Tumores estromales gastrointestinales / Stromal tumors gastrointestinal

Introducción: los tumores estromales gastrointestinales (GISTs)son un grupo eterogéneo de neoplasias mesenquimáticas, controvertidas para muchos en cuanto a morfología, criterios diagnósticos y comportamiento. Datos clínicos: se revisaron todos los tumores mesenquimáticos gastrointestinales de archivo del período 1992-2002. Se hallaron 7 casos de GISTs (25 por ciento de los tumores mesenquimáticos): 4 mujeres y 3 hombres, de 53 a 89 años; 5 fueron de estámago, 1 de intestino delgado y 1 de trascavidad de los epiplones. Métodos disgnósticos: el material se procesó según técnicas de rutina y se coloreó con H.E. Se efectuó IHQ para Actina Músculo Liso (AML), Desmina, S 100, CD 117. Hallazgo macroscópicos: todos los casos correspondieron a piezas quirúrgicas (gastrectomía, resección segmentaria intestinal o tumorectomía). El tamaño tumoral osciló entre 4 y 25 cm. Hallazgos microscópicos: consistieron en proliferaciones fusiformes, con grado variable de celularidad, atipía y actividad mitótica (AM)...

Tumores estromales gastrointestinales / Stromal tumors gastrointestinal

Introducción: los tumores estromales gastrointestinales (GISTs)son un grupo eterogéneo de neoplasias mesenquimáticas, controvertidas para muchos en cuanto a morfología, criterios diagnósticos y comportamiento. Datos clínicos: se revisaron todos los tumores mesenquimáticos gastrointestinales de archivo del período 1992-2002. Se hallaron 7 casos de GISTs (25 por ciento de los tumores mesenquimáticos): 4 mujeres y 3 hombres, de 53 a 89 años; 5 fueron de estámago, 1 de intestino delgado y 1 de trascavidad de los epiplones. Métodos disgnósticos: el material se procesó según técnicas de rutina y se coloreó con H.E. Se efectuó IHQ para Actina Músculo Liso (AML), Desmina, S 100, CD 117. Hallazgo macroscópicos: todos los casos correspondieron a piezas quirúrgicas (gastrectomía, resección segmentaria intestinal o tumorectomía). El tamaño tumoral osciló entre 4 y 25 cm. Hallazgos microscópicos: consistieron en proliferaciones fusiformes, con grado variable de celularidad, atipía y actividad mitótica (AM)...(AU)

[Granular cell tumor of the esophagus. Morphological and immunohistochemical study]. / Tumor de células granulares del esófago. Estudio morfológico e inmunohistoquímico.

Granular cell tumor or Abrikosoff's tumor is an infrequent and usually benign neoplasm which is found predominantly in the head and neck region, especially in the tongue. Its esophageal location is unusual, where most of them present as small, well circumscribed lesions which follow a benign course. Because of its low incidence in this site (less than 200 cases having been reported until 1993), we report two cases of esophageal granular cell tumors, both of them in male patients. CASE 1: A 34 year old patient who presented with epigastralgia, heartburn and abdominal distention. He was treated endoscopically because he had a firm new growth in the lower third of the esophagus measuring 1 cm in diameter. CASE 2: A 50 year old patient who presented with digestive tract haemorrhage (hematemesis and melena) 5 cm above the cardias a submucosal polyp was found of 0.8 cm in its largest diameter. MICROSCOPY: Both cases showed a subepithelially located new growth, composed of polygonal cells with eosinophilic granular cytoplasm, small rounded nuclei, and conspicuous intracytoplasmatic positivity for S100 protein. With these elements we reached the diagnosis of granular cell tumor. The bibliography is reviewed and an update is made of its histopathologic characteristics in addition to histogenetic and clinical considerations.

[Cystic duplication of the esophagus]. / Duplicación quística del esófago.

