Adenoma pleomorfo de la mama. A propósito de un caso / Pleomorphic adenoma of the breast. Apropos of a case

OBJETIVO: El adenoma pleomorfo es un tumor con una gran heterogenicidad arquitectural y citológica, de ahí su denominación como tumor mixto. Compuesto característicamente por células epiteliales y mioepiteliales con estroma mesenquimal, presenta un comportamiento benigno, siendo su localización habitual las glándulas salivares. La mama es una localización muy infrecuente para este tipo de tumores. CASO CLÍNICO: Presentamos el caso clínico de una paciente de 76 años sin antecedentes de patología mamaria, valorada en consultas externas de cirugía por una secreción unilateral de aspecto serosanguinolento desde la mama derecha, asociada a un nódulo de unos 2cm de diámetro mayor. Tras completar su estudio, se decide exéresis de la tumoración, obteniendo como resultado en la anatomía patológica una tumoración heterogénea con predominio de células miopiteliales; descripción compatible con un adenoma pleomorfo. DISCUSIÓN: El adenoma pleomorfo de la mama, es una tumoración epitelial benigna que tiene un patrón histológico similar al del tumor de las glándulas salivares. Los rasgos histológicos más importantes es la metaplasia ósea y mixocondroide, junto con presencia de calcificaciones, tejido epitelial (con o sin diferenciación glandular), y tejido mioepitelial; siendo esta gran variedad estructural lo que le caracteriza. Hay que realizar un diagnóstico diferencial con patología maligna a la cual asemeja. Se presenta de forma poco frecuente a nivel mamario y suele ser una lesión bien delimitada y solitaria, elastica y no adherida. Pese a su comportamiento benigno (no ha presentado en ninguno de los casos documentados metástasis a distancia) el tratamiento es quirúrgico, asegurando buenos margenes de resección para evitar recidivas

OBJECTIVE: Pleomorphic adenoma shows wide architectural and cytological heterogeneity and is consequently classified as a mixed tumour. These benign adenomas are characteristically composed of epithelial and myoepithelial cells with mesenchymal stroma and are usually located in the salivary glands. Localisation in the breast is extremely infrequent for this type of tumour. CASE REPORT: We report the case of a 76-year-old female patient with no prior history of breast disease who was assessed in the surgery outpatient clinic for unilateral serosanguinous secretion from the right breast associated with a nodule of approximately 2cm in diameter. After workup, it was decided to extirpate the tumour. Histological findings indicated a heterogeneous tumour with a predominance of myoepithelial cells, compatible with pleomorphic adenoma. DISCUSSION: Pleomorphic adenoma of the breast is a benign epithelial tumour whose histological pattern is similar to that of pleomorphic adenoma of the salivary glands. The most important histological features are osseous and myxochondroid metaplasia, together with the presence of calcifications, epithelial tissue (with or without glandular differentiation) and myoepithelial tissue. This wide structural variety is what characterises these tumours. The differential diagnosis should be performed with malignant disease, which these adenomas frequently mimic. Pleomorphic adenomas are very infrequent in the breast and are usually well-demarcated, solitary, elastic and non-adherent tumours. Despite their benign behaviour (there have been no reported cases of distant metastases), treatment is surgical, with good resection margins to avoid recurrences

Identification of Domains and Factors Involved in MINIYO Nuclear Import.

