RESUMEN
To efficiently treat type 1 diabetes, exogenous insulin injections currently represent the main approach to counter chronic hyperglycaemia. Unfortunately, such a therapeutic approach does not allow for perfectly maintained glucose homeostasis and, in time, cardiovascular complications may arise. Therefore, seeking alternative/improved treatments has become a major health concern as an increasing proportion of type 2 diabetes patients also require insulin supplementation. Towards this goal, numerous laboratories have focused their research on ß-cell replacement therapies. Herein, we will review the current state of this research area and describe the cell sources that could potentially be used to replenish the depleted ß-cell mass in diabetic patients.
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Tratamiento Basado en Trasplante de Células y Tejidos/métodos , Diabetes Mellitus Tipo 1/terapia , Células Madre Embrionarias Humanas , Células Madre Pluripotentes Inducidas , Células Secretoras de Insulina/trasplante , Diferenciación Celular , Técnicas de Reprogramación Celular , Hepatocitos , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Trasplante de Islotes Pancreáticos/métodos , Páncreas/citología , Células MadreRESUMEN
INTRODUCTION: Vulvar carcinomas comprise almost 5% of all malignant tumors of the female genital tract. The final diagnosis is made after histologic examination of biopsy specimens obtained from different sites in the vulva. Primary therapeutic approach in all cases is surgery, whereas the operative procedure depends on the size and location of the lesion, stage of the disease, general condition and age of the patient, as well as on the condition of the surrounding tissue and possible continuance of sexual life. METHODS: In the period from 1985-1999, there were 39 patients with invasive forms of vulvar carcinomas operated at the Department of Gynaecology in Novi Sad. Radical vulvectomy associated with inguinal-femoral lymphadenectomy was performed in 26 (66.6%) patients. During 1994, a wide "butterfly-shaped "block" dissection of the vulva, pubis and inguinal area was done, whereas during the following period, the operative area was reduced by application of separate inguinal incisions after Hacker, leaving the tissue bridge in between. RESULTS: The mean age of operated patients was 62.1 years (34-85). There were 53.8% stage I, 17.9% stage II, 20.7% stage III and 7.6% stage IV patients. In patients undergoing radical surgery the average number of extirpated lymph nodes was 16.3 out of which in 7 (26.9%) cases the nodes were positive. Lethal outcome was recorded in 4 (15.3%) patients. Two (7.6%) died of pulmonary thromboembolism and 2 (7.6%) during the following 5 years for diffuse dissemination of metastases. During 1994, complications were recorded in 69.2% operated patients versus 7.6% recorded during the following period. CONCLUSIONS: Radical vulvectomy associated with bilateral inguinal-femoral lymphadenectomy is a standard procedure in surgical treatment of invasive stages of vulvar carcinoma protruding more than 1 mm. The application of two separate inguinal incisions after Hacker resulted in shortening the intrahospital postoperative period from 34.2 to 14 days and reduction of the rate of wound dehiscence and postoperative complications in the period following 1994.
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Carcinoma/cirugía , Escisión del Ganglio Linfático , Vulva/cirugía , Neoplasias de la Vulva/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Ingle , Humanos , Persona de Mediana EdadRESUMEN
Squamous cell carcinoma is a morphologically heterogenous neoplasm of specific histologic entities involved in human papillomavirus infection. The condylomatous types of squamous cell vulvar carcinoma, caused by HPV-16, most often manifest as exophytic papillary tumors mimicking condylomas.
