Tumor maligno de la estroma gastrointestinal localizado en el epiplón. Falso diagnóstico de cistoadenocarcinoma ovárico / Malignant gastrointestinal tumor located in the omentum. False diagnosis of ovarian cystadenocarcinoma

Los tumores de la estroma gastrointestinal (GIST) son tumores mesenquimales del tracto gastrointestinal, que suelen revelar positividad para CD34 y CD117, y cuyo potencial de malignidad es difícil de predecir. Suelen clasificarse en benignos, borderline y malignos, si bien algunos de los etiquetados como benignos pueden metastatizar varios años después de un tratamiento quirúrgico oncológicamente correcto. Presentamos el caso de una paciente, a la que 7 años antes se le había realizado una resección intestinal por leiomioma mixoide de íleon y que fue intervenida quirúrgicamente con el diagnóstico de sospecha de cistadenocarcinoma de ovario. El estudio histológico reveló un tumor maligno de la estroma gastrointestinal con diferenciación mioide localizado en el epiplón. Del caso presentado y de la bibliografía consultada parece inferirse que el potencial maligno de los GIST es difícil de predecir y que a los 5 años la supervivencia, incluidas todas las formas de enfermedad, varía entre el 20 y el 50 por ciento (AU)

Determinants of allergen-induced late bronchial responses in mild asthmatics.

STUDY OBJECTIVE: To examine the baseline factors influencing the occurrence and magnitude of immediate- and late-phase responses in asthmatic patients after an allergen-induced bronchial provocation test (A-BPT). DESIGN: Cross-sectional analysis in a homogenous group of 31 mild, Dermatophagoides pteronyssinus-allergic patients with asthma. SETTING: Allergy Department, Hospital Virgen del Camino, Pamplona, Spain. INTERVENTIONS AND MEASUREMENTS: Patients completed an asthma symptom questionnaire and underwent skin tests, sputum induction, and methacholine bronchial provocation test. The A-BPT was performed on a separate day. Sputum cell profile and eosinophil cationic protein (ECP), tryptase, albumin, and interleukin-5 levels were quantified in the entire sputum supernatant. Assays were done for eosinophils in blood, and/or ECP, and total and specific IgE levels in serum. Exposure to D pteronyssinus major allergens (Der p1 and Der 2) was measured by an assay based on monoclonal antibodies. RESULTS: A-BPT findings were positive in all patients, and late-phase responses were detected in 29%. Late responders were exposed to higher levels of Der p1 (p = 0.028), had greater levels of ECP (p = 0.007) and albumin (p = 0.019) in sputum, and showed a trend toward higher lymphocyte numbers (p = 0.053) in sputum than isolated early responders. The allergen-induced provocative dose that induced a fall in FEV(1) values > or =20% from the postdiluent values correlated with bronchial hyperresponsiveness (r = 0.36). The late-phase response magnitude correlated with Der p1 exposure (r = 0.49) and showed a trend toward correlation with sputum ECP levels (r = 0.38). CONCLUSION: Factors involved in the development of allergen-induced immediate- and late-phase responses are different. Allergen natural exposure might prime the infiltration of the airway by activated inflammatory cells enhancing the appearance and the severity of late-phase responses.

[Lethality of prostatic origin]. / Letalidades de origen prostático.

We report a case of cutaneous metastasis originating from prostate adenocarcinoma. We underscore this rare site of metastasis and the poor outcome.

[Ceruminous adenocarcinoma: report of a case]. / Adenocarcinoma ceruminoso: a propósito de un caso.

A case of an adenocarcinoma of ceruminous glands located on the external auditory meatus is presented. It must be noted the discrepancy between the well-differenciated histologic appearance and the markedly aggressive clinical course.