Different environment, different reproductive strategies? Unexpected field observations in the harvestmen Discocyrtus prospicuus (Laniatores: Gonyleptidae).

The evolution of reproductive strategies depends on the relative balance between current benefits and future costs. Geographic variation in demographic and ecological factors has the potential to affect reproductive strategies by altering this optimal cost-benefit balance. Here, we studied a population of the harvestmen Discocyrtus prospicuus inhabiting an environment never studied before in this context: a tidal freshwater wetland. We made monthly observations of male-female interactions and their association with egg clutches during a two-year field survey. Our results do not match the expected pattern for this species, consisting of males deserting females immediately after copulation, and females laying isolated eggs and abandoning them after oviposition. Conversely, we show for the first-time pairs D. prospicuus, formed by a female and a male, resting together before and after oviposition. Females of this wetland population lay the eggs in small clutches and some of the clutches had eggs in more than one stage of development. Also, we found many females alone over or near the egg clutch in the typical resting position. These findings markedly widen the behavioral specter previously reported for this species and set the stage for future research to determine the causes of these variations.

Brain Metastases at Presentation in Patients With Non-Small Cell Lung Cancer.

OBJECTIVE: We used brain radiotherapy as a surrogate for the presence of brain metastases in patients with non-small cell lung cancer (NSCLC) to determine the prevalence of brain metastases using the Surveillance Epidemiology and End Results database. METHODS: Patients with NSCLC diagnosed between 1988 and 1997 were subdivided according to brain radiotherapy status at presentation into: "none" or "radiation therapy indicated." We calculated the frequency of brain radiotherapy use in all patients. Odds ratios (ORs) for the indication of brain radiotherapy were calculated for individual prespecified covariates of interest. All statistical tests were 2-sided and P<0.05 were considered significant. RESULTS: At presentation, brain radiotherapy was indicated in 10,963 (8.3%) of the 131,456 patients diagnosed with NSCLC between 1988 and 1997. On multivariable analysis the following were significantly associated with brain radiotherapy use: age (OR, 0.653 per 10 y increase in age; 95% confidence interval [CI]: 0.642, 0.665); female sex (OR, 1.05; 95% CI: 1.01, 1.10]); adenocarcinoma histology (HR, 1.67; 95% CI: 1.58, 1.76) or large cell or other histology (OR, 1.67; 95% CI: 1.57, 1.77); tumor size>3 cm (3.1 to 5 cm OR, 1.22; 95% CI: 1.14, 1.30 and >5 cm OR, 1.25; 95% CI: 1.17, 1.33); tumor grade >II (grade III OR, 1.82; 95% CI: 1.69, 1.95 and grade IV OR, 1.91; 95% CI: 1.73, 2.11); and nodal involvement N1 (OR, 1.33; 95% CI: 1.20, 1.47), N2 (OR, 2.24; 95% CI: 2.10, 2.40), and N3 (OR, 2.39; 95% CI: 2.19, 2.60). CONCLUSIONS: Brain radiotherapy is indicated in over 8% of patients with NSCLC at presentation. We demonstrated that the risk of brain metastasis at presentation may be stratified with the use of 6 clinical factors.

Predation among armored arachnids: Bothriurus bonariensis (Scorpions, Bothriuridae) versus four species of harvestmen (Harvestmen, Gonyleptidae).

Natural selection shapes prey-predator relationships and their behavioral adaptations, which seek to maximize capture success in the predator and avoidance in the prey. We tested the ability of adults of the scorpion Bothriurus bonariensis (Bothriuridae) to prey on synchronous and sympatric adults harvestmen of Acanthopachylus aculeatus, Discocyrtus prospicuus, Parampheres bimaculatus and Pachyloides thorellii (Gonyleptidae). In 72.5% of the cases B. bonariensis tried to prey on the harvestmen. The most successful captures occurred in the trials against A. aculeatus and D. prospicuus. In all the successful attacks the scorpions stung the prey between the chelicerae and consumed them, starting by the anterior portion of their bodies. The harvestmen used different defensive strategies such as fleeing before or after contact with the predator, exudating of chemical substances or staying still at the scorpion's touch. When scorpions contacted the chemical substances secreted by the harvestmen, they immediately rubbed the affected appendix against the substrate. However, exudating of chemical substances did not prevent, in any case, predation on the harvestmen. This is the first study showing the ability of scorpions to prey on different species of harvestmen, as well as the capture and defensive behaviors used by the predator and the prey.

