La anatomía patológica moderna en España: hitos evolutivos y su influencia médico-social / Modern pathology in Spain: evolutionary milestones and medical social influence

No disponible

Granular cell tumor of the bladder: a case report.

BACKGROUND: Granular cell tumor is usually a benign tumor, generally believed to be of neural origin, most commonly affecting the tongue and skin. Although it can present in any part of the body, the bladder is a rare location, with only 16 cases found in the English-language literature. CASE: We report the case of a 54-year-old woman with hematuria who had a solid tumor in the posterior wall of the bladder. Histological study of the samples obtained by transurethral resection revealed a granular cell tumor, confirmed by immunohistochemical techniques. CONCLUSION: Granular cell tumors of the bladder are rare and generally benign but frequently present macroscopic features resembling those of urothelial carcinoma. The similarity can lead to an erroneous clinical diagnosis and unnecessary, aggressive treatment. A careful histopathological assessment is essential for an accurate diagnosis.

Update on the diagnosis of cancer of unknown primary (CUP) origin.

The cancer of unknown primary (CUP) concept encompasses a heterogeneous group of cancers that are difficult to diagnose and that show diverse clinical and histopathological features. Currently, CUP is the fifth most frequent cancer diagnosis in women and the eighth in men. The ongoing development of new therapies specific to the various cancer types makes mandatory the identification of the primary tumour in CUP patients, so that they may benefit from advances in therapy and improvements in prognosis. Molecular detection techniques provide very useful tools in the prediction of primary tumour types and must be used together with clinical, histopathological and IHC diagnostic techniques. Steady collaboration and fluid communication between oncologists and pathologists is of the utmost importance for the correct interpretation of tests and the personalised approach required by each individual case. Work in multidisciplinary teams will result in significant changes in the diagnosis and treatment of these patients.

Stromal expression of vascular endothelial growth factor C is relevant to predict sentinel lymph node status in melanomas.

The dissemination of tumour cells to the lymph nodes is a complex process involving the formation of new lymph vessels, or lymphangiogenesis, produced by the tumour itself. The main growth factor involved in lymphangiogenesis is vascular endothelial growth factor C (VEGF-C), which is secreted by several different malignant tumours, including melanoma. Not only has VEGF-C expression been found in tumour cells, it has also been detected in tumour stromal cells like macrophages and fibroblasts. This study aimed to determine whether the expression of VEGF-C in tumour and stromal cells in cutaneous melanoma determines lymphangiogenesis and neoplastic dissemination to lymph nodes. We examined cases from 50 patients with melanoma who underwent selective biopsy of the sentinel lymph node. Immunohistochemical study was done with D2-40 to label lymph vessels, and the expression of VEGF-C was evaluated in tumour and stromal cells. Lymph vessel density was greater in sentinel lymph node-positive than in sentinel lymph node-negative cases, though the difference was not significant (P = 0.075). A significant correlation was seen between lymph vessel density and tumour thickness and the presence of ulceration. The main finding was that the expression of VEGF-C in fibroblasts was highly associated with the presence of metastasis in the sentinel node and with the Clark level. However, VEGF-C expression showed no relation in either tumour cells or macrophages with node status or other prognostic factors, such as the Breslow index or Clark level. Our results highlight the relevance of the stroma in tumour progression in cutaneous melanoma and its role in the spread to lymph nodes.

Vascular endothelial growth factor and vascular endothelial growth factor receptor-2 tumor expression in patients with advanced laryngeal cancer after induction chemotherapy for organ preservation.

BACKGROUND: Vascular endothelial growth factor (VEGF) expression seems to be associated with worse overall survival in patients with head and neck squamous cell carcinoma. The purposes of this study were to assess the prognostic values of the immunohistochemical expression of VEGF and vascular endothelial growth factor receptor-2 (VEGFR-2) in a cohort of patients with operable advanced laryngeal cancer who had been treated with induction chemotherapy. METHODS: VEGF and VEGFR-2 expression in the malignant cells was quantified by an enzyme immunosorbent assay in a retrospective series. RESULTS: Fifty-nine patients were included in this study. We found moderate to high VEGF expression in 61% of patients and none to low expression in 39%. VEGFR-2 expression was moderate to high in 58% of patients and was none to low in 42%. The probability of a complete response to induction chemotherapy was significantly higher in patients with none to low VEGF expression (74% vs 40%; p = .02). CONCLUSION: VEGF expression seems to be a significant predictor of complete response to induction chemotherapy.

