TCR-γ expression in primary cutaneous T-cell lymphomas.

Primary cutaneous γδ T-cell lymphomas (PCGD-TCLs) are considered a subgroup of aggressive cytotoxic T-cell lymphomas (CTCLs). We have taken advantage of a new, commercially available antibody that recognizes the T-cell receptor-γ (TCR-γ) subunit of the TCR in paraffin-embedded tissue. We have analyzed a series of 146 primary cutaneous T-cell lymphomas received for consultation or a second opinion in the CNIO Pathology Department. Cases were classified according to the World Health Organization 2008 classification as mycosis fungoides (MF; n=96), PCGD-TCLs (n=5), pagetoid reticulosis (n=6), CD30(+) primary cutaneous anaplastic large cell lymphomas (n=5), primary cutaneous CD8 aggressive epidermotropic CTCLs (n=3), primary cutaneous CTCL, not otherwise specified (n=4), and extranodal nasal-type NK/T-cell lymphomas primarily affecting the skin or subcutaneous tissue (n=11). Sixteen cases of the newly named lymphomatoid papulosis type D (LyP-D; n=16) were also included. In those cases positive for TCR-γ, a further panel of 13 antibodies was used for analysis, including TIA-1, granzyme B, and perforin. Clinical and follow-up data were recorded in all cases. Twelve cases (8.2%) were positive for TCR-γ, including 5 PCGD-TCLs, 2 MFs, and 5 LyP-Ds. All 5 PCGD-TCL patients and 1 MF patient died of the disease, whereas the other MF patient and all those with LyP-D were alive. All cases expressed cytotoxic markers, were frequently CD3(+)/CD8(+), and tended to lose CD5 and CD7 expressions. Eight of 12 and 5 of 11 cases were CD30(+) and CD56(+), respectively. Interestingly, 5/12 TCR-γ-positive cases also expressed TCR-BF1. All cases analyzed were negative for Epstein-Barr virus-encoded RNA. In conclusion, TCR-γ expression seems to be rare and is confined to cytotoxic primary cutaneous TCLs. Nevertheless, its expression is not exclusive to PCGD-TCLs, as TCR-γ protein can be found in other CTCLs. Moreover, its expression does not seem to be associated with bad prognosis by itself, as it can be found in cases with good and bad outcomes.

[Rabdomiosarcoma primario de corazón como causa de síncope recurrente en el adulto]. / Recurrent sycope secundary to primary cardiac rhabdomyosarcoma.

Primary or secondary neoplasms can affect the heart. Secondary are more common. However, primary neoplasms are relevant because is a group with diverse genesis, behavior, treatment and clinical manifestations. We present a case of a 45 year-old woman, with recurrent syncope started 1 year before her first consult. She had palpitations and chest pain. Echocardiography identified a left atrium mass of 2.1x1.8 cm. Endomyocardial biopsy document a primary rhabdomyosarcoma of the heart. The patient dies after a overall-survival of 22 months. This case presented had a good study of its symptoms with an accurate diagnosis and early treatment, which provided prolonged survival of this rare and aggressive neoplasm.

Rabdomiosarcoma primario de corazón como causa de síncope recurrente en el adulto / Recurrent sycope secundary to primary cardiac rhabdomyosarcoma

El corazón puede ser afectado por neoplasias primarias o secundarias. Estas últimas son más frecuentes. Sin embargo, las neoplasias primarias adquieren particular importancia ya que constituyen un grupo de diverso origen y comportamiento, que se traduce en un tratamiento y manifestaciones clínicas diferentes. Se presenta el caso de una mujer de 45 años, quien consultó por síncopes a repetición de un año de evolución, acompañados de palpitaciones y dolor torácico. El ecocardiograma identificó masa de 2.1 cm por 1.8 cm en aurícula izquierda. La biopsia endomiocárdica demostró un rabdomiosarcoma primario de corazón. La paciente muere luego de documentarse una sobrevida de 22 meses. En este caso se observó una sobrevida prolongada, gracias al adecuado estudio de sus síntomas, diagnóstico y tratamiento precoz.

Primary or secondary neoplasms can affect the heart. Secondary are more common. However, primary neoplasms are relevant because is a group with diverse genesis, behavior, treatment and clinical manifestations. We present a case of a 45 year-old woman, with recurrent syncope started 1 year before her first consult. She had palpitations and chest pain. Echocardiography identifed a left atrium mass of 2.1 x 1.8 cm. Endomyocardial biopsy document a primary rhabdomyosarcoma of the heart. The patient dies after a overall-survival of 22 months. This case presented had a good study of its symptoms with an accurate diagnosis and early treatment, which provided prolonged survival of this rare and aggressive neoplasm.

