[Is CT-guided biopsy of aggressive sacral tumors always able to reach a diagnosis?]. / Biopsia guiada por TC de tumores sacros agresivos. ¿Es siempre diagnóstica?

OBJECTIVES: To present a series of eight cases of rare sacral tumors that represent a wide spectrum of the aggressive disease involving the sacrum and to discuss the efficacy of CT-guided biopsy in these cases. MATERIAL AND METHODS: We reviewed all cases of sacral tumors biopsied under CT guidance in the last two years. Prior CT and MR images were analyzed before biopsy, and 3 mm CT slices of the lesion were obtained to determine the location of the target area and the path of the needle. All biopsies were performed using 11 G needles and 15 G coaxial needles. RESULTS: Eight sacral lesions were biopsied under CT guidance, and a diagnosis was reached in four. In three of these, the diagnosis (chordoma, plasmocytoma, and metastasis from melanoma) was reached in a single session. In the fourth case, three sessions were necessary to reach the diagnosis of Ewing's sarcoma. For various reasons, the remaining four cases required surgical biopsy to reach the diagnoses of chondrosarcoma, eosinophilic granuloma, and primary bone lymphoma in two patients. The diagnostic efficacy of CT-guided biopsy was 36%. CONCLUSION: Our results suggest that CT-guided biopsy is less useful in the characterization of primary tumors than in metastases. The diagnosis of primary bone lymphomas is especially complicated. Repeating the procedure after inconclusive results probably will not provide additional information, and it is recommendable to perform surgical biopsy in these cases.

[Primary cardiac tumours in infancy]. / Tumores cardíacos primarios en la infancia.

INTRODUCTION: Primary cardiac tumours are very rare in the paediatric age, their incidence varies from 0.0017 % to 0.28 %. More than 90 % are benign in nature. The most common variety is the rhabdomyoma, present in over 60 % of cases with tuberous sclerosis. MATERIAL AND METHODS: We performed a retrospective analysis of medical records with a diagnosis of primary cardiac tumor between March 1977 and March 2007, finding a total of 27 patients. RESULTS: The age of initial diagnosis is more prevalent in the neonatal period, beginning with the discovery of a heart murmur (11 cases). There was no difference in gender distribution. In 14 patients were found cardiomegaly on chest radiograph. According to the echocardiography characteristics there were diagnosed 20 rhabdomyomas, 2 fibromas, 2 pericardial teratomas and 3 non classifiable tumours. Most were located in the left ventricle. Echocardiography, cardiac catheterization was also performed in 3 cases and angioresonance in 5 cases. During their evolution, episodes of arrhythmias were observed in 11 patients, 5 patients required some sort of surgical procedure, which confirmed the histopathology diagnosis. In 3 patients the initial cause of death was cardiological. The 75 % of cases with rhabdomyomas presented or developed tuberous sclerosis. In most of the rhabdomyomas (13 cases), there was a spontaneous regression. CONCLUSIONS: Firstly, there is shown to be a low prevalence of this disorder in children. Rhabdomyoma is the most common primary cardiac tumour in our study and it was associated in 75 % of cases with tuberous sclerosis. The diagnosis is more common in the early neonatal period after auscultation of a cardiac murmur and echocardiography, the diagnostic technique of choice, other imaging techniques, such as angioMRI not being of much for diagnosis in children. The emergence of foetal echocardiography allows early detection. The course is benign in most tumours, rhabdomyomas tending to regress spontaneously. It must be monitored as the occurrence of arrhythmias during its evolution will require medical treatment. Surgery is needed in cases with severe symptoms, due to obstruction in the ventricular output tracts. One option is the surgical cardiac transplant in non-resectable life-threatening tumours.

[Pituitary magnetic resonance in women with a clinical suspicion of microprolactinoma]. / Resonancia magnética hipofisaria en mujeres con sospecha clínica de microprolactinoma.

Seventy-seven women with clinical suspect of microprolactinoma were studied by means of magnetic resonance of the pituitary gland. The homogeneity and signal intensity of the pituitary gland, presence of intraglandular nodule, height and gland morphology were evaluated. Radiological findings were correlated to prolactinemia values and the definite clinical diagnosis. The pituitary gland was normal in eleven out of the thirteen patients in whom the presence of hypophyseal endocrine pathology was not confirmed. In the remaining 64 women with hyperprolactinemia, 26 hypophyseal nodules were detected (40.6%), 3 questionable nodules (4.7%), 8 homogeneous glands (12.5%), 6 of empty sella turcica (9.4%) and 21 normal pituitary glands (32.8%). A correlation between radiological diagnosis, prolactinemia levels and definite clinical diagnosis was verified. The convexity degree of the pituitary gland was not useful for the diagnosis of microprolactinoma. In contrast, the height of the pituitary gland was indeed useful.

[Alkaline encrusted cystitis secondary to Proteus mirabilis infection in a HIV infected patient]. / Cistitis alcalina incrustante secundaria a infección por Proteus mirabilis en un paciente VIH.

We described for the first time an alkaline encrusting cystitis in a patient with the acquired immune deficiency. This is an entity characterized by severe dysuria and long standing urinary frequency, alkaline urine and radiographically visible calcification of the urinary bladder. It has been observed in patients with permanent Foley catheter, persistent infections due to microorganisms with urolytic activity, urinary bilharziosis or tuberculosis, or malignant bladder tumors. None of these entities were described and the patient had all conditions for this syndrome.

p29 protein in breast cancer: relation between estrogen and progesterone receptors.

An immunoradiometric assay was used to determine the presence of p29 protein in 68 breast cancer cyTOSOLS. The p29 values ranged from 0 to 1123 U/mg, with a mean value of 127 +/- 28.7 U/mg. Using a cutoff point of 20 U/mg the frequency of p29 positive tumors was about 55%. A quantitative and qualitative relation was found between p29 and estrogen receptor (ER), but not between p29 and progesterone receptor (PR). Discordance between p29 and ER status was found in 13 out of 68 tumors. Both the frequency of p29 positive tumors and the p29 values were significantly higher in postmenopausal than in premenopausal women, in a similar way to ER but different from PR. There was no difference in p29 content between primary tumor and metastasis. We did not find any relation among p29 primary tumors content and axillary lymph nodes involvement or tumor size.