ALOISIO SOUZA FELIPE DA SILVA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Patologia, Faculdade de Medicina - Docente
SVANPA-62, Hospital Universitário
LIM/14 - Laboratório de Investigação em Patologia Hepática, Hospital das Clínicas, Faculdade de Medicina
SVANPA-62, Hospital Universitário
LIM/14 - Laboratório de Investigação em Patologia Hepática, Hospital das Clínicas, Faculdade de Medicina
8 resultados
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- Immunohistochemical Assessment of the Expression of Biliary Transportation Proteins MRP2 and MRP3 in Hepatocellular Carcinoma and in Cholangiocarcinoma(2019) CIRQUEIRA, Cinthya Santos; FELIPE-SILVA, Aloisio Sousa; WAKAMATSU, Alda; MARINS, Lidiane Vieira; ROCHA, Eziel Cavalcanti; MELLO, Evandro Sobroza de; ALVES, Venancio Avancini FerreiraMultidrug resistance-associated protein 2 (MRP2) is a multi-specific organic anion transporter predominantly expressed in the canalicular membrane of hepatocytes, epithelial cells from gallbladder and apical membranes of proximal tubular kidney epithelium whereas multidrug resistance-associated protein 3 (MRP3) is present in the basolateral membrane of hepatocytes and cholangiocytes. This study aims to detect the expression of these transporters in hepatocellular carcinoma (HCC) and in cholangiocarcinoma (CC), searching for evidences for future studies on differential diagnosis and on clinical essays. The immunohistochemical reactivity (IHC) of these transporters was assessed in tissue microarrays of 80 HCC and 56 CC cases using monoclonal antibodies and compared with anatomopathological (AP) variables. The positivity of MRP2 was observed in 92.3% of HCC and in 96.3% of CC. The detection of high MRP2 expression in HCC was not significantly different (p > 0.05) according to the size, number of nodules architectural pattern and growth pattern of HCC and CC. Regarding histological grades, 22/22 well moderately differentiated HCC versus 50/56 poorly differentiated HCC were positive for MRP2. A trend for lower expression in poor differentiation HCC was found. And 50/50 well/moderately differentiated CC versus 2/4 poorly/undifferentiated CC were positive for MRP2. This result showed a reduced expression (p = 0,0004) in poorly differentiated CC. MRP3 positivity was observed in 18.8% of HCC and was not significantly different according to AP parameters. MRP3 was expressed in 44.5% CC, with a trend for lower expression in less differentiated CC and significantly lower rates in the ductular histological subtype (p = 0.023). The high expression of MRP2 in HCC and in CC is conserved regardless most of the anatomopathological parameters, except for a trend of lower expression in less differentiated HCC and CC. The observation of lower MRP3 expression in less differentiated CC and, especially, in the histological subtype with expression of hepatic progenitor cell phenotypes leads to future opportunities to evaluate the expression of this marker in cholangiocarcinomas.
conferenceObject The impact of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC): A retrospective study of 828 aspirates with emphasis on the prior ""indeterminate"" category(2012) FERREIRA, C.; LIMA, P.; MENTEM, M.; ESPOSITO, J.; WASSERSTEIN, L.; FELIPE-SILVA, A.Objective: We evaluated the impact of implementing TBSRTC in an academic community hospital. Method: FNAs from Jan/2004 to Dec/2010 were reclassified in TBSRTC: nondiagnostic (ND), benign (B), atypia or follicular lesion of undetermined significance (AUS/FLUS), suspicious for follicular neoplasm (FN), suspicious for malignancy (S) and malignant (M). FLUS and FN were classified according to presence of Hürthle