RESUMO
AIM: Balanitis xerotica obliterans (BXO) is a disease of the skin and mucosa of male genitals of unknown etiology that may affect children of any age. It has a low incidence (9-19%) and in adults is considered a potential premalignant lesion. The aim of our study is to establish the incidence of BXO in our center and to determine its correlation between the clinical and immunohistochemical (IHC) findings. METHODS: Prospective cohort including all children < 14 years with foreskin pathology that required a circumcision between 2014-2016. Statistical analysis of the clinical characteristics, histological and IHC findings searching for inflammatory response, premalignant lesions and microbiological findings. RESULTS: A total of 176 boys with phimosis had circumcision with a mean age of 7 ± 3 years (Range 2-14). Presurgical diagnosis of BXO was suspected in 28.4% (n= 50) whereas the AP confirmed a total of 29.5% (n= 53) with a very good interobserver concordance (kappa= 0.81: p< 0.01). Previous treatment with corticoids in BXO was found in 63.5% (n= 33/52). Meatal stenosis was found in 7.69% (n= 4/52) requiring meatal/urethral dilations. Patients with BXO had a T-Lymphocytes CD3+ mediated inflammatory response with a positive correlation between tumor suppressing protein (p53) expression and chronic inflammation. CONCLUSIONS: BXO is a chronic inflammatory disease mediated by T-lymphocytes with an incidence greater than previously reported. Surgeons' criterion has a very good concordance with the AP findings. The elevation of p53 in children with BXO may indicate a plausible malignant potential that may require a surgical treatment (circumcision) and an adequate follow-up.
OBJETIVO: La balanitis xerotica obliterans (BXO) es una enfermedad de etiología incierta, que afecta a piel y mucosa de genitales masculinos de cualquier edad. La incidencia en niños es baja (9-19%) y en adultos se considera una lesión premaligna. El objetivo de este estudio es establecer la incidencia de BXO en nuestro centro y determinar la correlación entre las características clínicas y los hallazgos inmunohistoquímicos (IHQ). METODOS: Cohorte prospectiva de niños ≤14 años con fimosis circuncidados entre 2014-2016. Análisis estadístico de las características clínicas e histológicas e IHQ para valorar la respuesta inflamatoria, presencia de lesiones premalignas y asociaciones microbiológicas. RESULTADOS: Se incluyeron 176 pacientes circuncidados con una edad media de 7 ± 3 años (rango 2-14 años). La sospecha clínica de BXO, 28,4% (n= 50), se confirmó mediante anatomía patológica en 29,5% (n= 52) con muy buena fuerza de concordancia interobservador (kappa= 0,81: p< 0,01). El 63,5% (n= 33/52) recibieron corticoterapia como tratamiento inicial. El 7,69% (4/52) presentaron estenosis meatal requiriendo dilataciones meatales/uretrales. Los casos de BXO presentaron una respuesta mediada por linfocitos-T: CD3+ (p< 0,01) y correlación positiva con la sobreexpresión de proteína supresora de tumores (p53) (p< 0,01). CONCLUSIONES: BXO es una enfermedad inflamatoria crónica mediada por linfocitos-T con una incidencia mayor a la reportada. La concordancia interobservador entre la sospecha de BXO y la confirmación histológica es muy buena. La elevación de p53 en los pacientes con BXO indica un posible potencial maligno que requiere tratamiento quirúrgico (circuncisión) y un seguimiento adecuado.
