Benign renal schwannoma: Case report and literature review.

Renal schwannoma is a very infrequent tumor. It is usually benign and it does not have any specific symptoms or imaging characteristics. Its final diagnosis is usually made after surgery. We present a 66 year-old-man that was referred to our center after the casual finding of a renal mass. With a suspected diagnosis of a renal cell carcinoma, a partial nephrectomy was performed. The histological study revealed the final diagnosis of a benign renal schwannoma.

Valor de la determinación inmunohistoquímica de SMARCA4/BRG1 en el diagnóstico del carcinoma de ovario de célula pequeña variante hipercalcémica. Presentación de dos casos / The value of immunohistochemistry using SMARCA4/BRG1 in the diagnosis of small cell ovarian carcinoma hypercalcemic type. A report of two cases

El carcinoma de células pequeñas de ovario variante hipercalcémica se describe dentro de los tumores de origen histológico incierto. Presentamos 2 casos en mujeres de 32 y 29años de edad, respectivamente. En el momento del diagnóstico ambas pacientes presentaban masas de gran tamaño en las que no era posible realizar cirugía completa. Histológicamente los dos tumores mostraban una proliferación celular difusa de células pequeñas con espacios pseudofoliculares. La imagen microscópica, en ambos casos, planteó diagnóstico diferencial con entidades como el tumor de células de la granulosa tipo adulto o juvenil, el carcinoma de células pequeñas de tipo pulmonar, el disgerminoma, e incluso con un tumor neuroectodérmico periférico. Para ello, la ausencia de inmunotinción para SMARCA4/BRG1 en la totalidad de las células tumorales junto a una imagen histológica concreta son de gran utilidad en el diagnóstico de esta entidad (AU)

Small cell carcinoma of ovary-hypercalcemic type is an undifferentiated carcinoma. We describe two cases in women aged 32 and 29. Both presented with large masses and complete surgical extirpation was impossible. Histologically, the images were similar, with diffuse cell proliferation, accompanied by the presence of follicle-like spaces. In both cases it was necessary to make a differential diagnosis with entities such as adult or juvenile granulosa cell tumour, small cell carcinoma of pulmonary type, dysgerminoma and even peripheral neuroectodermal tumour. The absence of SMARCA4/BRG1 immunostaining proved very useful in the diagnosis of hypercalcemic small cell ovarian carcinoma (AU)

[The value of immunohistochemistry using SMARCA4/BRG1 in the diagnosis of small cell ovarian carcinoma hypercalcemic type. A report of two cases]. / Valor de la determinación inmunohistoquímica de SMARCA4/BRG1 en el diagnóstico del carcinoma de ovario de célula pequeña variante hipercalcémica. Presentación de dos casos.

Small cell carcinoma of ovary-hypercalcemic type is an undifferentiated carcinoma. We describe two cases in women aged 32 and 29. Both presented with large masses and complete surgical extirpation was impossible. Histologically, the images were similar, with diffuse cell proliferation, accompanied by the presence of follicle-like spaces. In both cases it was necessary to make a differential diagnosis with entities such as adult or juvenile granulosa cell tumour, small cell carcinoma of pulmonary type, dysgerminoma and even peripheral neuroectodermal tumour. The absence of SMARCA4/BRG1 immunostaining proved very useful in the diagnosis of hypercalcemic small cell ovarian carcinoma.

Arteriovenous Malformations of the Temporalis Muscle: A Comprehensive Review.

