RESUMO
OBJECTIVE: The objective of this study was to establish the value of different markers in differentiating reactive mesothelial cells from metastatic adenocarcinomatous cells in serous effusions (SE). METHODS: Forty-five SE were processed for morphological examination (Papanicolaou stain), assessment of ploidy, AgNOR counting and immunocytochemical assay of carcinoembryonic antigen (CEA), epithelial membrane antigens (EMA), Ber-EP4 and Leu-M1. Ploidy was established in an image-analyser in smears stained by the Feulgen stain method. AgNOR dots were counted in the smears stained with the silver nitrate assay for non-histone proteins present in the nucleolar organizer region. CEA, EMA, Ber-EP4 and Leu-M1 were evaluated by immunocytochemistry using the streptavidin-biotin complex method. RESULTS: All the smears with positive cytology were aneuploid. Three false negatives by morphological studies were aneuploid, with AgNOR values in two of them corresponding to the neoplastic group. CEA and Leu-M1 showed a low specificity; EMA and Ber-EP4 showed moderate sensitivity. CONCLUSIONS: The assessment of ploidy and the study of AgNOR were better methods than immunocytochemistry for distinguishing between reactive mesothelial cells and adenocarcinomatous cells in serous fluid.
Assuntos
Adenocarcinoma/patologia , Antígenos Nucleares/metabolismo , Líquido Ascítico/citologia , Neoplasias/patologia , Proteínas Nucleares/metabolismo , Derrame Pleural/citologia , Adenocarcinoma/genética , Adenocarcinoma/metabolismo , Líquido Ascítico/metabolismo , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Humanos , Imuno-Histoquímica/métodos , Neoplasias/genética , Neoplasias/metabolismo , Derrame Pleural/genética , Derrame Pleural/metabolismo , Ploidias , Esfregaço Vaginal/métodosRESUMO
Nota del Editor: la diferenciación entre exudados y transudados constituye el primer paso en el diagnóstico diferencial de los derrames pleurales, desde 1972 el Doctor Richard W. Light propuso unos parámetros como guía para tal diferenciación.Medicina & Laboratorio ha recibido la autorización del propio autor, para la traducción del texto con el fin de que sea una herramienta de consulta en el manejo del ®derrame pleural¼, de vital importancia para la comunidad médica.
Assuntos
Derrame Pleural/citologia , Derrame Pleural/classificação , Derrame Pleural/complicações , Derrame Pleural/diagnóstico , Derrame Pleural/sangueRESUMO
BACKGROUND: Although myeloperoxidase (MPO) and adenosine-deaminase (ADA) levels are markers of activated leukocytes, both enzymes have not been currently addressed in inflammation models. AIMS: This study evaluates whether the concentrations of these enzymes are significantly correlated with the content of leukocytes in a pleurisy model. METHODS: The pleurisy was induced by carrageenan (1%) in mice, and the parameters analyzed 4 and 48 h after. RESULTS: After the induction of inflammation (4h), MPO and ADA levels peaked in parallel to neutrophils (p<0.01). Regarding the second phase of pleurisy (48 h), the highest concentrations of ADA were detected in parallel to the highest levels of mononuclears (p<0.01). At this time, MPO levels and neutrophils remained elevated, although at lower levels than those found at 4 h. A significant positive correlation was found among neutrophiLs and MPO, and mononuclears and ADA (p<0.01). CONCLUSIONS: These findings support the evidence that both enzymes are markers of the inflammatory process, and provide new tools for a better understanding of the immunoregulatory pathways that occur in inflammation.
