[Sinonasal mucosal melanoma]. / Melanomas mucosos nasosinusales.

Mucosal melanomas of the nasal cavity and paranasal sinuses are rare and agresive neoplasms and carries a bad prognosis. The diagnosis may require confirmatory immunohistochemical stains (S-100 protein, HMB-45, vimentin and cytokeratine). The clinical records of 6 patients with the diagnosis of sinonasal melanomas between 1991 and 2005 were retrospectively reviewed. The mean age was 70 years (range 51 to 83 years), there were 2 men and 4 women. Surgery was performed in four patients, adjuvant radiation therapy was used in one patient after local recurrence and chemotherapy in three patients. Three of four patients (75%) had a recurrence after previous treatment (surgery). The actuarial disease-free survival for this group of 6 is 33.3% (2 of 6). Mucosal melanoma of the head and neck remains a difficult disease to treat, with high locoregional recurrence rates and poor prognosis.

Melanomas mucosos nasosinusales / Sinonasal mucosal melanoma

Los melanomas mucosos de cavidad nasal y senos paranasales son tumores raros, agresivos y presentan un mal pronóstico. El diagnóstico de sospecha se confirma mediante el estudio inmunohistoquímico con la proteína S-, HMB, vimentina y citoqueratina. Se realiza una revisión retrospectiva de 6 pacientes entre 1991 y 2005, con el diagnóstico de melanoma nasosinusal. Con una edad media de 70 años y un rango variable entre 51 y 83 años, se registran dos varones y cuatros mujeres. Se realizó cirugía en cuatro pacientes, radioterapia después de una recidiva local reintervenidad en una paciente y quimioterapia en tres pacientes. Tres de los cuatro pacientes intervenidos (75%) tuvieron una recurrencia local. En la actualidad la supervivencia libre de esta enfermedad para esta patología es del 33% (2 de 6). Los melanomas mucosos de cabeza y cuello tienen un tratamieto difícil, alta recurrencia local y pobre pronóstico

Mucosal melanomas of the nasal cavity and paranasal sinuses are rare and agresive neoplasms and carries a bad prognosis. The diagnosis may require confirmatory immunohistochemical stains (S-100 protein, HMB-45, vimentin and cytokeratine). The clinical records of 6 patients with the diagnosis of sinonasal melanomas between 1991 and 2005 were retrospectively reviewed. The mean age was 70 years (range 51 to 83 years), there were 2 men and 4 women. Surgery was performed in four patients, adjuvant radiation therapy was used in one patient after local recurrence and chemotherapy in three patients. Three of four patients (75%) had a recurrence after previous treatment (surgery). The actuarial disease-free survival for this group of 6 is 33.3% (2 of 6). Mucosal melanoma of the head and neck remains a difficult disease to treat, with high locoregional recurrence rates and poor prognosis

[Cutaneous melanoma of the head and neck]. / Melanomas cutaneos de cabeza y cuello.

The clinical records of 20 patients with the diagnosis of cutaneous melanoma of the head and neck treated between 1991 and 2005 were retrospectively reviewed. Advances in diagnostic techniques and treatment have had obvious impact on outcomes in cutaneous melanoma. Cutaneous melanoma of the head of neck is treated with complete surgical resection in early stage disease. Resection margins are determined by the size and depth. Evaluation for regional and distant metastatic disease is necessary in advanced stage disease. Adjuvant therapy may be indicated in regional nodal disease.

Melanomas cutáneos de cabeza y cuello / Cutaneous melanoma of the head and neck

Se realiza una revisión retrospectiva de 20 pacientes diagnosticados de melanomas cutáneos de cabeza y cuello tratados entre 1991 y 2005. Los avances en las técnicas diagnósticas y en el tratamiento han tenido un impacto obvio en los resultados de los melanomas cutáneos. En estadios tempranos se realiza una resección quirúrgica completa. Los márgenes de resección están determinados por la extensión superficial y en profundidad. Cuando la enfermedad se diagnostica en un estadio avanzado es necesario el estudio de las metástasis regionales y a distancia. El tratamiento complementario podría estar indicado cuando existe afectación regional

The clinical records of 20 patients with the diagnosis of cutaneous melanoma of the head and neck treated between 1991 and 2005 were retrospectively reviewed. Advances in diagnostic techniques and treatment have had obvious impact on outcomes in cutaneous melanoma. Cutaneous melanoma of the head of neck is treated with complete surgical resection in early stage disease. Resection margins are determined by the size and depth. Evaluation for regional and distant metastatic disease is necessary in advanced stage disease. Adjuvant therapy may be indicated in regional nodal disease

[Fournier's gangrene secondary to urethral catheterization]. / Gangrena de Fournier secundaria a cateterismo uretral.