Assuntos
Balanite Xerótica Obliterante/diagnóstico , Circuncisão Masculina/métodos , Prepúcio do Pênis/cirurgia , Fimose/cirurgia , Adolescente , Balanite Xerótica Obliterante/epidemiologia , Balanite Xerótica Obliterante/cirurgia , Criança , Pré-Escolar , Estudos de Coortes , Prepúcio do Pênis/patologia , Humanos , Incidência , Inflamação/patologia , Masculino , Fimose/diagnóstico , Estudos Prospectivos , Linfócitos T/metabolismo , Proteína Supressora de Tumor p53/metabolismoRESUMO
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents in some cases with hemostatic and thrombotic complications. Pheochromocytomas are unusual, though potentially lethal tumors. Herein we describe the first case of hemorrhage in a pheochromocytoma related to SARS-CoV-2 infection. A 62-year-old man consulted for syncope, fever, and palpitations. He was diagnosed with SARS-CoV-2 pneumonia and presented with a hemorrhage in a previously unknown adrenal mass, which resulted in a catecholaminergic crisis. Medical treatment and surgery were required for symptom control and stabilization. We hereby alert clinicians to watch for additional/unreported clinical manifestations in COVID-19 infection.
Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , COVID-19/complicações , Hemorragia/complicações , Feocromocitoma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/complicaçõesRESUMO
Tumours of the middle ear are rare. Among them glomus tympanicum is the most frequent, followed by adenoma of the middle ear (AME). This insidious pathology entity displays unspecific clinical and audiological features. Advances in histology and immunohistochemistry have greatly contributed to an accurate diagnosis. We report our experience with two patients, a middle-aged man and a woman, diagnosed in our hospital. Both patients underwent surgical treatment and have shown no signs of recurrence after a 27- and 28-month follow-up. In both cases an accurate diagnosis was confirmed by histological and immunohistochemical analysis.
Assuntos
Adenoma/diagnóstico , Neoplasias da Orelha/diagnóstico , Orelha Média/patologia , Adenoma/complicações , Adenoma/cirurgia , Neoplasias da Orelha/complicações , Neoplasias da Orelha/cirurgia , Orelha Média/diagnóstico por imagem , Orelha Média/cirurgia , Feminino , Perda Auditiva/diagnóstico , Perda Auditiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Cytoreductive surgery with peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) represents a radical therapeutic approach to achieve complete cytoreduction in ovarian peritoneal carcinomatosis. The aim of the present study was to analyze the outcomes obtained by the application of these procedures in a single center with extensive experience treating peritoneal carcinomatosis. PATIENTS AND METHODS: A series of 218 consecutive patients diagnosed with peritoneal carcinomatosis from primary or recurrent ovarian cancer (FIGO stage IIIC-IV) and treated with CRS + HIPEC between January 1996 and June 2012 were included in this observational study. RESULTS: Peritoneal carcinomatosis was treated primarily in 56% (124/218) of the cases and recurrently in 43% (94/218). A total of 42/218 patients (19%) presented with FIGO stage IV. Compared to recurrent cases, patients with primary ovarian carcinomatosis were older and presented higher Peritoneal Cancer Index (PCI) and percentage of FIGO stage IV; however, no significant differences in survival (5-year overall survival in patients with R0 cytoreduction, 63% and 56%, respectively) were observed. Cytoreduction score, PCI, lymphatic involvement and surgical morbidity ≥Grade III were statistically significant prognostic factors for survival in both univariate and multivariate analysis. CONCLUSIONS: CRS + HIPEC treating macroscopic and microscopic disease is currently an excellent surgical approach to achieve high rates of complete cytoreduction and improve survival in patients with peritoneal carcinomatosis from ovarian cancer. In order to minimize the high potential morbidity of these procedures, CRS + HIPEC should be performed in highly experienced centers.
Assuntos
Carcinoma/terapia , Hipertermia Induzida , Recidiva Local de Neoplasia/patologia , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/terapia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/mortalidade , Carcinoma/secundário , Cisplatino/administração & dosagem , Procedimentos Cirúrgicos de Citorredução , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Infusões Parenterais , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Paclitaxel/administração & dosagem , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/secundário , Taxa de Sobrevida , Adulto JovemAssuntos
Glomerulonefrite/patologia , Podócitos/patologia , Adulto , Biomarcadores/análise , Desdiferenciação Celular , Progressão da Doença , Glomerulonefrite/complicações , Soronegatividade para HIV , Humanos , Deficiência Intelectual/complicações , Deficiência Intelectual/genética , Queratinas/análise , Antígeno Ki-67/análise , Falência Renal Crônica/etiologia , Falência Renal Crônica/terapia , Glomérulos Renais/ultraestrutura , Macrófagos/ultraestrutura , Masculino , Podócitos/química , Diálise RenalRESUMO
The Burkitt's lymphoma is a haematological neoplasia typical of early ages. In our country, the lymphatic nodes affectation is the most usual. We present a case report with a 12 year-old boy who consults for a asymptomatic cervical mass. The ultimate diagnosic was a nasopharyngeal Burkitt's lymphoma with neck extension.
