Citotécnico: análise do processo de trabalho em laboratórios de citopatologia e anatomopatologia no Estado do Rio de Janeiro / Cytology: analysis of the work process in cytopathology and pathology laboratories in the State of Rio de Janeiro

INTRODUÇÃO: Trata-se de um estudo sobre o processo de trabalho dos citotécnicos que atuam em laboratórios de Anatomopatologia e Citopatologia no Estado do Rio de Janeiro. OBJETIVOS: objetivo geral é: analisar a percepção dos citotécnicos sobre as competências necessárias à execução de sua atividade laboral; e específicos: (1) descrever a atividade laboral do citotécnico; (2) identificar o modo de produção da atividade por meio das inter-relações de trabalho; (3) conhecer e compreender as implicações do trabalho do citotécnico nas ações de controle do câncer. MATERIAL E MÉTODO: A investigação foi de abordagem qualitativa, de natureza descritiva e social, realizada em três laboratórios de Anatomopatologia e Citopatologia no Estado do Rio de Janeiro, com a participação de 33 citotécnicos. Os dados foram obtidos pela técnica de entrevista semiestruturada, aplicação de questionário, e grupo focal, no período de janeiro a agosto de 2014, e analisados com base na Análise de Conteúdo de Bardin, tendo como unidade de registro o tema. RESULTADOS: Os resultados revelaram: dos 33 citotécnicos, 73% são do sexo feminino; 34% estão distribuídos em igual percentual para as faixas etárias entre 41 a 50 anos e 51 a 60 anos. Com relação à variável do grau de escolaridade, 43% possuem especialização e 24% concluíram o curso superior. Em relação ao cargo exercido, 73% atuam como citotécnicos e 70% são funcionários públicos. O trabalho do citotécnico tem especificidade única desse trabalhador de nível técnico, que é a realização da primeira análise do exame citopatológico, com ações articuladas e complementares de natureza técnica, de gestão, e educativas vinculadas à equipe, com ênfase nos princípios de prevenção e promoção da saúde. Por meio da escala de avaliação do contexto de trabalho, foram avaliadas as condições físicas, materiais e organizacionais do processo de trabalho. O quesito clareza, na definição das tarefas, foi o maior valorado com 4,7% de média, seguido das relações socioprofissionais com média de 4,0%. Os resultados da análise de conteúdo revelaram: na trajetória da atividade laboral, emergiram quatro categorias associadas à motivação e ao ingresso na ocupação por pessoas de referência na formação, acesso ao mercado de trabalho, busca pelo aperfeiçoamento profissional e aprendizagem prática no trabalho; no conceito de modo de produção, emergiram cinco categorias: responsabilidade de salvar vidas, crítica em relação ao próprio trabalho com qualidade, características físicas, atividades distintas do citotécnico e do histotécnico, visão do trabalho com otimismo; nas condições de trabalho, emergiram quatro categorias: trabalho em equipe e responsabilidade individual, ambiguidade em relação à autonomia, precarização do trabalho, esperança no reconhecimento da profissão. CONCLUSÃO: O trabalho do citotécnico é uma ocupação fracamente regulamentada, que se caracteriza por ausência de perfil profissional específico compatível com o escopo de prática real observada no trabalho levando a condições de trabalho precário. O reconhecimento ocorre entre os próprios trabalhadores que se valorizam por serem responsáveis pela promoção da saúde tornando seu trabalho socialmente útil.