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Neoplasias del Ano/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Condiloma Acuminado/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Papillomaviridae/aislamiento & purificación , Neoplasias Cutáneas/diagnóstico , Neoplasias de la Vulva/diagnóstico , Abdomen/cirugía , Neoplasias del Ano/patología , Neoplasias del Ano/cirugía , Neoplasias del Ano/virología , Carcinoma de Células Escamosas/secundario , Carcinoma de Células Escamosas/cirugía , Condiloma Acuminado/complicaciones , Condiloma Acuminado/patología , Condiloma Acuminado/cirugía , Femenino , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Neoplasias Cutáneas/secundario , Neoplasias Cutáneas/cirugía , Colgajos Quirúrgicos , Neoplasias de la Vulva/patología , Neoplasias de la Vulva/cirugía , Neoplasias de la Vulva/virologíaRESUMEN
INTRODUCTION: Precancerous changes of the cervix frequently occur in women in their reproductive age and are associated with sexually transmitted diseases. The evolution of these lesions qualifies them as precursors of malignancy, and their origination is associate with various risk factors, human papillomavirus (HPV) being the most important one. A proper clinical approach to and treatment of these changes depend on histologic diagnosis, which must be both terminologically adequate and apprehensive. PREVIOUS CLASSIFICATIONS AND TERMINOLOGY: The continuous change in nomenclature and lack of a uniform terminology has become the source of confusion and misunderstanding between gynecologists and pathologists. The term carcinoma in situ was first introduced in 1930 to denote the lesion, which is a reliable precursor of malignancy. Less intensive epithelial changes of the cervix were classified as dysplasia. Depending on extensive the change was, dysplasias were subclassified into mild, moderate and severe. Carcinoma in situ and various degrees of dysplasias were more precisely defined at the First International Congress of Exfoliative Cytology, which has also enabled the biological differentiation between these entities. The histologic differentiation of these lesions was, however, subjective and quite unreliable. UP-TO-DATE CLASSIFICATION AND TERMINOLOGY: Cellular changes in carcinoma in situ and in severe dysplasias were mutually so similar that pathologists could not make a reproducible difference between these lesions. Therefore, a conclusion was reached that these changes were one and the same process, whereas the differences were merely of quantitative nature. This discovery resulted in a terminological change, i.e. in a unique term--cervical intraepithelial neoplasia (CIN), with its gradation from 1 to 3. The 3rd grade of cervical intraepithelial neoplasia, according to the new terminology, encompassed changes which pathologists could not properly differentiate before. Many other changes with various, mostly descriptive terminology have also been included in the CIN category, thus preventing misunderstanding between pathologists and gynecologists. Besides the CIN classification, which has been most widely used today, there is also a division into only two biologically different categories: low-grade cervical intraepithelial neoplasia (Lo-CIN) and high-grade cervical intraepithelial neoplasia (Hi-CIN). The latter modification is included in the Bethesda system of cytologic diagnoses as low-grade squamous intraepithelia lesion (L-Sil) and high-grade squamous intraepithelial lesions (H-Sil). CONCLUSION: The use of a uniform terminology and classification minimizes the problem of diagnosing precancerous cervical lesions and enables adequate clinical treatment of these patients.
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Lesiones Precancerosas/clasificación , Terminología como Asunto , Neoplasias del Cuello Uterino/clasificación , Femenino , Humanos , Lesiones Precancerosas/patología , Displasia del Cuello del Útero/patología , Neoplasias del Cuello Uterino/patologíaRESUMEN
A diagnostic and therapeutic approach in the identification of malignant lesions and the types of HPV in 11 patients with gigantic condylomatous vulvar protuberances is presented. Different histological types of squamous cell vulvar carcinoma have been found in 8 (72.7%) cases: condylomatous (4), verrucous (3) and basaloid type of the carcinoma (1). HPV type 16, confirmed in 5 cases, was most often present (4 condylomatous and 1 basaloid carcinoma types). Other types of HPV such as HPV-6 was detected in 3 cases of verrucous, type 11 in 2 cases of verrucous and condylomatous carcinoma and type 18 in 1 case of condylomatous carcinoma. Radical vulvectomy followed by bilateral inguinofemoral lymphadenectomy was performed in 4 patients with condylomatous carcinoma, hemivulvectomy in basaloid carcinoma whereas wide local excision was performed in the verrucous type of carcinoma. No patient died except 1 with condylomatous carcinoma in whom 6 positive lymph nodes were detected after the primary operation. The patient died 4 years later following 3 excisions of local recurrences.
