Prognostic factors in follicular carcinoma of the thyroid.

Although there are numerous publications on the nomenclature, morphological diagnostic criteria, and prognostic factors of follicular carcinoma of the thyroid, these issues remain controversial. We present the findings of a retrospective and comparative study of 82 patients who underwent thyroid surgery for thyroid neoplasms. Of these patients, 58 had follicular carcinoma, 12 had atypical adenoma, and the remaining 12 patients had adenoma with partial capsular invasion in the surgical specimen. The goal of the study was to determine diagnostic criteria and prognostic factors in follicular carcinoma. Our results showed that encapsulated thyroid follicular neoplasms should be considered malignant when they demonstrate total capsular invasion and/or vascular invasion. Statistical analysis of the cases of follicular carcinoma showed that higher morbidity rates were seen in the patients with metastasis at the time of diagnosis, with extensively invasive tumors, with age older than 35 years, and with tumors with simultaneous vascular and capsular invasion. The accumulated survival rate over 5 years based on mortality was 91%, and based on morbidity it was 71% (84% for patients with encapsulated tumors and 56% for patients with extensively invasive tumors). In the univariate survival study based on morbidity, we found a relationship with the following parameters: metastasis at the time of diagnosis, grade of local invasion, presence of capsular and vascular invasion, cellular atypia, histologic pattern (insular vs others), presence of thyroid nodule, and age of the patient at the time of diagnosis. In the multivariate survival study based on morbidity, the factors that showed prognostic value were metastasis at the time of diagnosis, grade of local invasion, and age of the patient at the time of diagnosis.

Thyroid carcinoma originating in a teratoma of the ovary.

The malignant degeneration of a cystic teratoma of the ovary is a rare complication which different authors place at between 0.8 to 4%. Adenocarcinomas represent a relatively rare complication, 8% of secondary cancers, those of thyroid origin being reported in only 5 cases. The aim of this paper is to present the sixth such case of thyroid carcinoma developed in a mature teratoma in the ovary.

[An intimal sarcoma of the pulmonary artery. An immunohistochemical study]. / Sarcoma intimal de la arteria pulmonar. Estudio inmunohistoquímico.

Pulmonary artery intimal sarcomas tend to be presented with symptoms of pulmonary thromboembolism and grow regionally, with little capacity to metastasize. They probably originate from subendothelial cells, that become myofibroblasts. Knowledge of it is important to establish a presurgery diagnosis, with the possibility of a total resection, the only useful treatment until now. We report a case of a pulmonary artery primary sarcoma, in a 73 year old woman, admitted with hemoptysis and pleuritic chest pain, who died ten days after. Autopsy revealed an intraluminal mass at the pulmonary artery trunk, without regional nor distance involvement. Microscopic study showed a pleomorphic tumor with spindle and epithelioid cells, positive for actin, desmin and vimentin. All these data support the diagnosis of primary intimal sarcoma of the pulmonary artery. We want to emphasize the myogenic differentiation of the tumor, uncommon in previously reported cases.

[Anatomopathologic and morphometric study of hepatocarcinoma]. / Estudio anatomopatológico y morfométrico del hepatocarcinoma.

UNLABELLED: Because of its great incidence and poor prognosis the hepatocarcinoma (HPC) has become a first line clinical challenge. This is the reason we have performed a descriptive anatomo-pathological analysis of our own cases and a study of the possible prognostic value of nuclear parameters. DESIGN: We have performed a retrospective study of 83 cases. We reviewed the clinical records and histologic preparations. METHODS: We analysed the following parameters: 1) Tumour site; 2) Association to cirrhosis; 3) Microscopic features (cellular type differentiation grade, peritumoral lymphocytic infiltration, architecture, mitotic index); 4) Metastatic frequency and location; 5) Morphometric nuclear parameters (area, perimeter, major diameter, major and minor axis, circle diameter, sphere volume, ellipse volume, shape factor. RESULTS: We highlight the following: 1) 50% of HPC associated to liver cirrhosis; 2) Ascites was more frequent in the tumours located in the right lobe or both lobes than in tumours affecting the left lobe (p < 0.005); 3) Macroscopically, the commonest type was the nodular one (47.8%); 4) Microscopically, the commonest findings were as follows: cellular type (93%); differentiation grade type II (61.4%); trabecular architecture (64.9%); lymphocytic infiltration grade I (57.9%); 5) Mean mitotic index was 16.3 m./high power field. 6) There were distant metastases in 81.1% and portal vein invasion in 44.6%. 7) The nuclear morphometric study did not support any influence on patients' survival. CONCLUSIONS: 1) This descriptive analysis allows a morphological data base that is very useful for subsequent morphological or prognostic studies. 2) Our data do not support any influence of nuclear parameters on patients' survival, although we cannot exclude some relation in a greater series.

