Bone marrow trephine biopsy involvement by lymphoma: pattern of involvement and concordance with flow cytometry, in 10 years from a single institution.

PURPOSE: To evaluate the features of bone marrow (BM) biopsy involvement by lymphoma, pattern of infiltration, morphological analysis and flow cytometry were reviewed at all lymphoma patients over a period of 10 years. METHODS/PATIENTS: 413 cases were included in the study if BM biopsy slides were available. Only 356 patients had both BM trephine biopsy and flow cytometry. RESULTS: The most frequent subtype was diffuse large B cell (31.2%), followed by follicular lymphoma (18.9%). The predominant pattern was mixed (nodular-interstitial) (9.2%). Morphological marrow infiltration was found in 138 cases, and flow cytometry identified 117 cases with BM involvement. A concordance between the two methods was detected in 305 cases (85.7%). There was discordance in 51 cases (14.3%): morphology positive/FC negative in 33 cases and morphology negative/FC positive in 18. CONCLUSIONS: Flow cytometry is slightly more useful in detecting involvement when the BM is affected, but this finding is not conclusive.

Usefulness of confocal microscopy in distinguishing between basal cell carcinoma and intradermal melanocytic nevus on the face.

The clinical distinction between basal cell carcinoma (BCC) and intradermal melanocytic nevus lesions on the face can be difficult, particularly in young patients or patients with multiple nevi. Dermoscopy is a useful tool for analyzing characteristic dermoscopic features of BCC, such as cartwheel structures, maple leaf-like areas, blue-gray nests and dots, and ulceration. It also reveals arborizing telangiectatic vessels and prominent curved vessels, which are typical of BCC, and comma vessels, which are typical of intradermal melanocytic nevi. It is, however, not always easy to distinguish between these 2 conditions, even when dermoscopy is used. We describe 2 facial lesions that posed a clinical and dermoscopic challenge in two 38-year-old patients; confocal microscopy showed separation between tumor nests and stroma and polarized nuclei, which are confocal microscopy features of basal cell carcinoma.

[Cutaneous follicular center B-cell lymphoma treated with intralesional rituximab]. / Linfoma cutáneo de células B del centro folicular tratado con rituximab intralesional.

Cutaneous follicular center B-cell lymphomas are indolent tumors characterized by the presence of neoplastic follicular center cells. They contain a mixture of centrocytes with a variable number of centroblasts. The tumor is usually treated by surgery or radiotherapy, although other treatments may be used such as interferon-alpha, chemotherapy, and biological agents (rituximab). Rituximab is a chimeric monoclonal anti-CD20 antibody that can be administered intravenously or intralesionally. We report the case of a 41-year-old man who consulted for violaceous nodular lesions in the left scapular region and who was diagnosed with cutaneous follicular center B-cell lymphoma after biopsy, laboratory tests, thoracic-abdominal-pelvic computed tomography, abdominal ultrasound, and bone marrow biopsy. It was decided to treat him with 30 mg of intralesional rituximab administered for 1 week (3 times) every month for 4 months. Complete response was obtained. We also review the published cases of cutaneous B-cell lymphoma treated with intralesional rituximab.

[Cutaneous adverse reaction to Bio-Alcamid implant]. / Reacción cutánea tras implante con Bio-Alcamid.

In the last years new and numerous materials for the correction of defects and wrinkles have been developed. One of these materials is Bio-Alcamid, a non reabsorbable gel polymer constituted by meshes of poly-alkyl-imide, without known adverse effects. We report a 34-year-old woman that had Bio-Alcamid implants for acne scars and several months after presented nodular lesions together with a painful inflammatory nodule. The nodule was drained and culture of the purulent material yielded Streptococcus viridans. A cytology and a cellular block of that material showed a granulomatous inflammatory reaction together with a foreign body. The different types of reactions to implants and their pathogenic mechanism are discussed. It is important to know these possible reactions to filler materials given their increasing use and the potential medico-legal consequences.

Sinonasal fibrosarcoma: a case report.

