COVID-19 Outcomes in Patients with Hematologic Malignancies in the Era of COVID-19 Vaccination and the Omicron Variant.

A greater understanding of clinical trends in COVID-19 outcomes among patients with hematologic malignancies (HM) over the course of the pandemic, particularly the Omicron era, is needed. This ongoing, observational, and registry-based study with prospective data collection evaluated COVID-19 clinical severity and mortality in 1818 adult HM patients diagnosed with COVID-19 between 27 February 2020 and 1 October 2022, at 31 centers in the Madrid region of Spain. Of these, 1281 (70.5%) and 537 (29.5%) were reported in the pre-Omicron and Omicron periods, respectively. Overall, patients aged ≥70 years (odds ratio 2.16, 95% CI 1.64-2.87), with >1 comorbidity (2.44, 1.85-3.21), or with an underlying HM of chronic lymphocytic leukemia (1.64, 1.19-2.27), had greater odds of severe/critical COVID-19; odds were lower during the Omicron BA.1/BA.2 (0.28, 0.2-0.37) or BA.4/BA.5 (0.13, 0.08-0.19) periods and among patients vaccinated with one or two (0.51, 0.34-0.75) or three or four (0.22, 0.16-0.29) doses. The hospitalization rate (75.3% [963/1279], 35.7% [191/535]), rate of intensive care admission (30.0% [289/963], 14.7% [28/191]), and mortality rate overall (31.9% [409/1281], 9.9% [53/536]) and in hospitalized patients (41.3% [398/963], 22.0% [42/191]) decreased from the pre-Omicron to Omicron period. Age ≥70 years was the only factor associated with higher mortality risk in both the pre-Omicron (hazard ratio 2.57, 95% CI 2.03-3.25) and Omicron (3.19, 95% CI 1.59-6.42) periods. Receipt of prior stem cell transplantation, COVID-19 vaccination(s), and treatment with nirmatrelvir/ritonavir or remdesivir were associated with greater survival rates. In conclusion, COVID-19 mortality in HM patients has decreased considerably in the Omicron period; however, mortality in hospitalized HM patients remains high. Specific studies should be undertaken to test new treatments and preventive interventions in HM patients.

Giant Cell Tumor of the Triquetrum: Clinical Case and Literature Review.

Giant cell tumor (GCT) is a benign, locally aggressive neoplasm with little incidence at the carpal bone level. We present a case of pyramidal bone GCT that required open biopsy for diagnosis. As a definitive treatment, en bloc resection of the pyramidal bone and luno-capitate arthrodesis were performed to avoid frequent relapses of these neoplasms and ensure proper functionality of the anatomical segment.

[Living-donor renal transplant. State of the art.] / Trasplante renal de donante vivo. Estado actual.

Living donor kidney transplantation is the best therapeutic option in a patient with end-stage renal failure, because it provides excellent functionality and graft survival. Laparoscopic living donor nephrectomyis the gold-standard for obtaining the graft. In exper thands, different minimally invasive surgeries can be offered with the main advantage of improving the a esthetic results. Although there may be controversy regarding laparoscopic devices for vascular ligation during living donor nephrectomy, both endostaplers and locking clips have proven to be safe as long as the proper techniqueis performed. Living donor nephrectomy has minimal morbidity and mortality. Age and glomerular filtration rate of the donor candidate are prognostic factor of long-term renal failure. In relation to the implant surgery,robotic kidney transplantation is now probably at the beginning of its development. Published series still do not allow to clearly establish its role compared to conventional open surgery.

El trasplante renal de donante vivo suponela mejor opción terapéutica en un paciente con insuficiencia renal terminal, por su excelente funcionalidad y supervivencia del injerto. La nefrectomía laparoscópica de donante vivo es la técnica de elección para la obtención del injerto. En manos expertas, distintas variantes mínimamente invasivas pueden ofrecerse con la principal ventaja de mejorar los resultados estéticos del donante. Aunque pueda existir controversia en relación a los dispositivos laparoscópicos para la ligadura vascular durante la nefrectomía de donante vivo, tanto las endograpadoras como los clips con cierre tipo Hem-olokhan demostrado ser seguros siempre que se respete la técnica adecuada en su empleo. La nefrectomía de donante vivo no está exenta de una mínima morbi-mortalidad.La edad y el filtrado glomerular del candidato a donante son orientativas del riesgo de enfermedad renal a largo plazo. En relación a la cirugía del implante, el trasplante renal robótico se encuentra en los albores de su desarrollo. Las series publicadas no permiten aún establecer claramente su papel frente a la cirugía abierta convencional.