The transition of stem cells from self-renewal into differentiation is tightly regulated to assure proper development of the organism. Arabidopsis MINIYO (IYO) and its mammalian orthologue RNA polymerase II associated protein 1 (RPAP1) are essential factors for initiating stem cell differentiation in plants and animals. Moreover, there is evidence suggesting that the translocation of IYO and RPAP1 from the cytosol into the nucleus functions as a molecular switch to initiate this cell fate transition. Identifying the determinants of IYO subcellular localization would allow testing if, indeed, nuclear IYO migration triggers cell differentiation and could provide tools to control this crucial developmental transition. Through transient and stable expression assays in Nicotiana benthamiana and Arabidopsis thaliana, we demonstrate that IYO contains two nuclear localization signals (NLSs), located at the N- and C-terminus of the protein, which mediate the interaction with the NLS-receptor IMPA4 and the import of the protein into the nucleus. Interestingly, IYO also interacts with GPN GTPases, which are involved in selective nuclear import of RNA polymerase II. This interaction is prevented when the G1 motif in GPN1 is mutated, suggesting that IYO binds specifically to the nucleotide-bound form of GPN1. In contrast, deleting the NLSs in IYO does not prevent the interaction with GPN1, but it interferes with import of GPN1 into the nucleus, indicating that IYO and GPN1 are co-transported as a complex that requires the IYO NLSs for import. This work unveils key domains and factors involved in IYO nuclear import, which may prove instrumental to determine how IYO and RPAP1 control stem cell differentiation.

Valoración del tratamiento del shunt portosistémico congénito en el adulto en función de la sintomatología asociada / Appreciation of the treatment in adult patients with congenital portosystemic connections in relation with their symptoms

Introducción: las comunicaciones porto-sistémicas congénitas intrahepáticas (síndrome de Abernethy) son variantes anatómicas muy poco frecuentes, estando clasificadas en función del tipo de unión que exista entre la vena porta y el sistema venoso central. En el adulto, su diagnóstico suele ser incidental, aunque algunos casos puede presentarse con clínica de encefalopatía en pacientes sin hepatopatía asociada. Casos clínicos: presentamos dos casos de shunt porto-sistémico, uno con desarrollo de encefalopatía y otro hallado de forma casual. Su tratamiento, por medio de radiología intervencionista se decidió en función de si presentaban o no sintomatología. Ambos casos (tratado y control) se presentan al control en consultas externas asintomáticos, sin asociar complicaciones derivadas de la decisión terapéutica. Este control se realiza anualmente con pruebas de imagen (ecografía/TAC) y análisis sanguíneo. Discusión: dada la escasa prevalencia de este tipo de malformación y su diagnóstico habitual en edades más tempranas (asociada a importantes alteraciones cognitivas) su tratamiento en adultos no está protocolizado. En estos casos la decisión del tratamiento estaría condicionada a la sintomatología asociada, siendo el tratamiento mínimamente invasivo mediante radiología intervencionista una opción terapéutica a valorar en el adulto sintomático. Por su parte la observación por medio de pruebas de imagen y control en consultas externas, sin tratamiento asociado, seria de elección en adultos en los que no se presenta sintomatología asociada

Background: portosystemic intrahepatic venous connections (Abernethy syndrome) are rare anatomical variants, which are classified according to the type of union between the portal venous circulation and the central venous system. In adults, the diagnosis is often incidental, although some cases can be presented with an encephalopathy without associated liver disease. Case reports: here we present two cases of portosystemic shunt, one with encephalopathy development, and the other casually caught. Its treatment by interventionist radiology, was decided in function of clinic symptoms. Both patients were asymptomatic at controls in the outpatient consultation. No complications derived from the therapeutic decision. The control is carried out annually with image tests and blood analysis. Discussion: given the low prevalence of malformation and its usual diagnosis at younger ages (associated with important cognitive alterations) its treatment in adults is not protocolized. In these cases the decision of the treatment would be conditioned to the associated symptomatology, being the minimally invasive treatment (by interventional radiology) a therapeutic option in the symptomatic adult. Observation by imaging tests and control in outpatient consultation (without associated treatment) would be a choice in asymptomatic adults

Appreciation of the treatment in adult patients with congenital portosystemic connections in relation with their symptoms.

