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1.
Forensic Sci Med Pathol ; 15(3): 369-381, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31292823

RESUMO

Forensic series on fatal anaphylaxis are scarce, probably because the diagnosis of anaphylaxis is often complex and the incidence is low. We report on the medicolegal, demographic and histopathological characteristics of a series of sudden deaths which were investigated for anaphylaxis at the Spanish National Institute of Toxicology and Forensic Sciences (INTCF) over a 17-year period (1998-2015). A total of 122 undetermined sudden deaths from a high percentage of Spanish regions (81.5% of the total population) were sent to the INTCF with anaphylaxis as the suspected cause of death for histological, biochemical, and medicolegal investigation. Two certified allergists confirmed that 46 of the 122 cases were fatal anaphylaxis. The results indicated a median age of 51 years (IQR = 29) and a male predominance (76%). The main causes of anaphylaxis were drugs (41%), hymenoptera stings (33%), and food (13%). A previous allergic event had been reported in both food anaphylaxis (67%) and drug anaphylaxis (53%). The deaths occurred in health care settings (37%), at home (22%), and outside the home (26.09%). Histopathology data were available for 40 individuals. The most frequent autopsy findings were angioedema of the upper airways (50%), pulmonary edema (47.5%), atheromatosis of coronary vessels (32.5%), and pulmonary congestion (27.5%). Our findings for fatal anaphylaxis indicated a predominance of men, older age (≥50 years) and death in a health care setting (one-third of cases). Previous episodes had occurred in two-thirds of cases of food-induced anaphylaxis and in half of the cases of drug-induced anaphylaxis.


Assuntos
Anafilaxia/mortalidade , Anafilaxia/patologia , Angioedema/patologia , Animais , Mordeduras e Picadas/mortalidade , Cianose/patologia , Hipersensibilidade a Drogas/mortalidade , Feminino , Hipersensibilidade Alimentar/mortalidade , Humanos , Himenópteros , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Edema Pulmonar/patologia , Púrpura/patologia , Estudos Retrospectivos , Espanha/epidemiologia , Triptases/sangue
2.
Clin Exp Allergy ; 49(1): 82-91, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30204277

RESUMO

BACKGROUND: Reports of fatal anaphylaxis remain scarce because of the rarity of the condition and the fact that information is limited to a few countries. OBJECTIVE: Our objective was to investigate clinical and demographic characteristics and the causes of fatal anaphylaxis in Spain using two databases of cases of fatal anaphylaxis. METHODS: We analysed fatal anaphylaxis in a series from the Spanish hospital system and a series from the National Institute of Toxicology and Forensic Sciences (Instituto Nacional de Toxicología y Ciencias Forenses [INTCF]), which predominantly comprise extrahospital deaths. Deaths from the Spanish hospital system were retrieved from among all deaths occurring during 1998-2011 using codes related to anaphylaxis. Deaths due to anaphylaxis in the INTCF database during the same period were retrieved by 2 allergists, who identified cases in which anaphylaxis was a possible cause of death. A logistic regression model was constructed to predict the characteristics of fatal anaphylaxis in each database. RESULTS: The incidence of death by anaphylaxis in Spain using both databases was 0.25 (95% CI, 0.24-0.26) deaths per million person-years. The most frequent causes of death in the hospital system were drugs (46.1%), unknown causes (40.0%), and foods (10.4%); in the INTCF, the most common causes of death were drugs (47.2%), insect stings (30.6%), and foods (11.1%). The logistic regression model showed that fatal anaphylaxis due to unknown causes (OR 15.2, 95% CI 1.8-129.8) was more likely in the hospital database, whereas insect stings (OR 100, 95% CI 10-833.3) and previous atopic comorbidity (OR 15.2, 95% CI 6.3-33.3) were more likely in the INTCF database. CONCLUSIONS & CLINICAL RELEVANCE: The estimated frequency of fatal anaphylaxis in Spain was among the lowest reported. Future studies of fatal anaphylaxis should use databases from different origins in order to show the considerable heterogeneity in this type of death.

