Valoración de técnicas de citología en mucosa bucal en pacientes con síndrome de Sjögren / Assessment of cytology techniques in oral mucosa of Sjögren's syndrome patients

Resumen El objetivo del presente trabajo es comparar dos técnicas de estudio de citología bucal, la citología exfoliativa y de impresión, para evaluar cambios en la mucosa oral que permitan el diagnóstico no invasivo de síndrome de Sjögren (SS). Pacientes: Se seleccionaron 50 pacientes apareados por sexo y edad, diagnosticados con síndrome de Sjögren según criterios del Consenso Americano-Europeo. Los pacientes fueron distribuidos en tres grupos experimentales: controles sanos (C), n = 14, boca y ojo secos sin SS (BO), n = 13, y con SS n = 23. Material y métodos: Para la citología exfoliativa se utilizó cepillo recolector de células (Citobrush) deslizándolo a lo largo de la lámina de vidrio, fijándose posteriormente en etanol al 95%. En citologías por impresión se utilizó papel de acetato de celulosa (Milipore Hawp 304®), en tiras de un cm de longitud colocadas sobre la superficie de la mucosa bucal sobre el surco vestibular superior inmovilizando el papel y presionando por tres segundos. Se tiñeron con técnica de Papanicolau (PAP). Se valoró la morfología e histomorfometría, estudiando: área citoplasmática (AC), área nuclear (AN), relación núcleo-citoplasma (N:C) y cantidad de células por milímetro cuadrado (mm2). Resultados: Ambas técnicas nos permitieron observar en C: células epiteliales pavimentosas aisladas, basófilos, núcleos centrales normales, 20 a 30 por mm2, relación N/C 1:8. En el grupo BO: células aisladas, agrupadas y plegadas, con citoplasma a predominio eosinófilo, aumento de la cantidad de células 40 por mm2, relación núcleo-citoplasma relación N/C 1:4. En los pacientes SS se observó el área nuclear con cromatina más densa, 400 células por mm2, y relación N/C 1:2 en relación a BO y C. Hubo diferencias estadísticamente significativas entre los grupos en todas las características estudiadas. Conclusión: Podríamos inferir que la citología por impresión puede ser utilizada en el diagnóstico de lesiones orales y sistémicas en pacientes con hiposalivación.

Abstract The aim of the present research project was to compare two techniques for oral cytology study (exfoliative cytology and impression cytology) in order to assess changes in oral mucosa which might allow non -invasive diagnosis of Sjögren's syndrome cases (SS). Patients: 50 patients were selected, patients were paired by age and gender, and had been diagnosed with Sjögren's syndrome according to criteria of the American-European Consensus. Patients were distributed into the following three experimental groups: healthy control group (C), n = 14, Dry mouth and eyes group without SS, (ME) n = 13, and SS group n = 23. Material and methods: A cell harvesting brush (Cytobrush) was used for the exfoliative cytology procedure, sliding it along a glass plate and later fixating harvested cells in 95% ethanol. Cellulose acetate paper (Millipore Hawp 304®) was used for the impression cytology procedure. The paper was in 1 cm long stripes which were placed on the oral mucosa surface above upper vestibular groove; stripes were immobilized and pressure was applied for three seconds. Papanicolau (PAP) technique was used for dyeing. Morphology and histomorphology were assessed studying the following: cytoplasmic area (CA), nuclear areas (NA) nucleus-cytoplasm relationship (N:C) and amount of cells per square millimeter (mm2). Results: Both techniques revealed the following in C: isolated single-layered epithelial cells, basophils, normal central nuclei, 20 to 30 per mm2, N:C ratio 1:8. In the eye and mouth group (EM): grouped and folded isolated cells, cytoplasm with eosinophilic predominance increase of cell amount to 40 per mm2, nucleus-cytoplasm relationship N/C 1:4. SS patients showed the following: nuclear area with denser chromatin, 400 cells per mm2, and 1:2 N/C relationship with respect to mouth and ears and control. Statistically significant differences wereobserved among groups in all studied characteristics. Conclusion: We can infer that impression cytology can be used in systemic and oral lesion's diagnosis in patients afflicted with hyposalivation.

