Immunoexpression of cyclooxygenase-2 in primary gastric carcinomas and lymph node metastases.

AIM: To evaluate immunoexpression of cyclooxygenase-2 (COX-2) in primary gastric carcinomas and respective lymph node metastases. METHODS: Immunohistochemistry to analyze COX-2 expression was performed on tissue microarray slices obtained from 36 specimens of gastrectomy and satellite lymph nodes from patients with gastric carcinoma. RESULTS: Immunostaining was seen in most cases, and COX-2 expression was higher in lymph node metastases than in corresponding primary gastric tumors of intestinal, diffuse and mixed carcinomas, with a statistically significant difference in the diffuse histotype (P = 0.0108). CONCLUSION: COX-2 immunoexpression occurs frequently in primary gastric carcinomas, but higher expression of this enzyme is observed in lymph node metastases of the diffuse histotype.

Apresentação incomum de sarcoma granulocítico mamário / Unusual presentation of granulocytic sarcoma in the breasts

O termo sarcoma granulocítico (SG) designa um raro tumor sólido composto de agregados de precursores granulocíticos imaturos em sítios extramedulares. A lesão geralmente ocorre durante o curso natural da leucemia mieloide aguda (LMA) ou após sua remissão. O SG primário manifesta-se mais comumente na pele e linfonodos, portanto, quando se apresenta na mama, o erro diagnóstico de linfoma não Hodgkin, carcinoma lobular, sarcoma e melanoma maligno é um problema comum. A mama tem sido relatada como um local incomum de SG. Relata-se um caso raro de SG bilateral em mamas concomitante com LMA numa mulher de 47 anos. A paciente foi admitida em nosso hospital devido a manifestações neurológicas e descobrimos, durante a investigação, tumorações nas mamas. A histopatologia das lesões sugeriu linfoma não Hodgkin, sendo iniciada quimioterapia esquema CHOP. No entanto, o mielograma mostrou hiperplasia das séries granulocíticas, e a imuno-histoquímica revelou mieloperoxidase e CD68 positivos, confirmando o diagnóstico de SG primário em mamas. A citogenética não detectou anomalias. A revisão da microscopia e a análise do líquor confirmaram a presença de infiltração no parênquima mamário e no sistema nervoso central por leucemia monoblástica aguda (LMA-M5a). O protocolo de indução da remissão foi iniciado com daunorrubicina, arabinosídeo-C e quimioterapia intratecal com metotrexate, arabinosídeo-C e dexametasona (MADIT). Um mês depois, a paciente recusou a continuação do tratamento, depois de ter feito pedido de alta.

Granulocytic sarcoma (GS) is an uncommon solid tumor composed of aggregates of immature granulocytic precursors in extramedullary sites. The lesion generally occurs during the natural course of acute myelogenous leukemia or after remission has been achieved. Primary GS manifests most commonly in skin and lymph nodes, therefore when it presents in the breast, misdiagnosis of non-Hodgkin's lymphoma, lobular carcinoma, sarcoma and malignant melanoma is a common problem. The breast has been reported to be an uncommon site for GS. We report on a rare case of granulocytic sarcoma presenting as bilateral breast masses concomitant with acute myeloid leukemia in a 47-year-old woman. The patient was admitted to our hospital due to neurological manifestations, at which time we discovered lesions in the breasts. The histopathology suggested non-Hodgkin lymphoma, and chemotherapy using the CHOP regimen was performed. However, a myelogram showed hyperplasia of the granulocyte cells and immunohistochemistry tests were positive for myeloperoxidase and CD68, confirming the diagnosis of primary granulocytic sarcoma of the breasts. Cytogenetic examinations did not detect anomalies. The review of microscopy and the analysis of cerebrospinal fluid confirmed the presence of infiltration in the breast and in the central nervous system by acute monoblastic leukemia (AML M5a). AML M5a protocols had been started with daunorubicin, arabinoside-C and intrathecal chemotherapy using methotrexate, arabinoside-C and dexamethasone (MADIT). One month later, the patient refused further treatment.

Linfoma não Hodgkin primário da coluna vertebral / Primary non-Hodgkin's lymphoma of the vertebral column

O linfoma primário do osso (LPO) é uma condição extremamente rara, habitualmente confundida com outras lesões ósseas primárias. É responsável por cerca de 3 por cento-5 por cento de todos os tumores malignos no osso e 4 por cento-7 por cento de todos os linfomas nãoHodgkin extranodais. Caracteriza-se pelo envolvimento de um ou vários locais ósseos, com ou sem comprometimento de linfonodos regionais e vísceras. Histopatologicamente, o linfoma non Hodgkin de grandes células B representa a maioria dos casos de LPO. Ossos longos são mais frequentemente comprometidos, e o fêmur é o sítio mais acometido. Osso ilíaco e da coluna vertebral também podem ser atingidos. Relatamos um caso raro de linfoma não Hodgkin da vértebra em mulher de 41 anos. A imuno-histoquímica revelou CD20 e CD45 positivos. Ela foi diagnosticada com linfoma primário difuso de grandes células B da coluna vertebral. O estudo histopatológico da medula óssea não detectou infiltração por hemopatia linfoide. A paciente foi tratada com quimioterapia CHOP juntamente com etoposide, seguida de radioterapia (dose total = 3600cGy) na região tóraco-lombar. Não houve evidência de recidiva em um período de vinte meses de acompanhamento.

