Value of KI-67/MIB-1 labeling index and simpson grading system to predict the recurrence of who grade I intracranial meningiomas compared to who grade II.

Simpson grading of resection has been used as a predictor of intracranial meningioma (IM) recurrence. Histopathological findings, like the Ki-67/MIB-1 labeling index, may be useful in the assessment risk of recurrence. Our objective was to analyze the predictive value of meningioma recurrence using both parameters. We retrospectively studied 322 consecutive patients with histopathological diagnosis of IM WHO grade I and 43 patients with IM WHO grade II in a 13-year period. Multivariate survival analysis was performed. In the WHO grade I IM group, recurrence was observed in 28 patients (8.69%). The Cox regression model for WHO grade I IM, provided a significative hazard ratio (HR) for Ki-67/MIB-1 index ≥3 (HR = 36.35, p < 0.001) and Simpson's grading resection, grade II (HR = 2.03, p = 0.045), grade III (HR = 3.41, p = 0.034) and grade IV (HR = 19.75, p ≥ 0.001). In the WHO grade II IM group, recurrence was observed in 10 patients (23.25%). The Cox regression model for WHO grade II IM, provided a significative hazard ratio (HR) for Ki-67/MIB-1 index ≥3% (HR = 1.66, p < 0.001) and Simpson's grading resection grade III (HR = 3.96, p = 0.027). The Kaplan-Meier survival curve showed a similar distribution of survival between WHO grade I IM with Ki-67/MIB-1 ≥3% and WHO grade II IM. In WHO grade I meningiomas, the Ki-67/MIB-1 index and Simpson grading were both independent predictors of recurrence. A similar management protocol should be advisable for WHO grade I with Ki-67/MIB-1 ≥3% and WHO grade II meningiomas.

Histiocitoma fibroso angiomatoide como simulador de una neoplasia vascular. Dos casos clinicopatológicos / Two cases of angiomatoid fibrous histiocytoma mimicking vascular neoplasia

El histiocitoma fibroso angiomatoide es un tumor de tejidos blandos poco frecuente y con un potencial bajo de malignidad; puede simular una neoplasia de origen vascular y suele afectar las extremidades de niños y adultos jóvenes. Inicialmente fue descrito como una variante maligna del histiocitoma fibroso, planteándose su origen histiocitario, aunque su histogénesis aún es desconocida. La morfología característica es la de una lesión bien circunscrita, con formación de nidos compuestos por células fusiformes a ovales, con un infiltrado inflamatorio periférico, cavidades quísticas y expresión variable de desmina, EMA, CD68 y CD99. Citogenéticamente existen 3 translocaciones t (12:16) (q13:p11), t (12:22) (q13:q12) y t (2:22) (q33:q12), las cuales no son específicas pero sí útiles con una adecuada correlación clinicopatológica. Presentamos 2 casos de 2 niños de 4 y 14 años con una masa quística en el antebrazo y en la cara posterior del muslo, respectivamente (AU)

Angiomatoid fibrous histiocytoma is an uncommon soft tissue tumour of low-grade malignancy found in the limbs of children and young adults. Due to its rarity, it may be misdiagnosed as a reactive lesion or a vascular neoplasm. Initially described as a type of malignant fibrous histiocytoma, suggesting a histiocytic origin although its histogenesis still unknown. Morphologically, it is a well circumscribed lesion with sheets of bland spindle to ovoid cells, peripheral lymphoplasmacytic infiltrate and blood-filled cystic cavities. Half the cases have a strong desmin expression. Cytogenetically, three translocations are found: t (12:16) (q13:p11), t (12:22) (q13:q12) and t (2:22) (q33:q12) that, although nonspecific, are useful when correlated with clinico-pathological data. We describe two cases found in a 4 year old child and a 14 year old adolescent presenting with an enlarging cystic mass in the arm and in the posterior aspect of the thigh respectively (AU)

Biopsia pleural con aguja Tru-cut y citología como primer procedimiento en el estudio del derrame pleural / Tru-Cut Needle Pleural Biopsy and Cytology As the Initial Procedure in the Evaluation of Pleural Effusion

