SDHB exon 1 deletion: A recurrent germline mutation in Colombian patients with pheochromocytomas and paragangliomas.

Pheochromocytomas (PCCs) and paragangliomas (PGLs) (known as PPGL in combination) are rare neuroendocrine tumors of the adrenal medulla and extra-adrenal ganglia. About 40% of the patients with PPGL have a hereditary predisposition. Here we present a case-series of 19 unrelated Colombian patients with a clinical diagnosis of PPGL tumors that underwent germline genetic testing as part of the Hereditary Cancer Program developed at the Instituto Nacional de Cancerología, Colombia (INC-C), the largest reference cancer center in the country. Ten of 19 patients (52.63%) were identified as carriers of a pathogenic/likely pathogenic (P/LP) germline variant in a known susceptibility gene. The majority of the P/LP variants were in the SDHB gene (9/10): one corresponded to a nonsense variant c.268C>T (p.Arg90*) and eight cases were found to be carriers of a recurrent CNV consisting of a large deletion of one copy of exon 1, explaining 42% (8/19) of all the affected cases. Only one additional case was found to be a carrier of a missense mutation in the VHL gene: c.355T>C (p.Phe119Leu). Our study highlights the major role of SDHB in Colombian patients with a clinical diagnosis of PGL/PCC tumors and supports the recommendation of including the analysis of large deletions/duplications of the SDHB gene as part of the genetic counselling to improve the detection rate of hereditary cases and their clinical care.

Greetings from belowground: two new species of truffles in the genus Pachyphlodes (Pezizaceae, Pezizales) from México.

Pachyphlodes is a lineage of ectomycorrhizal, hypogeous, sequestrate ascomycete fungi native to temperate and subtropical forests in the Northern Hemisphere. Pachyphlodes species form ectomycorrhizae mainly with Fagales hosts. Here we describe two new species of Pachyphlodes, P.brunnea, and P.coalescens, based on morphological and phylogenetic analysis. Pachyphlodesbrunnea is distributed in the states of Tamaulipas and Nuevo León in northern México, occurring with Quercus and Juglans species. It is characterized by its dark brown peridium, white gleba, and spores with capitate columns. Pachyphlodescoalescens is distributed in the states of Michoacán and Tlaxcala in central and southwestern México co-occurring with Quercus and is distinguished by its reddish-brown peridium, light yellow gleba, and spore ornamentation. Both species, along with P.marronina, constitute the Marronina clade. This clade contains North American species characterized by a brown peridium and spores ornamented with capitate spines to coalesced spine tips that form a partial perispore.

Two new species of Tuber previously reported as Tuber malacodermum.

Recent collections of Tuber malacodermum from Spain, Corsica, and Mexico were compared in an integrative morphological and molecular phylogenetic framework, including study of type material. Phylogenetic analyses of nuc rDNA internal transcribed spacer (ITS1-5.8S-ITS2 = ITS) and nuc 28S rDNA (28S) regions showed that specimens from Spain and Corsica form a monophyletic group closely related to T. melosporum and T. rufum, whereas Mexican specimens form a clade within the T. lyonii species complex. Peridium and ascospore morphology contribute clear morphological distinctions among specimens from Spain and Corsica, Mexico, and the type specimen of T. malacodermum. Based on results of the morphological and molecular phylogenetic analyses, we assigned the specimens from Spain and Corsica to Tuber pustulatum, sp. nov., and the Mexican specimens to Tuber theleascum, sp. nov. We restrict T. malacodermum to the sole type material. Formal descriptions and illustrations of these taxa are provided.

Historical biogeography and diversification of truffles in the Tuberaceae and their newly identified southern hemisphere sister lineage.