Sirolimus and trastuzumab combination therapy for HER2-positive metastatic breast cancer after progression on prior trastuzumab therapy.

Constitutive activation of the PI3K/Akt/mTOR pathway has been suggested as a mechanism of resistance to trastuzumab therapy. This phase II trial was designed to evaluate the safety and clinical activity of daily oral sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, in combination with trastuzumab in HER2-positive metastatic breast cancer following disease progression on prior trastuzumab therapy. Sirolimus 6 mg oral daily dose was administered with a standard dose and schedule of trastuzumab weekly or every 3 weeks. Pharmacodynamic studies included Western blot analysis of S6K1, phosphoS6K1, and mTOR in peripheral mononuclear cells, circulating tumor cells (CTC), and endothelial cells (CEC). Eleven patients were evaluable for safety; and nine were evaluable for response assessment. Subsequent enrollment was stopped due to slow accrual. Study treatment-related grade 3 toxicity included pneumonitis, myelosuppression (leukopenia/anemia), and dermatologic reactions (mucositis, nail changes and rash), with no grade 4 events. One patient received eight cycles (58 weeks) and achieved a partial response. Five patients treated for a total of 101 weeks (median 12 weeks, range 8-47 weeks) achieved stable disease as best response. Overall response rate was 1/9 (11 %) and clinical benefit rate was 4/9 (44 %). There was no statistically significant correlation between response and post-treatment change in levels of the mTOR pathway biomarkers, CTCs, HER2 CTCs, or CECs. Sirolimus 6 mg administered daily with trastuzumab appears to be well tolerated in patients with metastatic HER2-positive breast cancer following disease progression on prior trastuzumab therapy, with evidence of disease activity. mTOR inhibition may overcome resistance to trastuzumab in some HER2-positive tumors.

Müllerianosis of the urinary bladder: report of three new cases.

OBJECTIVE: We report three new cases of müllerianosis of the urinary bladder. METHODS: We present three cases of women in the third decade of life, two of them presenting hematuria and pelvic pain, and the third was referred to perform a recto-vaginal endometriosis surgical procedure. Diagnosis was made by ultrasound and cystoscopy in the first and second case, and by CT scan in the endometriosis case. RESULTS: Müllerianosis of the urinary bladder is described as the presence of müllerian remnants (endometrial, endosalpinx and endocervix) in the bladder wall. Diagnosis is made as a result of a pathologic study of the resected lesions. Although a relapse of the disease is infrequent, it can happen, and close monitoring of the patients must be performed. CONCLUSIONS: Müllerianosis of the bladder is a rare condition and differential diagnosis must be done with benign and malignant bladder lesions because it can affect the muscularis propia. It mostly presents as lower urinary tract symptoms and hematuria that can be cyclic. Transurethral resection is the treatment of choice in superficial and focal lesions. In the case of infiltration of the bladder muscle, and depending on the extension of the disease, partial cystectomy may be necessary.

