The effectiveness of electrocautery ablation for the treatment of high-grade anal intraepithelial neoplasia in HIV-infected men who have sex with men.

OBJECTIVES: Electrocautery is one of the main treatment options for high-grade anal intraepithelial neoplasia (HGAIN). However, data regarding its efficacy are scarce. The aim of the study was to evaluate the effectiveness of electrocautery for the treatment of HGAIN. METHODS: An observational study of HIV-infected men who have sex with men (MSM) who underwent screening for anal dysplasia was carried out. The on-treatment effectiveness of electrocautery was evaluated (according to biopsy findings measured 6-8 weeks after treatment) in patients with HGAIN. A complete response was defined as resolution of anal intraepithelial neoplasia (AIN), a partial response as regression to low-grade AIN and recurrence as biopsy-proven HGAIN during follow-up. RESULTS: From May 2009 to November 2014, 21.9% (126 of 576) of patients screened were found to have HGAIN. Electrocautery effectiveness was evaluated in 83 patients. A complete response was observed in 27 patients [32.5%; 95% confidence interval (CI) 23.4-53.2%], a partial response in 28 patients (33.7%; 95% CI 24.5-44.4%) and persistence in 28 patients (33.7%; 95% CI 24.5-44.4%). The patients with the most successful results (81.8%) required two to four sessions of electrocautery. After a mean follow-up of 12.1 months, 14 of 55 patients with a response (25.4%; 95% CI 15.8-38.3%) developed recurrent HGAIN within a mean time of 29.9 months (95% CI 22-37.7 months). No patient progressed to invasive cancer during the study or developed serious adverse events after treatment. No factors associated with poor response or recurrences were observed. CONCLUSIONS: Although electrocautery is the standard treatment for anal dysplasia, almost 50% of patients with HGAIN in our study did not respond or relapsed. New treatment strategies are necessary to optimize the management of anal dysplasia.

nm23-H1 immunoreactivity as a prognostic factor in differentiated thyroid carcinoma.

Several prognostic factors have been proposed to identify the patients at risk to develop metastases in differentiated thyroid carcinoma. Reduced nm23-H1 expression (a metastatic suppressor gene) has been correlated with high tumor metastatic potential in various human carcinomas, but the results obtained in differentiated thyroid carcinoma remain controversial. To elucidate the usefulness of nm23-H1 as a differentiated thyroid carcinoma prognosis factor, we evaluate the relationship between nm23-H1 immunoreactivity as well as both clinical status and patient outcome. For this purpose, thyroid resected specimens obtained from 94 differentiated thyroid carcinoma consecutive patients (64 papillary and 30 follicular) with at least 5 yr of follow-up were stained using monoclonal antibody to nm23-H1. We did not observe any relationship between nm23-H1 immunoreactivity and age, gender, initial differentiated thyroid carcinoma stage, local recurrence, or distant metastases in patients with papillary carcinoma. However, in patients with follicular carcinoma, a significant inverse association between metastatic disease and the expression of nm23-H1 product was obtained (P < 0.05). In addition, significant differences were found in the survival curves according to nm23-H1 immunoreactivity (log-rank P < 0.01). Finally, nm-23-H1 immunoreactivity was more specific but less sensitive than AMES score to predict metastases. In conclusion, our results suggest that nm23-H1 immunostaining could be added to the classic prognostic factors currently used to predict the outcome of patients with follicular thyroid carcinoma.

Malignant fibrous histiocytoma of bone at the site of a total hip arthroplasty. A case report.

A patient who presented with a malignant fibrous histiocytoma in the proximal femur after a total hip replacement is reported. The arthroplasty was of the Charnley-Müller type with detachment of the greater trochanter; polymethylmethacrylate cement was used. The possible tumour-forming effect of implant materials is discussed and the literature reviewed.

Cytologic study of renal angiomyolipoma by fine-needle aspiration biopsy: report of four cases.

