Primary giant cell tumor of soft tissue: fluid-fluid levels at MRI (2010:3b).

PURPOSE: Giant cell tumor of soft tissue (GCT-ST) is an extremely rare lesion with an unpredictable behavior. The histological appearance closely resembles that of giant cell tumor of bone and, as such, has been characterized as the soft-tissue equivalent. MATERIALS AND METHODS: We describe the clinical, histological and radiological features of an unusual magnetic resonance imaging (MRI) and deep intramuscular location of GCT-ST with fluid-fluid levels (FFLs) simulating other soft tissue tumors or a hydatid cyst in a 52-year-old man. The lesion was resected. RESULTS: Neither metastasis nor recurrence has occurred in the 6-month period since resection. A review of the literature did not reveal any similar description of intramuscular GCT-ST. CONCLUSION: GCT-ST should be included in the differential diagnosis of soft tissue tumors with FFLs.

Angiomiolipoma renal con quistes epiteliales (AMLEC): a propósito de un caso / Angiomyolipoma with epithelial cysts (AMLEC): a case report

Introducción: El angiomiolipoma pertenece a la familiade los PEComas. Es el tumor mesenquimal renal máscomún. La variante clásica (la más frecuente) típicamentecontiene tres componentes : muscular liso (predominante),vascular, con vasos gruesos, dismórficos y adiposo maduroDentro de los angiomiolipomas, se describió recientementeun raro subtipo, el angiomiolipoma con quistes epiteliales(AMLEC), con muy pocos casos publicados. Este tumor secaracteriza por contener quistes epiteliales macro y/omicroscópicos rodeados por una capa celular «cambiumlike» y estroma de aspecto mülleriano, que expresan HMB-45, Melan A y CD10, juntamente con receptores de estrógenosy progesterona. Estos tumores suelen ser esporádicosaunque a veces se asocian a esclerosis tuberosa. Son másfrecuentes en mujeres. Caso clínico: Se presenta un casoesporádico de angiomiolipoma renal con quistes epiteliales(AMLEC) en un varón de 30 años, con historia de ginecomastiaunilateral (sin previo tratamiento) y que acude porcuadro de litiasis ureteral izquierda, detectándose un tumoren riñón izquierdo, de 1,8 cm de diámetro, «sólido», conquistes epiteliales microscópicos y todas las característicasdescritas en los angiomiolipomas con quistes epiteliales.Discusión: Estos tumores, aunque con una morfologíacaracterística plantean una serie de diagnósticos diferenciales:tumores benignos como es el espectro nefroma quístico-tumor mixto renal estromal y epitelial (MEST) de riñón,incluido la variante PEComatosa y entidades malignascomo el carcinoma de células renales (convencional decélulas claras, el multiquístico y el sarcomatoide), entreotros, surgiendo una serie de cuestiones adicionales, queson consideradas. Su comportamiento es benigno, al igualque el angiomiolipoma convencional (AU)

Introduction: Angiomyolipomas belong to the familyof PEComas. They are the most common mesenchymalrenal tumours. Classic angiomyolipoma is composed ofsmooth muscle, thick abnormal blood vessels and matureadipose tissue. A new subtype of angiomyolipoma has beendescribed recently, with 16 cases reported to date, containingmacro- and/or microscopic epithelial cysts, surroundedby a «cambium-like» layer and with Müllerian type stroma,which are positive for melanocytic markers, CD10 and oestrogenand progesterone receptors. These neoplasms aremore frequent in women and are usually sporadic, althoughthey are can occur as part of the tuberous sclerosis complex.Clinical findings: Here we report a sporadic case ofangiomyolipoma with epithelial cysts occurring in a 30 yearold man with untreated gynaecomastia who presented withleft ureteral lithiasis. An apparently solid 1.8 cm left renaltumour which contained microscopic epithelial cysts wasrevealed; morphologically it corresponded to an angiomyolipomawith epithelial cysts. Discussion: Although thesetumours have a distinct histolology, differential diagnosismay include several different benign entities, such as cysticnephroma, mixed epithelial and stromal tumour (MEST) ofthe kidney, including PEComa, as well as malignant neoplasmssuch as renal cell carcinomas (NOS, multicystic andsarcomatoid), amongst others. Angiomyolipoma with epithelialcysts behaves in the same benign fashion as angiomyolipoma (AU)

[Advantages and risks of the use of prostate-specific antigen (PSA) in the health-care area No. 4 of Gijon (Asturias)]. / Ventajas y riesgos de la utilización del antígeno prostático específico (PSA) en el area sanitaria v de Gijón (Asturias).

