Hepatosplenic T-cell lymphoma in a young immunocompetent man.

Hepatosplenic T-cell lymphoma (HSTCL) is a rare, aggressive type of peripheral T-cell lymphoma that is characterised by extranodal disease, with infiltration and proliferation of malignant T-cells within the liver, spleen and bone marrow. The authors report the case of a young immunocompetent man, who was admitted to the hospital with a history of prolonged, unexplained fever, fatigue and weight loss. Initial blood work showed mild pancytopaenia and imaging studies revealed hepatosplenomegaly. The diagnosis was challenging, initially mimicking infectious disease, and it required an extensive investigation that ultimately revealed the characteristic clinical, histopathological and cytogenetic features of HSTCL. The clinical course was aggressive, and despite multiagent chemotherapy, the patient died 4 months after the diagnosis. This case highlights the difficulty of diagnosing HSTCL and the importance of considering it in a differential diagnosis of hepatosplenomegaly in young men who present with constitutional symptoms and no lymphadenopathy.

[CD4+, CD8+ AND CD19+ cells in individuals with dyslipidemia]. / Populações Celulares Periféricas (CD4+, CD8+ e CD19+) em Indivíduos Dislipidémicos.

INTRODUCTION: The past decade has witnessed an increasing recognition that inflammatory mechanisms play a central role in the pathogenesis of atherosclerosis and its complications. Recently, attention was focused on the potential role of plasma markers of inflammation as risk predictors among those at risk for cardiovascular events. Of these potential markers, C-reactive protein (CRP), IL6, metalloproteinases, ICAM, VCAM and other molecules, have been extensively studied. On the other hand, to our knowledge, there are only a few studies on the role of inflammatory cells, like T and B lymphocytes in the atherosclerosis. MATERIAL AND METHODS: By flow cytometry analysis we have determined on dyslipidemic people and on a control group, the percentage of some peripheral inflammatory cells, like CD3+, CD4+, CD8+, CD19+, CD56+, CD56CD8+, DN, CD25+, CD26+, CD25CD3+, CD26CD3+, CD25CD26CD3+, CCR5+, CCR5CD3+, CCR5CD4+, HLADR+, HLADRCD4+, HLADRCD8h+, HLADRCD8low+, HLADRCD8+, CD95+, CD95CD95L+, CD3CD95+, CD3CD95L+, CD62L+, CD3CD62L+, CD69+, CD69CD3+ e CD69CD4+. RESULTS: In the present study we have particularly studied the percentage of CD4+, CD8+ and CD19+ cells. The CD4+ cells have been significantly reduced in the people with dyslipidemia. DISCUSSION: We do not know the peripheral numbers of the subtype Th1 and Th2, neither the percentage of CD4+CD25+ cells (regulatory T cells). We have not find any differences on the percentage from the CD8+ and CD19+ cells. CONCLUSIONS: In spite of the identified limitations resulting from the small-sized samples, it was possible to show a reduction of some molecules after application of acetylsalicylic acid.

Introdução: Os mecanismos imunológicos e inflamatórios têm um papel crucial no desenvolvimento da aterosclerose e na sua tradução clínica. São inúmeros os estudos que procuraram relacionar os mais diversos marcadores inflamatórios ­ leucócitos, proteína C reactiva, interleucinas, quimiocinas, moléculas de adesão, metaloproteinases, etc ­ com os factores de risco clássicos da aterosclerose, a formação da placa e os fenómenos clínicos. Não são tantos, que tenhamos conhecimento, os trabalhos que analisaram o comportamento das diversas células mononucleares na fisiopatologia da aterosclerose. Sendo os monócitos/macrófagos e os linfócitos células fundamentais no desencadear e posterior evolução desta doença vascular, procurámos determinar as percentagens das diversas populações celulares periféricas em indivíduos dislipidémicos e em normolipidémicos.Material e Métodos: Por citometria de fluxo, determinámos em indivíduos com dislipidemia e num grupo controlo, as concentrações no sangue periférico dos CD3+, CD4+, CD8+, CD19+, CD56+, CD56CD8+, DN, CD25+, CD26+, CD25CD3+, CD26CD3+, CD25CD26CD3+, CCR5+, CCR5CD3+, CCR5CD4+, HLADR+, HLADRCD4+, HLADRCD8h+, HLADRCD8low+, HLADRCD8+, CD95+, CD95CD95L+, CD3CD95+, CD3CD95L+, CD62L+, CD3CD62L+, CD69+, CD69CD3+ e CD69CD4+. Resultados: Embora na sua grande maioria não tenham sido encontradas diferenças significativas entre os dois grupos de participantes, verificaram-se em algumas populações celulares, resultados que nos mereceram alguns comentários. Neste artigo debruçámo-nos apenas sobre as populações positivas para os CD4, CD8 e CD19.Discussão: A menor concentração das células CD4+ na nossa população de dislipidémicos foi aparentemente inesperada devido ao relacionamento existente entre este tipo celular, os factores de risco e a aterosclerose. Não foram determinados os subtipos Th1 e Th2, nem a população de células reguladoras CD4+CD25+, que poderiam explicar a menor percentagem de células CD4+ nos nossos dislipidémicos. Relativamente às células CD8+ e CD19+, apresentaram percentagens sobreponíveis nos dois grupos de participantes.Conclusões: Apesar das limitações evidenciadas em resultado da reduzida dimensão das populações, foi possível demonstrar uma redução em algumas moléculas após aplicação de ácido acetilsalicílico.