RESUMO
INTRODUCTION: Celiac disease (CD) diagnosis can be improved if a scoring system comprising clinical, nutritional, serological and histopathological elements is applied. DQß1*02 and/ or DQß1*0302 alleles can be expected to be more frequent among subjects with the highest scores. OBJECTIVES: To assess the relationship between score assigned to the patient by means of the system developed and alleles associated with CD. METHODS: Scores were assigned to 69 patients (Women: 68.1%; Ages ≤ 60 years: 95.7%) assisted by a multidisciplinary group for management of CD, using an updated version of a previously described score system (CeliacScore 2.0) were correlated with the occurrence of DQß1*02 and/or DQß1*0302 alleles. CD was diagnosed if the assigned score was ≥ 10. RESULTS: 17.4% of studied patients were diagnosed as CD. DQß1*02 and/or DQß1*0302 alleles were present in 56.5% of our cases. Scores assigned to patient's were independent of the presence of alleles of interest (c² = 2.3; p > 0.319). 75.0% of subjects with a score higher than 10 had the alleles of interest. The probability for the presence of DQß1*02 and/or DQß1*0302 alleles was 2.7 in patients with scores ≥ 10. CONCLUSIONS: The described system can be useful in the CD diagnosis. Alleles associated with CD concentrated among those with the highest scores. Scoring system's operating characteristics should be explored in further studies.
Assuntos
Doença Celíaca/diagnóstico , Doença Celíaca/genética , Adulto , Alelos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Although the nervous system is highly resistant to radiations, some cases have been reported about adverse effects of radiotherapy on patients with brain tumors. The following delayed effects have been observed: coagulation necrosis of all the cellular elements, fibrinoid and hyaline changes on the walls of the neoformed blood vessels, together with endothelial proliferation and perivascular fibrosis, reactive astrocytes, some of them with bizarre nuclei, as well as telangiectasia, hemorrhage and hemorrhagic infarcts. Telangiectasia and associated hemorrhage may occur in any of the irradiated zones of the brain. CLINICAL CASE: The present case is an example in which the indication of radiotherapy was due to an anatomopathological overdiagnosis. The first biopsy was diagnosed as a grade II cerebellar astrocytoma, after which 20 radiotherapy sessions were indicated. Nine years after that, a second operation was performed. This second biopsy revealed areas of fibrosis, hemorrhages, calcifications, necrosis, and thick hyaline-walled blood vessels. No tumor infiltration was observed. After an unfavorable evolution, the patient died. The microscopical study of the autopsy material revealed an area of neoplastic infiltration which was well defined as a pylocitic astrocytoma of the cerebellum. The rest of the cerebellum sections evidenced damage corresponding to an adverse effect of radiotherapy, particularly large zones of telangiectasia. CONCLUSIONS: It is stated that the patient s death was not because of the tumor. The adverse effects of radiotherapy, interpreted as tumor remains, motivated the second operation that generated complications causing the patient s death.
Assuntos
Astrocitoma/radioterapia , Neoplasias Cerebelares/radioterapia , Radioterapia/efeitos adversos , Hemorragia Subaracnóidea/etiologia , Telangiectasia/etiologia , Adolescente , Astrocitoma/diagnóstico , Astrocitoma/cirurgia , Atrofia/etiologia , Atrofia/patologia , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/patologia , Neoplasias Cerebelares/diagnóstico , Neoplasias Cerebelares/cirurgia , Evolução Fatal , Humanos , Imageamento por Ressonância Magnética , Masculino , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Hemorragia Subaracnóidea/patologia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: A central neurocytoma (CN) is a rare tumor, of neuronal origin, well-differentiated and found intraventricularly. It mainly affects young adults. Firm diagnosis is made on immunohistochemical (IHQ) and ultrastructural studies, since on optic microscopy it is similar in appearance to an oligodendroglioma or to an ependymoma. PATIENTS AND METHODS: We studied 4 cases, three after surgical resection and one on autopsy. The average age was 29, ranging from 3 to 63. Both sexes were equally affected. In all cases IHQ techniques were used (GFAP, neurofilament, synaptophysin and specific neuronal enolase) and they were studied by electron microscopy. RESULTS: IHQ was negative for GFAP and neurofilament, but intensely positive for synaptophysin and specific neuronal enolase. On ultrastructural study there were few neurofilaments, microtubules and dense central granules typical of neural differentiation. CONCLUSIONS: The findings in our cases lead to diagnosis of NC and confirm that this tumor is a distinct clinicopathological entity.
Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/ultraestrutura , Neurocitoma/diagnóstico , Neurocitoma/ultraestrutura , Adolescente , Adulto , Neoplasias Encefálicas/cirurgia , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Proteína Glial Fibrilar Ácida/ultraestrutura , Humanos , Masculino , Pessoa de Meia-Idade , Neurocitoma/cirurgia , Fosfopiruvato Hidratase/ultraestrutura , Sinaptofisina/ultraestrutura , Tomografia Computadorizada por Raios XRESUMO
Introducción. El neurocitoma central (NC) es un tumor raro, de origen neuronal, bien diferenciado y de localización intraventricular; afecta preferentemente a adultos jóvenes. El diagnóstico definitivo se establece por el estudio inmunohistoquímico (IHQ) y ultraestructural debido a su semejanza con el oligodendroglioma y el ependimoma al microscopio óptico. Pacientes y métodos. Se procesaron 4 casos, 3 procedentes de resección quirúrgica y 1 de autopsia. La edad media fue de 29 años, con un rango entre 3 y 63 años; ambos sexos se afectaron por igual. A todos los casos se les realizó técnicas de IHQ (GFAP, neurofilamento, sinaptofisina y enolasa neuronal específica) y se estudiaron por microscopía electrónica. Resultados. La IHQ resultó negativa para la GFAP y para el neurofilamento, y fue intensamente positiva para la sinaptofisina y la enolasa neuronal específica. El aspecto ultraestructural evidenció escasos neurofilamentos, microtúbulos y gránulos de centro denso propios de la diferenciación neural. Conclusiones. Los hallazgos encontrados en nuestros casos permitieron realizar el diagnóstico de NC y confirmaron a este tumor como una entidad clinicopatológica distintiva
Assuntos
Humanos , Imuno-Histoquímica , Neurocitoma/históriaRESUMO
Since some years ago in our country are reported "inspecific elements" in biliary drainage, name given to some round shaped structures of approximately 12 microns, which generally appear associated to trophozoites of Giardia lamblia, disappearing after an antigiardia treatment. Many gastroenterologists consider such elements as Giardia, but they are still unknown in nature. Our object was to study them at the optic and electronic microscope for their comparison with the biologic forms of G. lamblia. Samples of rich G. lamblia trophozoites and "inspecific elements" biliary drainage, culture trophozoites and G. lamblia cysts rich feces were used. The samples were processed by a routine technique for transmission electronic microscope, with some modifications. Our studies demonstrated that the morphologic characters of the "inspecific elements" correspond to macrophages.