Effectiveness of cladribine therapy in patients with pulmonary Langerhans cell histiocytosis.

BackgroundPulmonary Langerhans cell histiocytosis (PLCH) is a rare disorder characterised by granulomatous proliferation of CD1a-positive histiocytes forming granulomas within lung parenchyma, in strong association with tobacco smoking, and which may result in chronic respiratory failure. Smoking cessation is considered to be critical in management, but has variable effects on outcome. No drug therapy has been validated. Cladribine (chlorodeoxyadenosine, 2-CDA) down-regulates histiocyte proliferation and has been successful in curbing multi-system Langerhans cell histiocytosis and isolated PLCH.Methods and patientsWe retrospectively studied 5 patients (aged 37¿55 years, 3 females) with PLCH who received 3 to 4 courses of cladribine therapy as a single agent (0.1 mg/kg per day for 5 consecutive days at monthly intervals). One patient was treated twice because of relapse at 1 year. Progressive pulmonary disease with obstructive ventilatory pattern despite smoking cessation and/or corticosteroid therapy were indications for treatment. Patients were administered oral trimethoprim/sulfamethoxazole and valaciclovir to prevent opportunistic infections. They gave written consent to receive off-label cladribine in the absence of validated treatment.ResultsFunctional class dyspnea improved with cladribine therapy in 4 out of 5 cases, and forced expiratory volume in 1 second (FEV1) increased in all cases by a mean of 387 ml (100¿920 ml), contrasting with a steady decline prior to treatment. Chest high-resolution computed tomography (HRCT) features improved with cladribine therapy in 4 patients. Hemodynamic improvement was observed in 1 patient with pre-capillary pulmonary hypertension. The results suggested a greater treatment effect in subjects with nodular lung lesions and/or thick-walled cysts on chest HRCT, with diffuse hypermetabolism of lung lesions on positron emission tomography (PET)-scan, and with progressive disease despite smoking cessation. Infectious pneumonia developed in 1 patient, with later grade 4 neutrocytopenia but without infection.DiscussionData interpretation was limited by the retrospective, uncontrolled study design and small sample size.ConclusionCladribine as a single agent may be effective therapy in patients with progressive PLCH.

Follicular helper T cells: implications in neoplastic hematopathology.

A distinct subset of T helper cells, named follicular T helper cells (T(FH), has been recently described. T(FH) cells are characterized by their homing capacities in the germinal centers of B-cell follicles where they interact with B cells, supporting B-cell survival and antibody responses. T(FH) cells can be identified by the expression of several markers including the chemokine CXCL13, the costimulatory molecules PD1 and inducible costimulator, and the transcription factor BCL6. They appear to be relevant markers for the diagnosis of angioimmunoblastic T-cell lymphoma (AITL) and have helped to recognize subsets of peripheral T-cell lymphoma, not otherwise specified, with nodal or cutaneous presentation expressing T(FH) antigens that might be related to AITL. In B-cell neoplasms, T(FH) cells are present within the microenvironment of nodular lymphocyte-predominant Hodgkin lymphoma and follicular lymphoma, where they likely support the growth of neoplastic germinal center-derived B cells. Interestingly, the amount of PD1+ cells in the neoplastic follicles might have a favorable impact on the outcome of follicular lymphoma patients. Altogether, the availability of antibodies directed to T(FH)-associated molecules has important diagnostic and prognostic implications in hematopathology. In addition, T(FH) cells could represent interesting targets in T(FH)-derived lymphomas such as AITL, or in some B-cell neoplasms where they act as part of the tumor microenvironment.

Discovery of Dogger in the internal limestone dorsale to the S of Tetouan (Northern Rif, Morocco) - Paleogeographic consequences

The Dogger (Bajocian-Lower Bathonian) has been dated for the first time in the internal Limestone Dorsale of the Rif by means of ammonites and radiolarians. It shows radiolarian and nodular limestone facies. It is concluded, then, that radiolarian sedimentation began during the Dogger in this realm, and that a drowning of the `'Ghomaride margin'' occurred at that time.

Follicular Peripheral T-cell Lymphoma Expands the Spectrum of Classical Hodgkin Lymphoma Mimics.

