Prostatic morphological changes throughout life: Cytochemistry as a tool to reveal tissue aging markers.

The prostate undergoes normal or pathological morphological changes throughout life. An understanding of these changes is fundamental for the comprehension of aging-related pathological processes such as benign prostatic hyperplasia (BPH) and cancer. In the present study, we show some of these morphological changes, as well as histochemical techniques like Weigert's resorcin-fuchsin method, Picrosirius Red, and Gömöri's reticulin for use as tools in the study of prostate tissue under light microscopy. For this purpose, prostates of the Mongolian gerbil (n = 9), an experimental model that develops BPH spontaneously, were analyzed at three life stages: young (1 month old), adult (3 months old), and old (15 months old). The results showed that fibrillar components such as collagen, and reticular and elastic fibers, change throughout life. In young animals, the prostate has cuboidal epithelium surrounded by thin layers of smooth muscle, continuous collagen fibers, winding reticular fibers, and sporadic elastic fibers. With adulthood, the epithelium becomes columnar, encircled by compacted muscle cells among slender collagen fibers, elongated reticular fibers, and linear elastic fibers. In aging individuals, the prostate's epithelium stratifies, surrounded by thick muscle layers among dense collagen fibers, disordered reticular fibers, and elastic fibers in different planes. We also identified a few accumulations of lipid droplets and lipofuscin granules in adult animals and high accumulation in old animals evidenced by Oil red O and Gömöri-Halmi techniques, respectively. The histochemical techniques presented here have been demonstrated to be useful and accessible tools in prostate studies. RESEARCH HIGHLIGHTS: Cytochemical techniques to study prostate morphology. The prostate changes with age.

Diagnostic Utility of a Modified Reticulin Algorithm in Pediatric Adrenocortical Neoplasms.

Pediatric adrenocortical neoplasms (ACNs) are extremely rare tumors in contrast to their adult counterparts. Distinguishing benign from malignant is challenging based on pure morphologic grounds. Previously, 2 scoring systems were proposed in pediatric ACN, including the Wieneke criteria (WC) and its modified version (modified WC [mWC]). In adults, the reticulin algorithm (RA) has proven inexpensive, reliable, predictive, and reproducible; however, it has been validated only recently in children in a limited number of cases. This study aims to assess the RA utility compared with other scoring systems in a series of 92 pediatric ACNs. All cases were individually scored, and mitotic rate cutoffs were recorded. Reticulin alterations were classified as quantitative and qualitative. Outcome data were available in 59/92. The median age was 5 years (0.1 to 18 y) with an M:F of 0.6. Clinical presentation included virilization (39%), Cushing syndrome (21%), other symptoms (4%), and asymptomatic (36%). The reticulin framework was intact in 27% and altered in 73% of cases, showing qualitative (22%), quantitative (73%), and both (5%) alterations. In patients with favorable outcomes, 59% showed either intact reticulin or qualitative alteration compared with the unfavorable outcome group, where 90% showed quantitative alterations. All scoring systems WC ( P < 0.0001), mWC ( P = 0.0003), and the adult/pediatric RA ( P < 0.0001) had predictive value. The RA is comparable to WC and mWC, easier to apply, and is the most sensitive histopathological approach to identifying aggressive behavior in pediatric ACN. Its integration into the WC might be helpful in ACN of uncertain malignant potential and deserves further investigation.

A Case of Anti-reticulin Antibody-positivity in Metachronous Double Primary Cancer

No abstract available.

