Valor pronóstico de los receptores hormonales, índice de proliferación celular (Ki-67) y factores clinicopatológicos en el carcinoma ductal infiltrante de mama. estudio inmunohistoquímico de 192 pacientes / Prognostic value of hormonal receptors, cell proliferation index (Ki-67) and clinicopathologic factors of invasive ductal carcinoma of the breast. An immunohistochemical study of 192 patients

Objetivo. Valorar la relación entre los factores pronósticos clínicos, histológicos e inmunohistoquímicos en el carcinoma ductal infiltrante de mama. Material y métodos. Se estudiaron variables clínicas e histológicas, receptores hormonales e índice de proliferación celular (Ki-67) en 192 pacientes con carcinoma ductal infiltrante. Los receptores de estrógenos y progesterona fueron medidos de acuerdo con la intensidad de la tinción (I), con valores comprendidos entre 0 y 3, y el porcentaje de células positivas (P). Se calculó un histoscore para la fórmula (I + 1) × P (rango: 0-400). Los casos con un valor de histoscore por encima de 100 fueron considerados positivos. El índice de proliferación celular (Ki-67) fue medido contando 500 células, expresando el número de células positivas en porcentaje. Resultados.En 64,24 por ciento de los tumores se encontró tinción positiva para los receptores de estrógenos, mientras que el 49,12 por ciento fueron receptores de progesterona positivos. En 21,87 por ciento de los pacientes se encontró un índice de proliferación celular alto (> 25 por ciento). El tamaño tumoral, el número de mitosis, la presencia de necrosis y el estado ganglionar fueron factores pronósticos independientes en nuestro estudio estadístico. Conclusiones. Los receptores hormonales y el Ki-67 no son factores pronósticos independientes para la recidiva y la supervivencia global en nuestro estudio. Sólo los factores histológicos clásicos se han mostrado como factores pronósticos independientes. (AU)

[Pleural effusion as initial presentation of rheumatoid arthritis. Cytological diagnosis]. / Derrame pleural como forma de inicio de la artritis reumatoide. Diagnóstico citológico.

A 24-year-old woman with an unremarkable history presented with a large right-sided pleural effusion. Analysis of the pleural fluid showed a sterile exudate with a low sugar level. Complementary analyses were unable to pinpoint the etiology. The effusion was drained and the patient was released with no specific diagnosis. Nine months later the effusion recurred and the initial laboratory analyses were the same. Pleural fluid cytology revealed the presence of an amorphous necrotic background and non-small cells with multiple nuclei, two signs that constitute part of the pathognomonic triad of rheumatoid pleural effusions, the third characteristic benign fusiform histocytes. The biochemical characteristics of the pleural fluid thus suggested rheumatoid pleural effusion, and cytology confirmed the diagnosis. Corticoid therapy effected spectacular recovery, but when the dose was reduced, rheumatoid symptoms presented in the joints. Rheumatoid arthritis should be considered as a possible explanation for unexplained pleural effusion. Cytology must be used for diagnosis.

[Mikulicz disease as the beginning of AIDS]. / Enfermedad de Mikulicz como debut en un caso de SIDA.

Major salivary lymphoepithelial lesions accounted for less than 3 percent of all benign parotid tumors, prior to AIDS acquaintance. Defined as the presence of enlargement of one or more salivary glands and, in some cases, with diminished salivary function. The paper present the case of an acquired immunodeficiency syndrome starting as a Mikulicz's disease. Reviewed the medical literature and treatment options.

[Benign nasal melanosis transformed into malignant mucosal melanoma: a documented case]. / Melanosis benigna nasal hacia melanoma maligno mucoso: una transformación documentada.

We report a case of nasal mucosal melanosis transformed into malignant mucosal melanoma. We review the feature of these disorders, their association, and preventive treatment.

Squamous cell carcinoma in situ of the endometrium as superficial extension of cervical carcinoma.

Squamous cell carcinomas of the endometrium, either primary or secondary extending from the cervix, are rare. We report a 52-year-old woman with squamous cell carcinoma in situ of the cervix associated with squamous cell carcinoma in situ of the endometrium. The patient had received pelvic cobalt therapy 10 years earlier. She presented to the hospital with discomfort in the lower abdomen. Examination revealed vaginal stenosis and pyometra. After cervical cytology and a biopsy showing squamous cell carcinoma in situ, a wide abdominal hysterectomy with bilateral salpingo-oophorectomy (Wertheim modification) was performed. The unusual presentation of cervical carcinoma with a history of previous radiation treatment suggests the need for performing more cytologic and histologic studies on these patients, because of the risk of developing a secondary malignancy.

Pulmonary diffuse amyloidosis and ankylosing spondylitis. A rare association.

We report herein the association of primary pulmonary amyloidosis and ankylosing spondylitis. To our knowledge, this rare association has never been reported. This case reemphasizes that not all pulmonary complications that appear in the course of ankylosing spondylitis are related to the seronegative spondyloarthropathy. Primary pulmonary amyloidosis should be considered in patients with interstitial pulmonary disease.

