International Validation of the Immunoscore Biopsy in Patients With Rectal Cancer Managed by a Watch-and-Wait Strategy.

PURPOSE: No biomarker capable of improving selection and monitoring of patients with rectal cancer managed by watch-and-wait (W&W) strategy is currently available. Prognostic performance of the Immunoscore biopsy (ISB) was recently suggested in a preliminary study. METHODS: This international validation study included 249 patients with clinical complete response (cCR) managed by W&W strategy. Intratumoral CD3+ and CD8+ T cells were quantified on pretreatment rectal biopsies by digital pathology and converted to ISB. The primary end point was time to recurrence (TTR; the time from the end of neoadjuvant treatment to the date of local regrowth or distant metastasis). Associations between ISB and outcomes were analyzed by stratified Cox regression adjusted for confounders. Immune status of tumor-draining lymph nodes (n = 161) of 17 additional patients treated by neoadjuvant chemoradiotherapy and surgery was investigated by 3'RNA-Seq and immunofluorescence. RESULTS: Recurrence-free rates at 5 years were 91.3% (82.4%-100.0%), 62.5% (53.2%-73.3%), and 53.1% (42.4%-66.5%) with ISB High, ISB Intermediate, and ISB Low, respectively (hazard ratio [HR; Low v High], 6.51; 95% CI, 1.99 to 21.28; log-rank P = .0004). ISB was also significantly associated with disease-free survival (log-rank P = .0002), and predicted both local regrowth and distant metastasis. In multivariate analysis, ISB was independent of patient age, sex, tumor location, cT stage (T, primary tumor; c, clinical), cN stage (N, regional lymph node; c, clinical), and was the strongest predictor for TTR (HR [ISB High v Low], 6.93; 95% CI, 2.08 to 23.15; P = .0017). The addition of ISB to a clinical-based model significantly improved the prediction of recurrence. Finally, B-cell proliferation and memory in draining lymph nodes was evidenced in the draining lymph nodes of patients with cCR. CONCLUSION: The ISB is validated as a biomarker to predict both local regrowth and distant metastasis, with a gradual scaling of the risk of pejorative outcome.

Experimental Investigation on Strength and Stiffness Properties of Laminated Veneer Lumber (LVL).

This study presents a testing campaign aimed at evaluating the strength and stiffness properties of laminated veneer lumber (LVL) specimens. LVL is an engineered wood product composed of thin glued wood veneers whose use in construction for structural applications has increased due to its sustainability and enhanced mechanical performance. Despite LVL's growing popularity, there is a lack of comprehensive information regarding stress-strain responses, failure modes, and the full set of strength and stiffness properties. These are particularly essential when LVL is employed in pure timber structures or composite systems such as steel-timber or timber-concrete load-bearing elements. This research aims to bridge this knowledge gap, focusing on crossbanded LVL panels, known as LVL-C, crafted from Scandinavian spruce wood, which is an LVL product with 20% of crossbanded veneers. The study explores LVL-C mechanical behavior in three primary orthogonal directions: longitudinal, tangential, and radial. A series of mechanical tests, including compression, tension, shear, and bending, was conducted to provide a thorough assessment of the material's performance. In compression tests, different behaviors were observed in the three directions, with the longitudinal direction exhibiting the highest stiffness and strength. Tensile tests revealed unique stress-strain responses in each direction, with gradual tension failures. Shear tests showcased varying shear stress-strain patterns and failure modes, while bending tests exhibited significant strength and stiffness values in flatwise bending parallel to the grain and flatwise bending perpendicular to the grain. This paper summarizes the comprehensive testing results and discusses the obtained strength and stiffness properties of LVL-C panels, providing valuable insights into their mechanical behavior for engineering applications.

Comparison of transrectal and transabdominal transducers for use in fast localized abdominal sonography of horses presenting with colic.

