Linfoma Hodgkin Clásico en el departamento de Anatomía Patológica del Hospital Nacional Edgardo Rebagliati Martins durante los años 2015 a 2019 / Classic Hodgkin Lymphoma at the Edgardo Rebagliati Martins National Hospital during 2015 to 2019

RESUMEN Introducción: Los Linfomas Hodgkin son neoplasias linfoides de células B, caracterizadas histológicamente por un contexto celular inflamatorio mixto mayoritario y escasas células neoplásicas de Hodgkin/ Reed- Sternberg. El Linfoma Hodgkin Clásico (LHC) representa el 10% de todos los casos de linfoma y el 85% de todos los Linfomas Hodgkin. De acuerdo con la vigente clasificación de la Organización Mundial de la Salud, el LHC se divide en 4 variantes: Esclerosis Nodular (EN), Celularidad Mixta (CM), Rico en Linfocitos (RL) y Depleción Linfocítica (DL). Objetivo: En este estudio revisamos todos los casos de Linfoma Hodgkin Clásico en el Departamento de Anatomía Patológica del Hospital Nacional Edgardo Rebagliati Martins durante los años 2015 a 2019, para determinar la variante más frecuente, la incidencia en cuanto a edad y sexo, características fenotípicas y relación con el Epstein Barr Virus (EBV). Materiales y Métodos: Se realizó un estudio descriptivo retrospectivo de la casuística de Linfoma Hodgkin Clásico en sus 4 variantes clínico - patológicas en el Departamento de Anatomía Patológica del Hospital Nacional Edgardo Rebagliati Martins durante los años 2015 a 2019. Se identificaron 72 pacientes con el diagnóstico de Linfoma Hodgkin Clásico, de los cuales únicamente se seleccionaron para el estudio 64. Los criterios de exclusión fueron la ausencia de pruebas de inmunohistoquímica confirmatoria y los casos de recidiva. Resultados: Se observó que la variante más frecuente correspondió a Esclerosis Nodular con 34 casos (53.12%) y la menos frecuente a la variante Rica en Linfocitos con 2 casos (3.12%). Así mismo se observó una predominancia en el sexo masculino con 42 casos, 20 de ellos con Esclerosis Nodular y 14 no clasificables, como las variantes más frecuentes, y una mayor incidencia entre los 41 y 50 años de edad, sin detectarse el pico bimodal referido en la literatura internacional. El perfil inmunohistoquímico más frecuente de las células Hodgkin/ Reed- Sternberg es CD15 y CD30 positivo, con CD45 negativo. El EBV estuvo presente en el 36% de los casos realizados y es más frecuente en las variedades Celularidad Mixta y Depleción Linfocítica. Conclusiones: El Linfoma Hodgkin Clásico es un grupo de neoplasias linfoides con características clínicas, histológicas y fenotípicas definidas. Es más frecuente en varones entre 41 y 50 años. Para un adecuado diagnóstico se requiere una completa información clínica y una buena biopsia, de preferencia excisional. La variante Esclerosis Nodular es la más frecuente y la Rica en Linfocitos la menos frecuente. Las células Hodgkin/ Reed- Sternberg suelen ser positivas para CD15 y CD30 y negativas para CD45. La positividad tenue del Pax-5 permite diferenciarlo de Linfomas no Hodgkin de Células B. El EBV es más frecuente en las variantes Celularidad Mixta y Depleción Linfocítica.

