Squamous cell carcinoma of the tongue in patients older than 45 years.

This study aims to evaluate the clinicopathological features, TNM status, AJCC staging and behavior of squamous cell carcinoma of the tongue (SCCT) in patients older than 45 years. The files of the Department of Pathology of the Hospital General de México were reviewed and all cases of SCCT in patients older than 45 years were selected. Clinicopathological features, treatment, follow-up, microscopic diagnosis, and IJCC and TNM staging were retrieved. Complete data from 60 cases were evaluated. They were more common in males (mean age = 63.9 years). Unexpectedly a high rate of tumors (38.3%) were in the base of the tongue (BT). Moderately and poorly differentiated SCCT were the most common. 16.7% presented lymph node invasion, 15% were recurrent tumors and BT carcinomas recurred more frequently. A high rate (81.7%) were stage II and 48.3% were low-risk patients. SCCTs in the studied population displayed different clinico-pathological and behavioral features compared with worldwide data. Our results suggest that BT tumors should be treated more aggressively than those in the mobile tongue. BT located tumors were more frequent than previously published. Additional frequency studies will define outcomes in age cohorts with a consensus cut-off for young and elderly populations. More population-based studies should be performed in Latin American regions to acquire accurate data on SCC incidence in elder subpopulations and to identify precisely the etiological factors in these patients.

Squamous cell carcinoma of the tongue in patients older than 45 years

Abstract: This study aims to evaluate the clinicopathological features, TNM status, AJCC staging and behavior of squamous cell carcinoma of the tongue (SCCT) in patients older than 45 years. The files of the Department of Pathology of the Hospital General de México were reviewed and all cases of SCCT in patients older than 45 years were selected. Clinicopathological features, treatment, follow-up, microscopic diagnosis, and IJCC and TNM staging were retrieved. Complete data from 60 cases were evaluated. They were more common in males (mean age = 63.9 years). Unexpectedly a high rate of tumors (38.3%) were in the base of the tongue (BT). Moderately and poorly differentiated SCCT were the most common. 16.7% presented lymph node invasion, 15% were recurrent tumors and BT carcinomas recurred more frequently. A high rate (81.7%) were stage II and 48.3% were low-risk patients. SCCTs in the studied population displayed different clinico-pathological and behavioral features compared with worldwide data. Our results suggest that BT tumors should be treated more aggressively than those in the mobile tongue. BT located tumors were more frequent than previously published. Additional frequency studies will define outcomes in age cohorts with a consensus cut-off for young and elderly populations. More population-based studies should be performed in Latin American regions to acquire accurate data on SCC incidence in elder subpopulations and to identify precisely the etiological factors in these patients.

Prevalence trends of oral squamous cell carcinoma. Mexico City’s General Hospital experience

Objective: Recent reports suggest an increase in oral squamous cell carcinoma (OSCC) frequency. To improve programs in public health, it is necessary to understand the epidemiological conditions. The aim of this study was to analyze the trend in gender, age, anatomic zone and OSCC stage from Mexico City’s General Hospital patients from 1990 to 2008.Study design: A retrospective review of all OSCC cases diagnosed by the Pathology Department of the Mexico City General Hospital was performed. Demographic data, in addition to anatomic zone and histological degree of differentiation were obtained. Central tendency, dispersion and prevalence rate per 100,000 individuals were determined. Results: A total of 531 patients were diagnosed with OSCC; 58.4% were men, giving a male: female ratio of 1.4:1, and the mean age was 62.5 ± 14.9 years. The predominant anatomic zone was the tongue (44.7%), followed by the lips (21.2%) and gums (20.5%). The most frequent histological degree was moderately differentiated in 325 cases (61.2%). The rates of OSCC prevalence showed similar (..) (AU)

Mitosis is a source of potential markers for screening and survival and therapeutic targets in cervical cancer.

