[Quality of the exo-endocervical sampling in the prevention of uterine cervix cancer]. / Calidad de la toma exo-endocervical en la prevención del cáncer de cuello uterino.

Cervical and vaginal cytology, Papanicolaou test (PAP), is the most effective test for screening of preneoplastic lesions, and cervical cancer prevention. Its sensitivity goes from 50 to 98%, according to different statistics, and this variation is related to the sampling procedure. A satisfactory smear should be taken from the transformation zone, the junction between endocervix and exocervix. According to Bethesda, metaplastic and/or endocervical cells should be observed under the microscope. The traditional PAP smear includes an exo-endocervical sampling using the Ayre spatula; however, only near 50% of the smears are representative of the transformation zone. In this case report, we present the case of a 40-year-old woman who had negative cytology in five consecutive annual PAP smears, none of which showed metaplastic or endocervical cells. A new sample evidenced a carcinoma in situ (HSIL: high-grade squamous intraepithelial lesion). We emphasize the importance of performing a correct exo-endocervical sampling to allow prompt detection of all premalignant lesions and to prevent cervical cancer, which still persists with high mortality worldwide.

[Value of sputum analysis in the management of inflammatory airway diseases]. / Valor del estudio celular del esputo en el seguimiento de las enfermedades inflamatorias de la vía aérea.

Cellular analysis of sputum either spontaneous or by induced sputum technique, has become a widespread tool for the evaluation and guidance of treatment of inflammatory diseases of the airway, primarily asthma, COPD and eosinophilic bronchitis. Induced sputum method is a validated, standardized and non-invasive technique, useful in patients with difficulties to expectorate. Its implementation is simple and cost effective. Numerous investigations have shown the effectiveness of basing treatment decisions on the inflammatory component of the airway by counting cells in sputum. Several studies have demonstrated that in patients with asthma, results of this analysis can guide in defining strategies to reduce exacerbations and to improve lung function even in patients with severe asthma, as well as to decrease the remodeling; in addition, a reduction in exacerbations in COpD patients, monitored by this sputum examination, has also been described.

von Hansemann Cells from Fresh Urine Sediment Samples in the Diagnosis of Malakoplakia.

BACKGROUND: Malakoplakia is characterized by the presence of plaques with macrophages containing inclusion bodies. The diagnosis of this disease is carried out by biopsy of the lesion. The objective of this paper was to assess the value of fresh urine sediment in the diagnosis of malakoplakia. MATERIALS AND METHODS: Five suspected cases of malakoplakia that showed macrophages with inclusions called bodies of Michaelis-Gutmann (von Hansemann cells) in unstained urine sediment were processed with Papanicolaou, Giemsa, and periodic acid-Schiff (PAS) stains. Four of the five patients had a history of cystitis and had developed antibiotic resistance. The other patient had the characteristics cells in a routine urinalysis. RESULTS: Papanicolaou stain revealed intracytoplasmic eosinophilic or basophilic bodies, single or multiple in macrophages. Such bodies were stained deep red with PAS technique. Giemsa stain showed these bodies with a faint basophilic coloration, sometimes with a central core. Bladder biopsies established the definitive diagnosis, showing bodies within and outside macrophages, with a concentric "birds-eye" or "owl-eye" (targetoid) appearance. CONCLUSIONS: Finding of von Hansemann cells in fresh urine sediment of patients with cystitis and a history of resistance to antibiotic scan leads to the diagnosis of malakoplakia. Giemsa stain can show in some cases the characteristic central core of Michaelis-Gutmann bodies. Malakoplakia is probably the result of an acquired defect in macrophage function causing impairment of bactericidal activity. A correct diagnosis is important because the spread to ureters with bilateral stenosis and obstruction can lead to kidney failure.

Use of Sialic Acid as a Complementary Method in the Cytological Diagnosis: Preliminary Study.

INTRODUCTION: Cellular morphology does not allow, in many cases, to safely establish a diagnosis of malignancy or benignity. Sialic acid is found in the membranes of well-differentiated mature cells, normally located in the alpha-2,3 position. During tumor progression, changes occur in glycosylation of proteins and lipids, including alterations in the sialylation patterns of tumor cells. OBJECTIVE: To confirm the overexpression of alpha-2,6 sialinization in exfoliated cells of body fluids and bronchoalveolar lavage (BAL) as a malignant indicator mechanism, using glycan-binding lectins. MATERIALS AND METHODS: Thirty samples (20 effusion liquids and 10 BAL) diagnosed by Giemsa and Papanicolaou staining as negative and positive for malignancy, were studied. They were then stained with fluorescein-labeled Sambucus nigra lectin (Sigma Chemicals, USA), which specifically recognizes sialic acid in alpha-2,6 position. The fluorescence obtained at 515 nm evidenced the presence of sialic acid in the 2,6 position. RESULTS: Negative body fluids for malignancy showed a fine and homogeneous fluorescence pattern for reactive mesothelial cells. Neoplastic cells revealed a thick, heterogeneous pattern. In BAL, benign hyperplastic cells showed a homogeneous fine pattern while neoplastic cells showed a thick and heterogeneous fluorescence pattern. The pattern described was observed in all cases in the cell membrane. CONCLUSION: It was observed that the change in sialic acid conformation detected through Sambucus nigra Lectin could be used as a complementary method for the diagnosis of malignancy in different cytological samples.

