Estudio imagenológico de linfonodos en oncología de cabeza y cuello / Imaging study of lymph nodes in head and neck oncology

RESUMEN En la práctica clínica es habitual el estudio de linfonodos cervicales. La anamnesis y el examen físico orientan la etiología, pero ocasionalmente debemos recurrir a estudios imagenológicos. Esto es muy relevante en contexto de un linfonodo metastásico por un carcinoma escamoso de cabeza y cuello. Para esto podemos utilizar diversas herramientas imagenológicas. El ultrasonido se utiliza para el estudio inicial de una masa cervical en donde clínicamente no queda claro el origen. La tomografía computarizada permite la evaluación de manera global del cuello. Se utiliza ante sospechas o diagnósticos confirmados de carcinoma escamoso de cabeza y cuello. La resonancia magnética tiene utilidad en casos que requieren evaluación de un primario y el cuello, como cánceres de glándulas salivales, base de lengua, lengua oral o piso de boca. El PET-TC es un buen examen a la hora de evaluar un cáncer de cabeza y cuello de primario desconocido y posibles metástasis a distancia, como también cuando se quiere evaluar adenopatías persistentes postratamiento con radioquimioterapia. Tener una evaluación ordenada en el estudio de un linfonodo, por sobre todo con un uso adecuado del recurso imagenológico ayuda a no enlentecer el proceso diagnóstico y dar un diagnóstico y tratamiento más certero.

ABSTRACT In clinical practice, the study of cervical lymph nodes is common. The anamnesis and the physical examination often guide the etiology, however sometimes we have to use images studies. This is very relevant when we are assessing a metastatic lymph node due to head and neck squamous cell carcinoma. Ultrasound is usually used for the initial study of a cervical mass where the physician cannot determine its origin. The computed tomography allows a global evaluation of the neck. It is most often used when there is suspicion or confirmed diagnoses of head and neck squamous cell carcinoma. Magnetic resonance imaging is useful in cases that require evaluation of a primary neoplasm and the neck, such in salivary gland cancers, tongue base cancers, oral tongue or mouth floor tumors. PET-CT is a good test to evaluate head and neck cancers of unknown primary site and possible distant metastases, as well as evaluation of persistent adenopathies after treatment with radiochemotherapy. Having an organized evaluation in the study of a lymph node, with an adequate use of the imaging resource, helps not to hinder the diagnostic process and give an accurate diagnosis and treatment.

Anatomy of the lymphatic drainage of the upper limb and breast and its role in lymphedema prevention after breast cancer treatment / Anatomía del drenaje linfático del miembro superior y de la mama y su papel en la prevención del linfedema después del tratamiento del cáncer de mama

The surgical treatment of breast cancer has been enhanced throughout the years in order to offer oncologically safer and more effective results with lower esthetic impact and fewer sequelae. The lymphedema of the upper limb is still an iatrogenic result of great incidence and morbidity after this treatment. A possible existence of independent breast and upper limb lymphatic pathways has become the issue of many researchers willing to minimize its occurrence. This review aims to compare the lymphatic pathways in the axilla described by traditional anatomy books and recently published articles about Axillary Reverse Mapping (ARM). With this purpose, a comparative table was made with the descriptions found in books and articles, a statistic table of the data collected, a flowchart of anastomoses among nodes and an analytical drawing of the most statistically mentioned drained areas. It was observed that there is great variability in the descriptions of drainage and anastomoses among the lymph nodes in the references used, so there should be a consensus of a universal description which also assembles possible anatomical variations. Furthermore, the findings brought about by recent studies show possible anastomoses among pathways and lymph nodes, however they have not been taken into consideration when ARM was initially proposed. Therefore, the axillary resection with the preservation of the posterior and lateral axillary lymph nodes is theoretically possible to avoid lymphedema of the upper limb, but the development of an updated universal description that involves all possible anatomical variations will provide a safer and more effective treatment.

El tratamiento quirúrgico del cáncer de mama ha mejorado a lo largo de los años con el fin de ofrecer resultados oncológicamente más seguros y eficaces con menor impacto estético y menos secuelas. El linfedema del miembro superior es todavía un resultado iatrogénico de gran incidencia y morbilidad después de este tratamiento. La posible existencia de vías linfáticas de mama y de los miembros superiores independientes se ha convertido en un tema central de muchas investigaciones para lograr minimizar su ocurrencia. Esta revisión tiene como objetivo comparar las vías linfáticas en la axila descritas en los libros de anatomía tradicionales con artículos recientemente publicados sobre Mapeo Reverso Axilar (MRA). Con este fin, se realizó un cuadro comparativo con las descripciones y un diagrama de flujo de las anastomosis entre los nodos, además de un dibujo analítico de las áreas drenadas estadísticamente más mencionadas. Se observó que existe una gran variabilidad en las descripciones sobre el drenaje y las anastomosis entre los nodos linfáticos, por lo que la descripción universal no debería ser considerada un consenso debido a que también presenta posibles variaciones anatómicas. Por otra parte, los resultados producidos por los estudios recientes muestran posibles anastomosis entre las vías y los nodos linfáticos, sin embargo, no se han tomado en consideración cuando se propuso inicialmente el MRA. Por lo tanto, la resección axilar con la preservación de la parte posterior y los nodos linfáticos axilares laterales es teóricamente posible para evitar el linfedema del miembro superior, pero el desarrollo de una descripción universal actualizada, que incluya todas las posibles variaciones anatómicas, proporcionará un tratamiento más seguro y eficaz.

