Clinical significance of epithelial-mesenchymal transition-related markers expression in the micrometastatic sentinel lymph node of NSCLC.

OBJECTIVES: Metastatic lymph node affectation is the main prognostic factor in localised lung cancer. However, the pathological study of lymph nodes reveals tumour relapse for 20% of patients after oncological curative surgery. Recently, EMT (epithelial-mesenchymal transition) has been established as one of the main factors related to lymphatic dissemination and metastasis. This study evaluated the prognostic value of EMT-related gene expression in micrometastatic sentinel lymph nodes (SLN) of non-small cell lung cancer (NSCLC) patients. METHODS: The presence of genes CDH1, CDH2, VIM, TWIST1, SNAI1, SNAI2, ZEB1, and ZEB2 in mRNA was analysed in tumours and in the SLN of NSCLC patients for whom surgery was planned for treatment. The significant association between the expression level of EMT-related markers and patients' clinicopathological characteristics and relapse was assessed. RESULTS: Of the 96 patients, 56 (58.33%) presented molecular micrometastasis in SLN, which showed higher CDH1, CDH2, and VIM expressions than non-micrometastatic ones. An association linking a low CDH1/CDH2 ratio in SLN with molecular micrometastasis, adenocarcinoma, and non-smoking patients was found. The multivariate Cox regression analysis proved the prognostic accuracy of the CDH1/CDH2 ratio in SLN. CONCLUSIONS: The molecular EMT status of SLN could be used as an independent prognosis predictor in early stage NSLCL patients, and as a new tool to better stratify and predict patient outcomes.

Buenos resultados tras tratamiento con láser CO2 de leiomioma en el pezón / Successful Treatment of Leiomyoma of the Nipple With Carbon Dioxide Laser

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Adalimumab-induced lupus erythematosus.

Adalimumab, an anti-tumour necrosis factor agent, especially used in the treatment of rheumatoid arthritis, has a good safety profile. One of the most common side-effects of adalimumab is the development of autoantibodies. Despite the induction of autoantibodies, the clinical presentation of immune-mediated complications upon adalimumab therapy, including a lupus-like syndrome, is very rare. We have recently evaluated a new case of adalimumab-induced lupus erythematosus.

Primary cutaneous CD30+ anaplastic large-cell lymphomas mimicking keratoacanthomas.

Primary cutaneous anaplastic large cell lymphoma (ALCL) may be associated with keratoacanthoma (KA)-like epithelial hyperplasia and dense eosinophilic and neutrophilic infiltrates. Diagnosis in such cases is challenging both clinically and histologically, because the large atypical lymphoid cells may be obscured by the massive infiltrate of eosinophils and neutrophils, or confused with invasive squamous cell carcinoma or KA. We recently encountered two cases of CD30+ ALCL presenting with a KA-like tumour on the eyelid and nose, respectively. One showed features of KA histologically, with marked tissue eosinophilia and neutrophilia.

Sarcoma pleomórfico de partes blandas (liposarcoma) como cáncer de ovario con implantes peritoneales / Pleomorphic sarcoma in soft tissue (liposarcoma), similar to an ovarian cancer with peritoneal implants

Presentamos el caso de una mujer de 70 años que se diagnosticó mediante TC de 7 tumoraciones intraabdominales, con la sospecha clínica de cáncer de ovario con implantes peritoneales, que resultó ser un sarcoma pleomórfico (tipo liposarcoma) de partes blandas. Se extirparon todos los tumores, pero la paciente falleció antes de 2,5 meses desde la operación (AU)

Sarcoma primario de células claras de ganglio linfático de tendones y aponeurosis / Primary clear cell sarcoma of tendons and aponeuroses of lymph node

El sarcoma de células claras es un tumor poco frecuente que afecta preferentemente a las extremidades. Presentamos el caso de una niña de nueve años con una masa en la rodilla que ha ido creciendo lentamente durante 14 meses. Histológicamente, sé observaban restos de tejido ganglionar linfático completamente infiltrado por células poligonales o redondas, de citopasma claro y núcleo vesicular con nucléolo basófilo prominente. Las técnicas de inmunohistoquímica demostraron positividad intensa para vimentina y S100 y moderada para EMA. El examen ultraestructural mostró melanosomas aberrantes. Las características clinicopatológicas del caso apuntan con fuerza a un sarcoma de células claras primario de ganglio linfático primitivo. La localización primitiva en ganglio linfático de este raro tumor no ha sido previamente descrita en la literatura (AU)

Terapia hormonal sustitutiva de la menopausia y cistadenocarcinoma seroso de ovario bilateral / Hormonal replacement therapy during the menopause and bilateral ovarian cystadenocarcinoma

