RESUMO
OBJECTIVES: A kidney transplant recipient with recurrent pleuritis underwent an open lung biopsy, the results of which revealed multiple nodular infiltrates. Grocott and periodic acid-Schiff staining were positive. Fungal and Tropheryma whipplei PCR were, however, negative. Further identification was needed. METHODS: Formalin-fixed, paraffin-embedded (FFPE) extraction was performed using an FFPE extraction kit. T. whipplei was searched for using a real-time PCR targeting the noncoding repeat specific for T. whipplei. Identification of the bacteria in the extract was done using 16S rDNA and 23S rDNA sequencing and BLAST analysis. Internal transcribed spacer PCR was used for fungal DNA identification. RESULTS: The FFPE extract was negative for fungi and T. whipplei. 16S rDNA sequence analysis of a 1375 bp fragment gave T. whipplei as the best match with 26 mismatches, resulting in only 98% agreement. Sequence analysis of the 23S rDNA gene again gave T. whipplei as the best match, but with only 91% agreement. A pan-Tropheryma 16S rDNA real-time PCR was developed, and both the biopsy sample and a respiratory sample of the patient were strongly positive. The patient received antimicrobial treatment targeting T. whipplei with good clinical outcome. CONCLUSIONS: 16S and 23S rDNA sequencing gave T. whipplei as the best hit, although with limited agreement. These findings suggest that a novel Tropheryma species that lacks the noncoding repeat, most frequently used for molecular detection of Whipple disease, might be the cause of the pulmonary disease. Adaptation of current PCR protocols is warranted in order to detect all Tropheryma species.
Assuntos
Infecções por Actinomycetales/diagnóstico , Infecções por Actinomycetales/etiologia , Transplante de Rim/efeitos adversos , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/etiologia , Transplantados , Tropheryma/classificação , Biópsia , Humanos , Tipagem Molecular , RNA Ribossômico 16S/genética , RNA Ribossômico 23S/genética , Reação em Cadeia da Polimerase em Tempo Real , Análise de Sequência de DNA , Tropheryma/genética , Tropheryma/isolamento & purificaçãoAssuntos
Neoplasias Duodenais , Duodenoscopia/métodos , Duodeno/patologia , Paraganglioma , Idoso , Neoplasias Duodenais/complicações , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/cirurgia , Dispepsia/etiologia , Feminino , Humanos , Imuno-Histoquímica , Paraganglioma/complicações , Paraganglioma/diagnóstico , Paraganglioma/cirurgia , Robótica/métodos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Multiple myeloma (MM) is a B-cell malignancy, which often remains incurable because of the development of drug resistance governed by the bone marrow (BM) microenvironment. Novel treatment strategies are therefore urgently needed. In this study, we evaluated the anti-MM activity of JNJ-26481585, a novel 'second-generation' pyrimidyl-hydroxamic acid-based histone deacetylase inhibitor, using the syngeneic murine 5TMM model of MM. In vitro, JNJ-26481585 induced caspase cascade activation and upregulation of p21, resulting in apoptosis and cell cycle arrest in the myeloma cells at low nanomolar concentrations. Similar results could be observed in BM endothelial cells using higher concentrations, indicating the selectivity of JNJ-26481585 toward cancer cells. In a prophylactic and therapeutic setting, treatment with JNJ-26481585 resulted in an almost complete reduction of the tumor load and a significant decrease in angiogenesis. 5T2MM-bearing mice also developed a MM-related bone disease, characterized by increased osteoclast number, development of osteolytic lesions and a reduction in cancellous bone. Treatment of these mice with JNJ-264815 significantly reduced the development of bone disease. These data suggest that JNJ-26481585 has a potent anti-MM activity that can overcome the stimulatory effect of the BM microenvironment in vivo making this drug a promising new anti-MM agent.