Primary Myelofibrosis with MPL S505N Mutation: The First Case Reported in Korea

MPL mutation is an important molecular marker in myeloproliferative neoplasms (MPN). Although MPL W515 is a hot spot for missense mutations in MPN, MPL S505 mutations have been reported in both familial and non-familial MPN. A 72-year-old male visited the hospital, complaining mainly of dizziness and epistaxis. Leukocytosis, anemia, thrombocytopenia, tear drop cells, nucleated RBCs, and myeloblasts were observed in both complete blood cell counts and peripheral blood smears. Bone marrow aspiration failed due to dilution with peripheral blood. BM biopsy indicated hypercellular marrow, megakaryocytic proliferation with atypia, and grade 3 reticulin fibrosis. Conventional cytogenetics results were as follows: 46,XY,del(13)(q12q22)[19]/46,XY[1]. Molecular studies did not detect JAK2 V617F, BCR/ABL translocation, JAK2 exon 12, and CALR exon 9 mutations. The MPL S505N mutation was verified by colony PCR and Sanger sequencing following gene cloning. Based on the above findings, a diagnosis of overt primary myelofibrosis (PMF) was indicated. Mutation studies of buccal and T cells were not conducted. Further, family members were not subjected to mutation studies. Therefore, we were unable to determine whether this mutation was familial or non-familial. Six months after the first visit to the hospital, the patient died due to pneumonia and sepsis. Thrombotic symptoms or major bleeding events did not develop during the survival period following diagnosis of PMF. To the best of our knowledge, this may be the first reported case of PMF with the MPL S505N mutation in Korea.

Myxoid and Sarcomatoid Variants of Adrenocortical Carcinoma: Analysis of Rare Variants in Single Tertiary Care Center

The aim of this study is to describe rare variants of adrenocortical carcinoma (ACC) and to compare the prognosis with that of conventional ACC. We retrospectively reviewed 8 cases of myxoid variant, 1 sarcomatoid variant, and 14 cases of conventional ACC, who underwent surgical resection at the Asan Medical Center between 1996 and 2014. An analysis of the clinicopathological characteristics, including the Weiss score, Ki-67 labeling index, and reticulin framework assessment is presented. The mean age of patients with myxoid/sarcomatoid ACC was 45 years; 4 out of 9 patients were women. Mean primary tumor size was 12.9 cm and the mean weight was 702.4 g. Seven patients presented in an advanced stage (stage III/IV); 8 of these eventually developed distant metastasis. The mean Weiss score was 5.0 points and the Ki-67 labeling index was 15.6%. The extent of myxoid or sarcomatoid change on histological examination ranged from 10% to 75% of the examined tumor areas; reticulin framework alteration was observed in all cases. Four patients showed venous tumor thrombus. Most of the clinicopathological parameters were not significantly different from those of conventional ACC. However, myxoid or sarcomatoid variant (hazard ratios [HR], 3.59; 95% confidence intervals [CI], 1.13–11.38; P = 0.030) and Ki-67 labeling index (HR, 3.97; 95% CI, 1.18–13.41; P = 0.030) were independent predictors of overall survival after adjusting for age and sex. Myxoid or sarcomatoid histological features or an increased Ki-67 labeling index may be associated with poor overall survival in patients with ACC.

WHO Grade IV Gliofibroma: A Grading Label Denoting Malignancy for an Otherwise Commonly Misinterpreted Neoplasm

We report a 50-year-old woman with no relevant clinical history who presented with headache and loss of memory. Magnetic resonance imaging showed a left parieto-temporal mass with annular enhancement after contrast media administration, rendering a radiological diagnosis of high-grade astrocytic neoplasm. Tumour sampling was performed but the patient ultimately died as a result of disease. Microscopically, the lesion had areas of glioblastoma mixed with a benign mesenchymal constituent; the former showed hypercellularity, endothelial proliferation, high mitotic activity and necrosis, while the latter showed fascicles of long spindle cells surrounded by collagen and reticulin fibers. With approximately 40 previously reported cases, gliofibroma is a rare neoplasm defined as either glio-desmoplastic or glial/benign mesenchymal. As shown in our case, its prognosis is apparently determined by the degree of anaplasia of the glial component.

