Comparative study of the composition of the ambient particles deposited and retained in the lungs and hylar lymph nodes

INTRODUÇÃO: A exposição prolongada às partículas ambientais está associada à mortalidade prematura devido às causas cárdio-respiratórias e ao câncer do pulmão. O tamanho e composição destas partículas estão relacionados à maior toxicidade, agravada pela retenção prolongada destas partículas no pulmão. Pode-se postular que partículas com diferentes composições elementares podem ter distribuição diferente ao longo da árvore traqueobrônquica. A captura por micro-dissecção a laser (CML) aparece neste cenário como uma alternativa rápida e eficaz para se obter amostras para estudo da distribuição destas partículas no pulmão. OBJETIVOS: Testar a eficácia da CML no estudo de partículas retidas no pulmão comparando com outra técnica de análise de cortes de parafina (P), já consagrada na literatura. Comparar também o perfil elementar de partículas retidas ao longo da árvore traqueobrônquica e linfonodos em duas cidades com perfis distintos de poluição, através da CML, associada à espectometria de raios-X por dispersão de energia (RX-DE) aliada à microscopia eletrônica de varredura (MEV). MÉTODOS: Vinte e quatro casos autopsiados foram obtidos em duas cidades com perfis distintos de poluição (São Paulo e São José do Rio Preto). As amostras de parênquima pulmonar obtidas do lobo médio do pulmão direito foram coletadas em três regiões: tecido peribrônquico, parênquima pulmonar periférico e linfonodos hilares. Para P, a análise foi feita em áreas visualizadas no MEV correspondentes às áreas de antracose. Estas áreas de antracose foram também micro-dissecadas, usando CML e analisadas através do RX-DE aliado ao MEV. RESULTADOS: Quando os dois métodos foram comparados, a maioria dos elementos encontrados, mostrando diferença significante, foi vista na CML, exceto pelo Ca e Mg (mais comumente encontrados em P). A análise elementar das partículas depositadas ao longo da árvore traqueobrônquica mostra dois grupos de distribuição dos elementos, com deposição predominante peribronquiolar ou com deposição predominante linfonodal. A análise elementar das áreas peribrônquicas descrimina melhor (95.8 %), o tipo de exposição à poluição, sem diferença significante para os outros locais estudados. CONCLUSÃO: Os perfis elementares das partículas retidas ao longo da árvore traqueobrônquica mostram dois grupos com padrão de distribuição distinta. A região proximal é o principal local para discriminação do tipo de exposição do indivíduo, sendo a antracose o carimbo da exposição à poluição. A CML se mostrou também uma ferramenta útil para discriminar áreas de interesse no estudo da análise elementar de partículas retidas no pulmão quando comparada com a análise nos cortes de parafina.RATIONALE: Prolonged exposure to ambient particles is associated with premature mortality due to cardio respiratory diseases and lung cancer. Size and composition of these particles determine toxicity, aggravated by their long term retention in the lungs. In this context, it is plausible to postulate that different particles with different elemental composition must have distinct distribution patterns along the bronchial tree. Laser capture microdissection (LCM) appears as a rapid and efficient alternative for obtaining representative lung tissue for particle analysis. OBJECTIVES: To test laser capture microdissection (LCM) as a new tool for studying particle retention, comparing to a classical method using paraffin sections (PS). To compare the elemental profile of particles retained along the bronchial tree and lymph nodes in two cities with distinct pollution backgrounds by using LCM, through energy dispersive x-ray (EDX) and scanning electron microscopy (SEM). METHODS: Twenty-four right lung middle lobes from autopsied cases were obtained in two cities with different pollution backgrounds. Lung samples were collected from three distinct regions in the lungs at the time of autopsy: peribronchial tissue, peripheral parenchyma and hylar lymph nodes. For PS, analysis was performed in areas visualized in the SEM correspondent to anthracotic areas. These areas of anthracosis were also microdissected using LCM and analyzed for elemental composition through EDX allied to SEM. RESULTS: When the two methods were compared, the majority of the elements showing significant difference was predominantly found when LCM was used, except for Ca and Mg (more related to PS) Elemental analysis of particles deposited along the bronchial tree shows two groups of distribution: elements with preferable peribronchiolar or preferable lymph node deposition. Elemental profile of peribronchial areas discriminate accurately (95.8 %) the type of pollution exposure, with no statistical difference noted for the other sites. CONCLUSIONS: Elemental profiling of the particles retained along the bronchial tree shows two groups with distinct distribution patterns. The proximal bronchial tree is the main site for discrimination of pollution exposure, with an elemental finger print of anthracosis. LCM has also proven to be a useful tool in discriminating areas of interest for elemental analysis of particles retained in the lung when compared to analysis in PS

The Utility of Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Infectious Diseases—Report of Three Cases

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a fast and minimally invasive methodology with a crucial impact on patients’ management. It has an important and established role in the diagnosis and staging of mediastinal and abdominal malignancies, but little is discussed in the literature on the usefulness of this technique in the diagnosis of infectious diseases. In the current report, we present three different cases where EUS was essential for reaching the diagnosis of tuberculosis and paracoccidiodomicosis in cases otherwise seen as malignant. In conclusion, EUS was successful not only in obtaining enough cells for morphological analysis, but also for the production of cell blocks and assessment of the presence of the microorganisms by special stains. EUS allied to fine needle biopsy was an important tool in determining diagnoses of enlarged lymph nodes, revealing the diagnosis of infectious diseases in cases otherwise seen as malignant. The wide use of this methodology in cases such as those reported here cannot only rule out malignancy, but also aid critically ill patients by installing early proper therapy without the need for aggressive interventions

Automated screening of conventional gynecological cytology smears: feasible and reliable

OBJECTIVES: We tested the ability of automated screening in processing conventional gynecological cytology smears and its efficacy in assessing sample adequacy and stratifying cases for risk of malignancy. STUDY DESIGN: Cases were retrospectively selected, including unsatisfactory samples and slides with various sorts of artifacts. Automated screening was performed using the FocalPoint GS Imaging System (Becton Dickinson, Franklin Lakes, N.J., USA), with classification into five quintiles. For agreement purposes, cases were grouped into high risk for malignancy (quintiles 1 and 2) and low risk for malignancy (quintiles 3, 4 and 5). RESULTS: A total of 120 cases (median age 37.5 years, range 18-85) were included in the study. Eighty-three cases (69.2%) could be successfully classified into quintiles. When divided by risk, 31 cases were placed in the high-risk and 52 in the low-risk group. The overall sensitivity and specificity of the automated analysis was 100 and 70.3%, respectively. CONCLUSIONS: Automated analysis could analyze the majority of conventional smears, including one case previously screened as unsatisfactory. All malignant and high-grade lesions were correctly classified into the high-risk group. Broad use of this automation system could potentially decrease screening time and augment the efficacy in detecting precursor neoplastic changes in cervical cytology smears