Epstein-Barr virus (EBV)-infected B cells with Reed-Sternberg-like cell (RS) features may occur in peripheral T-cell lymphomas (PTCLs), especially in angioimmunoblastic T-cell lymphoma. Here, we report 5 patients presenting with lymphadenopathy whose first biopsies demonstrated nodular lymphoid proliferations containing scattered CD30, CD15, EBV Hodgkin and Reed-Sternberg-like cells, which led to an initial diagnosis of lymphocyte-rich classical Hodgkin lymphoma. However, the uncommon clinical features and/or the occurrence of relapse as PTCL prompted review of the biopsies with expanded immunohistologic and molecular studies and revision of the diagnoses to follicular variant of PTCL (F-PTCL). All cases had atypical small to medium-sized CD3 T cells that expressed CD10 (4/5) and the follicular helper T-cell (TFH) antigens BCL6, PD1, CXCL13, and ICOS. All demonstrated clonal T cells with a similar pattern in multiple samples from 4 patients. In 2 cases, flow cytometry demonstrated circulating lymphocytes with an abnormal sCD3, CD4, ICOS immunophenotype. Two patients had a skin rash at presentation, and 1 had B symptoms. Two of the 4 patients treated with polychemotherapy are alive at 3 and 6 years after first diagnosis. These cases highlight how some F-PTCLs may closely mimic lymphocyte-rich classical Hodgkin lymphoma requiring careful assessment of the T cells before rendering the latter diagnosis. The functional properties of TFH cells might lead to the presence of EBV-positive B blasts with RS-like features in TFH-derived PTCL such as angioimmunoblastic T-cell lymphoma and F-PTCL.

Abnormal balance between proliferation and apoptotic cell death in fibroblasts derived from keloid lesions.

A new culture model was developed to study the role of proliferation and apoptosis in the etiology of keloids. Fibroblasts were isolated from the superficial, central, and basal regions of six different keloid lesions by using Dulbecco's Modified Eagle Medium containing 10% fetal calf serum as a culture medium. The growth behavior of each fibroblast fraction was examined in short-term and long-term cultures, and the percentage of apoptotic cells was assessed by in situ end labeling of fragmented DNA. The fibroblasts obtained from the superficial and basal regions of keloid tissue showed population doubling times and saturation densities that were similar to those of age-matched normal fibroblasts. In contrast, the fibroblasts from the center of the keloid lesions showed significantly reduced doubling times (25.9 +/- 6.3 hours versus 43.5 +/- 6.3 hours for normal fibroblasts) and reached higher cell densities. In long-term culture, central keloid fibroblasts formed a stratified three-dimensional structure, contracted the self-produced extracellular matrix, and gave rise to nodular cell aggregates, mimicking the formation of keloid tissue. Apoptotic cells were detected in both normal and keloid-derived fibroblasts, but their numbers were twofold higher in normal cells compared with all keloid fibroblasts. To examine whether apoptosis mediates the therapeutic effect of ionizing radiation on keloids, the cells were exposed to gamma rays at a dose of 8 Gy. Under these conditions, a twofold increase in the population of apoptotic cells was detected. These results indicate that the balance between proliferation and apoptosis is impaired in keloid fibroblasts, which could be responsible for the formation of keloid tumors. The results also suggest that keloids contain at least two different fibroblast fractions that vary in growth behavior and extracellular matrix metabolism.

Geología del Montgrí

This paper, fundamentally stratigraphic, is based on the vertical distribution of fauna in sediments which constitute the Montgri Massif. The stratigraphic series is composed of two units: one allochtonous (Mesozoic) and a second one autochtonous (Paleogene). The latter crops out in front of the thrust belt and presents the typical facies described by PALLI (1972). The allochtonous part is formed by the following units (from bottom to top): variegated gypsiferous shales of Keuper age; marls, limestones and dolomites from the Lias (Domerian); gray breccia ted dolomites: supraliassic; and Cretaceous limestones with rare interbeds of calcareous marls and nodular shaly marls. In this unit the Neocomian, Barremian (?), Aptian, Albian, Cenomanian, Turonian (?) and Santonian haven been recognized. Structurally, the Montgri Massif is part of a thrust belt which has been divided into three parts of different development ang age. Both parts are affected by ample synclinal folds of NE-SW directions and fractures of NW-SE orientation. The fractures condition the torrential streams as well as the karstic phenomena present in the Massif. These and the eolian actions are the main causes of the present geomorphology of the Montgri

