RESUMO
Background and aim: patients with head and neck squamous cell malignancies have a higher risk of oesophageal squamous cell carcinomas. Lugol chromoendoscopy in oesophagus is a simple technique with a high diagnostic yield in premalignant lesions. The objective was to analyze its diagnostic accuracy in dysplasia and carcinoma of the oesophagus in high-risk patients. Methods: prospective study from April/2008 to January/2012 using lugol chromoendoscopy with biopsies of suspicious lugol voiding areas ≥ 5 mm. Patients with head and neck malignancies were included, except the ones with iodine allergy, oesophageal varices and contra-indications to standard endoscopy. The reference method was histopathology. Results: 89 patients were enrolled (mean age 62.8 ± 13.3 years, 87 % men). Primary tumour was located in oropharynx in 37 (41.6 %), in oral cavity in 29 (32.6 %) and in the larynx in 23 (25.8 %) cases. 40.4 % patients had previous treatments and 87 % reported alcohol or tobacco addition. All exams performed without anaesthesia or complications. Nine suspicious lugol voiding areas were observed and biopsied. Histopathological analysis revealed high-grade dysplasia in 2 (2.2 %) and inflammation or normal findings in the others. The sensitivity and specificity for detecting high-grade dysplasia were 100 % and 92 % (95 % CI: 87-97), respectively. Diagnostic accuracy of the test was 92 % (95 % CI: 86-98). Conclusion: lugol staining of the oesophagus during endoscopy seems to be a feasible, safe and justified procedure in high-risk population as it enhances the detection of premalignant lesions (AU)
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Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Carcinoma de Células Escamosas/patologia , Corantes , Neoplasias Esofágicas/patologia , Esofagoscopia/métodos , Neoplasias de Cabeça e Pescoço/patologia , Iodetos , Neoplasias Primárias Múltiplas/patologia , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
La gammagrafía con I-131 MIBG se utiliza de modo rutinario para el diagnóstico de tumores neuroendocrinos con alta especificidad. El radiofármaco se deposita mediante mecanismos de captación y se transpone activo hacia las vesículas presinápticas del almacenamiento. Los órganos con densa inervación simpática como las glándulas salivales, corazón, glándulas lacrimales, bazo y rarmente médula adrenal se visualizan normalmente con I-131 MIBG. La captación de las glándulas salivales asimétrica es importante en un paciente con sospecha de tumores neuroendocrinos. La ausencia de radioactividad puede resultar en denervación simpática o tumor. La ausencia de radioactividad bilateral es observada normalmente debido a las condiciones de almacenamiento de las drogas o radiofármacos. La exploración detallada de la región cervical es crucial para la localización de los tumores neuroendocrinos. Por lo tanto, debe tenerse en cuentalos falsos positivos
I-131 MIBG scintigraphy is routinely used in the diagnosis of neuroendocrine tumours with high specificity. The radiopharmaceutical is taken up via uptake mechanism and actively transported into storage vesicules. The organs with dense sympathetic innervation such as salivary glands, heart, lachrymal glands, spleen and rarely adrenal medulla are normally visualized with I-131 MIBG. Asymetrical salivary gland uptake is improtant in a patient with suspected neuroendocrine tumours. Absence of radioactivity may be a result of sympathic denervation or tumor. Bilateral radioactivity absence is observed usually due to drugs or radiopharmaceutical storage conditions. Detailed examination of cervical region is crutial for localisation of neuroendocrine tumours. Therefore, possible false positives should be kept in mind
Assuntos
Criança , Adulto , Humanos , 3-Iodobenzilguanidina/farmacocinética , 3-Iodobenzilguanidina , Síndrome de Horner , Radioisótopos do Iodo/farmacocinética , Neuroblastoma , Complicações Pós-Operatórias , Compostos Radiofarmacêuticos/farmacocinética , Glândulas Salivares , Neoplasias Abdominais , Diagnóstico Diferencial , Síndrome de Horner/etiologia , Iodetos/administração & dosagem , Radioisótopos do Iodo , Paraganglioma/diagnóstico , Compostos Radiofarmacêuticos , Neoplasias de Cabeça e Pescoço/diagnósticoRESUMO
Dendritic cells are antigen-presenting cellsfound in almost every type of tissue, includinglymphatic tissue, blood and skin. In the intestinaltract, these cells are likely to play a pivotalrole in the initiation and regulation of immuneresponses. Our earlier study of the human colonand ileum revealed the presence of zinc iodideosmium-positive dendritic cells. In the presentstudy we demonstrate the presence of ZIO-positivedendritic cells in the human appendix.ZIO-positive cells were seen in the region ofcrypts of Lieberkühn as well as in the surfaceepithelium. The cells showed a single longprocess directed towards the lumen. They werelong, slender, and triangular. In the region ofthe lymphoid follicle, two different types ofdendritic cells were noted. The follicular dendriticcells present in the germinal center werefew in number, larger in size and with thickdendritic processes. However, in the mantlezone typical dendritic cells were seen. Theywere smaller in size and had many thin processes.The distribution of dendritic cells in thehuman appendix confirms the role of theappendix in the immune response (AU)
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Assuntos
Feminino , Adulto , Humanos , Osmio/análise , Zinco/análise , Iodetos/análise , Células Dendríticas Foliculares/ultraestrutura , Apêndice/ultraestrutura , ColectomiaRESUMO
El carcinoma epidermoide esofágico es, junto con el adenocarcinoma, la neoplasia del esófago de mayor trascendencia clínica. Su baja incidencia en la población general supone que el establecimiento de estrategias de diagnóstico temprano no parezca prioritario, en comparación con otras neoplasias. Sin embargo, la baja supervivencia cuando se diagnostica la enfermedad en pacientes sintomáticos (inferior al 20% a los 5 años) obliga a investigar medidas de diagnóstico temprano. El empleo de la citología o de la cromoendoscopia con Lugol en países con elevada incidencia de carcinoma epidermoide, o en personas de riesgo aumentado (fundamentalmente alcohólicos y fumadores), ha permitido un reconocimento de las lesiones iniciales, su diagnóstico temprano y un tratamiento potencialmente curativo, lo cual ha incrementado de forma sustancial la esperanza de vida en este grupo de pacientes. Tales resultados deben motivar la evaluación y eventual instauración de programas para lograr el diagnóstico temprano y, por tanto, una mayor supervivencia de los pacientes afectados de carcinoma epidermoide esofágico en Occidente
Together with adenocarcinoma, epidermoid esophageal carcinoma is the most clinically important neoplasm of the esophagus. Because of the low incidence of epidermoid esophageal carcinoma in the general population, strategies for its early diagnosis are not a priority compared with other neoplasms. However, because survival is low when the disease is diagnosed in symptomatic patients (less than 20% at 5 years), methods for its early diagnosis should be investigated. The use of cytology or Lugol chromoendoscopy in countries with a high incidence of epidermoid carcinoma or in individuals at increased risk (mainly alcoholics and smokers) has allowed early diagnosis and potentially curative treatment, substantially increasing life expectancy in this group of patients. These results should stimulate the evaluation and eventual implementation of programs to achieve early diagnosis and therefore greater survival in patients with epidermoid esophageal carcinoma in Western countries
