Consenso mexicano de linfoma de Hodgkin / Mexican Consensus on Hodgkin's Lymphoma

Resumen El linfoma de Hodgkin (LH) se debe a la transformación clonal de células originadas en los linfocitos B, lo que genera las células binucleadas patognomónicas de Reed-Sternberg. El LH es una enfermedad de células B con una distribución bimodal, con mayor incidencia en la adolescencia y la tercera década de la vida y un segundo pico en personas mayores de 55 años. Las células del LH clásico habitualmente sufren una reprogramación de la expresión génica, ya que pierden la expresión de la mayoría de los genes típicos de las células B y han adquirido la expresión de múltiples genes que son típicos de otros tipos de células del sistema inmunitario. El algoritmo de tratamiento dependerá si se trata de LH clásico o de predominio linfocítico, si es un estadio temprano con marcadores de pronóstico desfavorables o no, el esquema inicial de manejo y si existe enfermedad voluminosa, entre las variables más relevantes.

Abstract Hodgkin's lymphoma is due to the clonal transformation of cells originating from B lymphocytes, generating the pathognomonic binucleate Reed-Sternberg cells. Hodgkin's lymphoma is a B cell disease with a bimodal distribution, with higher incidence in adolescence and the third decade of life, showing a second peak in people over 55 years of age. Classic Hodgkin lymphoma cells routinely undergo gene expression reprogramming, as they lose the expression of most of the typical B-cell genes and acquire the expression of multiple genes that are typical of other types of cells in the immune system. The treatment algorithm will depend on whether it is classic or predominantly lymphocytic HL, if it is early stage with unfavorable prognostic markers or not, the initial management regimen, and whether there is bulky disease, among the most relevant variables.

Importancia del estudio de la médula ósea en el Hospital Carlos Andrade Marín en el año 2013 / Importance of the bone marrow study of the year 2013 in Carlos Andrade Marin Hospital

Objetivo: el estudio de la biopsia de la médula ósea tiene como objetivo el diagnosticar los problemas que existen con los diversos tipos de células sanguíneas, con el fin de realizar un tratamiento y obtener un pronóstico adecuados; en el tiempo este exámen ha ido ampliándose y junto con el aspirado ayudan a la evaluación de patologías como anemia, trombocitopenia, linfomas, leucemias, tumores metastáticos, síndromes mieloproliferativos entre otros. Materiales y métodos: estudio retrospectivo, descriptivo y con diseño transversal. Se analizaron 450 muestras obtenidas desde enero a diciembre del 2013 para evaluar las distintas patologías que se presentan frecuentemente en nuestro hospital, de acuerdo a edad y sexo. Resultados: de los 450 casos receptados, analizados y reportados en el 2013; 236 muestras fueron negativas; 27 fueron muestras insuficientes e inadecuadas y 187 fueron positivas para lesiones benignas, borderline y malignas. La mayor parte de lesiones fueron más en hombres y en edades comprendidas entre 40 y 69 años. Las lesiones benignas más frecuentes fue la Hipoplasia y dentro de las lesiones malignas la infiltración linfocitica de inmunofenotipo B, la misma que se corroboró con estudio de Inmunohistoquimica. Conclusión: se determina que de los estudios realizados, la patología que con mayor frecuencia afecta a los pacientes del Hospital Carlos Andrade Marín, sometidos a biopsia de médula ósea en el año 2013 es la Infiltración de estirpe linfoide con biopsy has become important for the treatment and prognosis of diseases. Inmunofenotipo B. De ahí que el estudio de biopsia de médula ósea se ha tornado importante para el tratamiento y pronóstico de las diferentes patologías hematológicas y metastásicas.

