Incidence Trends and Main Features of Gastro-Intestinal Stromal Tumours in a Mediterranean Region: A Population-Based Study.

Gastro-Intestinal Stromal Tumours (GISTs) are a kind of neoplasm whose diagnosis in common clinical practice just started in the current century, implying difficulties for proper registration. Staff from the Cancer Registry of Murcia, in southeastern Spain, were commissioned by the EU Joint Action on Rare Cancers into a pilot study addressing GIST registration that also yielded a population-based depiction of GISTs in the region, including survival figures. We examined reports from 2001 to 2015 from hospitals as well as cases already present in the registry. The variables collected were sex, date of diagnosis, age, vital status, primary location, presence of metastases, and risk level according to Joensuu's Classification. In total, 171 cases were found, 54.4% occurred in males, and the mean age value was 65.0 years. The most affected organ was the stomach, with 52.6% of cases. Risk level was determined as "High" for 45.0%, with an increment of lower levels in recent years. Incidence for the year 2015 doubled that of 2001. Overall, the 5-year net survival estimation was 77.0%. The rising incidence magnitude is consistent with trends in other European countries. Survival evolution lacked statistical significance. A more interventional approach in clinical management could explain the increase in the proportion of "Low Risk GISTs" and the first occurrence of "Very Low Risk" in recent years.

Lower limb cutaneous melanoma surgery: location matters.

The anatomical location of cutaneous melanoma is a relevant independent prognostic factor in melanoma. The aim of the study is to know the prognosis of lower limb cutaneous melanoma related to their location within the limb, regardless of the histological type, and if there are any other influencing variables. A real-world data observational study was developed. The lesions were divided depending on the location of the melanoma (thigh, leg and foot). Bivariate and multivariate analysis were performed, and melanoma-specific survival and disease-free survival rates were calculated. When these analysis were done, the results showed that, in melanomas of the lower limb, location on the foot presented a lower melanoma-specific survival rate compared to more proximal locations, and only the anatomical location presents statistical significance to discriminate cases with a higher mortality risk and a lower disease-free survival rate among distal melanomas (mainly on the foot). In conclusion, this study confirms that a more distal location of lower limb cutaneous melanoma is a relevant prognostic factor.Trial registration number NCT04625491 retrospectively registered.

Biomarkers of Early Liver Graft Damage in Circulatory Death and Brain Death Donors: A Propensity Score Matching Analysis.

BACKGROUND: Donation after circulatory death (DCD) is related to a warm ischemia time and more complications compared with traditional donors (donation after brain death [DBD]). METHODS: This study included biopsy samples retrospectively collected from November 2014 to December 2018 to compare histologic and biological markers of DCD and DBD liver grafts. The analysis includes marker of early apoptosis (p21), senescence (telomerase reverse transcriptase [TERT]), cell damage (caspase-3 active), endothelial damage (vascular endothelial growth factor), stem cell (CD90), hypoxia (HIF1A), inflammatory activation (COX-2), and cross-organ allograft rejection (CD44). A propensity score matching (PSM) was used to match patients receiving DCD livers to those receiving DBD livers. We analyzed the immunohistochemical initial liver damage-related warm ischemia time. RESULTS: Positive staining expression of liver damage biomarkers (COX-2, CD44, TERT, HIF1A, and CD90) was found, but no significant differences were found between DCD and DBD and with ischemic cholangiopathy. After PSM, there was a significant relationship between CD90 and male donors (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.07-0.91), TERT with donor sodium (OR, 1.11; 95% CI, 1.02-1.2), HIF1A with steatosis (OR, 0.33; 95% CI, 0.13-0.83), and CD44 with donor vasoactive drugs (OR, 0.36; 95% CI, 0.13-1) and glutamic oxaloacetic transaminase 1 week increase (OR, 1.01; 95% CI, 1-1.03). CONCLUSIONS: DCD immunohistochemical initial liver damage was found to behave similarly to DBD. The increase in complications and cholangiopathy associated with warm ischemia could be related to a different later phenomenon.

Efficiency of Machine Learning Algorithms for the Determination of Macrovesicular Steatosis in Frozen Sections Stained with Sudan to Evaluate the Quality of the Graft in Liver Transplantation.

