La próstata líquida / The liquid prostate

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La metamorfología vs. la crisis de medicina / Metamorphology versus the crisis in medicine

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Tumor de células granulares en localización atípica / Granular cell tumor in unusual location

El tumor de células granulares es una neoplasia infrecuente, generalmente benigna, que suele afectar cara y cuello. Aparece entre la segunda y la sexta década, más frecuentemente en la raza negra y en mujeres. El 25% de los casos presenta lesiones múltiples. El único tratamiento es quirúrgico. Un varón de 17 años presentó una lesión nodular única epitroclear en el codo derecho. Se realizó una escisión amplia y el resultado anatomopatológico fue un tumor de células granulares. Tras un seguimiento de seis meses no hay evidencia de recidiva. La patogénesis debe ser claramente establecida, aunque la literatura sostiene la hipótesis de que tiene su origen en las células de Schwann. Los autores subrayan la peculiaridad de la localización epitroclear y discuten la clasifi cación, fi siopatología y el tratamiento del tumor con una revisión de la literatura.

Granular cell tumor is an infrequent neoplasm, benign in most of the cases, that usually affects head and neck. It develops between the second and sixth decades of life, more frequently among women and black people. 25% of the cases occur as multiple lesions. The only treatment is surgery. A 17- year old male presented a nodular, single and fi rm epithroclear lesion in his right elbow. A wide surgical excision was performed and the fi nal pathologic diagnosis was granular cell tumor. During follow-up of six months there is no evidence of tumour recurrence. The pathogenesis of the tumor has still to be clearly established, although literature sustains the hypothesis that it has origin in the Schwann ́s cells. The authors underscore the peculiarity of the epithroclear localization and discuss the classifi cation, pathophysiology and the treatment of Abrikossoff ́s tumor through a review of the literature.

[Hypersensitivity pneumonitis due to venlafaxine]. / Neumonitis por hipersensibilidad debida a venlafaxina.

Venlafaxine is a selective serotonin, noradrenalin, and dopamine reuptake inhibitor. Although side effects are rare, venlafaxine has very occasionally been associated with hypersensitivity pneumonitis. We report the case of a 61-year-old woman diagnosed with depressive disorder and treated with venlafaxine (Dobupal) at a dose of 150 mg/d for 18 months. When depression worsened, the dose was increased to 255 mg/d. Three weeks later she complained of nonproductive cough, shortness of breath with moderate effort, and asthenia. Clinical and radiologic findings, lung function, bronchoalveolar lavage, and histology of lung biopsies all indicated a diagnosis of hypersensitivity pneumonitis. Other causes were ruled out and venlafaxine was discontinued. Clinical, radiologic, and lung function findings then resolved without the use of corticosteroids or nonsteroid immune modulators. All findings were normal on follow-up after 3 months.

Neumonitis por hipersensibilidad debida a venlafaxina / Hypersensitivity pneumonitis due to venlafaxine

La venlafaxina es un antidepresivo que inhibe de formaselectiva la recaptación de serotonina, noradrenalina y dopamina.Los efectos secundarios son infrecuentes y excepcionalmentese ha asociado a neumonitis por hipersensibilidad.Describimos el caso de una mujer de 61 añosdiagnosticada de síndrome depresivo y tratada conDobupal® (venlafaxina), a dosis de 150 mg/24 h, desde hacía18 meses, que presentó un deterioro de su enfermedad, porlo que se incrementó la dosis de venlafaxina hasta 225mg/día. Tres semanas después desarrolló síntomas de tos noproductiva, disnea a esfuerzos moderados y astenia. El cuadroclinicorradiológico, los hallazgos en la función pulmonar,el lavado broncoalveolar y la histología de las biopsiaspulmonares eran indicativos de neumonitis por hipersensibilidad.Se descartaron otras etiologías y se retiró la venlafaxinasin utilizar corticoides ni otros inmunomoduladores,con lo que desaparecieron tanto la clínica como los hallazgosradiológicos y funcionales, que se normalizaron a los 3 meses

