) in the aorta. Inflammation in the submucosa, spongiosis, and higher immunostaining by IL-6 on the tongue are associated with higher immunostaining by IL-1α in the aorta. In addition, increased intensity in the presence of IL-6 in the tongue is also associated with increases in IL-6 and TNF-α in the aorta. Because these cytokines contribute to the process of atherosclerosis, and infectious agents are a major cause of inflammation in the tongue, it seems likely that proper prevention and treatment of lingual infections could reduce the risk of atherosclerosis. However, further studies are needed to corroborate these findings.

Immunostaining of stromal CD56 cells in ovarian malignancies

OBJECTIVES

The aim of this study was to evaluate CD56 immunostaining in the stroma of benign and malignant ovarian epithelial neoplasms and associate the CD56 immunostaining with prognostic factors and survival in ovarian cancer.

METHODS

Patients with ovarian epithelial neoplasia (n=77) were studied with a prospective cohort. The CD56 immunostaining was evaluated in the peritumoral stroma. Two groups were evaluated: benign ovarian neoplasms (n=40) and malignant ovarian neoplasms (n=37). Data were recorded for histological type and grade, International Federation of Gynecology and Obstetrics staging, molecular subtype, and lymph node metastases. Fisher's exact test and Kaplan-Meier survival curves were used, with a significance level of ≤0.05.

RESULTS

We found greater CD56 stromal immunostaining in malignant neoplasms when compared to the group of benign neoplasms (p=0.00001). There was no significant difference in relation to the prognostic factors and survival.

CONCLUSION

Malignant ovarian neoplasms showed higher stromal CD56 immunostaining. As the prognostic value of natural killer in ovarian cancer is controversial, knowing the specific function of each cell present both in the tumor tissue and systemically may help guide successful immunotherapies in the near future.

Mast cells and M2 macrophages in ovarian cancer

The objectives of this study were to investigate the immunohistochemical expression of markers of mast cells and M2 macrophages in benign and malignant ovarian neoplasms and to examine the prognostic value of this expression in ovarian cancer. The study was performed with samples from 32 patients, divided into benign (n = 16) and malignant (n = 16) neoplasm groups. Samples obtained by surgical resection were submitted to immunohistochemical analysis. Higher proportions of M2 macrophages (p = .041) and mast cells (p = .0054) were present in malignant than benign ovarian neoplasms. Histological grade 2/3 was related to higher proportions of M2 macrophages compared with grade 1 (p = .0102). Stages II-IV were also related to higher proportions of M2 macrophages (p = .0102). Logistic regression revealed that M2 macrophages predicted malignancy [odds ratio (OR) = 1.017; 95% confidence interval (CI), 1.003-1.037; p = .017], but that mastocytes had greater predictive value for this outcome (OR = 1.127; 95% CI, 1.018-1.105; p = .013). M2 macrophages predicted more advanced histological grades (OR = 1.060; 95% CI, 1.010-1.218; p = .003). The proportions of M2 macrophages and mast cells were greater in malignant than in benign ovarian neoplasms. Larger proportions of cells expressing M2 macrophages were related to more advanced histological grades and disease stages, and thus to worse prognoses for ovarian cancer.Impact StatementWhat is already known on this subject? Concentrations of mast cells and M2 macrophages have been observed in several tumour types, but their significance remains uncertain.What do the results of this study add? The proportions of M2 macrophages and mast cells were greater in malignant than in benign ovarian neoplasms. Larger proportions of cells expressing M2 macrophages were related to higher histological grades and more advanced stages of the disease.What are the implications of these findings for clinical practice and/or further research? Larger proportions of cells expressing M2 macrophages were related to worse prognoses for malignant ovarian neoplasia. The discovery of new prognostic factors in ovarian cancer may be the target of studies on new treatments and immunotherapies for this disease. In addition, it can help guide the oncologist towards more aggressive treatments for patients with worse prognostic factors.

CHRONIC USE OF PROTON PUMP INHIBITORS AND THE QUANTITY OF G, D, AND ECL CELLS IN THE STOMACH

BACKGROUND

Acid inhibition from chronic proton pump inhibitor use and a possible increase in gastrin can lead to changes in the regulation of hydrochloric acid production. However, it has not known whether such chronic use changes the presence of gastrin, delta, and enterochromaffin-like cells in the stomach or the relationship between gastrin and delta cells.

AIM

To analyze the number of gastrin-producing gastrin cells, somatostatin-producing cells, and histamine-producing cells in patients who were chronic users of proton pump inhibitor, with or without related Helicobacter pylori infection.

METHODS

Biopsies from 105 patients, including 81 chronic proton pump inhibitor users (experimental group) and 24 controls, were processed immunohistochemically and subjected to counting of gastrin, delta, and enterochromaffin-like cells in high-magnification microscopic fields and in 10 glands.

RESULTS

Gastrin cell, delta cell, and enterochromaffin-like cells counts were similar across the groups and appeared to be unaffected by Helicobacter pylori infection. The ratio between gastrin cells and delta cells was higher in the chronic users of proton pump inhibitor group than in controls.

CONCLUSION

Chronic users of proton pump inhibitor does not affect gastrin cell, delta cell, and enterochromaffin-like cell counts significantly, but may alter the ratio between gastrin cells and delta cells.

Overexpression of HIF-1α and Morphological Alterations in the Tongue of Rats Exposed To Secondhand Smoke

Smoking is a risk factor for serious health problems and is associated with several changes in the tissues of the oral cavity. The aim of this study was to evaluate the collagen percentage, mast cells density, intensity of immunolabeled cells by anti-HIF-1α in the musculature lingual of rats exposed to secondhand smoke. Twenty-seven female Wistar albino rats were divided into three groups: rats not exposed to tobacco smoke inhalation (Control group) (n=7); rats exposed to smoke inhalation for 30 days (TAB 30) (n=10); and rats exposed to smoke inhalation for 45 days (TAB 45) (n=10). Subsequently, the animals were submitted to euthanasia and removal of the tongue for histological and immunohistochemistry processing and analysis. In the groups TAB 30 and TAB 45 there were a lower percentage of collagen, a higher density of mast cells and a greater intensity of anti-HIF-1α immunolabeled cells compared to Control group. There was also a positive and significant correlation between the percentage of collagen and mast cell density. There was not significative difference between TAB 30 e TAB 45 in any of the parameters evaluated. Therefore, the exposure of rats to secondhand smoke for 45 days causes decrease in perimysial collagen fibers, increase in the number of mast cells and increase in the immunolabeling for HIF-1α in lingual muscle cells. The present study was the first to evaluate the percentage of collagen, mast cell density and immunostaining for HIF-1α in rat tongues exposed to tobacco smoke.