INTRODUCTION: This study examines the work processes of cytotechnicians employed in Anatomic Pathology and Cytopathology laboratories in Rio de Janeiro State, Brazil. OBJECTIVES: general purpose is: to analyze perceptions among cytotechnicians of the skills needed to perform their jobs; and more specifically: (1) to describe the work activities of cytotechnicians; (2) to identify activity production modes through workplace relationships; and (3) to explore and understand the implications of the work of cytotechnicians on cancer control actions. MATERIAL AND METHODS: Conducted at three Anatomic Pathology and Cytopathology laboratories in Rio de Janeiro State, this qualitative, descriptive and social research project involved 33 cytotechnicians. Obtained between January and August 2014 through semi-structured interviews, questionnaires and focus groups, the data were subsequently analyzed through the Bardin Content Analysis technique, with the theme constituting the record unit. RESULTS: The findings showed that 73% of these 33 cytotechnicians were women and 34% were split equally between two age brackets: 41  50 years old and 51  60 years old. For the education variable, 43% held specialty qualifications and 24% were university graduates. In terms of their positions, 73% worked as cytotechnicians while 70% were civil servants. The work of the cytotechnician has a specific characteristic that is unique to these technical level employees: they handle the initial analyses of cytopathologic tests through tight-knit team-based complementary actions involving technical, administrative and educational aspects, grounded on health promotion and disease prevention principles. The physical, material and organizational conditions of their work processes were assessed on a work-place rating scale. The issue of task definition clarity ranked highest with a 4.7% mean score, followed by social and professional relationships at a 4.0% mean score. The Content Analysis findings showed that four categories appeared for their work-place activities, associated with: motivation and career choices steered by persons of influence while studying; access to the job market; quest for professional enhancement; and on-the-job training using a hands-on approach. CONCLUSION: The production mode concept gave rise to five categories: responsibility for saving lives; criticism of their own work and quality; physical characteristics; activities specific to cytotechnicians and histotechnicians; and positive views of their jobs. Their working conditions resulted in four categories: teamwork and individual responsibilities; ambiguity about autonomy; weak job security; and hope for better professional acknowledgment. The work of cytotechnicians is covered by lax labor regulations, undermining the presence of a specific professional profile compatible with the scope of their actual job routines as observed and resulting in poor working conditions. They affirm they see themselves as buttressing health promotion, appreciatively aware that their work is useful to society.

Ligand based pharmacophore development for colorectal cancer drugs

Focusing on the drugs used for chemotherapy and their associated side effects, there is a need to design and develop new anti-colon cancer drugs with lesser side effects and improved efficacy. Pharmacophore model proves to be a very helpful tool serving in the designing and development of new lead compounds. Place and Duration: Department of Bioinformatics, Mohammad Ali Jinnah University, Islamabad from January 2014 to May 2014. In this paper, pharmacophore of 4 novel anti-colon cancer compounds has been identified and validated for the first time. Using LigandScout the pharmacophore features were predicted and 3D pharmacophore have been extracted via VMD software. A training set data was collected from literature and the proposed model was applied to the training set whereby validating and verifying their similar activity as that of the most active compounds. The pharmacophore model is a very handy tool for new lead compounds discovery and development. In this study pharmacophore models were built for novel drugs of colorectal cancer and they could be recommended for further studies

Thymosin ß4 expression in colorectal polyps and adenomas

OBJECTIVE: Thymosin beta 4 (Tβ4) is a ubiquitous peptide that plays pivotal roles in the cytoskeletal system and in cell differentiation. Recently, a role for Tβ4 has been proposed in experimental and human carcinogenesis, including gastrointestinal cancer. This study was aimed at evaluating the relationship between Tβ4 immunoreactivity and the initial steps of carcinogenesis. METHODS: In total, 60 intestinal biopsies, including 10 hyperplastic polyps, 10 sessile serrated adenomas/polyps, 15 colorectal adenomas with low-grade dysplasia, 15 adenomas with high-grade dysplasia, 15 adenocarcinomas and 10 samples of normal colon mucosa, were analyzed for Tβ4 expression by immunohistochemistry. RESULTS: Weak cytoplasmic reactivity for Tβ4 was detected in the normal colon mucosa. No reactivity for Tβ4 was found in hyperplastic and sessile serrated polyps/adenomas. Tβ4 expression was observed in 10/15 colorectal adenocarcinomas. In adenomas with low-grade dysplasia, Tβ4 immunoreactivity was mainly detected in dysplastic glands but was absent in hyperplastic glands. Tβ4 immunoreactivity was characterized by spot-like perinuclear staining. In high-grade dysplastic polyps, immunostaining for Tβ4 appeared diffuse throughout the entire cytoplasm of dysplastic cells. Spot-like perinuclear reactivity was detected in adenocarcinoma tumor cells. CONCLUSIONS: Our study shows for the first time that Tβ4 is expressed during different steps of colon carcinogenesis. The shift of Tβ4 immunolocalization from low-grade to high-grade dysplastic glands suggests a role for Tβ4 in colorectal carcinogenesis. However, the real meaning of Tβ4 reactivity in dysplastic intestinal epithelium remains unknown. .

