Brain lymphoma development related to a long lasting epidermoid cyst.

INTRODUCTION: Epidermoid cysts (EC) are benign and slow growing lesions. A primary brain lymphoma development related to a EC is presented, second case described in literature. CASE PRESENTATION: A woman 40 years old, harbouring a EC for more than 20 years, develops a fast growing brain lesion next to the EC. Surgery was performed and diagnosis was primary diffuse B cells lymphoma. DISCUSSION: Malignant transformation of EC has been described, usually to squamous cells carcinoma, and much less frequently, to another tumours. Inflammatory mechanisms have been advocated to explain this evolution. Chronic inflammation and lymphoma genesis are related, and this could be the mechanism behind this rare evolution of an EC. CONCLUSIONS: Even being benign lesions, EC can develop malignant tumours due to the chronic inflammation secondary to them.

Primary malignant PEComa of the mandible. Report of an unusual case.

Malignant PEComa is a rare entity that usually origins at visceral, retroperitoneal and abdominopelvic sites. In the present paper, we describe an extremely unusual manifestation of malignant PEComa involving the mandible in a 48 years-old female patient focusing on the anatomopathological findings and differential diagnosis. The therapeutic management based on the head and neck tumor board indications is also discussed. Key words:Malignant PEComa, PEComa of the mandible, PEComa pathology, Oral cavity unusual neoplasm.

Brain lymphoma development related to a long lasting epidermoid cyst. / Desarrollo de un linfoma cerebral con relación a un quiste epidermoide de larga evolución.

INTRODUCTION: Epidermoid cysts (EC) are benign and slow growing lesions. A primary brain lymphoma development related to a EC is presented, second case described in literature. CASE PRESENTATION: A woman 40 years old, harbouring a EC for more than 20 years, develops a fast growing brain lesion next to the EC. Surgery was performed and diagnosis was primary diffuse B cells lymphoma. DISCUSSION: Malignant transformation of EC has been described, usually to squamous cells carcinoma, and much less frequently, to another tumours. Inflammatory mechanisms have been advocated to explain this evolution. Chronic inflammation and lymphoma genesis are related, and this could be the mechanism behind this rare evolution of an EC. CONCLUSIONS: Even being benign lesions, EC can develop malignant tumours due to the chronic inflammation secondary to them.

Clinicopathological and prognostic significance of PD-L1 in oral cancer: A preliminary retrospective immunohistochemistry study.

OBJECTIVE: To evaluate the relation between PD-L1 expression in oral cavity squamous cell carcinomas and clinicopathological features as well as survival outcomes. METHODS: A retrospective immunohistochemical study was carried out on 55 archived tumours from 55 patients. Tumours were stained for PD-L1 and scored by the proportion of tumour cells with positive membranous staining. PD-L1 scores were compared to the patient's clinicopathological characteristics for any significant associations. Kaplan-Meier curves were constructed for PD-L1 positive and negative tumours to investigate any advantage to survival. RESULTS: Positive PD-L1 staining was found in 58% of tumours and was significantly more likely in non-smokers, non-drinkers and in tongue squamous cell carcinomas. Increased PD-L1 was also associated with increased lymphocyte infiltration as well as PD-L1 staining in lymphocytes and the epithelium adjacent to tumour invasion. No survival benefit was seen from PD-L1 expression in tumour cells. CONCLUSIONS: PD-L1 expression is more common in non-smokers and non-drinkers, and its presence in the adjacent non-tumour epithelium suggests it may be involved in early oncogenesis.

Association of ABCB1 and VEGFA gene polymorphisms with breast cancer susceptibility and prognosis.

