Exuberant complex metaplastic carcinoma of the breast with SOX2 expression: cove ring the full spectrum of ductal neoplasia of the breast / Carcinoma metaplásico de la mama con expresión de SOX2 y presentación clínica exuberante: recorriendo el amplio espectro de la neoplasia ductal de la mama

We report a unusual case of a 45-year-old woman with a massive metaplastic carcinoma of the breast with a complex admixture of components including giant pleomorphic cells, sarcomatoid areas, cysts with undifferentiated stratified epithelium, squamous carcinoma foci, high grade comedo-type ductal carcinoma in situ, high grade invasive carcinoma not otherwise specified (NOS) and foci with osseous differentiation. An extensive immunohistochemical panel showed expression of both epithelial and mesenchymal markers. The self-renewal marker SOX2 was expressed in different cell types, which was interpreted as a sign of the pluripotency what can in turn explain the diversity of histologic lineages present in this tumour (AU)

Presentamos el caso de una mujer de 45 años con un carcinoma metaplásico de presentación clínica exuberante, que mostraba una combinación compleja de diversos componentes, incluyendo células gigantes pleomórficas, áreas sarcomatoides, quistes con epitelio escamoso indiferenciado, focos de carcinoma escamoso, carcinoma ductal in situ de tipo comedo, carcinoma infiltrante de tipo usual y focos de diferenciación ósea. El amplio panel inmunohistoquímico mostraba expresión de marcadores tanto epiteliales como mesenquimales. El marcador de autorenovación SOX2 se expresaba en diferentes tipos celulares, lo cual fue interpretado como un signo de pluripotencialidad y podría explicar la diversidad de tipos histológicos presentes en este tumour (AU)

Biopsy of Brainstem Gliomas Using Flexible Endoscopes.

OBJECTIVES: To describe our experience and the results obtained in performing transventricular brainstem biopsy with the use of flexible neuroendoscops. METHODS: We identified patients who underwent a neuroendoscopic procedure with brainstem lesion biopsy to obtain histopathologic diagnosis and to treat obstructive hydrocephalus. All patients had follow-up examinations at months 1, 3, 6, and 12 postsurgery and then annually. RESULTS: Seven patients had a transventricular biopsy of the brainstem performed. Of those, five were pediatric patients. The median age was 10 years (range: 3-26 years). Five of them were female and two male. Four patients presented with secondary obstructive hydrocephalus. The main clinical presentations were intracranial hypertension syndrome in four patients, motor neuron disease in four patients, two with decreased state of alertness, two with gait ataxia, and one with Parinaud syndrome. The types of tumors found in the histopathology and their location were one ventral (pons) and one aqueductal anaplastic astrocytoma, two ventral, one aqueductal, and one attached to the floor of the fourth ventricle pilocytic astrocytoma and one ventral low-grade astrocytoma. The route taken to approach the ventral tumors was made through premammillary fenestration. The tumors of the aqueduct and floor of the fourth ventricle were approached transaqueductally. CONCLUSION: The use of flexible endoscops for biopsy of ventral, dorsal (tectum lamina quadrigemina), and diffuse brainstem tumors is a useful, effective, and safe procedure that also allows to treat obstructive hydrocephalus secondary to the tumors.

Spindle epithelial tumor with thymus-like differentiation of the thyroid (SETTLE): Report of two cases (one associated with a parathyroid adenoma).

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a rare tumor usually localized in the thyroid gland and perithyroid tissues. It is considered to arise from ectopic thymic tissue or branchial pouch remnants. It occurs more frequently in children and adolescents. We report 2 cases of spindle epithelial tumor with thymus-like differentiation localized in the thyroid gland, and 1 of them was associated with a parathyroid adenoma. We emphasize the need for a close and long-term follow-up in these patients.

Pleomorphic ductal carcinoma of the breast: predictors of decreased overall survival.

