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Habilitation Thesis
DOI
10.11606/T.5.2007.tde-19102007-104038
Document
Author
Full name
José Antonio Sanches Junior
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2006
Committee
Rivitti, Evandro Ararigboia (President)
Foss, Norma Tiraboschi
Martins, Jose Eduardo Costa
Nascimento, Leninha Valerio do
Paschoal, Luiz Henrique Camargo
Title in Portuguese
Avaliação morfológica e imunofenotípica de linfócitos no sangue periférico de doentes com eritrodermia: pesquisa de perfil indicativo para o diagnóstico de micose fungóide.
Keywords in Portuguese
Citometria de fluxo
Contagem de linfócitos
Dematite esfoliativa/sangue
Linfócitos T CD4-positivos
Micose fungóide/diagnóstico
Micose fungóide/sangue
Relação CD4-CD8
Abstract in Portuguese
Eritrodermia é condição cutânea caracterizada por eritema generalizado ocasionado pelo agravamento de dermatoses pré-existentes, por farmacodemias, neoplasias viscerais e por linfomas cutâneos de células T (micose fungóide e síndrome de Sézary). O diagnóstico é realizado pelo exame histopatológico da pele, que entretanto, em muitos casos é inespecífico, não permitindo a conclusão causal para a eritrodermia. MÉTODOS: O presente trabalho avaliou o sangue periférico de 13 doentes com eritrodermias por linfoma cutâneo e 24 com eritrodermias reativas. Analisou-se as alterações quantitativas dos leucócitos, linfócitos e eosinófilos no hemograma, as anomalias linfocitárias classificadas como células de Sézary e linfócitos pleomórficos em esfregaços de sangue periférico e quantificadas em cem leucócitos e, as subpopulações linfocitárias T CD2, CD3, CD4, CD5, CD7, CD8, TCRaß, CLA e CD25 através da avaliação quantitativa e de possíveis anomalias fenotípicas pela técnica de citometria de fluxo. OBJETIVOS: Identificar padrões auxiliares para o diagnóstico de linfoma cutâneo em pacientes com eritrodermias classificadas como idiopáticas. RESULTADOS: Observou-se que o número absoluto de linfócitos (p<0,018), o percentual de células de Sézary (p<0,014), de linfócitos pleomórficos (p<0,021) e de subpopulação de linfócitos T CD3/CD4 (p<0,049), assim como a relação CD4:CD8 (p<0,015), estiveram significantemente aumentados nos pacientes eritrodérmicos com diagnóstico de micose fungóide/síndrome de Sézary em relação aos pacientes com eritrodermias reativas e indivíduos normais e, que aberrações fenotípicas, como perda de marcadores de células T maduras (CD2, CD4, TCRaß) foram observadas exclusivamente na síndrome de Sézary.
Title in English
Morphologic and immunophenotypic study of peripheral blood lymphocytes in erythrodermic patients: searching for a contributory profile to the diagnosis of mycosis fungoides.
Keywords in English
CD4 positive T-lymphocytes
CD4-CD8 ratio
Exfoliative dermatitis/blood
Flow cytometry
Lymphocyte count
Mycosis fungoides/blood
Mycosis fungoides/diagnosis
Abstract in English
Erythroderma is a generalized erythema of the skin caused by the worsening of pre-existing dermatoses, by drug-eruptions, visceral cancers and cutaneous T-cell lymphomas (mycosis fungoides and Sezary syndrome). The diagnosis of these conditions is usually done by histopathological examination of the diseased skin, although it is not always conclusive, with many cases remaining without a correct diagnosis for many years. METHODS: Peripheral blood from 13 patients with erythrodermic cutaneous lymphoma and from 24 patients with reactive erythroderma was analyzed. The study searched for quantitative alterations in total lymphocytes, pleomorphic lymphocytes and Sézary cells in the hemogram and peripheral blood smears and for quantitative changes in CD2, CD4, CD5, CD7, CD8, TCRaß, CLA and CD25 subsets of T-cells, as well as for phenotypically abnormal T cells, by flow cytometry. The aim of this study was to identify a simple auxiliary profile to diagnose cutaneous lymphoma in patients with erytroderma classified as idiopathic. RESULTS: The comparison of the mean and median values of the studied parameters between patients with erythrodermic cutaneous lymphoma and the reactive ones revealed expanded counts of absolute lymphocytes (p<0,018), pleomorphyc lymphocytes (p<0,021), Sezary cells (p<0,014) and the CD4 T-cell subset (p<0,049) with increased CD4:CD8 ratio (p<0,015) in the former. Phenotypically abnormal CD2, CD4 and TCRaß T cells were found only in patients with Sezary syndrome.
 
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Publishing Date
2007-10-22
 
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