Surgical management of appendiceal adenocarcinoid. Case report and literature review

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Surgical management of appendiceal adenocarcinoid. Case report and literature review.

Adenocarcinoid tumour of the appendix is a rare entity characterised by the presence of a double component (neuroendocrine and glandular). It originates in the neuroendocrine cells of the appendicular mucosa. A preoperative diagnosis of a primary appendiceal tumour is uncommon and more so one suggesting an adenocarcinoid pathology. Optimal treatment is debated between a simple appendectomy and a more extensive resection, which occasionally includes hysterectomy and bilateral ovariectomy. Our aim is to report this rare entity and conduct a review of the literature on the different treatment options.

Algunos conceptos básicos de la teoría de colas aplicables en la planificación de un servicio de anatomía patológica / Some basics concepts of queueing theory applicable in the planning of a pathology department

Introducción: Nos planteamos el problema: ¿cuál es el número adecuado de facultativos en un servicio de anatomía patológica (SAP) para responder sin demora al número de solicitudes de estudio que se reciben? Material y métodos: Aplicamos conceptos básicos de teoría de colas y motivamos al lector a introducirse en ellos. Resultados y discusión: Un SAP funciona como un sistema de colas y se ajusta a los modelos de cola infinita con uno (M/M/1) y, todavía mejor, con múltiples recursos (M/M/m). El número de facultativos (m) ha de cumplir: m » velocidad de llegada de biopsias al SAP/velocidad de cierre de biopsias por facultativo Conclusiones: Como sistema de colas, un SAP solo es viable si su capacidad de respuesta es mayor que las necesidades planteadas por la demanda. El modelo de múltiples recursos (facultativos) amortigua mejor los aumentos sostenidos de la demanda (AU)

Introduction: The problem of the optimal number of pathologists required to provide a rapid response to the volume of studies requested is considered. Material and methods: The basic concepts of the queueing theory are applied and recommendations for their use are made. Results and discussion: Pathology departments (PD) work as a queuing system and adapt to infinite queue models with a (M/M1) or, preferably, multiple servers (M/M/m). The number of pathologists (m) must achieve: m » velocity of arrival of biopsies to the PD/velocity of completion of biopsy reports by pathologists. Conclusions: Like a queueing system, a PD is viable only if its capacity of response is greater than the demand. The model of multiple resources (pathologists) better absorbs a sustained growth in demand (AU)

Un método gráfico de análisis de costes asociados a los falsos resultados de una prueba diagnóstica / A graphical method for analyzing the cost of a diagnostic test, subject to the sensitivity and specificity of the test

Objetivo. Presentar un método de análisis gráfico de costes ocasionados por los falsos positivos (FP) y falsos negativos (FN) de una prueba diagnóstica. Material y métodos. Construimos una función de costes ligada a la sensibilidad (S) y a la especificidad (E) de la prueba diagnóstica. A partir de esta función obtenemos líneas de isocoste, cuya pendiente es la relación coste FP/coste FN. Representamos cada prueba diagnóstica en el espacio ROC como el punto (1-E, S). Resultados. Las líneas de isocoste permiten visualizar si el gasto asociado a FP y FN de una nueva prueba diagnóstica es menor o igual que el de la antigua. Conclusiones. El análisis gráfico de la función de costes de una prueba diagnóstica ayuda a decidir su introducción o su rechazo(AU)

Objective. We present a graphical method for analyzing the cost related to false positive (FP) and false negative (FN) results of diagnostic tests. Material and methods. We created a function relating cost to the sensitivity (S) and specificity (E) of the diagnostic test. Isocost straight lines were obtained, the gradient of which represents the ratio of false positive cost/false negative cost. The various diagnostic tests are plotted in the ROC space as the point (1-E, S). Results. Isocost straight lines allowed us to see if the cost of a new test is lower or the same as previous tests. Conclusions. Graphical analysis of the cost of a diagnostic test is helpful in deciding whether or not to introduce new diagnostic tests(AU)

Inter- and intra-observer assessment of the Galactogram Imaging Classification System (GICS).