Assuntos
Linfoma de Burkitt/patologia , Neoplasias Nasofaríngeas/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma de Burkitt/diagnóstico por imagem , Linfoma de Burkitt/tratamento farmacológico , Criança , Humanos , Masculino , Neoplasias Nasofaríngeas/diagnóstico por imagem , Neoplasias Nasofaríngeas/tratamento farmacológico , Tomografia Computadorizada por Raios XAssuntos
Neoplasias Encefálicas , Neoplasias Neuroepiteliomatosas , Adolescente , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/fisiopatologia , Criança , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Neoplasias Neuroepiteliomatosas/diagnóstico , Neoplasias Neuroepiteliomatosas/patologia , Neoplasias Neuroepiteliomatosas/fisiopatologia , Estudos RetrospectivosRESUMO
Objetivo. La balanitis xerotica obliterans (BXO) es una enfermedad de etiología incierta, que afecta a piel y mucosa de genitales masculinos de cualquier edad. La incidencia en niños es baja (9-19%) y en adultos se considera una lesión premaligna. El objetivo de este estudio es establecer la incidencia de BXO en nuestro centro y determinar la correlación entre las características clínicas y los hallazgos inmunohistoquímicos (IHQ). Métodos. Cohorte prospectiva de niños ≤14 años con fimosis circuncidados entre 2014-2016. Análisis estadístico de las características clínicas e histológicas e IHQ para valorar la respuesta inflamatoria, presencia de lesiones premalignas y asociaciones microbiológicas. Resultados. Se incluyeron 176 pacientes circuncidados con una edad media de 7 ± 3 años (rango 2-14 años). La sospecha clínica de BXO, 28,4% (n= 50), se confirmó mediante anatomía patológica en 29,5% (n= 52) con muy buena fuerza de concordancia interobservador (κ= 0,81: p<0,01). El 63,5% (n= 33/52) recibieron corticoterapia como tratamiento inicial. El 7,69% (4/52) presentaron estenosis meatal requiriendo dilataciones meatales/uretrales. Los casos de BXO presentaron una respuesta mediada por linfocitos-T: CD3+ (p< 0,01). Conclusiones. BXO es una enfermedad inflamatoria crónica mediada por linfocitos-T con una incidencia mayor a la reportada. La concordancia interobservador entre la sospecha de BXO y la confirmación histológica es muy buena. La elevación de p53 en los pacientes con BXO indica un posible potencial maligno que requiere tratamiento quirúrgico (circuncisión) y un seguimiento adecuado (AU)
Aim. Balanitis xerotica obliterans (BXO) is a disease of the skin and mucosa of male genitals of unknown etiology that may affect children of any age. It has a low incidence (9-19%) and in adults is considered a potential premalignant lesion. The aim of our study is to establish the incidence of BXO in our center and to determine its correlation between the clinical and immunohistochemical (IHC) findings. Methods. Prospective cohort including all children < 14 years with foreskin pathology that required a circumcision between 2014-2016. Statistical analysis of the clinical characteristics, histological and IHC findings searching for inflammatory response, premalignant lesions and microbiological findings. Results. A total of 176 boys with phimosis had circumcision with a mean age of 7 ± 3 years (Range 2-14). Presurgical diagnosis of BXO was suspected in 28.4% (n= 50) whereas the AP confirmed a total of 29.5% (n= 53) with a very good interobserver concordance (κ= 0.81: p < 0.01). Previous treatment with corticoids in BXO was found in 63.5% (n= 33/52). Meatal stenosis was found in 7.69% (n= 4/52) requiring meatal/urethral dilations. Patients with BXO had a T-Lymphocytes CD3+ mediated inflammatory response with a positive correlation between tumor suppressing protein (p53) expression and chronic inflammation. Conclusions. BXO is a chronic inflammatory disease mediated by T-lymphocytes with an incidence greater than previously reported. Surgeons' criterion has a very good concordance with the AP findings. The elevation of p53 in children with BXO may indicate a plausible malignant potential that may require a surgical treatment (circumcision) and an adequate follow-up (AU)
