Diagnostic yield of brush cytology for biliary stenosis during ERCP.

AIM: To evaluate the diagnostic yield of brush cytology for biliary strictures detected on ERCP when a systematic approach is used. PATIENTS AND METHODS: Data on 62 consecutive patients with a biliary stricture on ERCP were collected. Cytological samples were processed immediately after brushing in the endoscopy room, and all were analyzed by the same pathologist. For the statistical analysis specimens were classified as positive, negative, suspicious for malignancy (presence of atypias), and unsatisfactory for evaluation. Final diagnosis was based on either histopathologic (surgery or biopsies by other techniques) or clinical/radiographic diagnosis. RESULTS: A total of 71 cytological specimens were included. Definite diagnosis was malignancy in 49 samples, and benign stricture in 22. Three samples were excluded because of insufficient material or processing artifacts. The sensitivity of biliary brushing was 62% (95% CI 0.47-0.77), specificity was 100%, positive predictive value was 100%, and negative predictive value was 58% (95% CI 0.43-0.75). When suspicious samples were included as malignant, sensitivity was 67% (95% CI 0.54-0.81) without changes in the remaining parameters. Eight patients underwent more than one ERCP. Repeated brush cytology exams in these patients yielded a definitive diagnosis in every case. CONCLUSIONS: Brush cytology has intermediate sensitivity with a high specificity. A systematic approach with a dedicated pathologist and the inclusion of significant atypias as malignant results improves sensitivity. Due to its simplicity brush cytology should be performed in all cases of biliary strictures detected on ERCP, and in case of repeated ERCPs additional cytology brushings are recommended.

[Kikuchi-Fujimoto disease: report of two cases]. / Enfermedad de Kikuchi-Fujimoto: descripción de dos casos.

Kikuchi-Fujimoto disease, described for the first time in 1972, is an unusual diagnosis that is characterized by lymph node enlargement and fever. Cervical lymph nodes are affected so often that ENT specialists should be aware of this entity during differential diagnosis. The diagnosis was done by histological features, necrotizing lymphadenitis. The disease is self-limited and it has good prognosis. We have reviewed two cases in our hospital. We report an aseptic meningoencephalitis as a rare complication.

[Ménétrier disease. Clinical and histological study of 3 cases]. / Enfermedad de Ménétrier. Estudio clínico e histológico de tres casos.

Three cases of Ménétrier's disease diagnosed and treated in our hospital during the last 15 years are presented. We describe the clinical manifestations as well as the pathological findings; one of the cases was complicated by carcinomatous degeneration. On the basis of our experience, we briefly review the controversial clinical, diagnostic and therapeutic aspects of this rare condition.

[Mucinous carcinoma of the prostate: critical review of Elbadawi's criteria]. / Carcinoma mucinoso de la próstata: revisión crítica de los criterios de Elbadawi.

OBJECTIVES: We present our experience on prostatic mucinous adenocarcinoma and at once we practice an actualization and a critical review of Elbadawi's criteria. METHODS: After reviewing 206 prostatic carcinomas diagnosed in our hospital, we describe one case that fulfill criteria for being considered a prostatic mucinous adenocarcinoma. We also carry out a wide literature review trying to define anew the including criteria of this tumour by the light of modern knowledge and technology. CONCLUSIONS: We think that for accepting a tumour as a prostatic mucinous adenocarcinoma, this have to fulfill the following criteria: 1. "More than 25% of a significative tumoral sample is mucinous pattern and present, single or clustered, tumour cells floating in immunohistochemically probed, acidic and neutral, mucin lakes". 2. "Tumour is Gleason 3-4 cribiform pattern with direct transition to colloid areas and usually coexist with classic adenocarcinoma but papillary growth patterns should be excluded. Tumour may contain a moderate proportion of signet-ring cells". 3. "Immunohistochemical staining for PSA have to be strongly positive in both, cribiform and mucinous, areas". 4. "Those PSA nonreactive, or only focally positive, mucinous adenocarcinomas, could be labeled as prostatic only when local or distant mucinous carcinomas are ruled out".

[Kaposi's sarcoma: a sexually transmitted cancer?]. / Sarcoma de Kaposi: un cáncer de transmisión sexual?

Kaposi's sarcoma is a lymphoproliferative opportunistic tumor associated with acquired immunodeficiency syndrome whose frequency is going down due to the use of combined therapies including proteases and others antivirals. During the last years, it has been postulated that it's origin is in the oncogenic potential of HVH-8; however, for the development of the disease, it's necessary the presence of some coadjuvant factors including immunodeficiency and probably a propicious hormonal status. We practiced a bibliographic review of some recent works related with it's etiology and coadyuvant factors implicated in the development of this neoplasia, phrasing some questions that should be answered in the light of future investigative works.

Port site metastases after laparoscopic cholecystectomy for an unexpected gallbladder carcinoma.

Laparoscopic cholecystectomy is a proven, well-accepted surgical technique for removing the diseased gallbladder and has rapidly become the surgical procedure of choice over conventional open cholecystectomy. Radiologists must be aware of the possibility of inadvertent dissemination of incidental gallbladder cancer during laparoscopic cholecystectomy. We report a case of this unusual complication: a patient with port site metastases after laparoscopic cholecystectomy for an unexpected gallbladder carcinoma at an early stage.