BACKGROUND: portosystemic intrahepatic venous connections (Abernethy syndrome) are rare anatomical variants, which are classified according to the type of union between the portal venous circulation and the central venous system. In adults, the diagnosis is often incidental, although some cases can be presented with an encephalopathy without associated liver disease. CASE REPORTS: here we present two cases of portosystemic shunt, one with encephalopathy development, and the other casually caught. Its treatment by interventionist radiology, was decided in function of clinic symptoms. Both patients were asymptomatic at controls in the outpatient consultation. No complications derived from the therapeutic decision. The control is carried out annually with image tests and blood analysis. DISCUSSION: given the low prevalence of malformation and its usual diagnosis at younger ages (associated with important cognitive alterations) its treatment in adults is not protocolized. In these cases the decision of the treatment would be conditioned to the associated symptomatology, being the minimally invasive treatment (by interventional radiology) a therapeutic option in the symptomatic adult. Observation by imaging tests and control in outpatient consultation (without associated treatment) would be a choice in asymptomatic adults.

Cirugía mayor ambulatoria de la glándula tiroides y paratiroides: resultados tras 6 años de experiencia / Major outpatient surgery of the thyroid and parathyroid glands: results after 6 years experience

Objetivo: La cirugía mayor ambulatoria (CMA) y con estancia inferior a 24 horas (overnight stay) se ha consolidado en muchas patologías aunque en cirugía tiroidea y paratiroidea resulta controvertido. El objetivo es valorar nuestros resultados en cirugía del tiroides y paratiroides en régimen de CMA durante un periodo de 6 años. Material y Métodos: Estudio observacional prospectivo de pacientes con indicación de hemitiroidectomía o paratiroidectomía enfocada en régimen CMA entre enero de 2011 y diciembre de 2016. Los pacientes cumplían criterios de CMA. En los primeros años se excluyeron los nodulos tiroideos mayores de 3 cm y los pacientes ASA III. Los pacientes ingresaron la mañana de la intervención, tras el acto quirúrgico pasaron a la Unidad de Recuperación Posquirúrgica y posteriormente a sala de hospitalización. Tras 8 h, si cumplían criterios, fueron dados de alta. Resultados: Se intervinieron 270 pacientes, la tasa de aplicabilidad global fue del 59%, la tasa de aceptabilidad global del 83,6% y el índice de sustitución del 49,2%. El índice de ingresos no deseados fue del 10,4% para la paratiroidectomía y del 17,6% en la cirugía del tiroides. Ningún paciente presentó complicaciones mayores en su domicilio. El grado de satisfacción fue alto o muy alto en el 94% de los pacientes. Conclusiones: La paratiroidectomía enfocada y la hemitiroidectomía realizada por cirujanos expertos en pacientes seleccionados, es segura y efectiva en régimen ambulatorio. Es posible mejorar el índice de sustitución ambulatorio aumentando la tasa de aplicabilidad y aceptabilidad.

Objetive: Ambulatory or overnight stay surgery have been consolidated in many different procedures. However, its use in thyroid and parathyroid surgery is still controversial. The aim of this report is to present the results of 6 years of ambulatory patients undergoing surgery of the thyroid or parathyroid glands. Material and Methods: Prospective observational study of patients who underwent hemithyroidectomy or selective parathyroidectomy in the ambulatory program from January 2011 to December 2016. All patients included met the general criteria of ambulatory surgery. During the first years nodules bigger than 3 cm and patients classified as ASA III were excluded. Patients arrive at hospital the morning of surgery. After the operation, patients pass to the post-anesthesia care unit and then to the hospitalization room. 8 hours after surgery patients are discharged home if they meet the criteria. Results: 270 patients were operated, 159 of them met the inclusion criteria. The overall applicability rate was 59%. The acceptance rate was 83.6% and the substitution index was 49.2%. The unwanted hospital admission was 10.4% for the parathyroidectomy and 17.6% for the hemithyroidectomy. Any patient presented major complications at home. The satisfaction rate was high or very high for 94% of the patients. Conclusion: Selective parathyroidectomy and hemithyroidectomy performed by experienced surgeons in selected patients can be safely and effectively carried out in ambulatory surgery (outpatient). It would be possible to improve the substitution index by increasing the application and acceptability ratios.