Two Cases of Hepatic Sinusoidal Dilatation Mimicking Hepatic Metastases / 대한소화기학회지

Hepatic sinusoidal dilatation is a rare benign vascular disorder characterized by focal dilatation of the sinusoidal spaces. In most cases, the underlying etiology is unclear but it may be related to the impairment of venous outflow or sinusoidal infiltration by diverse causes. Diagnosing hepatic sinusoidal dilatation based soley on imaging study is not easy since there are no pathognomonic radiologic findings indicative of this condition. Recently, the authors experience two cases of hepatic sinusoidal infiltration. The first patient was a 53-year-old man detected to have multiple hepatic nodules on ultrasonography (US) during a routine medical check-up. The second patient was an 82-year-old woman with abdominal discomfort who was referred from local clinic with high suspicion of hepatic metastases on US. In both cases, CT scan demonstrated multiple nodules with rim enhancement on arterial phase that became iso-dense to adjacent liver parenchyma on delayed phase. On MRI, these nodules showed rim enhancement on arterial phase, had high signal intensity on T2 weighted images, and became iso-intense with partial defect on hepatobiliary phase. Because imaging studies could not exclude the presence of hepatic metastases, liver biopsy was performed and it demonstrated hepatic sinusoidal dilatation with well preserved reticulin fiber without any evidence of malignancy. Herein, we report two cases of idiopathic hepatic sinusoidal dilatation mimicking hepatic metastases.

Correlation of chromosome karyotype with dyshaematopoiesis and reticulin in myelodysplastic syndrome / 中国实验血液学杂志

This study was purposed to explore the correlation of chromosome karyotype with dyshaematopoiesis and reticulin in myelodysplastic syndrome (MDS). The data of 202 MDS patients diagnosed and treated in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed in term of chromosome karyotype, dyshaematopoiesis and reticulin detection results. The chromosome karyotypes were categorized according to the International Prognostic Scoring System (IPSS). The results showed that there was a positive correlation between chromosome karyotype grading and number of lineages with dyshaematopoiesis (r = 0.443, P < 0.05). The detected rates of multilineage dyshaematopoiesis in patients with good, intermediate and poor chromosome karyotypes were 44.4%, 71.4% and 96.3% respectively. There was a positive correlation between chromosome karyotype grading and reticulin grading (r = 0.451, P < 0.05). The positive rates of reticulin in patients with good grading, intermediate and poor chromosome karyotypes were 36.8%, 64.3% and 92.6% respectively. The detected rate of multilineage dyshaematopoiesis, number of lineages with dyshaematopoiesis, the positive rate of reticulin and reticulin grade in patients with poor karyotypes were higher than those in patients with intermediate or good chromosome karyotypes (separately P < 0.01). The above data in patients with intermediate chromosome karyotypes were higher than those in patients with good chromosome karyotypes (separately P < 0.01). It is concluded that the chromosome karyotype grading positively correlates with the number of lineages with dyshaematopoiesis and reticulin grading. When the chromosome karyotype changed from good to poor, the detected rate of multilineage dyshaematopoiesis, number of lineages with dyshaematopoiesis, positive rate of reticulin and reticulin grading became higher and higher.

Discrepant Results for BRAF V600E Mutation Among Different Specimens in a Case of Hairy Cell Leukemia

No abstract available.

High concentration of reticular fibers in periurethral region of the prostatic urethra from patients with benign prostatic hyperplasia as revealed by stereology / Alta concentración de fibras reticulares en la región periuretral de la uretra prostática de pacientes con hiperplasia prostática benigna revelada por estereología

The goal of this investigation was to analyze and quantify changes of the reticular fibers in the prostatic urethra of patients with benign prostatic hyperplasia (BPH) and compare with a control group. Prostatic urethra tissue samples were obtained from ten patients (age range 65 to 79 years, mean 66) with clinical symptoms of bladder outlet obstruction who had undergone open prostatectomy. The ten control group samples (urethral tissue samples from the transitional zone) were collected from prostates obtained during autopsy of accidental death adults of less than 25 years. The Vv of the reticular fibers was determined with stereologic methods from 25 random fields per sample using the point-count method with a M-42 grid test system. The quantitative data were analyzed using the Kolmogorov-Smirnov and Mann-Whitney U tests. The Vv (mean+/-SD) in the control and BPH groups respectively were: 23.4+/- 1.8 and 30.3 +/- 1.2 (0.001). BPH cause significant increase of reticular fibers in prostatic urethra...