Liver transplantation is the only curative treatment option in patients diagnosed with end-stage liver disease. The low availability of organs demands an accurate selection procedure based on histological analysis, in order to evaluate the allograft. This assessment, traditionally carried out by a pathologist, is not exempt from subjectivity. In this sense, new tools based on machine learning and artificial vision are continuously being developed for the analysis of medical images of different typologies. Accordingly, in this work, we develop a computer vision-based application for the fast and automatic objective quantification of macrovesicular steatosis in histopathological liver section slides stained with Sudan stain. For this purpose, digital microscopy images were used to obtain thousands of feature vectors based on the RGB and CIE L*a*b* pixel values. These vectors, under a supervised process, were labelled as fat vacuole or non-fat vacuole, and a set of classifiers based on different algorithms were trained, accordingly. The results obtained showed an overall high accuracy for all classifiers (>0.99) with a sensitivity between 0.844 and 1, together with a specificity >0.99. In relation to their speed when classifying images, KNN and Naïve Bayes were substantially faster than other classification algorithms. Sudan stain is a convenient technique for evaluating ME in pre-transplant liver biopsies, providing reliable contrast and facilitating fast and accurate quantification through the machine learning algorithms tested.

MITF induces escape from innate immunity in melanoma.

BACKGROUND: The application of immune-based therapies has revolutionized cancer treatment. Yet how the immune system responds to phenotypically heterogeneous populations within tumors is poorly understood. In melanoma, one of the major determinants of phenotypic identity is the lineage survival oncogene MITF that integrates diverse microenvironmental cues to coordinate melanoma survival, senescence bypass, differentiation, proliferation, invasion, metabolism and DNA damage repair. Whether MITF also controls the immune response is unknown. METHODS: By using several mouse melanoma models, we examine the potential role of MITF to modulate the anti-melanoma immune response. ChIP-seq data analysis, ChIP-qPCR, CRISPR-Cas9 genome editing, and luciferase reporter assays were utilized to identify ADAM10 as a direct MITF target gene. Western blotting, confocal microscopy, flow cytometry, and natural killer (NK) cytotoxicity assays were used to determine the underlying mechanisms by which MITF-driven phenotypic plasticity modulates melanoma NK cell-mediated killing. RESULTS: Here we show that MITF regulates expression of ADAM10, a key sheddase that cleaves the MICA/B family of ligands for NK cells. By controlling melanoma recognition by NK-cells MITF thereby controls the melanoma response to the innate immune system. Consequently, while melanoma MITFLow cells can be effectively suppressed by NK-mediated killing, MITF-expressing cells escape NK cell surveillance. CONCLUSION: Our results reveal how modulation of MITF activity can impact the anti-melanoma immune response with implications for the application of anti-melanoma immunotherapies.

Controlled donation after circulatory death up to 80 years for liver transplantation: Pushing the limit again.

Our main objective was to compare liver transplant (LT) results between donation after circulatory death (DCD) and donation after brainstem death (DBD) in our hospital and to analyze, within the DCD group, the influence of age on the results obtained with DCD donors aged >70 years and up to 80 years. All DCD-LTs performed were analyzed prospectively. The results of the DCD group were compared with those of a control group who received a DBD-LT immediately after each DCD-LT. Later, the results obtained within the DCD group were analyzed according to the age of the donors, considering 2 subgroups with a cut-off point at 70 years. Survival results for LT with DCD and super rapid recovery were not inferior to those obtained in a similar group of patients transplanted with DBD livers. However, the cost of DCD was a higher rate of biliary complications, including ischemic cholangiopathy. Donor age was not a negative factor.

