The Pan-TRK Antibody is a Sensitive and Specific Tool for the Detection of NTRK Fusion Genes.

Pan-TRK antibodies have been used to detect gene fusions in diverse types of tumors. Several tyrosine receptor kinases (TRK) inhibitors have recently been developed and have shown good response rates in neoplasms with NTRK; therefore, identifying these fusions is an essential tool in assessing treatment options for certain oncological diseases. Various algorithms have been designed to diagnose and detect NTRK fusions to optimize time and resources. This study explores the use of immunohistochemistry (IHC) as a screening method for NTRK fusions by comparing next-generation sequencing (NGS) and IHC to evaluate the pan-TRK antibody's performance as a marker for NTRK rearrangements. The present work studied 164 formalin-fixed paraffin-embedded blocks of different solid tumors. Two pathologists confirmed the diagnosis and selected the correct area to assess with IHC and NGS. Specific cDNAs were generated for the genes involved. NTRK fusions were identified in 4 patients positive for the pan-TRK antibody through NGS. The identified fusions were NTRK1-TMP3, NTRK3-EML4, and NTRK3-ETV6. That shows sensitivity and specificity of 100% and 98%, respectively. NTRK fusions were identified in 4 patients positive for the pan-TRK antibody through NGS. IHC tests (with the pan-TRK antibody) are a sensitive and specific method for identifying the presence of NTRK1-3 fusions.

Acute Abdomen Secondary to Ruptured Epithelial Ovarian Cancer during Pregnancy: The Relevance of Teamwork / Abdome agudo secundário à ruptura do câncer do ovário epitelial durante a gravidez: a importância do trabalho em equipe

Abstract Acute abdomen secondary to epithelial ovarian cancer rupture during pregnancy is a rare event. Our aim is to present how the work of a coordinated multidisciplinary team in a case of ruptured epithelial ovarian cancer during pregnancy is feasible to obtain the best results possible. A 34-year-old woman during the 37th week of her first gestation presented with an acute abdomen. During laparotomy, a ruptured 16.5-cm left ovarian tumor was detected; the tumor was extirpated and sent to pathologic evaluation. In the meantime, a Kerr cesarean section was performed, and a healthy female neonate was born. The tumor was diagnosed as a cystadenocarcinoma; therefore, the family and the combined surgical team (obstetricians and a surgical oncologist) decided to complete a definitive radical ovarian cancer surgery: hysterectomy, right salpingooophorectomy, lymphadenectomy, omentectomy and appendectomy. The patient's postoperative evolution was uneventful, and she was sent to adjuvant chemotherapy.

Resumo O abdome agudo secundário à ruptura do câncer do ovário epitelial durante a gravidez é um evento raro. Nosso objetivo é apresentar como o trabalho de uma equipe multidisciplinar coordenada em um caso de ruptura do câncer de ovário epitelial durante a gravidez é viável para obter os melhores resultados possíveis. Umamulher de 34 anos de idade, durante a 37a semana de sua primeira gestação, apresentou um abdome agudo. Durante a laparotomia, foi detectado um tumor ovariano esquerdo com ruptura de 16,5 cm; O tumor foi extirpado e enviado para avaliação patológica. Enquanto isso, uma cesariana de Kerr foi feita, e uma recém-nascida saudável nasceu. O tumor foi diagnosticado como um cistoadenocarcinoma; então, a família e a equipe cirúrgica combinada (obstetras e oncologista cirúrgico) decidiram concluir uma cirurgia radical definitiva do câncer de ovário: histerectomia, salpingo-ooforectomia direita, linfadenectomia, omentectomia e apendicectomia. A evolução pós-operatória da paciente foi sem intercorrências, e ela foi enviada para quimioterapia adjuvante.

Minimal (Limited) Pseudohyperplastic Prostatic Adenocarcinoma in Needle Prostatic Biopsy.