Breast cancer (BC) is the most common cause of cancer-related death in women worldwide. Several ABCB1 and VEGFA gene polymorphisms, such as ABCB1-G1199 T/A (rs2229109), VEGFA -634 G > C (rs2010963), VEGFA 2578 C > A (rs699947) and VEGFA 7 C > T (rs25648) have been associated with risk of BC and clinical outcomes. The purpose of this study was to evaluate the association between these gene polymorphisms and BC risk and prognosis. A retrospective case-control study was conducted, including 84 BC cases and 119 controls of Spanish (European, Caucasian) origin. ABCB1-G1199 T/A (rs2229109), VEGFA -634 G > C (rs2010963), VEGFA 2578 C > A (rs699947) and VEGFA 7 C > T (rs25648) gene polymorphisms were analysed by TaqMan®. The genotypic logistic regression model adjusted by aged revealed no association with any of the polymorphisms and BC risk, although the C-allele of VEGFA 2578 C > A showed a trend to higher BC risk in the allelic and recessive models (p = 0.055 and 0.054, respectively). There was no influence of these gene polymorphisms on overall survival (OS). The univariate Cox model showed that carriers of the A-allele for VEGFA 2578 C > A tended to have longer OS compared to CC patients (CC vs A-allele Hazard ratio (HR): 2.08; CI95 % = 0.96-4.49; p = 0.0587). There was no association between the gene polymorphisms analysed and disease-free survival (DFS). The univariate Cox model showed a trend toward a longer DFS in patients carrying ABCB1-G1199 T/A GG genotype compared to those with A-allele (GG vs A-allele HR: 0.43; CI95 % = 0.18-1.03; p = 0.0612). No influence of ABCB1-G1199 T/A (rs2229109), VEGFA -634 G > C (rs2010963), VEGFA 2578 C > A (rs699947) and VEGFA 7 C > T (rs25648) gene polymorphisms on risk of developing BC was found in our study. There was no association between the polymorphisms studied and DFS and OS.

Endometrial Changes in Surgical Specimens of Perimenopausal Patients Treated With Ulipristal Acetate for Uterine Leiomyomas.

Ulipristal acetate (UPA) is used to treat leiomyomas, and its effect on the endometrium has been studied in biopsy material. Reversible histologic modifications were found, named progesterone receptor modulators-associated endometrial changes (PAEC). However, hysterectomies from patients treated with UPA have not been analyzed. For the first time, we examined surgical specimens from 100 leiomyoma-treated patients for UPA-related endometrial changes. We analyzed the distribution of lesions, involution after treatment, and the relationship between type and extent of lesions and dosage. Clinically, 72 patients were treated with 1 cycle of UPA; 23 patients with 2 cycles, and 5 with 3 cycles. A total of 66 patients underwent surgery in the first 4 wk after treatment, 24 were operated between 5 and 12 wk after discontinuation of UPA, and 10 after more than 12 wk after the last cycle, up to a maximum of 32 wk. Histologically normal endometria were found in 41 cases and PAEC in 59 cases. PAEC consisted of irregular, cystic glands showing a flattened secretory-like epithelium with vacuolation, coexisting mitoses and apoptosis, and were found focally within cyclic endometria in 51 cases. Only in 8 cases did diffuse PAEC involve the whole endometrium, transforming it into a thick spongy cushion. PAEC also occurred in adenomyosis. There was no relationship between dosage and type and extent of lesions. Diffuse PAEC, which usually presents differential diagnoses with hyperplasia, occurred in only 8 cases, being only present during the first 4 wk after discontinuation of treatment and was independent of the number of cycles administered.

ABCB1 C3435T gene polymorphism as a potential biomarker of clinical outcomes in HER2-positive breast cancer patients.

