Caracterização da resposta imune in situ nas lesões de hanseníase indeterminada / Characterization of the in situ immune response in indeterminate leprosy

A forma indeterminada é a fase inicial da hanseníase, que se caracteriza histologicamente pelo infiltrado inflamatório leve, não granulomatoso, de linfócitos e histiócitos ao redor de vasos, anexos e nervos. No local de entrada do M. leprae, as células apresentadoras de antígeno do tipo células dendríticas são as primeiras a encontrar o bacilo. Este, no interior de células dendríticas, desencadeia a produção local de citocinas e quimiocinas, que resultam em proliferação de linfócitos T helper 1 ou T helper 2, assim definindo uma resposta imune celular ou humoral, respectivamente. As lesões tuberculoides mostram predominância das citocinas de padrão Th1 como IL-2, TNF-alfa, IFN-y, IL-12 e IL-18, enquanto que nas lesões virchowianas predominam citocinas de padrão Th2, como IL-4, IL-5, IL-10 e TGF-beta. Na pele, as principais células dendríticas são células dendríticas mieloides, células de Langerhans e alguns dendrócitos dérmicos. São identificadas respectivamente pela expressão imuno-histoquímica de S100, CD1a e Fator XIIIa. Células de Langerhans e dendrócitos dérmicos Fator XIIIa positivos estão aumentados em quantidade nas lesões tuberculoides quando comparadas com lesões virchowianas. Os objetivos do presente estudo foram: 1) caracterizar a inflamação "in situ" na hanseníase indeterminada através da quantificação das marcações imuno-histoquímicas de: CD57, CD4, CD8, CD1a, S100, FXIIIa, CD68, Foxp3, CD123, IL-1, IL-2r, IL-4, IL-6, IL-8, IL-10, IL-12, IL-18, IFN-, TNF-alfa, TGF-beta, iNOS, granzima B, receptor Toll-like 2/4, e antígeno BCG, 2) comparar o perfil fenotípico e citocínico das lesões na hanseníase indeterminada entre grupos de reação de Mitsuda positiva e negativa, a fim de investigar se existem padrões que possam prever para qual forma a doença evoluiria, e 3) revisar a histopatologia da forma indeterminada através da análise semiquantitativa das alterações vistas à coloração de hematoxilina/eosina. Foram selecionadas 15 lesões de pacientes...

The indeterminate form is the initial stage of leprosy, which is characterized histologically by mild inflammatory infiltrate, non granulomatous, with lymphocytes and histiocytes around vessels, nerves and adnexals. When M. leprae enter the host, antigen-presenting cells of dendritic type are the first cells to find the bacillus. Once inside dendritic cells, the bacillus elicits local production of cytokines and chemokines, which result in proliferation of T lymphocytes helper 1 or T helper 2, thereby defining a cellular or humoral immune response, respectively. The tuberculoid lesions show predominance of Th1 cytokines such as IL-2, TNF-alfa, IFN-y, IL-12 and IL-18, whereas in the lepromatous lesions predominate cytokines of Th2 pattern such as IL-4, IL-5 IL-10 and TGF-beta. In the skin, main dendritic cells are myeloid dendritic cells, Langerhans cells, and some dermal dendrocytes. They are identified respectively by immunohistochemical expression of S100, CD1a and Factor XIIIa. Langerhans cells and dermal dendrocytes Factor XIIIa positive are increased in number in tuberculoid lesions compared with lepromatous lesions. The objectives of this study were: 1) to characterize "in situ" inflammation in indeterminate leprosy through the quantification of immunohistochemical markers: CD57, CD4, CD8, CD1a, S100, FXIIIa, CD68, Foxp3, CD123, IL-1, IL-2r, IL-4, IL-6, IL-8, IL-10, IL-12, IL-18, IFN-y, TNF-alfa, TGF-beta, iNOS, granzyme B, Toll-like receptor 2/4, and BCG antigen, 2) compare the phenotypic and cytokinic profile of indeterminate leprosy lesions between positive and negative Mitsuda reaction groups in order to investigate if there are patterns that can predict which way the disease may evolve, and 3 ) review the histopathology of the indetermate form by semi-quantitative analysis of changes seen in hematoxylin / eosin. Fifteen lesions of patients with indeterminate leprosy were selected. There was used control groups of Factor...

Linfangioma perianal: relato de caso / Perianal lymphangioma: case report

O linfangioma é um tumor benigno que pode se desenvolver em qualquer região do corpo, uma vez que se origina de lesão dos vasos linfáticos. A apresentação perianal deste tipo de tumor é rara. O histórico do paciente e o exame físico nos levaram a suspeitar do tumor e identificá-lo. Este relato de caso envolve um paciente do sexo masculino com histórico de tumor que pode ser encontrado na região perineal. O tratamento escolhido foi cirurgia e o diagnóstico definitivo dado pelo patologista.