Valor de la determinación inmunohistoquímica de SMARCA4/BRG1 en el diagnóstico del carcinoma de ovario de célula pequeña variante hipercalcémica. Presentación de dos casos / The value of immunohistochemistry using SMARCA4/BRG1 in the diagnosis of small cell ovarian carcinoma hypercalcemic type. A report of two cases

El carcinoma de células pequeñas de ovario variante hipercalcémica se describe dentro de los tumores de origen histológico incierto. Presentamos 2 casos en mujeres de 32 y 29años de edad, respectivamente. En el momento del diagnóstico ambas pacientes presentaban masas de gran tamaño en las que no era posible realizar cirugía completa. Histológicamente los dos tumores mostraban una proliferación celular difusa de células pequeñas con espacios pseudofoliculares. La imagen microscópica, en ambos casos, planteó diagnóstico diferencial con entidades como el tumor de células de la granulosa tipo adulto o juvenil, el carcinoma de células pequeñas de tipo pulmonar, el disgerminoma, e incluso con un tumor neuroectodérmico periférico. Para ello, la ausencia de inmunotinción para SMARCA4/BRG1 en la totalidad de las células tumorales junto a una imagen histológica concreta son de gran utilidad en el diagnóstico de esta entidad (AU)

Small cell carcinoma of ovary-hypercalcemic type is an undifferentiated carcinoma. We describe two cases in women aged 32 and 29. Both presented with large masses and complete surgical extirpation was impossible. Histologically, the images were similar, with diffuse cell proliferation, accompanied by the presence of follicle-like spaces. In both cases it was necessary to make a differential diagnosis with entities such as adult or juvenile granulosa cell tumour, small cell carcinoma of pulmonary type, dysgerminoma and even peripheral neuroectodermal tumour. The absence of SMARCA4/BRG1 immunostaining proved very useful in the diagnosis of hypercalcemic small cell ovarian carcinoma (AU)

[The value of immunohistochemistry using SMARCA4/BRG1 in the diagnosis of small cell ovarian carcinoma hypercalcemic type. A report of two cases]. / Valor de la determinación inmunohistoquímica de SMARCA4/BRG1 en el diagnóstico del carcinoma de ovario de célula pequeña variante hipercalcémica. Presentación de dos casos.

Small cell carcinoma of ovary-hypercalcemic type is an undifferentiated carcinoma. We describe two cases in women aged 32 and 29. Both presented with large masses and complete surgical extirpation was impossible. Histologically, the images were similar, with diffuse cell proliferation, accompanied by the presence of follicle-like spaces. In both cases it was necessary to make a differential diagnosis with entities such as adult or juvenile granulosa cell tumour, small cell carcinoma of pulmonary type, dysgerminoma and even peripheral neuroectodermal tumour. The absence of SMARCA4/BRG1 immunostaining proved very useful in the diagnosis of hypercalcemic small cell ovarian carcinoma.

Pseudotumor gástrico ulcerado con afectación pancreática por enfermedad relacionada con inmunoglobulina G4: descripción de un caso y revisión de la literatura / An ulcerated gastric ulcer and pseudotumour with pancreatic affectation associated with immunoglobulin G4-related disease: a case report and literature review

Presentamos el caso de un varón de 67 años con una úlcera gástrica de 9 años de evolución, con clínica de hematemesis y melenas, que a nivel histológico mostró lesiones de fibrosis y acúmulos de células plasmáticas con positividad para inmunoglobulina G4, sin evidencia de malignidad. Esta lesión alcanzaba al páncreas, donde se observaron lesiones histológicas superponibles a las gástricas. El diagnóstico final fue el de pseudotumor gástrico ulcerado con afectación pancreática por enfermedad relacionada con inmunoglobulina G4 (AU)

We report the case of a 67 year old male who presented with a nine year history of a gastric ulcer with symptoms of hematemesis and melena. Histological analysis identified fibrotic lesions and the accumulation of immunoglobulin G4-positive plasma cells with no evidence of malignancy. The lesion extended into the pancreas, where histological lesions and gastric lesions were also observed. This is a case of an ulcerated gastric ulcer and pseudo-tumor with pancreatic affection that is associated with immunoglobulin G4-related disease (AU)

An ulcerated gastric ulcer and pseudotumour with pancreatic affectation associated with immunoglobulin G4-related disease: a case report and literature review.

