Giant cavernous hemangioma in renal graft: a case report.

BACKGROUND: We present a case of giant cavernous hemangioma in renal graft tumor; we have not found any cases described in literature. CLINICAL CASE: Patient transplanted from a deceased donor, 8 years previous to her admission due to deterioration in renal function, observing a 12-cm renal mass in the front face of the renal graft, which displaces it, provoking obstructive uropathy. On ultrasonography and computed tomography, it is seen as a complicated, cystic lesion. Tumorectomy with a good functional recovery of the graft was carried out. A histopathologic study showed a mass with extensive adherences to the perirenal adipose tissue and a cross section showed a spongy appearance with blood clots in the centre, microscopically formed by vascular channels, lined by a layer of endothelial cells, and filled with blood. CONCLUSIONS: Giant cavernous hemangioma in renal graft tumor has not been previously described. Given its benign condition, nephron-sparing surgery should be carried out if possible.

[Acute cell rejection in ex vivo model of swine-human renal xenotransplantation]. / Rechazo celular agudo en modelo ex vivo de xenotrasplante renal cerdo-hombre.

OBJECTIVE: Ex vivo perfusion model of pig-to-human kidney xenotransplantation to evaluate human antiporcine xenograft rejection once hyperacute rejection (HAR) is avoided. METHODS: Pig kidneys were perfused for 3 hours with pig blood (group 1; n = 5), human blood (group 2; n = 5), complement heat inactivated human blood (group 3; n = 5), platelet-depleted human blood (group 4; n = 5); and xenoreactive natural antibodies (XNA)-depleted human blood (group 5; n = 5). Tissue samples were studied with immunoperoxidase techniques. RESULTS: Pig kidneys perfused with human blood, group 2, showed HAR with interstitial haemorrhage, vascular thrombi and glomerular injury. Pig kidneys perfused with manipulated human blood (groups 3 to 5) had no histologic evidence of HAR, but showed signs of acute cellular rejection with different degrees of interstitial infiltrate of mononuclear cells, specially in the XNA-depleted group. CONCLUSIONS: The model may be valuable in the isolated evaluation of the elements involved in the pig-to-human xenorejection. The depletion of complement, platelets and XNA protected porcine kidneys form HAR in our study and allowed the development of an acute cellular rejection, a very unusual fact in this short time, 3 hours.

Rechazo celular agudo en modelo ex vivo de xenotrasplante renal cerdo-hombre / Cellular acute rejection pig to human in an ex vivo renal transplant model

OBJETIVOS: Desarrollo de un modelo ex vivo de perfusión de riñones de cerdo con sangre humana, intentando reproducir el xenotrasplante renal cerdo-hombre, para el estudio de las manifestaciones que se producen una vez evitado el rechazo hiperagudo. MÉTODO: Perfusión de los riñones de cerdo durante 3 horas con sangre de cerdo (grupo 1; n=5), sangre humana (grupo 2; n=5), sangre humana decomplementada por calor (grupo 3; n=5), sangre humana deplaquetada por centrifugación (grupo 4; n=5), sangre humana inmuonadsobida con proteína A estafilocócica (grupo 5; n=5). Las piezas se estudian por microscopía óptica e inmunohistoquímica. RESULTADOS: Rechazo hiperagudo con hemorragia difusa, trombosis y lesiones glomerulares en el grupo con sangre humana sin manipular. Ausencia de rechazo hiperagudo en el resto de los grupos: decomplementada, deplaquetada e inmunoadsorbida, con presencia de rechazo celular agudo con diferentes grados de infiltración intersticial de células mononucleares, en especial en el grupo con sangre inmunoadsorbida. CONCLUSIONES: El modelo que permite valorar de forma aislada elementos de la respuesta inmune xenogénica cerdo-hombre. La depleción de complemento, plaquetas y xenoanticuerpos protege a los riñones de cerdo del rechazo hiperagudo, observando por primera vez la presencia de rechazo celular agudo en 3 horas, manifestación que suele precisar para su aparición varios días (AU)

Results and prognostic factors in stage I(E)-II(E) primary gastric lymphoma after gastrectomy.

