Mieloma múltiple IgA en paciente obstétrica / Multiple Myeloma in an obstetric patient

El mieloma múltiple es una neoplasia caracterizada por la proliferación anómala de células plasmáticas en la médula ósea, usualmente diagnosticada en pacientes mayores de 60 años, siendo rara su presentación antes de los 40 años de edad. Se presenta el caso de paciente femenina de 29 años de edad, sin antecedentes patológicos conocidos, a quien se le realiza el diagnóstico de mieloma múltiple IgA lambda en el primer trimestre del embarazo. Durante su estancia hospitalaria presenta hipercalcemia en rango de malignidad, con falla renal expresada en elevación de azoados y acidosis metabólica compensada. Se realizó serie radiológica ósea que mostró lesiones líticas en bóveda craneana. En la RMN de columna lumbar se evidencian fracturas patológicas de en columna lumbar (L4). Asimismo se solicitó electroforesis de proteínas en suero y orina e inmunofenotipo, corroborándose el diagnóstico de mieloma múltiple IgA lambda estadío IIIA según criterios de Durie Salmon. La paciente fue tratada con esteroides, evidenciándose disminución de la lesión en región frontal y mejoría de la función renal. El MM durante el embarazo es raro, habiendo sólo 42 casos descritos desde 1968 hasta la actualidad; de los cuales 4 corresponden a MM IgA. Reportamos el quinto caso en la literatura de mieloma múltiple IgA en una paciente obstétrica(AU)

Multiple myeloma is a hematologic malignancy characterized by the abnormal proliferation of plasma cells in the bone marrow. This disease is usually diagnosed in patients older than 60 years, with rare presentation before 40 years of age. We present the case of a female, 29 years - old patient, with no medical history, with IgA lambda myeloma diagnosed in the first trimester of pregnancy and who, during her hospitalization, presented malignant hypercalcemia, with renal failure. Bone survey revealed litic lesions in the skull. The MRI scan showed pathologic fractures of lumbar spine. The patient was treated with steroids, with a decrease of the frontal lesion and improvement of renal function. A protein electrophoresis is also requested in serum and urine, and immunophenotype, corroborating diagnosis of multiple myeloma IgA lambda IIIA stage according to Durie Salmon criteria. Myeloma multiple during pregnancy is extremely rare and there are 42 cases described from 1968 to date, and 4 of them are IgA MM. We report the fifth case in the literature of IgA multiple myeloma in an obstetric patient(AU)

Morphology and morphometry of feline bone marrow-derived mesenchymal stem cells in culture / Morfologia e morfometria das células-tronco mesenquimais isoladas de medula óssea de gato

Mesenchymal stem cells (MSC) are increasingly being proposed as a therapeutic option for treatment of a variety of different diseases in human and veterinary medicine. Stem cells have been isolated from feline bone marrow, however, very few data exist about the morphology of these cells and no data were found about the morphometry of feline bone marrow-derived MSCs (BM-MSCs). The objectives of this study were the isolation, growth evaluation, differentiation potential and characterization of feline BM-MSCs by their morphological and morphometric characteristics. in vitro differentiation assays were conducted to confirm the multipotency of feline MSC, as assessed by their ability to differentiate into three cell lineages (osteoblasts, chondrocytes, and adipocytes). To evaluate morphological and morphometric characteristics the cells are maintained in culture. Cells were observed with light microscope, with association of dyes, and they were measured at 24, 48, 72 and 120h of culture (P1 and P3). The non-parametric ANOVA test for independent samples was performed and the means were compared by Tukey's test. On average, the number of mononuclear cells obtained was 12.29 (±6.05x106) cells/mL of bone marrow. Morphologically, BM-MSCs were long and fusiforms, and squamous with abundant cytoplasm. In the morphometric study of the cells, it was observed a significant increase in average length of cells during the first passage. The cell lengths were 106.97±38.16µm and 177.91±71.61µm, respectively, at first and third passages (24 h). The cell widths were 30.79±16.75 µm and 40.18±20.46µm, respectively, at first and third passages (24 h).The nucleus length of the feline BM-MSCs at P1 increased from 16.28µm (24h) to 21.29µm (120h). However, at P3, the nucleus length was 26.35µm (24h) and 25.22µm (120h). This information could be important for future application and use of feline BM-MSCs.(AU)