Lymphoglandular complexes in proximal colon of buffalo calves (Bubalus bubalis) / Complejos linfoglandulares en colon proximal de terneros de buffalo (Bubalus bubalis)

The present study was conducted on six healthy early neonatal and six prepubertal buffalo calves to study the location, gross morphology, histomorphology and histochemistry of lymphoglandular complexes in proximal colon. In very proximal part of colon of buffalo calves, an irregular oval mucosal lymphoid patch was found grossly as a proximal colon (PC) patch. Histologically, in proximal colon patch of early neonates (3-4 weeks), an extensive invasion of mucosal glands was observed towards lymphoid nodules that were present in submucosa. The structure as a whole thus formed a complex known as lymphoglandular complex (LGC). Large number of such complexes i.e., LGCs were observed in submucosa of proximal colon at this age. At some places, invasion of mucosal glands into lymphoid tissue was restricted to superficial layer of complexes, with the lymphoglandular complexes opening directly into the lumen but some were deep seated. However, by the age of 6 months in buffalo calves i.e., prepubertal period, LGCs were reduced and were present in single layer within the submucosa of the proximal colon. Moreover, some of LGCs were completely encapsulated by their own lamina muscularis mucosae. But some of the complexes still had their mucosal openings into lumen while others had lost their connection with tunica mucosa. Histochemically, the glands that were observed within LGCs contained mucosubstances, glycogen, mucopolysaccharides, and mucin. However, lipids were present around the lymphocytes observed towards the periphery of these LGCs.

El presente estudio se llevó a cabo en seis terneros de búfalo neonatos sanos y seis terneros prepuberales para estudiar la ubicación, morfología macroscópica, histomorfología e histoquímica de los complejos linfoglandulares en el colon proximal. Se observó en un área del colon proximal (AP) de los terneros de búfalo un óvalo linfoide de mucosa irregular en la parte más proximal de éste. Histológicamente, en el área proximal del colon de los terneros neonatos (3-4 semanas), se observó una invasión extensa de las glándulas mucosas hacia los nódulos linfáticos presentes en la submucosa. La estructura en su totalidad formaba un complejo conocido como complejo linfoglandular (CLG). A esta edad se observó un gran número de estos complejos es decir, se observaron CLGs en la submucosa del colon proximal. La invasión de las glándulas mucosas en el tejido linfoide, se limita a la capa superficial de los complejos, los complejos linfoglandulares distribuidos directamente en el lumen, sin embargo otros se encontraban arraigados de manera profunda. En búfalo a los 6 meses de edad, es decir en el período prepuberal, se observó un número reducido de CLGs presentes en una sola capa dentro de la submucosa del colon proximal. Por otra parte, algunos de CLGs estaban completamente encapsulados por su propia lamina muscularis mucosae. Algunos de los complejos mantenían abertura de las mucosas en el lumen, mientras que otros habían perdido su conexión con la mucosa. En análisis histoquímico, las glándulas que se observaron dentro del CLGs contenían mucosustancias, glucógeno, mucopolisacáridos y mucina. Sin embargo, se encontraron lípidos presentes alrededor de los linfocitos hacia la periferia de los CLGs.

Alternative treatment for open bite Class III malocclusion in a child with Williams-Beuren syndrome

Williams-Beuren syndrome (WBS) is a rare genetic condition that affects approximately 1 in every 20,000 - 50,000 live births. WBS children have specific skeletal deformities, dental malformations and rare lingual muscle dysfunction. The need for orthodontic and orthognathic therapy has arisen and has been considered a real clinical challenge even for experienced professionals, once it requires a complex and individualized treatment plan. This study reports a case of orthopedic expansion of the maxilla, in which a modified facial mask was used for protraction of the maxillary complex associated with clockwise rotation of the maxilla. In addition, special considerations about treatment time and orthopedic outcomes are discussed.

A síndrome de Williams-Beuren (WBS) é uma doença genética rara, acometendo, aproximadamente, de 1:20.000 a 1:50.000 crianças nascidas. As crianças com WBS têm deformidades esqueléticas específicas, má formações dentárias e, algumas vezes, disfunção muscular da língua. As necessidades ortodônticas e ortognáticas têm sido consideradas um verdadeiro desafio clínico, até mesmo para aqueles profissionais com vasta experiência, uma vez que requerem um plano de tratamento individualizado e complexo. Esse relato de caso aborda uma expansão ortopédica da maxila, em que foi utilizada uma máscara facial modificada para protração do complexo maxilar, acompanhada de uma rotação horária da maxila. Além disso, considerações especiais sobre o tempo de tratamento e resultados ortopédicos são discutidas.

Axillary lymph node in rheumatoid arthritis: Does it associate disease activity?

Lymph node [LN] in rheumatoid arthritis [RA] has been the focus of recent research work; as it is implicated in disease pathogenesis. Power Doppler ultrasonography [PD-US] is increasingly used for imaging of lymph nodes in conditions other than arthritis. To assess the axillary LN in RA using PD-US, and to correlate the findings to disease activity. Fourteen Consecutive RA patients were subjected to clinical examination and PD-US of axillary LNs, metacarpophalangeal joints [MCPJs] and wrist joints of the ipsilateral sides. LNs were assessed for cortex/hilum [CH] area ratio, longitudinal/transverse [LT] axis ratio and PD signal type. Joints were assessed for grey scale [GS] score and PD score. GS and PD signals were assigned to each joint in accordance with semi-quantitative 0-3 scales for each. DAS28 score was used for disease activity assessment. PD-US detected subclinical LN changes in 24/28 of the examined axillae in RA patients. Changes included hypertrophy mainly of the cortical area and amplification of vascularity of the central type. LN changes did not correlate to DAS28 score; rather correlated to GS and PD scores of ipsilateral wrist and MCPJs as assessed by PD-US. PD-US detects subclinical axillary LN changes in RA patients. These changes do not correlate to DAS28. Axillary LN changes associate signs of synovitis in ipsilateral wrist and MCPJs as assessed by PD-US. Owing to the small number of patients enrolled, results presented in this work should be considered preliminary