Arteriovenous malformations of the temporalis muscle (TM-AVMs) are rare lesions commonly considered as a variant of scalp AVMs. A study was designed in order to analyze TM-AVMs features and to confirm them as a certain entity different from scalp AVMs. Seven TM-AVMs cases (5 from literature plus 2 from our database) were studied. Clinical, epidemiological, radiological, and therapeutic data were analyzed and compared to common scalp AVMs features. All TM-AVMs presented as large soft tumor-like masses on the temporal region (mean diameter: 6 cm). Pain was referred in half of cases, while overlying cutaneous stigmas were described only once. No masticatory malfunction was reported. TM-AVMs tend to appear in young patients (mean: 29 yr), commonly as longstanding and slow-evolving lesions (mean evolution time before diagnosis: 5 yr). All cases displayed a diffuse slow-flow blush on angiogram. All TM-AVMs were completely located within the TM, with no involvement of scalp or bone. The pathological analysis of all cases demonstrated the presence of striate muscular bundles intermingled with fairly mature arterial and venous vessels. No clearly distorted vessel was found within the TM-AVMs. Surgery was performed for all cases with complete removal. Preoperative embolization was done in 4 cases to reduce blood loss during surgery. No clinical/radiological recurrence was reported. Opposite to TM-AVMs, scalp AVMs commonly present as high-flow lesions with no evident tumor mass, mainly located in the subcutaneous tissue. TM-AVMs present clearly distinct features compared to scalp AVMs, for which they should be considered as a certain pathological entity and not as a variant of scalp AVMs.

Pseudotumor gástrico ulcerado con afectación pancreática por enfermedad relacionada con inmunoglobulina G4: descripción de un caso y revisión de la literatura / An ulcerated gastric ulcer and pseudotumour with pancreatic affectation associated with immunoglobulin G4-related disease: a case report and literature review

Presentamos el caso de un varón de 67 años con una úlcera gástrica de 9 años de evolución, con clínica de hematemesis y melenas, que a nivel histológico mostró lesiones de fibrosis y acúmulos de células plasmáticas con positividad para inmunoglobulina G4, sin evidencia de malignidad. Esta lesión alcanzaba al páncreas, donde se observaron lesiones histológicas superponibles a las gástricas. El diagnóstico final fue el de pseudotumor gástrico ulcerado con afectación pancreática por enfermedad relacionada con inmunoglobulina G4 (AU)

We report the case of a 67 year old male who presented with a nine year history of a gastric ulcer with symptoms of hematemesis and melena. Histological analysis identified fibrotic lesions and the accumulation of immunoglobulin G4-positive plasma cells with no evidence of malignancy. The lesion extended into the pancreas, where histological lesions and gastric lesions were also observed. This is a case of an ulcerated gastric ulcer and pseudo-tumor with pancreatic affection that is associated with immunoglobulin G4-related disease (AU)

An ulcerated gastric ulcer and pseudotumour with pancreatic affectation associated with immunoglobulin G4-related disease: a case report and literature review.

We report the case of a 67 year old male who presented with a nine year history of a gastric ulcer with symptoms of hematemesis and melena. Histological analysis identified fibrotic lesions and the accumulation of immunoglobulin G4-positive plasma cells with no evidence of malignancy. The lesion extended into the pancreas, where histological lesions and gastric lesions were also observed. This is a case of an ulcerated gastric ulcer and pseudo-tumor with pancreatic affection that is associated with immunoglobulin G4-related disease.

Endometrial stromal nodule of the vaginal wall with a review of vulvovaginal endometrial stromal neoplasms.

•It is reported the first endometrial stromal nodule (ESN) in the vagina.•This is an excepcionall ESN because it was not associated with endometriosis•It was successfully treated by local resection.•Primary vulvovaginal endometrial stromal neoplasms are rare (only 5 reported).

Algunos conceptos básicos de la teoría de colas aplicables en la planificación de un servicio de anatomía patológica / Some basics concepts of queueing theory applicable in the planning of a pathology department

Introducción: Nos planteamos el problema: ¿cuál es el número adecuado de facultativos en un servicio de anatomía patológica (SAP) para responder sin demora al número de solicitudes de estudio que se reciben? Material y métodos: Aplicamos conceptos básicos de teoría de colas y motivamos al lector a introducirse en ellos. Resultados y discusión: Un SAP funciona como un sistema de colas y se ajusta a los modelos de cola infinita con uno (M/M/1) y, todavía mejor, con múltiples recursos (M/M/m). El número de facultativos (m) ha de cumplir: m » velocidad de llegada de biopsias al SAP/velocidad de cierre de biopsias por facultativo Conclusiones: Como sistema de colas, un SAP solo es viable si su capacidad de respuesta es mayor que las necesidades planteadas por la demanda. El modelo de múltiples recursos (facultativos) amortigua mejor los aumentos sostenidos de la demanda (AU)