Human growth plate development in the fetal and neonatal period.

The development of the normal human upper tibial growth plate was studied at autopsy in 46 stillborns and 79 newborns of 20-41 weeks gestational age. During this time period, the histology of this plate evolves from a highly cellular structure with relatively poor columnar organization and matrix development to the well known structure seen later in postnatal life. The thickness of the growth plate, assessed in the area surrounding the longitudinal tibial axis, decreases continuously from 1.15 mm on the 20th week to 0.6 mm on the 38th week. This decrease results from losses of both matrix and cellular components, mostly of the latter. However, the relative fraction of area occupied by the matrix significantly increased (12%) and matrix area per cell increased 1.5 times over the last half of gestation, indicating a maturation process of the plate towards a more matrix-oriented structure with age. In this maturation process the number of cells per unit area does not change and the average size of the cells appears to decrease. Plate thickness does not decrease further in the final 3 weeks of pregnancy and increases in early neonatal life; this has no apparent influence on the tibial growth rate. In the period under study the relative anatomical participation of the upper tibial growth plate decreases from approximately 4% of the radiographic length of the tibia on the 20th week to less than 1% at term. Present data will provide fetal and neonatal growth plate standards needed to obtain a better understanding of this structure during both normal and abnormal conditions.

Angiolymphoid hyperplasia with eosinophilia of the tongue: report of a case and review of the literature.

Angiolymphoid hyperplasia with eosinophilia has been described mainly in the dermis and subcutaneous tissues of the head and neck, and only occasionally in the oral cavity. A case of angiolymphoid hyperplasia with eosinophilia of the tongue in an 82-year-old man with typical morphologic features is presented. The diagnosis criteria and treatment of this lesion reported in the English literature are also reviewed.

Sirenomelia and anencephaly.

We report on a monozygotic twin with sirenomelia and anencephaly. This association seems to have been observed only twice before. In addition to these anomalies the patient had cleft palate, rachischisis, and segmentation vertebral anomalies affecting the cervical and the upper thoracic spine. The second twin was a liveborn female infant with a large cystic paraovarian teratoma, and duplication of internal genitalia.

Risk of cancer in patients with gastric dysplasia. Follow-up study of 67 patients.

This work is based on the follow-up evaluation of 67 moderate (MD) or severe gastric dysplasias (SD) diagnosed by endoscopic biopsy. Forty-one patients had moderate gastric dysplasia, 22 (53.65%) had regression of MD, 14 patients (34.4%) had persistence, three (7.31%) had progression to SD, and two (4.87%) had transformation in gastric adenocarcinoma. Twenty-six patients were diagnosed with severe gastric dysplasia: in 12 patients (46.15%) gastric lesions regressed to normality (five cases), mild (six cases) or moderate dysplasia (one case); six patients (23.07%) showed persistent histologic changes of SD in the subsequent biopsy specimens; eight patients (30.7%) presented progression of lesions to gastric adenocarcinoma after 1 to 79 months of follow-up evaluation. The authors conclude that moderate and severe gastric dysplasias are preneoplastic lesions and a valuable marker of gastric cancer risk; the risk of gastric cancer after moderate or severe dysplasia is of 9.52%, excluding those cases with short follow-up. The authors claim that these patients may receive a conservative clinical treatment with frequent endoscopic studies until the appearance of either early carcinoma to indicate gastrectomy, or no dysplasia at all or mild dysplasia in specimens from at least two consecutive biopsies.

Malignant fibrous histiocytoma in a child's hand.

A 3-year-old girl had a 4-month history of a tumor in her right hand. The tumor was located in the subcutaneous and soft tissues of the palm and the long, ring, and small fingers. Histologic studies showed a malignant fibrous histiocytoma that was confirmed by the ultrastructural study as having a fibroblastic and histiocytic origin. The long, ring, and small fingers were amputated. The postoperative course was normal, and 18 months later no recurrence or metastases were observed.

Caudal deficiency and asplenia anomalies in sibs.

The caudal deficiency and asplenia anomalies have been described separately in children. Two sibs with these two entities are described. Only another similar case, with caudal deficiency and polysplenia anomalies was found in the literature. It is possible that this association could be a new syndromic entity. An autosomal recessive mode of inheritance is suggested.

Malakoplakia of the maxillary sinus.

The first case of malakoplakia in the nasal cavities is reported. The patient, a 21-year-old man, presented a polypoid formation in the left maxillary sinus that was removed and studied by light and electron microscopy. The polypoid formation consisted of pseudostratified epithelium surrounding a central myxoid tissue which contained fibroblasts, histiocytes, and small inflammatory infiltrates. The most relevant features were histiocyte accumulations containing 1 to 5-microns diameter granules which displayed a concentric multilayered configuration. Ultrastructural findings revealed three types of lysosomes within the histiocyte cytoplasm: phagolysosomes, intermediate bodies, and Michaelis-Gutmann bodies. Septate junctions between lysosomes were frequent. The etiopathogenesis of this lesion is discussed.