Liquid technology in the cytological diagnosis of bladder pathology

Objective. To study the effectiveness of liquid cytological diagnosis of bladder cancer and its local relapses using the Cellprep Plus technology as an example.Materials and methods. We analyzed outpatient records of patients with urothelial pathology (n = 806) who underwent a urine cytology exam by the methods of liquid (n = 383) and conventional (n = 423) cytology.Results. The diagnostic sensitivity and specificity of the cytological examination method for diagnosing urothelial carcinoma using the method of liquid cytology have been found to be 93.4 % and 95.4 % respectively, which significantly exceeds the similar indices in the use of the method of conventional cytology – 42.4 % and 93.6 % respectively. The use of the method of liquid cytology considerably increases the accuracy of the cytological examination of bladder pathology and allows obtaining conclusions that coincide with the histological conclusion in 94.0 % of cases. In the use of the method of conventional cytology, the coincidence with histological findings is only 44.6 % (χ2 = 25.08, p < 0.001).Conclusion. The Cellprep Plus liquid technology standardizes the pre-analytical stage and increases the efficiency of the cytological method in the primary diagnosis and monitoring of patients with urothelial pathology. A promising direction of using the method of liquid cytology in the diagnosis of urothelial carcinoma is the development and implementation of the cytological criteria of differential diagnosis between reactive cell atypia and atypia characteristic of a malignant tumor.

Endocrine Disorders and Genital Infections Impair Gynecological Health in APECED (APS-1)

ObjectiveIn autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) defects in the autoimmune regulator gene lead to impaired immunotolerance. We explored the effects of immunodeficiency and endocrinopathies on gynecologic health in patients with APECED.DesignCross-sectional cohort study combined with longitudinal follow-up data.MethodsWe carried out a gynecologic evaluation, pelvic ultrasound, and laboratory and microbiologic assessment in 19 women with APECED. Retrospective data were collected from previous study visits and hospital records.ResultsThe study subjects’ median age was 42.6 years (range, 16.7-65.5). Sixteen patients (84%) had premature ovarian insufficiency, diagnosed at the median age of 16.5 years; 75% of them used currently either combined contraception or hormonal replacement therapy. In 76% of women, the morphology and size of the uterus were determined normal for age, menopausal status, and current hormonal therapy. Fifteen patients (79%) had primary adrenal insufficiency; three of them used dehydroepiandrosterone substitution. All androgen concentrations were under the detection limit in 11 patients (58%). Genital infections were detected in nine patients (47%); most of them were asymptomatic. Gynecologic C. albicans infection was detected in four patients (21%); one of the strains was resistant to azoles. Five patients (26%) had human papillomavirus infection, three of which were high-risk subtypes. Cervical cell atypia was detected in one patient. No correlation between genital infections and anti-cytokine autoantibodies was found.ConclusionsOvarian and adrenal insufficiencies manifested with very low androgen levels in over half of the patients. Asymptomatic genital infections, but not cervical cell atypia, were common in female patients with APECED.

RETROSPECTIVE ANALYSIS OF CERVICAL CYTOPATHOLOGICAL EXAMS PERFORMEDAT AT THE LABORATORY OF PATHOLOGICAL ANATOMY AND CYTOPATHOLOGY OF THE HOSPITAL ESCOLA ÁLVARO ALVIM

Each year about 272,610 new cases of cancer are diagnosed in Brazil, being cervical cancer the third most incident among women. Our country is among those that have made the most progress in consolidating the integrated cancer tracking and surveillance system. This article aims to collect sociodemographic and clinicopathological data from patients who underwent cervical cytopathological examinations at the Laboratory of Pathological Anatomy and Cytopathology at the Hospital Escola Álvaro Alvim (HEAA) from 2014 to 2018, considering a retrospective and longitudinal observation of the data. Sociodemographic and clinicopathological data were collected from 121,044 patients, and it was observed that women from Campos dos Goytacazes (84.7%) over 40 years old (56.8%) were the most prevalent at the service. The following cytological characteristics that predominated in these patients were: absence of atrophy (83.6%) or metaplasia (92.6%) of the uterine epithelium, presence of microorganisms (96.4%) and inflammation (97.2%). The presence of cell atypia (6.5%), squamous intraepithelial lesion (2%) and malignant neoplasm (0.1%) was also observed. Therefore, it becomes possible to highlight the importance of cytological examination in the process of diagnosis of malignant neoplasms of the uterine cervix, being essential for a better control and adequate screening, implementing an effective early diagnosis. It also demonstrates the profile of the patients examined at the Pathological Anatomy and Cytopathology Laboratory of HEAA, as well as the scope of this service for early diagnosis of cervical cancer in the North and Northwest Fluminense.

