Radi jasnijeg priopćavanja rezultata citološke analize urina i izjednačavanja terminologije članovi Hrvatskog društva za kliničku citologiju izradili su standardizirani obrazac za priopćavanje nalaza ...citološke analize urina. Prihvaćene su dijagnostičke kategorije Pariške klasifi kacije citologije urina te dodani opisi netumorske problematike urološke citologije. Predviđeno je da nalaz sadržava podatke o pacijentu, vrsti analiziranog uzorka, makroskopski pregled, metode obrade uzorka, primjerenost uzorka, citomorfološki opis i semikvantitativnu procjenu epitelnih i upalnih stanica, mikroorganizme, nestanične elemente, prisutnost i morfologiju eritrocita, dijagnozu prema Pariškoj klasifikaciji, komentar i zaključak te preporuke.
U ovom radu prikazujemo Parišku klasifikaciju dijagnostičkih kategorija u citologiji urina. Svjetska je radna skupina za citologiju urina osnovana 2013. godine radi uvođenja izjednačene terminologije ...i načina izvještavanja o nalazu u urološkoj citologiji. Smjernice za citologiju urina pod nazivom The Paris System (TPS) for Reporting Urine Cytology objavljene su 2015. godine, a uključuju specifične dijagnostičke kategorije te pouzdane citomorfološke kriterije za dijagnostiku lezija prijelaznog epitela. Dijagnostičke kategorije Pariške klasifikacije jesu: negativno na karcinom visokog stupnja (engl. Negative for High-Grade Urothelial Carcinoma – NHGUC), atipične stanice prijelaznog epitela (engl. Atypical Urothelial Cells – AUC), suspektno na karcinom prijelaznog epitela visokog stupnja (suspektno) (engl. Suspicious for High-Grade Urothelial Carcinoma – SHGUC), karcinom prijelaznog epitela visokog stupnja (engl. High-Grade Urothelial Carcinoma – HGUC), neoplazma prijelaznog epitela niskog stupnja (engl. Low-Grade Urothelial Neoplasm – LGUN) i drugi maligni primarni i metastatski tumori te različite lezije.
Fine-needle aspiration (FNA) biopsy has become a well established technique in the diagnosis, staging, and follow-up of patients with head and neck lesions. As in lymphoma diagnostics, FNA serves as ...a screening method in evaluating potentially affected lymph node for open or core biopsy. According to the World Health Organization classification of lymphoid neoplasms, today it is important to recognize cell morphology and reveal its phenotype, then combine it with different genotypic information and clinical data to provide appropriate therapy. The aim of this study was to assess the efficacy of FNA and immunocytochemistry based lymphoma diagnostic in head and neck region. We conducted a retrospective study during a period of three years where cases with either FNA diagnosis or clinical suspicion of newly recognized or relapsing lymphoma were reviewed. In the study were included patients that were referred to our laboratory from hematology department, in whom head and neck lymphadenopathia was found and lymph node FNA preceded other procedures. Two hundred eighty-five aspirations from 248 patients fulfilled study criteria. Adequate specimens were diagnosed as lymphoma in 100 cases (36%), in 65 male and 35 female patients, 76 in patients with newly discovered disease and 24 in patients with prior lymphoma diagnosis. Overall sensitivity of FNA specimens in the diagnosis of head and neck lymphomas was 90%, specificity 88%, predictive value of a positive result 97%, and predictive value of negative result 61%. Based on our results FNA corroborated with immunophenotyping by immunocytochemistry can be method of choice in primary lymphoma diagnosis as a method complementary to histopathology in lymphoma diagnostics.
Transformation of leukemic cells is associated with delay in maturation and in apoptosis, and to altered responsiveness to growth factors. However, some studies have revealed that Fas (CD95/APO1) ...which mediates apoptotic signal and decrease of anti-apoptotic Bcl-2 are frequently observed in acute myeloid leukemia (AML) M4/M5 leukemic cells. The aim of the study was to compare cytomorphology and cytochemistry of bone marrow (BM) apoptotic leukemic cells to preserved peripheral blood (PB) leukemic cells in our patient, a 76-year-old man with AML-M5b treated at Zagreb University Hospital Center. BM and PB of the AL patient were analyzed after Pappenheim and cytochemical stainings, and leukemic cells were classified according to FAB and WHO classification. Analysis of PB revealed leukocytosis and 80-90% monocytic cells (46% monoblasts, 29% promonocytes and 11% monocytes). Only a few preserved monoblasts and promonocytes were found in BM, together with numerous morphologically altered cells with characteristic chromatin condensation and pyknosis of nucleus, as well as nuclear fragmentation and formation of apoptotic bodies. Thus, cytomorphology of PB leukemic cells pointed to proliferation of immature monocytic cells, and cytomorphology of BM to cell apoptosis. Cytochemistry of PB monocytic cells and BM apoptotic cells confirmed monocytic cell lineage because esterase was strongly positive in almost all BM apoptotic leukemic cells and PB leukemic cells, and esterase was completely inhibited with sodium fluoride. On the basis of these findings, AML-M5b was diagnosed in our patient. There are many possible explanations for our observation of BM leukemic cell apoptosis in a patient with AML-M5. The most reliable one is that apoptosis was induced ex vivo after BM aspiration in course of the air drying of BM specimen before staining. Mass BM leukemic cell apoptosis that was recorded in contrast to numerous preserved leukemic cells in PK could be probably connected to unfavorable ratio of relatively low concentration of cytokines in relation to high leukemic cell number in BM aspirated cytologic specimen.
