Unexpected Tumor: Primary Asymptomatic Schwannoma in Thyroid Gland.

The discovery of a tumor as a primary schwannoma in the thyroid gland is rare (Andrion et al. in Virchows Arch 413:367-372, 1988). It represents less than 1 % of mesenchymal neoplasms of this gland. Therefore, few cases of this type are described in medical literature (Aron et al. in Cytopathology 16:206-209, 2005; Cashman et al. in Medscape J Med 10(8):201, 2008; Coleman et al. in AJR Am J Roentgenol 140:383-7, 1983). In this article, we introduce the clinical case of a 27-year-old female patient, who presented a nodular mass located in the neck region. This mass was not associated with other symptoms and during the imagistic investigation it appeared to be a thyroglossal duct cyst. A fine needle aspiration biopsy was performed which revealed benign mesenchymal cells. After a pathology study of the piece resected through a thyroidectomy, it was confirmed that the tumor had neural characteristics, the final diagnosis being a primary schwannoma. The importance of a cytology study is emphasized, since in this case, it made it possible to accurately diagnose a mesenchymal tumor, despite their low frequency. It constitutes a highly useful tool for diagnosing non-epithelial neoplasia of the thyroid gland.

Cytological changes induced by embolization in meningiomas.

OBJECTIVE: To describe cytological changes in meningiomas induced by embolization, which may be carried out a few days before surgery in order to soften the tumour and minimize intraoperative bleeding. Although histological changes have been described, we have found no description of such changes in the cytological literature. METHODS: We reviewed 22 cases of meningiomas with prior embolization in which cytological material was obtained during intraoperative consultation. In 13 of them recognizable cytological changes induced by embolization were present. On histology, these 13 tumours were grade I and showed intravascular embolic material. RESULTS: Cellular dissociation was prominent, with frequent single cells and small groups. Ischaemic cellular changes were a common finding and consisted of cell shrinkage, nuclear pyknosis and karyorrhexis. Confluent areas of necrosis were seen in one case. Additionally, numerous macrophages were present, many containing cellular debris, and neutrophils, giving a characteristic appearance of acute cellular ischaemia. Embolic material was seen cytologically in four cases as well-defined spherules surrounded by empty halos. Features of viable meningioma were recognized in all cases. CONCLUSION: Embolization of meningiomas induces cytological changes that mirror those seen on histology, but cellular dissociation with changes of ischaemia may result in a worrisome image. When faced with such changes the pathologist should consider the possibility of embolization, avoiding misdiagnosis of higher grade meningioma or metastatic carcinoma.

Utilidad de la citología en el diagnóstico y manejo de tumores renales y perirrenales del adulto / Usefulness of cytology in diagnosis and management of renal and perirenal tumors in adults

Introducción: El uso cada vez mas extendido de tumorectomías, nefrectomías parciales y tratamientos no quirúrgicos de tumores renales ha supuesto un renovado interés en el uso diagnóstico de la citología. Ya sea de forma preoperatoria, a través de la punción aspiración con aguja fina (PAAF), o durante el análisis intraoperatorio, la citología ofrece la posibilidad de un diagnóstico morfológico específico. En esta revisión se actualiza la información concerniente al valor diagnóstico de la citología de tumores renales. Material y métodos: Se ha revisado la bibliografía relativa a las descripciones citológicas de masas renales. Para ello se ha procedido tanto a búsqueda computerizada en la base de datos Medline, como a búsqueda bibliográfica manual. Del mismo modo se incluye la experiencia de los autores tanto en la PAAF de estas lesiones como en el uso intraoperatorio de la citología. Resultados: Entre las neoplasias con presentación citológica más característica destacan el carcinoma renal de células claras y el carcinoma renal papilar. El carcinoma cromófobo y el oncocitoma renal pueden mostrar similitudes, si bien la experiencia acumulada en los últimos años refleja que su diferenciación es posible en la mayoría de los casos. Para el diagnóstico de angiomiolipoma, carcinoma urotelial y metástasis en riñón, la información clínica y de imagen resulta es de gran interés para el patólogo. La integración de dichos datos suele permitir un diagnóstico específico. Conclusión: En general, la citología refleja con fidelidad las características histológicas de las neoplasias renales, permitiendo en muchos casos un diagnóstico específico. Ante la cada vez más frecuente situación de “incidentaloma” renal, consideramos muy apropiado el uso diagnóstico de la citología. La naturaleza mínimamente invasiva de la PAAF y la posibilidad de realización de análisis citológico rápido durante estudios intraoperatorios ofrecen importante información para el manejo terapéutico de estos pacientes