Assuntos
Adenosina Desaminase/metabolismo , Peroxidase/metabolismo , Derrame Pleural/enzimologia , Pleurisia/enzimologia , Animais , Carragenina , Modelos Animais de Doenças , Feminino , Contagem de Leucócitos , Leucócitos Mononucleares/fisiologia , Masculino , Camundongos , Neutrófilos/fisiologia , Derrame Pleural/citologia , Pleurisia/induzido quimicamente , Pleurisia/fisiopatologia , Análise de RegressãoRESUMO
Antecedentes: los descubrimientos de derrames pleurales ofrecen al clínico la oportunidad de muestrear fluidos de cavidades corporales en un ensayo diagnóstico del enfermo. Objetivo: conocer la utilidad del estudio citopatológico para diagnósticar neoplasias en pacientes con derrame pleural. Material y métodos: se realizó un estudio retrospectivo, longitudinal, observacional y desciptivo de 70 pacientes con derrame pleural en un periodo de 19 meses. Resultados: por medio del examen citoquímico de exudado se detectaron 31 pacientes (44.2 por ciento) con derrame pleural, de quienes se envió una segunda muestra para citopatología y se descubrió malignidad en 20 casos (64.5 por ciento), de los cuales seis (30 por ciento) presentaron tabaquismo como antecedente. La mayor incidencia de malignidad en derrames pleurales se presentó en pacientes mayores de 70 años. Conclusiones: es indispensable realizar estudios básicos a todos los pacientes con derrame pleural para poder tomar decisiones acertadas en cuanto al diagnóstico y la terapéutica que contrarreste la enfermedad ya que no es posible determinar un diagnóstico a través del reporte citopatológico puesto que éste describe sólo células compatibles como malignidad
Assuntos
Humanos , Masculino , Feminino , Idoso , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Derrame Pleural/citologia , Derrame Pleural/patologia , Fatores Etários , FumarAssuntos
Humanos , Exsudatos e Transudatos , Exsudatos e Transudatos/citologia , Exsudatos e Transudatos/microbiologia , Exsudatos e Transudatos/fisiologia , Derrame Pleural , Derrame Pleural/classificação , Derrame Pleural/complicações , Derrame Pleural/citologia , Derrame Pleural/diagnóstico , Derrame Pleural/tratamento farmacológico , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Derrame Pleural/microbiologia , Derrame Pleural/mortalidade , Derrame Pleural/fisiopatologia , Derrame Pleural/terapiaRESUMO
Adenosine deaminase (ADA) and lymphocyte proportion are known to be independently elevated in tuberculous effusions, but are non-specific, and false positive results are frequent. To overcome this problem the combined use of both parameters was prospectively studied in 276 patients with pleural effusion seen at Porto Alegre, Brazil. Using a cut-off level of 40 U/l at 37 degrees C (method of Giusti19) for ADA activity and lymphocyte proportion of more than 50%, the correct diagnosis of tuberculosis (sensitivity) was made in 90.7% (CI 87.3-94.1%) of 54 patients. A specificity of 97.7% (CI 95.9-99.5%) was recorded. Five false positive diagnoses of tuberculous effusion were made. Five false negative diagnoses were made: three cases with haematogenous tuberculous dissemination with low ADA levels, and two other patients with low lymphocyte proportion. The combined use of ADA activity determination and lymphocyte proportion is a highly efficient diagnostic strategy of low cost, that merits wider use.
Assuntos
Adenosina Desaminase/análise , Contagem de Leucócitos , Linfócitos , Derrame Pleural/citologia , Derrame Pleural/enzimologia , Tuberculose/diagnóstico , Brasil , Ensaios Enzimáticos Clínicos , Humanos , Valor Preditivo dos Testes , Tuberculose Pleural/diagnósticoRESUMO
A técnica de imunoperoxidase foi usada para testar a especificidade do CEA (antígeno carcinoembriônico) e EMA (antígeno de membrana epitelial) em células epiteliais esfoliadas de líquidos cavitários neoplásicos ou reativos. O CEA mostrou-se específico para células tumorais, derivadas de carcinoma. O EMA revelou positividade näo só em células tumorais, mas em 61,5 porcento dos líquidos näo neoplásicos. A coloraçäo para CEA mostrou-se útil näo só no diagnóstico diferencial de células do carcinoma, como também para visualizaçäo de raras células tumorais isoladas em meio a células mesoteliais e inflamatórias.