Müllerianosis vesical: presentación de tres nuevos casos / Müllerianosis of the Urinary Bladder: Report of Three New Cases

OBJETIVO: Presentación de 3 nuevos casos de müllerianosis vesical. MÉTODO: Se presentan tres casos de mujeres en la tercera década de la vida, dos de ellas consultan por hematuria y dolor pélvico, la tercera es remitida para cirugía electiva por endometriosis rectovaginal. Las dos primeras se diagnostican mediante ecografía y cistoscopia de lesiones polipoides vesicales y la tercera se realiza el diagnóstico de endometriosis mediante TAC. RESULTADO: La müllerianosis vesical consiste en la presencia de restos müllerianos (endometrio, endosálpinx y endocérvix) en la pared vesical. Se diagnostica por estudio anatomopatológico y por tanto precisa resección de la lesión. Pese a la infrecuencia de las recidivas, éstas pueden ocurrir, por lo que debe realizarse seguimiento de las pacientes. CONCLUSIONES: La müllerianosis es una entidad poco común y debe incluirse en el diagnóstico diferencial de lesiones benignas y malignas de la vejiga tanto superficiales como infiltrantes ya que puede infiltrar en ocasiones la muscular propia. Se presenta principalmente con síntomas irritativos del tracto urinario inferior y hematuria que puede ser cíclica. El tratamiento debe ser quirúrgico mediante resección transuretral en los casos superficiales y focales. Si hay infiltración de la capa muscular y/o afectación extensa puede requerir una cistectomía parcial

OBJECTIVE: We report three new cases of müllerianosis of the urinary bladder. METHODS: We present three cases of women in the third decade of life, two of them presenting hematuria and pelvic pain, and the third was referred to perform a recto-vaginal endometriosis surgical procedure. Diagnosis was made by ultrasound and cystoscopy in the first and second case, and by CT scan in the endometriosis case. RESULTS: Müllerianosis of the urinary bladder is described as the presence of müllerian remnants (endometrial, endosalpinx and endocervix) in the bladder wall. Diagnosis is made as a result of a pathologic study of the resected lesions. Although a relapse of the disease is infrequent, it can happen, and close monitoring of the patients must be performed. CONCLUSIONS: Müllerianosis of the bladder is a rare condition and differential diagnosis must be done with benign and malignant bladder lesions because it can affect the muscularis propia. It mostly presents as lower urinary tract symptoms and hematuria that can be cyclic. Transurethral resection is the treatment of choice in superficial and focal lesions. In the case of infiltration of the bladder muscle, and depending on the extension of the disease, partial cystectomy may be necessary

Phase I clinical trial of the mammalian target of rapamycin inhibitor everolimus in combination with oral topotecan for recurrent and advanced endometrial cancer.

OBJECTIVES: Preclinical data suggest that mammalian target of rapamycin inhibitors may potentiate the efficacy of topotecan. We evaluated the optimal schedule of oral topotecan in combination with everolimus in patients with endometrial cancer. METHODS: Women with a history of advanced or recurrent endometrial cancer were enrolled. Escalating dose of oral topotecan (1.5 mg/m, 1.9 mg/m, and 2.3 mg/m) daily on days 1 to 5 and everolimus (5 mg every other day, 5 mg daily, and 10 mg daily) were administered in a 21-day cycle. A "run-in" treatment of topotecan daily for 5 days followed by everolimus for 7 days (4-7 doses depending on dose level) was administered for the purpose of pharmacokinetic assessments. RESULTS: Ten patients were enrolled on the study, and 9 were evaluable for safety analysis. A total of 28 cycles were administered (range, 1-10 cycles per patient). The patients had a median age of 73 years (range, 42-79 years). Previous lines of chemotherapy were 1 (n = 2), 2 (n = 5), 3 (n = 2), and 4 (n = 1). Seven patients had previous vaginal brachytherapy, and 2 had pelvic external beam radiation therapy. The median number of cycles (including cycle 1) is 2 (range, 1-10). Dose-limiting toxicity occurred in 3 patients (1 patient treated with 1.9-mg/m topotecan and 5-mg everolimus given every other day as well as 2 patients treated with 1.9-mg/m topotecan and 5-mg of everolimus daily) and included neutropenia and thrombocytopenia. Seven patients were evaluable for response. Stable disease was the best response in 3 patients who completed the 3, 4, and 10 cycles each. CONCLUSIONS: The dose-limiting toxicity for the combination of oral topotecan and everolimus was myelosuppression. The maximum tolerated dose was topotecan 1.9 mg/m on days 1 to 5 in combination with oral everolimus 5 mg every other day. Administration of higher dose of each agent in combination was limited because of overlapping myelosuppression.