Managing the front-line treatment for diffuse large B cell lymphoma and high-grade B cell lymphoma during the COVID-19 outbreak.

The COVID-19 pandemic has dramatically challenged care for cancer patients, especially those with active treatment who represent a vulnerable population for SARS-CoV-2 infection. Aggressive lymphoid neoplasms, such as diffuse large B cell lymphoma and high-grade B cell lymphoma, need to be treated without delay in order to get the best disease outcome. Because of that, our clinical practice was changed to minimise the risk of SARS-CoV-2 infection while continuing haematological treatment. In this report, we analyse the management of front-line therapy in 18 patients during the COVID-19 outbreak, as well as the results of the implemented measures in their outcome.

IgA Nephropathy After Renal Transplant: Recurrences and De Novo Cases.

IgA nephropathy (IgAN) recurrence in the renal graft is variable. Several factors can influence the risk of recurrence of IgAN and renal graft failure. We carried out a retrospective observational study between the years 1990 and 2018. The study group was patients diagnosed, by means of biopsy, as having post-renal transplant (RT) IgAN in our hospital in the study period. The control group was patients with pre-RT histologic diagnosis of IgAN who did not develop recurrence of the disease after the RT. A total of 1535 RTs were performed in our center in the study period. Of those, 24 patients developed IgAN in the renal graft. The time elapsed from the RT to the development of allograft IgAN was 7 (SD, 5.3) years. The patients with allograft IgAN tended to be younger (P = .069), and HLA-DR4 was more common in these patients (P = .078). We observed a very significant difference in the use of induction immunosuppressive therapy (study group vs control group: 13.6% vs 57.7%, P < .001). The 3 patients who presented crescents in the biopsy specimen lost the renal graft. As in the native kidney, the presence of crescents is an indicator of poor prognosis. In our experience, the patients with post-RT IgAN received induction therapy less frequently; this finding would support the conclusion that such treatments should be applied to patients with pre-RT diagnosis of IgAN.

[Actualities in endometrial carcinoma]. / Actualité sur les cancers de l'endomètre.

Endometrial carcinoma is one of the most frequent women cancer. Its incidence is increasing due to the aging of the population and changes in life. Fortunately, these cancers are usually detected at an early stage due to post-menopausal bleeding. The prognostic factors are quite well determined : loco-regional and distant tumoral extension according to the FIGO classification, grade and histological type and the presence of lympho-vascular space invasions. These cancers, however, are usually of good prognosis because of an early diagnosis, and their treatment is based on surgery, preferably minimally invasive approach, whose extension is adapted to the prognostic factors from the pre-therapeutic assessment. The definitive histological examination will condition the adjuvant treatments.

Les cancers de l'endomètre représentent l'un des cancers les plus fréquents de la femme, et leur incidence est en augmentation du fait du vieillissement de la population et des modifications de vie. Heureusement, ces cancers sont habituellement détectés à un stade précoce du fait de métrorragies postménopausiques. Les facteurs pronostiques sont assez bien déterminés : extension tumorale loco-régionale et à distance selon la classification FIGO, grade et type histologique et présence d'invasions lymphovasculaires. Ces cancers sont cependant de bon pronostic du fait habituellement d'un diagnostic à un stade précoce et leur traitement repose sur une chirurgie de préférence mini-invasive dont l'extension est adaptée aux facteurs pronostiques issus du bilan préthérapeutique. L'examen histologique définitif conditionnera les traitements adjuvants.

Prenatal Diagnosis of an Aortopulmonary Window With an Interrupted Aortic Arch.

A prenatal aortopulmonary window with an interrupted aortic arch was detected in a 22-week-old fetus. The 3-vessel and trachea view showed a communication between the ascending aorta and the pulmonary artery. Early postnatal surgery was successful. A PubMed-based search identified all cases of prenatal aortopulmonary windows between 2002 and 2015. Nine articles were identified. The average gestational age at diagnosis was 28 weeks (range, 22-33 weeks). The most frequent aortopulmonary window was type I (40%). All cases were associated with congenital heart defects, mainly an interrupted aortic arch (50%). No chromosomal or extracardiac abnormalities were seen. Prenatal echocardiography is useful for early diagnosis of an aortopulmonary window. The prognosis depends on the time of surgery and the nature of the associated anomalies.

