The impact of repeat fine-needle aspiration in thyroid nodules categorized as atypia of undetermined significance or follicular lesion of undetermined significance: A single center experience.

BACKGROUND: Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) is the most controversial category of the Bethesda System. The present study was conducted to compare the histological findings in a series of thyroid nodules diagnosed with AUS/FLUS after single or repeat fine needle aspiration (FNA) cytology. METHODS: Retrospective analysis of our institution's series of 514 patients with an initial diagnosis of AUS/FLUS between 11/2011 and 02/2020. RESULTS: Of 4887 FNA samples, 11.8% were classified as AUS/FLUS. Of patients with an initial AUS/FLUS diagnosis, 11.5% (59/514) underwent surgery after a single FNA, 55.4% (285/514) had a repeat FNA, and 32.7% (168/514) were either observed or lost to follow-up. Surgical pathology was available in 123 cases (23.9%), and malignancy was confirmed in 32.5% (40/123) cases, with similar rates in the single 32.2% (19/59) and repeat FNA 32.8% (21/64) groups. Repeat FNA reclassified 78.9% of the AUS/FLUS cases to a different category: 57.2% were reclassified as benign, 10.5% as follicular neoplasm, and 5.6% as suspicious for malignancy or malignant. The rates of nonneoplastic benign lesions were 52.5% (31/59) and 31.2% (20/64) in the single and repeat FNA groups, respectively (P = .018). The rates of follicular adenomas were higher when repeat FNA was performed (23/64, 35.9%) compared with a single FNA (9/59; 15.2%) (P = .013). CONCLUSION: In this series, a repeat FNA in cases of AUS/FLUS increased detection of follicular adenomas but not the detection of malignancy. Repeat FNA reduced the rate of benign nonneoplastic lesions by 40% in the surgical samples.

Prognosis and treatment-selection criteria for patients with high-grade stage IIIc-IV serous ovarian, fallopian tube or peritoneal cancer / Pronóstico y selección de tratamiento en pacientes con cáncer seroso de ovario, de trompas de Falopio o peritoneal de alto grado, estadio IIIc-IV

Objective: To determine the impact of implementing strict treatment-selection criteria on the overall outcome of women with high-grade serous advanced stage ovarian, fallopian tube, or primary peritoneal carcinoma. Material and methods: We included patients treated for high-grade serous advanced stage ovarian, fallopian tube, or primary peritoneal carcinoma at our Institution from January 2007 to March 2015. All other non-serous, low-grade histology tumors and secondary cytoreductions were excluded. strict treatment-selection criteria was used to decide on primary cytoreductive surgery versus neoad-juvant chemotherapy and type of adjuvant therapy. Collected data included patient and tumor characteristics, preoperative diagnostic procedures, surgical treatment, perioperative complications, and neoadjuvant and adjuvant chemotherapies. Appropriate statistical tests were used and survival analysis performed. Results: We identified 71 eligible patients. Mean age was 58.5 ± 11.8 years, 28.2% received neoadjuvant chemotherapy, and 77.5% had optimal cytoreductive surgery to < 1 cm residual disease. Major complications were observed in 16.9% of women, with no significant difference between neoadjuvant chemotherapy and primary cytoreductive surgery groups. With a median follow-up of 35.7 months, median overall survival was not achieved and 57.2% of patients were alive 54 months after surgery. A total of 24 out of 71 (33.8%) died of disease, 11 (45.8%) within two years after surgery. Median progression-free survival was 19.5 months (95% CI 14.8-24.3). Conclusions: Applying strict treatment-selection criteria for patients with high-grade serous advanced stage ovarian, fallopian tube, or primary peritoneal carcinoma ensures few surgical complications and excellent survival rates for the majority of these women