The effect of preventive human papillomavirus (HPV) vaccination on the reduction of the cervical cancer (CC) burden will not be known for 30 years. Therefore, it's still necessary to improve the procedures for CC screening and treatment. The objective of this study was to identify and characterize cellular targets that could be considered potential markers for screening or therapeutic targets. A pyramidal strategy was used. Initially the expression of 8,638 genes was compared between 43 HPV16-positive CCs and 12 healthy cervical epitheliums using microarrays. A total of 997 genes were deregulated, and 21 genes that showed the greatest deregulation were validated using qRT-PCR. The 6 most upregulated genes (CCNB2, CDC20, PRC1, SYCP2, NUSAP1, CDKN3) belong to the mitosis pathway. They were further explored in 29 low-grade cervical intraepithelial neoplasias (CIN1) and 21 high-grade CIN (CIN2/3) to investigate whether they could differentiate CC and CIN2/3 (CIN2+) from CIN1 and controls. CCNB2, PRC1, and SYCP2 were mostly associated with CC and CDC20, NUSAP1, and CDKN3 were also associated with CIN2/3. The sensitivity and specificity of CDKN3 and NUSAP1 to detect CIN2+ was approximately 90%. The proteins encoded by all 6 genes were shown upregulated in CC by immunohistochemistry. The association of these markers with survival was investigated in 42 CC patients followed up for at least 42 months. Only CDKN3 was associated with poor survival and it was independent from clinical stage (HR = 5.9, 95%CI = 1.4-23.8, p = 0.01). CDKN3 and NUSAP1 may be potential targets for the development of screening methods. Nevertheless, further studies with larger samples are needed to define the optimal sensitivity and specificity. Inhibition of mitosis is a well-known strategy to combat cancers. Therefore, CDKN3 may be not only a screening and survival marker but a potential therapeutic target in CC. However, whether it's indispensable for tumor growth remains to be demonstrated.

Prevalence trends of oral squamous cell carcinoma. Mexico City's General Hospital experience.

OBJECTIVE: Recent reports suggest an increase in oral squamous cell carcinoma (OSCC) frequency. To improve programs in public health, it is necessary to understand the epidemiological conditions. The aim of this study was to analyze the trend in gender, age, anatomic zone and OSCC stage from Mexico City's General Hospital patients from 1990 to 2008. STUDY DESIGN: A retrospective review of all OSCC cases diagnosed by the Pathology Department of the Mexico City General Hospital was performed. Demographic data, in addition to anatomic zone and histological degree of differentiation were obtained. Central tendency, dispersion and prevalence rate per 100,000 individuals were determined. RESULTS: A total of 531 patients were diagnosed with OSCC; 58.4% were men, giving a male:female ratio of 1.4:1, and the mean age was 62.5 ± 14.9 years. The predominant anatomic zone was the tongue (44.7%), followed by the lips (21.2%) and gums (20.5%). The most frequent histological degree was moderately differentiated in 325 cases (61.2%). The rates of OSCC prevalence showed similar patterns in terms across time. A significant correlation (P = 0.007) between anatomic zone and age was observed. CONCLUSION: According to our results, the prevalence of OSCC does not show important variations; however, a relationship between age and anatomic zone was observed. These data could be used as parameters for the diagnosis of OSCC as well as for the development and dissemination of preventive programs for the early detection of oral cancer.

Extrapulmonary locations of mycobacterium tuberculosis DNA during latent infection.

BACKGROUND: One-third of the world's population has latent infection with Mycobacterium tuberculosis, and 10%-15% of cases of reactivation occur at extrapulmonary sites without active pulmonary tuberculosis. METHODS: To establish the frequency and location of mycobacterial DNA, organ specimens from 49 individuals who died from causes other than tuberculosis were studied by means of polymerase chain reaction (PCR), PCR plus DNA hybridization, in situ PCR, real-time PCR, and spoligotyping. RESULTS: Lung specimens from most subjects (36) were positive for M. tuberculosis, as were specimens from the spleen (from 35 subjects), kidney (from 34), and liver (from 33). By in situ PCR, mycobacterial DNA was found in endothelium, pneumocytes, and macrophages from the lung and in Bowman's parietal cells and convoluted proximal tubules from the kidney. In spleen, macrophages and sinusoidal endothelial cells were positive, whereas in liver, Kupffer cells and sinusoidal endothelium were commonly positive. Spoligotyping of 54 pulmonary and extrapulmonary positive tissues from 30 subjects showed 43 different genotypes, including 36 orphan types. To confirm the viability of mycobacteria, 10 positive tissue samples were selected for isolation of mycobacterial RNA. All samples showed 16S ribosomal RNA expression, while 8 and 4 samples showed expression of the latent infection genes encoding isocitrate lyase and α-crystallin, respectively. CONCLUSIONS: M. tuberculosis persists in several sites and cell types that might constitute reservoirs that can reactivate infection, producing extrapulmonary tuberculosis without lung involvement.

