Preoperative lymphoscintigraphy and tumor histologic grade are associated with surgical detection of the sentinel lymph node.

OBJECTIVE: To study which variables involved in the process of selective sentinel node biopsy (SSNB) influence the intraoperative detection of the sentinel lymph node. MATERIAL AND METHODS: This was a prospective cross-sectional study in 210 patients (mean age, 54 years) diagnosed with breast cancer who underwent SSNB. We recorded clinical, radiological, radioisotope administration, surgical, and histological data as well as follow-up data. We did a descriptive analysis of the data and an associative analysis using multivariable regression. RESULTS: Deep injection alone was the most common route of radioisotope administration (72.7%). Most lesions were palpable (57.1%), presented as nodules (67.1%), measured less than 2 cm in diameter (64.8%), were located in the upper outer quadrant (49.1%), were ductal carcinomas (85.7%), were accompanied by infiltration (66.2%), and had a histologic grade of differentiation of ii (44.8%). Preoperative scintigraphy detected the sentinel node in 97.6% of cases and 95.7% were detected during the operation. One axillary relapse was observed. In the associative study, the variables "preoperative lymphoscintigraphy" and "histologic grade of differentiation of the tumor" were significantly associated with the detection of the sentinel lymph node during the operation. CONCLUSION: The probability of not detecting the sentinel lymph node during the surgical intervention is higher in patients with high histologic grade tumors or in patients in whom preoperative lymphoscintigraphy failed to detect the sentinel node.

[Micrometastasis in the sentinel node and axillary lymph node macro-metastasis in breast cancer]. / Micrometástasis en el ganglio centinela y macrometástasis ganglionares axilares en el cáncer de mama.

AIM: The study of the sentinel node has made it possible to obtain more comprehensive knowledge about the extent of axillary involvement in breast cancer. It has also decreased the surgical morbidity associated to the surgical examination of the axilla. The systematic use of immunohistochemical staining and molecular biology techniques improves the ability to detect the presence of micrometastasis or isolated tumor cells in a significant number of cases when this is the only sign of the lymph node extension of the disease. The possibility of avoiding complete axillary lymphadenectomy in those patients who are only affected by micrometastasis is proposed because of the low incidence of further involvement of the remaining lymph nodes. MATERIAL AND METHOD: 159 patients diagnosed of stage T1 or T2 breast cancer, in which the sentinel node had been identified by scintigraphy and intraoperative localization, were included in the study. Complete axillary lymphadenectomy was performed when micro- or macrometastases were found in the sentinel node, in order to determine the degree of axillary involvement. RESULTS: A total of 40 patients (25%) showed infiltration of the sentinel node. This infiltration was only by micrometastasis in 17 of them (10.7%). Of these 17 patients, only 2 (11.8%) showed macro-metastasis in the lymphadenectomy. In the remaining subjects, the final staging reached after the sentinel node study was not modified. CONCLUSION: It is possible to speculate that, in the future, axillary dissection can be avoided in those patients diagnosed of micrometastasis in the sentinel node, pending the conclusions of the on-going multicenter studies.

[A benign retroperitoneal schwannoma: a review of the literature and a report of a new case]. / Schwanoma retroperitoneal benigno: revisión de la literatura y aportación de un nuevo caso.

In a 42-years-old woman, an abdominal sonography was done, and a 10 x 9-cm solid cystic tumor on the left kidney appeared. Abdominal CT and arteriography showed a retroperitoneal heterogeneous mass surrounding and obstructing the ureteropelvic left junction. Tumor was removed under open surgery and the pathological study showed a benign schwannoma. We present this case because of its rarity 1%-10% of all primary retroperitoneal tumors.

[Prevalence of micrometastases and isolated tumor cells in the sentinel node at early stage breast cancer]. / Prevalencia de micrometástasis y células aisladas en el ganglio centinela en estadios iniciales del cáncer de mama.

