Análise retrospectiva dos diagnósticos histopatológicos de 304 biopsias intestinais felinas e avaliação da imunoexpressão de cd3 e ki67 na doença inflamatória intestinal e no linfoma intestinal de baixo grau
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Data
2023-03-31
Autores
Terrabuio, Verônica Maria Teixeira de Castro
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Universidade Estadual Paulista (Unesp)
Resumo
As enteropatias crônicas felinas são um conjunto de distúrbios de grande importância para a gastroenterologia felina, e dentre as afecções mais comumente diagnosticadas figuram a doença inflamatória intestinal (DII) linfoplasmocitária e o linfoma intestinal de baixo grau T (LIBG-T). Ambas as afecções, apesar de possuírem tratamentos e prognósticos distintos, possuem muitas similaridades no âmbito clínico e histomorfológico, tornando sua diferenciação um grande desafio diagnóstico. O objetivo do presente estudo foi caracterizar as principais enteropatias crônicas felinas por meio da avaliação retrospectiva dos diagnósticos histopatológicos de 304 amostras de biopsias intestinais. As lesões foram segregadas de acordo com sua origem em neoplásicas, não neoplásicas e borderlines. Foram analisados e comparados dados de resenha como raça, idade, sexo e o método de obtenção das biopsias. O diagnóstico mais prevalente foi o de DII linfoplasmocitária representando 42,76%(n=130) das amostras, seguido pelos linfomas intestinais que representaram 20,73% (n=63), o linfoma de baixo grau representou 10,53%(n=32) das amostras, enquanto o de alto grau representou 10,2% (n=31). Na sequência, o carcinoma intestinal prevaleceu em 11,84% (n=36) dos casos, em 5,26% (n=16) dos casos, os resultados foram ambíguos e a histopatologia isoladamente não foi capaz de diferenciar DII e LIBG. Os pacientes com lesões neoplásicas apresentaram média de idade (10,4 anos) significativamente superior em relação ao grupo de pacientes com lesões não neoplásicas (6,6 anos). A segunda parte dessa pesquisa, se dedicou a comparar os resultados histológicos e imunoistoquímicos obtidos de pacientes com DII linfoplasmocitária e LIBG-T, para tal, cada grupo foi constituído por 25 amostras. Após a imunoistoquímica, 32% (n=8) dos casos mudaram o diagnóstico, de DII linfoplasmocitária para LIBG-T. Todos os pacientes que foram diagnosticados com LIBG-T pela histologia permaneceram com o mesmo diagnóstico após a IHQ. Os pacientes do grupo LIBG-T tiveram uma média de idade (11,9 anos) significativamente superior em relação ao grupo DII linfoplasmocitária (5,5 anos), os felinos sem raça definida prevaleceram e não foi verificada uma predisposição sexual em ambos os grupos. A concordância entre os resultados obtidos pela histopatologia e IHQ foi de 68%. As médias de imunomarcação de Ki67, que representam o índice de proliferação, foram substancialmente superiores no grupo LIBG-T em relação ao grupo DII linfoplasmocitária, tanto em epitélio quanto em lâmina própria. Verificou-se que o índice de proliferação pode ser empregado como uma ferramenta complementar para auxiliar na diferenciação de distúrbios inflamatórios ou neoplásicos que acometem o trato gastrointestinal felino.