OBJECTIVES: The diagnosis of prostate cancer has changed significantly with the introduction of PSA in the clinical practice. Despite screening is under controversy the use of PSA has become widespread. The objective of this paper is to know the use of PSA in our health-care area and to analyze perceived risks and benefits. METHODS: From the informatic archives we analyze PSA determinations performed in our health-care area (290.956 citizens) over 2000 and 2001. We also analyzed prostate biopsies generated and number of cancers detected. RESULTS: 25.519 PSA determinations were performed. 59% came from general practitioners (GP), 34% from urologists and 7% from the rest of specialists. 39% are performed to men older than 70 years. PSA was normal in 78.7% of the patients and higher than 4 ng/ml in 21.2%. 488 prostatic biopsies were performed diagnosing 178 cancers (diagnostic yield 36.5%). Depending on the first PSA, diagnosis was started by a GP in 44% of the cases, a urologist in 46%, and the remaining 10% by other specialists. Mean time from first PSA to diagnosis was 5 months, without significant differences between GPs and specialities . The use of PSA by GPs is variable (between 8.1 and 45.8 determinations per 100 men over 50 years), without significant differences in prostate cancer detection by number of PSAs or differences in age. In comparison with the period 1982-1993 the incidence of prostate cancer goes from 30.76 to 52.8 new cases/100.000 inhabitants/year. There is a greater incidence and increase of cancer in the rural area (from 33.52 to 221.1 new cases/ 100.000 inhabitants/year). CONCLUSIONS: We confirm the general use of this test and the trend to screening in the primary health-care level, which participates in an important manner in the diagnosis. PSA brings forward the diagnosis of prostate cancer 5 years in our area, and shoots its incidence rates. The high use of such marker in our population of advanced age may be considered inadequate.

Ventajas y riesgos de la utilización del antígeno prostático específico (PSA) en el área sanitaria V de Gijón (Asturias) / Advantages and risk´s of the use of PSA in the health-care area Nº. 5 of Gijon (Asturias)

OBJETIVO: Con la introducción del PSAen la práctica clínica diaria, el diagnóstico del cáncerde próstata ha sufrido importantes cambios. Aunque elscreening es controvertido, su uso parece que se hageneralizado. Conocer la utilización que se hace delPSA en nuestro área sanitaria y analizar los beneficiosy riesgos que se perciben.MÉTODO: A través del archivo informático, analizamoslas determinaciones realizadas durante los años2000 y 2001 en nuestro área (290.956 habitantes).Se analizaron también las biopsias de próstata generadasy los cánceres detectados.RESULTADOS: Se realizaron 25.590 determinacionesde PSA. Proceden de Atención Primaria 59%, Urología34% y resto de especializada 7%. El 39% se realizana hombres mayores de 70 años. El PSA fue normal enel 78,7%, y mayor de 4 ng/mL en 21,2%. Se realizaron488 biopsias prostáticas, detectándose 178 carcinomas(36,5% rendimiento diagnóstico). Según el primerPSA el diagnóstico parte de primaria en 44%,Urología en 46% y resto de especializada 10%. Eltiempo medio desde el primer PSA hasta el diagnósticofue de 5 meses, sin diferencias significativas entrePrimaria y Especializada. El uso del PSA por Primariaes variable (entre 8,1 y 45,8 determinaciones porcada 100 hombres mayores de 50 años), sin diferenciassignificativas de detección de cáncer prostáticosegún número de PSAs ni diferencias de edad. Frenteal periodo 1982-1993 la incidencia de cáncer prostáticopasa de 30,76 a 52,8 nuevos casos/ 100.000habitantes/ año. Existe mayor incidencia e incrementodel cáncer en la zona rural (de 33,52 a 221,1 nuevoscasos/ 100.000 habitantes/ años).CONCLUSIONES: Confirmamos la utilización generalizadade esta prueba y la tendencia al cribado en primaria,que participa de manera importante en el diagnóstico.El PSA adelanta el diagnóstico del cáncer depróstata en 5 años en nuestro área, y dispara las tasasde incidencia de este cáncer. La elevada utilización deeste marcador en población de edad avanzada sepuede considerar inadecuada

OBJECTIVES: The diagnosis of prostatecancer has changed significantly with the introductionof PSA in the clinical practice. Despite screening isunder controversy the use of PSA has become widespread.The objective of this paper is to know the use of PSA inour health-care area and to analyze perceived risks andbenefits.METHODS: From the informatic archives we analyzePSA determinations performed in our health-care area(290.956 citizens) over 2000 and 2001. We alsoanalyzed prostate biopsies generated and number ofcancers detected.RESULTS: 25.519 PSA determinations were performed.59% came from general practitioners (GP), 34% fromurologists and 7% from the rest of specialists. 39% areperformed to men older than 70 years. PSA was normalin 78.7% of the patients and higher than 4 ng/ml in21.2%. 488 prostatic biopsies were performeddiagnosing 178 cancers (diagnostic yield 36.5%).Depending on the first PSA, diagnosis was started by aGP in 44% of the cases, a urologist in 46%, and theremaining 10% by other specialists. Mean time fromfirst PSA to diagnosis was 5 months, without significantdifferences between GPs and specialities . The use ofPSA by GPs is variable (between 8 .1 and 45.8determinations per 100 men over 50 years), withoutsignificant differences in prostate cancer detection bynumber of PSAs or differences in age. In comparisonwith the period 1982-1993 the incidence of prostatecancer goes from 30.76 to 52.8 new cases/100.000inhabitants/year. There is a greater incidence andincrease of cancer in the rural area (from 33.52 to221.1 new cases/100.000 inhabitants/year).CONCLUSIONS: We confirm the general use of thistest and the trend to screening in the primary health-carelevel, which participates in an important manner in thediagnosis. PSA brings forward the diagnosis of prostatecancer 5 years in our area, and shoots its incidencerates. The high use of such marker in our population ofadvanced age may be considered inadequate