Objective: the study of bone marrow biopsy aims to diagnose the problems that exist with the different types of blood cells, with the aim of treatment and obtain an acertive prognosis, with time this test has become popular and together with the aspirate helps with the evaluation of diseases such as anemia, trombocitopenia, leucemias, lymphomas among others, myeloproliferative syndromes, and metastatic tumors. Materials and methods: a retrospective descriptive study with cross-sectional design was used to analyze 450 samples obtained from january to december of 2013 in order to evaluate the different pathologies that arise frequently in our hospital, profiled by age and sex. Results: of the 450 analyzed cases and reported in the 2013; 236 samples were negative; 27 were insufficient and inadequate samples, 187 were positive for benign lesions, borderline or malignant. Most of the lesions were in men aged between 40 and 69 years; Hypoplasia was amongst the most benign lesions and among the malignant lesions was the Immune B Lymphocytic Infiltration, which was corroborated with inmunohistochemical staining. Conclusion: this study determines that the disease which most often affects patients of the Hospital Carlos Andrade Marín undergoing bone marrow biopsy in the year 2013 was lineage with Immune B lymphoid infiltration. Hence the study of bone marrow biopsy has become important for the treatment and prognosis of diseases.

CDX-2, MUC-2 and B-catenin as intestinal markers in pure mucinous carcinoma of the breast

BACKGROUND: Pure mucinous adenocarcinoma of the breast is a rare entity characterized by the production of variable amounts of mucin comprising 1% to 6% of breast carcinomas. Some mucinous adenocarcinomas have shown expression of intestinal differentiation markers such as MUC-2. This study examines the expression of intestinal differentiation markers in this type of breast carcinoma. RESULTS: Twenty-two cases of pure mucinous adenocarcinoma of the breast were assessed. Immunochemistry was performed for beta-catenin, CDX-2 and MUC-2. All cases were positive for B-catenin. MUC-2 positivity was observed in all cases; 63. 6% were 3 plus positive. All cases were negative for CDX-2. CONCLUSIONS: These results suggest that mucinous breast carcinomas express some markers of intestinal differentiation, such as MUC-2 and beta-catenin; however, future studies with a larger series of cases and using molecular techniques that help affirm these results are needed.

Yersiniose em Trachinotus marginatus (pampo): diagnóstico histopatológico e imuno-histoquímico / Yersiniosis in Trachinotus marginatus (pampo): histopathological and immunohistochemical diagnostic

Descreveu-se um surto de yersiniose em uma criação de pampo Trachinotus marginatus estudado no Laboratório de Piscicultura Estuarina e Marinha da Universidade Federal do Rio Grande. A enfermidade manifestou-se por transtornos natatórios, exoftalmia com panoftalmite e pela clássica boca vermelha, nome pelo qual se denomina "enfermidade da boca vermelha" (EBV). Na necropsia, foram observados focos de hemorragia peritoneal, esplenomegalia e hepatomegalia. Microscopicamente, foi observada panoftalmite com infiltrados inflamatórios densos que afetavam quase todas as estruturas oculares. Esses infiltrados estavam constituídos por granulócitos, linfócitos, macrófagos e células granulares eosinofílicas. No exsudado, observaram-se estruturas pequenas, pouco coradas, de aspecto bacteriano Gram negativo. O estudo imuno-histoquímico, que se utilizou de um anticorpo monoclonal anti-Yersinia ruckeri, resultou positivo. Este é o primeiro surto conhecido de yersiniose em Trachinotus marginatus no Brasil.

In the "Laboratório de Piscicultura Estuarina e Marinha da Universidade Federal do Rio Grande" the rearing of Trachinotus marginatus (pompano) is studied, and in one of these rearing a yersioniosis outbreak occured. The disease was manifested by swimming disturbances, exophthalmiawith panophthalmitis and the classic red mouth, (red mouth disease (RMD). The necropsies revealed focus of peritoneal hemorrhage, esplenomegalyand hepatomegaly.Microscopically a panophthalmitis with dense inflammatory infiltrates was observed, which affected almost all ocular structures. These infiltrates were constituted by granulocytes, lymphocytes, macrophages and eosinophylicgranular cells (ECG), in the exudatessmall structures less colored with Gram negative bacteria aspect were observed. The immunohistochemical, which used a monoclonal antibody anti- Yersinia ruckeri waspositive. The RMD is caused by enterobacteriaGram negative, which affects both freshwater and saltwater fish, with predominance in salmonids. This is the first known yersiniosis outbreak in Trachinotus marginatus in Brazil and it is necessary to keep this disease in mind at the moment of rearing fish of this species.

