Application of modified Matutes score containing CD200 in diagnosis of chronic lymphocytic leukemia / 中南大学学报(医学版)

OBJECTIVES@#Immunophenotyping technique is a powerful tool for the diagnosis and differential diagnosis of chronic lymphocytic leukemia (CLL) and other B-cell chronic lymphoproliferative diseases (B-CLPD). CD200 is strongly expressed in CLL. This study aims to analyze the clinical value of modified Matutes score (MMS) containing CD200 in the diagnosis of CLL.@*METHODS@#We retrospectively analyzed 103 B-CLPD patients diagnosed from January 2020 to July 2021, including 64 CLL patients, 11 follicular lymphoma (FL) patients, 14 mantle cell lymphoma (MCL) patients, 6 marginal zone lymphoma (MZL) patients, 1 hairy cell leukemia (HCL) patient, and 7 lymphoplasmic lymphoma/Waldenstrom macroglobulinemia (LPL/WM) patients. The expression of CD markers between the CLL group and the non-CLL group was compared, and the sensitivity, specificity, and clinical consistency of MMS and Royal Marsden Hospital (RMH) immunophenotyping score system were analyzed.@*RESULTS@#There were significant differences in the expressions of CD5, CD23, FMC7, CD22, CD79b, CD200, and sIg between the CLL group and the non-CLL group (χ2 values were 37.42, 54.98, 30.71, 11.67, 55.26, 68.48, and 17.88, respectively, all P<0.01). When the RMH immunophenotyping score≥4, the sensitivity was 79.7%, and the specificity was 100%. When the MMS≥3, the sensitivity was 95.3%, and the specificity was 100%. The Kappa coefficient of RMH immunophenotyping system was 0.677, and the Kappa coefficient of MMS system was 0.860.@*CONCLUSIONS@#The MMS system containing CD200 has better sensitivity and same specificity compared with RMH immunophenotyping system, and MMS system may be more useful in the diagnosis of CLL.

B cells and tumor immune escape / 中南大学学报(医学版)

B lymphocyte is an important component of the human immune system and it has a role in the process of the body's specific immunity. In recent years, the research on B cells and tumor immune escape has rapidly progressed. Studies have shown that different types of B cells play different roles in tumor microenvironment through a variety of mechanisms. B cells in the tertiary lymphatic structure promote anti-tumor immunity, while regulatory B cells promote tumor immune escape. Antibody drugs targeting B cells are a promising direction for tumor immunotherapy.

Linfoma Cutáneo de Células B Centrofolicular / Centrofollicular B-cell cutaneous lymphoma

Resumen Los Linfomas cutáneos son proliferaciones clonales de Linfocitos T o B neoplásicos. Los linfomas cutáneos B son un grupo heterogéneo de linfomas que se presentan en la piel sin evidencia de compromiso extra cutáneo al momento del diagnóstico y corresponden entre el 20% al 25 % de los linfomas cutáneos primarios.Se presenta un paciente masculino de 71 años, con un linfoma cutáneo de células B centrofolicular localizado en dorso.

Abstract Cutaneous lymphomas are clonal proliferations of neoplastic T or B lymphocytes. Cutaneous B lymphomas are a heterogeneous group of lymphomas presented in the skin without evidence of extra cutaneous harm at the moment of diagnosis and correspond between the 20% and the 25% of primary cutaneous lymphomas. In the current research, a 71 year old masculine patient case is presented, with a cutaneous lymphoma of centrofollicular B cells located at the back.

Inmunopatología de la brucelosis osteoarticular / Immunopathology of osteoarticular brucelosis

La brucelosis es una de las enfermedades zoonóticas más importantes a nivel mundial capaz de producir enfermedad crónica en los seres humanos. La localización osteoarticular es la presentación más común de la enfermedad activa en el hombre. Sin embargo, algunos de los mecanismos moleculares implicados en la enfermedad osteoarticular han comenzado a dilucidarse recientemente. Brucella abortus induce daño óseo a través de diversos mecanismos en los cuales están implicados TNF-α y RANKL. En estos procesos participan células inflamatorias que incluyen monocitos/macrófagos, neutrófilos, linfocitos T del tipo Th17 y linfocitos B. Además, B. abortus puede afectar directamente las células osteoarticulares. La bacteria inhibe la deposición de la matriz ósea por los osteoblastos y modifica el fenotipo de estas células para producir metaloproteinasas de matriz (MMPs) y la secreción de citoquinas que contribuyen a la degradación del hueso. Por otro lado, la infección por B. abortus induce un aumento en la osteoclastogénesis, lo que aumenta la resorción de la matriz ósea orgánica y mineral y contribuye al daño óseo. Dado que la patología inducida por Brucella afecta el tejido articular, se estudió el efecto de la infección sobre los sinoviocitos. Estos estudios revelaron que, además de inducir la activación de estas células para secretar quemoquinas, citoquinas proinflamatorias y MMPs, la infección inhibe la muerte por apoptosis de los sinoviocitos. Brucella es una bacteria intracelular que se replica en el retículo endoplásmico de los macrófagos. El análisis de los sinoviocitos infectados con B. abortus indicó que las bacterias también se multiplican en el retículo endoplasmático, lo que sugiere que la bacteria podría usar este tipo celular para la multiplicación intracelular durante la localización osteoarticular de la enfermedad. Los hallazgos presentados en esta revisión intentan responder a preguntas sobre los mediadores inflamatorios implicados en el daño osteoarticular causado por Brucella. (AU)