Whole Exon Sequencing of Primary Lesion and Liver Metastatic Lesion in Pancreatic Neuroendocrine Tumor：A Case Report and Review of the Literature

Background: Pancreatic neuroendocrine neoplasms(p-NENs) are classified into neuroendocrine tumors (NET) G1, G2, G3, and neuroendocrine carcinoma (NEC) according to WHO classification. NET and NEC are different pathogenesis. The two kinds of tumors that occurred in the same part have not been reported. We found 4 foci of NEN G3 in a primary pancreatic NET G2. The cell atypia was obvious with Ki67 index of 50-70%, focal necrosis, there were 12 hepatic metastatic nodules with similar morphology to NEN G3, which is difficult to identify NEC and NET G3.Case presentation: A patient with pancreatic NET was selected to perform whole exome sequencing on primary pancreatic NET G2 and liver metastatic NEN G3 paraffin tissues.NET G2 had 13 somatic mutations, while NEN G3 had 72 somatic mutations and Copy number variation in 4 genes. P.S493N point mutation of TRIOBP gene was detected in NET G2 and NEN G3. 5-fold amplification of MDM4 is found in the metastatic liver lesion.Conclusion: NET G2 and NEN G3 are closely related to TRIOBP gene. Oncogene amplification (MDM4) in liver metastases may be associated with morphological malignant transformation.

Criteria for Excision of Suspicious Calcifications Using the Breast Lesion Excision System (BLES)

Background: The aim of the study was to retrospectively evaluate possible imaging and histopathology criteria that can be used in a clinical basis to assess the success of excision of suspicious calcifications using the breast lesion excision system (BLES).Methods: We investigated 400 BLES stereotactic biopsies of suspicious calcifications with the mean size of 15.38 mm (st. dev.= 13.579 mm, range 3-78 mm) using a 20 mm probe performed in our department between January 2014 and 2016. The mean age of our population was 58.5 years old (range 39-78 years). The pathology results of BLES specimens were compared with the final surgical results to assess excision success rates. Possible imaging and histopathology criteria for removal were statistically analyzed (mammographic size, disease free margins, grade, comedo phenotype, molecular type).Results: The results showed that 90/400 (22.5%) biopsies were cancers (80% DCIS) and 38/400 were lesions with cell atypia (9.5%) of which 29/38 had subsequent surgery and were included in the study. Excision was achieved in 31/90 cancers (34.4%) and in 23/29 lesions with cell atypia (76.3%). The imaging and histopathology criteria for BLES excision that could be potentially clinically assessed were the initial mammographic size (p<0.001), the distance of the lesion from the specimen margins (p<0.001), the presence of comedo necrosis (p=0.014) and the grade of the cancers (p=0.021). The underestimation rate was 15.5%. Conclusion: the mammographic size, grade, comedo presence and disease-free margins, were the main criteria for BLES success rate of excision of suspicious calcifications.

Cellular changes diagnosed by cérvico-vaginal cytology in a public health laboratory of Teresina-PI

<p>Cervical cancer is one of the most common malignant diseases of women, which begins with precursor lesions that can progress to become invasive cancers. However, its development can be prevented by cytology screening and appropriate treatment. This study aimed to verify the frequency of the cellular alterations of the female genital tract in women assisted by a clinical laboratory of Teresina – Piaui, Brazil, in 2016. The data were collected from the cervical cytology reports of 2016. 9040 reports were analyzed, among which 8,095 (89.55%) had negative oncology and 945 (10.45%) were positive. It was identified 1.97% of squamous cells of indeterminate significance, with 5.84%, low-grade intraepithelial lesions (LSIL), 1.33% of high-grade intraepithelial lesions, 1.25% of glandular cell atypia (ACG) and 0.06% of invasive squamous cell carcinoma. Regarding the level of schooling, women who did not complete elementary school corresponded to the higher percentage to attend to cytopathological exams. It is concluded that the incidence of atypia was considerably higher than described in the literature. Thus, it is recommended the adoption of strategies of health promotion designed to improve the cytopathological care.</p>