Padronização da nomenclatura dos linfonodos axilares baseada em critérios anatômicos / Anatomical criteria based padronization on the axilary lymph nodes nomenclature

Os linfonodos axilares recolhem a linfa de todo membro superior e de parte da parede torácica. A glândula mamária drena 80% de sua linfa para estes linfonodos. O conhecimento da drenagem de cada quadrante mamário para os respectivos grupos axilares é de suma importância para o cirurgião que vai realizar o esvaziamento axilar, bem como para o radioterapeuta na instituição do tratamento complementar. As literaturas anatômica, cirúrgica e oncológica denominam os linfonodos axilares em grupos com diferentes números de componentes e com as mais diversas nomenclaturas, fato este que causa confusão na difusão dos conhecimentos a respeito das patologias malignas nesta área. Visando esclarecer estas dúvidas, realizou-se uma revisão bibliográfica, bem como a efetuação de dissecações, no sentido de padronizar o número e a nomenclatura dos diferentes grupos de linfonodos dentro da axila. Foram dissecadas seis axilas de cadáveres adultos, não fixados, de ambos os sexos e de variados grupos éticos. Na literatura mundial encontram-se 21 diferentes denominações para estes linfonodos. Segundo os achados, a melhor nomenclatura a ser seguida é a que classifica os linfonodos axilares em cinco grupos: apicais, centrais, laterais, torácicos laterais e subescapulares.

Anatomia ultrassonográfica dos linfonodos abdominais de furões europeus hígidos / Ultrasonographic anatomy of abdominal lymph nodes in the normal ferret

Nos últimos anos o furão (Mustela putorius furo) tornou-se um conhecido animal de estimação sendo observada uma população em constante crescimento no Brasil, e por conseqüência cada vez mais presente em clínicas veterinárias. O presente trabalho teve como objetivo avaliar a anatomia ultrassonográfica dos linfonodos abdominais de furões-europeus hígidos. Foram utilizados 20 animais, dentre os quais nove eram machos e onze fêmeas, com idade média total de três anos. Localizaram-se em 100 por cento dos furões os linfonodos mesentéricos, em 55 por cento dos animais os linfonodos pancreático-duodenal e esplênico, em 20 por cento o linfonodo gástrico e em 5 por cento o linfonodo hepático. Conclui-se que a localização e características ultrassonográfica dos linfonodos abdominais em furões são muito similares aos linfonodos abdominais de gatos, sendo este estudo uma orientação preliminar para a localização dos linfonodos abdominais de furões hígidos.

In recent years the ferret (Mustela putorius furo) has become popular pet featuring a ever growing population in Brazil, and being increasingly found in veterinary clinics. This study aimed to evaluate the ultrasound anatomy of abdominal lymph nodes of healthy ferrets. We used 20 animals, nine of which males and eleven females, with overall mean age of three years. We located the mesenteric lymph nodes in 100 percent of the ferrets, the pancreatic-duodenal lymph nodes and the splenic ones in 55 percent, the gastric lymph node in 20 percent, and the hepatic lymph node in 5 percent. We measured their lengths. It is concluded that the location and sonographic characteristics of the abdominal lymph nodes in ferrets are very similar to the abdominal lymph nodes of cats. This is a preliminary orientation for the location of abdominal lymph nodes of healthy ferrets.

Pharyngeal lymphatic ring: anatomical review

The tonsils form part of a circular band of adenoid tissue which guards the opening into the digestive andrespiratory tubes, known as Waldeyer’s ring. The anterior part of the ring is formed by the submucouslymphoid clusters (lingual tonsil) on the posterior part of the tongue; the lateral portions consist of thepalatine tonsils and the lymphoid tissue in the vicinity of the auditory tubes, while the ring is completedbehind by the pharyngeal tonsil on the posterior wall of the pharynx. In the intervals between these mainsmaller collections of lymphoid tissue are found. This paper intends to give to the clinician an anatomicalreview about the subject.

Punción con aguja fina guiada por ultrasonido en metástasis axilares de cáncer de mama / Fine needle ecoguide puncture in axillaries metastases of breast cancer

Presentar nuestra experiencia en la utilización de la punción con aguja fina ecoguiada en identificación de metástasis axilares en pacientes con cáncer de mama. Nuestra experiencia en 399 pacientes, evaluados desde enero de 2007 hasta julio de 2009. El protocolo impone la realización de una punción ecoguiada de cualquier ganglio axilar sea sospechoso o no. Se utilizan equipos de ultrasonido dedicados únicamente para la exploración de la mama, con transductores multifrecuenciales, empleo del software del equipo de manera particular al momento de la exploración de la axila, que permite mejorar la imagen ecográfica de esa zona. En 55,89 por ciento (223/399) se identificaron ganglios axilares por ultrasonido, y se les practicó la punción con aguja fina a un 51,12 por ciento (114/223) se les identificó una metástasis axilar. En un 41,26 por ciento (92/223) esta punción fue negativa y en un 7,62 por ciento (17/223) no fue concluyente. Se diagnóstico metástasis en 34,61 por ciento (9/26) de tumores T1, 46,6 por ciento (42/90) de T2. Cuando el tamaño del tumor fue determinado por ultrasonido, se identificó metástasis axilar en 40,00 por ciento (32/80) de los T1 y 57,8 por ciento (59/102) de los T2. La experiencia ganada, sumado al adecuado manejo de la tecnología de los equipos de ultrasonido, nos ha permitido identificar con mayor frecuencia los ganglios axilares en estas pacientes. Es importante estudiarlos independiente de su característica morfológica, pues las células metastásicas pueden estar presentes sin ocasionar alteración alguna en su apariencia ecográfica.