Objetivo: determinar el impacto de la implementación de criterios estrictos de selección de tratamiento sobre el pronóstico de las mujeres con carcinoma seroso de ovario, trompa de Falopio o peritoneal primario en estadio avanzado y de alto grado. Material y métodos: entre enero de 2007 y marzo de 2015 se incluyeron pacientes tratadas por carcinoma ovárico seroso avanzado de alto grado, trompa de Falopio o carcinoma peritoneal primario en nuestro hospital. Se utilizaron criterios estrictos de selección de tratamiento para decidir sobre la cirugía citorreductora primaria versus quimioterapia neoadyuvante y el tipo de tratamiento adyuvante. Los datos recogidos incluyeron características del paciente y del tumor, procedimientos diagnósticos preoperatorios, tratamiento quirúrgico, complicaciones perioperatorias y quimioterapias neoadyuvantes y adyuvantes. Se utilizaron pruebas estadísticas adecuadas y se realizó un análisis de supervivencia. Resultados: se incluyeron 71 pacientes. La edad media fue de 58,5 ± 11,8 años, el 28,2% recibió quimioterapia neoadyuvante y el 77,5% tuvo una cirugía citorreductora óptima (< 1 cm de enfermedad residual). Se observaron complicaciones mayores en el 16,9% de las mujeres, sin diferencias significativas entre los grupos de quimioterapia neoadyuvante y de cirugía citorreductora primaria. Con una mediana de seguimiento de 35,7 meses, no se alcanzó la mediana de supervivencia global y el 57,2% de los pacientes estaban vivas 54 meses después de la cirugía. Un total de 24 de 71 (33.8%) murieron de enfermedad, 11 (45.8%) en los dos años después de la cirugía. La mediana de supervivencia libre de progresión fue de 19,5 meses (IC del 95%: 14,8-24,3). Conclusiones: la aplicación de criterios estrictos de selección de tratamiento para pacientes con carcinoma seroso ovárico, de trompa de Falopio o carcinoma peritoneal primario en estadio avanzado de alto grado asegura pocas complicaciones quirúrgicas y buenas tasas de supervivencia para la mayoría de estas pacientes

Resultados obstétricos y perinatales en gestaciones tras técnicas de reproducción asistida / Obstetrical and perinatal outcomes in pregnancies after assisted reproductive techniques

Material y Métodos: estudio observacional retrospectivo que compara 704 gestaciones conseguidas tras técnicas de reproducción asistida en el periodo 2008-2012 (grupo estudio), con 2.507 gestaciones espontaneas (grupo control). Resultados: mayor riesgo de gestaciones múltiples en el grupo estudio 24,3% contra 1% del grupo control p < 0,001 RR 25,5 (17,3-37,6). El parto fue a las 37,79 semanas en grupo estudio y 38,99 grupo control p < 0,001. Manteniéndose las diferencias en gestaciones únicas con una media de 38,5 en grupo estudio y 39 en grupo control p < 0,001. Niños prematuros en grupo estudio 23,2%, contra 6,2% grupo control p < 0,001 RR 4,5 (3,6-5,8). Reduciéndose a la mitad el riesgo relativo cuando solo comparamos gestaciones únicas. Cesarea en 52% gestaciones por técnicas de reproducción asistida, contra 18,6% en gestaciones espontaneas p < 0,001 RR 2,85 (2,56-3,22). Manteniéndose diferencias comparando gestaciones únicas 15,6% en grupo estudio y 18,3% grupo control. No encontramos diferencias en el sexo del recién nacido. La tasa de bajo peso al nacer también fue mayor en grupo estudio 23,8% contra 7,97% grupo control p < 0,001 RR 3,6 (2,8-4,5); manteniéndose diferencias en gestaciones únicas con 11% recién nacido de bajo peso contra 5,8% p < 0,001 RR 2 (1,46-2,8). Malformaciones congénitas mayor en grupo control 9,45% respecto grupo estudio 3,69%. Conclusiones: la gestación tras técnicas de reproducción asistida presenta 25 veces más riesgo de gestación múltiple; las madres son 5 años más añosas; 4,5 veces más riesgo de tener un parto pretérmino; 2 veces mayor si comparamos gestaciones únicas; 3 veces más de tener recién nacido de bajo peso, el doble si comparamos gestaciones únicas; cesárea en más del doble tanto gestaciones únicas como en total gestaciones (AU)