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Condiloma Acuminado/patología , Papillomaviridae/clasificación , Enfermedades de la Vulva/patología , Adulto , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/virología , Condiloma Acuminado/cirugía , Condiloma Acuminado/virología , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Enfermedades de la Vulva/cirugía , Enfermedades de la Vulva/virología , Neoplasias de la Vulva/patología , Neoplasias de la Vulva/cirugía , Neoplasias de la Vulva/virologíaRESUMEN
INTRODUCTION: Mature cystic teratoma is the most common type of ovarian teratomas and also the most frequent tumor originating from germ cells. Usually unilateral, it is, by definition, composed of well-differentiated derivates which originate from all three layers. It is most frequently diagnosed in the female reproductive period; in its pure form, it is generally benign, but occasionally it may undergo malignant transformation in one of its elements. CASE HISTORY: The authors report a case of a 43-year-old woman who underwent a thyroid regulation substitutive therapy 12 years after thyroidectomy which had been performed because of Basedow's disease. On the occasion of her fourth delivery by cesarean section, bilateral cystical formations in both ovaries were found. Upon ending the delivery, the right ovary with the cyst was surgically removed, as well as part of the cystically changed left ovary. The pathohistological analysis of the samples taken from the left ovary cyst pointed to the following diagnosis: dermoid cyst of the ovary a mature cystic teratoma, whereas the samples from the cystic tumor of the right ovary were diagnosed as: ovarian teratoma malignant a papillary carcinoma of the thyroid tissue and cystadenoma papillare serosum ovarii. The histological type of the malignant thyroid tissue neoplasm in the teratoma was a papillary carcinoma consisting of papillary proliferations lined by cuboidal, cylindrical and pseudostratified epithelium with charasteristic "ground glass" nuclei, but without invasion into the blood vessels. DISCUSSION: Malignant transformation of the ectopic thyroid tissue, which is one of the elements of the ovarian cystic teratoma, is extremely rare: it is diagnosed on basis of the histological picture and criteria which are the same as for the tumor of the thyroid gland. One should not exclude a pssibility that the identical or different pathological alterations characteristic of the thyroid gland may also be detected in the ectopic thyroid tissue of a dermoid cyst. CONCLUSION: The reported case was chosen due to its complex and rich clinical and pathohistological picture characterized by the occurrence of a bilateral dermoid cyst with the malignant transformation of the thyroid tissue. The malignant neoplasm in the mature ovarian cystic teratoma was papillary carcinoma of the thyroid tissue with all histological properties typical for the thyroid gland carcinoma. The possibility of the malignant transformation of the endodermal thyroid tissue in the mature ovarian cystic teratoma and changes in the thyroid gland of the Basedow's disease type diagnosed before are without clear causation.
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Carcinoma Papilar/complicaciones , Coristoma , Quiste Dermoide/complicaciones , Neoplasias Ováricas/complicaciones , Glándula Tiroides , Neoplasias de la Tiroides/complicaciones , Adulto , Carcinoma Papilar/patología , Coristoma/patología , Quiste Dermoide/patología , Femenino , Humanos , Neoplasias Ováricas/patología , Glándula Tiroides/patología , Neoplasias de la Tiroides/patologíaRESUMEN
INTRODUCTION: Human papillomavirus (HPV) infection of the female genital tract is a sexually transmissible disease most frequently manifested by warts on the vulva, anogenital region, vagina and cervix. Precancerous lesions of vulvar intraepithelial neoplasia (VIN) as well as the development of invasive malignant neoplasms are also related to the infections caused by some HPV types. Infections with HPV-6 and HPV-11, the disease is often polycentric, sometimes reaching gigantic dimensions, elicit venereal warts. Amongst several histological criteria for diagnosing this change, the most typical is koilocytosis, with perinuclear halo formation with a thick cytoplasmic border. Precancerous changes of the vulva and anogenital region are displastic changes of the squamous epithelium, characterized by high mitotic activity, disturbance of nucleocytoplasmic relationship and lack of differentiation in the upper epithelial layers. The changes in the epithelium divided into thirds starting from basal membrane is the main criterion in estimating the degree of dysplasia, marked by VIN 1, VIN 2 and VIN 3. According to the nuclear and cytoplasmic characteristics. VINs are subclassified into three types: basaloid, verrucous (condylomatous) and well differentiated. Basaloid and verrucous (condylomatous) VIN types are morphological markers of HPV infection. The squamous cell carcinoma of the vulva and anogenital region is a morphologically heteregenous neoplasm with particular histological entities connected with HPV infection. CASE REPORTS: Four cases of patients with changes in the anogenital region in the form of small to gigantic polypoid formations were reported. The histological features corresponded to vulvar intraepithelial neoplasms (VIN lesions), as well as to neoplastic changes characteristic of HPV infection. The evolution of the changes from typical condylomas through VIN lesions to infiltrative neoplasms, taking place over the years, was also verified. DISCUSSION: Some histologically typical epithelial changes in the scope of VIN, as well as some histological types of malignant neoplasms, are associated with HPV-16 and HPV-18, and with HPV-31 to a smaller extent. The oncogenic potential of these viruses is established by in vitro cultures, but also by their finding in 50-90% of genital neoplasia in different series analyzed. The oncogenic potential of the virus depends on numerous heteregenous and complex factors denoted as risk factors. A typical, morphologically well-differentiated change is condyloma acuminatum, with the finding of acanthosis, hyperkeratosis, parakeratosis, dyskeratosis, and koilocytosis, which is always an accompanying morphological quality in these changes. In precancerous lesions and infiltrative neoplasms, koilocytosis is not a necessary finding. CONCLUSION: The HPV infection of the vulva and anogenital region is reflected in a spectrum of histological changes. Condylomatous verrucous lesions, smaller papular or plaque-like changes with VIN histological features, as well as infiltrative malignant neoplasia with certain histological properties, could be induced by different HPV types. In the absence of data of in situ hybridization and immuno-electron microscopy as the reliable evidence of the presence of a certain HPV genotype, histological changes mostly characteristic of HPV infection could serve as an indirect pathway.