BACKGROUND: Study of minimum adenocarcinoma has been done almost exclusively on conventional acinar adenocarcinoma. Pseudohyperplastic adenocarcinoma can be confused with benign lesions because of its well-differentiated appearance and has not been studied when the biopsy shows few malignant glands (limited carcinoma). METHODS: We reviewed 94 pseudohyperplastic adenocarcinomas diagnosed in prostatic biopsies for a period of 12 years and selected those measuring less than 1 mm or involving less than 5% of the biopsied tissue. We also reviewed 200 consecutive consultations. RESULTS: Four (4.2%) of the 94 cases were limited pseudohyperplastic adenocarcinomas, and 3 were from consultations. Three of them were mistaken for hyperplastic nodules, prostatic adenosis, or prostatic intraepithelial neoplasm. The number of glands varied between 6 and 50 (average 23). Three nodular histological patterns were identified-nodular, adenosis-like, and pseudohyperplastic carcinoma resembling prostatic intraepithelial neoplasia. The diagnosis of adenocarcinoma was not related to the number of neoplastic glands. Histological criteria that were useful included: crowded medium to large glands, papillary infoldings, branching glands, straight luminal borders, hyperchromatic nuclei, nucleomegaly, and apparent nucleoli. Areas of transition to conventional acinar adenocarcinoma were useful in recognizing four of these neoplasms, but were barely apparent in 2 of them. Hyperchromatic nuclei were found in all cases, whereas apparent nucleoli and nucleomegaly were only present in 4. CONCLUSIONS: The architectural and cytological criteria for limited acinar adenocarcinoma are only partially useful in interpreting minimum pseudohyperplastic adenocarcinomas. Knowledge of the criteria for malignancy in both neoplasms is important in order to avoid underdiagnosis of malignancy.

Acute Abdomen Secondary to Ruptured Epithelial Ovarian Cancer during Pregnancy: The Relevance of Teamwork.

Acute abdomen secondary to epithelial ovarian cancer rupture during pregnancy is a rare event. Our aim is to present how the work of a coordinated multidisciplinary team in a case of ruptured epithelial ovarian cancer during pregnancy is feasible to obtain the best results possible. A 34-year-old woman during the 37th week of her first gestation presented with an acute abdomen. During laparotomy, a ruptured 16.5-cm left ovarian tumor was detected; the tumor was extirpated and sent to pathologic evaluation. In the meantime, a Kerr cesarean section was performed, and a healthy female neonate was born. The tumor was diagnosed as a cystadenocarcinoma; therefore, the family and the combined surgical team (obstetricians and a surgical oncologist) decided to complete a definitive radical ovarian cancer surgery: hysterectomy, right salpingo-oophorectomy, lymphadenectomy, omentectomy and appendectomy. The patient's postoperative evolution was uneventful, and she was sent to adjuvant chemotherapy.

O abdome agudo secundário à ruptura do câncer do ovário epitelial durante a gravidez é um evento raro. Nosso objetivo é apresentar como o trabalho de uma equipe multidisciplinar coordenada em um caso de ruptura do câncer de ovário epitelial durante a gravidez é viável para obter os melhores resultados possíveis. Uma mulher de 34 anos de idade, durante a 37a semana de sua primeira gestação, apresentou um abdome agudo. Durante a laparotomia, foi detectado um tumor ovariano esquerdo com ruptura de 16,5 cm; O tumor foi extirpado e enviado para avaliação patológica. Enquanto isso, uma cesariana de Kerr foi feita, e uma recém-nascida saudável nasceu. O tumor foi diagnosticado como um cistoadenocarcinoma; então, a família e a equipe cirúrgica combinada (obstetras e oncologista cirúrgico) decidiram concluir uma cirurgia radical definitiva do câncer de ovário: histerectomia, salpingo-ooforectomia direita, linfadenectomia, omentectomia e apendicectomia. A evolução pós-operatória da paciente foi sem intercorrências, e ela foi enviada para quimioterapia adjuvante.

Low grade urothelial carcinoma mimicking basal cell hyperplasia and transitional metaplasia in needle prostate biopsy.

