Penfigoide ampolloso inducido por crioterapia / Bullous pemphigoid induced by cryotherapy

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Hoyuelos cutáneos como consecuencia de amniocentesis: hallazgos histopatológicos / Skin Dimpling as a Complication of Amniocentesis: Histopathologic Findings

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Neuroma en la incisión de Pfannestiel como causa de un dolor abdominal intratable / Traumatic neuroma under Pfannestiel’s incision as a cause of untreatable abdominal pain

El neuroma es un crecimiento disperso y desordenado de las fibras nerviosas entremezcladas en tejido fibroso durante su proceso de regeneración. Es una patología poco común en la práctica clínica, y su diagnóstico en ocasiones resulta dificultoso y demorado en el tiempo. Presentamos el caso de una paciente de 13 años de edad con un cuadro de dolor abdominal incoercible y sin alteraciones en las pruebas diagnósticas realizadas, cuya causa resultó un neuroma en la cicatriz quirúrgica previa (AU)

The neuroma is a dispersed and disordered growth of the nervous fibers intermingled with fibrous tissue during its process of regeneration. It is a fairly uncommon pathology in the clinical practice and the diagnosis sometimes proves to be difficult and delayed in time. The author presents the clinical case of a 13-year-old patient with a severe abdominal pain, all diagnostic tests being normal without any alterations. The cause of the abdominal pain was a neuroma in a previous surgical scar (AU)

Eosinophilic panniculitis and insect bite-like eruption in a patient with chronic lymphocytic leukaemia: a spectrum of the same entity.

Background. Eosinophilic dermatosis of hematologic disorders is a reactive process that may cause a variety of clinical manifestations. Methods. We report a patient who had outbreaks of skin lesions since the onset of chronic lymphocytic leukaemia. Results. The cutaneous eruptions began as eosinophilic panniculitis and after changed to insect bite-like lesions. Conclusion. We think that eosinophilic panniculitis and insect bite-like lesions may be part of the spectrum of the same entity in patients with hematologic disorders.

Treatment of multiple eruptive vellus hair cysts with carbon dioxide laser vaporization and manual lateral pressure.

Treatment of eruptive vellus hair cysts (EVHC) is often unsatisfactory. Laser treatment has been described as an adequate treatment in a few reports. Pulsed carbon dioxide (CO(2)) laser has been used effectively for facial EVHC and erbium:yttrium-aluminium-garnet laser has been used to treat truncal EVHC with variable outcomes. We report our experience with CO(2) laser and lateral manual pressure to extract the cysts as an effective treatment in two cases of EVHC. Good cosmetic results were obtained in both cases. No lesion recurrence was observed after a follow-up of 10 years in the first case and 3 years in the second one. CO(2) laser vaporization and further extraction of cysts by manual lateral pressure might be an effective method to treat EVHC, achieving good cosmetic results and no recurrence.

[Renal involvement by AA amyloidosis in inclusion body myositis]. / Afectación renal por amiloidosis AA en paciente con miositis por cuerpos de inclusión.

Inclusion body myositis is currently considered a variant of adult inflammatory myopathies. Clinical course is insidious and besides typical proximal muscles disorder, extension to distal ones is found in up to 95% of cases. Mean survival ranges from 3 to 5 years. Infections are the first death cause, secondary to existing disability a few years after diagnosis. Chronic rheumatic diseases related amyloidosis has became the most frequent kind of reactive amyloidosis or AA amyloidosis. Clinical manifestations of AA amyloidosis mainly affect the kidney. We present the case of a woman with Inclusion body myositis and renal involvement by AA amyloidosis. In our review of literature we haven t found any article relating AA amyloidosis with idiopathic inflammatory myopathies of the adult, what would turn this case into the first ever reported. We can probably find the reason in the bad prognosis of this entity. So we propose making a renal biopsy to all those patients with a long lasting rheumatologic disease and unexpected impaired renal function.