Brucellosis is one of the most important zoonotic diseases that can produce chronic disease in humans worldwide. Osteoarticular involvement is the most common presentation of human active disease. The molecular mechanisms implicated in bone damage have started to be elucidated. B. abortus induces bone damage through diverse mechanisms in which TNF-α and RANKL are implicated. These processes are driven by inflammatory cells, including monocytes/macrophages, neutrophils, Th17 lymphocytes and B cells. Also, Brucella abortus (B. abortus) can directly affect osteoarticular cells. The bacterium inhibits bone matrix deposition by osteoblast and modifies the phenotype of these cells to produce matrix methalloproteinases (MMPs) and cytokine secretion that contribute to bone matrix degradation. B. abortus also affects osteoclast increasing mineral and organic bone matrix resorption and contributing to bone damage. Since the pathology induced by Brucella species involves joint tissue, experiments conducted in sinoviocytes revealed that besides inducing the activation of these cells to secrete chemokines, proinflammatory cytokines and MMPS, the infection also inhibits sinoviocyte apoptosis. Brucella is an intracellular bacterium that replicate in the endoplasmic reticulum of macrophages. The analysis of B. abortus infected sinoviocytes indicated that bacteria also replicate in their reticulum suggesting that the bacterium could use this cell type for intracellular replication during the osteoarticular localization of the disease. The findings presented in this review try to answer key questions about the inflammatory mediators involved in osteoarticular damage caused by Brucella. (AU)

Intravascular large B-cell lymphoma with multi-organ failure presenting as a pancreatic mass: a case with atypical presentation and definite diagnosis postmortem

Intravascular large B-cell lymphoma (IVLBCL) is a very rare extra nodal lymphoma that tends to proliferate within small blood vessels, particularly capillaries and postcapillary venules while sparing the organ parenchyma. The cause of its affinity for the vascular bed remains unknown. Because of its rarity and unremarkable clinical presentation, a timely diagnosis of IVLBCL is very challenging. Here, we describe a case of IVLBCL presenting as pancreatic mass that was ultimately diagnosed at autopsy. A 71-year-old Caucasian female presented with a 3-month history of fatigue, abdominal pain, and weight loss. She was referred to the emergency room with a new diagnosis of portal vein thrombosis and lactic acidosis. During her hospital course she was found to have a 1.9 × 1.8 cm lesion in the pancreatic tail on imaging; The cytologic specimen on the mass showed a high-grade lymphoma. A bone marrow biopsy showed no involvement. The patient's condition rapidly deteriorated and she, later, died due to multi-organ failure. An autopsy revealed diffuse intravascular invasion in multiple organs by the lymphoma cells. Based on our literature review­and to the best of our knowledge­there are virtually no reports describing the presentation of this lymphoma with a discernible tissue mass and associated multi-organ failure. The immunophenotypic studies performed revealed de novo CD5+ intravascular large B-cell lymphoma, which is known to be aggressive with very poor prognosis. Although it is a very rare lymphoma, it should be considered as a potential cause of multi-organ failure when no other cause has been identified. A prompt tissue diagnosis, appropriate high-dose chemotherapy and stem cell transplantation remain the only viable alternative to achieve some kind of remission.

Telomere length analysis in monoclonal B-cell lymphocytosis and chronic lymphocytic leukemia Binet A

Monoclonal B-cell lymphocytosis (MBL) is an asymptomatic clinical entity characterized by the proliferation of monoclonal B cells not meeting the diagnosis criteria for chronic lymphocytic leukemia (CLL). MBL may precede the development of CLL, but the molecular mechanisms responsible for disease progression and evolution are not completely known. Telomeres are usually short in CLL and their attrition may contribute to disease evolution. Here, we determined the telomere lengths of CD5+CD19+ cells in MBL, CLL, and healthy volunteers. Twenty-one CLL patients, 11 subjects with high-count MBL, and 6 with low-count MBL were enrolled. Two hundred and sixty-one healthy volunteers aged 0 to 88 years were studied as controls. After diagnosis confirmation, a flow cytometry CD19+CD5+-based cell sorting was performed for the study groups. Telomere length was determined by qPCR. Telomere length was similar in the 3 study groups but shorter in these groups compared to normal age-matched subjects that had been enrolled in a previous study from our group. These findings suggest that telomere shortening is an early event in CLL leukemogenesis.