We report the case of a 67 year old male who presented with a nine year history of a gastric ulcer with symptoms of hematemesis and melena. Histological analysis identified fibrotic lesions and the accumulation of immunoglobulin G4-positive plasma cells with no evidence of malignancy. The lesion extended into the pancreas, where histological lesions and gastric lesions were also observed. This is a case of an ulcerated gastric ulcer and pseudo-tumor with pancreatic affection that is associated with immunoglobulin G4-related disease.

Molecular characterization and clinical interpretation of BRCA1/BRCA2 variants in families from Murcia (south-eastern Spain) with hereditary breast and ovarian cancer: clinical-pathological features in BRCA carriers and non-carriers.

This is the first study performed in Murcia (south-eastern Spain) in which 592 families with hereditary breast and ovarian cancer were identified thanks to Genetic Counselling Units from this area over 6 years. Diagnostic performance was 18.1% and 194 different genetic variants were obtained. Variants with uncertain significance accounted for only 5.6% of the total number of reports, so our population has been well characterised. In BRCA1 gene, two novel variants were found (c.1859delT and c.3205C > T) and the most frequently detected mutations were c.68_69delAG, c.212 + 1G > A, c.5123C > A, c.211A > G and c.1918C > T, which together represented 56.67% of total pathogenic mutations. In BRCA2 gene, four recurrent variants were described (deletion of entire exon 2, c.9117G > A, c.3264dupT and c.3455T > G) representing 43.5% of the mutations in this gene. Mutation c.68_69delAG and deletion of entire exon 2 in BRCA1 and BRCA2 genes respectively were the most prevalent variants in our population. Regarding the genotype-phenotype relation, mutation c.212 + 1G > A appeared in an important percentage of breast and ovarian cancer cases, c.5123C > A in bilateral breast cancer and c.9117G > A in bilateral breast cancer and ovarian cancer. With respect to clinical-pathological characteristic, BRCA1/BRCA2 mutation carriers showed earlier onset age of breast tumour and higher risk of developing contra lateral breast cancer than non-informative cases. Moreover, association between either molecular subtype triple negative breast cancer or ovarian cancer and BRCA1 carriers was obtained.

Primary Signet-Ring Cell/Histiocytoid Carcinoma of the Eyelid: A "Binocle" Presentation of the "Monocle Tumor".

Primary cutaneous signet-ring cell carcinoma is a rare and aggressive neoplasm which diffusely involves dermis and subcutis of the eyelid or axillae. Neoplastic cells show a signet-ring cell or histiocytoid morphology in variable number, and can be found intermingled among collagen bundles, sparing the epidermis. This neoplasm typically appears in the eyelids of elderly men, in the form of a painless infiltration and swelling but with no other specific clinical feature, and frequently causes diagnostic retardation and worse prognosis. Frequent involvement of both eyelids of the same eye has given it the name of monocle tumor. Only 29 cases have been described in English literature to date, of which 7 developed metastases, mainly on regional lymph nodes. The authors present a case of involvement of contralateral eyelid, which has only been described previously in 2 cases. The immunohistochemical profile of the involvement in the contralateral eye, and the absence of other metastasis, suggest that it is locally spread from the initial lesion. However the possibility of being a second primary tumor or metastasis cannot be readily ruled out.

Factores pronósticos del carcinoma folicular de tiroides / Prognostic factors of follicular thyroid carcinoma

