Jornal de Citologia e Histologia

Objectives: Improve treatment outcomes and clarify the biological characteristics of neuroblastoma, development of an international histological classification started several years ago. Aiming at the establishment of a cytology criteria corresponding to the new histological classification, we investigated a criteria comparing lesions related to neuroblastoma on referring to the morphological indices of neuroblastoma reported in the international classification.
Methods: Several tumor specimens were investigated: 37 cases of neuroblastoma (undifferentiated type: 3, poorly differentiated type: 34), 3 cases of ganglioneuroblastoma (mixed type: 2, nodular type: 1), and one case of ganglioneuroma. Stamp cytology samples were prepared from cut surfaces of the tumors and then stained to the Papanicolaou method.
Results: In neuroblastoma of the undifferentiated type, tumor cells contained a small oval nucleus with a high N/C ratio, showing a bare nucleus, and the nucleolus was distinct: no rosette formation or neutrophil was observed. In the poorly differentiated type, tumor cells showed a round-oval bare nucleus were scattered: rosette arrangement was observed in the background neuroblasts containing a bare nucleus. In ganglioneuroblastoma, immature neuroblasts showed a round-oval nucleus and large ganglion-like cells possessed a distinct nucleolus similar to poorly differentiated-type epithelial adenocarcinoma.
Conclusion: In neuroblastoma, neutrophils were stained light green, and a partial Homer-Wright-type rosette arrangement was observed in the background. In the poorly differentiated type, tumor cells were generally large compared to those observed in the undifferentiated type. In ganglioneuroblastoma, cytological diagnosis can be relatively easily made when differentiated mature ganglion like cells are observed. In the case of surgery, a histological diagnosis of nervous system tumors is often performed using frozen sections, however tissue is usually damaged during freezing. Thus, cytology is more advantageous for diagnosis. The diagnostic accuracy can be improved utilizing the cytological characteristics of neuroblastic tumors.

Thalassemia is one of the most prevalent inherited blood disorders all over the world. There are some specific hematologic tests and molecular genetic techniques known for diagnosis of thalassemia. Nowadays, various types of drugs are used for the treatment of thalassemia. Hydroxyurea, Hydroxycarbamide, Deferiprone, Deferisirox, Butyrate and its derivatives are some of the most common and well known drugs which are used for increasing the HbF percentage and iron chelation. Pharmacogenomics is the branch of pharmacology that is associated with the influence of genetic variations on the drug response among patients by correlating genetic variations, expression pattern or single-nucleotide polymorphisms with a drug's efficacy or toxicity. With the help of Pharmacogenomics study "personalized medicine” has been explored, in which drugs and drug combinations are optimized for the genetic makeup of each individual.

Background: Thrombotic Microangiopathy (TMA) is a multi-organ dysfunction syndrome characterized by microvascular thrombosis, thrombocytopenia and hemolytic anemia with diverse etiologies ranging from primary Thrombotic thrombocytopenic purura (TTP) and Hemolytic uremic syndrome (HUS) to secondary phenomena to medications, severe uncontrolled hypertension and autoimmune disorders i.e Scleroderma renal crises, catastrophic antiphospholipid syndrome and pre-eclampsia, prompt diagnosis, identification of potential etiologies and treatment are essential steps for reducing morbidity and mortality.
Case Report: We describe a case of a 34-year-old man who presented with features of advanced renal impairment, severe uncontrolled hypertension and thrombotic microangiopathy, overall clinical picture was most consistent with malignant hypertension and hypertensive nephrosclerosis secondary to long standing uncontrolled hypertension, however a serum test ordered measuring the activity of ADAMTS 13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) resulted one week later was consistent with reduced enzyme activity, challenging the first diagnosis.
Conclusions: Clinical correlation and high index of suspicion are essential in the diagnosis and management of thrombotic microangiopathy, The reduction in ADAMTS -13 activity or antigen level has been thought to be a primary cause of thrombotic microangiopathies I.e TTP and HUS, however recent studies have shown a negative correlation between ADAMTS-13 activity and elevated blood pressure (BP) in malignant hypertension.

The water resources pollution is a worldwide problem. In this manuscript, sediment elutriate (SE) from Tambis River, Barobo, Surigao Del Sur was evaluated for possible cytotoxic effect in actively dividing cells of Allium cepa root meristems. Result shows that at higher concentrations (1000 g/L and500 g/L) can exert mitodepressive effect, Cmitoses as a result of spindle damage, and chromosomal anomalies in actively dividing A. cepa root meristems with P<0.05. This effect was dose dependent and irreversible. Exposure of Allium cepa root to sediment elutriate for 72 hr produced significant atypical changes of chromosomes, sticky metaphases and anaphase bridges. The study suggests that cytotoxic and mutagenic effects of sediment elutriate from Tambis River was significantly higher from negative control (P<0.05).

Extramedullary hematopoiesis is a rare entity to consider in patients with cancer and signs of bone marrow infiltration that can involve a diagnosis challenge in clinical practice. We report the case of a metastatic prostate cancer patient progressing with liver nodes and hepatic dysfunction symptoms that presented a great response to an alternative chemotherapy schedule regimen used to avoid liver toxicity of taxanes.