The Amerindian mtDNA haplogroup B2 enhances the risk of HPV for cervical cancer: de-regulation of mitochondrial genes may be involved.

Although human papillomavirus (HPV) infection is the main causal factor for cervical cancer (CC), there are data suggesting that genetic factors could modulate the risk for CC. Sibling studies suggest that maternally inherited factors could be involved in CC. To assess whether mitochondrial DNA (mtDNA) polymorphisms are associated to CC, HPV infection and HPV types, a case-control study was performed in the Mexican population. Polymorphism of mtDNA D-loop was investigated in 187 CC patients and 270 healthy controls. HPV was detected and typed in cervical scrapes. The expression of 29 mitochondrial genes was analyzed in a subset of 45 tumor biopsies using the expression microarray ST1.0. The Amerindian haplogroup B2 increased the risk for CC (odds ratio (OR)=1.6; 95% confidence interval (CI): 1.05-2.58) and enhanced 36% (OR=208; 95% CI: 25.2-1735.5) the risk conferred by the HPV alone (OR=152.9; 95% CI: 65.4-357.5). In cases, the distribution of HPV types was similar in all haplogroups but one (D1), in which is remarkable the absence of HPV18, a very low frequency of HPV16 and high frequencies of HPV45, HPV31 and other HPV types. Two mtDNA genes (mitochondrial aspartic acid tRNA (MT-TD), mitochondrial lysine tRNA (MT-TK)) could be involved in the increased risk conferred by the haplogroup B2, as they were upregulated exclusively in B2 tumors (P<0.01, t-test). Although the association of mtDNA with CC and HPV infection is clear, other studies with higher sample size will be needed to elucidate the role of mtDNA in cervical carcinogenesis.

Sarcoma del estroma endometrial del ovario. Presentación de un caso y revisión del cuadro clínico-patológico / Endometrial stromal sarcoma of the ovary. A case report and review of the literature

Se presenta el caso de una mujer de 48 años de edad con sarcoma del estroma endometrial en ambos ovarios, con implantes peritoneales, asociado a endometriosis ovárica y uterina, así como diferenciación focal del tumor ovárico con tumor semejante al de los cordones sexuales. Se realizaron reacciones de inmunohistoquímica para los tumores ováricos y su diferenciación a cordones sexuales. Se hace una revisión de la literatura, ilustrando las características morfológicas y se discute los diagnósticos diferenciales(AU)

A case of bilateral ovarian endometrial stromal sarcoma and peritoneal implants associated with ovarian and uterine endometriosis in a 48 year old woman is presented. Focal differentiation into areas of sex-cord stromal tumour were found. Immunohistochemistry for both the ovarian tumour and the sex-cord stromal tumour was carried out. The morphology and differential diagnosis are discussed together with a review of the literature(AU)

Carcinoma renal sarcomatoide. Revisión de 7 casos con análisis de inmunohistoquímica / Sarcomatous renal carcinoma. Presentation of 7 cases and immunohistochemical study