[Prenatal diagnosis of fetal aortic stenosis with mitral insufficiency. Review of the ultrasound diagnosis and perinatal prognosis: a case report]. / Diagnóstico prenatal de la estenosis aórtica crítica con insuficiencia mitral. Revisión del diagnóstico ecográfico y pronóstico perinatal. A propósito de un caso.

This is a report about a case of prenatal diagnosis of critical fetal aortic stenosis with severe mitral valve insufficiency in a 35+6 weeks fetus. Aortic stenosis represents 3% of congenital heart diseases, but its association with mitral regurgitation is quite unusual. Thanks to the latest advances in fetal ultrasonography we can now achieve a more precise diagnosis and we have been able to improve the understanding of its physiopathology. Based on this case we have reviewed the most recent literature about fetal aortic stenosis and mitral valve insufficiency, with the aim of summarizing its main physiopathological features, highlighting the clues and key points for its intrauterine diagnosis, describing its principal complications and summarizing its current treatment options.

Interobserver variability in the interpretation of tumor cell necrosis in uterine leiomyosarcoma.

On the basis of the most recent World Health Organization classification, distinction of leiomyosarcoma (LMS) from leiomyoma is based on the presence of the following morphologic criteria: (1) nuclear atypia; (2) mitotic index; and (3) tumor cell necrosis (TCN). Unlike ischemic-type necrosis, which may be seen in benign and malignant smooth muscle tumors (SMTs), TCN is thought to be found only in LMS. The distinction between these 2 types of necrosis can be challenging, especially during the early stages, when necrotic foci are small, or when overlapping features are identified. The aim of this study is to assess the interobserver variability in the interpretation of TCN in uterine LMS. Thirty-four LMS cases were retrieved, and a representative hematoxylin and eosin slide showing 1 area of necrosis was selected from each case. Pathologists from 6 different institutions subspecializing in gynecologic pathology performed a blinded, independent review of the slides. Using the current World Health Organization criteria for assessment of TCN, they had to classify the necrotic foci into: (1) TCN; (2) no TCN; or (3) indeterminate for TCN. Agreement among panelists was categorized as: full-all pathologists in agreement; partial-4 or 5 pathologists in agreement; no agreement-≤3 pathologists placing the case into the same category. Full agreement regarding the presence or absence of TCN was reached in 12 cases (35%) (7 thought to show TCN); partial agreement in 16 (47%); and no general consensus was obtained in 6 (18%). Overall, the level of agreement was moderate (κ=0.436). In 8 of 34 instances (23.5%), ≥1 pathologist made a diagnosis of "TCN" and ≥1 pathologist made the diagnosis of "no TCN" for the same slide. The number of cases diagnosed as "indeterminate for TCN" by each pathologist ranged from 0 to 10 with a mean of 5.8. In 20 cases, at least 1 pathologist diagnosed "indeterminate for TCN" (59%), at least 2 and 3 were undecided in 10 (29%) and 4 (12%) cases, respectively, and 4 pathologists diagnosed "indeterminate for TCN" in 1 instance. When excluding foci of necrosis diagnosed as "indeterminate" by any pathologist, disagreement occurred in 2/14 (14%) cases. From these results we conclude that the level of interobserver agreement among expert gynecologic pathologists in the assessment of TCN in uterine SMTs is only moderate. These results further reiterate the importance of assessing for both nuclear atypia and mitotic activity when differentiating between benign and malignant SMTs and not relying solely on the presence of TCN.

Molecular profile of grade 3 endometrioid endometrial carcinoma: is it a type I or type II endometrial carcinoma?