Prognostic value of carcinoembryonic antigen distribution in tumor tissue of colorectal carcinoma / Valor prognóstico da distribuição do antígeno carcinoembriônico (CEA) no tecido neoplásico do carcinoma colorretal

CONTEXT: Carcinoembryonic antigen (CEA) can be detected in colorectal tumor tissue but its role in the survival of patients remains controversial. OBJECTIVE: To characterize the expression of tissue CEA using immunohistochemical staining in colorectal tumors and to analyze the relationship between this finding and preoperative plasmatic level of CEA, morphologic features and survival of patients operated with curative intent for colorectal carcinoma. METHOD: Forty-seven patients were included in the study: 18 (38.3 percent) males and 29 (61.7 percent) females, with a mean age of 67.8 ± 9.7 years (37 to 84 years). Immediately before laparotomy, pre-operative serum levels of CEA were obtained where normal levels were considered <2.5 ng/mL for non-smokers, and <5.0 ng/mL for smokers. CEA immunohistochemical studies were carried out using anti-human CEA monoclonal mouse antibody. The expression of immunostaining for each neoplasia was classified according to the pattern of CEA tissular distribution into apical or cytoplasmic. The variables considered for the statistical analysis were plasmatic preoperative CEA level, location of the lesion within the large intestine, lesion diameter, lymph node involvement, Duke's classification, vein invasion, grade of cellular differentiation, survival and pattern of CEA tissular distribution. The statistical models utilized were Spearman's correlation and the Mann-Whitney, Kruskal-Wallis and Student t tests. Patients' survival was analyzed using the Kaplan-Meier method. RESULTS: The mean preoperative CEA value was 15.4 ± 5.5 ng/mL (0.2 to 92.1 ng/mL). The neoplasm was located in the colon in 29 (61.7 percent) and in the rectum in 18 (38.3 percent) patients. Eight (17.0 percent) patients were classified as Duke's stage A, 22 (46.8 percent) as stage B and 17 (36.2 percent) as stage C. On immunohistochemical studies, the pattern of CEA tissular distribution was apical in 33 (70.2 percent) patients and cytoplasmic...

