Miocarditis y miocardiopatía inflamatoria confirmadas por biopsia endomiocárdica: perfil clínico y pronóstico / Endomyocardial biopsy-confirmed myocarditis and inflammatory cardiomyopathy: clinical profile and prognosis

Introducción y objetivos La biopsia endomiocárdica (BEM) es la única técnica capaz de establecer el diagnóstico etiológico de pacientes con miocarditis o miocardiopatía inflamatoria (MI). El objetivo de este estudio es conocer el perfil clínico, la evolución y los factores pronósticos de los pacientes con sospecha de miocarditis o MI sometidos a BEM. Métodos Se analizaron retrospectivamente las características clínicas, los hallazgos histológicos y la evolución de todos los pacientes con sospecha de miocarditis o MI sometidos a BEM entre 1997 y 2019 en un hospital terciario español. Se evaluó el rendimiento del diagnóstico histológico mediante los criterios de Dallas frente a los criterios inmunohistoquímicos (IHQ). Resultados Se realizó BEM a 99 pacientes (el 67% varones; edad, 42± 15 años; fracción de eyección media, 34±14%). El 28% presentaba miocarditis o MI confirmada por criterios de Dallas y el 54% aplicando los criterios IHQ (p <0,1). Se diagnosticaron 47 miocarditis linfocitarias, 6 miocarditis eosinofílicas, 3 sarcoidosis y 1 miocarditis de células gigantes. Tras una mediana de seguimiento de 18 meses, 23 pacientes (23%) precisaron trasplante cardiaco o asistencia ventricular o fallecieron. El 21% de los pacientes con miocarditis confirmada mediante IHQ precisó trasplante cardiaco o asistencia o falleció, frente al 7% de aquellos sin inflamación (p=0,056). La fracción de eyección ≤ 30%, un diámetro telediastólico del ventrículo izquierdo ≥60mm y una clase NYHA III-IV iniciales se asociaron con peor pronóstico, especialmente en presencia de inflamación. Conclusiones La BEM permite establecer un diagnóstico etiológico en más de la mitad de los casos de sospecha de miocarditis o MI cuando se emplean técnicas IHQ. La inflamación confirmada por IHQ añade valor pronóstico y permite identificar a los pacientes con mayor probabilidad de sufrir complicaciones (AU)

Introduction and objectives Endomyocardial biopsy (EMB) is the only technique able to establish an etiological diagnosis of myocarditis or inflammatory cardiomyopathy (ICM). The aim of this study was to analyze the clinical profile, outcomes, and prognostic factors of patients with suspected myocarditis/ICM undergoing EMB. Methods We retrospectively analyzed the clinical characteristics, histological findings, and follow-up data of all patients with suspected myocarditis or ICM who underwent EMB between 1997 and 2019 in a Spanish tertiary hospital. The diagnostic yield was compared using the Dallas criteria vs immunohistochemical criteria (IHC). Results A total of 99 patients underwent EMB (67% male; mean age, 42±15 years; mean left ventricular ejection fraction [LVEF], 34%±14%). Myocarditis or ICM was confirmed in 28% with application of the Dallas criteria and in 54% with the IHC criteria (P <.01). Lymphocytic myocarditis was diagnosed in 47 patients, eosinophilic myocarditis in 6, sarcoidosis in 3, and giant cell myocarditis in 1 patient. After a median follow-up of 18 months, 23 patients (23%) required heart transplant (HTx), a left ventricular assist device (LVAD), and/or died. Among the patients with IHC-confirmed myocarditis, 21% required HTx/LVAD or died vs 7% of those without inflammation (P=.056). The factors associated with a worse prognosis were baseline LVEF ≤ 30%, left ventricular end-diastolic diameter ≥ 60mm, and NYHA III-IV, especially in the presence of inflammation. Conclusions EMB allows an etiological diagnosis in more than half of patients with suspected myocarditis/ICM when IHC techniques are used. IHC-confirmed inflammation adds prognostic value and helps to identify patients with a higher probability of developing complications (AU)

18F-FDG-PET/CT in SARS-CoV-2 infection and its sequelae.