Four cases of renal angiomyolipoma (AML) diagnosed by fine-needle aspiration biopsy (FNAB) are reported. One case was associated with the clinical complex of tuberous sclerosis. The tumors were solitary in two cases and multiple and bilateral in the fourth. The cytologic features of the four cases were similar to those described in the literature: smooth muscle cells intermingled with mature fat cells and blood vessels, together with a lipoidic background. These tumors are currently considered benign although they may present characteristics accepted as criteria of malignancy in other tumors: pleomorphism and atypical smooth muscle cells, vascular invasion, capsular rupture, and lymphatic involvement. We conclude that it is important and possible to establish preoperative cytologic diagnosis, since treatment of these tumors is conservative and obviates aggressive nephrectomy.

Fine-needle aspiration biopsy of hepatic papillary cystadenocarcinoma in Caroli's disease.

A case of papillary adenocarcinoma arising in Caroli's disease (CD) in a 25-yr-old woman is reported. The diagnosis of malignancy was made by ultrasound-guided, fine-needle aspiration biopsy (FNAB). As there were no metastasis, a liver transplant was performed and the diagnosis was histologically confirmed. Only 22 cases of malignant transformation of CD have been reported to date, all among middle-aged subjects (mean age: 52 yr) of both sexes. Most of these reported cases (83%) were found to be bile duct adenocarcinomas with occasional reports of hepatocellular and undifferentiated carcinomas. Our case is the youngest reported to date and the first to be diagnosed cytologically.

Cytologic diagnosis of salivary duct carcinoma: a review of seven cases.

The cytomorphologic findings in fine-needle aspirates from 7 cases of salivary duct carcinoma (SDC) are reviewed and correlated with the histologic features. Malignant cytologic characteristics are clear in this tumor, and no false-negative results were obtained. But the absence of cribriform or papillary groups suggests an inconclusive diagnosis and sometimes the need to establish a differential diagnosis with other salivary tumors, and in particular with adenocarcinoma not otherwise specified (ADC-NOS) and high-grade mucoepidermoid carcinoma (h-g MEC). The pitfalls in the cytologic diagnosis of this tumor are discussed. In addition, the literature on the subject is reviewed.

Leishmania lymphadenitis diagnosed by fine-needle aspiration biopsy.

A case of Leishmania lymphadenitis which presented clinically as an isolated left laterocervical lymph node is described. Diagnosis was made by fine-needle aspiration biopsy (FNAB), as in other cases previously reported. The material obtained yielded abundant histiocytes, multinucleated giant cells, and epithelioid microgranulomas with Leishman-Donovan pathognomic bodies in the cytoplasm of cells, together with free forms of the parasite. This paper comments on the main differential diagnoses to be considered in our region when faced with granulomatous adenitis and the role of FNAB in the identification of this parasite in endemic areas.

[Pheochromocytoma and sudden death (author's transl)]. / Feocromocitoma y muerte súbita.

Five cases of pheochromocytoma are described in which sudden death was the form of the initial clinical presentation in almost all of them. After a brief review on the history and the incidence of the tumor within the general population, diverse cases are analyzed from a clinical point of view and in relation to the data appeared in the literature. In the analysis of the symptoms emphasis is placed on the important psychomotor manifestations which are present in the majority of those patients and which causes serious difficulties in the initial diagnosis. All of the patients showed signs of shock at the time of being observed or during the course of this observation, and in the majority of them the presence of acute pulmonary edema was confirmed; facts which we attribute to an initial hypertensive episode associated to a left heart failure. The onset of the crisis in two patients was related to known triggering factors: anesthesia and sulpiride. In other two patients associated conditions were diagnosed: medullary carcinoma of the thyroid gland in one of them, and cystic necrosis of the middle layer of the aorta in the other.

[Primary solid hepatic sarcoma. Diagnosis by cytological puncture]. / Sarcoma sólido hepático primitivo. Diagnóstico por punción citológica.

The clinical case of a 56 year old patient who developed a grafted hepatic tumoration on a year after diagnosis of liver cirrhosis of alcoholic etiology is reported. Diagnosis of the mass was made by fine needle aspiration punction ecographically guided obtaining a cellular block which, upon anatomopathological study, revealed the presence of a malignant mesenchymal tumor; a leiomyosarcoma. Not only is this type of primary hepatic tumor rare but its appearance on a liver of alcoholic cirrhosis is also of interest. It is much more common to find primary hepatic tumors of epithelial origin, concretely hepatocarcinomas. The value of this finding is discussed with the importance of the ecographically guided punction enabling the establishment of a precise histological diagnosis being underlined. The prognosis of malignant hepatic mesenchymal tumors is commented upon as well as the long survival associated to the same, which, in this case, was longer than 18 months.