Granuloma faciale: clinical, morphological and immunohistochemical aspects in a series of 10 patients

Abstract Granuloma faciale is a chronic, benign, cutaneous vasculitis with well-established clinical and morphological patterns, but with an unknown etiology. This study describes clinical and pathologic aspects of patients diagnosed with granuloma faciale. The authors analyzed demographic, clinical, morphological and immunohistochemical data from patients with a final diagnosis of granuloma faciale, confirmed between 1998 and 2012. There was a proportional and mixed inflammatory infiltrate, Grenz zones were present in almost all the samples. Immunophenotyping confirmed a higher intensity of T lymphocytes than B lymphocytes in thirteen samples, with a predominance of T CD8 lymphocytes in 64% of cases, in contrast to the literature, which indicates that the major component is T CD4 lymphocytes. All cases were positive for IgG4 but the majority (12/14) had less than 25% of stained cells. The pathogenesis of granuloma faciale remains poorly understood, making studies of morphological and immunohistochemical characterization important to better understand it.

Frequency of monoclonal B-cell lymphocytosis in relatives of patients with chronic lymphocytic leukemia / Frecuencia de linfocitosis monoclonal de células B en familiares de pacientes con leucemia linfoide crónica

Introduction: monoclonal B-cell lymphocytosis is a symptom free condition characterized by the circulation of small clonal population of B lymphocytes in peripheral blood (less than 5x10(9)/L) expressing an immunophenotype similar to chronic lymphocytic leukemia. Different studies based on big hospital series have manifested a higher risk in subjects with monoclonal B-cell lymphocytosis to progress to a chronic lymphocytic leukemia. The behavior of this hematologic entity is unknown therefore its frequency in sporadic chronic lymphocytic leukemia patient relatives was determined. Methods: transversal descriptive study, 8 color flow cytometry was performed using two of the tubes of the Euro Flow recommended panel, with modifications, for the diagnose of chronic lymphoproliferative disorders of B lymphocytes; besides, a fluorescence in situ hybridization was performed. univariate and bivariate analyses of the information were performed. Results: monoclonal B-cell lymphocytosis frequency found in 51 analyzed relatives was 2%, it was a female participant, 59 years old, with a total leukocyte count of 7.7x109/L and a B lymphocyte count of 0.124x10(9)/L; from these, 0.04x10(9)/L were clonal cells with restrictions of the kappa light chain. Rearrangements of the IGH gene (14q32) were found. Conclusion: monoclonal B-cell lymphocytosis was detected in one relative of a patient with sporadic chronic lymphocytic leukemia in a frequency similar to the one reported in general population.

Introducción: La linfocitosis monoclonal de células B es una condición asintomática que se caracteriza por la circulación de pequeñas poblaciones clonales de linfocitos B en sangre periférica (menos de 5x10(9)/L) que expresan un inmunofenotipo similar al de la leucemia linfoide cónica. Diferentes estudios basados en grandes series hospitalarias, han puesto de manifiesto un riesgo más elevado de los sujetos con linfocitosis monoclonal de células B de progresar a una leucemia linfoide crónica. En Colombia se desconoce el comportamiento de esta entidad hematológica, por tal razón se determinó su frecuencia en familiares de pacientes con leucemia linfoide crónica esporádica. Métodos: Estudio descriptivo transversal, se realizó citometría de flujo de 8 colores utilizando dos de los tubos del panel recomendado por Euro Flow para el diagnóstico de enfermedades linfoproliferativas crónicas de linfocitos B con modificaciones, además se hizo hibridación fluorescente in situ. Se realizó análisis univariado y bivariado. Resultados: La frecuencia de linfocitosis monoclonal de células B encontrada en los 51 familiares analizados fue del 2%, se trató de un participante del sexo femenino y 59 años de edad, con un recuento total de leucocitos de 7,7x10(9)/L y un recuento de linfocitos B de 0,124x109/L; de estos 0,04x10(9)/L eran células clonales con restricción de la cadena ligera kappa. Se encontraron reordenamientos del gen IGH (14q32). Conclusión: Se detectó linfocitosis monoclonal de células B en un familiar de paciente con leucemia linfoide cónica esporádica en una frecuencia similar a la informada en la población general.