HER2-positive breast cancer patients treated with trastuzumab schemes have good initial clinical outcomes. Despite this beneficial effect, many patients experiment resistance to these drugs. Several gene polymorphisms in ABCB1, HER2, and CCND1 have been proposed as potential predictors of clinical outcomes of trastuzumab schemes. The aim of this study was to evaluate the association between 4 gene polymorphisms potentially responsible for bad prognosis (HER2-Ile655Val, CCND1-A870G and ABCB1C1236T, C3435T) and clinical outcomes in HER2-positive BC patients. A retrospective cohorts study was performed. Eighty-four HER2-positive BC patients treated with trastuzumab schemes were included. The four gene polymorphisms were analyzed by PCR Real-Time with Taqman® probes. Genotypes were investigated for their association with tumor response, survival and resistance. Patients with CC genotype of ABCB1-C3435T presented higher risk of resistance to chemotherapy/trastuzumab schemes, compared to those carrying the T-allele (RR: 2.71; CI95%:1.29-5.68; p=0.013888), progression (RR: 1.89; p=0.017964); and exitus (RR: 2.09; p=0.03276). Multivariate logistic regression analysis considering clinical variables and ABCB1-C3435T revealed that the only independent factor associated to resistance to therapy was ABCB1-C3435T gene polymorphism (ORCT/CC: 0.25; p=0.0123; ORTT/CC: 0.09; p=0.0348. The protective effect of ABCB1-C3435T T-allele was confirmed in the multivariate Cox regression analysis for PFS (HRCT/CC: 0.41; p=0.00806; HRTT/CC: 0.22; p=0.01982) and OS (HRCT/CC: 0.49; p=0.0555; HRTT/CC: 0.12; p=0.0398). ABCB1-C1236T, CCND1-A870G and HER2-Ile655Val polymorphisms were not associated to resistance, PFS or OS (p>0.05). The A-allele for CCND1-rs9344 was associated with higher response rates (RR: 3.44; uncorrected p-value: 0.03816) in the bivariate analysis, but no statically association was found after Bonferroni correction (p=0.15264). ABCB1-C3435T, ABCB1-C1236T and HER2-Ile655Val gene polymorphisms were not associated with response. Although this study demonstrates a prognostic value of ABCB1-C3435T gene polymorphism to predict clinical outcomes, further studies with a larger sample will be necessary to validate this result.

Biopsia del ganglio centinela y quimioterapia neoadyuvante en pacientes con cáncer de mama: nuestra experiencia / Sentinel lymph node biopsy and neoadjuvant chemotherapy in breast cancer patients: our experience

Objetivo. Revisar nuestra experiencia en la biopsia selectiva del ganglio centinela (BGC) en pacientes con cáncer de mama operable tratadas con quimioterapia neoadyuvante (QTN). Material y métodos. Estudio prospectivo, enero de 2008/diciembre de 2014, 235 BGC en pacientes con cáncer de mama infiltrante T1-3/N0-1, tratadas con epirrubicina/ciclofosfamida, docetaxel y trastuzumab en Her2/neu positivas. El estatus axilar se estableció por exploración física, ecografía axilar y punción de ganglios sospechosos. El día antes de la cirugía se inyectaron periareolarmente 74-111 MBq de 99mTc-nanocoloide de albúmina. Al finalizar el tratamiento se realizó BGC y linfadenectomía axilar. El GC se analizó por cortes de congelación, hematoxilina-eosina, inmunohistoquímica o one-step nucleic acid amplification. Se determinaron tasa de identificación (Id.GC) y falsos negativos (FN). Resultados. Grupo I BGC pre-QTN pacientes cN0 de inicio: n = 73, Id.GC 97,2% (IC 95% 90,5-99,2). Grupo II 2.a BGC pos-QTN pacientes pN1(gc) de inicio: n = 31, Id.GC 61,3% (IC 95% 43,8-76,3), FN 18,2% (IC 95% 5,1-47,7). Grupo III BGC pos-QTN pacientes cN0 de inicio: n = 54, Id.GC 96,3% (IC 95% 87,5-99,0), FN 9,5% (IC 95% 2,7-28,9). Grupo IV BGC pos-QTN pacientes cN1 de inicio, ycN0 posneoadyuvancia: n = 77, Id.GC 83,1% (IC 95% 73,2-89,8), FN 8,3% (IC 95% 2,9-21,8). Conclusiones. La identificación de la BGC pre-QTN es excelente. En pacientes pN1(gc) al diagnóstico, una 2.a BGC pos-QTN no es válida para su aplicación clínica. La BGC pos-QTN puede realizarse con fiabilidad en pacientes cN0 y cN1 de inicio, con axila clínicamente negativa al finalizar la neoadyuvancia (ycN0), y linfadenectomía axilar si el resultado del GC es positivo o no se identifica en la cirugía, en el ámbito de un equipo multidisciplinar con experiencia (AU)