In this work we present our updated experience on the fine needle aspiration puncture in patients with breast cancer. Our experience in 399 patients with breast cancer, evaluated from january 2007 through july of 2009. The protocol of this work imposes a puncture ecoguide at any axillaries lymph node, were suspicion or not. Ultrasound equipment is used solely dedicated to the exploration of the breast, transducers multifrecuenciales and use of software in a particular way when the exploration of the axils needed and to improve the ultrasound image of the area. In 55.89 percent of patients (223/399) axillaries lymph nodes were identified for ultrasound and underwent fine needle aspiration puncture. Of the 223 patients 51.12 percent (114/223) metastases was identified. 1.26 percent (92/223) fine needle puncture was negative in 7.62 percent (17/223) was suggestive but not conclusive. Regarding clinical tumor size, the metastases diagnosis was 34.61 percent (9/26) of T1 and 46.6 percent (42/90) of T2 tumors. When the tumor size was determined by ultrasound, the axillaries metastases were identified in 40.00 percent (32/80) of T1 size tumors and 57.8 percent (59/102) of T2. The gained experience, added to proper management of the ultrasounds equipment, has allowed us to identify more frequently in those patients axillaries lymph nodes. It is important to study the nodes independently of their morphological characteristics, as the metastatic cells may be present without causing any alteration in appearance ultrasonic graphically.

Utilidad de la biopsia de médula ósea en estadificación de pacientes con cáncer de mama / Usefulness of bone marrows biopsy in the breast cancer patients staging

El objetivo del presente estudio es determinar la utilidad de la biopsia de médula ósea en la estadificación de pacientes con cáncer de mama. Estudio prospectivo, descriptivo y con diseño transversal. La población estuvo representada por los nuevos casos diagnosticados como cáncer de mama en la consulta de cirugía oncológica y patología mamaria, la muestra quedó conformada por 18 casos. Los datos obtenidos se clasificaron y procesaron en una matriz de datos, se analizaron mediante técnica de estadística simple descriptiva o “tabulación simple porcentual” apoyadas en medias de dispersión (frecuencias relativas). La mayoría de los casos se estadificaron en etapas clínicas IIA y IIB. La totalidad de los casos incluidos en esta investigación resultaron negativos para micrometástasis en médula ósea, lo cual podría predecir que se tratan de pacientes con buen pronóstico. Ante la falla como factor pronóstico del estado ganglionar se especula que la detección de células tumorales tempranas puede predecir el curso de la enfermedad mejor que el estado de los ganglios axilares. Actualmente la determinación genética ha tenido un impacto mayor como factor pronóstico que los estudios de estadificación convencionales. Ahora bien la determinación de células tumorales en la médula podría establecerse como parte del protocolo de estadificación en los diversos centros de referencia oncológico, y convertirse al igual que la determinación del perfil genético, como un factor pronóstico y predictivo importante en las pacientes con cáncer de mama y etapa clínicas tempranas.

The objective of the present study is to determine the usefulness and importance of bone marrows biopsy in the breast cancer patients staging. To such end, a cross sectional, prospective, and descriptive study was performed. The population was represented by new diagnosed cases of breast cancer view and evaluated in the consult of surgery oncology y mammalian pathology of our institution, formed the sample by 18 cases. The data obtained were processed and classified in an adequate data matrix; the results once separated were analyzed by the simple descriptive statistic technique or percentile simple tabulation, supported by the dispersion measures (the relative frequencies). Most of the cases were classified in IIA and IIB clinical stages. All included cases in this research were negative to bone marrow´s micro metastases, and which can predict good prognosis in these patients. At lymph node staging failure as a prognostic factor we can be speculate that the early tumor cell detection can predict the course of the disease better than the staging of axillaries lymph nodes. Actually the genetic determination has a better impact as a prognostic factor that the conventional staging studies. The determination of bone marrow´s tumor cell can be establish as a very important part of the staging protocol in the different especial oncologic reference centers, and became as same as genetic profile determination in an important prognostic and predictive factor in breast cancer patients at early stages.

effect of MS14 on body weight, spleen index and structures of kidney, liver, spleen, lung, lymph node and bone marrow histology in Balb/c mice

MS 14 is an Herbal-marine preparation that has been used in experimental studies for the management of Multiple sclerosis, [MS]. In this study the effect of MS 14 on body weight, spleen index and the histological picture of various organs was evaluated. Female Balb/C mice of 6-8 weeks age were divided into control and test groups. MS 14 was orally administrated at a dose of 100 mg/kg for five days to the experimental group and normal saline given to the control group. After euthanasia on day six, the body weight was measured, spleen index was calculated and representative pieces of tissues including kidney, liver, spleen, lung, lymph node and bone marrow were collected in 10% formalin solution and processed through a standard paraffin embedding method. Sections of 5 micrometer thickness were cut and stained with hematoxylin and eosin. MS 14 at 100 mg/kg did not affect body weight and spleen index, but in the test group, at least 50% of spleen and 90% of lymph node micro sections showed lymphoid hyperplasia: no reactive changes were observed in controls. In both groups, histological evaluation of kidney, liver, spleen, lung, lymph node and bone marrow micro sections showed no significant histological alterations in the normal architecture. According to result of this study, it seems that although MS 14 has no effect on body weight and spleen index, it may induce hyperplastic changes in spleen and lymph nodes, thus signaling activation of the immune system

