Doença inflamatória intestinal em cães: ensaio de um modelo de classificação histopatológica
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2016-04-01
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A histopatologia gastrointestinal tem sido usada para definir a distribuição e a gravidade das doenças gastrointestinais em cães e gatos, sendo hoje em dia um componente de rotina da avaliação clínica da doença intestinal. Possuindo o intestino uma mucosa fisiologicamente povoada por uma população de células imunes, torna-se um pouco difícil distinguir entre uma proliferação celular que ocorre para manter a homeostasia e uma proliferação de origem inflamatória. Para tentar uniformizar a avaliação da inflamação intestinal, o Grupo para a Estandardização Gastrointestinal da World Small Animal Veterinary Association propôs um sistema de classificação histológica para a inflamação gastrointestinal do cão e do gato, onde definiu os parâmetros considerados normais e patológicos para cada característica identificativa de inflamação, nomeadamente: número aumentado de linfócitos intraepiteliais, linfócitos/plasmócitos, eosinófilos e neutrófilos da lâmina própria, presença de atrofia/fusão das vilosidades, lesão epitelial, dilatação/distensão/abcedação das criptas intestinais, dilatação dos quilíferos e fibrose da mucosa. O objetivo deste estudo foi a reavaliação do intestino delgado de cães previamente diagnosticados com inflamação intestinal, utilizando o Sistema de Classificação Histológica da WSAVA, resultados depois comparados com a análise prévia das amostras, assim como o ensaio de um novo modelo de classificação da gravidade da inflamação intestinal, foram para o efeito reavaliadas vinte e uma amostras histopatológicas intestinais.
A alteração mais frequentemente encontrada nas amostras debiopsias estudadas foi o aumento do número de células linfoplasmocitárias da lâmina própria. O diagnóstico prevalente foi o de “Enterite Linfoplasmocitária” (62%), seguido da “Enterite Eosinofílica” (24%) e relativamente à gravidade da inflamação, a característica “Enterite Suave” foi a mais frequente, seguida da “Enterite Moderada” e por último “Enterite Grave”.
Relativamente à metodologia de avaliação da gravidade da inflamação, este estudo demonstra que é possível criar um rácio, baseado na avaliação dos parâmetros estudados, que terá de ser, no entanto, submetido a várias modificações, assim como experimentado e validado por outros histopatologistas.
Gastrointestinal histopathology has been used to define the distribution and severity of gastrointestinal disease in dogs and cats, and the assessment of tissue pathology has now become a routine componentof the clinical evaluation of small intestinal disease. Being the gut mucosa populated by a significant proportion of a overall cellular population of the immune system, its becomes difficult to distinguish between a cellular proliferation that occurs to maintain the homeostasis and an inflammatory type proliferation. In an attempt to standardizing the intestinal inflammation evaluation, the WSAVA International Gastrointestinal Standardization Group have proposed a histologic classification system to the gastrointestinal inflammation in dog and cat, where they define the parameters that are considered normal and pathologic for each one of the identifying inflammatory features, namely: presence of an increased number of intraepithelial lymphocytes, lamina propria lymphocytes/plasma cells, eosinophils and neutrophils, presence of villus stunting, epithelial lesion, crypt distension, lacteal dilation and mucosal fibrosis. The aim of this study was the reassess previously small intestine pieces diagnosed with intestinal inflammation in dogs, using the WSAVA Group Histologic Classification System and the rehearsal of a new classification model to evaluate intestinal inflammation severity. The results obtain with this analysis where then compared with the previous analysis. For the purpose, twenty-one intestinal histopathological samples were reevaluated. The most frequent finding in biopsies studied was the increased number of lymphocytes and plasma cells of the lamina propria. The most common diagnosis was “Lymphoplasmocitic Enteritis” (62%), followed by “Eosinophilic Enteritis” (24%) and for the severity of the inflammation, the feature “Mild Enteritis” was the most frequent, then the “Moderated Enteritis” and last “Severe Enteritis”. Regarding the methodology for evaluating the inflammation severity, this study demonstrate that is possible to create a score, based on evaluation of the parameters that have been studied previously, which must be, however, subject to various modifications, as well as tried and validated by other pathologists.
Gastrointestinal histopathology has been used to define the distribution and severity of gastrointestinal disease in dogs and cats, and the assessment of tissue pathology has now become a routine componentof the clinical evaluation of small intestinal disease. Being the gut mucosa populated by a significant proportion of a overall cellular population of the immune system, its becomes difficult to distinguish between a cellular proliferation that occurs to maintain the homeostasis and an inflammatory type proliferation. In an attempt to standardizing the intestinal inflammation evaluation, the WSAVA International Gastrointestinal Standardization Group have proposed a histologic classification system to the gastrointestinal inflammation in dog and cat, where they define the parameters that are considered normal and pathologic for each one of the identifying inflammatory features, namely: presence of an increased number of intraepithelial lymphocytes, lamina propria lymphocytes/plasma cells, eosinophils and neutrophils, presence of villus stunting, epithelial lesion, crypt distension, lacteal dilation and mucosal fibrosis. The aim of this study was the reassess previously small intestine pieces diagnosed with intestinal inflammation in dogs, using the WSAVA Group Histologic Classification System and the rehearsal of a new classification model to evaluate intestinal inflammation severity. The results obtain with this analysis where then compared with the previous analysis. For the purpose, twenty-one intestinal histopathological samples were reevaluated. The most frequent finding in biopsies studied was the increased number of lymphocytes and plasma cells of the lamina propria. The most common diagnosis was “Lymphoplasmocitic Enteritis” (62%), followed by “Eosinophilic Enteritis” (24%) and for the severity of the inflammation, the feature “Mild Enteritis” was the most frequent, then the “Moderated Enteritis” and last “Severe Enteritis”. Regarding the methodology for evaluating the inflammation severity, this study demonstrate that is possible to create a score, based on evaluation of the parameters that have been studied previously, which must be, however, subject to various modifications, as well as tried and validated by other pathologists.
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Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Cães , Gastroenteropatias , Intestino delgado , Inflamação , Histopatologia , Enterite eosinofílica , Enterite Linfoplasmocitária