Primary bone lymphoma (PBL) is an extremely rare condition, commonly confused with other primary bone injuries. It accounts for approximately 3-5 percent of all malignant bone tumors and 4-7 percent of all extranodal non-Hodgkin's lymphomas. It is characterized by the involvement of one or multiple bone locations, with or without the involvement of regional lymph nodes and viscera. Histopathologically, diffuse large-B-cell lymphomas account for the majority of cases of PBL. Long bones are usually involved, with the femur being the most commonly affected site. Pelvic bones and the vertebral column can also be involved. We report on a rare case of PLB of the vertebra in a 41-year-old woman. Immunohistochemistry examinations revealed CD20 and CD45 positive cells. She was diagnosed with primary diffuse large B-cell lymphoma presenting as a vertebral column tumor. The histopathologic analysis of the bone marrow did not show lymphoproliferative disorders. The patient was treated with a CHOP plus etoposide regimen. Systemic chemotherapy was followed by radiotherapy (total dose = 3600 cGy) in the thoracolumbar region. There was no evidence of recurrence in the 20-month follow up.

Mediastinal nonleukemic granulocytic sarcoma with cardiac infiltration / Sarcoma granulocítico mediastinal não associado à leucemia com infiltração cardíaca

We report on a case of mediastinal granulocytic sarcoma with cardiac infiltration in a young man with no evidence of leukemia involving the bone marrow or peripheral blood. Diagnosis was accomplished by immuno-histochemistry with expressions of myeloperoxidase and CD99 antigens. The patient achieved clinical remission, but evolved with febrile neutropenia during chemotherapy and died. Although subclinical cardiac infiltrations are commonly found at autopsy in patients with acute non-lymphoblastic leukemia, only one case of involvement of the heart with granulocytic sarcoma in the absence of bone marrow disease has been published in the literature. A diagnosis of granulocytic sarcoma should not be excluded when the biopsy of the bone marrow does not show any evidence of leukemic infiltration.

Relata-se o caso de um adulto jovem com sarcoma granulocítico (SG) mediastinal com infiltração cardíaca sem evidência de leucemia envolvendo medula óssea ou sangue periférico. O diagnóstico foi revelado pela imuno-histoquímica com positividade para mieloperoxidase e CD99. O paciente apresentou remissão clínica, porém evoluiu com neutropenia febril durante a quimioterapia e foi a óbito. Embora infiltrados cardíacos subclínicos sejam comumente detectados na autópsia em pacientes com leucemia aguda nãolinfoblástica, somente um caso de SG com envolvimento cardíaco na ausência de doença na medula óssea foi descrito na literatura. Um diagnóstico de SG não deve ser excluída quando a biópsia da medula óssea não mostrar nenhuma evidência de infiltração leucêmica.

Sarcoma granulocítico com apresentação inicial cutânea e ganglionar: [carta ao editor] / Granulocytic sarcoma of skin and lymph nodes: [letter to the editor]

A case of granulocytic sarcoma of skin and lymph nodes is reported in a 65-year-old man as an initial presentation of a myeloproliferative disorder, chiefly involving myelofibrosis. The symptoms, physical examination, hematological findings, imunohistochemistry and anatomopathological results and evolution of the disease are described. As this is an unusual case, stress was placed on the diagnostic confusion that may occur.

Células dendríticas foliculares: imunofenotipagem no linfoma de Hodgkin clássico esclerose nodular / Dendritic follicular cells: immunophenotyping in classic Hodgkin's lymphoma nodular sclerosis