Two types of endometrial carcinoma (EC) have been delineated on the basis of clinicopathologic studies. Low-grade endometrioid carcinoma (EEC) is the prototype of type I EC and is characterized by microsatellite instability and PTEN, K-ras, and/or ß-catenin gene mutations, whereas type II EC is typically represented by serous and clear cell carcinomas (SCs/CCCs), the former frequently showing p53 mutations and c-erb-2 overexpression; however, the molecular profile of grade 3 EEC has not yet been well characterized. The goal of this study was to define the immunohistochemical and molecular profile of grade 3 EEC. We studied 25 patients with grade 3 EEC ranging in age from 35 to 87 (mean 61) years. At the time of initial diagnosis, 16 patients had stage I tumors, whereas 3, 5, and 1 had stages II, III, and IV tumors, respectively. Only 1 patient with stage IV tumor had disease in the peritoneum because of direct extend of tumor through the uterine wall. Two tissue microarrays were constructed from paraffin-embedded blocks and stained for MLH-1, MSH-2, p16, cyclin D1, C-erb-B2, WT-1, and p53. Loss of MLH-1 and MSH-2 was seen in 3 of 25 and 1 of 24 tumors, respectively; none showed loss of both. Diffuse p16 nuclear expression was found in 7 of 23 cases; diffuse and strong nuclear immunostaining for p53, cyclin D1, and Her-2 was seen in 9 of 24 neoplasms, 9 of 25, and 3 of 25 carcinomas, respectively. WT-1 was negative in all 25 tumors. One of the 3 grade 3 EECs with Her-2 overexpression showed gene amplification by fluorescence in situ hybridization analysis. No gene amplification for cyclin D1 was found. Follow-up information was available for all patients. Sixteen had stage I tumors. Of these patients, 11 were alive and well (AW), 3 died of disease (DOD), and 2 died of unrelated causes (DUC), with a mean follow-up time of 56 months (range, 24 to 96 mo); 2 of 3 patients with stage II tumors DOD, and 1 was AW with a mean follow-up time of 81 months (range, 6 to 66 mo); of the 5 patients with stage III tumors, 2 DOD, 1 was AW, 1 was alive with lung metastases, and 1 DUC [mean follow-up of 29 months (range, 12 to 74 mo)]; the only patient who had a stage IV tumor DOD 12 months later. Interestingly, patients with grade 3 EECs showing loss of MLH-1/MSH-2 had stage I tumors, and all were AW (60 to 84 mo). Seventy-seven percent (7 of 9) of patients with tumors showing cyclin D1 overexpression were stage I, and none died of disease, whereas 85% (6 of 7) of patients with p16-positive tumors were high stage (2 stage II, 3 stage III, and 1 stage IV), and 5 DOD. All but one of these patients had tumors that also had p53 overexpression. All 3 patients with Her-2 overexpression DOD (stages I, III, and IV). In conclusion, this study shows that grade 3 EEC shares with low-grade EEC the overexpression but not amplification of cyclin D1 and low frequency of Her-2 overexpression and amplification. Grade 3 EEC shares with SC the relatively common p53 and p16 overexpression and low frequency of loss of mismatch repair genes. However, in contrast to SC ECs, which often show WT-1, cyclin D1 amplification, and Her-2 overexpression and/or amplification, grade 3 EECs rarely overexpressed any of these markers. Moreover, in this study, patients with tumors showing loss of MLH-1/MSH-2 or cyclin D1 overexpression were more likely to have low-stage tumors (stage I), whereas patients with tumors that overexpressed p53, p16, or Her-2 were frequently associated with high-stage tumors.

[Importance of breastfeeding in the prevalence of metabolic syndrome and degree of childhood obesity]. / Importancia de la lactancia materna en la prevalencia de síndrome metabólico y en el grado de obesidad infantil.