El objetivo de esta investigación fue analizar y cuantificar los cambios de las fibras reticulares en la uretra prostática de pacientes con hiperplasia prostática benigna (HPB) y compararlo con un grupo control. Muestras de tejido de uretra prostática se obtuvieron de diez pacientes (rango de edad 65 a 79 años, media 66) con síntomas clínicos de obstrucción del tracto urinario inferior que se habían sometido a prostatectomía abierta. Las diez muestras del grupo de control (muestras uretrales de tejido de la zona de transición) se obtuvieron de próstatas durante la autopsia de sujetos adultos con muerte accidental menores de 25 años. El Vv de las fibras reticulares se determinó con métodos estereológicos de 25 campos al azar por muestra utilizando el método de valor de conteo con el sistema M-42. Los datos cuantitativos se analizaron mediante la prueba de Kolmogorov-Smirnov y Mann-Whitney U. El Vv (media +/- DE) en el grupo control y BPH, respectivamente, fueron: 23,4 +/- 1,8 y 30,3 +/- 1,2 (0,001). La BPH causó aumento significativo de fibras reticulares en uretra prostática...

Autologous peripheral blood stem cell transplantation with high-dose therapy for anaplastic large cell lymphoma with progressive myelofibrosis / 대한내과학회지

Myelofibrosis is a myeloproliferative neoplasm characterized by abnormal bone marrow megakaryocyte proliferation with reticulin and collagen fibrosis, leukoerythroblastosis, anemia, increased level of serum lactate dehydrogenase and splenomegaly. Myelofibrosis associated with malignant lymphoma is rare and survival rates appear to have been poor. Herein, we describe our experience in a patient who remained in complete remission with high-dose therapy (HDT) with autologous peripheral blood stem cell transplantation (PBSCT) for ALK-negative ALCL presenting with rapidly progressing myelofibrosis.

Evaluación sistemática de la biopsia de médula ósea en casos de sospecha de mielofibrosis primaria. Propuesta de informe diagnóstico estandarizado. Consenso de expertos de las SEAP/SEHH / Systematic evaluation and standardised reporting of cases with suspicion of primary myelofibrosis. Consensus of SEAP/SEHH hematopathology experts

Se ha elaborado un consenso aplicando la metodología Delphi para acordar cuál debe ser la sistemática de evaluación e información de las biopsias de médula ósea en las neoplasias mieloproliferativas crónicas, especialmente en casos de mielofibrosis primaria (MFP). Un panel de 10 expertos hematopatólogos ha elaborado un cuestionario que se ha remitido a 37 hematopatólogos con preguntas acerca de los datos clínicos, analíticos y moleculares a conocer en la fase pre-analítica, parámetros histopatológicos a evaluar y contenido del informe diagnóstico final. Se realizaron 2 rondas buscando un consenso mínimo del 70% para los parámetros imprescindibles y recomendables. A partir de los resultados del consenso se elabora y propone un prototipo de informe histopatológico para informar de manera homogénea y reproducible los casos de MFP (AU)

A consensus based on Delphi methodology was developed to produce a guide for the evaluation and reporting of bone marrow biopsies in patients with a clinical suspicion of myeloproliferative neoplasm with fibrosis. Ten expert haematopathologists formulated a questionnaire including: clinical and laboratory data required before regarding a biopsy suspicious for primary myelofibrosis (PMF), descriptive aspects to be reported and the main histopathological differential diagnoses to be considered. It was circulated among 37 hematopathologists and consensus was defined when more than 70% of the experts "strongly agreed" or "agreed" after two rounds. The recommendations gave rise to a proposal for a standardized diagnostic report form to aid in the diagnostic workup and homogeneous reporting of cases with a clinical suspicion of PMF (AU)