Assuntos
Humanos , Masculino , Pré-Escolar , Criança , Adolescente , Balanite Xerótica Obliterante/epidemiologia , Balanite Xerótica Obliterante/patologia , Imuno-Histoquímica , Balanite Xerótica Obliterante/complicações , 28599 , Circuncisão Masculina/métodos , Proteína Supressora de Tumor p53/análise , Linfócitos T/patologia , Estudos Prospectivos , Estudos Longitudinais , Ciclina D1/análiseRESUMO
Babesiosis is a rare worldwide-distributed protozoal zoonosis caused by a haemoprotozoan of the genus Babesia, transmitted through bites of tick of the genus Ixodes. The first demonstrated case of human babesiosis in the world was discovered in Europe, in 1957. However, most of the cases were reported later in the north-east of the United States where Babesia microti has been the cause of over 300 cases of human babesiosis since 1969. In Europe, the most severe cases are observed in asplenic patients infected by a parasite of cattle, the Babesia divergens. Only two cases of babesiosis have been reported in Spain. We present a case of erythema figuratum associated to septic babesiosis in a non-splenectomized man, which is currently the third case of babesiosis in Spain.
Assuntos
Babesiose/complicações , Eritema/etiologia , Eritema/patologia , Idoso , Animais , Babesia/patogenicidade , Babesiose/patologia , Eritema/diagnóstico , Humanos , Masculino , Sepse/complicações , Sepse/etiologia , Pele/patologia , Espanha , Doenças Transmitidas por Carrapatos/complicações , Doenças Transmitidas por Carrapatos/patologiaAssuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia , Anticorpos Anticitoplasma de Neutrófilos/análise , Autoanticorpos/análise , Autoantígenos/imunologia , Membrana Basal Glomerular/imunologia , Glomerulonefrite/imunologia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Terapia Combinada , Ciclofosfamida/uso terapêutico , Resistência a Medicamentos , Quimioterapia Combinada , Glomerulonefrite/tratamento farmacológico , Glomerulonefrite/patologia , Glomerulonefrite/terapia , Humanos , Imunossupressores/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Plasmaferese , Diálise RenalRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Glomerulonefrite/fisiopatologia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/fisiopatologia , Doença Antimembrana Basal Glomerular/fisiopatologia , Azitromicina/uso terapêutico , Biópsia , Terapia de Substituição RenalRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Glomerulonefrite/patologia , Podócitos/patologia , Insuficiência Renal Crônica/complicações , Proteinúria/complicações , Síndrome Nefrótica/complicaçõesRESUMO
BACKGROUND: Pseudomyxoma peritonei (PMP) is a rare, slowly progressive disease whose prognosis depends primarily on the completeness of cytoreduction. The value of intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and of additional factors predicting long-term outcome and disease-free survival (DFS) remains poorly understood. This study aims to analyse survival rates and prognostic factors in patients undergoing maximal cytoreduction and HIPEC. METHODS: Thirty patients were selected from a prospective database of records for patients undergoing cytoreduction and HIPEC with mitomycin C or paclitaxel. Overall survival (OS), DFS, and the prognostic factors influencing them, were examined using multivariate analysis. RESULTS: Median follow-up was 44 months (range, 8-144). Histological classification of PMPs was DPAM in 6/30 of cases, PMCA-I in 10/30 