Assuntos
Modelos Animais de Doenças , Inibidores de Histona Desacetilases , Ácidos Hidroxâmicos/farmacologia , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/patologia , Animais , Apoptose/efeitos dos fármacos , Western Blotting , Doenças Ósseas/tratamento farmacológico , Doenças Ósseas/etiologia , Medula Óssea/efeitos dos fármacos , Medula Óssea/patologia , Ciclo Celular/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL , Mieloma Múltiplo/irrigação sanguínea , Neovascularização Patológica/prevenção & controle , Osteólise/tratamento farmacológico , Osteólise/etiologiaRESUMO
Aplidin is an antitumour drug, currently undergoing phase II evaluation in different haematological and solid tumours. In this study, we analysed the antimyeloma effects of Aplidin in the syngeneic 5T33MM model, which is representable for the human disease. In vitro, Aplidin inhibited 5T33MMvv DNA synthesis with an IC(50) of 3.87 nM. On cell-cycle progression, the drug induced an arrest in transition from G0/G1 to S phase, while Western blot showed a decreased cyclin D1 and CDK4 expression. Furthermore, Aplidin induced apoptosis by lowering the mitochondrial membrane potential, by inducing cytochrome c release and by activating caspase-9 and caspase-3. For the in vivo experiment, 5T33MM-injected C57Bl/KaLwRij mice were intraperitoneally treated with vehicle or Aplidin (90 microg kg(-1) daily). Chronic treatment with Aplidin was well tolerated and reduced serum paraprotein concentration by 42% (P<0.001), while BM invasion with myeloma cells was decreased by 35% (P<0.001). Aplidin also reduced the myeloma-associated angiogenesis to basal values. This antiangiogenic effect was confirmed in vitro and explained by inhibition of endothelial cell proliferation and vessel formation. These data indicate that Aplidin is well tolerated in vivo and its antitumour and antiangiogenic effects support the use of the drug in multiple myeloma.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Antineoplásicos/uso terapêutico , Depsipeptídeos/uso terapêutico , Modelos Animais de Doenças , Mieloma Múltiplo/tratamento farmacológico , Inibidores da Angiogênese/farmacologia , Animais , Antineoplásicos/farmacologia , Western Blotting , Ciclo Celular , Replicação do DNA/efeitos dos fármacos , Depsipeptídeos/farmacologia , Camundongos , Camundongos Endogâmicos C57BL , Mieloma Múltiplo/patologia , Peptídeos Cíclicos , RatosRESUMO
A 66-year-old female patient was treated for a posterior mediastinal tumour with unknown histology. During thoracotomy, repetitive hypertensive crises had to be treated. The tumour was completely resected. Pathology revealed an extra-adrenal pheochromocytoma. Diagnosis of pheochromocytoma is usually made on the basis of clinical presentation and elevated catecholamine levels in serum or urine. Imaging is used primarily for localizing tumours prior to surgery. Complete surgical excision is the primary treatment. The only absolute indicator of malignancy is the identification of distant metastases to bone, liver, lung or lymph nodes.
Assuntos
Neoplasias das Glândulas Suprarrenais/patologia , Mediastino , Feocromocitoma/patologia , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The present study describes portal vein thrombosis (PVT) in two women as the first and single presenting symptom of latent or masked myeloproliferative disease (MPD). Essential thrombocythemia (ET) was suspected by a sustained increase in platelet count (>400 x 10(9)/l) and slight splenomegaly on echogram. ET could be diagnosed by the presence of large platelet in peripheral blood smear, an increase in clustered large megakaryocytes in bone marrow smear and the presence of the JAK2(V617F) mutation. A subsequent biopsy specimen was consistent with the diagnosis of true ET. In patients with a first episode of splanchnic vein thrombosis (SVT), analysis of any venous thrombophilic risk factors as well as a JAK2(V617F) mutation status indicative for MPD is warranted. Administration of heparin followed by oral anticoagulation with vitamin K antagonists is the treatment of choice in patients with SVT. Anticoagulation therapy combined with low-dose aspirin and proper treatment of the MPD is recommended in patients with SVT associated with the JAK2(V617F) mutation.
Assuntos
Síndrome de Budd-Chiari/etiologia , Janus Quinase 2/genética , Trombocitemia Essencial/complicações , Trombocitemia Essencial/genética , Adulto , Síndrome de Budd-Chiari/genética , Feminino , Predisposição Genética para Doença , Humanos , Veias Mesentéricas/patologia , Polimorfismo de Nucleotídeo Único/genética , Veia Porta/patologia , Veia Esplênica/patologia , Trombocitemia Essencial/diagnósticoRESUMO
We report the case of a 78-year-old man who presented with acute myeloid leukaemia showing subpopulations of cells expressing platelet-associated markers and the presence of a pan-myeloid component, besides glycophorin A-positive cells. Most of the immature cells had a proerythroblast-like morphology and we classified this case as an FAB-M6 variant, as suggested by Bain (1). According to the WHO classification, this leukaemia fulfilled the criteria of'AML with multilineage dysplasia' (2). Immunophenotyping characteristics showed two distinct aberrant subpopulations, a young pan-myeloid (CD45+ with low density, CD34+, CD117+, CD13+, CD33+, partial cytoplasmic myeloperoxidase (MPO)+) population with platelet-associated markers (CD41+, CD42+, CD61+) and a CD45+, CD117+, CD34- population with partial CD235a positivity indicative for erythroid maturation. This case belongs to the group of 'early' erythroblastic leukaemias where a subset of progenitor cells present with erythroid-megakaryocyte bipotentiality or are blocked at an early BFU-E (burst-forming unit erythrocyte)-like stage of erythroid differentiation (11, 12, 13).