Escore clínico-patológico para predizer o risco de metástases e recorrência local em pacientes com carcinoma cortical adrenal e papel do algoritmo da reticulina na distinção entre adenomas e carcinomas corticais adrenais / Clinicopathological score for predicting the risk of metastases and local recurrence in patients with adrenal cortical carcinoma and role of the reticulin algorithm in distinguishing between adrenal cortical adenomas and carcinomas

INTRODUÇÃO: o padrão-ouro para o diagnóstico histológico dos tumores corticais adrenais (TCAs) e sua diferenciação entre adenomas e carcinomas é o sistema de Weiss, cuja aplicação é limitada pela baixa reprodutibilidade de alguns dos critérios que o compõe. Recentemente foi proposto e validado um algoritmo diagnóstico para os TCAs baseado na integridade do arcabouço de reticulina e da membrana basal. Os carcinomas adrenais são tumores raros e apresentam prognóstico reservado, mesmo nos pacientes com doença aparentemente localizada. Além do estadiamento e da extensão da ressecção cirúrgica, outros dados foram reportados na literatura como tendo importância prognóstica, tais como idade ao diagnóstico, padrão funcional, tamanho tumoral, extensão local do tumor primário e alguns achados histológicos e imuno-histoquímicos, com destaque à taxa mitótica e ao índice de Ki-67. O sistema de Weiss, embora permita o diagnóstico diferencial entre adenomas e carcinomas, não foi testado completamente como uma ferramenta para distinguir os carcinomas com boa evolução clínica daqueles com desfecho desfavorável. OBJETIVOS: o presente estudo teve como objetivo primário construir um nomograma para estimar o risco de metástases e recorrência local em portadores de carcinoma adrenal, a partir de dados clínico-patológicos. O objetivo secundário foi avaliar o desempenho do algoritmo da reticulina no diagnóstico diferencial entre adenomas e carcinomas do córtex adrenal. MÉTODOS: para a construção do nomograma, foram analisados dados clínico-patológicos de 129 portadores de carcinomas adrenais atendidos no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 1976 e 2010. A avaliação do desempenho do algoritmo da reticulina para o diagnóstico histológico dos TCAs foi feita a partir do exame de 89 lâminas (45 adenomas e 44 carcinomas adrenais)...

INTRODUCTION: The gold standard for the histological diagnosis of adrenal cortical tumors (ACTs) and for the differentiation between adenomas and carcinomas is the Weiss system, whose application is limited by poor reproducibility of some of its criteria. Recently, a diagnostic algorithm for ACT diagnosis based on the integrity of the reticulin network and the basal membrane has been proposed and validated. Adrenal carcinomas are rare tumors and have a poor prognosis, even in patients with apparently localized disease. Besides tumor staging and extent of surgical resection, other data have been reported in the literature as having prognostic importance, such as age at diagnosis, the functional pattern, tumor size, local extension of the primary tumor and some histological and immunohistochemical findings, such as the mitotic rate and the Ki-67 index. The Weiss system, while allowing the differential diagnosis between adrenal cortical adenomas and carcinomas, has not been fully tested as a tool for distinguishing carcinomas with favorable clinical outcome from those with unfavorable outcome. OBJECTIVES: The primary objective of this study was to construct a nomogram for estimating the risk of metastasis and local recurrence in patients with adrenal cortical carcinoma, based on clinical and pathological data. The secondary objective was to evaluate the performance of the reticulina algorithm in the differential diagnosis between adenomas and carcinomas of the adrenal cortex. METHODS: For the construction of the nomogram, clinical and pathological data from 129 patients with adrenal cortical carcinomas treated at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between 1976 and 2010 were analyzed. The evaluation of the performance of the reticulin algorithm for the histological diagnosis of ACTs was made from the examination of 89 slides (45 adenomas and 44 adrenal carcinomas)...