ABSTRACT Introduction: Hodgkin lymphomas are B-cell lymphoid neoplasms histologically characterized by a mixed inflammatory cellular component and few Hodgkin/Reed-Sternberg neoplastic cells. Classical Hodgkin Lymphoma (CHL) represents 10% of all lymphoma cases and 85% of all Hodgkin Lymphomas. According to the current World Health Organization classification, CHL is divided into 4 types: Nodular Sclerosing (NS), Mixed Cellularity (MC), Lymphocyte-Rich (LR), and Lymphocyte-Depleted (LD). Objective: We reviewed all cases of Classical Hodgkin Lymphoma in the Pathological Anatomy Department at Edgardo Rebagliati Martins National Hospital during 2015 to 2019, in order to determine the most frequent type, the incidence according to age and gender, phenotypical characteristics and relation to Epstein Barr Virus (EBV). Materials and Methods: We performed a retrospective descriptive case study of Classical Hodgkin Lymphoma and its 4 clinical-pathological types in the Pathological Anatomy Department at Edgardo Rebagliati Martins National Hospital during 2015 to 2019. 72 patients were identified with Classical Hodgkin Lymphoma diagnosis, of which only 64 were selected for the study. The exclusion criteria were the absence of confirmatory immunohistochemical tests and relapse cases. Results: The most frequent type observed was Nodular Sclerosing with 34 cases (53.12%) and the least frequent type was Lymphocyte-Rich with 2 cases (3.12%). Likewise, a predominance in the male gender was observed, with 42 cases, 20 of which were Nodular Sclerosing and 14 not classified, as the most frequent types, and a greater incidence among those 41 to 50 years of age, without detection of the bimodal peak referenced in international literature. The most frequent immunohistochemical profile of Hodgkin/ Reed- Sternberg was CD15 and CD30 positive, with CD45 negative. EBV was present in 36% of cases and is more frequent in the Mixed Cellularity and Lymphocyte-Depleted types. Conclusions: Classical Hodgkin Lymphoma is a group of lymphoid neoplasms with clinical, histological, and phenotypically defined characteristics. It is more frequent in men between 41 and 50 years of age. A complete clinical information and a good biopsy, preferably excisional, is required for an adequate diagnosis. The Nodular Sclerosing type is the most frequent and the Lymphocyte-Rich is the least frequent type. Hodgkin/ Reed- Sternberg cells are usually CD-15 and CD-30 positive and CD-45 negative. The Pax-5 mild positivity allows it to be differentiated from B-cell Non-Hodgkin Lymphomas. EBV is most frequent in Mixed Cellularity and Lymphocyte-Depleted types.

Leptomeningeal involvement by relapsed follicular lymphoma detected by flow cytometry despite exceedingly low white blood cell counts in cerebrospinal fluid: A case report

Follicular lymphoma is usually an indolent non-Hodgkin lymphoma that rarely involves the central nervous system (CNS) and flow cytometric detection of such lymphoma in cerebrospinal fluid (CSF) is often challenging because of low cellularity and viability of CSF samples. Here, we report our experience in a 52-year-old man whose relapsed follicular lymphoma with leptomeningeal involvement was confirmed by flow cytometric analysis of CSF, despite an exceedingly low white blood cell count (3/cumm).

Celularidade do leite e unidades formadoras de colônias nas mastites causadas por Staphylococcus coagulase positiva e coagulase negativa / Milk cellularity and colony forming units in mastitis caused by coagulase-positive staphylococci and coagulase negative

A mastite é a principal afecção do gado destinado à produção leiteira, que impacta significativamente a cadeia produtiva do leite, com reflexos ainda para a saúde pública. Estudou-se aspectos relacionados à etiologia, celularidade e de contagem bacteriana em 10 propriedades leiteiras, localizadas no Estado de São Paulo. Foram examinadas 1148 vacas em lactação, totalizando 4584 glândulas mamárias. Foram considerados os casos, em que houve isolamento de estafilococos coagulase positiva (SCP) e estafilococos coagulase negativa (SCN). Os resultados revelaram microbiota com vários patógenos e diferentes espécies de SCN (128 casos) e SCP (45), Staphylococcus aureus(90), Streptococcus agalactiae(70), Streptococcus dysgalactiae (69), Streptococcus uberis(29), Corynebacteriumspp. (230), Klebsiella pneumoniae(28), Klebsiella oxytoca(2), Escherichia coli(15), Enterobactersp. (3). Os resultados de contagem de células somáticas (CCS) relacionados aos SCP e SCN não mostraram diferenças entre as propriedades avaliadas, entretanto com diferenças significantes ao se avaliar a CCS entre os dois grupos de estafilococos, como pode ser evidenciado ao comparar SCN Discreto e SCP exuberante (P<0,01), SCP Discreto e SCP exuberante (P<0,001) e SCN moderado e SCP exuberante (P<0,01). A avaliação da CCS relacionada à intensidade da infecção, considerando-se como crescimento discreto o isolamento de até nove colônias, moderado de dez a 29 colônias e exuberante, com 30 ou mais colônias, revelou para ambos os grupos de estafilococos que quanto maior o número de unidades formadoras de colônias (UFC), a CCS é mais elevada, sendo sempre maior nos casos de SCP. Conclui-se que quando há maior número de UFC, há concomitantemente maior CCS/mL de leite, no caso dos SCP e SCN...

