Pancreatic fusocellular sarcoma. The importance of endoscopic ultrasound-guided fine needle aspiration in the differential diagnosis of solid pancreatic tumors.

In the presence of a pancreatic tumor, the main diagnostic problem is to determine the benign o malignant nature of the lesion, and then to evaluate its resectability. A preoperative biopsy was usually rejected based on the fact that negative results do not exclude malignancy, that such biopsy may hamper the possibility of curative surgery because of potential seeding along the biopsy s trajectory, that surgical morbidity and mortality are low, and also because of the high diagnostic sensitivity of the various imaging techniques. Biopsy for solid pancreatic tumors was limited to irresectable tumors, and isolated cases with suspicion of tuberculosis, lymphoma or neuroendocrine tumors. Nowadays the performance of a pancreatic biopsy is becoming essential for the correct management of solid lesions, and is useful not only to establish malignancy, but also for a better knowledge of all kind of pathologies and, thus, for better therapeutic management. In this context, endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has proven a safe technique with a low rate of complications and a diagnostic accuracy superior to other procedures, this being considered the method of choice for the study of solid pancreatic lesions. An illustrative example is the case we report in this article -a patient diagnosed of a solid, locally advanced-stage pancreatic tumor with imaging techniques (abdominal ultrasounds and EUS) under EUS-guided FNA; the procedure could establish a final diagnosis of pancreatic fusocellular sarcoma.

Sarcoma fusocelular de páncreas: importancia de la PAAF guiada por ultrasonografía endoscópica en el diagnóstico diferencial de los tumores sólidos pancreáticos / Pancreatic fusocellular sarcoma. The importance of endoscopic ultrasound-guided fine needle aspiration in the differential diagnosis of solid pancreatic tumors

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Solitary focus in the liver in a thyroid cancer patient after a whole body scan with 131 iodine.

A 51-year-old woman diagnosed with follicular variant of papillary thyroid carcinoma underwent a total thyroidectomy followed four weeks later by an ablative dose of 3.7 GBq of 131I. A whole body scan 5 days after ablation showed an intense uptake within the thyroid bed and a focal uptake located in the right lung base or liver dome. Computed tomography examination revealed a hypodense hepatic node in segment VII resembling a liver metastasis. Histological examination after ultrasound-guided fine-needle aspiration characterized the lesion as a liver abscess. The abscess regressed after antibiotic therapy. Liver metastases from papillary thyroid carcinoma are uncommon. On the other hand, false positive findings of 131I whole body scans have been described. A focal hepatic uptake might represent a metastasis (rare in papillary carcinomas) or be related to other causes (cysts, inflammation or infection, non-thyroidal neoplasms, etc.).

Solitary focus in the liver in a thyroid cancer patient after a whole body scan with 131 iodine

A 51-year-old woman diagnosed with follicular variant of papillary thyroid carcinoma underwent a total thyroidectomy followed four weeks later by an ablative dose of 3.7 GBq of 131I. A whole body scan 5 days after ablation showed an intense uptake within the thyroid bed and a focal uptake located in the right lung base or liver dome. Computed tomography examination revealed a hypodense hepatic node in segment VII resembling a liver metastasis. Histological examination after ultrasound-guided fine-needle aspiration characterized the lesion as a liver abscess. The abscess regressed after antibiotic therapy. Liver metastases from papillary thyroid carcinoma are uncommon. On the other hand, false positive findings of 131I whole body scans have been described. A focal hepatic uptake might represent a metastasis (rare in papillary carcinomas) or be related to other causes (cysts, inflammation or infection, non-thyroidal neoplasms, etc.)

Se presenta el caso de una mujer de 51 añosdiagnosticada de carcinoma papilar de tiroides, variante folicular, sometida a tiroidectomía total seguida 4 semanas después por una dosis ablativa de 3,7 GBq de 131I. El rastreo corporal total a los 5 días mostró una intensa captación en el lecho tiroideo, y una captación focal localizada en la base del pulmón derecho o la cúpula hepática. La tomografía axial computarizadasubsecuente reveló un nódulo hipodenso en el segmentoVII hepático, sugestivo de metástasis. El estudio patológico del material obtenido mediante punción-aspiración con aguja fina (PAAF) lo caracterizó como absceso hepático. Tras tratamiento antibiótico se objetivó regresión del mismo. Las metástasishepáticas de carcinoma papilar de tiroides son infrecuentes y, por otro lado, se han descrito con anterioridad falsos positivos del rastreo con 131I. Una captación focal hepática podría representar una metástasis (rara en carcinomas papilares) o estar relacionada con otras causas (quistes, inflamación o infección, tumores no tiroideos, etc.) (AU)

