Radial scars without atypia in percutaneous biopsy specimens: can they obviate surgical biopsy? / Cicatriz radial sin atipia en biopsia percutánea. ¿Puede evitarse la biopsia quirúrgica?

OBJECTIVE: To evaluate the need for surgical biopsy in patients diagnosed with radial scars without atypia by percutaneous biopsy. MATERIAL AND METHODS: In this retrospective observational study, we selected patients with a histological diagnosis of radial scar in specimens obtained by percutaneous biopsy during an 8-year period. The statistical analysis was centered on patients with radial scar without atypia (we assessed the radiologic presentation, the results of the percutaneous biopsy, and their correlation with the results of surgical biopsy and follow-up) and we added the patients with atypia and cancer in the elaboration of the diagnostic indices. RESULTS: We identified 96 patients with radial scar on percutaneous biopsy; 54 had no atypia, 18 had atypia, and 24 had cancer. Among patients with radial scar without atypia, there were no statistically significant differences between patients who underwent imaging follow-up and those who underwent surgical biopsy (p>0.05). The rate of underdiagnosis for percutaneous biopsy in patients without atypia was 1.9%. The rates of diagnosis obtained with percutaneous biopsy in relation to follow-up and surgical biopsy in the 96 cases were sensitivity 92.3%, specificity 100%, positive predictive value 100%, negative predictive value 97.2%, and accuracy 97.9%. The area under the ROC curve was 0.96 (p<0.001), and the kappa concordance index was 0.95 (p<0.001) CONCLUSIONS: We consider that it is not necessary to perform surgical biopsies in patients with radial scars without atypia on percutaneous biopsies because the rate of underestimation is very low and the concordance between the diagnosis reached by percutaneous biopsy and the definitive diagnosis is very high.

Epidemiological Characteristics of the Largest Kidney Transplant Program in Mexico: Western National Medical Center, Mexican Institute of Social Security.

BACKGROUND: According to the National Transplant Center (CENATRA), in 2013, a total of 2707 transplantations were performed in Mexico; of them, 10% (270 transplantations) were done in our Tertiary Care Hospital (Western National Medical Center). This means that one in 10 transplant recipients undergoes transplantation at our medical center. The aim of our study was to describe the characteristics of and to compare changes in the kidney transplantation program over time. MATERIALS AND METHODS: This was a cross-sectional study. Data were collected from the hospital transplant registry from January 1994 to December 2014. RESULTS: During the study period, 3643 kidney transplantations were conducted; most were living donor 3236 (89%), and only 407 patients (11%) received a graft from a deceased donor. Of living donors, 2786 (87%) were related, and 450 (13%) were genetically unrelated. The average recipient age was 28 years, and the average age of the donor was 34 years. It was observed that siblings donated more frequently (51%), followed by parents (34%). Among unrelated donors, spouses donated the most (66%). In 80% of cases, the cause of end-stage renal disease (ESRD) was unknown (80%). The most frequent renal replacement therapy was peritoneal dialysis (54%), followed by hemodialysis (18%); only 5% of patients received preemptive kidney transplant. The most frequent immunosuppression scheme was tacrolimus, mycophenolate mofetil, and prednisone in 70% of patients. CONCLUSION: The Western National Medical Center is the largest kidney transplantation program in Mexico. The main activity is living donor transplantation. Recipients are relatively young persons with unknown etiology of ESRD.

Early Steroid Withdrawal in Recipients of a Kidney Transplant From a Living Donor: Experience of a Single Mexican Center.

BACKGROUND: Early steroid withdrawal (ESW) can improve lipid and hemodynamic profiles without severe acute rejection (AR) events in renal transplant patients. Our objective was to evaluate the effects of ESW on the frequency and severity of AR. METHODS: A randomized, open-label, controlled clinical trial was performed on renal transplant recipients with a follow-up of 12 months. In the ESW group, patients were selected for corticosteroid treatment withdrawal on the fifth day post transplantation. In the Control group, patients continued with steroid treatment. All patients were over 18 years of age with panel reactive antibody (PRA) class I and II HLA <20%. RESULTS: In total, 71 patients, 37 in the ESW group (52.1%) and 34 in the Control group (47.9%), had comparable AR incidences at the end of the follow-up (16% vs 15%) (NS) (RR = 1.20, 95% CI = 0.32-3.33). Although renal graft survival was similar between the ESW and Control groups (87% vs 94%), renal function was superior in the ESW group (85 vs 75 mL/min). Additionally, hypertension was less frequent in the ESW group (3% vs 35%), requiring the use of fewer antihypertensives (8% vs 50%). CONCLUSIONS: ESW was also associated with better blood pressure control and similar AR risk. The ESW group exhibited stable renal function.