Abdominal ultrasonography is valuable in the diagnosis of equine colic. Fast localized abdominal sonography of horses (FLASH) enables practitioners with limited experience to perform ultrasonography in emergency settings. However, many practitioners only possess rectal format linear array transducers (RFLT). The hypotheses are: (a) A low frequency curvilinear transducer (LFCT) and RFLT will detect free abdominal fluid and abnormal small intestinal loops with similar frequency during FLASH, and (b) there will be a difference between the transducers for detection of gastric abnormalities and nephrosplenic entrapment. The objective is to compare transcutaneous abdominal ultrasonographic detection of abnormalities in horses presenting with colic using a LFCT and RFLT. Twenty-four horses requiring FLASH for investigation of colic were enrolled. Horses that were too painful to undergo transcutaneous abdominal ultrasonographic examination were excluded. A single investigator performed FLASH on all horses using a RFLT, while one of three other clinicians simultaneously performed FLASH using a LFCT. Comparison of abnormal findings between the two transducers was performed using Chi square, Fisher's exact or Wilcoxon tests. The incidence of identification of abnormal findings was similar between the two transducers for all comparisons except the visibility of the left kidney and stomach (kidney LFCT 81.25% vs. RFLT 22.92%, stomach LFCT 87.5% vs. RFLT 62.5%). While there are limitations to using a RFLT to identify nephrosplenic entrapment of the colon and detection of the stomach, it reliably detects other common abnormalities, including peritoneal effusion, lesions of the small intestine, and changes to the wall of the large colon and cecum.

Incidence of superficial abdominal organ identification is similar using high-frequency linear (transrectal) and low-frequency curvilinear (abdominal) transducers in clinically healthy horses: A pilot study.

Abdominal organ displacement is a potentially life-threatening condition in horses. Primary care veterinarians commonly make referral decisions based on a combination of clinical and ultrasonographic findings. However, published studies describing the effects of transducer on identifying abdominal organ locations in horses are currently lacking. The objective of this prospective, methods comparison, pilot study was to compare organ identification using a high-frequency linear (transrectal) transducer and a low-frequency curvilinear (abdominal) transducer for transcutaneous abdominal ultrasonography of healthy horses. Twelve clinically normal adult horses owned by the University of Calgary were enrolled in the study. Abdominal ultrasonography was performed by four practitioners, each randomly assigned to an alternating rotation of transrectal or abdominal transducer and left or right side of a horse. Using a Chi square test or Fisher's exact test, the frequency of identification for each organ was compared between both transducers. There was no significant difference in organ identification on the right side of the abdomen. On the left side, the stomach, liver, and kidney were less likely to be detected with the transrectal transducer. Compared with a low-frequency abdominal transducer, a high-frequency linear transrectal transducer delivers images that allow for organ identification in transcutaneous ultrasonography of the equine abdomen except for the left kidney, left liver, and stomach.

Evaluación de la metilación del DNA en tejidos de cáncer colorrectal fijados en formalina y embebidos en parafina (FFPE) / Evaluation of DNA methylation in formalin-fixed, paraffin embedded colorectal cancer tissues (FFPE)

Resumen Las alteraciones en la metilación de dinucleótidos CpG en regiones promotoras es uno de los mecanismos epigenéticos implicados en cáncer que tiene uso potencial como biomarcador. Su evaluación, a partir de tejidos fijados en formalina y embebidos en parafina (FFPE), representa un gran desafío dadas la degradación parcial, el entrecruzamiento y las bajas cantidades del DNA obtenido. En esta nota técnica, describimos un protocolo para el estudio del estado de metilación del promotor distal del proto-oncogén K-RAS, a partir de varias muestras obtenidas de dos tejidos FFPE de cáncer colorrectal con antigüedad de 11 años. Se empleó un protocolo de conversión con bisulfito alternativo al usual; se usó una DNA polimerasa modificada y una PCR anidada y se optimizó la secuenciación directa del DNA convertido con bisulfito. Este protocolo podría ser aplicado para determinar estados de metilación en otros genes y tipos de cáncer en tejidos FFPE.

Abstract Alterations in the methylation of CpG dinucleotides in promoter regions is one of the epigenetic mechanisms involved in cancer that has potential use as a biomarker. Its evaluation from formalin-fixed and paraffin-embedded (FFPE) tissues represents a great challenge given the partial degradation, crosslinking, and low amounts of the obtained DNA. In this technical note we describe a protocol for the study of the methylation status of the distal promoter of the K-RAS proto-oncogene from several samples obtained from two 11-years old FFPE tissues of colorectal cancer. An alternative bisulfite conversion protocol to the usual one was used; a modified DNA polymerase and a nested PCR were used and the direct sequencing of the converted DNA with bisulfite was optimized. This protocol could be applied to determine methylation states in other genes and types of cancer.