Small clonal B-cell population in the bone marrow as a possible tool in the diagnosis of occult primary parotid lymphoma / Pequeña población de células B monoclonales en medula ósea como posible herramienta diagnóstica en el linfoma oculto primario de parótida

Case Description: An 82-years old Hispanic woman with a past medical history significant for pulmonary thromboembolism on oral anticoagulation, rheumatoid arthritis, and hypertension developed a new onset thrombocytopenia. Clinical Findings: Small clonal B-cells populations (SCBP) also known as monoclonal B-cell lymphocytosis was found as part of the workup for an idiopathic thrombocytopenia and lead ultimately to the diagnosis of parotid primary follicular lymphoma coexisting with Warthin tumor involving the bone marrow in a small extent and oncocytic papilloma located in the maxillary sinus. Treatment and Outcome: Patient was treated with Rituximab monotherapy with improvement on her platelet count. Clinical relevance: Although it is unclear the role of this clonal cells, they may work as a possible diagnostic tool for occult lymphomas. Further prospective studies are needed to confirm this possible association.

Descripción de caso: Mujer hispana de 82 años con una historia médica significativa de tromboembolismo pulmonar en anticoagulación, artritis reumatoide e hipertensión, la cual desarrolló recientemente una trombocitopenia. Hallazgos clínicos: Una pequeña población de células B monoclonales también conocida como linfocitosis monoclonal de células B fue encontrado dentro del estudio de una trombocitopenia idiopática que conllevó al diagnóstico de un linfoma folicular primario de parótida coexistiendo con un tumor de Warthin y un papiloma oncocítico localizado en el seno maxilar. Tratamiento y resultado: La paciente fue tratada con monoterapia de Rituximab con una mejoría en su conteo de plaquetas. Relevancia clínica: Aunque el rol de las pequeñas poblaciones B monoclonales no está completamente dilucidado, podrían tener una aplicación como herramienta diagnóstica. Futuros estudios prospectivos son necesarios para confirmar esta posible asociación.

Estigma e discriminação: experiências de mulheres HIV positivo nos bairros populares de Maputo, Moçambique / Stigma and discrimination: the experiences of HIV-positive women in poor neighborhoods of Maputo, Mozambique / Estigma y discriminación: las experiencias de las mujeres VIH positivas en los barrios populares de Maputo, Mozambique

A epidemia de HIV/AIDS é um sério problema de saúde pública em Moçambique, que convive com altas taxas de prevalência do HIV. O impacto da epidemia é agravado pelo forte estigma que atinge as pessoas soropositivas. O objetivo deste estudo foi investigar, com base em uma perspectiva socioantropológica, a experiência de mulheres HIV positivo nos bairros populares de Maputo e como lidam com o estigma e a discriminação. Foram realizadas entrevistas semiestruturadas com dez mulheres HIV positivo, residentes nos bairros populares de Maputo. Os resultados mostram como a desigualdade de gênero atua de forma importante na construção da vulnerabilidade das mulheres ao HIV, assim como em sua estigmatização e discriminação. No enfrentamento do estigma, as mulheres procuram preservar o sigilo do diagnóstico buscando apoio na reunião em grupos de pares HIV positivo. É fundamental que se implementem políticas públicas voltadas para o empoderamento das mulheres e redução do estigma associado ao HIV/AIDS.

The HIV/AIDS epidemic is a serious public health problem in Mozambique. The country has high prevalence rates, and the epidemic's impact is aggravated by the stigma affecting HIV-positive persons. This study takes a socio-anthropological perspective to analyze the experience of HIV-positive women in poor neighborhoods of Maputo and the ways they cope with stigma and discrimination. Semi-structured interviews were conducted with 10 HIV-positive women. The results show how gender inequalities increase women's vulnerability to HIV and contribute to their stigmatization and discrimination. In dealing with stigma, women try to keep their diagnosis confidential, seeking support in group meetings with others living with HIV. Public policies should focus on women's empowerment and the reduction of HIV/AIDS-related stigma.

El VIH/SIDA es un problema de salud pública grave en Mozambique, que convive con altas tasas de prevalencia del VIH. El impacto de la epidemia se ve agravada por el fuerte estigma que afecta a las personas con VIH. El objetivo de este estudio fue investigar, desde una perspectiva antropológica, la experiencia de las mujeres VIH positivas en los barrios populares de Maputo y cómo enfrentan el estigma y la discriminación. Se realizaron entrevistas semi-estructuradas con 10 mujeres VIH positivas que viven en barrios pobres de Maputo. Los resultados muestran cómo la desigualdad de género juega un papel importante en la construcción de la vulnerabilidad de las mujeres frente al VIH, así como en la estigmatización y discriminación. Para hacer frente el estigma, las mujeres buscan preservar la confidencialidad del diagnóstico y buscar apoyo en la reunión de grupos de pares con VIH. Es imprescindible implementar políticas públicas enfocadas al empoderamiento de las mujeres y a la reducción del estigma asociado con el VIH/SIDA.

