[Translated article] Comparative study of deep lipomas and atypical lipomatous tumours: Malignancy risk factors.

BACKGROUND AND OBJECTIVES: The diagnostic suspicion of an atypical lipomatous tumour (ALT) is difficult. The aim of this study is to delve into the most controversial diagnostic aspects of the subject. MATERIAL AND METHOD: Observational, longitudinal and retrospective study of a series of 96 deep adipose tumours (75 lipomas and 21 TLA) from 2006 to 2016: demographic, clinical, imaging and pathological variables were analysed and compared, as well as other variables related to treatment and oncological outcomes of the patients. A descriptive analysis of the collected variables was performed for the statistical study. To evaluate the potential predictor variables of malignancy, a multivariate logistic regression analysis was performed, including those that were statistically significant in the univariate analysis. RESULTS: Older age at diagnosis, lower limb location and larger size were significantly more frequent in ALTs. MRI findings showed no statistically significant differences between the two groups. In multivariate analysis, the same clinical variables were confirmed as predictors of malignancy. In the ROC curve, an optimal cut-off point of 134.0mm was used as a predictor of malignancy. CONCLUSIONS: Advanced age, location in the lower limbs and larger size are risk factors for malignancy in the differential diagnosis of deep lipomas and atypical lipomatous tumours. No radiological variable on MRI reached significance as a predictor of malignancy in our series.

Comparative study of deep lipomas and atypical lipomatous tumours: Malignancy risk factors. / Estudio comparativo de lipomas profundos y tumor lipomatoso atípico. Factores pronósticos de malignidad.

BACKGROUND AND OBJECTIVES: The diagnostic suspicion of an atypical lipomatous tumour (ALT) is difficult. The aim of this study is to delve into the most controversial diagnostic aspects of the subject. MATERIAL AND METHOD: Observational, longitudinal, and retrospective study of a series of 96 deep adipose tumours (75 lipomas and 21 TLA) from 2006 to 2016: demographic, clinical, imaging and pathological variables were analysed and compared, as well as other variables related to treatment and oncological outcomes of the patients. A descriptive analysis of the collected variables was performed for the statistical study. To evaluate the potential predictor variables of malignancy, a multivariate logistic regression analysis was performed, including those that were statistically significant in the univariate analysis. RESULTS: Older age at diagnosis, lower limb location and larger size were significantly more frequent in ALTs. MRI findings showed no statistically significant differences between the two groups. In multivariate analysis, the same clinical variables were confirmed as predictors of malignancy. In the ROC curve, an optimal cut-off point of 134.0 mm was used as a predictor of malignancy. CONCLUSIONS: Advanced age, location in the lower limbs and larger size are risk factors for malignancy in the differential diagnosis of deep lipomas and atypical lipomatous tumours. No radiological variable on MRI reached significance as a predictor of malignancy in our series.

Osteochondromas of the Proximal Humerus. Diagnostic and Therapeutic Management. / Osteocondromas del extremo proximal del húmero. Manejo diagnóstico y terapéutico.

OBJECTIVE: 1) To recall the epidemiology and signs of osteochondromas of the proximal humerus (OPH); 2) determine treatment indications; 3) and make recommendations for surgical treatment. METHODS: Retrospective, observational and longitudinal study of 20 solitary and 12 multiple osteochondromas of the proximal humerus. We analyzed the epidemiological, clinical and imaging characteristics and treatment results with an average time of follow-up of the operated cases of 45 months. RESULTS: Eleven (55%) males and 9(45%) females with an average age of 21 years presented solitary osteochondromas. Twelve (60%) cases were operated on at a mean age of 23 years because they were symptomatic or, in one case, malignancy was suspected. Two solitary osteochondromas could have spontaneously regressed. Multiple osteochondromas were found in 11(92%) males and one (8%) female of whom 3required surgery. There were no complications or recurrences. Functional outcome was excellent in all patients. DISCUSSION: Osteochondromas of the proximal humerus are relatively common, although most publications are case reports or short series. CONCLUSIONS: Osteochondromas of the proximal humerus do not differ from those in other locations. Symptomatic cases and those in which malignancy is suspected would be operated, the former preferably at the end of growth. The surgical treatment is summarized in planning the approach, using CT and/or MRI, extraperiosteal en bloc resection, and eventual bone reconstruction, ideally with allograft.