INTRODUCCIÓN: La mayoría de los estudios pronósticos en el carcinoma diferenciado incluyen un alto número de carcinomas papilares y pocos foliculares, por lo que no todas sus conclusiones son aplicables a este último. OBJETIVO: Analizar los factores pronósticos, tanto clínicos, histológicos como terapéuticos, del carcinoma folicular de tiroides. PACIENTES Y MÉTODOS: Criterios de selección: pacientes con el diagnóstico histológico de carcinoma folicular, sin enfermedad diseminada al diagnóstico, con cirugía potencialmente curativa, y con un seguimiento mínimo de 5 años. Variables de estudio: se consideró recidiva del tumor: a) lesiones tumorales con citología sospechosa de malignidad; y/o b) el aumento de los niveles de tiroglobulina mayor de 2 ng/ml en pacientes con tiroidectomía total. Para valorar los factores pronósticos se analizan variables clínicas, terapéuticas e histológicas. Estadística: curvas de supervivencia aplicando el test de Breslow. Modelo de regresión de Cox. RESULTADOS: Se han presentado 25 recidivas (38%) en los 66 pacientes estudiados. La mayoría eran recidivas analíticas (n=20) que fueron tratadas con I-131. En los casos restantes (n=5) se realizó exéresis de la lesión localizada y posteriormente se aplicó I131. Actualmente, dos casos (3%) presentan metástasis a distancia, y otros dos (3%) han sido éxitus por evolución de la enfermedad. El tiempo medio libre de enfermedad fue de 154 ± 14 meses, siendo las tasas de pacientes libres de enfermedad a los 5, 10, 15 y 20 años del 71, 58, 58 y 58% respectivamente. Los factores que influyen en la recidiva son: 1) la edad (p = 0,0035); 2) el sexo (p = 0,0114); 3) la clínica local (p = 0,0026); 4) la infiltración de estructuras vecinas (p = 0,0000); 5) el tipo de carcinoma (p = 0,0000); 6) el tamaño (p = 0,0162); 7) la invasión vascular (p = 0,0085); y 8) las adenopatías (p = 0,046). En el estudio multivariante persisten la clínica local (p = 0,018) y la infiltración de estructuras (p = 0,045). CONCLUSIONES: En el carcinoma folicular los principales factores predictivos son la presencia de clínica local al diagnóstico y la infiltración de estructuras vecinas

INTRODUCTION: Most prognostic studies in differentiated carcinoma have included a high number of papillary carcinomas and few follicular carcinomas, and not all of their conclusions therefore apply to the latter. OBJECTIVE: To analyze the prognostic factors of follicular thyroid carcinoma. PATIENTS AND METHODS: Selection criteria: Patients with histological diagnosis of follicular carcinoma who had undergone potentially curative surgery, had no disseminated disease at diagnosis, and had been followed up for at least 5 years. Study Variables: Tumor recurrence was defined as: 1) tumor lesions with cytological analysis suggesting malignancy and/or 2) patients with total thyroidectomy with thyroglobulin levels >2 ng/mL. Clinical, therapeutic, and histological parameters were analyzed to assess prognostic factors. RESULTS: Recurrence was found in 25 (38%) of the 66 study patients during a follow-up period of 99 ± 38 months. Most patients with recurrence (n=20) had increased Tg levels without anatomical location, and were initially treated with radioactive I131. In the remaining 5 cases, surgical excision of the lesion was performed, and three patients required surgery during the follow-up period. Two patients died due to the disease (3%), and two other patients (3%) currently have distant metastases. Mean disease-free interval was 154 ± 14 months, and rates of disease-free patients at 5, 10, 15, and 20 years were 71, 58, 58, and 58% respectively. Clinical factors influencing recurrence included 1) age (p = 0.0035); 2) sex (p = 0.0114); and 3) cervical pain (p = 0.0026). Histological/surgical factors associated with recurrence included 1) infiltration into neighboring structures (p = 0.0000); 2) type of carcinoma (p = 0.0000); 3) size (p = 0.0162); 4) vascular invasion (p = 0.0085); and 5) adenopathies (p = 0.046). In the multivariate study, cervical pain (p = 0.018) and extrathyroid invasion (p = 0.045) continued to be significant factors. CONCLUSIONS: In follicular carcinoma, rates of disease-free patients are 71% at 5 years and 58% at 10 years, and the main predictive factors are presence of local clinical symptoms and infiltration into neighboring structures

Prognostic factors of follicular thyroid carcinoma.