Histoplasmosis in HIV-Infected Patients: Epidemiological, Clinical and Necropsy Data from a Brazilian Teaching Hospital

Histoplasmosis occurs in 5-10% of HIV-infected patients in endemic areas and evolves to severe and disseminated infection with mortality rates over 50% in some regions. This report presents epidemiological, clinical and outcome data from HIV-infected patients with histoplasmosis confirmed by culture and/or at necropsy who were admitted to a Brazilian teaching hospital. Data from 65 patients were obtained from their respective medical and necropsy records. From 2005 to 2018, 36 HIV-infected patients were diagnosed with histoplasmosis confirmed by culture. At admission, most of these patients presented disseminated fungal infection, whereas 15 (41.7%) were simultaneously diagnosed with both HIV infection and histoplasmosis. Fever, weight loss, hepatosplenomegaly, respiratory and digestive symptoms were present in 86.2%, 50%, 44.4% and 41.7% of the patients, respectively. At admission, 24 patients had low CD4 T-cell count and high viral load values. Among the 30 patients who received antifungals, 16 (53.3%) were cured, 13 (43.3%) died, and one was lost to follow-up. Six patients died prior to therapy. From 1990 to 2018, 63 necropsies of patients with Histoplasma capsulatum infection were performed. Of these patients, 29 (46.0%) were HIV-infected individuals, including 21 (72.4%) who presented disseminated histoplasmosis and 21 (72.4%) who were diagnosed with histoplasmosis at necropsy. The epidemiological, clinical and outcome profiles presented herein are similar to those described elsewhere and reinforce the difficulties that are still present in limited-resource settings where advanced immunodeficiency, combined with severe fungal infection and late patient admissions, is related to poor outcomes.

Hemophagocytic Lymphohistiocytosis in Autopsied Adults: Clinical, Laboratory and Immunohistochemical Evaluation for CD68 and CD57. Case Report and Literature Review

AbstractHemophagocytic lymphohistiocytosis (HLH) is a rare, usually fatal and underdiagnosed autoimmune-activated disease. The present study aimed to perform a macroscopic, histopathological and immunohistochemical evaluation for CD68 and CD57 in organs of autopsied adults with HLH. A total of 604 autopsy reports were analyzed, and all the patients that filled the diagnostic criteria for HLH (n = 2) were selected. These patients were 18 and 37 years old. Were evaluated both clinical and autopsy reports and performed histopathological and immunohistochemical analysis of the liver and spleen. Both patients filled the diagnostic criteria for HLH, as well as presented common signs and symptoms of this disease, such as chills, abdominal pain, diaphoresis, and jaundice. Hemophagocytosis was observed in the spleen, bone marrow, and lymph nodes of the two patients at autopsy. Immunostaining in the liver and spleen of both patients was mainly severe for CD68, and predominantly mild for CD57, indicating a decrease in NKC numbers and an increase in the number of macrophages, respectively. This was the first study to evaluate CD57 and CD68 in autopsies of adults with HLH. Thus, more studies are required, not only to better elucidate the pathogenetic mechanisms involved in the secondary HLH, but also to disseminate the results in the clinical environment, contributing to the early diagnosis and treatment with consequent reduction of mortality rate. Keywords: Autoimmune Diseases. Histiocytosis. Biomarkers. ResumoA Linfohistiocitose Hemofagocítica (HLH) é uma doença autoimune rara, geralmente fatal e subdiagnosticada. Este estudo tem como objetivo realizar avaliação macroscópica, histopatológica e imunohistoquímica para CD68 e CD57 em órgãos de pacientes adultos com HLH submetidos a autópsia. Um total de 604 laudos de autópsias foram analisados e todos os pacientes que preencheram os critérios diagnósticos para HLH (n = 2) foram selecionados. Esses pacientes tinham 18 e 37 anos de idade. Foram analisados tanto os prontuários quanto os laudos de autópsia, bem como foram realizadas análises histopatológicas e imunohistoquímicas do fígado e baço dos pacientes. Ambos preencheram os critérios diagnósticos para HLH e apresentarem sinais e sintomas comuns da doença, como calafrios, dor abdominal, sudorese e icterícia. A hemofagocitose foi observada no baço, medula óssea e linfonodos dos dois pacientes na autópsia. A imunohistoquímica do fígado e do baço de ambos os pacientes demonstrou imunomarcação acentuada para CD68 e predominantemente discreta para CD57, que indicam diminuição do número de NKC e aumento do número de macrófagos, respectivamente. Este foi o primeiro estudo a avaliar o CD57 e CD68 em autópsias de adultos com HLH. Assim, mais estudos são necessários, não apenas para melhor elucidar os mecanismos patogenéticos envolvidos na HLH secundária, mas também para disseminar os resultados no ambiente clínico, contribuindo para o diagnóstico e tratamento precoces com consequente redução da taxa de mortalidade. Palavras-chave: Doenças Autoimunes. Histiocitose. Biomarcadores.

Lingual salivary gland hypertrophy and decreased acinar density in chagasic patients without megaesophagus

Although the salivary glands present several functions, there are few studies evaluating these glands in Chagas disease (CD). This study aimed to compare the percentage of collagen, the presence of inflammation, the density of chimase and tryptase mast cells, the area and density of lingual salivary gland acini in autopsied individuals with and without (CD). We analyzed 400 autopsy reports performed in a tertiary public hospital from 1999 to 2015 and selected all the cases in which tongue fragments were collected (27 cases), 12 with chronic CD without megaesophagus (CH) and 15 without CD (non-chagasic - NC). The histological sections of the tongue were stained by Picrosirius red for collagen evaluation and Hematoxylin-eosin for morphometric evaluation of salivary gland acini and inflammation. Anti-chimase and anti-tryptase antibodies were used for the immunohistochemical evaluation of mast cells. The chagasic patients presented higher volume and lower density of salivary glands acini. There was no difference in the collagen percentage, inflammation and density of mast cell chymase and tryptase between the groups. Although we did not observe a significant difference between the groups regarding the collagen percentage, inflammatory process and mast cell density, our results suggest that even without megaesophagus, chagasic patients present hypertrophy of the lingual salivary glands and lower acinar density probably due to mechanisms independent of the esophagus-glandular stimulus.

