Consulta interinstitucional en patología: estudio de 877 casos / Interinstitutional consultation in pathology: study of 877 cases

Objetivos: en el Departamento de Patología del Hospital de Clínicas se revisa el material histológico y citológico de pacientes que son derivados a la institución, consulta interinstitucional (CI). El objetivo del presente trabajo fue evaluar de manera retrospectiva los resultados de la misma. Materiales y métodos: se estudiaron 877 CI recibidas entre agosto de 1994 y mayo de 1998. El material consistió en 307 tacos incluidos en parafina y 570 preparados histológicos o citológicos. Ciento cinco casos (11,9 por ciento) requirieron tinciones de inmunohistoquímica para realizar el diagnóstico. Resultados: de acuerdo con nuestro diagnóstico dividimos a los casos según las siguientes categorías: tumores malignos 618 (71 por ciento), tumores benignos 109 (12 por ciento), procesos inflamatorios 94 (11 por ciento), descripción morfológica 35 (4 por ciento) y diagnóstico diferido 21 (2 por ciento). De los 877 casos se conocía el informe original en 729. Comparamos el diagnóstico original con el de la CI y obtuvimos los siguientes grupos: coincidencia diagnóstica (CD), 527 casos (72,3 por ciento), diferencia diagnóstica mayor (DDMa), 95 (13,0 por ciento), diferencia diagnóstica menor (DDMe) 107 (14,7 por ciento) y sin diagnóstico original 148. La discrepancia diagnóstica total fue del 28 por ciento. El diagnóstico realizado por el Departamento de Patología fue confirmado por el estudio de piezas operatorias, evolución clínica, respuesta al tratamiento y seguimiento de los pacientes. El 13 por ciento de los casos con DDMa fueron causa de nuevos procedimientos diagnósticos, cambios terapéuticos o en la evolución clínica de los pacientes. Conclusiones: la implementación de la consulta interinstitucional provee información útil que determina un cambio en la conducta diagnóstica o terapéutica en un número considerable de casos

Consulta interinstitucional en patología: estudio de 877 casos / Interinstitutional consultation in pathology: study of 877 cases

Objetivos: en el Departamento de Patología del Hospital de Clínicas se revisa el material histológico y citológico de pacientes que son derivados a la institución, consulta interinstitucional (CI). El objetivo del presente trabajo fue evaluar de manera retrospectiva los resultados de la misma. Materiales y métodos: se estudiaron 877 CI recibidas entre agosto de 1994 y mayo de 1998. El material consistió en 307 tacos incluidos en parafina y 570 preparados histológicos o citológicos. Ciento cinco casos (11,9 por ciento) requirieron tinciones de inmunohistoquímica para realizar el diagnóstico. Resultados: de acuerdo con nuestro diagnóstico dividimos a los casos según las siguientes categorías: tumores malignos 618 (71 por ciento), tumores benignos 109 (12 por ciento), procesos inflamatorios 94 (11 por ciento), descripción morfológica 35 (4 por ciento) y diagnóstico diferido 21 (2 por ciento). De los 877 casos se conocía el informe original en 729. Comparamos el diagnóstico original con el de la CI y obtuvimos los siguientes grupos: coincidencia diagnóstica (CD), 527 casos (72,3 por ciento), diferencia diagnóstica mayor (DDMa), 95 (13,0 por ciento), diferencia diagnóstica menor (DDMe) 107 (14,7 por ciento) y sin diagnóstico original 148. La discrepancia diagnóstica total fue del 28 por ciento. El diagnóstico realizado por el Departamento de Patología fue confirmado por el estudio de piezas operatorias, evolución clínica, respuesta al tratamiento y seguimiento de los pacientes. El 13 por ciento de los casos con DDMa fueron causa de nuevos procedimientos diagnósticos, cambios terapéuticos o en la evolución clínica de los pacientes. Conclusiones: la implementación de la consulta interinstitucional provee información útil que determina un cambio en la conducta diagnóstica o terapéutica en un número considerable de casos (AU)

[Identification of Epstein-Barr virus in nasopharyngeal carcinomas in Argentina. Its relation with p53 and the determination of proliferation indices]. / Identificación del virus Epstein-Barr en carcinomas nasofaríngeos en Argentina. Su relación con p53 y determinación de índices de proliferación.