As células tronco mesenquimais são utilizadas na terapia de várias doenças na medicina humana e veterinária. As células tronco foram isoladas da medula óssea de gato, entretanto, existem poucos dados referentes a morfologia e não existem informações sobre a morfometria das células tronco isoladas da medula óssea. Os objetivos do presente estudo foram o isolamento, avaliação do crescimento, potencial de diferenciação e caracterização morfológica e morfométrica das células mesenquimais de gato isoladas de medula óssea. A diferenciação in vitro foi realizada para confirmar a multipotencialidade das células mesenquimais de gato (diferenciação em osteoblastos, condrócitos, adipócitos). As células mesenquimais foram mantidas em cultivo para avaliações morfológica e morfométrica. As células foram coradas e observadas em microscopia ótica. As mensurações foram realizadas com 24, 48, 72 e 120h de cultura (primeira e terceira passagens). O teste não paramétrico ANOVA foi utilizado e as médias foram comparadas pelo teste de Tukey. O número médio de células mononucleares obtido foi de 12,29 (±6,05x106) células/mL de medula óssea. As células mesenquimais são longas e fusiformes, e escamosas com citoplasma abundante. No estudo morfométrico, observou-se aumento no comprimento médio das células durante a primeira passagem. As medidas de comprimento das células foram: 106,97±38,16µm e 177,91±71,61µm, respectivamente, na primeira e terceira passagens (24 horas). As medidas de largura das células foram: 30,79±16,75 µm e 40,18±20,46 µm, respectivamente, na primeira e terceira passagens (24 horas). O comprimento do núcleo na primeira passagem aumentou de 16,28µm (24h) para 21,29µm (120h) e na terceira passagem foi de 26,35µm (24h) para 25,22µm (120h). As informações são importantes para futuras aplicações e uso da célula mesenquimal de gato.(AU)

Exame imuno-histoquímico na biópsia de medula óssea: uma importante ferramenta complementar à morfologia / Immunohistochemistry in bone marrow biopsy: an important complementary tool for morphology

Por razões técnicas e históricas, a utilização da imuno-histoquímica (IHQ) em biópsias de medula óssea (BMO) levou algum tempo a ocupar espaço na avaliação diagnóstica desse tipo de material. Entretanto, esse cenário vem se modificando graças ao crescimento exponencial do número de anticorpos disponíveis para a utilização em material incluído em parafina, além do aperfeiçoamento das técnicas de recuperação antigênica e descalcificação do material. Este texto tem a finalidade de auxiliar o patologista na seleção/ interpretação de painéis de anticorpos utilizados nos laboratórios de rotina, de acordo com a experiência do autor, assim como de enumerar referências da literatura de grande utilidade para a prática diagnóstica.

Due to historical and technical reasons, the use of immunohistochemistry (IHC) in bone marrow biopsies (BMB) has not till recently been introduced in diagnostic evaluation. However, this scenario has changed owing to the exponential growth in the number of antibodies available for paraffin-embedded material and the development of techniques for antigen retrieval and material decalcification. Not only does this text aim to assist pathologists in the selection/interpretation of antibody panels used in routine laboratories, but it also lists literature references highly useful for diagnostic practice in accordance with the author's experience.

