Cutaneous Myoepithelioma: An Unusual Tumor in the Hand.

Cutaneous myoepithelioma (CM) is a rare tumor among the primary skin neoplasms. We present the case of a patient with a diagnosis of CM in the right hypothenar region. Histological study showed a proliferation of myoepithelial cells with a solid, reticular growth pattern in a chondromyxoid stroma. The tumor cells were positive for CK AE, S-100, EMA, and p63.

Mesonephric adenocarcinoma of the cervix: a case report with a three-year follow-up, lung metastases, and next-generation sequencing analysis.

BACKGROUND: Mesonephric adenocarcinoma (MNAC) is a rare tumor of the female genital tract, which originates from mesonephric duct remnants. Its diagnosis is pathologically challenging, because MNAC may exhibit a mixture of morphological patterns that complicates the differential diagnosis. CASE PRESENTATION: The patient in this case was a 48-year-old woman with a polypoid mass protruding into the endocervical canal. The patient underwent a total hysterectomy outside the institution. During biopsy, the mass showed a cerebroid aspect. Histological study revealed a tumor with a predominantly tubular and ductal growth pattern. The immunoprofile showed negative staining for calretinin, carcinoembryonic antigen (CEAm), estrogen receptors (ER), and progesterone receptors (PR), and positive staining for CD10, p16, and PAX2. The Ki-67 score was 46%. Using a next-generation sequencing assay, we documented genomic alterations in KRAS and CTNNB1, low tumor mutation burden (TMB), and an absence of microsatellite instability. In addition, gain of the long arm of chromosome 1 (1q) was also documented using chomogenic in situ hybridization (CISH). Three years later, the patient presented pulmonary nodules in the lingula and left basal lobe that were resected by thoracotomy. The histopathologic study of the pulmonary nodules confirmed the presence of metastases. CONCLUSION: Carcinomas of mesonephric origin are among the rarest subtypes of cervical tumors. We report the first case of mesonephric adenocarcinoma of the cervix with lung metastases showing a CTNNB1 gene mutation.

Secretory Carcinoma of the Parotid: Making the Correct Diagnosis of a Rare Salivary Gland Carcinoma When Molecular Biology Testing Is Not Available.

Secretory carcinoma (SC) is a recently described entity occurring in the salivary glands. Before its description, SC was frequently classified as acinic cell carcinoma (ACC) or adenocarcinoma, not otherwise specified. Its particular histopathological and immunohistochemical characteristics are reminiscent of breast secretory carcinoma. Moreover, it displays a characteristic t(12;15) (p13;q25) translocation that results in the ETV6-NTRK3 gene fusion. This translocation has not been reported in any other salivary gland carcinoma. Identification of the t(12;15) (p13;q25) translocation is the gold standard for diagnosis, although some cases that do not present this specific translocation have already been reported. In such cases, diagnosis is challenging. In addition, some diagnostic pathology laboratories lack the resources to perform the molecular analysis to diagnose SC. In this scenario, morphology and immunohistochemistry are fundamental. Therefore, we report a case emphasizing the typical morphology of SC and its immunochemical profile to establish a final diagnosis without molecular biology tests. This case aims to demonstrate the importance of recognizing the typical presentation of a rare tumor so that clinicians will be informed or reminded of it and consider this entity among the differential diagnoses, when necessary. Moreover, in low-resource settings where molecular analysis is not available, being familiar enough with the histology of this tumor and using the immunoprofile as a key tool for differential diagnosis would be of great importance in establishing the correct diagnosis. The differential diagnosis includes, above all, acinic cell carcinoma and other salivary neoplasms such as intraductal carcinoma, low-grade mucoepidermoid carcinoma, and adenocarcinoma, not otherwise specified, which is actually a rule-out diagnosis.

Variación de la somnolencia diurna y proteína c reactiva en los integrantes de la IX Expedición Antártica Ecuatoriana, 2004 / Variation of daytime drowsiness and protein c reagent on the members of the ix antarctic ecuadorian expedition, 2004

Se ha demostrado que las condiciones climáticas y laborales extremas en la Antártida, alteran la relación sueño-vigilia, modificando los grados de somnolencia diurna. Objetivos: determinar la correlación entre el score de somnolencia diurna y la PCR cuantitativa como marcador inflamatorio en 20 expedicionarios ecuatorianos sometidos a horarios laborales estrictos durante 10 semanas en el verano peninsular Antártico y su relación con el score de somnolencia diurna en el trópico. Tipo de estudio: longitudinal, prospectivo, realizado a un grupo de expedicionarios durante el verano polar Antártico. Resultados: la escala de Epworth inicial una semana antes de la expedición, reportó un paciente 5(n=20) con hiepersomnolencia diurna excesiva con 11 puntos, el mismo que disminuyó 4 puntos en la escala final, clasificándose como no hipersomnolente. Se observó que todo el grupo tuvo una disminución en la escala de Epworth final vs. inicial con tendencia de al menos 1 punto (p=0.04). La correlación entre PCR y escala de Epworth inicial fue positiva con “r” Pearson de (0,55); esta correlación desapareció hacia el final de las 10 semanas de expedición. La PCR en el 100(n=20) fue de (0,17+/-0,16) al inicio y de (0,17+/-0,19) al final con un valor referencial normal de 0 a 1,20 mg/dL. Conclusiones: el estrés ambiental y laboral al que fueron sometidos los expedicionarios aumentó el estado de alerta en todo el grupo en relación con la escala de Epworth del trópico. La PCR inicial y final no alcanzó niveles significativos, manteniéndose siempre dentro de los parámetros normales, comprobándose la no existencia del componente inflamatorio al no haber hipersomnolencia diurna excesiva.

The extreme climatic and working conditions in the Antarctica alter the relation sleep-alertness, modifying the degrees of daytime drowsiness. Type of study: longitudinal, prospective, practiced on a group of expeditionary people during the Antarctic Polar summer. Objectives: to determine correlation between the score of daytime drowsiness and the quantitative RPC as inflammatory marker in 20 Ecuadorian expeditonary people submitted to strict working schedules during 10 weeks in the Antarctic peninsular summer and its connection with the score of daytime drowsiness in the Tropic. Results: the Initial Epworth scale a week before the expedition reported one patient 5 (n=20) with excessive daytime hypersomnia with 11 points. This patient reduced 4 points at the end of the scale, having been classified as non hypersomniac. In was observed that everybody in the group had a decrease in the Epworth scale final vs. initial with tendency of almost 1 point (p=0.04). The correlation between RPC and Initial Epworth scale was positive with “r” Pearson of (0.55); this correlation disappeared towards the end of the 10 weeks of expedition. The RPC in 100 (n=20) was of (0.17 +/-0.16) at the beginning and of (0.17+/-0.19) at the end with a normal referential value from 0 to 1.20 mg/dl. Conclusions: the environmental and working stress that they underwent increased alertness in all the group according to the Epworth scale of the Tropic. The initial and final (RPC) did not reach significant levels either, being always inside the normal parameter, proving the inexistence of the inflammatory component since there was no excessive daytime hypersomnia.