PURPOSE: The vast majority of urothelial carcinomas infiltrating the bladder are consistente with high-grade tumors that can be easily recognized as malignant in needle prostatic biopsies. In contrast, the histological changes of low-grade urothelial carcinomas in this kind of biopsy have not been studied. MATERIALS AND METHODS: We describe the clinicopathologic features of two patients with low-grade bladder carcinomas infiltrating the prostate. They reported dysuria and hematuria. Both had a slight elevation of the prostate specific antigen and induration of the prostatic lobes. Needle biopsies were performed. At endoscopy bladder tumors were found in both cases. RESULTS: Both biopsies showed nests of basophilic cells and cells with perinuclear clearing and slight atypia infiltrating acini and small prostatic ducts. The stroma exhibited extensive desmoplasia and chronic inflammation. The original diagnosis was basal cell hyperplasia and transitional metaplasia. The bladder tumors also showed low-grade urothelial carcinoma. In one case, the neoplasm infiltrated the lamina propria, and in another, the muscle layer. In both, a transurethral resection was performed for obstructive urinary symptoms. The neoplasms were positive for high molecular weight keratin (34BetaE12) and thrombomodulin. No metastases were found in either of the patients, and one of them has survived for five years. CONCLUSIONS: The diagnosis of low-grade urothelial carcinoma in prostate needle biopsies is difficult and may simulate benign prostate lesions including basal cell hyperplasia and urothelial metaplasia. It is crucial to recognize low-grade urothelial carcinoma in needle biopsies because only an early diagnosis and aggressive treatment can improve the prognosis for these patients.

Low grade urothelial carcinoma mimicking basal cell hyperplasia and transitional metaplasia in needle prostate biopsy

ABSTRACT Purpose The vast majority of urothelial carcinomas infiltrating the bladder are consistent with high-grade tumors that can be easily recognized as malignant in needle prostatic biopsies. In contrast, the histological changes of low-grade urothelial carcinomas in this kind of biopsy have not been studied. Materials and Methods We describe the clinicopathologic features of two patients with low-grade bladder carcinomas infiltrating the prostate. They reported dysuria and hematuria. Both had a slight elevation of the prostate specific antigen and induration of the prostatic lobes. Needle biopsies were performed. At endoscopy bladder tumors were found in both cases. Results Both biopsies showed nests of basophilic cells and cells with perinuclear clearing and slight atypia infiltrating acini and small prostatic ducts. The stroma exhibited extensive desmoplasia and chronic inflammation. The original diagnosis was basal cell hyperplasia and transitional metaplasia. The bladder tumors also showed low-grade urothelial carcinoma. In one case, the neoplasm infiltrated the lamina propria, and in another, the muscle layer. In both, a transurethral resection was performed for obstructive urinary symptoms. The neoplasms were positive for high molecular weight keratin (34BetaE12) and thrombomodulin. No metastases were found in either of the patients, and one of them has survived for five years. Conclusions The diagnosis of low-grade urothelial carcinoma in prostate needle biopsies is difficult and may simulate benign prostate lesions including basal cell hyperplasia and urothelial metaplasia. It is crucial to recognize low-grade urothelial carcinoma in needle biopsies because only an early diagnosis and aggressive treatment can improve the prognosis for these patients.

The value of SATB2 in the differential diagnosis of intestinal-type mucinous tumors of the ovary: primary vs metastatic.

Primary mucinous adenocarcinomas of the ovary are a diagnostic challenge because their histologic and immunohistochemical features usually overlap with metastatic tumors. SATB2 is a recently identified protein with restricted expression in the glandular cells lining the lower gastrointestinal tract. The aim of this study is to examine the differential expression of SATB2 in primary and metastatic tumors of the ovary. Mucinous ovarian tumors of intestinal type were retrieved from the pathology files of the Instituto Nacional de Cancerología de México. A double reading of the hematoxylin and eosin-stained slides was performed to confirm the diagnosis, and a detailed review of the clinical chart was performed to define the primary origin of the tumor (ovarian vs metastatic). Immunohistochemical staining for CK20, CDX2, and SATB2 was performed and evaluated by 2 gynecopathologists. A total of 106 mucinous tumors were identified, 26 of which were considered to be metastatic, and 80 of which were primary ovarian tumors. All of the primary tumors that were not associated with cystic teratomas were negative for SATB2, and the 4 that were associated with a teratoma were positive for SATB2. All 20 of the metastatic tumors of the colon and appendix were positive for CK20, and 4 were positive for CK7. In addition, all 20 of these tumors were positive for SATB2, and 19 were positive for CDX2. SATB2 appears to be a useful marker for the diagnosis of primary vs metastatic mucinous intestinal-type neoplasms and is highly sensitive in detecting lower gastrointestinal tract metastasis.