Atuação de Acidithiobacillus na solubilização de fosfato natural em solo de tabuleiro cultivado com jacatupé (Pachyrhizus erosus)

Realizou-se um experimento em casa de vegetação para avaliar a atuação do enxofre (S) inoculado com Acidithiobacillus na disponibilidade de fósforo (P) de fosfato natural (FN), em diferentes modos de aplicação do fertilizante, em um Espodossolo Ferrocárbico Órtico, do tabuleiro costeiro da Zona da Mata de Pernambuco, cultivado com jacatupé (Pachyrhizus erosus). As plantas foram inoculadas com rizóbio (NFB 747 e NFB 748) e adicionado tratamento-controle sem inoculação com rizóbio. Os tratamentos com P foram: (1) FN revestindo o enxofre inoculado com Acidithiobacillus (FN S*), (2) FN revestido com S e com Acidithiobacillus (S* FN), (3) mistura FN com S e com Acidithiobacillus (FN + S*), (4) mistura FN com S e sem Acidithiobacillus (FN + S), (5) superfosfato triplo (ST) e (6) sem aplicação de fósforo (P0). Os tratamentos foram aplicados: (a) na superfície, (b) em sulco 10 cm abaixo da semente, e (c) em sulco 10 cm abaixo e ao lado da semente. A biomassa nodular foi maior no tratamento (FN + S*) com melhor efeito quando aplicado ao lado e abaixo das sementes. O (FN + S*) também aumentou a altura das plantas, a biomassa da parte aérea e das túberas e o N total da parte aérea, especialmente quando aplicado 10 cm abaixo das sementes. O P total da parte aérea foi mais elevado com (S* FN) aplicado 10 cm abaixo das sementes. Os melhores teores de P no solo foram obtidos com (FN + S*) e (S* FN), com efeito mais evidente quando aplicados 10 cm abaixo das sementes.

Eficiência e competitividade de variantes espontâneos isolados de estirpes de Bradyrhizobium spp recomendadas para a cultura da soja (Glycine max)

O cultivo sucessivo de soja inoculada numa mesma área proporcionou a adaptação de uma população de rizóbios, que podem não ser tão eficientes quanto à capacidade de fixação de N2, mas apresentam alta competitividade, dificultando a introdução de novas estirpes mais eficientes. Com a finalidade de avaliar o desempenho simbiótico (eficiência e competitividade) de variantes espontâneos isolados de estirpes de B. japonicum (SEMIA 5079 e SEMIA 5080) e B. elkanii (SEMIA 587 e SEMIA 5019), realizou-se um experimento em casa de vegetação onde os variantes foram inoculados isoladamente e em diferentes combinações entre os variantes e uma estirpe comprovadamente mais competitiva (SEMIA 587 ou SEMIA 5019) a partir da adição de inóculos mistos (1/1; v/v) no cultivar de soja BR-16. Por meio da avaliação das variáveis analisadas (nodulação, produção de matéria de seca da parte aérea, N total acumulado na parte aérea e ocupação nodular), foi possível constatar que o determinante da maior eficiência em tratamentos co-inoculados não foi a ocupação nodular de determinada estirpe ou variante presente no inóculo, mas, sim, o tipo de interação (sinérgica ou antagônica) predominante no tratamento co-inoculado e que é possível selecionar variantes eficientes e competitivos para a cultura da soja a partir de estirpes parentais que já apresentam características desejáveis para utilização em inoculantes comerciais.

Inflammation palpébrale pseudotumorale. A propos d'une observation anatomo-clinique [Pseudotumoral eyelid inflammation. Apropos of an anatomo-clinical case].

A clinicopathological case of a 76-year-old male patient with a chronic inflammatory change of the inferior left eyelid is reported. The inflammation appeared as a reddish area of the inner part of the eyelid, without sharp limits, but with loss of lashes. Numerous local treatments did not to cure this condition. As some true eyelid tumors may mimic an inflammation during growth and, for example, sebaceous carcinoma may clinically present as chronic unilateral blepharitis, a surgical excisional biopsy was performed on this left eyelid. Its histopathological study showed a granulomatous inflammation, which was typical of a simple chalazion. This case clearly illustrates that the chalazion may not always appear as a limited nodular inflammation of the eyelid, but may have a more diffuse clinical presentation.