OBJECTIVES: We report one case of Fournier's gangrene secondary to urethral catheterization. METHODS: We describe the clinical case, in which the initial cause was identified, and perform a short bibliographic review. RESULTS: Although Fournier's gangrene was initially considered as idiopathic in etiology, currently it is possible to identify the entrance site of the infection. In the present case the insertion of a urethral catheter was the starting mechanism, associated with factors such as diabetes and alcoholism which favour its development. The patient was treated by surgical debridement and partial urethrectomy but finally died. CONCLUSIONS: We want to point out that urethral instrumentation should be done by expert hands due to the severity of possible complications. We should insist in the need of precocious treatment with wide spectrum antibiotics, radical debridement and complete urologic evaluation.

Gangrena de Fournier secundaria a cateterismo uretral / Fournier´s gangrene secondary to urethral catheterization

OBJETIVOS: Mediante el formato de casoclínico presentamos un caso de Gangrena de Fourniersecundario a cateterismo uretral.MÉTODOS: Realizamos una descripción del caso clínicoque nos ocupa, en el que se ha identificado la causa inicial,así como una breve revisión bibliográfica de estapatología.RESULTADO: Aunque la gangrena de Fournier se considerabainicialmente como de etiología idiopática, en laactualidad es posible identificar en la mayoría de loscasos la puerta de entrada de la infección. En nuestrocaso la colocación de un catéter uretral fue el mecanismode inicio de la infección, asociado a dos factores como ladiabetes y el alcoholismo que favorecen el desarrollo dela misma. Se trató mediante desbridamiento quirúrgico yse realizó uretrectomía parcial. El paciente fue finalmenteexitus.CONCLUSIONES: Se debe llamar la atención sobre lanecesidad de que la manipulación uretral sea realizadapor manos expertas dada la gravedad de las posiblescomplicaciones.Hay que insistir en la necesidad de un tratamiento precozcon una cobertura de antibióticos de amplio espectro, undesbridamiento radical y una revisión urológica completa

OBJECTIVES: We report one case ofFournier`s gangrene secondary to urethral catheterization.METHODS: We describe the clinical case, in which theinitial cause was identified, and perform a shortbibliographic review.RESULTS: Although Fournier`s gangrene was initiallyconsidered as idiopathic in etiology, currently it ispossible to identify the entrance site of the infection. Inthe present case the insertion of a urethral catheter wasthe starting mechanism, associated with factors such asdiabetes and alcoholism which favour its development.The patient was treated by surgical debridement andpartial urethrectomy but finally died.CONCLUSIONS: We want to point out that urethralinstrumentation should be done by expert hands due tothe severity of possible complications. We should insistin the need of precocious treatment with wide spectrumantibiotics, radical debridement and complete urologicevaluation

Un caso de osificación endometrial / A case of endometrial ossification

La osificación endometrial es un proceso raro, principalmente asociado con dos situaciones: por un lado, un tumor maligno, fundamentalmente un tumor mülleriano mixto. Por otro, un aborto previo. La patogenia del proceso de osificación no es del todo bien comprendida. Mientras que para algunos representa una mera inclusión de partes fetales en el estroma endometrial, para otros es el resultado de una metaplasia ósea completa. Presentamos un caso de osificación endometrial en una mujer de 27 años, secundario a un legrado previo por aborto, ocurrido 7 meses antes (AU)

Hiperplasia endotelial papilíferaintravascular en el seno de un granulomapiógeno / Intravascular papillary endotelial hiperplasia developped in a pyogenic granuloma

La hiperplasia endotelial papilífera intravascular (HEPIV) representa un proceso vascular benigno de aspecto clínico inespecífico. Histopatológicamente se caracteriza por proliferación papilar de células endoteliales, habitualmente asociada con material trombótico. Puede presentarse en un vaso normal dilatado, o en asociación con diversas lesiones vasculares proliferativas. La importancia de su conocimiento reside principalmente en su diferenciación del hemangiosarcoma. Aportamos un nuevo caso de HEPIV desarrollada en el seno de un granuloma piógeno. Se discuten los aspectos clínicos, histológicos y etiopatogénicos de esta peculiar lesión (AU)

Linfomas MALT CD5+ / CD5+ MALT lymphomas

Propósito: Los linfomas MALT son linfomas de bajo grado y se caracterizan por ausencia de expresión de CDS. No obstante, se han descrito algunos casos CD5 positivos. Material y métodos: Presentamos 6 linfomas MALT de bajo grado, 5 de estómago y uno de colon, CD5 positivos. Resultados: Los pacientes tenían una enfermedad localizada y no había invasión de médula ósea. El seguimiento medio fue de 12,6 meses. Concusiones: Nuestros casos demuestran que los linfomas MALT de bajo grado pueden presentar de forma atípica expresión de CD5 (AU)

[Lipoma of spermatic cord; report of a case]. / Lipoma de cordón espermático; presentación de un caso.

