ABSTRACT
La citología cérvico-vaginal, test de Papanicolaou (PAP), es la técnica diagnóstica de cribado más efectiva para la detección de lesiones precancerosas y la prevención del cáncer de cuello uterino. La sensibilidad de la prueba varía en las diferentes estadísticas entre el 50% y el 98%; la causa de esta amplitud depende de la toma de muestra. Para que la toma se considere satisfactoria es necesario que se realice de la zona escamocolumnar, zona de transformación, y según el sistema Bethesda en el extendido se deben observar células metaplásicas y/o endocervicales. El PAP convencional incluye la toma exo-endocervical con espátula de Ayre; sin embargo, solo el 50% aproximadamente de las muestras son representativas de la zona de transformación. Para ejemplificar esta situación se presenta el caso de una mujer de 40 años que, a pesar de tener citologías negativas durante cinco años, ninguna con células endocervicales o metaplásicas, una toma adecuada mostró un carcinoma in situ (HSIL: lesión intraepitelial escamosa de alto grado). Recalcamos la importancia de la correcta toma exo-endocervical para poder detectar todas las lesiones premalignas y prevenir este tipo de cáncer que aún tiene alta tasa de mortalidad en todo el mundo.
Cervical and vaginal cytology, Papanicolaou test (PAP), is the most effective test for screening of preneoplastic lesions, and cervical cancer prevention. Its sensitivity goes from 50 to 98%, according to different statistics, and this variation is related to the sampling procedure. A satisfactory smear should be taken from the transformation zone, the junction between endocervix and exocervix. According to Bethesda, metaplastic and/or endocervical cells should be observed under the microscope. The traditional PAP smear includes an exo-endocervical sampling using the Ayre spatula; however, only near 50% of the smears are representative of the transformation zone. In this case report, we present the case of a 40-year-old woman who had negative cytology in five consecutive annual PAP smears, none of which showed metaplastic or endocervical cells. A new sample evidenced a carcinoma in situ (HSIL: high-grade squamous intraepithelial lesion). We emphasize the importance of performing a correct exo-endocervical sampling to allow prompt detection of all premalignant lesions and to prevent cervical cancer, which still persists with high mortality worldwide.
Subject(s)
Humans , Female , Adult , Specimen Handling/methods , Uterine Cervical Neoplasms/diagnosis , Papanicolaou Test/methods , Specimen Handling/standards , Uterine Cervical Neoplasms/prevention & control , Sensitivity and Specificity , False Negative Reactions , Papanicolaou Test/standardsABSTRACT
Activation of epidermal growth factor receptor (p-EGFR) is one of the triggers in the development of many malignant tumors, and the measurement of Argentophilic Nucleolus Organizer Regions (AgNOR) area is used as a marker of tumor proliferation. Alpha actin smooth muscle (αASM) of peritubular cells (PT) and Vimentin expression are modified during the expansion of the CIS /intratubular germ cell neoplasia (ITGCN) to solid seminoma. We evaluated the expression pEGFR, the AgNOR areas, the expression of αASM in PT and the Vimentin in neoplastic cells from CIS/ ITGCN to solid seminoma. 28 formalin-fixed paraffin-embedded archival tissue blocks of Seminomas from the Departments of Pathology of Clinical Hospital and Ramos Mejía Hospital (CABA, Argentina) were used in this study. pEGFR was expressed in CIS/ ITGCN with membranous pattern (8/9), switching to a cytoplasmic pattern in the solid seminoma (15/19). AgNOR areas of atypical gonocytes were increasing from CIS (3.5±0.3 µ2) to intratubular seminoma (3.8±0.4µ2) (p<.5), until solid seminoma (5.3±0.7 µ2) (p<.01). Increase of AgNOR areas is proportional to the expression of pEGFR. Conclusions: pEGFR was expressed in CIS/ ITGCN with membranous pattern, switching to a cytoplasmic pattern in the solid seminoma. The activation of this receptor could be the first step in the mitogenic signal transduction. AgNOR areas complement diagnosis of testicular CIS, but not differentiate between CIS and intratubular seminoma. The value of AgNOR areas is maximum in the invasive seminoma, and statistically different from intratubular seminoma. The intensity of αASM in PT decreased as the tumor progressed and Vimentin was negative in neoplastic cells.