Venlafaxine is a selective serotonin, noradrenalin, anddopamine reuptake inhibitor. Although side effects are rare,venlafaxine has very occasionally been associated withhypersensitivity pneumonitis. We report the case of a61-year-old woman diagnosed with depressive disorder andtreated with venlafaxine (Dobupal) at a dose of 150 mg/d for18 months. When depression worsened, the dose wasincreased to 255 mg/d. Three weeks later she complained ofnonproductive cough, shortness of breath with moderateeffort, and asthenia. Clinical and radiologic findings, lungfunction, bronchoalveolar lavage, and histology of lungbiopsies all indicated a diagnosis of hypersensitivitypneumonitis. Other causes were ruled out and venlafaxinewas discontinued. Clinical, radiologic, and lung functionfindings then resolved without the use of corticosteroids or nonsteroid immune modulators. All findings were normalon follow-up after 3 months

[Primary testicular lymphoma. Report of two cases and bibliographic review]. / Linfoma testicular primario. Presentación de dos casos y revisión de la literatura.

OBJECTIVE: We report two cases of primary testicular lymphoma and performed a bibliography review about this pathology. METHODS/RESULTS: We describe two cases of primary testicular lymphoma in two male patients 69 and 61 yr. old respectively. In both cases, reason for consultation was increase of the right testicular size. After inguinal orchyectomy the diagnosis for the first case was large and medium T cell diffuse lymphoma, stage I (E)-A; three years after chemotherapy (R-CHOP) the patient is in complete remission. In the second case, the diagnosis was diffuse large B-cell lymphoma, and after receiving various chemotherapy regimens died 14 months after diagnosis. CONCLUSIONS: Testicular lymphoma is a very rare entity, despite being considered the most common testicular tumor in patients over the age of 60 years. Most of them are non-Hodgkin diffuse, intermediate or high grade of malignancy, B-cell immunophenotype, being T cell exceptional. Prognosis is poor due to their high tendency to systemic dissemination. The treatment is based on orchiectomy, chemotherapy and radiotherapy, although there is not a standardized regimen.

Clear cell carcinoma of the ovary diagnosed in ascitic fluid. A case report.

BACKGROUND: Clear cell carcinoma of the ovary (CCC) is a rare variety of ovarian cancer. CASE: A case of CCC in a 49-year-old woman was diagnosed in asciticfluid on thin-layer preparations. Peritoneal fluid cytology revealed papillary clusters of cells with clear cytoplasm and extracellular hyaline material generally without neoplastic cells. The tumor was excised, and the histologic sections confirmed the cytologic diagnosis. CONCLUSION: CCC has a distinctive cytomorphologic appearance, and the entity may be diagnosed on ascitic fluid cytology.

Extraovarian primary peritoneal carcinoma. A case report

Se presenta un caso de carcinoma peritoneal primario extraovárico. Este raro e interesante tumor se caracteriza por una carcinomatosis peritoneal y por un patrón histológico similar al del carcinoma papilar seroso de ovario, pero sin comprometer o sólo afectando microscópicamente la superficie de los ovarios. La paciente presentaba hinchazón abdominal, ascitis con citología positiva y el CA-125 elevado en el suero. En el momento de la cirugía se encontró una afectación peritoneal difusa o multifocal, existiendo afectación microscópica de la superficie serosa ovárica. Las células tumorales fueron positivas para citoqueratina (AE1/AE3), antígeno de membrana epitelial, B72.3, Ber- EP4, Leu-M1, p53, antígeno carcinoembrionario, fosfatasa alcalina placentaria, proteína S-100, CA-125 y receptores estrogénicos

One case of extraovarian primary peritoneal carcinoma is reported. This rare interesting tumor is characterized by a peritoneal carcinomatosis with ascites and by a histological pattern similar to ovarian serous papillary carcinoma, but it either spares the ovaries or involves the surface of the ovaries only microscopically. The patient had abdominal swelling, ascites with positive cytology, and elevated serum CA-125. At surgery multifocal or diffuse peritoneal involvement was found. Microscopic ovarian serosal surface involvement was demonstrated. Tumor cells stained positive for cytokeratin (AE1/AE3), epithelial membrane antigen, B72.3, Ber-EP4, Leu-M1, p53, carcinoembryonic antigen, placental alkaline phosphatase, S-100, CA-125, and estrogen receptors

Primary pulmonary botryomycosis diagnosed by fine needle aspiration cytology: a case report.