Presentamos un caso de cistadenocarcinoma seroso de ovario bilateral en una mujer de 62 años, tratada durante casi 7 años con terapia hormonal sustitutiva de la menopausia. Discutimos el estado del problema en la actualidad. (AU)

Tumor maligno de ovario de células de Sertoli-Leydig / Malignant ovarian tumour of Sertoli Leydig cells. A clinical case

Presentamos un caso raro de tumor de Sertoli-Leydig de ovario, de diferenciación intermedia, en una mujer de 64 años, que consultó por manchado posmenopáusico. En la ecografía y la TAC se puso de manifiesto un tumor maligno de ovario derecho. El CA 125 estaba aumentado. En la laparotomía, neoplasia adherida a pared pélvica, asas intestinales y cara posterior uterina. Practicamos histerectomía total, anexectomía bilateral y omentectomía. Sin tratamiento adyuvante, al año presenta controles normales (AU)

Adenocarcinoma de endometrio y ovarios poliquísticos en mujer de 26 años / Endometrial adenocarcinoma and polycystic ovaries in a 26 year old women. A clinical case and literature review

Presentamos un caso de adenocarcinoma de endometrio y ovarios poliquísticos en una mujer de 26 años, obesa, nuligrávida y con oligomenorreas. Presentó 9 años antes, en un legrado, una hiperplasia glanduloquística de endometrio, al parecer sin tratamiento posterior. En la histeroscopia observamos la cavidad ocupada por una formación neoplásica. La biopsia endometrial informó de adenocarcinoma endometrial bien diferenciado. La paciente no deseó tratamiento conservador y le fue practicada histerectomía total y anexectomía bilateral. Presentamos la iconografía completa del caso y revisamos esta enfermedad en la bibliografía (AU)

[Spontaneous pneumothorax. Apropos 2507 cases]. / Neumotórax espontáneo. A propósito de 2.507 casos.

This retrospective study of 2,507 cases of spontaneous pneumothorax (SP) involves 1,873 patients treated at our hospital over nearly 20 years. Men represented 92.4% and most patients were between 16 and 30 years old (56.2%). Presenting more than one episode were 29.7%. The treatment of choice was placement of a pleural drain whenever SP had led to lung collapse amounting to more than 10% of volume. Thoracotomy was performed when the patient had experienced three or more episodes of SP; when a pleural drain had not resolved the condition 10 days after placement; in hemo-SP with severe hemorrhage; and in 2 cases in which SP was bilateral. A total of 419 thoracotomies were performed on 384 patients (20.7%). All episodes were resolved and complications were few. Six patients died (0.32%), three following thoracotomy. All of these had antecedents of chronic obstructive lung disease and all were over 70, excepting one who was 56.

Nd:YAG laser photoresection of low-grade malignant tumors of the tracheobronchial tree.

Nineteen patients with low-grade malignant tumors of the tracheobronchial tree received Nd:YAG laser treatment. They were referred for palliation of symptomatic airway obstruction due to carcinoid (14 cases) or adenocystic carcinoma (five cases). In all patients, laser treatment was followed by symptomatic relief. Fifteen patients have done well and remain in good condition between six months and four years after laser photoresection. Two of the five patients with adenocystic carcinoma died because of hemoptysis at one and 49 months after laser therapy. In the group of 14 patients with carcinoids, two episodes of bleeding (more than 250 ml) occurred that were controlled by tamponade with the tube and coagulation by the laser beam itself. Two patients with carcinoid died of unrelated causes (stroke and gastric carcinoma).

[Treatment of obstructive tracheobronchial disease with the Yag-Nd laser: 400 procedures in a 4-year experience]. / Tratamiento con láser Yag-Nd en patología traqueobronquial obstructiva: 400 administraciones en 4 años de experiencia.

Overall, 400 procedures with the Yag-Nd laser were carried out in 252 patients with tracheobronchial disease susceptible to photoresection during a 4-year period. Most procedures were carried out under general anesthesia and with a rigid bronchoscope. 149 tumors were treated. Of these, 118 were malignant, 16 had low malignancy and 15 were benign. These patients received overall 203 procedures. 92 patients with 113 tracheal stenoses underwent overall 185 procedures. Finally, a miscellaneous group of 11 patients with several conditions underwent 12 procedures. Immediate results were classified as excellent, good or poor, depending on the achieved tracheal or bronchial diameter. No significant complications were found. After a 4-year experience, the authors believe that laser photoresection is currently the most effective and safe procedure to relieve obstruction in the stenoses caused by malignant proliferative tracheal or bronchial diseases not amenable to surgery. It is also the ideal substitute for surgery in benign tumors and in some cases of non-tumoral tracheal stenosis.