In recent months, much of the scientific efforts have focused on research on SARSCoV-2 infection and its consequences in humans. Still, many aspects remain unknown. It is known that the damage caused by SARS-CoV-2 is multifactorial and that its extension goes beyond lung inflammation and the acute phase, with the appearance of numerous complications and sequelae. To date, knowledge about the usefulness of 18F-FDG-PET/CT in the acute phase has been limited to the incidental detection of SARS-CoV-2 unsuspected pneumonia. Recent studies have been appearing collecting the findings of 18F-FDG-PET/CT in long COVID-19 or persistent COVID-19 state as well as the alterations caused after mass vaccination of the population in the metabolic studies. This work aims to review the existing literature focusing on these three issues and to briefly present our own preliminary experience.

[18F-FDG-PET/CT in SARS-CoV-2 infection and its sequelae]. / 18F-FDG-PET/TC ante la infección por SARS-CoV-2 y sus secuelas.

In recent months, much of the scientific efforts have focused on research on SARSCoV-2 infection and its consequences in humans. Still, many aspects remain unknown. It is known that the damage caused by SARS-CoV-2 is multifactorial and that its extension goes beyond lung inflammation and the acute phase, with the appearance of numerous complications and sequelae. To date, knowledge about the usefulness of 18F-FDG-PET/CT in the acute phase has been limited to the incidental detection of SARS-CoV-2 unsuspected pneumonia. Recent studies have been appearing collecting the findings of 18F-FDG- PET/CT in long COVID-19 or persistent COVID-19 state as well as the alterations caused after mass vaccination of the population in the metabolic studies. This work aims to review the existing literature focusing on these three issues and to briefly present our own preliminary experience.

[Cardiac myxoma: an analysis of 30 patients]. / Mixoma cardíaco: serie de 30 pacientes.

INTRODUCTION: Myxomas are the most common type of benign heart tumors. The aim of this study was to correlate the clinical forms of presentation of cardiac myxoma and complementary laboratory results with the morphological features of the tumor. MATERIALS AND METHODS: We reviewed retrospectively a total of 30 cardiac myxomas seen in 2 institutions after a period of 22 years. In the same period 5 cardiac sarcomas were identified. The Chi-Square test and Fischer's exact test were used to compare the variables. In one patient the IL-6 production by peripherals blood cells before and after surgical tumor resection was evaluated. RESULTS: The patients were evenly distributed between genders. The mean age of this group was 60 years. The most prevalent clinical manifestations were cardiac symptoms (73,3%), constitutional symptoms (30%) and embolisms (26,7%). All cases were diagnosed by transthoracic echocardiography and the most frequent location of the tumor was the left atrium. Larger-diameter myxomas were observed in older patients and correlated with cardiac symptoms, radiological and electrocardiographical abnormalities. Smaller-diameter myxomas presented more frequently embolic phenomenons. There were no deaths during the postoperative period and the principal postoperative complication was transient arrhytmias. There was no evidence of recurrence of the disease. In one patient with systemic manifestations monocytes were observed to contribute to the increased serum levels of IL-6. CONCLUSIONS: Myxomas are the most frequent tumors of the heart. The most common initial manifestations were cardiac symptoms. Diagnosis was achieved in all patients by transthoracic echocardiography. The size and macroscopic appearance of the tumor correlated with the age of the patients and some clinical symptoms and laboratory RESULTS: Surgical excision was a safe and effective procedure. (c) 2009 Elsevier España, S.L. All rights reserved.