BACKGROUND: Primary pulmonary botryomycosis is an uncommon suppurative bacterial infection of the lung. Cytologic findings by conventional methods and thin-layer preparations in1 case are presented. CASE: A 45-year-old man had primary pulmonary botryomycosis diagnosed by fine needle aspiration cytology (FNAC). Aspiration smears were characterized by densely packed microorganisms surrounded by polymorphonuclear leukocytes. Microbiologic analysis of cytologic material revealed colonies of Streptococcus constellatus. CONCLUSION: FNAC diagnosis of pulmonary botryomycosis offers the opportunity to distinguish this bacterial infection from lung cancer and avoid unnecessary surgery.

Linfoma primario cutáneo anaplásico de células grandes CD30 (Ki-1) positivo simulando un sarcoma epitelioide / CD30 (Ki-1) primary cutaneous anaplastic large-cell lymphoma mimicking an epithelioid sarcoma

Presentamos un caso de linfoma primario cutáneo de células grandes CD30 (Ki-1) positivo con características histológicas que recuerdan a un sarcoma epitelioide. El linfoma primario cutáneo anaplásico de células grandes CD30 positivo es una entidad clinicopatológica recientemente descrita, reconocida por criterios inmunohistoquímicos. Describimos el caso de una mujer de 74 años de edad con un tumor ulcerado en el tronco, de 3 meses de evolución. El diagnóstico se hizo en base a los hallazgos inmunohistoquímicos. No se detectó afectación sistémica. La paciente está bien, sin enfermedad extracutánea concurrente, tras 6 años de seguimiento. Los estudios clínicos indican un mejor pronóstico en los linfomas cutáneos anaplásicos de células grandes CD30 positivos que en los linfomas anaplásicos de células grandes CD30 positivos nodales y que en los otros linfomas cutáneos anaplásicos de células grandes. Este es pues, un caso de regresión espontánea y seguimiento favorable en este tipo de linfomas cutáneos, que tiene unos rasgos morfológicos peculiares, como es su parecido morfológico con un sarcoma epitelioide (AU)

Dermal analogue tumor of the salivary gland diagnosed by fine needle aspiration cytology. A case report.

BACKGROUND: Dermal analogue tumor of the salivary gland is a rare form of salivary gland adenoma. Cytologic and histologic findings of 1 case are presented. CASE: A 74-year-old-female had a dermal analogue tumor in the parotid gland diagnosed by fine needle aspiration cytology (FNAC). Aspiration smears were characterized by aggregates of uniform epithelial cells, and cell groups bordered on thick, basement membrane-like material. The tumor was excised, and the histologic sections confirmed the cytologic diagnosis. CONCLUSION: Dermal analogue tumor of the salivary gland has a distinctive cytomorphologic appearance, and diagnosis of this neoplasm by FNAC is possible. Preoperative FNAC of salivary gland lesions is important in planning the most appropriate type of treatment.

Extramedullary plasmacytoma presenting as a primary mass in the breast. A case report.

BACKGROUND: Extramedullary plasmacytoma (EMP) of the breast is extremely rare, especially that not associated with multiple myeloma. CASE: A case of plasmacytoma of the breast in a 73-year-old man was diagnosed by fine needle aspiration cytology (FNAC). Aspiration smears revealed a dispersed population of plasmacytoid cells at various stages of maturation. The tumor was excised, and the histologic sections confirmed the cytologic diagnosis. CONCLUSION: FNAC diagnosis of plasmacytoma of the breast offers the opportunity to distinguish these neoplasms from primary mammary tumors and avoid unnecessary surgery.

Malignant phyllodes tumor with pleomorphic liposarcomatous stroma diagnosed by fine needle aspiration cytology: a case report.

BACKGROUND: Liposarcomatous differentiation within a phyllodes tumor is extremely rare. Cytologic and histologic findings of a case of malignant phyllodes tumor with liposarcomatous stroma of the breast are presented. CASE: A 45-year-old female had a malignant phyllodes tumor with pleomorphic liposarcomatous stroma diagnosed by fine needle aspiration (FNA) cytology. The cytologic findings were representative of the histologic features. CONCLUSION: Malignant phyllodes tumor of the breast can be diagnosed by FNA. It is very important to acknowledge the morphologic variants of sarcomatous stroma and to recognize the cytologic features of such rare tumors to prevent misdiagnosis as primary sarcomas of the breast. Preoperative diagnosis is important in planning the most appropriate type of treatment. It is also important to follow patients for long periods for recurrence and metastasis after surgery for this tumor.