Primary malignant solitary fibrous tumor/hemangiopericytoma of the parotid gland / Tumor fibroso solitario maligno primario/hemangiopericitoma de la glándula parótida

Solitary fibrous tumor (SFT) was first described in the pleura by Lietaud in 1767; later in 1870, Wagner described the localized nature of this type of tumor and Klemperer and Rabin classified pleural tumors into two types: diffuse mesotheliomas and localized mesotheliomas. Recent years have seen the redefinition of this neoplasm, due to better technology; it is now proven that this neoplasm may have multiple different extrapleural origins including the head and neck regions. This diversity of locations is related to the particular mesenchymal histogenesis of SFT which allows its development from very unusual sites such as the salivary glands (SGs). In this particular site, this neoplasm is very infrequent and most of reported cases refer to benign disease, with just one case informed so far of primary malignant SFT (AU)

El tumor fibroso solitario (TFS) fue primeramente descrito en la pleura por Lietaud en 1767; posteriormente en 1870, Wagner describió la naturaleza localizada de este tipo de tumor y Klemperer y Rabin, en 1931, clasificaron los tumores pleurales en dos tipos: mesoteliomas difusos y mesoteliomas localizados. En los últimos años se ha redefinido esta neoplasia, debido a la mejora de las tecnologías; ahora se ha probado que puede tener múltiples y diferentes orígenes extra-pleurales, incluyendo la región de cabeza y cuello. Esta diversidad de localizaciones se relaciona con la histogénesis mesenquimal particular del TFS, que permite su desarrollo desde localizaciones muy inusuales tales como las glándulas salivares (GS). En esta localización particular este tumor es muy infrecuente, y muchos casos reportados se refieren a una enfermedad benigna, con un único caso informado hasta la fecha de TFS maligno primario (AU)

Intrathyroidal parathyroid carcinoma in a pediatric patient.

Parathyroid carcinoma is unusual and its intrathyroidal variant is extremely rare. Therefore, few cases have been reported to describe a case of parathyroid carcinoma located inside the thyroid gland. The case corresponds to a 14-year-old girl who came to the office with a severe osteoarticular disease, depression, calcemia of 14.3 mg/dl and parathyroid hormone of 2,792 pg/ml. Right neck exploration was conducted and a parathyroid carcinoma was found located intrathyroidally. A right thyroid lobectomy was performed. A 20-month follow-up period revealed no recurrence of clinical or biochemical signs. In patients with severe hypercalcemia and significant elevation of parathyroid hormone, the diagnosis of parathyroid carcinoma has to be considered. It is worth highlighting the early age of presentation in this case. Treatment has allowed the effective control of the disease and its recommended long-term follow-up.

Tumor maligno de la vaina del nervio periférico del mediastino en un paciente con neurofibromatosis tipo 1 / Mediastinal malignant peripheral nerve sheath tumor in a neurofibromatosis type 1 patient

El tumor maligno de la vaina del nervio periférico (TMVNP), es una neoplasia maligna originada en las células de Schwan de la vaina de revestimiento del nervio periférico. Describir el caso de un hombre con neurofibromatosis tipo 1 (NF1), quién presentó un TMVNP de bajo grado, y realizar una discusión sobre esta enfermedad. Hombre de 28 años, con antecedente de NF1 diagnosticada a los 15 años de edad, con dolor pleurítico izquierdo, disnea y pérdida de peso de 10 meses de evolución. Al examen de tórax, se observó marcada hipercifosis dorsal con disminución del murmullo pulmonar. La radiografía de tórax y tomografía axial computarizada (TAC), evidenciaron gran masa radioopaca bien delimitada en mediastino posterior. Por lo anterior, se realizo biopsia por punción con aguja gruesa guiada por TAC, en la cual se identificó una neoplasia maligna mesenquimal. Se decidió realizar resección del tumor a través de toracotomía posterolateral, en la que se obtuvo gran masa de 8x9x9 cm, de superficie externa irregular, pardo-violácea y consistencia firme. El estudio histopatologico e inmunofenotípico concluyo el diagnóstico de TMVNP en mediastino posterior Grado 1. Posterior a la cirugía, el paciente se encuentra asintomático. Se presentó un caso de TMVNP originado en un paciente con NF1, presentación que generalmente cursa con peor pronóstico, además se realizo una breve revisión de los aspectos más relevantes de esta enfermedad, algunos de los cuales han tenido un avance vertiginoso en años recientes.