Carcinoma mucinoso de mama: experiencia de 10 años / Mucinous carcinoma of the breast: ten years experience

El carcinoma mucinoso es un carcinoma ductal invasor de bajo grado de malignidad que se caracteriza por células tumorales inmersas en cúmulos de moco extracelular. Representa el 1% al 7% de todos los cánceres de mama, siendo más frecuente en mujeres mayores. Conocer las características clínicas, factores pronósticos, variedades histológicas, tratamiento aplicado y sobrevida global en pacientes con el diagnóstico de carcinoma mucinoso de mama en el Instituto de Oncología “Dr. Miguel Pérez Carreño”. Estudio descriptivo, transversal, pacientes con el diagnóstico de carcinoma mucinoso de mama vistos entre los años 2002-2011. Se evaluaron las historias clínicas de 17 pacientes, encontrando que el grupo etario más afectado es el de 36-45 años con un 29,4%, la mama con mayor afectación fue la izquierda con un 58,8%, el nódulo palpable fue el síntoma predominante, el cuadrante mayormente afectado fue el súpero externo en un 41,20%, el estadio IIA fue el más frecuente 41,17%, carcinoma mucinoso puro se encontró en 94,11%. El diagnóstico inmunohistoquímico de luminal A fue el de mayor incidencia en 54,54% de los pacientes, 47,05% recibió neoadyuvancia, 76,47% se le practicó una mastectomía radical modificada. 41,7% pacientes presentaron una supervivencia global a los 10 años. Carcinoma mucinoso de mama es una entidad poco frecuente que muestra altas tasas de cura y control con un adecuado tratamiento.

The mucinous carcinoma is invasive ductal carcinoma of low grade malignancy is characterized by tumor cells embedded in extracellular clumps of mucus. They represent 1% to 7% of all breast cancers, are most frequently in older women. Determine the clinical characteristics, prognostic factors, the histological types, the treatment applied and the overall survival in patients with the diagnosis of mucinous carcinoma of breast, viewed at the Oncology Institute “Dr. Miguel Pérez Carreño”. We realized a descriptive study of patients with the diagnosis of mucinous breast carcinoma viewed between the years 2002-2011. We evaluated the medical records of 17 patients and found that the age group most affected is the 36-45 years old with 29.4%, the most affected breast was the left with 58.8%, the palpable nodule was the predominant symptom, the most affected quadrant was the upper outer in a 41.20%, stage IIA was the most predominate, 41.17% pure mucinous carcinoma was found in 94.11%, the immunohistochemistry diagnosis of luminal A was the most prevalent in 54.54% of the patients. 47.05% of all the patients received neoadjuvant treatment, 76.47% were practicing modified radical mastectomy. 41.7% patients had an overall survival at 10 years. The mucinous carcinoma of the breast is a rare entity showing high rates of cure and control with a proper and adequate treatment.

