Actualización del reporte de biopsiapor aspiración con aguja fina de mama / Report of breast fine needle aspiration biopsy: an update

Las recomendaciones para la biopsia por aspiración con aguja fina de mama se desarrollaron y aprobaron en 1997 por el Instituto Nacional de Cáncer en Bethesda, Estados Unidos y fueron adaptadas a nuestro país en 2007, sin embargo, en los últimos años no se han realizado cambios formales en estas indicaciones. El objetivo de este módulo es presentar la actualización del reporte de biopsia por aspiración con aguja fina de mama, usando el sistema de reporte Bethesda, realizado por consenso con un grupo de patólogos, clínicos, radiólogos, cirujanos de mama y otros profesionales de la salud de Colombia y otros países, y con base en la experiencia realizando biopsia por aspiración con aguja fina de mama del Hospital Pablo Tobón Uribe y de Dinámica IPS.

Recommendations for breast fine needle aspiration biopsy were developed and approved in 1997 by The National Cancer Institute of Bethesda, United States, , and were adapted to our country on 2007, however, in last years these indications have not changed in a formal manner. The purpose of this review was to provide an update of the report for breast fine needle aspiration biopsy using the Bethesda system. This guide was made by consensus with pathologists, clinicians, radiologists, breast surgeons and other health professionals of Colombia and other countries. The update was basis on the experience of Hospital Pablo Tobon Uribe and Dinamica IPS in performing breast fine needle aspiration biopsy.

Combined itraconazole-pentoxifylline treatment promptly reduces lung fibrosis induced by chronic pulmonary paracoccidioidomycosis in mice.

Fibrosis is a severe and progressive sequel of many pulmonary diseases, has no effective therapy at present and, consequently, represents a serious health problem. In Latin America, chronic pulmonary paracoccidioidomycosis (PCM) is one of the most important, prevalent and systemic fungal diseases that allows the development of lung fibrosis, with the additional disadvantage that this sequel may appear even after an apparently successful course of antifungal therapy. In this study, was propose the pentoxifylline as complementary treatment in the pulmonary PCM due to its immunomodulatory and anti-fibrotic properties demonstrated in vitro and in vivo in liver, skin and lung. Our objective was to investigate the possible beneficial effects that a combined antifungal (Itraconazole) and immunomodulatory (Pentoxifylline) therapy would have in the development of fibrosis in a model of experimental chronic pulmonary PCM in an attempt to simulate the naturally occurring events in human patients. Two different times post-infection (PI) were chosen for starting therapy, an "early time" (4 weeks PI) when fibrosis was still absent and a "late time" (8 weeks PI) when the fibrotic process had started. Infected mice received the treatments via gavage and were sacrificed during or upon termination of treatment; their lungs were then removed and processed for immunological and histopathologic studies in order to assess severity of fibrosis. When pulmonary paracoccidioidomycosis had evolved and reached an advanced stage of disease before treatment began (as normally occurs in many human patients when first diagnosed), the combined therapy (itraconazole plus pentoxifylline) resulted in a significantly more rapid reduction of granulomatous inflammation and pulmonary fibrosis, when compared with the results of classical antifungal therapy using itraconazole alone.

Histopathologic and immunologic effects of the itraconazole treatment in a murine model of chronic pulmonary paracoccidioidomycosis.

A comparative study, based on histopathologic findings (inflammation, cellularity, and fibrosis) and immunologic parameters (pro-inflammatory and anti-inflammatory cytokines), was carried out in order to evaluate the effects of itraconazole (ITC) treatment and its starting time in a BALB/c murine model of chronic pulmonary paracoccidioidomycosis (PCM), induced by intranasal inoculation of Paracoccidioides brasiliensis (Pb) conidia. Two different groups of mice were exposed to ITC therapy beginning at the 4th or 8th week after Pb infection, respectively. ITC was administered daily, via gavage, for a period of sixty days. At weeks 0, 4, 8, 12 and 16 the animals were sacrificed and their lungs removed for histology staining with hematoxylin and eosin (H&E), Masson's trichromic and Gomori-Grocott; pulmonary levels of IL-1ß, TNF-α, IFN-γ, IL-13 and TGF-ß were also measured by ELISA. The development or absence of the principal pulmonary PCM sequela, lung fibrosis, was directly related to the therapy's starting time. This and other histopathologic findings were related to the behavior of cytokine levels.