cells as HCLUS and FN-HC. Results: A total of 828 FNAs (480 patients) were obtained: 46 ND (5.55 %), 682 B (82.4 %), 9 S (1.1 %) and 25 M (3.0 %). The 66 (8.0 %) indeterminate categories were reclassified: 1 ND (1.5 %), 8 B (12.1 %), 5 AUS (7.6 %), 34 FLUS (51.5 %), 5 HCLUS (7.6 %), 3 FN (4.5 %), 9 FN-HC (13.6 %) and 1 S (1.5 %). Thyroidectomies were performed in 125 patients (26 %): benign lesions in 83 (66.4 %), 7 (5.6 %) follicular adenoma and 2 (1.6 %) follicular carcinomas, 1 (0.8 %) medullary carcinoma, 21 (16.8 %) papillary carcinomas and 16 (12.8 %) papillary microcarcinomas (PMC). Risk of malignancy (RM) excluding PMC: B 1.4 %, AUS/FLUS/HCLUS 5 %, FN/FN-HC 11.1 %, SM 50 % and M 77.8 %. Conclusion: TBSRTC criteria led to more specific diagnosis. FN/FN-HC category has a two-fold RM when compared to AUS/FLUS/HCLUS.conferenceObject The Value of Repeated Fine-Needle Aspiration Biopsy in an Academic Community Hospital after the Bethesda System(2012) FERREIRA, C. R.; LIMA, P. P.; MENTEM, M. S.; ESPOSITO, J. P.; WASSERSTEIN, L. H.; FELIPE-SILVA, A.Background: Follow-up of thyroid nodules with repeated fine-needle aspiration biopsies (rFNA) is recommended in nondiagnostic (ND) samples and in cases of atypia of unknown significance (AUS)/follicular lesions of uncertain significance (FLUS), however, the impact of this approach is generally unexplored. We evaluated the risk of neoplasia (RN) and malignancy (RM) in rFNA. Design: All FNA from Jan/04 to Dec/10 were reclassified according to Bethesda System: ND, benign (B), AUS/FLUS, suspicious for follicular neoplasm (FN), suspicious for malignancy (SM) and malignant (M). Patients with one FNA (1FNA) and with rFNA were compared according to the worst diagnosis in the first FNA (fFNA) or in the rFNA. Surgical pathology (SP) and clinical follow-up were retrieved Results: In 480 patients (F:M=7:1, average age 53), 70 (14.6%) had rFNA. Average number of rFNA was 1.3±0.8. A total of 125 (26%) had a thyroidectomy (21.4% in the rFNA and 26.8% in 1FNA - p=0.3). Diagnoses upon fFNA in rFNA group were ND in 10 (14.3%), B in 49 (70%), AUS/FLUS in 8 (11.4%) and FN/SM in 3 (4.3%). In B group rFNA changed in 3 patients (6.1%) (2 AUS/FLUS, 1 FN) and 11 patients (22.4%) had SP follow-up: 1 follicular adenoma (FA) and 10 benign non-neoplastic lesion (BN), including 1 patient with AUS/FLUS at rFNA. In ND group rFNA changed in all patients: 9 (90%) to B and 1 (10%) to M – SP confirmed papillary carcinoma (PC). In AUS/FLUS group rFNA changed to B in 3 (37.5%) and ND in 1 (12.5%), none with SP. AUS/FLUS rFNA was unchanged in 4 (50%) – SP available in 3: 1 PC, 1 papillary microcarcinoma (PMC) and 1 BN. rFNA changed to B in the 3 patients of FN/MS group, one with BN at SP. Diagnoses in 1FNA group with SP follow-up were ND in 1 (0.9%), B in 60 (54.5%), AUS/FLUS in 15 (13.6%) and FN/SM/M in 34 (30.9%). The 1 ND was BN at SP. In 1FNA B group SP confirmed 7 incidental PMC (11.7%) and 1 FA (1.7%). In 1FNA AUS/FLUS group SP showed 1 FA (6.7%), 1 PC (6.7%) and 1 PMC (6.7%). In 1FNA FN/SFN/M group SP showed 18 PC (52.9%), 6 PMC (17.6%), 1 follicular and 1 medullary carcinoma. RM was 9.1% for all ND FNA. General RN was 9.1% in rFNA B group, 15% in the 1FNA B, 66% in rFNA AUS/FLUS, 20% in 1FNA AUS/FLUS and 82.4% in 1FNA FN/SM/M. Conclusions: Our data support the recommendation of rFNA in ND category. A repeated diagnosis of AUS/FLUS increased the general RN from 20% to 66% (p=0.1). A B fFNA diagnosis had a 4% chance of changing upon rFNA, and a virtually null RM.conferenceObject A Broad Immunohistochemistry Panel in Hepatocellular Carcinoma (HCC) Seems to Segregate Molecular Subtypes by Grade: A