Citologia da cúpula vaginal com suspeita de lesão intraepitelial de grau indeterminado: estudo de caso

No presente artigo é relatado um caso de uma paciente de 42 anos, diagnosticada em 2011 com Adenocarcinoma in situ e displasia grave do epitélio de revestimento pavimentoso, que foi tratada por traquelectomia. Em Novembro de 2013, a paciente realizou uma citologia da cúpula vaginal, onde se observaram achados citológicos compatíveis com lesão intraepitelial de baixo grau mas também a presença de células que favorecem o diagnóstico de lesão intraepitelial de alto grau. Não sendo possível classificar a lesão intraepitelial como sendo claramente baixo ou alto grau, atribuiu-se a interpretação de lesão intraepitelial de grau indeterminado. Para confirmação e esclarecimento do diagnóstico foi efetuada biopsia com resultado de displasia grave do epitélio de revestimento pavimentoso vaginal sem evidência de invasão do estroma. Por fim foi indicada a pesquisa e tipificação de vírus do papiloma humano, com resultado positivo para o tipo 16. Diagnósticos citológicos de lesão intraepitelial de grau indeterminado apresentam um follow-up histológico estatisticamente diferente das lesões intraepiteliais de alto e baixo grau, e estão na sua maioria associadas a infeção por vírus do papiloma humano de alto risco. Os achados citológicos do presente estudo apoiam a necessidade de se estabelecer esta lesão como categoria de diagnóstico no Sistema de Bethesda, com um follow-up definido.

Novel method using a laser scanning cytometer for detection of Mycobacteria in clinical samples

In order to evaluate the capacity of laser scanning cytometry (LSC) to detect acid-fast bacilli directly on clinical samples, a comparison between Kinyoun-stained smears analyzed under light microscopy and propidium iodide-auramine-stained smears analyzed by LSC was performed. The results were compared with those for culture on BACTEC MGIT 960. LSC is a new, reliable methodology to detect Mycobacteria.

Optimization of immunocytochemistry in cytology: comparison of two protocols for fixation and preservation on cytospin and smear preparations

Objective: A new protocol for fixation and slide preservation was evaluated in order to improve the quality of immunocytochemical reactions on cytology slides. Methods: The quality of immunoreactions was evaluated retrospectively on 186 cytology slides (130 direct smears, 56 cytospins) prepared from different cytology samples. Ninety-three of the slides were air dried, stored at -20 °C and fixed in acetone for 10 minutes (Protocol 1), whereas the other 93 were immediately fixed in methanol at -20 °C for at least 30 minutes, subsequently protected with polyethylene glycol (PEG) and stored at room temperature (Protocol 2). Immunocytochemical staining, with eight primary antibodies, was performed on a Ventana BenchMark Ultra instrument using an UltraView Universal DAB Detection Kit. The following parameters were evaluated for each immunoreaction: morphology preservation, intensity of specific staining, background and counterstain. The slides were blinded and independently scored by four observers with marks from 0 to 20. Results: The quality of immunoreactions was better on methanol-fixed slides protected with PEG than on air-dried slides stored in the freezer: X¯ = 14.44 ± 3.58 versus X¯ = 11.02 ± 3.86, respectively (P < 0.001). Conclusion: Immediate fixation of cytology slides in cold methanol with subsequent application of PEG is an easy and straightforward procedure that improves the quality of immunocytochemical reactions and allows the storage of the slides at room temperature.

Dosimetria e análise de incertezas em braquiterapia ginecológica

Mestrado em Radiações Aplicadas às tecnologias da Saúde

Carcinossarcoma: estudo de caso em citologia ginecológica

O carcinossarcoma uterino, ou tumor mülleriano misto maligno, é um tumor raro, que compreende 2-5% dos tumores malignos do útero, com origem nos canais embrionários denominados canais müllerianos, que dão origem aos componentes epitelial e mesenquimatoso do órgão. O carcinossarcoma tem mau prognóstico e a taxa de sobrevida aos 5 anos é de 33-39%. Desenvolve-se geralmente em mulheres pós-menopausa, com idade superior a 60 anos, sem antecedentes ginecológicos, com maior incidência em mulheres obesas, hipertensas, nulíparas e/ou diabéticas. A sintomatologia inclui piometra, hemorragia vaginal, dor abdominal e massa abdominal.

Impact of a training course on the quality of malaria diagnosis by microscopy in Angola

Background: In Angola, malaria is an endemic disease having a major impact on the economy. The WHO recommends testing for all suspected malaria cases, to avoid the presumptive treatment of this disease. In malaria endemic regions laboratory technicians must be very comfortable with microscopy, the golden standard for malaria diagnosis, to avoid the incorrect diagnosis. The improper use of medication promotes drug resistance and undesirable side effects. The present study aims to assess the impact of a three-day refresher course on the knowledge of technicians, quality of blood smears preparation and accuracy of microscopy malaria diagnosis, using qPCR as reference method. Methods: This study was implemented in laboratories from three hospitals in different provinces of Angola: Bengo, Benguela and Luanda. In each laboratory samples were collected before and after the training course (slide with thin and thick blood smears, a dried blood spot and a form). The impact of the intervention was evaluated through a written test, the quality of slide preparation and the performance of microscopy. Results: It was found a significant increase on the written test median score, from 52.5% to 65.0%. A total of 973 slides were analysed to evaluate the quality of thick and thin blood smears. Considering all laboratories there was a significant increase in quality of thick and thin blood smears. To determine the performance of microscopy using qPCR as the reference method we used 1,028 samples. Benguela presented the highest values for specificity, 92.9% and 98.8% pre and post-course, respectively and for sensitivity the best pre-course was Benguela (75.9%) and post-course Luanda (75.0%). However, no significant increase in sensitivity and specificity after the training course was registered in any laboratory analysed. Discussion: The findings of this study support the need of continuous refresher training for microscopists and other laboratory staff. The laboratories should have a quality control programme to supervise the diagnosis and also to assess the periodicity of new training. However, other variables needed to be considered to have a correct malaria diagnosis, such as adequate equipment and reagents for staining and visualization, good working conditions, motivated and qualified personnel.