Intraoperative and external beam radiotherapy in invasive bladder cancer: pathological findings following cystectomy.

The pathological findings observed following intraoperative radiotherapy (IORT) boost (15Gy) to the whole bladder, external beam fractionated irradiation (46Gy in 5 weeks), and planned radical cystectomy in patients with deep invasive bladder carcinoma are analyzed. Clinical pretreatment stage of disease was T3 (16 cases) and T4 (two cases). No evidence of residual tumor (pT0) was demonstrated in 11 cystectomy specimens (61%) and residual tumor (pT+) was observed in seven (39%). Toxicity and complications related to the treatment approaches were minor and reversible. It is concluded that IORT is a feasible boosting modality in the management of invasive bladder cancer, able to induce high rates of pT0 cystectomy specimens, and might be considered as a valuable technique for organ preservation treatment programs.

[Amebic liver abscesses with bacterial superinfection in a nonendemic area]. / Abscesos hepáticos amebianos sobreinfectados por bacterias en un área no endémica.

A 26-year-old man was admitted to hospital with asthenia, weight loss, right upper quadrant abdominal pain, diarrhea without blood, and fever. Abdominal ultrasonography showed multiple hypoechoic areas in the left hepatic lobe. On abdominal CT, multiple hypodense areas without contrast capture were consistent with hepatic abscesses. Cultures were obtained and the patient was placed empirically on metronidazole, gentamicin and ampicillin, without improvement in the first 72 hours, and a drain was placed in the largest lesion collecting a purulent material. The abscess culture was positive for group C beta-hemolytic Streptococcus. Entamoeba histolytica serology was positive and colon biopsies revealed trophozoites. Multiple left hepatic lobe abscesses secondary to E. histolytica, with bacterial superinfection, is an unusual presentation of amoebic infection, considering that Spain is not an endemic area.

[Mucinous adenocarcinoma of the appendix associated with ovarian tumors and pseudomyxoma peritonei. The difficulty in differential diagnosis]. / Adenocarcinoma mucinoso de apéndice asociado con tumores ováricos y pseudomixoma peritonei. Dificultad en el diagnóstico diferencial.

Mucinous adenocarcinoma of the appendix is rare. If there is a concomitant ovarian tumor to determine the primary might be difficult. Histological features are not always determinant, but there are some macroscopic findings that may suggest an origin in the appendix. We report a case of synchronous tumors in appendix and ovaries with pseudomyxoma peritonei. The patient presented with mass sensation in the right lower quadrant, asthenia, anorexia and weight loss. Abdominal ultrasound and CT scan showed a tumor involving cecum, appendix, terminal ileum and pelvis. Findings on colonoscopy and biopsies were inconclusive. At laparotomy, the tumor compressed appendix, cecum and ascendant colon, terminal ileum, ovaries and peritoneum. Histopathological analysis demonstrated a well-differentiated mucinous adenocarcinoma of appendiceal origin with metastasis in ovaries and peritoneum (pseudomyxoma peritonei).

[Primary malignant melanomas of the nasal fossae]. / Melanomas malignos primarios de fosas nasales.

Melanoma of the nasal and paranasal sinus mucosa represented less than 1% of all melanomas. Melanoma to be localized commonly in nasal septum and your prognosis is poor. We presented three cases with a mean age of 75 years. The tumor was localized in nose. The melanocytes were presented in only case. All the tumoral cells stained with S-100 and HMB-45. In a case the vascular invasion was presented. Only a patient was treated with surgical excision. Two patients death 8 months after diagnosis.

Study of the immunoexpression of Bcl-2 by a cutaneous granular cell tumor.

BACKGROUND: Cutaneous granular cell tumors have only rarely been examined for Bcl-2, a marker that is expressed by granular cell tumors from other parts of the body. OBJECTIVE: We retrospectively studied three cases of cutaneous granular tumors from our archives. METHODS: We immunohistochemically tested for neuron-specific enolase (NSE), CD68 (KP1), Bcl-2, and S-100. In Cases 1 and 3, we also tested for CD34, HMB-45, and melan-A. In Case 3, we additionally tested for smooth muscle actin, CD68-PGM1, cytokeratin AE1-AE3, epithelial membrane antigen, desmin, CD1a, and CD117. RESULTS: None of our cases presented any of the histological markers traditionally considered to be indicators of potential malignancy in granular cell tumors. All cases strongly expressed S-100, CD68, NSE, and Bcl-2. Case 3 also expressed CD68-PGM1. The rest of the markers were not expressed by the tumors. CONCLUSIONS: Bcl-2 is expressed by cutaneous granular cell tumors.

