RESUMO
We report a case of Hodgkin's lymphoma in a patient aged 75, presenting with acute cardiopulmonary insufficiency, hospitalized in a geriatrics ward. The deterioration of his general condition and the discovery of several lymph nodes led us to perform an aspiration of a lymph node and a bone marrow biopsy. Reed-Sternberg cells, pathognomonic of Hodgkin's disease were identified on the smears and biopsy sections. Due to the poor condition of the patient, it was decided not to treat with chemotherapy. The diagnostic approach and treatment strategy of Hodgkin's disease are summarized in this paper, especially the particular features of the disease in the elderly.
Assuntos
Doença de Hodgkin , Idoso , Doença de Hodgkin/diagnóstico , Humanos , MasculinoRESUMO
Dendritic cell neoplasms of the World Health Organization classification comprise Langerhans cell histiocytosis, Langerhans cell sarcoma, interdigitating dendritic cell sarcoma, follicular dendritic cell sarcoma, and dendritic cell sarcoma, not otherwise specified. Several studies based on immunohistochemical and ultrastructural analysis tried to further clarify the origin of these neoplasms which are thought to derive from mesenchymal or bone marrow precursors. Lymphatic vessel endothelium hyaluronan receptor-1 (LYVE-1) was recently described as a marker for lymphatic endothelium which is expressed on normal liver blood sinusoid lining cells, spleen endothelium, activated tissue macrophages, blood vessels in the lung, endothelial cells of lymphatic sinuses, and in fibroblastic reticular cells in lymph nodes. We present a case of LYVE-1-positive reticulum cell neoplasm in an axillary lymph node. To the best of our knowledge, there has been no report about LYVE-1 expression in histiocytic or dendritic cell neoplasms so far. Due to the assumed specificity of this antibody, we propose designation of this reticulum cell sarcoma as lymphatic sinus lining cell sarcoma which might finally represent another subtype of reticulum cell sarcomas.
Assuntos
Células Dendríticas Foliculares/patologia , Endotélio Linfático/patologia , Linfoma não Hodgkin/classificação , Linfoma não Hodgkin/patologia , Adulto , Idoso , Biomarcadores Tumorais/metabolismo , Células Dendríticas Foliculares/metabolismo , Endotélio Linfático/metabolismo , Feminino , Humanos , Linfonodos/metabolismo , Linfonodos/patologia , Vasos Linfáticos/metabolismo , Vasos Linfáticos/patologia , Linfoma não Hodgkin/metabolismo , Masculino , Pessoa de Meia-Idade , Proteínas de Transporte Vesicular/metabolismoRESUMO
Hematogones are bone marrow precursors of B-lymphoid cells which are morphologically difficult to distinguish from blasts and/or from small lymphocytes. We report the case of a patient presenting idiopathic myelofibrosis with minimal myeloid blastic transformation causing severe pancytopenia, treated by allograft and showing in a bone marrow biopsy, a hyperplasia of B-lymphoid cells. Histopathology and immunohistochemistry identified these cells as hyperplasia of hematogones and not a transformation into lymphoblastic acute leukaemia. The cytology of a myelogram confirmed the diagnosis.