Assuntos
Células da Medula Óssea/patologia , Leucemia Eritroblástica Aguda/diagnóstico , Leucemia Megacarioblástica Aguda/diagnóstico , Idoso , Biópsia por Agulha , Diagnóstico Diferencial , Evolução Fatal , Humanos , Imunofenotipagem , Leucemia Eritroblástica Aguda/complicações , Leucemia Eritroblástica Aguda/imunologia , Leucemia Megacarioblástica Aguda/complicações , Leucemia Megacarioblástica Aguda/imunologia , MasculinoRESUMO
The clinical criteria for the diagnosis of essential thrombocythemia (ET) according to the polycythemia vera study group (PVSG) do not distinguish between ET and thrombocythemia associated with early stage PV and prefibrotic chronic idiopathic myelofibrosis (CIMF). The clinical criteria of the PVSG for the diagnosis of polycythemia vera (PV) only detects advanced stage of PV with increased red cell mass. The bone marrow criteria of the World Health Organization (WHO) are defined by pathologists to explicitly define the pathological criteria for the diagnostic differentiation of ET, PV, and prefibrotic and fibrotic CIMF. As the clinical PVSG and the pathological WHO criteria show significant shortcomings, an updated set of European Clinical and Pathological (ECP) criteria combined with currently available biological and molecular markers are proposed to much better distinct true ET from early PV mimicking ET, to distinguish ET from thrombocythemia associated with prefibrotic CIMF, and to define the various clinical and pathological stages of PV and CIMF that has important therapeutic and prognostic implications. Comparing the finding of clustered giant abnormal megakaryocytes in a representative bone marrow as a diagnostic clue to MPD, the sensitivity for the diagnosis of MPD associated with splanchnic vein thrombosis was 63% for increased red cell mass, 52% for low serum EPO level, 72% for EEC, and 74% for splenomegaly indicating the superiority of bone marrow histopathology to detect masked early and overt MPD in this setting. The majority of PV and about half of the ET patients have spontaneous EEC, low serum EPO levels and PRV-1 over-expression and are JAK2 V617F positive. The positive predictive value for the diagnosis of PV of spontaneous growth of endogenous erythroid colonies (EEC) of peripheral blood (PB) and bone marrow (BM) cells is about 80-85% when either PB or BM EEC assays, and up to 94% when BM and PB EEC assays were performed. The diagnostic impact of low serum EPO levels (ELISA assay) in a large study of 186 patients below the normal range (<3.3 IU/l) had a sensitivity specificity and positive predictive value of 87%, 97% and 97.8%, respectively, for the diagnosis of PV. There is a significant overlap of serum EPO levels in PV versus control and controls versus SE. The specificity of a JAK2 V617F PCR test for the diagnosis of MPD is high (near 100%), but only half of ET and MF (50%) and the majority of PV (up to 97%) are JAK2 V617F positive. The use of biological markers including JAK2 V617 PCR test, serum EPO, PRV-1, EEC, leukocyte alkaline phosphatase score and peripheral blood parameters combined with bone marrow histopathology has a high sensitivity and specificity (almost 100%) to diagnose the early and overt stages of ET, PV and CIMF in JAK2 V617F positive and negative MPDs.