Seroprevalence and seroincidence of Leptospira infection in dogs during a one-year period in an endemic urban area in Southern Brazil

INTRODUCTION: Leptospirosis is a zoonosis that affects both humans and animals. Dogs may serve as sentinels and indicators of environmental contamination as well as potential carriers for Leptospira. This study aimed to evaluate the seroprevalence and seroincidence of leptospirosis infection in dogs in an urban low-income community in southern Brazil where human leptospirosis is endemic. METHODS: A prospective cohort study was designed that consisted of sampling at recruitment and four consecutive trimestral follow-up sampling trials. All households in the area were visited, and those that owned dogs were invited to participate in the study. The seroprevalence (MAT titers ≥100) of Leptospira infection in dogs was calculated for each visit, the seroincidence (seroconversion or four-fold increase in serogroup-specific MAT titer) density rate was calculated for each follow-up, and a global seroincidence density rate was calculated for the overall period. RESULTS: A total of 378 dogs and 902.7 dog-trimesters were recruited and followed, respectively. The seroprevalence of infection ranged from 9.3% (95% CI; 6.7 - 12.6) to 19% (14.1 - 25.2), the seroincidence density rate of infection ranged from 6% (3.3 - 10.6) to 15.3% (10.8 - 21.2), and the global seroincidence density rate of infection was 11% (9.1 - 13.2) per dog-trimester. Canicola and Icterohaemorraghiae were the most frequent incident serogroups observed in all follow-ups. CONCLUSIONS: Follow-ups with mean trimester intervals were incapable of detecting any increase in seroprevalence due to seroincident cases of canine leptospirosis, suggesting that antibody titers may fall within three months. Further studies on incident infections, disease burden or risk factors for incident Leptospira cases should take into account the detectable lifespan of the antibody. .

EBV-driven B-cell lymphoproliferative disorders: from biology, classification and differential diagnosis to clinical management

Epstein-Barr virus (EBV) is a ubiquitous herpesvirus, affecting >90% of the adult population. EBV targets B-lymphocytes and achieves latent infection in a circular episomal form. Different latency patterns are recognized based on latent gene expression pattern. Latent membrane protein-1 (LMP-1) mimics CD40 and, when self-aggregated, provides a proliferation signal via activating the nuclear factor-kappa B, Janus kinase/signal transducer and activator of transcription, phosphoinositide 3-kinase/Akt (PI3K/Akt) and mitogen-activated protein kinase pathways to promote cellular proliferation. LMP-1 also induces BCL-2 to escape from apoptosis and gives a signal for cell cycle progression by enhancing cyclin-dependent kinase 2 and phosphorylation of retinoblastoma (Rb) protein and by inhibiting p16 and p27. LMP-2A blocks the surface immunoglobulin-mediated lytic cycle reactivation. It also activates the Ras/PI3K/Akt pathway and induces Bcl-xL expression to promote B-cell survival. Recent studies have shown that ebv-microRNAs can provide extra signals for cellular proliferation, cell cycle progression and anti-apoptosis. EBV is well known for association with various types of B-lymphocyte, T-lymphocyte, epithelial cell and mesenchymal cell neoplasms. B-cell lymphoproliferative disorders encompass a broad spectrum of diseases, from benign to malignant. Here we review our current understanding of EBV-induced lymphomagenesis and focus on biology, diagnosis and management of EBV-associated B-cell lymphoproliferative disorders.

Classical natural ovine scrapie prions detected in practical volumes of blood by lamb and transgenic mouse bioassays

Scrapie is diagnosed antemortem in sheep by detecting misfolded isoforms of prion protein (PrP(Sc)) in lymphoid follicles of the rectal mucosa and nictitating membranes. Assay sensitivity is limited if (a) the biopsy is collected early during disease development, (b) an insufficient number of follicles is collected, or (c) peripheral accumulation of PrP(Sc) is reduced or delayed. A blood test would be convenient for mass live animal scrapie testing. Currently approved techniques, however, have their own detection limits. Novel detection methods may soon offer a non-animal-based, rapid platform with detection sensitivities that rival the prion bioassay. In anticipation, we sought to determine if diseased animals could be routinely identified with a bioassay using B lymphocytes isolated from blood sample volumes commonly collected for diagnostic purposes in small ruminants. Scrapie transmission was detected in five of six recipient lambs intravenously transfused with B lymphocytes isolated from 5~10 mL of blood from a naturally scrapie-infected sheep. Additionally, scrapie transmission was observed in 18 ovinized transgenic Tg338 mice intracerebrally inoculated with B lymphocytes isolated from 5~10 mL of blood from two naturally scrapie-infected sheep. Based on our findings, we anticipate that these blood sample volumes should be of diagnostic value.