Assuntos
Linfócitos B/patologia , Medula Óssea/patologia , Hiperplasia/patologia , Leucemia Megacarioblástica Aguda/patologia , Linfócitos/patologia , Mielofibrose Primária/patologia , Adulto , Evolução Fatal , Humanos , Masculino , Pancitopenia/patologiaAssuntos
Linfoma Cutâneo de Células T/diagnóstico , Linfoma de Células T Periférico/diagnóstico , Neoplasias Cutâneas/diagnóstico , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Técnicas Imunoenzimáticas , Imunofenotipagem , Linfoma Cutâneo de Células T/metabolismo , Linfoma Cutâneo de Células T/patologia , Linfoma de Células T Periférico/patologia , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/patologiaRESUMO
Nutritional supplementation with glutamine, arginine and their precursors has been proposed to contribute to the protection against ischemia-reperfusion-related injuries. The aim of this study was to evaluate in an isolated perfused rat liver model the preventive effect of a 4-day oral ornithine alpha-ketoglutarate (OKG) supplementation against warm ischemia-reperfusion (I-R) injury, and the involvement of nitric oxide synthesis. Rats were fed a controlled regimen supplemented with either OKG (5 g kg(-1); n=15) or an isonitrogenous mixture of non-essential amino acids (Control; n=6) for 4 days. Livers were subsequently prepared for isolated perfusion experiments, including a 45 min no-flow ischemic period. The OKG-treated group was divided into two groups according to the absence (OKG; n=8) or presence of a NO-synthase inhibitor, L-N(omega)-nitro-arginine methyl ester (OKG L-NAME; n=7) during liver perfusion. Liver cytolysis after ischemia was demonstrated by an elevated alanine aminotransferase release during the last 15 min of reperfusion that was significantly higher in the OKG-L-NAME group. Tumor necrosis factor alpha (TNF(alpha)) production was transiently increased only in the control group just after ischemia. At the end of the reperfusion period, liver superoxide dismutase activity was significantly lower in the OKG-L-NAME group compared to control animals. Dietary OKG administration had only a limited effect in this model of mild hepatic I-R, leading mainly to reduced TNF(alpha) production. As the content of lipid peroxidation products was not modified, it seems that OKG acts on the inflammatory response rather than on oxidative reactions. This action can tentatively be attributed to the role of OKG as a glutamine precursor rather than to the synthesis of arginine and nitric oxide.
Assuntos
Fígado/irrigação sanguínea , Fígado/efeitos dos fármacos , Ornitina/análogos & derivados , Traumatismo por Reperfusão/prevenção & controle , Animais , Inibidores Enzimáticos/farmacologia , Ácido Glutâmico/sangue , Técnicas In Vitro , Fígado/metabolismo , Fígado/fisiologia , Masculino , NG-Nitroarginina Metil Éster/farmacologia , Óxido Nítrico Sintase/antagonistas & inibidores , Óxido Nítrico Sintase/metabolismo , Ornitina/sangue , Ornitina/farmacologia , Estresse Oxidativo , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/sangueRESUMO
The aim of this study was to evaluate the T-cell receptor (TCR) Vbeta repertoire in the two main histological subtypes of nodal non-anaplastic peripheral T-cell lymphoma: Not Otherwise Specified (NOS) and angioimmunoblastic lymphoma (AIL). Frozen lymph node tissues of eight NOS and six AIL were analyzed. A reverse transcriptase polymerase chain reaction (RT-PCR) was carried out to assess the expression of the 24 Vbeta gene families. Our study showed a broad TCR Vbeta repertoire in AIL and NOS, with a slight increase in the number of Vbeta families in AIL (16 vs 10 on agarose gels). Nevertheless, there was a clear difference in four cases. A predominant Vbeta family was observed in two NOS, whereas no predominant Vbeta family was observed in the AIL. Two AIL showed the whole Vbeta repertoire, whereas it was never observed in NOS. This pattern may help to categorize these histopathological entities and further suggests a differential T-cell response. These results show that numerous reactive T-cells are present both in AIL and NOS. Possibly, they play a role in the growth of these lymphomas.