Citologia de medula óssea das primeiras seis semanas de vida de bovinos da raça Holandesa / Cytology of the bone marrow of the first six weeks of life of Holstein cattle

The possible changes in the bone marrow associated with hematological changes in peripheral blood during the first six weeks of life in cattle were evaluated. To this purpose, blood samples were evaluated at 2, 4, 7, 10, 14, 21, 28, 35, and 42 days of life, and cytologic examination of bone marrow at 2, 7, 21, and 42 days of life in 10 Holstein calves. The bone marrow examination showed, in different times, myeloid:erythroid ratio from 0.60 to 0.69. The erythroid lineage distribution remained pyramidal, with concentration of precursor cells above the initial reference values for adult cattle. Proliferation pool of myeloid lineage also remained above the reference range, with decreases of concentrations in the third and sixth weeks. In the lymphoid lineage, the concentration of lymphocytes showed a decrease in the first three weeks, with a tendency to rise in the sixth week.

Inclusões intracitoplasmáticas hialinas na medular da adrenal de bovinos / Intracytoplasmic hyaline inclusions in adrenal medulla of bovine

Cytoplasmic inclusion bodies in adrenal medullary chromaffin cells have been described in various species including humans. These inclusions are believed to be related to certain infectious, toxic and neurodegenerative diseases. No reports concerning such adrenal inclusions have been described in bovines. Adrenal glands from twenty bovines were evaluated in a retrospective study. Seven of these exhibited inclusions - three cases of rabies, two cases of chronic suppurative bronchopneumonia, one case of chronic suppurative peritonitis, and one case of gangrenous mastitis. The inclusions were present in higher numbers especially in cases of rabies and also in one case of chronic suppurative bronchopneumonia. The inclusions were intracytoplasmic, eosinophilic, rounded, single or multiple, of various sizes, strongly stained by PAS and were present in higher numbers in the external layer of the adrenal medulla. The inclusions were negative when subjected to immunohistochemistry for detection of viral antigens in the cases of rabies. Although inclusion bodies were present in adrenal glands devoid of other histological alterations, they were more abundant in cases in which the adrenal gland had other alterations. The correlation between certain diseases and the development of inclusion bodies is not known, which highlights the importance of further studies on these inclusions in adrenal glands of bovines.

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

Histologia da medula óssea / Bone marrow histology

A biópsia de medula óssea, após a utilização da agulha de Jamshidi, tornou- se um evento de rotina em virtude da simplificação na obtenção do material. A adequação das dimensões da amostra e a diminuição do tempo de descalcificação melhoraram muito a qualidade histológica e possibilitaram ao patologista um aprofundamento da interpretação morfológica das doenças hematológicas e não hematológicas. Para um laudo correto é necessário o conhecimento do tecido hematopoético normal, suas diferentes linhagens celulares, variações dependentes da idade e integração com outros dados clínicos e laboratoriais.

The bone marrow biopsy after the introduction of the Jamshidi needle has come into a routine practice due to the facilitation to obtain good sample. Due to the adequate size of the sample, the decalcification time decreased and consequently the histological quality improved allowing to the pathologist a more deep and precise morphological interpretation and diagnosis of the hematological and non- hematological disorders. For a correct diagnosis, the pathologist should be acquainted with the normal histology of the bone marrow parenchyma, it variations depending on age, as well as with the clinico- laboratorial data to integrate them with the morphological features.

Age-related marrow conversion and developing epiphysis in the proximal femur: evaluation with STIR MR imaging / 华中科技大学学报（医学）（英德文版）

In order to observe the feature of age-related marrow conversion and maturation of epiphyseal cartilage and analyze the distribution of red and yellow marrow in the proximal femur at STIR MR imaging, STIR and T(1) weighted MR imaging of the proximal femur in 52 subjects, aged 4 months to 25 years old, were retrospectively analyzed for the distribution and appearance of red and yellow marrow. The subjects with no known bone marrow abnormalities were divided into 6 age groups. The signal intensity of the marrow in the proximal epiphysis, proximal metaphysis, proximal diaphysis, distal diaphysis and greater trochanter was compared with the signal intensity and homogeneity of surrounding muscle and fat and graded by two observers. The results showed that the conversion of hematopoietic marrow in the proximal femur followed a well-defined sequence, occurring first in the proximal epiphysis, followed by the distal diaphysis, and then greater trochanter and metaphysis. STIR in combination with T(1)-weighted imaging could display clearly the origin of ossification center and the course of conversion from red to yellow marrow in proximal epiphysis and greater trochanter. STIR imaging showed that the marrow conversion in proximal metaphysic began below epiphyseal plate and intertrochanter. The site of red yellow was distributed in weight-bearing axis by 20 years of age. The marrow conversion of diaphysis was from distal end to proximal end, and the consequence of conversion was that distal diaphysis contained yellow marrow but proximal diaphysis partly red marrow connected with the red marrow of metaphysic. The epiphyseal cartilage had different characters of signal-intensity with age in STIR sequence. The distribution of red marrow in STIR imaging was more close to that of anatomy than T(1)-weighted imaging. It was concluded that STIR could dynamically display the feature of marrow conversion and the development of epiphyseal cartilage and accurately reveal the age-related distribution of red and yellow marrow on STIR imaging in the proximal femur.