Pseudohyperplastic prostate carcinoma: histologic patterns and differential diagnosis.

The similarity between some carcinomas and many benign glandular proliferations has been mentioned in the literature for decades. The description of the main histologic features of pseudohyperplastic carcinoma has been very useful in avoiding errors of interpretation, particularly false-negative results. In recent years, we have found some histologic variants of this neoplasm that have not been mentioned previously. In order to classify the different histologic growth patterns and comment on their differential diagnosis, we reviewed the architectural and cytologic features of 34 cases of pseudohyperplastic adenocarcinoma in 2 radical prostatectomies, 4 transurethral resections, and 28 needle biopsies. Growth patterns most commonly observed included nodular, complex, and mixed (nodular and complex) patterns. Other less frequent histologic varieties included adenosis-like pattern, prostatic intraepithelial neoplasia-like pattern, pseudohyperplastic adenocarcinoma with xanthomatous features, and limited pseudohyperplastic adenocarcinoma. Frequent changes in neoplastic glands included papillary infoldings, large/cystic glands, and branching. Criteria associated with malignancy include nuclear enlargement (92%), apparent nucleoli (85%), pink amorphous secretions (78%), and transition to small acinar carcinoma (70%). However, in some biopsies, nuclear atypia was little apparent. Fifteen of the 34 cases were misdiagnosed as benign and 5 as other malignant neoplasms, and included the following diagnoses: hyperplastic nodules (11), prostatic adenosis (2), diffuse adenosis of the peripheral zone (1), benign cystic glands (1), and less frequently other malignant tumors including xanthomatous carcinoma (2), low-grade prostatic adenocarcinoma (2), and atrophic carcinoma (1). It is important to recognize the different growth patterns of this neoplasm in order to avoid an underdiagnosis of malignancy.

Atypical small acinar proliferation: utility of additional sections and immunohistochemical analysis of prostatic needle biopsies.

BACKGROUND: In surgical pathology, atypical small acinar proliferation is commonly detected in prostate biopsies. Most studies on atypical small acinar proliferation have examined morphological characteristics and the utility of immunohistochemical studies. However, these resources are not available to many pathology departments. We have found that examining additional sections is a simple and inexpensive method that allows better evaluation of focal prostatic glandular atypia. OBJECTIVES: The present report compares the diagnostic utility of immunohistochemical techniques versus examining additional sections in prostate biopsies with focal glandular atypia. PATIENTS AND METHODS: Thirty recently studied prostate biopsies with focal glandular atypia were selected. In each case, 3 additional levels were examined. An immunohistochemical study was performed on one level using an antibody against high-molecular-weight keratin (34BetaE12). Two additional sections were stained with hematoxylin and eosin. RESULTS: The diagnosis of focal carcinoma was established with only additional sections in 4 cases (13.3%). In 2 of these biopsies, additional areas of carcinoma were found that were not identified in the original sections. In 4 other cases, immunohistochemical analysis was the only useful method for diagnosing cancer. In 9 cases (30%), both methods were useful for classifying focal glandular atypia as carcinoma. In the remaining 13 cases,neither immunohistochemical analysis nor additional sections were useful in changing the diagnosis of focal glandular atypia. CONCLUSIONS: Focal glandular atypia in prostatic needle biopsies should be routinely examined with additional sections, particularly when immunohistochemical analysis is not possible. Some biopsies with atypical glandular proliferation may show focal carcinoma in additional sections, even if the immunohistochemical analysis did not provide a diagnosis of malignancy. Additional sections can also reveal areas of carcinoma that were not apparent in the original sections.

Pseudohyperplastic prostatic carcinoma in simple prostatectomy.