Inflammation in disseminated lesions: an analysis of CD4+, CD20+, CD68+, CD31+ and vW+ cells in non-ulcerated lesions of disseminated leishmaniasis

Disseminated leishmaniasis (DL) differs from other clinical forms of the disease due to the presence of many non-ulcerated lesions (papules and nodules) in non-contiguous areas of the body. We describe the histopathology of DL non-ulcerated lesions and the presence of CD4-, CD20-, CD68-, CD31- and von Willebrand factor (vW)-positive cells in the inflamed area. We analysed eighteen biopsies from non-ulcerated lesions and quantified the inflamed areas and the expression of CD4, CD20, CD68, CD31 and vW using Image-Pro software (Media Cybernetics). Diffuse lymphoplasmacytic perivascular infiltrates were found in dermal skin. Inflammation was observed in 3-73% of the total biopsy area and showed a significant linear correlation with the number of vW+ vessels. The most common cells were CD68+ macrophages, CD20+ B-cells and CD4+ T-cells. A significant linear correlation between CD4+ and CD20+ cells and the size of the inflamed area was also found. Our findings show chronic inflammation in all DL non-ulcerated lesions predominantly formed by macrophages, plasmacytes and T and B-cells. As the inflamed area expanded, the number of granulomas and extent of the vascular framework increased. Thus, we demonstrate that vessels may have an important role in the clinical evolution of DL lesions.

Monoclonal B-cell lymphocytosis: a brief review for general clinicians / Linfocitose monoclonal de células B: uma breve revisão para clínicos gerais

Monoclonal B-cell lymphocytosis (MBL) is a recently described medical condition that displays biological similarities to the most common subtype of adult leukemia in the Western world, i.e. chronic lymphocytic leukemia (CLL). Diagnostic criteria have been published with the aim of differentiating between these two entities. The overall prevalence of MBL is at least 100 times higher than that of CLL, which indirectly suggests that MBL is not necessarily a pre-leukemic condition, although in some circumstances, CLL cases can really be preceded by MBL. In view of this high prevalence rate, general clinicians and even non-hematological specialists have a high chance of being faced with individuals with MBL in their routine clinical practice. MBL is classified as "clinical MBL", "population-screening MBL" and "atypical MBL" and the clinical management of affected individuals depends greatly on this differentiation. The present review provides a guide to diagnosing and following up MBL patients.

A linfocitose monoclonal de células B (LMB) é uma condição médica recentemente descrita que exibe similaridades biológicas com o mais comum subtipo de leucemia em adultos de países ocidentais, qual seja, a leucemia linfocítica crônica (LLC). Critérios diagnósticos foram publicados com o intuito de separar as duas entidades. A prevalência global da LMB é pelo menos 100 vezes maior do que a da LLC, o que, indiretamente, sugere que a LMB não é necessariamente uma condição pré-leucêmica, embora, em algumas circunstâncias, casos de LLC possam realmente ser precedidos pela LMB. Em virtude dessa alta taxa de prevalência, clínicos gerais e mesmo outros especialistas não hematologistas têm grande chance de deparar-se com casos de LMB em suas rotinas clínicas. A LMB é classificada como "LMB clínica", "LMB de screening populacional" e "LMB atípica", sendo que o manuseio clínico dos indivíduos afetados depende substancialmente dessa diferenciação. A presente revisão fornece um guia para o diagnóstico e acompanhamento dos pacientes com LMB.

Risk factors for type 1 diabetes mellitus among children and adolescents in Basrah

Environmental factors play an important role in the pathogenesis of type 1 diabetes mellitus, many of these factors have been uncovered despite much research. A case-control study was carried out to determine the potential maternal, neonatal and early childhood risk factors for type 1 diabetes mellitus in children and adolescents in Basrah. A total of 96 diabetic patients who have been admitted to the pediatric wards at 3 main hospitals in Basrah, and those who have visited primary health care centers over the period from the 4th of November 2006 to the end of May 2007 were recruited. In addition, 299 non-diabetic children were included, their age ranged from 18 months to 17 years. Family history of type 1 diabetes mellitus and thyroid diseases in first and second degree relatives was found to be an independent risk factor for type 1 diabetes mellitus, [p<0.001]. Regarding maternal habits and illnesses during pregnancy, the study has revealed that tea drinking during pregnancy is a risk factor for type 1 diabetes mellitus in their offspring, [p<0.05]. In addition, maternal pre-eclampsia and infections were found to be significant risk factor for type 1 diabetes mellitus, [p<0.001]. Neonatal infections, eczema and rhinitis during infancy were also significantly associated with development of type 1 diabetes mellitus. Moreover, the results revealed that duration of<6 months breast feeding is an important trigger of type 1 diabetes mellitus. Exposure to environmental risk factors during pregnancy [tea drinking, pre-eclampsia, and infectious diseases], neonatal period [respiratory distress, jaundice and infections] and early infancy are thought to play an important role in triggering the immune process leading to B-cell destruction and the development of type 1 diabetes mellitus