Assuntos
Genes Codificadores da Cadeia beta de Receptores de Linfócitos T , Linfadenopatia Imunoblástica/genética , Linfonodos/patologia , Linfoma de Células T Periférico/genética , DNA de Neoplasias/análise , Regulação Neoplásica da Expressão Gênica , Rearranjo Gênico , Genes Codificadores da Cadeia gama de Receptores de Linfócitos T/genética , Humanos , Linfadenopatia Imunoblástica/patologia , Linfoma de Células T Periférico/patologia , RNA Neoplásico/análise , Reação em Cadeia da Polimerase Via Transcriptase ReversaAssuntos
Doenças Hematológicas/etiologia , Hospedeiro Imunocomprometido , Antineoplásicos/efeitos adversos , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/imunologia , Doenças Hematológicas/patologia , Fatores de Crescimento de Células Hematopoéticas/efeitos adversos , Humanos , Linfoma não Hodgkin/etiologia , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/virologia , Transtornos Linfoproliferativos/etiologia , Transtornos Linfoproliferativos/patologia , Transtornos Linfoproliferativos/virologia , Transtornos Mieloproliferativos/etiologia , Transtornos Mieloproliferativos/patologia , Fenótipo , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Transplante Homólogo/efeitos adversosAssuntos
Anti-Inflamatórios/efeitos adversos , Colite Ulcerativa/tratamento farmacológico , Hepatite Viral Humana/induzido quimicamente , Herpes Simples/induzido quimicamente , Hospedeiro Imunocomprometido , Infecções Oportunistas/induzido quimicamente , Doença Aguda , Adulto , Colectomia , Colite Ulcerativa/cirurgia , Hepatite Viral Humana/diagnóstico , Hepatite Viral Humana/imunologia , Herpes Simples/diagnóstico , Herpes Simples/imunologia , Humanos , Imuno-Histoquímica , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , EsteroidesRESUMO
We describe the association of 2 types of small B-cell lymphomas with different morphologic and immunophenotype patterns inside the same lymph node. Morphologically distinct zones were detected and studied with immunohistochemistry analyses. Most of the areas examined were characteristic of classic mantle cell lymphoma (CD20+, CD5+, cyclin D1+) with nodular and mantle zone areas. However, other areas had the morphologic and immunohistochemistry pattern of follicular lymphoma (CD20+, CD10+, Bcl2+). The diagnosis of both lymphomas was confirmed by polymerase chain reaction detection of both Bcl-1 MTC and Bcl-2 MBR rearrangements. DNA degradation in fixed tissue prevented a complete polymerase chain reaction analysis of immunoglobulin heavy chain rearrangements, but a single immunoglobulin H rearrangement was detected at the FR3 locus. These findings confirm the presence of a monoclonal cell population but do not demonstrate the same clonal origin for both lymphoma populations.
Assuntos
Linfoma Folicular/patologia , Linfoma de Célula do Manto/patologia , Neoplasias Primárias Múltiplas/patologia , Idoso , Feminino , Rearranjo Gênico de Cadeia Pesada de Linfócito B , Humanos , Imuno-Histoquímica , Linfoma Folicular/genética , Linfoma de Célula do Manto/genética , Neoplasias Primárias Múltiplas/genética , Reação em Cadeia da PolimeraseRESUMO
We report the case of a 62-year-old patient presenting with 3 different patterns of follicular helper T-cell lymphoma. The patient initially presented with angioimmunoblastic T-cell lymphoma. A nodal relapse in the form of follicular T-cell lymphoma with a progressively transformed germinal center pattern occurred 8 years later. Two years later, this was followed by another relapse presenting as a predominantly large-cell peripheral T-cell lymphoma, unspecified. All neoplastic cells expressed CD3, CD5, and CD2, with some neoplastic cells also expressing CD7. These cells also expressed CD4, with some expressing CD10, bcl-6, CXCL13, and programmed death-1, all of which are characteristic of the normal subset of follicular T-helper cells. The immunophenotype showed a progressive increase in the proportion of cells expressing CD10, bcl-6, CXCL13, and programmed death-1 from the first to the last lymphoma. In addition, neoplastic T cells from the last biopsy sample expressed CD20.