The malignant peripheral nerve sheath tumor (MPNST) is a malignant neoplasm originated in the Schwan cells of the periferic nerves sheath. We describe a case of a man with Neurofibroatosis Type 1 (NF1), who developed a low grade MPNST, and subsequent to a discussion of this disease. 28-year-old Man with pleuritic pain in the left hemithorax, dyspnea and weight loss, with a previous diagnosis of NF1, from the age of 15 and a family history of NF1. At chest examination the patient had an intense thoracic kyphosis, with a decline in the ventilation of the inferior two thirds of the left hemithorax, where a dull sound to percusión was also found. The chest X rays showed a large radiopaque and well delimited mass in the posterior mediastinum, that pushed the cardiovascular structures to the anterior region, which was also documented by chest computed tomography (CT). In view of the above, a puncture biopsy was performed with thick needle guided by CT, from where a malignant mesenhymal neoplasm was identified. It was decided to perform the resection of the tumor of the left posterior mediastinum, by left posterior lateral thoracotomy, in which a large mass of 8x9x9 cm was obtanied, with irregular external surface, brown-violet, and firm. The histopathological and inmunophenotypic study concluded the diagnosis of MPNST in the posterior mediastinum grade 1. Following surgery the patient was asymptomatic. We present a case of MPNST which originated in a patient with NF1, who would usually have a worse prognosis. A brief review of the more relevant aspects of this disease was also reported, some of which have shown important progress in recent years.

[Primary malignant solitary fibrous tumor/hemangiopericytoma of the parotid gland]. / Tumor fibroso solitario maligno primario/hemangiopericitoma de la glándula parótida

Solitary fibrous tumor (SFT) was first described in the pleura by Lietaud in 1767; later in 1870, Wagner described the localized nature of this type of tumor and Klemperer and Rabin classified pleural tumors into two types: diffuse mesotheliomas and localized mesotheliomas. Recent years have seen the redefinition of this neoplasm, due to better technology; it is now proven that this neoplasm may have multiple different extrapleural origins including the head and neck regions. This diversity of locations is related to the particular mesenchymal histogenesis of SFT which allows its development from very unusual sites such as the salivary glands (SGs). In this particular site, this neoplasm is very infrequent and most of reported cases refer to benign disease, with just one case informed so far of primary malignant SFT.

Primary yolk sac tumor of the urachus.

INTRODUCTION: Neoplasms originating from the urachus are rare. The most common urachal malignancy is adenocarcinoma, whereas extragonadal germ cell tumors, primarily of the urachus, are an extremely rare finding. OBJECTIVE: To describe a primary yolk sac tumor (YST) of the urachus in an adult. CASE REPORT: A 44-year-old woman presented with 6 months of pelvic pain associated with a sensation of progressive mass growth. At the time of tumor resection, the tumor was found to be attached by a pedicle to the dome of the bladder, with no injury to the adjacent organs. Pathological study showed a neoplasm with epithelioid cells, pseudocysts, a myxomatous background, and Schiller-Duval body formations. Immunohistochemistry stains showed positivity to AE1/AE3, α-1-fetoprotein, and α-1-antitrypsin and negativity to other markers. CONCLUSION: An unusual case of a YST in the urachus is presented. This is the first reported adult case based on the authors' bibliographic search.

Neurotequeoma (mixoma de la vaina neural) celular atípico del pie / Atypical cellular neurothekeoma (nerve sheath myxoma) of the foot. A case report

Introducción. Los neurotequeomas o mixomas de la vaina neural son tumores benignos poco frecuentes, derivados de la vaina de los nervios periféricos, que suelen alojarse en la dermis y en el tejido subcutáneo de la cabeza, el cuello, las extremidades superiores de adultos jóvenes, raramente observados en los miembros inferiores. Objetivo. Se presenta un caso de neurotequeoma celular atípico localizado en el pie de un niño. Caso clínico. Niño de 10 años, que presento nódulo bien circunscrito en dorso de pie derecho de 0,6×0,5cm de diámetro, de 3 años de evolución. Fue resecado realizando el diagnóstico de neurotequeoma celular atípico del pie. Conclusión. Los neurotequeomas son lesiones poco frecuentes, descritas recientemente, de la cual se han descrito algunos casos localizados en el pie. Se han descrito 3 variedades de probable diferente origen, lo que explicaría sus características morfológicas e inmunohistoquímicas particulares. Las características de atipia están en relación con hallazgos morfológicos pero carecen de significado clínico en relación con el comportamiento. Estos tumores pueden confundirse fácilmente con una amplia gama de lesiones tumorales, que pueden excluirse gracias a tinciones de inmunohistoquímica(AU)

Introduction. Neurothekeomas, or nerve sheath myxomas, are rare benign tumours, arising from the sheath of peripheral nerves. They are usually found in young adults, in the dermis and subcutaneous tissue of the head, neck and upper limbs and only rarely occur in the lower limbs. Objective. A case of atypical cellular neurothekeoma of the foot in a child is presented. Case report. A 10 year-old child presented with 3 year history of a well circumscribed nodule on the dorsum of the right foot. A 0.6×0.5 nodule was surgically removed and a diagnosis of atypical cellular neurothekeoma was made. Conclusion. Neurothekeomas are a rare new entity, a few cases of which have been described in the foot. Three distinct varieties have been reported, each of which is probably of a different origin, which would explain their morphological features and immunohistochemical findings. The atypia only refers to morphological findings and is not reflected in their clinical behaviour. These tumours can easily be confused with many other lesions and immunohistochemistry is helpful in the differential diagnosis(AU)

Early age renal synovial sarcoma.