BACKGROUND: A new system for the classification of galactograms is reported. To date, there is no universally accepted classification system. PURPOSE: To evaluate inter- and intra-observer agreement of the Galactogram Imaging Classification System (GICS) MATERIAL AND METHODS: Six observers with different levels of experience retrospectively evaluated 30 galactograms using the GICS. Images were reviewed independently twice within a four-week period. The kappa statistic was calculated for intra- and inter-observer variability. RESULTS: The kappa for inter-observer agreement was moderate to substantial (range 0.41-0.72). Overall, the intra-observer kappa values were excellent (range 0.80-0.94). CONCLUSION: The present study shows a good to very good inter- and intra-observer agreement with the GICS. We believe the GICS can be incorporated into daily practice.

Galactography: an application of the Galactogram Imaging Classification System (GICS).

BACKGROUND: Galactography is the technique of choice for investigating pathological nipple discharge. However, there is no standardized interpretation system for this procedure. PURPOSE: To evaluate radiological and histological correlation using a Galactogram Imaging Classification System (GICS). MATERIAL AND METHODS: We retrospectively studied all galactograms obtained in 62 women with pathological nipple discharge who subsequently had biopsy at our institution between 1999 and 2007. The GICS proposes five categories for galactographic findings: GICS 1: negative; GICS 2: benign; GICS 3: probably benign; GICS 4: suspect for malignancy; GICS 5: highly suspect for malignancy. RESULTS: The galactographic findings were classified as follows: GICS 2: 25.8% (16/62); GICS 3: 30.6% (19/62); GICS 4: 25.8% (16/62); and GICS 5: 17.7% (11/62). A good correlation was observed between histological diagnosis and GICS categories (P < 0.05). All the cases diagnosed with carcinoma (n = 11) were classified in GICS category 5. CONCLUSION: The present study shows a good correlation between GICS categories and histological diagnosis.

Glioma cordoide del III ventrículo: descripción de un nuevo caso y revisión de la literatura / Chordoid glioma of the third ventricle: case report and literature review

El glioma cordoide del tercer ventrículo es un tumorcerebral poco frecuente, de reciente descripción, localizadoen la región hipotalámica - III ventrículo. Hasta la fecha, tansólo hay 56 casos publicados desde que se describiera porprimera vez en 1998 por Brat y cols. Histológicamente, eltumor está compuesto por células poligonales dispuestas ennidos o cordones, inmersas en una matriz mucoide con unintenso infiltrado inflamatorio linfoplasmocitario. Las célulasneoplásicas coexpresan característicamente marcadoresinmunohistoquímicos de Proteína Ácida Gliofibrilar(PAGF), Citoqueratinas, Vimentina y CD-34. A nivel ultraestructuralmuestra características de diferenciación ependimariay recientemente también se han identificado alteracionesgenéticas características distintas a las de los gliomas. Laextirpación tumoral fue incompleta tras un abordaje anterior.Nosotros describimos un nuevo caso de este tumor en unvarón de 26 años y revisamos la literatura(AU)

Chordoid glioma of the third ventricle is an infrecuentbrain tumor, located the third ventricle-hypothalamicregion. Described for the first time by Brat in 1998, only 56cases have been described in the literature. Histologically,the tumor consisted of polygonal epithelioid cells embeddedin a mucinous matrix with a prominent lymphoplasmacyticinfiltrate. The tumor cells expressed Glial Fibrillary AcidicProtein (GFAP), Cytokeratins, Vimentin and CD-34. Thisneoplasm exhibits features of ependymal differentiation onultrastructural examination. Another authors also suggest adistinct genetic origin from other gliomas with specificmolecular characterization. An incomplete resection wasperformed via an anterior approach. A case in a 26 years oldman is reported and a review of the literature is included(AU)

Diagnósticos Críticos en Anatomía Patológica: una contribución a la seguridad clínica del paciente hospitalizado / Critical diagnoses in pathology: a contribution to the clinical safety of the hospitalized patient