Mastitis is the main affection of cattle intended for dairy production, which significantly impacts the milk production chain, with consequences yet to public health. It was studied aspects related to etiology, cellularity and bacterial count in 10 dairy farms, in the State of São Paulo. There were examined 1148 milking cows, totaling 4584 mammary glands. Cases in which there was isolation coagulase positive staphylococci (CPS) and coagulase-negative staphylococci (CNS) were considered. The results showed microbiota with various different pathogens and CNS (128 cases) and CPS (45), Staphylococcus aureus (90), Streptococcus agalactiae (70), Streptococcus dysgalactiae (69), Streptococcus uberis (29), Corynebacterium spp . (230), Klebsiella pneumoniae (28), Klebsiella oxytoca (2), Escherichia coli (15), Enterobacter spp. (3). The somatic cell count (SCC) related to CPS and CNS showed no differences among the evaluated properties, although with significant differences when evaluating the SCC between both groups of staphylococci, as evidenced by comparing discreet CNS and exuberant CPS (P <0.01), discreet CPS and exuberant CPS (P <0.001) and moderate SCN and exuberant SCP (P <0.01). The evaluation of SCC was related to the intensity of infection, considering how slight growth isolation of up to nine colonies, moderate ten to 29 colonies and lush, with 30 or more colonies, revealed for both groups of staphylococci that the higher the number of colony forming units (CFU), SCC is higher being larger in cases of CPS. The results indicate that the importance of both CPS and CNS when considering the high occurrence of the evaluated properties and the fact that it raises the SCC, which compromises the quality of milk. We conclude that when there is a larger number of CFU, is concomitantly higher SCC/ml of milk, in the case of CPS and CNS...

Indicadores de qualidade e composição de leite informal comercializado na região Sudeste do Estado de São Paulo

Abstract:The informal milk is recognized as the product marketed without inspection. We evaluated the microbiological quality, nutritional ingredients and substances inhibiting bacterial growth in 100 informal samples from cows milk, marketed in the southwest region of the state of São Paulo, Brazil. It was found that 77% of Somatic Cell Count (SCC) and 86% of Total Bacterial Count (TBC) of the samples were at odds with the maximum values required by Instruction Rules 62 of the Ministry of Agriculture and Livestock Supply. It was identified to solids contents in disagreement (36%), protein (23%), fat (38%), nonfat dry extract (43%) and 73% urea nitrogen. In 59% of the samples was detected residues of the bacterial growth inhibitors. Were isolated 240 strains of micro-organisms with a prevalence of enterobacteria, streptococci, staphylococci and fungi. The informal milk is marketed in the region without the minimum hygienic conditions and present risks to public health, and represents serious socio-economic problem for the region.

Resumo:O leite informal é reconhecido como o produto comercializado sem inspeção. Avaliou-se a qualidade microbiológica, constituintes nutricionais e presença de substâncias inibidoras do crescimento bacteriano em 100 amostras informais de leite de vacas, comercializadas na região sudoeste do estado de São Paulo, Brasil. Verificou-se que 77% da Contagem de Células Somáticas (CCS) e 86% da Contagem Bacteriana Total (CBT) das amostras estavam em desacordo com os valores máximos exigidos pela Instrução Normativa 62 do MAPA. Identificaram-se teores em desacordo para sólidos totais (36%), proteína (23%), gordura (38%), extrato seco desengordurado (43%) e nitrogênio uréico (73%). Em 59% das amostras detectou-se a presença de resíduos de inibidores do crescimento bacteriano. Isolaram-se 240 linhagens de micro-organismos com predomínio de enterobactérias, estreptococos, estafilococos e fungos. O leite informal é comercializado na região sem as mínimas condições de higiene e oferece riscos a saúde pública, além de representar sério problema sócio-econômico para região.

Acelularidad del líquido cefalorraquídeo como factor pronóstico adverso en meningitis criptocóccica / Acellularity of cerebrospinal fluid as adverse prognostic factor in cryptococcal meningitis