INTRODUCTION: Most prognostic studies in differentiated carcinoma have included a high number of papillary carcinomas and few follicular carcinomas, and not all of their conclusions therefore apply to the latter. OBJECTIVE: To analyze the prognostic factors of follicular thyroid carcinoma. SELECTION CRITERIA: Patients with histological diagnosis of follicular carcinoma who had undergone potentially curative surgery, had no disseminated disease at diagnosis, and had been followed up for at least 5 years. STUDY VARIABLES: Tumor recurrence was defined as: 1) tumor lesions with cytological analysis suggesting malignancy and/or 2) patients with total thyroidectomy with thyroglobulin levels >2 ng/mL. Clinical, therapeutic, and histological parameters were analyzed to assess prognostic factors. RESULTS: Recurrence was found in 25 (38%) of the 66 study patients during a follow-up period of 99 ± 38 months. Most patients with recurrence (n=20) had increased Tg levels without anatomical location, and were initially treated with radioactive I131. In the remaining 5 cases, surgical excision of the lesion was performed, and three patients required surgery during the follow-up period. Two patients died due to the disease (3%), and two other patients (3%) currently have distant metastases. Mean disease-free interval was 154 ± 14 months, and rates of disease-free patients at 5, 10, 15, and 20 years were 71, 58, 58, and 58% respectively. Clinical factors influencing recurrence included 1) age (p=0.0035); 2) sex (p=0.0114); and 3) cervical pain (p=0.0026). Histological/surgical factors associated with recurrence included 1) infiltration into neighboring structures (p=0.0000); 2) type of carcinoma (p=0.0000); 3) size (p=0.0162); 4) vascular invasion (p=0.0085); and 5) adenopathies (p=0.046). In the multivariate study, cervical pain (p=0.018) and extrathyroid invasion (p=0.045) continued to be significant factors. CONCLUSIONS: In follicular carcinoma, rates of disease-free patients are 71% at 5 years and 58% at 10 years, and the main predictive factors are presence of local clinical symptoms and infiltration into neighboring structures.

Algunos conceptos básicos de la teoría de colas aplicables en la planificación de un servicio de anatomía patológica / Some basics concepts of queueing theory applicable in the planning of a pathology department

Introducción: Nos planteamos el problema: ¿cuál es el número adecuado de facultativos en un servicio de anatomía patológica (SAP) para responder sin demora al número de solicitudes de estudio que se reciben? Material y métodos: Aplicamos conceptos básicos de teoría de colas y motivamos al lector a introducirse en ellos. Resultados y discusión: Un SAP funciona como un sistema de colas y se ajusta a los modelos de cola infinita con uno (M/M/1) y, todavía mejor, con múltiples recursos (M/M/m). El número de facultativos (m) ha de cumplir: m » velocidad de llegada de biopsias al SAP/velocidad de cierre de biopsias por facultativo Conclusiones: Como sistema de colas, un SAP solo es viable si su capacidad de respuesta es mayor que las necesidades planteadas por la demanda. El modelo de múltiples recursos (facultativos) amortigua mejor los aumentos sostenidos de la demanda (AU)

Introduction: The problem of the optimal number of pathologists required to provide a rapid response to the volume of studies requested is considered. Material and methods: The basic concepts of the queueing theory are applied and recommendations for their use are made. Results and discussion: Pathology departments (PD) work as a queuing system and adapt to infinite queue models with a (M/M1) or, preferably, multiple servers (M/M/m). The number of pathologists (m) must achieve: m » velocity of arrival of biopsies to the PD/velocity of completion of biopsy reports by pathologists. Conclusions: Like a queueing system, a PD is viable only if its capacity of response is greater than the demand. The model of multiple resources (pathologists) better absorbs a sustained growth in demand (AU)

Un método gráfico de análisis de costes asociados a los falsos resultados de una prueba diagnóstica / A graphical method for analyzing the cost of a diagnostic test, subject to the sensitivity and specificity of the test

Objetivo. Presentar un método de análisis gráfico de costes ocasionados por los falsos positivos (FP) y falsos negativos (FN) de una prueba diagnóstica. Material y métodos. Construimos una función de costes ligada a la sensibilidad (S) y a la especificidad (E) de la prueba diagnóstica. A partir de esta función obtenemos líneas de isocoste, cuya pendiente es la relación coste FP/coste FN. Representamos cada prueba diagnóstica en el espacio ROC como el punto (1-E, S). Resultados. Las líneas de isocoste permiten visualizar si el gasto asociado a FP y FN de una nueva prueba diagnóstica es menor o igual que el de la antigua. Conclusiones. El análisis gráfico de la función de costes de una prueba diagnóstica ayuda a decidir su introducción o su rechazo(AU)