Los Diagnósticos Críticos en Anatomía Patológica han sido recientemente introducidos y son equiparables a los establecidos a nivel clínico, de forma que, situaciones clínicas concretas pueden precisar de un diagnóstico rápido (ya sea por parte del patológo o del citopatólogo) y del contacto urgente con el clínico con el fin de facilitar una intervención clínica urgente o instaurar un tratamiento determinado, de los que el paciente se beneficiaría. Basándonos en la experiencia diaria, presentamos diferentes situaciones clínico-patológicas en las que el diagnóstico es crítico (AU)

Critical diagnoses in surgical pathology and cytology have recently been introduced in a similar way to critical values in clinical pathology (laboratory medicine). Thus, some situations require that the clinician be informed urgently of the diagnosis in order to facilitate rapid clinical intervention or treatment and ensure that the patient receives optimal care. Based on day to day experience, this article provides examples of different situations in which critical diagnoses in pathology are necessary (AU)

[Immunohistochemical characterisation of breast cancer: towards a new clasification?]. / Características inmunohistoquímicas del cáncer de mama: hacia una nueva clasificación?

BACKGROUND: The aim of this paper is to determine the possible association between five different profiles of immunohistochemical expression related to clinical, histopathological and immunohistochemical known prognostic value variables for breast cancer. MATERIAL AND METHOD: A total of 194 breast carcinoma tumour samples were studied. In this study five groups or immunohistochemical profiles were defined, based on expression of hormone receptors (oestrogen or progesterone) and/or Her2/neu (luminal-type A, luminal-type B, mixed profile, Her2/neu profile and triple-negative-type profile) and we studied whether there are differences between them with regard to clinical, histopathological and immunohistochemical variables that have a known prognostic significance. RESULTS: In the series we found 134 (69%) cases corresponding to a luminal immunophenotype, of which 98 (50.5%) were from the luminal A group and 36 (18.6%) from luminal B. Twenty-nine cases (15.9%) were triple-negative, 18 (9.3%) mixed and 13 (6.7%) Her2/neu type. It is worth noting the relationship between the triple-negative and Her2/neu immunophenotypes and the more poorly differentiated histological forms (62% and 60%, respectively) and between the luminal A group and well-differentiated tumours (p = 0.008). Expression of ki67 was high in the triple-negative group (73.9%) and low in the luminal A group (26.3%; p = 0.001). The expression of p53 was also greater for the Her2/neu (55.5%) and triple-negative (60.8%) groups (p = 0.0005) than for the others. CONCLUSIONS: The subgroups without hormone receptor expression, with Her2/neu overexpression or without (triple-negative group), have characteristics associated with variables of a poorer prognosis. The lack of progesterone receptor expression also seems to be associated with these.

Características inmunohistoquímicas del cáncer de mama: ¿hacia una nueva clasificación? / Immunohistochemical characterisation of breast cancer: towards a new classification?

Introducción. El objetivo de este trabajo es determinarla posible asociación de cinco perfiles diferentes de expresión inmunohistoquímica con variables clínicas, histopatológicas e inmunohistoquímicas de conocido valor pronóstico en el cáncer de mama. Material y método. Se estudiaron 194 muestras de carcinoma ductal infiltrante de mama. Se definieron 5perfiles inmunohistoquímicos basados en la expresión de receptores hormonales (estrogénicos o de progesterona)y/o Her2neu (luminal A, luminal B, mixto,Her2neu y triple negativo) y se estudió si había diferencias entre ellos en relación con variables clínicas, histopatológicas e inmunohistoquímicas de conocido valor pronóstico. Resultados. En la serie se encontraron 134 (69%) casos correspondientes a un inmunofenotipo luminal, de los que 98 (50,5%) fueron del grupo luminal A y 36(18,6%) del luminal B; 29 (15,9%) casos fueron triples negativos, en 18 (9,3%) se daba un tipo mixto y en 13(6,7%), del tipo Her2neu. Destaca la relación entre los inmunofenotipos triple negativos y Her2neu con formas histológicas peor diferenciadas (el 62 y el 60%,respectivamente) y del grupo luminal A con tumores bien diferenciados (p = 0,008). La expresión de ki67fue mayor en el grupo triple negativo (73,9%) y baja en el luminal A (26,3%) (p = 0,001). La expresión de p53también fue mayor para los grupos Her2neu (55,5%) y triple negativo (60,8%) (p = 0,0005) respecto a los otros. Conclusiones. Los subgrupos sin expresión de receptores hormonales, con sobreexpresión de Her2neuo sin ella (triple negativo) presentan características asociadas con variables de peor pronóstico. La pérdida de expresión de receptores a progesterona también parece asociarse con ellas (AU)

