Depósitos cálcicos cutáneos diagnosticados mediante ecografía / Ultrasound Diagnosis of Calcified Skin Deposits

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Primary breast lymphoma: report of 2 cases / Primary breast lymphoma: report of 2 cases

El linfoma no hodgkiniano primario de mama (LNHPM) constituye un hallazgo muy poco común, representa un 0,04-0,53 por ciento de todos los tumores malignos de mama y aproximadamente un 2,2 por ciento de los linfomas extranodales. El diagnóstico se basa en los hallazgos clínicos y anatomopatológicos y exige un exhaustivo estudio de extensión. Las técnicas de imagen no han demostrado ser útiles en el diagnóstico precoz debido al rápido crecimiento del LNHPM y su similitud radiológica con otras tumoraciones mamarias. El fenotipo histológico es un factor determinante en la elección del tratamiento, esencialmente en los casos que precisa quimioterapia, que variarán dependiendo de cada entidad histopatológica. La radioterapia puede ser una opción como tratamiento complementario en la mama. La estadificación de Ann Arbor representa el único factor pronóstico estadísticamente significativo. A continuación, presentamos 2 casos de esta variedad clínica, diagnosticados en nuestro servicio en los 2 últimos años. El primer caso corresponde a un linfoma de Burkitt estadio IV A de Ann Arbor y el segundo a un linfoma difuso de células grandes B estadio I. En ambos casos se ha conseguido la remisión completa mediante tratamiento con exéresis local, radioterapia y quimioterapia, y no se ha evidenciado recurrencia ni progresión clínica tras un año de seguimiento. Hemos realizado una amplia revisión de la bibliografía al respecto, haciendo énfasis sobre su verdadera incidencia, factores pronósticos y combinaciones terapéuticas recomendadas. El LNHPM constituye un hallazgo muy poco frecuente, pero a pesar de su excepcionalidad, no debemos olvidar incluirlo en el diagnóstico diferencial de las tumoraciones mamaria (AU)

Intracranial extraskeletal myxoid chondrosarcoma: case report and review of the literature.

BACKGROUND: We describe a patient with an intracranial extra skeletal myxoid chondrosarcoma (EMC), an unusual neoplasm of the deep soft tissues of the extremities. Very rarely are they localised as an intracranial lesion, and we believe it is very important to accurately distinguish EMC from other intracranial tumours such as classical or "skeletal" chondrosarcomas, mesenchymal chondrosarcoma, enchondroma, and myxoid tumours (chordoma, and chondromyxoid fibroma) in order to determine their prognostic implications. Furthermore, this case presents with the second local recurrence, higher-grade cellular areas, such an event has never been reported in intracranial cases. METHOD: A 17 year-old female presented with tonic and clonic seizures, episodic left hemiplegia and intense right-sided headaches. Computed tomography and magnetic resonance of the skull showed a right fronto-parietal cortical lesion. Complete surgical excision of the lesion through a right parieto-temporal craniotomy was performed. The tumoral lesion recurred locally twice (16 and 19 months after the initial surgery respectively). FINDINGS: First and second surgical specimens where diagnosed as extra skeletal myxoid chondrosarcoma. Microscopically, the third specimen (second local recurrence) showed abrupt transition from areas of conventional myxoid chondrosarcoma to high-grade cellular areas with fusiform features. INTERPRETATION: Extra skeletal myxoid chondrosarcoma is very rarely described as an intracranial lesion. Reference on this topic is very confusing as there is no clear-cut distinction between skeletal chondrosarcomas with prominent myxoid matrix and extra skeletal myxoid chondrosarcoma which is a definite entity first defined by Enzinger and Shiraki in 1972 in deep soft tissues of the extremities. We review the cases reported in the literature with the diagnosis of myxoid chondrosarcoma either of extra skeletal origin or with skeletal attachment, and analyse their clinic and pathological features.

Fibrohisticitioma maligno primario de pulmón / Malignant fibrous histiocytoma of the lung

Presentamos un nuevo caso de fibrohistiocitoma maligno primario de pulmón y revisamos la literatura con la intención de exponer sus principales características clínicopatológicas. Se trata de una entidad poco frecuente, cuya etiopatogenia sigue siendo desconocida. Es una lesión de difícil diagnóstico, que plantea el diagnóstico diferencial con sarcomas metastásicos y con lesiones fusocelulares primitivas, fundamentalmente el carcinosarcoma, el carcinoma fusocelular y, en niños, el pseudotumor inflamatorio. Es imprescindible un estudio clínico radiológico que descarte otra lesión primitiva y la ayuda de técnicas de inmunohistoquímica y mícroscopia electrónica (AU)

Cutaneous signet ring cell carcinoma: a report of a case and review of the literature.