Alterações microscópicas em linfonodos de bovinos sorologicamente positivos para brucelose / Microscopic changes in cattle lymph odes serologically positive for brucellosis / Cambios microscópicos en ganglios linfáticos de bovinos serológicamente positivos para brucelosis

A Brucelose é uma doença infecto-contagiosa provocada por bactérias intracelulares facultativas do gênero Brucella spp., zoonose de distribuição mundial. As principais manifestações clínicas da doença provocam redução na produção dos animais, e suas implicações econômicas causam barreiras na comercialização. Objetivou-se pesquisar alterações microscópicas nos linfonodos de bovinos sorologicamente positivos para brucelose, relacionando à reação inflamatória ganglionar como achado indicativo para o diagnóstico histopatológico da doença. Foram colhidas amostras de linfonodos cervicais superiores em vinte bovinos fêmeas, 10 da raça Gir e 10 da raça Nelore, enviadas ao Laboratório de Patologia Animal da Universidade de Uberaba. Ao realizar o exame macroscópico dos linfonodos, verificou-se que todos se apresentavam reacionais, mesmo que discretamente. Na leitura das lâminas histopatológicas, diagnosticou-se em 100% deles linfadenite crônica, compatível com o quadro de brucelose. O impacto econômico e zoonótico da doença justificam a necessidade definitiva do estabelecimento de programas de controle e erradicação, sendo que o diagnóstico representa grande relevância neste processo, e o exame histopatológico perfaz importante auxílio na confirmação do diagnóstico sorológico.

Brucellosis is an infectious and contagious disease caused by intracellular bacteria of the genus Brucella spp., zoonosis of worldwide distribution. The main clinical manifestations of this disease cause reduction in the animals’ production, and their economic implications provoke barriers in trade. The aim of this study is to find microscopic changes in cattle lymph nodes from animals serologically positive for brucellosis, associating the inflammatory reaction nodes as indicative findings for the histopathologic diagnosis of the disease. Samples were collected from upper cervical lymph nodes in twenty cows, ten from Gir breed, and ten, Nellore, sent to Laboratory of Animal Pathology at the University of Uberaba. In macroscopic examination of the lymph nodes, it was found that all had been reactive even if discretely. In reading the histopathological slides, it was diagnosed in 100% of cases, the same chronic lymphadenitis, compatible with the framework of brucellosis. The economic impact and the zoonotic characteristic of the disease justify the definitive need to establish programs of control and eradication, as the diagnosis is very relevant in this process, histopathological examination turns an important aid to confirm serological diagnosis.

La brucelosis es una enfermedad infectocontagiosa causada por bacterias intracelulares facultativas del género Brucella spp, zoonosis de distribución mundial. Las principales manifestaciones clínicas de la enfermedad provocan reducción en la producción de los animales, y sus implicaciones económicas causan obstáculos en la comercialización. En esta investigación se buscó encontrar cambios microscópicos en los ganglios linfáticos de ganados sorológicamente positivos para brucelosis, listando la reacción inflamatoria de los ganglios linfáticos como indicativo para el diagnóstico histopatológico de la enfermedad. Las muestras fueron recolectadas en los ganglios linfáticos superiores del cuello de veinte vacas, diez de la raza Gir, y diez de la raza Nelore, y enviadas al Laboratorio de Patología Animal de la Universidad de Uberaba. Al realizar el examen macroscópico de los ganglios linfáticos, se comprobó que todos se presentaban reactivos, aunque discretamente. En la lectura de las diapositivas histopatológicas, se diagnosticó en 100% de ellos linfadenitis crónica, compatible con el cuadro de brucelosis. El impacto económico y zoonótico de la enfermedad justifican la necesidad definitiva de establecer programas de control y erradicación, siendo que el diagnóstico representa gran relevancia en este proceso, y el examen histopatológico se convierte en importante ayuda en la confirmación del diagnóstico serológico.

Análise histomorfométrica da matriz extracelular do linfonodo poplíteo de cães naturalmente infectados por Leishmania (L. ) chagasi / Histomorphometry of extracellular matrix Analysis of Sentinel dog naturally infected by Leishmania (l. )chagasi

Nas Américas, a leishmaniose visceral canina é causada por Leishmania (Leishmania) chagasi, um protozoário intracelular obrigatório do sistema fagocítico mononuclear; as principais alterações histológicas associadas a essa doença ocorrem nos em órgãos linfóides. Apesar de o cão ser considerado o principal mantenedor e disseminador da leishmaniose no ambiente urbano, são escassos estudos dos aspectos histopatológicos e histomorfométricos, em cães naturalmente infectados com L. chagasi, que investiguem a interação entre o parasito e a matriz extracelular. Este estudo visou caracterizar e quantificar as alterações dos componentes celulares e da matriz extracelular (colágenos I e III) do linfonodo poplíteo de 22 cães com infecção natural por L. chagasi detectada através da reação de imunofluorescência indireta (RIF) e compará-las com as alterações encontradas no linfonodo poplíteo de 10 cães não-infectados, negativos na RIF e clinicamente saudáveis. Fragmentos dos linfonodos foram seccionados longitudinalmente, processados rotineiramente para exame histológico e corados por hematoxilina-eosina. Cortes adicionais do mesmo linfonodo incluídos em glicol metacrilato foram corados pelo azul de toluidina para histomorfometria. Linfonodos de cães infectados apresentaram linfadenopatia generalizada, aumento do tamanho e do número dos folículos linfóides, hipertrofia da cápsula e hiperplasia linfóide significativa. Nos linfonodos de cães do grupo infectado, a análise quantitativa de fibras colágenas mostrou significativo predomínio do colágeno I sobre o colágeno III. Esses resultados demonstram que cães infectados por L. chagasi apresentam degradação dos constituintes da matriz extracelular e conseqüente destruição do arcabouço linfóide, alterando a morfologia do órgão.