Proliferation of the b -cells of pancreas in diabetic rats treated with Urtica dioica / Proliferación de las células b del páncreas en ratas diabéticas tratadas con Urtica dioica

This investigation was carried out to evaluate the effect of the extract of Urtica dioica leaves on hyperglycemia and quantitative changes of b-cells in streptozotocin-diabetic rats. Forty male Wistar rats were allocated in groups of normal, diabetic, treatment and protective. Hyperglycemia induced by administrating one dose of 80 mg/kg streptozotocin (STZ) intraperitoneally. Animals in treatment group received Urtica dioica (100 mg/kg/day) for 4 weeks intraperitoneally, one week after injection of STZ. In protective group animals received U. dioica (100 mg/kg/day) for 5 days before inducing diabetes. After five weeks the animals were sacrificed and whole pancreas removed. Pancreas specimens were used for quantitative morphometric analysis after Chromealum hematoxiline - phloxine staining. The mean +/- SE of b-cells in non hyperglycemic animals in protective group was higher than in hyperglycemic animals in the same group (54.33 +/- 2.4 versus 1.25 +/- 0.5, P<0.05). Hyperglycemia was improved in 6 (60 percent) of rats in protective group and 1 (10 percent) rat in treatment group OR=0.07 (CI 95 percent: 0.0-1.1, p=0.06). The logistic regression analysis showed an association between decrease of blood glucose, increase of number of b-cells and administration of Urtica before induction of diabetes. This study showed proliferation of b-cells when of the U. dioica leaves extract (100 mg/kg/day) administrated before induction of diabetes in animal model.

Este estudio evalúa el efecto del extracto de hojas de Urtica dioica sobre la hiperglicemia y de los cambios cuantitativos de células b en ratas diabéticas por estreptozotocina. Cuarenta ratas Wistar macho, fueron distribuidas en grupos normal, diabético, en tratamiento y protector. La hiperglicemia fue inducida, por vía intraperitoneal, a través de la administración de una dosis de 80 mg/kg de estreptozotocina (STZ) . Los animales del grupo en tratamiento recibieron Urtica dioica (100 mg/kg/día) durante 4 semanas por vía intraperitoneal, una semana después de la inyección de STZ. En los animales del grupo de protección recibieron U. dioica (100 mg/kg/día) durante 5 días antes de inducir la diabetes. Después de cinco semanas, los animales fueron sacrificados y se extirpó el páncreas. Muestras de páncreas se utilizaron para el análisis morfométrico cuantitativo después de la tinción hematoxilina/floxina. La media +/- SE de células b en los animales sin hiperglicemia y en el grupo de protección fue mayor que en los animales con hiperglicemia (54,33 +/- 2,4 frente a 1,25 +/- 0,5, p<0,05). La hiperglicemia mejoró en 6 (60 por ciento) de las ratas del grupo de protección y 1 (10 por ciento) de ratas en grupo de tratamiento OR=0,07 (IC 95 por ciento: 0,0-1,1, p=0,06). El análisis de regresión logística mostró una asociación entre la disminución de la glucosa en sangre, aumento del número de células b y la administración de Urtica antes de la inducción de la diabetes. Este estudio mostró una proliferación de las células b cuando el extracto de las hojas de U. dioica (100 mg/kg/día) administrado antes de la inducción de la diabetes en modelos animales.

Hallazgo de células clonales B en leucemia mielomonocítica aguda / Presence of B cell clones in acute myelomonocytic leukemia

La coexistencia de enfermedades mieloproliferativas y linfoproliferativas en el mismo paciente no es común. La mayoría de los casos corresponden a pacientes que desarrollan leucemia aguda durante el curso evolutivo de una leucemia linfática crónica tratada con drogas quimioterápicas. Se presenta un caso de leucemia mielomonocítica aguda y leucemia linfática crónica B diagnosticadas simultáneamente en un paciente en el cual, el análisis por citometría de flujo utilizando un amplio panel de anticuerpos monoclonales, permitió identificar las diferentes poblaciones patológicas y determinar su inmunofenotipo característico. Una revisión de la bibliografía muestra solamente la descripción de casos aislados sin encontrar datos sobre la incidencia de esta asociación. Destacamos la utilidad de la técnica de citometría de flujo para identificar las células anormales que nos llevan al diagnóstico de estas dos enfermedades.