Topografia do cone medular da paca (Agouti paca, Linnaeus - 1766) / Topography of the medullar cone in the paca (Agouti paca, Linnaeus - 1766)

Objetivamos neste trabalho determinar a esqueletopia da terminação do cone medular da paca relacionando com as vértebras lombares esacrais, visando assim estabelecer parâmetros morfométricos etopográficos do cone medular nesta espécie. Para tanto, procedemos à dissecação, mediante incisão, rebatimento da pele, da tela subcutânea e da musculatura da região dorsal à coluna vertebral, com posterior secção e remoção dos arcos vertebrais para melhor visualização da medula espinhal. Após a individualização do cone medular, registramos os aspectos anatômicos de interesse, enfatizando seu início (base) e seu término (ápice) em relação às vértebras, e a partir deentão efetuamos suas medidas com o auxílio de paquímetro; visando documentar nossos achados, realizamos fotografias e esquemas dos espécimes estudados.

We object in this work to determine the skeleton sintopy of the medular cone termination of the paca relating to the lumbar and sacral vertebrae, thus aiming at establishing morphometric and topographical parameters of the medular cone in this specie. We accomplished the dissection through skin incision, subcutaneous divulsion and dissection of the vertebral column dorsal region musculature, sectioning and removing the vertebrae arcs for better visualization of the spinal medulla. After the individualization of the medular cone, we registered the anatomical aspects of interest, emphasizing the basis and its apex in relation to the vertebrae, following the measuring of the region using a caliper rule; photographs and schematic drawing were made to register the findings of studied specimens.

Aspectos morfológicos de células da série eritrocítica de Caiman crocodilus yacare (Daudin, 1802; Reptilia, crocodilia) / Morphologic caracteristics of cells on the erytrocytic series of the Caiman crocodilus yacare (Daudin, 1802; Reptilia, crocodilia)

Com o objetivo de estudar o sistema hematopoético do réptil Caiman crocodilus yacare, foram utilizados cinco exemplares hígidos e jovens (aproximadamente um ano de idade), provenientes de São Paulo e de Mato Grosso do Sul. Amostras de sangue periférico foram colhidas em EDTA, através da punção do seio venoso cervical, e da medula óssea por punção aspirativa do osso femural. Estudo histológico da medula óssea femural foi realizado através da coloração por HE, Giemsa e técnica de Gomori para fibras reticulínicas. Os esfregaços de sangue e de medula foram processados para coloração panótica (Leishman ou Rosenfeld). A presença de sítios hematopoéticos ativos foi demonstrada histologicamente nos cortes transversais do fêmur, principalmente no terço distal. As células da linhagem eritrocítica foram encontradas dentro dos vasos capilares sinusóides medulares, na região central do osso. As células precursoras desta linhagem estavam aderidas à parede do vaso, e suas sucessoras distribuídas em direção ao centro do sinusóide à medida que amadureciam. Nos esfregaços de medula, as células imaturas da linhagem eritrocítica mostraram-se arredondadas e com núcleo predominantemente frouxo, em contraposição às células maduras, de núcleo condensado e forma em geral elíptica. Foram vistos pró-eritroblastos, eritroblastos basofílicos, policromáticos e ortocromáticos, e finalmente eritrócitos.

