ABSTRACT
AIM: We aimed to determine the frequency and clinical significance of breast incidental uptake (BIU) detected through fluorine-18 fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in a single, high-load center. PATIENTS AND METHODS: In this retrospective study, we analyzed a total of 13 763 PET/CT studies performed from January 2017 to January 2020. After excluding 3148 scans, the maximum standardized uptake value (SUVmax) and maximum diameter (cm) of each BIU were measured. Clinical management, ultrasound/mammography and pathology reports were analyzed. RESULTS: We found BIU in 27 scans of 26 patients (0.3% of the studies). Mean age was 62.2 years and 88.5% were women; 84.6% underwent PET/CT for oncological indications. Ultrasound/mammography was consequently performed in 23 patients (88.5%), and histological correlations were available for Breast Imaging Reporting and Data System categories 4 and 5. Finally, lesions were benign in 14 patients (60.9%; two of them with low/intermediate risk of malignancy) and malignant in nine patients (39.1%). The remaining three patients had no ultrasound/mammography reports. Mean SUVmax of benign and malignant lesions were 2.6 ± 1.4 and 5.8 ± 3.5, respectively (P = 0.002). Considering a SUVmax cut-off value of 4.0, the sensitivity and specificity for differentiating benign vs. malignant lesions were 67 and 93%, respectively. Benign lesions were smaller than malignant in CT (maximum diameter:1.3 ± 0.5 cm vs. 2.0 ± 1.0 cm, P = 0.02). CONCLUSION: Although BIU detected by 18F-FDG PET/CT is infrequently found, the risk of malignancy remains very high (39.1%). Both SUVmax and maximum diameter were greater in malignant than in benign lesions. An exhaustive study with ultrasound/mammography and selective histopathological correlation is mandatory after BIU findings, even in small lesions.
Subject(s)
Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Humans , Incidental Findings , Male , Middle Aged , Retrospective StudiesABSTRACT
Objective: The objective of the study was to analyze cases of endometrial vascular dystrophy in the Hysteroscopy Unit of Hospital Clínico San Carlos, Madrid, Spain. Review: We reviewed a total of 7,658 hysteroscopies carried out in the unit during 2011-May 2017. We identified a total of 8 cases and analyzed both the hysteroscopy and the histopathology data. Conclusion: The condition known as endometrial vascular dystrophy does not comprise vascular disorders, but rather involves tortuous secretory glands (normal) filled with retained blood. We can find no explanation for this phenomenon
Objetivo: el objetivo del trabajo es analizar los casos de "Distrofia Vascular Endometrial" encontrados en la unidad de histeroscopias del Hospital Clínico de San Carlos (UCM). Material y métodos: se revisan un total de 7.658 histeroscopias, practicadas en la unidad durante el periodo de tiempo comprendido entre 2011- mayo de 2017. Se analizan las histeroscopias, así como el estudio histopatológico e histoquimico de los 8 casos de DVE encontrados. Resultados: se encuentran un total de 8 casos de DVE, totalmente documentados con videos, desechándose otros casos que no están documentados. Conclusión: los autores llegan a la conclusión de que la llamada Distrofia Vascular Endometrial, no está constituida por alteraciones vasculares, sino que se trata de glándulas secretoras tortuosas (normales) pero llenas de sangre retenida y material de secreción. No encuentran explicación a este fenómeno
Subject(s)
Humans , Female , Hysteroscopy/statistics & numerical data , Endometrial Hyperplasia/diagnostic imaging , Vasculitis/diagnostic imaging , Endometrial Hyperplasia/epidemiology , Histocytochemistry/methods , Retrospective StudiesABSTRACT
Los adenomioepiteliomas (AME) mamarios son tumores muy poco frecuentes, de histología variable, que pueden simular otras lesiones epiteliales, mioepiteliales y bifásicas de la mama. En el presente estudio analizamos los hallazgos clínico-patológicos de 4 casos de AME diagnosticados en el Hospital Clínico San Carlos en el periodo 2005-2015. La media de edad fue de 57años. Eran nódulos sólidos de bordes irregulares localizados en todos los casos en cuadrantes superiores (3 en mama derecha y uno en mama izquierda), con tamaño medio de 13mm. Microscópicamente 2 de ellos eran variante tubular y 2, lobulada. Se observaron cambios hialinos, áreas mixoides, quísticas, pseudoinfiltración periférica y nódulos satélite en algunos de los casos. Las células mioepiteliales eran fusiformes y fueron positivas para actina, calponina, p63, S100 y CD10 y negativas para CKAE1-AE3, con CK34BE12 y CK5/6 variables. En todos los casos la tumorectomía fue curativa, sin recurrencias ni transformación maligna (AU)