[Primary localized amyloidosis of glans penis. A new case and review of the literature]. / Amiloidosis primaria localizada en glande peneano. Caso clínico y revisión de la literatura.

Primary localized amyloidosis urinary tract is rare. Localized amyloidosid only glands is a very rare entity. The clinical impression may resemble neoplastic disease but the diagnosis is confirmed by histochemical study. Biopsy of the lesion revealed dermal deposits of amorphous eosinophilic material. A case of patient with primary amyldosis of glands penis is reported. The literature is reviewed and the diagnostic and therapeutic options are discussed. This is the seventh reported case of localized amyloidosis of the glands penis.

[Mucinous adenocarcinoma of the prostate]. / Adenocarcinoma mucinoso de próstata.

OBJECTIVE: To describe a case of mucinous adenocarcinoma of the prostate. METHODS: A 77-year-old patient presented with urinary complaints. Patient evaluation showed an enlarged prostate and increased PSA levels. RESULTS: A prostate biopsy showed a glandular neoplasm with extensive mucinous differentiation and abundant lacunae of PAS positive mucus (mucinous adenocarcinoma). The patient remains well one year after the diagnosis. CONCLUSIONS: Mucinous adenocarcinoma of the prostate is a rare variant that should be recognized and does not necessarily imply a worse prognosis than other carcinomas of the prostate.

[Bladder adenocarcinoma with glandular cystitis areas]. / Adenocarcinoma vesical con áreas de cistitis glandular.

OBJECTIVE: To describe a case of adenocarcinoma of the urinary bladder. METHODS: A 63-year-old patient consulted for gross hematuria. Ultrasound evaluation showed a bladder neoplasm and CT demonstrated extensive infiltration of adjacent structures. RESULTS: Histological analysis of the TUR specimen confirmed a muscle infiltrating glandular neoplasm (adenocarcinoma) with diffuse areas of cystitis glandularis. Patient evolution has been poor and he is now in the end stage of the disease. CONCLUSIONS: The morphology is not unlike that of colorectal carcinoma, which should be distinguished. The association of areas of cystitis glandularis indicates a possible relationship.

[Subacute thyroiditis associated with positive antibodies to the Epstein-Barr virus]. / Tiroiditis subaguda asociada a anticuerpos positivos al virus de Epstein-Barr.

Subacute thyroiditis is an inflammatory disorder of the thyroid caused probably by viruses. It is clinically characterized by the presence of anterior cervical pain and/or painful goiter, and rarely as fever of unknown origin or as prolonged fever syndrome. We report a case of a 49-year-old female admitted to the hospital because of fever during last month, leukocytosis and accelerated erythrocyte sedimentation rate. Following observation, slight tenderness over the thyroid gland and signs of hyperthyroidism occurred. After the laboratory studies, low thyroidal radioactive iodine uptake and fine-needle aspiration cytology (FNAC) of thyroid, she was diagnosed of subacute thyroiditis with hyperthyroidism. We believe that the etiologic agent was the Epstein-Barr virus because heterophile and Epstein-Barr virus-specific antibodies were positive. The patient was treated with acetaminophen (1.500 mg/day) with prompt and complete resolution of the clinical and laboratory abnormalities. There has been no recurrence of the disease during a 1 year follow-up.

[Atypical stromal hyperplasia of the prostate (stromal proliferation of uncertain malignant potential)]. / Hiperplasia estromal atípica de próstata (proliferación estromal de potencial maligno incierto).

OBJECTIVE: To describe a case of atypical stromal hyperplasia of the prostate. METHODS: A 62-year-old patient presented with prostatic syndrome. Physical examination disclosed an indurated prostate and PSA determination showed increased levels. A prostate biopsy was performed. RESULTS: The histological analysis showed atypical stromal proliferation with elongated nuclei and immunohistochemical expression for vimentine, smooth muscle actin and CD34 with glandular hyperplasia. The diagnosis was that of atypical stromal hyperplasia of the prostate (prostatic stromal proliferation of uncertain malignant potential). CONCLUSIONS: A careful histological study is necessary to make the correct diagnosis of prostatic stromal proliferation of uncertain malignant potential. CD34 expression is a characteristic finding. As its name indicates, its evolution is uncertain.

[Pacinian neurofibroma of the vulva]. / Neurofibroma pacciniano de la vulva.

OBJECTIVE: To report on a rare case of Pacinian neurofibroma of the vulva. METHODS: A 27-year-old patient who presented with a vulvar tumor is described. Patient evaluation showed no other remarkable findings. RESULTS: The nodule was resected without difficulty. The histopathological analysis-demonstrated Pacinian neurofibroma with abundant concentric laminar structures. The immunohistochemical (CD34+), ultrastructural and histological analyses showed perineural cells. No signs of neurofibromatosis were found. CONCLUSIONS: Pacinian neurofibroma may present in the vulva and could probably arise from the so-called perineural fibroblasts.