Cross-Sectional Study in 80 Brazilian Autopsies(2014) FELIPE-SILVA, A.; WAKAMATSU, A.; CIRQUEIRA, C. S.; CASSOL, C.; ALVES, V.conferenceObject The Value of Repeated Fine-Needle Aspiration Biopsy in an Academic Community Hospital after the Bethesda System(2012) FERREIRA, C. R.; LIMA, P. P.; MENTEM, M. S.; ESPOSITO, J. P.; WASSERSTEIN, L. H.; FELIPE-SILVA, A.Background: Follow-up of thyroid nodules with repeated fine-needle aspiration biopsies (rFNA) is recommended in nondiagnostic (ND) samples and in cases of atypia of unknown significance (AUS)/follicular lesions of uncertain significance (FLUS), however, the impact of this approach is generally unexplored. We evaluated the risk of neoplasia (RN) and malignancy (RM) in rFNA. Design: All FNA from Jan/04 to Dec/10 were reclassified according to Bethesda System: ND, benign (B), AUS/FLUS, suspicious for follicular neoplasm (FN), suspicious for malignancy (SM) and malignant (M). Patients with one FNA (1FNA) and with rFNA were compared according to the worst diagnosis in the first FNA (fFNA) or in the rFNA. Surgical pathology (SP) and clinical follow-up were retrieved. Results: In 480 patients (F:M=7:1, average age 53), 70 (14.6%) had rFNA. Average number of rFNA was 1.3±0.8. A total of 125 (26%) had a thyroidectomy (21.4% in the rFNA and 26.8% in 1FNA - p=0.3). Diagnoses upon fFNA in rFNA group were ND in 10 (14.3%), B in 49 (70%), AUS/FLUS in 8 (11.4%) and FN/SM in 3 (4.3%). In B group rFNA changed in 3 patients (6.1%) (2 AUS/FLUS, 1 FN) and 11 patients (22.4%) had SP follow-up: 1 follicular adenoma (FA) and 10 benign non-neoplastic lesion (BN), including 1 patient with AUS/FLUS at rFNA. In ND group rFNA changed in all patients: 9 (90%) to B and 1 (10%) to M – SP confirmed papillary carcinoma (PC). In AUS/FLUS group rFNA changed to B in 3 (37.5%) and ND in 1 (12.5%), none with SP. AUS/FLUS rFNA was unchanged in 4 (50%) – SP available in 3: 1 PC, 1 papillary microcarcinoma (PMC) and 1 BN. rFNA changed to B in the 3 patients of FN/MS group, one with BN at SP. Diagnoses in 1FNA group with SP follow-up were ND in 1 (0.9%), B in 60 (54.5%), AUS/FLUS in 15 (13.6%) and FN/SM/M in 34 (30.9%). The 1 ND was BN at SP. In 1FNA B group SP confirmed 7 incidental PMC (11.7%) and 1 FA (1.7%). In 1FNA AUS/FLUS group SP showed 1 FA (6.7%), 1 PC (6.7%) and 1 PMC (6.7%). In 1FNA FN/SFN/M group SP showed 18 PC (52.9%), 6 PMC (17.6%), 1 follicular and 1 medullary carcinoma. RM was 9.1% for all ND FNA. General RN was 9.1% in rFNA B group, 15% in the 1FNA B, 66% in rFNA AUS/FLUS, 20% in 1FNA AUS/FLUS and 82.4% in 1FNA FN/SM/M. Conclusions: Our data support the recommendation of rFNA in ND category. A repeated diagnosis of AUS/FLUS increased the general RN from 20% to 66% (p=0.1). A B fFNA diagnosis had a 4% chance of changing upon rFNA, and a virtually null RM.- Small biopsies for pancreatic lesions: Is there still room for fine needle aspiration?(2024) BUENO, Adriana; FELIPE-SILVA, Aloisio; SAIEG, MauroPancreatic carcinoma is an aggressive tumour with increasing incidence in both sexes worldwide. Early detection is, therefore, essential for patient management. A recent advancement involves the utilization of larger, thicker gauge needles, which enable the collection of core-type biopsies (FNB). Here, we investigated the role of fine needle aspiration and cytopathology in the diagnostic workflow of pancreatic lesions. A search query was designed to search for articles in the PubMed database comparing FNA and FNB for biopsy of pancreatic lesions, and detailed data were extracted from selected studies. Statistical analyses were performed using the R package meta version 6.2. Twenty-one studies made the