[Ulcerative colitis and amyloidosis. Presentation of a case and review of the literature]. / Colitis ulcerosa y amiloidosis. Presentación de un caso y revisión de la literatura.

A case of ulcerative colitis associated with secondary amyloidosis in a 62-year-old man who died from septic shock and pneumonia complicating head injury is reported. Amyloid deposition was incidentally found at autopsy. Proteinuria and hepatomegaly discovered a few days before his death were the only signs of amyloidosis. The postmortem examination showed chronic ulcerative colitis (remitting form) with pseudo-polyps and amyloid deposition in the liver, spleen, pancreas, rectum, adrenals and kidneys. Although secondary amyloidosis complicating with Crohn's disease has been frequently reported, amyloidosis associated with ulcerative colitis has been exceptionally described and only 10 cases have been collected from the literature.

[Cytological diagnosis of malignant melanoma of the esophagus]. / Diagnóstico citológico de melanoma maligno de esófago.

Malignant melanoma of the esophagus is an extremely rare neoplasm. We presented a case of this neoplasm diagnosed on a cytologic smear from a 84 year-old women. The smear was characterized by scattered dissociated cells with hyperchromatic irregular nuclei, prominent nucleoli and occasional cytoplasmic brown pigment. The immunohistochemical study revealed positivity for HMB-45 and S-100 protein.

Adenomatoid odontogenic tumor arising in a dental cyst: report of unusual case.

The case of an adenomatoid odontogenic tumor developing over a dentigerous cyst is reported. A 12-year-old boy was referred by his pediatric dentist to the service of Oral and Maxillofacial Surgery of the Asturias Central Hospital (Spain) for evaluation of a radiolucent image compatible with a dentigerous cyst. Microscopic examination revealed the presence of an adenomatoid odontogenic tumor located over the linear epithelium of a dentigerous cyst. Based on the literature, the clinico-pathological, diagnostic, radiological and therapeutic characteristics of the case are commented in detail.

[Extramedullary anaplastic plasmacytoma]. / Plasmocitoma anaplásico extramedular.

A case of extramedullary plasmacytoma of the maxillary sinus, locally aggressive, in a 65 years old man is presented. Clinical diagnosis of adenocarcinoma was suspected but the pathological study showed an anaplastic morphology, with little plasmacytic differentiation and lack of stain with cytokeratins and epithelial membrane antigen (EMA), immunohistochemical marker of plasmatic cells, among others. Definitive diagnosis was based on light chain restriction and lack of multiple myeloma.

[Miliary tuberculosis. Autopsy study of 29 cases]. / Tuberculosis miliar. Estudio autópsico de 29 casos.

A retrospective anatomoclinic study of 29 cases of miliary tuberculosis, selected from 2.808 necropsies carried out at Hospital Central de Asturias between 1971 and 1994, is described. Fifty eight per cent of the patients were older than 50 years. Predisposing factors were identified in 80%: diabetes, alcoholism, chronic hepatopaty, silicosis, chronic renal failure, immunessupresive treatment and malignant neoplasms. A premorten correct clinical diagnosis were done in 8 cases (27.5%) and were suspected in 4 (13.7%). Typical miliary radiologic pattern was established in 17%. The more frequently affected organs were lungs (100%), liver (82%), spleen (75%), lymphatic nodes (55%) and bone marrow (41%). Early diagnosis and treatment is nowadays more difficult because of increasing of cryptic tuberculosis, involvement of resistant organs (pancreas), new predisposing factors (chronic renal failure), new risk groups (AIDS) and lack of demonstrative clinical and radiologic findings, so is necessary to maintain suspect of this disease always in mind.

[Intestinal tuberculosis, a difficult suspected diagnosis]. / Tuberculosis intestinal, un difícil diagnóstico de presunción.

Intestinal tuberculosis (ITB) is an always difficult clinical diagnosis; we must keep in mind it in the diagnosis of patients with abdominal pain, even without concomitant lung involvement. Seven patients with ITB were revised. Five patients were male and two female, with a mean age of 45 years; all of them presented abdominal pain. Ileocecal region was involved in 71.4% of the cases. Only one patient showed old specific pulmonary lesions radiologically. Neoplasia was the most frequent clinical presumption. ITB diagnosis was made only in one case, as first possibility. Histopathological examination revealed caseous granulomas in all the cases, with acid-alcohol resistant bacilli in 71.4% of them. We want to underline the need of thinking about ITB, in the clinical evaluation of in specific abdominal pain, above all in immunosuppressed patients, and to emphasize the importance of histopathologic findings in the final diagnosis of this entity.