Material and Methods: Retrospective observational study comparing outcomes of 704 pregnancies after assisted reproductive techniques 2008-2012 (study group), with 2507 spontaneous pregnancies (control group). Results: There are difference in outcome between assisted reproductive techniques (study group) and naturally conceived pregnancies (control group). We found differences in increased risk of multiple pregnancies in the study group 24.3% to 1% of control group p < 0.001 RR 25.5 (17.3-37.6). Mean weeks in which the delivery occurred study group was 37.79 and 38.99 in the control group p < 0.001. Maintaining differences when only singleton pregnancies compared with an average of 38.5 in the study group and control group 39 weeks p < 0.001. In the study group are at higher risk of preterm birth with 23.2% versus 6.2% control group, p < 0.001 RR 4.5 (3.6-5.8). Reduced to half the relative risk when compared only single pregnancies. Cesarean was performed in 52% of pregnancies by assisted reproductive techniques, while it was 18.6% incidence of spontaneous pregnancies p < 0.001 RR 2.85 (2.56-3.22). He maintained even comparing differences singleton pregnancies in both groups with 15.6% in the study group and 18.3% control group. Without differences in sex of newborns. The rate low birth weight was also higher in the study group 23.8% vs control group 7.97% p < 0.001 RR 3.6 (2.8-4.5); maintaining differences in single pregnancies with 11% low birth weight against 5.8%, study group against control group, p < 0.001 RR 2 (1.46-2.8); Although increased incidence of congenital malformations in the control group 9.45% from 3.69% in the study group. Conclusions: These results suggest that assisted reproductive techniques is associated with increased risk of multiple pregnancy, delivery preterm, higher risk of low birth weight (< = 2500g), and more cesarean section. The increased risk of preterm, low birth weight, and cesarean persisted in singleton pregnancies (AU)

Embryonal (botryoides) rhabdomyosarcoma of the uterus harboring a primitive neuroectodermal tumor component.

The association of a uterine sarcoma botryoides of the adolescence with a primitive neuroectodermal tumor is reported in a 12-year-old patient who presented with abnormal vaginal bleeding that occurred after passing per vaginam a polypoid mass. The sarcoma botryoides of the adolescence exhibited foci of cartilage and a central area of primitive neuroectodermal tumor with a trabecular, adamantiform histology and prominent angiogenesis. Primitive neuroectodermal tumor was positive for vimentin, synaptophysin, neuron-specific enolase, CD99, and SOX2 and negative for both the FLI-1 fusion protein and the rearrangement of ESWR1 gene. The neoplasm exhibited a nonaggressive behavior similar to sarcoma botryoides of the adolescence, being alive and well 3 y after its presentation. This is possibly related to its polypoid nature and the absence of invasive features at its uterine insertion level. A conservative approach without further resection and chemotherapy was indicated taking into account the patient's age.

Mutations in FGFR3 and PIK3CA, singly or combined with RAS and AKT1, are associated with AKT but not with MAPK pathway activation in urothelial bladder cancer.

Different members of the phosphoinositide 3 kinase--serine threonine protein kinase (PI3K-AKT) pathway are altered in bladder cancer. Fibroblast growth factor receptor 3 (FGFR3) mutations characterize the low-grade tumors, and RAS genes are mutated in approximately 13% of all bladder tumors. Interestingly, a percentage of bladder tumors have alterations in more than 1 PI3K-AKT or rat sarcoma viral oncogene homolog-RAF mitogen activated protein kinase (RAS-MAPK) pathway gene or their upstream regulators, but some combinations are mutually exclusive. We analyzed mutations in FGFR3, phosphoinositide 3 kinase catalytic alpha polypeptide (PIK3CA), v-akt murine thymoma viral oncogene homolog 1 (AKT1), v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS), v-Ha-ras Harvey rat sarcoma viral oncogene homolog (HRAS), and v-raf murine sarcoma viral oncogene homolog B1 (BRAF) in 88 urothelial cell carcinomas and the immunohistochemical expression of phospho-v-akt murine thymoma viral oncogene homolog (AKT) and mitogen-activated protein kinase 1 and 2 (pERK1/2) in 80 and 77 urothelial cell carcinomas, respectively. Approximately 43% and 20.5% of tumors presented 1 and 2 mutated genes, respectively. FGFR3 mutations were more frequent alone, whereas PIK3CA mutations were associated with another mutated gene (FGFR3 and KRAS). Overall, mutated FGFR3 (FGFR3(mut)) and mutated FGFR3 (FGFR3(mut))-mutated PIK3CA (PIK3CA(mut)) genotypes were associated with low-grade bladder tumors and mutated PIK3CA (PIK3CA(mut))-mutated KRAS (KRAS(mut)) and mutated AKT1 (AKT1(mut)) were only present in high-grade tumors. There are no mutated FGFR3 (FGFR3(mut))-mutated RAS (RAS(mut)) nor mutated PIK3CA (PIK3CA(mut))-mutated AKT1 (AKT1(mut)) combinations. Fifty percent and 56% of tumors showed high levels of pAKT and pERK1/2, respectively. High levels of pAKT were associated with total mutations, FGFR3(mut), and PIK3CA(mut) tumors but not with tumor grade or stage. Wild-type tumors presented significantly higher pERK1/2 expression. Mutations in FGFR3 and FGFR3-PIK3CA but not single PIK3CA mutations characterize low-grade bladder tumors. Single FGFR3 or PIK3CA mutations and the different mutation combinations FGFR3-PIK3CA/AKT1 and PIK3CA-RAS can activate the AKT but not the MAPK pathway. Other genes different from FGFR3 may be related with the pERK activation in bladder tumors.