Effect of periodized high intensity interval training (HIIT) on body composition and attitudes towards hunger in active men and women.

BACKGROUND: High intensity interval training (HIIT) increases maximal oxygen uptake similar to aerobic exercise. However, changes in body composition are equivocal in response to HIIT. We examined changes in body composition and dietary restraint in response to 20 sessions of HIIT varying in structure. METHODS: Thirty nine active men and women (age and VO2max=22.5±4.4 years and 40.1±5.6 mL/kg/min) were randomized to one of three periodized HIIT regimes performed on a cycle ergometer. Before and after training, body composition was assessed using skinfolds (SKF), circumference measures, and Bioelectrical Impedance Analysis (BIA) following standardized procedures. Hunger, restraint, and disinhibition were also measured using the 3-Factor Eating Questionnaire and Power of Food Survey. Control participants (N.=32, age and VO2max=25.6±4.4 years and 40.6±4.9 mL/kg/min) matched for age and fitness level underwent all testing but did not complete HIIT. RESULTS: There was no change (P>0.05) in body mass, circumferences, or BIA-derived body fat in response to HIIT. However, SKF-derived body fat declined (P=0.04) with HIIT, and gender x time (P=0.03) and gender x time x regimen interactions (P=0.04) were shown in that women but not men exhibited significant reductions in body fat. Hunger was reduced from baseline to post-training (P=0.028), but this response was not different in response to HIIT compared to controls. CONCLUSIONS: Twenty sessions of low-volume HIIT reduce body fat in women but not men, but do not alter perceptions of hunger.

Utilidad del estudio del ganglio centinela en carcinoma ductal in situ diagnosticado mediante biopsia con sistema de corte por vacío / Utility of sentinel lymph node biopsy in ductal carcinoma in situ diagnosed with a vacuum-assisted core biopsy

Introducción. Alrededor del 24% de los pacientes con carcinoma ductal in situ (CDIS) de la mama diagnosticados con aguja gruesa (BAG) tendrán un componente invasivo cuando la lesión es extirpada en su totalidad. Esta subestimación de infiltración es menor cuando la biopsia es realizada con sistema de corte-vacío (SCV). Hemos evaluado nuestra experiencia en el diagnóstico del CDIS con SCV y el resultado final en la biopsia del ganglio centinela (BGC) en estas pacientes. Métodos. Este estudio incluyó a pacientes de la base de datos de CECLINES en Caracas, Venezuela, desde 1998 hasta 2013. De las 841 BGC realizadas durante este período, 64 correspondieron a CDIS con SCV, bajo guía estereotáxica o ultrasonido. Se excluyó a aquellos pacientes con microinvasión (pT1mic), lesiones mixtas y aquellas lesiones diagnosticadas mediante BAG. La metodología de la toma de muestra durante el procedimiento percutáneo consistió en múltiples muestras de diferentes partes de la lesión. Las indicaciones para la BGC en CDIS fueron: tamaño de la lesión > 30mm (DCIS extenso) o en pacientes planificadas para mastectomía. Resultados. La tasa de identificación fue del 95,3% (61/64). La mediana del tamaño de la lesión fue 40mm (DE 19,6); el 67,1% (43/64) tuvo diagnóstico de CDIS extenso. En el 87,5% (56/64) el hallazgo fue mamográfico; el 92,1% (59/64) fueron lesiones no palpables. Se obtuvo una mediana de 16 (DE 10,4) muestras por cada lesión. Al 82,8% (53/64) de las pacientes se les realizó una mastectomía. La distribución del grado histológico fue: G1 15,6% (10/64), G2 60,9% (39/64) y G3 23,5% (15/64). Ningún paciente presentó BGC positiva. En aquellos pacientes a los cuales se les realizó una disección axilar, no se encontró ningún ganglio positivo. La subestimación del componente infiltrante en biopsia con SCV fue del 6,2% (4/64). Conclusiones. La subestimación del componente infiltrante en el CDIS es muy baja cuando la biopsia se realiza con una SCV, obteniendo varias muestras en lesiones no palpables, cuyo hallazgo mamográfico son microcalcificaciones, independientemente de su tamaño o el grado histológico. Consideramos que la BGC puede omitirse en pacientes seleccionados con CDIS (AU)