AIM: To analyze the prevalence of isolated tumor cells (ITC) and micrometastases in the sentinel node of early stage breast cancer. MATERIAL AND METHODS: A total of 234 patients diagnosed of breast cancer, stages T1 or T2, with no axillary involvement detected by palpation or ultrasound-FNA, were studied. The sentinel node (SN) was identified by lymphoscintigraphy and removed in the operating room. Serial sections and immunohistochemical staining were then performed, classifying them as negative (SN-), negative with ITC (SN-ITC), positive with micrometastases (SN+mic) and positive with macrometastases (SN+mac). A complete axillary lymphadenectomy (CAL) was carried out in those cases with micro- or macrometastases, the former being classified as negative (CAL-), positive with micrometatases (CAL+mic), and positive with macrometastases (CAL+mac). The follow-up ranged from 6-71 months. RESULTS: ITC were found in 12 patients (5.1%) and micrometastases in 24 (10.3%). Thus, a total of 36 patients were affected by some of these conditions (15.4%). In the group with micrometastases, the result of CAL was CAL- in 19/24 (79.1%), CAL+mic in 2 (8.3%) and CAL+mac in 3 (12.5%). No axillary recurrences have occurred up to date. CONCLUSIONS: ITC and micrometastases were found in the sentinel node in a significant percentage of patients in the early stages of breast cancer. The low percentage of further axillary invasion in the group of micrometastases may open up the possibility of avoiding CAL in favor of other adjuvant treatments (chemotherapy, radiotherapy).

Pápula solitaria nasal de larga evolución / Long-Standing Solitary Nasal Papule

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[Report of a new case of small cell carcinoma of the oat-cell type in the bladder and review of the literature]. / Aportación de un nuevo caso de carcinoma de células pequeñas tipo "oat cell" de localización vesical y revisión de la literatura.

We report an additional case of small cell carcinoma of the bladder with oat cell features in a 67-year-old male patient. This tumor, recently described at this site, has clinico-pathological features that make it distinct from other bladder tumors. Histologically, it closely resembles its pulmonary counterpart with positive results for epithelial markers and neuroendocrine differentiation. The latter has been confirmed by the observation of the typical neurosecretory granules at ultrastructural level. It generally presents in the elderly male patients. It is extremely aggressive and responds poorly to the commonly used treatment. The histogenesis of this rare tumor of the bladder has, as yet, not been elucidated. The different hypotheses that have been put forward are discussed.

[Primary choriocarcinoma of the bladder. A case report with immunohistochemical and ultrastructural study]. / Coriocarcinoma primario de vejiga urinaria. Aportación de un caso con estudio inmunohistoquímico y ultraestructural.

Some tumors frequently encountered in other organs and usually with a high grade of malignancy and a poor prognosis have been recently described in the urinary bladder, very often in close relationship with a pre-existing transitional cell carcinoma. Of these, primary choriocarcinoma of the urinary bladder is one of the most uncommon and its histogenesis much discussed. It is important to identify this tumor type, since a change in the oncologic treatment may be warranted. We report an additional case of this rare bladder tumor with clinicopathologic study and discuss the histogenetic and therapeutic aspects.

[Adrenal pseudocysts. Therapeutic attitude]. / Pseudoquistes suprarrenales. Actitud terapéutica.