Truffles have evolved from epigeous (aboveground) ancestors in nearly every major lineage of fleshy fungi. Because accelerated rates of morphological evolution accompany the transition to the truffle form, closely related epigeous ancestors remain unknown for most truffle lineages. This is the case for the quintessential truffle genus Tuber, which includes species with socio-economic importance and esteemed culinary attributes. Ecologically, Tuber spp. form obligate mycorrhizal symbioses with diverse species of plant hosts including pines, oaks, poplars, orchids, and commercially important trees such as hazelnut and pecan. Unfortunately, limited geographic sampling and inconclusive phylogenetic relationships have obscured our understanding of their origin, biogeography, and diversification. To address this problem, we present a global sampling of Tuberaceae based on DNA sequence data from four loci for phylogenetic inference and molecular dating. Our well-resolved Tuberaceae phylogeny shows high levels of regional and continental endemism. We also identify a previously unknown epigeous member of the Tuberaceae--the South American cup-fungus Nothojafnea thaxteri (E.K. Cash) Gamundí. Phylogenetic resolution was further improved through the inclusion of a previously unrecognized Southern hemisphere sister group of the Tuberaceae. This morphologically diverse assemblage of species includes truffle (e.g. Gymnohydnotrya spp.) and non-truffle forms that are endemic to Australia and South America. Southern hemisphere taxa appear to have diverged more recently than the Northern hemisphere lineages. Our analysis of the Tuberaceae suggests that Tuber evolved from an epigeous ancestor. Molecular dating estimates Tuberaceae divergence in the late Jurassic (~156 million years ago), with subsequent radiations in the Cretaceous and Paleogene. Intra-continental diversification, limited long-distance dispersal, and ecological adaptations help to explain patterns of truffle evolution and biodiversity.

New North American truffles (Tuber spp.) and their ectomycorrhizal associations.

Recent surveys of belowground fungal biodiversity in México and USA have revealed many undescribed truffle species, including many in the genus Tuber. Here we describe seven new species: Tuber beyerlei, T. castilloi, T. guevarai, T. lauryi, T. mexiusanum, T. miquihuanense and T. walkeri. Phylogenetic analyses place these species within the Maculatum group, an understudied clade of small truffles with little apparent economic value. These species are among the more taxonomically challenge-ing in the genus. We collected Tuber castilloi, T. mexiusanum and T. guevarai as fruit bodies and ectomycorrhizae on Quercus spp. in forests of eastern México. Tuber mexiusanum has a particularly broad geographic range, being collected in eastern USA under Populus deltoides and in Minnesota and Iowa in mixed hardwood forests. T. walkeri is described from the upper midwestern USA, and T. lauryi and T. beyerlei occur in the western USA.

Follow-up of the tumor load in patients with de novo chronic myeloid leukemia and in complete cytogenetic remission treated with imatinib in Colombia / Seguimiento de la carga tumoral en pacientes con leucemia mielode crónica de novo y en remisión citogenética completa tratados con imatinib en Colombia

ABSTRACT Objective: To evaluate the hematological, cytogenetic, and molecular responses in Colombian patients with CML chronic myeloid leukemia (CML) treated with imatinib. Methods: Two groups of patients, one with the novo diagnostic and another in state of complete cytogenetic remission were followed for 12 months with quantitative PCR evaluations every three months and with chromosomal analysis every 6 months. Results: The group with the novo diagnosis showed 50% of complete cytogenetic remission at 12 months while the other 50% were considered to have primary resistance. Respect the molecular analysis, 10.5% of the patients reached undetectable BCR-ABL transcripts at 12 months. In the complete cytogenetic remission group, 10.6% lost the state of complete cytogenetic remission at 12 months, 50% reached undetectable BCR-ABL transcripts but 10% showed levels higher than 10%, which in our standardization was equal to no molecular response. Conclusions: Despite having received the conventional dosages of 400 mg/day of imatinib, the cytogenetic and molecular responses obtained in our group of Colombian patients with CML, were lower than those in other international studies.