Ultrasonographic characteristic influencing of non-diagnostic results for ultrasound-guided fine-needle aspiration of thyroid nodules / 中华超声影像学杂志

Objective To explore the clinical and ultrasonographic characteristics leading to non-diagnostic results after ultrasound-guided fine-needle aspiration ( US-FNA) in patients with thyroid nodules . Methods One thousand and thirty-four thyroid nodules of 1009 patients who underwent US-FNA from June 2013 to September 2015 in Fudan University Shanghai Cancer Center were included in this study . The ultrasonographic characteristics , cytological and histological diagnosis were collectecl . Univariate and multivariate logistic methods were applied to analyze the factors bringing about non-diagnostic results . Results Of the 1034 nodules ,174 ( 16 .8％ ) had non-diagnostic results and 860 ( 83 .2％ ) had diagnostic results . Age ,echogenicity ,anteroposterior/transverse diameter ratio ( AT ) ,calcification ,margin and depth were associated with nondiagnostic results . Age ≥45 years ,the largest diameter ≤10 mm ,AT <1 ,located at the middle 1/3 and dorsal 1/3 in the cross section of nodules , macrocalcification were proved as independent influencing factors for non-diagnostic results of FNA . Conclusions Age≥45 years ,the largest diameter ≤10 mm ,AT < 1 ,located at the middle 1/3 and dorsal 1/3 in the cross section of nodules , macrocalcification are independent influencing factors of non-diagnostic results . As a result ,for nodules with the characteristics above it may recommend follow up instead of FNA . During follow-up ,it may recommend surgery if the nodule has progressed .

Leishmaniasis in a patient with HIV co‑infection: Diagnosis on fine needle aspiration cytology.

Leishmaniasis is a vector borne parasitic disease caused by obligate intracellular protozoa Leishmania and is transmitted by the bite of sand fly. The disease typically presents in visceral, cutaneous and mucocutaneous forms and is endemic in some states of India. Cases with atypical presentation are seen when patient has co- infection with HIV. We report a case of Leishmaniasis occurring in a HIV seropositive expectant mother diagnosed initially on fine needle aspiration cytology. The patient was resident of non endemic area and had presented with isolated cervical lymphadenopathy and fever without spleenomegaly. Characteristic morphological features of Leishmania seen in the fine needle aspiration smears from the neck nodes were identified and definitive diagnosis of Leishmaniasis could be given. Cytological features were not suggestive of any other disease. Timely diagnosis of the disease facilitated proper management in our patient.

Manifestaciones bucales de la candidiasis en pacientes con trasplante renal / Oral manifestations of candidiasis in patients with renal transplantation

Se efectuó un estudio descriptivo y transversal de 125 pacientes con trasplante renal, afectados por candidiasis bucal debido al tratamiento con medicamentos inmunosupresores, atendidos en la consulta estomatológica del Policlínico de Especialidades del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde julio de 2012 hasta igual mes de 2015, con vistas evaluar los resultados del diagnóstico clínico y citológico. En la serie prevalecieron el sexo masculino, el grupo etario de 50- 59 años, la ausencia de síntomas clínicos, el paladar duro como sitio anatómico de mayor susceptibilidad y la candidiasis seudomembranosa como forma clínica más relevante; asimismo, esta infección predominó en quienes tenían deficiente higiene bucal, en los que practicaban el hábito de fumar y en los tratados con los mencionados fármacos. Los resultados de la citología exfoliativa confirmaron la presencia de este agente fúngico.

A descriptive and cross-sectional study of 125 patients with renal transplantion, who had oral candidiasis due to the immunosupressive therapy , assisted in the Stomatology Department of the Specialties Polyclinic from "Saturnino Lora Torres" Clinical Surgical Teaching Provincial Hospital in Santiago de Cuba was carried out from July, 2012 to the same month of 2015, with the objective of evaluating the results of the clinical and cytological diagnosis. The male sex, the age group 50 - 59 years, the absence of clinical symptoms, the hard palate as anatomical site of greater susceptibility and the pseudomembranous candidiasis as the most outstanding clinical form prevailed in the series; also, this infection prevailed in those who had scarce oral hygiene, in those who practiced the smoking habit and in those patients treated with the mentioned drugs. The results of the exfoliative cytology confirmed the presence of this fungal agent.

