RESUMO
BACKGROUND Leukocytoclastic vasculitis (LCV) is an atypical form of cutaneous paraneoplastic manifestation. Its association with multiple myeloma (MM) is even rarer and is associated with poor prognosis and short survival, regardless of the therapy instituted. Different treatment approaches are necessary. We present a case in which LCV was the first manifestation of MM, and high-intensity laser therapy (HILT) was used as an option to accelerate healing and control pain. CASE REPORT A 76-year-old woman presented with pain and paresthesia in her lower limbs, associated with palpable purpura. The clinical diagnosis was small-vessel vasculitis. Laboratory tests showed an elevated gamma globulin monoclonal peak on protein electrophoresis. The immunophenotypic study of bone marrow aspirates led to the diagnosis of MM. Due to pain refractory to conventional analgesics, and the progressive evolution of the lesions, despite corticosteroid therapy, we performed photo-biomodulation with a neodymium-doped yttrium aluminum garnet laser (Nd: YAG), wavelength 1064 nanometers, using a 7-mm probe and energy density 6 J/cm². After the first session, the patient was referred for pain management, and after 5 weeks, we observed complete healing in ulcerated lesions and involution of bullous lesions. CONCLUSIONS This case report shows the positive effects of the Nd: YAG laser in modulating healing and reducing pain. HILT is an innovative, non-invasive, and effective treatment and should be considered a promising technique to accelerate healing and controlling pain.
Assuntos
Terapia a Laser , Mieloma Múltiplo , Vasculite Leucocitoclástica Cutânea , Feminino , Humanos , Idoso , Cicatrização , Vasculite Leucocitoclástica Cutânea/diagnóstico , Dor , AutoanticorposRESUMO
ABSTRACT PURPOSE: Analyze the relationship between PCNA and p53 protein imunoexpression, the histological grading of malignancy and the clinical features of oral squamous cell carcinoma (OSCC). METHODS: An immunohistochemical analysis was carried out using the streptavidin-biotin method in 14 cases of OSCC. All cases were classified according to an adaptation of the histological malignancy grading system proposed by Anneroth, Batsakis, Luna. Thus, 7 cases were classified as low score (Group I) and 7 cases as high score (Group II) of malignancy. The clinical data from the patients was obtained through their medical files and the immunohistochemical study was performed using monoclonal antibodies anti-PCNA and anti-p53. Finally, it was obtaineid the labeling index (LI) in each case. RESULTS: The LI for PCNA at Group I was 56.0% and at Group II 83.8%. The expression of p53 was similar at the studied groups with a LI of 41.2% and 41.3% at Group I and II, respectively. There was statistical correlation in PCNA values and score of malignancy. No significant correlation in the overall clinical data was verified. CONCLUSION: The high number of PCNA positive cells correlated with high score of malignancy indicates evident proliferative activity in these lesions. However, this correlation was not reached in regard to p53 expression.
OBJETIVO: Analisar a imunoexpressão das proteínas PCNA e p53 em carcinoma de células escamosas oral (CCEO) vislumbrando verificar uma possível correlação entre o escore de malignidade e os dados clínicos dos pacientes. MÉTODOS: Selecionou-se 14 casos de CCEO e classificando-os de acordo com uma adaptação do sistema de gradação histológica de malignidade proposto por Anneroth, Batsakis, Luna, enquadrando-se 7 casos como baixo escore de malignidade (Grupo I) e 7 casos como alto escore (Grupo II). As informações dos pacientes foram coletadas através de fichas clínicas e os dados tabulados. Realizou-se, então, o estudo imuno-histoquímico utilizando anticorpos monoclonais anti-PCNA e anti-p53, obtendo-se o índice de positividade (IP) em cada caso. RESULTADOS: Identificou-se um IP médio ao PCNA de 56,0% no Grupo I e 83,8% no Grupo II. Com relação à p53 o IP médio no Grupo I e no Grupo II correspondeu, respectivamente, a 41,2% e 41,4%. A análise estatística demonstrou correlação significativa entre o índice de células PCNA positivas e o escore de malignidade. Nenhuma outra correlação foi observada. CONCLUSÕES: O maior número de células PCNA positivas correlacionou-se com elevado escore de malignidade em CCEOs, sugerindo maior atividade proliferativa nestas lesões, entretanto, tal correlação não se estabeleceu quando da análise da imunoexpressão da p53.