Increased serum gastrin in patients with different clinical forms of Chagas disease coinfected with Helicobacter pylori

Trypanosoma cruzi and Helicobacter pylori (HP) are pathogens that cause chronic diseases and have been associated with hypergastrinemia. The aim of this study was to evaluate the fasting gastrin levels in patients with different clinical forms of Chagas disease (CD), coinfected or not by HP. The enrolled individuals were outpatients attending at the university hospital. HP infection was assessed by serology and 13 C-urea breath test. Fasting serum gastrin concentration was measured by chemiluminescence assay. Gastric endoscopic and histological features were also evaluated. Associations between CD and serum gastrin level were evaluated in a logistical model, adjusting for age, gender and HP status. A total of 113 patients were evaluated (45 with Chagas disease and 68 controls). In the multivariate analysis, increasing serum gastrin levels (OR= 1.02; 95% CI= 1.01-1.12), increasing age (OR= 1.05; 95% CI= 1.02 - 1.09) and HP-positive status (OR = 2.88; 95% CI = 1.10 - 7.51) remained independently associated with CD. The serum gastrin levels were significantly higher in the group of patients with the cardiodigestive form ( P = 0.03) as well as with digestive form ( P = <0.001) of Chagas disease than in the controls. In conclusion, patients with cardiodigestive and digestive clinical forms of CD have increased basal serum gastrin levels in comparison with controls. Moreover, we also demonstrated that H. pylori coinfection contributes to the hypergastrinemia shown in CD.

Melatonin treatment in fetal and neonatal diseases

This literature review aims to address the main scientific findings on oxidative stress activity in different gestational disorders, as well as the function and application of melatonin in the treatment of fetal and neonatal changes. Oxidative stress has been associated with the etiopathogenesis of recurrent miscarriages, preeclampsia, intrauterine growth restriction, and stillbirth. Both, the exacerbated consumption of the antioxidant enzymes superoxide dismutase, catalase and glutathione peroxidase, and the increased synthesis of reactive oxygen species, such as superoxide, peroxynitrite, and hydrogen peroxide, induce phospholipid peroxidation and endothelial dysfunction, impaired invasion and death of trophoblast cells, impaired decidualization, and remodeling of maternal spiral arteries. It has been postulated that melatonin induces specific biochemical responses that regulate cell proliferation in fetuses, and that its antioxidant action promotes bioavailability of nitric oxide and, thus, placental perfusion and also fetal nutrition and oxygenation. Therefore, the therapeutic action of melatonin has been the subject of major studies that aim to minimize or prevent different injuries affecting this pediatric age group, such as intrauterine growth restriction, encephalopathy, chronic lung diseases, retinopathy of prematurity Conclusion: the results antioxidant and indicate that melatonin is an important therapy for the clinical treatment of these diseases.

Role of Alpha-Smooth Muscle Actin and Fibroblast Activation Protein Alpha in Ovarian Neoplasms

BACKGROUND/AIMS

Studies show that tumor growth is not just determined by the presence of malignant cells, since interactions between cancer cells and stromal microenvironment have important impacts on the cancer growth and progression. Cancer-associated fibroblasts play a prominent role in this process. The aims of the study were to investigate 2 cancer-associated fibroblasts markers, alpha-smooth muscle actin (α-SMA), and fibroblast activation protein alpha (FAP) in the stromal microenvironment of benign and malignant ovarian epithelial neoplasms, and to relate their tissue expression with prognostic factors in ovarian cancer.

METHODS

α-SMA and FAP were evaluated by immunohistochemistry in malignant (n = 28) and benign (n = 28) ovarian neoplasms. Fisher's exact test was used with a significance level lower than 0.05.

RESULTS

FAP immunostaining was stronger in ovarian cancer when compared to benign neoplasms (p = 0.0366). There was no significant difference in relation to α-SMA expression between malignant and benign ovarian neoplasms as well as prognostic factors. In ovarian cancer, FAP stainings 2/3 was significantly related to histological grades 2 and 3 (p = 0.0183).

CONCLUSION

FAP immunostaining is more intense in malignant neoplasms than in benign ovarian neoplasms, as well as in moderately differentiated and undifferentiated ovarian carcinomas compared to well-differentiated neoplasms, thus indicating that it can be used as a marker of worse prognosis.

Angiogenic and antiangiogenic factors in preeclampsia

BACKGROUND

Pre-eclampsia is a multifactorial hypertensive disorder that is triggered by placental insufficiency and that accounts for up to 15% of maternal deaths. In normal pregnancies, this process depends on the balance between the expression of angiogenic factors and antiangiogenic factors, which are responsible for remodeling the spiral arteries, as well as for neoangiogenesis and fetal development.

PURPOSE

The aim of this review is to discuss the main scientific findings regarding the role of angiogenic and antiangiogenic factors in the etiopathogenesis of preeclampsia.

METHODS

An extensive research was conducted in the Pubmed database in search of scientific manuscripts discussing potential associations between angiogenic and antiangiogenic factors and preeclampsia. Ninety-one papers were included in this review.

RESULTS

There is an increased expression of soluble fms-like tyrosine kinase receptor and soluble endoglin in pre-eclampsia, as well as reduced placental expression of vascular endothelial growth factor and placental growth factor. Systemic hypertension, proteinuria and kidney injury - such as enlargement and glomerular fibrin deposit, capillary occlusion due to edema, and hypertrophy of endocapillary cells - are some of these changes. The complex etiopathogenesis of preeclampsia instigates research of different biomarkers that allow for the early diagnosis of this entity, such as vascular endothelial growth factor, placental growth factor, soluble fms-like tyrosine kinase receptor, soluble endoglin, placental glycoprotein pregnancy-associated plasma protein-A and protein 13.

CONCLUSION

Even though it is possible to establish an efficient and effective diagnostic tool, three key principles must be observed in the management of preeclampsia: prevention, early screening and treatment.