Avaliação da biodiversidade de rizóbios simbiontes do feijoeiro (Phaseolus vulgaris L.) em Santa Catarina

Os solos brasileiros, em geral, apresentam uma população abundante de rizóbios capazes de nodular e fixar N2 em simbiose com o feijoeiro (Phaseolus vulgaris L.); contudo, a diversidade dessas bactérias ainda é pouco conhecida. Este estudo teve por objetivo conhecer a biodiversidade de microssimbiontes do feijoeiro em Santa Catarina e, para isso, foram obtidos 117 isolados de nódulos de plantas coletadas em campo, em 23 áreas do extremo oeste, do meio oeste e do planalto sul catarinense. Com base nos atributos morfofisiológicos, os isolados foram classificados em nove grupos. Pela análise dos perfis de DNA após a amplificação (PCR) com o "primer" BOX, que codifica regiões conservadas e repetidas do genoma, 107 perfis distintos foram agrupados em um nível final de similaridade de apenas 26,9 %. Os perfis obtidos pela amplificação do gene 16S ribossômico - referência na taxonomia atual de procariotos - seguida pela digestão com três enzimas de restrição (técnica de RFLP-PCR), resultaram em seis agrupamentos principais e cinco bactérias isoladas. As populações consistiram de 17,1 % de Rhizobium tropici, 35,9 % de R. etli, 32,5 % de R. leguminosarum, 1,7 % de R. giardinii e 12,8 % com perfis distintos das espécies descritas de rizóbios de feijoeiro. R. tropici predominou em solos ácidos do meio oeste e do planalto sul, R. leguminosarum não foi detectado no extremo oeste e R. etli ocorreu nas três regiões, essas duas últimas espécies em solos menos ácidos. Os resultados enfatizam a diversidade genética elevada de rizóbios, inter e intra-específica, nos solos catarinenses, inclusive com a indicação de novas espécies.

Specific (granulomatous) oral lesions of sarcoidosis: Report of two cases

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology that usually presents with bilateral hiliar adenopathies, pulmonary infiltrations, and ocular and cutaneous lesions. The specific cutaneous lesions, or granulomatous, are produced in from 9% to 37% of patients with systemic sarcoidosis. Nevertheless, few patients have been described having specific lesions from sarcoidosis in the oral mucous membrane. We present 2 patients with systemic sarcoidosis who developed specific sarcoidosis lesions in the oral mucous membrane. The first patient presented a plaque on the tongue of a chronic nature associated with facial lupus pernio. The second patient presented a rapidly growing nodular lesion on the lower lip that was in fact the presentation sign of the disease. Although infrequent, oral lesions may constitute the first sign of systemic sarcoidosis. For this reason the oral mucous membrane needs to be explored when there is suspicion of sarcoidosis, and systemic sarcoidosis must be included in the differential diagnosis of oral granulomatous lesions.

Especificidade hospedeira de variantes Bradyrhizobium spp em soja (cvs peking e clark), caupi e guandu

A expansão da cultura da soja evidenciou uma alta especificidade hospedeira, requerendo a pesquisa de novas estirpes que apresentassem capacidade de nodular a soja e bom potencial de competição com a população de rizóbios naturalizada nos solos. O objetivo deste trabalho foi avaliar a especificidade hospedeira de variantes isolados de estirpes de Bradyrhizobium spp quanto à nodulação e eficiência relativa de fixação de N2 atmosférico em soja (cvs peking e clark), caupi e guandu. O experimento foi realizado sob condições controladas em câmara de crescimento por meio de testes de variantes de B. japonicum e B. elkanii e suas respectivas estirpes originais quanto à habilidade de nodular soja, caupi e guandu. A colheita foi realizada aos 35 dias, sendo avaliada a nodulação (número, peso dos nódulos secos), produção de matéria seca na parte aérea, eficiência relativa de fixação de N2 atmosférico. Os variantes e estirpes de Bradyrhizobium spp nodularam Glycine max (cultivares BR-16, Clark e Peking), Vigna unguiculata e Cajanus cajan, contudo, apenas para Glycine max a interação rizóbio-leguminosa demonstrou eficiência simbiótica significativa.