Todos los tipos histológicos de carcinoma renal pueden presentar un componente sarcomatoide que es una variante poco común. Material y métodos. Se revisaron los archivos de patología quirúrgica del Hospital General de México en un periodo de 7 años (2002–2009) para determinar su frecuencia, presentación clínica, características morfológicas e inmunohistoquímicas. Resultados. Se recabaron 7 casos (2,8%), predominaron en hombres (5 casos), el tamaño promedio del tumor fue 9,5cm. Los componentes sarcomatoides encontrados fueron: rabdomiosarcoma (3 casos), fibrosarcoma (un caso) e histiocitoma fibroso maligno (un caso); 2 casos correspondieron a sarcomas indiferenciados. Las áreas de carcinoma renal presentaron grado nuclear de Fürhman de 3 (6 casos). Las áreas sarcomatoides fueron en su mayoría de grado intermedio de malignidad. La inmunohistoquímica demostró expresión de AE1/AE3 en los 7 casos (100%), CK8 en 4 casos (57,1%) y CD10 en 3 casos (42,8%). Se objetivó expresión de vimentina en todos los casos. WT-1 se expresó en el citoplasma de las células neoplásicas en 2 casos (28,5%) y CD117 fue positivo en un caso (14,2%). No hubo expresión de AAML, AAME ni desmina. Conclusiones. La frecuencia de esta variante es muy baja. Se pueden reconocer patrones específicos de sarcomas. Están asociados con necrosis, invasión hiliar y angioinvasión. Se cuenta con marcadores para demostrar el origen epitelial de estas neoplasias(AU)

Although all histological types of renal carcinoma (RCC) can have a sarcomatous component (SRCC), this variant is rare. Material and methods. The surgical pathology archives of the General Hospital of Mexico for a period of 7 years (2002–2009) were reviewed in order to determine the frequency, clinical presentation, morphological and immunohistochemical features of SRCC. Results. 7 cases were found (2.8%) with a predominance in males (5 cases) and an average tumour size of 9.5cm. The sarcomatous components detected were: rhabdomyosaroma (3 cases), fibrosarcoma (1 case) and malignant fibrous histiocytoma (1 case); the other 2 cases were undifferentiated sarcomas. In 6 cases the RCC areas had a Fürhman nuclear grade of 3; the majority of the sarcomatous areas had an intermediate grade of malignancy. Immunohistochemistry showed positivity for AE1/AE3 in all 7 cases (100%), for CK8 in 4 cases (57.1%) and CD10 in 3 cases (42.8%); all cases were positive for vimentin. WT1 was expressed in the cytoplasm of the neoplastic cells in 2 cases (28.5%) and CD117 was positive in 1 case (14.2%). There was no positivity for AAML, AAME or desmine. Conclusions. Specific types of sarcoma can be identified in this rare variant, which is associated with necrosis, hiliar invasion and angioinvasion. Immunohistochemical study can demonstrate the epithelial origin of these neoplasms(AU)

Utilidad diagnóstica del CD10, BCL-6 y desmina en el linfoma T angioinmunoblástico. Estudio inmunohistoquímico de 7 casos / Diagnostic utility of CD10, BCL-6 and desmin, in Angioimmunoblastic T-cell lymphoma. Immunohistochemical study of 7 cases

Antecentes: El Linfoma T Angioinmunoblástico es un linfoma T periférico que representa solo el 1-2% de los Linfomas no Hodgkin. Este linfoma tiene características clínicas y patológicas particulares que lo sitúan dentro del grupo de linfomas agresivos y de mal pronóstico. Estudios recientes han demostrado diversos hallazgos inmunofenotípicos y genéticos que pueden ser de utilidad en el diagnóstico de esta entidad. El objetivo de este estudio es investigar si la expresión de CD10, BCL-6 y la expansión de las células dendríticas es constante y por consecuencia útil en el diagnóstico de LTA. Material y métodos: Se estudiaron siete casos de Linfoma T Angioinmunoblástico, obtenidos del departamento de Patología del American British Cowdray Medical Center en la Ciudad de México. Se realizaron tinciones con H&E y tinción retículo de Gordon-Sweet e inmunohistoquímica con CD20, CD3, CD10, Bcl-6, Desmina y queratina de amplio espectro. Resultados: Todos los casos mostraron expresión aberrante de CD10 y Bcl-6, así como también la expansión de la red de células dendríticas foliculares y en tres casos además aumento de células reticulares fibroblásticas desmina/citoqueratina positivas. Conclusiones: La proliferación de las células dendríticas foliculares y de células reticulares fibroblásticas desmina/citoqueratina positivas, así como la expresión aberrante de CD10 y Bcl-6 son características constantes en el Linfoma T Angioinmunoblástico. Estos hallazgos inmunohistoquímicos son útiles en al diagnóstico de LTA (AU)

