Mycobacterium leprae on Palatine Tonsils and Adenoids of Asymptomatic Patients, Brazil.

We investigated palatine tonsil and adenoid specimens excised from otorhinolaryngological patients in a leprosy-endemic region of Brazil. Fite-Faraco staining identified Mycobacterium spp. in 9 of 397 specimen blocks. Immunohistochemistry and molecular analysis confirmed the presence of Mycobacterium leprae, indicating that these organs can house M. leprae in persons inhabiting a leprosy-endemic region.

Clinical presentation of tuberculoid leprosy in an epidermodysplasia verruciformis patient.

Epidermodysplasia verruciformis (EV) is triggered by a variety of mechanisms that at least partly include genetic background. We present a Brazilian man with a 30-year history of flat, wart-like lesions with clinical, histopathological, and evolutive aspects consistent with papillomavirus (HPV)-associated EV. Histological analysis of the wart lesions showed epidermis with hyperkeratosis, regular acanthosis, hypergranulosis, and cells with abundant basophilic cytoplasm. Moreover, a perivascular lymphocytic infiltrate was found in the superficial dermis, consistent with a viral wart. Type-2-HPV DNA was detected in various fragments of skin-wart lesions using the polymerase chain reaction (PCR). Two years after the EV diagnosis, the patient presented with an anesthetic well-demarcated, erythematous and mildly scaly plaque on his right forearm. A histopathological analysis of this lesion demonstrated the presence of a compact tuberculoid granuloma. Ziehl-Neelsen staining demonstrated the presence of rare acid-fast bacilli and confirmed the tuberculoid leprosy diagnosis. The patient's Mitsuda Intradermal Reaction was positive. To elucidate the possible mechanism involved in this case of EV, we genotyped the HLA genes of this patient. DQB genotyping showed the polymorphic HLA alleles DQB1*0301 and 0501. The patient was treated with a paucibacillary multi-drug therapy scheme, and the disease was cured in six months. This report describes an EV patient with an M. leprae infection, confirming that tuberculoid leprosy patients possess a relatively specific and efficient cell-mediated immunity against the bacillus and, therefore, localized forms of the disease. Moreover, we show the possible involvement of the polymorphic HLA alleles DQB1*0301 and 0501 in EV induction mechanisms.

[Clinical diagnosis and anatomic-pathologic diagnosis: disagreements]. / Diagnóstico clínico e anatomopatológico: discordâncias.

UNLABELLED: Many pathologic entities in the clinical practice generate disagreements regarding its identification, not only by its likeness with other lesions but also by its semantics. BACKGROUND: The goal of this work is to clarify which disagreements are more frequent in the clinical practice, supply new knowledges to facilitate the identification of the larger pathologies controversies and to enlarge its differentials diagnosis. METHODS: We revised 1825 reports of referring biopsies to the period of 1992 up to 1999, belonging to the Laboratory of Pathological Anatomy of Unoeste, being excluded 439 lauds that did not introduce diagnostic hypothesis, or that had as signals hypothesis and clinical indications or "for clearing". We confronted the clinical hypothesis with the diagnosis Anatomic-pathological, obtaining itself 444 (32.05%) of discordant cases. RESULTS: Note that the biggest disagreements were between Hansen's disease clinical diagnosis, which in 65.7% cases were chronicles Unspecific Dermatitises, between Sebaceous Cyst, which in 80% cases were cyst of Epidermical Inclusion and Incomplete Abortion, which in 68.2% cases were complete Abortion. CONCLUSION: We conclude that an adequate concepts definition discerning an anamnese and narrow correlation of the clinical characteristics of the lesions promote a minor disagreements number among clinical diagnosis and Anatomic-pathological.

Diagnóstico clínico e anatomopatológico: discordâncias / Clinical diagnosis and anatomic-pathologic diagnosis: disagreements

Muitas patologias na prática clínica geram discordâncias quanto a sua identificação, não somente pela sua semelhança com outras lesões mas também pela sua semântica. OBJETIVO: Este trabalho visa esclarecer quais discordâncias são mais freqüentes na prática clínica, fornecer novos conhecimentos para facilitar a identificação das patologias de maiores controvérsias e ampliar seus diagnósticos diferenciais. MÉTODOS: Revisamos 1.825 laudos de biópsias referentes ao período de 1992 até 1999, pertencentes ao Laboratório de Anatomia Patológica da Unoeste, sendo excluídos 439 laudos que não apresentavam hipótese diagnóstica ou que tinham como hipótese sinais e sintomas clínicos ou "a esclarecer". Confrontamos a hipótese clínica com o diagnóstico anatomopatológico, obtendo-se 444 (32,05 por cento) casos discordantes. RESULTADOS: Observamos que as maiores discordâncias foram entre o diagnóstico clínico de hanseníase, que em 65,7 por cento dos casos tratavam-se de dermatites crônicas inespecíficas, entre cisto sebáceo, que em 80 por cento dos casos tratavam-se de cisto de inclusão epidérmica e aborto incompleto, que em 68,2 por cento dos casos tratavam-se de aborto completo. CONCLUSÃO: Concluímos que uma adequada definição de conceitos, uma anamnese criteriosa e estreita correlação das características clínicas das lesões promovem um menor número de discordâncias entre os diagnósticos clínico e anatomopatológico.