Predictive value of PET-CT for pathological response in stages II and III breast cancer patients following neoadjuvant chemotherapy with docetaxel / Valor predictivo de la PET-TC en la respuesta a la quimioterapia neoadyuvante en el cáncer de mama en estadios II y III

Purpose. To prospectively study the value of PET-CT with fluorine-18 fluorodeoxyglucose (FDG) to predict neoadjuvant chemotherapy (NAC) response of locoregional disease of stages II and III breast cancer patients. Material and methods. A written informed consent and approval were obtained from the Ethics Committee. PET-CT accuracy in the prediction of pathologic complete response (pCR) after NAC was studied in primary tumors and lymph node metastasis in 43 women (mean age: 50 years: range: 27-71 years) with histologically proven breast cancer between December 2009 and January 2011. PET-CT was performed at baseline and after NAC. SUVmax percentage changes (ΔSUVmax) were compared with pathology findings at surgery. Receiver-operator characteristic (ROC) analysis was used to discriminate between locoregional pCR and non-pCR. In patients not achieving pCR, it was investigated if ΔSUVmax could accurately identify the residual cancer burden (RCB) classes: RCB-I (minimal residual disease (MRD)), RCB-II (moderate RD), and RCB-III (extensive RD). Results. pCR was obtained in 11 patients (25.6%). Residual disease was found in 32 patients (74.4%): 16 (37.2%) RCB-I, 15 (35.6%) RCB-II and 2 (4.7%) RCB-III. Sensitivity, specificity, and accuracy to predict pCR were 90.9%, 90.6%, and 90.7%, respectively. Specificity was 94.1% in the identification of a subset of patients who had either pCR or MRD. Conclusion. Accuracy of ΔSUVmax in the locoregional disease of stages II and III breast cancer patients after NAC is high for the identification of pCR cases. Its specificity is potentially sufficient to identify a subgroup of patients who could be managed with conservative surgery (AU)

Objetivo. Estudiar de forma prospectiva el valor de la PET-TC con fluor-18-desoxiglucosa (FDG) para predecir la respuesta a la quimioterapia neoadyuvante (NAC) de la enfermedad locoregional en pacientes con cáncer de mama en estadios II y III.Material y métodos. Se obtuvo un consentimiento informado por escrito y la aprobación del Comité Ético. Se estudió la precisión de la PET-TC para predecir la respuesta completa patológica (pCR) tras la NAC en los tumores y en los ganglios de 43 mujeres (edad media: 50 años; rango: 27-71 años) que presentaban cáncer de mama diagnosticado por histología entre diciembre del 2009 y Enero del 2011. Los estudios PET-TC se realizaron al diagnóstico y tras la NAC. Los cambios en el porcentaje del SUVmax (delta-SUVmax) se compararon con los hallazgos de la anatomía patológica de la pieza quirúrgica. Se realizaron análisis de Característica Operativa del Receptor (ROC) para discriminar entre pCR y no-pCR en la enfermedad locoregional. En las pacientes que no alcanzaron la pCR, se investigó si el delta-SUVmax podía identificar de forma precisa las siguientes categorías de carga tumoral residual: RCB-I (enfermedad mínima residual (MRD)), RCB-II (moderada RD), y RCB-III (extensa RD).Resultados. Se obtuvo pCR en 11 pacientes (25,6%). Se encontró enfermedad residual en 32 pacientes (74,4%): 16 (37,2%) RCB-I, 15 (35,6%) RCB-II y 2 (4,7%) RCB-III. La sensibilidad, especificidad y precisión para predecir la pCR fueron 90,9%, 90,6%, y 90,7%, respectivamente. En la identificación del subgrupo de pacientes con pCR o MRD la especificidad fue del 94,1%.Conclusión. El delta-SUVmax identifica con elevada precisión la pCR en la enfermedad locoregional de las pacientes con cáncer de mama en estadios II y III tras la NAC. La especificidad es potencialmente suficiente para identificar un subgrupo de pacientes que podrían ser candidatas a cirugía conservadora (AU)

Predictive value of PET-CT for pathological response in stages II and III breast cancer patients following neoadjuvant chemotherapy with docetaxel.