Introduction: Angioimmunoblastic T-cell lymphoma (ATL) is a peripheral T-cell lymphoma representing only 1- 2% of non-Hodgkin’s lymphomas. Clinical course of ATL is aggressive and its prognosis is poor. Recent studies have identified useful immunohistochemical and genetic features in the diagnosis of this entity. The aim of this study was to investigate the expression of CD10, BCL-6 and dendritic cells expansion in ATL. Patients and methods: Seven cases of ATL retrieved form the files of the Department of Pathology of the American British Cowdray Medical Center in Mexico City were studied. Sections were stained with H&E and Gordon-Sweet for reticular fibers. Immunohistochemistry for CD20, CD3, CD10, BCL-6, desmin and wide spectrum cytokeratins was done. Results: All cases showed aberrant expression for CD10 and BCl-6. In all cases expansion of follicular dendritic cells was found. An increase in number of desmin/cytokeratin positive reticulum cells was also found in three patients. Conclusions: Dendritic follicular cells and desmin positive/cytokeratin positive reticular cells proliferation, as well as aberrant expression of CD10 and BCl-6 are constant characteristics of ATL. These findings are useful immunophenotypical features in the diagnosis of ALT (AU)

Siringoma de células claras: estudio clinicpatológico de un caso y revisión de la literatura / Clear cells syringoma. A clinicopathological study of a case and literature review

Se reporta el caso de un hombre de 59 años de edad, con un tumor pequeño, de aspecto papilar, en párpado inferior del ojo izquierdo, de 20 años de evolución. El tumor corresponde a un siringoma de células claras, con aumento en el número de células claras en las glándulas sudoríparas no tumorales y asociado a diabetes mellitus. La asociación de siringoma de células claras con diabetes mellitus quizás represente un dato morfológico en la piel relacionado con la endocrinopatía mencionada.

Leiomiomatosis difusa del útero: presentación de un caso y revisión de la literatura / Diffuse leiomyomatosis of the uterus: a case report and review of the literature

Se presenta el caso de una mujer de 41 años de edad con crecimiento uterino, debido a la presencia de tumores de estirpe muscular lisa, muchos de ellos microscópicos, y con proliferación de células miógenas alrededor de vasos sanguíneos. Los datos anteriores conforman el cuadro morfológico de leiomiomatosis difusa. Se comenta la patogénesis del padecimiento y el diagnóstico diferencial con sarcoma del estroma endometrial de bajo grado y la adenomiosis.

Tumor de senos endodérmicos del ovario con patrón hepatoide predominante y metástasis a hígado / Tumor of endodemic ovarian sinus with prevailing hepatoid pattern and liver metastasis

Se presenta el caso de una mujer de 16 años de edad, con tumor de senos endodérmicos del ovario derecho, macroscópicamente sólido y con patrón histológico de crecimiento predominantemente de tipo hepatoide. Este tumor cursó con metástasis masivas a hígado y ascitis, lo que planteó el diagnóstico diferencial de tumor de senos endodérmicos de tipo hepatoide con metástasis a hígado o carcinoma hepatocelular con metástasis a ovario, o bien un carcinoma hepatoide del ovario. Se considera que éste es el primer caso en los archivos de la Unidad de Patología del Hospital General, en el que un tumor de senos endodérmicos presenta un patrón hepatoide tan extenso.