A Diagnostic Biopsy-Adapted Immunoscore Predicts Response to Neoadjuvant Treatment and Selects Patients with Rectal Cancer Eligible for a Watch-and-Wait Strategy.

PURPOSE: No biomarker to personalize treatment in locally advanced rectal cancer (LARC) is currently available. We assessed in LARC whether a diagnostic biopsy-adapted immunoscore (ISB) could predict response to neoadjuvant treatment (nT) and better define patients eligible to an organ preservation strategy ("Watch-and-Wait"). EXPERIMENTAL DESIGN: Biopsies from two independent cohorts (n 1 = 131, n 2 = 118) of patients with LARC treated with nT followed by radical surgery were immunostained for CD3+ and CD8+ T cells and quantified by digital pathology to determine ISB. The expression of immune-related genes post-nT was investigated (n = 64 patients). Results were correlated with response to nT and disease-free survival (DFS). The ISB prognostic performance was further assessed in a multicentric cohort (n = 73 patients) treated by Watch-and-Wait. RESULTS: ISB positively correlated with the degree of histologic response (P < 0.001) and gene expression levels for Th1 orientation and cytotoxic immune response, post-nT (P = 0.006). ISB high identified patients at lower risk of relapse or death compared with ISB low [HR, 0.21; 95% confidence interval (CI), 0.06-0.78; P = 0.009]. Prognostic performance of ISB for DFS was confirmed in a validation cohort. ISB was an independent parameter, more informative than pre- (P < 0.001) and post-nT (P < 0.05) imaging to predict DFS. ISB combined with imaging post-nT discriminated very good responders that could benefit from organ preservation strategy. In the "Watch-and-Wait" cohort (n = 73), no relapse was observed in patients with ISB high (23.3%). CONCLUSIONS: ISB predicts response to nT and survival in patients with LARC treated by surgery. Its usefulness in the selection of patients eligible for a Watch-and-Wait strategy is strongly suggested.

Diferencias y controversias entre el reporte de patología y la interpretación clínica en patología tiroidea. II PARTE: Aspectos patológicos y métodos diagnósticos con impacto terapéutico / Thyroid diseases: Differences and controversies between the pathology report and clinical interpretation. PART II: Pathological aspects and diagnostic methods with therapeutic impact

Resumen Como revisamos en la primera parte1 hay algunos conceptos que deben ser considerados para el adecuado manejo médico por parte del equipo clínico que recibe el reporte de patología, de esta misma manera existen aspectos por parte del patólogo que este debe conocer, los cuales tienen impacto terapéutico. En esta segunda parte queremos revisar algunos conceptos que son de importancia por parte del patólogo que aplican directamente sobre la interpretación del clínico, como: procesamiento macroscópico; estudio de la citología por aspiración con aguja fina (FNA) vs. biopsia trucut, utilidad de la biopsia por congelación y de la inmunohistoquímica, así como los métodos e imágenes diagnósticas.

Abstract As was reviewed in the first part, there are some concepts that should be considered for the appropriate medical management by the medical team that receives the pathology report. Similarly, there are some aspects that the pathologist should know, such as those that can have therapeutic impact. In this second part, a short review is presented on some of the concepts that are of importance to the pathologist that apply directly to the interpretation by the clinician, such as the macroscopic processing, the cytology study of the fine-needle aspirate (FNA) vs. "tru-cut" biopsy, the usefulness of the frozen biopsy, and immunohistochemistry, as well as diagnostic methods and diagnostic images.

Circulating Cell-Free Tumor DNA Analysis of 50 Genes by Next-Generation Sequencing in the Prospective MOSCATO Trial.

