Effect of Alprostadil on Colorectal Anastomoses Under Relative Ischemia.

BACKGROUND: Anastomotic leak after colorectal surgery, which remains a serious clinical problem that causes augmented morbidity and mortality, is usually favored by ischemia. The aim of this study was to determine whether alprostadil may improve anastomotic wound healing under ischemic condition. METHODS: Ninety-three adult Wistar rats were randomized into three groups: control, ischemia (by devascularization along the first 2 cm at each anastomotic end), and ischemia plus alprostadil. Resection of a colonic segment at the colorectal junction and an anastomosis was performed. Animals were euthanized at 8 d. Surgical site infection, anastomotic leak, and grade of intra-abdominal adhesions using a validated scale were determined. Bursting pressure and tension were calculated and histologic examination of the anastomosis was performed. RESULTS: The ischemic group revealed an increased anastomotic leak rate (14/31 versus 3/31) and a lower bursting pressure and tension when compared to control group, validating therefore the experimental model. After intraperitoneal injection of alprostadil, anastomotic leak rate was significantly lower (5/31) and the bursting pressure and tension were significantly increased. Histologic examination revealed a lower presence of inflammatory cells, and a significantly higher neovascularization and a higher presence of fibroblasts in treated animals when compared with the ischemic group. CONCLUSIONS: Alprostadil may have a positive effect on colonic anastomotic wound healing under relative ischemic condition. Alprostadil administration increases anastomotic bursting pressure, decreases leak rate, and reverses most of the histological changes caused by blood flow decrease. These protective effects could be caused by vasodilation, stimulation of neovascularization, and immunomodulatory properties.

Giant Plantar Epidermoid Cyst with Invasion of the Interosseous Muscles.

Epidermoid cysts of the sole of the foot are rare lesions that must be differentiated from other, more common subcutaneous pathologic abnormalities located on the sole. Cases of epidermoid cysts that extend to the interosseous musculature are rarer still. We report the case of a giant epidermal cyst in a 64-year-old individual that extended to the intrinsic musculature of the third space of the right foot and that was diagnosed after fine-needle aspiration biopsy and subsequent cytologic study. Differential diagnosis of these lesions should be made with the support of additional imaging tests, and diagnostic confirmation should always be obtained after surgical removal and subsequent histopathologic study.

Dermatofibroadenoma apocrino hemosiderótico/quiste glandular apocrino con estroma similar al dermatofibroma hemosiderótico / Apocrine hemosiderotic dermatofibroadenoma/apocrine glandular cyst with hemosiderotic dermatofibroma-like stroma

Presentamos un nuevo caso de una infrecuente lesión cutánea caracterizada por un quiste glandular apocrino rodeado por un estroma similar al dermatofibroma hemosiderótico. Revisamos la literatura, en particular con respecto a las características morfológicas, patogénicas y terminológicas de esta curiosa lesión (AU)

A new case of an unusual cutaneous lesion characterized by an apocrine gland cyst surrounded by a hemosiderotic dermatofibroma-like proliferating stroma is reported. We review the literature, especially with regard to the morphology, pathogenesis and terminology of this curious lesion (AU)

Effect of pentoxifylline on the healing of ischemic colorectal anastomoses.

PURPOSE: The aim of this study was to evaluate the effect of pentoxifylline on the healing of experimental ischemic colorectal anastomoses. METHODS: Ninety-three Wistar rats were randomized into three groups (n = 31) and underwent resection of a colonic segment at the colorectal junction. Group A rats received standard end-to-end anastomoses. Ischemic anastomoses were performed in Groups B and C rats by coagulating mesocolon vessels 2 cm along each anastomotic end. Group C rats were treated with intraperitoneal injection of pentoxifylline. Wound complications, intra-abdominal abscesses, intraperitoneal adhesions, and anastomotic leaks and stenosis were recorded. Bursting pressure and tension were calculated. Histologic examination of the anastomosis was also performed. RESULTS: Ischemia increased wound and intra-abdominal infections, adhesion formation, and anastomotic stenosis. Anastomotic leakage was significantly higher in Group B (45.2 percent) than in Group A (9.7 percent). Bursting pressure and tension were significantly lower in Group B (118.19 mmHg and 48.43 N/m) than in Group A (191.84 mmHg and 86.82 N/m). There was evidence for decreased perianastomotic fibrosis and neutrophils presence after induced ischemia and a strong tendency to reduced neovascularization. Pentoxifylline administration ameliorated the effects of ischemia, reducing wound and intra-abdominal infections, adhesion formation, and leaks (16.1 percent). Anastomotic strength increased (bursting pressure and tension of 205.55 mmHg and 87.68 N/m, respectively). Treated Group C had significantly higher neutrophils infiltration and fibrosis formation and a strong tendency to increased neovascularization compared with Group B. CONCLUSIONS: Selective anastomotic devascularization induces ischemia and impairs experimental anastomotic healing, increasing leakage rate. These effects may be ameliorated by pentoxifylline administration.