Carcinoma apocrino mamario: análisis morfológico e inmunohistoquímico en sus formas infiltrantes puras y mixtas asociadas o no a carcinoma in situ / Apocrine breast carcinoma: morphologic and inmunohistochemical analysis of invasive pure and mix forms asociated or not with in situ carcinoma

Objetivo: Caracecterizar morfológica e inmunohitoquimicamente el carcinoma apocrino mamamario. Materiales y métodos: Este estudio toma 24 casos diagnosticados como carcinomas apocrinos o con rasgos apocrinos, clasificándolos como puros y mixtos, reconociendo la presencia de componentes in situ asociados, para evaluar la expresión inmunohistoquími- ca del receptor de andrógenos (AR), receptor de estrógenos (ER), receptor de progesterona (PR), gross cistyc disease proteína (GCDFP-15), BCL2, KI67 y ERB-2 tanto en las áreas infiltrantes como intraepiteliales, estudiando adicionalmente la amplificación génica del ERB-2 en el cromosoma 17 por métodos de FISH. Resultados: Los tumores clasificados como puros correspondieron a 11 casos que expresan la siguiente positividad inmunohistoquímica en las áreas infiltrativas: AR (100%), ER (18%), PR (18%), GCDFP (63%), BCL2 (54%), KI67 (28%) y ERB-2(28%) con una positividad de GCDFP-15(100%) en la áreas in situ. Los tumores mixtos correspondientes a 13 casos mostraron la siguiente positividad inmunohistoquímica: AR (58%), ER (46%), PR (46%), GCDFP-15 (50%), BCL2 (33%), KI67 (58%) y ERB-2(16%), con una positividad de GCDFP-15 (100%) en las áreas in situ. Las áreas in situ expresan GCDFP-15 en todos los casos con una reducción de la expresión en las zonas de infiltración del mismo al 63 y 50% en los tumores puros y mixtos, respectivamente. Conclusiones: Los carcinomas mamarios apocrinos puros deben ser distinguidos de los mixtos mediante un examen morfológico detallado y por su perfil inmunohistoquímico (AR+, ER-, PR-/GCDFP+, BCL2+/-, KI67-, ERB2/-)...

Objetive: To recognize the morphologic and inmunohistochemical aspects of cases of apocrine mamary carcinomas. Matherials and methods: Twenty four cases of apocrine mamary carcinomas and ductal mamary carcinomas with apocrine diferetiation (mix apocine carcinomas) were studied morphologically and inmunohistochemiclly detected androgen receptor (AR), progesterone receptor (PR), gross cystic disease protein-15(GCDFP-15), BCL2, KI67 and CERB-2 in infiltrative and in situ areas of the same tumor and adicionally demonstrated the gene amplificacion of ERB-2 in the 17 cromosome by FISH analysis. Results: Eleven cases of pure apocrine carcinomas were encountered, inmunohistochemically positivity was as follows: AR (100%), ER (18%), PR (18%), GCDFP(63%)BCL2 (54%), KI67 (28%), and ERB-2(28%) with positivity of GCDFP-15(100%) over in situ areas; the rest 13 cases of mix apocrine carcinomas expresed positivity as follows: AR (58%), ER (46% ), PR (46% ), GCDFP-15 (50%), BCL-2 (33%), KI67 (58%) and ERB-2 (16%). In situ areas expresed of GCDFP-15 in all cases (100%) with a reduccion of the expression in the infiltrating areas of the same case to 63% and 50% of pure and mix tumors respectivilly. Conclution: Pure apocrine carcinoma most be distinguied of the mix apocrine forms of ductal and lobular carcinomas by a gently morfologic analysis of the tumor and the following combination would allow for and immunohistochemical identification: AR+, ER-, PR...