Introduction: The problem of the optimal number of pathologists required to provide a rapid response to the volume of studies requested is considered. Material and methods: The basic concepts of the queueing theory are applied and recommendations for their use are made. Results and discussion: Pathology departments (PD) work as a queuing system and adapt to infinite queue models with a (M/M1) or, preferably, multiple servers (M/M/m). The number of pathologists (m) must achieve: m » velocity of arrival of biopsies to the PD/velocity of completion of biopsy reports by pathologists. Conclusions: Like a queueing system, a PD is viable only if its capacity of response is greater than the demand. The model of multiple resources (pathologists) better absorbs a sustained growth in demand (AU)

Un método gráfico de análisis de costes asociados a los falsos resultados de una prueba diagnóstica / A graphical method for analyzing the cost of a diagnostic test, subject to the sensitivity and specificity of the test

Objetivo. Presentar un método de análisis gráfico de costes ocasionados por los falsos positivos (FP) y falsos negativos (FN) de una prueba diagnóstica. Material y métodos. Construimos una función de costes ligada a la sensibilidad (S) y a la especificidad (E) de la prueba diagnóstica. A partir de esta función obtenemos líneas de isocoste, cuya pendiente es la relación coste FP/coste FN. Representamos cada prueba diagnóstica en el espacio ROC como el punto (1-E, S). Resultados. Las líneas de isocoste permiten visualizar si el gasto asociado a FP y FN de una nueva prueba diagnóstica es menor o igual que el de la antigua. Conclusiones. El análisis gráfico de la función de costes de una prueba diagnóstica ayuda a decidir su introducción o su rechazo(AU)

Objective. We present a graphical method for analyzing the cost related to false positive (FP) and false negative (FN) results of diagnostic tests. Material and methods. We created a function relating cost to the sensitivity (S) and specificity (E) of the diagnostic test. Isocost straight lines were obtained, the gradient of which represents the ratio of false positive cost/false negative cost. The various diagnostic tests are plotted in the ROC space as the point (1-E, S). Results. Isocost straight lines allowed us to see if the cost of a new test is lower or the same as previous tests. Conclusions. Graphical analysis of the cost of a diagnostic test is helpful in deciding whether or not to introduce new diagnostic tests(AU)

Chronic spontaneous diploic hematoma.

The authors report the case of a 23-year-old woman with café-au-lait spots and axillary and inguinal freckling who presented with a diploic chronic spontaneous hematoma of the left parietal bone. To the authors' knowledge, this case represents the first description of a diploic hematoma in a patient with stigmata of neurofibromatosis Type 1 unrelated to head trauma. Plain skull radiography showed an osteolytic lesion with well-circumscribed margins, corresponding to the hematoma, together with exuberant perilesional vascular markings. Angiography demonstrated an incidental aneurysm of the left supraclinoidal internal carotid artery and an unusual cortical venous drainage toward the diploic vessels. The blood flow of these vessels on the right hemicranium was sluggish and exhibited enlarged diploic venous lacunas. The authors hypothesize that the hematoma was formed by both an abnormal venous drainage toward the diploic vascular net, together with a vasculopathy that caused stenosis and obstruction of the normal drainage pathways from these vessels.

Spinal dermal sinus and pseudo-dermal sinus tracts: two different entities.