The coexistence of acute myeloid leukemia and chronic lymphocytic leukemia in the same patient is rare. The majority of the cases correspond to patients that developed acute leukemia during the evolutionary course of a chronic lymphatic leukemia following treatment with chemotherapy drugs. We report a case of acute myelomonocytic leukemia concurrent with untreated B-cell chronic lymphocytic leukemia in which the use of flow cytometry analysis with a large panel of monoclonal antibodies, allowed the demonstration of different pathological populations and determine immunophenotyping patterns. Published cases of simultaneous chronic lymphocytic leukemia and acute leukemia are reviewed. The use of multiparametric flow cytometry to differentiate the populations demonstrates the utility of this technology in the diagnosis of these hematological malignancies.

Immunohistochemical evaluation of the inflammatory response in periodontal disease

In order to contribute to the knowledge of the pathogenesis of periodontal disease, an immunohistochemical analysis of the density of inflammatory mononucleated cells and the number of dendritic cells was performed using anti-CD4, anti-CD20, anti-CD25, anti-CD68 and anti-protein S-100 antibodies in 17 cases of chronic gingivitis (CG) and 25 of chronic periodontitis (CP). The CD4+ and CD68+ cells exhibited a diffuse distribution in the connective tissue. CD20+ cell distribution was predominantly in groups and the CD25+ cells exhibited a diffuse or focal distribution. The S-100+ cells were identified in the epithelium and the lamina propria, exhibiting distinct morphology and number. The statistical analysis showed no significant differences (p>0.05) between CG and CP regarding the density of the CD4+ and CD20+ cells and the number of S-100+ cells. However, significant differences (p<0.05) were found between the groups in the density of CD25+ and CD68+ cells . The density of macrophages was greater in CG and the level of cellular activation of the lymphocyte infiltrate was greater in CP. No differences were detected between the aforementioned conditions regarding the density of the T and B lymphocytes and to the number of the dendritic cells.

Com o objetivo de contribuir para um melhor entendimento na etiopatogenia da doença periodontal, um análise imuno-histoquímica da densidade das células inflamatórias mononucleares e da quantidade das células dendríticas foi realizada utilizando os anticorpos anti-CD4, anti-CD20, anti-CD25, anti-CD68 and anti-proteína S-100 em 17 casos de gengivite crônica (GC) e 25 casos de periodontite crônica (PC). As células CD4+ e CD68+ exibiram distribuição difusa no tecido conjuntivo, enquanto que a distribuição das células CD20+ foi predominantemente em grupos, e as CD25+ exibiram distribuição ora difusa ora focal. As células S-100+ foram identificadas no epitélio e na lamina própria, exibindo morfologia e números distintos. A análise estatística não demonstrou diferenças estatisticamente significativas em relação a densidade das células CD4+ e CD20+ e no número de células S-100+ entre os casos de CG e PC. Entretanto, houve diferenças em relação a densidade das células CD25+ e CD68+ entre os grupos (p<0,05). A densidade dos macrófagos foi maior em GC e o nível de ativação celular do infiltrado linfocítico foi maior em PC, não havendo diferenças em relação a densidade de linfócitos T e B, bem como no número de células dendríticas entre as condições anteriormente mencionadas.

Determinación de clonalidad en linfoma no Hodgkin de células B: estudio comparativo con procesos linfoproliferativos benignos para validar el diagnóstico de LNH de células B mediante un panel básico de inmunohistoquímica / Determination of clonality in B-cell non-Hodgkin's lymphoma: comparative study with benign lymphoproliferatives processes to validate the diagnose of B-cell NHL by means an immunohistochemistry basic panel

Sin duda para quienes se desempeñan en investigación científica y en histopatología, el diagnóstico y clasificación de linfomas y leucemias representa el campo mas desafiante dentro de la anatomía patológica, ya que es en esta área donde la inmunidad y los procesos neoplásicos, así como la creación de nuevos conceptos y técnicas son puestos constantemente a prueba. En el presente trabajo se ha seleccionado al linfoma no hodkin (LNH) como objeto de estudio, debido a que es el de aparición mas frecuente tanto en Chile como en el mundo. El objetivo es lograr un diagnóstico diferencial mediante anticuerpos monoclonales, entre los linfomas no hodkin de células B y los síndromes linfoproliferativos benignos (SLB), patologías que a nivel morfológico resultan –en muchas oportunidades- difíciles de distinguir. Se utilizó un panel básico de inmunohistoquímica, específico para la identificación de cadenas livianas kappa y lambda, se determinó la clonalidad de 10 casos diagnosticados por biopsia diferida como LNH de células B y 10 casos diagnosticados por biopsia diferida como SLB. Los resultados obtenidos han permitido corroborar que una alteración en la proporción esperada kappa/lambda (2:1) es indicador de proceso monoclonal y en consecuencia se está ante la presencia de una neoplasia de células linfoides. Esta información permite efectuar el correcto diagnóstico de una patología, confirmando o descartando la presencia de un proceso neoplásico, lo que implica que un paciente pueda comenzar con prontitud su tratamiento en el sistema público de salud.