Pseudohyperplastic carcinoma (PHPC) is a prostatic neoplasm that can be easily mistaken for nodular hyperplasia or atypical adenomatous hyperplasia. To determine the frequency and clinicopathologic characteristics of PHPC, we reviewed 200 simple prostatectomy specimens. We found 3 cases (1.5%) of PHPC. The tumors were small and ranged in size from 4 to 6 mm. Two of them were erroneously diagnosed as benign glandular proliferations in the original interpretation. Their histologic aspect at low magnification showed nodules of well-differentiated medium-sized glands with cystic dilation in a tight arrangement that imparted a benign appearance. Corpora amylacea were found in 2 cases. However, the lining cells showed nucleomegaly and prominent nuclei in most of the neoplastic glands, and the high-molecular-weight keratin (34BE12) immunostain revealed absence of basal cells. α-Methylacyl-CoA-racemase was positive in 2 cases. In one case, a small focus of moderated acinar adenocarcinoma was found adjacent to the pseudohyperplastic glands facilitating the diagnosis. The 3 patients are disease-free 3 and 4 years after surgery probably because of the small size of the tumors; however, it must be emphasized that most PHPC are considered moderately differentiated and potentially aggressive neoplasms.

Neuroendocrine metastatic tumors of the liver resembling hepatocellular carcinoma.

Certain neuroendocrine tumors (NET) metastasized to the liver can resemble hepatocellular carcinoma (HCC) in cytological needle biopsy. Experience concerning the histologic characteristics of metastatic NET resembling HCC in core needle hepatic biopsies has been scarce. The aim of this study is to describe the histological criteria in seven metastatic NET that resembled HCC in core needle hepatic biopsy. From a total of 285 needle biopsies with primary or metastasized hepatic neoplasms, seven cases were selected originally diagnosed as HCC or HCC vs. NET metastasized to the liver. Fourteen needle biopsies of hepatocellular carcinomas were also studied for comparative purposes. In all of these neoplasms the diagnosis of endocrine tumor was confirmed by immunohistochemical studies and the following information was recorded: age, sex, radiological alterations, primary site of the NET, and follow-up. The following histological data were also recorded: fibrotic stroma associated or not with the neoplastic cells, growth pattern, form of the cells, cellular size, mitotic figures, nucleomegaly, apparent nucleoli, chromatin in salt and pepper, plasmacytoid cells, intranuclear inclusions, and biliary pigment. In conclusion, these characteristics were common in metastasized neuroendocrine tumors: extensive stromal fibrosis, slight to moderate atypia, hyperchromatic nuclei, plasmacytoid cells, and thin delicate strands of fibrovascular tissue supporting larger acinar groups of net cells. HCC had a more infrequent fibrotic stroma, moderate to marked atypia, and in some biopsies biliary pigment, intranuclear inclusions, and clear cells.

Chordoid meningioma of the foramen magnum in a child: a case report and review of the literature.

We report a 3-year-6-month-old boy with chordoid meningioma in the foramen magnum. Chordoid meningioma represents between 0.5 and 1.0% of all meningiomas, and it is frequently located in the supratentorial region. The patient started with an episode of instability, falls, and headache; after which, he developed cuadriparesis, cervical pain, and neck stiffness, which slightly improved after medical treatment, so he was referred to our hospital. Physical examination revealed left hemiparesis and cervical muscle spasm with left torticollis. Magnetic resonance imaging (MRI) demonstrated an intradural-extramedullary well-circumscribed, homogeneous enhancing mass, in the anterior part of the foramen magnum with cervical extension. The operative technique was the extreme-lateral craniocervical retrocondylar approach with total removal and dural coagulation. Histopathological examination demonstrated a chordoid meningioma, with meningotelial basophilic mucoid chordoma-like component in 80% of the tissue. The immunohistochemical stains were positive to epithelial membrane antigen, vimentin, and S-100 protein. At 10 months follow-up, the patient showed improvement in his neurological deficit with physical rehabilitation, and motor response in his extremities are now normal; neck stiffness with cervical spasm disappeared postoperatively. MRI showed no residual tumor. To our knowledge, this is the first report of a chordoid meningioma on the foramen magnum in a child.

Long-term survival in children under 3 years of age with low-grade astrocytoma.