Solitary Cutaneous Myxoma

A solitary cutaneous myxoma, referred to as superficial angiomyxomas, is relatively uncommon benign myxoid soft tissue tumors. The lesion usually present on the head, neck, and trunk of adults as a slowly growing asymptomatic nodule. Herein, we describe a case of a pedunculated solitary cutaneous myxoma arising on the vertex of a 48-year-old man, but with no evidence of Carney syndrome. Histologically, the tumor was composed of vascular, mucinous matrix with a network of fine collagen and reticulin fibers, containing stellate and spindle-shaped fibroblasts. There was no evidence of malignancy

Intracranial Solitary Fibrous Tumor

Solitary fibrous tumor is a spindle cell neoplasm that can arise in any place of the body. Intracranial solitary fibrous tumors are rare. To our knowledge, only 57 cases with intracranial lesion have been reported. In Korea three cases have been reported. Our case was a 23-year-old woman who presented with morning headache. MRI showed a large intra-axial mass involving falx with typically isointense and heterogeneous strong enhancement on T1 weighted image in the right parieto-occipital region. Histologically the tumor showed spindle shaped cells within matrix with thick collagen deposition, hypercellularity, focal necrosis, and pleomorphism. Immunohistochemical study demonstrated diffuse positivity for CD34, Vimentin, Reticulin. In case of the intracranial tumors involving the meninges, we also should consider the solitary fibrous tumor with immunohistochemical staining for accurate diagnosis.

Reduced Intensity Conditioning Regimen Followed by Allogeneic Peripheral Blood Stem Cell Transplantation for Acute Panmyelosis with Myelofibrosis

A 44-year-old male presented with a month history of exertional dyspnea and dizziness. A peripheral blood smear revealed a pancytopenia with 3% of blasts. We were not able to obtain a bone marrow aspirate, but a biopsy specimen showed hypercellularity, proliferation of trilineage cell lines (panmyelosis) with extensive myelofibrosis, and clusters of immature cells at the paratrabecular area. After remission induction therapy with idarubicin 12mg/m2 (D1-3) and cytosine arabinoside 100mg/m2 (D1-7), the bone marrow blast count was decreased, but the marrow fibrosis and pancytopenia persisted. Peripheral blood stem cell transplantation from his HLA-matched brother was performed after administering fludarabine 30mg/m2 for 5 days and busulfan 3.2mg/kg for 2 days. Early engraftment occurred and the bone marrow reticulin fibrosis disappeared. Full-donor chimerism was demonstrated at day 22 by performing short tandem repeats analysis and this was maintained for 1 year. The patient has survived 20 months after transplantation without any complication.

Reticulin morphometry and collagen fibers optical anisotropy as assessed by image analysis after silver impregnation

A new method for the impregnation of tissue sections with ammoniacal silver carbonate in terms of single-step reaction, no gold toning, no oxidation step and silver impregnation after treatment with pancreatic (alfa)-amylase is described. This method yields silver nanocrystalloids with 18.40 nm in average diameter [16]. Natural carbohydrate radicals probably acting as natural reducing agents for silver are assumed to occur. Despite the fact that the method is not specific, reticulin fibers (type III colagen) were clearly distinguished from other collagen fibers types and easily and accurately segmented by image analysis (IA) systems, when using this procedure. Data from myocardial reticulin fibers are presented. Collagen bundles (type I collagen rich structures) exhibited intense linear dichroism (LD) interms of gray averages measured by IA (non-impregnated, natural, collagen fibers do not show LD) Anomalous dispersion of birefringence was also detected, highlighting typical morphologies, including crimp, which allow us to propose the methodo for molecular order studies and to assess collagen bundles as chiral objects, especially together with LD data.