OBJECTIVE: Cystic tumors of the adrenal gland are uncommon, but are being increasingly more frequently diagnosed during routine radiological evaluation as "incidentalomas". We discuss the differential diagnosis, therapeutic approach and the existing controversies concerning the management of this tumor type. METHODS: Two additional cases of adrenal pseudocyst in two women aged 47 and 38 years are presented. In one case the tumor was discovered incidentally, whereas the other case presented with acute pain arising from intracystic hemorrhage. RESULTS: The fist patient had a cystic tumor of 8 cm with some inner walls. Fine needle aspiration biopsy revealed a benign cystic lesion of the right adrenal gland. At laparotomy, an 8.5 x 4.5 cm multiloculated cystic lesion was excised. The second patient presented with abdominal pain due to intracystic hemorrhage. A Doppler US did not disclose any vessel inside the lesion. We performed a lumbotomy and excised a 7.5 x 6 cm cystic tumor located in the right adrenal gland. Both lesions were diagnosed as adrenal pseudocyst; the second case was a hemorrhagic one. CONCLUSIONS: The therapeutic approach in adrenal cystic tumors can be based upon the radiological and cytological findings since malignant cystic tumors are uncommon. A clear liquid and a negative cytology practically discard malignant tumors. Furthermore, cystic adenocarcinomas are usually large and the cystic liquid is cloudy with abundant cellularity. Surgical treatment is justified in the symptomatic, big or complex tumors (mixed, non-homogeneous).

La linfogammagrafía prequirúrgica y el grado histológico del tumor se asocian a la detección quirúrgica del ganglio centinela / Preoperative lymphoscintigraphy and tumor histologic grade are associated with surgical detection of the sentinel lymph node

Objetivo. Estudiar qué variables implicadas en el proceso de la biopsia selectiva del ganglio centinela (BSGC) influyen en la detección intraoperatoria del ganglio centinela. Material y métodos. Estudio transversal prospectivo de 210 pacientes (edad media: 54 años) diagnosticadas de cáncer de mama a las que se les realizó BSGC. Se recogieron los datos clínicos y radiológicos, de la administración del radioisótopo, quirúrgicos, de anatomía patológica y de seguimiento, y se realizó un análisis descriptivo y asociativo mediante una regresión múltiple multivariante. Resultados. La vía de inyección del radioisótopo más utilizada fue la profunda aislada (72,7%). La mayoría de las lesiones fueron palpables (57,1%), se presentaron como nódulos (67,1%), fueron menores de 2 cm (64,8%), se localizaron en el cuadrante supero-externo (49,1%), se trataba de carcinomas ductales (85,7%), con infiltración (66,2%) y el grado de diferenciación histológica fue ii (44,8%). Con la gammagrafía prequirúrgica se detectó el ganglio centinela en el 97,6% de los casos, y en el quirófano el 95,7%. Se observó una recurrencia axilar. En el estudio asociativo, las variables «linfogammagrafía prequirúrgica» y «grado de diferenciación histológica del tumor» mostraron una asociación estadísticamente significativa con la detección del ganglio centinela en el quirófano. Conclusión. La probabilidad de no detectar el ganglio centinela durante la intervención quirúrgica es mayor en los pacientes con tumores de alto grado histológico o en las que no se ha conseguido verlo en la linfogammagrafía prequirúrgica (AI)

Objective. To study which variables involved in the process of selective sentinel node biopsy (SSNB) influence the intraoperative detection of the sentinel lymph node. Material and methods. This was a prospective cross-sectional study in 210 patients (mean age, 54 years) diagnosed with breast cancer who underwent SSNB. We recorded clinical, radiological, radioisotope administration, surgical, and histological data as well as follow-up data. We did a descriptive analysis of the data and an associative analysis using multivariable regression. Results. Deep injection alone was the most common route of radioisotope administration (72.7%). Most lesions were palpable (57.1%), presented as nodules (67.1%), measured less than 2 cm in diameter (64.8%), were located in the upper outer quadrant (49.1%), were ductal carcinomas (85.7%), were accompanied by infiltration (66.2%), and had a histologic grade of differentiation of ii (44.8%). Preoperative scintigraphy detected the sentinel node in 97.6% of cases and 95.7% were detected during the operation. One axillary relapse was observed. In the associative study, the variables «preoperative lymphoscintigraphy» and «histologic grade of differentiation of the tumor» were significantly associated with the detection of the sentinel lymph node during the operation. Conclusion. The probability of not detecting the sentinel lymph node during the surgical intervention is higher in patients with high histologic grade tumors or in patients in whom preoperative lymphoscintigraphy failed to detect the sentinel node (AU)