Objective. We present a graphical method for analyzing the cost related to false positive (FP) and false negative (FN) results of diagnostic tests. Material and methods. We created a function relating cost to the sensitivity (S) and specificity (E) of the diagnostic test. Isocost straight lines were obtained, the gradient of which represents the ratio of false positive cost/false negative cost. The various diagnostic tests are plotted in the ROC space as the point (1-E, S). Results. Isocost straight lines allowed us to see if the cost of a new test is lower or the same as previous tests. Conclusions. Graphical analysis of the cost of a diagnostic test is helpful in deciding whether or not to introduce new diagnostic tests(AU)

Hidradenocarcinoma originado en hidradenoma nodular: descripción de un caso / Hidradenocarcinoma arising in a nodular hidradenoma: a case report

El hidradenoma nodular maligno o hidradenocarcinoma es un tumor maligno de glándula sudorípara, extremadamente infrecuente, que generalmente surge de novo aunque se han descrito unos pocos casos surgidos sobre un hidradenoma nodular. El comportamiento biológico de este tipo de neoplasias es altamente agresivo con recurrencias locales y metástasis ganglionares en un alto porcentaje.El tratamiento de elección de estos tumores es la escisión quirúrgica con márgenes amplios si bien en la enfermedad metastásica estaría indicado el tratamiento neoadyuvante con quimio y/o radioterapia. Recientemente, se ha propuesto el tratamiento con trastuzumab para los casos con sobreexpresión de Her-2/neu así como la realización de ganglio centinela.Presentamos el caso de un hidradenocarcinoma surgido en un hidradenoma nodular en piel de región intermamaria en una mujer de 55 años. El tumor fue tratado con escisión amplia y se realizó ganglio centinela. La paciente recibió radioterapia posquirúrgica sin que haya evidencia de metástasis tras un año de seguimiento(AU)

Malignant nodular hidradenoma or hidradenocarcinoma is a rare, malignant tumour of sweat glands that usually arises de novo, although a few cases originating in a nodular hidradenoma have been reported. They are very aggressive neoplasms that recur locally and frequently metastasize to the lymph nodes. The treatment of choice is surgical excision with wide margins, followed by chemotherapy and/or radiotherapy when metastases have occurred. Recently, sentinel lymph node sampling and treatment with Trastuzumab have been proposed for cases with overexpression of Her-2/neu. A case of hidradenocarcinoma arising in a nodular hidradenoma of the breast skin of a 55 year old woman is presented. The tumour was surgically removed with a wide excision and the patient treated with postoperative radiotherapy. She is alive and well without evidence of metastatic disease one year later(AU)

Expression profiles of ProEx C and Ki67 in squamous cell carcinoma in situ of the skin and their relationship with human papillomavirus genotypes.

BACKGROUND: ProExC is a new marker for identification of precursor lesions of cervical carcinoma. Its utility in noncervical squamous cell carcinoma in situ (SCCIS) such as Bowen's disease (BD) and actinic keratosis (AK) where human papillomavirus (HPV) plays a role has not been elucidated. Our aim was to ascertain the immunohistochemical features and clinical utility of ProExC in SCCIS of the skin. METHODS: HPV presence was tested in SCCIS (38 BD and 7 AK) using GP5+/6+ and Short PCR fragment (SPF) primers and subsequently genotyped. Histopathologic sections were stained for ProExC and Ki67. A set of non-neoplastic skin proliferative lesions were included for immunohistochemical evaluation [14 psoriasis (PS) and 6 psoriasiform dermatitis (PSD)]. RESULTS: HPV was detected in 18.9% BD. ProExC and Ki67 in the whole epidermis thickness was observed in 86.5 and 37.1% BD, respectively (p < 0.0001). ProExC and Ki67 were restricted to the lower third of the epidermis in PS and PSD. CONCLUSIONS: ProExC expression is not associated with HPV in SCCIS of the skin. Proliferating cells are better delineated in SCCIS by ProExC which may be useful to assess the extent of these lesions. Different immunohistochemical profiles seen in neoplasic and non-neoplastic skin lesions suggest diverse alteration of cell-cycle kinetics.