Sialosis Parotídea Alcohólica: estudio Estructural y Ultraestructural

Objetivos: El propósito del presente trabajo fue establecer posibles diferencias histopatológicas entre los estadíos iniciales y terminales de la sialosis alcohólica, patología que generalmente involucra hipertrofia parotídea y afecta estructuralmente en diverso grado a las demás glándulas salivales. Diseño del estudio: se analizaron y compararon las modificaciones estructurales y ultraestructurales de glándulas parótidas provenientes de: A) biopsias de alcohólicos crónicos con diagnóstico clínico de cirrosis hepática, de las que una fracción fue procesada para microscopía óptica (MO) y otra fracción fue fijada en glutaraldehído y procesada para microscopía electrónica de trasmisión (MET) Jeol JEM 1010 B) autopsias de individuos fallecidos por cirrosis hepática alcohólica, procesadas para MO y re-procesadas posteriormente para MET. Una porción de glándula normal obtenida de material quirúrgico fue usada como control. Resultados: Las alteraciones encontradas en las biopsias son considerablemente comparables a las modificaciones encontradas en las autopsias de alcohólicos, especialmente debido a la acumulación de gránulos secretorios de diferente tamaño, forma y electrodensidad, generalmente ocupando todo el citoplasma de las células acinares. En ambos tipos de muestras los ductos excretores se encontraban dilatados y el epitelio de los conductos estriados presentaba células claras y oscuras, con núcleos de aspecto y disposición irregular. Se observó asimismo moderada infiltración grasa en el estroma y leve edema periacinar. En las biopsias se observaron al MO y MET inclusiones lipídicas en las células acinares y ductales del parénquima glandular. Conclusiones: Los resultados estructurales y ultraestructurales encontrados en biopsias y autopsias de parótidas, ponen de manifiesto que las alteraciones ya están presentes en las glándulas salivales de alcohólicos crónicos antes de la etapa terminal de la cirrosis hepática. La dilatación de los lúmenes del sistema ductal podría ser la principal responsable de la hipertrofia glandular.Objectives: The purpose of this study is to demonstrate the histopathological differences between the initial and advanced stages of Alcoholic Sialosis, a pathology that generally involves parotid hypertrophy and structurally affects, to diverse degrees, the other salivary glands. Study design: An analysis and comparison was carried out of the structural and ultrastructural modifications of the parotid glands from the hepatic biopsies of chronic alcoholics with clinical diagnosis of cirrhosis and from autopsies on individuals who had died from alcoholic hepatic cirrhosis. Various samples of normal gland obtained from surgical material were used as a control. Results: The alterations found in the biopsies corresponded to the modifications discovered in the autopsies of alcoholics. Notable in both cases was the massive accumulation of secretory granules of different size, shape and electrodensity, which occupied the cytoplasm of the acinar cells. In both sample types the excretory ducts were enlarged and the epithelium of the striate ducts presented cells with nuclei and cytoplasm of irregular appearance and arrangement. A moderate adipose infiltration in the stroma and slight periacinal edema was also observed. The biopsies revealed, both at optical and electron microscopical levels, lipid inclusions in the acinar cells and the glandular parenchymal ducts. Conclusions: The structural and ultrastructural findings of the parotid biopsies and autopsies, clearly show that alterations are already present in the salivary glands of chronic alcoholics before the terminal phase of hepatic cirrhosis. The enlargement of the ductal system lumens could be the principal cause of glandular hypertrophy

Alteraciones salivares en pacientes con diabetes tipo 2

La diabetes mellitus tipo 2 es el desorden metabólico más frecuente, siendo además causante de una importante morbi-mortalidad. En estos pacientes se han descrito alteraciones estructurales de la parotida (sialosis) que podrían comportar modificaciones en la composición salivar, así como un incremento de patología dental y periodontal. Objetivos: establecer las alteraciones bioquímicas de la saliva y su posible correlación con los hallazgos morfológicos. Diseño del estudio: se realizo un estudio clínico de 33 pacientes, 17 de ellos con diabetes tipo 2. Se recogieron muestras de saliva para análisis bioquímico y suero para control metabólico. Resultados: en la saliva de los pacientes diabéticos encontramos un incremento de la urea y las proteínas totales, así como una reducción de la microalbumina. La glucosa salivar estaba solo aumentada en los diabéticos con mal control metabólico. Los síntomas de xerostomía se detectaron en el 76,4% de los casos y las lesiones dentales y periodontales en el 100% de los pacientes. Conclusión: estos desordenes bioquímicos en la saliva de los pacientes con diabetes tipo 2 se pueden correlacionar con las alteraciones estructurales descritas previamente.Diabetes mellitus type 2 is the most common metabolic disorder and it causes an important morbimortality. The structural modifications in the parotid gland (sialosis) had already been described in these patients and could result in variations in the salivary composition, as well as an increase in periodontal and dental pathology. Objectives: to compare the biochemical findings in the saliva and to correlate these biochemical disturbances with the morphologic findings previously described. Patients and methods: clinical information were gathered about 33 patients, 17 had type 2 diabetes. Samples of whole saliva were obtained for biochemical analysis and serum samples to determine metabolic control. Results: in the diabetics saliva we found urea and total proteins increased and reduced levels of microalbumina. Salivary glucose was only augmented in patients with poor metabolic control. Clinical symptoms of xerostomia were present in 76,4% and dental and periodontal disease in 100%. The parotid gland was characterised by the presence of small acini, lipid intracytoplasmic droplets, as well as adipose stroma infiltration. The acinar cytoqueratins¿ expression was heterogeneous and very positive in the hyperplasic ducts. Conclusions: these biochemical disorders in the saliva of the type 2 diabetic patients would be related with the structural changes previously observed in parotid glands