Adenomyoepitheliomas of the breast are infrequent tumors with a variable histological appearance, and they can mimic several epithelial, myoepithelial and biphasic lesions of the breast. We have reviewed four cases of adenomyoepithelioma of the breast diagnosed between 2005 and 2015 in our institution (Hospital Clínico San Carlos). Mean age was 57years. All lesions were solid irregular masses located in the upper quadrants (3 of them in the right breast and one in the left), with an average size of 13mm. Microscopically 2 of them were tubular and the remaining 2 were lobulated subtypes. Hyaline, myxoid and cystic areas, peripheral pseudoinfiltration and satellite nodules were occasionally seen. Myoepithelial cells were fusiform and immunohistochemically they were actin, calponin, p63, S100 and CD10 positive and CKAE1-AE3 negative, with variable CK23BE12 and CK5/6 staining. In all cases lumpectomy was curative, no recurrences or malignant degeneration were observed (AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Adenomyoepithelioma/pathology , Breast Neoplasms/pathology , Biomarkers, Tumor/analysis , Diagnosis, Differential , Mastectomy/methods , Myoepithelioma/pathologyABSTRACT
Adenomyoepitheliomas of the breast are infrequent tumors with a variable histological appearance, and they can mimic several epithelial, myoepithelial and biphasic lesions of the breast. We have reviewed four cases of adenomyoepithelioma of the breast diagnosed between 2005 and 2015 in our institution (Hospital Clínico San Carlos). Mean age was 57years. All lesions were solid irregular masses located in the upper quadrants (3 of them in the right breast and one in the left), with an average size of 13mm. Microscopically 2 of them were tubular and the remaining 2 were lobulated subtypes. Hyaline, myxoid and cystic areas, peripheral pseudoinfiltration and satellite nodules were occasionally seen. Myoepithelial cells were fusiform and immunohistochemically they were actin, calponin, p63, S100 and CD10 positive and CKAE1-AE3 negative, with variable CK23BE12 and CK5/6 staining. In all cases lumpectomy was curative, no recurrences or malignant degeneration were observed.
Subject(s)
Adenomyoepithelioma/pathology , Breast Neoplasms/pathology , Adult , Aged , Female , Humans , Middle AgedSubject(s)
Microscopic Polyangiitis/complications , Retinal Vasculitis/etiology , Scleritis/etiology , Antibodies, Antineutrophil Cytoplasmic/blood , Cyclophosphamide/therapeutic use , Drug Therapy, Combination , Fluorescein Angiography , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Male , Methylprednisolone/therapeutic use , Microscopic Polyangiitis/diagnosis , Microscopic Polyangiitis/drug therapy , Middle Aged , Retinal Vasculitis/diagnosis , Retinal Vasculitis/drug therapy , Scleritis/diagnosis , Scleritis/drug therapyABSTRACT
El linfoma B de células grandes intravascular es una variante poco frecuente de linfoma B de célula grande incluido en la actual clasificación de la Organización Mundial de la Salud. Este linfoma se caracteriza por la ausencia de marcada linfadenopatía, clínica inespecífica y comportamiento agresivo. El diagnóstico de esta neoplasia es difícil y muchos de los casos publicados han sido diagnosticados en autopsias. Presentamos el caso de una mujer de 82 años cuyos primeros síntomas fueron una clínica de infartos cerebrales multifocales progresivos. La paciente desarrolló un deterioro neurológico progresivo. La resonancia magnética mostró la presencia de múltiples infartos y hemorragias en los hemisferios cerebrales. La tríada diagnóstica en estos linfomas está formada por una encefalopatía subaguda, infartos múltiples y elevación sérica de la lactato deshidrogenasa (LDH). Los principales diagnósticos diferenciales en la clínica incluyen vasculitis cerebrales, encefalopatías sépticas o infecciones del sistema nervioso central. Los diagnósticos diferenciales en anatomía patológica incluyen otros tumores con angiotropismo como linfomas T/NK, granulomatosis linfomatoide, carcinomas indiferenciados o melanomas(AU)
Intravascular large B-cell lymphoma is a rare variant of large B-cell lymphoma, according to the current WHO classification. It has a non-specific clinical presentation and is characterised by absence of marked lymphoadenopathy and aggressive behaviour. Its diagnosis is extremely difficult and many of the reported cases were diagnosed post-mortem. We report the case of an 82-year-old woman who presented with the clinical features of progressive multifocal cerebral infarction. Her neurological condition subsequently deteriorated. A brain MRI showed multistage intraparenchymal infarction and haemorrhage in the cerebral hemispheres. The hallmark in this lymphoma is the triad of a subacute encephalopathy, multiple strokes and elevated serum lactate dehydrogenase (LDH) levels. Clinical differential diagnoses should include cerebral vasculitis, septic encephalopathy or infections of the central nervous system. Differential pathological diagnoses include other angiotropic tumours such as T/NK lymphomas, lymphomatoid granulomatosis, undifferentiated carcinoma or malignant melanoma(AU)
Subject(s)
Humans , Female , Aged, 80 and over , Cerebral Infarction/pathology , Lymphoma, B-Cell/pathology , Diagnosis, Differential , Vincristine/therapeutic use , Prednisone/therapeutic use , Lymphatic Diseases/psychology , Magnetic Resonance Imaging/instrumentation , Magnetic Resonance Imaging/methods , Cyclophosphamide/therapeutic useABSTRACT