Lymphangioma is a benign tumor that can develop anywhere on the body, since it is derived from a lesion of the lymphatic vessels. Perianal presentation of this kind of tumor is rare. Patient history and a physical examination led us to suspect and identify the tumor. This case report is about a male patient with a history of a tumor that can be found throughout the perineal area. The treatment of choice is surgery and definitive diagnosis is given by the pathologist.

Abscesso hepático por klebsiella pneumoniae e suas complicações sistêmicas / Liver abscess by klebsiella pneumoniae and its systemic complications

Abscesso hepático por Klebsiella pneumoniae é incomum em países ocidentais e tem sido associado a complicações severas, sobretudo em pacientes diabéticos. A manifestação clínico-laboratorial da doença é inespecífica. Endoftalmite é uma rara complicação de septicemia por Klebsiella pneumoniae. Atraso terapêutico pode resultar em perda visual acentuada e irreversível. Relatamos um caso de abscesso hepático por Klebsiella pneumoniae complicado com endoftalmite, embolia pulmonar séptica e endocardite em homem diabético.

Klebsiella pneumoniae liver abscess is unco mmon in western countries and has been associated with severe complications, especially in diabetic patients. The clinical and laboratory manifestations of the disease are nonspecific. Endophthalmitis is a rare complication of septicemia due to Klebsiella pneumoniae. Therapeutic delay can result in severe and irreversible visual loss. We report a case of Klebsiella pneumoniae liver abscess complicated by endophthalmitis, septic pulmonary emboli and endocarditis in diabetic man.

Involucrin in the differential diagnosis between linear psoriasis and inflammatory linear verrucous epidermal nevus: a report of one case.

Inflammatory linear verrucous epidermal nevus is a variant of verrucous epidermal nevus, characterized by recurrent inflammatory phenomena. Despite well-established clinical manifestations, the differential diagnosis between inflammatory linear verrucous epidermal nevus and linear psoriasis remains difficult. Clinical history, physical examination and histopathology analysis may not be sufficient to confirm the diagnosis. We report the case of a 4-year-old girl in which the involucrin immunostaining was helpful in the diagnosis of inflammatory linear verrucous epidermal nevus. Our findings confirm that involucrin immunohistochemistry is a useful tool in such cases.

Involucrin in the differential diagnosis between linear psoriasis and inflammatory linear verrucous epidermal nevus: a report of one case / Involucrina na diagnose diferencial entre a psoriase linear e o nevo epidermico verrucoso inflamatorio linear: relato de um caso

Inflammatory linear verrucous epidermal nevus is a variant of verrucous epidermal nevus, characterized by recurrent inflammatory phenomena. Despite well-established clinical manifestations, the differential diagnosis between inflammatory linear verrucous epidermal nevus and linear psoriasis remains difficult. Clinical history, physical examination and histopathology analysis may not be sufficient to confirm the diagnosis. We report the case of a 4-year-old girl in which the involucrin immunostaining was helpful in the diagnosis of inflammatory linear verrucous epidermal nevus. Our findings confirm that involucrin immunohistochemistry is a useful tool in such cases.

O nevo epidérmico verrucoso inflamatório linear é uma variante do nevo epidérmico verrucoso caracterizada por fenômenos inflamatórios recorrentes. A despeito das manifestações clínicas bem estabelecidas o diagnóstico diferencial entre nevo epidérmico verrucoso inflamatório linear e psoríase linear permanece difícil. A história clínica, o exame físico e análise histopatológica podem não ser suficientes para a confirmação diagnóstica. Nós relatamos o caso de uma menina de 4 anos de idade no qual o uso da involucrina foi útil para o diagnóstico do nevo epidérmico verrucoso inflamatório linear . Nossos achados corroboram a imunohistoquímica com a involucrina como uma ferramenta importante nestes casos.

Genitogluteal porokeratosis -- case report.

We report the case of a patient diagnosed with genitogluteal porokeratosis, a disorder of epidermal keratinization. The location described is extremely rare and very often late diagnosed or even misdiagnosed. Histopathology showed a typical cornoid lamella of great value to support this diagnosis. The importance of awareness of this entity by the specialist is emphasized as a differential diagnosis among genital diseases of chronic evolution and difficult treatment.

