Tumores sincrónicos de glándula salivar. A propósito de dos casos / No disponible

Presentamos dos casos de pacientes con tumores sincrónicos deglándula salivar. El primero se refiere a dos tumores benignos en la mismaglándula parótida, mientras que el segundo caso se trata de una lesiónmaligna y otra benigna en glándulas parótida y submaxilar ipsilaterales.Los dobles tumores sincrónicos homolaterales de glándula salivar son muyinfrecuentes, suponiendo menos del 0,3% de los tumores de esta localización.La bibliografía revisada refiere 42 casos entre los que sólo 9 presentanun tumor maligno y otro benigno.El diagnóstico citológico preoperatorio, junto con una exhaustiva inspecciónmacroscópica intraoperatoria son las claves para detectar los segundostumores, habitualmente más pequeños y no detectados en estudiosprevios, y así adecuar el procedimiento terapéutico

We present two new cases of synchronous tumorsof the salivary gland. The first one refers to two benign tumorsin the same parotid gland, while second one shows a benignlesion and a malignant tumor in two ipsilateral salivaryglands.The appearance of synchronous multiple unilateral parotidtumors of different histologic types is extremely rare, accountingfor less than 0.3%; this is usually a Warthin´s Tumorassociated to other tumors. The current literature has beenreviewed and 42 cases have been found entailing two differentparotid tumors coexisting. Of these 11 referred to adenolymphomaassociated with pleomorphic adenoma.Preoperative cytological diagnosis, as well as an exhaustiveintraoperative inspection are the clues to discover nonidentifiedsecond tumors

Strongyloides stercolaris infection mimicking a malignant tumour in a non-immunocompromised patient. Diagnosis by bronchoalveolar cytology.

Autoinfective strongyloidiasis is often fatal in immunosuppressed patients or in immunocomprised hosts. An interesting case of Strongyloides stercolaris hyperinfection was seen in an immunocompetent patient. This report describes a case of fatal strogyloidiasis in a 79 year old man, who had suffered gastrointestinal discomfort for years, and who presented because of respiratory illness. A chest radiograph showed an irregular mass close to the mediastinum and interstitial infiltrates, but blood eosinophilia was not observed. Cytological examination of the samples obtained from bronchial aspiration and brushing identified several filariform larvae. Thus, cytology was essential for the correct diagnosis in this patient and is a very reliable method to diagnose lung parasitosis.

Fibroma ameloblástico versus quiste folicular hiperplásico / Ameloblastic fibroma versus hyperplastic follicular cyst

El fibroma ameloblástico (FA) es un tumor odontogénico mixto, compuesto por tejido mesenquimal y epitelio odontogénico, representando el 2 por ciento de los tumores odontogénicos, mientras que el quiste dentígero o folicular (QF), el segundo quiste odontogénico en frecuencia, está compuesto exclusivamente por tejido conjuntivo laxo (mesénquima), si bien, el saco fibroso puede contener restos de epitelio odontogénico incluidos, dando lugar a una imagen histológica muy similar.La importancia de esta diferenciación radica en el tratamiento, que es ligeramente más agresivo en el FA y en el comportamiento biológico, ya que el FA puede derivar en un sarcoma ameloblástico, y el QF puede evolucionar hacia ameloblastoma y más raramente carcinoma mucoepidermoide. (AU)

Significado del test del VPH en pacientes con citologías diagnosticadas como ASCUS y dentro de la normalidad / Significance of HPV testing in patients with Pap test diagnosed as ASCUS and Within Normal Limits

