Masa pélvica en posmenopáusica. Linfocele / Pelvic mass in a postmenopausal woman. Lymphocele

Se presenta el caso de una paciente de 60 años, con trasplante renal, con una masa pélvica de aspecto quístico situada entre el canto uterino y el riñón trasplantado. Se describe cómo se llegó al diagnóstico, el tratamiento que se siguió y su evolución (AU)

Müllerian adenosarcoma of the cervix with heterologous elements: report of a case and review of the literature.

BACKGROUND: Müllerian adenosarcoma (MA) is a rare neoplasm composed of benign epithelial and malignant stromal components. Its location in the cervix and the presence of heterologous elements are extremely infrequent (to our knowledge, only 14 more cases have been reported in the English literature). We describe another case of MA of the uterine cervix with heterologous elements and review the clinical and pathological features of these tumors. CASE REPORT: A nulliparous 25-year-old woman was admitted to the hospital because of metrorrhagia and recurrent masses, dependent on the cervix, initially considered endocervical polyps. Microscopically, the last curettage performed revealed a tumor composed of two elements, epithelial and mesenchymal. The epithelial elements were benign endocervical type glands, and the mesenchymal were sarcomatous, containing minor foci of cartilage. A diagnosis of endocervical heterologous adenosarcoma was reached, and a total hysterectomy and bilateral salpingo-oophorectomy were performed. The patient is alive 2 years after the surgical procedure. Neither chemotherapy nor other adjuvant therapies have been administered, and she is clinically free of disease at the moment. CONCLUSION: Because MA with heterologous elements seems to appear at the earliest stages of the reproductive lifespan in women, commonly with a history of recurrent polyps, and because its malignant potential is uncertain, gynecologists and pathologists should be aware and think about the possibility of this tumor. Long-term follow-up is essential and so is the accumulation of individual cases to provide further experience with these unusual neoplasms.

Evaluation of an immunohistochemical test with polyclonal antibodies raised against mycobacteria used in formalin-fixed tissue compared with mycobacterial specific culture.

An immunohistochemical (IH) test (commercially available polyclonal antiserum rabbit anti-Myco-bacterium bovis; DAKO A/S) was used to detect the presence of mycobacteria in 65 formalin-fixed, paraffin-embedded tissue blocks from different organs, showing necrotizing caseous granuloma lesions on hematoxylin and eosin sections from 65 patients. These 65 samples were dyed using an acid-fast fluorescent technique and compared using the immunohistochemical method. Both results were also compared with the mycobacterial cultures. The IH test, compared with the culture, showed a sensitivity (S) of 52%, a specificity (Sp) of 76%, a positive predictive value (PV pos) of 61% and a negative predictive value (PV neg) of 69%. We analyze these data and discuss the possible causes of false-positive and -negative results of the IH test. This rapid test on paraffin embedded tissue seems valuable in the period when waiting for the culture results.

[Cutaneous zygomycosis caused by Rhizopus arrhizus in a surgical wound.]. / Zigomicosis cutánea por Rhizopus arrhizus en herida quirúrgica.

We report a case of cutaneous zygomycosis caused by Rhizopus arrhizus in a surgical wound following colostomy. The patient was a diabetic and in addition presented others risk factors. Zygomycosis was suspected when a necrotic wound surface appeared in the appropiate clinical setting. Diagnosis was confirmed on a combined histological and microbiological study. Extensive surgical resection, high doses of amphotericin B and treatment of the underlying conditions permitted the control of the infection.

Microinvasive follicular thyroid carcinoma detected by fine needle aspiration skeletal metastases. A case report.

BACKGROUND: Fine needle aspiration biopsy (FNAB) for the cytologic diagnosis of bone metastatic lesions is often useful for locating the primary tumor and choosing treatment. The cytologic picture of follicular carcinoma most commonly resembles normal thyroid but may exhibit variable anaplasia. Marginal vacuoles, also known as fire flare-like vacuoles and "flame cells," have been found mainly in toxic goiter but also in some non-toxic goiter. The presence of marginal vacuoles of FNAB of metastatic follicular carcinoma was first reported by Pitts et al in 1988. CASE: A 77-year-old male presented with multiple lytic lesions involving the vertebral bones and ribbons. FNAB of vertebral bone showed tumor cell clusters in a follicular pattern with peripherically situated, pink-stained vacuoles on May-Grünwald-Giemsa stain. CONCLUSION: FNAB is useful in the diagnosis of metastatic thyroid neoplasms. The recognition of marginal vacuoles, along with the appropriate cytologic findings, should provide morphologic clues leading to a suspicion of thyroid neoplasm metastasis in FNAB.