PURPOSE: Liquid biopsies based on circulating cell-free DNA (cfDNA) analysis are described as surrogate samples for molecular analysis. We evaluated the concordance between tumor DNA (tDNA) and cfDNA analysis on a large cohort of patients with advanced or metastatic solid tumor, eligible for phase I trial and with good performance status, enrolled in MOSCATO 01 trial (clinical trial NCT01566019). EXPERIMENTAL DESIGN: Blood samples were collected at inclusion and cfDNA was extracted from plasma for 334 patients. Hotspot mutations were screened using next-generation sequencing for 50 cancer genes. RESULTS: Among the 283 patients with tDNA-cfDNA pairs, 121 had mutation in both, 99 in tumor only, 5 in cfDNA only, and for 58 patients no mutation was detected, leading to a 55.0% estimated sensitivity [95% confidence interval (CI), 48.4%-61.6%] at the patient level. Among the 220 patients with mutations in tDNA, the sensitivity of cfDNA analysis was significantly linked to the number of metastatic sites, albumin level, tumor type, and number of lines of treatment. A sensitivity prediction score could be derived from clinical parameters. Sensitivity is 83% in patients with a high score (≥8). In addition, we analyzed cfDNA for 51 patients without available tissue sample. Mutations were detected for 22 patients, including 19 oncogenic variants and 8 actionable mutations. CONCLUSIONS: Detection of somatic mutations in cfDNA is feasible for prescreening phase I candidates with a satisfactory specificity; overall sensitivity can be improved by a sensitivity score allowing to select patients for whom cfDNA constitutes a reliable noninvasive surrogate to screen mutations. Clin Cancer Res; 22(12); 2960-8. ©2016 AACR.

Consenso médico de biopsia por aspiración con aguja fina de tiroides. reporte de citología tiroidea basado en el sistema de bethesda / Medical consensus of fine-needle aspiration biopsy of the thyroid. bethesda system for reporting thyroid cytopathology

En este artículo se presenta un consenso médico basado en el sistema de Bethesda del Instituto Nacionalde Cáncer (Estados Unidos) para el uso de la biopsia por aspiración con aguja fina en el manejo de nódulos tiroideos, realizado en conjunto con patólogos, radiólogos, endocrinólogos y otras especialidades médicas de Colombia, España, Chile, Venezuela, Estados Unidos y Panamá. En este trabajo se describen las indicaciones de la biopsia por aspiración con aguja fina de tiroides, requisitos previos, entrenamiento, acreditación, técnicas, terminología diagnóstica, pruebas complementarias y opciones de tratamiento. El objetivo del actual artículo es presentar ante la comunidad médica la clasificación de los reportes citológicos, el reporte de ecografía que propone usar el sistema de datos y el reporte de imágenes tiroideas (TIRADS, del inglés The Thyroid Imaging Reporting and Data System), el uso de la medición de tiroglobulina en biopsia por aspiración con aguja fina y técnicas de citología líquida;...

This article presents a medical consensus based on the Bethesda system of the National Cancer Institute (USA) for the use of fine needle aspiration biopsy in the management of thyroid nodules. This consensus was performed in conjunction with pathologists, radiologists, endocrinologists, and other medical specialties of Colombia, Spain, Chile, Venezuela, United States, and Panama. In this work was described the indications for fine needle aspiration biopsy of thyroid, prerequisites, training, accreditation, techniques, diagnostic terminology, additional tests and treatment options. The aim of this article is present to the medical community the classification of cytological report, ultrasound report using the data system, and the thyroid imaging reporting and data system (TIRADS); as well as, the use of thyroglobulin measurement in fine needle aspiration biopsy, and liquid-based cytology techniques...

IGF1R gene expression as a predictive marker of response to ionizing radiation for patients with locally advanced HPV16-positive cervical cancer.