Anticorpos séricos na doença celíaca / Celiac disease serum antibodies

O diagnóstico acurado da doença celíaca é muito importante porque os pacientes devem aderir a uma dieta sem glúten por toda a vida e diante do maior risco de complicações, como as neoplasias intestinais, que poderá advir do não cumprimento rigoroso da dieta. Nesta revisão são apresentados os novos conceitos referentes às formas de apresentação da doença (ativa, silenciosa, latente e potencial) e sua associação com outras enfermidades e são focalizados principalmente o valor e a eficácia da determinação dos anticorpos séricos antigliadina e dos autoanticorpos anti-reticulina, antiendomísio e antitransglutaminase tecidual, no auxílio ao diagnóstico e seguimento da doença celíaca.

Comparaçäo dos anticorpos anti reticulina e antiendomísio classe IgA para diagnóstico e controle da dieta na doença celíaca / Comparison of IgA class reticulin an endomysium antibodies for diagnosis and control of the diet in celiac disease

Sensibilidade ao glúten é um estado de elevada resposta imunológica (celular e humoral) à ingestão de proteínas do glúten do trigo, centeio, cevada e aveia, em indivíduos geneticamente predispostos. A doença celíaca é sua expressão mais freqüente, variando as formas de apresentação. Tem como tratamento a exclusão de alimentos contendo as gliadinas tóxicas. Embora a biopsia do intestino delgado proximal seja necessária, tem-se ressaltado a importância de testes sorológicos no rastreamento, diagnóstico e monitorização da dieta isenta de glúten em pacientes com doença celíaca. O objetivo do presente estudo foi investigar a presença dos anticorpos antiendomísio (EmA-IgA) e anti-reticulina (ARA-IgA) em 56 pacientes celíacos (17 recém-diagnosticados; 24 aderentes à dieta; 15 com trasngressão à dieta). Os anticorpos foram detectados por imunofluorescência indireta, utilizando como substrato cordão umbilical humano para os EmA-IgA, fígado e rim de rato para os ARA-IgA. Nos pacientes recém diagnosticados e no grupo com transgressão à dieta houve positividade total de 100 por cento para os EmA-IgA e 59,4 por cento para ARA-IgA. Nos pacientes aderentes à dieta nenhum dos anticorpos foi detectado. Dentre os 32 pacientes positivos, a concordância foi de 59,4 por cento (19), sendo que 40,6 por cento (13/32) eram ARA-IgA negativo e EmA-IgA positivo. Nenhum paciente mostrou-se positivo para os ARA-IgA e negativo para os EmA-IgA. Portanto, a sensibilidade para os EmA-IgA foi de 100 por cento e de 59,4 por cento para os ARA-IgA. A associação dos dois testes não aumentou os índices de positividade total nas amostras. Conclui-se que, atualmente, a pesquisa dos EmA-IgA pode constituir teste sorológico de escolha, seja para diagnóstico, seja para seguimento dos pacientes celíacos, pelo alto valor preditivo, alta sensibilidade e especificidade e relativo baixo custo quando se utiliza cordão umbilical humano como substrato.

Staining Characteristics of Granular Deposits of Granular Dystrophy in Six Cases

Penetrating keratoplasty was performed in six eyes of granular corneal dystrophy. Vision was improved from worse than 0.05 to better than 0.4. Mean follow-up period is 14 months (12-18 months). Corneal deposits were stained for H and E. Masson trichrome, Wilder's reticulin and Luxol fast blue but not for PAS, Congo red and Oil red a stain. Electron micorscopic examination showed that polymorphic, electron dense rod-shaped bodies were present in the Bowman's layer and between stromal lamellae and in the interceliular space of corneal epithelium. And, for the first time we found a area looked like a transformation from normal stroma to the granular deposit.