Nodular cervical induration in a violinist. Report of a case with fine needle aspiration cytologic findings.

BACKGROUND: Nodular indurations due to repeat trauma have been previously described. These subcutaneous lesions have been reported as occupational disease in male cyclists ("accessory testicles"). CASE: The cytologic findings from a case of nodular cervical induration in a 47-year-old violinist are reported. It consisted of a well-delimited, nodular lesion in the left submandibular soft parts. Fine needle aspiration cytology (FNAC) smears showed few spindle cells with no atypia and scarce adipocytes in a collagen background. CONCLUSION: FNAC findings are important in the differential diagnosis of cervical nodules. In this case, the subcutaneous nodule was a violinist's occupational disease, for which we propose the term "violinist's nodule."

Cutaneous Alternaria alternata infection successfully treated with itraconazole.

A case of cutaneous alternariosis due to Alternaria alternata in a 47-year-old man who had the CREST (calcinosis, Raynaud's phenomenon, oesophageal dysfunction, sclerodactyly and telangiectasia) syndrome with pulmonary hypertension is presented. The patient, who lived in a rural area and was receiving prostacycline by continuous infusion, prednisone and azathioprine for his underlying disease, showed cutaneous lesions of the lower extremities spreading from the knees to the ankles. The patient was successfully treated with high doses of oral itraconazole.

[Zygomycosis: review of 16 cases]. / Zigomicosis: revisión de 16 casos.

BACKGROUND: Zygomycosis (mucormycosis or phycomycosis) is the infection caused by zygomycetes (non partitioned mycelial fungi, usually saprophytes). All cases of zygomycosis diagnosed in the Hospital 12 de Octubre in Madrid, Spain, from 1976 to 1994 were reviewed. METHODS: The underlying diseases of the patients, the factors favoring infection (alteration of the cutaneous barrier and administration of antimicrobians and corticosteroids) and the possible nosocomial origin of infection were analyzed. RESULTS: Over this period of time, 16 cases of zygomycosis were diagnosed with different clinical forms depending on the route of entry (rhino-orbital-cerebral, cutaneous or disseminated). The species isolated were Rhizopus oryzae, Rhizomucor pusillus, Absidia corymbifera and Rhizopus stolonifer. The species could not be determined in two cases. CONCLUSIONS: The diagnosis of zygomycosis should be based on a combined histological and microbiological study which allows both, differentiation between colonization and infection and isolation of the implicated species. Treatment is that of the underlying diseases, extensive surgical resection and amphotericin B.

Ultrastructural study of a perineurioma with ribosome-lamella complexes.

The participation of the perineurial cell in peripheral nerve tumors is the subject of much debate. The case of a 75-year-old female with a soft tissue tumor on her left shoulder is presented. The tumor had histological, ultrastructural, and immunohistochemical characteristics of a pure perineurial cell neoplasm. Ultrastructurally, distinctive ribosome-lamella complexes were found in the cytoplasm of the perineurial cells. This may be the first time that these structures have been described in perineurioma.

Primary mucinous cystadenocarcinoma of the retroperitoneum. Report of a case and literature review.

Primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is a rare tumour, similar to its ovarian counterpart but without any evidence of ovarian, pancreatic or another extra-retroperitoneal origin. Histogenesis of this neoplasm remains uncertain. Mucinous or coelomic metaplasia of retroperitoneal mesothelium has been recently proposed as its origin. In a 43-year-old woman with a 15-cm cystic lesion in the right retroperitoneum mucinous cystadenocarcinoma was diagnosed, and no primary tumour was identified. Two peritoneal endometriotic foci were found on further surgery. We suggest a common histogenesis for PRMC and these endometriotic foci.