Genitogluteal porokeratosis - Case report / Poroqueratose genitoglútea - Relato de caso

We report the case of a patient diagnosed with genitogluteal porokeratosis, a disorder of epidermal keratinization. The location described is extremely rare and very often late diagnosed or even misdiagnosed. Histopathology showed a typical cornoid lamella of great value to support this diagnosis. The importance of awareness of this entity by the specialist is emphasized as a differential diagnosis among genital diseases of chronic evolution and difficult treatment.

Relata-se o caso de um paciente com diagnóstico de poroqueratose genitoglútea, uma desordem da queratinização epidérmica, cuja localização exclusiva é extremamente rara, sendo muitas vezes tardia ou erroneamente diagnosticada. A histopatologia demonstra a clássica lamela cornóide, de grande valia para elucidação diagnóstica. Ressalta-se a importância do conhecimento desta entidade pelo especialista como diagnóstico diferencial entre as afecções genitais de evolução arrastada e de difícil tratamento.

A new experimental model for inducing interstitial cystitis by oxidative stress using intravesical instillation of a nitric oxide donor gel / Novo modelo experimental de indução de cistite intersticial por estresse oxidativo utilizando instilação intravesical de gel doador de óxido nítrico

Objective: The aim of this study was to develop an experimental model of inducing interstitial cystitis through intravesical instillation of a polymeric solution containing the NO donor S-nitrousglutathione (GSNO) and to compare it to the experimental interstitial cystitis induced by vesical instillation of protamine and potassium chloride. Methods: A total of 40 female Wistar rats were used and divided into four groups: 1 - ten rats treated with saline solution + GSNO; 2 - ten rats treated with saline solution + polymeric solution (without GNSO); 3 - ten rats treated with protamine sulphate + KCl; 4 - ten rats treated with protamine sulphate + GSNO. The rats received one application (five animals in each group) or three applications (five animals in each group) of the corresponding substance through intravesical instillation, and after six days (five animals in each group) or nine days (five animals in each group) they were euthanized and their bladders were removed for macroscopic evaluation and histological study. Results: In the macroscopic evaluation edema and hyperemia of the mucosa were observed in 2 (22%) animals in Group 1, in no (0%) animal in Group 2, in 10 (100%) animals in Group 3, and in 5 (50%) animals in Group 4. In the protamine + KCl group and in saline + GSNO, similar effects were observed in the bladder wall. The animals in Group 2 (saline + polymeric solution) showed significantly less vascular congestion compared to the other groups after 9 days of the instillation (p = 0.0035). Significant fibrosis was observed in Groups 3 and 4, 6 days (p = 0.3781) and 9 days (p = 0.0459) after instillations, when compared to controls (Group 2). All groups presented neutrophilic infiltrate of variable intensity, 6 days after instillations (p = 0.7277). After 9 days, there was a regression of the infiltrate, with no evidence of accentuated neutrophilic reaction in all the groups (p = 0.2301). Conclusions: The inflammatory response to bladder instillation with an aqueous solution of S-nitrousglutathione was very similar to that induced by bladder instillation of protamine and KCl. Instillation of an aqueous solution of S-nitrousglutathione can be considered a new model for experimental induction of interstitial cystitis.

Objetivo: O objetivo deste estudo foi o desenvolvimento de um modelo experimental para a indução de cistite intersticial, por meio da instilação vesical de uma solução polimérica de gel doador de óxido nítrico S-nitrosoglutationa (GSNO), e compará-lo ao modelo experimental para a indução da cistite intersticial por instilação vesical de protamina e cloreto de potássio. Métodos: Foram utilizadas 40 ratas Wistar, divididas em quatro grupos: 1 - dez ratas tratadas com solução salina + GSNO; 2 - dez ratas tratadas com solução salina + solução de polímeros (sem GNSO); 3 - dez ratas tratadas com sulfato de protamina + KCl; 4 - dez ratas tratadas com sulfato de protamina + GSNO. As ratas receberam uma aplicação (cinco animais em cada grupo) ou três aplicações (cinco animais em cada grupo) da substância correspondente através de instilação vesical, e após seis dias (cinco animais em cada grupo) ou nove dias (cinco animais em cada grupo) foram sacrificadas, e a bexiga foi removida para exame macroscópico e estudo histológico. Resultados: Na avaliação macroscópica observou-se edema e hiperemia da mucosa em 2 animais (22%) do Grupo 1, em nenhum animal (0%) do Grupo 2, em 10 animais (100%) do Grupo 3, e em 5 animais (50%) do Grupo 4. No grupo protamina + KCl e no grupo solução salina + GSNO, observamos efeitos semelhantes sobre a parede da bexiga. Os animais do Grupo 2 (salina + polímeros) apresentaram significantemente menos congestão vascular que os dos outros grupos após 9 dias de instilação (p = 0,0035). Observou-se fibrose significante nos Grupos 3 e 4, 6 dias (p = 0,3781) e 9 dias (p = 0,0459) após as instilações, quando comparados com o grupo controle (Grupo 2). Todos os grupos apresentaram infiltrados neutrofílicos de intensidade variável, 6 dias após as instilações (p = 0,7277). Após 9 dias, observou-se regressão do infiltrado, sem evidência de acentuada reação neutrofílica em todos os grupos (p = 0,2301). Conclusão: A resposta inflamatória à instilação da bexiga com uma solução aquosa de S-nitroglutationa foi muito semelhante àquela induzida pela instilação de protamina e KCl. A instilação de uma solução aquosa de S-nitroglutationa pode ser considerada um novo modelo experimental para a indução da cistite intersticial.