Controversial origin of Pseudomyxoma peritonei

Pseudomyxoma peritonei describes the accumulation of mucinous material in the abdominal cavity. The main diagnostic problem appears when the primary site of origin could be appendix or ovary. In this paper describe clinicopathological features and biological markers that support appendiceal origin (AU)

[Epidermoid carcinoma of the larynx: anatomo-pathological results of 58 cases]. / Carcinoma epidermoide de laringe: resultados anatomopatológicos en 58 casos.

In this study was considered 58 patients diagnosed of squamous cell carcinoma of larynx and operated between 1991 and 1996 at the Ear Nose and Throat Service of the University Hospital Complex of Santiago de Compostela. They are all men but one female and the biggest percentage were T2 (39.7%) and T3 (37.9%) tumours. The macroscopic characters such as the average diameter of the pieces was 6.91 cm and 2.66 cm of the tumour. The most usual tumoral shape encounter was exofitic and ulcerous. And between the microscopic characters we valued the histologic grade of differentiation and the most usual were the well (44.8%) and moderated (41.4%) differentiated. The average of mitosis was 20.6 and 31 tumours presented necrosis.

Congenital hydranencephalic-hydrocephalic syndrome with proliferative vasculopathy: a possible relation with mitochondrial dysfunction.

We report the case of a fetus aborted at gestation week 20 because of hydranencephalic-hydrocephalic syndrome. The fetus was the third pregnancy of a nonconsanguineous couple whose first child exhibited congenital hydranencephalic-hydrocephalic syndrome associated with muscle histology findings consistent with mitochondrial cytopathy and deficiency of complexes III and IV of the respiratory chain and whose second pregnancy had terminated in an elective abortion on detection of progressive hydrocephalus at gestation week 19. The third pregnancy had a normal course according to obstetric and ultrasonography examinations performed at gestation weeks 5, 10, and 15, and negative results were obtained in standard serologic and polymerase chain reaction (PCR) tests for prenatal infections of the mother. However, the ultrasonography examination at gestation week 18 revealed hydrocephalus, in response to which the parents requested an abortion, which was performed at gestation week 20; the fetus was male and with no evident external malformations. Histopathologic studies of the brain and medulla oblongata revealed proliferative vasculopathy (glomeruloid vessels, intracytoplasmic inclusions, and microcalcifications) and intracytoplasmic inclusions in the voluntary muscle. Microbiologic and PCR tests of hepatic and spleen tissue were negative for prenatal infections. In view of the precedent of a sister with mitochondrial dysfunction, these findings raise the pos sibility that at least some cases of familial syndrome of congenital hydranencephalic-hydrocephalic syndrome with proliferative vasculopathy can be attributed to alterations in the mitochondrial respiratory chain.

Molecular epidemiology of human herpesvirus 8 in africa: both B and A5 K1 genotypes, as well as the M and P genotypes of K14.1/K15 loci, are frequent and widespread.

We have studied 52 new HHV8 strains by sequencing the complete hypervariable K1 gene and genotyping the K14.1/K15 loci located at both sides, respectively, of the viral genome. The samples originated from 49 patients with Kaposi's sarcoma (KS; 32 patients), multicentric Castleman's disease (MCD; 12 patients), or primary effusion lymphoma (PEL; 5 patients). Among these patients, 32 were of African origin (West and Central African countries and Creoles from French Guiana) and the 17 others were mostly French homosexuals. Comprehensive phylogenetic studies allowed the identification of distinct groups within the three already known main subtypes. Interestingly, two new sequences that did not cluster within a known subtype or group could be considered as prototypes of early/ancient variants of the C subtype and A/C set, respectively. Among the 32 African strains, the majority were either of the B subtype (13 cases) or of the A5 group (11 cases), indicating that this latter genotype is frequent and widespread in Africa. In contrast, a subtype C strain infected most of the 17 other patients. PCR-based genotyping of the K14.1/K15 loci revealed an overall predominance of P subtype, except in the A5 and B K1 groups, in which the P and M alleles were equally represented. The implications of these data on the evolution and spread of HHV8 among human African populations are discussed.