AIM: The aim of this study was to evaluate the predictive utility of Insulin-like growth factor-1 receptor (IGF1R), IGF1, IGF2, Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and of hemoglobin levels for tumor response to exclusive radiotherapy, in patients with locally advanced Human papillomavirus (HPV) 16-positive cervical cancer. PATIENTS AND METHODS: From 102 patients treated at our institutes, 38 patients with histologically-proven HPV16-positive cervical cancer were included in this prospective case-controlled study. All patients underwent exclusive radiotherapy-only. Complete response was defined as an absence of residual disease at clinical examination and radiological imaging, three months after the completion of treatment. Gene expression levels, assessed before radiotherapy, were compared between responders and non-responders. Controls consisted of normal cervical tissue samples from 30 patients with non-oncological indications. RESULTS: Twenty patients (52.6%) showed a complete response. Gene expressions of IGF1R (34%), IGF2 (24%), and GAPDH (median=3.26 versus 2.12) were increased in cancer patients, in comparison with the control group. Higher levels of expression of GAPDH were observed in patients co-expressing IGF2 and IGF1R, who had a hemoglobin level ≤ 11 g/dl (p=0.05). Clinical characteristics in the responder and in the non-responder groups were similar. In bi-variate and multi-variate analyses, IGF1R expression was the only factor predictive of response to radiotherapy (p=0.018). Accordingly, patients with IGF1R expression had a 28.6-fold greater risk of treatment failure. CONCLUSION: In our study, IGF1R was a strong predictive marker of lack of response to radiotherapy. Larger prospective trials are needed to validate IGF1R as a biomarker of radiation response for patients with HPV16-positive cervical cancer.

Paraganglioma funcional extraadrenal, una causa infrecuente de eclampsia / Functional extradrenal paraganglioma, an infrequent cause of eclampsia

Los paragangliomas funcionales son tumores raros, originados en el tejido cromafín extraadrenal productor de catecolaminas, y su presentación durante el embarazo es aún más inusual; existen pocos casos de esta condición reportados en la literatura. No obstante, la sospecha de paraganglioma debe ser tenida en cuenta como diagnóstico diferencial en pacientes con hipertensión durante el embarazo; en especial, cuando esta se presenta de manera paroxística antes de la semana 20 de gestación, asociada a fogajes faciales, sin proteinuria ni edemas. La confirmación se realiza mediante pruebas bioquímicas e imagenológicas, y el tratamiento es principalmente quirúrgico; se da especial atención al control pre, trans y postoperatorio de las cifras tensionales y del estado hemodinámico de la paciente, dada la naturaleza del tumor. Este artículo presenta el caso de una mujer adulta con diagnóstico de paraganglioma funcional retroperitoneal, cuya primera manifestación clínica fue eclampsia. Seguidamente se hace una breve revisión de la literatura relacionada.

Functional paragangliomas are rare tumors which originate in the extra-adrenal chromaffin tissue which produces catecolaminas; and, their appearance during pregnancy is even rarer; very few cases have been reported upon in the literature. Nevertheless, the suspicion of paraganglioma should be considered as a differential diagnosis in pregnant patients with hypertension, especially when occuring paroxistically before the 20th month of gestation, and when associated with facial flushing unaccompanied by proteinuria or edemas. Confirmation is made with biochemical or imaging tests, and treatment is primarily surgical. Special attention is paid to patient´s blood pressure stats and hemodynamic state at pre-, trans- and postoperative stages, due to the nature of the tumor. This article presents the case of an adult female diagnosed with functional extradrenal paraganglioma whose first clinical manifestation was eclampsia. A brief review of the related literature is also included.

Microcarcinoma papilar de tiroides (MCPT) metastásico a hueso / Metastatic Papillary phyroid microcarcinoma (PTMC) to bone

Clásicamente se han descrito los carcinomas papilares de tiroides (CPT) como tumores de comportamiento benigno; especialmente, aquellos con lesiones menores a 1 cm y cada vez mas, se encuentran pacientes con enfermedad agresiva que recaen local, regionalmente y/o a distancia. Recientemente se propuso incluir en la clasificación patológica el término microtumor papilar de tiroides (PMiT), que corresponde a una lesión menor a 1 cm, y que no tiene factores de riesgo histopatológicos, anteriormente denominado microcarcinoma papilar (MCPT). En el Instituto Nacional de Cancerología de Colombia (INC) fue atendido un paciente masculino de 49 años, quien consultó por fractura patológica del fémur izquierdo. Con biopsia del hueso se le confirmó carcinoma papilar metastásico de origen tiroideo, por lo cual se procedió a tiroidectomía total. Su diagnóstico final fue de MCPT. Por tratarse de un caso poco común, se reporta en el presente trabajo, y, a la vez, se comenta la nueva clasificación de tumores papilares de tiroides.

