Factors related to muscle strength in postmenopausal women aged younger than 65 years with normal vitamin D status.

Objective: The study aimed to determine the impact of age, age at menopause, body mass index (BMI), and lumbar and hip bone mineral density (BMD) on muscle strength in young postmenopausal women with normal vitamin D levels. Methods: This was a cross-sectional study performed in 392 postmenopausal women aged <65 years with normal serum 25-hydroxyvitamin D levels (≥30 ng/ml) and no physical disabilities. The following variables were recorded: age, age at menopause, BMI, BMD (measured by dual-energy X-ray absorptiometry [DXA] scanning and expressed as lumbar and hip T-scores), and dominant hand grip strength (measured with a digital dynamometer). Results are reported as mean ± standard deviation or odds ratio (OR) and 95% confidence interval (CI) as appropriate. Results: The mean age of the whole sample was 57.30 ± 3.69 years with a mean age at menopause of 50.46 ± 2.16 years and a mean BMI of 24.93 ± 3.78. Mean DXA results were lumbar T-score of -1.16 ± 1.18 and hip T-score of -0.98 ± 0.93. The mean dominant hand grip force was 24.10 kg. A total of 12.2% (48/392) of women were diagnosed with dynapenia using a cut-off value of <20 kg. A weak but significant inverse correlation was found between grip strength in the dominant hand and age (r = -0.131, p = 0.009). Multivariable logistic regression analysis determined that earlier age at menopause (50 years or younger) was significantly associated with a higher risk of dynapenia (OR 2.741, 95% CI 1.23-6.11, p = 0.014). No other significant association was found with the other variables. Conclusions: A total of 12.2% of the studied young postmenopausal women with normal vitamin D status had dynapenia. There was a weak inverse correlation between grip strength and age, and earlier age at menopause was associated with an increased dynapenia risk.

Impact of Surgery on the Evolution of Uterine Sarcomas.

STUDY OBJECTIVE: To identify the characteristics of uterine sarcomas and assess the impact of morcellation on prognosis. DESIGN: Case-control study. (Canadian Task Force classification II-2). SETTING: Hospital Quiron-Dexeus, an academic hospital. PATIENTS: Patients with uterine sarcoma histologically diagnosed and treated in our center between 1987 and 2013. INTERVENTION: All descriptive data, including type of surgery and clinical and pathological data, were reviewed. Survival analysis was performed comparing patients with hysterectomy/myomectomy without any type of morcellation and patients with morcellation during surgery. MEASUREMENTS AND MAIN RESULTS: A total of 37 sarcomas were diagnosed during the study period. The most common symptom was metrorrhagia (50%). The indication for surgery was related to myoma growth in 40% of cases and to metrorrhagia in 37.1% of cases. Open surgery was performed in 23 patients (62.2%), and laparoscopy was performed in 9 (24.3%). Myomectomy was performed in 14 patients (37.8%), and 23 patients (62.1%) underwent hysterectomy as initial surgery. Morcellation for tumor extraction was done in 8 cases (21.6%). Survival analysis by surgical approach showed increased disease-free survival (DFS) in the laparotomy group compared with the laparoscopy group (median, 70.3 months vs 10.4 months; p = .018). Median DFS according to type of surgery was 6.3 months in morcellation cases, 11.9 months in vaginal fragmentation cases, and 149.9 months in nonmorcellated cases (p < .002). The median time to progression was shorter in morcellated cases (laparocopic and vaginal) compared with nonmorcellated cases (11.9 vs 14.9 months; p < .001). No statistically significant differences in prognosis were related to myomectomy versus hysterectomy; however, there were significants difference between morcellation and nonmorcellation cases. CONCLUSION: Taking into account the negative impact of morcellation in sarcomas, the use of this technique should be reconsidered in cases of myoma with atypical clinical presentation or symptomatology. Patients must be informed about the possibility of a nonidentified sarcoma and the possible impact on prognosis resulting from its morcellation.

Biological and pathological features in pregnancy-associated breast cancer: a matched case-control study.