Background. The aim of this paper is to determine the possible association between five different profiles of immunohistochemical expression related to clinical, histopathological and immunohistochemical known prognostic value variables for breast cancer. Material and method. A total of 194 breast carcinomatumour samples were studied. In this study five groups or immunohistochemical profiles were defined, based on expression of hormone receptors (oestrogenor progesterone) and/or Her2/neu (luminaltypeA, luminal-type B, mixed profile, Her2/neu profile and triple-negative-type profile) and we studied whether there are differences between them with regard to (..) (AU)

Hallazgos poco frecuentes en citología del aparato respiratorio (presentación de 4 casos) / Infrequent findings in respiratory system cytology. Presentation of 4 cases

Presentamos cuatro casos clínico-citológicos del aparato respiratorio, poco habituales en la práctica diaria, donde la morfología además de las técnicas especiales, son suficientes para llegar a un diagnóstico correcto (Strongyloides stercoralis, Cuerpos ferruginosos, Aspergillus y virus del herpes en carcinoma epidermoide)

Four clinical-cytological cases of the respiratory apparatus appear, little habitual actually daily, where the morphology in addition to the special techniques, is sufficient to arrive at a correct diagnosis (Strongyloides stercoralis, ferruginous Bodies, Aspergillus and virus herpes in epidermoide carcinoma)

Hallazgos poco frecuentes en citología del aparato respiratorio (presentación de 4 casos) / Infrequent findings in respiratory system cytology. Presentation of 4 cases

Presentamos cuatro casos clínico-citológicos del aparato respiratorio, poco habituales en la práctica diaria, donde la morfología además de las técnicas especiales, son suficientes para llegar a un diagnóstico correcto (Strongyloides stercoralis, Cuerpos ferruginosos, Aspergillus y virus del herpes en carcinoma epidermoide)

Four clinical-cytological cases of the respiratory apparatus appear, little habitual actually daily, where the morphology in addition to the special techniques, is sufficient to arrive at a correct diagnosis (Strongyloides stercoralis, ferruginous Bodies, Aspergillus and virus herpes in epidermoide carcinoma)

Carcinoma de células pequeñas de glándula salival submaxilar / Small cell carcinoma of the submaxillary gland

El carcinoma de células pequeñas de la glándula salivalsubmaxilar es una entidad rara en esta localización. Para sudiagnóstico definitivo es importante realizar estudio inmunohistoquímicoy descartar la posibilidad de metástasis. Eneste artículo presentamos un nuevo caso en un paciente de76 años, sin patología pulmonar conocida y revisamos laliteratura publicada hasta la fecha

Background: Small cell carcinoma in the submaxillarygland is a very rare entity. To achieve a correct pathologicaldiagnosis it is very important to perform a detailed clinicopathologicalcorrelation and a precise immunohistochemicalstudy. Patients and methods: A case in a 76 years oldman with no previous pulmonary pathology is reported. Areview of literature is included

Utility of frozen-section examination for diagnosis of malignancy associated with multinodular goiter.