OBJECTIVES: To evaluate the relationship between breastfeeding and the prevalence of obesity and metabolic syndrome in a group of obese children and adolescents. MATERIAL AND METHODS: We performed a retrospective study in obese children and adolescents treated at the Endocrinology and Nutrition Service of the Hospital de Getafe (Madrid). The variables studied were age, sex, height, weight, body mass index (BMI), waist circumference, waist-height ratio, blood pressure, triglycerides, high-density lipoprotein and fasting glucose. Information was also collected on food received in the first months of life. Breastfeeding was defined as feeding with maternal milk for at least 3 months. The SPSS v.15 statistical package was used. RESULTS: A total of 126 patients with obesity were recruited (71 boys and 55 girls) with a mean age of 11.94 +/- 3.12 years. Of these, 117 (92.86%) were morbidly obese (BMI > 97th percentile for age and sex). All patients had a waist circumference > 90th percentile for age and sex. Of the 126 patients evaluated, 36.8% were breastfed for more than 3 months and 63.2% were fed with artificial milk only. Compared with patients fed with artificial milk, those who were breast fed had a lower BMI (31.53 +/- 5.77 vs 32.08 +/- 6.78) and lower waist circumference (95.02 +/- 3.4 vs. 95.69 +/- 3.2 cm), although this difference was not statistically significant. The prevalence of metabolic syndrome in the study population was 19.8%. Within this group, 64% had not been breast fed compared with 36% who had been fed with artificial milk. CONCLUSIONS: Breast feeding for at least 3 months was associated with lower levels of obesity, smaller waist circumference and fewer complications related to metabolic syndrome in childhood and adolescence. Sixty-four percent of children with complete metabolic syndrome had received artificial feeding. Further studies are needed to ascertain the impact of breastfeeding on the development of obesity and cardiometabolic risk.

Giant adrenal myelolipoma: case report and literature review.

Adrenal myelolipomas are rare benign tumors comprising mature adipose tissue and diverse hematopoietic elements. These neoplasms are usually incidental findings, although bulky masses can generate abdominal pain as well as other symptoms related to compression of adjacent organs. Diagnosis is usually provided by ultrasonography or computed tomography. Asymptomatic patients with tumors with a maximum diameter of less than 6cm can benefit from periodic surveillance, whereas local compression symptoms and size larger than 6cm are indications for surgical treatment. We present a case of giant adrenal myelolipoma and provide a review of the literature.

Bcl-2 expression in breast cancer: a comparative study at the mRNA and protein level.

BACKGROUND: Bcl-2 is one of the most important antiapoptotic genes. Although it facilitates the survival of tumor cells, its expression has been consistently associated with a better prognosis for breast cancer. Virtually all studies on Bcl-2 conducted in breast cancer have been carried out by means of immunohistochemistry. The aim of this study was to examine for the first time the expression of Bcl-2 in a series of human breast cancer, both at the mRNA and protein level. MATERIALS AND METHODS: One hundred samples from previously untreated human breast cancers were used; Bcl-2 expression was determined both by means of immunohistochemistry using the bcl-2/100/D5 monoclonal antibody and differential RT-PCR. Additionally, the expression of hormone receptors (ER and PR), c-erb-B2, p53 and the proliferation-associated Ki-67 antigen were also studied by means of immunohistochemistry as part of the standard pathological workup. RESULTS: Any degree of immunohistochemical staining correlated significantly and inversely with c-erb-B2 expression (p = 0.0008), nuclear grade 3 (p = 0.0015), a Ki-67 labeling index > 10% (p = 0.02) and tumor size (p = 0.048), and in a direct fashion with estrogen (p = 0.0003) and progesterone receptor expression (p = 0.0002). mRNA expression of the Bcl-2 gene showed a significant inverse correlation with c-erb-B2 (p = 0.016) and p53 (p = 0.014) expression, as well as with a nuclear grade 3 (p = 0.006), and a direct correlation with estrogen (p = 0.0004) and progesterone (p = 0.001) receptor expression, as well as with nodal invasion (p = 0.04). CONCLUSION: The study of Bcl-2 expression in breast cancer by means of either immunohistochemistry or RT-PCR yields very similar results. In spite of its role opposing tumor cell death, Bcl-2 is associated with biological features of the tumors which define a better intrinsic prognosis, such as hormone receptor expression, low proliferation and absence of c-erb-B2 and mutant p53 expression. This may in great part explain why Bcl-2 expression has been invariably found to correlate with a better prognosis of breast cancer.

Frecuencia de hepatitis B y C en niños con hemopatías malignas / Frequency of hepatitis B and C with malignant hemopathies

Se estudiaron 101 niños con hemopatías malignas diagnosticados y atendidos en el Instituto de Hematología e Inmunología (IHI). Se investigó la frecuencia del antígeno de superficie de la hepatitis B (AgsHB) y la presencia de anticuerpos contra el virus de la hepatitis C (AcVHC). En la relación del AgsHB con el diagnóstico, se evaluó el tiempo de evolución de la enfermedad, la etapa de tratamiento y la transfusión de componentes sanguíneos. A todos los pacientes se les determinó el AgsHB y el AcVHC con los estuches UMELISA. De los pacientes estudiados, 7 (6,93 %) fueron positivos para el AgsHB y 2 (1,98 %) fueron positivos al AcVHC, para un total de 9 pacientes (8,91 %). Debido a que solo 2 pacientes fueron positivos al AcVHC, no se realizó el análisis estadístico de estos parámetros.