Role of Intracystic Cytokines and Nitric Oxide in Ovarian Neoplasms

The development of new biomarkers for the diagnosis and prognosis of ovarian cancer may provide an opportunity for new therapies. In this study, we aimed to compare cytokines (interleukin [IL]-2, IL-5, IL-6, IL-8, IL-10 and tumour necrosis factor [TNF]-α) and nitric oxide (NO) metabolite levels in non-neoplastic tumours, benign primary ovarian tumours and malignant primary ovarian neoplasms. The secondary aim was to relate cytokine and intracystic NO metabolite levels to clinical, laboratory and pathologic characteristics for patients with primary ovarian malignancies. We evaluated 110 patients with adnexal masses. Cytokine concentrations were quantified by enzyme-linked immunosorbent assay and nitrate concentrations by enzymatic reduction of nitrite by nitrate reductase. Patients with malignant neoplasms had higher IL-6, IL-8 and NO levels compared to patients with benign neoplasms. Histologic grade 1 tumours were associated with elevated IL-2 levels, whereas anaemia was associated with elevated IL-6 levels. On average, those patients with elevated IL-8 levels also had a neutrophil/lymphocyte ratio (NLR) greater than 2.6 and less than 36 months of disease-free survival (DFS). Patients with normal CA 19-9 levels had elevated IL-10 levels. TNF-α was elevated in patients with two carcinogenesis and those with a platelet/lymphocyte ratio (PLR) less than 300. NO levels were higher in patients with an NLR less than 2.6 and CA 19-9 greater than 35 U/ml. Elevated intracystic cytokine levels, especially IL-6 and IL-8, are associated with worse prognosis in ovarian cancer.

Sarcomatous transformation of a hemosiderotic fibrohistiocytic lipomatous tumor: a case report

Hemosiderotic fibrohistiocytic lipomatous tumors are rare neoplasms that were first described in 2000. Initially considered a benign lipotamous lesion of the soft tissues, nowadays they are considered to be a locally aggressive tumor. They occur mainly in the foot and ankle of women in their fifth and sixth decades, although they may be found in any place in the lower limbs and, more rarely, in other parts of the body. Histologically, hemosiderotic fibrohistiocytic lipomatous tumors consist of a mixture of mature adipose tissue, fusiform cell fascicles, macrophages that often contain cytoplasmic hemosiderin, mononuclear inflammatory infiltrate, and stroma that may be focally myxoid. Local recurrence is observed in nearly one-third of all cases. There is no consensus in the literature whether this tumor is a part of a spectrum that comprises pleomorphic hyalinizing angiectatic tumors and myxoinflammatory fibroblastic malignant tumors, or if it is an independent entity.

The authors report a case of a neoplasia after a diagnosis of a hemosiderotic fibrohistiocytic lipomatous tumor in a 38-year-old woman, with two recurrences and later sarcomatous transformation. An immunohistochemical study indicated myofibroblastic differentiation of a malignant neoplasm. To the best of the authors’ knowledge, there are only few reported cases of malignant transformation in hemosiderotic fibrohistiocytic lipomatous tumors.

Intrauterine infection, immune system and premature birth

Preterm birth accounts for nearly one million deaths among children under five years of age, and although its etiopathogenesis is not fully elucidated, ascending intrauterine infection and fetal inflammatory response seem to be the main triggers. The intense inflammatory response mediated by IL-1β, TNF-α, PAF, IFN-γ and IL-6, PGE₂ and MMP-1 and MMP-9 causes fetal membrane damage and rupture, increased uterine contractions and biochemical and structural changes in the cervix. Furthermore, preterm neonates have deficient innate and adaptive immune responses characterized by reduced levels of IgG, opsonization and phagocytosis, as well as increased activation of Th1 cells in relation to Th2 cells. Therefore, this triad is favors the occurrence of neonatal complications, such as respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Due to serious maternal and child health complications of intrauterine infection, several studies have tried to identify biomarkers for the early diagnosis of this entity. This literature review aims to discuss the main scientific findings regarding the association between ascending intrauterine infection, immune system and preterm birth.

Evaluation of the immunohistochemical expression of Gal-1, Gal-3 and Gal-9 in the colon of chronic chagasic patients

OBJECTIVE AND DESIGN

The aim of the present study was to evaluate the immunohistochemical expression of Gal-1, Gal-3 and Gal-9 in the colon of chronic chagasic patients compared to biopsied non-chagasic patients.

MATERIAL OR SUBJECTS

Thirty-two colon fragments were selected from chagasic patients with megacolon (n=25) and nonchagasic patients without megacolon (n=7).

METHODS

Immunohistochemistry for Gal-1, Gal-3 and Gal-9 was performed using a common light microscope and the results were scored 0-3 according to labeling intensity. Data were analyzed statistically by the chi-square test.

RESULTS

Higher Gal-1, Gal-3 and Gal-9 expression was observed in the myenteric plexus ganglia of chagasic patients compared to non-chagasic patients, p=0.0487, p=0.0019 and p=0.0325, respectively, whereas no significant differences were observed between groups regarding the expression of Gal-1, Gal-3 and Gal-9 in the muscle layer.

CONCLUSION

Since Gal-1, Gal-3 and Gal-9 galectin expression was higher in the myenteric plexus ganglia of chagasic patients, we believe that these lectins may be associated with ganglionitis in the chagasic megacolon. However, since the present study was the first to report the participation of Gal-9 in Chagas disease, further investigations are needed to elucidate the role of galectin 9 in this disease.

Gastric and jejunal histopathological changes in patients undergoing bariatric surgery

BACKGROUND

- Morbid obesity is a multifactorial disease that is increasingly treated by surgery.

OBJECTIVE

- To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery.

METHODS

- This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative.

RESULTS

- In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in Helicobacter pylori infection (P=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%.

CONCLUSION

- There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients.

GASTRIC AND JEJUNAL HISTOPATHOLOGICAL CHANGES IN PATIENTS UNDERGOING BARIATRIC SURGERY

Background:

Morbid obesity is a multifactorial disease that increasingly is being treated by surgery.

Aim:

To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery.

Methods:

This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative.

Results:

In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in H. pylori infection (p=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%.

Conclusion:

There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients.

Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil

Cryptococcosis occurs in acquired immunodeficiency syndrome (AIDS) patients with poor compliance to antiretroviral therapy or unaware of their human immunodeficiency virus status who present severe immunosuppression at admission. Consequently, high mortality rates are observed due to disseminated fungal infection. This report presents clinical and postmortem data of AIDS patients with cryptococcosis in a teaching hospital in Brazil. Retrospectively, medical and necropsy records of AIDS patients with cryptococcosis clinically confirmed and/or postmortem verified were reviewed. Clinical data were compared with those of patients presenting a good outcome to evaluate disseminated fungal infection and the agreement between clinical and postmortem diagnosis. At admission, most of the 45 patients with cryptococcal meningitis who died, presented more altered consciousness (P = 0.0047), intracranial increased pressure (P = 0.047), and severe malnutrition (P = 0.0006) than the survivors. Of 29 (64.4%) patients with cryptococcal meningitis, 23 died before week 2 on antifungal therapy, and the other six during the next 3 months. The remaining 16 (35.6%) cases had other diagnoses and died soon after. At necropsy, 31 (68.9%) presented disseminated infection involving two or more organs, whereas 14 (31.1%) cases had meningeal or pulmonary localized infection. The agreement of 64.4% between clinical and postmortem diagnosis was similar to some studies. However, other reports have shown figures ranging from 34% to 95%. Currently, a progressive worldwide decrease of autopsies is worrying because the role of postmortem examination is pivotal to verify or identify the death causes, which contributes to improve the quality of clinical diagnosis and medical training.

Comparison of Classical and Secondary Cytologic Criteria Relative to Hybrid Capture for Diagnosing Cervical-vaginal Infection by Human Papillomavirus

OBJECTIVE

To compare the diagnostic accuracy of the classic Meisels cytologic criteria and the Schneider secondary criteria relative to the hybrid capture method for diagnosing HPV infection.

METHODS

This was a retrospective study performed at a public university hospital. A total of 41 patients with a cytologic diagnosis of HPV infection and 40 HPV-negative patients were selected for review of the cervical-vaginal smears seeking to classical and secondary criteria. A single pathologist reviewed the slides in search of the criteria. The classical and secondary cytologic criteria were compared with the hybrid capture for diagnosing HPV infection. Bartleti test was applied for the age analysis, and Fisher's exact test was used to compare proportions. The tests were considered significant when the probability of rejecting the null hypothesis was less than 5% (p < 0.05).

RESULTS

The Meisels criteria were less sensitive (34.0%) than the secondary Schneider criteria (57.5%) when compared with the hybrid capture (p < 0.0001), although the specificity of the former criteria was non-significantly higher (91.2% and 67.7%, respectively). In cases of moderate or intense inflammation, the sensitivity and specificity of the Schneider criteria were decreased, 33.3% and 50.0% respectively (p = 0.0115).

CONCLUSIONS

Compared with hybrid capture for diagnosis of HPV infection, the sensitivity of the secondary Schneider criteria was higher than the classical Meisels criteria.Moderate or intense inflammation reduces the sensitivity and specificity of the secondary Schneider criteria for diagnosing HPV infection using the hybrid capture as the gold standard.

Blood vessels in ganglia in human esophagus might explain the higher frequency of megaesophagus compared with megacolon

This study aimed to determine the existence of blood vessels within ganglia of the myenteric plexus of the human esophagus and colon. At necropsy, 15 stillborns, newborns and children up to two years of age, with no gastrointestinal disorders, were examined. Rings of the esophagus and colon were analyzed and then fixed in formalin and processed for paraffin. Histological sections were stained by hematoxylin-eosin, Giemsa and immunohistochemistry for the characterization of endothelial cells, using antibodies for anti-factor VIII and CD31. Blood vessels were identified within the ganglia of the myenteric plexus of the esophagus, and no blood vessels were found in any ganglia of the colon. It was concluded that the ganglia of the myenteric plexus of the esophagus are vascularized, while the ganglia of the colon are avascular. Vascularization within the esophageal ganglia could facilitate the entrance of infectious agents, as well as the development of inflammatory responses (ganglionitis) and denervation, as found in Chagas disease and idiopathic achalasia. This could explain the higher frequency of megaesophagus compared with megacolon.

Tonsillar hyperplasia and recurrent tonsillitis: clinical-histological correlation

Hypertrophy and recurrent tonsillitis are common indications of tonsillectomy. However, the pathological reports are similar, regardless of clinical aspects.

Objective

Search for histopathological changes that differentiate palatine tonsils operated because of hypertrophy vis-à-vis those operated because of recurrent tonsillitis.

Method

A prospective cross-sectional descriptive study involving 46 children divided into group I - 22 with hypertrophy; and group II - 24 with recurrent tonsillitis, in the period between 2010 and 2012, in a public hospital. We evaluated clinical and histopathological features (lymph follicles, germinal centers, fibrosis, necrosis, reticulation, infiltration by plasma cells and neutrophils).

Results

The patients' ages ranged between 2 and 11 years (5.17 ± 2.28). In group I, half of the patients had had the latest infection at seven months or more, and all with obstruction degree greater than 3 (≥ 50%). In group II, all had had the latest infection at less than seven months, and most with obstruction degree below 4 (≤ 75%). There was a statistically significant difference in the degree of obstruction (p = 0.0021) and number of germinal centers (p = 0.002) was higher in group I.

Conclusion

This study suggests that the number of germinal centers is the only histopathological criterion that can be used to differentiate the two groups.

A retrospective study on cervical intraepithelial lesions of low-grade and undetermined significance: evolution, associated factors and cytohistological correlation

CONTEXT AND OBJECTIVES

Cervical cancer is an important cause of morbidity and mortality throughout the world. There is some controversy about the factors that may be associated with infection by the human papillomavirus (HPV) that may favor or protect against evolution from a low-grade intraepithelial lesion to a high-grade intraepithelial lesion or invasive neoplasia. The objective here was to evaluate the evolution of low-grade intraepithelial lesions and squamous or glandular lesions of undetermined significance, the associated factors and cytohistological correlations.

DESIGN AND SETTING

Retrospective study conducted in a public tertiary-level university hospital.

METHODS

Information was obtained by reviewing patient records and/or colposcopy reports. A statistical analysis was performed using logistic regression, calculating the odds ratio and applying chi-square tests.