BACKGROUND: Frozen-section examination (FSE) has traditionally been used for the intraoperative diagnosis of thyroid cancer. However, the utility of the technique is now controversial, especially in multinodular goiter (MNG), on which there are few studies. The aim of this study was to analyze the utility of FSE for ruling out malignancy in patients undergoing surgery for MNG. PATIENTS AND METHODS: FSE was performed in 197 patients with MNGs undergoing surgery for suspected malignancy, either preoperatively (n = 145; 74%) or intraoperatively (n = 52; 26%), and where the preoperatively planned surgical technique was partial resectional surgery. The FSE diagnosis was classified as benign, suggestive of malignancy, or malignant. The following FSE parameters were calculated for diagnosing MNG-associated carcinoma: true- and false-positives and true- and false-negatives, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy. The chi2 and Student's t tests were applied. RESULTS: The FSE revealed benignity in 191 cases (97%), suggested malignancy in 3 (1.5%), and were malignant in the remaining 3. The final histology revealed 16 carcinomas (8%), of which only 3 were detected by FSE. Only tumor size was a factor significantly associated with FSE carcinoma detection (p = 0.0012). The sensitivity of the technique for detecting carcinoma was 19%, specificity, 100%; positive predictive value, 100%; negative predictive value, 93%; and diagnostic accuracy, 93%. CONCLUSIONS: FSE should not be used routinely in the management of MNG, and considering its low rate of sensitivity for detecting malignancy, the decision on the extent of the thyroidectomy should be based on other factors and explorations.

Pólipo fibroepitelial estromal vulvo-vaginal y de cérvix / Vulvovaginal and cervical fibroepithelial polyps: clinico-pathological features of a series of 22 cases

El pólipo fibroepitelial estromal es una entidad benigna, cuya peculiaridad más importante es la variedad de hallazgos histopatológicos que puede presentar, y que todavía frecuentemente se diagnostica erróneamente como maligno, a pesar de que es una entidad bastante bien estudiada en la literatura. Hemos recogido nuestra casuística en los últimos 5 años y revisado la literatura (AU)

[Primary non-lymphoid thymic neoplasms. A study of 58 cases]. / Neoplasias primarias del timo de estirpe no linfoide. Estudio de 58 casos.

BACKGROUND AND OBJECTIVE: Primary non-lymphoid thymus tumors (PNLTT) are an uncommon though quite varied pathology. Our objective was to identify the clinical, therapeutic and histologic variables with a prognostic value in these neoplasms. PATIENTS AND METHOD: We studied 58 PNLTT cases, corresponding to 52 epithelial neoplams (PTEN), 4 thymolipomas (7%) and 2 neuroendocrine tumors (3%). Commonest clinical manifestations were myasthenia gravis (41%) and dyspnea (21%). Three patients were symptom-free (24%). We used Kaplan-Meier survival curves and Cox regression model. RESULTS: All patients underwent surgery which consisted of thymectomy. Four patients underwent a biopsy procedure alone. Perioperative mortality was 3% (n = 2) and morbidity was 31% (n = 18), mainly because of respiratory and wound problems. 24 patients with PTEN, Masaoka degrees III and IV, and a patient with a lymphoepithelial carcinoma received adjuvant chemotherapy and/or radiotherapy. With a follow-up of 13 + 5 years, 12 PTEN patients and one patient with a neuroendrocrine tumor died as a consequence of the evolution of the disease. Cumulative survival was 80% at 5 years, 71% at 7 years and 63% at 10 years. There are currently two local relapses in two PTEN cases after 9 and 8 years of follow-up, respectively. Main prognostic factors are the histologic type and subtype and the clinical stage (p < 0.001). CONCLUSIONS: In PNLTT early diagnosis is crucial in order to administer a correct treatment before the clinical stage is more advanced. Main prognostic factors are the histologic type and subtype and the clinical stage.

Tumor filodes de mama maligno, unilateral y multicéntrico / Unilateral and multicentric malignant phylloides tumor of the breast

El tumor filodes es un tumor mamario infrecuente, de estirpe fibroepitelial, que tiene generalmente un comportamiento biológico benigno. En el presente trabajo presentamos un caso clínico de tumor filodes maligno multicéntrico y unilateral (AU)