OBJECTIVE: The purpose of this study is to analyze clinical aspects and disease-free survival (DFS) in children less than 3 years of age diagnosed with low-grade astrocytoma. METHODS: In a period of 24 years (1980-2004), a total of 43 (5.4%) children were registered with these characteristics. Twenty-three patients had pilocytic astrocytoma, 18 diffused, and 2 mixed. Thirty-one (72.1%) children had incomplete surgical tumor resection and 12 (27.9%) had a complete tumor resection. Twelve (27.9%) patients had cranial radiotherapy and 17 (39.5%) received chemotherapy. Overall survival was recorded in 23 (53%). DFS was 50% at 250 months of follow-up for the whole group. DFS for the supratentorial group was 60% at 250 months, whereas, for the infratentorial, it was 22% at 120 months (p = 0.008). CONCLUSION: The only favorable prognostic pattern was the supratentorial presentation. Radiotherapy and chemotherapy did not alter the outcome.

Atypical regenerative hyperplasia of the esophagus in endoscopic biopsy: a mimicker of squamous esophagic carcinoma.

CONTEXT: Atypical regeneration can mimic carcinoma in various epithelia. On endoscopic biopsies, atypical regenerative hyperplasia of the esophagus may show pleomorphism and atypia, simulating esophageal squamous cell carcinoma. OBJECTIVE: To establish the most useful histologic features to distinguish atypical regenerative hyperplasia from esophageal carcinoma in endoscopic biopsies. DESIGN: To study the frequency and histologic appearance of atypical regenerative hyperplasia, which simulate carcinoma, we reviewed 600 endoscopic biopsies (555 with chronic esophagitis and 45 with carcinomas of the esophagus). We selected those cases in which the differential diagnosis included regenerative atypical hyperplasia versus esophageal carcinoma and cases of atypical regenerative hyperplasia that were mistaken for carcinoma. For comparative purposes, we studied 10 cases of esophageal carcinoma from endoscopic biopsies that were confirmed by esophagectomy. RESULTS: Among the cases with chronic esophagitis, we found 10 biopsies (1.8%) in which atypical regenerative hyperplasia mimicked carcinoma. In 7 cases, there were 4 to 12 years of follow-up, and no patient developed esophageal neoplasm. The remaining 3 patients were submitted to esophagectomy. None of these patients had carcinoma or dysplasia in the esophageal resection (false-positive biopsies). The most useful architectural changes in squamous carcinoma included stromal infiltration by nests, cords, or thin prongs of neoplastic keratinocytes, palisading desmoplasia, and in situ carcinoma in the adjacent epithelium. Malignant keratinocytes showed variable degrees of differentiation with differently shaped and sized cells, squamous epithelial pearls, individual keratinization, and atypical mitosis. In contrast, biopsies with atypical hyperplasia showed detached nests or irregular fragments without stroma and were made up of immature and relatively monotonous medium or small keratinocytes that were intermixed with inflammatory cells. Individual keratinization was rare, and no squamous pearls were seen. Other features of atypical hyperplasia included granulated tissue with atypical endothelial cells, nonatypical mitosis, lymphoid hyperplasia, and the absence of dysplasia or carcinoma in situ. Two biopsies showed stromal pseudoinfiltration as a result of tangential sectioning and were characterized by thick, round prongs composed of keratinocytes that penetrated regions with granulation or the inflamed tissues of esophageal ulcers. CONCLUSIONS: Atypical esophageal regenerative hyperplasia may mimic carcinoma in a small percentage of esophageal biopsies. If the histologic changes are not sufficient to establish an accurate diagnosis, medical treatment and subsequent biopsies should be performed, particularly if there are no endoscopic or radiologic data to support the presence of a neoplasm.

Pseudohyperplastic prostatic adenocarcinoma in transurethral resections of the prostate.