Introduction: The use more and more extended of tumorectomy, partial nephrectomy and nonsurgical treatments of renal tumors has supposed a renewed interest in the diagnosis use of cytology. Whether during preoperative period, through the puncture aspiration with fine needle (PAAF), or during the intraoperative analysis, the cytology offers the possibility of a specific morphologic diagnosis. In this revision the information concerning the diagnostic value of the cytology in renal tumors is updated. Material and methods: The references related to renal masses cytological descriptions has been reviewed. For this purpose we have searched both with computer in Medline data base and also manually. In the same way we include authors experience as much in the PAAF of these lesions as in the intraoperative use of the cytology. Results: Between neoplasias with more cytological typical presentation are the clear cell renal and papillary carcinomas. The chromophobe and oncocytoma can show similarities, although the accumulated experience in the last years reflects that its differentiation is possible in most of the cases. For the diagnosis of angiomyolipoma, urothelial carcinoma and kidney metastasis, the clinical and image information are of great interest for the pathologist. The integration of these data usually allows a specific diagnosis. Conclusion: Generally, cytology reflects with accuracy the histological characteristics of renal neoplasias, allowing in many cases a specific diagnosis. We consider much appropriated the use of cytology, due to the more and more frequent situation of “incidentaloma”. The PAAF minimum invasive nature and the possibility of performing a fast cytological analysis during intraoperative studies offer important information for the therapeutic management of these patients

[Usefulness of cytology in diagnosis and management of renal and perirenal tumors in adults]. / Utilidad de la citología en el diagnóstico y manejo de tumores renales y perirrenales del adulto.

INTRODUCTION: The use more and more extended of tumorectomy, partial nephrectomy and nonsurgical treatments of renal tumors has supposed a renewed interest in the diagnosis use of cytology. Whether during preoperative period, through the puncture aspiration with fine needle (PAAF), or during the intraoperative analysis, the cytology offers the possibility of a specific morphologic diagnosis. In this revision the information concerning the diagnostic value of the cytology in renal tumors is updated. MATERIAL AND METHODS: The references related to renal masses cytological descriptions has been reviewed. For this purpose we have searched both with computer in Medline data base and also manually. In the same way we include authors experience as much in the PAAF of these lesions as in the intraoperative use of the cytology. RESULTS: Between neoplasias with more cytological typical presentation are the clear cell renal and papillary carcinomas. The chromophobe and oncocytoma can show similarities, although the accumulated experience in the last years reflects that its differentiation is possible in most of the cases. For the diagnosis of angiomyolipoma, urothelial carcinoma and kidney metastasis, the clinical and image information are of great interest for the pathologist. The integration of these data usually allows a specific diagnosis. CONCLUSION: Generally, cytology reflects with accuracy the histological characteristics of renal neoplasias, allowing in many cases a specific diagnosis. We consider much appropriated the use of cytology, due to the more and more frequent situation of "incidentaloma". The PAAF minimum invasive nature and the possibility of performing a fast cytological analysis during intraoperative studies offer important information for the therapeutic management of these patients.

Fine needle aspiration cytology of mammary carcinoma with osteoclast-like giant cells.

Carcinoma with osteoclast-like giant cells (OCGC) is an uncommon neoplasm characterized by giant cells, prominent vascularization, haemorrhage and areas of cribriform epithelial growth with moderate atypia. Multinucleated giant cells (MGC) have been described in several other breast lesions raising an interesting differential diagnosis, mainly with benign disorders. Due to its rarity few cases have been described cytologically. We retrospectively reviewed 13 fine needle aspiration samples from nine patients with this variant of carcinoma. Nine corresponded to breast tumours and four to axillary, liver, subcutaneous and mediastinal metastatic lesions. The expression of CD68 by giant cells was evaluated immunocytochemically in six cases. All patients had a complete pathological study of the breast neoplasm. Smears showed a double component of epithelial and giant cells. Epithelial clusters were predominantly of intermediate size with irregular contours. Most were cohesive but others showed cellular dissociation with scarce to moderate cellular pleomorphism. Giant cells had well defined, deeply stained cytoplasm and round to elongated morphology. Two metastatic cases were devoid of them. Haemosiderin-laden macrophages were common in smears from breast tumours. In the six cases tested CD68 was expressed in MGC. Cytological features of mammary carcinoma with OCGC correlate closely with the histological ones. Most cases are clearly recognizable as malignant but in others cytological atypia may be minimal, mimicking a benign lesion. In difficult cases the presence of haemosiderin-laden macrophages and the histiocytic nature of the MGC are helpful diagnostic features.

Malignant oncocytoma of a minor salivary gland: an unusual presentation at the base of the tongue.