3.
Diagn Cytopathol ; 40(4): 297-304, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22431317

RESUMO

Metastatic neoplasms of the breast are rare. Mammary metastases as the initial presentation are even more infrequent and can simulate a primary malignancy clinically and radiologically. Recognition of metastatic tumors in the breast is important because it would prevent unnecessary mutilating surgery and would lead to appropriate treatment of the primary tumor. There is a broad variety of cytological appearances reported about primary tumors and few reports about secondary breast malignancies, specially diagnosed by FNAC. This study was carried out to examine the clinical and cytomorphologic features of metastatic breast tumors found in 12 de Octubre University Hospital during a period of 20 years. It confirms the utility of FNAC and describes findings that can help in the differential diagnosis that sometimes can be very difficult. Seven cases of nonhematological metastatic neoplasms of the breast were identified from the files of the Department of Pathology of the 12 de Octubre University Hospital from a total of 64,000 aspirates. We included only metastatic tumors from extramammary nonhematological neoplasms. There were nine cases of hematological metastatic neoplasm that were excluded. They were diagnosed with FNAC and confirmed by histopathology, with at least three years of follow up. The breast lump was the first manifestation of malignancy in one case of synovial sarcoma. The other six cases had been previously diagnosed of cancer. These included one malignant melanoma, one alveolar rhabdomyosarcoma, one mixed müllerian tumor, one medullary carcinoma of thyroid, one colonic adenocarcinoma, and one gastric adenocarcinoma. The period of time between primary tumor and metastases ranged from one month to eight years. An accurate cytologic diagnosis was made in all the cases. Immunocytochemistry was available but diagnosis could be made with cytomorphology alone in the seven cases. Fine-needle aspiration cytology is an excellent first line diagnostic modality that is particularly informative when clinical previous data are known. If metastatic disease is suspected, the material obtained by FNAC may provide a definitive diagnosis and prevent open surgical biopsy or mastectomy. We concur with previous reports that FNAC is a reliable, rapid, secure, and cost-effective approach to the diagnosis of palpable metastatic breast tumors.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/secundário , Mama/patologia , Neoplasias/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Neoplasias da Mama/patologia , Criança , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Coloração e Rotulagem , Adulto Jovem
5.
Acta Cytol ; 48(2): 234-8, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15085759

RESUMO

BACKGROUND: Lymphoepithelioid cell lymphoma (LCL) is a rare morphologic variant of peripheral T-cell lymphoma. Although their histopathologic and immunohistochemical findings are well known, the cytopathologic features have not been well documented. This report describes the fine needle aspiration cytology (FNAC) findings of a case of LCL. CASE: A 75-year-old woman presented with cervical, supraclavicular, axillary and mediastinal lymphadenopathy. FNAC of a cervical lymph node was performed. The smears contained a polymorphous infiltrate formed by abundant histiocytes disposed singly or in clusters, small and medium-sized to large atypical lymphoid cells and reactive cells, including eosinophils and plasma cells. Isolated capillary-sized vessels also were observed. Histopathologic and immunohistochemical examination confirmed the diagnosis of Lennert's lymphoma. CONCLUSION: Although histopathologic and immunohistochemical studies were required for a definitive diagnosis, the findings of FNAC in this case appeared distinctive and suggested the possibility of LCL.


Assuntos
Linfonodos/patologia , Doenças Linfáticas/patologia , Linfoma de Células T/patologia , Idoso , Antígenos de Superfície/metabolismo , Biomarcadores Tumorais/metabolismo , Biópsia por Agulha Fina , Tamanho Celular/fisiologia , Epitopos de Linfócito T/imunologia , Feminino , Humanos , Doenças Linfáticas/etiologia , Linfócitos/imunologia , Linfócitos/patologia
6.
Acta Cytol ; 47(3): 485-9, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12789937

RESUMO

BACKGROUND: Neurothekeoma (NT) is a rare, benign neoplasm of soft parts with a distinctive histologic appearance. To our knowledge, the cytologic findings have not been described before. We present a case of NT with the cytologic features on fine needle aspiration cytology (FNAC). CASE: A 54-year-old female presented with a circumscribed nodule in the left breast. The lesion was evaluated by FNAC. The smears showed an abundant, metachromatic, myxoid matrix with fusiform and epithelioid cells, some binucleated or multinucleated, loose or in groups and sometimes forming concentric whorls. The lesion was removed, and the diagnosis of NT was made after histopathologic study. CONCLUSION: NT is an extremely rare neoplasm in the mammary region. Fusiform and epithelioid cells arranged in concentric whorls in a myxoid tumor of soft tissue are a distinctive characteristic of this neoplasm and can suggest the diagnosis.