OBJECTIVE: To report an additional case of lipoma of the spermatic cord, an uncommon, silent tumor. METHODS: A case of lipoma of the spermatic cord is described. The patient had presented with an enlarged scrotum with no symptoms. The literature on lipoma of the spermatic cord is briefly reviewed, with special reference to its diagnosis, forms of presentation and treatment. RESULTS: US evaluation demonstrated a mass adhered to the epididymis. An epididymal tumor was suspected and surgical exploration by the inguinal approach was performed. CONCLUSIONS: Lipoma is the most common tumor of the spermatic cord. Its etiology is unknown. It frequently appears in the fourth and fifth decades of life and usually involves the left hemiscrotum. It is silent and is detected by enlargement of the scrotum. The diagnosis is histological supported by US, which offers a reliability of 80%-100%. Treatment is by surgery in all cases.

[Malignant diffuse mesothelioma: contribution of 23 cases]. / Mesotelioma difuso maligno: aportación de 23 casos.

Malignant diffuse mesothelioma is a tumour related to asbestos exposure, more common in males and located primarily in the chest cavity. Its diagnosis requires ruling out other tumours with pleural or peritoneal metastases, a biopsy showing a morphological pattern consistent with mesothelioma and in many cases to perform immunohistochemical markers to rule out an adenocarcinoma. We report here 20 cases of diffuse pleural mesothelioma and three cases of peritoneal mesothelioma in 20 males and three cases of peritoneal mesothelioma in 20 males and three females. Asbestos exposure was observed for 31% of cases. The most common clinical manifestations included headache and dyspnea; interestingly, three cases had hydropneumothorax with poor response to drainage. The diagnostic confirmation was obtained mainly with thoracotomy or laparoscopy biopsies and to rule out an adenocarcinoma immunohistochemical stainings were performed.

[Heterotopic gastric mucosa in the ileum with perforated ulcer]. / Mucosa gástrica heterotópica de íleon con úlcera perforada.

Heterotopic gastric mucosa (HGM) in the small bowel, other than in the Meckel's diverticulum or other congenitally anomalous bowel, is exceedingly rare. A patient with HGM of the small intestine with perforation of the ileum due to ulceration of the adjacent mucosa is presented. The authors remark the importance of the histological criteria to differentiate between true HGM from metaplastic changes, two entities with different behavior and prognostic implications.

[Cardiac myxoma. Anatomo-clinical and immunohistochemical study of 13 cases]. / Mixomas cardíacos. Estudio anatomoclínico e inmunohistoquímico de 13 casos.

INTRODUCTION: Cardiac myxomas are the most frequent benign heart tumors, and have an uncertain histogenesis. An endothelial, subendocardial and an undifferentiated mesenchymal cell origin with vasoformative characteristics has been suggested. The aim of this study was to make a review the cardiac myxomas at our institution paying special attention to its histogenesis. MATERIAL AND METHODS: We reviewed the clinico-pathological features of the 13 cardiac myxomas studied at our hospital, and we stained them with immunohistochemical stains. RESULTS: The average age on presentation was 62.8 years. 12 cases were left atrial, one of them with cerebral metastasis. The average size was 6.3 cm. Microscopically all of them were composed of a myxoid-matrix with spindled cells and small neoformed vessels. The tumors were completely positive for Vimentin and randomly positive with Actin and VIII-RA. CAM 5.2 was strictly negative. CONCLUSION: These results show that these kinds of tumors are neoplasms arising from mesenchymal pluripotential cells which are capable of many types of differentiation (endothelium, etc).

[Undifferentiated small cell carcinoma (oat-cell type) of the colon. Prognostic and therapeutic implications]. / Carcinomas indiferenciados de células pequeñas (Tipo oat-cell) de colon. Implicaciones pronósticas y terapéuticas.

AIM: This report reviews the clinical and pathologic features of four patients with small-cell anaplastic carcinoma (SCAC) of the colon and describes in detail their histological and immunohistochemical characteristics. METHODS: Four patients with a SCAC of the colon diagnosed by conventional light microscopy, immunohistochemistry and ultrastructure were reviewed; clinical presentation, tumor location and spread, surgical procedure, adjuvant therapy and clinical outcome were recorded. RESULTS: There were two women and two man, with an average age of 55 (range, 40-66) years. Two tumors were located in the sigmoid and two in right colon. Cases 1, 3 and 4 were removed at laparotomy by segmental resection along with lymph nodes. All cases had liver metastases. Pathologic study identified out-cell subtype in all cases and two histopathologic patterns: pure SCAC (cases 2 and 4) and mixed exocrine-SCC differentiation (cases 1 and 3). Three patients were treated with cyclophosphamide, cisplatin and etoposide. Two patients (cases 2 and 4) died of widely metastatic disease; cases 1 and 3 had partial remission lasting 9 and 3 months, respectively. CONCLUSIONS: Due to extremely aggressive behavior of colon SCAC with early metastatic spread, CT scans of the chest-abdomen and radionuclide bone scan should be performed. In the presence of metastatic disease, multiagent chemotherapy with combined etoposide and cisplatin should be instituted.