Assuntos
Policitemia Vera/diagnóstico , Mielofibrose Primária/diagnóstico , Trombocitemia Essencial/diagnóstico , Substituição de Aminoácidos , Biomarcadores , Contagem de Células Sanguíneas , Medula Óssea/patologia , Linhagem da Célula , Ensaio de Unidades Formadoras de Colônias , Progressão da Doença , Ensaio de Imunoadsorção Enzimática , Volume de Eritrócitos , Células Precursoras Eritroides/patologia , Eritropoetina/sangue , Proteínas Ligadas por GPI , Humanos , Isoantígenos/sangue , Janus Quinase 2/genética , Glicoproteínas de Membrana/sangue , Mutação de Sentido Incorreto , Mutação Puntual , Policitemia Vera/sangue , Policitemia Vera/genética , Policitemia Vera/patologia , Reação em Cadeia da Polimerase , Valor Preditivo dos Testes , Mielofibrose Primária/sangue , Mielofibrose Primária/genética , Mielofibrose Primária/patologia , Receptores de Superfície Celular/sangue , Sensibilidade e Especificidade , Trombocitemia Essencial/sangue , Trombocitemia Essencial/genética , Trombocitemia Essencial/patologia , Organização Mundial da SaúdeRESUMO
Thalidomide and the analogues lenalidomide (CC-5013, Revlimid) and CC-4047 (Actimid) belong to the family of immunomodulatory drugs (IMiDs). These agents have anti-angiogenic properties, modulate TNFalpha and IL-12 secretion, co-stimulate T cells, increase NK cell toxicity and have direct anti-tumour effects. These characteristics have made of them promising drugs for treatment of relapsed, refractory and newly diagnosed MM. It seems that lenalidomide and CC-4047 are more powerful in inhibiting TNFalpha and have, except for myelosuppression, less side effects than Thal. Combination of IMiDs with dexamethasone, bortezomib and with chemotherapeutic agents are tested in numerous trials, which will help in determining the optimal combination and administration schedule of different molecules to take advantage of non-overlapping toxicities and synergisms between those agents.
Assuntos
Antineoplásicos/administração & dosagem , Citocinas/imunologia , Fatores Imunológicos/administração & dosagem , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/imunologia , Talidomida/análogos & derivados , Talidomida/administração & dosagem , Animais , Apoptose/efeitos dos fármacos , Humanos , Resultado do TratamentoRESUMO
The cell surface expression of CD9, a glycoprotein of the tetraspanin family influencing several processes including cell motility and metastasis, inversely correlates with progression in several solid tumors. In the present work, we studied the expression and role of CD9 in multiple myeloma (MM) biology using the 5T33MM mouse model. The 5T33MMvitro cells were found to be CD9 negative. Injection of these cells in mice caused upregulation of CD9 expression, while reculturing them resulted in downregulation of CD9. Coculturing of CD9-negative 5T33MMvitro cells with BM endothelial cells (BMECs) resulted in a partial retrieval of CD9. Laser microdissection followed by real-time polymerase chain reaction and immunohistochemistry performed on bone sections of 5T33MMvivo diseased mice demonstrated strong local expression of CD9 on MM cells in contact with BMEC compared to MM cells further away. These findings were also confirmed by immunohistochemistry in MM patients. Neutralizing anti-CD9 antibodies inhibited transendothelial invasion of CD9-expressing human MM5.1 and murine 5T33MMvivo cells. In conclusion, we provide evidence that CD9 expression by the MM cells is upregulated in vivo by close interaction of the cells with BMEC and that CD9 is involved in transendothelial invasion, thus possibly mediating homing and/or spreading of the MM cells.
Assuntos
Antígenos CD/metabolismo , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Glicoproteínas de Membrana/metabolismo , Mieloma Múltiplo/metabolismo , Mieloma Múltiplo/patologia , Animais , Antígenos CD/genética , Biópsia , Células da Medula Óssea/metabolismo , Células da Medula Óssea/patologia , Comunicação Celular , Linhagem Celular Tumoral , Modelos Animais de Doenças , Citometria de Fluxo , Regulação Neoplásica da Expressão Gênica , Humanos , Imuno-Histoquímica , Glicoproteínas de Membrana/genética , Camundongos , Camundongos Endogâmicos C57BL , Mieloma Múltiplo/fisiopatologia , Invasividade Neoplásica , Tetraspanina 29 , Regulação para CimaRESUMO
Although the diagnosis of fat embolism syndrome is usually based on clinical findings, we describe ill-defined centrilobular and subpleural nodules in addition to ground-glass opacities and consolidation on a computed tomography scan of the chest in a trauma patient with fat embolism syndrome. The nodules presumably represent alveolar oedema, microhaemorrhage and an inflammatory response secondary to ischaemia and cytotoxic emboli in fat embolism syndrome. The literature of computed tomography findings in patients with fat embolism syndrome is reviewed and summarized.