O linfoma de Hodgkin clássico esclerose nodular (LHCEN), de origem linfóide da célula B do centro germinativo (CG), apresenta agregados de células dendríticas foliculares (CDF), célula Hodgkin/Reed Sternberg e variantes, células B formando complexos relacionados ao CG, sugerindo uma associação entre esclerose nodular e formação do centro germinativo. O objetivo desse estudo foi avaliar a célula dendrítica folicular, por imunofenotipagem com o anticorpo fascina, em biópsia de linfonodo periférico ou massa do mediastino de pacientes com LHCEN previamente diagnosticados, procurando identificar critérios como fatores prognósticos. Foram selecionados 38 pacientes, 55,2 por cento do sexo masculino com relação M:F de 1,23: 1 e a idade com média de 29,3 anos; 52,6 por cento em estádios clínicos I-II, sendo 68,4 por cento com sintomas B. Foram analisados 38 espécimes de biópsias, sendo 57,9 por cento do subtipo esclerose nodular II. O estudo imuno-histoquímico mostrou 100 por cento de positividade para o CD30 e 68,4 por cento para o CD15. As CDFs foram identificadas pelo anticorpo fascina, considerado padrão-ouro, através da técnica imunoenzimática indireta peroxidase-anti-peroxidase estreptavidina-avidina-biotina (PAP-Strept ABC), realizada em lâminas pré-tratadas do material de biópsia incluído em blocos de parafina. Foi evidenciado padrão CDF1 em 7,9 por cento, CDF2 em 47,4 por cento e CDF3 em 44,7 por cento. Não houve relação entre a presença da CDF e sexo, idade, estádio clínico e resposta ao tratamento, mas foi demonstrada uma tendência para associação (p=0,056) entre CDF os subtipos LHCEN. Os pacientes com presença de célula dendrítica folicular foram acompanhados por maior período, com média de 32,9 meses, com associação estatisticamente significativa (p=0,001).

Classic nodular sclerosis HodgkinÆs lymphoma (CNSHL) is a lymphoid neoplasm of germinal center (GC) B cells, presenting with aggregates of follicular dendritic cells (FDC), Hodgkin/Reed Sternberg cells and variants and B cells forming complexes related to the GC. This suggests an association between nodular sclerosis and GC formation. The goal of this study was to evaluate the follicular dendritic cells by immunophenotyping with fascin from lymph node or mediastinal mass biopsies of patients previously diagnosed as having CNSHL, in order to attempt to identify criteria as prognostic factors. Thirty-eight patients were selected. A total of 55.2 percent were male with a M:F ratio of 1.23:1 and a mean age of 29.3 years. 52.6 percent were in clinical stage I-II and 68.4 percent had symptoms B. Thirty-eight biopsy specimens were analysed and 57.9 percent were nodular sclerosis II. Immuno­phenotyping showed 100 percent positivity for CD30 and 68.4 percent for CD15. The FDC were identified by fascin, using the peroxidase-antiperoxidase streptavidin-avidin-biotin indirect immuno­enzimatic technique, which was performed on pre-treated slides with the biopsy specimens embedded in paraffin blocks. Fascin was considered to be the gold-standard. The CDF1 pattern was present in 7.9 percent, CDF2 in 47.4 percent and CDF3 in 44.7 percent. There was no association between the presence of the FDC and gender, age, clinical stage, response to treatment, but a tendency for association (p=0.056) between the subtypes of CNSHL. Patients with FDC present in their biopsies were followed up for a longer period of time - about 32.9 months. This enabled a significant statistical association (p=0.001) between the presence of FDC and length of follow-up.

Survival and growth of goat primordial follicles after in vitro culture of ovarian cortical slices in media containing coconut water.

The development of culture systems to support the initiation of growth of primordial follicles is important to the study of the factors that control the earliest stages of folliculogenesis. We investigated the effectiveness of five culture media, two supplements and three culture periods on the survival and growth of goat primordial follicles after culturing ovarian cortex. The media were based on minimal essential minimum (MEM) and coconut water solution (CWS) added in the proportion of 0, 25, 50, 75 or 100%. The two supplements were none versus supplemented with insulin-transferrin-selenium, pyruvate, glutamine, hypoxanthine, and BSA. Pieces of goat ovarian cortex were cultured in the media for 1, 3 or 5 days and representative samples were evaluated at day 0 as non-cultured controls. The replicates were the two ovaries of five mixed breed goats. The number of primordial, intermediate, primary and secondary follicles at each period of culture and the number of degenerated follicles were evaluated. Mitotic activity of granulosa cells was studied by immunolocalization of proliferating cell nuclear antigen (PCNA). The number of follicles in each stage and degenerated follicles were statistically analyzed by ANOVA using a factorial design and the significance of differences assessed using Tukey test. Chi-square test was used to compare the percentage of follicles with PCNA positive granulosa cells. As the culture period progressed, the number of primordial follicles fell and there was a significant increase in the number of primary follicles. The fall in the number of primordial follicles was particularly marked after 1 day culture. No effect of media on the number of primordial and primary follicles was observed after culture, but MEM as well as supplements increased the number of intermediate follicles. Follicular degeneration was kept at the same level after culture in the media tested, except for pure CWS that increased the number of degenerated follicles. In contrast, addition of supplements to culture media reduced follicular degeneration. In non-cultured tissue, PCNA was expressed in granulosa cells of 31.6% of the growing follicles. This percentage had not significantly changed after 5 days culture in the various media, indicating the maintenance of proliferation activity of granulosa cells during culture. In conclusion, it is shown that goat primordial follicles may be successfully activated after in vitro culture in all media tested. However, when pure CWS is used the follicular degeneration is enhanced, but the addition of supplements to culture media decrease follicular degeneration.