RESULTS

Of the 3390 patients, 409 evolved to high-grade intraepithelial lesions, of which 354 had an initial diagnosis of HPV infection, 27 of squamous atypia of undetermined significance, 22 of low-grade intraepithelial lesions with or without cytological diagnosis of infection by associated HPV and six of glandular cell atypia of undetermined significance.

CONCLUSIONS

Lactobacillus sp and bacterial vaginosis on the smears, smoking and immunodepression were factors associated with evolution. A single partner, use of hormonal contraceptives, lower parity, age and a cytological diagnosis of cytolytic vaginosis, T. vaginalis, Candida sp or cocci were factors associated with protection. With regard to cytohistological correlation, there was a 74.08% agreement among patients with high-grade lesions and a biopsy obtained during the same period.

An evaluation of immune system cell infiltrate in the cervical stroma of patients with grade III cervical intraepithelial neoplasia after treatment with intralesional alpha-2B interferon

The aim of this study was to characterize infiltrating immune cells in cervical stroma biopsy samples from patients diagnosed with cervical intraepithelial neoplasias (CINs) who were treated with IFN-alpha 2b. The authors studied 13 volunteers who were diagnosed with Cervical intraepithelial neoplasia CIN II or III and who received intra-lesional treatment with IFN-alpha 2b. They collected pre- and post-treatment biopsies from each patient. They also examined the slides under a common optical microscope with a X400 lens for biopsy sample sections that were labeled with immunohistochemistry for T lymphocyte, B lymphocyte, natural killer cell, macrophage, iNOS, and perforin markers. The presence of immune response cells in the lesion was observed after treatment with intralesional IFN-alpha 2b in patients with CIN II/III changes, a reduction in CD4+ and CD8+ T lymphocyte infiltration in the women who responded well to treatment. However, there was a significant increase in these markers in samples from women who did not respond to treatment. Nonetheless, immunotherapy with IFN-alpha 2b administered intralesionally in patients with CIN II/III yields favorable results in patients who do not smoke.

Testicular myeloid sarcoma: case report

Myeloid sarcomas are extramedullary solid tumors composed of immature granulocytic precursor cells. In association with acute myeloid leukemia and other myeloproliferative disorders, they may arise concurrently with compromised bone marrow related to acute myeloid leukemia, as a relapsed presentation, or occur as the first manifestation. The testicles are considered to be an uncommon site for myeloid sarcomas. No therapeutic strategy has been defined as best but may include chemotherapy, radiotherapy and/or hematopoietic stem cell transplantation. This study reports the evolution of a patient with testicular myeloid sarcoma as the first manifestation of acute myeloid leukemia. The patient initially refused medical treatment and died five months after the clinical condition started.

Loss of heterozygosity in the fragile histidine triad (FHIT) locus and expression analysis of FHIT protein in patients with breast disorders

PURPOSE OF INVESTIGATION

The fragile histidine triad (FHIT) gene is a tumor suppressor frequently inactivated in various types of tumors. The authors evaluated the occurrence of loss of heterozygosity (LOH) in the FHIT locus and FHIT protein changes in breast tissue.

MATERIALS AND METHODS

Blood and breast tissue samples were obtained from 35 women with mammary disorders. The occurrence of LOH in FHIT locus was assayed by polymerase chain reaction (PCR), and the results obtained from blood and breast tissues from each patient were compared. FHIT protein expression was evaluated by immunohistochemistry.

RESULTS

LOH in the FHIT gene occurred in 48.6% (17/35) of patients with mammary disorder. Among patients with malignant breast disorders, 59.1% (13/22) presented LOH in the FHIT gene in comparison with patients with benign breast lumps, in which the LOH was observed in 30.8% (4/13) of women, suggesting that changes in this gene occur prior to the process of mammary carcinogenesis. The changes in the locus of the FHIT gene occur with greater frequency in the coded region of the gene, principally near exons 5 and 8, where the FRA3B site and the histidine triad respectively are found. Changes in FHIT did not modify protein expression. The association between menopause and LOH in the FHIT gene was evident.

CONCLUSIONS

LOH in the FHIT gene may be related to menopause in women with breast disorders.

Invasive thymoma in a child: a rare case report

Thymomas are neoplasms of the anterior mediastinum and generally occur between the fourth and sixth decades of life. In children, they are rare, with few reported cases. We describe a 9-year-old boy with invasive thymoma treated successfully by surgery alone. The patient was previously healthy and under treatment for a community-acquired pneumonia. A chest radiograph showed an opacity at the left lung base, and thoracic computed tomographic scan showed a mass with thick walls and liquid content situated in the lingula with no cleavage plane with the mediastinum. The patient underwent a left anterolateral thoracotomy, which showed a mass extending from the anterior mediastinum, infiltrating the left upper lobe of lung, phrenic nerve, and pericardium. A left upper lobectomy and resection of the mediastinal mass and lymph nodes were carried out. The pathologic analysis showed it to be a type B3 fusiform-cell thymoma, infiltrating the left upper lobe and 1 peribronchial lymph node. A multidisciplined tumor group decided to observe the patient and followed with thoracic computed tomographic scans every 3 months. After 2 years of follow-up, the patient has no evidence of recurrent disease.

Local lymphocytes and nitric oxide synthase in the uterine cervical stroma of patients with grade III cervical intraepithelial neoplasia

OBJECTIVES

Precancerous and cancerous cells can trigger an immune response that may limit tumor development and can be used as a prognostic marker. The aims of the present study were to quantify the presence of B and T lymphocytes, macrophages and cells expressing inducible nitric oxide synthase (iNOS) in the cervical stroma of women with grade III cervical intraepithelial neoplasia (CIN III) or in the intratumoral and peritumoral tissue of women with stage I invasive carcinoma.

METHODS

Cervical tissue specimens were obtained from 60 women (20 each from control tissues, CIN III and invasive carcinomas). The average ages in the control, CIN III and invasive groups were 43.9 (+/- 4.3), 35.5 (+/- 9.5), and 50 (+/- 11.2) years, respectively. The specimens were immunohistochemically labeled with antibodies to identify T lymphocytes (CD3), cytotoxic lymphocytes (CD8), B lymphocytes (CD20), macrophages (CD68) and iNOS. We evaluated the markers in the stroma above the squamocolumnar junction (control), at the intraepithelial lesion (CIN cases), and in the infiltrating tumor. Two independent observers performed the immunohistochemical analysis.