ABSTRACT
Objectives: The aim of this study was to evaluate the usefulness of different cutoffs applied to the cellularity and various biochemical parameters (BP) (metabolic and enzymatic) to contribute to the etiologic diagnosis of pleural fluids (PF). Design and Methods: We studied 150 samples from patients with pleural effusion, admitted to the Clinical Hospital. The cell count was total/mm3 (TCC) and differential. The simultaneous determination in pleural fluid (PF) and serum (S) of BP were performed on Roche Hitachi 917 autoanalyzer: Glucose (GLU), protein (PT), albumin (ALB), cholesterol (COL), triglycerides (TG), lactate dehydrogenase (LDH), creatine kinase (CK), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (FAL), amylase (AMI), total bilirubin (BT). Statistical methods were c² and Fisher. A value of p<0.05 was considered significant. Results: The most common cause of PF among transudates (T) was the heart failure (26%). In exudates (E), infections (43%) and cancer (25%) were the most frequent causes of PF. A TCC ≥ 500 cells/mm3 increased the detection of exudates without affecting the detection of transudate- type fluids. The PF / S ratio of LDH was the most useful among all BP in differentiating between T and E. PT, ALB, COL PF / S relations, and BT value > 0.5 mg / dl would be also suitable for differentiating T and E, and to a lesser extent PF / S for CK, AMI and SAAG. GLU value < 60 mg / dl showed no utility except in empyema. ALP, AST and ALT did not allow differentiating exudates from transudates. Conclusions: The use of a new cutoff for the TCC ≥ 500 cells / mm3 in the differential diagnosis of PF is suggested. Different BP contributed to the differentiation between E and T.
ABSTRACT
El análisis celular del esputo, espontáneo u obtenido mediante la técnica de esputo inducido, se ha transformado en una herramienta ampliamente difundida para la evaluación y orientación del tratamiento de las enfermedades inflamatorias de la vía aérea, principalmente asma, enfermedad pulmonar obstructiva crónica y bronquitis eosinofílica. Se han aportado evidencias sobre la utilidad de la técnica del esputo inducido, validada y estandarizada, para ser empleada en pacientes con dificultades para expectorar. Numerosas investigaciones dieron cuenta de la efectividad de basar las decisiones terapéuticas en el componente inflamatorio de la vía aérea mediante el recuento de células en el esputo. Varios estudios mostraron que, en pacientes con asma el análisis celular de esputo guía en la determinación de estrategias para disminuir las exacerbaciones y para mejorar la función pulmonar, aun en pacientes con asma grave, para disminuir el remodelamiento; también se ha descrito su utilidad en pacientes con EPOC, para la disminución de las exacerbaciones.
Cellular analysis of sputum either spontaneous or by induced sputum technique, has become a widespread tool for the evaluation and guidance of treatment of inflammatory diseases of the airway, primarily asthma, COPD and eosinophilic bronchitis. Induced sputum method is a validated, standardized and non-invasive technique, useful in patients with difficulties to expectorate. Its implementation is simple and cost effective. Numerous investigations have shown the effectiveness of basing treatment decisions on the inflammatory component of the airway by counting cells in sputum. Several studies have demonstrated that in patients with asthma, results of this analysis can guide in defining strategies to reduce exacerbations and to improve lung function even in patients with severe asthma, as well as to decrease the remodeling; in addition, a reduction in exacerbations in COPD patients, monitored by this sputum examination, has also been described.
Subject(s)
Humans , Asthma/diagnosis , Bronchitis/diagnosis , Eosinophilia/diagnosis , Pulmonary Disease, Chronic Obstructive/diagnosis , Sputum/cytology , Asthma/therapy , Bronchitis/therapy , Cell Count , Eosinophilia/therapy , Pulmonary Disease, Chronic Obstructive/therapyABSTRACT
Background: AgNOR technique detects, using silver salts, argyrophylic proteins of the nucleolar organizer region (NOR). The number and size of NOR reflect cell activity, proliferation and transformation and may help to differentiate benign from malignant cells. Aim: To assess the value of AgNOR assay to differentiate reactive mesothelial cells from malignant cells in serous effusions. Material and methods: Thirty one fluids obtained from 16 pleural, 14 peritoneal and one pericardial effusion, were studied. The fluids were processed with Giemsa and Papanicolau stains and with the AgNOR technique. The number of AgNOR dots were counted (only when it was possible to distinguish each individual dot) and the mean value per nucleus was calculated for each smear. Results: Mesothelial cells had a mean of 4,88 ñ 1,5 dots compared with 13,78 ñ 3,88 dots in the malignant cells (p<0,001). Conclusions: AgNOR assay can be useful for the differentiation of benign and malignant cells in serous effusions