In contrast to malignant oncocytomas of the parotid gland, malignant oncocytomas arising from minor extraparotid glandular tissue are rare. The latter may display a locally aggressive behaviour as well as a variable tendency to develop secondary cervical lymph nodes. We report a new case of malignant oncocytoma in a 43-year-old man presenting with greatly enlarged cervical lymph nodes accompanied by a poorly defined swelling at the base of the tongue microscopically identified as a malignant oncocytoma. The diagnosis was strongly supported by the ultrastructural features of the cells almost completely filled with mitochondria. The cervical mass was excised, and the patient has suffered no recurrence for nearly 2 years after surgical treatment.

Absence of hypoalbuminemia despite massive proteinuria in focal segmental glomerulosclerosis secondary to hyperfiltration.

We observed that some patients do not develop hypoalbuminemia despite the presence of massive proteinuria. To investigate whether the absence or presence of hypoalbuminemia could be a marker in the distinction between idiopathic focal segmental glomerulosclerosis (FSG) and FSG secondary to hyperfiltration, we reviewed all our patients with biopsy-proven FSG and persistent nephrotic-range proteinuria (>3.5 g/24 h). Patients who met these conditions were then separated into those with hypoalbuminemia (serum albumin level <3 g/dL; group I; n = 19) and those with normoalbuminemia (>3.5 g/24 h; group II; n = 18). All group I patients had nephrotic edema in contrast with the absence of edema in all group II patients. Serum cholesterol and triglyceride levels were significantly greater in group I. All group I patients had been diagnosed with idiopathic FSG. The diagnoses of group II patients were FSG secondary to massive obesity in eight patients (44%), vesicoureteral reflux in five patients (27%), and renal mass reduction in three patients (16%); only two patients (11%) in this group had idiopathic FSG. The case histories of 19 other patients with nephrotic-range proteinuria associated with hyperfiltering disorders (reflux nephropathy, massive obesity, renal mass reduction), but without renal biopsy, were also reviewed; despite massive proteinuria (5.8 +/- 3.1 g/24 h), serum albumin and total protein levels were always within normal values. In conclusion, patients with FSG secondary to hyperfiltration do not develop hypoalbuminemia or the other characteristic complications of nephrotic syndrome, despite the presence of massive proteinuria values.

Single dose pharmacokinetics and tolerance of pancopride in healthy volunteers.

Pancopride (LAS 30451, CAS 121650-80-4) is a new selective 5-hydroxytryptamine3 receptor antagonist which has demonstrated antiemetic properties in animal models. The tolerance and pharmacokinetics of pancopride and its effect on the 5-hydroxytryptamine flare test were examined in healthy male volunteers, in three single-dose studies. The studies consisted of two rising dose tolerance and kinetic studies with placebo control, each involving 14 volunteers, and an absolute bioavailability study involving 12 volunteers. The doses used in the rising dose studies were 0.5-20 mg intravenous pancopride in the first study, and 5-40 mg pancopride as oral solution in the second study. For the absolute bioavailability study, 20 mg doses as intravenous infusion, oral tablet and oral solution were compared. Pancopride was well tolerated at these doses in these studies. There were no significant effects on pulse rate, blood pressure, or electrocardiograms, or on haematology or serum biochemistry. Few adverse events were recorded, the most significant being gastrointestinal effects (including diarrhoea and soft stools) seen particularly with the 40 mg oral dose. Pharmacokinetic parameters for the 24 h after dosing were derived from plasma and urine pancopride levels, determined using a capillary gas chromatography-mass spectrometry method. Linear kinetics appeared to apply over the intravenous dose range 5-20 mg. Urinary recovery of unchanged pancopride was in the order of 10-17% over the 24 h after dosing.(ABSTRACT TRUNCATED AT 250 WORDS)

Repeated dose pharmacokinetics of pancopride in human volunteers.

The aim of this study was to assess the pharmacokinetic profile of pancopride after repeated oral dose administration of 20 mg pancopride in tablet form once a day for 5 d in 12 healthy male volunteers. Plasma levels were measured by HPLC using a solid phase extraction method and automated injection. The minimum quantification limit of pancopride in plasma was 2 ng mL-1. The maximum plasma concentration (mean +/- SD) after the first dose was 92.5 +/- 41.5 ng ML-1 and tmax was 1.7 +/- 0.9 h. The elimination half-life (t1/2) was 14.3 +/- 6.9 h. The area under the concentration-time curve from zero to infinity (AUC) was 997 +/- 396 ng h mL-1. The maximum plasma concentration (mean +/- SD) at steady state (day 5) was 101.8 +/- 36.9 ng mL-1 and tmax was 2.2 +/- 1.2 h. The elimination half-life (t1/2) was 16.3 +/- 2.7 h and the minimum plasma concentration (Cssmin) was 16.6 +/- 6.9 ng mL-1. The area under the concentration-time curve during the dosing interval (AUCss tau) was 995 +/- 389 ng h mL-1. The average plasma concentration at steady state (Cssav) was 43.3 +/- 16.1 ng mL-1 and the experimental accumulation ratio (RAUC) was 1.34 +/- 0.19, whereas the mean theoretical value (R) was 1.40 +/- 0.29. The results obtained showed a good correlation between the experimental plasma levels and the expected values calculated using a repeated dose two-compartment model assessed by means of the Akaike value. It is concluded that the pharmacokinetics of pancopride are not modified after repeated dose administration.(ABSTRACT TRUNCATED AT 250 WORDS)

[The clinical development of an antiemetic in oncology. A meta-analysis]. / Desarrollo clínico de un antiemético en oncología. Metaanálisis.