Carcinoma adenoideo quístico de glándula mamaria diagnosticado mediante biopsia con aguja fina / Cysto-adenoid carcinoma of breast diagnosed by means of a fine needle biopsy

El carcinoma adenoideo quístico es un tumor poco frecuente que representa menos del 1 por ciento de los carcinomas de la glándula mamaria, tiene mejor pronóstico en comparación con los tumores del mismo tipo histológico que se presentan en glándulas salivales, lagrimales y en otros sitios. Su morfología es idéntica en todas esta glándulas. Se informa el caso de un carcinoma adenoideo quístico, cuyo diagnóstico se efectuó mediante biopsia por aspiración con aguja fina y se corroboró por cortes histológicos de la pieza quirúrgica

Síndrome de deterioro intelectual: nuevos conceptos para el diagnóatico y tratamiento / Intelectual impairment syndrome: new trends for diagnosis and treatment

En todo el mundo se ha observado un incremento en la incidencia de enfermedades que tienen un denominador común "deterioro intelectual". Los resultados observados para determinar la fisiopatología de este proceso, la asocian con una pérdida de la acetilcolinesterasa, reducción de la concentración de noradrenalina y 5 hidroxitriptamina (5-HT) en corteza de hipocampo. En este artículo se analizan los criterios diagnósticos y las pautas de tratamiento, así como el pronóstico de estos enfermos, el cual es variable, dependiendo de la progresión de los síntomas, señalando una supervivencia de hasta 15 años entre el inicio de los síntomas y la muerte, originada principalmente por procesos infecciosos metabólicos o de desnutrición asociado a todo esto con la repercución económica, familiar y social que ello representa

Tumor de células transicionales del ovario. Revisión del material quirúrgico de la unidad de patología del Hospital General de Méxioc, en un periodo de 20 años / Ovarian transitional cell tumors. Review of surgical material from a Pathology Unit, Hospital General de México, in a 20 year period

Se estudiaron 127,483 informes histopatológicos de biopsias y piezas quirúrgicas; entre éstos se econtraron 1490 casos de tumores ováricos malignos y benignos, de los que hubo ocho casos de tumores de células transicionales , representando una frecuencia de 0.54 por ciento. Los diagnósticos histopatológicos fueron los siguientes: cinco tumores de Brenner benignos, un tumor de Brenner proliferante, otro tumor de Brenner de bajo grado de malignidad y el retante correspondió a un carcinoma de células transicionales. La localización predominante fue el ovario izquierdo: la edad de las pacientes varió de 33 a 70 años con un promedio de 49.4 años. Macroscopicamente cuatro tumores fueron sólidos, uno sólido-quístico y los 3 restantes predominantemente quísticos, correspondiendo respectivamente al tumor proliferante, el tumor de bajo grado de malignidad y el carcinoma de células transicionales. El tamaño de los tumores varió de 1.2 cm a 25 cm, con un promedio de 11.7 cm. Los tumores de mayor tamaño correspondieron a los tumores quísticos, que a su vez representaron a las neoplasias de comportamiento más agresivo. Lo anterior parece indicar que ante un tumor predominantemente quístico y de gran tamaño se deberán hacer un muestreo exhaustivo para descartar malignidad

Cáncer gástrico e infección por Helicobacter pylori / Gastric cancer and infection by Helicobacter pylori

Se efectuó un estudio retrospectivo analizado dos periodos (1960-1970 y 1980-1990) y comparando la asociación de Helicobacter pylori con cáncer gástrico. De cada periodo se estudiaron 50 casos con esta neoplasia. En el primer periodo la frecuencia de H. pylori fue de 44 por ciento y en el segundo de 42 por ciento. Si bien la presencia de la infección fue casi la misma, no resultó así la de cáncer gástrico, la cual fue de 47 por ciento para los tumores gastrointestinales en los años 70 y de 36 por ciento en los años 80. Lo anterior sugiere que el H. pylori es un factor más en el cortejo multifactorial de la génesis del cáncer gástrico. Por lo que respecta a la edad de aparición del cáncer gástrico, ésta no fue estadísticamente entre pacientes con o sin infección de H. pylori; por lo tanto, esta infección no condiciona, al parecer, una evolución más rápida de la neoplasia