BACKGROUND: The prognosis for breast cancer has been considered to be worsened by the coexistence of pregnancy. However, to date, significant controversy still exists regarding the pathological tumor features and prognosis of patients diagnosed with pregnancy-associated breast cancer (PABC). The aim of the present study was to analyze the different prognostic factors and outcome in PABC subset versus a non-PABC control group matched for age and year of diagnosis. MATERIALS AND METHODS: A total of 56 PABC cases were diagnosed from 1990 to 2008, for whom 73 non-PABC patients were identified. Pathological characteristics, immunohistochemical fea- tures, and differences in overall and disease-free survival were compared between both groups. RESULTS: Compared to non-PABC controls, PABC patients presented more advanced disease (31% vs 13%, p = 0.024) and greater lymph node involvement (53% vs 34%, p = 0.034). Pathological and tumor features tended to present poorer prognostic factors in the PABC subset. Survival was poorer in the PABC patients (five-year DFS 68% in PABC vs 86% in non-PABC, p = 0.12). However, analysing survival adjusted for stage and age, the authors did not find significant differences between both groups. CONCLUSIONS: PABC patients tended to be diagnosed in advanced breast disease and presented tumors with adverse pathological prognostic factors. While the authors found a poorer outcome in PABC group, no significant differences were observed with stage-matched analysis. The present results may suggest that the poorer prognosis observed within PABC women could not be due to pregnancy itself, but with a delay in diagnosis and tumor subtype pathological features.

Hormone receptor and HER2 status: The only predictive factors of response to neoadjuvant chemotherapy in breast cancer.

We report our experience in neoadjuvant breast cancer chemotherapy in a single centre between 2000 and 2011. We looked for predictive factors for response to neoadjuvant chemotherapy in the present study. A total of 110 consecutive breast cancer patients were treated with neoadjuvant chemotherapy in our centre. Pathological response was achieved in 24 HR+/HER2- (38.7%), 25 HER2+ (67.6%) and five triple-negative (45.5%) (p = 0.02) patients. No statistically significant differences were found in pathological tumour response according to T stage. The multivariate analysis revealed tumour subtype was the only associated factor for pathological response, with HER2 + tumours the best responders, OR 3.9 (1.5-9.9): 5-year DFS was 40% HER2+/no response; 78% HER2+/response; 65% HR+/HER2-/no response; 82% HR+/HER2-/response; 25% triple-negative/no response and 100% triple-negative/response. HR and HER2 status were the only prognostic factors for pathological response. pCR was correlated with survival in all tumour subtypes.

Atypical ultrasonographic presentation of ovarian vein thrombosis.

Ovarian vein trombosis (OVT) is a pathologic entity classically considered as a postpartum complication and only rarely associated with other diseases. Due to its vague symptoms, it is usually underdiagnosed. However its consequences can be fatal. We report a case of an incidental finding of ovarian thrombosis in an asymptomatic 45-year-old woman who underwent surgery due to the ultrasonographic finding of a para-ovarian cyst.

Role of lymphadenectomy in endometrioid endometrial cancer.

OBJECTIVE: To assess the risk factors associated with node involvement. STUDY DESIGN: In the period 1990-2008 a total of 265 endometrial cancers were treated in the Institut Universitari Dexeus. We analysed the rate of myometrial invasion, tumour grade, histological type and node involvement. RESULTS: Overall, 86% of tumours were endometrioid, 5.3% papillary serous, 4.9% mixed and 2.6% endometrial stroma sarcoma. Among those with endometrioid histology, lymphadenectomy was not performed (NL) in 85 cases (37.2%), whereas pelvic lymphadenectomy (PL) or pelvic and aortic lymphadenectomy (PAL) was carried out in 84 (36.84%) and 59 patients (25.87%), respectively. In NL patients the overall disease-free survival (DFS) rate at five years was 92.8%. In the PL group, node involvement was observed in 2.4% of cases and the five-year DFS rate was 92.3%. Among PAL patients, 18.6% showed node involvement (72.7% positive pelvic nodes and 63.6% aortic). Aortic involvement was present in 5.9% of cases when there was no pelvic disease, whereas in the presence of positive pelvic nodes the rate of aortic involvement was 50%. The DFS rate at five years was 93.6%. Referring to the risk factors, when infiltration was > 50% of the myometrium, lymph node involvement occurred in 37% of cases and G3 tumors in 45.5%. CONCLUSIONS: Node involvement is more commonly observed in cases with > 50% myometrial invasion and G3, accounting for 25% of cases that can be considered as at-risk patients. When node involvement is present it is equally distributed between the pelvic and aortic levels. As node involvement is a predictive factor for distant metastasis, the 25% of patients considered to be at risk should undergo pelvic and aortic lymphadenectomy

Three-dimensional power Doppler color ultrasonographic features of a minimal deviation adenocarcinoma of the uterine cervix.

A case of minimal deviation adenocarcinoma of the cervix in a 34-year-old female is presented. The ultrasonographic and three-dimensional power Doppler color studies revealed a nodular cervical lesion with vascularization more prominent in the center of the nodule but also present at the periphery. The imaging diagnosis was suggestive of a myoma but with more vascularization than a conventional one.

Morphologic changes in breast biopsies after duct endoscopy.