and PMCA in 14/30. Complete cytoreduction (CC-0 and CC-1) was achieved in 28/30 of patients and CC-2 in 2/30. Median OS was 111 months (range 0-230) and five-year OS rate was 67%. Median DFS was 53.5 months (range 0-120) and 5-year DFS rate was 44%. Incomplete cytoreduction, lymph node involvement and PCI>20 were associated with poor prognosis for OS, while lymph node involvement, elevated CA-125 levels, unfavourable histology and previous chemotherapy were associated with poor outcomes for DFS. There was morbidity of Grade 3 or higher in 9/30. Post-operative mortality occurred in 1 case. CONCLUSION: Cytoreduction plus peritonectomy procedures combined with HIPEC is a safe treatment and could improve survival rates. Since the optimal cytoreduction is the primary prognostic factor, patients should be centralised under the care of experienced teams (AU)
Assuntos
Humanos , Masculino , Feminino , Antineoplásicos/administração & dosagem , Hipertermia Induzida/métodos , Hipertermia Induzida , Mitomicina/administração & dosagem , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/cirurgia , Pseudomixoma Peritoneal/tratamento farmacológico , Pseudomixoma Peritoneal/cirurgia , Quimioterapia do Câncer por Perfusão Regional/métodos , Quimioterapia do Câncer por Perfusão Regional/tendências , Paclitaxel/administração & dosagemRESUMO
Los tumores del oído medio son poco habituales, siendo el de mayor frecuencia el glomus timpánico seguido en mucha menor frecuencia por el adenoma de oído medio (AOM). Es una entidad que se presenta de forma insidiosa, con unos hallazgos clínicos y audiológicos muy inespecíficos, a cuyo diagnóstico de certeza han contribuido de forma importante los avances en histología e inmunohistoquímica. Presentamos dos casos diagnosticados recientemente en nuestro centro, en un hombre y una mujer ambos de mediana edad. Los dos pacientes fueron tratados mediante cirugía y permanecen sin signos de recidiva después de 27 y 28 meses de seguimiento. En ambos casos se llegó al diagnóstico definitivo mediante el análisis histológico e inmunohistoquímico
Tumours of the middle ear are rare. Among them glomus tympanicum is the most frequent, followed by adenoma of the middle ear (AME). This insidious pathology entity displays unspecific clinical and audiological features. Advances in histology and immunohistochemistry have greatly contributed to an accurate diagnosis. We report our experience with two patients, a middle-aged man and a woman, diagnosed in our hospital. Both patients underwent surgical treatment and have shown no signs of recurrence after a 27- and 28-month follow-up. In both cases an accurate diagnosis was confirmed by histological and immunohistochemical analysis
Assuntos
Masculino , Feminino , Pessoa de Meia-Idade , Humanos , Adenoma/diagnóstico , Neoplasias da Orelha/diagnóstico , Orelha Média/patologia , Tomografia Computadorizada por Raios X , Perda Auditiva/diagnóstico , Perda Auditiva/etiologia , Orelha Média/cirurgia , Adenoma/complicações , Neoplasias da Orelha/complicações , Neoplasias da Orelha/cirurgiaRESUMO
El linfoma de Burkitt es una neoplasia hematológica propia de edades tempranas. En nuestro medio su forma de presentación más habitual es la enfermedad ganglionar. Presentamos el caso clínico de un varón de 12 años que consulta por una masa cervical asintomática, que se correspondía con un linfoma de Burkitt primario de cavum con extensión hacia el cuello (AU)
The Burkitt's lymphoma is a haematological neoplasia typical of early ages. In our country, the lymphatic nodes affectation is the most usual. We present a case report with a 12 year-old boy who consults for a asymptomatic cervical mass. The ultimate diagnosic was a nasopharyngeal Burkitt's lymphoma with neck extension (AU)