Las neoplasias mucinosas papilares intraductales de páncreas (NMPI) constituyen una entidad bien reconocida, relativamente rara, entre las neoplasias pancreáticas. La OMS las define como neoplasias papilares productoras de mucina que se desarrollan en el conducto de Wirsung o en sus ramas principales. Presentamos 2 casos de NMPI. El primero corresponde a un varón de 69 años que presenta una tumoración única de 7,5cm en cabeza de páncreas con dilatación del conducto de Wirsung que se diagnosticó como NMPI de tipo intestinal. El segundo se trataba de una mujer de 60 años con una tumoración quística multifocal en cabeza de páncreas de 2cm y afectación del borde de resección del cuerpo y la cola del páncreas que se diagnosticó como NMPI de tipo foveolar. En el estudio inmunohistoquímico, las tumoraciones presentaron una expresión diferente para citoqueratinas, siendo la NMPI de tipo intestinal positivo para CK-7 y CK-20 y negativo para CK34βE12; y el foveolar, positivo para CK-7 y CK34βE12 y negativo para CK-20. Estas neoplasias tienen un pronóstico excelente tras la cirugía en ausencia de componente invasor. La diferente expresión de citoqueratinas encontradas en nuestro estudio puede ser útil para determinar el tipo de neoplasia en biopsias de pequeño tamaño(AU)
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a well known but relatively infrequent entity. The World Heath Organization defines it as a papillary mucin producing neoplasm developing in the duct of Wirsung or in its principal branches. We present two cases of IPMN of the pancreas. The first was diagnosed as an intestinal type IPMN occurring in a 69 year old male who presented with a single, 7.5cm tumour in the head of the pancreas with a dilated duct of Wirsung. The second case was a foveolar type IPMN found in a 60 year old woman with a 2cm, multifocal, cystic tumour in the head of the pancreas involving the resection margins in the body and tail of the pancreas. The immunohistochemistry revealed a different expression of cytokeratins in each case; the intestinal type IPMN was positive for CK7 and CK20 and negative for CK34βE12, whilst the foveolar type tumour was positive for CK7 and CK34βE12 but negative for CK20. The post operative prognosis is excellent when no invasion has occurred. The difference in cytokeratin expression found in the reported cases could prove useful in the diagnosis of small biopsy samples(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Neoplasms, Cystic, Mucinous, and Serous/diagnosis , Neoplasms, Cystic, Mucinous, and Serous/pathology , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/pathology , Pancreaticoduodenectomy/methods , Pancreaticoduodenectomy/trends , Immunohistochemistry/methods , Neoplasms, Cystic, Mucinous, and Serous/complications , Risk FactorsABSTRACT
El embarazo ectópico se presenta en el 10-12% de los casos tras una esterilización tubárica y suele localizarse en la trompa. El 1% de los embarazos ectópicos son abdominales y la implantación en el epiplón es una rara entidad (sólo se han descrito 16 casos). Según Studdiford, pueden clasificarse como primarios o secundarios en función de que se originen o no en la cavidad peritoneal. Presentamos el caso de un embarazo abdominal secundario, localizado en el epiplón, en una mujer con esterilización tubárica previa, aspecto no relacionado hasta la fecha en ninguna publicación. Se trata de un embarazo abdominal con origen en un aborto tubárico, puesto que no hay invasión trofoblástica del epiplón y hay restos del mismo tejido en la trompa derecha
The ectopic pregnancy appears in the 10-12% of cases after tubal sterilization and it is usually located in the tube. 1% of ectopic pregnancies are abdominal and the implantation in omentum is a rare condition with only 16 described cases. According to Studdiford, they can be classified as primary or secondary depending on whether they are originated or not in the peritoneal cavity. We present the case of a secondary abdominal pregnancy located in omentum, in a woman with previous tubal sterilization, which has not been described to date; one is an abdominal pregnancy with origin in a tubal abortion, since trofoblastic invasion does not exist in omentum and there are remains of the same tissue in the right tube
Subject(s)
Female , Pregnancy , Adult , Humans , Pregnancy, Abdominal/diagnosis , Pregnancy, Abdominal/surgery , LaparotomyABSTRACT
La telepatología es la transmisión de imágenes digitales de anatomía patológica por sistemas de telecomunicación, y con fines de consulta, diagnóstico, investigación, o docencia. La telepatología estática utiliza imágenes fijas, mientras que la dinámica se basa en el envió de imágenes obtenidas mediante videocámara. La telepatología estática comienza con la selección por un patólogo de las imágenes demostrativas de una lesión. Posteriormente las imágenes deben ser procesadas y comprimidas, lo que permite mejorar su calidad diagnóstica y, fundamentalmente su tamaño, para que puedan ser enviadas de forma efectiva por vías de comunicación con anchos de banda limitados. En este artículo se analizan todas estas etapas y sus aspectos técnicos. En la actualidad, la telepatología estática cuenta con un papel dentro de la patología diagnóstica, aunque este papel es todavía limitado. En otros campos, como la docencia, foros de discusión y consulta de imágenes de casos, la telepatología estática cuenta con una amplia aceptación (AU)