PURPOSE: To prospectively study the value of PET-CT with fluorine-18 fluorodeoxyglucose (FDG) to predict neoadjuvant chemotherapy (NAC) response of locoregional disease of stages II and III breast cancer patients. MATERIAL AND METHODS: A written informed consent and approval were obtained from the Ethics Committee. PET-CT accuracy in the prediction of pathologic complete response (pCR) after NAC was studied in primary tumors and lymph node metastasis in 43 women (mean age: 50 years: range: 27-71 years) with histologically proven breast cancer between December 2009 and January 2011. PET-CT was performed at baseline and after NAC. SUV(max) percentage changes (ΔSUV(max)) were compared with pathology findings at surgery. Receiver-operator characteristic (ROC) analysis was used to discriminate between locoregional pCR and non-pCR. In patients not achieving pCR, it was investigated if ΔSUV(max) could accurately identify the residual cancer burden (RCB) classes: RCB-I (minimal residual disease (MRD)), RCB-II (moderate RD), and RCB-III (extensive RD). RESULTS: pCR was obtained in 11 patients (25.6%). Residual disease was found in 32 patients (74.4%): 16 (37.2%) RCB-I, 15 (35.6%) RCB-II and 2 (4.7%) RCB-III. Sensitivity, specificity, and accuracy to predict pCR were 90.9%, 90.6%, and 90.7%, respectively. Specificity was 94.1% in the identification of a subset of patients who had either pCR or MRD. CONCLUSION: Accuracy of ΔSUV(max) in the locoregional disease of stages II and III breast cancer patients after NAC is high for the identification of pCR cases. Its specificity is potentially sufficient to identify a subgroup of patients who could be managed with conservative surgery.

Alteraciones del pelo como signo de enfermedad mitocondrial / Hair disorders as sign of mitochondrial disease

Introducción: Los trastornos de la cadena respiratoria mitocondrial conllevan una disminución del aporte energético celular, lo que puede afectar al crecimiento y al desarrollo del pelo. Objetivo: Valorar si una técnica sencilla, como es el análisis microscópico del pelo, podría servir como herramienta de orientación diagnóstica de las enfermedades mitocondriales. Resultados: Se estudiaron 13 pacientes con enfermedad mitocondrial, de los cuales 6 tenían el pelo quebradizo y fino, pero sólo uno de ellos presentaba alteraciones más concretas(pili torti et canaliculi). En el grupo de controles sanos no se observó ninguna alteración. Conclusiones: Las alteraciones del pelo pueden formar parte del amplio espectro clínico de las enfermedades mitocondriales. Sin embargo, al ser tan inespecíficas, por sí solas son poco útiles como herramienta de orientación diagnóstica(AU)

Introduction: Disorders of the mitochondrial respiratory chain lead to a decrease in celular energy supply and this can affect hair growth and development. Objective: The aim of this study was to assess whether microscopic hair examination could be used as an easy diagnostic tool of mitochondrial diseases. Results: 6 out of 13 patients with mitochondrial disease had fragile and thin hair, but only one had specific alterations (pilitorti et canaliculi). The healthy control group revealed no apparent abnormality. Conclusions: Hair disorders might belong to the broad spectrum of presenting symptoms of mitochondrial diseases. However, these anomalies are unspecific and have not much performance as diagnostic tool(AU)

Perianal metastases from lobular breast carcinoma.

Breast cancer gastrointestinal and soft tissue metastases are extremely rare. We present the case of a woman with perianal metastases from a primary lobular breast carcinoma 11 years after mastectomy and local radiotherapy.