110 children with malignant hemopathies that were diagnosed and seen at the Institute of Hematology and Immunology were studied. The frequency of hepatitis B surface antigen (HBsAg) and the presence of antibodies against the hepatitis C virus (HCVAbs) was investigated. In the relation of HBsAg to the diagnosis, the time of evolution of the disease, the treatment stage and the transfusion of blood components were evaluated. All the patients were determined HbsAg and HCVAb with UMELISA kits. Of the studied patients, 7 (6.93 %) were positive for HbsAg and 2 (1.98 %) tested positive for HCVAb, for a total of 9 patients (8.91 %). As only 2 patients were positive for VHCAb, the statistical analysis of these parameters was not made.

A computer-assisted morphometric quantitative analysis of iron overload in liver biopsies. A comparison with histological and biochemical methods.

The aim of this study was to evaluate a new method of image analysis used to quantify the iron load in routinely processed liver biopsies. Sixty-four liver biopsies from the same number of patients were studied. Both biochemical determination of iron concentration and histopathological semiquantification and quantification were performed. The latter was performed on Perls-stained liver sections by a semiautomatic system of image analysis that yields the percentage of stained liver tissue. In 43 samples with an hepatic iron content higher than 2000microg/mg of dry tissue, this morphometric index was compared to the liver iron load measured biochemically, showing a significant correlation (Spearman's test) between both variables (rho = 0.686, p<0.001). Moreover, there is a better correlation when the semiquantitative Deugnier's histological index is compared with the biochemical method (rho = 0.425, p<0.004). Thus, we conclude that image analysis may be a valid method to assess hepatic iron storage in patients with liver diseases and that it may be more accurate than semiquantitative grading systems, such as the one described by Deugnier, since the morphometric method shows a closer correlation with the hepatic iron concentration determined biochemically.

Hongos saprofitos con actividad biológica frente a los fitopatógenos Botrytis cinerea y Alternaria solani / Fungi saprophytes with activity biologica front to the phytopathogenic botrytis cinerea and Alternaria terrace

De un tamizaje realizado entre las cepas fúngicas que conforman el cepario del IIFB, como parte del proyecto “Biodiversidad Microbiana” del Programa UMSA-Asdi/ Sarec que se desarrolla en forma conjunta con eldepartamento de Biotecnología Ambiental de la Universidad de Lund, se seleccionaron 6 cepas con actividad biológica contra Botrytis cinerea y Alternaria solani, estas fueron clasificadas, a nivel de género, comoTrichoderma sp., (12-QD), Cephalosporium sp., (8-QD),Aspergillus sp., (24-QD), Rizophus sp., (291-QD),— Wardomyces sp., (178-QD), Streptomyces sp., (22-QD).Estos microorganismos saprofiticos fueron sometidos a condiciones de fermentación, en estanco y agitado. Losfiltrados de los fermentos que presentaron mayor actividad fueron los obtenidos de Trichoderma sp con un 79,9% de actividad frente a Botrytis cinerea y 61% frente a Alternaria solani. Se observó que la actividadbiológica esta relacionada con la génesis de pigmentos amarillos

Frecuencia de hepatitis B y C en adultos con hemopatías malignas / Frequency of hepatitis B and C in adults with malignant hemopathies

Se estudiaron 139 pacientes adultos con hemopatías malignas, diagnosticados y atendidos en el Instituto de Hematología Inmunología (IHI). Se investigó la frecuencia del antígeno de superficie de la hepatitis B (AgsHB) y la presencia de anticuerpos contra el virus de la hepatitis C (AcVHC), así como su relación con el diagnóstico, el tiempo de evolución de la enfermedad, la etapa de tratamiento y la transfusión de componentes sanguíneos. A todos los pacientes se les determinó el AgsHB y el AcVHC mediante los estuches UMELISA-HBsAg y UMELISA-HCVAc. De los pacientes estudiados, 13 (9,35 por ciento) fueron positivos para el AgsHB y en 19 (13,67 por ciento) se detectaron anticuerpos para el virus de la hepatitis C, para un total de 32 pacientes (23,02 por ciento). La presencia del AgsHB no se relacionó con los parámetros señalados anteriormente. Se demostró asociación entre la presencia de AcVHC con el tipo de enfermedad hematológica, con las transfusiones y la etapa de tratamiento

Sertoli cell tumors of the ovary: a clinicopathologic and immunohistochemical study of 54 cases.