Successful treatment of perforating granuloma annulare with 0.1% tacrolimus ointment.

Perforating granuloma annulare (PGA) is a rare subtype of granuloma annulare (GA) named in 1971 by Owens and Freeman. It is characterized by necrobiotic areas surrounded by histiocytes and lymphocytes with transepidermal elimination. Many treatments for PGA have been used, often with unsatisfactory results. Tacrolimus in its topical formulation has been established as a safe and effective alternative to topical corticosteroids because of its mild side effects and its minimal systemic absorption. Topical tacrolimus has been approved for the treatment of atopic dermatitis; moreover, ample data exist which demonstrate the usefulness of tacrolimus for the specific treatment of other inflammatory diseases. We report a 70-year-old diabetic woman with PGA, in whom the ulceration due to PGA responded to 0.1% topical tacrolimus.

Composite cutaneous hemangioendothelioma on the back.

Composite cutaneous hemangioendothelioma (HE) is the most recently described variant of the lesions known as HEs. It is characterized by a mixture of histologic patterns, namely, epithelioid HE, retiform HE, and spindle cell hemangioma. We report a new case of this rare tumor located on the back of a 23-year-old woman. This neoplasm is considered to be of borderline or low-grade malignancy, because despite its frequency it rarely metastasizes.

Association between VEGF expression in tumour-associated macrophages and elevated serum VEGF levels in primary colorectal cancer patients.

OBJECTIVE: Angiogenesis is stimulated by angiogenic factors released by tumour cells, though other cells, such as tumour-associated macrophages (TAMs), also contribute towards increasing the angiogenic process in colorectal cancer (CRC). The aim of this study was to determine in CRC patients the contribution of vascular endothelial growth factor (VEGF) expression in TAMs and tumour cells towards circulating VEGF levels, their association with p53 expression and microvascular density (MVD), and their prognostic value. METHODS: Immunohistochemical techniques were used to identify TAMs and p53 protein, and to evaluate the VEGF expression in TAMs, MVD and tumour cells in 110 primary CRC patients. Serum VEGF levels were determined using an enzyme immune assay. RESULTS: There was a greater expression of VEGF in tumours with a positive p53 expression than a negative stain (p<0.01). The macrophage index was not related to tumour VEGF secretion. No significant association was observed between serum VEGF levels and VEGF tumour expression, node status, histological grade, MVD or p53 expression. However, the patients with high values of VEGF expression in TAMs showed significantly higher presurgery serum VEGF levels than those patients with low values of VEGF expression in TAMs (p=0.021). No statistical significant differences in survival were found when we compared patients with high VEGF expression in TAMs vs low or median VEGF expression in TAMs (p=0.093). Serum VEGF levels were increased 6-8 hours after tumour removal (p=0.001). CONCLUSIONS: Our data suggest that in primary CRC, presurgery circulating VEGF levels are related to VEGF produced by TAMs.

Elevated serum levels of vascular endothelial growth factor are associated with tumor-associated macrophages in primary breast cancer.

We analyzed serum and tumor samples from 133 patients with operable primary breast cancer to determine the possible relationship between presurgery and postsurgery circulating serum vascular endothelial growth factor (VEGF) levels and tumor-associated macrophage (TAM) numbers, tumor VEGF expression, and other immunohistochemical parameters. A significant positive correlation was observed between the number of TAM and postsurgery circulating VEGF values (P < .05). Moreover, patients with a p53+ tumor had higher postsurgery serum VEGF levels than those with a p53- tumor (P < .05), and tumor p53 overexpression correlated significantly with TAM number (P = .007). We observed no significant association between serum values and tumor VEGF expression. Although the macrophage index was higher in VEGF+ than in VEGF- tumors, the differences were not statistically significant. Our data show a positive interrelation between high circulating VEGF levels, the number of TAM, and p53 overexpression, a relationship that might have an important role in the enhanced angiogenesis processes in breast cancer.