Mixoma cardíaco: serie de 30 pacientes / Cardiac myxoma: an analysis of 30 patients

Introducción y objetivos: El mixoma es la neoplasia benigna cardíaca más frecuente. El objetivo de este estudio es relacionar los síntomas y los hallazgos en las pruebas complementarias de los pacientes diagnosticados de mixoma con las características macroscópicas del tumor. Material y métodos: Se analizaron de forma retrospectiva en dos hospitales de tercer nivel un total de 30 mixomas cardíacos en los últimos 22 años. En el mismo período se identificaron 5 sarcomas cardíacos. Para las comparaciones se utilizó el test de la ji cuadrado y el test exacto de Fischer. En un paciente con síntomas sistémicos e inflamatorios se determinó la producción de interleucina 6 (IL-6) en células mononucleares de sangre periférica antes y después de la cirugía. Resultados: La distribución de los enfermos fue equitativa para ambos sexos. La edad media fue de 60 años. Las manifestaciones clínicas más prevalentes fueron los síntomas cardíacos (73,3%), seguidos de los síntomas generales (30%) y las manifestaciones embólicas (26,7%). El diagnóstico se realizó mediante ecocardiograma, siendo la localización predominante la aurícula izquierda. Los tumores de mayor tamaño se presentaron en edades avanzadas y se relacionaron más frecuentemente con manifestaciones cardíacas y con más alteraciones radiológicas y electrocardiográficas. Por el contrario, los tumores de menor tamaño y pediculados tuvieron manifestaciones embólicas con mayor asiduidad. No hubo mortalidad postoperatoria aunque sí arritmias transitorias. No se describieron recidivas locales. Se comprobó que los monocitos de sangre periférica contribuyen de forma mayoritaria a la producción de IL-6 en un paciente con síntomas sistémicos. Conclusiones: El mixoma es la neoplasia cardíaca más frecuente. Los síntomas cardíacos son la forma de presentación más común de los mixomas. El diagnóstico se realizó mediante ecocardiografía. El tamaño y la morfología del tumor se relacionan con la edad del paciente y con algunas manifestaciones clínicas y hallazgos de las pruebas complementarias. El tratamiento es quirúrgico y suele ser seguro y curativo (AU)

Introduction: Myxomas are the most common type of benign heart tumors. The aim of this study was to correlate the clinical forms of presentation of cardiac myxoma and complementary laboratory results with the morphological features of the tumor. Materials and methods: We reviewed retrospectively a total of 30 cardiac myxomas seen in 2 institutions after a period of 22 years. In the same period 5 cardiac sarcomas were identified. The Chi-Square test and Fischer's exact test were used to compare the variables. In one patient the IL-6 production by peripherals blood cells before and after surgical tumor resection was evaluated. Results: The patients were evenly distributed between genders. The mean age of this group was 60 years. The most prevalent clinical manifestations were cardiac symptoms (73,3%), constitutional symptoms (30%) and embolisms (26,7%). All cases were diagnosed by transthoracic echocardiography and the most frequent location of the tumor was the left atrium. Larger-diameter myxomas were observed in older patients and correlated with cardiac symptoms, radiological and electrocardiographical abnormalities. Smallerdiameter myxomas presented more frequently embolic phenomenons. There were no deaths during the postoperative period and the principal postoperative complication was transient arrhytmias. There was no evidence of recurrence of the disease. In one patient with systemic manifestations monocytes were observed to contribute to the increased serum levels of IL-6. Conclusions: Myxomas are the most frequent tumors of the heart. The most common initial manifestations were cardiac symptoms. Diagnosis was achieved in all patients by transthoracic echocardiography. The size and macroscopic appearance of the tumor correlated with the age of the patients and some clinical symptoms and laboratory results. Surgical excision was a safe and effective procedure (AU)

Mujer de 36 años con tumoración quística pancreática y trombopenia / 36-year old woman with cystic pancreatic tumor and thrombopenia

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“Plasmocitoma-like” gástrico en un paciente trasplantado cardíaco. Revisión de algunos conceptos etiopatogénicos y terapéuticos / Gastric plasmacytoma-like in a patient with heart transplant: review of some etiopathogenic and therapeutic concepts