Duct endoscopy is a recent technique used for a direct view of the breast ductal system. The aim of this study is to determine any morphological changes in breast tissue attributable to low-pressure irrigation with saline solution that the technique requires. A total of 26 breast biopsies from patients who underwent ductal endoscopy before surgery were compared with 26 breast specimens from the retroareolar region. Breast specimens from duct endoscopy showed more frequent epithelial detachment (73%), epithelial loss (35%), periductal clefts (77%), stromal disaggregation (46%) and displacement of epithelial cells into the stroma (27%) than the control group in which epithelial detachment was seen in 4% of patients, periductal clefts in 15%, and stromal disaggregation in 15%. Epithelial loss and epithelial displacement where not seen in the control group. Although low-pressure fluid perfusion used for duct endoscopy induced morphological changes in breast tissue, these can easily be distinguished from malignancy, and are most likely to occur as the result of duct rupture.

Role of microsatellite instability in borderline ovarian tumors.

This study was designed to establish the role of microsatellite instability (MSI) in the development of sporadic tumors of the ovary. The instability of 6 microsatellites (BAT25, BAT26, NME1, D17S250, D5S346 and D2S123) was determined by comparing MSI in healthy and tumoral tissue in each of 40 patients undergoing surgery for a sporadic ovarian tumor. BAT26 and D2S123 instability was detected in borderline tumors, and ovarian carcinomas were found to present instability in the microsatellites BAT25, NME1 and D17S250. Our findings indicate that microsatellite instability lacks a significant role in the appearance or progression of sporadic ovarian tumors.

Localized fibrous tumor of the pleura: immunohistochemical and flow-cytometric DNA study.

This report describes three cases of localized fibrous tumor of the pleura (LFTP) with clinical and pathological differences. Case 1 presented with symptoms; the tumor size was 6.5 cm and it was attached to the lung and chest wall; histologically it was composed of spindle cells with pleomorphism, mitoses, hemorrhage and necrosis. Cases 2 and 3 were casual findings and consisted of well-circumscribed tumors of 3 and 8.5 cm, respectively; histologically both showed hypocellularity. All cases exhibited positive stains for vimentin and negative for keratin. These results, added to histological features, suggested a mesenchymal origin. Flow cytometry quantitation of DNA disclosed a diploid pattern in all three cases with a small "near diploid" cell population additionally in Case 1; the S-phase fraction was low in all cases. These findings, that could be considered favourable prognostic signs, and the complete tumoral resection performed in the three tumors, could explain the absence of recurrences after 32, 27 and 19 months, respectively.

Disseminated and recurrent sarcoid-like granulomatous panniculitis due to bovine collagen injection.

Three to five percent of patients treated with injectable collagen implants have adverse local reactions. Systemic signs or symptoms are infrequent. We describe the case of a 53-year-old woman who developed local and general complaints 2 months after receiving two collagen injections in both nasolabial folds. She presented asthenia, malaise, polyarthralgia and inflammatory nodular panniculitis in the places of injection as well as on the forearms and lower extremities. Skin testing was compatible with hypersensitivity to collagen. This case raises the question as to whether the injection of animal-derived collagen induces manifestations similar to those observed in connective autoimmune diseases or human adjuvant disease.

Congenital plate-like osteoma cutis of the forehead: an atypical presentation form.

Cutaneous ossifications or osteoma cutis can be found in many syndromes. Primary osteoma cutis, present since birth or the first months of life, in the absence of metabolic disorders or trauma, is found in congenital plate-like osteoma cutis and progressive osseous heteroplasia, coexisting in the latter with deep connective tissue ossifications. This report documents the case of a 7-year-old female with a plate-like cutaneous ossification of the forehead causing aesthetic deformities. Other dermal ossifications in the inguinal and preauricular region, as well as the left hand and a small focus in the extraocular muscles of the left orbit, were also present. These lesions did not show progression, and most of them were present since birth. The lesion of forehead was treated surgically. The lack of progression and the fact that the orbital lesion was solitary still fits the criteria for the diagnosis of plate-like osteoma cutis. Plate-like osteoma cutis and progressive osseous heteroplasia may represent varieties of the same disorder.

Endometrial cancer: factors affecting survival.

PURPOSE: To evaluate the influence in survival of clinical and pathological findings in patients with endometrial cancer. METHODS: In 152 women treated for endometrial cancer from 1982 to 1996, personal, obstetrical and oncological data, histology, grade, myometrial invasion, peritoneal cytology, FIGO stage and treatment were correlated with survival. RESULTS: Mean age was of 60.3 +/- 11.1 years old. Eight patients had a previous history of other neoplasms (seven of them gynecological). The mean clinical complaint was abnormal uterine bleeding. The most common histological type was endometrioid (84.9%), only 51 cases did not show myometrial invasion and 119 women were in Stage I at diagnosis. Peritoneal cytology was negative in 113 patients. Seven patients out of 85 in whom lymphadenectomy was performed showed metastasis. Seventeen of the patients died. The factors influencing survival were age, myometrial invasion and lymph node metastasis. CONCLUSION: Lack of myometrial invasion, absence of lymph node metastasis and age younger than 60 years seem to be the most significant predicting factors of survival.

