Characterization of invisible breast cancers in digital mammography and tomosynthesis: radio-pathological correlation. / Caracterización de cánceres de mama sintomáticos invisibles en mamografía digital y tomosíntesis: correlación radiopatológica.

OBJECTIVE: To review the radio-pathologic features of symptomatic breast cancers not detected at digital mammography (DM) and digital breast tomosynthesis (DBT). MATERIAL AND METHODS: Retrospective analysis of 169 lesions from symptomatic patients with breast cancer that were studied with DM, DBT, ultrasound (US) and magnetic resonance (MR). We identified occult lesions (true false negatives) in DM and DBT. Clinical data, density, US and MR findings were analyzed as well as histopathological results. RESULTS: We identified seven occult lesions in DM and DBT. 57% (4/7) of the lesions were identified in high-density breasts (type c and d), and the rest of them in breasts of density type b. Six carcinomas were identified at US and MR (BI-RADS 4 masses); the remaining lesion was only identified at MR. The tumor size was larger than 3cm at MRI in 57% of the lesions. All tumors were ductal infiltrating carcinomas, six of them with high stromal proportion. According to molecular classification, we found only one triple-negative breast cancer, the other lesions were luminal-type. We analyzed the tumor margins of two resected carcinomas that were not treated with neoadjuvant chemotherapy, both lesions presented margins that displaced the adjacent parenchyma without infiltrating it. CONCLUSION: Occult breast carcinomas in DM and DBT accounted for 4% of lesions detected in patients with symptoms. They were mostly masses, all of them presented the diagnosis of infiltrating ductal carcinoma (with predominance of the luminal immunophenotype) and were detected in breasts of density type b, c and d.

Style polymorphism in Linum (Linaceae): a case of Mediterranean parallel evolution?

Heterostyly is a sex polymorphism that has challenged evolutionary biologists ever since Darwin. One of the lineages where heterostyly and related stylar conditions appear more frequently is Linum (Linaceae). This group is particularly suitable for testing competing hypotheses about ancestral and transitional stages on the evolutionary building up of heterostyly. We generated a phylogeny of Linum based on extensive sampling and plastid and nuclear DNA sequences, and used it to trace the evolution of character states of style polymorphism. We also revised available data on pollination, breeding systems, and polyploidy to analyse their associations. Our results supported former phylogenetic hypotheses: the paraphyly of Linum and the non-monophyly of current taxonomic sections. Heterostyly was common in the genus, but appeared concentrated in the Mediterranean Basin and the South African Cape. Ancestral character state reconstruction failed to determine a unique state as the most probable condition for style polymorphism in the genus. In contrast, approach herkogamy was resolved as ancestral state in some clades, giving support to recent hypotheses. Some traits putatively related to heterostyly, such as life history and polyploidy, did show marginal or non-significant phylogenetic correlation, respectively. Although pollinator data are limited, we suggest that beeflies are associated with specific cases of heterostyly. The consistent association between style polymorphism and heteromorphic incompatibility points to ecological factors as drivers of the multiple evolution of style polymorphism in Linum. Albeit based on limited evidence, we hypothesised that specialised pollinators and lack of mating opportunities drive evolution of style polymorphism and loss of the polymorphism, respectively.

[Transitional cell tumor in a 12-year-old patient]. / Urotelioma vesical en paciente de 12 años.

Transitional cell papillomas, which are tumors of epithelial origin, are the most common urinary tract neoplasm in adults but are extremely rare in children. In both groups the main location is the bladder, often around one of the ureteric orifices. Symptoms vary widely but the most frequent is gross hematuria. Transitional cell papillomas are histologically low-grade tumors and total excision is considered curative. However the rate of recurrence in the literature is high, and there is a potential for a more aggressive type of tumor. We report the case of a 12-year-old girl who presented with a transitional cell papilloma near the right ureteric orifice and describe the etiopathogenesis, diagnosis, treatment and outcome of this entity.

Study of the immunostimulating effect of IM-104 in mice.

The results of this study show that the product IM-104 has a marked immunostimulant effect, when administered intraperitoneally in mice, as seen by the increase in the number of haemolytic plaque-forming cells producing antibodies against sheep erythrocytes, as compared with saline-treated controls.

Concept and limits of the reflex sympathetic dystrophy.

Reflex sympathetic dystrophy (RSD) is a clinical syndrome defined in the English literature by pain, dystrophic tissue changes and local disturbance of autonomic function in a limb or part of a limb. Algodystrophy is the common name used for the condition in the French literature, in which the concept also includes the "transient regional osteoporosis" and the "regional migratory osteolysis". We want to discuss three points: 1) Are the RSD, transient regional osteoporosis and migratory osteolysis different diseases or different manifestations of a single condition? We believe that an objective differentiation is not possible between them. Our report about 28 cases of polytopic RSD shows the frequent association in the same patient of these manifestations and we believe that this represents the broad spectrum of a single disease. 2) Is the accepted classic pathophysiologic mechanism of RSD accurate? The conception of a disturbance of autonomic function is not easily linked with its association with conditions such as diabetes, hyperthyroidism, hyperlipidaemia and others. Even more difficult to explain is the association with malignancy and osteomalacia. The deposit of immunoglobulins that we have demonstrated in two cases in the palmar fascia of RSD associated with malignancy suggests a possible immunological mechanism. 3) What are the limits of RSD? The association between RSD and aseptic necrosis of the hip has been reported. Are they two different conditions or is the aseptic necrosis only a more developed form of RSD? Finally, we report the first single case of Munchausen syndrome mimicking a RSD of the hand with the same clinical, radiological and scintigraphic appearance.

[Septic arthritis caused by S. pneumoniae. Report of 2 cases with unusual location]. / Artritis séptica por S. pneumoniae. A propósito de dos casos de localización inusual.

Arthritis by S. pneumoniae, although no frequent, is a well-known disease in patients with underlying diseases and in which they complaint previous articular disease. In the present article 2 cases of location in shoulder and sacroiliac joints are described respectively in a woman with multiple myeloma and an esplenectomizaded man, associations nondescribed previously in literature. The importance of its suspicion in patients with factors of risk for sepsis by S. pneumoniae is emphasized.

Munchausen's syndrome simulating reflex sympathetic dystrophy.

A 15 year old girl who had pain, oedema of her left hand, and fever of four months' duration is described. Marked demineralisation of her hand was shown by radiography, and increased articular uptake by technetium-99m bone scan. All these changes were indistinguishable from reflex sympathetic dystrophy. After two admissions to hospital and multiple explorations we discovered that she had induced her symptoms herself and a diagnosis of Munchausen's syndrome was made. As far as we know this presentation has not been previously reported and might help to explain the physiopathology of some signs of reflex sympathetic dystrophy.

[Reactive arthritis. Prospective clinico-microbiologic study]. / Artritis reactivas. Estudio prospectivo clínico-microbiológico.

We study with a prospective design all reactive arthritis diagnosed at the Service of Rheumatology in Bellvitge Hospital during a thirty months period, from August 1985 to February 1988; in order to describe its clinical features, etiological factors and prognosis. Thirty patients who fulfilled the admission criteria were admitted to the study. A previously designed protocol of clinical, serological and microbiologic study was applied to all. A microorganism was identified in 21 patients. In 14 cases it was Yersinia enterocolitica, in 4 Chlamydia trachomatis, in 2 Salmonella enteritidis and in 1 a group A beta-hemolytic Streptococcus. The averaged length of the disease was 7.6 +/- 8 months.