UNLABELLED: Duplication is defined as the presence of a complete or partial double structure, with a variable length. In esophagus, duplications, diverticuli and cysts might be manifestations of the same embriologic defect. The most common is the Cystic Duplication of the esophagus (CDE), which represents the esophageal duplication, either spherical or tubular, with squamous or columnar epithelium, and a double muscular layer. CLINICAL CASE: male, 38 years old with no previous relevant data, and sudden, complete and persistent post ingestion aphagia, intense presternal pain, and a 12 Kg. weight loss in 15 days. Endoscopy showed unsurpassable stenosis of the lower third of the esophagus, with normal mucosa. Total esophagectomy and replacement with a gastric tube, was performed. He had a good postoperative course. PATHOLOGY: A total esophagectomy open specimen showing a cystic structure at the posterior wall was submitted, which showed a thick, muscular-like wall and hemorrhagic internal surface. Microscopically it had a pseudostratified columnar, ciliated epithelium, alternating with sloughed hemorrhagic areas, fibrosis and stromal siderophagi Leiomuscular double-layered wall. CDE is very infrequent, and is the second most frequent after leiomiomas as a benign esophageal mass. From 10 to 15% of all digestive duplications take place at the esophagus. There are different theories to explain its origin. Differential diagnosis must be made mainly with brochogenic cyst, generally anterior and with cartilage. Treatment is surgical.

Duplicación quística del esófago / Cystic duplication of the esophagus

Duplication is defined as the presence of a complete or partial double structure, with a variable length. In esophagus, duplications, diverticuli and cysts might be manifestations of the same embriologic defect. The most common is the Cystic Duplication of the esophagus (CDE), which represents the esophageal duplication, either spherical or tubular, with squamous or columnar epithelium, and a double muscular layer. Clinical Case: male, 38 years old with no previous relevant data, and sudden, complete and persistent post ingestion aphagia, intense presternal pain, and a 12 Kg. weight loss in 15 days. Endoscopy showed unsurpassable stenosis of the lower third of the esophagus, with normal mucosa. Total esophagectomy and replacement with a gastric tube, was performed. He had a good postoperative course. PATHOLOGY: A total esophagectomy open specimen showing a cystic structure at the posterior wall was submitted, which showed a thick, muscular-like wall and hemorrhagic internal surface. Microscopically it had a pseudostratified columnar, ciliated epithelium, alternating with sloughed hemorrhagic areas, fibrosis and stromal siderophagi Leiomuscular double-layered wall. CDE is very infrequent, and is the second most frequent after leiomiomas as a benign esophageal mass. From 10 to 15 percent of all digestive duplications take place at the esophagus. There are different theories to explain its origin. Differential diagnosis must be made mainly with brochogenic cyst, generally anterior and with cartilage. Treatment is surgical.

Tumor de células granulares del esófago. Estudio morfológico e inmunohistoquímico. / [Granular cell tumor of the esophagus. Morphological and immunohistochemical study]

Granular cell tumor or Abrikosoffs tumor is an infrequent and usually benign neoplasm which is found predominantly in the head and neck region, especially in the tongue. Its esophageal location is unusual, where most of them present as small, well circumscribed lesions which follow a benign course. Because of its low incidence in this site (less than 200 cases having been reported until 1993), we report two cases of esophageal granular cell tumors, both of them in male patients. CASE 1: A 34 year old patient who presented with epigastralgia, heartburn and abdominal distention. He was treated endoscopically because he had a firm new growth in the lower third of the esophagus measuring 1 cm in diameter. CASE 2: A 50 year old patient who presented with digestive tract haemorrhage (hematemesis and melena) 5 cm above the cardias a submucosal polyp was found of 0.8 cm in its largest diameter. MICROSCOPY: Both cases showed a subepithelially located new growth, composed of polygonal cells with eosinophilic granular cytoplasm, small rounded nuclei, and conspicuous intracytoplasmatic positivity for S100 protein. With these elements we reached the diagnosis of granular cell tumor. The bibliography is reviewed and an update is made of its histopathologic characteristics in addition to histogenetic and clinical considerations.