Cáncer de mama y embarazo / Pregnancy and breast cancer

Determinar la incidencia, el comportamiento clínico patológico y el tratamiento de las pacientes con cáncer de mama y embarazo. Se revisaron retrospectivamente 7 historias de pacientes con cáncer de mama asociado a embarazo, tratadas en el Instituto de Oncología “Dr. Miguel Pérez Carreño” desde el año 2001 hasta el 2010. La edad promedio fue de 32 años (42%). La edad gestacional correspondió en 3 pacientes 8, 18 y 29 semanas respectivamente, 3 en puerperio y una con 6 semanas en el posoperatorio mediato de mastectomía. Solo una ingirió anticonceptivos orales por 3 años. El tipo histológico predominante fue el carcinoma ductal infiltrante con 5 (71,4%) pacientes seguido de carcinoma lobulillar invasor y un apocrino. El tamaño tumoral osciló entre 3 cm y 5 cm, solo 1 (14,2%) paciente consultó con una lesión de 1 cm; el estadio patológico IIIA se presentó en 3 (42,8%) pacientes, estadio IV una paciente, estadio I: una paciente; estadio IIA: 1 paciente. 5 (71,4%) pacientes recibieron neo-adyuvancia las cuales completaron el tratamiento con mastectomía total más disección axilar de los niveles I-II de Berg, solamente una fue a cirugía preservadora y una a tratamiento paliativo, un caso fue triple negativo. El manejo del cáncer de mama durante el embarazo debe hacerse de acuerdo al estadio y considerar el aspecto emocional que conlleva la decisión

The objective of this work is to determine the incidence, clinical and the pathological behavior and the treatment of patients with diagnostic of breast cancer and pregnancy. We retrospectively reviewed 7 patients with histories of breast cancer associated with pregnancy, treated at the Institute of Oncology “Dr. Miguel Perez Carreño” from theyear 2001 to the year 2010. The mean age was 32 years (42%). The gestational age corresponded to 3 patients 8, 18 and 29 weeks respectively, 3 postpartum and 6 weeks in the postoperative mediate mastectomy. Only one ingested oral contraceptives for 3 years. The predominant histological type was infiltrating ductal carcinoma 5 (71.4%) patients followed by invasive lobular carcinoma and the apocrine type. The tumor size ranged from 3 cm to 5 cm, only 1 (14.2%) patients consulted with a lesion of 1 cm size, stage IIIA disease occurred in 3 (42.8%) patients, one patient stage IV, stage I: One patient, stage IIA: 1 patient. 5 (71.4%) patients received neo-adjuvant chemotherapy which completed treatment with total mastectomy more axillaries dissection of levels I-II of Berg, only one was a conservative surgery and palliative treatment. Regarding the case was a triple immunohistochemistry negative. The management of the breast cancer during pregnancy should be made according to the stage and consider the emotional aspect involved in this decision

Carcinoma de mama triple negativo experiencia en Instituto de Oncología “Dr. Miguel Pérez Carreño” / Triple negative breast cancer: experience in the Institute Oncology Dr. Miguel Pérez Carreño

Presentar la experiencia de nuestra institución en el tratamiento del carcinoma de mama triple negativo. Se realiza estudio retrospectivo, descriptivo. En 998 historias de pacientes con diagnóstico de carcinoma de mama que acudieron a nuestro instituto desde 2000 al 2004, seleccionando pacientes triple negativo, realizando un seguimiento de las mismas hasta diciembre de 2009. Un total de 998 historias clínicas de pacientes con diagnóstico de carcinoma de mama, 940 tenían examen de inmunohistoquímica de las cuales 53 (6 por ciento) eran triple negativo. Edad media 48,3 años. Tipo histológico más frecuente fue adenocarcinoma ductal infiltrante con 47 (88 por ciento) pacientes. Estadio IIB en 42 (43 por ciento) casos. Neoadyuvancia se aplicó a 45 (83 por ciento) pacientes. Esquemas de quimioterapia aplicados CAF 45 (83 por ciento); AC 6 (11 por ciento); CMF a 3 (6 por ciento). Se realizaron 35 (65 por ciento) MT+VAI-II y 01 MPO. 48 (90 por ciento) pacientes recibieron adyuvancia, a 35 (66 por ciento) se les aplicó quimioterapia y radioterapia. Permanecen libres de enfermedad 34 (64 por ciento) pacientes con intervalo libre de enfermedad más prolongado de 49 meses en 15 (44 por ciento) casos. Presentaron recaída 10 (19 por ciento) casos. Mayor frecuencia de recaída fue ósea 03 (30 por ciento). Se debe realizar el examen de inmunohistoquímica con el fin de obtener una clasificación más precisa y así individualizar a cada paciente para brindarle un tratamiento más eficaz, con miras a aumentar el intervalo libre de enfermedad y así la sobrevida global