RESUMEN Objetivo. Evaluar las respuestas hematológica, citogenética y molecular en pacientes colombianos con leucemia mieloide crónica tratados con imatinib. Métodos. Dos grupos, uno con diagnóstico de novo y otro en el estado de remisión citogenética completa, se siguieron mediante estudios citogenéticos en médula ósea cada 6 meses y reacción en cadena de la polimerasa cuantitativa (Q-PCR) cada 3 meses. Resultados. En el grupo de novo, el 50% alcanzó el estado de remisión citogenética completa mientras el otro 50% se consideró con Resistencia primaria. Respecto al análisis molecular, 10.5% mostró transcriptos BCR-ABL indetectables. En el grupo de remisión citogenética completa, 10.6% perdió la condición de remisión citogenética completa, en el 50% los transcriptos BCR-ABL fueron indetectables mientras el 10% mostró niveles por encima del 10% considerado como no respuesta molecular, según nuestra estandarización. Conclusión. Aunque los pacientes recibieron las dosis convencionales de 400 mg/día de imatinib, las tasas de respuesta citogenética y molecular en los pacientes colombianos fueron menores que las obtenidas en estudios internacionales.

Follow-up of the tumor load in patients with de novo chronic myeloid leukemia and in complete cytogenetic remission treated with imatinib in Colombia.

OBJECTIVE: To evaluate the hematological, cytogenetic, and molecular responses in Colombian patients with CML chronic myeloid leukemia (CML) treated with imatinib. METHODS: Two groups of patients, one with the novo diagnostic and another in state of complete cytogenetic remission were followed for 12 months with quantitative PCR evaluations every three months and with chromosomal analysis every 6 months. RESULTS: The group with the novo diagnosis showed 50% of complete cytogenetic remission at 12 months while the other 50% were considered to have primary resistance. Respect the molecular analysis, 10.5% of the patients reached undetectable BCR-ABL transcripts at 12 months. In the complete cytogenetic remission group, 10.6% lost the state of complete cytogenetic remission at 12 months, 50% reached undetectable BCR-ABL transcripts but 10% showed levels higher than 10%, which in our standardization was equal to no molecular response. CONCLUSIONS: Despite having received the conventional dosages of 400 mg/day of imatinib, the cytogenetic and molecular responses obtained in our group of Colombian patients with CML, were lower than those in other international studies.

OBJETIVO: Evaluar las respuestas hematológica, citogenética y molecular en pacientes colombianos con leucemia mieloide crónica tratados con imatinib. MÉTODOS: Dos grupos, uno con diagnóstico de novo y otro en el estado de remisión citogenética completa, se siguieron mediante estudios citogenéticos en médula ósea cada 6 meses y reacción en cadena de la polimerasa cuantitativa (Q-PCR) cada 3 meses. RESULTADOS: En el grupo de novo, el 50% alcanzó el estado de remisión citogenética completa mientras el otro 50% se consideró con Resistencia primaria. Respecto al análisis molecular, 10.5% mostró transcriptos BCR-ABL indetectables. En el grupo de remisión citogenética completa, 10.6% perdió la condición de remisión citogenética completa, en el 50% los transcriptos BCR-ABL fueron indetectables mientras el 10% mostró niveles por encima del 10% considerado como no respuesta molecular, según nuestra estandarización. CONCLUSIÓN: Aunque los pacientes recibieron las dosis convencionales de 400 mg/día de imatinib, las tasas de respuesta citogenética y molecular en los pacientes colombianos fueron menores que las obtenidas en estudios internacionales.

Actualidad en la patología y tratamiento de los gangliogliomas: un tumor no tan benigno / Update on treatment and pathology of gangliogliomas: a not so benign tumor

Los gangliogliomas (GG) se definen como tumores mixtos conformados por células de glía y neurona; son considerados como benignos, sin embargo hay reportes de GG que se diferencian por ser tumores de alto grado tipo glioblastoma; este cambio se observa más en el componente glial, pero el componente neuronal puede tenerlo. La patogénesis de los GG se conoce mejor, parte de esto esta representado por la identificación de cambios en los genes de p53 y la definición de marcadores de diferenciación tumoral como el Ki 67, ambos importantes para el pronóstico y las decisiones terapéuticas. El tratamiento se basa en una resección quirúrgica amplia considerando la morbilidad del paciente; la quimioterapia y la radioterapia son opciones que han mejorado la sobrevida de los pacientes con GG anaplásicos. Este manuscrito revisa los cambios en la clasificación histológica y los aportes hechos por la inmunohistoquímica, la genética y las opciones de tratamiento en los GG. Se presentan dos casos de pacientes, con diferentes edades, para ilustrar el GG benigno y el que se diferencia haciaun tumor de alto grado tipo glioblastoma multiforme, con una detallada revisión patológica.