OBJECTIVE: We report a primary renal Synovial Sarcoma (SS) case and analyze its features. METHOD: A 15 year old male presented with left abdominal mass and weight loss. CT scan images showed a 13 cm mass located in the lower pole of the left kidney. Renal biopsy recognized an undifferentiated neoplasm, the immunohistochemistry suggesting the probability of neuroectodermic primitive tumor versus SS. Chemotherapy and radical nephrectomy were carried out. Pathological study showed a big multilobulated necrotic tumor 22 x 13 x 12.5 cm. Histopathological study demonstrated a neoplasm composed by immature cells. Currently, patient has survived 1,8 years. A structured bibliographical search was performed in the Medline, Imbiomed and Scielo databases. RESULTS: The final immunohistochemistry studies gave the diagnosis of poorly differentiated renal SS small cell variety. CONCLUSION: The renal SS is extremely infrequent, with less than 40 cases reported, of which this case reports the earlier age. These tumors, when located in the kidney, represent a great diagnostic challenge that requires adequate clinical, radiological, surgical, and pathological correlation for appropriate diagnosis and treatment.

Sarcoma sinovial renal en edad temprana / Early age renal synovial sarcoma

OBJECTIVE: We report a primary renal Synovial Sarcoma (SS) case and analyze its features.METHOD: A 15 year old male presented with left abdominal mass and weight loss. CT scan images showed a 13 cm mass located in the lower pole of the left kidney. Renal biopsy recognized an undifferentiated neoplasm, the immunohistochemistry suggesting the probability of neuroectodermic primitive tumor versus SS. Chemotherapy and radical nephrectomy were carried out. Pathological study showed a big multilobulated necrotic tumor 22x13x12.5 cm. Histopathological study demonstrated a neoplasm composed by immature cells. Currently, patient has survived 1,8 years.A structured bibliographical search was performed in the Medline, Imbiomed and Scielo databases.RESULTS: The final immunohistochemistry studies gave the diagnosis of poorly differentiated renal SS small cell variety.CONCLUSION: The renal SS is extremely infrequent, with less than 40 cases reported, of which this case reports the earlier age. These tumors, when located in the kidney, represent a great diagnostic challenge that requires adequate clinical, radiological, surgical, and pathological correlation for appropriate diagnosis and treatment (AU)

OBJETIVO: Describir un caso de Sarcoma Sinovial (SS) renal primario y realizar una revisión sobre este tema.MÉTODO: Paciente masculino de 15 años de edad, con masa abdominal izquierda y pérdida de peso. A quien se documentaron por imágenes una lesión de 13 cm de diámetro, localizada en el polo inferior del riñón izquierdo, por lo cual, se realizó una biopsia renal, en la que se evidenció un tumor maligno indiferenciado, cuyos estudios de inmunohistoquimica sugerían los diagnósticos de tumor neuroectodermico primitivo Vs SS. Con lo anterior, iniciaron quimioterapia y realizaron nefrectomía radical. Actualmente el paciente presenta una sobrevida de 1.8 años.RESULTADO: Se reconoció gran tumor renal izquierdo, de 22x13x12.5cm, multilobulado, con áreas de necrosis. Cuyo estudio histopatológico mostro una neoplasia maligna indiferenciada, compuesta por sabanas de células inmaduras. Los estudios de inmunohistoquimica permitieron concluir el diagnóstico de sarcoma sinovial renal pobremente diferenciado de variedad de células pequeñas. Estrategia de búsqueda de la literatura. Se realizó una búsqueda estructurada de la literatura, en las bases de datos Medline, Imbiomed y Scielo.CONCLUSIÓN: Los SS de localización renal son extremadamente infrecuentes, con menos de 40 casos reportados, del cual se presenta el caso informado a edad más temprana. Estos tumores cuando se localizan en el riñón, representan un gran reto diagnóstico que requiere de la adecuada correlación clínico, imagenologica, quirúrgica, y patológica para su adecuado diagnóstico y manejo (AU)

Testis T-cell lymphoma. Presentation of 2 cases and review.

