Invasive lobular carcinoma of the breast with extracellular mucin: A case report.

BACKGROUND: Invasive lobular carcinoma is the second most common histological type of breast carcinoma, accounting for approximately 5%-15% of all invasive breast cancers. The extracellular mucin secretion is by default a feature of ductal carcinoma. Only four cases of infiltrative lobular carcinoma with extracellular mucin have been report. CASE SUMMARY: A 60 year old female asymptomatic patient with palpable breast mass and architectural distortion by mammography on external upper quadrant of the right breast was diagnosed as invasive lobular carcinoma with extracellular mucin in the resection, confirmed with immunohistochemistry markers. DISCUSSION: Previous report in the literature of four cases of Invasive lobular carcinoma of breast with extracellular mucin, all of them sharing the same histologic features: the presence of extracellular and intracellular mucin with appearance of infiltrates lobular carcinoma with signet ring cells and "Indian files". CONCLUSION: It is important to know that extracellular mucin production is not exclusive of ductal lesions and keep in mind the lobular carcinomas with extracellular mucin as a differential diagnosis.

Neurotoxicidad subaguda letal por metotrexato intratecal / Intrathecal methotrexate induced lethal subacute neurotoxicity

El metotrexato es un inhibidor de la dihidrofolato reductasa ampliamente utilizado en el tratamiento de la leucemia, el linfoma y otros tumores sólidos en pacientes pediátricos. Se ha descrito que puede producir neurotoxicidad por mecanismos aún no bien aclarados. La toxicidad neurológica puede ser aguda, subaguda o crónica, según el tiempo de manifestación tras la administración del fármaco. La clínica suele ser reversible, pero ocasionalmente causa la muerte del paciente o importantes secuelas, por lo que conviene vigilar a los pacientes en riesgo. La resonancia magnética nuclear es útil en el diagnóstico, mostrando alteraciones en la difusión de manera precoz. Se han ensayado tratamientos farmacológicos pero ninguno ha demostrado su eficacia actualmente. Presentamos el caso de un adolescente de 15 años de edad con leucemia linfoblástica aguda tipo B que se encontraba en remisión completa y sin infiltración del sistema nervioso central tras la terapia de inducción y consolidación. Después de la administración de metotrexato intratecal desarrolla neurotoxicidad subaguda grave, con deterioro neurológico progresivo hasta un estado de coma persistente con graves alteraciones en la resonancia magnética y el trazado electroencefalográfico. La clínica no mejora con ningún tratamiento. El paciente falleció tras realizarse limitación del esfuerzo terapéutico de acuerdo con la familia (AU)

Methotrexate inhibits dihydrofolate reductase and it is widely used in the treatment of leukemia, lymphoma and other tumors in paediatric patients. There has been described that can produce neurotoxicity for still not well clarified mechanisms. Neurological toxicity can be acute, subacute or chronic, according to the time of manifestation after the administration of the drug. Neurological symptoms often are reversible, but occasionally methotrexate can produce the death of the patient or cause important sequels. For this reason is important to monitor patients in risk. Magnetic resonance imaging is very useful in diagnosis, showing alterations in diffusion-weighted imaging of a precocious way. Several pharmacological treatments have been proved but none of them have demonstrated its efficiency until now. We present the case of a 15-year-old boy diagnosed of acuteB-cell lymphoblastic leukemia in complete remission and without central nervous system leukemic involment postinduction and consolidation therapy. After the administration of intrathecal methotrexate he develops severe subacute neurotoxicity. Neurological symptoms were deteriorating progressively up to a persistent coma with serious alterations in magnetic resonance imaging and electroencephalogram pattern. Clinic did not improve with any treatment. The patient died after limitation of therapeutic effort of agreement by the family (AU)

Nuevos marcadores de gravedad / New markers of severity

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Massive lower gastrointestinal haemorrhage, successfully treated with corticosteroids, as main symptom of Schönlein-Henoch purpura.