Gangliogliomas (GG) are defined as mixed tumors compose from glia and neurons usually with a benign biologicalbehavior. However, there are reports of GG that differentiate toward high grade glioblastoma. This change is observed more frequently in the glial component but neuronal part could be also involved.Pathophysiology is better understood currently, part of this is represented by the identification of changes in genesat p53 and the definition of tumoral markers like Ki 67, both of them important at the moment of prognosisdefinition and therapeutic decisions.Treatment of these tumors implies broad surgical resection due to high morbidity of them. Chemotherapy andradiotherapy are options which improve survival of patients who suffer anaplastic varieties. This paper review recent changes in histological classification and recent contributions on histology, inmunochemistry, genetics and treatment. In addition we discuss two cases in two different ages and stages showing the usual benign behavior and the transformation to a multiform gliobastoma, along with a detailed pathological review.

The impact of acute lymphoblastic leukemia treatment on central nervous system results in Bogota, Colombia.

To improve the outcome of children with acute lymphoblastic leukemia (ALL) treated at the National Cancer Institute, Bogota, Colombia, a protocol based on the BFM-90 (Berlin, Frankfurt, Munster study) and the LSA2L2 regimens was implemented in the year 1993. The patients were classified as being standard risk (SR) or high risk (HR) according to clinical criteria, to which cytogenetic information and day-8 prednisone response were also added. A 123-patient cohort entered the study, 18 of them being considered SR and 105 HR. There was a 94% 10 years' event-free-survival rate for the SR group and 36% for the HR group. Decreased induction death rate (7% vs. 14%), increased complete remission (CR) rate (81% vs. 75%), and continuous CR (45% vs. 33%) were found in comparison with the previous study. A significant improvement was achieved in relapse rate, 44% to 28% (P=0.029), mainly due to reduced central nervous system relapse rate from 16% to 6% (P=0.037), whereas the number of patients receiving cranial radiation was reduced to 55%. A major problem concerned the increased CR mortality rate, 5% to 14% (P=0.06). Improved supportive care therapy and socioeconomic conditions will hopefully reduce the CR mortality rate in the future.

Alteraciones cromosómicas estructurales inducidas por bioflavonoides de la dieta en linfocitos de anemia de Fanconi / Structural Chromosomal Alterations Induced by Dietary Bioflavonoids in Fanconi Anemia Lymphocytes

Introducción. La anemia de Fanconi es una enfermedad genética con herencia autosómica recesiva caracterizada por aplasia medular, predisposición a leucemia mieloide aguda, tumores sólidos y aumento en la inestabilidad cromosómica. Este síndrome puede considerarse como modelo biológico para analizar sustancias naturales con posible efecto genotóxico, difíciles de evaluar en células normales. Los objetivos de este estudio son describir y cuantificar las alteraciones cromosómicas estructurales inducidas por cinco flavonas, dos isoflavonas y una droga quimioterapéutica inhibidora de la topoisomerasa II, en cultivos de linfocitos de anemia de Fanconi a fin de determinar si existe un incremento en el número y tipo de daño cromosómico respecto al control. Materiales y métodos. Se analizaron los cromosomas de linfocitos estimulados con fitohemaglutinina M de una paciente con anemia de Fanconi. Se evaluaron 100 metafases de cada uno de los cultivos expuestos a las sustancias y control basal. Las alteraciones cromosómicas fueron documentadas con fotografías convencionales y digitales mediante analizador de imágenes. Se utilizó la prueba de c2 para determinar diferencias significativas entre el daño cromosómico entre cultivos expuestos y no expuestos con un valor de P <0,05. Resultados. Se encontraron 431 alteraciones cromosómicas en 1000 metafases analizadas; la genisteína tuvo el mayor efecto genotóxico, seguida de la genistina, fisetina, kaenferol, quercetina, baicaleína y miricetina. Las anomalías más frecuentes fueron las rupturas cromatídicas, rupturas cromosómicas, brechas (gaps) cromatídicas y cromosómicas, intercambios cuadri-radiales, cromosomas dicéntricos y rearreglos complejos. Conclusión. Los bioflavonoides genisteína, genistina y fisetina, presentes comúnmente en la dieta, aumentaron el número de alteraciones cromosómicas de manera significativa respecto al control en linfocitos de anemia de Fanconi.