Clinical significance of RET/PTC and p53 protein expression in sporadic papillary thyroid carcinoma.

AIMS: Rearranged during Transfection (RET)/papillary thyroid carcinoma (PTC) and p53 are two genes involved in the pathogenesis of PTC. It has been suggested that RET/PTC expression is associated with higher rates of local extension and lymph node involvement, whereas p53 mutations are more frequent in poorly differentiated and anaplastic carcinomas. In addition, experimental studies have shown that p53 activity can modify the behaviour of PTC carrying RET/PTC. The aim of this study was to investigate the expression of both RET/PTC and p53 in order to evaluate their usefulness as prognostic factors. METHODS AND RESULTS: Resected specimens of 61 cases of PTC were studied immunohistochemically using a polyclonal antibody to RET and a monoclonal antibody to p53 protein. RET/PTC expression was associated with extrathyroid extension of PTC, at diagnosis (P < 0.05). In contrast, no relationship between p53 immunoreactivity and clinical status was found. In addition, p53 expression was more prevalent among RET/PTC+ patients, and significantly influenced the relationship observed between RET/PTC and extrathyroid extension of the disease. CONCLUSION: Our results suggest that immunohistochemistry for both PTC/RET and p53 could be useful in the clinical evaluation of patients with PTC.

Subretinal membranes in proliferative vitreoretinopathy. An immunohistochemical study.

Proliferative vitreoretinopathy may be associated with taut subretinal membranes (SRMs) that prevent retinal reattachment. Light microscopic and immunohistochemical procedures were used to identify the cell composition of 15 surgically excised SRMs. Anti glial fibrillary acidic protein (anti-GFAP) and anti S-100 protein stainings were used to examine the distribution of glial cells, and antikeratin staining was used to investigate the distribution of epithelial cells. Our findings confirm the presence of retinal pigment epithelium (RPE) and glial cells in human SRMs. A semiquantitative evaluation of the immunohistochemical studies demonstrated the prevailing role of cells derived from the RPE (48.4%). The glial component of the SRMs appeared to be smaller than in epiretinal membranes, but was not negligible (30.8%). A high incidence (26.6%) of damaged external retina adhered to the SRMs was also observed.

Epiretinal membranes in Tersons syndrome. A clinicopathologic study.

BACKGROUND: Visual impairment resulting from retinal, subhyaloid, or vitreous hemorrhages in association with Tersons syndrome is often significant. The most common long-term sequelae that may result in permanent visual deficit is the formation of an epimacular membrane. METHODS: This report provides clinicopathologic documentation of epiretinal membrane proliferation secondary to Tersons syndrome. Pars plana vitrectomy was performed in 16 eyes of 11 patients with Tersons syndrome. After removal of vitreous hemorrhage, epimacular membranes were found in 10 eyes (62.5%). The posterior cortical vitreous and the epiretinal tissue were examined histologically. RESULTS: Immunostainings with glial and retinal pigment epithelial cell markers showed that the majority of cells derived form the glia. Perls staining, specific for iron, showed that the high melanic-like component contained in the histopathologic samples corresponded to degradation of blood products secondary to chronic hemorrhage. CONCLUSION: The high risk of epiretinal membrane formation and the toxicity of blood breakdown products over the inner retina worsen the long-term visual prognosis in Tersons syndrome. Early surgery is advocated in such cases.

Extra-uterine müllerian carcinosarcoma.

Carcinosarcoma of the Müllerian system is an uncommon tumor. We report here a case of extra-uterine carcinosarcoma from pelvic wall, presenting 11 years after hysterectomy. Accidental surgical implantation of endometrioid cells is suggested as the pathogenic mechanism in this case.

CT of primary bilateral adrenal lymphoma.

Two cases of bilateral primary adrenal lymphoma are presented. One case had a cystic appearance and the other a homogeneous density.