BACKGROUND: Occult spinal dysraphism (OSD) encompasses various conditions. A dermal sinus tract (DST) consists of a duct communicating to the skin with deep structures that carries an important risk of infection. A different lesion consisting of a translucent skin opening and a fibrous tract that lacks a lumen can also be found in OSD. We termed this lesion pseudo-dermal sinus tract. PATIENTS AND METHODS: We reviewed clinical features of 20 patients with spinal skin orifices. The patients were classified into two categories: group 1 comprised children with true DST and group 2 included patients with skin dimples resembling a DST. AIMS: The aim of this study was to analyze differential features of patients in these two groups as they behaved dissimilarly in regard to clinical significance and outcomes, especially those concerning infectious risk. RESULTS: Children of group 1 (n = 8) presented with tiny skin orifices and with superficial or deep infection. In contrast, group 2 (n = 12) mostly manifested with neurological symptoms. No patient in group 2 developed an infection preoperatively. In both groups, magnetic resonance showed tracts that ended in different structures. Histopathology of the lesions were dissimilar, those of group 1 being hollow tubular structures lined by epithelium while those of group 2 being solid tracts of fibrous connective tissue. CONCLUSIONS: DST constitutes a clinicopathological diagnosis. Although sharing some common cutaneous and neuroimaging findings, both groups behaved differently. Patients of group 1 tended to show up with infection requiring urgent surgery. Patients of group 2 often presented with neurological manifestations and skin lesions, but needed no immediate operation.

Embryonal tumor with abundant neuropil and true rosettes (ETANTR): a new distinctive variety of pediatric PNET: a case-based update.

BACKGROUND: Embryonal central nervous system (CNS) tumors are currently classified into three types: medulloblastoma, atypical rhabdoid/teratoid tumors, and primitive neuroectodermal tumor (PNET). A distinctive subtype of PNET called "embryonal tumor with abundant neuropil and true rosettes" (ETANTR) was reported in 2000. DISCUSSION: ETANTR is a recently described variety of PNET that combines microscopic features of neuroblastoma and ependymoblastoma, demonstrating areas of fine fibrillary neuropil intermingled with cellular zones and ependymoblastic rosettes. It has been suggested that this neoplasm should be considered as a separate entity. ETANTR is an eminently pediatric tumor that has been reported exclusively in children younger than 4 years. ILLUSTRATIVE CASES: A 9-month-old girl underwent subtotal resection of a brainstem neoplasm. A 23-month-old girl was submitted to surgery for a frontoparietal tumor. In both instances, the histopathological diagnosis confirmed ETANTR. Both children were treated with chemotherapy and one with radiotherapy. Death in both patients occurred after a mean period of 10 months. CONCLUSIONS: By reporting these two new instances of ETANTR, we want to contribute to the knowledge of this highly malignant CNS embryonal neoplasm that occurs only in young children, given its present lethal prognosis, the scarcity of reported cases, and the lack of treatment guidelines.

Foreign body reactions causing spinal cord tethering: a case-based update.

BACKGROUND: Patients operated on for myelomeningocele (MMC) and lipomeningocele (LMC) can suffer from late functional worsening that, in many cases, is due to spinal cord tethering by the post-repair scarring process. ILLUSTRATIVE CASES: In this case-based update, we report two patients operated on for MMC and LMC, respectively, who presented the clinical manifestations of spinal cord tethering, which we attributed to severe foreign body reactions to the materials used at their primary back surgery. In the first case, the cause of the tethering was an intense fibrotic scar around the silk suture used at the initial MMC repair, while in the second one, it was due to a fibrotic mesh containing the lyophilized dural graft implanted for LMC surgery. After a search of the current literature, we were unable to find cases of spinal cord tethering related to excessive scarring after dural repair with foreign materials used for the surgical correction of spinal dysraphism. DISCUSSION AND CONCLUSIONS: The pathogenesis of spinal cord tethering in our instances closely relate with the histopathologically observed intense foreign body reaction around the materials used at the primary back surgery. We recommend avoiding as much as possible the use of foreign materials during the initial repair of spinal dysraphism.