Introduction. Fanconi anemia is an autosomal recessive disease characterized by a variety of congenital abnormalities, progressive bone marrow failure, increased chromosomal instability and higher risk to acute myeloid leukemia, solid tumors. This entity can be considered an appropriate biological model to analyze natural substances with possible genotoxic effect. The aims of this study were to describe and quantify structural chromosomal aberrations induced by 5 flavones,² isoflavones and a topoisomerase II chemotherapeutic inhibitor in Fanconi anemia lymphocytes in order to determine chromosomal numbers changes and/ or type of chromosomal damage. Materials and methods. Chromosomes stimulated by phytohaemagglutinin M, from Fanconi anemia lymphocytes, were analysed by conventional cytogenetic culture. For each chemical substance and controls, one hundred metaphases were evaluated. Chromosomal alterations were documented by photography and imaging analyzer. To statistical analysis was used chi square test to identify significant differences between frequencies of chromosomal damage of basal and exposed cell cultured a P value less than 0.05. Results. There were 431 chromosomal alterations in 1000 metaphases analysed; genistein was the more genotoxic bioflavonoid, followed in descendent order by genistin, fisetin, kaempferol, quercetin, baicalein and miricetin. Chromosomal aberrations observed were: chromatid breaks, chromosomal breaks, cromatid and chromosomal gaps, quadriratials exchanges, dicentrics chromosome and complex rearrangements. Conclusion. Bioflavonoids as genistein, genistin and fisetin, which are commonly present in the human diet, showed statistical significance in the number of chromosomal aberrations in Fanconi anemia lymphocytes, regarding the basal damage.

Neoplasia endocrina múltiple tipo 2: un ejemplo para la prevención del cáncer / Multiple endocrine neoplasia type 2: a model for cancer prevention

La Neoplasia endocrina múltiple tipo 2 es un síndrome caracterizado por carcinoma medular de tiroides y feocromocitomas. La identificación de mutaciones del proto-oncogén RET como responsables de este síndrome ha brindado un método preciso para la identificación de los individuos susceptibles de desarrollar esta enfermedad. Además, la identificación de estas mutaciones ha permitido caracterizar la expresión clínica y la gravedad del carcinoma medular de tiroides, su tratamiento preventivo y su seguimiento. Esta revisión presenta una discusión concisa sobre el uso de la evaluación genética en el manejo del carcinoma medular de tiroides hereditario con énfasis en la intervención primaria para prevenir la mortalidad y la morbilidad asociadas con esta enfermedad.

Beneficial effect of angiotensin-blocking agents on graft fibrosis in hepatitis C recurrence after liver transplantation.

BACKGROUND: Hepatitis C recurrence after liver transplantation is often associated with accelerated graft fibrosis and progression to cirrhosis. Because drugs blocking the action of angiotensin-II can reduce fibrosis in different human and experimental models, we assessed the possible beneficial effect of these drugs on graft fibrosis in hepatitis C recurrence after liver transplantation. METHODS: We retrospectively reviewed the charts of 128 liver-transplant recipients with hepatitis C recurrence. Twenty-seven patients (group I) received angiotensin converting enzyme inhibitors or angiotensin-II receptor antagonists as antihypertensive treatment, and 101 patients (group II) did not receive these drugs. RESULTS: No significant differences were found between groups I and II in demographic, clinical, and laboratory data. In contrast, cirrhosis in the graft was less frequently observed in group I than in group II during postransplant follow-up: 15% versus 35% (P=0.035), respectively, with a probability of cirrhosis of 9% versus 32% at 5 years after transplantation and 35% versus 70% at 10 years (P=0.0049). Furthermore, the fibrosis stage (scored from 0-4) in the liver biopsy obtained at the end of follow-up was significantly lower in group I than in group II (median [and range]: 1 [0-4] vs. 2 [0-4]; P=0.038), and the fibrosis progression index (increase of fibrosis stage per year) was also lower in group I than in group II (0.21 [0-0.45] vs. 0.52 [0-2.58]; P=0.006). CONCLUSION: The administration of angiotensin-blocking agents may be beneficial to reduce the development of graft fibrosis in hepatitis C recurrence after liver transplantation.