La infección por el virus del papiloma humano (VPH) es el principal factor etiológico en el desarrollo de la neoplasia de cérvix. El presente estudio se ha basado en el análisis del VPH a través de hibridación mixta y captura de secuencias específicas de ADN viral en muestras de pacientes con citología no displásica. Se han definido dos grupos en función del diagnóstico citológico: a) dentro de los límites de la normalidad (DLN), y b) atipias escamosas de significado indeterminado (ASCUS), dividiéndolo a su vez en ASCUS de probable origen reactivo (ASCUS-R) y probablemente displásico (ASCUS-D). El 15% de las muestras no ASCUS-D (DLN + ASCUS-R) resultó positivo para VPH, mientras que en el 81% de los ASCUS-D se detectó VPH. En el grupo DLN se obtuvieron tres resultados positivos que en controles posteriores se negativizaron. En conclusión, la detección del VPH por hibridación mixta es un método de gran utilidad en pacientes que, a pesar de contar con citologías no concluyentes de acción viral, presentan alta sospecha clínica para dicha infección. Asimismo, resulta una inestimable herramienta a la hora de reclasificar las citologías informadas como ASCUS, lo que orienta hacia una posible displasia y permite intensificar el control de estas pacientes. Consideramos que actualmente el mejor método de cribado del cáncer cervicovaginal se sustenta en el test de Papanicolau apoyado en la determinación del VPH (AU)

Image cytometry in nonproliferative fibrocystic breast changes. Ploidy evaluation and epidemiologic study.

OBJECTIVE: To determine the usefulness of image cytometry on fine needle aspirates from patients with fibrocystic changes (FCCs) to assess the subsequent risk of breast cancer. STUDY DESIGN: Thirty-five hundred archival cases with fine needle aspiration (FNA) biopsy were assessed to select nonproliferative FCCs of the breast (500 cases), also classified as type 1 (FCC I). DNA evaluation was analyzed by means of image cytometry on ductal epithelial cells and on apocrine metaplastic cells; 97 quantifications were performed. Cytometric variables investigated were: DNA ploidy, G0/G1 peak of diploid nuclei, S-phase fraction, 5cER, 2cDI and coefficient of variation. Two groups each with 15 years of follow-up were formed: Simple pathology (SP), fibrocystic changes alone; associated pathology (AP), FCCs plus breast cancer. Each was studied separately and compared. RESULTS: In SP cases the average ploidy was 2.2 for epithelial cells and 4.2 for apocrine cells. The proportion of G0G1 diploid nuclei was 100%. In the study of AP, the average ploidy was 2.2 for epithelial ductal cells and 4.1 for apocrine ones, for a slight increase in SPF. Ductal cells were diploid, while apocrine cells were tetraploid, with statistical significance of P < .05. For the epidemiologic study we calculated the proportion of patients with FCC I who developed cancer by referring to a historical cohort study, obtaining a relative risk of 0.7. CONCLUSION: Our results prove that DNA image cytometry applied on FNA cytology is a very useful, minimally invasive and reliable tool to determine higher activity and risk for development of breast cancer in FCC I and thus to establish the need for closer follow-up of these patients. In addition, apocrine metaplastic cells of the breast display a tetraploid DNA histogram, while the other karyometric variables remain in the range of normality.

Cytologic features of pulmonary hamartoma. Report of a case diagnosed by fine needle aspiration cytology.

BACKGROUND: Pulmonary hamartoma (PH) is the most common benign tumor of the lung. It is usually composed of cartilage, fat, smooth muscle and respiratory epithelium. Its diagnosis is based on imaging methods (radiography, computed tomography) and cytohistomorphologic study by means of fine needle aspiration cytology (FNAC). CASE: A 59-year-old female had a productive cough and lung mass on chest radiography. Fine needle aspiration of the nodule showed a fusiform tumor cell, which was diagnosed as consistent with PH. The patient underwent surgery for the tumor. Histopathologic study confirmed the diagnosis of PH. CONCLUSION: The fluoroscopically guided FNAC specimen was adequate in achieving a diagnosis. Cytologic features consisted of a serosanguineous background in which scant cellular elements of spindle and stellate cells, as well as fibromyxoid material, enabled us to make a definitive diagnosis. Since this technique is relatively noninvasive, it is very useful in diagnosing PH before a preoperative biopsy.