Aim. To analyze our experience of sentinel lymph node biopsy (SLNB) in patients with operable breast cancer treated with neoadjuvant chemotherapy (NAC). Material and methods. A prospective study was conducted between January 2008 and December 2014 in 235 SLNB in patients with infiltrating breast carcinoma T1-3/N0-1 treated with epirubicin/cyclophosphamide, docetaxel and trastuzumab in Her2/neu-positive patients. Axillary evaluation included physical examination and ultrasound, with guided core needle biopsy of any suspicious lymph nodes. The day before surgery, 74-111 MBq of 99mTc-albumin nanocolloid was injected periareolar. Following NAC, patients underwent SLNB and axillary lymph node dissection. SLN were examined with hematoxylin-eosin staining and immunohistochemical analysis or one-step nucleic acid amplification. The identification rate (IR) and false-negative rate (FNR) were determined. Results. Group I SLNB pre-NAC in patients cN0 at diagnosis: n = 73, IR 97.2% (95%CI: 90.5-99.2). Group II 2nd SLNB pos-NAC in patients pN1(sn) at diagnosis: n = 31, IR 61.3% (95%CI: 43.8-76.3), FNR 18.2% (95%CI: 5.1-47.7). Group III SLNB pos-NAC in patients cN0 at diagnosis: n = 54, IR 96.3% (95%CI: 87.5-99.0), FNR 9.5% (95%CI: 2.7-28.9). Group IV SLNB pos-NAC in patients cN1 at diagnosis and ycN0 post-treatment: n = 77, IR 83.1% (95%CI: 73.2-89.8), FNR 8.3% (95%CI: 2.9-21.8). Conclusions. The detection rate for SLNB prior to NAC is excellent. A second SLNB after NAC in women with a positive SLN at diagnosis is not useful. SLNB after NAC is feasible in cN0 and cN1 patients at diagnosis, clinically axillary node-negative after therapy (ycN0), with subsequent axillary lymph node dissection if the SLNB is positive or not identified during surgery, when performed by an experienced multidisciplinary team (AU)

¹8F-Fluorocholine PET/CT as a complementary tool in the follow-up of low-grade glioma: diagnostic accuracy and clinical utility.

PURPOSE: The follow-up of treated low-grade glioma (LGG) requires the evaluation of subtle clinical changes and MRI results. When the result is inconclusive, additional procedures are required to assist decision-making, such as the use of advanced MRI (aMRI) sequences and nuclear medicine scans (SPECT and PET). The aim of this study was to determine whether incorporating (18)F-fluorocholine PET/CT in the follow-up protocol for treated LGG improves diagnostic accuracy and clinical utility. METHODS: This was a prospective case-series study in patients with treated LGG during standard follow-up with indeterminate clinical and/or radiological findings of tumour activity. All patients underwent clinical evaluation, aMRI, (201)Tl-SPECT and (18)F-fluorocholine PET/CT. Images were interpreted by visual evaluation complemented with semiquantitative analysis. RESULTS: Between January 2012 and December 2013, 18 patients were included in this study. The final diagnosis was established by histology (five surgical specimens, one biopsy specimen) or by consensus of the Neuro-Oncology Group (11 patients) after a follow-up of >6 months (mean 14.9 ± 2.72 months). The global diagnostic accuracies were 90.9% for aMRI (38.8% inconclusive), 69.2 % for (201)Tl-SPECT (11.1% inconclusive), and 100% for (18)F-fluorocholine PET/CT. (201)Tl-SPECT led correctly to a change in the initial approach in 38.9% of patients but might have led to error in 27.8%. The use of (18)F-fluorocholine PET/CT alone rather than (201)Tl-SPECT led correctly to a change in the approach suggested by routine follow-up in 72.2% of patients and endorsed the approach in the remaining 27.8%. CONCLUSION: Our results support the need to complement structural MRI with aMRI and nuclear medicine procedures in selected patients. (18)F-Fluorocholine PET/CT can be useful in the individualized management of patients with treated LGG with uncertain clinical and/or radiological evidence of tumour activity.

Segunda biopsia del ganglio centinela después de quimioterapia neoadyuvante en pacientes con cáncer de mama, axila negativa y ganglio centinela metastásico al diagnóstico inicial. Resultados preliminares / Second sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients with negative axilla and metastatic sentinel lymph node at presentation. Preliminary results