Application of liquid based cytology test in detection of fiber bronchoscopic aspirates / 重庆医学

Objective To study liquid based cytology test and its application values in the detection of fiber bronchoscopic aspi‐rates .Methods LBP sedimentation type of ThinPrep cell production system combined with the conventional smear were used to de‐tect 2000 specimens of fiber bronchoscopic aspirates ,and conduct microscope observation and cytological diagnosis .Results Based on liquid based cytology cell production method ,there were 614 positive cases (30 .7% ) ,267 cases of squamous cell carcinoma (13 .4% ) ,and 217 cases of adenocarcinoma(10 .9% ) ,83 cases of small cell carcinoma (4 .2% ) ,and 47 cases of undifferentiated car‐cinoma (2 .4% ) .The diagnostic sensitivity for lung cancer of liquid‐based cytology test was 64 .6% and conventional smear was 49 .2% .We also found 7 cases of fungus positive ,35 cases of typical caseous necrosis with liquid based cytology test .Conclusion The ThinPrep cell production has a more clean background ,more intact cell structure ,more efficient observation and increased posi‐tive rate of detection of cancer cells than the smears made by traditional methods .A combination of two methods can increase the accuracy of cytological detection of fiber bronchoscope aspirates and positive detection rate ,and also can assist the diagnosis of fungi and TB infections .

Cytological diagnosis of mucoepidermoid carcinoma of parotid - A diagnostic dilemma.

Mucoepidermoid carcinoma (MEC) of parotid, a rare disease, was diagnosed by fine needle aspiration in a young child and later confirmed on histopathology. Of all salivary gland tumors, mucoepidermoid carcinoma is the most difficult to diagnose by fine needle aspiration cytology due to overlapping cytomorphology with benign lesions. So, fine needle aspiration cytology helps in early diagnosis and management

Detección del virus del papiloma humano de alto riesgo por captura híbrida II® según hallazgos citológicos en mujeres tratadas por lesiones escamosas intraepiteliales de cuello uterino, período 2006/2010 / Detection of high risk human papillomavirus by hybrid capture II(r) according cytological findings in women treated for squamous intraepithelial lesions of the cervix, period 2006/2010

OBJETIVO: Determinar la frecuencia del virus de papiloma humano de alto riesgo oncogénico (HR-HPV) por captura híbrida II (r) (CH II(r)) según hallazgos citológicos en mujeres tratadas por lesiones escamosas intraepiteliales (SIL) de cuello uterino. MATERIAL Y MÉTODO: Estudio descriptivo de corte transverso de una serie de casos, en donde se incluyeron 122 mujeres tratadas, 79 (65%) por SIL de bajo grado (LSIL) y 43 (35%) por SIL de alto grado (HSIL) que concurrieron al Laboratorio de HPV del Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, para realizarse un control post-tratamiento, periodo 2006/2010. RESULTADOS: Se observó un total del 28% (34/122) de mujeres tratadas por SIL positivas para HR-HPV, detectándose infección viral en un 20% de las mujeres con ausencia de SIL (NSIL) (22/108), 83% de las mujeres con LSIL (10/12) y 100% de las mujeres con HSIL (2/2). De las 34 mujeres positivas para HR-HPV, 10 mujeres (29%) presentaron valores altos (100 pg/mL o más) de carga viral relativa, detectándose un aumento de casos positivos con la severidad de la lesión (28% NSIL, 30% LSIL, 50% HSIL). CONCLUSION: La detección de HR-HPV por CH II(r), así como los valores de carga viral relativa altos, en especial en mujeres con NSIL podrían ayudar a identificar mujeres tratadas con riesgo a desarrollar recidivas, contribuyendo así a fortalecer el programa de prevención de cáncer de cuello uterino. .

OBJECTIVE: To determinate the frequency of high risk human papillomavirus (HR-HPV) by hybrid capture II (r) (CH II(r)), according cytology results in women treated for squamous intraepithelial lesions of the cervix (SIL). MATERIAL AND METHODS: A descriptive cross-sectional study of a series of cases that included 122 women treated, 79 (75%) for low grade SIL (LSIL) and 43 (35%) for high grade SIL (HSIL) attending at the HPV Laboratory at the Health Sciences Research Institute (IICS), National University of Asunción (UNA), for post-treatment control during period 2006/2010. RESULTS: A total of 28% (34/122) of women treated for SIL were positive for HR-HPV, detecting viral infection in 20% of women with no SIL (NSIL) (22/108), in 83% of women with LSIL (10/12) and in 100% of women with HSIL (2/2). Of 34 women positive for HR-HPV, 10 women (29%) had high values (100 pg / mL or more) of relative viral load, detecting an increase of positive cases with severity of the lesion (28% NSIL, 30% LSIL, 50% HSIL). CONCLUSION: HR-HPV detection by CH II(r) and high relative viral load values especially in women with NSIL could help to identify treated women at risk of developing recurrence, thereby contributing to strengthening the cervical cancer prevention program. .