Perianal metastases from lobular breast carcinoma

Breast cancer gastrointestinal and soft tissue metastases are extremely rare. We present the case of a woman with perianal metastases from a primary lobular breast carcinoma 11 years after mastectomy and local radiotherapy (AU)

Inmunodeficiencia grave combinada / Severe combined immunodeficiency

Los síndromes de inmunodeficiencia grave combinada tienen un pronóstico grave, originando la muerte en el primer o segundo año de vida si no se hace un diagnóstico precoz. La importancia actual de estas enfermedades es que, a pesar de su rareza, la reconstitución inmunológica puede lograrse mediante trasplante de medula ósea o terapia de reemplazamiento enzimático. Con gran frecuencia, y de ahí el interés de presentar este caso, puede sospecharse por la existencia de diversas manifestaciones cutáneas como dermatitis seborreica o dermatitis atópica más o menos intensas o el hallazgo de una linfopenia en una analítica realizada por cualquier motivo antes de que aparezcan infecciones (AU)

P53 overexpression predicts endometrial carcinoma recurrence better than HER-2/neu overexpression.

OBJECTIVE: to investigate the prognostic value of p53 and HER-2/neu overexpression in endometrial cancer. STUDY DESIGN: p53 and HER-2/neu immunostaining was performed in 114 paraffin-embedded specimens of endometrial cancer diagnosed and treated between 1990 and 1997. Nuclear p53 and membrane HER-2/neu immunostaining were used. RESULTS: p53 and HER-2/neu overexpression was observed in 17 cases (14.9%) and in 19 cases (16.7%), respectively. In univariate analysis p53 (P<0.001) and HER-2/neu (P=0.018) overexpression had a positive correlation with a high risk of recurrence. In multivariate analysis, age (P<0.001), FIGO stage (P<0.001), differentiation (P=0.013), non-endometrioid subtypes (P<0.001) and p53 overexpression (P<0.001), but not HER-2/neu overexpression, were independent prognostic indicators of recurrence. Simultaneous p53 and HER-2/neu overexpression made worse the prognostic (P<0.001). CONCLUSIONS: p53 overexpression was an independent predictor of recurrent disease in endometrial cancer. HER-2/neu overexpression had a more limited effect but enhance the effect of p53.

A comparison of epithelial membrane antigen overexpression in benign and malignant endometrium.

OBJECTIVE: The aim of this study was to analyze the value of epithelial membrane antigen (EMA) overexpression in benign and malignant endometrium and its prognostic significance. METHODS: EMA immunostaining was performed in 178 paraffin-embedded specimens including 105 endometrial cancers, 40 endometrial hyperplasias, and 33 benign endometriums. EMA immunostaining was correlated with traditional prognostic factors and progression-free survival in endometrial cancer specimens. RESULTS: EMA overexpression was observed more frequently in adenocarcinomas (60%) than in hyperplasias (15%) or benign endometrium (9.1%). EMA overexpression was observed in two patients with endometrial hyperplasia who progressed to carcinoma. In adenocarcinomas, EMA overexpression had a positive correlation with nonendometrioid subtypes (P = 0.012). In multivariate analysis, FIGO stage (P = 0.025) and EMA overexpression (P = 0.017) were independent prognostic factors for progression-free survival. CONCLUSIONS: EMA overexpression appears to be a marker of malignant transformation in the endometrium and it is an independent predictor of recurrent disease in endometrial cancer.

La anatomía patológica como factor pronóstico en el carcinoma lobulillar invasivo de la mama / Invasive lobular carcinoma of the breast : histopathology as a prognostic factor

Propósito: El carcinoma lobulillar invasivo de la mama presenta características únicas que lo diferencian del carcinoma ductal, como los hallazgos frecuentes de multicentricidad, bilateralidad, afectación de la mama contralateral, la positividad de los márgenes de la pieza y un teórico mayor porcentaje de afectación a nivel regional, que podrían influir en el pronóstico de la enfermedad. Material y métodos: Con el ánimo de evaluar las características definitorias del pronóstico en este tipo tumoral, se han estudiado ciertos factores de la anatomía patológica, como lo son el tamaño tumoral, el nivel de afectación axilar, el grado de malignidad tumoral, la afectación de los márgenes de la pieza, la muticentridad y la positividad de los receptores tumorales, para relacionarlos con la supervivencia a largo plazo en una población de 390 casos de carcinoma lobulillar invasivo de la mama en un estudio multicéntrico que refiere los resultados del período 1980-1997. Resultados y conclusiones: En conclusión, se observa que el pronóstico del carcinoma lobulillar se determina por el nivel de afectación regional, el tamaño tumoral y el grado de malignidad tumoral principalmente; la afectación axilar demuestra esta influencia en períodos avanzados del seguimiento de la paciente la positividad de los márgenes tumorales y la multicentricidad no se relacionan significativamente con el pronóstico (AU)

