Hemangioendotelioma epitelioide hepático primario: un simulador de metástasis / Primary hepatic epithelioid hemangioendothelioma: a metastatic-like tumor

El hemangioendotelioma epitelioide hepático es un tumor raro en el adulto, de etiología desconocida y origenvascular, que afecta más a mujeres. Suelen cursar asintomáticos o con síntomas poco específicos y con frecuenciasu diagnóstico es casual. La lesión suele ser múltiple, afecta a ambos lóbulos hepáticos y su tamaño esmuy variable. Las características de la lesión en las técnicas diagnósticas por imagen son superponibles a lasde un proceso metastático. El diagnóstico histológico requiere estudio inmunohistoquímico complementario yno aporta criterios de valor pronóstico. La evolución es imprevisible y letal en el 50% de los pacientes. La extirpaciónquirúrgica de la lesión y el transplante hepático son las opciones terapéuticas más útiles.Describimos las características clínico-patológicas de esta rara lesión, aportando un caso diagnosticado inicialmentede metástasis hepática

Hepatic epithelioid hemangioendothelioma is a rare vascular tumor of adults of unknown etiology, that ismore common in women. It is usually asymptomatic or presents only non specific symptoms, making thediagnosis frequently casual. The lesions are usually multifocal and of variable sizes, involving both lobes. Thecharacteristics of the lesions shown by the imaging diagnostic techniques are superposable to those of of themetastatic disease. The histologic diagnosis requires immunohistological studies and does not contribute withprognostic criteria. The course is unexpected and 50 % of the patients die of the disease. Surgery and hepatictransplant are the most useful therapeutic options. We describe the clinicopathologic characteristics of this rarelesion and contribute with a case, thay was initially diagnosed as hepatic metastatic disease

Pathogenic implications of interleukin-8 activity and bacterial phenotype in antral gastritis associated with Helicobacter pylori.

OBJECTIVE: Helicobacter pylori (Hp) infection is characterized by an intense inflammatory infiltrate in the gastric mucosa, which is chemoattracted by different cytokines. Interleukin-8 (IL-8) seems to play an important role in the recruitment of circulating neutrophils, and modulation of IL-8 secretion seems to be a strain marker. This study was designed to examine IL-8 concentrations in the gastric mucosa and their relationship with H. pylori phenotype and histologic findings. METHODS: Gastric biopsies were obtained from the antrum and corpus in 106 patients (69 Hp-positive and 37 Hp-negative). IL-8 levels in the gastric mucosa were analyzed by ELISA and Hp phenotype was determined with a western blot test. RESULTS: 75% of H. pylori strains were CagA+ and 54.2% were VacA+. The Houston classification was used for histologic findings. No association between gastric atrophy or intestinal metaplasia and Hp phenotype was found. The highest IL-8 levels were found in CagA+ infected gastric mucosa, but the difference with respect to infection by a VacA+ strain was not statistically significant. IL-8 levels were highest when neutrophils were the predominant cell in the gastric inflammatory infiltrate (p < 0.05). IL-8 levels were higher in patients with atrophic gastritis than in patients with nonatrophic gastritis (p < 0.05). CONCLUSIONS: In patients with H. pylori infection, IL-8 levels are higher than in Hp-negative patients regardless of Hp phenotype. There is an association between IL-8 and a neutrophilic infiltrate. Perpetuation of a chronic infiltrate could lead to more severe lesions such as atrophic gastritis or intestinal metaplasia, as deduced from the IL-8 levels found in these types of lesion.