[Intramuscular lipomas: Large and deep benign lumps not to underestimated. Review of a series of 51 cases]. / Lipomas intramusculares: bultos benignos grandes y profundos. Revisión de una serie de 51 casos.

OBJECTIVE: To review a poorly studied pathology in the scientific literature. MATERIAL AND METHODS: An observational, longitudinal and ambispective study of a series of 51 intramuscular lipomas in 50 patients. The frequency distribution of qualitative variables, and the median and the interquartile range (IQR) for continuous variables were calculated. The relationship between the size of the lipomas (recoded into two values) and the study variables were analyzed using the Fisher exact test. RESULTS: Men made up 62% of the series, and the median age was 61 years, with 55% of the total being overweight. About half of the patients were diagnosed in the upper limb. More than three-quarters (78%) were strictly intramuscular lipomas. Location, clinical and image presentation, treatment and results are described. DISCUSSION: Intramuscular lipomas have their own particular characteristics. Nevertheless, MRI is sometimes unable to distinguish them from well differentiated liposarcomas. Using size as the only criterion for referring a patient with a soft tissue injury to a reference center is still debatable. CONCLUSIONS: Patients with intramuscular lipomas, although they may be typical in their presentation, especially when they are large and show findings that can be confused with a well-differentiated low grade liposarcoma, should be treated in experienced centers.

[Xanthogranulomatous cystitis: report of a case]. / Cistitis xantogranulomatosa: presentación de un caso.

OBJECTIVE: To report a case of xanthogranulomatous cystitis, a rare disease especially in the western countries (12 of the 16 cases reported were Japanese and Korean). METHODS: A case of xanthogranulomatous cystitis in a 34-year-old female is presented. Patient evaluation included histological, histochemical and immunohistochemical studies. RESULTS/CONCLUSIONS: The lesion was localized to the bladder dome, anatomically related with the urachus. It consisted of collections of histiocytes with lymphoplasmocytic infiltrate. The adhesions observed in the omentum in this case indicate a possible relationship with a previous inflammatory process. Surgery is advocated in most of the cases with good results.

Embolization of mesothelial cells in lymphatics: the route to mesothelial inclusions in lymph nodes?

AIMS: To provide evidence that lymphatic embolization is the mechanism for mesothelial inclusions in lymph nodes. METHODS AND RESULTS: A 60-year-old man with alcoholic cirrhosis and ascites had an umbilical hernia resected. The herniorrhaphy specimen contained numerous dermal and submesothelial lymphatic vessels filled by cells similar to the cells that lined the hernia sac. Most of the cells in lymphatics were submesothelial reactive cells, whose cytoplasm stained with antibodies against cytokeratins (AE1-AE3; 8, 18), smooth muscle actin, vimentin, desmin and tissue polypeptide antigen (TPA). Some cells seemed to be superficial mesothelial cells, being positive with high molecular weight anticytokeratin antibody 34 beta E12. On ultrastructural study submesothelial cells with intermediate cytoplasmic filaments, rough endoplasmic reticulum and primitive cell junctions, and scanty superficial mesothelial cells with microvilli, tonofilaments and desmosomes were found in the lymphatics. CONCLUSIONS: Lymphatic dissemination of mesothelial and submesothelial cells is an uncommon and not well known phenomenon. Lymphatic dissemination is probably the route by which the mesothelial cells reach the lymphatic nodes. These cells may be mistaken for malignant cells.

[An undifferentiated neuroendocrine carcinoma of the rectum with cervical metastases]. / Carcinoma indiferenciado neuroendocrino de recto con metástasis cervicales.

Sigma undifferentiated carcinoma of the rectum is a neuroendocrine tumor embracing less than 1% of all primary malignant epithelial tumors in this location. Recent studies have demonstrated that these tumors are biologically aggressive neoplasias with early metastatic extension. We present one case of loco-regional invasion at the time of the intervention and with distal metastasis within a period of time shorter than one year. We perform a clinical, histological and immunohistochemical study and we comment on the histogenesis of these tumors, their prognosis and treatment, stressing the need of an early diagnosis, an aggressive treatment and an adequate follow-up.