Mastopatía diabética, una lesión que no se debe olvidar / Diabetic mastopathy, a lesion wich should not be forgotten

La mastopatía diabética es una enfermedad benigna de la mama que afecta a pacientes con diabetes mellitus tipo 1 de larga evolución, habitualmente en localización subareolar, pudiendo ser bilateral y recidivando con gran frecuencia. Nosotros hemos querido acercar esta patología a los profesionales clínicos para, desde el conocimiento de la lesión poder realizar un abordaje terapéutico acorde con sus características de benignidad. Tras revisar toda la bibliografía, hemos hallado 9 series que representan un total de 90 casos, además de un nuevo caso de mastopatía diabética de aportación personal. Con estos datos realizamos una correlación clinicopatológica, destacando los criterios histológicos constituidos por fibrosis queloidea, lobulitis, ductitis y perivasculitis, así como la evolución clínica caracterizada por tumores mamarios de 2-10 cm, que pueden presentar imagen radiológica sospechosa, y son tributarias de PAAF o incluso biopsia. Es frecuente que estas masas sean resecadas quirúrgicamente, aunque en el plazo de unos meses hasta el 37 por ciento recidivan. Como conclusión, apuntamos la necesidad de pensar en esta entidad ante toda paciente con diabetes mellitus tipo 1 con tumor mamario, y recordamos la posible bilateralidad, así como la muy alta tasa de recurrencia, lo que unido a su benignidad nos lleva a recomendar, ante un diagnóstico de certeza, el control de estas lesiones por medio de PAAF, evitando la práctica de biopsias repetidas, que no aportarían mayor luz al diagnóstico (AU)

[Prognostic value of cytology in terms of survival in prostatic cancer]. / Valor pronóstico de la citología en el cáncer de próstata en relación a la supervivencia.

The cytologic grade of malignancy and its relationship with survival was evaluated en 154 consecutive patients with prostatic cancer. The cytological aspirates were stained by the Papanicolay method and evaluated by two cytopathologists. Specimens were characterized as well, moderately or poorly differentiated, based on standard criteria. Patients without tumoral extension were initially untreated, and in the case of tumoral extension or posterior progression in the case of initially localized tumors, they were hormonally treated. The follow-up had a range between 33 and 120 months. The disease-specific survival was estimated by the Kaplan-Meier's curves. Our results indicate that there is a worse survival expectancy to the moderately differentiated tumors compared with the well differentiated. No difference was showed with the poorly differentiated, due to the low number of patients with it. The overall survival was compared to the control population survival, showing no difference except for the patients younger than 65 years old. The cytological aspirate of the prostate is not only a good method to diagnose prostatic cancer, our results confirm the prognostic value of the cytologic malignancy grading.

[Significance of ploidy in prostatic cancer, quantified by a prospectively applicable procedure]. / Valor de la ploidía en el cáncer de próstata, cuantificada mediante un procedimiento de aplicabilidad prospectiva.

OBJECTIVES: To determine the ploidy of prostatic adenocarcinoma cells obtained by fine-needle punction-aspiration biopsy using computer-assisted image analysis and its prognostic value. METHODS: The clinical applications of the two most commonly utilized methods, flow cytometry and cytophotometry, is difficult. The ploidy of prostatic adenocarcinoma cells obtained by fine-needle punction-aspiration biopsy in 54 patients was determined by image analysis. Previous cytological preparations from our files were utilized in the present study. Before processing the preparations, the Papanicolau stain used originally was removed. To make the technique simpler, we did not use the Feulgen stain but the progressive hematoxylin stain, which is faster and easier to use. The representative ploidy histograms were classified into four types first and then into two grades of DNA malignancy. The survival curves were plotted using the Kaplan-Meier method and according to the ploidy. RESULTS: Patients with high grade DNA malignancy had a worse survival rate than those with low grade malignancy. Statistical analysis using the log-rank test showed a significant difference, with p < 0.001. CONCLUSIONS: Tumor ploidy in prostate cancer can be determined prospectively using cytological smears with progressive hematoxylin staining and has a prognostic value.