Consideraciones anatomopatológicas sobre los sacos pericoronarios de los terceros molares inferiores

El el presente trabajo, se analizan los posibles cambios que pueden sufrir los sacos pericoronarios con la edad. El mismo se llevó a cabo en el departamento de Medicina y Cirugía Bucofacial de la universidad Complutense de Madrid, seleccionándose 15 pacientes subsidiarios de la extracción de los terceros molares inferiores. Una vez extraido se dividían en grupos de edades: hasta los 18 años, de 19 a 40 años y por encima de los 40 años, siendo remitidos los sacos pericoronarios correspondientes para su estudio anatomopatológico mediante las técnicas de hematoxilina-eosina y tricómico de mason. Los parámetros analizados ponen de manifiesto que a medida que aumenta la edad del paciente el epitelio ameloblástico sufre una transformación a epitelio escamoso, desapareciendo la presencia de restos epiteliales. También resultó evidente que el tejido conjuntivo de los sacos pericoronarios con la edad pasa de laxo a un tajido mas fibroso, disminuyendo la cantidad de restos epiteliales en el conjuntivo según avanza la edad (AU)

Non-absorbable prosthetic meshes: which is the best option in the repair of abdominal wall defects?

The mechanical properties and macroscopic behaviour of non-absorbable materials have been widely studied. Nevertheless, biological tissue response to contact with these prostheses is not well-known. Our purpose was to compare the microscopic behaviour of two non-absorbable materials. Polypropylene and mersilene meshes were implanted on 36 female Wistar rats each (PPL and ME groups) . Six animals per group were sequentially sacrificed at 1, 2, 3, 5, 10 and 15 weeks. Global cell density and number of polymorphonuclear leukocytes, giant cells, fibroblasts and histiocytes were compared for every studied phase. The polypropylene group showed higher cell density and polymorphonuclear response in the initial phases, while scores for giant cells were higher in the mersilene group. Fibrohistiocytic reaction was increased in the polypropylene group. Polypropylene tends to provoke higher acute inflammatory reaction and connective tissue formation than mersilene. The latter induces higher foreign body reaction.

[New contributions to the study of chromophobe-cell renal carcinoma]. / Nuevas aportaciones en el estudio del carcinoma renal de células cromófobas.

OBJECTIVE: The present study describes a case of the recently discovered chromophobe cell carcinoma of the kidney. Additional findings that have not been previously reported are presented and the importance of the clinical and anatomopathological diagnosis of this tumor type is underscored. METHODS: The tumor presented in a 72-year-old female with symptoms and signs that were not distinct from those of other more common renal tumors. She underwent a right radical nephrectomy. Histopathological, immunohistochemical and ultrastructural studies were performed and the findings were compared with those reported in the literature. RESULTS: The foregoing studies disclosed a chromophobe cell renal carcinoma, with some findings-chiefly ultrastructural-that have not been previously described. CONCLUSION: Chromophobe cell renal carcinoma, a tumor type that has recently been identified, is the subject of several studies that have been conducted to permit its clinical and anatomopathological characterization. The present study describes some observations which, to our knowledge, have not been previously described elsewhere.

Experimentally contaminated reabsorbable meshes: their evolution in abdominal wall defects.