Introducción y objetivos: El estudio del derrame pleural (DP) incluye distintas técnicas, como la biopsia pleural (BP). Los objetivos han sido analizar la rentabilidad diagnóstica de la BP con aguja Tru-cut (BPTC) y determinar si existen factores clínico-radiológicos que permitan indicar la realización de la BPTC como primer procedimiento. Metodología: Estudio retrospectivo de las BPTC de un centro hospitalario (2010-2012). Se excluyeron casos de lesiones pleurales sin DP. Se analizaron variables clínico-radiológicas, la rentabilidad diagnóstica, las complicaciones de la BPTC y los factores asociados con la rentabilidad diagnóstica de la combinación de la BPTC y toracocentesis como primer procedimiento. Resultados: Se revisaron 127 BPTC; el 29,1% fueron DP malignos y en el 18,9% no se llegó a la causa del DP. La rentabilidad diagnóstica de la BPTC para tuberculosis fue del 76,5% (13/17) y para DP malignos, del 54% (20/37). Hubo un 4,7% de complicaciones. En 72 pacientes con diagnóstico final conocido, la BPTC se hizo simultáneamente a la primera toracocentesis. La rentabilidad diagnóstica de la combinación de BPTC/citología como primera técnica fue del 43% (31/72) frente al 12,5% (9/72) de la citología sola (p = 0,01). La única variable predictora para la indicación de BPTC como técnica inicial fue la cuantía del DP > 2/3 (p = 0,04). Conclusiones: La BPTC es segura y ha demostrado una rentabilidad diagnóstica aceptable, sobre todo cuando se combina con la citología simultánea en el estudio del DP de diferentes etiologías. La aplicación de criterios radiológicos podría ayudar a seleccionar en qué pacientes podría estar indicada como primera técnica inicial junto a la toracocentesis

Introduction and objectives: The evaluation of pleural effusion (PE) includes various techniques, including pleural biopsy (PB). Our aim was to study the diagnostic yield of Tru-Cut needle PB (TCPB) and to define clinical/radiological situations in which TCPB might be indicated as an initial procedure. Methodology: Retrospective study of TCPB in a hospital center (2010-2012). Cases of pleural lesions without effusion were excluded. Clinical and radiological variables, diagnostic yield, TCPB complications and factors associated with the diagnostic yield of the combination of TCPB and thoracocentesis as initial procedure were analyzed. Results: One hundred and twenty-seven (127) TCPB were reviewed: 29.1% were cases of malignant PE and in 18.9% the cause of the PE could not be determined. The diagnostic yield of TCPB for tuberculosis was 76.5% (13/17) and 54% (20/37) for malignant PE. Complications occurred in 4.7% of the cases. In 72 patients with a final definitive diagnosis, TCPB was performed at the same time as the initial thoracocentesis. Diagnostic yield for the combination of TCPB/cytology as an initial technique was 43% (31/72) compared to 12.5% (9/72) for cytology only (P = 0.01). The only predictive variable for the indication of TCBP as an initial technique was a PE volume > 2/3 (P = 0.04). Conclusions: TCPB is safe and provides an acceptable diagnostic yield, particularly when combined with simultaneous cytology in the evaluation of PE of various aetiologies. Radiological criteria may help guide the selection of patients who could benefit from this technique as an initial procedure combined with thoracocentesis

Tru-cut needle pleural biopsy and cytology as the initial procedure in the evaluation of pleural effusion.

INTRODUCTION AND OBJECTIVES: The evaluation of pleural effusion (PE) includes various techniques, including pleural biopsy (PB). Our aim was to study the diagnostic yield of Tru-Cut needle PB (TCPB) and to define clinical/radiological situations in which TCPB might be indicated as an initial procedure. METHODOLOGY: Retrospective study of TCPB in a hospital centre (2010-2012). Cases of pleural lesions without effusion were excluded. Clinical and radiological variables, diagnostic yield, TCPB complications and factors associated with the diagnostic yield of the combination of TCPB and thoracocentesis as initial procedure were analysed. RESULTS: One hundred and twenty-seven (127) TCPB were reviewed: 29.1% were cases of malignant PE and in 18.9% the cause of the PE could not be determined. The diagnostic yield of TCPB for tuberculosis was 76.5% (13/17) and 54% (20/37) for malignant PE. Complications occurred in 4.7% of the cases. In 72 patients with a final definitive diagnosis, TCPB was performed at the same time as the initial thoracocentesis. Diagnostic yield for the combination of TCPB/cytology as an initial technique was 43% (31/72) compared to 12.5% (9/72) for cytology only (p=0.01). The only predictive variable for the indication of TCBP as an initial technique was a PE volume>2/3 (P=.04). CONCLUSIONS: TCPB is safe and provides an acceptable diagnostic yield, particularly when combined with simultaneous cytology in the evaluation of PE of various aetiologies. Radiological criteria may help guide the selection of patients who could benefit from this technique as an initial procedure combined with thoracocentesis.