Presenting the experience of our institution in the treatment of negative triple breast carcinoma and assess their behavior. Is a retrospective and descriptive study. We evaluating 998 stories of patients with a diagnosis of breast carcinoma that attended the Institute of Oncology “Dr. Miguel Perez Carreño” from 2000 to 2004, selecting patient’s negative triple, tracking them until December 2009. We are reviewed a total of 998 medical histories of patients with a diagnosis of breast carcinoma in a period of four years (2000-2004). 940 had immunohistochemistry which 53 (6 percent) were triple negative review. The average age was 48.3. Histological type frequent was ductal adenocarcinoma infiltrating 47 (88 percent) patients. Stage IIB was 42 (43 percent) cases. Neoadyuvancia apply in 45 (83 percent) patient. Treatment with CAF 45 was (83 percent); AC 6 (11 percent); CMF chemotherapy schemas 3 (6 percent). Were 35 (65 percent) MT+VAI-II and 01 MPO cases found. 48 (90 percent) patients receiving adyuvancia, 35 (66 percent) were they apply chemotherapy and radiation therapy. Budget free of disease 34 (64 percent) patients with interval longer disease free 49 months 15 (44 percent) cases. Submitted 10 relapse (19 percent) cases. Increased frequency of relapse was the bone 03 (30 percent). Consideration of in order to obtain immunohistochemistry a more precise classification and thus identify each patient to provide more effective, with a view to increasing disease-free interval treatment should be and thus the survival overall

Familial Mediterranean fever presenting with pulmonary embolism.

Familial Mediterranean fever (FMF) is the autoinflammatory disease and hereditary periodic fever syndrome that most commonly affects people of Eastern Mediterranean origin. It is characterized by recurrent self-limited attacks of fever and serositis, with an increase in acute-phase reactant markers, and is transmitted in an autosomal recessive pattern. Inflammation shifts the hemostatic mechanisms favoring thrombosis. There are few reports of an increased risk of hypercoagulability in patients with FMF in the absence of amyloidosis and nephrotic syndrome. In this case report, we describe a 43-year-old Turkish patient who presented with right-sided pleuritic chest pain and pulmonary embolism. The patient described having prior similar attacks of serositis, but had never been diagnosed with FMF. Further workup revealed an increase in acute phase reactants, negative hypercoagulability studies and heterozygosity for the M694V mutation in the pyrin (MEFV) gene. We identified untreated FMF and chronic inflammation as his only risk factor for pulmonary embolism. With this case report, we support recent studies that have demonstrated that inflammation may lead to prothrombotic states in patients with FMF.

Enfermedad de paget de la mama: reporte de 13 casos / Paget disease of the breast: 13 cases report

Reportar y describir las características clínicas y conducta terapéutica de 13 casos de enfermedad de Paget en el Instituto de Oncología “Dr. Miguel Pérez Carreño” en el período comprendido entre 1986-2008. Se realizó un estudio no experimental, descriptivo, de tipo retrospectivo. Se revisaron historias clínicas del departamento de dicha institución. Total de casos encontrados: 13, 100 por ciento de los pacientes fueron del sexo femenino. La edad promedio de presentación fue de 58 años. 44 por ciento de los casos se presentó con una lesión eccematosa a nivel de pezón y un 14 por ciento se encontraban en estadio I en el momento de diagnóstico. 87 por ciento presentaban extensión centro-mamaria; el tiempo de evolución fue menor o igual a 6 meses en un 50 por ciento de los casos. El síntoma de presentación en un 45 por ciento fue la presencia de un nódulo mamario más lesión ulcerativa del pezón. 25 por ciento cursaba con adenopatía clínicamente palpable. En un 65 por ciento, la conducta quirúrgica fue mastectomía total con vaciamiento axilar en niveles I y II. 37 por ciento recibieron tratamiento adyuvante y en un 72 por ciento el tiempo de sobrevida comprendió entre el rango de 1 a 5 años. La enfermedad de Paget constituye una entidad especial poco frecuente. El grupo etario afectado está entre 50-60 años. El tratamiento terapéutico establecido en la mayor parte de las series publicadas, independientemente de la etapa, ha sido la mastectomía radical.

