RESUMO
BACKGROUND: Among Western populations, the declining incidence of Helicobacter pylori infection coincides with a growing clinical impact of autoimmune gastritis. AIMS: To describe the histological phenotype of autoimmune gastritis, also to test the prognostic impact of OLGA staging in the autoimmune setting. METHODS: A single-institutional series (spanning the years 2003-2011) of 562 consecutive patients (M:F ratio: 1:3.7; mean age = 57.6 ± 14.4 years) with serologically confirmed autoimmune gastritis underwent histology review and OLGA staging. RESULTS: Helicobacter pylori infection was ascertained histologically in 44/562 cases (7.8%). Forty six biopsy sets (8.2%) featured OLGA stages III-IV; they included all four cases of incidental epithelial neoplasia (three intraepithelial and one invasive; three of these four cases had concomitant H. pylori infection). There were 230 (40.9%) and 139 (24.7%) cases, respectively, of linear and micro-nodular enterochromaffin-like cell hyperplasia; 19 (3.4%) type I carcinoids were detected. The series included 116 patients who underwent repeated endoscopy/biopsy sampling (mean time elapsing between the two procedures = 54 months; range 24-108). Paired histology showed a significant (P = 0.009) trend towards a stage progression [the stage increased in 25/116 cases (22%); it remained unchanged in 87/116 cases (75%)]. CONCLUSIONS: In autoimmune gastritis, the cancer risk is restricted to high-risk gastritis stages (III-IV), and is associated mainly with concomitant H. pylori infection. OLGA staging consistently depicts the time-dependent organic progression of the autoimmune disease and provides key information for secondary gastric cancer prevention strategies.
Assuntos
Doenças Autoimunes/patologia , Gastrite/patologia , Helicobacter pylori/isolamento & purificação , Adulto , Idoso , Doenças Autoimunes/microbiologia , Biópsia , Tumor Carcinoide/patologia , Progressão da Doença , Endoscopia Gastrointestinal/métodos , Feminino , Gastrite/microbiologia , Infecções por Helicobacter/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Lesões Pré-Cancerosas/patologia , Fatores de Risco , Índice de Gravidade de Doença , Neoplasias Gástricas/imunologia , Neoplasias Gástricas/patologiaRESUMO
Os autores apresentam 3 casos da sindrome de urticaria cronica com vasculite necrosante (SUC), que ainda nao foi descrita no Brasil.Essa sindrome se caracteriza por surtos recorrentes de urticaria artralgia e ocasionalmente artrite, dor abdominal e glomerulonefite apresentando particularidades clinicas e laboratoriais que permitem individualiza-la como entidade distinta dentro do grupo das doencas difusas do tecido conjuntivo. Sao apresentados resultados de sinovianalise, bem como 2 nao descritos na SUC: alopecia generalizada e orquite. Tambem e documentado o segundo caso de SUC com biopsia de sinovia e sao discutidos dados de evolucao clinica, diagnostico diferencial e tratamento