BACKGROUND: Infrequency of gastric lymphomas and lack of homogeneity of studies dealing with them preclude accurate management schemes. Helicobacter pylori (HP) and Isaacson's classification are new factors to consider. Our aim was to analyze these and other prognostic factors in a homogeneous series. STUDY DESIGN: Fifty-four patients (mean age 62.4 years) treated by gastrectomy for primary gastric non-Hodgkin's lymphoma in stages IE or IIE were retrospectively reviewed. Twenty-seven patients received postoperative chemotherapy. HP and histologic features were studied using new slides from the paraffin-embedded gastrectomy specimens. RESULTS: Postoperative morbidity and mortality rates were 19% and 5.6%, respectively. Five-year survival was 83%. Classification showed low-grade tumors in 59% and high-grade tumors in 41%. HP was positive in 64% of the patients. A poorer survival was associated with high-grade tumors (p = 0.02) and serosa involvement (p = 0.02). We did not find any significant difference between patients treated either by partial or total gastrectomy (p = 0.2), or receiving chemotherapy or not (p = 0.9). Nor did we appreciate any differences concerning margin involvement (p = 0.9). CONCLUSIONS: Most primary gastric lymphoma patients have gastric HP. Serosa involvement and high-grade tumors adversely influence survival but gastrectomy type, resection margin invasion, and postoperative chemotherapy did not appear to have any influence.

Prognostic factors in supraglottic laryngeal carcinoma.

We carried out a retrospective study of patients with supraglottic carcinomas who were treated surgically at the Marques de Valdecilla Hospital (Santander, Spain) between 1978 and 1987 and who were followed up for at least 5 years. The Kaplan-Meier survival curves were calculated for 24 clinical, histologic, and morphometric parameters. Multivariate analysis was then performed by means of the Cox regression model. In the univariate analysis, survival was related to presence of capsule rupture of the involved lymph nodes (p = 0.00001), number of metastatic lymph nodes (p = 0.0002), postoperative TNM stage (p = 0.004), grade of cell differentiation (p = 0.001), presence of intratumoral necrosis (p = 0.01), and type of invasion (p = 0.04). The nuclear area did not have an influence on survival. Only the presence or absence of capsule rupture of the metastatic lymph nodes and the grade of cell differentiation were included in the final Cox model and proved to be parameters with independent prognostic significance.

[Prognostic significance of DNA content measured by flow cytometry in supraglottic laryngeal carcinoma]. / Valor pronóstico del contenido de ADN por citometría de flujo en el carcinoma supraglótico de laringe.

Eighty-five patients with squamous that were cell carcinoma of the supraglottis treated surgically in the Department of Otolaryngology at the Marqués de Valdecilla Hospital in Santander (Spain) over a 10-year period from January 1, 1978 to December 31, 1987 were studied retrospectively. In 81 cases a flow cytometric study was made from the surgical specimen included in paraffin blocks, to determine the DNA index and the percentage of cells in the S phase of the cellular cycle. An statistical analysis was made to determine the correlation between these parameters and survival was analyzed using the Kaplan-Merer method. Survival curves were compared using the log-rank test. In 67 cases (82.7%) DNA content was diploid and in 14 cases (17.3%) it was aneuploid. The percentage of cells in S phase was 3.8 and 55.4, with a mean value of 15.19. Comparison of with the five these parameters years survival showed no statistical differences between groups, although tumors with more than 19% S phase had worse prognosis (p < 0.1) and tumors in advanced stages were more frequently aneuploid and had higher S phase values (p = 0.1).

[Papillary adenocarcinoma of the rete testis. Report of a case]. / Adenocarcinoma papilar de la rete testis. Presentación de un caso.

OBJECTIVES: Another case of adenocarcinoma of the rete testis is described and the literature on this uncommon tumor type reviewed. METHODS/RESULTS: The clinical features, pathological findings and treatment of adenocarcinoma of the rete testis in a 72-year-old male are presented. CONCLUSIONS: Adenocarcinoma of the rete testis is a rare tumor type; few cases have been reported in the literature. Although treatment is primarily by surgery, recognition of new cases will provide further insight into this primary tumor of the rete testis.