Hidradenocarcinoma originado en hidradenoma nodular: descripción de un caso / Hidradenocarcinoma arising in a nodular hidradenoma: a case report

El hidradenoma nodular maligno o hidradenocarcinoma es un tumor maligno de glándula sudorípara, extremadamente infrecuente, que generalmente surge de novo aunque se han descrito unos pocos casos surgidos sobre un hidradenoma nodular. El comportamiento biológico de este tipo de neoplasias es altamente agresivo con recurrencias locales y metástasis ganglionares en un alto porcentaje.El tratamiento de elección de estos tumores es la escisión quirúrgica con márgenes amplios si bien en la enfermedad metastásica estaría indicado el tratamiento neoadyuvante con quimio y/o radioterapia. Recientemente, se ha propuesto el tratamiento con trastuzumab para los casos con sobreexpresión de Her-2/neu así como la realización de ganglio centinela.Presentamos el caso de un hidradenocarcinoma surgido en un hidradenoma nodular en piel de región intermamaria en una mujer de 55 años. El tumor fue tratado con escisión amplia y se realizó ganglio centinela. La paciente recibió radioterapia posquirúrgica sin que haya evidencia de metástasis tras un año de seguimiento(AU)

Malignant nodular hidradenoma or hidradenocarcinoma is a rare, malignant tumour of sweat glands that usually arises de novo, although a few cases originating in a nodular hidradenoma have been reported. They are very aggressive neoplasms that recur locally and frequently metastasize to the lymph nodes. The treatment of choice is surgical excision with wide margins, followed by chemotherapy and/or radiotherapy when metastases have occurred. Recently, sentinel lymph node sampling and treatment with Trastuzumab have been proposed for cases with overexpression of Her-2/neu. A case of hidradenocarcinoma arising in a nodular hidradenoma of the breast skin of a 55 year old woman is presented. The tumour was surgically removed with a wide excision and the patient treated with postoperative radiotherapy. She is alive and well without evidence of metastatic disease one year later(AU)

Glioma cordoide del III ventrículo: descripción de un nuevo caso y revisión de la literatura / Chordoid glioma of the third ventricle: case report and literature review

El glioma cordoide del tercer ventrículo es un tumorcerebral poco frecuente, de reciente descripción, localizadoen la región hipotalámica - III ventrículo. Hasta la fecha, tansólo hay 56 casos publicados desde que se describiera porprimera vez en 1998 por Brat y cols. Histológicamente, eltumor está compuesto por células poligonales dispuestas ennidos o cordones, inmersas en una matriz mucoide con unintenso infiltrado inflamatorio linfoplasmocitario. Las célulasneoplásicas coexpresan característicamente marcadoresinmunohistoquímicos de Proteína Ácida Gliofibrilar(PAGF), Citoqueratinas, Vimentina y CD-34. A nivel ultraestructuralmuestra características de diferenciación ependimariay recientemente también se han identificado alteracionesgenéticas características distintas a las de los gliomas. Laextirpación tumoral fue incompleta tras un abordaje anterior.Nosotros describimos un nuevo caso de este tumor en unvarón de 26 años y revisamos la literatura(AU)

Chordoid glioma of the third ventricle is an infrecuentbrain tumor, located the third ventricle-hypothalamicregion. Described for the first time by Brat in 1998, only 56cases have been described in the literature. Histologically,the tumor consisted of polygonal epithelioid cells embeddedin a mucinous matrix with a prominent lymphoplasmacyticinfiltrate. The tumor cells expressed Glial Fibrillary AcidicProtein (GFAP), Cytokeratins, Vimentin and CD-34. Thisneoplasm exhibits features of ependymal differentiation onultrastructural examination. Another authors also suggest adistinct genetic origin from other gliomas with specificmolecular characterization. An incomplete resection wasperformed via an anterior approach. A case in a 26 years oldman is reported and a review of the literature is included(AU)

Diagnósticos Críticos en Anatomía Patológica: una contribución a la seguridad clínica del paciente hospitalizado / Critical diagnoses in pathology: a contribution to the clinical safety of the hospitalized patient