Introducción: las enfermedades oportunistas, y dentro de ellas la meningitis criptocóccica en pacientes inmunodeprimidos, constituyen causa mayor de letalidad en países en vías de desarrollo. Objetivo: identificar factores de mal pronóstico como la acelularidad del líquido cefalorraquídeo (LCR) para individualizar medidas terapéuticas encaminadas al logro de una mayor supervivencia y calidad de vida de estos pacientes. Métodos: se estudió la celularidad de todos los LCR de los 170 casos de Bojanala, North West, ingresados en el Hospital Provincial de Rustenburg, South África por meningitis criptocóccica desde mayo de 2001 hasta abril de 2004. Se interrelacionó el número de células blancas del LCR con la letalidad intrahospitalaria, seropositividad al virus de inmunodeficiencia humana (VIH) y nivel de linfocitos T4. Resultados: se detectó una asociación altamente significativa entre acelularidad basal del LCR y riesgo a morir, y significativa con progresión lineal de mayor mortalidad en los casos con descenso evolutivo del número de células blancas en sucesivos LCR. Se constató un alto índice de letalidad (36,5 por ciento)por meningitis criptocóccica. No hubo diferencias significativas entre acelularidad y letalidad en pruebas de comparación de grupos acorde al nivel de linfocitos T4 y a la confirmación o no de la seropositividad al VIH. Conclusiones: tanto la acelularidad basal como la progresión descendente evolutiva del número de células blancas del LCR constituyen herramientas útiles para la predicción del riesgo a morir por meningitis criptocóccica

Introduction: opportunistic diseases, and among them, cryptococcal meningitis in immune-compromised patients, are a major cause of lethality in developing countries Objective: to identify mal prognostic factors such as acellularity of cerebrospinal fluid (CSF) to identify therapeutic measures aimed to achieve improved survival and quality of life of these patients. Methods: cellularity was studied in all CSF of the 170 cases in Bojanala, North West, who were admitted to the Rustenburg Provincial Hospital, South Africa for cryptococcal meningitis from May 2001 to April 2004. The number of CSF white cell with hospital mortality, seropositive human immunodeficiency virus (HIV) and level of T4 lymphocytes were interrelated. Results: a highly significant association was found between baseline CSF acellularity and risk of death, and significant linear progression of increased mortality in patients with developmental decline in the number of white cells in successive CSF. A high fatality rate (36.5 percent) for cryptococcal meningitis was also found. No significant differences was found between acellularity and lethality tests comparing groups according to the level of T4 lymphocytes and the confirmation or otherwise of HIV seropositivity. Conclusions: both basal acellularity and evolutionary downward progression of the number of CSF white cells are useful tools for predicting the risk of death for cryptococcal meningitis

Bone Marrow Cellularity Measurement by Myelocrit / 대한진단검사의학회지

BACKGROUND: The bone marrow (BM) cellularity has been used as a major index for the evaluation of hematologic diseases and malignancies. However, the microscopic evaluation lacks objectivity because of considerable variations among different observers. We measured myelocrit cellularity as an objective method to evaluate the cellularity. METHODS: Between November 2007 and January 2008, 489 consecutive BM aspirates including 25 cases of AML D7 marrow (7 days after initiation of chemotherapy) were examined. The conventional BM cellularity was evaluated using BM needle biopsies after hematoxylin-eosin stain. EDTA-anticoagulated BM aspirates were put into the Wintrobe tubes, centrifuged and the thickness of 5 layers from the bottom was measured: RBC, buffy coat (BC), plasma, BM particle, and fat layers. The myelocrit cellularity was defined as the ratio of BC to the BC plus fat layers. RESULTS: Both of the thickness of BC layer (r=0.721, P=0.000) and the myelocrit cellularity (r=0.735, P=0.000) correlated well with the conventional cellularity. However, the AML D7 BM cellularity correlated with BC layer (r=0.589, P=0.002), but not with the myelocrit cellularity (r=0.281, P=0.231). The cellularity of the BM other than AML D7 marrow showed a better correlation with the myelocrit cellularity (r=0.826, P=0.000) than the BC layer (r=0.713, P=0.000). CONCLUSIONS: The myelocrit is a simple, reproducible and objective method to determine the BM cellularity. For accurate assessment of BM cellularity, measurement of the thickness of BC layer in AML D7 BM and of the myelocrit cellularity in other BM samples has better be used.