Calidad de la toma exo-endocervical en la prevención del cáncer de cuello uterino / Quality of the exo-endocervical sampling in the prevention of uterine cervix cancer

La citología cérvico-vaginal, test de Papanicolaou (PAP), es la técnica diagnóstica de cribado más efectiva para la detección de lesiones precancerosas y la prevención del cáncer de cuello uterino. La sensibilidad de la prueba varía en las diferentes estadísticas entre el 50% y el 98%; la causa de esta amplitud depende de la toma de muestra. Para que la toma se considere satisfactoria es necesario que se realice de la zona escamocolumnar, zona de transformación, y según el sistema Bethesda en el extendido se deben observar células metaplásicas y/o endocervicales. El PAP convencional incluye la toma exo-endocervical con espátula de Ayre; sin embargo, solo el 50% aproximadamente de las muestras son representativas de la zona de transformación. Para ejemplificar esta situación se presenta el caso de una mujer de 40 años que, a pesar de tener citologías negativas durante cinco años, ninguna con células endocervicales o metaplásicas, una toma adecuada mostró un carcinoma in situ (HSIL: lesión intraepitelial escamosa de alto grado). Recalcamos la importancia de la correcta toma exo-endocervical para poder detectar todas las lesiones premalignas y prevenir este tipo de cáncer que aún tiene alta tasa de mortalidad en todo el mundo.

Cervical and vaginal cytology, Papanicolaou test (PAP), is the most effective test for screening of preneoplastic lesions, and cervical cancer prevention. Its sensitivity goes from 50 to 98%, according to different statistics, and this variation is related to the sampling procedure. A satisfactory smear should be taken from the transformation zone, the junction between endocervix and exocervix. According to Bethesda, metaplastic and/or endocervical cells should be observed under the microscope. The traditional PAP smear includes an exo-endocervical sampling using the Ayre spatula; however, only near 50% of the smears are representative of the transformation zone. In this case report, we present the case of a 40-year-old woman who had negative cytology in five consecutive annual PAP smears, none of which showed metaplastic or endocervical cells. A new sample evidenced a carcinoma in situ (HSIL: high-grade squamous intraepithelial lesion). We emphasize the importance of performing a correct exo-endocervical sampling to allow prompt detection of all premalignant lesions and to prevent cervical cancer, which still persists with high mortality worldwide.

Valor del estudio celular del esputo en el seguimiento de las enfermedades inflamatorias de la vía aérea / Value of sputum analysis in the management of inflammatory airway diseases

El análisis celular del esputo, espontáneo u obtenido mediante la técnica de esputo inducido, se ha transformado en una herramienta ampliamente difundida para la evaluación y orientación del tratamiento de las enfermedades inflamatorias de la vía aérea, principalmente asma, enfermedad pulmonar obstructiva crónica y bronquitis eosinofílica. Se han aportado evidencias sobre la utilidad de la técnica del esputo inducido, validada y estandarizada, para ser empleada en pacientes con dificultades para expectorar. Numerosas investigaciones dieron cuenta de la efectividad de basar las decisiones terapéuticas en el componente inflamatorio de la vía aérea mediante el recuento de células en el esputo. Varios estudios mostraron que, en pacientes con asma el análisis celular de esputo guía en la determinación de estrategias para disminuir las exacerbaciones y para mejorar la función pulmonar, aun en pacientes con asma grave, para disminuir el remodelamiento; también se ha descrito su utilidad en pacientes con EPOC, para la disminución de las exacerbaciones.

Cellular analysis of sputum either spontaneous or by induced sputum technique, has become a widespread tool for the evaluation and guidance of treatment of inflammatory diseases of the airway, primarily asthma, COPD and eosinophilic bronchitis. Induced sputum method is a validated, standardized and non-invasive technique, useful in patients with difficulties to expectorate. Its implementation is simple and cost effective. Numerous investigations have shown the effectiveness of basing treatment decisions on the inflammatory component of the airway by counting cells in sputum. Several studies have demonstrated that in patients with asthma, results of this analysis can guide in defining strategies to reduce exacerbations and to improve lung function even in patients with severe asthma, as well as to decrease the remodeling; in addition, a reduction in exacerbations in COPD patients, monitored by this sputum examination, has also been described.

Utilidad de la técnica de AgNOR en la interpretación de los derrames de cavidades serosas / Usefulness of AgNOR assay in the assessment of serous effusions

Background: AgNOR technique detects, using silver salts, argyrophylic proteins of the nucleolar organizer region (NOR). The number and size of NOR reflect cell activity, proliferation and transformation and may help to differentiate benign from malignant cells. Aim: To assess the value of AgNOR assay to differentiate reactive mesothelial cells from malignant cells in serous effusions. Material and methods: Thirty one fluids obtained from 16 pleural, 14 peritoneal and one pericardial effusion, were studied. The fluids were processed with Giemsa and Papanicolau stains and with the AgNOR technique. The number of AgNOR dots were counted (only when it was possible to distinguish each individual dot) and the mean value per nucleus was calculated for each smear. Results: Mesothelial cells had a mean of 4,88 ñ 1,5 dots compared with 13,78 ñ 3,88 dots in the malignant cells (p<0,001). Conclusions: AgNOR assay can be useful for the differentiation of benign and malignant cells in serous effusions