Duplicación quística del esófago. / [Cystic duplication of the esophagus]

Duplication is defined as the presence of a complete or partial double structure, with a variable length. In esophagus, duplications, diverticuli and cysts might be manifestations of the same embriologic defect. The most common is the Cystic Duplication of the esophagus (CDE), which represents the esophageal duplication, either spherical or tubular, with squamous or columnar epithelium, and a double muscular layer. Clinical Case: male, 38 years old with no previous relevant data, and sudden, complete and persistent post ingestion aphagia, intense presternal pain, and a 12 Kg. weight loss in 15 days. Endoscopy showed unsurpassable stenosis of the lower third of the esophagus, with normal mucosa. Total esophagectomy and replacement with a gastric tube, was performed. He had a good postoperative course. PATHOLOGY: A total esophagectomy open specimen showing a cystic structure at the posterior wall was submitted, which showed a thick, muscular-like wall and hemorrhagic internal surface. Microscopically it had a pseudostratified columnar, ciliated epithelium, alternating with sloughed hemorrhagic areas, fibrosis and stromal siderophagi Leiomuscular double-layered wall. CDE is very infrequent, and is the second most frequent after leiomiomas as a benign esophageal mass. From 10 to 15

of all digestive duplications take place at the esophagus. There are different theories to explain its origin. Differential diagnosis must be made mainly with brochogenic cyst, generally anterior and with cartilage. Treatment is surgical.

Duplicación quística del esófago / Cystic duplication of the esophagus

Duplication is defined as the presence of a complete or partial double structure, with a variable length. In esophagus, duplications, diverticuli and cysts might be manifestations of the same embriologic defect. The most common is the Cystic Duplication of the esophagus (CDE), which represents the esophageal duplication, either spherical or tubular, with squamous or columnar epithelium, and a double muscular layer. Clinical Case: male, 38 years old with no previous relevant data, and sudden, complete and persistent post ingestion aphagia, intense presternal pain, and a 12 Kg. weight loss in 15 days. Endoscopy showed unsurpassable stenosis of the lower third of the esophagus, with normal mucosa. Total esophagectomy and replacement with a gastric tube, was performed. He had a good postoperative course. PATHOLOGY: A total esophagectomy open specimen showing a cystic structure at the posterior wall was submitted, which showed a thick, muscular-like wall and hemorrhagic internal surface. Microscopically it had a pseudostratified columnar, ciliated epithelium, alternating with sloughed hemorrhagic areas, fibrosis and stromal siderophagi Leiomuscular double-layered wall. CDE is very infrequent, and is the second most frequent after leiomiomas as a benign esophageal mass. From 10 to 15 percent of all digestive duplications take place at the esophagus. There are different theories to explain its origin. Differential diagnosis must be made mainly with brochogenic cyst, generally anterior and with cartilage. Treatment is surgical. (Au)

Estudio sistematico de piezas de gastrectomia por cancer en busqueda de carcinomas sincronicos / Systematic study of gastrectomy specimens for cancer, in search of synchronic carcinomas

Multiple carcinomas were searched in 50 successive gastrectomies, 17 females (34 percent) 33 males (66 percent) from 40 to 83 years old. Macroscopic handling of the specimens included pinning an a board, fresh, half-fixed and completely fixed examination, not only by naked eye but also through a magnifying glass. The stomach were totally studied, according to japanese method. A satisfactory slide was obtained from each block, stained with H.E. and examined by each of the authors. Synchronous tumors were found in 4 cases (8 percent), 3 males and one female. Compared to the main lesion, two cases showed a proximal tumor, one case showed a distal tumor, and the last one showed two tumors, one of them proximal and the other distal. Three tumors were macroscopically and two were microscopically detected. Two of them coexisted with advanced carcinoma and three with early carcinoma. Four of them were located in mucosa with intestinal metaplasia. Histologically, four cases belong to the same type of the original tumor, and one of them did not coincide. We conclude that stomachs resected for cancer must be thoroughly and methodically studied before and after fixation. We suggest that resection must include the whole mucosa with intestinal metaplasia, in order to avoid leaving a synchronous tumor in the gastric stump.