Papel de la actividad de interleucina-8 y el fenotipo en la patogenia de la gastritis antral asociada a Helicobacter pylori / Pathogenic implications of interleukin-8 activity and bacterial phenotype in antral gastritis associated with Helicobacter pylori

La interleucina-8 (IL-8) es fundamental en la atracción del infiltrado inflamatorio que acompaña a la infección por Helicobacter pylori (Hp). La distinta capacidad de Helícobacter pylori en inducir la modulación de IL-8 se ha propuesto como una característica cepa dependiente, y en virtud a esta capacidad se diferenciarían cepas con distinto potencial patógeno. OBJETIVO: analizar los niveles de IL-8 en mucosa gástrica y su relación con el fenotipo y hallazgos histológicos. MATERIAL Y MÉTODOS: hemos estudiado 106 pacientes [69 con infección por Hp (Hp+) y 37 controles (Hp-)] a los que se determinó los niveles de IL-8 mediante ELISA en mucosa gástrica y el fenotipo se determinó por técnica de Western Blot. Los hallazgos histológicos se clasificaron según la clasificación de Houston. RESULTADOS: El 75 por ciento de las cepas de nuestra serie son CagA+ y el 54,2 por ciento VacA+. En nuestra serie no existe asociación significativa del fenotipo con gastritis crónica atrófica ni con metaplasia intestinal. Los mayores niveles de IL-8 detectados en los pacientes CagA+ (167,08 pg/rng proteinas) no fueron estadísticamente significativos respecto al fenotipo VacA+ (160,22 pg/mg proteínas). Sí encontramos niveles de IL-8 más elevados en los pacientes con actividad neutrofílica de forma significativa (p < 0,05) que si predominaba en el infiltrado otro tipo de células. También los pacientes con gastritis crónica atrófica (GCA) tienen niveles de IL-8 más elevados significativamente (302,6 pg/mg proteínas; p < 0,05) que los pacientes con gastritis crónica no atrófica (173,3 pg/rng proteínas). CONCLUSIONES: En los pacientes con infección por Hp existen niveles de IL-8 significativamente más elevados que en los pacientes HP-, independientemente del fenotipo. También existe una clara relación entre la IL8 con el infiltrado de neutrófilos y a largo plazo la perpetuación del infiltrado inflamatorio puede desarrollar lesiones más severas como GCA y MI como sugiere los niveles más elevados de IL-8 encontrados en estas lesiones (AU)

Tumores del músculo liso del tracto digestivo / Smooth muscle tumors of the digestive tract

Propósito: Los tumores de estirpe muscular son raros en el tracto esofágico y gastrointestinal. En este trabajo presentamos nuestra experiencia reciente en su manejo. Material y métodos> Hemos incluido en nuestro estudio los pacientes tratados de estas neoplasias en el Servicio de Cirugía General y Digestiva del Hospital Virgen Macarena de Sevilla (Prof. Cantiliana Martinez) desde 1991 a 1996, analizando la clínica, los métodos diagnósticos empleados y la terapéutica utilizada (AU)

[The assessment of colonic polyps found via colonoscopy]. / Valoración de los pólipos colónicos hallados mediante colonoscopia.

AIM: To evaluate the histopathological characteristics of colonic polyps, found during colonoscopy examination and endoscopic polypectomy, and their relation to age, tumor location, sex, histological type and degree of epithelial dysplasia. MATERIAL AND METHODS: Between 1996 and 1997, 2,465 total colonoscopies were performed at the Gastroenterology Department of the Virgin Macarena University Hospital in Seville. Different size polyps were found in 318 patients who had been referred because of several symptoms/by several centers. The mean age was 59.2 years in men and 61.5 years in women. RESULTS: 446 polyps were removed by endoscopic polypectomy, 32 (7.2%) were hyperplastic polyps, 402 were adenomas (90.2%) and 12 (2.6%) were adenomas with adenocarcinoma. Seventy-five percent of adenomas were located in the left colon and rectum and 25% in right colon. Hyperplastic polyps were found in left colon. Of the polyps removed, 55.1% were smaller than 1 cm, 26.5% were between 1 and 2 cm and 18.4% were between 2 and 7 cm. Histopathologic study of adenomas revealed that 17% were villous adenoma, 80% were tubular adenomas and 3% were tubulovillous adenomas. Adenocarcinomas were found in 12 (2.8%) adenomas. Of the adenomatous polyps, 87.4% had low-grade dysplasia and 12.6% high-grade dysplasia. Statistical analysis showed a strong correlation between size of adenoma and degree of dysplasia (p < 0.05). Similar significant relation was found between histological type and size (p < 0.05) but there were no statistically significant differences between location, sex or age, and degree of dysplasia (p < 0.05). CONCLUSIONS: Size of colonic polyps is related to epithelial dysplasia and histological type (p < 0.05). No correlation was found between location, sex or age and degree of dysplasia.