Clasificación inmunofenotípica de 3 casos de adenomas hepatocelulares. Diagnóstico diferencial con hiperplasia nodular focal / Immunophenotypic classification of 3 cases of hepatocellular adenoma. Differential diagnosis with focal nodular hyperplasia

El descubrimiento de los cambios moleculares de los adenomas ha dado lugar a un renovado interés en este tipo de tumor. En la última edición de la OMS de los tumores del tracto gastrointestinal (2010) se incluyen 4 tipos de adenomas hepáticos, bien caracterizados inmunohistoquímicamente, genotípicamente y fenotípicamente, en los que tienen un papel importante los antecedentes clínicos y su comportamiento morfológico para determinar el posterior riesgo de malignidad, fundamentalmente en aquellos con mutación de la b-catenina. La presencia de esteatosis, inflamación y cambios vasculares, unidos a la respuesta frente a la FABP, el amiloide sérico A y la glutamina sintetasa nos permite clasificarlos en 4 grupos: con mutación de HNF1A (H-HCA), con mutación de b-catenina (b-HCA), inflamatorios (IHCA) y sin marcadores. La ausencia de expresión frente al glypican 3, el HSP 70 y el mapeo perivenular frente a la glutamina sintetasa ayuda a excluirlos frente a los hepatocarcinomas bien diferenciados. En este trabajo describimos el comportamiento clínico, morfológico e inmunofenotípico de 3 casos de pacientes diagnosticados de adenomas hepáticos en un período de 2 años (AU)

Interest in adenomas has been renewed by the discovery of the molecular changes in these tumors. The latest World Health Organization publication on gastrointestinal tract tumors (2010) includes four types of hepatic adenomas, which are well characterized immunohistochemically, genotypically and phenotypically. In these tumors, medical history and morphological behavior play an important role in determining the risk of malignancy, mainly in adenomas with a b-catenin mutation. The presence of steatosis, inflammation, vascular changes linked to response to L-FABP, serum amyloid A, and glutamyl synthetase help to classify these tumors into four groups: hepatocellular adenomas with the HNF1A mutation (H-HCA), those with the b-catenin mutation (b-HCA), inflammatory HCA (IHCA), and HCA without markers. The absence of glypican 3 expression, HSP 70 and perivenular mapping of glutamyl synthetase helps to distinguish these tumors from well differentiated hepatocellular carcinoma. We describe the clinical, morphological and immunophenotypic features of three patients diagnosed with hepatic adenomas in a 2-year period (AU)

[Immunophenotypic classification of 3 cases of hepatocellular adenoma. Differential diagnosis with focal nodular hyperplasia]. / Clasificación inmunofenotípica de 3 casos de adenomas hepatocelulares. Diagnóstico diferencial con hiperplasia nodular focal.

Interest in adenomas has been renewed by the discovery of the molecular changes in these tumors. The latest World Health Organization publication on gastrointestinal tract tumors (2010) includes four types of hepatic adenomas, which are well characterized immunohistochemically, genotypically and phenotypically. In these tumors, medical history and morphological behavior play an important role in determining the risk of malignancy, mainly in adenomas with a b-catenin mutation. The presence of steatosis, inflammation, vascular changes linked to response to L-FABP, serum amyloid A, and glutamyl synthetase help to classify these tumors into four groups: hepatocellular adenomas with the HNF1A mutation (H-HCA), those with the b-catenin mutation (b-HCA), inflammatory HCA (IHCA), and HCA without markers. The absence of glypican 3 expression, HSP 70 and perivenular mapping of glutamyl synthetase helps to distinguish these tumors from well differentiated hepatocellular carcinoma. We describe the clinical, morphological and immunophenotypic features of three patients diagnosed with hepatic adenomas in a 2-year period.