SELNET clinical practice guidelines for bone sarcoma.

Bone sarcoma are infrequent diseases, representing < 0.2% of all adult neoplasms. A multidisciplinary management within reference centers for sarcoma, with discussion of the diagnostic and therapeutic strategies within an expert multidisciplinary tumour board, is essential for these patients, given its heterogeneity and low frequency. This approach leads to an improvement in patient's outcome, as demonstrated in several studies. The Sarcoma European Latin-American Network (SELNET), aims to improve clinical outcome in sarcoma care, with a special focus in Latin-American countries. These Clinical Practice Guidelines (CPG) have been developed and agreed by a multidisciplinary expert group (including medical and radiation oncologist, surgical oncologist, orthopaedic surgeons, radiologist, pathologist, molecular biologist and representatives of patients advocacy groups) of the SELNET consortium, and are conceived to provide the standard approach to diagnosis, treatment and follow-up of bone sarcoma patients in the Latin-American context.

Perineurioma versus meningioma. A multi-institutional immunohistochemical and ultrastructural studY.

The differential diagnosis between perineurioma (PN) and meningioma (MEN) can be difficult by histology and immunohistochemistry (IHC) because the perineurium and arachnoid have the same embryological origin. However, there are no comparative studies determining conclusive parameters for the differential diagnosis. The aim of this study is to compare IHC of PN and MEN and their ultra-structural characteristics to elucidate which are the useful data that allow differentiate both entities. Thirty-five MEN were analyzed, and 15 PN, (11 skin and soft tissues and four oral cavity). IHC for epithelial membrane antigen (EMA), Claudin-1, GLUT-1, somatostatin-2 receptor (SSTR-2), and progesterone receptor (RP) was performed. Ultrastructural studies were performed on 8 MEN and 15 PN. Only in PN Claudin-1 was positive in 9/11 (90%) cases and GLUT-1 in 7/11 (63%) cases. In MEN, the progesterone receptor was expressed in 21/35 (60%) cases and no case expressed Claudin-1 and GLUT-1; EMA was expressed in all MEN cases and 93% of PN. SSTR-2 was expressed weakly in six cases of MEN (17%), and it was not considered useful for differential diagnosis. On ultrastructure, PN showed thin and parallel processes, some caveolae, and lacked cell junctions. The cellular processes were surrounded by a collagenous stroma in 94% of the cases. MEN were characterized by curved cytoplasmic cell processes showing desmosomes in 75% of cases. Ultrastructural findings aid in the differential diagnosis between PN and MEN, especially if molecular studies are not available.

Prognostic factors and treatment strategies for adult head and neck soft tissue sarcoma.

Adult head and neck soft tissue sarcomas are rare and display a variety of histological types and clinical characteristics; they are also associated with a variety of mortality risks. The purpose of this study was to examine all patients treated at the Instituto Nacional de Cancerologia for head and neck sarcoma during a 5-year period. Fifty-one adult patients were examined and treated for head and neck sarcomas from 2004 to 2009. The 51 tumours were histologically re-evaluated by expert pathologists and classified as low, intermediate or high grade sarcomas. A multivariate analysis was performed to evaluate the surgical margins, histological grades, and clinical stages as prognostic factors for the disease. Adult head and neck soft tissue tumours are rare, and they are associated with poor prognosis for patients, especially at clinical stages III and IV. The average survival rate after 2 years is 45%, and most of these patients die because of disease progression and metastases.

Dilated intercellular spaces in subtypes of gastroesophagic reflux disease.

BACKGROUND: Dilatation of the intercellular spaces by electron microscopy has been considered as an early morphological marker of tissue injury in gastroesophageal reflux disease. The degree of dilatation in Barret's esophagus in currently unknown. OBJECTIVES: To determine the frequency of dilated intervellular spaces in Barrett's esophagus. MATERIAL AND METHODS: Cross-sectional and prospective analysis of consecutive patients with gastroesophageal reflux disease. We selected symptomatic patients > 18 years and both sexes. Patients with recent PPI use (< 14 days), H-2 antagonists, NSAID's or previous upper GI tract surgery were excluded. VARIABLES INCLUDED: Clinical-demographic data, Carlsson-Dent score, conventional endoscopy findings, pH-metry results (in non-erosive) and normal mucosal biopsies at 2 and 5 cm above the squamocolumnar junction. Dilation of intercellular spaces was measured by electron microscopy. STATISTICS: Chi square test with a significance level 0.05 was calculated. The following four groups were compared: a) non-erosive reflux disease (n = 14); b) erosive esophagitis (n = 5); c) Barrett's esophagus (n = 13); and d) healthy controls (n = 5). RESULTS: the dilation of intervellular spaces was increasingly greater form non-erosive revlux to Barrett's esophagus and higher in biopsies taken at 5 cm than at 2 cm of the squamous columnar junction (2.72 +/- 1.35 vs. 1.71 +/- 0.48 microg) (p = 0.001). There was no difference between biopsies at 2 and 5 cm in the order groups. CONCLUSION: dilation of intercellular spaces was greater in Barrett s esophagus than in the other groups and higher at 5 cm from the squamocolumnar junction.

