Abstract Since its first introduction into medical practice, reflectance confocal microscopy (RCM) has been a valuable non-invasive diagnostic tool for the assessment of benign and malignant neoplasms of the skin. It has also been used as an adjunct for diagnosing equivocal cutaneous neoplasms that lack characteristic clinical or dermoscopic features. The use of RCM has led to a decreased number of biopsies of benign lesions. Multiple published studies show a strong correlation between RCM and histopathology thereby creating a bridge between clinical aspects, dermoscopy, and histopathology. Dermatopathologists may potentially play an important role in the interpretation of confocal images, by their ability to correlate histopathologic findings. RCM has also been shown to be an important adjunct to delineating tumoral margins during surgery, as well as for monitoring the non-surgical treatment of skin cancers. Advanced technology with smaller probes, such as the VivaScope 3000, has allowed access to lesions in previously inaccessible anatomic locations. This review explains the technical principles of RCM and describes the most common RCM features of normal skin with their corresponding histological correlation.

RESUMO CONTEXTO: Esclerose hepatoportal EHP ou venopatia portal obliterativa VPO, um dos diagnósticos diferenciais para a hipertensão portal não cirrótica, é caracterizada pelo desaparecimento dos ramos portais, fibrose portal e septal, fibrose sinusoidal e hiperplasia nodular regenerativa HNR. A EHP é um doença espectral, que pode progredir para hipertensão portal severa. Sua etiopatologia é ainda pouco compreendida, especialmente no Brasil, onde ela é provavelmente subdiagnoticada devido as suas similaridades com a forma hepatoesplênica da esquistossomose. OBJETIVO: Analizar o perfil dos pacientes com EHP no Nordeste do Brasil, e demontrar as características patológicas da EHP. MÉTODOS: Analisamos restrospectivamente os casos de VPO em biópsias hepáticas e explantes de um centro de referência em fígado na Bahia, Brasil. A análise qualiquantitativa dos tratos portais e parênquima hepático foi realizada, permitindo a comparação entre os nossos paciente e os achados descritos por outros autores. RESULTADOS: Entre os 62 paciente identificados com EHP, 42% era do sexo masculino, 58% era do sexo feminino. A média de idade no diagnótico foi 48,3 anos. Desse grupo, analizamos a biópsia hepática de 10 pacientes nos quais o diagnóstico de esquistossomose pode ser excluído. Desses pacientes, 100% 10/10 se apresentou com fibrose portal densa e obliteração venosa portal. Atrofia do perênquima hepático estava presente em 60% 6/10 dos pacientes, dilatação sinusiodal em 30% 3/10 a presença de septos portais ocorreu em 50% 5/10 e fibrose portal densa foi achada em todos os pacientes. Hiperplasia nodular regenerativa foi encontrada em 30% dos pacientes. CONCLUSÃO: A EHP parece ser negligenciada e subdiagnosticada no Brasil, devido as suas similaridades com esquistossomose. Em nosso estudo, fibrose portal densa, obliteração dos ramos da veia porta, atrofia do parênquima, dilatação sinusoidal e hiperplasia nodular do parênquima foram os principais achados histopatológicos e foram semelhantes aos descritos em outros países.

ABSTRACT BACKGROUND: Hepatoportal sclerosis HPS or obliterative portal venopathy (OPV), one of the differential diagnoses for non-cirrohtic portal hypertension, is characterized by the disappearance of the portal branches, portal and septal fibrosis, perisinusoidal fibrosis and regenerative nodular hyperplasia (RNH). It is a spectral disease that may progress to severe portal hypertension. Its etiopathogenesis is still little understood, especially in Brazil, it has been probably misdiagnosed due to its histopatological similarities with the hepatosplenic form of schistosomiasis. OBJECTIVE: To analyze the profile of patients with HPS in Northeastern Brazil and to demonstrate the pathological characteristics of HPS. METHODS: We retrospectively analyzed cases of OPV in liver biopsies and explants from a referral center for liver in Bahia - Brazil. The qualitative and quantitative analysis of the portal tracts and liver parenchyma was made so that comparisons could be done among the HPS findings of our population and the findings described by other authors. RESULTS: From the 62 patients identified with HPS, 42% were male, while 58% were female. The average age at diagnosis was 48.3 years. From this group, we analyzed the liver biopsy of 10 patients whose diagnosis of schistosomiasis could be ruled out. From these 100% (10/10) presented dense portal fibrosis and portal venous obliteration. Liver parenchymal atrophy was present in 60% (6/10) of the patients, sinusoidal dilation was present in 30% (3/10), the presence of portal septa occurred in 50% (5/10) and dense portal fibrosis in all patients analyzed. Nodular regenerative hyperplasia was found in 30% (3/10) of the patients. CONCLUSION: HPS seems to be neglected and misdiagnosed in Brazil, due to its similarities with schistossomiasis. In our study dense portal fibrosis, obliteration of the portal vein branches, parenchymal atrophy, sinusoidal dilatation and parenchymal nodular hyperplasia were the main histopathological findings and were similar to that described in other countries.