The objective of this study was report and describes the clinical characteristics and therapeutically conducts in 13 cases of Paget disease view in the Oncology Institute Dr. Miguel Perez Carreño between the years 1986-2008. We realized a study not experimental, descriptive and retrospective. We review the clinical department history of our institution. The total cases found was 13, 100 percent of the patients were female. The average age at the presentation was 58 years old. The 44 percent of the cases were presented with an eczematous lesion in the nipple level, 14 percent of the cases were in stage I at the diagnostic moment. The 87 percent of cases present a center mammalian extension to the diagnostic moment. The evolution time were minor or equal to 6 month in a 50 percent of the cases. The dominant symptom in 45 percent was the presence of a mammalian nodule and an ulcerative lesion in the nipple. In the 66 percent of the cases the surgical conduct was a total mastectomy with axillaries dissection in the level I and II. Only 37 percent receive adjuvant treatment and in a 72 percent the super life were between the 1 and 5 years range. Paget disease is a less special entity. The average groups affected are between the 50 and 60 years old. The established therapeutically treatment in the majority of series published independent of the stage was the surgical.

Adenocarcinoma de pezón: a propósito de un caso / Nipple adenocarcinoma: a purpose of a case

Se presenta el caso de paciente femenino de 47 años, natural de Italia y procedente del Estado Barinas, quien acude a la consulta de patología mamaria y refiere lesión papular en pezón de mama izquierda de 2 meses de evolución, con antecedentes de mamoplastia de aumento a los 43 años, padre muerto por cáncer de pulmón, nuligesta. Al examen físico se aprecia: mamas simétricas, cicatriz periareolar bilateral. Se observa en pezón de mama izquierda lesión papular, polipoidea de 4 mm, color rosada, lisa, uniforme, ovoide en región central del pezón. Axilas y fosas supraclaviculares sin adenopatías. Se le realizó biopsia incisional que reportó adenocarcinoma ductal infiltrante. Se analizan factores pronósticos y predictivos por inmunohistoquímica, lo infrecuente y excepcional de este tipo de neoplasia en esta localización y el tratamiento realizado.

Present a clinical case of feminine patient 47 years old, natural of Italy precedent of Barinas state, she consult in the mammalian pathology, and refer a papular lesion in the nipple of left breast to 2 month of evolution, has history of increase mamoplasty to 43 years old, her father died for lung cancer, she has not pregnancy. In physical examination we found breast symmetric, periareolar bilateral cicatrize. Observed in nipple of left breast, a papular lesion polypoid 4 mm, rose color, lice uniform, ovoid in central region. Axillaries, supraclavicular fosse doesn’t have lymphatic nodes. Realized an incisional biopsy, report is ductal infiltrante adenocarcinoma. The prognostic and predictive factors are value for immunohistochemestry, the less frequent and exceptional of this type of neoplasia in this localization and the realized treatment.