Objetivo. Valorar la validez diagnóstica de una segunda biopsia del ganglio centinela (GC) en pacientes con cáncer de mama operable y axila negativa al diagnóstico, con GC metastásico, tratadas con quimioterapia neoadyuvante (QTN). Pacientes y métodos. Estudio prospectivo realizado en 52 mujeres con cáncer de mama infiltrante (2 bilateral); estadio II-A (cT2N0M0): 50, II-B (cT3N0M0): 4. El estatus axilar se estableció por exploración física, ecografía y punción ecoguiada de los ganglios sospechosos. Pauta QTN: epirrubicina/ciclofosfamida × 4, y docetaxel × 4. El día antes de la cirugía se inyectó periareolarmente 74-111 MBq de nanocoloide de albúmina. El GC se analizó por amplificación de ácido nucleico de un solo paso. Se realizó linfadenectomía axilar en las pacientes con GC positivo al diagnóstico. Resultados. El GC axilar pre-QTN se identificó en el 96,3% de los casos; GC extirpados 1,8 ± 0,8 (rango 1-4). En el 55,8% el resultado del GC fue positivo. Actualmente, 44 pacientes (2 bilateral) han completado el tratamiento. Se ha realizado una segunda biopsia del GC posneoadyuvancia en 22 pacientes: 20 con GC pre-QTN positivo, 2 sin migración axilar preneoadyuvancia. Solo se identificó el GC en el 54,5% de las pacientes; GC resecados 1,5 ± 0,8 (rango 1-3). En 9 de las 10 mujeres sin migración la linfadenectomía axilar fue negativa. En 7 pacientes el GC fue un verdadero positivo, y en 4 de ellas los GC eran los únicos afectados de la axila. En 2 casos el resultado fue falso negativo (22,2%). Conclusiones. Los resultados de una segunda biopsia del GC post-QTN no son adecuados para su aplicación en la práctica clínica (AU)

Aim. To evaluate the accuracy of a second sentinel lymph node (SLN) biopsy in patients with operable breast cancer and clinically negative axilla, with metastatic SLN at diagnosis, treated with neoadjuvant chemotherapy (NAC). Patients and methods. A prospective study was performed in 52 women with invasive ductal carcinoma (2 bilateral); stage IIA (cT2N0M0): 50, IIB (cT3N0M0): 4. Axillary evaluation included physical examination and axillary ultrasound, with ultrasound-guided core needle biopsy of any suspicious lymph node. The NAC scheme consisted of epirubicin/cyclophosphamide × 4, and docetaxel × 4. The day before surgery, 74-111 MBq albumin nanocolloid was injected periareolarly. The SLN was analyzed by one-step nucleic acid amplification. Axillary lymph node dissection was performed in patients with positive SLN at presentation. Results. Pre-NAC axillary SLN was identified in 96.3% of the patients. The mean number of extirpated SLN was 1.8 ± 0.8 (range 1-4). In 55.8% of the patients, the SLN was positive. Currently, 44 patients (2 bilateral) have completed NAC and surgical treatment. A second SLN biopsy was performed post-NAC in 22 patients: 20 with positive pre-NAC SLN and 2 without pre-NAC SLN identification. SLN was only identified in 54.5% of cases. The mean number of extirpated SLN was 1.5 ± 0.8 (range 1-3). Non migration occurred in 10 patients, 9 patients without axillary lymph node dissection involvement. In 7 patients, the post-NAC SLN was a true positive and was the only axillary lymph node affected in 4. The false negative rate was 22.2%. Conclusions. A second SLN biopsy after NAC in women with a positive SLN at diagnosis is not a useful option (AU)

Early radiation-induced laryngeal malignant fibrous histiocytoma (MFH).

Postradiation sarcoma is a potential late sequela of ionising radiation and its frequency is rare. We present the case of a man with a radiation-induced malignant fibrous histiocytoma with a latent period of 20 months.

Factores histopatológicos en el carcinoma lingual de células escamosas / Histopathologic factors in the squamous carcinoma of tongue