RESULTS

T lymphocytes, B lymphocytes, macrophages and iNOS were present more frequently (P<0.05) in the stroma of peritumoral invasive tumors compared to the controls and intratumoral invasive cancer samples. CD3+ and CD20+ lymphocytes were present more frequently in CIN III patients compared to samples from patients with intratumoral invasive cancer (P<0.05).

CONCLUSION

High numbers of T and B lymphocytes, macrophages and iNOS-expressing cells in the peritumoral stroma of the invasive tumors were observed. Cell migration appeared to be proportional to the progression of the lesion.

Gynecological malignant neoplasias diagnosed after hysterectomy performed for leiomyoma in a university hospital

PURPOSE

To analyze the findings of malignant neoplasms after hysterectomy for benign conditions.

METHODS

A retrospective study from January 1987 to December 2008 was conducted. We analyzed all simple hysterectomies with or without salpingo-oophorectomy for benign conditions (leiomyoma). Incomplete dossiers of patients or cases with uncertain clinical diagnostics were excluded. We analyzed histopathological results, age, parity, indications for hysterectomies with or without salpingo-oophorectomy, stage (if malignant) and therapy.

RESULTS

2,016 hysterectomies with or without salpingo-oophorectomy were performed. Of 2,016, 652 (32.3%) had had a previous diagnosis of malignancy and 1,364 (67.7%) had had a clinical diagnosis of benignancy (leiomyoma). From the total of 1,364, three (0.22%) cases of cancer were diagnosed after anatomopathological study of the uterine specimen, two sarcomas and one endometrial cancer. No cases of incidental ovarian or uterine cervical cancer were diagnosed.

CONCLUSIONS

Gynecological malignances in surgical specimens of patients submitted to surgery (hysterectomy and/or salpingo-oophorectomy) for benign conditions are rarely found.

Galactocele: an unusual cause of breast enlargement in children

Galactoceles in children, either cystic or pseudotumors, are described in the literature as a rare cause of increasing breast size and can appear in males. We report a case of galactocele in a 15-month-old male, treated at our institution. The patient presented with a tumor in the right breast that had appeared 6 months earlier with no pain, signs of inflammation, or nipple secretion. Twelve cases found in the literature emphasize the importance of including galactocele in the differential diagnosis of benign breast masses in infancy.

Metástase pulmonar de tumor de células gigantes benigno: relato de caso

O tumor de células gigantes é a sexta neoplasia óssea primária mais comum. Acomete a metáfise de ossos longos, sendo mais comum em adultos jovens. Na radiologia mostra-se como lesão lítica, excêntrica e de limites definidos. Os autores relatam um caso de tumor de células gigantes benigno em paciente que apresentou metástases pulmonares cinco anos após a retirada do tumor primário.

Peri- and intratumoral T and B lymphocytic infiltration in breast cancer

PURPOSE

To investigate peritumoral and intratumoral infiltrates in surgical specimens obtained from patients with invasive breast cancer, and of relating these to tumor size.

METHODS

Twenty-six surgical specimens obtained from patients diagnosed with breast cancer underwent immunohistochemical preparation and CD3, CD8, CD20 and CD68 labeling. The positive cells were counted in the tissue samples and correlated with the tumor size determined by imaging methods (TIA < or = 2 or TIB > 2 cm).

RESULTS

There was a significant reduction in intratumoral B lymphocytes (CD20+), although this reduction could only be observed in TIA. In relation to peritumoral T lymphocytes (CD3+), there was a significant reduction in TIB, in comparison with TIA. Peritumoral and intratumoral CD3+ and CD68+ presence in completely opposite ways in both sizes of tumors.

CONCLUSION

Peritumoral and intratumoral infiltrates of T and B lymphocytes are different and depend on tumor size.

Disseminated Balamuthia mandrillaris amoeba infection in an AIDS patient from Brazil

This report describes a 32-year-old male AIDS patient. He presented with a clinical picture characterized by severe headache, blurred vision, and fever that had lasted for 10 days. At admission, no remarkable neurologic abnormalities were observed. Cranial tomography showed a ring-enhanced lesion with edema and a mass effect in the right occipital lobe. The initial diagnosis was toxoplasmosis, and treatment of this was administered. However, 5 days later, the patient's clinical status worsened and he died. The necropsy showed necrotizing and hemorrhagic encephalitis, with trophozoites similar to an amoeba species. Furthermore, the kidneys, adrenal glands, thyroid gland, and liver were also involved. The amoeba Balamuthia mandrillaris was identified by an immunofluorescence test.

Niacin metabolite excretion in alcoholic pellagra and AIDS patients with and without diarrhea

OBJECTIVE

Malnourished patients with the acquired immunodeficiency syndrome (AIDS) can develop pellagra-like manifestations such as dermatitis, diarrhea, and dementia; therefore, we tested the hypothesis that patients with AIDS and diarrhea would have niacin depletion. This study compared 24-h urine excretion of N1-methyl-nicotinamide (N1MN) among patients with pellagra and patients with AIDS who did and did not have diarrhea.

METHODS

Three groups were studied: G1 (patients with AIDS and diarrhea, n = 5); G2 (patients with AIDS and no diarrhea, n = 7), and G3 (patients with alcoholic pellagra and without the human immunodeficiency virus, n = 8). Diarrhea was defined as the production of at least three liquid stools per day over 3 to 5 d. Studies included mucosal intestinal biopsy, malabsorption tests, detection of parasites in stool, and serum albumin measurements. Semiquantitative food-frequency questionnaire, anthropometry, and daily urinary N1MN excretion were also determined. Groups were matched in relation to age, sex, presence of parasites in stool, and intestinal absorption results.

RESULTS

G1 had normal intestinal examination by light microscopy and no parasites in stools. G2 group showed lower levels of serum albumin (2.6 +/- 0.3 g/dL) when compared with G1 (3.4 +/- 0.3 g/dL) and G3 (3.1 +/- 0.7 g/dL). Except for patients with pellagra, groups met their energy requirements. Patients in G3 (0.013, 0.01-0.081 mg/dL) and G1 (0.062, 0.001-0.33 mg/dL) excreted smaller amounts of N1MN in urine than did those in G2 (0.63, 0.02-2.9 mg/dL).

CONCLUSIONS

Patients with AIDS and diarrhea excreted less N1MN in urine than did those without diarrhea. These patients may have an impaired niacin nutritional status, possibly associated with increased metabolic needs.

