Punción aspiración con aguja fina en patología mamaria. Experiencia en nuestra institución y correlación histopatológica / Fine needle aspiration in breast pathology. Experience in our institution and histophatologic correlation

Introducción: La punción aspiración con aguja fina (paaf) es una técnica segura, efectiva, económica y adecuada para el diagnóstico presuntivo de lesiones mamarias palpables, no palpables y adenopatías. Objetivo: El objetivo de este trabajo es describir la sensibilidad (s), especificidad (e), tasa de falsos positivos (fp) y negativos (fn), valor predictivo positivo (vpp) y negativo (VPN) de las paaf de nuestro servicio para patología mamaria benigna y maligna, comparando los hallazgos citológicos con los resultados histopatológicos. Material y Método: Estudio de corte transversal de 387 paaf efectuadas en el Sector de Patología Mamaria del Hospital C. G. Durand. entre enero de 2011 y agosto de 2014. Se correlacionaron 172 resultados con su estudio histopatológico. Las punciones fueron realizadas por la misma citopatóloga que procesó y analizó las muestras. Resultados: Se obtuvo una s y una e del 95,3% y del 100%, respectivamente, con una tasa de fn de 4,6% y de fp de 0%, vpn de 92,6 % y vpp de 100%. Conclusiones:La paaf es un método altamente sensible y específico para planificar el posterior tratamiento de las pacientes con patología mamaria. Destacamos la importancia de constituir un equipo de trabajo entre un mastólogo y un citopatólogo entrenado...

Variabilidad de Receptores Hormonales y her2 post neoadyuvancia en cáncer de mama / Variability in Hormone Receptor and HER2 status after neoadjuvant chemotheraphy in breast cancer

La quimioterapia neoadyuvante es un pilar fundamental en el tratamiento del cáncer de mama localmente avanzado, y la medida en que modifica la expresión de los receptores hormonales y her2 es motivo de controversia. esta variabilidad tiene importantes consecuencias pronósticas y terapéuticas. Objetivo: Evaluar la variabilidad de los Receptores Hormonales y del her2/neu pre y post neoadyuvancia en pacientes tratadas en el Hospital General de Agudos Carlos G. Durand. Material y método: Estudio retrospectivo de las historias clínicas de las pacientes sometidas a quimioterapia neoadyuvante entre septiembre de 2010 y septiembre de 2014. Se obtuvieron datos de 32 pacientes (34 tumores, 2 de las pacientes presentaron cáncer de mama bilateral). Se evaluaron Receptores Hormonales y her2 en la punción biopsia Core y en la pieza quirúrgica, y se analizó su concordancia. Resultados: La concordancia observada entre la biopsia pre neoadyuvancia y el tumor residual fue para re del 14,8% (k=0,60), para rp del 25,9% (k=0,33), para rh tomados en conjunto del 18,5% (k=0,35) y para her2 del 7,4% (k=0,70). Conclusiones: En nuestra serie encontramos una concordancia buena para her2, moderada para re y débil para rp y rh entre las muestras pre y post neoadyuvancia. La variabilidad encontrada justifica el retesteo de los biomarcadores en la pieza quirúrgica...

Kinetoplastid membrane protein-11 exacerbates infection with Leishmania amazonensis in murine macrophages

In Leishmania amazonensis, kinetoplastid membrane protein-11 (KMP-11) expression increases during metacyclogenesis and is higher in amastigotes than in promastigotes, suggesting a role for this protein in the infection of the mammalian host. We show that the addition of KMP-11 exacerbates L. amazonensis infection in peritoneal macrophages from BALB/c mice by increasing interleukin (IL)-10 secretion and arginase activity while reducing nitric oxide (NO) production. The doses of KMP-11, the IL-10 levels and the intracellular amastigote loads were strongly, positively and significantly correlated. The increase in parasite load induced by KMP-11 was inhibited by anti-KMP-11 or anti-IL-10 neutralising antibodies, but not by isotype controls. The neutralising antibodies, but not the isotype controls, were also able to significantly decrease the parasite load in macrophages cultured without the addition of KMP-11, demonstrating that KMP-11-induced exacerbation of the infection is not dependent on the addition of exogenous KMP-11 and that the protein naturally expressed by the parasite is able to promote it. In this study, the exacerbating effect of KMP-11 on macrophage infection with Leishmania is for the first time demonstrated, implicating it as a virulence factor in L. amazonensis. The stimulation of IL-10 production and arginase activity and the inhibition of NO synthesis are likely involved in this effect.

Atypical Mucocutaneous Leishmaniasis Caused by Leishmania braziliensis in an Acquired Immunodeficiency Syndrome Patient: T-cell Responses and Remission of Lesions Associated with Antigen Immunotherapy

An atypical case of acquired immunodeficiency syndrome-associated mucocutaneous lesions due to Leishmania braziliensis is described. Many vacuolated macrophages laden with amastigote forms of the parasite were found in the lesions. Leishmanin skin test and serology for leishmaniasis were both negative. The patient was resistant to therapy with conventional drugs (antimonial and amphotericin B). Interestingly, remission of lesions was achieved after an alternative combined therapy of antimonial associated with immunotherapy (whole promastigote antigens). Peripheral blood mononuclear cells were separated and stimulated in vitro with Leishmania antigens to test the lymphoproliferative responses (LPR). Before the combined immunochemotherapy, the LPR to leishmanial antigens was negligible (stimulation index - SI=1.4). After the first course of combined therapy it became positive (SI=4.17). The antigen responding cells were predominantly T-cells (47.5 percent) most of them with CD8+ phenotype (33 percent). Very low CD4+ cells (2.2 percent) percentages were detected. The increased T-cell responsiveness to leishmanial antigens after combined therapy was accompanied by interferon-g (IFN-g) production as observed in the cell culture supernatants. In this patient, healing of the leishmaniasis lesions was associated with the induction of a specific T-cell immune response, characterized by the production of IFN-g and the predominance of the CD8+ phenotype among the Leishmania-reactive T-cells

Tumor necrosis factor-æ in human American tegumentary leishmaniasis

Tumor necrosis factor-alpha (TNF-alpha) is a cytokine produced by activated macrophages and other cells. In order to verify whether the serum levels of TNF-alpha in American tegumentary leishmaniasis patients are associated with the process of cure or aggravation of the disease, 41 patients were studied: 26 cases of cutaneous leishmaniasis (CL) and 15 of mucocutaneous leishmaniasis (MCL). During active disease the serum levels of TNF-alpha of MCL patients were significantly higher than those of CL patients and control subjects (healthy individuals and cutaneous lesions from other etiologies). The MCL patients had serum titers of TNF-alpha significantly lower at the end of antimonial therapy than before therapy. After a six-month follow-up, the MCL patients had serum levels of TNF-alpha similar to those observed at the end of the therapy as well as to those of Cl patients and control subjects. No significant variation in the serum levels of TNF-alpha was observed in CL patients throughout the study period (before, at the end of therapy and after a six-month follow-up). The possible relationship between the high TNF-alpha serum levels and severity of the disease is discussed.