Dermatofibroma epitelioide esclerótico. Una variante histológica singular / Sclerotic epithelioid dermatofibroma. An unusual histological variant

El dermatofibroma es una frecuente lesión cutánea con muchos subtipos sobre la base de la gran variedad de patrones histológicos. La presencia de patrones inusuales y/o la coexistencia de 2 o más patrones en una misma lesión causan dificultades diagnósticas. La variante epitelioide es un infrecuente y poco reconocido subtipo de dermatofibroma y debería ser diferenciado de otros tumores benignos y malignos cutáneos con patrón epitelioide. Nosotros presentamos un nuevo caso de dermatofibroma que combina características epitelioides y esclerosantes, y revisamos la literatura, en particular con respecto a acontecimientos morfológicos y de diagnóstico diferencial (AU)

Dermatofibroma is a common skin lesion with many subtypes based on the great variety of architectural patterns. The presence of unusual patterns and/or coexistence of two or more patterns in the same lesion can cause diagnostic difficulties. The epithelioid variant is an uncommon and poorly recognized subtype of dermatofibroma and should be differentiated from other benign and malignant skin tumours with an epithelioid pattern. We present a case of dermatofibroma with both epithelioid and sclerosing features and review the literature paying particular attention to morphology and differential diagnosis (AU)

Linfoma B difuso de células grandes primario testicular. Presentación de 3 casos y revisión de la literatura / Primary diffuse testicular large B-cell lymphoma. A report of 3 cases and a review of the literature

Los linfomas testiculares primarios representan aproximadamente el 5% de todas las neoplasias testiculares malignas, el 1% de los linfomas no Hodgkin y el 4% de los linfomas no Hodgkin extranodales. Se trata por tanto de neoplasias infrecuentes aunque muy agresivas en la mayoría de los casos ya que entre el 80% y el 90% de los linfomas testiculares pertenecen al subtipo no Hodgkin B difuso de células grandes. Esta neoplasia constituye el tumor maligno testicular más frecuente en ancianos. La presentación clínica típica es una masa testicular unilateral acompañada a veces de hidrocele y dolor agudo escrotal. A pesar de que existe buena tasa de respuestas a la quimioterapia, sobre todo en estadios tempranos, el porcentaje de recaídas es alto y el pronóstico muy pobre. Presentamos aquí 3 casos y estudiamos la histología y la inmunohistoquímica, y revisamos la literatura en este sentido repasando las nuevas perspectivas terapéuticas (AU)

Primary testicular lymphoma accounts for approximately 5% of malignant tumours of the testis, 1% of all non-Hodgkin lymphomas and 4% of extra-nodal non-Hodgkin's lymphoma. 80-90% of testicular lymphomas belong to the diffuse large B-cell lymphoma group which is clinically very aggressive. Although infrequent, it is the most common malignant testicular tumour in the elderly. The typical presentation is a unilateral testicular mass sometimes accompanied by acute scrotal pain or a hydrocele. Although the initial response to chemotherapy may be favorable, relapses are frequent and the overall prognosis of this neoplasm is very poor. We present three cases with histopathological and immunohistochemical studies, a review the literature and new therapeutic perspectives (AU)

Lesión lipomatosa fibrohistiocítica hemosiderótica (tumor fibrolipomatoso hemosiderótico). Presentación de un caso y revisión de la literatura / Hemosiderotic fibrohistiocytic lipomatous lesion (hemosiderotic fibrolipomatous tumor). A case report and a review of the literature

La lesión lipomatosa fibrohistiocítica hemosiderótica, también llamada tumor fibrolipomatoso hemosiderótico, es una rara y recientemente descrita entidad fibrolipomatosa. Inicialmente considerada como el resultado de un proceso inflamatorio reactivo secundario a trauma o enfermedad vascular, evidencias más recientes sugieren que pueda ser de origen neoplásico. Presentamos el caso de una mujer de 57 años y revisamos la literatura, particularmente con respecto a acontecimientos genéticos, morfológicos, inmunohistoquímicos y de diagnóstico diferencial, con especial atención a su relación con el tumor angiectásico hialinizante pleomorfo precoz y el sarcoma fibroblástico mixoinflamatorio (AU)

A hemosiderotic fibrohistiocytic lipomatous lesion, also called hemosiderotic fibrolipomatous tumour, is a newly described, rare fibrolipomatous entity. Initially considered to be the result of a reactive inflammatory process subsequent to trauma or vascular disease, recent evidence suggests that it may have a neoplastic origin. We report a case occurring in a 57-year-old woman and review recent reports on current genetic developments, morphology, immunohistochemistry and differential diagnosis, paying special attention to its relation with early pleomorphic hyalinizing angiectatic tumour and myxoinflammatory fibroblastic sarcoma (AU)

Histiocitoma fibroso angiomatoide Presentación de un caso y revisión de la literatura / Angiomatoid fibrous histiocytoma. A case report and a review of the literature