Cytology-based screening has limited sensitivity to detect cervical precancerous lesion. Hihg risk human papilloma virus (HR HPV) DNA tests increase the detection of CIN II+ lesions, however it cannot differentiate if the infection is or transient or persistent. Its use is often limited by the need of standardisation of laboratory technics and relatively high costs. Recently, several studies analysed the diagnostic performance of p16/Ki67 dual-stained cytology as the possible alternative or coexisting option to HR HPV testing. In most of them the smear is obtained for liquid-based cytology. This study was designed to analyze the usefulness of p16/Ki67 dual immunostaining in conventional cytology, which is the method of choice in cervical cancer screening in our country. 68 women with positive Pap test results were selected. Colposcopy, cervical biopsy and HR HPV DNA tests were performed in all patients. Separate slides for p16/Ki67 were collected at the time of colposcopy. Statistical analysis was performed to establish sensitivity, specificity, positive predictive value, negative predictive value and accurancy for all used tests. Biopsy-confirmed CIN was used as a gold standard for study purposes. The diagnostic accurancy of p16/Ki67 dual-staining was the highest among used tests. Sensitivity of this test to detect CINII+ lesion was comparable to and specificity was higher than for HR HPV test. Similar results were observed for cytologic categories: LSIL and ASCUS. These results suggest that p16/Ki67 immunostaining performed on conventional smears may become alternative or additional to HPV tests, due to its low costs and relatively simple procedure.

Primary squamous cell carcinoma (SCC) of the stomach is rare. In this paper, the patient in Case 1 is a 57-yearold man who underwent partial gastrectomy and adjuvant chemotherapy for primary SCC of the stomach. He survives more than 4 years as of the writing of this report. The patient in Case 2 is a 49-year-old man who was also diagnosed as primary SCC of the stomach. He died of massive gastric cancer bleeding 2 months after the diagnosis. This report is followed by a literature review and further discussion of diagnostic criteria and palliative gastrectomy in these patients.

E-Cadherin is calcium-dependent cell adhesion molecule encoded by CDH1 gene at chromosome 16q22.1. Ecadherin regulates cell-cell adhesions and controls mobility and proliferation of epithelial cells. Recently, the role of E-cadherin in erythroid maturation has been elucidated. It is selectively expressed in immature erythroblasts and gradually down regulated as erythroid precursors mature. Acute erythroid leukemia is neoplastic proliferation of immature erythroid precursors in bone marrow with or without significant myeloblasts component. In the recent years E-cadherin has emerged as the most sensitive and specific marker for immature erythroblasts. Moreover, combination of E-cadherin with glycophorin A in immunohistochemistry staining can effectively separate immature vs. mature erythroid precursors in bone marrow biopsy. In this short review I will shed light on the key points related to the nature of relationship between E-cadherin and acute erythroid leukemia.

Cytomegalovirus (CMV) is generally asymptomatic in immunocompetent patients. The most common clinical syndrome associated with CMV is mononucleosis syndrome characterized by fever, fatigue, sore throat, generalized lymphadenopathy, impaired liver function, and lymphocytosis. Ä°n this case a 51 year-old female patient was considered as having tumor lysis syndrome due to presentation with weight loss, fever and night sweats and high levels of creatinine and uric acid. In this case lymphoproliferative diseases were the first to be investigated, however corresponding test results were negative and the serological tests showed an active CMV infection.

Background: Green tea intake is accompanied with a lower incidence of cancer, cardiovascular disease, and neurodegenerative disorders; hence green tea extract is included in multivitamins and other dietary supplements.
Aim of the work: Studying the effect of ketamine administration on the liver of adult male albino rats and demonstrating the possible protective role of green tea extract.
Material and methods: Forty adult male albino rats were divided into four groups, ten rats each. Group I: control group. Group II: rats received green tea extract orally (50 mg/Kg/day) for five weeks. Group III: rats were injected intraperitoneally with ketamine (100 mg/kg/day) for two weeks. Group IV: rats received green tea extracts orally (50 mg/Kg/day) for three weeks, and then continued for further two weeks concomitantly with intraperitoneally injected ketamine (100 mg/kg/day). Serum levels of AST, ALT, GSH and MDA were measured. Liver sections were subjected to H & E, iNOS immunohistochemical stain, and toluidine blue stain and transmission electron microscopic examination. Followed by statistical analysis of biochemical and morphometric results.
Results: In group III, serum liver enzymes and oxidative stress indicators together with positive area of iNOS immunohistochemical stain were significantly increased as compared to control. In liver sections of ketamine treated group, hepatocytes showed signs of degeneration and multiple cytoplasmic vacuoles of variable sizes with dilated blood sinusoids. At ultrastructural level, nuclei with irregular outline, dilated and discontinued RER with empty spaces within the cytoplasm of hepatocytes were recorded. Interestingly, the picture was comparable to control with concomitant use of green tea extract.
Conclusion: Green tea extract has a hepato-protective effect in rats exposed to ketamine.

This study evaluated the expression levels of IGF-I, insulin peptides, and their respective receptors, IGF-IR and IR, in the dental pulp of rats subjected to protein malnutrition. The nourished group (N) received a diet with 20% casein, while the malnourished group (M) received a diet with 5% casein. The renourished group (R) consisted of M group members maintained on the N group diet from the 22nd to the 60th day of life to evaluate the effects of renourishment. Dental pulps of the maxillary first molars were stained with hematoxylin and eosin, and picrosirius red, and were subjected to immunohistochemical tests. Malnutrition altered the odontoblastic layer and the collagen component of the dental pulp. IGF-I and IGF-IR expression levels were higher in the N group but there were no differences in the insulin expression levels between the groups. IR immunoexpression was higher in the N group compared with groups M and R. The results suggest that protein deprivation changed the constitution of the dental pulp and affected the factors that influence its development. The process of renutrition during puberty was not able to support the recovery of pulp morphology.

Myiasis is the infestation of live human and vertebrate with dipterous larvae that feed on the host's tissues. We report a case of a nosocomial oral myiasis in an unconscious patient.