Sinonasal fibrosarcoma (SFS) is an infrequent malignant neoplasm. It usually presents as other sarcomas in this region, with nasal obstruction and epistaxis. The final diagnosis is based on the histopathology and immunohistochemistry. We report the case of a 58-year-old man with an 8-month history of left proptosis, recurrent epistaxis and nasal obstruction. Nasal endoscopy confirmed a left nasal neoplasia. CT and MRI showed the extension of the neoplasia, occupying the left nasal fossa and ethmoid sinuses, and eroding the medial wall of the orbit. Complete removal was achieved through endoscopic sinus surgery, preserving the orbit. SFS was found on histopathologic examination. After 4 years of follow-up, nasal endoscopy, CT and MRI imaging show no sign of recurrence.

[Brain abscesses due to Listeria monocytogenes]. / Abscesos cerebrales por Listeria monocytogenes.

INTRODUCTION: Listeria monocytogenes is a gram-positive bacillus which causes sporadic infections in immunocompromised humans, with a special propensity for the central nervous system, in the form of acute, subacute or chronic meningitis, rhombencephalitis or abscesses in the brain or spinal cord. The final diagnosis is established by germ culture in blood or in cerebrospinal fluid (CSF). Preferred treatment is ampicillin in association with aminoglycosides. CASE REPORT: We report the case of a 70-year-old male patient with a history of arterial hypertension and chronic lymphatic leukaemia with no specific treatment, who suffered meningoencephalitis and brain abscesses caused by L. monocytogenes. Symptoms were a 48-hour history of headache and a febrile condition. The CSF showed lymphocytic pleocytosis with hypoglycorrhachia. Magnetic resonance scans of the brain revealed areas of cerebritis and multiple brain abscesses in the right frontal lobe. Specific treatment was established with ampicillin for 13 weeks, associated with gentamicin and vancomycin during the first few weeks, until x-rays showed the lesions to be resolved. CONCLUSIONS: L. monocytogenes infections must be investigated in all patients with cellular immunosuppression who present febrile symptoms. The central nervous system may be the only area of the body infected. Moreover, this site will need studying in patients who present neurological focus data or an alteration in the state of consciousness and bacteraemia due to L. monocytogenes. Establishing suitable treatment as early as possible can improve the prognosis.

[Hydrocepahlia and subarachnoid cyst due to neurocysticercosis. A new case from rural Extremadura]. / Hidrocefalia y quiste subaracnoideo por neurocisticercosis. Un nuevo caso en una zona rural de Extremadura.

INTRODUCTION: Neurocystercicosis (NCC) is a disorder caused by the Taenia solium larva. It is the commonest parasitosis of the CNS. In Spain most patients are from countries where the condition is endemic. However, sporadic cases still occur amongst the non immigrant population of rural regions. We report a new case of NCC from the Valle del Jerte in rural Extremadura. CASE REPORT: A 51 year old man presented with intellectual impairment, motor aphasia, apraxia, right hemiparesia and sphincter incontinence for the past six months. On cranial CAT and MR hydorcephalia was seen together with a subarachnoid cyst in the left Sylvan fissure. Serology was positive for cysticercosis in both plasma and CSF. The patient was treated with albendazol after insertion of a ventriculo peritoneal shunt. Three months later there was both clinical and radiological improvement. CONCLUSION: NCC is still a condition which must be included in the differential diagnosis of patients in Spain who present with CNS involvement and cystic lesions on neuro imaging investigations, even when they are not from countries where the disease is endemic. Treatment with albendazol and steroids given after insertion of a ventriculo peritoneal shunt was effective in our patient.

Characterization of the ecdysteroid UDP-glucosyltransferase (egt) gene of Anticarsia gemmatalis nucleopolyhedrovirus.

