Risk of progression to high-grade anal intraepithelial neoplasia in HIV-infected MSM.

OBJECTIVE: To assess the value of several factors to predict the risk of progression to high-grade anal intraepithelial neoplasia (HGAIN) in a cohort of HIV-infected MSM. DESIGN: Longitudinal study of 556 HIV-infected MSM who underwent screening for anal dysplasia (include anal cytology and high-resolution anoscopy at each visit). METHODS: Progression rate to HGAIN was estimated by Kaplan-Meier analysis. Predictors of progression were assessed by Cox-proportional hazards regression. RESULTS: Sixty-eight incidents HGAIN cases over 649 person-years of follow-up were diagnosed, resulting in a progression rate of 10.5 cases/100 person-years [95% confidence interval (CI), 8.1-13.3). The cumulative incidence of HGAIN was 7.2% at 12 months (95% CI, 4.3-10.1) and 16.2% at 24 months (95% CI, 11.7-20.7). Independent risk factors for progression were as follows: abnormal cytology [hazard ratio (HR), 2.5 (95% CI, 1.2-4.9) if low-grade squamous intraepithelial lesion, HR 2.76 (95% CI, 1.4-5.3) if atypical squamous cells of uncertain significance and HR 7.73 (95% CI, 2.3-25.4) if high-grade squamous intraepithelial lesion], abnormal high-resolution anoscopy (HR 3.57; 95% CI, 2-6.4) and infection by 16 or 18 human papillomavirus (HR 1.63; 95% CI, 1-2.6). To be receiving HAART (HR 0.4; 95% CI, 0.2-0.7) and have stable sexual couple (HR 0.62; 95% CI, 0.4-0.9) were protective factors. Patients with favorable predictors had an incident rate of 2.86 cases/100 person-years (95% CI, 3.5-10.3). CONCLUSION: The rate of progression to HGAIN varies according to different predictors that should be considered when assessing the particular risk of each patient. Patients with low risk of progression could be screened at longer intervals. BRIEF SUMMARY: We describe the risk of progression to HGAIN in a cohort of 556 HIV-infected MSM. The incidence rate of HGAIN varies widely according to different predictors. These factors should be considered when assessing the particular risk of each patient.

Fluorescence in situ hybridization and immunohistochemistry as diagnostic methods for ALK positive non-small cell lung cancer patients.

BACKGROUND: Anaplastic Lymphoma Kinase (ALK) positivity represents a novel molecular target in a subset of Non-Small Cell Lung Cancers (NSCLC). We explore Fluorescence in situ Hybridization (FISH) and Immunohistochemistry (IHC) as diagnostic methods for ALK positive patients and to describe its prevalence and outcomes in a population of NSCLC patients. METHODS: NSCLC patients previously screened for Epidermal Growth Factor Receptor (EGFR) at our institution were selected. ALK positive patients were identified by FISH and the value of IHC (D5F3) was explored. RESULTS: ninety-nine patients were identified. Median age was 61.5 years (range 35-83), all were caucasians, eighty percent were adenocarcinomas, fifty-one percent were male and thirty-eight percent were current smokers. Seven (7.1%) patients were ALK positive by FISH, thirteen (13.1%) were EGFR mutant, and 65 (65.6%) were negative/Wild Type (WT) for both ALK and EGFR. ALK positivity and EGFR mutations were mutually exclusive. ALK positive patients tend to be younger than EGFR mutated or wt patients. ALK positive patients were predominantly never smokers (71.4%) and adenocarcinoma (71.4%). ALK positive and EGFR mutant patients have a better outcome than negative/WT. All patients with ALK FISH negative tumours were negative for ALK IHC. Out of 6 patients positive for ALK FISH with more tissue available, 5 were positive for ALK IHC and 1 negative. CONCLUSIONS: ALK positive patients represent 7.1% of a population of selected NSCLC. ALK positive patients have different clinical features and a better outcome than EGFR WT and ALK negative patients. IHC is a promising method for detecting ALK positive NSCLC patients.