Pseudohyperplastic prostatic adenocarcinoma is a recently described variety of adenocarcinoma that has been studied in core-needle biopsies and prostatectomy specimens. It is characterized by malignant glands that simulate benign hyperplastic glands with complex, medium to large-sized glands with papillary infoldings, luminal undulations, branching or cystic dilatations, and columnar cells with macronucleoli and nuclear enlargement. Our aim was to define frequency, tumor volume, and histologic features of pseudohyperplastic prostatic adenocarcinoma in transurethral resections of prostate. We studied 250 specimens from transurethral resections; 150 specimens were originally diagnosed as benign glandular hyperplasia, and 100 as conventional prostate adenocarcinomas. Of the 150 biopsies originally diagnosed as benign glandular hyperplasia, two (1.3%) had areas of pseudohyperplastic carcinoma. In both cases the neoplasm was limited to two chips and measured 3 and 4 mm in diameter, respectively. Both patients were asymptomatic 2 and 4 years after diagnosis. Of the 100 biopsies with adenocarcinoma, areas of pseudohyperplastic carcinoma were found in three cases. In the first two these areas were found in two fragments, and in the other case they were found in three chips, and measured 3, 4, and 6 mm, respectively. The clinical course in these cases was unfavorable, and two patients had metastasis. Main histologic findings included crowded glands (5/5), papillary projections (5/5), nuclear enlargement (5/5) macronucleoli (4/5) cystic glandular dilatation (4/5) straight luminal borders (4/5), pink amorphous secretions (4/5) nuclear hyperchromasia (3/5) and transition to small acinar pattern of adenocarcinoma (3/5). In conclusion, pseudohyperplastic prostate carcinoma is rare in transurethral resection specimens and is found in scarce chips. Frequency of false negative results in biopsies originally diagnosed as benign glandular hyperplasia was 1.3%. In biopsies diagnosed as carcinoma, this frequency was 3%. These patients had an adverse clinical course, apparently due to association with areas of conventional adenocarcinoma.

Telomerase activity in well-differentiated papillary thyroid carcinoma correlates with advanced clinical stage of the disease.

Clinical relevance and stage correlation of telomerase activity in well-differentiated papillary thyroid carcinoma (WD PTC) has not been well determined, as its reported activity could be due to the analysis of tumors with lymphocytic infiltrates or aggressive variants of papillary carcinomas. We conducted a prospective study of telomerase activity in WD PTC without inflammatory infiltrates and correlated it with clinical stage. Fifty WD PTCs were analyzed for telomerase activity by PCR-based TRAP (telomeric repeat amplification protocol) assay. Results were correlated with stage and other clinicopathologic variables. Twenty-one (42%) WD PTCs demonstrated telomerase activity. The enzyme was detected more frequently in stage III/IVa WD PTCs (p = 0.02) and in tumors with extra thyroidal extension (p = 0.04). The risk of presenting advanced disease (stage III/IVa) and extrathyroidal growth was significantly increased in telomerase-positive tumors (p = 0.01; odds ratio [OR] 4.4 [95%CI 1.3-14.7]) and (p = 0.04; OR 3.6 [95%CI 1.1-11.7]), respectively. Also, a correlation was found between telomerase activity and age. There was no correlation of telomerase activity with gender, histologic variant, tumor size, or cervical lymph node metastasis. Telomerase activity was observed in 42% of WD PTC and was detected more frequently in AJCC TNM stage III/IVa cases. This finding suggests that telomerase deregulation could be involved in tumor progression.

Cerebral malignant nerve sheath tumor, triton tumor variant: case report.

A case of a cerebral malignant triton tumor in a 3-year-old boy with a 2-month history of frontal headache and no clinical evidence of neurofibromatosis is reported. The computed tomography (CT) scan showed a large, irregular tumor in the right parietooccipital lobe. A partial surgical resection was performed. Histologically, the tumor was highly cellular and consisted of spindle cells with hyperchromatic and pleomorphic nuclei. Focally, neoplastic cells with rhabdomyoblastic features were found. The immunohistochemical study showed that tumor cells were positive for S-100 protein and CD57, and the rhabdomyoblasts expressed desmin, Myo-D1, and myoglobin. During the postoperative period, a massive intraparenchymal hemorrhage was identified and surgical drainage was performed. The patient worsened and died 10 days after the first surgery. Postmortem study was not authorized. Six cases of cerebral malignant nerve sheath tumor have been described; however, primary intraparenchymal malignant triton tumor has not been previously described.

Fibrolamellar hepatocellular carcinoma in mexican patients.