Cyanamide and its calcium form: do they differ with respect to their action on the liver cell? Experimental study in the rat.

Cyanamide is a drug frequently used as aversion therapy in chronic alcoholism. A chronic hepatocytic lesion induced by cyanamide has been described by a member of our team over the last few years. It consists of distinctive cytoplasmic inclusion bodies, similar to those observed in Lafora's disease. The inclusion body-bearing liver cells resemble the ground-glass hepatocytes observed in type B viral infections. This hepatocytic lesion is predictable and reproducible in the rat liver. The high frequency of alcoholic patients with inclusion bodies observed in Spain is striking in contrast with the scarcity of cases published abroad. The medicine commonly used in Spain contains plain cyanamide, while Temposil used in Canada and Dipsan used in Scandinavia contain its calcium form (calcium carbimide). In an attempt to discover if the chemical nature of the drug is an important determinant in the development of the lesion, the present study was carried out using groups of Wistar rats. One group received cyanamide and the other one calcium carbimide. The drug was placed in the stomach via a cannula, daily, at a dose of 16 mg/kg body weight, for 25 weeks. The characteristic inclusion bodies were only found in the group receiving plain cyanamide.

[Papillomas of the esophagus: presentation of 5 cases and review of the literature]. / Papilomas del esófago: aportación de cinco casos y revisión de la literatura.

Papilloma of the esophagus is an uncommon benign tumor. We report five cases, four diagnosed by gastroscopy and one on autopsy. Three were women and two men. All the tumors were located in the distal third, except one in the middle third. The average size was 0.5 cm. In four cases there was gastroesophageal reflux and in two there was also hiatal hernia. In one case there was koilocytosis.

[Histopathological features of carcinomas of the bladder treated with radiotherapy. Anatomo-clinical correlation]. / Características histopatológicas de los carcinomas de vejiga tratados con radioterapia. Correlación anatomoclínica.

We evaluated the effects of radiotherapy (total dose 6,100 rads; 1,500 intraoperative and 4,600 external irradiation) on urothelial carcinomas in 16 patients. Tumor response and the histopathological changes were evaluated. All but one of the patients were men. Mean patient age was 58 years. The urothelial tumors were graded from I-III according to the histological features and degree of invasion. Two were classed as grade I, 6 grade II and 8 grade III. The post-irradiation cystectomy specimens revealed no tumor cells in 9 cases (56%); 2 grade II and 7 grade III tumors. All cystectomy specimens revealed histopathological changes following radiotherapy: edema and congestion (16 cases), squamous metaplasia (11 cases), multinucleated giant cells (7 cases), fibroblast proliferation (6 cases), dystrophic calcification (4 cases), macrophages with lipids (3 cases) and osseous formation (1 case). The mean patient follow-up was 18 months. Four patients died (3 from the tumor). Mean patient survival was 12 months. The foregoing findings indicate that radiotherapy appears to be more effective in destroying the more undifferentiated and deeper urothelial carcinoma.

Chondroid metaplasia in the tunica media of the aorta in dogs submitted to saphenous vein aorto-cava by-pass.

We submitted twelve dogs to aorto-superior vena cava by-pass with saphenous vein. Six months later, all dogs had developed areas of chondroid metaplasia in the tunica media of the aorta, near the area of anastomosis. Three dogs also had bony metaplasia. The Foci of metaplasia had no relation to sutures. This lesion begins with a build-up store of glycosaminoglycans in the tunica media. Later, elastic fibers show a fenestration and dissolution, while chondrocytes replace smooth muscle fibres. We suggest that the rupture of the vasa vasorum during operation and the traction and pulsation of the by-pass over the area of suture could be the cause of this direct metaplasia.

Inflammatory metastatic carcinoma. A clinical and histopathologic study of three cases.

The inflammatory metastatic carcinoma is a rare clinical entity, histologically characterized by lymphatic dermal invasion by neoplastic cells. We report three cases of inflammatory metastatic carcinoma, two of them secondary to a breast carcinoma, and the third secondary to a colon adenocarcinoma.