Frecuencia y carga viral relativa del virus del papiloma humano de alto riesgo según el diagnóstico citológico en mujeres paraguayas por captura híbrida II / Frequency and relative viral load of high risk human papilloma virus according to the cytological diagnosis in paraguayan women by hybrid capture II

El cáncer de cuello uterino es el tumor maligno más frecuente en mujeres de Latinoamérica y su agente causal es el virus del papiloma humano (HPV). Recientemente en Paraguay incorporamos el método de captura híbrida II (CH II), el cual detecta 13tipos de HPV de alto riesgo oncogénico (HR-HPV) y proporciona valores relativos de carga viral. El objetivo del estudio fue determinar la carga viral relativa de HR-HPV por CH IIsegún el diagnóstico citológico. Fueron incluidas 566 mujeres (33 + 10 años) atendidas en el Instituto de Investigaciones en Ciencias de la Salud 2006/2009. Fue detectado HRHPVen 43% de las mujeres (241/566), observándose una alta frecuencia del 23% en mujeres con ausencia de lesión intraepitelial (NSIL). Según el diagnóstico citológico, se evidenció una diferencia altamente significativa entre los valores de carga viral relativa(p<0,0001; Kruskal Wallis), observándose un aumento de carga viral relativa de mujeres con NSIL a mujeres con SIL (68 pg/ml en ausencia de SIL; 710 pg/ml para SIL de bajo grado-LSIL y 474 pg/ml para SIL de alto grado-HSIL). No se observó cambio significativo en la carga viral relativa entre LSIL y HSIL (p=0,60; prueba t de Student). Los resultados sugieren que los valores de carga viral relativa proporcionados por CH II pueden ser considerados como un indicador importante en el manejo de mujeres con sospecha de SIL.

Cervical cancer is the most frequent malignant tumor in women of Latin America being human papillomavirus (HPV) the main causative agent. Recently in Paraguay, we incorporated the method of hybrid capture II (CH II) which detects 13 types of HPV ofhigh oncogenic risk (HR-HPV) and provides relative values of viral load. The aim of this study was to determine the frequency and relative viral load of HR-HPV by CH II according to the cytological diagnosis. There were 566 women (33 + 10 years) included in the study that attended the Research Institute in Health Sciences during the period 2006/2009. HR-HPV was detected in 43% of the women (241/566), being observed a high frequency of 23% in women negative to squamous intraepithelial lesions (NSIL). According to the cytological diagnosis, there was a highly significant difference between the values of relative viral load (p <0.0001; Kruskal Wallis), with an increase of relative viral load of women with NSIL to women with SIL (mean values: 68 pg/ml in NSIL; 710 pg/ml in low grade SIL-LSIL and 474 pg/ml in high grade SIL-HSIL). Significant change was not observed in the relative viral load between LSIL and HSIL (p=0.60; Student’s t test).The results suggest that the values of relative viral load provided by CH II could be considered an important indicator for managing women with suspicion of SIL.

Cell morphology and micronuclei in oral exfoliative cells / 实用口腔医学杂志

砄bjective: To evaluate the diagnostic significance of exfoliative cytological examination and micronucleus assay. Methods: 26 cases of leukoplasia (LK) and 18 cases of oral squamous cell carcinoma (SCC) were examined. Cells were scrapped from the lesions, stained with Papaniceolaou. The keratinization types and the configuration of the cells were studied. Smears were also stained using the Feulgen plus fast green method. The frequency of micronucleated cells was counted. Results: Mixed keratinization was observed in all 15 cases of LK without dysplasia and in 7 out of 11 cases of LK with dysplasia. Parakeratosis was found in 17 out of 18 cases of SCC. There was a significant difference of cell keratinization types and cytologic diagnosis between the cases of LK and SCC( P 0.05).Conclusion: Parakeratosis in oral exfoliative cells may indicate a high risk of malignance.