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Enfermedades del Ano/patología , Condiloma Acuminado/patología , Papillomaviridae , Infecciones por Papillomavirus/patología , Infecciones Tumorales por Virus/patología , Enfermedades de la Vulva/patología , Anciano , Neoplasias del Ano/patología , Neoplasias del Ano/virología , Femenino , Neoplasias de los Genitales Femeninos/patología , Neoplasias de los Genitales Femeninos/virología , Humanos , Persona de Mediana Edad , Lesiones Precancerosas/patología , Neoplasias de la Vulva/patología , Neoplasias de la Vulva/virologíaRESUMEN
In order to reveal the morphologic basis of clinically recognized pseudo Cushing syndrome in chronic alcoholism, we performed an analysis of histologic characteristics of hypothalamo-hypophyseal adrenal axis components. The experiment included Wistar rats which were given 15% ethanol solution in water for three months. By methods of classical histology, histochemistry and immunofluorescence adrenal and hypophyseal sections of experimental animals exposed to continual effects of alcohol and those from the control group were examined. ACTH (adrenocorticotropin) cells of the experimental group show expressed immunofluorescence as a proof of their high secretory granules present in numerous cytoplasmic endings which contribute to significantly increased number of these cells comparing to the control group. In the adrenal cortex of animals exposed to alcohol, in the zona fasciculata and zona reticularis, under the influence of hypophyseal corticotropin (ACTH) secretion, there is a statistically significant increase of the compact cells region, as synthetic active elements, in regard to vacuolized cells, as inactive elements, which has been established stereologically. Simultaneous hyperfunction of hypophyseal ACTH cells and ACTH dependent zones of the adrenal cortex in chronic alcoholism, proves that alcohol primarily acts at the level of hypothalamus and hypophysis, while adrenals react to hypersecretion of ACTH cells. The way alcohol affects neurotransmitters is the topic of the discussion, whereas stimulated synthesis of acetylcholine is pointed out.
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Alcoholismo/fisiopatología , Sistema Hipófiso-Suprarrenal/fisiopatología , Corteza Suprarrenal/metabolismo , Corteza Suprarrenal/patología , Hormona Adrenocorticotrópica/metabolismo , Alcoholismo/metabolismo , Alcoholismo/patología , Animales , Técnica del Anticuerpo Fluorescente , Masculino , Hipófisis/metabolismo , Hipófisis/patología , Ratas , Ratas WistarRESUMEN
The increase of morbidity concerning diseases of heart, CNS, kidneys and of other organs is primarily connected with atherosclerotic changes of blood vessels. The population of cardiovascular patients includes a great number of diabetics and in that case manifestations of illness are directly conditioned and connected with changes of blood vessels.
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Envejecimiento/patología , Vasos Sanguíneos/patología , Angiopatías Diabéticas/patología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The objective of intraoperative histological diagnostics of thyroid gland diseases using the tissue freezing method is planning the appropriate surgical scope at the time of operation. This necessitates maximal diagnostic accuracy having in mind the fact that freezing changes the tissue structure resulting in numerous technical defects in the histological preparation. These defects can be eliminated by multiplying histomorphological criteria, accurate explanation of their significance and interdependency and by making a conclusion in the form of ex tempore diagnosis. We studied 88 cases of ex tempore diagnosed changes in the thyroid gland using 15 different morphological criteria. The adjustment of the metrics scale to arithmetic progression enabled us to use certain number of parametric tests. A universal approach along with non-parametric methods with highly significant results made it possible to evaluate histomorphological criteria which can be regularly used in intraoperative diagnostics of pathological changes in the thyroid gland.