In the Americas, canine visceral leishmaniasis is caused by Leishmania (Leishmania) chagasi, an obligatory intracellular parasite of the phagocytic-monocytic system; the main histological changes associated with this disease occur in the lymphoid organs. Although dogs are considered to be the main carriers and disseminators of leishmaniasis in urban areas, there are few studies on the histopathologic and histomorphometric aspects in dogs naturally infected by L.chagasi analyzing the interaction between parasite and extracellular matrix. The current study characterize and quantify changes in the cellular and extracellular matrix (collagens type I and III) components of the popliteal lymph node from of 22 dogs with the natural infection by L. chagasi confirmed by indirect immuno-fluorescence assay (IFA) and compare theses findings with those fund in the popliteal lymph node from 10 non-infected dogs, that reacted negative in the IFA, and were clinically healthy. Lymph node fragments were longitudinally sliced and sections were processed for routine histopathology and stained by hematoxylin and eosin. For histomorphometry, additional sections from the same lymph node were fixed in glycol methacrylate and stained with toluidine blue. Lymph nodes from affected dogs were systemically enlarged, had increased numbers of lymphoid follicles, capsule hyperplasia and hypertrophy, and significant hyperplasia of lymphoid cells. In the lymph nodes from infected dogs, quantitative analyses of collagen fibers revealed predominance of type I collagen over type III fibers. These results demonstrate that dogs infected by L.chagasi experience degradation of the extracellular matrix components and consequently destruction of the lymphoid framework, thus altering nodal morphology.

Erythropoiesis and erythrophagocytosis in bovine haemal nodes / Eritropoyesis y eritrofagocitosis en nodos linfáticos hemales de bovino

Whether bovine haemal nodes are involved in turnover of red blood cells has been a subject of some controversy In this study, fluorescent and conventional optical microscopy of conventionally or immunohistochemically stained node sections, together with transmission electron microscopy, showed the presence of erythrocyte precursors and megakaryocytes, and evidence of active involvement in the destruction and replacement of old or degenerate red cells and the platelets.

Si nodos linfáticos hemales bovinos están involucrados en la cantidad de volumen de glóbulos rojos ha sido objeto de cierta controversia. En este estudio, secciones de nodos linfáticos teñidas convencionalmente o inmunohistoquimicamente fueron analizadas con microscopía óptica fluorescente y convencional, junto con microscopio electrónico de transmisión, los que revelaron la presencia de precursores eritrocíticos y megacariocitos, y la evidencia de participación activa en la destrucción y sustitución de glóbulos rojos viejos o degenerados y plaquetas.

Avances en el tratamiento kinésico del linfedema secundario en pacientes con cáncer de mama / Progress in Kinesic treatment of secondary lymphedema in patients with breast cancer

En el tratamiento del cáncer de mama, la complicación más frecuente que se presenta es el linfedema secundario del miembro superior. El linfedema es una enfermedad crónica provocada por una destrucción de la anatomía linfática normal. Aparece en un 20% -25% de los casos y hasta un 35% cuando la cirugía se asocia a radioterapia. Pese a los importantes avances existentes en el tratamiento de linfedema, no hay un consenso entre los investigadores respecto a la elección de la terapia adecuada, debido a la falta de criterios uniformes de diagnósticos, que se traducen en la derivación tardía de los pacientes hacia los profesionales especializados. El enfoque terapéutico actual consiste en la integración de equipos multidisciplinarios reunidos en un Programa Integral de Rehabilitación del Edema (PIR), el que reúne enfoques preventivos - a través de la educación del paciente - y conservadores tales como el Drenaje Linfático Manual, presoterapia secuencial intermitente, ejercicios específicos, vendaje multicapas y elementos de contención. Estos tratamientos si bien no buscan la cura del Linfedema, permiten minimizar las secuelas funcionales y mejorar la calidad de vida de las pacientes portadoras de esta patología.

In breast cancer treatment, the most common complication is the Secondary Lymphedema of the upper limb. Lymphedema is a chronic disease caused by the destruction of the normal lymphatic anatomy. It is produced in a 20-25% of the cases, and up to 35% when the surgery is associated to radiotherapy. Despite the important existing advances in the management of Iymphedema, there is no consensus between the investigators with respect to the election of the suitable therapy, due to the lack of uniform criteria of diagnosis, which are translated in a delayed derivation of the patients towards the specialized professionals. The present therapeutic approach, consists of the integration of multidisciplinary teams joined in an Integral Program of Rehabilitation of Edema (IPR), which gathers preventive approaches - through the education of the patient - and conservative approaches, such as the MDL (Manual Lymphatic Drainage), Intermittent Sequential Pressotherapy specific. Exercises, multi layer Bandage, and elements of containment. These treatments, although do not aim at the cure of the Lymphedema, allow the decrease of the functional sequels and improve the quality of life of the patients who carry this pathology.