Invasive micropapillary carcinoma. Distinct features of a poorly recognized variant of breast carcinoma.

INTRODUCTION: Invasive micropapillary carcinoma (IMC) is a histological variant of breast cancer with a poor prognosis. MATERIAL AND METHODS: Pathological findings of 15 cases of IMC are compared with those of 144 invasive duct carcinoma (IDC) and 10 invasive papillary carcinoma (IPC). RESULTS: Only 33% of cases were diagnosed in stage I. Mean tumor size was 2.3 cm. Nuclear grade 3 was found in 60% of cases, aneuploidy in 78%, and 92% had hormone receptors. Nine patients showed lymph node metastasis. Tumor size, nuclear grade, mitotic rate and lymph node involvement were higher in IMC when compared with IDC grade I and IPC, but not when compared with IDC grade II and III. Four cases of IMC (27%) recurred before two years. Recurrences and lymph node metastases showed the same architectural pattern as the primary tumor. DISCUSSION: IMC shows a high incidence of lymph node involvement and a high early recurrence rate.

[Extrabronchial small-cell carcinoma: apropos 6 cases]. / Carcinoma de célula pequeña extrabronquial: a propósito de 6 casos.

Extrabronchial small cell carcinoma (ESCC) is an infrequent tumor with controversial histogenesis, clinical evolution and therapeutic strategy. The aim of this study was to know the immunohistochemical features and the clinical evolution of patients diagnosed of ESCC during a 10 year period. All the diagnoses of small cell carcinoma (bronchial and extrabronchial) carried out by the Unit of Pathology between 1980-1989 were reviewed. In all the ESCC an immunohistochemical study was performed with three neuroendocrine markers, chromogranin, neurospecific enolase and synaptophysin. The clinical evolution of the patients is described. The 6 patients with ESCC represented 4.7% of all the small cell carcinomas. The primary localization was: parotid, urinary bladder, the skin, maxillary sinus and esophagus (2 patients). In five cases positivity was observed for one or more of the neuroendocrine markers. In two cases the ESCC was associated with differentiated cell populations (squamous carcinoma). The diagnosis of ESCC logically obliges the bronchial origin and the presence of ectopic hormonal secretion syndromes to be discarded. The administration of chemotherapy regimes used in small cell lung carcinoma is advised.

[Intraluminal crystalloids in prostatic carcinoma: morphologic and histochemical study]. / Cristaloides intraluminales en el carcinoma de próstata: estudio morfológico e histoquímico.

The histological sections of 302 diagnosed cases of prostate carcinoma were analyzed for intraluminal crystalloids, correlating their presence, number and characteristics with other morphological parameters used for the diagnosis of prostate carcinoma. Evidence of these structures was found in 65 cases (21.5%). The majority developed in malignant glands though they were also found in benign glands adjacent to cancerous foci. Their presence indicates good tumoral differentiation and both their number and shape are dependent on the tumour's histological grade.

[Impression cytology and LASIK]. / Citología de impresión y LASIK.

PURPOSE: To study the ocular surface changes following laser assisted in situ keratomileusis (LASIK). METHODS: Prospective study of pre and post-LASIK impression cytology in two sites of the conjunctival epithelium of 12 eyes from 6 patients. The samples were studied for changes in cellularity, cell size, nucleus size, nucleus-cytoplasm ratio, number of goblet cells, PAS positivity and number of inflammatory cells. RESULTS: All the samples except two, showed pathological changes like a decrease in nuclear size, increase in cytoplasm, change in nucleus-cytoplasm ratio, a significant decrease in goblet cell density and certain degree of squamous metaplasia. CONCLUSIONS: One month following LASIK we observed histopathologic changes in the perilimbal conjunctiva, mainly a decrease in the number of goblet cells and different grades of squamous metaplasia.

[De novo growth of a capillary hemangioma of the conjunctiva]. / Crecimiento de novo de un hemangioma capilar conjuntival.

CLINICAL CASE: A 22-year-old woman patient, diagnosed with an inclusion cyst of the conjunctiva in the nasal sector of the left eye, who after 2 shot/needle injections in the lesion came to our clinic with a dense subconjunctival hemorrhage in four quadrants and with severe pain. After excision biopsy, a capillary hemangioma of the conjunctiva was diagnosed. DISCUSSION: Conjunctival capillary hemangioma is mainly a benign lesion, asymptomatic and mostly congenital in origin, its progression or de novo growth is rare in adulthood.