Assuntos
Biópsia por Agulha/métodos , Mama/patologia , Neurotecoma/patologia , Neoplasias de Tecidos Moles/patologia , Biomarcadores Tumorais/análise , Mama/cirurgia , Células Epitelioides/patologia , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Neurotecoma/química , Neurotecoma/cirurgia , Neoplasias de Tecidos Moles/química , Neoplasias de Tecidos Moles/cirurgia , Vimentina/análise
7.
Rev. esp. patol ; 36(1): 29-43, ene. 2003. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-21742

RESUMO

El diagnóstico en punción aspiración con aguja fina de "Proliferación-Neoplasia Folicular" en la patología tiroidea es poco preciso en determinar la condición neoplásica benigna o maligna de las lesiones foliculares. Este diagnóstico se basa en que haya celularidad folicular destacable o aumentada de carácter neoplásico y escaso o ausente coloide de fondo, tratando de establecer un diagnóstico concreto de benignidad o malignidad, con prioridad en este último de la exéresis quirúrgica. En este trabajo relatamos nuestra experiencia en 200 casos con el diagnóstico citopatológico de "Proliferación Folicular" y la exéresis quirúrgica, excluyendo los diagnósticos de benignidad (Bocios Coloides, Tiroiditis) o malignidad (Carcinoma Papilar, Medular u otros) con características propias. Tras el examen histológico, 83 casos (42 por ciento) fueron lesiones benignas (71, Hiperplasia Uni o Multinodular; 6, Hiperplasia Difusa y 6, Tiroiditis Linfocitaria Crónica). 65 (32,5 por ciento) correspondieron a Adenomas Foliculares.52 casos (26 por ciento) fueron Carcinomas: (27, Carcinoma Papilar; 20, Carcinoma Folicular; 3, Carcinoma Medular; 1, Carcinoma Epidermoide de Laringe poco diferenciado; 1, Carcinoma Metastásico de Colon). En 58 casos (29 por ciento) se enunció ademas el diagnóstico de Sospecha de malignida, confirmándose en 39 (68 por ciento) la presencia de carcinoma. Se postula que en el 70 por ciento de estos diagnósticos, deben ser prioritarios para la cirugía por su carácter neoplásico, tratando de delimitar las lesiones neoplásicas más agresivas. La media de la exéresis quirúrgica en los casos que fueron Carcinomas fue de 11298 días (AU)


Assuntos
Humanos , Carcinoma Papilar, Variante Folicular/patologia , Neoplasias da Glândula Tireoide/patologia , Biópsia por Agulha/métodos , Tireoidite Autoimune/patologia , Bócio/patologia , Carcinoma Medular/patologia , Carcinoma Papilar/patologia , Tireoidite Supurativa/patologia , Imuno-Histoquímica/estatística & dados numéricos
8.
Acta Cytol ; 46(2): 364-8, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-11917586

RESUMO

OBJECTIVE: To evaluate light microscopic examination of lymph node fine needle aspiration biopsy (FNAB) in order to determine the indications for ancillary procedures and biopsy. STUDY DESIGN: Reports and smears from 693 consecutive lymph node FNABs were reviewed. Fifty-five cases were excluded because of inadequacy of the material, and another 26 were excluded because follow-up information was not available. RESULTS: Cytologically, 220 cases were diagnosed as positive for malignancy and 392 as negative. Global sensitivity was 94.1% and specificity 96.9%. Sensitivity was higher for nonlymphoid neoplasms (98.2%) than for lymphoproliferative disorders (82.8%). CONCLUSION: Lymph node FNAB is a cost-effective procedure, and with adequate cytologic examination and follow-up, a large number of biopsies and time-consuming ancillary techniques can be avoided.


Assuntos
Linfonodos/patologia , Transtornos Linfoproliferativos/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/economia , Biópsia por Agulha/métodos , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Humanos , Transtornos Linfoproliferativos/diagnóstico , Microscopia/economia , Microscopia/métodos , Pessoa de Meia-Idade , Sensibilidade e Especificidade
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