The classic description of papillary thyroid carcinoma (PTC) is that it is benign; particularly in lesions less than 1 cm. However, it is often observed that patients with aggressive diseases suffer from local, regional, and/or distant relapse. A recent proposal for pathology classification is the term papillary thyroid micro tumor (PMiT), which corresponds to a lesion less than 1 cm. and which does not have histopathological risk factors previously designated as papillary thyroid microcarcinoma (PTMC). A 49-year-old male patient sought treatment at the National Cancer Institute (NCI) for pathological fracture in the left femur. Bone biopsy confirmed metastatic papillary carcinoma of thyroid origin; thus leading to total thyroidectomy. His final diagnosis was PTMC. Due to the fact that this was a rare case, it is the subject of this report which also focuses on the new classification for papillary thyroid tumors.

Tumor de Sertoli variante célula grande calcificante asociado a síndrome de peutz-jeghers / Large cell calcifying sertoli cell tumor associated with peutz-jeghers syndrome

El tumor de células de Sertoli calcificante de células grandes (TCSCCG) es una neoplasia testicular muy rara, con 60 casos descritos en todo el mundo; en Latinoamérica y Colombia son escasos los casos reportados en la literatura. Esta neoplasia se origina en el estroma gonadal/cordones sexuales, y, en general, tiende a mostrar un comportamiento biológico benigno. Se piensa que estos tumores tienen características de presentación diferente, dependiendo de si se presentan en el contexto de un síndrome congénito complejo, en cuyo caso tienden a ser bilaterales y multifocales, en contraposición a los no asociados a síndromes, que tienden a ser unilaterales y focales. El estudio de inmunohistoquímica es fundamental para el diagnóstico; en especial, para diferenciar estos tumores de neoplasias germinales. Se reportan en esta investigación tres casos de esta neoplasia, uno de ellos asociado al síndrome de Peutz-Jeghers, y haciendo énfasis en los criterios histológicos para definir malignidad.

The large cell calcifying Sertoli cell tumor (LCCSCT) is a very rare testicular tumor with 60 cases reported worldwide; in Latin America and Colombia, few cases are reported in the literature. This neoplasm originates in the gonadal stromal/sex cord, and, in general, tends to display benign biological behavior. It is thought that these tumors may display differing characteristics: depending upon whether they occur in the context of a complex congenital syndrome, in which case they tend to be bilateral and multifocal; as opposed to those not associated with syndromes, which tend to be unilateral and focal. Immunohistochemical study is essential for diagnosis, in particular, to differentiate these tumors from germ cell tumors. This study reports on three cases of this tumor--one associated with Peutz-Jeghers Syndrome—and emphasis is given to histological criteria to define malignancy.

Effects of aerobic and anaerobic fluid collection on biochemical analysis of peritoneal fluid in healthy horses and horses with colic.

OBJECTIVE: To determine whether in healthy horses and those with colic, exposure of peritoneal fluid to room air affects values obtained on biochemical analysis. STUDY DESIGN: Prospective study. ANIMALS: Adult horses with a primary complaint of acute abdominal pain (n=29) and 12 healthy horses. METHODS: Peritoneal fluid was aseptically collected under aerobic and anaerobic conditions. After collection, pH, PCO(2) , PO(2) , HCO(3) (-) , Na(+) , ionized Ca(2+) , K(+) , lactate, and glucose were immediately measured using a commercial blood gas analyzer. Biochemical variables were compared between aerobically and anaerobically obtained samples using a paired t-test. RESULTS: In healthy horses, peritoneal fluid samples collected under anaerobic conditions had higher PCO(2) and ionized Ca(2+) and lower PO(2) , HCO(3) (-) , and pH compared with samples exposed to air. No differences were observed for K(+) , Na(+) , glucose, and lactate. In horses with colic, samples collected anaerobically had higher PCO(2) , ionized Ca(2+) , Na(+) , and glucose and lower PO(2) , HCO(3) (-) , and pH value compared with samples exposed to air. No differences were observed for K(+) and lactate. CONCLUSION: Exposure of peritoneal fluid to room air had a significant effect on pH, PCO(2) , PO(2) , and variables associated or dependent on changes in pH such as HCO(3) (-) and ionized Ca(2+) . Interpretation of biochemical analysis of peritoneal fluid may be influenced by sample collection method.