Introduction. About 24% of patients with ductal carcinoma in situ (DCIS) diagnosed with a core biopsy will also be found to have an invasive component when the lesion is completely excised. This underestimation is reduced when the biopsy is undertaken with a vacuum-assisted device (VAD). We evaluated our experience in the diagnosis of DCIS with a VAD and the final result of the sentinel lymph node biopsy (SLNB) in these patients. Methods. This study included patients from the CECLINES database in Caracas (Venezuela) from 1998 to 2013. Out of 841 SLNB performed during that period, 64 corresponded to DCIS, diagnosed by a VAD under stereotactic or ultrasound guidance. Patients with microinvasion (pT1mic) or mixed lesions at the time of the pathological evaluation of the biopsy specimen, as well as those diagnosed by a core device, were excluded from this investigation. The methodology for the biopsy consisted of multiple samples from different parts of the lesion. The indications for SLNB in DCIS were: size >30mm (extensive DCIS) or a scheduled mastectomy. Results. The detection rate was 95.3% (61/64). Median lesion size was 40mm (SD 19.6). A total of 67.1% (43/64) had a diagnosis of extensive DCIS. In 87.5% (56/64), the mammographic findings were microcalcifications. Most of the lesions (92.1% [59/64]) were non-palpable. A median of 16 (SD 10.4) samples per lesion were obtained. Mastectomy was performed in 82.8% (53/64) of the patients. The distribution of histological grade was: G1 in 15.6% (10/64), G2 in 60.9% (39/64) and G3 in 23.5% (15/64). None of the patients had a positive SLNB. No positive lymph nodes were found in any of the patients who underwent axillary dissection. The underestimation rate for biopsy with a VAD was 6.2% (4/64). Conclusions. The underestimation rate of DCIS was very low when the biopsy was performed with a VAD and when multiple samples were obtained in non-palpable lesions, regardless of the lesion size or the histological grade. We believe that SLNB can be omitted in selected patients with DCIS (AU)

RIMA-Dependent Nuclear Accumulation of IYO Triggers Auxin-Irreversible Cell Differentiation in Arabidopsis.

The transcriptional regulator MINIYO (IYO) is essential and rate-limiting for initiating cell differentiation in Arabidopsis thaliana Moreover, IYO moves from the cytosol into the nucleus in cells at the meristem periphery, possibly triggering their differentiation. However, the genetic mechanisms controlling IYO nuclear accumulation were unknown, and the evidence that increased nuclear IYO levels trigger differentiation remained correlative. Searching for IYO interactors, we identified RPAP2 IYO Mate (RIMA), a homolog of yeast and human proteins linked to nuclear import of selective cargo. Knockdown of RIMA causes delayed onset of cell differentiation, phenocopying the effects of IYO knockdown at the transcriptomic and developmental levels. Moreover, differentiation is completely blocked when IYO and RIMA activities are simultaneously reduced and is synergistically accelerated when IYO and RIMA are concurrently overexpressed, confirming their functional interaction. Indeed, RIMA knockdown reduces the nuclear levels of IYO and prevents its prodifferentiation activity, supporting the conclusion that RIMA-dependent nuclear IYO accumulation triggers cell differentiation in Arabidopsis. Importantly, by analyzing the effect of the IYO/RIMA pathway on xylem pole pericycle cells, we provide compelling evidence reinforcing the view that the capacity for de novo organogenesis and regeneration from mature plant tissues can reside in stem cell reservoirs.