Ganglios linfáticos lumbo-aórticos: bases anatómicas para el vaciamiento retroperitoneal y otros procedimientos quirúrgicos / Retroperitoneal lymph nodes: anatomical basis for retroperitoneal lymph node dissection and others surgical procedures

Estudiamos la anatomía de la región comprendida entre los uréteres, los vasos renales y la bifurcación de las arterias iliacas primitivas, en relación a los vaciamientos linfáticos retroperitoneales. Disecamos 25 cadáveres adultos y comparamos los resultados con el material de resección de 56 vaciamientos bilaterales. Las disecciones cadavéricas siguieron el mismo procedimiento que las intervenciones quirúrgicas. Se describieron 8 grupos ganglionares, su localización, número y relaciones. El total de ganglios linfáticos varió entre 9 y 51. Los grupos linfáticos fueron inconstantes. Se consideraron las relaciones con los uréteres, las venas gonadales, los vasos lumbares, los nervios simpáticos lumbares, la vena cava inferior, la aorta, los vasos renales, etc. Se hace referencia a los factores de riesgo quirúrgico en la región.

We studied the anatomy of the region involved among the renal vessels, the ureters and the iliac artery bifurcation, in relation with the retroperitoneal lymph node dissection. We presented 25 anatomical dissections and compared the findings with those of 56 surgical pieces of bilateral lymphadenectomy. Dissections followed the same procedure than surgical interventions. We described 8 lymphatic groups, their location, number and relations. Total number varied between 9 and 51. Group appearance was not constant. There were considerations on the ureters, gonadal vessels, lumbar vessels, lumbar sympathetic nerves, inferior vena cava, aorta, renal vessels, etc. We commented anatomical risk factors for surgery.

Distribuição, tamanho e número dos linfonodos mediastinais: definições por meio de estudo anatômico / Mediastinal lymph node distribution, size and number: definitions based on an anatomical study

OBJETIVO: Criar um mapa de referência dos linfonodos mediastinais através da análise de seu tamanho, número e distribuição nas diversas cadeias. MÉTODO: Um total de 50 cadáveres foram estudados, 38 do sexo masculino e 12 do feminino, sendo 39 brancos, com média de idade de 59,9 ± 14,1 anos, altura de 173,1 ± 7,6 cm e peso de 71,0 ± 12,0 kg. A dissecção do mediastino foi realizada bilateralmente, sendo todos os linfonodos ressecados e isolados. A área e os diâmetros transversos maior e menor de cada linfonodo foram determinados por análise de imagem. RESULTADOS: Em 485 cadeias, foram dissecados 1742 linfonodos (2,58 ± 1,89 linfonodos/cadeia). Observou-se uma média de 21,2 ± 8,5 linfonodos à direita e 13,6 ± 6,3 à esquerda. As cadeias 1, 2R, 4R, 5, e 7 estão presentes em mais de 90 por cento da amostra. Apenas as cadeias 4R e 7 estiveram sempre presentes. As cadeias 2L, 3p e 8 estiveram presentes em 32, 36 e 54 por cento, respectivamente. Os linfonodos mediastinais estão presentes em maior número nas cadeias 2R, 4R e 7. Estas mesmas cadeias também congregam os maiores linfonodos mediastinais. CONCLUSÃO: A composição de um mapa referencial para os tamanhos linfonodais foi factível. A distribuição, número e tamanho dos linfonodos não se alteraram no intervalo de idades estudado e não sofreram influência do sexo, raça, peso ou altura.

OBJECTIVE: To create a reference map of mediastinal lymph nodes through the analysis of their size, number and distribution in various lymph node stations. METHOD: A total of 50 cadavers, 38 males and 12 females, were studied. Of those 50, 39 were Caucasian. The mean age was 59.9 ± 14.1 years, the mean height was 173.1 ± 7.6 cm, and the mean weight was 71.0 ± 12.0 kg. A bilateral mediastinal dissection was performed in order to resect and isolate all lymph nodes. The area, as well as the major and minor transverse diameters, of each lymph node was determined by radiographic imaging analysis. RESULTS: In a sample of 485 chains, 1742 lymph nodes were dissected (2.58 ± 1.89 lymph nodes/station), revealing a mean number of 21.2 ± 8.5 lymph nodes on the right and 13.6 ± 6.3 on the left. The lymph node stations 1, 2R, 4R, 5, and 7 were present in more than 90 percent of the sample. Only the 4R and 7 lymph node stations were always present. The lymph node stations 2L, 3p, and 8 were present in 32, 36, and 54 percent of the sample, respectively. Mediastinal lymph nodes were present in greater numbers in the 2R, 4R and 7 lymph node stations. In addition, these stations presented the largest mediastinal lymph nodes. CONCLUSION: Composing a reference map for lymph node sizes was feasible. No alterations were observed in the distribution, number, or size of lymph nodes in the age brackets studied, regardless of gender, race, weight, or height.

Influência de Agaricus blazei Murrill sobre o tumor sólido de Ehrlich e linfonodos poplíteos de camundongos / Influence of Agaricus blazei Murrill in solid Ehrlich tumor and popliteal lymph nodes in mice

Estudou-se a influência do tratamento diário com filtrado aquoso de Agaricus blazei Murrill (ABM) (25mg/ml), via oral, por 17 e 57 dias, em camundongos inoculados com tumor sólido de Ehrlich (TSE) por meio da curva de crescimento tumoral, do peso relativo do tumor, da contagem de regiões organizadoras de nucléolos (AgNORs) e dos padrões histológicos das massas tumorais e linfonodos poplíteos. Os animais que ingeriram o extrato aquoso do ABM por 57 dias apresentaram menor (P<0,05) crescimento do TSE, no segundo e terceiro dias, fase inflamatória do crescimento tumoral. Quanto ao peso relativo das massas tumorais, valores de AgNORs, padrões morfoistopatológicos do TSE e ocorrência de processos metastáticos, não houve alteração significativa (P>0,05) entre os animais tratados e não tratados.