Carcinoma adenoescamoso primario de vesícula biliar: reporte de un nuevo caso y consideraciones sobre su etiología / Primary adenosquamous carcinoma of gallbladder: a case report and considerations on its etiology

El carcinoma adenoescamoso primario de vesícula biliar (CAEVB), es una neoplasia infrecuente cuya etiología y comportamiento biológico no están totalmente aclarados. Describimos un caso de un paciente masculino con un carcinoma adenoescamoso infiltrante primario de vesícula biliar diagnósticado en una colecistectomía por colelitiasis. Morfológicamente se encontró asociado a los elementos glandulares y escamosos malignos, la presencia de displasia de bajo y alto grado del epitelio glandular y metaplasia escamosa entre las zonas glandulares y escamocelulares, que permiten hacer el diagnostico de este tipo de carcinoma. El estudio de inmunohistoquímica mostraba marcadores tanto de diferenciación glandular como escamosa. Por tratarse de una variante infrecuente de Carcinoma de vesícula biliar reportamos este caso por las dificultades que genera su diagnóstico. Nuestras observaciones sugieren que se trata de un adenocarcinoma con áreas de metaplasia escamosa y posterior transformación maligna de los elementos escamosos.

The adeno-squamous gallbladder carcinoma is a frequent neoplasm with blurred etiology and biological course. A case report is presented from a male with an incidental finding of a gallbladder carcinoma diagnosed during a cholecystectomy. Associated to malignant glandular and squamous morphological findings, low grade dysplasia and squamous metaplasia were observed, allowing the final diagnosis. Immunohistochemistry analyses revealed both glandular and squamous differentiation biomarkers. The report of a rare gallbladder carcinoma illustrates difficulties for proper diagnosis. The analysis suggests an adenocarcinoma with squamous metaplasia areas that evolved towardsthe malignant transformation of squamous components.

Carcinoma papilar de tiroides, variante esclerosante difusa: un subtipo histológico de difícil diagnóstico / Diffuse sclerosing variant of papillary thyroid carcinoma: a histological type with difficult diagnosis

El carcinoma papilar de tiroides constituye el tumor maligno más frecuente de la glándula tiroides y en general tienden a tener un buen comportamiento biológico, sin embargo algunas variantes histológicas, como la esclerosante difusa tienden a mostrar una mayor agresividad con compromiso locorregional y metástasis a distancia. Esta variante es un reto diagnóstico para el patólogo por las especiales características arquitecturales y citológicas, ya que puede con llevar a diagnósticos incorrectos, en especial al ser confundido lesiones benignas con una tiroiditis linfocítica. Describimos un caso de un paciente atendido en Instituto Nacional de Cancerología de Colombia con carcinoma papilar de tiroides variedad esclerosante con enfermedad metastásica pulmonar. Por tratarse de una variante infrecuente de carcinoma papilar de tiroides reportamos este caso por las dificultades que genera tanto al clínico como al patólogo tanto en su detección inicial así como en su morfología, con las subsecuentes implicaciones debido a su comportamiento biológico más agresivo.

The papillary thyroid carcinoma is the most frequent thyroid neoplasm and usually it is a non aggressive tumor; nevertheless, some histological variants such as the diffuse sclerosing variant are more aggressive producing locoregional invasion and distant metastasis. This specific variant challenges the pathological diagnosis since the architectural and cytological characteristics might be confusing, particularly regarding benign lesions such as the lymphocytic thyroiditis. We present a case report of a patient at the National Cancer Institute of Colombia with a lung metastasis from a diffuse sclerosing papillary thyroid carcinoma. The difficulties for diagnosis, for both clinical and pathology experts, are illustrated as well as their relevance for determining the biological course of the disease.

Hand-assisted laparoscopic removal of a nephroblastoma in a horse.