Presentación inusual de un linfoma que simulaba un sarcoma de Ewing: Diagnóstico diferencial clínico, radiológico y patológico / Presentation inuse in lymphoma

Se informa del caso de una niña de 12 años quien presentó un cuadro clínico que simuló un sarcoma de Ewing.Los estudios complementarios de patología,inmunohistoquímica y citogenética confirmaron el diagnóstico de un linfoma con presentación ósea inicial de tipo linfoblástico pre-B, con translocación t(1;19)(q23:P13).Se discute sobre las características de esta neoplasia y sobre la importancia de los estudios complementarios de inmunohistoquímica y citogénetica para realizar un diagnóstico correcto. Conclusiones:El diagnóstico diferencial es difícil, en general es el de un (Tumor maligno de células pequeñas redondas y azules),que en pacientes en edad pediátrica incluyen sarcoma de Ewing,rabdomiosarcoma,osteosarcoma de células pequeñas redondas,PNET,condrosarcoma mesenquimal,tumor de células pequeñas redondas desmoplásico,carcinomas neuroendocrinos,neuroblastoma metastásico y los linfomas. A esta edad,el cuadro tanto clínico, radiológico y patológico se superpone de manera que la inmunotipificación es definitiva para un diagnóstico y tratameintos adecuados. Utilizar criterios limitados, clínicos, radiológicos, de microscopia de rutina y un panel incompleto de marcadores, contribuye al diagnóstico erróneo de estas neoplasias.

Prednisona en el tratamiento de la artritis reumatoide / Prednisone in the treatment of rheumatoid arthritis

La artritis reumatoide (AR) de larga evolución por sí misma conlleva el riesgo de desarrollar osteoporosis, la que se atribuye a la disminución de la actividad física y uso de corticosteroides durante el tratamiento de la misma. De ahí la duda para iniciar tratamiento con esteroides durante el curso de la enfermedad. En la actualidad se ha demostrado que el uso de corticosteroides, a dosis bajas, es realmente efectivo para disminución de sintomatología dolorosa y el retardo en la destrucción articular. En la presente revisión, se analizan las indicaciones, dosis recomendadas y reacciones adversas más frecuentes durante su uso; y se valora el riesgo-beneficio de la utilización durante el tratamiento de ésta patología

Leche evaporada con sustitución parcial de la grasa lactea por aceite de girasol / Evaporated milk partial replacement of milk fat by sunflower oil

Se elaboró una leche evaporada con sustitución del 50 %de la grasa láctea por aceite de girasol. Los parámetros de homogeneización definidos fueron: 215 kg/cm a la 2 y temperatura de 49,5 -C. El producto experimental se conservó sin presentar alteraciones de calidad durante 4 meses a temperatura ambiente. La composición en ácidos grasos no mostró procesos oxidativos durante 5 meses. Hubo el 100 %de aceptación y ningún caso de intolerancia

Leche evaporada con sustitución parcial de la grasa lactea por aceite de girasol / Evaporated milk partial replacement of milk fat by sunflower oil

Se elaboró una leche evaporada con sustitución del 50

de la grasa láctea por aceite de girasol. Los parámetros de homogeneización definidos fueron: 215 kg/cm a la 2 y temperatura de 49,5 -C. El producto experimental se conservó sin presentar alteraciones de calidad durante 4 meses a temperatura ambiente. La composición en ácidos grasos no mostró procesos oxidativos durante 5 meses. Hubo el 100

de aceptación y ningún caso de intolerancia