Assuntos
Embolia Gordurosa/diagnóstico , Traumatismo Múltiplo/complicações , Embolia Pulmonar/diagnóstico , Acidentes de Trânsito , Adolescente , Terapia Combinada , Cuidados Críticos/métodos , Embolia Gordurosa/etiologia , Embolia Gordurosa/terapia , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Escala de Coma de Glasgow , Humanos , Escala de Gravidade do Ferimento , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/cirurgia , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Radiografia Torácica , Medição de Risco , Índice de Gravidade de Doença , Síndrome , Tomografia Computadorizada por Raios XRESUMO
Multiple myeloma (MM) is a malignant disease that results from an excess of monotypic plasma cells in the bone marrow (BM). This malignancy is characterised by complex karyotypic aberrancies. In 60% of all MM there are recurrent primary translocations involving the heavy chain gene locus. The MM cells strongly interact with the BM microenvironment, which is composed of endothelial cells, stromal cells, osteoclasts, osteoblasts, immune cells, fat cells and the extracellular matrix. This interaction is responsible for the specific homing in the BM, the proliferation and survival of the MM cells, the resistance of MM cells to chemotherapy, the development of osteolysis, immunodeficiency and anaemia. New therapeutic agents target both the MM, as well as the interaction MM cell - BM microenviroment.
Assuntos
Células da Medula Óssea/fisiologia , Mieloma Múltiplo/metabolismo , Mieloma Múltiplo/patologia , Animais , Humanos , Mieloma Múltiplo/epidemiologia , Mieloma Múltiplo/fisiopatologiaRESUMO
Sweet's syndrome is an uncommon acute skin disease, associated with a variety of medical problems. The drug-induced variant is even rarer. We describe two cases of this syndrome associated with the administration of the proteasome inhibitor bortezomib. The diagnostic criteria for drug-induced Sweet's syndrome as proposed by Walker and Cohen were fulfilled. Vasculitis and neutrophilic eccrine hidradenitis were excluded.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ácidos Borônicos/efeitos adversos , Inibidores de Proteases/efeitos adversos , Pirazinas/efeitos adversos , Síndrome de Sweet/induzido quimicamente , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ácidos Borônicos/administração & dosagem , Bortezomib , Esquema de Medicação , Disfunção Erétil/induzido quimicamente , Humanos , Imunossupressores/uso terapêutico , Masculino , Melfalan/administração & dosagem , Metilprednisolona/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Dor/induzido quimicamente , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Prednisolona/administração & dosagem , Inibidores de Proteases/administração & dosagem , Pirazinas/administração & dosagem , Recidiva , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/tratamento farmacológico , Síndrome de Sweet/patologia , Doenças Testiculares/induzido quimicamenteRESUMO
Collagen vascular diseases and malignancies have common systemic and immune features. We report a case of a 21 year old female patient with constitutional symptoms, polyserositis, spontaneous rupture of the spleen, leukocytoclastic vasculitis and acute renal failure. The tentative diagnosis of SLE was made because she developed a positive antinuclear factor (1/640), with anti-SSA antibodies and a positive lupus anticoagulans. Two months later a cervical lymphadenopathy occurred while recieving treatment with prednisolone. A lymph node biopsy revealed morphologic features of a SLE, similar to those observed in multicentric Castleman's disease (MCD). MCD is a distinct type of a lymphoproliferative disorder of unknown etiology. The difficulties in differential diagnosis of these two diseases are discussed.
Assuntos
Hiperplasia do Linfonodo Gigante/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Adulto , Biópsia , Hiperplasia do Linfonodo Gigante/complicações , Hiperplasia do Linfonodo Gigante/patologia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/patologia , Linfonodos/patologia , Serosite/etiologiaRESUMO
The aim of the study was to compare the angiogenic status, potential qualitative differences in microvessels and carbonic anhydrase IX expression in bone-marrow (BM) metastases and different haematological tumours at time of diagnosis. The microvessel density (MVD), endothelial-cell proliferation (ECP) and carbonic anhydrase IX (CA IX) immunoreactivity were determined on 210 trephine biopsies from 57 patients with multiple myeloma (MM), 13 with acute myeloid leukaemia (AML), 48 with chronic myeloproliferative syndrome (CMPS), 26 with chronic lymphocytic leukaemia (CLL), 25 with epithelial BM metastases, 18 with monoclonal gammopathy of undetermined significance (MGUS) and from a control group composed of 23 patients without haematological neoplasm. There was an increased MVD and ECP in epithelial BM metastases, MM, AML, CMPS and in a part of CLL. While an ECP greater than 0 was detected in 72% of MM, 75% of CMPS and 92% of AML, it was invariably observed (100%) in the BM metastases. The absence of ECP together with a MVD comparable with the control group in our MGUS cases supports the view that MGUS is a pre-angiogenic condition. Qualitative differences in microvessels were associated with growth patterns in MM and CLL and were observed between the different entities of CMPS. In one-third of the epithelial BM metastases, there was a focal CA IX immunoreactivity, which was never observed in the haematological diseases.
