Immunohistochemical evaluation of ProEx C in human papillomavirus-induced lesions of the cervix.

AIMS: Considering the sparse information about the clinical utility of the novel immunohistochemical marker ProEx C in histological sections, a decision was taken to study the pattern of ProEx C expression in normal/benign cervical epithelium (N/B), low-grade squamous intraepithelial lesion (LGSIL) and high-grade squamous intraepithelial lesion (HGSIL), as well as the association of ProEx C expression with human papillomavirus (HPV) genotypes. METHODS: 100 cervical samples, including 21 N/B cervices, 16 LGSILs, 61 HGSILs and two cervical invasive carcinomas, were obtained from conisation and hysterectomy. Surgical specimens were arranged in three tissue microarrays and stained for ProEx C. Ninety-three samples were HPV genotyped. Genotyping was performed by DNA amplification and hybridisation with genotype-specific probes on a low-density DNA array. RESULTS: ProEx C-positive expression in more than the lower third of the epithelium was observed in 14.3% of N/B, 62.5% of LGSIL and 90.2% of HGSIL. Seventy percent of HPV positivity was found in cases with expression in more than the lower third of the epithelium. Of 31 cases that were positive for HPV16, 16.1% showed ProEx C expression restricted to one or two basal layers, and 83.9% showed ProEx C expression in more than the lower third of the epithelium. CONCLUSIONS: ProEx C is significantly associated with HPV16 infection and is a useful adjunct in the identification of LGSIL and HGSIL in histological sections when expressed in more than the lower third of the epithelium.

Utility of fine-needle aspiration in the diagnosis of panniculitis.

This is a retrospective reassessment of the most important cytopathologic features of 23 FNA smears with a cytologic diagnosis of panniculitis (PN). Patients were sent by clinicians. Clinical diagnoses were as follows: 16 suspicious of PN; three cutaneous metastases of an extracutaneous primary neoplasm; four with no clinical diagnosis. Thirteen cases were subsequently submitted to histopathologic study. The following cytoarchitectural patterns were found to be very useful for the cytologic diagnosis of PN: adipocytes intermingled with foamy histiocytes, donut-like granulomas, aggregates of adipocytes intermingled with plump histiocytes, a granular basophilic background forming a lattice-like pattern, and well-formed granulomas with or without multinucleated giant cells. Inflammatory cells could be seen combined with any of these cytoarchitectural patterns. FNA does not pretend to replace excisional biopsy as the diagnostic procedure for these entities but it is a very useful diagnostic tool in certain cases: for confirming the recurrence of PN previously diagnosed by histology, for evaluating the onset of subcutaneous nodules in patients with a non-cutaneous malignant primary neoplasm, for evaluating cutaneous nodules with no clinical suspicion, and for confirming a clinical diagnosis of PN and differentiating it from other entities that mimic PN clinically.

[Aortoenteric fistula: an unusual cause of gastrointestinal hemorrhage]. / Fístula aortoentérica: una causa inusual de hemorragia digestiva.

The formation of an aortoenteric fistula is an infrequent cause of intestinal bleeding which carries out a bad prognosis. The causes may be diverse and the clinical picture is, occasionally, very unspecific with a high index of suspicion being fundamental in the management of this type of patients. Four cases of aortoenteric fistula which the authors believe to be clearly demonstrative are presented. One of these cases may currently be considered as very rare in Spain due to the etiology of the same. The authors emphasize the importance of exhaustive exploration by oral endoscopy which is able to diagnosis the localization of the bleeding in 80% of the cases. However they also underline the need for laparotomy, particularly in carriers of aortic vascular grafts which are currently the most important risk group, since confirmation of diagnosis by imaging methods may be delayed.

[An evaluation of the clinical significance of gastric dysplasia: a histological follow-up study]. / Evaluación del significado clínico de la displasia gástrica: estudio de seguimiento histológico.

To evaluate the clinical and prognostic significance of gastric dysplasia, we have carried out a study on 59 patients with histologic data obtained in a sequential way. The initial diagnosis was mild dysplasia in 24 patients, moderate in 18 cases and severe in 17 cases. The length of the follow up varied from one month to 13 years. The results suggest that, whereas cases of mild and moderate intensity tend to stability or regression, severe dysplasia is a reliable marker of high risk of gastric cancer. However, in our series as well as in the experience of others, the time elapsed between the diagnosis of severe dysplasia and the development of gastric carcinoma is usually very short. Because of this, we conclude that a carcinoma was probably already present when the initial biopsy was made. This conclusion emphasizes its diagnostic rather than its prognostic value in most occasions. Of 12 cases in our series which evolved to gastric carcinoma, 4 were diagnosed in an early stage (intramucosal). This fact confirms the importance of the recognition of gastric dysplasia for the early detection and control of these patients.