El Plasmocitoma-like es una entidad poco frecuenteenglobada dentro de los trastornos linfoproliferativospostransplante (TLPT). La inmunosupesióny la infección con virus de Epstein-Barr (VEB)juegan un papel primordial en su desarrollo. Sudiagnóstico preoperatorio es difícil si no se aplicanestudios inmunohistoquímicos sobre las biopsias, yel tratamiento adecuado debe ser quirúrgico y/o radioterápico,asociado a la reducción de la dosis deinmunosupresores. El seguimiento de estos enfermosdebe ser estrecho ya que puede ocurrir la recurrenciadel tumor, así como la aparición de rechazodel trasplante por la disminución de los inmunosupresores.Presentamos un paciente trasplantado cardíacoque desarrolló un TLPT tipo "plasmocitoma-like"en el estómago siete años después del trasplante, comentamoslas teorías etiopatogénicas, los criteriosdiagnósticos y sus posibilidades de tratamiento

Plasmacytoma-like tumour is an infrequent entityobserved among the post-transplant lymphoproliferativedisorders (PTLD). Immunosuppression andEpstein.Barr virus (EBV) infection play animportant role in the development of the process.The preoperative diagnosis is difficult, but it can bemade by means of immunohistochemical studies ofthe biopsies. The adequate treatment consists ofsurgery, radiotherapy and reduction of theadministered immunosuppressor drugs. The patientsneed a close follow up because the resultingimmusuppression facilitates the recurrence of thetumour or the rejection of the transplanted organ.We present the case of a patient with a hearttransplant who developed a gastric plasmacytomalikePTLD seven years after transplantation. Wediscuss the etiopathogenic theories, the diagnosticcriteria and the treatment options

[Gastric metastasis from renal cell carcinoma. Pathogenical hypothesis and literature revision]. / Metástasis gástrica de un adenocarcinoma renal. Hipótesis patogénica y revisión de la literatura.

Secondary gastric tumours are very uncommon clinical entities and even more so when the site for the primary tumour is the kidney. Only 11 cases of life diagnosis have been described up to now. Contribution of one case report: a female patient presenting with upper GI tract haemorrhage secondary to gastric metastasis from renal cell carcinoma four years after radical nephrectomy. A literature review is made on the cases described up to date in living patients and a pathogenic hypothesis established based on the theoretical dissemination routes for the cases of gastric location of the metastasis.

Metástasis gástrica de un adenocarcinoma renal. Hipótesis patogénica y revisión de la literatura / Gastric metastasis from renal cell carcinoma. Pathogenical hypothesis and literature revision

Los tumores gástricos secundarios constituyen una entidad clínica poco habitual, más aún si la localización del tumor primitivo es el riñón. Hasta la actualidad tan solo se han descrito 11 casos diagnosticados en vida. Se presenta un caso clínico de una mujer que presentó una hemorragia digestiva alta secundaria a la presencia de una metástasis gástrica de carcinoma de células renales cuatro años después de la nefrectomía radical. Se realiza una revisión bibliográfica de los casos descritos hasta la fecha en pacientes vivos y se establece una hipótesis patogénica de acuerdo a las teóricas rutas de diseminación para los casos de localización metastática gástrica

Secondary gastric tumours are very uncommon clinical entities and even more so when the site for the primary tumour is the kidney. Only 11 cases of life diagnosis have been described up to now. Contribution of one case report: a female patient presenting with upper GI tract haemorrhage secondary to gastric metastasis from renal cell carcinoma four years after radical nephrectomy. A literature review is made on the cases described up to date in living patients and a pathogenichy pothesis established based on the theoretical dissemination routes for the cases of gastric location of the metastasis

[Paratesticular dermoid cyst. Report of a case and review of the literature]. / Quiste dermoide paratesticular. Aportación de un caso y revisión de la literatura.

It is discussed a dermoid cyst case that depends on paratesticular structures, clinical entity which has low frequency of presentation. It is analyzed the controversial terminology of this tumours and are established anatomopathological criteria for this disease.