The Anticarsia gemmatalis nucelopolyhedrovirus (AgMNPV) egt gene was cloned, sequenced and its expression characterized by RT-PCR and western blot analysis. Sequence analysis of the gene indicated the presence of an open reading frame (ORF) of 1482 nucleotides, which codes for a polypeptide of 494 amino acids. ATATA box and a conserved regulatory sequence (CATT) found in other baculovirus early genes were present in the promoter region of the egt gene. A poly-A consensus sequence was present in the 3' untranslated region (3'-UTR) of the gene. Homology comparisons showed that the EGT protein of AgMNPV is most closely related (95.9% amino acid sequence identity) to the EGT from the Choristoneura fumiferana DEF nucleopolyhedrovirus (CfDEF). Transcriptional analysis of the AgMNPV egt gene showed that egt-specific transcripts can be detected both early and late in infection. The EGT protein was detected, by western blot analysis, in the intra- (from 12 to 48 h post-infection) and extra-cellular (from 12 to 96 h post-infection) fractions of infected insect cells. The AgMNPV Bgl II-F fragment, which has homology to the AcMNPV ie-1 gene, was cloned and used to cotransfect SF21 cells with the cloned AgMNPV egt gene. EGT activity was observed, suggesting that AgMNPV ie-1 can transactivate egt expression.

Subcutaneous nodular amyloidosis in Sjögren's syndrome.

We describe a female patient with primary Sjögren's syndrome (SS) associated with a subcutaneous tumor formed by amyloid surrounded by mature IgG-kappa plasma cells, in the absence of lymphoproliferation or amyloid deposit in other organs. This case represents an unusual presentation of localized amyloidosis, without systemic involvement. Together with other reported cases this suggests that only immunocytic and not reactive systemic amyloidosis develops in chronic SS patients.

Nodular regenerative hyperplasia of the liver in early histological stages of primary biliary cirrhosis.

Nodular regenerative hyperplasia (NRH) is a condition characterized by hepatocytic nodules distributed throughout the liver without perinodular fibrosis. The etiology is unknown, but it has been reported in patients with a variety of diseases, including autoimmune diseases and primary biliary cirrhosis (PBC). In this study, the liver biopsies of 64 patients with PBC were reviewed. Thirty-five biopsies in histological stages I or II belonging to 30 patients were suitable for study. NRH was found in 43% of biopsies (47% of patients). In 80% of these biopsies, nodular transformation was focal, while it was diffuse in the remaining 20%. Splenomegaly was more common in patients with NRH. Laparoscopy displayed evidence of portal hypertension in two of these patients and endoscopy showed esophageal varices in one patient. Serum levels of gamma-glutamyl transpeptidase were also higher in these patients. Lesions in small intrahepatic vessels, florid bile duct lesions, and portal granulomas were found more frequently in biopsies with NRH. We conclude that nodular hyperplastic changes are very common in early histological stages of PBC, and consequently, this disease should be considered in the etiology of NRH. These changes may contribute to early development of portal hypertension in these patients.

Epithelial atypia in gynecomastia induced by chemotherapeutic drugs. A possible pitfall in fine needle aspiration biopsy.

The clinical, cytopathologic and histopathologic features of a case of gynecomastia induced by chemotherapeutic drugs are described. Fine needle aspiration (FNA) smears showed epithelial atypia, and an erroneous cytologic diagnosis of carcinoma was made. Histopathologic study showed gynecomastia with epitheliosis, papillomatosis and atypical ductal hyperplasia. Review of the FNA smears showed the findings to be more typical of a reparative or regenerative process; these findings had been cytologically overinterpreted, partly due to the lack of adequate clinical information submitted with the aspirate. The possible causes of gynecomastia, the induction of epithelial atypia by cytotoxic chemotherapy and the cytologic features whose recognition may prevent false-positive diagnoses in such cases are discussed.

Primary malignant melanoma of the uterine cervix: case report and review of the literature.

A case of primary malignant melanoma of the uterine cervix is presented. So far only 26 cases have been reported. Vaginal bleeding was the most common complaint. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and adjuvant radiotherapy is the elective treatment. Prognosis for this entity is poor. The tumor seems to arise from melanocytes that are usually present in the cervix.