[Relationship between pesticide exposure and low-grade superficial bladder urothelial carcinoma]. / Relación entre la exposición a pesticidas y el desarrollo de carcinoma urotelial vesical superficial de bajo grado.

BACKGROUND AND OBJECTIVE: Few studies have been published analyzing the association between pesticides use and the increased risk of developing urothelial cancer of the bladder (UCB). The aim of this work was to investigate, in a geographical area with a high prevalence of UCB (Axarquia, Malaga province, southern Spain) if a) subjects with occupational exposure to pesticides have greater risk of developing UCB and b) there are histopathological differences with regard to UCB in patients without any exposure. PATIENTS AND METHOD: Case control study. During two years (1994-1996) 96 cases of UCB were included. The histologic grade and the depth of the invasion as well as the associated inflammatory infiltrate were analyzed. A questionnaire was answered by the patients. RESULTS: 58.3% of the case group were working with or had history of exposure to pesticides, compared to 40.6% in the control group (OR = 2.04; 95% CI, 1.1-3.6). The risk increased with a greater time of exposure. In exposed subjects, low grade tumors (OR = 2.6; 95% CI, 1.3-5.2) as well as superficial tumors (OR = 2.3; 95% CI, 1.2-4.4) were more frequent. They were more frequently accompanied by a chronic inflammatory infiltrate (OR = 4.5; 95% CI, 1.8-11.1). CONCLUSIONS: The subjects with occupational exposure to pesticide have greater risk of developing UCB, which is directly proportional to the exposure time. In comparison with the population in the zone without exposure, patients who use pesticides present low grade UCB and less invasive tumors more frequently. These facts were not modified when they were adjusted for tobacco consumption. Exposed patients have UCB with chronic (moderate) inflammatory reaction more frequently than the tumors in non-exposed subjects.

Relación entre la exposición a pesticidas y el desarrollo de carcinoma urotelial vesical superficial de bajo grado / Relationship between pesticide exposure and low-grade superficial bladder urothelial carcinoma

FUNDAMENTO Y OBJETIVO: Son escasas las publicaciones sobre la asociación de la utilización de pesticidas y el mayor riesgo de desarrollar cáncer urotelial de vejiga (CUV). En un área geográfica con alta prevalencia de CUV (Axarquía, en la provincia de Málaga, en el sur de España), hemos investigado si las personas con exposición ocupacional a pesticidas tienen mayor riesgo de desarrollar CUV respecto a pacientes no expuestos, y si hay diferencias histopatológicas respecto al CUV en pacientes no expuestos. PACIENTES Y MÉTODO: Se ha realizado un estudio de casos y controles. Durante 2 años (19941996) se recogieron 96 casos de CUV, de los que se analizaron el grado histológico y la profundidad de la invasión, así como el infiltrado inflamatorio acompañante. Se realizó un cuestionario en el que se incluían los antecedentes de exposición a pesticidas. RESULTADOS: El 58,3 por ciento de los casos (56/96) utilizaban o tenían antecedentes de exposición a pesticidas en comparación con el 40,6 por ciento de los controles (39/96) (odds ratio [OR] = 2,04; intervalo de confianza [IC] del 95 por ciento, 1,1-3,6). El riesgo aumentó conforme mayor fue el tiempo de exposición. Asimismo, en los sujetos expuestos fueron más frecuentes los tumores de bajo grado (OR = 2,6; IC del 95 por ciento, 1,3-5,2), así como los superficiales (OR = 2,3; IC del 95 por ciento, 1,24,4), y se acompañaban más frecuentemente de un infiltrado inflamatorio crónico (OR = 4,5; IC del 95 por ciento, 1,8-11,1). CONCLUSIONES: Los pacientes con exposición a pesticidas presentaron un mayor riesgo de desarrollar CUV, en una proporción directamente relacionada con el tiempo de exposición. En comparación con los no expuestos, los pacientes que usan pesticidas tienen más frecuentemente CUV de bajo grado y los tumores son menos invasivos. En ellos, los CUV presentan una reacción inflamatoria crónica (moderada) de manera más frecuente que los tumores en personas no expuestas (AU)