The influence of daily administration of Agaricus blazei Murrill (ABM) aqueous solution (25mg/ml) during 17 and 57 days in mice bearing solid Ehrlich tumor was studied. Tumoral growth, tumoral and spleenic relative weights, nucleoly organization regions AgNORs values and tumor and popliteal lymph nodes histopathology were daily evaluated. The animals that received ABM during 57 days showed lower values (P<0.05) of tumoral growth on second and third days after the period corresponding to the inflammatory phase of tumoral growth. The relative weight of the tumor and AgNORs values were similar (P>0.05) between treated and non-treated animals. No difference in microscopic evaluation of the tumors in treated and non-treated animals was seen and metastasis in popliteal nodes of the tumor occurred in all the animals.

Detección de mamoglobina y mage-A3: en ganglios linfáticos axilares: histológicamente negativos: en cáncer de mama / Detection of MAGE-A3 and mamoglobina: axillary lymph node: histologically negative in breast cancer

La detección histológica de metástasis en los ganglios linfáticos axilares es un parámetro de mayor valor pronóstico en cáncer de mama. Un 30 por ciento de pacientes con ganglios linfáticos negativos tienen recaída en cinco años, sugiriendo que, este estudio no es suficiente para detectar todas la metástasis. En el presente estudio, se determinó la expresión de marcadores mamoglobina y MAGE-A3. en ganglios axilares histológicamente negativos de pacientes con cáncer de mama, mediante reacción en cadena polimerasa transcriptasa-reversa, a fin de detectar células tumorales aisladas o micrometástasis. La expresión mamoglobina y MAGE-A3 se detectaron en 55,6 por ciento y 33,3 por ciento, respectivamente. Se amplificó el ARN de mamoglobina y MAGE-A3 en ganglios histológicamente positivos en un 72,7 por ciento y 54,5 por ciento, respectivamente. Se relacionó la presencia o ausencia de células tumorales en ganglios negativos con tamaño tumoral, grado histológico, émbolos neoplásicos vasculares, obteniendo resultados no concluyentes, no se logró distribución equitativa de las muestras. Estos resultados muestran que la mamoglobina y MAGE-A3 son útiles para detección de células tumorales aisladas en ganglios axilares negativos.

Histological detection of metastasis in axillary lymph nodes is a current practice, and the parameter has greatest prognostic value in breast cancer. 30 per cent of negative lymph nodes patients at histology studies has disease relapse in five years, suggesting that this nethod is inadequate to identify all cases with metastasis. In this study, the expression of mammaglobin and MAGE-A3 markers were determined in histological negative axillaries lymph nodes brest cancer patients, by reverse transcriptase polymerase chain reaction. The expression mammaglobin and MAGE-A3 were detected in 55.6 per cent and 33.3 per cent, respectively. The ARN of mammaglobin and MAGE-A3 was amplified in patients with histological positive axilaries lymph nodes, obtaining an expression of 72,7 percent and 54,5 per cent, respectively. Finally, presence or absence of tumour cells detected in negative lymph nodes were related to tumour seze, histological grade, vascular tumour emboli; non conclusive results were obtaining because it wasn't possible to obtain an equitable distribution of the samples. These results show that mammaglobin and MAGE-A3 are useful for detection of isolated tumour cells in axilar node negative.

Estudo anátomo-clínico do linfonodo sentinela no câncer de mama / Anatomo-clinical study of sentinel lymph node in breast cancer

Duas grandes evoluções ocorreram no tratamento cirúrgico do câncer de mama, a cirurgia conservadora e a B.L.S. como opção para o esvaziamento dos gânglios axilares nos tumores iniciais da mama. O objetivo da B.L.S. é evitar a morbidade decorrente da linfadenectomia axilar, principalmente o linfedema, parestesia e limitação da mobilidade do membro superior. Linfonodo Sentinela é definido como o primeiro linfonodo à receber drenagem linfática do tumor primário, sendo capaz de predizer o estado dos demais gânglios axilares em mais de 90% dos casos. Krag e Giuliano introduziram a B.L.S. no câncer de mama e este procedimento tem sido adotado em muitas instituições. Analisamos retrospectivamente 111 pacientes do Centro de Avaliação em Mastologia submetidas à B.L.S. entre fim de 1999 e dezembro de 2004. Dividimos o estudo em duas fases: na primeira (fase de aprendizado) o objetivo foi adquirir experiência com B.L.S. e, na segunda, esta biopsia foi feita de rotina em nosso serviço. A técnica utilizada para a identificação do L.S. foi a combinada (azul-patente mais radio-farmaco), o sítio de injeção foi peritumoral na primeira fase e subareolar ou peritumoral na segunda fase. O estudo imunohistoquímico foi feito nas pacientes com L.S. negativos da segunda fase através da técnica da avidina- biotina-peroxidase com anticorpo monoclonel A E1/A E3 (DAKO, na diluição 1:250). Para este estudo recuperamos as lâminas arquivadas no Departamento de Patologia da Faculdade Medicina de Botucatu - UNESP.