The relationship between survival and cell proliferation index in squamous cell carcinoma of larynx.

Cell proliferation index is one of the most important factors in assessment of growth and progression of tumours. At present, the most suitable method of determining cell proliferation is by means of immunohistochemical techniques which use the monoclonal anti-body MIB-1 which reacts against Ki-67, a protein released only in the proliferation phases of the cell cycle. In this study, 44 patients diagnosed with squamous cell carcinoma of the larynx were analysed retrospectively and different macroscopic and microscopic parameters were assessed, such as MIB-1 in relation to the current status of the patient. A statistically significant relationship was found between the cell proliferation index, the histological grade of differentiation and the clinical evolution of the illness.

Insuficiencia hepática grave y lesiones ocupantes de espacio en el hígado en una paciente de 33 años / Severe hepatic failure and space occupying lesions in the liver in a 33-year-old patient

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Prognostic value of nuclear morphometry in colorectal cancer.

PURPOSE: In many types of cancer, certain morphometric characteristic of tumor cells correlate with patient survival. Our observations suggested that the survival of patients with colorectal carcinomas is negatively correlated with tumor-cell nucleus size. METHODS: We investigated relationships between postsurgery survival and nucleus morphometrics in 90 patients who had undergone resection for a colorectal tumor. The nucleus-size variables considered were maximum diameter, minimum diameter, perimeter, area, and form factor (means for 100 nuclei from each patient were used in all cases). RESULTS: Our results confirmed that patients with large maximum nucleus diameter (where large = greater than the first quartile) have significantly worse survival than patients with smaller maximum nucleus diameter (mean survival, 28 vs. 43 months). Similar results were obtained for the other nucleus-size variables. Stepwise Cox regression analysis was then performed, with postsurgery survival time as the dependent variable and the following candidate independent variables: age, gender, Dukes class, degree of histologic differentiation, the various nucleus-size variables, and relative frequencies of different nucleus shapes (spherical, oval, cylindrical, fusiform, and irregular). The variables selected for the prognostic model were Dukes class, relative frequency of irregular nuclei, and maximum nucleus diameter. CONCLUSIONS: These findings indicated that nucleus size and shape are useful predictors of survival. Even if Dukes class is known, consideration of nucleus size and shape significantly improves prediction of survival.

[Smooth muscle tumor of the lower lip. A report of a case of rapid growing and increased mitotic activity]. / Tumor de músculo liso de labio inferior. Reseña de un caso de rápido crecimiento y elevada actividad mitósica.

Smooth-muscle tumors are not often found in the oral cavity. The tumors found usually are benign tumors of the angioleiomyoma type. We report a new case of oral smooth-muscle tumor, in the lower lip of a 74-year-old woman. Immunohistochemistry and electron microscopic study confirmed the nature of the lesion. Although some mitoses were visible, the outcome has been favorable.

Waldeyer's ring lymphomas: an epidemiological study of 55 cases.

Waldeyer's ring is a relatively common location for non-Hodgkin's lymphoma. Here, we report an epidemiological study of Waldeyer's ring lymphomas based on data for 55 cases treated over a 19-year period at three centers in northern Spain. In most respects our results confirm those of previous studies. The average delay between first consultation and diagnosis was 3.8 months, and was longer for nasopharyngeal lymphomas than for tonsillar lymphomas.

Cutaneous granulomatous vasculitis after herpes zoster infection showing polyarteritis nodosa-like features.

Various cutaneous lesions have been described after herpes zoster infection, such as lymphomas, pseudolymphoma and granulomatous conditions (granuloma annulare, tuberculoid granuloma, sarcoidosis). However, granulomatous vasculitis is an extremely rare sequel. We now describe a case of superficial granulomatous vasculitis with deep 'polyarteritis nodosa (PAN)-like' arteritis that developed after herpes zoster infection. Polymerase chain reaction did not detect genome of the herpes virus. We suggest that this condition could be an immune response to viral proteins.