OBJECTIVE: To present two clinical cases of testicular T cell lymphomas and perform a review of this condition. METHODS/RESULTS: Case 1. Forty-two year old male presenting with painful mass in the right testicle which appeared 2 months earlier. Testicular ultrasound showed diffuse increase in size of the testicle, with alteration in its echogenicity. The patient underwent orchidectomy, and based on histopathological and immunohistochemical tests, a peripheral nonspecific T cell lymphoma was diagnosed. Case 2. Forty-four year old male who presents with a 3 month history of left testicular enlargement without pain associated with reddish-brown macular lesions in the thigh and back and subsequent involvement of the right side of the scrotum. The ultrasonography showed testicles with increased size, with echogenicity altered diffusely. Left orchidectomy was performed and sent for histopathological and Immunophenotypic study which revealed a non-Hodgkin peripheral T cell lymphoma. CONCLUSION: T cell lymphomas involve the testis infrequently, which deserve special attention because of the poor prognosis and the need to make an appropriate diagnosis which could lead to a better therapeutic strategy.

Condroblastoma pélvico / Pelvic Chondroblastoma

Este artículo describe el caso de una mujer de 24 años de edad con un condroblastoma de localización pélvica, con una masa a la altura de la cresta iliaca derecha, de seis meses de evolución y crecimiento progresivo. Los rayos X mostraron una lesión osteolítica con densidad heterogénea y extensión hacia los tejidos blandos; el estudio histopatológico evidenció un condroblastoma. Los condroblastomas son tumores óseos benignos productores de cartílago que aparecen en las epífisis de los huesos largos de personas jóvenes. Alrededor del 75% de estos tumores afectan los huesos largos, principalmente el fémur, la tibia y el húmero; excepcionalmente se localizan en los huesos planos craneofaciales y en los huesos pélvicos. Los condroblastomas tienen características radiológicas e histopatológicas distintivas, y pese a su comportamiento biológico benigno, pueden causar una alta morbilidad para los pacientes, debido a su localización y a su tratamiento exclusivamente quirúrgico.

This article describes the case of a 24-year old woman with a pelvic chondroblastoma localized at the top of the right iliac crest, with six months of evolution and progressive growth. X-rays revealed an osteolytic lesion with heterogeneous density, extending toward soft tissue; the hisopathologic study provided evidence of chondroblastoma. Chondroblastomas are benign bone tumors producers of cartilage which appears in the long bone epiphysis of young people. Nearly 75% of such tumors affect the long bones, principally the femur, the tibia, and the humerus; exceptions include those in the flat craniofacial bones and the pelvis bones. Chondroblastomas have distinct radiological and histopathologic characteristics, and despite their benign biological behavior, can cause elevated morbidity among patients due to their localization and being treated exclusively with surgery.

[Primary prostatic tuberculosis. Case report and bibliographic review]. / Tuberculosis prostática primaria. Presentación de un caso y revisión de la literatura.

OBJECTIVE: Primary prostatic tuberculosis is a very rare form of presentation of the tuberculous infection, which is generally caused by the M. tuberculosis, and which has shown an increase in incidence and prevalence, due to an increase of immunocompromised patients and the pandemic of the Syndrome of Acquired Immune Deficiency (AIDS).We describe a case of primary prostatic tuberculosis attended at the Hospital Universitario de Santander, Colombia, and to perform a discussion about this topic. METHODS/RESULTS: 65 year old man who consulted with symptoms of frequency, dysuria and hesitancy, and 10 Kg weight loss in the last 6 months, without pulmonary symptoms and negative ELISA test for HIV. On physical examination there was evidenceof the presence of a high volume, irregular and hard prostatic gland. That is why a prostatic Doppler ecography was performed showing a prostatic volume of 39 cm3, without sign of malignity. Biopsy of the prostatic gland showed multiple granulomas and the ZN staining was positive for mycobacteria. With these findings the diagnosis of primary prostatic tuberculosis was established, and treatment was carried out and now the patient is asymptomatic with no evidence of active tuberculosis. CONCLUSIONS: Primary prostatic tuberculosis without history or evidence of commitment of the immune system is a very rare condition, nevertheless, it is particularly important to know it due to the progressive increase of its presentation and the possibility of a curative treatment to affected patients.