Melanoma maligno amelanótico en un ganglio de glándula parótida. Estudio clinicopatológico, inmunohistoquímico y molecular de un caso / The clinicopathological, immunohistochemical and molecular features of a case of amelanotic malignant melanoma in a parotid gland lymph node

Aportamos un caso de melanoma maligno amelánico que se presentó como un tumor primario en un ganglio intraparotídeo en una mujer de 24 años de edad. Ante las dudas de diagnóstico que presentó en su momento se catalogó como «tumor maligno S-100 positivo» y se consideró como posible metástasis de un melanoma con primario desconocido. Quince años más tarde se confirmó la positividad de Melan-A en las células tumorales y recientemente se comprobó la presencia de mutaciones BRAF tal como ocurre en los melanomas cutáneos. Nunca se ha encontrado un primario y la paciente, 15 años después, presenta excelente estado de salud. Se discute el posible origen de la lesión y su comportamiento excepcional(AU)

We report a case of primary amelanotic malignant melanoma in the intraglandular lymph node of the parotid gland in a 24 year-old woman. The initial diagnosis was S-100 positive malignant tumour, presumed to be a metastasis of a regressive malignant melanoma although a primary was not found. 15 years later, Melan-A expression and BRAF mutations have been identified in tumour cells, comparable to cutaneous melanomas. 15 years postoperatively the patient is alive and free of disease. The possible origin and the behaviour of the lesion are discussed(AU)

Dos casos de sarcoma de partes blandas de presentacióninsólita, con dificultades para el diagnóstico (El hombre deEstambul. Una situación bastante habitual: no reconoceruna lesión porque no está en el lugar «adecuado») / Soft tissue sarcoma: 2 cases of unusual presentation and difficult diagnosis. («The man from Istanbul»: a fairly frequent situation in which a lesion is not recognised due to it occurring in an «unexpected»place)

Para un patólogo preparado, reconocer un tumor cuandopresenta la morfología característica y está en su localizaciónhabitual es fácil. Pero cuando se presenta en un lugarinsólito y además la biopsia para diagnóstico es pequeña, esfácil caer en un error de orientación y, aunque a veces lastécnicas auxiliares nos puedan ayudar, en algunas ocasionesno se concreta el diagnóstico hasta que una biopsia completao la extirpación del tumor nos permiten ver la totalidad dela lesión, con la sobrecarga de tiempo, riesgo para el pacientey gasto económico que ello conlleva.El Prof. Rosai describe esta situación con la historia quecontaba Lauren V. Ackerman y que tituló «El hombre deEstambul»: el empecinamiento en no reconocer un tumorporque no está en «su» lugar.Aportamos dos casos de sarcomas de partes blandas quese presentaron en localizaciones que podríamos llamar«invertidas»: un sarcoma sinovial mandibular y un mioepiteliomamaligno yuxtaarticular en un dedo del pie y exponemoslas dificultades que presentaron para su diagnóstico inicial (AU)

A tumour with a characteristic morphological appearanceoccurring in a usual location is easy to diagnose. However,if a tumour is found in an unexpected site and only asmall amount of biopsy material is available, it is more difficultto reach a correct diagnosis.Dr Rosai quotes an expression often used by Lauren V.Ackerman to describe such a situation: «the man from Istanbul», ie. a common lesion occurring in the wrong place.Two cases of common soft tissue tumours located inuncommon places are presented: a synovial sarcoma in themandible and a malignant myoepithelioma (mixed tumour)near the phalangeal joint of the foot. The difficulties of acorrect initial diagnosis are discussed (AU)

[Hepatic angiomyolipoma in two patients infected with hepatitis C virus]. / Angiomiolipoma hepático en dos pacientes con infección por el virus de la hepatitis C.

AIM: The aim of this study is to present our experience with two cases of hepatic angiomyolioma in hepatitis C virus (HCV) positive patients, and to up-date the clinical manage, diagnostic and treatment of this entity. CLINICAL OBSERVATIONS: Both cases were presented in women in their 4-5th decade of life. Clinical presentation was with symptoms in one but incidental in the other. Both were HCV positive. Values of alpha-fetoprotein were normal. Radiological imaging was not diagnostic. Histopathological examination and immunohistochemical findings gave the diagnosis of angiomyolipoma. At time of diagnosis the size of tumours was 4.8 and 8 cm of diameter. Both cases were treated with surgery in order to definetly rule out malignancy. After 6 and 3 years of follow-up, there is no evidence of recurrence. DISCUSSION AND CONCLUSION: The hepatic angiomyolipoma is a rare benign tumour, mimicking other liver tumours. Although no patognomonic features, there are some radiological findings that point out to the diagnosis of angiomy olipoma. Nevertheless, definitive diagnosis is done by his tological and immunohistochemical findings (HMB-45). The hepatic angiomyolipoma consists of varing proportion of three elements, mature fat cells, smooth muscle cells and blood vessels. Although it is a benign tumour, the difficulty in ruling out malignancy, prompted surgical management. It is not described its relation with HCV virus, thus we consider our cases as an coincident finding.