Assuntos
Linfoma Folicular/patologia , Linfoma de Células T/patologia , Segunda Neoplasia Primária/patologia , Linfócitos T Auxiliares-Indutores/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/análise , Humanos , Imuno-Histoquímica , Imunofenotipagem , Linfoma Folicular/tratamento farmacológico , Linfoma Folicular/metabolismo , Linfoma de Células T/tratamento farmacológico , Linfoma de Células T/metabolismo , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/tratamento farmacológico , Segunda Neoplasia Primária/metabolismo , Linfócitos T Auxiliares-Indutores/metabolismoRESUMO
BACKGROUND & AIMS: Glutamine and vitamin E may prevent hepatic ischemia-reperfusion (I/R) injuries. Our aim was to investigate the effects of glutamine, either alone or combined with vitamin E, against I/R in the isolated perfused rat liver. METHODS: Four groups of 8 livers from male Sprague-Dawley rats were isolated and submitted to a 45-min no-flow ischemia and reperfusion in the presence of alanine 2 mM, alanine 2 mM plus vitamin E 150 microM, Alanyl-Glutamine (AlaGln) 2 mM, or AlaGln 2 mM plus vitamin E 150 microM. Six non-perfused livers were studied in parallel. Liver function, metabolic parameters, oxidative stress and inflammatory parameters have been studied. RESULTS: AlaGln was rapidly cleared from the perfusate (436+/-41 nmol min(-1) g(-1)) and lowered transaminase release during reperfusion (ALT: -59%), significantly so in the AlaGln+Vit E group (ALT: -65%, p<0.05). The association of glutamine with vitamin E led to lower degrees NO (-83%, p<0.05) production, better preserved hepatic glutathione content and, as with vitamin E alone, preserved hepatic vitamin A and significantly decreased malondialdehyde (-85%, p<0.05). CONCLUSION: Both glutamine, by attenuating inflammatory response, and vitamin E, via its antioxidative properties, showed complementary protective effects against I/R-induced hepatic injury. These data emphasize the potential benefit of combining glutamine and vitamin E supplementation in hepatic I/R injury.
Assuntos
Glutamina/farmacologia , Fígado/irrigação sanguínea , Estresse Oxidativo/efeitos dos fármacos , Traumatismo por Reperfusão/prevenção & controle , alfa-Tocoferol/farmacologia , Animais , Dipeptídeos , Modelos Animais de Doenças , Combinação de Medicamentos , Glutationa/análise , Glutationa/metabolismo , Fígado/efeitos dos fármacos , Fígado/lesões , Fígado/metabolismo , Masculino , Óxido Nítrico/análise , Óxido Nítrico/metabolismo , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Histopathological study of bone marrow biopsy (BMB) in chronic myelomonocytic leukemia (CMML) is often difficult and might benefit from an immunohistochemical approach. We immunostained 15 cases of CMML, focusing at two new antibodies staining for CD14 and CD16 on paraffin-embedded tissues. CD68 (KP1), CD68 (PG-M1), and CD163 were not differentially expressed between CMML and chronic myelogenous leukemia (CML). In CMML BMB, we found a significant increase in the number of CD14+ monocytes. This increase was made of dispersed cells in the interstitium, often exhibiting bilobated nuclei, and being difficult to differentiate from neutrophils. There was no expansion of CD16+ monocyte-like cells. However, we found a significant decrease in the number of granulocytes expressing CD16, MPO, and CD15 in CMML compared to CML and control BMB, probably related to dysgranulopoiesis. Indeed, BMB immunohistochemistry can be helpful in CMML by identifying both the monocyte expansion with CD14 and the dysgranulopoiesis with CD16.
Assuntos
Biomarcadores Tumorais/análise , Células da Medula Óssea/patologia , Leucemia Mielomonocítica Crônica/diagnóstico , Receptores de Lipopolissacarídeos/biossíntese , Receptores de IgG/biossíntese , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Células da Medula Óssea/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Leucemia Mielogênica Crônica BCR-ABL Positiva/metabolismo , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Leucemia Mielomonocítica Crônica/metabolismo , Leucemia Mielomonocítica Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Inclusão em ParafinaRESUMO