Structural and functional salivary disorders in type 2 diabetic patients

Diabetes mellitus type 2 is the most common metabolic disorder and it causes an important morbimortality. The structural modifications in the parotid gland (sialosis) had already been described in these patients and could result in variations in the salivary composition, as well as an increase in periodontal and dental pathology. Objectives: to compare the biochemical findings in the saliva and to correlate these biochemical disturbances with the morphologic findings previously described. Patients and methods: clinical information were gathered about 33 patients, 17 had type 2 diabetes. Samples of whole saliva were obtained for biochemical analysis and serum samples to determine metabolic control. Results: in the diabetics saliva we found urea and total proteins increased and reduced levels of microalbumina. Salivary glucose was only augmented in patients with poor metabolic control. Clinical symptoms of xerostomia were present in 76,4% and dental and periodontal disease in 100%. The parotid gland was characterised by the presence of small acini, lipid intracytoplasmic droplets, as well as adipose stroma infiltration. The acinar cytoqueratins? expression was heterogeneous and very positive in the hyperplasic ducts. Conclusions: these biochemical disorders in the saliva of the type 2 diabetic patients would be related with the structural changes previously observed in parotid glands

Diferencias estructurales entre las sialosis parotidea de etiología diabética y alcohólica.

Entre los agentes etiológicos de la sialosis se citan el alcoholismo crónico y la diabetes. Ambas entidades nosológicas se describen con un cuadro histopatológico similar. Objetivos: El objetivo de este trabajo fue analizar y comparar las modificaciones estructurales de la sialosis diabética con las de etiología alcohólica. Diseño del estudio: Se analizaron 7 biopsias de glándula parótida de individuos diabéticos y 4 de pacientes no diabéticos (controles), con patología oncológica en regiones vecinas. El estudio comparativo se efectuó con muestras de archivo que comprendieron 12 biopsias parotídeas de pacientes con diagnóstico clínico de cirrosis hepática alcohólica y 6 autopsias de individuos que fallecieron por cirrosis hepática alcohólica. El material fijado en formol e incluído en parafina, se coloreó con técnicas de rutina y se marcó con anticuerpos para citoqueratinas EA/1 y EA/3. Resultados: En los diabéticos, la parótida se caracterizó por presentar acinos de tamaño más reducido, mayor cantidad de inclusiones lipídicas intracitoplasmáticas en las células acinares y ductales e infiltración grasa abundante en el estroma, comparado con los alcohólicos. Se observó que la expresión de citoqueratinas fue heterogénea a nivel de los acinos e intensamente positiva en los ductos hiperplásicos, comparada con los grupos alcohólico y control. Conclusion: Estas valoraciones cualitativas indican diferencias en el cuadro histopatológico entre estas sialosis de distinto origen.Between the sialosis' etiologic agents, we can find the chronic alcoholism and diabetes. Both nosologic entities are descirbed using a similar histopathologic pattern. Objectives: The purpose of this work has been analyzing and comparing the histopathological differences between the diabetic and alcoholic sialosis.Study design: We studied 7 parotid glands samples of diabetic patients and 4 samples of normal glands obtained from surgical material were used as a control. For the comparative study, we used 12 parotid glands from chronic alcoholic patients with clinical diagnosis of cirrhosis and 6 autopsies on individuals who had died from alcoholic hepatic cirrhosis. This material was fixed in formaline, processed for embedding in paraffin, standart coloration techniques and immunotechnique for cytokeratin EA/1 y EA/3. Results: In the cases of diabetics, the parotid gland was characterised by the presence of small acini, a bigger number of lipid intracytoplasmic droplets in the acinar and ductal cells, as well as an abundant adipose infiltration in the stroma when compared to the alcoholics. We observed that the cytoqueratins' expression was heterogeneous at the acinar level, and very positive in the hyperplasic ducts, compared to the alcoholic and control groups. Conclusions: These qualitative valorations indicate the differences between the histopathologic pattern of sialosis with different origins

Expression profiles of angiogenesis in two high grade chondrosarcomas: A xenotransplant experience in nude mice

Background. Chondrosarcomas (Chs) are malignant cartilage-forming tumors that represent the third most common malignant solid tumor of bone in adults. Angiogenesis is a major factor for tumor growth and metastasis. Our aim was to make a histological, immunohistochemical, ultrastructural and molecular characterization of the neovascularization established between xenotransplanted Chs and the host during the initial phases of growth in nude transfer, in order to find potential markers for distinguishing between high grades II and III Chs. Methods. two xenotransplanted high grade human Chs were evaluated. Tumor pieces were implanted subcutaneously on the backs of 14 athymic Balb-c nude mice. The animals were sacrificed 24, 48, and 96 hours; and 7, 14, 21 and 28 days after implantation. Two grade I Chs were also transferred in nude but did not grow. Results. Morphological differences were apparent between these two Chs during the early stages of neoplastic growth. Immunohistochemistry demonstrated overexpression of pro-angiogenic factors 24h-48h after tumor implantation. Additionally, neoplastic cells co-expressed chemokines (CXCL9, CXCL10 and GRO) and their receptors. Molecular studies showed two expression profiles, revealing an early and a late phase in the angiogenic process. Conclusion. High grade Chs demonstrated two different stages of induced angiogenesis, with an intimate association between structural and molecular events that might explain the different aggressive biological behavior of grade II and III Chs. The present model may be useful for testing the effect of anti-angiogenic drugs