El histiocitoma fibroso angiomatoide es una neoplasia mesenquimal de malignidad intermedia e histogénesis incierta que se da frecuentemente en las extremidades de niños o adultos jóvenes. Su morfología es peculiar, y está constituida como una lesión circunscrita de células fusiformes, infiltrado linfoplasmocitario periférico, cavidades quísticas rellenas de sangre y frecuente expresión de desmina. Nosotros presentamos un nuevo caso y revisamos la literatura, en particular con respecto a acontecimientos genéticos, de diferenciación, morfológicos, inmunohistoquímicos y de diagnóstico diferencial (AU)

Angiomatoid fibrous histiocytoma is a mesenchymal neoplasm of intermediate grade malignancy which is most commonly found in the extremities of children and young adults. Its histogenesis is uncertain and its morphology is unusual as it is a circumscribed lesion with spindle cells, peripheral lymphoplasmacytic infiltrate, blood-filled cystic cavities and frequent desmin expression. We report a new case and review the literature, paying special attention to genetic developments, differentiation, morphology, immunohistochemistry and differential diagnosis (AU)

Tumor de Sertoli-Leydig como hallazgo casual en quistectomía por endometriosis / Sertoli-Leydig tumour as a casual finding during laparoscopy for endometriosis

Los tumores de ovario se diagnostican en su mayoría mediante hallazgos casuales en pruebas diagnósticas realizadas por otro motivo. La endometriosis sintomática es un motivo de consulta frecuente en mujeres jóvenes. Los tumores de Sertoli-Leydig son tumores de origen embrionario muy poco habituales. En este caso, el diagnóstico del tumor embrionario se produce en una intervención quirúrgica por endometriosis y como hallazgo de una biopsia del ovario contralateral en una mujer con deseo reproductivo y sin sospecha previa (AU)

Ovarian tumours are mostly casual findings in imaging tests performed for another reason. Symptomatic endometriosis is a common reason in young women attending clinics. Sertoli-Leydig tumours have an embryological origin and are very rare. In this case the diagnosis was made during surgery for an endometriosis and as a finding in the contralateral ovarian biopsy (AU)

Tumor de la granulosacoexistente con cistoadenomamucinoso en el ovariocontralateral / Concurrent granulosa tumor and mucinous cystoadenoma in the contralateral ovary

Presentamos el caso de una mujer de 57 años concistoadenoma mucinoso en un ovario y tumor dela granulosa como hallazgo casual en el anejocontralateral. Clínicamente, la paciente, que referíauna amenorrea primaria, debutó con metrorragia ytumoración abdominal.Los tumores de la granulosa del adulto, quepertenecen a las neoplasias del estroma gonadaldel ovario, son más frecuentes en mujeresposmenopáusicas. En la clínica suelen debutar consíntomas secundarios a la secreción estrogénica,aunque la proporción de tumores de la granulosasecretores de hormonas es difícil de establecer (AU)

We present the case of a 57-year-old womanwith mucinous cystoadenoma in one ovary andgranulosa tumor as an incidental finding in theother. The patient reported primary amenorrhea,and clinical presentation consisted of metrorrhagiaand an abdominal mass.Adult granulosa tumors, which belong to thegroup of gonadal stroma neoplasms of the ovary,are more common in postmenopausal women.Clinically, these tumors usually manifest withsymptoms secondary to estrogen secretion, althoughthe proportion of tumors of this kind that secretehormones is difficult to establish (AU)

Coexistencia de teratoma y adenocarcinoma de células claras en un mismo ovario / Coexistence of teratoma and clear cell adenocarcinoma in the same ovary

La coexistencia de un teratoma quístico maduro con un adenocarcinoma de células claras en el mismo ovario es rara. No hemos encontrado ninguna referencia sobre esta asociación en la literatura médica.Presentamos el caso de una paciente de 56 años, asintomática, intervenida de masa anexial compleja con elevación de los marcadores tumorales ováricos, en estadio quirúrgico IIc. El resultado anatomopatológico fue teratoma quístico maduro asociado a carcinoma de células claras en el mismo ovario.Los teratomas pueden malignizar (1-2%), pero generalmente a carcinoma epidermoide. No está descrita la transformación a carcinoma de células claras. Existen referencias de degeneración en este sentido de lesiones histológicamente benignas, como la endometriosis. La rareza del caso nos hace plantearnos si se trata de una simple coincidencia o de una malignización del teratoma

The coexistence of mature cystic teratoma and clear cell adenocarcinoma in the same ovary is extremely infrequent. We found no reports of this association in the literature.We report the case of a 56-year-old asymptomatic patient who underwent surgery for a complex annexal mass with elevated ovarian tumoral markers. Surgical stage was IIc. Pathological diagnosis was mature cystic teratoma associated with clear cell carcinoma in the same ovary.Teratomas can become malignant (1-2%) but transformation is usually to epidermoid carcinoma. Transformation to clear cell carcinoma has not previously been described. There have been reports of this type of degeneration inhistologically benign lesions such as endometriosis. The rarity of this case prompted us to question whether the association was coincidental or was due to malignanttransformation of the teratoma