A 3-year-old Thoroughbred was presented for evaluation of hematuria post exercise. On physical examination, an enlarged kidney was identified, as well as serum biochemical abnormalities such as an elevated creatine kinase (CK) and hypoalbuminemia. The kidney was removed laparoscopically and a nephroblastoma was identified.

Carcinoma folicular de tiroides mínimamente invasivo en edad pediátrica / Minimally invasive follicular thyroid carcinoma in pediatric age

Los carcinomas de la glándula tiroides son poco usuales en edad pediátrica, pero su presencia ha aumentado durante los últimos años; posiblemente, debido al incremento en la irradiación de la cabeza, cuello y mediastino. Entre estas neoplasias, el carcinoma papilar es el más habitual, y los carcinomas foliculares verdaderos son, por el contrario, bastante raros y se asocian al bocio endémico, a alteraciones genéticas y al incremento de los niveles de TSH. Sus características morfológicas son particulares y ayudan a su diagnóstico, el cual ha sido redefinido recientemente. Describiremos el caso de una adolescente de 13 años con carcinoma folicular de tiroides mínimamente invasivo, con nódulo tiroideo hipocaptante en el polo inferior del lóbulo izquierdo, de 6 meses de evolución. La punción aspiración con aguja fina demostró una lesión de células foliculares sospechosa de neoplasia. Se realizó lobectomía tiroidea, con reporte de carcinoma folicular mínimamente invasivo.

Thyroid carcinomas are rare during childhood and adolescence. They have increased recently probably due to a higher frequency radiation over the head, neck and mediastinum. The papillary carcinoma is the most common and true follicular carcinoma is far less common. Follicular thyroid carcinoma is associated with endemic goiter, genetic disorders, and increased TSH levels. Its morphological characteristics are peculiar and have been recently redefined, thus helping the diagnosis. A minimally invasive follicular thyroid carcinoma in 13 years old girl is described, presenting a hypocaptant thyroid nodule in the left lobe lower pole. The fine needle aspiration biopsy revealed a follicular cell lesion suspicious of malignancy. Thyroid lobectomy was performed reporting minimally invasive follicular carcinoma.

Recomendaciones para el procesamiento de especímenes en patología ósea. Experiencia del Instituto Nacional de Cancerología de Colombia / Recommendations for processing bone specimens in pathology: practice at the National Cancer Institute of Colombia

El procesamiento y estudio de la patología ósea es un reto diario para el patólogo debido a su complejidad diagnóstica. Las muestras con componente óseos requieren procedimientos como la manipulación de grandes piezas quirúrgicas y su descalcificación para obtener tejidos evaluables al microscopio. Lo anterior retarda el reporte patológico 20 a 30 días demorando el diagnóstico definitivo y el inicio de tratamiento o la evaluación de la respuesta a terapias neoadyudantes. Se desarrolló una guía de procesamiento de especímenes óseos que reduce los tiempos hasta el diagnóstico definitivo en 2 a 3 días para biopsias y en 13 a 15 días para amputaciones y resecciones en bloque. Presentamos una guía práctica, rápida y reproducible.

The processing and study of bone biopsias represent a challenge for the pathologist due to the complexity of diagnosis. Bone samples require special processing such as the manipulation and decalcification of big surgical specimens in order to obtain evaluable tissue under the microscope. Consequently, the pathology is performed in about 20-30 days delaying the final diagnosis, the beginning of treatment, or the evaluation of neoadyuvant therapy response. A practical guideline for bone specimen processing was developed reducing layout time for final diagnosis around 2-3 days for biopsies and 13-15 days for surgical specimens. A practical, nimble, and reliable guideline is presented.

Diaphragmatic herniation in the horse: 31 cases from 2001-2006.

Diaphragmatic rent and visceral herniation in the horse is seldom diagnosed, but historically carries a poor prognosis. The objective of this study was to document the presentation and surgical management of all diaphragmatic rents as presented to 2 referral institutions over a 5-year period. A review of 31 cases demonstrated that even with advances in surgical management of abdominal and thoracic conditions, little has been done to change the prognosis for this condition. Success rate was 23% for all horses presented for colic and were ultimately diagnosed with a diaphragmatic hernia, and 46% for those cases for which surgical management was elected.