Abstract 2372
Poster Board II-349
Chlorambucil is an effective and safe oral alkylating agent used for treatment of indolent lymphoproliferative disorders. While once considered a drug of choice for ...CLL, it has recently fallen out of favor, mostly due to clinical trials showing that fludarabine-based combinations have better disease-free, albeit not overall survival (OS). In these studies chlorambucil was administered once every 2-4 weeks. Results of some clinical trials suggest that continuous use of high doses of chlorambucil (≥ 10mg /day) is superior to intermittent administration. However, there are very few publications reporting outcomes of this type of treatment, especially outside of clinical trials. Here we summarize our experience with this approach in unselected patients with CLL. This was a retrospective study performed by chart-review of patients treated at our center. Patients were included in this analysis if they had CLL according to standard immunologic, morphologic and hematologic criteria, were in need of treatment and received chlorambucil at a daily dose of 10 mg or more for at least 4 weeks or until response or unacceptable toxicity as front-line treatment. Simultaneous administration of steroids but not other cytotoxic drugs was allowed. Use of low-dose chlorambucil maintenance (≤ 5 mg/day) after stopping high-dose chlorambucil was not considered treatment failure. The Kaplan-Meier method was used for creating survival curves and log-rank for comparisons of temporal variables. We identified 88 patients fulfilling the inclusion criteria, 70 men and 18 women, who were at the time of treatment start 38-88 years old (median 64). Nineteen patients were in Binet stage A, 38 B and 31 C; 2 were in Rai stage 0, 27 stage 1, 38 stage 2, 6 stage 3 and 25 stage 4. Twenty-nine had a low and 59 high total-tumor-mass index (TTM). The dose of chlorambucil ranged form 10 to 20 mg daily (median 15) and duration of treatment 2 to 20 wks (median 5). Forty-seven patients (53%) also received low-dose chlorambucil maintenance. The treatment was well tolerated. Three patients (3%) had serious infections, 2 died; 5 (6%) had severe hematological toxicity, mostly thrombocytopenia. Nausea, very common with pulse-doses of chlorambucil, was absent or mild; only 1 patient had severe nausea. Sixty-nine patients (78%) responded. After a median follow-up of survivors of 58 months, 26 patients are still alive and 17 have not failed treatment. Median OS was 53 months, 95% confidence-interval (CI) 40-66 months, time to treatment failure (TTF) 20 months (95% CI 13-27) (Fig. 1) and progression-free survival 15 months (95% CI 8-22). Age had no influence on treatment outcome. OS of patients with favorable stages (Rai 0-2, Binet A&B) was 60 months and of those with unfavorable stages 44 months. TTF was 30 and 11 months in these groups respectively. Both of these differences barely failed to reach statistical significance (p=0.067 and 0.058). TTM of 9 or higher was the only statistically significant negative prognostic factor that we were able to identify. OS was 78 vs. 44 months (p=0.021) and TTF 46 vs. 15 months (p=0.027). In conclusion, our results suggest that continuous administration of relatively high doses of chlorambucil is superior to intermittent administration, resulting in better efficacy and lower toxicity. While our results are inferior to those generally reported with fludarabine-based front-line treatments, continuous high-dose chlorambucil is less toxic, cheaper, the duration of treatment is shorter and OS is not different. This makes continuous high-dose chlorambucil an interesting approach for elderly, time- or financially constrained patients or health-care systems. Also, the low-toxicity and short treatment duration make it an interesting platform for the addition of non-toxic targeted drugs, like rituximab.
Display omitted
No relevant conflicts of interest to declare.
Hairy cell leukemia is a chronic B-cell lymphoproliferative disorder characterized by clonal proliferation of hairy cells. Treatments of choice are purine analogues, particularly cladribine. We ...treated thirty patients with cladribine either by continuous 7-day infusion at a daily dose of 0.1 mg/kg or by 2-h infusion for 5 consecutive days at a daily dose of 0.14 mg/kg. Remission was achieved in 90% of the patients. After a median follow-up of 44 months overall survival is 93% and time to treatment failure more than 6 years. Two patients did not respond, one patient died of infection shortly after the treatment. Side-effects resulted mainly from hematological toxicity, 23% of the patients had neutropenic fever while 20% required platelets or packed red cell transfusions. Our results show that cladribine is safe and effective in the treatment of hairy cell leukemia. There were no significant differences in toxicity and response between 7-day continuous infusion and 5-day intermittent infusions of the drug.
PDF