A new experimental model for inducing interstitial cystitis by oxidative stress using intravesical instillation of a nitric oxide donor gel.

OBJECTIVE: The aim of this study was to develop an experimental model of inducing interstitial cystitis through intravesical instillation of a polymeric solution containing the NO donor S-nitrousglutathione (GSNO) and to compare it to the experimental interstitial cystitis induced by vesical instillation of protamine and potassium chloride. METHODS: A total of 40 female Wistar rats were used and divided into four groups: 1 - ten rats treated with saline solution + GSNO; 2 - ten rats treated with saline solution + polymeric solution (without GNSO); 3 - ten rats treated with protamine sulphate + KCl; 4 - ten rats treated with protamine sulphate + GSNO. The rats received one application (five animals in each group) or three applications (five animals in each group) of the corresponding substance through intravesical instillation, and after six days (five animals in each group) or nine days (five animals in each group) they were euthanized and their bladders were removed for macroscopic evaluation and histological study. RESULTS: In the macroscopic evaluation edema and hyperemia of the mucosa were observed in 2 (22%) animals in Group 1, in no (0%) animal in Group 2, in 10 (100%) animals in Group 3, and in 5 (50%) animals in Group 4. In the protamine + KCl group and in saline + GSNO, similar effects were observed in the bladder wall. The animals in Group 2 (saline + polymeric solution) showed significantly less vascular congestion compared to the other groups after 9 days of the instillation (p = 0.0035). Significant fibrosis was observed in Groups 3 and 4, 6 days (p = 0.3781) and 9 days (p = 0.0459) after instillations, when compared to controls (Group 2). All groups presented neutrophilic infiltrate of variable intensity, 6 days after instillations (p = 0.7277). After 9 days, there was a regression of the infiltrate, with no evidence of accentuated neutrophilic reaction in all the groups (p = 0.2301). CONCLUSIONS: The inflammatory response to bladder instillation with an aqueous solution of S-nitrousglutathione was very similar to that induced by bladder instillation of protamine and KCl. Instillation of an aqueous solution of S-nitrousglutathione can be considered a new model for experimental induction of interstitial cystitis.

Bilateral inverted papilloma: case report and literature review.

The inverted papilloma is an uncommon unilateral nasosinusal benign tumor. The clinical picture presents nonspecific signs and symptoms, such as unilateral nasal obstruction, anosmia and headache. The diagnosis is established by anamnesis, physical exam, computed tomography and magnetic resonance imaging. Treatment is essentially surgical. This report has the objective of presenting an uncommon bilateral inverted nasal papilloma and making a literature review.

Papiloma invertido bilateral: relato de caso e revisão da literatura / Bilateral inverted papilloma: case report and literature review

O papiloma invertido é um raro tumor nasossinusal benigno e unilateral. As manifestações clínicas são inespecíficas, como obstrução nasal unilateral, rinorréia, epistaxe, hiposmia e cefaléia. O diagnóstico é realizado por meio de anamnese detalhada, exame otorrinolaringológico e exames complementares. A tomografia computadorizada e a ressonância magnética são exames fundamentais na elucidação diagnóstica, no tratamento e no acompanhamento do paciente. O tratamento é essencialmente cirúrgico. Este trabalho tem como objetivo relatar um caso de papiloma invertido bilateral e realizar uma revisão da literatura.

The inverted papilloma is an uncommon unilateral nasosinusal benign tumor. The clinical picture presents nonspecific signs and symptoms, such as unilateral nasal obstruction, anosmia and headache. The diagnosis is established by anamnesis, physical exam, computed tomography and magnetic resonance imaging. Treatment is essentially surgical. This report has the objective of presenting an uncommon bilateral inverted nasal papilloma and making a literature review.