Feline chronic enteropathies are a set of disorders of great importance for feline gastroenterology, and among the most diagnosed conditions are lymphoplasmacytic inflammatory bowel disease (IBD) and low-grade intestinal lymphoma T (LIBG-T). Both conditions, despite having different treatments and prognoses, have many similarities in the clinical and histomorphological scope, making their differentiation a major diagnostic challenge. The objective of the present study was to characterize the main feline chronic enteropathies through the retrospective evaluation of the histopathological diagnoses of 304 intestinal biopsy samples. Lesions were segregated according to their origin into neoplastic, non-neoplastic and borderline. Review data such as race, age, sex, and method of obtaining biopsies were analyzed and compared. The most prevalent diagnosis was lymphoplasmacytic IBD representing 42.76% (n=130) of the samples, followed by intestinal lymphomas which represented 20.73% (n=63), low-grade lymphoma represented 10.53% (n =32) of the samples, while the high grade represented 10.2% (n=31). Subsequently, intestinal carcinoma prevailed in 11.84% (n=36) of the cases, in 5.26% (n=16) of the cases, the results were ambiguous, and histopathology alone was unable to differentiate IBD and LIBG. Patients with neoplastic lesions had a mean age (10.4 years) significantly higher than the group of patients with non-neoplastic lesions (6.6 years). The second part of this research was dedicated to comparing the histological and immunohistochemical results obtained from patients with lymphoplasmacytic IBD and T-LIBG, for this purpose, each group consisted of 25 samples. After immunohistochemistry, 32% (n=8) of the cases changed the diagnosis, from lymphoplasmocytic IBD to T-LIBG. All patients who were diagnosed with T-LIBG by histology remained with the same diagnosis after IHC. Patients in the LIBG-T group had a significantly higher mean age (11.9 years) than the lymphoplasmocytic IBD group (5.5 years), mixed-breed cats prevailed, and no sexual predisposition was found in both groups. The agreement between the results obtained by histopathology and IHC was 68%. Ki67 immunostaining averages, which represent the proliferation index, were substantially higher in the LIBG-T group than in the lymphoplasmocytic IBD group, both in the epithelium and in the lamina propria. It was found that the proliferation index can be used as a complementary tool to help differentiate inflammatory or neoplastic disorders that affect the feline gastrointestinal tract.
Feline chronic enteropathies are a set of disorders of great importance for feline gastroenterology, and among the most diagnosed conditions are lymphoplasmacytic inflammatory bowel disease (IBD) and low-grade intestinal lymphoma T (LIBG-T). Both conditions, despite having different treatments and prognoses, have many similarities in the clinical and histomorphological scope, making their differentiation a major diagnostic challenge. The objective of the present study was to characterize the main feline chronic enteropathies through the retrospective evaluation of the histopathological diagnoses of 304 intestinal biopsy samples. Lesions were segregated according to their origin into neoplastic, non-neoplastic and borderline. Review data such as race, age, sex, and method of obtaining biopsies were analyzed and compared. The most prevalent diagnosis was lymphoplasmacytic IBD representing 42.76% (n=130) of the samples, followed by intestinal lymphomas which represented 20.73% (n=63), low-grade lymphoma represented 10.53% (n =32) of the samples, while the high grade represented 10.2% (n=31). Subsequently, intestinal carcinoma prevailed in 11.84% (n=36) of the cases, in 5.26% (n=16) of the cases, the results were ambiguous, and histopathology alone was unable to differentiate IBD and LIBG. Patients with neoplastic lesions had a mean age (10.4 years) significantly higher than the group of patients with non-neoplastic lesions (6.6 years). The second part of this research was dedicated to comparing the histological and immunohistochemical results obtained from patients with lymphoplasmacytic IBD and T-LIBG, for this purpose, each group consisted of 25 samples. After immunohistochemistry, 32% (n=8) of the cases changed the diagnosis, from lymphoplasmocytic IBD to T-LIBG. All patients who were diagnosed with T-LIBG by histology remained with the same diagnosis after IHC. Patients in the LIBG-T group had a significantly higher mean age (11.9 years) than the lymphoplasmocytic IBD group (5.5 years), mixed-breed cats prevailed, and no sexual predisposition was found in both groups. The agreement between the results obtained by histopathology and IHC was 68%. Ki67 immunostaining averages, which represent the proliferation index, were substantially higher in the LIBG-T group than in the lymphoplasmocytic IBD group, both in the epithelium and in the lamina propria. It was found that the proliferation index can be used as a complementary tool to help differentiate inflammatory or neoplastic disorders that affect the feline gastrointestinal tract.
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Palavras-chave
Imuno-histoquimica, Endoscopia, Histopatologia, Indice de proliferação, Enterite linfoplasmocitária