Sarcoma sinovial monofásico primario de pulmón: reporte de un caso y revisión de la literatura / Single primary synovial sarcoma of the lung: a case report and review of the literature

El sarcoma sinovial es una entidad morfológica, clínica y genéticamente distinta y se puede apreciar en cualquier ubicación. Es un tumor mesenquimal de células fusiformes con una diferenciación epitelial variable. No existe una terapia estandarizada, generalmente el tratamiento es quirúrgico, con una resección total de la lesión, aplicándose en algunos casos radioterapia adyuvante. Los sarcomas sinoviales han mostrado quimiosensibilidad a la ifosfamida y a la doxorrubicina con una respuesta aproximada del 24 por ciento. Se presenta caso de una paciente de 32 años de edad quien presenta tumor en lóbulo inferior de pulmón izquierdo. Se le realizan estudios de extensión, paraclínicos y biopsia por punción dirigida por fluoroscopia que reportó neoplasia epitelial maligna poco diferenciada. Se diagnostica como cáncer de pulmón estadío I realizándose lobectomía inferior izquierda cuya biopsia y estudios inmunohistoquímicos diagnostica un sarcoma sinovial monofásico. Evoluciona satisfactoriamente refiriéndose a los servicios de oncología médica y radioterapia para tratamiento adyuvante.

Synovial Sarcoma is morphologic, clinical organization and genetically different and is possible to be appreciated in any location. Is mesenquimal tumor fusiform cell with variable epithelial differentiation. Treatment, standardized therapy does not exist; the treatment is generally surgical, with total resection of the injury, being applied in some cases adjuvant radiotherapy. Synovial sarcomas has shown chemo sensibility to ifosfamide one and doxorrubicin with an approximated answer of 24 %. A case of a patient of 32 years of age appears that presents displays tumor in inferior lobe of left lung. Studies of extension, paraclinics are made to him and biopsy by punction directed by fluoroscopy that reported neoplasia epithelial vitiates little differentiated. It is diagnosed as lung cancer stage I being made left inferior lobotomy whose inmunohystochemestry biopsy and studies diagnose Synovial sarcoma single-phase. It evolves satisfactorily talking about to the services of medical oncology and radiotherapy for adjuvant treatment.

ADAMTS13 activity and inhibitor.

Thrombotic thrombocytopenic purpura (TTP) is often associated with acquired or congenital deficiency of the von Willebrand factor-cleaving metalloprotease, ADMATS13 (Lammle B et al., J Thromb Haemost 2005;3:1663-1675; Schneppenheim et al., Blood 2003;101:1845-1850). Although undetectable levels of enzyme activity (<10%) are diagnostic of inherited or acquired TTP in the correct clinical setting (absence is specific), not all patients diagnosed with TTP have severe protease deficiency, and it is therefore not recommended as an initial test for diagnosis (Copelovitch and Kaplan, Pediatr Nephrol, in press). Many prospective and retrospective studies have demonstrated that patients with severe protease deficiency have a higher likelihood of relapse, making it helpful as an indicator of recurrence. The short-term prognostic usefulness of ADAMTS13 testing during acute TTP warrants further investigation because of limited prospective studies (Ferrari S et al., Blood 2007;109:2815-2822; Peyvandi et al., Haematologica 2008;93:232-239).

Schwanoma pancreático: a propósito de un caso / Pancreatic schwannoma: a clinical case

Se presenta el caso de una paciente femenina de 85 años con diagnóstico previo de pseudoquiste pancreático en estudio por el servicio de Gastroenterología durante un año y medio, quien sufrió traumatismo abdominal cerrado motivo por el cual ingresó de emergencia y se realizó laparotomía exploradora, donde se evidenció ruptura del pseudoquiste pancreático. Se realizó cistoyeyunoanastomosis en Y y de Roux y toma de biopsia en la pared del pseudoquiste cuyo resultado histológico reportó: Neurilemoma Pancreático. Evolucionó tórpidamente por lo que se realizó drenaje transgástrico endoscópico con colocación de dos prótesis, las cuales se obstruyeron a las dos semanas. Es intervenida para exéresis del tumor; pero debido a las múltiples adherencias se decidió practiar cistogastroanastomosis. El diagnóstico definitivo de estas lesiones es pr evaluación inmunohistoquímica. Se reconoce como el tratamiento adecuado a la resección completa del mismo y en presencia de una alta tasa de morbi-mortalidad según el caso by-pass de la lesión.