Mycobacterium fortuitum is a rapidly growing nontuberculous Mycobacterium that can cause a range of diseases in humans. Complications from M. fortuitum infection have been associated with numerous surgical procedures. A protective immune response against pathogenic mycobacterial infections is dependent on the granuloma formation. Within the granuloma, the macrophage effector response can inhibit bacterial replication and mediate the intracellular killing of bacteria. The granulomatous responses of BALB/c mice to rapidly and slowly growing mycobacteria were assessed in vivo and the bacterial loads in spleens and livers from M. fortuitum and Mycobacterium intracellulare-infected mice, as well as the number and size of granulomas in liver sections, were quantified. Bacterial loads were found to be approximately two times lower in M. fortuitum-infected mice than in M. intracellulare-infected mice and M. fortuitum-infected mice presented fewer granulomas compared to M. intracellulare-infected mice. These granulomas were characterized by the presence of Mac-1+ and CD4+ cells. Additionally, IFN-γmRNA expression was higher in the livers of M. fortuitum-infected mice than in those of M. intracellulare-infected mice. These data clearly show that mice are more capable of controlling an infection with M. fortuitum than M. intracellulare. This capacity is likely related to distinct granuloma formations in mice infected with M. fortuitum but not with M. intracellulare.

OBJETIVO: Descrever os achados clínicos, histopatológicos e imunoistoquímicos de cinco pacientes portadores de leishmaniose tegumentar americana com manifestações oftalmológicas. MÉTODOS: Estudo retrospectivo, no período de quatro anos, compreendendo análise dos prontuários de pacientes do Hospital Universitário Professor Edgard Santos e das lâminas de histopatologia e do estudo imunoistoquímico. RESULTADO: O sintoma mais frequente foi a hiperemia conjuntival (2/5), seguida por lesão crostosa palpebral (1/5), leucoplasia conjuntival (1/5) e prurido ocular (1/5).Todos os pacientes foram submetidos à biópsia. O estudo histológico evidenciou inflamação crônica (3/5) e hiperplasia pseudoepiteliomatosa (2/5). Todos os pacientes com aspecto histopatológico de hiperplasia pseudoepiteliomatosa apresentaram resultado positivo para leishmaniose pela imunoistoquímica (anticorpo policlonal antileishmania). CONCLUSÃO: Devido ao polimorfismo das manifestações oculares da leishmaniose tegumentar americana, à inespecificidade do quadro histopatológico e à grande dificuldade de visualização de amastigotas na coloração hematoxilina-eosina, a biópsia com estudo imunoistoquímico contribuiu para a confirmação diagnóstica.

PURPOSE: To describe the clinical, histopathological and immunoistochemical findings of ocular leishmaniasis in five patients presenting positive Montenegro reaction. METHODS: Retrospective study in four years of the clinical charts, histopathologic and immunoistochemic study of the material obtained by biopsy of ocular lesions in five patients with positive Montenegro reaction. RESULTS: The most frequent clinical findings was conjunctival hyperemia (2/5), followed by crusting lid lesion (1/5), conjunctival leukoplakia (1/5) and ocular itching (1/5). The histopathological study disclosed chronic inflammation (3/5) and pseudoepitheliomatous hyperplasia (2/5). The all patients that presented pseudoepitheliomatous hyperplasia in the biopsy material also presented immunohistochemical positivity for polyclonal antibody anti-leishmania. CONCLUSION: The immunoistochemical study was contribuitory for the diagnosis of ocular leishmaniasis in the five patients of this study.