Afectación renal por amiloidosis AA en paciente con miositis por cuerpos de inclusión / Renal involvement vy AA amyloidosis in inclusion body myositis

La miositis por cuerpos de inclusión (MCI) se considera actualmente una variante de las miopatías inflamatorias del adulto. El curso clínico es insidioso y además de la típica afectación de la musculatura proximal termina involucrando a los músculos distales en el 95% de los casos. La supervivencia media oscila entre los 3-5 años. La primera causa de muerte son las complicaciones infecciosas, debido a la incapacidad a los pocos años de su diagnóstico. La amiloidosis secundaria a enfermedades reumáticas crónicas se ha convertido en el tipo más frecuente de amiloidosis secundaria o tipo AA. Las manifestaciones clínicas de la amiloidosis AA predominan principalmente en riñón. Presentamos el caso de una mujer con MCI y afectación renal por amiloidosis AA. En la bibliografía no hemos encontrado ninguna comunicación relacionando la amiloidosis AA con miopatías inflamatorias idiopáticas del adulto, por lo que nuestra paciente sería el primer caso descrito. Probablemente el sombrío pronóstico de esta entidad sea el motivo por el que no han sido descritos otros casos. Creemos conveniente plantear la realización de biopsia renal en los pacientes con enfermedad reumatológica de larga evolución y deterioro inexplicado de la función renal

Inclusion body myositis is currently considered a variant of adult inflammatory myopathies. Clinical course is insidious and besides typical proximal muscles disorder, extension to distal ones is found in up to 95% of cases. Mean survival ranges from 3 to 5 years. Infections are the first death cause, secondary to existing disability a few years after diagnosis. Chronic rheumatic diseases related amyloidosis has became the most frequent kind of reactive amyloidosis or AA amyloidosis. Clinical manifestations of AA amyloi- dosis mainly affect the kidney. We present the case of a woman with Inclusion body myositis and renal involve- ment by AA amyloidosis. In our review of literature we haven´t found any article rela- ting AA amyoloidosis with idiopatic inflamatory myopaties of the adult, what would turn this case into the first ever reported.We can probably find the reason in the bad prognosis of this entity. So we propose making a renal biopsy to all those patients with a long lasting rheumatologic disease and unexpected impaired renal function

[Association between membranous glomerulonephritis and Crohn's disease]. / Asociación de glomerulonefritis membranosa y enfermedad de Crohn.

We report the case of a 37 year old man who suffered from Crohn's Disease (CD), and was receiving treatment with mesalazine (5-ASA). Nine years after the diagnosis, because of detecting a slight proteinuria, a renal biopsy is made, being the anatomo-pathologic result compatible with membranous glomerulonephritis (MGN). Checking previous literature we have only found two cases reported of MGN in coincidence with Inflammatory Bowel Disease (IBD), one in association with Ulcerative Colitis and the other with Crohn's Disease in a 12 years old boy. This is, therefore, the second case presenting MGN associated with CD and the first in an adult patient.

Renal smooth muscle tumor with features of lymphangioleiomyomatosis. Problems in histological diagnosis.

A 44-year-old woman with left kidney tumor involving the perirenal and retroperitoneal lymph nodes is presented. Imaging findings including ultrasonography and computerized tomography showed renal and para-aortic masses and no features of lymphangioleiomyomatosis or angiomyolipoma were seen. The histopathological examination was considered as a renal smooth muscle tumor with features of lymphangioleiomyomatosis. Diagnosis considerations, particularly histopathological, immunohistochemical and hormonal studies are discussed and we comment the distinction of this case from the benign mesenchymal tumors.

Spectrum of nonrandom associations between microsatellite loci on human chromosome 11p15.

Most evidence about nonrandom association of alleles at different loci, or gametic disequilibrium, across extensive anonymous regions of the human genome is based on the analysis of overall disequilibrium between pairs of microsatellites. However, analysis of interallelic associations is also necessary for a more complete description of disequilibrium. Here, we report a study characterizing the frequency and strength of both overall and interallelic disequilibrium between pairs of 12 microsatellite loci (CA repeats) spanning 19 cM (14 Mb) on human chromosome 11p15, in a large sample (810 haplotypes deduced from 405 individuals) drawn from a single population. Characterization of disequilibrium was carried out, taking into account the sign of the observed disequilibria. This strategy facilitates detection of associations and gives more accurate estimates of their intensities. Our results demonstrate that the incidence of disequilibrium over an extensive human chromosomal region is much greater than is commonly considered for populations that have expanded in size. In total, 44% of the pairs of microsatellite loci and 18% of the pairs of alleles showed significant nonrandom association. All the loci were involved in disequilibrium, although both the frequency and strength of interallelic disequilibrium were distributed nonuniformly along 11p15. These findings are especially relevant since significant associations were detected between loci separated by as much as 17-19 cM (7 cM on average). It was also found that the overall disequilibrium masks complicated patterns of association between pairs of alleles, dependent on their frequency and size. We suggest that the complex mutational dynamics at microsatellite loci could explain the allele-dependent disequilibrium patterns. These observations are also relevant to evaluation of the usefulness of microsatellite markers for fine-scale localization of disease genes.

