Intraductal carcinoma of the prostate is an aggressive form of invasive carcinoma and should be graded.

Infiltration of the prostatic ducts by prostatic adenocarcinoma occurs relatively frequently, being most commonly associated with high grade disease. It is now recognised that intraductal carcinoma of the prostate (IDCP) has an associated poor prognosis and this is reflected in its histological, molecular and immunohistochemical features. The current recommendation of the World Health Organization is that IDCP not be taken into consideration when grading prostate adenocarcinoma. It is apparent that Gleason did not differentiate between IDCP and stromal invasive carcinoma when developing and validating his grading system, and recent studies suggest that the incorporation of IDCP grading into the overall grading of the specimen provides additional prognostic information.

The International Society of Urological Pathology Education web-a web-based system for training and testing of pathologists.

Pathology training resources remain scarce in many parts of the world. With rapid economic development comes the need to educate new pathologists to meet the medical care demands. Our aim was to set up a cost-effective system for training and testing the diagnostic skills of pathologists. Pathologists in nine countries in Asia and South America were invited by the International Society of Urological Pathology (ISUP) to participate in a prostate pathology education course combining image-based tests with lectures and on-line tutorials. The tests and tutorials are available free of charge at the ISUP education website www.edu.isupweb.org . A total of 603 pathologists registered on the website. Of these, 224 completed pre- and post-lecture assessments (tests 1 and 2). Replies were classified as correct/acceptable, when a lesion was accurately classified into clinically relevant categories (benign, cancer, high-grade prostatic intraepithelial neoplasia, intraductal carcinoma of the prostate). The rate of correct/acceptable replies increased from 60.7 to 72.3% in Tests 1 and 2, respectively. In Test 1, pathologists from upper middle, lower middle, and low resource countries gave a correct/acceptable diagnosis in 65.8%, 61.0%, and 47.4%, respectively. Their results improved in Test 2 to 76.4%, 72.5%, and 62.8%, respectively. The greatest improvement in diagnostic ability was achieved in pathologists from the low resource group of countries. The use of web-based testing and training, combined with lectures, is an efficient method for improving diagnostic skills of pathologists in low to middle resource countries.

Determinación inmunohistoquímica de la proteína p53 en biopsias de cuello uterino / Immunohistochemistry determination of the p53 protein in cervical biopsy

El gen p53 regula el ingreso de las células a la fase S del ciclo celular mediante la síntesis de una proteína efectora. La mutación de este gen se relacionaría con la pérdida de la capacidad supresora y la concomitante progresión tumoral. La génesis del carcinoma de cérvix podría vincularse a la mutación del gen p53 por acción del ADN viral (HPV). Realizamos la inmunomarcación de la proteína p53 en 88 biopsias de cérvix. De éstas, 10 correspondieron a cuello normal, 41 a lesiones intraepiteliales de bajo grado, 24 a lesiones intraepiteliales de alto grado y 13 a carcinomas invasores. La positividad fue del 10 por ciento, 58,5 por ciento, 70,8 por ciento y 92,3 por ciento respectivamente. Se evaluó también: atipia coilocitótica, reacción inflamatoria, localización e intensidad de la inmunomarcación, tipo de carcinoma invasor, etc. En este informe queda demostrado que el mayor grado de lesión correlaciona con mayor expresión de proteína p53 anómala o mutada

Neurofibroma intraparietal aislado del colédoco / Isolated neurofibroma of the common bile duct

Los tumores neurogénicos de la vía biliar son raros siendo generalmente neuromas de amputación posteriores a colecistectomía.Describimos un neurofibroma aislado del colédoco en un varón joven sin antecedentes quirúrgicos. Presentaba dolor abdominal crónico recurrente, vómitos y pérdida de peso sin signos clínicos de enfermedad de Von Recklinghausen o icterícia.El hepatograma era normal.La ecografía detecto una formación sólida que comprimía el colédoco proximal.La colangiopancreatografía retrógrada confirmó la estenosis.Se realizó exéresis quirúrgica del tumor y anastomosis bi-hepático yeyunal.El examen microscópico reportó neurofibroma intraparietal del colédoco. Como entidad aislada, nosotros conocemos solamente un caso publicado.