[Expression of annexins Al and A2 in the mucosa of the upper airdigestive tract]. / Expresión de las anexinas Al y A2 en la mucosa del tracto aerodigestivo superior.

INTRODUCTION: Annexins A1 and A2 have been related with the maintenance of tissue integrity. They have been identified in a wide variety of tissues, but little is known regarding their expression in upper the aerodigestive tract. The aim of this work is to describe the expression of these proteins in the mucosa of the upper aerodigestive tract. MATERIAL AND METHODS: Tissue samples from respiratory (nasal and laryngeal) and digestive (oral and pharyngeal) mucosa from non-oncological patients were studied. Annexin A1 and A2 expression was determined by immunohistochemistry. RESULTS: Both annexins were expressed in the ciliated and in the stratified non-keratinized epithelia, but with a different pattern; ANXA1 was expressed in the more differentiated cells whereas ANXA2 was expressed in the less differentiated ones (with the exception of the cilia of ciliated cells). CONCLUSION: Although annexins A1 and A2 are structurally and philogenetically related its expression pattern in the upper aerodigestive tract suggests that they have different functions.

Hürthle cell and mitochondrion-rich cell tumors. A clinicopathologic study.

Hürthle cells are large eosinophilic thyroid cells that contain a large number of mitochondria with a high content of oxidative enzymes. In the last 10 years several reports have emphasized the disagreement over the morphologic features, biologic behavior and treatment of Hürthle cell tumors. The authors reviewed the clinical and pathologic features of 28 patients with Hürthle cell and mitochondrion-rich cell tumors (16 adenomas, 10 follicular carcinomas, and 2 papillary carcinomas) and present electron microscopic, immunohistochemical, and morphometric data. The results suggest that there is a correlation between biologic behavior and pathologic findings, that tumor size should not be considered a special conditioning factor in order to assign a biologic behavior, that nuclear size and anisokaryosis are not an absolute criteria for diagnosing malignancy, and finally, that electron microscopic examination is not useful in separating benign from malignant Hürthle cell tumors.

Chondroid syringoma: a histological and immunohistochemical study of 15 cases.

Fifteen cases of chondroid syringoma have been studied histologically and by immunohistochemical methods in an attempt to establish their phenotypic profile and to elucidate their histogenesis. The epithelial elements were classified as tubuloglandular, solid nests and stromal cells. The inner cell layers of tubuloglandular components had distinct epithelial features, expressing cytokeratin, carcino-embryonic antigen and epithelial membrane antigen. The outer cell layers expressed vimentin, S-100 protein, neuron-specific enolase and muscle-specific actin and were negative for epithelial markers. The immunophenotypes of stromal cells and solid nests were similar to those of the outer cell layers. These data suggest that the stromal components may derive from the outer cell of tubuloglandular elements and that myo-epithelial cells have an important role in the histogenesis of these lesions and in their mesenchymal matrix production.

[Alveolar rhabdomyosarcoma with massive infiltration of the bone marrow as its initial manifestation]. / Rabdomiosarcoma alveolar con infiltración masiva de medula ósea como manifestación inicial.

We report a case of alveolar rhabdomyosarcoma (AR) with massive infiltration of bone marrow at presentation, and initial diagnosis in bone marrow aspirate. A 35 year old man presented with a submandibular mass, and hematomas after mild traumatisms. Peripheral blood showed thrombocytopenia and a normocytic anaemia. Bone marrow film showed diffuse involvement by undifferentiated blasts with rhabdomyoblastic features. Subsequent biopsy of submandibular lymph node confirmed the diagnosis with positivity for specific muscle actin and desmin, and negativity for lymphoid markers. Initial presentation of AR with extensive bone marrow involvement is extremely rare, and it could lead to wrong diagnosis and treatment of acute leukaemia, with the serious consequences that this would have. Immunohistochemical study and morphologic differential features can be of great diagnostic help.

[Primary round-cell liposarcoma of the bladder]. / Liposarcoma de células redondas primario de vejiga urinaria.

OBJECTIVE: To report a rare case of primary round cell liposarcoma of the urinary bladder. METHODS: A case of primary round cell liposarcoma of the urinary bladder in an 80-year-old female with hematuria is presented. The patient had a large, solid, non-circumscribed bladder tumor of 6.5 cms. The radiological, histological and immunohistochemical findings are discussed. RESULTS: The neoplasm was composed of isolated lipoblasts among numerous small round cells that were positive for S-100 and vimentin, and a high proliferation rate was demonstrated by Ki-67. The patient died 10 months after the histologic diagnosis. CONCLUSION: Primary liposarcoma of the urinary bladder is a very rare tumor with a poor prognosis that usually presents as a large tumor mass.