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Biopsia , Enfermedades de la Tiroides/diagnóstico , Glándula Tiroides/patología , Secciones por Congelación , Humanos , Periodo Intraoperatorio , Enfermedades de la Tiroides/patología , Enfermedades de la Tiroides/cirugíaRESUMEN
We investigated chronic effects of ethyl alcohol on adenohypophysis in adult Wistar rats and adenohypophysis in development including the postnatal period up to 30 days. Morphological findings in gonadotropic, prolactin and follicular cells were compared. After three months of constant alcohol consumption in the form of a 15% liquid solution, vacuolization of gonadotropic cells which acquire the shape of a seal ring, as well as nodular hyperplasia of chromophobe cells combined with sparse somatotropic cells, occur in the adenohypophysis of adult male rats. Electronic microscope revealed a small quantity of prolactin granules in light-microscopic chromophobe cells. In young rats exposed to alcohol gonadotropic and prolactin cells are unchanged but an accumulation of follicular cells within multiple smaller pseudofollicles is present. In the explanation of the differences between the findings obtained in adult and young rats with reference to LH/FSH and PRL cells, a stress is given to the role of the peripheral metabolism of testosterone and of hyperestrogenemia caused by alcohol consumption in adult rats lacking in young ones. The increased number of the follicular cells in adenohypophyses of young rats is likely to reflect the suppressed maturation of hypophyseal secretory cells.
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Envejecimiento/patología , Etanol/farmacología , Adenohipófisis/efectos de los fármacos , Animales , Masculino , Ratas , Ratas WistarRESUMEN
The paper reviews the results of an extensive morphological analysis of 49 lymph nodes draining the area of histologically evidenced tumor on the basis of immunomorphological changes by the quantitative and semiquantitative methods. Reactive changes in different topographic zones being a morphological manifestation of the immune response to the presence of tumor depend on the type and localization of the tumor. Sinus histiocytosis is the most significant morphological reaction in the analyzed draining nodes. The intensity of sinus histiocytosis could, by itself, represent an important factor in a morphological recognition of the lymph node draining the tumor area.
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Ganglios Linfáticos/patología , Metástasis Linfática/patología , Adulto , Femenino , Técnicas Histológicas , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Primary malignant lymphoma of extranodal localization is a rare disease which mainly occurs in organs with greater or less quantity of lymphocytic tissue or in the organs with the previous history of lymphocytic infiltrate. Extranodal localization of malignant lymphoma in the thyroid gland is rare and numerous authors associate it with the previous existence of chronic lymphocatic thyroiditis (Hashimoto struma). This paper dealt with the histologically analysed material obtained by subtotal or total thyreoidectomy over one-year period. Out of 49 cases, histologic diagnosis of chronic diffuse lymphocytic thyroiditis was established in nine patients (18%) but the frequency of the appearance of this autoimmune disease may well be grater because a relatively small number of patients underwent the operation. Apart from all morphologic characteristics of Hashimoto struma, primary malignant lymphoma of extranodal localization in the thyroid gland was diagnosed in one patient. Simultaneous or previous evolution of chronic lymphocyttic thyroiditis into malignant lymphoma was confirmed in the papers of numerous authors. The authors presented a patient aged 58 in whom malignant lymphoma had evolved from the chronic diffuse lymphocytic thyroiditis. Cellular characteristics pointed to lymphoma of transformed cells being extended extrathyroidically into the surrounding connecting and muscular tissue with the involvement of regional lymph glands. Of particular importance was the area in which the usual architectonics of lymphocytic thyroiditis was discretely ruined and the infiltrate received neoplastic characteristics. On the basis of data from literature, lymphocytic thyroiditis should be regarded as a prelymphomatous state which was attached a great importance from the aspect of histopathologic analysis. Beside the operation, conservative therapy was employed and it showed good results until now, although it was too early to make decisive conclusions on the outcome of disease.