Vacunación en huéspedes inmunocomprometidos / Vaccine in immunocompromiced host

Los lactantes, niños y adolescentes con inmunodeficiencia primaria o secundaria constituyen una población creciente. La adecuada utilización de las vacunas incluídas en el Calendario Nacional y otras son una valiosa herramienta para la calidad de vida. Debe considerarse simultáneamente la vacunación de los convivientes. La indicación de la vacuna es personalizada. Se revisan las indicaciones en los pacientes con tratamiento prolongado con corticoides; inmundeficiencia primaria (humoral, celular/combinada); inmunodeficiencia secundaria (cáncer, transplante médula ósea/órganos sólidos.)

Histological study of the bone marrow mast cells in ovariectomized adult albino rats

Ten 90 days old female albino rats were utilized in this research aiming to study the bone marrow mast cells in ovariectomized adult albino rats in an attempt to clarify one of the possible underlying cellular causes of postmenopausal osteoporosis. These rats were equally classified into 2 groups [a control group and an experimental one]. Bilateral ovariectomy was performed to the rats of the experimental group. After 30 days of the ovariectomy, all the rats of the two groups were sacrificed. Their tibiae were dissected out carefully and their proximal parts were obtained and processed for light and electron microscope examinations. The spongy bone at the proximal tibial metaphysis of the ovariectomized rats appeared with few bone trabeculae. Numerous osteoclasts were observed in the examined sections. These cells appeared with multiple euchromatic nuclei and prominent nucleoli and their cytoplasm contained numerous mitochondria. The surrounding bone marrow contained numerous mast cells. Some of these cells were seen near the bone trabeculae. In conclusion, the concomitance between increased bone marrow mast cells number and osteoclasts number and activity with reduced bone trabeculae of the spongy bone of the proximal tibial metaphysis of the estrogen- deficient rats may suggest a role for mast cells in postmenopausal osteoporosis. So, regulation of mast cells activation may be a critical issue and a promising therapeutic approach in the treatment of this disease

Early histopathological changes in bone marrow of Paracoccidioides brasiliensis-infected mice

The involvement of bone marrow in the pathology of experimental P. brasiliensis infection in BALB/c mice was investigated. The histopathological features of bone marrow induced by the fungus were correlated with hematological changes in peripheral blood from 1 to 28 days post-infection. Intense lymphopenia and moderate neutrophilia were detected. The early changes in bone marrow included (i) maturation arrest characterized by an increase immature blood cell precursors, mainly of granulocytic origin, (ii) intense vascular congestion when compared with the vessels of normal marrow, and (iii) an increased number of megakaryocytes. The normal histological pattern of bone marrow was restored by 28 days post-infection. No histologically recognizable lesion, such as granuloma formation or an abnormal cellular infiltrate, which could indicate the presence of the P. brasiliensis in bone marrow, was observed. In addition, special stains were unable to detect the fungus. The mechanisms responsible for the alterations described here are still unclear but are probably related to more general phenomena affecting the host rather than the direct damage of the precursors cells by P. brasiliensis.

Bone marrow and histochemical features of malignant histiocytosis

To study the hematological and histochemical features of malignant histiocytosis cases diagnosed at King Khalid University Hospital. This is a retrospective analysis of malignant histiocytosis cases diagnosed by bone marrow examinations at the Hematology Section, Department of Pathology, King Khalid University Hospital. The medical records were evaluated for clinical symptoms and signs at presentation and peripheral blood count. Bone marrow aspirates and biopsies were reviewed for morphological features. Immunohisto-chemical staining of bone marrow trephine biopsies was performed. Over 11 years, from February 1984 to March 1995, four cases of malignant histiocytosis were diagnosed at King Khalid University Hospital [KKUH] in Riyadh. They were two males and two females. The age range was 25-56 years. The predominant symptoms at presentation were fever and fatigability. All patients had hepatomegaly and three had splenomegaly. One patient had localized lymphadenopathy and skin involvement. Three patients had pancytopenia while one patient had anemia, thrombocytopenia and leukocytosis. Immunohistochemical stains on three cases showed positivity with 1 antitrypsin and lysozyme. One case showed CDS [T cell marker] positivity by flow cytometry. The clinical, hematological and immunohistochemical staining findings are described