Expresión inmunohistoquímica de la proteína p53 en relación con el grado histológico y riesgo de recidivas en meningiomas intracraneanos

Los meningiomas son neoplasias primarias frecuentes del sistema nervioso central, usualmente benignas y susceptibles de curación mediante cirugía. El grado histológico de la Organización Mundial de la Salud y la extensión de la resección quirúrgica inicial son factores pronósticos determinantes en estos tumores. Sin embargo, una tasa de recidiva cercana al 20 por ciento en meningiomas benignos totalmente resecados plantea la necesidad de considerar nuevos factores pronósticos. Un total de 93 casos fueron seleccionados para el estudio inmunohistoquímico de la proteína p53 en relación con el grado histológico y riesgo de recidivas en los meningiomas. El índice de marcaje inmunohistoquímico de la proteína p53 se incrementó con la progresión del grado histológico (promedios de 37,15 por ciento para el grado I, 44,49 por ciento para el II y 57,81 por ciento para el III) y fue significativamente superior en meningiomas recidivantes (46,19 por ciento vs 32,29 por ciento de los no recidivantes). El punto de corte de 40 por ciento resultó estadísticamente útil para separar a los meningiomas benignos (grado I) de los no benignos (grados II-III) y a los tumores recidivantes de los no recidivantes. De esta manera, un índice de marcaje de la proteína p53 igual o mayor de 40 por ciento puede indicar la posibilidad de un grado más alto en casos histológicamente ambiguos o un riesgo mayor para desarrollar recidivas en meningiomas de un grado histológico en particular (especialmente en tumores benignos)

Meningiomas are frequent primary neoplasms of the central nervous system, usually benign and susceptible to healing through surgery. The histological grade of the World Health Organization and the extension of the initial surgical resection, are determining prognostic factors in these tumors. Nevertheless, a recurrence rate close to 20 percent in benign meningiomas completely resected arises the need of considering new prognostic factors. A total of 93 cases were selected for the immunohistochemical study of p53 protein in relation to the histological grade and the risk of recurrences in meningiomas. The immunohistochemical labeling index of p53 protein increased with the progression of the histological grade (means of 37,15 percent for grade I, 44,49 percent for grade II, and 57,81 percent for grade III) and was significantly superior in recurrent meningiomas (46,19 percent vs 32,29 percent of non recurrent). The cut off of 40 percent became statistically useful to separate the benign meningiomas (grade I) from the non benign (grade II and III) and the recurrent tumors from the non recurrent. In this way, a labelling index of p53 protein equal or superior to 40 percent can indicate the possibility of a higher grade in histologically ambiguous cases or a higher risk to develop recurrencies in meningiomas of a particular histological grade (specially in benign tumors)

IMMUNOHISTOCHEMICAL STUDY OF G_2AP ARTERY SLEEVE BRIDGING IN PERIPHERAL NERVE / 中华显微外科杂志

Objective:For studing the mechanism of growth and regeneration of peripheral nerve using artery sleeve bridging.Methods:The models of in-situ epineurium suture and 2 mm gap artery sleeve bridging at the common fibular nerves in rat were made to observe the changes of Schwann cells,neurofilament,phosphorylated neurofilament and growth come with immunohisto-chemical stain at 7,14,21 and 28 days after surgery.Results:(1)Schwann cells extend by the artery wall and axons growth above the Schwann cells in the artery tube;(2)The new axons need about 2 weeks to pass the 2 mm gap;(3)The regeneration rate of axon in distal site of nerves is similar at 3 weeks after repair. Conclusion:The small gap sleeve bridging might become a effective method to increase growth rate of nerve.