[Differential diagnosis of intrascrotal calcification: lithiasis attached to hydrocele wall]. / Diagnóstico diferencial de calcificación intraescrotal: litiasis adherida a pared de hidrocele.

OBJECTIVE: To report a case of scrotal calculus in a hydrocele, attached to the parietal portion of the tunica vaginalis, complicating the differential diagnosis. METHODS: A 54-year-old patient with a clinical diagnosis of hydrocele is described. Ultrasound confirmed the diagnosis and demonstrated a calcified structure in the hydrocele fluid, attached to the parietal portion of the tunica vaginalis. A calculus of 1.7 cm diameter was found during the surgical procedure. CONCLUSION: The presence of calculus in a hydrocele does not change the prognosis or treatment of this condition, although some doubts may arise during sonographic assessment if it is attached to the parietal portion of the tunica vaginalis.

[Non-specific granulomatous epididymitis]. / Epididimitis granulomatosa inespecífica.

OBJECTIVE: A case of granulomatous epididymitis is presented. METHODS: A 23-year-old patient consulted for nonspecific pain in the left supratesticular region. Physical examination showed a hard, indolent, enlarged epididymis. An ultrasound scan revealed normal testes with small bilateral hydrocele and left epididymal enlargement with calcifications. Resection was performed via the inguinal approach. RESULTS: The histopathological analysis demonstrated intense granulomatous reaction with multinucleated giant cells and foci of spermatozoal remnants. Staining for fungi and acid-fast bacilli were negative. CONCLUSION: The condition was diagnosed as nonspecific granulomatous epididymitis.

[Pigmented renal carcinoma, rich in hemosiderin]. / Carcinoma renal pigmentado, rico en hemosiderina.

OBJECTIVE: To report a case of hemosiderin-rich, pigmented renal cell carcinoma. METHODS: A 70-year-old patient referred several episodes of gross hematuria during the last few weeks, without any other symptoms. CT demonstrated a renal mass compatible with carcinoma. A right renal nephrectomy was performed. RESULTS: Anatomopathological analysis revealed a hemosiderin-rich, pigmented, papillary renal cell carcinoma localized to the renal capsule that stained blue with the iron staining method. The postoperative period was unremarkable and the patient is asymptomatic one year postoperatively. CONCLUSION: Papillary renal cell carcinoma can present as a pigmented lesion due to the accumulation of iron in the cytoplasm. This peculiar form must be distinguished from neuromelanin-pigmented lesions.

[Renal carcinoma with intranuclear inclusions associated with colon carcinoma]. / Carcinoma renal con inclusiones intranucleares asociado a carcinoma de colon.

OBJECTIVE: To report a case of renal cell carcinoma associated with carcinoma of the colon. METHODS: A right renal mass was detected during US control evaluation of a patient that had undergone surgery for rectosigmoid carcinoma 4 months earlier. A previous abdominal CT scan revealed a renal mass with characteristics of malignancy. Fine-needle aspiration biopsy showed clear cell renal carcinoma. This case was considered as two different and synchronous primaries, and the patient was submitted to surgery. RESULTS: Intestinal adhesions secondary to radiotherapy were found intraoperatively, but there was no evidence of local intestinal recurrence, and therefore nephrectomy was performed. The histopathological study demonstrated clear cell renal carcinoma with intranuclear inclusions. CONCLUSIONS: Although the patient may have a previous history of carcinoma at another site, the finding of a renal mass excludes synchronous tumors and nephrectomy should be the treatment of choice. The finding of clear cells in the cytological study supports the interpretation that these lesions were different primaries. Renal carcinoma should be included among the neoplasms with intranuclear inclusions.

[Bladder metastasis of signet-ring cell adenocarcinoma from the stomach]. / Metástasis vesical de adenocarcinoma de células en anillo de sello de origen gástrico.

OBJECTIVE: To describe an additional case of metastatic bladder tumor from gastric signet-ring cell adenocarcinoma. METHODS/RESULTS: Local recurrence was demonstrated by gastrointestinal endoscopy and biopsy in a 52-year-old female who underwent total gastrectomy for signet-ring cell gastric adenocarcinoma two years earlier. A CT scan showed bilateral hydronephrosis and diffuse thickening of the bladder wall. Bladder biopsy demonstrated signet-ring cell adenocarcinoma. Palliative treatment with ureteral catheterization was instituted. CONCLUSIONS: Signet-ring cell adenocarcinoma of the bladder is usually a primary tumor. Metastatic signet-ring cell adenocarcinoma to the urinary bladder is uncommon.