Contamination by septic materials may represent an important handicap in evaluating the tolerance of reabsorbable prostheses, increasing the possible onset of abdominal fistulae. This is also the case when these materials are used in the treatment of abdominal wall defects. Nevertheless, reabsorbable meshes exist that allow visceroprosthetic contact without risk, thus making it possible to use them in spite of the presence of infection. We have performed this experimental study with the aim of evaluating the behaviour and evolution of polyglycolic acid reabsorbable meshes contaminated by septic materials in the treatment of abdominal wall defects. For this purpose, 40 Wistar rats were operated and distributed into two series of 20 animals each. Massive mesh contamination by fecaloid material did not jeopardise the fact that prostheses were well tolerated in experimental animals throughout the reabsorption process, without increasing the incidence of infection.

[Primary choriocarcinoma of the bladder. A case report with immunohistochemical and ultrastructural study]. / Coriocarcinoma primario de vejiga urinaria. Aportación de un caso con estudio inmunohistoquímico y ultraestructural.

Some tumors frequently encountered in other organs and usually with a high grade of malignancy and a poor prognosis have been recently described in the urinary bladder, very often in close relationship with a pre-existing transitional cell carcinoma. Of these, primary choriocarcinoma of the urinary bladder is one of the most uncommon and its histogenesis much discussed. It is important to identify this tumor type, since a change in the oncologic treatment may be warranted. We report an additional case of this rare bladder tumor with clinicopathologic study and discuss the histogenetic and therapeutic aspects.

[Peritoneal mesothelioma and complete auriculo-ventricular block as late complications in Hodgkin's disease]. / Mesotelioma peritoneal y bloqueo aurículo-ventricular completo como complicaciones tardías de la enfermedad de Hodgkin.

A patient who had been successfully treated of Hodgkin's disease (nodular sclerotic type) with mediastinal radiotherapy and polychemotherapy, suffered an acute pericarditis immediately after radiotherapy and a complete atrial-ventricular block 14 years later. Five years later she presented refractory hemorrhagic peritonitis. Necropsy study showed a peritoneal mesothelioma (in non radiated area) and diffuse subpericardial fibrosis. Complete A-V block is a very rare late complication of mediastinal radiotherapy and mesotheliomas (almost exclusively in irradiated areas), also. We have not found any reports on other cases of peritoneal mesotheliomas not attributable to radiotherapy as second neoplasia in Hodgkin's disease.

[Ultrastructural study of the colon after massive intestinal resection in rats]. / Estudio ultraestructural del colon tras la resección intestinal masiva en ratas.

The modifications suffered by the colon after massive intestinal resection (RIM) have been barely studied, especially from the ultrastructural point of view. On the basis of optical microscope studies we planned this experimental study to evaluate fundamentally the ultrastructural changes in the colonic mucosa and its cellular elements. A total of 115 Wistar rats weighing 350 to 550 grams were used. Twenty animals constituted group 0 (controls), 30 underwent intestinal section (group I) and 65 were submitted to resection of 90% of the intestine (group II). After weighing, the animals were sacrificed by groups on days 15, 30, 45 and 60 of the operation to obtain histologic samples of the ascendant colon for study by transmission (MET) and scanning (MEB) electron microscopy. All the animals resected showed statistically significant weight loss (p less than 0.001), an expression of short intestine syndrome. Groups 0 (controls) and I (intestinal section) did not evidence important ultrastructural changes. In contrast, although in the initial electron microscopic scan the colonic mucosal surface offered a normal aspect, at 45 days it presented irregularities, without the appearance of villi. Days 60 there were deep folds and the mucosal surface had acquired a foliaceous aspect similar to that of the surface of the small intestine of the rat. The abundance of microorganisms adhered to the surface, constituting clumps of bacteria, was striking. Transmission electron microscopy confirmed the greater number and height of the enterocytes, covered by well-developed apical microvilli with dimensions that increased throughout the experiment. The cellular nuclei are voluminous and occasionally have various nucleoli. The cytoplasm showed changes that affected fundamentally the mitochondria.(ABSTRACT TRUNCATED AT 250 WORDS)