Pyelic metastasis from a renal cell carcinoma following partial nephrectomy.

The majority of ureteropelvic metastatic tumors are of non-urologic origin. A case of metastatic clear cell adenocarcinoma to the renal pelvis in a patient with a bilateral, asynchronous renal tumor is presented. Conservative surgical treatment involved open pyelotomy and local resection of the tumor. At the 12-month follow-up, the patient is alive, asymptomatic and not on dialysis. The hypothesis for the mechanisms of dissemination and the relevance of conservative treatment are discussed.

Large B-cell lymphoma of the uterine corpus: case report with immunohistochemical and molecular study.

Primary lymphoma of the uterine corpus (PLUC) is an extremely rare neoplasm. We report a case of PLUC in a 78-year-old woman with vaginal bleeding without hepatosplenomegaly, adenopathies, or bone marrow infiltration, classified as stage I. A diagnosis of diffuse large B-cell lymphoma was made in endometrial curettage tissue. Immunohistochemical study showed tumoral cells of B-cell nature. Two different polymerase chain reaction (PCR) techniques showed immunoglobulin heavy chain gene rearrangement and we could not demonstrate, with PCR technique, either Epstein-Barr virus or papilloma virus infection. Total hysterectomy with bilateral salpingo-oophorectomy was carried out and adjuvant chemotherapy was given. She was alive and free of disease after a follow-up period of 7 years, and the patient has been in perfect health.

Hypopituitarism due to lymphocytic hypophysitis in a patient with retroperitoneal fibrosis.

We present a 78-year-old woman with clinical acute hypopituitarism in whom pathologic findings showed lymphocytic hypophysitis and retroperitoneal fibrosis. Lymphocytic hypophysitis should be included in the differential diagnosis of hypopituitarism at any age. The association with idiopathic retroperitoneal fibrosis suggest an autoimmune origin for this entity.

[Mucinous adenocarcinoma of the anal region. Study of 4 cases]. / Adenocarcinoma mucinoso de región anal. Estudio de 4 casos.

OBJECTIVE: We report 4 cases of a special anal tumor featuring a long history of inflammatory signs and fistulas in that area. DESIGN: A retrospective study from the histologic diagnosis back to the first symptom and up to the last follow-up or death. PATIENTS: We studied all patients with a histologic diagnosis of mucinous adenocarcinoma of the anus admitted to our hospital. RESULTS: All of them showed a long history of anal inflammatory signs and/or fistula before diagnosis. In all cases, the tumors were mucinous adenocarcinomas with minimal cytologic atypia. Of the 4 patients, one is dead, and we have lost the follow-up of another one 13 months after surgery when he had no evidence of recurrence. CONCLUSIONS: In every patient with a long-standing anal fistula or a recurrent anal abscess, a biopsy is mandatory to rule out an underlying low grade mucinous carcinoma and if it shows a low grade mucinous adenocarcinoma, the treatment of choice will be local resection if it is available. If not, an abdominal perineal resection showed be done without hesitation.

[Signet ring cell carcinoma of the Vater's ampulla]. / Carcinoma de células en anillo de sello de ampolla de Vater.

We report an unusual type of carcinoma of the ampulla of Vater composed of signet-ring cells with few neuroendocrine cells and without other variants of carcinoma. The tumor presented with obstructive jaundice and invaded diffusely the ampulla and adjacent duodenal wall. The patient is alive and disease free 24 months after Whipple's resection.