Analysis of the Bone Marrow Aspirates with Automated Hematology Analyzer for Assessment of the Bone Marrow Cellularity and Effective Hematopoiesis / 대한진단검사의학회지

BACKGROUND: Microscopic examination of the bone marrow (BM) smear has been a major method for the diagnostic and post-therapeutic evaluation of hematologic disease but is laborious and imprecise due to small number of cells counted. Recently, automated reticulocyte counting is available by the automated hematology analyzer. We analyzed the bone marrow aspirates using Coulter GEN S (GEN S) automated hematology analyzer and compared the results with those by the microscopic examination. METHODS: Total nucleated cells (TNC), leukocyte subpopulations, red cell count, hemoglobin and reticulocyte indices of the peripheral blood (PB) and the BM aspirates, were measured by GEN S in 392 samples including 142 normal control samples. Differential counts by microscopic examination of Wright stained BM films were used as a reference. RESULTS: TNC of the BM obtained by automated hematology analyzer correlated with the BM cel-lularity estimated by microscopic examination (r=0.587, P=0.000). The differential counts of neutrophils and monocytes correlated between these two methods (r=0.582, P=0.000, r=0.309, P=0.000). In acute leukemia, TNC of the PB and the BM, and the BM lymphocyte fraction were increased and the BM neutrophil fraction was decreased. In chronic myelogenous leukemia, TNC of the PB and the BM were high but distribution of leukocyte subpopulations was normal. In normal control group, the number of erythroid precusors correlated with the percentages of reticulocyte in the PB (r=0.425, P=0.000), and in patients with increased erythropoiesis, it showed strong correlation with immature reticulocyte fraction (IRF) of the PB (r=0.708, P=0.033). In aplastic anemia, IRF of the PB was reversely correlated to hemoglobin level, but in myelodysplastic syndrome, reticulocyte indices of the PB and the BM had no correlation with hemoglobin level. In patients with increased erythropoiesis, the percentages of reticulocyte in the PB were increased and those of the BM were decreased in proportion to reduction of hemoglobin level in the PB. CONCLUSIONS: Analysis of the BM aspirates using automated hematology analyzer will be useful in screening of pathological hematologic diseases and in estimating the bone marrow cellularity objectively before those by the microscopic examination. In anemia, this study could provide an additional information to evaluate the ineffective hematopoiesis using reticulocyte indices of the PB and the BM.

Bronchoalveolar Lavage Cellularity between Classic Asthma with Wheezing and Viral Associated Wheeze in Children / 소아알레르기및호흡기학회지

PURPOSE: Many young children with no other asthma features have episodic wheezing that is triggered solely by viral respiratory infections. We investigated the differential cytology in an effort to determine whether significant differences in bronchoalveolar lavage(BAL) cellularity to the pathophysiology of wheezing exist between classic astham(CA) and viral associated wheeze(VAW) in children. METHODS: Bronchoscopy with BAL was performed on 44 children, 6 months and 15 years old: 12 CA, 13 VAW. 13 viral pneumonia(VP), and 6 control cases. Viral cultures were carried out. Differential cell counts were determined on cytospin slide stained with May Grunwald Giensu. RESULTS: Total BAL fluid recovered was similar in all group(37+/-2.5%, mean+/-SEM) No significant differences in the total cell counts were observed among the four groups. Compared with the control, newtrophil percentages of VAW and VP(38.6+/-7.1% and 42.4+/-6.9%, respectively) were significantly(P<0.05) elevated than those of VAW and VP(2.0+/-0.1% and 0.4+/-0.3%, respectively). All cell types did not differ significantly between VAW and VP. The blood totol cosinophil counts were correlated with the BAL eosinophil percentage levels(r-0.795, P=0.0000). CONCLUSIONS: In conclusion, neutrophils were prominent in children with viral associated wheeze, as eosinophils in those with classic asthma. Thses findings suggest that there are different implications of cell types for the pathophysiology in these two diseases.

Age-related Changes of the Cellularity and Acid Mucopolysaccharides in the Trabecular Meshwork of the Normal Korean

We evaluated thirty normal human eyes(aged from 22 to 95) to investigate the changes with age of the cellularity and acid mucopolysaccharides in the trabecular meshwork. The cellularities were evaluated from the number of the cells per unit area of trabecular meshwork and the number of cells per unit length of trabecular meshwork. In addition, acid mucopolysaccharides(AMS) were investigated by counter staining the trabecular meshwork specimens, with Van Gieson following colloidal iron. The results were as follows: 1. With age, cellularities of the whole trabecular meshwork and the counterpart of filtration region decreased significantly(p0.05). 2. The trabecular meshwork cellularity and the absolute number of cells were decreased by 40.0% and 35.9%, respectively, for those aged from 22 to 95. 3. There was no strong relation between the change of acid mucopolysaccharides of the trabecular meshwork and aging process. The grade +1 AMS was observed in 15 eyes(50.0%) and was the most prevalent.