I. Introducción: Se realiza un estudio sobre los principalesparámetros histopatológicos en el carcinoma escamosode lengua, neoplasia que representa hoy día un auténtico problemade salud pública. II. Material y Métodos: 1. Diseño:Estudio retrospectivo de base hospitalaria integrado por 60pacientes desde enero de 1990 a julio de 1997 (seguimientomínimo de 8 años). 2. Variables: Filiación del paciente (edady sexo) y factores histopatológicos (diferenciación tumoral,índice mitótico, eosinofilia peritumoral, infiltración perivasculary perineural y patrón de crecimiento). 3. Estadística:Análisis descriptivo y estadística inferencial mediante test dechi-cuadrado y test exacto de Fischer (p<0,05). III. Resultados:Se obtuvieron un 26,66% de mujeres frente a un 73,34%de hombres, con una edad media de 58 años (Rango de 88-21). La invasión perineural y perivascular se asoció con unpatrón de crecimiento tumoral tipo II (8.4; p=0,01 y 9,74;p=0,03). Se obtuvo independencia estadística entre índicemitótico y diferenciación tumoral. IV. Conclusiones: Se hadeterminado una alta asociación entre la infiltración perivasculary perineural con el patrón de crecimiento tipo II. Estoshallazgos permiten elaborar un protocolo aplicable de formarutinaria en la evaluación del carcinoma epidermoide lingual

I. Introduction: A study is made of the main histopathologicalparameters in squamous cell carcinoma of thetongue. This neoplasm represents nowadays a outstandinghealth problem. II. Material and Methods: 1. Design: Ahospital population retrospective study over 60 patients sinceJanuary-1990 to July-1997 (minimal follow-up of 8years). 2. Variables: Patient data (age and sex) and histopathologicalfactors (tumoral grading, mitotic index, peritumoraleosinophilic, vascular and perineural infiltration,growth pattern). 3. Statistics: Descriptive analysis. Associationbetween variables was assessed with chi-square test andFischer exact test. (p<0.05). III. Results: There were26.66% females and 73.34% males, with a mean age of 58(range 88-21). The perineural and perivascular infiltrationwas associated with a tumoral pattern type II (8.4; p=0.01and 9.4; p=0.03). Mitotic Index and tumoral grading wereindependent parameters. IV. Conclusions: We determine ahigh association between perivascular and perineural infiltrationwith the tumoral pattern type II. This protocol maybe applied as routine for an accurate evaluation of the squamouscell carcinoma of the tongue

Mesotelioma multiquístico de túnica vaginal testicular / Multicystic mesothelioma of the testicular tunica vaginalis

OBJETIVO: Aportamos un caso excepcional de mesotelioma multiquístico de túnica vaginal testicular. MÉTODO: Varón de 72 años remitido para estudio de masa escrotal. Se realiza examen físico, analítico y ecográfico previo a la extirpación quirúrgica y estudio anatomopatológico de la lesión. RESULTADO: En el estudio ecográfico se apreció una lesión quística multilobulada junto a cordón espermático. Los hallazgos anatomopatológico fueron múltiples formaciones quísticas de 3-4 mm,con papilas rudimentarias revestidas por epitelio hipercromático e inmunofenotipo vimentina (+), CD34 (+). CONCLUSIÓN: El mesotelioma multiquístico es una forma rara de mesotelioma, bien reconocido pero infrecuente. Este tumor afecta normalmente a la superficie peritoneal de la pelvis y del abdomen, aunque se han descrito otras localizaciones menos frecuentes, la localización testicular es excepcional. Presentamos el caso de un paciente afecto de un mesotelioma multiquístico de túnica vaginal testicular y revisamos el diagnóstico, la histopatología y las opciones de tratamiento de este tipo de tumor (AU)

[Multicystic mesothelioma of the testicular tunica vaginalis]. / Mesotelioma multiquístico de túnica vaginal testicular.

OBJECTIVES: To report an exceptional case of multicystic mesothelioma of the testicular tunica vaginalis. METHODS: A 72-year-old male was referred for study of a scrotal mass. Physical examination, blood tests, and ultrasound were performed prior to surgical excision and pathologic study of the lesion. RESULTS: The ultrasound study showed a multilobar cystic lesion near the spermatic cord. Pathology reported multiple 3-4 mm cystic formations, with rudimentary papillae covered by a hyperchromatic epithelium and vimentin (+), CD 34 (+) immunophenotype. CONCLUSIONS: Multicystic mesothelioma is a rare form of mesothelioma, easy to recognize but infrequent. This tumor generally affects the peritoneal surface of the pelvis and abdomen; although other less frequent locations have been described testicular location is exceptional. We report the case of a patient presenting with a multicystic mesothelioma of the testicular tunica vaginalis and review the diagnosis, pathology and treatment options for this type of tumor.