Los Diagnósticos Críticos en Anatomía Patológica han sido recientemente introducidos y son equiparables a los establecidos a nivel clínico, de forma que, situaciones clínicas concretas pueden precisar de un diagnóstico rápido (ya sea por parte del patológo o del citopatólogo) y del contacto urgente con el clínico con el fin de facilitar una intervención clínica urgente o instaurar un tratamiento determinado, de los que el paciente se beneficiaría. Basándonos en la experiencia diaria, presentamos diferentes situaciones clínico-patológicas en las que el diagnóstico es crítico (AU)

Critical diagnoses in surgical pathology and cytology have recently been introduced in a similar way to critical values in clinical pathology (laboratory medicine). Thus, some situations require that the clinician be informed urgently of the diagnosis in order to facilitate rapid clinical intervention or treatment and ensure that the patient receives optimal care. Based on day to day experience, this article provides examples of different situations in which critical diagnoses in pathology are necessary (AU)

Carcinoma intraductal de glándula salival menor. Descripción de un caso en paladar blando / Intraductal carcinoma in minor salivary gland. A case report in soft palate

El carcinoma intraductal de glándula salival mayor es un tumor agresivo tanto clínica como citológicamente. En glándula salival menor, son muy raros y a pesar de tener una citología agresiva son tumores con buen comportamiento clínico. Presentamos un caso en paladar blando, fácilmente diagnosticable por la presencia de abundantes células mioepiteliales que rodean conductos con células epiteliales grandes, atípicas, con mitosis y necrosis. Un año después de la extirpación permanece asintomático

Intraductal carcinoma of major salivary gland is a very agressive neoplasm in clinical and cytological grounds. In minor salivary gland it´s very rare and have a good clinical evolution irrespective of the cytological agressivity. We report a case in soft palate, without diagnostics problems by the easy demonstration of myoepithelial cells around all epithelial units.The epithelial cells are large, atypical with mitosis and necrosis.A year later the patient is well

Hallazgos poco frecuentes en citología del aparato respiratorio (presentación de 4 casos) / Infrequent findings in respiratory system cytology. Presentation of 4 cases

Presentamos cuatro casos clínico-citológicos del aparato respiratorio, poco habituales en la práctica diaria, donde la morfología además de las técnicas especiales, son suficientes para llegar a un diagnóstico correcto (Strongyloides stercoralis, Cuerpos ferruginosos, Aspergillus y virus del herpes en carcinoma epidermoide)

Four clinical-cytological cases of the respiratory apparatus appear, little habitual actually daily, where the morphology in addition to the special techniques, is sufficient to arrive at a correct diagnosis (Strongyloides stercoralis, ferruginous Bodies, Aspergillus and virus herpes in epidermoide carcinoma)

Hallazgos poco frecuentes en citología del aparato respiratorio (presentación de 4 casos) / Infrequent findings in respiratory system cytology. Presentation of 4 cases

Presentamos cuatro casos clínico-citológicos del aparato respiratorio, poco habituales en la práctica diaria, donde la morfología además de las técnicas especiales, son suficientes para llegar a un diagnóstico correcto (Strongyloides stercoralis, Cuerpos ferruginosos, Aspergillus y virus del herpes en carcinoma epidermoide)

Four clinical-cytological cases of the respiratory apparatus appear, little habitual actually daily, where the morphology in addition to the special techniques, is sufficient to arrive at a correct diagnosis (Strongyloides stercoralis, ferruginous Bodies, Aspergillus and virus herpes in epidermoide carcinoma)

Poorly differentiated primary monophasic synovial sarcoma of the lung.

Primary monophasic synovial sarcoma of the lung is rarely seen in clinical practice. We report the case of a 60-year-old male who underwent a left lower lobectomy for lung sarcoma. The patient received adjuvant therapy after surgery. Diagnosis was confirmed with SYT-SSX2 translocation detection.