Primary cutaneous signet-ring cell carcinoma (CSRCC) is a very unusual but distinctive clinicopathologic entity. It is defined as a diffuse malignant epithelial neoplasia localized in dermis and subcutis without epidermal involvement, showing variable amounts of signet ring cells, without evidence of a visceral adenocarcinoma. We report a case of CSRCC in a 70-year-old man along with its histologic and ultrastructural characteristics, and review of previous cases. We describe their main diagnostic features and discuss its wide differential diagnosis.

Combined use of novel epithelial (MOC-31) and mesothelial (HBME-1) immunohistochemical markers for optimal first line diagnostic distinction between mesothelioma and metastatic carcinoma in pleura.

AIMS: To determine the value of immunohistochemistry in differentiation of malignant pleural mesothelioma from carcinoma in a pleural biopsy we optimized a double panel of MOC-31 and HBME-1 and compared the results with others from the literature. METHODS AND RESULTS: A multi-antibody panel was applied to biopsy samples from 44 cases of malignant pleural mesothelioma and 23 cases of carcinoma metastatic to the pleura. We used monoclonal antibodies against keratins, epithelial membrane antigen (EMA), epithelial antigen Ber-EP4, carcinoembryonic antigen (CEA), tumour-associated glycoprotein (B72.3), LeuM1, vimentin, desmin, epithelial related antigen (MOC-31) and mesothelial cell (HBME-1). Positivity for MOC-31 and Ber-EP4 was found to have the highest nosologic sensitivity (94.1% and 84.6%, respectively) and specificity (86.3% both antibodies) for carcinoma. Positive staining for HBME-1 and vimentin had the highest sensitivity (90.9% and 100%, respectively) and specificity (91.3% and 60%, respectively) for mesothelioma. A two-marker antibody panel with HBME-1 and MOC-31 was the most efficient for the distinction between carcinoma and malignant pleural mesothelioma. CONCLUSION: A combination of MOC-31 (an anti- epithelial marker) and HBME-1 (an anti-mesothelial marker) has a diagnostic efficiency of 76.1% for the distinction between carcinoma and mesothelioma in pleura.

Small cell carcinoma of the kidney: a case report and review of the literature.

Small cell carcinoma is a malignant tumor composed of small cells with a diffuse growth pattern. It has immunohistochemical and ultrastructural features of both neuroendocrine and epithelial neoplasms. These tumors constitute 10% to 20% of malignant tumors in the lung, which is their most frequent site. They have been described in other extrapulmonary sites, where they are defined using the same criteria as used in the lung. These tumors are rarely found in the genitourinary tract. Fewer than 30 cases have been reported in the kidney. The differential diagnosis mainly includes other small round cell tumors and metastatic small cell lung carcinoma. We present and discuss a primary small cell carcinoma of the kidney (to our knowledge the 9th to be reported in the literature), which we studied with light microscopy, immunohistochemistry, electron microscopy, and, for the first time, flow cytometry.

Intracapsular and para-articular chondroma adjacent to large joints: report of three cases and review of the literature.

Para-articular chondroma is a rare tumor that has been reported in only 30 cases adjacent to large joints in the Anglo-Saxon literature. We report three new cases of this entity, describe its clinical, radiological and pathological features, and review the previous literature. Para-articular chondromas have an insidious clinical presentation and on radiographs show a large soft tissue mass with variable ossification. They appear as a lobulated mass of hyaline cartilage with variable endochondral ossification in the central area. These rare benign tumors arise from the capsule or the para-articular connective tissue of a large joint (mainly the knee), which suffers cartilaginous metaplasia and subsequent ossification. Cases 1 and 2 of this presentation fit all the features described previously. Case 3 has identical clinical features but differs from the former two cases in its microscopic appearance, being composed almost entirely of fibrocartilage and myxoid areas within the fibroadipose tissue of the joint instead of mature trabecular bone surrounded by hyaline cartilage. To the best of our knowledge this is the first description of this histological variant of para-articular chondroma.