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1.
Arthritis Res Ther ; 24(1): 276, 2022 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-36544236

RESUMO

BACKGROUND: To evaluate the effects of tumor necrosis factor inhibitors (TNFi), interleukin-6 receptor inhibitors (IL-6Ri), and Janus kinase inhibitors (JAKi) on hemoglobin (Hb) and C-reactive protein (CRP) levels in adults enrolled in CorEvitas (formerly Corrona), a large US rheumatoid arthritis (RA) registry. METHODS: Patients who initiated TNFi, IL-6Ri, or JAKi treatment during or after January 2010, had Hb and CRP measurements at baseline and 6-month follow-up (± 3 months) and had continued therapy at least until that follow-up, through March 2020, were included in the analysis. Changes in Hb and CRP were assessed at month 6. Abnormal Hb was defined as < 12 g/dL (women) or < 13 g/dL (men); abnormal CRP was ≥ 0.8 mg/dL. Differences in Hb and CRP levels were evaluated using multivariable regression. RESULTS: Of 2772 patients (TNFi, 65%; IL-6Ri, 17%; JAKi, 17%) evaluated, 1044 (38%) had abnormal Hb or CRP at initiation; an additional 252 (9%) had both abnormal Hb and CRP. At month 6, the IL-6Ri group had a greater Hb increase than the TNFi (mean difference in effect on Hb: 0.28 g/dL; 95% CI 0.19-0.38) and JAKi (mean difference in effect on Hb: 0.47 g/dL; 95% CI 0.35-0.58) groups, regardless of baseline Hb status (both p < 0.001). The CRP decrease at month 6 was greater with IL-6Ri compared with TNFi and JAKi, regardless of baseline CRP status (both p < 0.05). CONCLUSION: These real-world results align with the mechanism of IL-6R inhibition and may inform treatment decisions for patients with RA.


Assuntos
Anemia , Antirreumáticos , Artrite Reumatoide , Inflamação , Adulto , Feminino , Humanos , Masculino , Anemia/induzido quimicamente , Antirreumáticos/efeitos adversos , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Hemoglobinas/química , Inflamação/induzido quimicamente , Sistema de Registros , Inibidores do Fator de Necrose Tumoral/efeitos adversos , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Fator de Necrose Tumoral alfa , Receptores de Interleucina-6/antagonistas & inibidores
2.
Pathol Int ; 59(5): 345-53, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19432678

RESUMO

Anaplastic large cell lymphoma (ALCL) is a distinct type of T/null-cell non-Hodgkin lymphoma that commonly involves nodal and extranodal sites. The World Health Organization of lymphoid neoplasms recognizes two types: anaplastic lymphoma kinase (ALK) positive or ALK negative, the former as a result of abnormalities involving the ALK gene at chromosome 2p23. Patients with ALCL rarely develop a leukemic phase of disease, either at the time of initial presentation or during the clinical course. Described herein is a patient with ALK+ ALCL, small cell variant, associated with the t(2;5)(p23;q35), who initially presented with leukemic involvement and an extraordinarily high leukocyte count of 529 x 10(9)/L, which subsequently peaked at 587 x 10(9)/L. Despite chemotherapy the patient died 2(1/2) months after diagnosis. In the literature review 20 well-documented cases are identified of ALCL in leukemic phase reported previously, with a WBC ranging from 15 to 151 x 10(9)/L. Leukemic phase of ALCL occurs almost exclusively in patients with ALK+ ALCL, most often associated with the small cell variant and the t(2;5)(p23;q35), similar to the present case. Patients with leukemic phase ALK+ ALCL appear to have a poorer prognosis than most patients with ALK+ ALCL.


Assuntos
Linfoma Anaplásico de Células Grandes/sangue , Linfoma Anaplásico de Células Grandes/patologia , Adulto , Quinase do Linfoma Anaplásico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Aberrações Cromossômicas , Citometria de Fluxo , Humanos , Imuno-Histoquímica , Hibridização in Situ Fluorescente , Contagem de Leucócitos , Linfoma Anaplásico de Células Grandes/genética , Masculino , Reação em Cadeia da Polimerase , Proteínas Tirosina Quinases/metabolismo , Receptores Proteína Tirosina Quinases
3.
Arch Pathol Lab Med ; 132(5): 829-37, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18466042

RESUMO

CONTEXT: In the diagnosis of lymphomas and leukemias, flow cytometry has been considered an essential addition to morphology and immunohistochemistry. The interpretation of immunophenotyping results by flow cytometry involves pattern recognition of different hematologic neoplasms that may have similar immunologic marker profiles. An important factor that creates difficulty in the interpretation process is the lack of consistency in marker expression for a particular neoplasm. For this reason, a definitive diagnostic pattern is usually not available for each specific neoplasm. Consequently, there is a need for decision support tools to assist pathology trainees in learning flow cytometric diagnosis of leukemia and lymphoma. OBJECTIVE: Development of a Web-enabled relational database integrated with decision-making tools for teaching flow cytometric diagnosis of hematologic neoplasms. DESIGN: This database has a knowledge base containing patterns of 44 markers for 37 hematologic neoplasms. We have obtained immunophenotyping data published in the scientific literature and incorporated them into a mathematical algorithm that is integrated to the database for differential diagnostic purposes. The algorithm takes into account the incidence of positive and negative expression of each marker for each disorder. RESULTS: Validation of this algorithm was performed using 92 clinical cases accumulated from 2 different medical centers. The database also incorporates the latest World Health Organization classification for hematologic neoplasms. CONCLUSIONS: The algorithm developed in this database shows significant improvement in diagnostic accuracy over our previous database prototype. This Web-based database is proposed to be a useful public resource for teaching pathology trainees flow cytometric diagnosis.