CONTEXTO: O antígeno carcinoembrionário (CEA) pode ser detectado no tecido do carcinoma colorretal, mas seu papel na sobrevivência dos doentes permanece controverso. OBJETIVO: Caracterizar a expressão do CEA tecidual com coloração imunoistoquímica na neoplasia colorretal e analisar a relação entre esse achado e os níveis plasmáticos pré-operatórios do CEA, aspectos morfológicos e a sobrevivência dos doentes operados com intenção curativa de carcinoma colorretal. MÉTODO: Quarenta e sete doentes foram incluídos neste estudo: 18 (38,3 por cento) homens e 29 (61,7 por cento) mulheres, com média de idade de 67,8 ± 9,7 anos (37 to 84 anos). Imediatamente antes da laparotomia, foram obtidos os níveis plasmáticos pré-operatórios do CEA. Níveis séricos pré-operatórios normais de CEA foram considerados < 2,5 ng/mL para não-fumantes e <5,0 ng/mL para fumantes. O estudo imunoistoquímico do CEA foi realizado utilizando anticorpo monoclonal de rato anti-CEA humano. A expressão da imunocoloração de cada neoplasia foi classificada de acordo com o padrão de distribuição tecidual do CEA em apical ou citoplasmática. As variáveis consideradas para a análise estatística foram os níveis plasmáticos pré-operatórios do CEA, localização da lesão no intestino grosso, diâmetro da lesão, comprometimento dos linfonodos, classificação de Dukes, invasão venosa, grau de diferenciação celular, sobrevivência e padrão da distribuição tecidual do CEA. Os modelos estatísticos utilizados foram correlação de Spearman, teste de Mann-Whitney, teste de Kruskal-Wallis e teste t de Student. A sobrevivência dos doentes foi analisada utilizando-se o método de Kaplan-Meier. RESULTADOS: O valor médio de CEA pré-operatório foi de 15,4 ± 5,5 ng/mL (0,2 a 92,1 ng/mL). A neoplasia estava localizada no colo em 29 (61,7 por cento) e no reto em 18 (38,3 por cento) doentes. Oito (17,0 por cento) doentes foram classificados como estádio A de Dukes, 22 (46,8 por cento) como estádio B e 17...

Effects of TNF-alpha on Angiogenesis in CT-26 Mouse Colon Carcinoma Homograft Model / 대한소화기학회지

BACKGROUND/AIMS: Tumor necrosis factor-alpha (TNF-alpha) exerts its anti-tumor effect through direct cytotoxicity on tumor cells and damage to the tumor vasculature. However, its role in tumor angiogenesis is controversial. We evaluated the angiogenic effect of TNF-alpha on BALB/c mouse colon carcinoma homograft model. METHODS: Ten BALB/c mice were inoculated intraperitoneally with CT-26 mouse colon carcinoma cells. After a week, recombinant mouse TNF-alpha (2microgram/mL) were given four times on every other day to five animals and the same volume of phosphate buffered saline was given at the same interval to five animals as control. Harvested tumor tissues were stained by immunohistochemistry with CD31 and VEGF antibodies. Number of microvessels and VEGF expression were counted by light microscope. RESULTS: The mean microvessel counts per 200x field of TNF-alpha treated animals were 70.2+/-7.8 and those of nontreated animals were 83.8+/-8.3 (p<0.05). The VEGF score of both groups were 3. CONCLUSIONS: TNF-alpha treated animals showed decreased microvessel counts in tumor tissue but VEGF expression in both groups showed no difference. Therefore, TNF-alpha showed antiangiogenic effects on colon carcinoma homograft model.

Clinical Significance of HER-2/neu Expression in Colon Cancer / 대한소화기학회지

BACKGROUND/AIMS: The HER-2/neu protein is involved in normal cell proliferation and tissue growth because it is extensively homologous and related to epidermal growth factor receptor. As a prognostic marker, HER-2/neu is used to forecast the clinical course and poor outcome in breast cancer. As a predictive marker, HER-2/neu is used to predict the therapeutic response to adjuvant chemotherapy and endocrine therapy in breast cancer. In this study, we investigated the relationships between clinical and pathologic characteristics of tumor and prognosis according to the HER-2/neu expression in colon cancer. This study was conducted for the future introduction of Herceptin(r) therapy for colon cancer patients. METHODS: Overexpression of HER-2/neu was examined by semiquantitative standardized immunohistochemical staining kit in 88 patients with colon cancer. The patients underwent curative surgery at the Kangbuk Samsung Hospital. RESULTS: Overexpression of HER-2/neu was detected in 11 (12.5%) of 88 patients. Tumors with positive HER-2/neu staining showed a tendency for higher rates of nodal metastasis and poor mean survival (1,646 +/- 269 vs 2,631 +/- 141 days) and 5-year survival (65.5% vs 78.9%). CONCLUSIONS: Tumors with positive HER-2/neu staining showed a tendency for higher rates for nodal metastasis and poor clinical survival rate.