final cut for data extraction. Overall, median age was 64.3 years (+/- 6.1; 47.6-71.5), male: female proportion 53.9 (+/- 11.3; 27.6-67.4), lesion size 3.1 cm (+/- 0.5; 1.9-4.2 cm) and percentage of malignant cases 78.3% (+/- 26.8; 2.1-100). FNA and FNB diagnostic yield was 85.8% (+/- 10.3; 70.0-100.0) and 89.2% (+/- 7.7; 70.0-98.6), respectively. Average accuracy was 89.5% (+/- 11.7; 63.0-100.0) for FNA and 90.8% (+/- 7.1; 77.0-100.0) for FNB. Adverse effects rate was 1.0% (+/- 1.3; 0-4.3) for FNA and 2.2% (+/- 4.4; 0-16.1) for FNB. None of the selected variables had a significant statistical difference between both methods. FNA and FNB perform similarly for diagnostic material acquisition in pancreatic lesions. The best outcome comes from the association of both techniques, emphasizing the value of combining cytological and histological morphology for the most accurate analysis. Much has been debated about the supposed advantages of FNB versus FNA sample acquisition for pancreatic lesions, with limited improvement in clinical parameters. According to our analysis, FNA and FNB perform similarly for diagnostic material acquisition in pancreatic lesions, with room for association of both techniques, emphasizing the value of combining cytological and histological morphology for the most accurate analysis.image
- Old dilemma: asthma with irreversible airway obstruction or COPD(2015) FATTAHI, Fatemeh; VONK, Judith M.; BULKMANS, Nicole; FLEISCHEUER, Ruth; GOUW, Annette; GRUNBERG, Katrien; MAUAD, Thais; POPPER, Helmut; FELIPE-SILVA, Aloisio; VRUGT, Bart; WRIGHT, Joanne L.; YANG, Hui-Min; KOCKS, Janwillem W. H.; HYLKEMA, Machteld N.; POSTMA, Dirkje S.; TIMENS, Wim; HACKEN, Nick H. T. tenOlder asthmatic patients may develop fixed airway obstruction and clinical signs of chronic obstructive pulmonary disease (COPD). We investigated the added value of pathological evaluation of bronchial biopsies to help differentiate asthma from COPD, taking into account smoking, age, and inhaled corticosteroid (ICS) use. Asthma and COPD patients (24 of each category) were matched for ICS use, age, FEV1, and smoking habits. Five pulmonary and five general pathologists examined bronchial biopsies using an interactive website, without knowing patient information. They were asked to diagnose asthma or COPD on biopsy findings in both a pairwise and randomly mixed order of cases during four different phases, with intervals of 4-6 weeks, covering a maximal period of 36 weeks. Clinically concordant diagnoses of asthma or COPD varied between 63 %-73 %, without important differences between pairwise vs randomly mixed examination or between general vs pulmonary pathologists. The highest percentage of concordant diagnoses was in young asthmatic patients without ICS use and in COPD patients with ICS use. In non ICS users with fixed airway obstruction, a COPD diagnosis was favored if abnormal presence of glands, squamous metaplasia, and submucosal infiltrate was present and an asthma diagnosis in case of abnormal presence of goblet cells. In ICS users with fixed airway obstruction, abnormal presence of submucosal infiltrates, basement membrane thickening, eosinophils, and glands was associated with asthma. Histological characteristics in bronchial biopsies are reproducibly recognized by pathologists, yet the differentiation by histopathology between asthma and COPD is difficult without information about ICS use.
- A Broad Immunohistochemistry Panel in Hepatocellular Carcinoma (HCC) Seems to Segregate Molecular Subtypes by Grade: A Cross-Sectional Study in 80 Brazilian Autopsies(2014) FELIPE-SILVA, A.; WAKAMATSU, A.; CIRQUEIRA, C. S.; CASSOL, C.; ALVES, V.