Bone marrow histopathological changes in visceral leishmaniasis

Over a period of two years [June 1989-May 1991], bone marrow trephine biopsies from 16 patients with visceral leishmaniasis were examined histologically to assess the correlation between the peripheral blood counts and bone marrow status. Only 25% of patients had normal peripheral blood counts. Of the remainder, 25% had anemia alone, 25% had anemia with thrombocytopenia, and 25% had pancytopenia. The anemia was microcytic/hypochromic in 88.7% of cases and normocytic in 12.3% of cases. Thrombocytopenia was a notable feature, with mean platelet count of 115 +/- 72.47 x 10 9/L, and eight patients having thrombocytopenia below 120 x 10 9/L. There was diffuse bone marrow hypercellularity in 13 cases and focal hypocellularity in three. The increased cellularity was attributable to trilineage hyperplasia, with a predominance of erythroid activity in most cases. Increase in the histiocytic population was a prominent feature in all the cases. In 10 cases, most of the histiocytes were found to be full of LD bodies, while in the other six, the parasite load was much less. Megakaryocytes were abundant in number, forming aggregates in most cases. Other notable features included erythrophagocytosis [nine cases] and moderate perivascular plasmacytosis [13 cases]

Púrpura trombocitopénica asociada a brucelosis / Thrombocytopenic purpura in human brucellosis

Entre los años 1981 a 1990 se estudiaron las características clínicas de la púrpura trombocitopénica asociada a brucelosis. De 1091 pacientes con brucelosis, 27 presentaron púrpura durante la enfermedad, de éstos, 22 (81.5 por ciento) fueron hospitalizados y 5 (18.5 por ciento) evaluados ambulatoriamente. Veintiuno (77.7 por ciento) fueron mujeres y 6 hombres (22.3 por ciento). El rango de edad fluctuó entre 2 y 77 años, promedio de 28.7 años. Presentaron anemia 23 pacientes (85.1 por ciento), leucopenia 10 (37 por ciento) y trombocitopenia 22 (88 por ciento). Se observó pancitopenia en 10 pacientes (37 por ciento). El estudio de médula ósea en 22 pacientes mostró: hipercelularidad en 16 (72.2 por ciento), hiperplasia megacariocítica en 11 (50 por ciento), histiocitofagocitosis en 8 (36.4 por ciento), ausencia de hierro medular en 13 (59.1 por ciento) y granulomas en el coágulo de la médula ósea en 2 pacientes. Se utilizó corticoterapia en todos los pacientes con trombocitopenia severa observándose remisión completa en el 73 por ciento de los casos. Tres pacientes necesitaron esplenectomía por ser refractarios a la corticoterapia. Dos pacientes fallecieron por hemorragia en el sistema nervioso central

Chronic lymphocytic leukaemia: clinical staging and bone marrow histological patterns in 68 Iraqi patients

Clinical, haematological and bone marrow histo!ogical patterns were studied in a series of 68 Iraqi patients with chronic lymphocytic Leukaemia. The application of the two major clinical staging systems [namely the Rai and Binet systems] to the classification of patients in this series showed that the majority had an advanced stage at presentation [63.2% were Binet stage C [Rai stages III and IV]], Bone marrow histological patterns were diffuse in 51.5%, mixed in 32.3% and interstitial in 16.2%, while none were nodular. Such findings are quite different. from those reported from North America and Europe, Where early and Intermediate clinical stages and interstitial marrow histological patterns predominate. Furthermore, significant correlations between the marrow histological patterns and both Rai and Binet staging systems were found, a finding which is consistent with studies from Western countries