Tumor de células de la granulosa extraovárico / Extraovarian Granulosa cell tumour

Introducción: Los tumores de células de la granulosa,en algunas ocasiones se pueden situar en lugares aberrantesextra gonadales. Estas formas ectópicas son extremadamenteinfrecuentes. Sin embargo, existe un gran debatesobre el origen de estas neoplasias. Objetivo: Describir uncaso de tumor de células de la granulosa extraovárico identificadoen una paciente del Hospital Universitario de Santandery realizar una discusión sobre su génesis, clínica ehistopatología. Caso Clínico: Mujer de 69 años de edad,que consultó por masa abdominal, con historia de histerectomíacon salpingo ooferectomia bilateral, 14 años antes,por múltiples leiomiomas uterinos, a quien se le encontróuna gran masa, dolorosa a la palpación, a nivel de hipocondrioy flanco izquierdo, la cual fue documentada porecografía abdominal y Tomografía Axial Computarizada(TAC), en retroperitoneo a la altura de la cola pancreática.La masa fue resecada, encontrándose numerosas adherenciasque comprometían el riñón izquierdo y el colon. EstudioAnatomo-Patológico: La masa era sólido quística, de950 g y de 12 x 11,5 x 10 centímetros de diámetros mayorescruzados. En el estudio histopatológico e inmunofenotípicose confirmó el diagnóstico de tumor de células de lagranulosa extra ovárico. Estrategia de búsqueda de laliteratura: Se realizó una búsqueda estructurada de la literatura,con base en la metodología Cochrane, en las basesde datos Medline, Imbiomed y Scielo. Conclusión: Lostumores de células de la granulosa extra ováricos son neoplasiasextremadamente infrecuentes, con el presente soloexisten 11 casos reportados, los cuales parecen ser derivadosde tejidos gonadales ectópicos, o de la diferenciación aestos, por parte de células mesenquimales primitivas. Suadecuado estudio por medio de una correcta correlaciónclínica, morfológica e inmunofenotipica, permite su reconocimientoentre un amplio número de diagnósticos diferenciales(AU)

Introduction: Occasionally, granulosa cell tumours arefound in unusual, extragonadal locations, although suchectopic forms are extremely rare and the origin of these neoplasmsis controversial. Objective: A case of extraovariangranulosa cell tumour is described and its origin, clinicalfeatures and histopathology are discussed. Case history: A69 year old woman presented with an abdominal mass. Shehad undergone hysterectomy and bilateral salpingooophorectomyfor uterine leiomyomas 14 years previously. A large,tender mass was present in the left hypochondrium andleft lumbar region, which was seen on abdominal ultrasonographyand CT scan to be situated in the retroperitoneumnear the tail of the pancreas. Surgery revealed that the leftkidney and colon were involved. Pathology: The 950 g,12 × 11.5 × 10 cm mass was composed of both solid andcystic areas. Histological and immunophenotypical findingsindicated a diagnosis of extraovarian granulosa cell tumour.Review of the literature: A review of the literature wasmade from Medline, Imbiomed and Scielo databases, usingthe Cochrane methodology. Conclusion: Extraovarian granulosacell tumours are extremely infrequent neoplasms,with only 10 cases reported to date. They would appear toarise from ectopic gonadal tissue or from the differentiationof primitive mesenchymal cells. Clinical, morphologicaland immunophenotypical features should all be consideredin order to reach a correct differential diagnosis from a widerange of entities(AU)

Sarcoma sinovial digital / Digital Synovial Sarcoma

El sarcoma sinovial es una entidad bien definida clínica y morfológicamente y, a pesar de su nombre, es muy raro en las cavidades articulares. Este sarcoma afecta zonas sin relación aparente con las estructuras sinoviales y representa entre el 5% y el 10% de todos los sarcomas de los tejidos blandos. Se encuentra con mayor frecuencia en las extremidades, especialmente en las inferiores, donde tiende a localizarse en la vecindad de las grandes articulaciones; se han informado muy pocos casos de sarcomas sinoviales en las manos o los pies, con una evolución clínica favorable. Así mismo, es más frecuente de 15 a 40 años de edad (con una edad media de 34 años). Este artículo presenta el caso de una mujer adulta a quien se le realizó el diagnóstico histopatológico e inmunohistoquímico de un sarcoma sinovial en el quinto dedo de la mano derecha.

Synovial sarcoma is a clinically and morphologically well defined entity which, in spite of its name, is rare in joint cavities. This sarcoma affects zones without any apparent relation to synovial structures and represents from 5% to 10% of all sarcomas in soft tissues. It is most frequently found in the extremities, especially the lower ones, where it tends to be located in the vicinity of the major articulations; there are very few favorable reports on the clinical evolution of synovial sarcomas in the hands or feet. It is most frequent between the ages of 15 to 40 (median age, 34). This article presents the case of an adult woman who underwent histopathologic and immunohistochemical diagnosis of a synovial sarcoma on the little finger of her right hand.