Early gastric stump carcinoma with rhabdoid features. Case report.

Among 474 cases of gastric carcinoma studied in gastrectomy specimens from 1990 to 1996, only one (0.21%) showed positivity for vimentin. It was located on a gastric stump and, endoscopically, the tumor was classified as early gastric carcinoma type IIb + IIc. Histologically, tumor cells were extensively round to polygonal and had eosinophilic, or clear cytoplasm; the nuclei were large with conspicuous nucleoli. In some areas, the cytoplasm showed vimentin and(or cytokeratin coexpression by double immunostaining. Our results and the patient's rapid deterioration (death occurred six months after surgery) suggest that this type of tumor, although diagnosed as early carcinoma, behaved like an advanced malignancy.

Double duplication in a nonrotational colon. Study of a case associated with mucinous adenoma.

Duplications of gastrointestinal tract are unusual anomalies, especially in the colon. We report a case with two colonic duplications in a 20 year old woman who complained of recurrent backache associated with left lower quadrant abdominal pain. Neither physical examination nor laboratory test alterations were detected. Roentgenographic examination showed organic scolinosis, no intestinal gas and a mass with central hyperdensity and thickened wall in the descending colon area on the CT scan. Laparotomy was performed in which 22 cm of ascending colon and terminal ileum sited on left side, was excised. Pathological study revealed two unrelated and cystic duplications without communication to intestinal lumen. Their epithelial lining were of colonic or gastric types and showed a mucinous adenoma; the remaining layers were normal except for eosinophilic inflammatory infiltrate with Charcot-Leyden like crystaloids. In conclusion, we present a double spherical colonic duplication type I associated to a mucinous adenoma on a non-rotational ascending colon in a patient with organic scoliosis.

Cutaneous sarcoid granulomas with oat cell carcinoma of the lung.

A case of a 68-year-old male is presented, with a history of asymptomatic slight scaling, infiltrated patches with an atrophic central portion, of 3 months of evolution on the face and trunk. A chest X-ray showed an oat cell lung carcinoma, with the same evolution time as the cutaneous lesions. Several cutaneous biopsies showed typical sarcoid granulomas, with profuse giant cells. An immunohistochemical study showed B-cell-positive granulomas. The patient was treated with cytostatic drugs and prednisone, leading to cutaneous, radiological and clinical complete regression of the lesions. We think that this case corresponds to a tumor-related cutaneous sarcoid granuloma reaction.

Ultrastructural distribution of lectin-binding sites on gastric superficial mucus-secreting epithelial cells. The role of Golgi apparatus in the initial glycosylation.

Normal human gastric epithelial cells were examined by electron microscopy using each of five biotinylated lectins [Ulex europaeus agglutinin I (UEA-I), peanut agglutinin (PNA), wheat germ agglutinin (WGA), soybean agglutinin (SBA) and Dolichos biflorus agglutinin (DBA)] as a probe. We employed 35 gastric surgical specimens removed from complicated peptic disease. The lectin-binding sites were revealed with streptavidin-colloidal gold complex. All specimens were embedded in Spurr and LR White resins. In superficial foveolar epithelial cells, the lectins used were generally positive in all cell types (mainly UEA-1 and PNA) on the Golgi region and mucus cytoplasmic vacuoles, with many variations among cells in the same case. On the other hand, extracellular mucus was negative for WGA. Labelling with PNA revealed a biphasic pattern (peripheral positivity) on mucous droplets in surface and foveolar cells. The cis side of the Golgi apparatus was labelled with SBA and PNA and rough endoplasmic reticulum with SBA (only five cases). Lectin-binding variability could be related to heterogeneous composition of gastric mucus. Our results with SBA suggest initiation of O-glycosylation at the Golgi apparatus; however a role of the rough endoplasmic reticulum cannot be excluded (N-glycosylation). We propose the following sequence of sugar addition to the carbohydrate side-chains of gastric glycoproteins: (1) GaNAc (Golgi apparatus cis-side), (2) GlcNAc (Golgi apparatus intermediate face), (3) GalNac or Gal, alpha-L-fucose (Golgi apparatus trans-side).