Colecistitis retrohepática en paciente con virus de la inmunodeficiencia humana / Retrohepatic cholecystitis in a human immunodeficiency virus-infected patient

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Lesiones inflamatorias mamarias benignas / Benign inflammatory breast lesions

El proceso diagnóstico de las lesiones inflamatorias mamarias incluye la descripción de su patrón histopatológico. El objetivo del trabajo es identificar los patrones inflamatorios mamarios. Se ha realizado una revisión de la literatura científica. Los patrones identificados son mastitis aguda con galactoforitis infecciosa inespecífica, galactoforitis crónica supurativa recidivante con mastitis periductal y de células plasmáticas, mastitis eosinofílica, lobulillitis linfocítica, mastitis granulomatosas, vasculitis mamaria, pseudotumores inflamatorios y necrosis grasa. Estos patrones y sus subtipos se han diferenciado analizando su composición, localización, mecanismo de producción y diagnóstico diferencial. En las biopsias de las inflamaciones mamarias se pueden identificar patrones histológicos inflamatorios desde los que se definen subtipos de mastitis. Para realizar el diagnóstico debe realizarse un completo estudio histopatológico y microbiológico de la biopsia de una mastitis y completar el diagnóstico con una adecuada correlación clinicopatológica (AU)

The diagnosis of chronic inflammatory breast disease includes the description of the histological pattern and location. The objective of this revision of the literature is to identify breast inflammatory patterns which are: acute mastitis with nonspecific infectious galactoforitis, chronic suppurative galactoforitis with periductal and plasma cell mastitis, eosinophilic mastitis, lymphocytic lobulillitis, granulomatous mastitis, breast vasculitis, inflammatory pseudotumour and fat necrosis. The composition, location, production mechanism and differential diagnosis of all types and subtypes are analyzed. Several inflammatory histological patterns with subtypes can be identified in biopsies of mastitis. A correct diagnosis requires a comprehensive histopathological and microbiological study in correlation with adequate clinicopathological data (AU)

Hipoplasia de vesícula biliar con cuadro colestásico como primera manifestación clínica / Cholestasis as the first symptom of gallbladder hypoplasia

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Un caso de osteocondritis disecante secundario a plica infrapatelar: reporte de un caso / A case of dissecans osteocondritis a infrapatelar plica: report of a case

Se presenta un caso clínico-radiológico de osteocondritis disecante (OCD) en un adolescente a quien se le realizó exploración artroscópica combinada con artrotomía. Durante el acto quirúrgico se encuentra una plica infrapatelar que ocasionaba la lesión. Se toma un fragmento de cartílago y un segmento de plica para estudio histopatológico. A las 8 semanas del postoperatorio el paciente se reintegra a su actividad deportiva. Se comprueba por histopatología que la lesión es causada por un proceso inflamatorio, desencadenado por fricción de la plica, contra el espacio intercondileo. Se describen signos clínicos y radiológicos para el diagnóstico de la plica infrapatelar patológica

Osteitis y osteomielitis: actuación de conceptos / Osteitis and osteomyelitis: current of conceps

De 819 quirúrgicos almacenados en una base de datos, se encuentran que 119 corresponden a tratamientos por exposición ósea o infecciones del hueso. En vista de la estrecha relación que hay entre las fracturas abiertas y la infección ósea, se toma una muestra representativa de 10, igualmente se incluyen en este estudio 5 casos de infección por vía hematógena y finalmente 1 caso de infección ósea por "inoculación directa". De acuerdo al mecanismo como se produjo la infección se describen diferentes procedimientos y técnicas, utilizados en el tratamiento de cada uno de ellos. Se insiste en dos técnicas en especial, el drenaje subperióstico para la osteomielitis hematógena subaguda y la osteitis por "inoculación directa"; recanalización de la medular ósea para la osteitis postraumática y la osteomielitis hematógena crónica. Apoyado en la literatura y con la experiencia en el tratamiento de estos casos, se actualizan los conceptos de osteitis y osteomielitis, objetivo final del presente trabajo