[Bladder pheochromocytoma]. / Feocromocitoma vesical.

OBJECTIVES: The present study reports on a case of paraganglioma of the urinary bladder and briefly reviews the literature. METHODS/RESULTS: The patient presented with gross hematuria and no history of hypertension. The pathological findings were diagnostic of paraganglioma of the urinary bladder. CONCLUSIONS: Extra-adrenal pheochromocytoma is uncommon. Although it usually presents with typical symptoms, these are also determined by tumor location. Currently, there are no anatomopathological criteria to distinguish the benign from the malignant form.

[Leiomyoma of the epididymis. Report of a case and review of the literature]. / Leiomioma de epidídimo. Presentación de un caso y revisión de la literatura.

Leiomyoma of the epididymis is a benign tumor that is rarely diagnosed and is second only to epididymal adenomatoid lesions in frequency. A case of leiomyoma of the epididymis in a 62-year-old patient is described. The patient presented with a tumor in the tail of the left epididymis which was definitively diagnosed following surgical resection and subsequent anatomopathological analysis. The classification, clinical features, diagnosis and treatment of this tumor type are briefly discussed.

Glioblastoma multiforme of donor origin after renal transplantation: report of a case.

A case of transmission of a glioblastoma multiforme from the donor to a kidney transplant recipient in the absence of previous ventriculosystemic shunt is described. The recipient was a 48-year-old woman who developed a fever with no other associated symptoms 17 months posttransplant. Physical examination revealed a large nonpulsatile mass on the upper graft pole. Histopathologic examination showed a highly cellular neoplasm with fusiform and globoid cells, a high grade of nuclear pleomorphism and mitosis, necrosis with pseudopalisading, and vascular proliferation. Immunohistochemistry of the cells showed them to contain glial fibrillary acidic and S-100 proteins, consistent with a glioblastoma multiforme. We conclude that the risk of tumor transmission from donors with primary central nervous system tumors to kidney transplant recipients, is real and should be considered when evaluating a graft mass in such patients.

[Anatomopathologic and morphometric study of hepatocarcinoma]. / Estudio anatomopatológico y morfométrico del hepatocarcinoma.

UNLABELLED: Because of its great incidence and poor prognosis the hepatocarcinoma (HPC) has become a first line clinical challenge. This is the reason we have performed a descriptive anatomo-pathological analysis of our own cases and a study of the possible prognostic value of nuclear parameters. DESIGN: We have performed a retrospective study of 83 cases. We reviewed the clinical records and histologic preparations. METHODS: We analysed the following parameters: 1) Tumour site; 2) Association to cirrhosis; 3) Microscopic features (cellular type differentiation grade, peritumoral lymphocytic infiltration, architecture, mitotic index); 4) Metastatic frequency and location; 5) Morphometric nuclear parameters (area, perimeter, major diameter, major and minor axis, circle diameter, sphere volume, ellipse volume, shape factor. RESULTS: We highlight the following: 1) 50% of HPC associated to liver cirrhosis; 2) Ascites was more frequent in the tumours located in the right lobe or both lobes than in tumours affecting the left lobe (p < 0.005); 3) Macroscopically, the commonest type was the nodular one (47.8%); 4) Microscopically, the commonest findings were as follows: cellular type (93%); differentiation grade type II (61.4%); trabecular architecture (64.9%); lymphocytic infiltration grade I (57.9%); 5) Mean mitotic index was 16.3 m./high power field. 6) There were distant metastases in 81.1% and portal vein invasion in 44.6%. 7) The nuclear morphometric study did not support any influence on patients' survival. CONCLUSIONS: 1) This descriptive analysis allows a morphological data base that is very useful for subsequent morphological or prognostic studies. 2) Our data do not support any influence of nuclear parameters on patients' survival, although we cannot exclude some relation in a greater series.

[Carcinoma of Bellini's duct]. / Carcinoma del conducto de Bellini.