Cutaneous ganglion cell choristoma. Report of a case.

We describe the histological, immunohistochemical, and ultrastructural findings of a cutaneous tumour composed of ganglion cells, without any other proliferating component. As ganglion cells are not normal components of the skin, we propose the term "ganglion cell choristoma" for this lesion. The differential diagnosis of related lesions such as cutaneous ganglioneuroma, well-differentiated metastases from neuroblastoma, autonomic ganglia entrapped by neurofibroma, and reactive processes, and the possible histogenesis of ganglion cell choristoma are discussed.

[Postoperative gastritis due to alkaline reflux. Our results]. / Gastritis postquirúrgica por reflujo alcalino. Nuestros resultados.

We present the results of a retrospective study carried out on 23 patients with alkaline gastric reflux (AGR) verified through endoscopy, biopsies and Tc99m HIDA, which were operated on in our department with Y of Roux, Braun, Henley as the correction techniques of this pathology. The criteria of surgical indications were evaluated in these patients as also the results obtained in reference to residual symptoms and changes in the histologic and gammagraphic patterns.

[Non-specific chronic gastritis and gastric dysplasia, what is their clinical values?]. / Gastritis crónica inespecífica y displasia gástrica, cuál es su valor clínico?

Although nonspecific chronic gastritis and gastric dysplasia are considered as risk factors in the development of gastric cancer, the magnitude of this risk has not been well established. We made an endoscopic and histologic follow-up of 24 patients with an initial diagnosis of atrophic chronic gastritis and some degree of dysplasia over a period of 8 years. The first study revealed slight dysplasia in 8 patients, moderate dysplasia in 13 and severe dysplasia in 3. In our observation, dysplasia considered overall shows a probability of almost 54% of evolution to regression. In our study, the association of atrophic chronic gastritis and severe dysplasia is a reliable marker of gastric cancer. We think it is opportune to carry out periodic follow-ups by endoscopy and biopsy of patients with chronic gastritis and dysplasia.

Cytometric and histologic predictors of prognosis in ampullary carcinoma treated with pancreatico-duodenectomy.

The association between several clinical, histologic and karyometric variables and the survival rates of patients with ampullary carcinoma was examined. Cases were limited to those treated exclusively by pancreaticoduodenectomy for which follow-up data was available, eliminating those cases with deaths due to other causes. The histologic type was classified as papillary, intestinal or mixed while the differentiation was recorded as well, moderate or poor. The stroma was categorized as scanty, moderate or abundant, and the tumor stage was evaluated according to Martin's classification. High-resolution morphometric and microphotometric (DNA content) evaluation of Feulgen-stained nuclei was performed using the microTICAS system. Statistical analyses were performed to examine the relationship between these variables and survival. Neither the tumor stage nor the presence of positive lymph nodes was a significant prognostic indicator, nor was the degree of differentiation or the amount of stroma. However, the survival showed a significant association with several karyometric variables and with the histologic type. Specifically, aneuploid DNA ploidy profiles, higher mean ploidy values and larger nuclei were associated with a lower survival rate. Short-term survivors (less than five years) had a mean ploidy of 2.8N, a mean 5N exceeding rate of 8.3% and a mean nuclear area of 41 sq microns, while long-term survivors (greater than or equal to five years) had corresponding means of 1.9N, 0.6% and 26 sq microns. These differences are all significant at a two-tailed significance level of less than .05 using a separate variance estimate t-test. In addition, papillary tumors showed a better prognosis than did intestinal or mixed tumors (Breslow P less than .04 and Mantel-Cox P less than .009).