Síndrome de Meigs y peritonitis esclerosante: una asociación poco frecuente / Meigs’ syndrome and sclerosing peritonitis: an uncommon association

Los tecomas ováricos son tumores estromales relativamente frecuentes que ocasionalmente pueden asociarse con derrame pleural. Los tecomas pueden presentar focos de luteinización y en estos casos se pueden asociar a peritonitis esclerosante. Esta entidad es muy poco frecuente, presenta características histopatológicas propias y clínica heterogénea. Se presenta el caso de una mujer posmenopáusica con dificultad respiratoria y un tumor anexial con sospecha clínica de cáncer ovárico metastásico cuyo estudio anatomopatológico evidenció un tecoma luteinizante con peritonitis esclerosante. Debido a la asociación de una masa ovárica junto a las manifestaciones clínicas que causaba la peritonitis esclerosante es relativamente usual que el diagnóstico de presunción sea de tumor maligno. Todo ello hace importante conocer la entidad, cuya fisiopatología y tratamiento no están consensuados (AU)

Ovarian thecomas are relatively frequent stromal tumors that can occasionally be associated with pleural effusion. Thecomas may contain luteinized foci, and in these cases, can be associated with sclerosing peritonitis. This is a rare, clinically diverse, entity, with its own histopathologic features. We report the case of a postmenopausal woman with respiratory symptoms, bilateral adnexal tumors and suspected metastasizing ovarian cancer, which histopathological study revealed to be a luteinized thecoma associated with sclerosing peritonitis. Due to the clinical manifestations derived from the sclerosing peritonitis and the abdominal mass, a presumptive diagnosis of malignant tumor is quite common. Familiarity with this entity is therefore important. There is no consensus on its physiopathology and treatment (AU)

Granulomatosis linfomatoide con presentación neurológica. A propósito de un caso y revisión de la literatura / Lymphomatoid granulomatosis with a neurological presentation. Case report and a review of the literature

La granulomatosis linfomatoide es un tipo poco frecuente de linfoma de célula B grande de afectación extranodal con un crecimiento angiocéntrico y angiodestructivo característico. En una cuarta parte de los casos se asocia a afectación cerebral, pudiendo dar lugar a una constelación de síntomas, si bien lo más frecuente es que se presente en forma de accidente cerebral vascular (AVC). Cuando la enfermedad se presenta únicamente con afectación cerebral y de forma catastrófica, llegar al diagnóstico de esta entidad resulta altamente complicado, siendo prácticamente imposible sin el estudio autópsico(AU)

Lymphomatoid granulomatosis is a rare form of EBV related large B-cell lymphoma, with an angiocentric and angiodestructive growth pattern in extranodal sites. Brain involvement is relatively frequently found, but not as the initial and unique clinical manifestation. When it occurs, brain stroke is the most frequent clinical picture. Moreover, in that setting, patient can die without a definitive diagnosis, and autopsy is then required for a definitive diagnosis purpose(AU)