An unusual uterine tumour with signet ring cell features

Objective: Lymphomas with signet ring cell features are rare, as is uterine dissemination of lymphomas. We report an exceptional case of a uterine tumor combining these two characteristics. Method: A 61-year-old female was diagnosed in 2004 with localized nodal grade 2 follicular lymphoma (stage IA). She received local radiation therapy, experienced total remission, and did well until 2009 when a systematic CT scan evidenced a pelvic anterior-lateral mass. Total enlarged hysterectomy was performed. Results: The anterior uterine wall contained a 4.8-cm fish flesh well-delineated mass corresponding to a mostly diffuse and focally nodular proliferation of medium to large cells with extensive signet ring cell changes. Tumor cells were CD20-, CD10-, Bcl2-, and Bcl6-positive with a low proliferation rate (<10-15%); CD21 underlined a focal follicular architecture. The vacuoles were PAS-negative and did not stain for immunoglobulin; ultrastructural analysis revealed nonspecific degenerative vacuoles. No lymph nodes were identified isolated from the surgical specimen. The tumor was considered as a secondary localization of the systemic follicular lymphoma, though no signet ring cells were evidenced in the cervical lymph node biopsy (reviewed). Follow-up showed retroperitoneal tissue infiltration (PET-CT) and normal medullar biopsy. She recently started R-CHOP chemotherapy. Conclusion: This case illustrates both an unusual site of dissemination and challenging cytological characteristics in a follicular lymphoma. The signet ring cell changes challenged the adequate classification of this lymphoma as either a large B cell or a follicular B cell lymphoma.

Simultaneous renal oncocytoma and lymphoma: interest of lymphadenectomy

Kidney lesions may be difficult to diagnose only by radiological exams, often requiring proof by tissue biopsy. Moreover, if enlarged regional lymph nodes are also present, the spectrum of differential diagnoses is even greater. The role of regional lymph node dissection in this setting is not clearly established. We show the case of a patient with a kidney mass associated with a conglomerate of para-aortic and iliac lymphadenopathies corresponding to an oncocytoma and a nodular lymphocyte predominant Hodgkin' lymphoma, respectively. Diagnosis of these two lesions was performed by morphology and immunohistochemistry. This case reflects how imaging can mislead to diagnosis and how histological confirmation helps decide treatment management.

Resposta do feijão-caupi à inoculação com estirpes de Bradyrhizobium recomendadas para a soja

O uso de inoculantes contendo bactérias fixadoras de N2 aumenta anualmente na cultura do feijão-caupi nas regiões Norte, Nordeste e Centro-Oeste do Brasil. Entretanto, em muitas ocasiões vêm sendo utilizadas estirpes recomendadas para a cultura da soja, mesmo existindo estirpes próprias para o feijão-caupi. Este trabalho foi conduzido com o objetivo de avaliar a resposta das estirpes de Bradyrhizobium recomendadas para a soja na nodulação e no crescimento e desenvolvimento das plantas de feijão-caupi. Conduziu-se um experimento em condições controladas em casa de vegetação com a cultivar BRS Guariba inoculada com as estirpes recomendadas para a cultura da soja: SEMIA 5079 (= CPAC 15), SEMIA 5080 (= CPAC 7), SEMIA 587 e SEMIA 5019 (= BR 29); duas estirpes recomendadas para o feijão-caupi: SEMIA 6462 (= BR 3267) e SEMIA 6464 (= BR 3262); um tratamento com adubação nitrogenada; e um controle absoluto. Os resultados mostraram que a estirpe SEMIA 587 apresentou eficiência na FBN na cultura do feijão-caupi semelhante à das estirpes BR 3262 e BR 3267. Por outro lado, apesar de as estirpes CPAC 15 e CPAC 7 proporcionarem a formação de elevado número de nódulos no feijão-caupi, ocasionaram crescimento de plantas, eficiência nodular e acúmulo de N inferiores aos das estirpes BR 3262 e BR 3267, não devendo ser utilizadas como inoculante para a cultura.