First case in the Spanish literature of a carcinoma of Bellini's duct. Differentiation of this tumor from the classic renal adenocarcinoma, mainly the papillary type, is based on the different embryological origin, microscopic characteristics and immunohistochemical studies. Prognosis is worse than for the other renal adenocarcinomas.

[Langerhans cells do not influence the postoperative survival of esophageal epidermoid carcinoma]. / Las células de Langerhans no influyen en la supervivencia postoperatoria del carcinoma epidermoide esofágico.

OBJECTIVE: Langerhans' cells (LC) in several tumors have been related to a better postoperative prognosis. We have performed the present study in order to verify this hypothesis for oesophageal squamous cell carcinoma (OSCC). EXPERIMENTAL DESIGN: A retrospective analysis of histologic preparations of OSCC was made. For the identification of LC, the deparaffinized sections were stained with anti S-100 protein antibody using the avidin-biotin-peroxidase complex (ABC) method. We assessed the presence of LC in the whole tumour, in the stroma and in the epithelium. We also analyzed their influence on postoperative survival and their relation to histologic differentiation, wall involvement, peritumoral lymphocytic infiltration and microscopic growth type. PATIENTS: 35 patients who underwent standard esophagectomy for OSCC. None had received radiotherapy and none died from postoperative complications. RESULTS: LC were found in 88.6% of patients. In 31.4% only in the epithelium and 17.1% exclusively in the stroma. Mean cellular density was greater in epithelium (NS). A higher two-year survival was found in patients with a greater cellular density without statistical significance. More than 15 LC/mm2 were associated with infiltrative growth type tumors whereas less than 15 LC/mm2 were associated with infiltrative growth type ones (P < 0.01). No statistical significant correlations were found with other parameters. CONCLUSIONS: Our results do not support an influence of the LC on the OSCC postoperative survival. We have shown an association between LC density and growth type but its significance is still undetermined.

Nuclear morphometry lacks prognostic value in squamous cell carcinoma of the oesophagus.

In order to determine the possible influence in oesophageal squamous cell carcinoma of nuclear measurements on patients' postoperative survival and on various histological tumour features, we performed a nuclear morphometry study on 53 patients (50 males, 3 females) with a mean age of 57.4 years (37-79). A statistical correlation was revealed between area, perimeter and diameter and the analysis was, therefore, performed only in terms of nuclear area. No influence of nuclear area on postoperative survival was observed. Nor was a relationship found between mean nuclear area and either involvement of the oesophageal wall or degree of histological differentiation. The tumours showing expansive growth had a larger mean nuclear area than those of the infiltrative growth type, although differences did not reach statistical significance. The nuclear area standard deviation (reflecting anisocytosis of the tumour) showed no correlation with survival. In conclusion, our data do not support that measurement of nuclear parameters by static methods is of any prognostic value in surgically-treated squamous cell carcinoma of the oesophagus.

Epidermoid carcinoma of the lung in stage I: factors of prognostic interest.

Factors affecting stage I epidermoid cancer of the lung were studied in a series of 29 patients treated only by surgery and followed up for ten years. A set of 13 variables with a possible influence on prognosis were investigated. The application of the Cox Univariate Analysis to the different variables showed the grade of cell differentiation and the mitotic index to be predictors. In the Cox Multivariate Analysis, the proportional regression equation revealed two independently significant variables (p < 0.01), which were the Mitotic Index and Nuclear Area. Grouping patients on the basis of the prognostic variables indicated allows a better prediction for survival to be made for this series of patients.

Radiohistology and histochemistry of barium granuloma of the colon and rectum.

Barium granuloma of the colon and rectum is a rare complication of X-ray examination of the digestive tract using barium. The authors report 5 new cases occurring in the last 3 years. Histological examination revealed a granulomatous reaction with greyish finely granular refractile PAS-negative material located in the cytoplasm of histiocytes and in the interstitial space. The radiographic study of the paraffin blocks confirmed the nature of this material, which was X-ray opaque, and this was corroborated histochemically with the rhodizonate technique.