RESUMO
AIMS: Acral lentiginous melanoma (ALM) is the most common type of melanoma in people with darker skin phototypes. There is some evidence that the aetiology, pathogenesis, risk factors and natural history of ALM differ from those of superficial spreading melanoma (SSM). ALM behaves more aggressively than SSM, but the biological explanation for these differences remains unknown. The presence of one subtype of macrophages, termed M2-macrophage (M2-M), has been found to be related to local progression, metastasis and poor prognosis in several neoplasms. The aim of this study was to compare the density of M2-Ms in ALMs versus SSMs, and to examine whether or not the density of M2-Ms is associated with histopathological features predictive of adverse prognosis in cutaneous melanoma (CM), as well as development of metastasis. METHODS AND RESULTS: Sixty-seven ALMs and 67 SSMs cases were analysed. The tumours were classified according to thickness, ulceration, mitosis and metastasis. M2-M quantity was evaluated using immunohistochemistry with anti-CD163 and anti-CD206 antibodies. M2-Ms were increased in ALM compared with SSM, and were related to the histopathological features predictive of adverse prognosis in CM, such as thickness > 1.0 mm, ulceration and mitotic activity, and the development of metastasis. CONCLUSIONS: Our study is the first, to our knowledge, to demonstrate the increased presence of M2-Ms in ALM compared with SSM. Our findings suggest that the increased M2-Ms in ALM are associated with the main histopathological features predictive of adverse prognosis in CM, as well as the presence of metastasis, and that these cells can be related to the aggressive behaviour seen in ALMs.
Assuntos
Macrófagos/patologia , Melanoma/patologia , Neoplasias Cutâneas/patologia , Pele/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto JovemRESUMO
La implantación de marcapaso definitivo (MPD) se realiza en portadores de alteraciones en la generación del impulso eléctrico del corazón y/o con trastornos de la conducción. Las guías clínicas para su manejo proponen un seguimiento precoz, regular y de por vida, posterior al implante de MPD, con el fin de pesquisar alteraciones. Objetivo: caracterizar y evaluar adherencia a seguimiento en pacientes con primoimplante de MPD del Hospital Gustavo Fricke (HGF) en el período 2007. Pacientes y método: estudio descriptivo y retrospectivo, cuyo universo fueron los pacientes con primoimplante de MPD del HGF en el año 2007. Se caracterizaron los pacientes de acuerdo a sexo, edad y diagnóstico de indicación de MPD; se describió el porcentaje de inasistencia al primer, segundo y tercer control post-implante del MPD (correspondiente por garantías explícitas en salud) y finalmente se buscaron causas de inasistencia a estos controles. Resultados: el universo fue de 181 pacientes, 101 hombres. El grupo etáreo predominante fueron mayores de 70 años (56,9 por ciento). Los diagnósticos más frecuentes fueron: bloqueo auriculoventricular completo (31,4 por ciento) y enfermedad del nodo sinusal (30,9 por ciento). De los 181 pacientes del universo, 110 faltaron al menos a un control con una curva de insistencia ascendente en el tiempo, observándose que a los 6 meses (tercer control) más de la mitad estuvo inasistente. De estos 110 pacientes, 60 pudieron ser contactados telefónicamente para aplicarles una encuesta de causas de inasistencia, encontrándose que 37 de ellos no asistieron a control por falta de citación. La caracterización de pacientes respecto a sexo, edad y diagnóstico de indicación de MPD coincidió con la literatura. Conclusiones: el importante ascenso de las inasistencias a controles post-implante de MPD contrasta con las recomendaciones de seguimiento.
The difinitive pacemaker (DPM) implantation is performed in patients with alterations in the generation of electrical impulse from heart and / or conduction disturbances. Clinical guidelines for management proposed early tracking, regular and for life, post DPM implantation in order to detect alterations. Aim: characterize and assess adherence to monitoring in patients with first DPM implantation at the Hospital Gustavo Fricke (HGF) during 2007. Method and patients: retrospective and descriptive study. The universe were patients with first DPM implantation at HGF during 2007. Patients were characterized according to sex, age and diagnosis of DPM indication; percentage of absence at the first, second and third control post DPM implantation (corresponding to clinical guidelines in Chile) was described and finally causes of absences to the controls were investigated. Results: the universe was 181 patients; 101 men. The most frequent age group were older than 70 years (56.9 percent). The most common diagnoses were: complete atrioventricular block (31.4 percent) and sinus node disease (30.9 percent). Of 181 patients of the universe, 110 missed at least one control in an ascending curve in time so that at 6 months (third control) more of 50 percent did not attend the medical control. Of these 110 patients, 60 could be contacted to make a telephone poll to know the causes of the absence and it was found that 37 of them did not attend due to lack of appointment. Characterization of patients regarding sex, age and diagnosis of DPM indication coincided broadly with those reported in the literature. Conclusions: the significant rise in absences to post implantation DPM controls contrasts sharply with the follow-up recommendations.