Tuberculosis prostática primaria. Presentación de un caso y revisión de la literatura / Primary prostatic tuberculosis. Case report and bibliographic review

OBJETIVO: La tuberculosis prostática primaria es una forma de presentación de la infección tuberculosa muy poco frecuente, es ocasionada generalmente por el M. Tuberculosis, la cual ha mostrado un aumento en su incidencia y prevalencia, debido al aumento de pacientes inmunodeficientes y la pandemia del Síndrome de Inmuno-Deficiencia Adquirida (SIDA).Describir un caso de tuberculosis prostática primaria atendido en el Hospital Universitario de Santander, Colombia, y realizar una discusión de este tema.MÉTODO/RESULTADO: Hombre de 65 años de edad quien consultó por polaquiuria, disuria y hesitancia. Con pérdida de 10 Kg. de peso en los últimos 6 meses, sin sintomatología pulmonar y prueba de ELISA negativa para VIH. En el examen físico se documentó la presencia de una próstata aumentada de volumen, irregular y dura. Por lo cual se realizo ecografía Doppler prostática que mostró un volumen prostático de 39 cm3, sin características indicadoras de malignidad. La biopsia por punción de la glándula mostró múltiples granulomas y la tinción de Ziel-Nielsen fue positiva para micobacterias. Con los anteriores hallazgos se realizó el diagnostico de tuberculosis prostática primaria, la cual fue tratada y actualmente el paciente se encuentra asintomático sin evidencia de enfermedad tuberculosa activa.CONCLUSIONES: La tuberculosis prostática primaria sin historia o evidencias de compromiso del sistema inmune, es una enfermedad muy poco frecuente, a pesar de lo anterior su conocimiento es de particular importancia debido al aumento progresivo de su presentación y a la posibilidad de realizar un tratamiento curativo a los pacientes afectados(AU)

OBJECTIVE: Primary prostatic tuberculosis is a very rare form of presentation of the tuberculous infec-tion, which is generally caused by the M. tuberculosis, and which has shown an increase in incidence and prevalence, due to an increase of immunocompromised patients and the pandemic of the Syndrome of Acquired Immune Deficiency (AIDS).We describe a case of primary prostatic tuberculosis attended at the Hospital Universitario de Santander, Colombia, and to perform a discussion about this topic.METHODS/RESULTS: 65 year old man who consulted with symptoms of frequency, dysuria and hesitancy, and 10 Kg weight loss in the last 6 months, without pulmonary symptoms and negative ELISA test for HIV. On physical examination there was evidenceof the presence of a high volume, irregular and hard prostatic gland. That is why a prostatic Doppler ecography was performed showing a prostatic volume of 39 cm3, without sign of malignity. Biopsy of the prostatic gland showed multiple granulomas and the ZN staining was positive for mycobacteria. With these findings the diagnosis of primary prostatic tuberculosis was established, and treatment was carried out and now the patient is asymptomatic with no evidence of active tuberculosis.CONCLUSIONS: Primary prostatic tuberculosis without his-tory or evidence of commitment of the immune system is a very rare condition, nevertheless, it is particularly important to know it due to the progressive increase of its presentation and the possibility of a curative treatment to affected patients(AU)

[Evaluation of endoscopic visualisation for identifying premalignant gastric lesions in a Columbian population using histopathology as a reference]. / Evaluación de la visualización por endoscopia en la identificación de lesiones gástricas premalignas en una población colombiana con prueba de referencia histopatológica.

AIM: To evaluate the performance of endoscopic visualization in the identification of premalignant gastric lesions, with histopathological examination of biopsy samples as a reference test, in Bucaramanga, Colombia. LOCATION: League for the Fight Against Cancer, Bucaramanga, Colombia. DESIGN: Diagnostic technology evaluation with cross-sectional sampling. MEASUREMENTS: We calculate the sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio (+), likelihood ratio (-), kappa index and the prevalence rate kappa. RESULTS: A total of 155 patients were studied, with a mean age of 45.43 (14.15) years and an approximate male:female ratio of 2:1. The endoscopic visualization had a sensitivity of 87.84%, a specificity of 55.56%, a positive predictive value of 64.36%, a negative predictive value of 83.33%, a likelihood ratio+of 1.98, a likelihood ratio-de 0.22 and a kappa index of 0.4272, in the identification of preneoplastic lesions of the stomach in a population with a disease prevalence of 47.74%. CONCLUSIONS: The endoscopic visualization of the gastrointestinal mucosa, allows a moderate and fast identification of early preneoplastic lesions, providing an opportunity of its early histopathological diagnosis.