Assuntos
Bases de Dados Factuais , Educação de Pós-Graduação em Medicina , Citometria de Fluxo/métodos , Neoplasias Hematológicas/diagnóstico , Patologia Clínica/educação , Algoritmos , Biomarcadores Tumorais/metabolismo , Sistemas de Apoio a Decisões Clínicas , Diagnóstico por Computador , Diagnóstico Diferencial , Neoplasias Hematológicas/imunologia , Neoplasias Hematológicas/metabolismo , Humanos , Imunofenotipagem , Software
4.
Arch Pathol Lab Med ; 130(10): 1497-502, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17090191

RESUMO

CONTEXT: Pleural involvement by lymphoma is relatively common. However, there are very few clinicopathologic studies reported in the literature of lymphomas involving the pleura. OBJECTIVE: To characterize the clinicopathologic features of lymphomas involving the pleura. DESIGN: We reviewed the clinicopathologic features of 34 patients with lymphoma involving the pleura proven by biopsy and classified these neoplasms using the World Health Organization classification. RESULTS: There were 22 men and 12 women, with an average age of 62 years (range, 22-82 years). Nine (26.5%) patients had pleural involvement as the only site of disease, 22 (64.7%) had other sites of involvement, and 3 (8.8%) had inadequate staging data. Eighteen (56.2%) of 32 patients with adequate clinical data had a history of lymphoma (including 3 patients with pleural involvement as the only disease site). In 29 (85.3%) cases, a specific diagnosis according to the World Health Organization classification could be made: 17 (58.6%) diffuse large B-cell lymphoma, 5 (17.2%) follicular lymphoma (including a case with areas of diffuse large B-cell lymphoma), 2 (6.9%) small lymphocytic lymphomas/chronic lymphocytic leukemia, 2 (6.9%) precursor T-cell lymphoblastic lymphoma/leukemia, 1 (3.4%) mantle cell lymphoma, 1 (3.4%) posttransplant lymphoproliferative disorder, and 1 (3.4%) classical Hodgkin lymphoma. The other 5 cases were B-cell lymphomas that could not be further classified. Cytologic examination of pleural fluid was performed in 15 cases and was positive for lymphoma in 8 (53.3%) cases. CONCLUSIONS: Most patients with lymphoma involving the pleura have simultaneous evidence of systemic involvement. The most frequent type is diffuse large B-cell lymphoma, followed by follicular lymphoma. Cytologic examination can have negative results in patients with pleural involvement by lymphoma.


Assuntos
Linfoma/patologia , Pleura/patologia , Neoplasias Pleurais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Líquidos Corporais/citologia , Feminino , Humanos , Imunofenotipagem , Incidência , Linfoma/classificação , Linfoma/imunologia , Linfoma de Células B/epidemiologia , Linfoma Folicular/epidemiologia , Linfoma Difuso de Grandes Células B/epidemiologia , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Segunda Neoplasia Primária/patologia , Pleura/metabolismo , Neoplasias Pleurais/classificação , Neoplasias Pleurais/epidemiologia , Neoplasias Pleurais/imunologia , Estudos Retrospectivos , Organização Mundial da Saúde
6.
Ann Diagn Pathol ; 9(1): 49-53, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15692952

RESUMO

We describe a rare case of malignant gastrointestinal stromal tumor (GIST) of the esophagus presenting in an HIV-positive man. Not only did the tumor arise from an unusual anatomic site for GIST, namely, the esophagus, but it also had a predominant epithelioid cell morphology that is uncommon and preferentially associated with aggressive behavior. Exhaustive immunohistochemical studies showed strong reactivities to the classic GIST marker, CD34, and to the current more sensitive and more specific GIST marker, CD117/ c-kit protein. This immunophenotype corresponded to that of stromal tumors arising in the more common sites like stomach and small intestine as well as to that of a reported series of esophageal GISTs in the general population. Mutations of the c-kit protein was detected in the tumor, confirming previous observations. This further documents that esophageal GIST and the more common benign esophageal spindle cell lesions are pathologically distinct entities and despite its rarity, esophageal GIST should be recognized by pathologists and clinicians. The occurrence of this tumor in an HIV-positive patient is coincidental, and it resulted in an extremely unusual metastatic site that has not been reported for GISTs.