Multifocal sporotrichosis with meningeal involvement in a patient with AIDS

This report describes a 29-year-old man with AIDS and disseminated lymphocutaneous sporotrichosis diagnosis presenting a poor therapeutic adhesion to itraconazole therapy that later evolved to neurological impairment and death. Necropsy showed granulomatous reaction and yeast-like forms similar to Sporothrix schenckii in meninges, lymph nodes, marrow bone, skin, testicles, epididymides and pancreas. Meningeal sporotrichosis cases associated to AIDS are reviewed in brief.

Morphometric study of the fibrosis and mast cell count in the circular colon musculature of chronic Chagas patients with and without megacolon

A morphometric study of the circular colon musculature was performed, in which the mast cell count was determined and the connective fibrous tissue in this layer was measured. The objective was to gain better understanding of Chagas megacolon morphology and contribute towards the knowledge of fibrosis pathogenesis in Chagas megas. An evaluation was made of 15 distal sigmoid rings from Chagas patients with megacolon (MCC), 15 without megacolon (CSMC) and 15 non-Chagas patients (NC). The rings were fixed in formol, embedded in paraffin, and 7mm thick sections were cut and stained using Azan-Heidenhain and Giemsa. The mast cell count and fibrosis were greater in the MCC group than in the CSMC and NC groups (p< 0,05; Kruskal-Wallis test) and there was no significant difference between the latter two. The fibrosis and increased mast cell count in the colon musculature of the MCC group possibly indicates that there is a relationship between mastocytosis and fibrosis, as has already been demonstrated in other pathologies.

Association of chagasic megacolon and cancer of the colon: case report and review of the literature

There are few descriptions of association between chagasic megacolon and colon cancer. We report a case of obstructive abdomen caused by adenocarcinoma of the left colon in chagasic megacolon. A review of the literature revealed 8 cases of this association and, analyzing together the series of findings of cancer in chagasic organomegalies, we found a frequency of 4.8% in megaesophagus and 0.1% in megacolon.

Neuron count reevaluation in the myenteric plexus of chagasic megacolon after morphometric neuron analysis

This study was made with the objective of reevaluating the colon denervation in chronic Chagas' disease. The diameters of neuron perikaryons of the myenteric plexus were measured on paraffin sections in a ring from the sigmoid in Chagas' disease patients, 17 with and 10 without megacolon and in 10 non-chagasic controls. All neurons were counted in ten en-echelon sections. Neuron hypertrophy only occurred in the group with megacolon, and the average increase in diameter was 69.3%. This could generate an error factor in the neuron count by increasing the probability of neurons being seen in a greater number of histological sections. The original result of the neuron count gave medians of 1264, 1961, and 2665 in the groups of chagasic patients with megacolon, without megacolon, and in the control, respectively. The denervation was greater than 55% in only seven megacolon cases (41.2%). After applying a correction factor, the median in the group with megacolon was 746, and the denervation was greater than 55% in 13 cases (76.5%). This occurrence demonstrates the need to apply a correction factor when the neuron count in chagasic megacolon is being evaluated and in the other pathologies where neuron hypertrophy may be found.

Leiomyosarcoma of the esophagus in a patient with chagasic megaesophagus: case report and literature review

Leiomyosarcoma constitutes approximately 0.5% of the malignant neoplasias of the esophagus and its association with megaesophagus has not been described. We report on a case of a woman with dysphagia that was slowly progressive from the age of 19 due to chagasic megaesophagus. The woman was subjected to cardiomyotomy at the age of 49. She presented a rapid worsening of the dysphagia due to leiomyosarcoma at the age of 61, and was subjected to subtotal esophagectomy with cervical esophagogastroplasty. She developed pulmonary and hepatic metastases 14 months after surgery and died six months later.

Cyto-histological correlation of 219 patients submitted to surgical treatment due to diagnosis of cervical intraepithelial neoplasia

CONTEXT

Cervical cytology continues to be the most appropriate method for investigating cervical neoplasia and its precursors. Greater diagnostic acuity is obtained by combining cytology, colposcopy and guided biopsy methods.

OBJECTIVE

To analyze the diagnostic acuity of cyto- and histopathological exams and causes of diagnostic error.

DESIGN

Retrospective study.

SETTING

A public tertiary referral center.

SAMPLE

Reports on 219 patients submitted to cone biopsy and/or hysterectomy due to diagnosis of cervical intraepithelial neoplasia (CIN) in the period between January 1982 and March 1997 were reviewed, comparing.

MAIN MEASUREMENTS

Cytological and histological exams (guided biopsy and surgically-removed tissue). In cases of discordance, the cyto- and histological preparations were reviewed to try to evaluate the causes of errors.

RESULTS

In 193 cases (88.1%) there was cyto-histological agreement but none in 26 (11.9%). Review of the discordant cases showed that in 2 (0.9%) there was invasion of the stromata to a depth greater than 3 mm, and in 7 (3.2%) microinvasion, unsuspected via cytology; in 2 (0.9%) microinvasion was suspected via cytology but not confirmed by the final histological exam; and in 15 (6.8%) there was disagreement about the degree of CIN.

CONCLUSION

The principal causes of error in the cytological exam were the lack of reliable morphological criteria for microinvasion, absence of sampling of the squamocolumnar junction, and scarcity of neoplastic cells in the sample. As for the histological exam, the errors were related to inadequate technical processing and underestimation of focal lesions.

Leucoencefalopatia multifocal progressiva como manifestação inicial da síndrome da imunodeficiência adquirida

Relata-se caso de homem portador da Síndrome da Imunodeficiência Adquirida que apresentou quadro agudo e grave de Leucoencefalopatia Multifocal Progressiva (LMP) como primeira manifestação da Síndrome. A LMP foi caracterizada macro e microscopicamente e através de estudo imuno-histoquímico utilizando o anticorpo antivírus JC.

[Progressive multifocal leukoencephalopathy as initial manifestation of acquired immunodeficiency]

This is a report of a man with acquired immunodeficiency syndrome (AIDS) who presented acutely ill with severe progressive multifocal leukoencephalopathy (PML) as the first manifestation of AIDS. PML was diagnosed in the brain after gross and microscopical examination as well as by immunohistochemistry with an antibody against JC virus.