We report the case of a patient treated with a combination of fludarabine and cyclophosphamide after suffering from B-cell chronic lymphocytic leukemia for 10 years. Three months after treatment, the patient presented with an unusual association, not previously reported in the literature: Richter syndrome (monotypic Epstein-Barr virus- negative large B-cell lymphoma) with the proliferation of Epstein-Barr virus-positive B cells secreting a polytypic immunoglobulin A. The Epstein-Barr virus-positive lymphoproliferation can be accounted for by the type of immunosuppression induced by the treatment.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Infecções por Vírus Epstein-Barr/etiologia , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Linfoma de Células B/etiologia , Linfoma Difuso de Grandes Células B/etiologia , Síndrome de Lise Tumoral/etiologia , Ciclofosfamida/administração & dosagem , Infecções por Vírus Epstein-Barr/patologia , Infecções por Vírus Epstein-Barr/virologia , Evolução Fatal , Herpesvirus Humano 4/isolamento & purificação , Humanos , Imunoglobulina A/imunologia , Leucemia Linfocítica Crônica de Células B/patologia , Leucemia Linfocítica Crônica de Células B/virologia , Linfoma de Células B/patologia , Linfoma de Células B/virologia , Linfoma Difuso de Grandes Células B/imunologia , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária , Síndrome de Lise Tumoral/patologia , Síndrome de Lise Tumoral/virologia , Vidarabina/administração & dosagem , Vidarabina/análogos & derivadosRESUMO
OBJECTIVE: Some amino acids (AAs) display potent regulatory activities on cell metabolism, including via anti-oxidative defences. The aim of this study was to evaluate the protective effect of these AAs on warm ischaemia-reperfusion (I/R) injury in the isolated perfused rat liver. MATERIAL AND METHODS: Livers from fasted male Sprague-Dawley rats were isolated and perfused without (control group) or with (AP group) a mixture of regulatory AAs (glutamine, histidine, leucine, methionine, proline, phenylalanine, tryptophan and alanine). After 45 min of perfusion, warm ischaemia was induced for 45 min by clamping the portal vein catheter; thereafter, reperfusion was performed for 30 min. RESULTS: TNF-alpha production was significantly lower in the AP group during reperfusion ( CONTROL: 39+/-7 versus AP: 16+/-2 pg min-1 g-1, p<0.05), and lactate dehydrogenase (LDH) release decreased significantly during the last 15 min of reperfusion ( CONTROL: 0.13+/-0.03 versus AP: 0.04+/-0.02 IU min-1 g-1, p<0.05), despite similar levels of oxidative stress. The addition of regulatory AAs was not associated with variations in portal flow, bile flow, hepatic glucose or urea metabolism. However, significant changes in intrahepatic glutamine ( CONTROL: 1.4+/-0.2 versus AP: 2.6+/-0.5 micromol g-1, p < 0.05) together with higher glutamate release in the AP group ( CONTROL: 10.2+/-5.4 versus AP: 42.6+/-10.9 nmol min-1 g-1, p < 0.05) indicated modifications in nitrogen metabolism. CONCLUSIONS: Taken together, the lower TNF-alpha production, suggesting decreased inflammatory response, the decrease in LDH release in the AP group, demonstrating a better preservation of liver viability, and the increase in hepatic glutamine indicate that AAs play an important role in the liver's response to I/R.
Assuntos
Aminoácidos/farmacologia , Fígado/irrigação sanguínea , Fígado/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Traumatismo por Reperfusão/prevenção & controle , Algoritmos , Animais , Modelos Animais de Doenças , Técnicas In Vitro , L-Lactato Desidrogenase/análise , Fígado/metabolismo , Masculino , Perfusão , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/análiseRESUMO
We studied 86 bone marrow biopsies (BMB) from 58 patients presenting with primary splenic marginal zone lymphoma (PSMZL). In 42 patients, a splenectomy was performed which enabled a histopathological diagnosis. In these patients, 44 biopsies were carried out before, and 25 after, splenectomy. In 16 recently observed patients, 17 BMB led to PSMZL diagnosis, and these patients were treated without splenectomy. Seven different patterns of infiltrates were recognized: intravascular, interstitial, nodular, massive, plasmacytic mimicking myeloma and transformation into large B-cell lymphoma (DLBCL). The association of an intravascular infiltrate and nodules with a germinal centre and/or a marginal zone favoured a diagnosis of MZL. Immunohistochemistry demonstrated the expression of B cell-associated antigens and, in 40% of the patients, a monotypic lymphoplasmacytic cell component. These patients often presented a serum M component and autoimmune disorders. In the past, such cases have been diagnosed as lymphoplasmacytic lymphoma. BM involvement was present in all patients. Successive biopsies showed progression and, after chemotherapy, a slight decrease in infiltrates. Transformation into DLBCL occurred in 11 of 34 patients. The patterns described are not specific for PSMZL and occur also in primary nodal MZL and, more rarely, in MALT-type lymphoma.