Estudio sistematico de piezas de gastrectomia por cancer en busqueda de carcinomas sincronicos / Systematic study of gastrectomy specimens for cancer, in search of synchronic carcinomas

Multiple carcinomas were searched in 50 successive gastrectomies, 17 females (34 percent) 33 males (66 percent) from 40 to 83 years old. Macroscopic handling of the specimens included pinning an a board, fresh, half-fixed and completely fixed examination, not only by naked eye but also through a magnifying glass. The stomach were totally studied, according to japanese method. A satisfactory slide was obtained from each block, stained with H.E. and examined by each of the authors. Synchronous tumors were found in 4 cases (8 percent), 3 males and one female. Compared to the main lesion, two cases showed a proximal tumor, one case showed a distal tumor, and the last one showed two tumors, one of them proximal and the other distal. Three tumors were macroscopically and two were microscopically detected. Two of them coexisted with advanced carcinoma and three with early carcinoma. Four of them were located in mucosa with intestinal metaplasia. Histologically, four cases belong to the same type of the original tumor, and one of them did not coincide. We conclude that stomachs resected for cancer must be thoroughly and methodically studied before and after fixation. We suggest that resection must include the whole mucosa with intestinal metaplasia, in order to avoid leaving a synchronous tumor in the gastric stump. (AU)

[Systematic study of gastrectomy specimens for cancer, in search of synchronous carcinomas]. / Estudio sistematico de piezas de gastrectomia por cáncer en búsqueda de carcinomas sincrónicos.

Multiple carcinomas were searched in 50 successive gastrectomies, 17 females (34%) 33 males (66%) from 40 to 83 years old. Macroscopic handling of the specimens included pinning on a board, fresh, half-fixed and completely fixed examination, not only by naked eye but also through a magnifying glass. The stomach were totally studied, according to Japanese method. A satisfactory slide was obtained from each block, stained with H.E. and examined by each of the authors. Synchronous tumors were found in 4 cases (8%), 3 males and one female. Compared to the main lesion, two cases showed a proximal tumor, one case showed a distal tumor, and the last one showed two tumors, one of them proximal and the other distal. Three tumors were macroscopically and two were microscopically detected. Two of them coexisted with advanced carcinoma and three with early carcinoma. Four of them were located in mucosa with intestinal metaplasia. Histologically, four cases belong to the same type of the original tumor, and one of them did not coincide. We conclude that stomachs resected for cancer must be thoroughly and methodically studied before and after fixation. We suggest that resection must include the whole mucosa with intestinal metaplasia, in order to avoid leaving a synchronous tumor in the gastric stump.

Solid cell nests of the thyroid gland. Optic and immunohistochemical study at autopsies.

In order to establish the prevalence of solid cell nests (SCN) in adult thyroids, we studied 100 consecutive glands at necropsy. These were serially sectioned and stained with routine and immunoperoxidase techniques in order to detect calcitonin, carcinoembryonic antigen, thyroglobulin and keratin. SCN may be considered as normal thyroid gland components, and they share with C cells a common origin in the ultimobranchial body.

Occult papillary thyroid carcinoma at autopsy in La Plata, Argentina.

Although clinically evident thyroid carcinoma is not a frequent neoplasm (incidence 2.7 per 100,000 persons in La Plata, Argentina), occult carcinomas are present in a high proportion of the population, but there are marked differences along geographical lines. The purpose of the present study is to establish the prevalence of occult papillary thyroid carcinoma (OPC) in La Plata. Thyroid glands obtained from 100 consecutive adult necropsies were examined. The material was fixed in buffered formaldehyde at 4 degrees C, serially sectioned at 2 mm intervals, and routinely processed. Eleven thyroid glands contained OPC, corresponding in three cases to multiple lesions. Eight carcinomas were found in 59 men (13.6%) and three in 41 women (7.3%). The ages ranged from 26 to 78 years. The neoplasms varied in size from microscopic foci to 9 mm in diameter. The prevalence rate of OPC in the present study is lower than that found in Finland, Japan, and the US, and higher than for the rest of the series recorded.

[Basocellular epithelioma. Considerations on its histogenesis]. / Epitelioma basocelular. Consideraciones acerca de su histogénesis.

Twenty-nine cases of basal cell carcinoma were studied with immunoperoxidase techniques for the detection of carcinoembryonic antigen. Results presented in the text would indicate that a high percentage of basal cell carcinomas have sweat gland histogenetic origins and that this is independent of its morphologic features. The use of immunohistochemical techniques in the detection of biological markers demonstrates once again their value not only in identifying a disease but also in determining its histogenetic origins.