Dermatofibrosarcoma protuberans: ultrastructural and immunocytochemical observations.

In an attempt to elucidate the histogenesis of dermatofibrosarcoma protuberans, 38 specimens were examined by electron microscopy and immunocytochemistry. The cumulative evidence strongly favors a fibroblastic/myofibroblastic derivation.

Clinical and cellular effects of colchicine in fibromatosis.

The proliferating cells in fibromatoses are myofibroblasts that produce abundant stromal collagen and contain intracellular native and widely spaced collagen fibers. To assess the clinical and cellular effects of colchicine in such tumors, this drug was administered to three patients, one with musculoaponeurotic desmoid fibromatosis, one with Dupuytren's palmar fibromatosis, and one with Peyronie's disease. All three patients had an excellent clinical response, with reduction of tumor size and improvement of contracture. Two cases were studied ultrastructurally; the main cellular changes detected were collapse of the rough endoplasmic reticulum cisternae, reduction of myofilaments, and disappearance of intracellular widely spaced collagen. The findings from this study indicate another probable application for colchicine and support the concept that collagen fibers can be formed intracellularly.

Optically clear and vacuolated nuclei. Two useful signs for the transoperative diagnosis of papillary carcinoma of the thyroid.

Ground glass nuclei and Orphan Annie Eye nuclei are currently accepted as the most useful signs for the diagnosis of papillary carcinoma of the thyroid. The nuclear appearance, however, is not used in transoperative studies because the general opinion is that they are only found in permanent sections. To compare the nuclear aspect of the permanent with frozen sections and imprints, a prospective double-blind study of 48 transoperative thyroid specimens was performed. The results show that the nuclei are similar when examined by the three techniques.

Lesiones pulmonares y renales en pancreatitis aguda. Estudio retrospectivo en material de autopsia. / Pulmonary and renal lesions in acute pancreatitis. Retrospective study in autopsy specimens

Con el objeto de dilucidar si las alteraciones pulmonares y renales que se describen en la literatura como caracteristicas de la pancreatitis aguda (PA) son particularmente frecuentes en este padecimiento, se efectuo un estudio a ciegas de 35 casos de autopsia con PA comparados con un grupo control de 32. Se obervaron en forma significativamente mas frecuente en pancreatitis intensa: edema pulmonar, congestion y membranas hialinas o fibrina intraalveolar (P < 0.05), con analisis semicuantitativo de los signos en conjunto se observo una mayor diferencia (P < 0.01) independientemente de la intensidad de la PA. Las alteraciones renales frecuentes en pancreatitis aguda fueron: edema intersticial y aumento de celularidad y matriz mesangial (P < 0.05), fueron mas significativas en PA intensa (P < 0.01). Si se analizam en forma semicuantitativa estas y otras alteraciones del "rionon de choque" la diferencia es aun mas aparente (P < 0.01).Se concluye que las lesiones de "rinon de choque" y "pulmon de choque" son particularmente frecuentes en PA. En base a la literatura se analiza la fisiopatologia de dichas lesiones

Evaluacion prospectiva de radiologia y endoscopia en el diagnostico del sindrome ulceroso. / Prospective evaluation of radiology and endoscopy in the diagnosis of ulcerative syndrome

Se presenta un estudio de 100 pacientes adultos con sintomatologia ulcerosa cronica, en donde se compara en forma prospectiva, la eficacia del diagnostico endoscopico con la del diagnostico radiologico.La metodologia fue disenada de tal manera que ningun metodo tuviese ventaja sobre el otro. Participaron en el estudio especialistas de las siguientes disciplinas: gastroenterologia, radiologia, patologia y cirugia. Sirvieron como diagnostico definitivo la biopsia, la fotografia endoscopica y la biopsia quirurgica cuando fue posible realizarla. Los resultados muestran que la endoscopia tuvo un 98% de eficacia para aclarar la etiologia del sindrome y que la radiologia lo logro en el 61% de los casos. La radiologia presento falsas negativas y falsas positivas ademas de hallazgos indefinidos; la endoscopia presento una falsa negativa y una falsa positiva. Como informacion adicional util para el manejo del paciente, la radiologia aporto datos en el 8% de los casos y la endoscopia en el 19% de los casos. Los diagnosticos finales correspondieron a: ulcera duodenal 31 casos, ulcera gastrica 25 casos, gastritis 13, carcinoma gastrico 10, esofagitis 6, ulcera pilorica 5, duodenitis 5 y 5 casos normales. Concluimos que la endoscopia es el metodo mas confiable en el paciente con sindrome ulceroso y se propone como el estudio de eleccion, aun cuando no exista informacion radiologica para el endoscopista