INTRODUÇÃO: Esteatose ocorre com freqüência na hepatite crônica pelo vírus C (HCV) e parece estar relacionada a fatores clínicos e/ou virológicos. Contudo, a presença de esteato-hepatite, uma condição indutora de fibrose, tem sido pouco estudada. OBJETIVO: Estudar a associação de HCV com esteato-hepatite em material de biópsia hepática, correlacionando-a com dados clínicos. MÉTODOS: As biópsias hepáticas de pacientes com HCV foram avaliadas quanto a atividade, estádio e presença de alterações morfológicas de esteato-hepatite. Os dados morfológicos foram correlacionados a parâmetros clínicos que incluíam: consumo alcoólico, IMC, colesterol, triglicérides, glicemia, exposição a petroquímicos e genótipo viral. RESULTADOS: Esteato-hepatite foi encontrada em 42 de 252 (16,6%) pacientes com HCV. Entre os 42 casos, critérios para obesidade, diabetes e dislipidemia foram encontrados em 16,7%; 16,7% e 21,4%, respectivamente. O genótipo 3 esteve presente em 38,1% dos casos. Fatores de risco para esteato-hepatite não-alcoólica (NASH) foram encontrados em 73% dos casos em genótipos diferentes do 3, enquanto tais fatores foram presentes em 37,5% dos casos com genótipo 3 (p = 0,05). O padrão morfológico mais freqüente foi a esteatose macrovacuolar de moderada intensidade (61,9%) com distribuição difusa (64,3%). Tanto o padrão de fibrose de NASH quanto o de HCV foram notados: fibrose perissinusoidal (87,8%), portal (87,8%), septal (69,0%) e cirrose (30,9%). CONCLUSÕES: Esteato-hepatite é freqüente em pacientes com HCV, apresentando padrão peculiar de distribuição da esteatose e alta freqüência de cirrose. Em genótipos diferentes do 3, a esteato-hepatite parece estar relacionada à sobreposição de fatores de risco para NASH.

INTRODUCTION: Steatohepatitis and hepatitis C virus (HCV) have been related to several clinical and virological factors and fibrosis progression. OBJECTIVE: To describe clinical and morphological aspects of steatohepatitis associated to HCV. METHODS: The study included patients with HCV without treatment. Biopsies were evaluated by METAVIR score and steatohepatitis was evaluated according to criteria of Sociedade Brasileira de Patologia (SBP). Clinical parameters included alcoholic intake history and determination of risk factors for non-alcoholic steatohepatitis (NASH). RESULTS: Steatohepatitis was observed in 42 out of 252 patients (16.6%) with HCV, and 76.2% were male. Risk factors for NASH were present in 37.5% of the patients with genotype 3 and in 73% of the patients with other genotypes (p = 0.05). Obesity was present in 16.7%, diabetes in 16.7%, hyperlipidemia in 21.4%, and genotype 3 in 38.1%. Macrovacuolar steatosis presented mild intensity in 61.9% and was diffuse in 64.3%. Cirrhosis was present in 33.3% of the patients. CONCLUSIONS: Diffuse steatosis and ballooning of mild to moderate intensity characterized steatohepatitis related to HCV. Patients with genotype different from genotype 3 presented with known risk factors for NASH, whereas most of the patients with genotype 3 had only viral genotype as risk factor for steatosis. The frequency of cirrhosis was relevant and suggests that the association of steatohepatitis with HCV contribute to fibrosis progression.

This paper reports the overall effects of three lectins, extracted from Canavalia brasiliensis, Dioclea violacea, and D. grandiflora, on BALB/c mice popliteal draining lymph nodes. These lectins have presented high stimulatory capacity on lymph node T cells. Additionally, they were able to induce apoptosis and inflammation (frequently associated with high endothelial venule necrosis). The data presented here suggest that the Diocleinae lectins studied can stimulate in vivo T cell activation and apoptosis, as well as present important side effects.