The World Health Organization classification of tumors of the breast includes a rare variant of invasive ductal carcinoma termed pleomorphic carcinoma. This variant has marked nuclear pleomorphism (>6-fold variation in nuclear size by definition, but often>10-fold) and characteristically contains multinucleated tumor giant cells. Approximately one-third of the cases in the initial series contained a focal spindle cell metaplastic component. The tumors are reported to have an aggressive behavior, but because some contain a spindle cell metaplastic component, it is unclear whether the metaplastic component or other clinicopathologic features account for the poor clinical outcome. We identified 37 cases of pleomorphic carcinoma of the breast and evaluated the association between clinical outcome and multiple clinicopathologic features. Patients with invasive pleomorphic lobular carcinoma and those without at least a tissue biopsy before chemotherapy were excluded. Patients ranged in age from 23 to 78 years (median, 49 y). Tumor size was >5 cm in 12 cases and <5 cm in 22. A focal spindle cell component (<25% of the tumor) was present in 14 tumors (38%). Clinical follow-up was available for 36 patients (median, 17 mo). In multivariate analysis, when the 2 stage-IV patients were excluded, the presence of a spindle cell component and tumor size >5 cm were each independently associated with decreased overall survival. The actuarial 5-year overall survival for patients with and without a metaplastic spindle cell component was 38%+/-15% and 89%+/-7%, respectively. Poor clinical outcome, therefore, is associated with the subset of pleomorphic carcinomas with a spindle cell metaplastic component. As the morphologic features of pleomorphic carcinoma can be seen in primary tumors from other sites, it is important to recognize this tumor as a rare variant of invasive breast carcinoma.

Severe pneumonia associated with pandemic (H1N1) 2009 outbreak, San Luis Potosí, Mexico.

We describe the clinical characteristics and outcomes of adults hospitalized with pneumonia during the pandemic (H1N1) 2009 outbreak. Patients admitted to a general hospital in San Luis Potosí, Mexico, from April 10 through May 11, 2009, suspected to have influenza virus-associated pneumonia were evaluated. We identified 50 patients with suspected influenza pneumonia; the presence of influenza virus was confirmed in 18: 11 with pandemic (H1N1) 2009 virus, 5 with unsubtypeable influenza A virus, 1 with seasonal influenza A virus (H3N2), and 1 in whom assay results for seasonal and pandemic (H1N1) 2009 viruses were positive. Eighteen patients were treated in the intensive care unit, and 10 died. During the pandemic (H1N1) 2009 outbreak, severe pneumonia developed in young adults who had no identifiable risk factors; early diagnosis and treatment of influenza virus infections may have a determinant role in outcome.

Comparison of the pathology caused by H1N1, H5N1, and H3N2 influenza viruses.

The spectrum of morbidity and mortality of H1N1, H5N1, and H3N2 influenza A viruses relates to the pathology they produce. In this review, we describe and compare the pathology of these viruses in human cases and animal models. The 1918 H1N1, the novel 2009 H1N1 pandemic virus, and H5N1 show inflammation, congestion, and epithelial necrosis of the larger airways (trachea, bronchi and bronchioles) with extension into the alveoli causing diffuse alveolar damage. Seasonal influenza A viruses (H3N2 and H1N1) have primarily caused inflammation, congestion and epithelial necrosis of the larger airways with lesser extension of the inflammatory process to alveoli. Localization of the inflammation and cellular damage relate to the presence of virus in different cell types. Infections with 1918 H1N1, the novel 2009 H1N1 pandemic virus, and H5N1 show virus in mucosal epithelial cells of the airways (from the nasopharynx to the bronchioles), alveolar macrophages, and pneumocytes, whereas infections with seasonal influenza viruses show viral antigens primarily in mucosal epithelial cells of the larger airways. The increased morbidity that has been encountered with the 2009 H1N1 virus is related to infection of cells in the upper and lower airways. The 2009 H1N1 virus shows similar pathology to that encountered with other highly virulent influenza A viruses such as the 1918 H1N1 and H5N1 viruses.

Ulcera eosinofílica de la lengua: reporte de un caso clínico / Eosinophilic ulcer of the tongue: report of a clinical case

El propósito de este trabajo es describir un caso clínico de úlcera eosinofílica de la lengua en una mujer de 71 años y hacer énfasis en sus características clínicas e histológicas, así como en el diagnóstico diferencial con carcinoma epidermoide, cuyo tratamiento y pronóstico es diferente. Otras entidades con las que puede confundirse incluyen: tuberculosis, histoplasmosis, chancro, infiltración leucémica, linfoma, etc. Se destaca la importancia de la biopsia y el establecimiento del diagnóstico correcto