Thirty-seven nasopharyngeal carcinomas were studied obtaining the tissue from nasopharyngeal biopsies that were formalin fixed and paraffin embedded. The patients were born in Argentina, 23 men and 14 women with a mean age of 50 years. Histologically the tumors were classified as queratinizing squamous cell carcinomas, 1 case (2%); non-queratinizing squamous cell carcinomas, 15 cases (41%) and undifferentiated carcinomas, 21 cases (57%). The proliferating index (PI) was determined using monoclonal antibodies against PCNA and Ki-67 (MIB-1), resulting in 26% for PCNA and 17% for Ki-67 while no differences were found comparing PI with histological type and cases with clinical stage III and IV. The PI was of 2% in the 3 cases with clinical stage II. Immunostains for p53 were positive in 30 out of the 37 cases with no differences between the histological types, exception made for the queratinizing carcinoma which was negative. With a cut off point of 7% in the 12 cases with follow up, two groups were found with a mean survival of 35 and 12 months, a finding that was not statistically significant. Epstein-Barr virus was detected by PCR using the paraffin embedded material in 31 out of the 37 cases: 21 were undifferentiated carcinomas and 15 non-queratinizing squamous cell carcinomas; the queratinizing squamous cell carcinoma was negative. These results, published for the first time in samples from Argentinian patients are similar to those found in areas of high and low incidence of nasopharyngeal carcinomas and can be of clinical use in determining the nasopharyngeal origin of a cervical metastatic lymph node of an unknown primary.

[Immunological changes in common vitiligo]. / Alteraciones inmunológicas en el vitiligo vulgar.

Three theories have been mentioned so as to explain vitiligo: normal, autocytotoxic and autoimmune. In this work we study the cellular immune elements in normal vitiligo. Concerning the skin, there is an increase of Langerhans cells (p less than 0.001) en its activation (DR+) (p less than 0.001). Regarding the blood, there is an increase of T cytotoxic lymphocytes (p less than 0.001), T activated lymphocytes (DR+) (p less than 0.001) and B lymphocytes (p less than 0.01). Total T lymphocytes and T cooperators (CD4+) are not increased. These results suggest that immune mechanisms mediated by T cytotoxic lymphocytes may be the cause of the melanocytes destruction in normal vitiligo.

[Analysis of circulating T-lymphocyte subpopulations with monoclonal antibodies in psoriasis]. / Análisis de subpoblaciones linfocitarias T circulantes con anticuerpos monoclonales en psoriasis.

Subsets of peripheral blood lymphocytes were studied by surface markers in 21 patients with psoriasis. 12 had active lesions and 9 had stable lesions. The number of T cells was estimated by indirect immunofluorescence with the monoclonal antibody OKT3. The number of T inducer cells was estimated with the monoclonal antibody OKT4. The number of the activated cell was estimated with the monoclonal antibody Edu I. The patients with psoriasis had decreased T cell number, decreased T inducer cell number and increased T activated cell number. The patients with active lesions had the most pronounced alterations of T cells subsets. In these patients was observed also a decreased inducer/T suppressor cell ratio. The results, that show alterations in T cell number and it ratio are not able to establish or clarify an inducer or suppressor T cell activity in the course of psoriasis. The number of T suppressor cells was estimated with the monoclonal antibody OKT8.

[Lymphocyte subpopulations in alopecia areata]. / Subpoblaciones linfocitarias en alopecia areata.

Subsets of peripheral blood lymphocytes were studied in 19 patients with alopecia areata. The results shows: a decreased Tm/Tg ratio, decreased number of OKT4+ cells, increased OKT8+ cells, decreased OKT4+/OKT8+ cell ratio. Total lymphocytes, T cells, Tm cells, Tg cells, T DR+ cells and B lymphocytes were normal. The results are similar to those founded in autoimmune diseases and suggest the existence of an immunopathogenic mechanism in these disease.

[Halo nevus. In situ study using monoclonal antibodies]. / Halo nevo. Estudio "in situ" con anticuerpos monoclonales.

Using immunocytochemical methods the inflammatory-cell infiltrate from 7 halo nevi were studied. Monoclonal antibodies, Cris-1, OKT3, OKT4, OKT8, A47, Edu-1, OKT6 and anti-immunoglobulins were employed. The results shows that the predominant cells in the inflammatory-cell infiltrate were T cytotoxic/suppressor activated lymphocytes. An increased number of epidermal Langerhans cells and IgM deposits in epidermal-dermal junction was also observed. Thus, the results are able to postulate that self-involution of halo nevi was mediated by cytotoxic cellular immune reactions.

[Analysis of circulating T-lymphocyte subpopulations with monoclonal antibodies in psoriasis]. / Análisis de subpoblaciones linfocitarias T circulantes con anticuerpos monoclonales en psoriasis.

Subsets of peripheral blood lymphocytes were studied by surface markers in 15 patients with psoriasis. Eighth of them had active lesions and 7 had stable lesions. The number of T cells was estimated by indirect immunofluorescence with the monoclonal antibodies OKT3. The number of T inducer cells was estimated with the monoclonal antibodies OKT4. The number of T suppressor cells was estimated with the monoclonal antibodies OKT8. The number of T activated cells was estimated with the monoclonal antibodies Edu 1. The patients with psoriasis had increased T cell number, decreased T inducer cell number and increased T activated cell number. The patients with active lesions had the most pronounced alterations of T cells subsets. In these patients was observed also a decreased T inducer/T suppressor cell ratio. The results, that show alterations in T cell number and it ratio are not able to establish or clarify an inducer or suppressor T cell activity in the course of psoriasis.