IgG4-Related Disease Affecting Testicle and Myelodysplastic Syndrome: Just a Coincidence?

Immunoglobulin G4-related disease (IgG4-RD) is progressive immune-mediated fibrotic condition characterised by a tendency to form tumefactive lesions in different organs and by elevated IgG4 serum concentrations. Urological manifestations are rare and normally occur together with other systemic affections. Myelodysplastic syndromes (MDS) are hematopoietic stem cell neoplasms, with different subtypes based on the type of blood cells involved. MDS can be associated with other pathologies or medical treatments. We present an uncommon case of testicular manifestation associated with myelodysplastic syndrome here. LEARNING POINTS: Testicular inflammation is a manifestation of IgG4-related disease.Testicular inflammation and myelodysplastic syndrome can simultaneously present.

Consensus and evidence-based medication review to optimize and potentially reduce psychotropic drug prescription in institutionalized dementia patients.

BACKGROUND: Dementia patients often show neuropsychiatric symptoms, known as behavioral and psychological symptoms of dementia (BPSD). These are a common motive for medical consultations, hospitalizations, and nursing home stays. Various studies have suggested that the high prevalence of psychotropic drug use to treat BPSD in institutionalized dementia patients may lead to impaired cognitive capacity, rigidity, somnolence, and other complications during the course of the illness. The aim of this study was to design a consensus-based intervention between care levels to optimize and potentially reduce prescription of psychotropic drugs in institutionalized patients with dementia and assess the changes occurring following its implementation. METHODS: Design: Prospective, quasi-experimental, pre/post intervention, multicenter study. SCOPE: 7 nursing homes associated with a single primary care team. INCLUSION CRITERIA: Institutionalized patients diagnosed with dementia and under treatment with 1 or more psychotropic drugs for at least 3 months. SAMPLE: 240 individuals; mean age, 87 years (SD: 6.795); 75% (180) women. INTERVENTION: Creation of evidence-based therapeutic guidelines for psychotropic drug use in the treatment of BPSD by consensus between reference professionals. Joint review (primary care and geriatric care nursing home professionals) of the medication based on the guidelines and focusing on individual patient needs. Primary variable: Number of psychotropic drugs used per patient. ASSESSMENT: Preintervention, immediate postintervention, and at 1 and 6 months. RESULTS: Overall, the number of psychotropic drugs prescribed was reduced by 28% (from 636 before to 458 after the intervention). The mean number of psychotropic drugs prescribed per patient decreased from 2.71 at baseline to 1.95 at 1 month postintervention and 2.01 at 6 months (p < 0.001 for both time points). Antipsychotics were the drug class showing the highest reduction rate (49.66%). Reintroduction of discontinued psychotropic drugs was 2% at 1 month following the intervention and 12% at 6 months. CONCLUSIONS: A consensus guidelines-based therapeutic intervention with a patient-centered medication review by a multidisciplinary team led to a reduction in prescription of psychotropic drugs in institutionalized dementia patients.

Tumor de células de la granulosa de tipo adulto. Un caso raro de tumor testicular. Presentación de un caso / Adult type granulosa cell tumor: a rare testicular neoplasm. A case report

Los tumores de células de la granulosa (TCG) pertenecen al grupo de tumores del estroma y cordones sexuales de las gónadas. Se distinguen 2 tipos: juvenil y adulto. Los TCG de tipo adulto testicular son extremadamente raros, y solo un pequeño número de casos han sido publicados. Su comportamiento biológico es incierto, con casos descritos de metástasis a distancia años después de su presentación inicial. Su diagnóstico se basa en el reconocimiento de las características citológicas y arquitecturales descritas en su homólogo ovárico, ya que ambos son morfológicamente indistinguibles. Describimos un nuevo caso de TCG de tipo adulto testicular en un varón de 23 años, haciendo hincapié en su comportamiento clínico, así como en las características inmunofenotípicas de este raro tumor (AU)

Granulosa cell tumors (GCT) belong to the group of sex cord-gonadal stromal tumours. Two types can be differentiated: juvenile and adult. Adult testicular GCT are extremely rare with only a small number of published cases. Their biological behaviour is not completely clear with cases of distant metastasis appearing years after the initial diagnosis. Diagnosis is based on the cytological and architectural characteristics described in its ovarian counterpart, since both are morphologically indistinguishable. We present a further case of GCT of the adult type in a 23 year old man. We discuss the clinical behavior and immunophenotypical characteristics of this rare tumour (AU)

Correlación citohistológica en tumores de la glándula parótida / Cyto-histological correlation in parotid gland tumors

Objetivo: Evaluar la eficacia de la citología por punción aspiración con aguja fina (PAAF) en el diagnóstico de malignidad de los tumores de la glándula parótida con el fin de planificar el tratamiento más adecuado para cada caso. Material y método: Se realiza un estudio retrospectivo en una muestra de 41 pacientes, en el que se evalúa la correlación entre la PAAF y los hallazgos histopatológicos de la pieza quirúrgica de los tumores de la glándula parótida, realizadas entre los años 2004 y 2008. Resultados: La sensibilidad de la PAAF para detectar malignidad fue de un 71% y la especificidad de un 91%, con un valor predictivo positivo de 62,5% y un valor predictivo negativo de 93,7%. La tasa de falsos negativos fue de 29% mientras que la de falsos positivos de 9%. Conclusiones: La PAAF es un procedimiento diagnóstico de gran utilidad en el diagnóstico de malignidad de tumores de la glándula parótida, que permite establecer el tratamiento más adecuado e individualizado para cada paciente. No obstante, no está exenta de limitaciones en cuanto a su precisión diagnóstica (AU)

Objective: To evaluate the usefulness of fine needle aspiration biopsy (FNAB) in the study of parotid gland tumour malignancy in order to plan the most suitable treatment in each case. Material and Method: a retrospective study was made of 41 cases, in which we evaluated the correlation between the FNAB and the histopathological findings of the surgical piece of parotid gland tumours, from 2004 to 2008, as well as the epidemiological information of these patients. Results: The sensitivity of FNAB in the detection of malignancy was 71% and the specificity was of 91%, with a positive predictive value of 62.5% and a negative predictive value of 93.7%. The rate of false negatives was 29% whereas that of false positives was of 9%. Conclusions: The use of the FNAB in the study of parotid gland tumors is a useful and simple tool that guides us in the diagnosis and planning of treatment. Nevertheless, it is not exempt from limitations in its diagnostic accuracy (AU)

[Cyto-histological correlation in parotid gland tumors]. / Correlación citohistológica en tumores de la glándula parótida.

OBJECTIVE: To evaluate the usefulness of fine needle aspiration biopsy (FNAB) in the study of parotid gland tumour malignancy in order to plan the most suitable treatment in each case. MATERIAL AND METHOD: a retrospective study was made of 41 cases, in which we evaluated the correlation between the FNAB and the histopathological findings of the surgical piece of parotid gland tumours, from 2004 to 2008, as well as the epidemiological information of these patients. RESULTS: The sensitivity of FNAB in the detection of malignancy was 71% and the specificity was of 91%, with a positive predictive value of 62.5% and a negative predictive value of 93.7%. The rate of false negatives was 29% whereas that of false positives was of 9%. CONCLUSIONS: The use of the FNAB in the study of parotid gland tumors is a useful and simple tool that guides us in the diagnosis and planning of treatment. Nevertheless, it is not exempt from limitations in its diagnostic accuracy.