Quiste dermoide paratesticular. Aportación de un caso y revisión de la literatura / Paratesticular dermoid cyst. Presentation of one case and bibliographic revision

Se presenta un caso de un quiste dermoide que depende de las estructuras paratesticulares, entidad clínica de baja frecuencia de presentación. Se analiza la controvertida terminología de estos tumores y se establecen los criterios anatomopatológicos de esta enfermedad que preside el diagnóstico (AU)

It is discussed a dermoid cyst case thath depends on paratesticular structures, clinical entity which has low frecuency of presentation. It is analyced the controversial terminology of this tumours and are established anatomopathological criteria for this disease (AU)

[Mediastinal dumbbell angiolipoma]. / Angiolipoma mediastínico en reloj de arena.

Dumbbell tumors are extremely rare. Most are neurogenic in origin. Growth is both inside and outside the spinal canal, and symptoms debut with medullary or spinal compression. References to non-neurogenic dumbbell tumors are uncommon. This report describes the case of a 56 year-old woman with a dumbbell angiolipoma having mediastinal and spinal cord portions. The tumor was successfully resected using a two-stage procedure. First, the spinal portion was resected using a posterior neurosurgical approach, with improvement of symptoms. Then, the mediastinal portion was removed thoracoscopically.

Angiolipoma mediastínico en reloj de arena / Mediastinal dumbbell angiolipoma

Los tumores en reloj de arena son extremadamente raros. Suele tratarse de tumores neurogénicos con crecimiento intra y extracanal, que comienzan con síntomas neurológicos por compresión medular o raquídea. Las referencias respecto a estos tumores no neurogénicos son excepcionales. Se describe el caso de una paciente de 56 años con un angiolipoma en reloj de arena, con una porción localizada en el mediastino posterior y otra en el canal raquídeo. El tumor fue resecado satisfactoriamente mediante un abordaje en dos tiempos. Primero, mediante un acceso neuroquirúrgico posterior, se extrajo la porción intracanal, mejorando la sintomatología; en un segundo tiempo se resecó la porción mediastínica mediante videotoracoscopia (AU)

Tumores gástricos estromales: factores pronósticos y tratamiento quirúrgico / Gastric stromal tumors: prognostic factors and surgical treatment

Introducción. Los criterios para determinar el grado de malignidad de los tumores gástricos estromales no están claramente definidos, por lo que el tratamiento quirúrgico de estas lesiones es controvertido. Métodos. Se han estudiado las características clínicas, morfológicas y quirúrgicas de 49 pacientes diagnosticados de tumor gástrico estromal entre 1968 y 1999. Se han analizado las tablas de frecuencias y se ha llevado a cabo un estudio de supervivencia. Resultados. Se han hallado 29 tumores malignos, mientras que el resto eran benignos. Los síntomas más frecuentes consistieron en un síndrome constitucional, hemorragia digestiva alta y masa abdominal en el 20 por ciento de los casos. El análisis de la supervivencia demostró que la presencia de masa abdominal, el tamaño tumoral mayor de 10 cm y la necrosis tumoral son indicadores de mal pronóstico, mientras que la presencia de ulceración indica buen pronóstico. Un índice mitótico elevado (> 10) y una resección quirúrgica amplia no tienen impacto en la supervivencia de estos pacientes. Conclusiones. Recomendamos una resección completa pero limitada de estos tumores dada la menor complejidad técnica, la menor morbilidad y el idéntico pronóstico que los asociados con resecciones más amplias (AU)

Pseudotumor inflamatorio: presentación de 12 casos

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[Treatment of asthma with antileukotrienes and Churg-Strauss syndrome]. / Tratamiento del asma con antileucotrienos y síndrome de Churg-Strauss.

Since antileukotriene treatment for asthma was introduced, there has been debate about whether such therapy can lead to Churg-Strauss Syndrome (CSS) or whether CSS is simply inhibited by the use of steroids, as various authors have suggested. We report a case in which we suspected CSS in a patient with bronchopulmonary, cutaneous and analytical signs and whom we treated with oral steroids. After clinical improvement, one year later, steroids were replaced by antileukotrienes, after which the same clinical picture developed. The vasculitis characteristic of CSS was confirmed pathologically.