Ovarian Sertoli cell tumors are rare, and their morphologic spectrum, behavior, and factors influencing the latter are not clearly established. They may be mimicked by many different tumors, some of them more frequent than Sertoli cell tumors; immunohistochemistry may aid in this differential, but its role has not been analyzed in a large series. We studied the clinicopathologic features of 54 Sertoli cell tumors, including the immunohistochemical profile of 23 of them. The patients, 6 of whom had Peutz-Jeghers syndrome, ranged from 2 to 76 years of age (mean, 30 years). Eleven patients had estrogenic and 4 had androgenic manifestations. The tumors ranged from 0.8 to 30 cm, with the majority being in the range of 4 to 12 cm. They were all unilateral, usually solid, and often yellow. The predominant microscopic pattern was tubular, seen, albeit often only focally, in all tumors; other patterns were cords or trabeculae (28), diffuse (21), pseudopapillary (4), retiform (3), islands or alveolar arrangements (3), and spindled (3). The tubules were solid or hollow with the former being somewhat more common. Delicate septa were occasionally seen and were conspicuous in areas of one tumor. The stroma was abundant in 15 tumors with marked sclerosis in 4. The cells usually had pale to occasionally densely eosinophilic cytoplasm, but 6 tumors were composed of cells with prominent foamy cytoplasm, falling in the category of "lipid-rich" Sertoli cell tumor, and one had cells with clear non-foamy cytoplasm. Forty-four tumors were stage I (42 of them were stage Ia and 2 were stage Ic), 1 was stage II, 3 were stage III, and 6 were not adequately staged. Follow-up was available for 27 patients with stage I tumors, and all were alive and well at last follow-up except for 2 patients with stage Ia and 1 with stage Ic disease. Those 3 patients had pelvic-abdominal recurrences 18, 36, and 9 months, respectively, after the initial diagnosis. Two of the three clinically malignant stage I tumors had moderate to severe cytologic atypia and brisk mitotic activity (>5 or more mitoses/10 high power fields [HPFs]), and one of these had tumor cell necrosis. Among the 10 clinically benign stage I tumors with more than 5 years of follow-up, only 3 had >5 mitoses/10 HPFs, but none had more than mild cytologic atypia and none had tumor cell necrosis. Two of the three patients with stage III disease had follow-up information and one was alive at 16 months and the second developed splenic metastases 2 years after the initial diagnosis. Two of the three stage III tumors had at least moderate cytologic atypia and brisk mitotic activity. Immunohistochemical stains showed positivity for AE1/3-Cam5.2 in 15 of 23 tumors; Epithelial membrane antigen (EMA) was negative in all the tumors. Inhibin was positive in 18 of 22 tumors, calretinin in 10 of 20, CD99 in 19 of 22, vimentin in 17 of 18, smooth muscle actin in 4 of 18, neuron specific enolase in 8 of 16, S-100 in 2 of 20, and chromogranin was negative in all 21 cases studied. Although Sertoli cell tumors usually have a distinctive tubular pattern that facilitates the diagnosis, other patterns may occasionally predominate, causing confusion with various other primary and metastatic ovarian tumors. EMA, inhibin, and chromogranin represent the most helpful triad of immunomarkers serving to exclude two common mimics of Sertoli cell tumors (endometrioid carcinoma [inhibin-; EMA+; chromogranin-] and carcinoid tumor [inhibin-; EMA+; chromogranin+]). Although CD99 and calretinin are often expressed in these tumors, they are much less specific and not as helpful in the differential diagnosis. Most Sertoli cell tumors are stage I, unilateral, cytologically bland, and clinically benign, but occasional examples are high stage, and about 11% of stage I tumors have worrisome histologic features that may portend an adverse outcome. The tumors typically occur in young females, sometimes children who typically present with sexual precocity, and occasional patients have Peutz-Jeghers syndrome.