Schönlein-Henoch purpura is a small vessel disease that affects mainly skin and kidney, although several gastrointestinal symptoms may occur including abdominal pain, intussusception, perforation or bleeding. Massive lower gastrointestinal haemorrhage is rare and even more as the main symptom of the disease. We present a case of a 2-year-old boy with Schönlein-Henoch purpura who developed a massive lower gastrointestinal bleeding requiring blood transfusion. In this patient both Schönlein-Henoch purpura and gastrointestinal haemorrhage were successfully treated with intravenous methylprednisolone, avoiding surgical intervention. Physicians need to have a high index of suspicion when evaluating these patients, even more when dermatologic signs are scarce. Glucocorticosteroid therapy may be effective when treating severe gastrointestinal symptoms.

[Pure alexia: presentation of three cases and review of the literature]. / Alexia pura: presentación de tres casos y revisión de la literatura.

INTRODUCTION: Pure alexia is a syndrome characterized by the inability to read aloud in the absence of agraphia or apnasia. CLINICAL CASES: Three clinical cases showing this syndrome are presented. Case I had a left occipital lesion compatible with a subacute haematoma. He had problems with reading, visuo-spatial recognition, digital gnosia and memorizing texts. One year later there was considerable improvement in most of the sub-tests evaluated. There was still deficient colour naming right/left orientation and understanding of letters and words. Case 2 presented with a right homonymous hemianopia and slight left paresis. He had a small left occipital ischaemic infarct. One year later there was improvement on testing, with some deficit still in visual recognition, naming colours and memory. Case 3 presented with right homonymous hemianopia, slight right paresis and a left occipito-parietal expansive lesion. He had defective reading, choosing and naming of colours, right/left orientation and memory. On later evaluation, considerable improvement was seen. There was still colour agnosia, although less severe and mild 'laziness' of the right side. CONCLUSIONS: In the review of the literature, the disorder and the contributions of various authors, from Déperine in 1892 to the present day, are considered in detail.

[Time in neuropsychological examination of dementias: Alzheimer's disease versus Parkinson disease]. / El tiempo en la exploración neuropsicológica de las demencias: enfermedad de Alzheimer versus enfermedad de Parkinson.

The importance of time factor studying specificity and sensitivity of neuropsychological tests was studied in two groups of patients with Parkinson's disease and Alzheimer's disease with their respective control groups, through a discriminant analysis. The results indicate that patients with Parkinson's disease are detected with mor sensitivity and specificity applying tests that control time. These findings suggest to develop bradyphrenia and frontal syndrome terms in Parkinson's disease.

[The prevalence of markers for hepatitis A, B and C in a hospital in Mexico]. / Prevalencia de marcadores para hepatitis A, B y C en un hospital de México.

A prospective study was carried to determine the relative frequency of hepatitis A, B and C in patients with elevated liver enzymes (transaminases greater than two times normal) who had a viral hepatitis profile requested by their physicians between August of 1990 and July of 1992 in the Angeles Hospital in Mexico City. Prevalence of serological evidence of HBsAg and anti-hepatitis C antibodies was also studied in healthy blood donors seen at the hospital's blood bank during the same period. Among the 405 patients with elevated liver enzymes, 24.7 per cent had acute hepatitis A (positive anti-hepatitis A IgM), 7.9 per cent had active hepatitis B (positive HBsAg and/or HBcAb IgM) and 14.8 per cent had active or previous hepatitis C as evidenced by the presence of anti-hepatitis C antibodies. In blood donors the incidence of anti-hepatitis C and HBsAg was 0.61 and 0.32 per cent, respectively. A percentage of 46.2 of patients with anti-hepatitis C antibodies and transaminases greater than two-times normal had a past history of one or more blood transfusions. These data suggest that infection with the hepatitis C virus is more common than that caused by the B virus in both healthy blood donors, as well as in patients with hepatitis in this hospital.