Edema cerebral difuso y pseudo-hemorragia subaracnoidea en un paciente con síndrome compartimental abdominal por peritonitis aguda / Diffuse cerebral edema and pseudo-subarachnoid hemorrhaging in a patient with abdominal compartment syndrome due to acute peritonitis

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Prevalencia de micrometástasis y células aisladas en el ganglio centinela en estadios iniciales del cáncer de mama / Prevalence of micrometastases and isolated tumor cells in the sentinel node at early stage breast cancer

Objetivo. Estudiar la prevalencia de células tumorales aisladas (CTA) y micrometástasis en el ganglio centinela del cáncer de mama en estadios iniciales. Material y métodos. Estudiamos 234 enfermas con cáncer de mama estadios T1 o T2, sin afectación axilar clínica ni con ecografía-PAAF. El ganglio centinela fue identificado mediante linfogammagrafía y extraído en el quirófano. Posteriormente se estudió mediante cortes seriados y tinciones inmunohistoquímicas, y catalogados como negativo (GC−), negativo con CTA (GC−CTA), positivo por micrometástasis (Mic) y positivo con macrometástasis (GC+mac). Se realizó linfadenectomía axilar completa cuando se hallaron micro o macrometástasis en el ganglio centinela, siendo catalogada en el primer caso como negativa (LAC−), positiva con micrometástasis (LAC+mic) y positivo con macrometástasis (LAC+mac) el resto. El período de seguimiento fue de entre 6 y 71 meses. Resultados. Se detectaron CTA en el ganglio centinela en 12 enfermas (5,1%), y micrometástasis en otras 24 (10,3%). Por tanto, un total de 36 pacientes se vieron afectadas por alguna de estas dos entidades (15,4%). Por su parte la LAC en el grupo con micrometástasis fue LAC− en 19/24 (79,1%), positivo LAC+mic en 2 (8,3%) y LAC+mac en 3 (12,5%). No existen recaídas axilares hasta la fecha. Conclusiones. La infiltración del ganglio centinela por CTA o micrometástasis en estadios iniciales del cáncer de mama afecta a un porcentaje significativo de enfermas. La escasa frecuencia de LAC+ en los GC+ mic invita a plantear la posibilidad de evitar la LAC en favor de otros tratamientos adyuvantes (quimioterapia, radioterapia)(AU)

Aim. To analyze the prevalence of isolated tumor cells (ITC) and micrometastases in the sentinel node of early stage breast cancer. Material and methods. A total of 234 patients diagnosed of breast cancer, stages T1 or T2, with no axillary involvement detected by palpation or ultrasound-FNA, were studied. The sentinel node (SN) was identified by lymphoscintigraphy and removed in the operating room. Serial sections and immunohistochemical staining were then performed, classifying them as negative (SN−), negative with ITC (SN-ITC), positive with micrometastases (SN+mic) and positive with macrometastases (SN+mac). A complete axillary lymphadenectomy (CAL) was carried out in those cases with micro- or macrometastases, the former being classified as negative (CAL−), positive with micrometatases (CAL+mic), and positive with macrometastases (CAL+mac). The follow-up ranged from 6-71 months. Results. ITC were found in 12 patients (5.1%) and micrometastases in 24 (10.3%). Thus, a total of 36 patients were affected by some of these conditions (15.4%). In the group with micrometastases, the result of CAL was CAL− in 19/24 (79.1%), CAL+mic in 2 (8.3%) and CAL+mac in 3 (12.5%). No axillary recurrences have occurred up to date. Conclusions. ITC and micrometastases were found in the sentinel node in a significant percentage of patients in the early stages of breast cancer. The low percentage of further axillary invasion in the group of micrometastases may open up the possibility of avoiding CAL in favor of other adjuvant treatments (chemotherapy, radiotherapy)(AU)