Evaluación de la visualización por endoscopia en la identificación de lesiones gástricas premalignas en una población colombiana con prueba de referencia histopatológica / Evaluation of endoscopic visualisation for identifying premalignant gastric lesions in a Columbian population using histopathology as a reference

Objetivos: evaluar el rendimiento de la visualización directa por endoscopia en la identificación de lesiones gástricas premalignas, utilizando como prueba de referencia el examen histopatológico de muestras obtenidas por biopsia. Emplazamiento: liga de Lucha Contra el Cáncer, de Bucaramanga, Colombia. Diseño: estudio de evaluación de tecnologías diagnósticas con muestreo transversal. Mediciones principalesse calculó la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo, el likelihood ratio positivo, el likelihood ratio negativo, el índice kappa y la prevalencia. Resultados: se estudió a 155 pacientes con una media de edad de 45,43±14,15 años y una relación varón:mujer aproximada de 2:1. La visualización por endoscopia tuvo una sensibilidad del 87,84%, una especificidad del 55,56%, un valor predictivo positivo del 64,36%, un valor predictivo negativo del 83,33%, un likelihood ratio positivo de 1,98, un likelihood ratio negativo de 0,22 y un índice kappa de 0,4272, en la identificación de lesiones preneoplásicas del estómago en una población con una prevalencia de la enfermedad del 47,74%. Conclusiones: la visualización mediante endoscopia de la mucosa gastrointestinal permite una rápida y moderada identificación de lesiones preneoplásicas tempranas, lo que da la posibilidad de su diagnóstico histopatológico precoz(AU)

Aim: To evaluate the performance of endoscopic visualization in the identification of premalignant gastric lesions, with histopathological examination of biopsy samples as a reference test, in Bucaramanga, Colombia. Location: League for the Fight Against Cancer, Bucaramanga, Colombia. Design: Diagnostic technology evaluation with cross-sectional sampling. Measurements: We calculate the sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio (+), likelihood ratio (−), kappa index and the prevalence rate kappa. Results: A total of 155 patients were studied, with a mean age of 45.43 (14.15) years and an approximate male:female ratio of 2:1. The endoscopic visualization had a sensitivity of 87.84%, a specificity of 55.56%, a positive predictive value of 64.36%, a negative predictive value of 83.33%, a likelihood ratio+of 1.98, a likelihood ratio−de 0.22 and a kappa index of 0.4272, in the identification of preneoplastic lesions of the stomach in a population with a disease prevalence of 47.74%. Conclusions: The endoscopic visualization of the gastrointestinal mucosa, allows a moderate and fast identification of early preneoplastic lesions, providing an opportunity of its early histopathological diagnosis(AU)

Tiroiditis de Riedel / Riedel’s thyroiditis

Justificación: La Tiroiditis de Riedel (TR) es una enfermedadinflamatoria crónica de la glándula tiroides, en la cualtejido fibroso reemplaza el parénquima glandular y se extiendea estructuras adyacentes. Objetivo: Describir un caso deTR en una mujer colombiana atendida en el Hospital Universitariode Santander en el año 2006. Caso Clínico: Pacientede sexo femenino, de 63 años de edad, con historia de 6 mesesde evolución, de masa cervical derecha, dolorosa, de 5 cm dediámetro, asociado a astenia y adinamia. Intervención: Tiroidectomíatotal. Resultados: En el lóbulo derecho, se reconociólesión blanquecina, pétrea que compromete difusamentetodo el lóbulo. Los cortes microscópicos mostraron parénquimatiroideo del lóbulo derecho extensamente reemplazadopor tejido fibroso densamente colagenizado, con atrofia marcadade los folículos tiroideos, ocasionales agregados linfoidescon centro germinativo prominente y extensión al tejidoperitiroideo adyacente. El diagnostico fue Tiroiditis de Riedel.Conclusiones: Presentamos un caso de esta inusual yfascinante enfermedad, en la cual se han realizado notablesavances en la patogénesis, al igual que en el diagnostico ymanejo. Son analizadas sus características clínicas, macro,microscópicas e immunohistoquimicas (AU)

Justification: Riedel’s thyroiditis (RT) is a chronicinflammatory disease of the thyroid gland, in which fibroustissue replaces glandular parenchyma and extends to closeststructures. Objective: A case of RT in a Colombian womanattended at the University Hospital of Santander in 2006,will be described. Clinical case: Female Patient, 63 yearsold, with history of 6 months of evolution, cervical massright and painful with 5 cm of diameter, associated to astheniaand adynamia. Intervention: Total thyroidectomy.Results: A diffuse hard whitish lesion affecting the entireright thyroidal lobe was found. Histological sections revealedright thyroidal parenchima widely replaced by denselycollagenized fibrous tissue with marked thyroid folliclesatrophy, scarce lymphoid aggregates with prominent germinalcenters and spread to neighbour perithyroidal tissue. Thediagnosis was Riedel’s thyroiditis. Conclusions:We presenteda case of this unusual and fascinating disease, in whichhave made significant advances in the pathogenesis, diagnoseand treatment. The clinical, gross, microscopic andimmunohistochemical characteristics are analyzed (AU)