Sarcomatoid Carcinoma of the Colon: A Case Report

Sarcomatoid carcinoma is a rare biphasic tumor characterized by a combination of malignant epithelial and mesenchymal cells. We report a rare case of sarcomatoid carcinoma of the colon. A 41-yr-old woman was hospitalized with a history of melena. Total colectomy was performed under the impression of colonic carcinoma. Histologically, the tumor was composed of differentiated adenocarcinoma in superficial portion and sarcomatoid spindle cells in deeper portion with a transitional area between the two portions. The sarcomatous areas revealed polygonal and spindle-shaped anaplastic malignant cells arranged in sheet, short fascicular or haphazard pattern. Immunohistochemically, tumor cells showed a positive immunoreaction for cytokeratin, epithelial membrane antigen, and vimentin. The histopathological and immunohistochemical transitions between the adenocarcinoma area and the spindle cell area suggested that the sarcomatous elements originated from the adenocarcinoma during tumor progression.

Insulin receptors tyrosine kinase activity in colon carcinoma

Colon carcinoma is the most common tumor of the gastrointestinal tract. According to some investigators, insulin, epidermal growth factor (EGF) and insulin-like growth factor I (IGF-I) may be involved in the neoplastic proliferation. Insulin-binding and receptor tyrosine kinase activity were investigated in colon carcinomas and in normal colons. The insulin receptor concentration, as shown by binding assays, was 17.4 ñ 4.3 fmol/mug in normal colon and 29.69 ñ 9.4 fmol/mug in colon carcinoma. Nevertheless, the insulin affinity of the receptor was similar in both groups (Kd ( 1 nM). Both normal and neoplastic colon showed phosphorylation of the insulin receptor. The electrophoretic migration of the Beta-subunit of the insulin receptors purified from colon carcinomas was similar to that of normal colon and both tissues demonstrated an insulin-dependent autophosphorylation. The receptor tyrosine kinase activity was measured by the incorporation of [gamma32P]ATP into the Beta-subunit. The basal and the insulin-stimulated tyrosine kinase activities were significantly higher in colon carcinomas compared to normal colon tissues (2.2 and 1.6 times, respectively). Understanding the metabolism of neoplastic cells may contribute to the development of prevention strategies as well as new therapies. It is now necessary to study other steps of the insulin signal transduction pathway, such as insulin receptor substrate 1 phosphorylation.

An immunohistochemical study of the expression of p53 protein in colon cancer

A total of 471 cases of colonic adenocarcinomas and 28 cases of colonic adenomas were examined immunohistochemically to evaluate the expression of p53 protein in the light of their relationship with various prognostic factors. A monoclonal antibody, p53 DO-7, was used in the study. Two hundred and fourteen adenocarcinomas (45.5%) showed positive staining for p53, however only three of the adenomas (10.3%) were positive (P < 0.05). p53 was stained to neoplastic nuclei. Adjacent normal mucosal cells were negative. There were no significant correlations between p53 expression and prognostic parameters such as age, sex, gross configuration, modified Astler-Coller stages, microscopic tumor growth patterns, tumor depth, tumor size and lymph node involvements. However, left sided adenocarcinomas (49.3%) expressed p53 more often than right sided adenocarcinomas (35.6%) (P = 0.01). The positive rates were different according to the histologic differentiation; 45.2% in well differentiated, 51.3% in moderately well differentiated, 23.8% in poorly differentiated, and 26.5% in mucinous carcinomas (P = 0.011). The mean survival periods of the p53 positive and negative groups were 29 months and 32 months, respectively (P = 0.385). However, overall survival for patients with grade one and two positive p53 was better than those of grade three and four positive cases (P = 0.028). In conclusion, the result of this multivariate analysis suggests that immunohistochemically strong p53 protein expression (more than 30% of tumor cells) has value in estimating a prognosis for patients with colorectal adenocarcinomas.