Los organizadores nucleolares en el diagnóstico diferencial entre fibroadenoma y tumor filoides con diversos grados de malignidad / Nucleolar organizers in the differential diagnosis between fibroadenoma and phyllodes tumor with different degree of malignancy

El tumor filoide es un tumor de pronóstico incierto, lo que ha llevado a varios investigadores a buscar factores que permitan predecir su comportamiento biológico. Uno de los criterios más enfatizados es la actividad mitósica. Con base en esto último, nos propusimos a valorar el grado de certeza de este criterio, aplicando una técnica histoquímica con plata coloidal que permite identificar a las proteínas asociadas a los organizadores nucleolares e indirectamente a estos mismos. A través de la contabilización de los organizadores nucleolares es posible separar lesiones benignas de malignas, como ya ha sido probado en otros tejidos. En el presente trabajo se contaron los organizadores nucleolares en 45 casos, separados de la siguiente manera: cinco casos de mama normal (grupo control), 10 casos de tumores filoides de bajo grado de malignidad, 10 casos de tumores filoides de grado medio, 10 casos de tumores filoides de alto grado de malignidad y 10 casos de fibroadenoma mamario. Los resultados obtenidos al analizar el número de organizadores nucleolares demuestran que el criterio de actividad mitósica permite diferenciar glándula mamaria normal frente a fibroadenoma y tumores filoides; así como entre fibroadenoma y tumores filoides, lo mismo que a estos últimos en sus diversos grados de malignidad

Coriocarcinoma gestacional avanzado: estudio clínico patológico de 40 casos / Advanced gestational choriocarcinoma: clinico-pathological study of 40 cases

Se presentan 42 casos de coriocarcinoma gestacional avanzado; cuatro de estas pacientes tuvieron una estancia intrahospitalaria menor a 24 horas y dado lo inespecífico y atípico de la sintomatología, se reconoció su naturaleza en 20 casos, en los 22 restantes donde el cuadro clínico predominante estuvo dado por invasión local de estructuras vecinas o por las metástasis, se establecieron diversos diagnósticos como carcinoma cervicouterino, carcinoma endometrial, metástasis pulmonares, tumor cerebral, sangrado de tubo digestivo, etc. Las 20 pacientes con diagnóstico de coriocarcinoma fueron tratadas mediante histerectomía en 9 más omentectomía en una de ellas, siete recibieron quioterapia a base de metotrexate, y 4 solo medidas de sostén, obteniéndose resultados desfavorables con una sobrevida que varió de 1 a 20 semanasm, con un promedio de cinco semanas

Pilomatrixoma atípico en el material quirúrgico del Hospital General de México: estudio en el periodo 1987-1993 / Atypical pilomatrixoma in the surgical material of the Hospital General de Mexico. A seven years period study(1987-1993)

El pilomatrixoma es una neoplasia originada del folículo piloso, es más frecuente en la segunda década de la vida y tradicionalmente se ha considerado como un tumor benigno. Sin embargo, en 1927, se descrubrió el primer caso con características malignas. Para este informe se revisaron 90,314 reportes histopatológicos. Entre éstos hubo 60 casos (0.06 por ciento) de pilomatrixoma; de estos últimos, 11 casos (18.3 por ciento) llenaban los criterio histopatológicos del pilomatrixoma maligno: proliferación de células basaloides en relación con células fantasmas (40.5 a 59.5 por ciento), invasión estromal y/o capsular en los 11 casos, necrosis de mayor o menor grado también en el 100 por ciento de los casos y numerosas figuras de mitosis, promedio 29 mitosis por 10 campos seco fuerte; sin embargo, a diferencia de los tumores de comportamiento maligno descritos en la literatura, en ninguno de estos 11 casos se han presentado recurrencias o metástasis en un periodo promedio de observación de 150 días. Por el comportamiento benigno y por los datos histológicos de malignidad que nuestros casos han mostrado, proponemos que se denominen pilomatrixoma atípicos, con la sugerencia de tratarlos con cirugía no mutilante, pero sí suficiente para dar márgenes quirúrgicos libres de tumor, y con la recomendación de seguimiento clínico periodico a estos pacientes