BACKGROUND: To perform meta-analysis (MT) on antiemetic efficacy of LAS 30451 (Pancopride) in high and moderately emetogenic chemotherapy (CT). METHODS: The results of 13 phase II and III clinical trials comparing the efficacy of different doses of the drug under study with or without corticoids, or versus standard treatment (methochlopramide and/or corticosteroids and diphenhydramine) were included. The principal variable was complete protection in the acute phase (0 vomiting following 24 h post treatment). RESULTS: The design was open in 3, simple blind in 4 and double blind in 6, with 11 being parallel and 2 crossed. The trials were carried out in 39 centers of 5 countries with 999 patients who received 1,292 cycles of antiemetic treatment. On comparison of lower or equal doses at 0.2 mg/kg of pancopride vs higher doses global OR was 0.94 (p = 0.72) with a global percentage difference (GPD) of -4.69% (p = 0.23) and GPD equal to -6.90. On treatment without cysplatin global OFR was equal to 1.10 (p = 0.69) with GPD of -8.99% favoring dosage lower than or equal to 0.2 mg/kg. The dexamethasone increased antiemetic efficacy of pancopride in both treatments with cysplatin (50% vs 76%, p = 0.08) and without cysplatin (50% to 89%, p = 0.02). When pancopride was compared with that of standard antiemetic treatment (methochlopramide and/or corticosteroids) global OR was equal to 0.69 (p = 0.07) with GPD of -6.84% favoring the control treatment. In CT containing cysplatin, global OR was equal to 0.73 (p = 0.38) with GPD of -3.28% and with CT without cysplatin the global OR was 0.66. (p = 0.12) with a GPD of -4.92% in both cases favoring the control treatment. CONCLUSIONS: No statistically significant differences were observed with regard to the antiemetic efficacy of pancopride on comparison of different doses of the drug. The antiemetic efficacy of pancopride increases when given together with dexamethasone. The efficacy of pancopride is lower to that of methochlopramide in combination with corticosteroids and/or diphenhydramine although the differences are not statistically significant.

[The effect of a new formulation of almagate on gastroesophageal reflux in esophagitis patients. A randomized, single-blind and cross-over study]. / Efecto de una nueva formulación de almagato sobre el reflujo gastroesofágico en pacientes con esofagitis. Estudio randomizado, simple ciego y cruzado.

The effect of postprandial administration of a new formulation of almagate (1.5 g, po) or an association of alginate + antacid (2.4 g, po) on gastric alkalinization and gastroesophageal reflux were assessed in a randomized, single-blind, cross-over study in 21 patients with gastroesophageal reflux disease. Continuous intragastric and esophageal acidity was evaluated by postprandial intraluminal pHmetry. When comparing both preparations, the new formulation of almagate significantly improved all pHmetric variables (number of reflux episodes (3 vs 6, p = 0.029), time of esophageal exposition to pH < 4.0 (1vs 9 minutes, p = 0.009), duration of longest reflux episode (1 vs 3 minutes, p = 0.036), reflux index (1 vs 2, p = 0.047), and intragastric time with pH greater than 4.0 (108 vs 46 minutes, p = 0.003). This results suggest that the new formulation of almagate could be effective in the treatment of gastroesophageal reflux disease, since acidity profile of patients treated with it have been shown an intragastric long-lasting alkalinization wave.

[A methodology for clinical trials in parenteral nutrition]. / Metodología de ensayos clínicos en nutrición parenteral.

Recent and progressive knowledge on parenteral nutrition has not been accompanied by due attention to the methodology for clinical testing in this therapeutical field. Although many different laws, guidelines or norms do exist which can be applied to any clinical test, in the case of parenteral nutrition several characteristic aspects arise that should be taken into account in the design of clinical tests. This review places special emphasis on the definition of clinical testing, the role of the researcher and the ethical, methodological and design-related requirements to be considered when preparing a protocol for study. Not only is the importance of the selection and the size of the sample mentioned, but also the different variables normally used in parenteral nutrition. The correct follow-up, measurement, evaluation and statistical analysis of these variables makes it possible to reach valid conclusions, and provide the basic information for later study. The application of ethical norms and the control of adverse conditions guarantees the correct undertaking of this type of clinical research.