Assuntos
Neoplasias Esofágicas/patologia , Tumores do Estroma Gastrointestinal/patologia , Infecções por HIV/patologia , Neoplasias Complexas Mistas/secundário , Antígenos CD34/análise , Biomarcadores Tumorais/análise , Endossonografia , Células Epitelioides/química , Células Epitelioides/patologia , Neoplasias Esofágicas/química , Tumores do Estroma Gastrointestinal/química , Tumores do Estroma Gastrointestinal/complicações , Infecções por HIV/complicações , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Neoplasias Complexas Mistas/química , Neoplasias Complexas Mistas/cirurgia , Proteínas Proto-Oncogênicas c-kit/análise
7.
Am J Clin Pathol ; 123(3): 456-64, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15716243

RESUMO

T-cell prolymphocytic leukemia (T-PLL) can involve extramedullary sites, but the diagnosis is usually established by examination of blood and bone marrow. As a result, the histologic findings at extramedullary sites are poorly documented in the literature. We describe 19 extramedullary biopsy specimens from 14 patients with T-PLL. Skin (n = 10) was the most common site biopsied. T-PLL surrounded dermal blood vessels and appendages (n = 6), diffusely replaced dermis (n = 3), or formed a subcutaneous mass (n = 1). Other extramedullary sites included liver and lymph nodes (3 each) and spleen, lung, and cecum (1 each). In liver and lymph nodes, the neoplasm predominantly involved portal tracts and paracortex, respectively. Cytologically, the T-PLL cells were round (n = 16) or Sezary cell-like (n = 3). Nucleoli were observed in a subset of cells in 8 specimens and were prominent in 3 specimens. Immunostaining for T-cell leukemia-1 (TCL-1) was positive in specimens from 9 (64%) of 14 patients. We conclude that the prolymphocytoid features of T-PLL cells can be difficult to detect in routinely stained sections of extramedullary biopsy specimens. TCL-1 expression can aid in diagnosis at extramedullary sites.


Assuntos
Leucemia Prolinfocítica/patologia , Leucemia de Células T/patologia , Tecido Linfoide/patologia , Neoplasias Cutâneas/patologia , Idoso , Biomarcadores Tumorais/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Imunofenotipagem , Leucemia Prolinfocítica/metabolismo , Leucemia Prolinfocítica/mortalidade , Leucemia de Células T/metabolismo , Leucemia de Células T/mortalidade , Tecido Linfoide/metabolismo , Masculino , Pessoa de Meia-Idade , Síndrome de Sézary/metabolismo , Síndrome de Sézary/mortalidade , Síndrome de Sézary/patologia , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/mortalidade , Taxa de Sobrevida , Texas/epidemiologia
8.
Int J Gynecol Pathol ; 23(3): 278-83, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15213605

RESUMO

Two cases of Langerhans cell histiocytosis involving the vulva are reported. The clinical features of Case 1 have been previously reported. The patients, aged 31 (Case 1) and 52 (Case 2) years, had disease limited to the vulva at the time of diagnosis. In both cases, the vulvar lesions were composed of Langerhans cells with twisted nuclei and nuclear grooves, associated with eosinophils and other inflammatory cells. Immunohistochemical studies using fixed, paraffin-embedded tissue sections showed that the Langerhans cells were positive for CD1A and S-100 protein in both cases, supporting the morphologic diagnosis. The first patient had multiple local recurrences during 3 years despite radiation therapy and vulvectomy, but is currently in remission and being treated with thalidomide. The second patient experienced disseminated disease involving multiple bony sites and the mouth despite radiation therapy. Including the present two cases, 6 of 18 (33%) cases of isolated vulvar LCH subsequently disseminated, most commonly to bone; other patients had local recurrences. Thus isolated vulvar LCH has the potential for aggressive clinical behavior, either as local recurrence or disseminated disease. New treatment modalities are needed for this disease.


Assuntos
Histiocitose de Células de Langerhans/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias Vulvares/patologia , Adulto , Antineoplásicos/uso terapêutico , Neoplasias Ósseas/secundário , Feminino , Histiocitose de Células de Langerhans/terapia , Humanos , Imuno-Histoquímica , Imunossupressores/uso terapêutico , Pessoa de Meia-Idade , Neoplasias Vulvares/terapia
9.
Clin Infect Dis ; 37(8): 1044-9, 2003 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-14523768

RESUMO

Most human cases of West Nile virus infection are acquired via bites from an infected mosquito. In some cases, infection may also be transmitted by infected blood products or transplanted organs. There have been recent publications suggesting that chemotherapy and immunosuppression may increase a person's risks of developing central nervous system disease if the person is infected with the West Nile virus. Because patients undergoing hematopoietic stem cell transplantation not only are immunocompromised, but also receive multiple blood products, they are at a particularly high risk for acquiring symptomatic disease if exposed to the West Nile Virus. We describe here 2 patients who underwent hematopoietic transplantation at our institution and subsequently developed fatal West Nile virus infections.


Assuntos
Encefalite/virologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Febre do Nilo Ocidental/etiologia , Vírus do Nilo Ocidental , Idoso , Encefalite/prevenção & controle , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Febre do Nilo Ocidental/prevenção & controle
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