Assuntos
Antígenos de Neoplasias/metabolismo , Neoplasias da Medula Óssea/secundário , Anidrases Carbônicas/metabolismo , Endotélio Vascular/patologia , Neoplasias Hematológicas/patologia , Neovascularização Patológica/patologia , Paraproteinemias/patologia , Biomarcadores Tumorais/metabolismo , Biópsia , Neoplasias da Medula Óssea/enzimologia , Capilares/patologia , Capilares/fisiopatologia , Anidrase Carbônica IX , Divisão Celular , Neoplasias Hematológicas/enzimologia , Humanos , Imuno-Histoquímica , Microcirculação , Paraproteinemias/enzimologiaRESUMO
Increased microvessel density (MVD) has been observed in the bone marrow (BM) of patients with multiple myeloma (MM), acute lymphoblastic leukaemia, acute myeloid leukaemia, and myelodysplastic and myeloproliferative syndrome. The MVD is the net result of cumulative phases of angiogenesis and angio-regression and is as such not an indicator of the ongoing angiogenesis at the time of biopsy. There is, therefore, a need for additional methods that allow the estimation of ongoing angiogenesis. Double immunostainings for CD34 and Ki-67 can be used on paraffin-embedded tissue to determine the endothelial proliferation fraction. The BM endothelial cells, as a component of the BM stroma, have a close interaction with the malignant cells. In MM, for example, they are involved in the specific homing and are a source of paracrine growth factors. Targeting the BM microvessels will not only influence the nutrient and oxygen supply, but will in addition reduce the growth stimuli provided by the EC.
Assuntos
Medula Óssea/fisiopatologia , Endotélio Vascular/patologia , Neoplasias Hematológicas/patologia , Neoplasias Hematológicas/fisiopatologia , Transtornos Mieloproliferativos/patologia , Neovascularização Patológica , Inibidores da Angiogênese/uso terapêutico , Animais , Antígenos CD34/análise , Medula Óssea/irrigação sanguínea , Medula Óssea/imunologia , Medula Óssea/patologia , Divisão Celular , Hipóxia Celular , Humanos , Imuno-Histoquímica , Antígeno Ki-67/análise , Microcirculação , Mieloma Múltiplo/irrigação sanguínea , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/patologia , Mieloma Múltiplo/fisiopatologiaRESUMO
Small cell carcinoma of the ovary is a rare type of ovarian carcinoma with a poor prognosis. Two types should be distinguished: the hypercalcemic type and the pulmonary type. We report the case history of a 54-year-old woman with both a Stage IIIC small cell carcinoma, pulmonary type and a well-differentiated endometrioid adenocarcinoma of the left ovary in combination with a Brenner tumor in the right ovary. A review of the literature on small cell carcinoma of the ovary is given and the findings of our patient are brought into perspective in terms of both histopathogenesis and treatment outcome.
Assuntos
Tumor de Brenner/diagnóstico , Carcinoma Endometrioide/diagnóstico , Carcinoma de Células Pequenas/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Ovarianas/diagnóstico , Tumor de Brenner/patologia , Tumor de Brenner/terapia , Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/terapia , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Pequenas/terapia , Terapia Combinada , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/terapia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapiaRESUMO
Vertebral bone biopsy is an accurate, rapid, and cost-effective method to diagnose benign and malignant spine lesions. The major complications are uncommon. Nondiagnostic or insufficient specimens are encountered in less than ten per cent. The accuracy of the biopsy depends on the location and type of the lesion, needle system, and biopsy route. The major indications are focal lesions with non-specific medical imaging findings, to exclude metastasis in patients with known primary malignancy, lesion without response to treatment, no clinical improvement in children with diskitis after six weeks of therapy to exclude occult tumor and extreme pain due to vertebral collapse. If histology yields only peripheral blood elements in an obviously destructive mass, biopsy can be repeated, by directing at a slightly different area of the lesion. No more than three percutaneous biopsies of the same lesion should be performed.