Sarcoma de células claras de riñón metastásico a mandíbula. Informe de un caso / Clear cell sarcoma of kidney metastatic to the mandible. Report of a case

Se presenta el caso de un paciente masculino de 8 años de edad, con antecedentes de nefroblastoma (tumor de Wilms) a la edad de cinco años, con manejo terapéutico a base de nefrectomía, quimioterapia y radioterapia, quien treinta meses después presentó aumento de volumen en hemicara izquierda con lesión lítica en cuerpo y rama ascendente del lado izquierdo mandibular. La revisión de laminillas del tumor original se interpretó como sarcoma de células claras de riñón. La lesión mandibular mostró la misma imagen, con lo cual el diagnóstico fue de sarcoma de células claras de riñón, metastásico a hemimandíbula izquierda. Este caso es excepcional y en nuestro conocimiento el primero en la literatura mundial. Llamamos la atención sobre la dificultad diagnóstica, tanto en la entidad primaria como en la metástasis, en este último caso con diagnósticos diferenciaels de sarcomas primarios como metástasis

Rabdomioma cardiaco neonatal: Informe de uncaso y consideraciones clínico-epidemiológicas / Neonatal rhabdomyoma of the heart: case report and clinico epidemiological considerations

Los tumores cardiacos primarios son entidades raras en todos los grupos de edad, de ellos el más frecuente en la edad pediátrica es el rabdomioma, el cual se encuentra asociado a esclerosis tuberosa en el 37 a 80 por ciento de los casos, con una frecuencia informada de hasta 1 por cada 40,000 recién nacidos vivos. El presente caso es el de un recién nacido, que desde las primeras horas de vida presentó soplo pansistólico, cardiomegalia grado IV, datos electrocardiográficos de hipertrofia ventricular e insuficiencia cardiaca. El ecocardiograma y la imagen por resonancia magnética mostraron múltiples tumores en la porción muscular del septum y paredes ventriculares. La biopsia confirmó el diagnóstico de rabdomioma. Lo que, aunado a las máculas hipomelanóticas, áreas de hipodensidad del parénquima cerebral y crisis convulsivas, permitió establecer el diagnóstico de esclerosis tuberosa. En nuestro medio existe poca información sobre ambas enfermedades, por lo que se revisa la incidencia, diagnóstico, pronóstico y manejo de casos como el presente

Taponamiento cardiaco en neonatos con catéter venoso central y alimentación parenteral / Neonatal cardiac tamponade, central venous catheter and parenteral nutrition

Objetivo: Llamar la atención sobre una entidad poco frecuente o poco informada pero con alta letalidad y que por lo tanto debe considerarse para su detección y tratamiento oportuno en todo neonato críticamente enfermo con alimentación parenteral por catéter venoso central. Reporte de casos: Se trató de dos neonatos, uno de término y otro de pretérmino con catéter venoso central y alimentación parenteral que presentaron deterioro súbito y muerte, secundario a taponamiento cardiaco. Discusión: El taponamiento cardiaco secundario a la instalación de un catéter venoso central es una entidad poco señalada en la literatura nacional e internacional. La incidencia estimada varío de 0.3 por ciento hasta 2 por ciento con letalidad de 74 a 100 por ciento por lo que su sospecha, diagnóstica y manejo temprano son imperativos (si se pretende evitar la muerte) e incrementar la sobrevida de estos neonatos

Arteritis temporal. Informe de un caso originario de San Luis Potosí, México / Temporal arteritis. A case report

La arteritis temporal o de células gigantes, en una vasculitis generalizada que afecta característicamente las arterias craneanas, de etiología desconocida, con cierta predilección racial y geográfica, cuya ocurrencia en nativos mexicanos no ha sido descrita. Informamos una paciente de 85 años, del centro del país y con ascendencia genética también local. Su historia de 3 meses de evolución con dolor, aumento de volumen y tortuosidad de arterias extracraneanas, manifestaciones de polimialgia reumática y amaurosis bilateral; cursó con eritrosedimentación elevada y en la biopsia de arteria temporal se evidenció el infiltrado inflamatorio y de células gigantes características. Con esteroides mejoró sólo parcialmente la agudeza visual. Destacamos la importancia de considerar esta patología, dado que el retraso en el diagnóstico y tratamiento puede resultar en secuelas permanentes