Micrometástasis en el ganglio centinela y macrometástasis ganglionares axilares en el cáncer de mama / Micrometastasis in the sentinel node and axillary lymph node macrometastasis in breast cancer

ObjetivoEl estudio del ganglio centinela ha permitido tener un conocimiento más preciso del grado de afectación axilar en el cáncer de mama, disminuyendo a su vez la morbilidad quirúrgica asociada a la exploración de la axila. El uso sistemático de técnicas inmunohistoquímicas y de biología molecular permite detectar la presencia de micrometástasis o de células aisladas en un porcentaje relevante de casos, como único signo de extensión linfática de la enfermedad. Actualmente, se plantea la posibilidad de evitar la linfadenectomía axilar completa en aquellas enfermas que solo presentan micrometástasis, dada la baja incidencia de afectación en el resto de los ganglios axilares.Material y métodoSe incluyeron 159 enfermas con cáncer de mama en estadio T1 o T2, en las que se identificó mediante gammagrafía y se localizó intraoperatoriamente el ganglio centinela, practicándoseles una linfadenectomía axilar completa en el caso de observarse afectación por micro o macrometástasis, con el fin de determinar el grado de extensión axilar.ResultadosUn total de 40 enfermas (25%) mostraron afectación del ganglio centinela, siendo en 17 de ellas (10,7%) invasión sólo por micrometástasis. De entre estas 17 enfermas, solo 2 (11,8%) mostraron invasión por macrometástasis en la linfadenectomía, no modificándose en el resto la estadificación alcanzada tras el estudio del ganglio centinela.ConclusiónCabe conjeturar que en el futuro pueda evitarse la disección axilar en las enfermas con afectación por micrometástasis, a la espera de los resultados que arrojen los estudios multicéntricos actualmente en marcha(AU)

AimThe study of the sentinel node has made it possible to obtain more comprehensive knowledge about the extent of axillary involvement in breast cancer. It has also decreased the surgical morbidity associated to the surgical examination of the axilla. The systematic use of immunohistochemical staining and molecular biology techniques improves the ability to detect the presence of micrometastasis or isolated tumor cells in a significant number of cases when this is the only sign of the lymph node extension of the disease. The possibility of avoiding complete axillary lymphadenectomy in those patients who are only affected by micrometastasis is proposed because of the low incidence of further involvement of the remaining lymph nodes.Material and method159 patients diagnosed of stage T1 or T2 breast cancer, in which the sentinel node had been identified by scintigraphy and intraoperative localization, were included in the study. Complete axillary lymphadenectomy was performed when micro- or macrometastases were found in the sentinel node, in order to determine the degree of axillary involvement.ResultsA total of 40 patients (25%) showed infiltration of the sentinel node. This infiltration was only by micrometastasis in 17 of them (10.7%). Of these 17 patients, only 2 (11.8%) showed macrometastasis in the lymphadenectomy. In the remaining subjects, the final staging reached after the sentinel node study was not modified.ConclusionIt is possible to speculate that, in the future, axillary dissection can be avoided in those patients diagnosed of micrometastasis in the sentinel node, pending the conclusions of the on-going multicenter studies(AU)

Dermatitis granulomatosa periorificial infantil / Childhood granulomatous periorificial dermatitis

La dermatitis granulomatosa periorificial infantil (DGPI) es un cuadro exclusivamente cutáneo, benigno y poco frecuente. Aparece en niños en edad prepuberal, y es más frecuente en la raza negra. Clínicamente, se caracteriza por la presencia de pápulas asintomáticas alrededor de la boca, los párpados y la nariz. En la biopsia se observan granulomas perifoliculares y los cultivos microbiológicos son negativos. Aunque las lesiones se resuelven de forma espontánea en unos meses, el tratamiento con antibióticos orales o tópicos puede acelerar la curación. Esta enfermedad puede considerarse una variante de la dermatitis perioral. Desde el punto de vista práctico, es importante descartar una sarcoidosis o una infección (AU)