UNLABELLED: The aim of this report is to describe the frequency, clinical, and morphologic characteristics of fibrolamellar hepatocellular carcinoma in Mexican patients. Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare variant of hepatocellular carcinoma. Although this tumor appears to be predominant among the Caucasian population of the U.S, FLHCC has been described in many other countries. The frequency and characteristics of FLHCC in Latin American population is almost unknown. The clinico-pathologic characteristics of seven (5.8%) Mexican patients with FLHCC, obtained among 121 hepato-cellular carcinomas are described. The frequency of these tumors was compared with the frequency reported in other geographic areas in the international literature between 1980 and 1999. There were four women and three men. Two patients had taken oral contraceptives for six months and a year prior to diagnosis; another patient had positive serology for the hepatitis B virus. Common symptoms included a palpable mass, abdominal pain and weight loss; two patients presented jaundice. In two patients the tumor had been removed eight and three years previously, and they were readmitted when FLHCC recurred. In three patients the diagnosis was suspected in radiological studies (computed tomography and/or magnetic resonance). Laboratory tests were non-specific. In four patients, resection of the tumor was performed, and in the remaining three the neoplasm was diagnosed by percutaneous hepatic biopsy. Two patients had died of disease at the time of the study, and another was alive with recurrent disease. CONCLUSIONS: fibrolamellar hepatocarcinoma is an uncommon, but not an exceptional neoplasm in our population and represents 5.8% of all hepatocarcinomas reviewed.

Lipoma primario de hígado / Primary lipoma of the liver

Se informa un caso de lipoma primario del hígado en una mujer de 57 años con historia de diabetes mellitus no insulinodependiente y tres días con dolor abdominal, distensión, náusea y vómito. A la exploración física se encontró hígado palpable 5 cm por debajo del margen costal derecho sin esplenomegalia ni ascitis. La tomografía computada reveló un tumor bien delimitado con atenuación de grasa y la RM demostró lesión bien circunscrita con intensidad de señal brillante. Se realizó lobectomía hepática derecha. El espécimen resecado midió 28.6 x 18.3 x 8.2 cm y pesó 2,200 g. El tumor de color amarillo y bien circunscrito midió 15 x 9.5 cm, estaba constituido por células adiposas maduras que empujaban al tejido hepático en la periferia. La paciente se encontraba asintomática seis meses después de la cirugía.

Enteropatía neutropénica asociada a enfermedades autoinmunes. Una presentación más agresiva / Autoimmune disease-associated neutropenic enteropathy. A more aggressive presentation

Antecedentes: sólo existe un informe de caso de enteropatía neutropénica asociada a enfermedades autoinmunes. Método: se analizaron las autopsias de pacientes con diagnóstico de neoplasias y enfermedades autoinmunes, se revisaron las fotografías macroscópicas y preparaciones histológicas de tubo digestivo. En forma cegada se cuantificó el porcentaje de mucosa enteral con afección macroscópica. Los datos clínicos y de laboratorio se obtuvieron del expediente clínico y del resumen post mortem. Resultados: se identificaron 17 casos de enteropatía neutropénica en un periodo de 13 años (1,068 autopsias). En pacientes con enfermedades hematológicas ocurrió en 14 casos y tres asociados a enfermedades autoinmunes. Los síntomas agudos tuvieron una evolución de seis días caracterizados por dolor abdominal, diarrea, ascitis y fiebre en las enfermedades autoinmunes. La extensión del daño colónico fue de 58 por ciento y 13 por ciento en intestino delgado. Los casos asociados a enfermedades hematológicas tuvieron mayor tiempo de evolución con fiebre y dolor abdominal, lesiones colónicas en 21 por ciento de la superficie y lesiones en intestino delgado en 6 por ciento de la mucosa. No se observó infiltrado inflamatorio agudo alrededor de las zonas necróticas en ninguno de los grupos. Los medicamentos asociados con neutropenia fueron esteroides, azatioprina, metotrexate y agentes alquilantes. Conclusión: la enteropatía neutropénica asociada a enfermedades autoinmunes fue más grave que la asociada a enfermedades hematológicas atendiendo al porcentaje de mucosa enteral afectada y al curso clínico.