Angiomiolipoma hepático en dos pacientes con infección por el virus de la hepatitis C / Hepatic angiomyolipoma in two patients infected with hepatitis C virus

Objetivo: El objetivo de este estudio era presentar nuestra experiencia con 2 casos de angiomiolipoma hepático en pacientes con virus de la hepatitis C (VHC) positivo, y realizar una actualización del manejo clínico y tratamiento del angiomiolipoma hepático. Observaciones clínicas: Ambos casos se presentaron en mujeres en la cuarta-quinta décadas de la vida. La presentación clínica fue sintomática en una de ellas e incidental en la otra. Las 2 pacientes presentaban anticuerpos contra el VHC, y se planteó el diagnóstico diferencial con el hepatocarcinoma. Los valores de alfafetoproteína fueron normales. Las pruebas de imagen no fueron concluyentes y sólo la punción-aspiración con aguja fina y la inmunohistoquímica orientaron el diagnóstico de angiomiolipoma. El tamaño de las tumoraciones fue grande: 4,8 y 8 cm de diámetro, respectivamente. En ambos casos se requirió la realización de cirugía exerética para descartar definitivamente la malignidad. No hay evidencia de recidiva tras 6 y 3 años de seguimiento, respectivamente. Discusión y conclusión: El angiomiolipoma es una tumoración hepática benigna poco frecuente, que mimetiza otras lesiones hepáticas. Pese a la dificultad diagnóstica, una serie de datos radiológicos apoyan el diagnóstico de esta enfermedad. No obstante, el diagnóstico definitivo lo proporciona la anatomía patológica y la immunohistoquímica (HMB-45). Se trata de una lesión compuesta por tejido adiposo, células musculares lisas y vasos sanguíneos en diversas proporciones. Pese a su carácter benigno, la dificultad para descartar su malignidad obliga al tratamiento quirúrgico. No está descrita su relación etiopatogénica con el VHC, por lo que consideramos nuestros casos como un hallazgo coincidente

Aim: The aim of this study is to present our experience with two cases of hepatic angiomyolioma in hepatitis C virus (HCV) positive patients, and to up-date the clinical manage, diagnostic and treatment of this entity. Clinical observations: Both cases were presented in women in their 4-5th decade of life. Clinical presentation was with symptoms in one but incidental in the other. Both were HCV positive. Values of alpha-fetoprotein were normal. Radiological imaging was not diagnostic. Histopathological examination and immunohistochemical findings gave the diagnosis angiomyolipoma. At time of diagnosis the size of tumours was 4.8 and 8 cm of diameter. Both cases were treated with surgery in order to definetly discard malignancy. After 6 and 3 years of follow-up, there is no evidence of recurrence. Discussion and conclusion: The hepatic angiomyolipoma is a rare benign tumour, mimicking other liver tumours. Although no patognomonic features, there are some radiological findings that point out to the diagnosis of angiomy olipoma. Nevertheless, definitive diagnosis is done by his tological and immunohistochemical findings (HMB-45). The hepatic angiomyolipoma consists of varing proportion of three elements, mature fat cells, smooth muscle cells and blood vessels. Although it is a bening tumour, the difficulty in discarding malignancy, prompt to surgical management. It is not described its relation with HCV virus, thus we consider our cases as an coincident finding

[Neonatal listeriosis]. / Listeriosis neonatal.

We present the case of a male with a neonatal Listeria monocytogenes infection. Its evolution was favorable with intravenous ampicillin and gentamicin. Listeriosis is an infrequent cause of neonatal pustulosis. The infection is acquired from the mother after bacteremia with few symptoms (early-onset forms) or while passing through an infected birth canal (late-onset forms). A cytological study and the quick stain technique make fast diagnosis of potentially serious neonatal pustuloses possible.

Listeriosis neonatal / Neonatal listeriosis

Presentamos el caso de un varón con infección neonatal por Listeria monocytogenes. La evolución fue favorable con ampicilina y gentamicina intravenosas. La listeriosis es una causa infrecuente de pustulosis neonatal. El contagio se produce desde la madre, tras una bacteriemia paucisintomática (formas tempranas) o durante el paso por el canal del parto contaminado (formas tardías). El estudio citológico y las tinciones urgentes permiten el diagnóstico rápido de pustulosis neonatales potencialmente graves

We present the case of a male with a neonatal Listeria monocytogenes infection. Its evolution was favorable with intravenous ampicillin and gentamicin. Listeriosis is an infrequent cause of neonatal pustulosis. The infection is acquired from the mother after bacteremia with few symptoms (early-onset forms) or while passing through an infected birth canal (late-onset forms). A cytological study and the quick stain technique make fast diagnosis of potentially serious neonatal pustuloses possible