Résumé
Fundamento: la leucoplasia bucal es la lesión premaligna más frecuente, puede presentarse con displasia epitelial, que es el rasgo más importante de sus diversos cambios histopatológicos. Los métodos morfométricos y estereológicos permiten complementar el análisis histopatológico convencional de la displasia epitelial. Objetivo: caracterizar las lesiones de la mucosa con leucoplasia bucal según grado de displasia epitelial a través de indicadores morfométricos y estereológicos. Método: se realizó un estudio observacional descriptivo. El universo lo conformaron 68 biopsias de pacientes con diagnóstico clínico e histopatológico de leucoplasia y la muestra fue de 15 biopsias de leucoplasias displásicas, en las que se analizaron parámetros morfométricos y estereológicos. Resultados: se encontró que la altura de las crestas epiteliales y la altura del epitelio aumentan a medida que avanza el grado de la displasia epitelial. El valor promedio y su desviación estándar del factor de forma en la displasia ligera fue de 0,86 ± 0,08, en la displasia moderada fue de 0,88 ± 0,09 y en la displasia severa fue de 0,85 ± 0,11. El promedio y la desviación estándar del volumen nuclear y la densidad de perfiles nucleares epiteliales descienden al aumentar la displasia. Conclusiones: a partir del análisis de las variables analizadas en esta investigación podemos sugerir el estudio y la evaluación de la posibilidad de la existencia de algún modelo de relación volumen nuclear-perfiles nucleares-altura del epitelio como instrumento para determinar el comportamiento de la displasia.
Background: oral leukoplakia is the most frequent premalignant lesion; it can appear with epithelial dysplasia that is the most important feature of its various histopathological changes. Morphometric and stereological methods allow complementing the conventional histopathological analysis of epithelial dysplasia. Objective: to characterize the lesions of the mucosa with oral leukoplakia according to the degree of epithelial dysplasia through morphometric and stereological indicators. Method: a descriptive, observational study was conducted. The universe was composed of 68 biopsies from patients with a histopathological and clinical diagnosis of leukoplakia; the sample was composed of 15 biopsies from patients with dysplastic leukoplakias in which morphometric and stereological parameters were analyzed. Results: it was found that as the degree of epithelial dysplasia becomes greater, the more the height of the epithelial crest and the height of the epithelium rise. The average value and its standard deviation of the shape factor in minor dysplasia was of 0.86 ± 0.08, in moderate dysplasia was of 0.88 ± 0.09, and in serious dysplasia was of 0.85 ± 0.11. As the dysplasia becomes greater, the average and the standard deviation of the nuclear volume and the density of epithelial nuclear profile decrease. Conclusions: from the analysis of the variables through this investigation, we can suggest the study and evaluation of the possibility of the existence of a model of nuclear volume-nuclear profile-height of the epithelium relation, as an instrument to determine the behavior of dysplasia.
Résumé
PURPOSE: As the number of patients with localized renal cell carcinoma has increased, there are conflicting reports on the nuclear grade as a prognostic factor. The aim of this study was to evaluate the significance of the nuclear grade as a prognostic factor. MATERIALS AND METHODS: We retrospectively enrolled 172 patients with localized renal cell carcinoma and who underwent radical nephrectomy. The patients were staged according to the 1997 TNM stage and the Fuhrman grading. The survival rate was analyzed by the Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazard model. RESULTS: The overall 1- , 5- and 10-year survival rates were 98.1, 72.5 and 68.4%, respectively. The 5-year survival rates for grades I, II, III and IV were 100, 92.6, 85.0 and 60.9%, respectively (p<0.0001). According to the Fuhrman grade in each T stage, 1) for patients with pT1b, the 5-year survival rates were 100, 85.0, 85.71 and 33.3% for patients with grade I, II, III and IV, respectively (p=0.002). 2) for patients with pT2, the 5-year survival rates were 100, 92.3, 60.0 and 25.0% for patients with grade I, II, III and IV, respectively (p<0.0001). A comparison of the survival curves by the Fuhrman grade showed a statistically significant difference. CONCLUSIONS: The Fuhrman grade is an important prognostic factor for patients with localized renal cell carcinoma. A high nuclear grade tends to have metastatic potential and a poor prognosis. This group of patients with a high nuclear grade must be followed up more closely. Determining the pathologic stage along with using the Fuhrman grade-based surveillance protocols are a logical approach to follow-up.