Indicadores de calidad en patología pleural: consentimiento informado / Quality indicators in pleural pathology: informed consent

Objetivo. Medir el grado de cumplimiento de dos indicadores de calidad en patología pleural: consentimiento informado en toracocentesis (CIT) y consentimiento informado en biopsia pleural cerrada (CIBPC). Material y métodos. Estudio retrospectivo realizado en 6 hospitales de la Comunidad de Madrid. Se seleccionaron todas las toracocentesis y biopsias pleurales cerradas realizadas por un neumólogo desde el 01/12/2016 al 28/02/2017, en pacientes >16 años con derrame pleural. Variables a estudio: edad, sexo, modelo de consentimiento informado, presencia del CIT y CIBPC en la historia clínica o en archivos parciales e informatización del hospital. Se consideró buen cumplimiento cuando el consentimiento informado estaba presente y correctamente cumplimentado en > 90% de las historias clínicas. Las variables se recogieron en una tabla Excel. Análisis mediante Stata v.12. Resultados. Se realizaron 146 toracocentesis (63 mujeres/83 varones, edad media: 69) y 20 biopsias pleurales cerradas (7 mujeres/13 varones, edad media: 64). De forma global el indicador del CIT se cumple en 125/146 (85,6%) de las historias clínicas revisadas y el CIBPC en 18/20 (90%). Por hospitales 3/6 (50%) cumplen el indicador del CIT y 5/6 (83%) el CIBPC. Están informatizados 5 de los hospitales participantes, sólo uno utiliza la firma electrónica y existen archivos parciales en 2/6. No hay homogeneidad en los consentimientos informados. Conclusiones. El 50% de los hospitales cumple el indicador del CIT y el 83% el CIBPC. Existen diversos modelos de consentimiento informado en la Comunidad de Madrid localizados en la historia clínica, en la digital y en archivos parciales, que se deberían homogeneizar y simplificar

Objective. To measure the degree of compliance of two quality indicators in pleural pathology: informed consent in thoracocentesis (ICT) and informed consent in transthoracic needle biopsy (ICTTNB). Material and methods. Retrospective study carried out in 6 hospitals of the Community of Madrid. All thoracocentesis and transthoracic needle biopsy performed by a pneumologist were selected from 12/01/2016 to 02/28/2017, in patients > 16 years with pleural effusion. Variables to study: age, sex, model of informed consent, presence of ICT and ICTTNB in the clinical history or in partial files and computerization of the hospital. Good compliance was considered when the informed consent was present and correctly completed in > 90% of the clinical history. The variables were collected in an Excel table. Analysis by Stata v.12. Results. 146 thoracocentesis was performed (63 women/83 men, average age: 69) and 20 transthoracic needle biopsy (7 women/13 men, mean age: 64). Overall, the ICT indicator is met in 125/146 (85.6%) of the revised clinical history and the ICTTNB in 18/20 (90%). By hospitals 3/6 (50%) meet the ICT indicator and 5/6 (83%) the ICTTNB. They are computerized 5 of the participating hospitals, only one uses the electronic signature and there are partial files in 2/6. There is no homogeneity in the informed consent. Conclusions. 50% of the hospitals meet the ICT indicator and the 83% ICTTNB one. There are several informed consent's models in the Community of Madrid located in the clinical history, in digital and in partial files, which should be standardized and simplified

Derrame pleural maligno como debut de neoplasia no conocida / No disponible

Objetivo: Conocer el origen de la neoplasia en los pacientes con derrame pleural maligno (DPM) como primera manifestación de enfermedad tumoral. Diseño: Estudio retrospectivo y multicéntrico, desarrollado en 11 hospitales públicos de la Comunidad de Madrid, en el que se incluyeron todos los pacientes consecutivos con DPM, sin antecedentes de neoplasia conocida entre el 1 de abril de 2008 y el 1 de abril de 2013. Resultados: El diagnóstico del tumor primario se realizó mediante muestras citohistológicas en 339 pacientes (84%). El cáncer de pulmón destacó como el origen más frecuente del DPM tanto en hombres (59%) como en mujeres (46%), siendo el adenocarcinoma la estirpe histológica más frecuente. Los tumores pleurales primarios ocuparon el segundo lugar en frecuencia (20%), de los que el 92% fueron mesoteliomas. En tercer lugar se situaron en igual proporción (5,5%), las neoplasias hematológicas y los tumores ováricos. El cáncer mamario, junto con los tumores digestivos, renales y urológicos fueron muy infrecuentes (<2%). En 39 pacientes (9,7%) no fue posible determinar el origen neoplásico. Se hallaron otras metástasis a distancia en 187 pacientes (47%). Conclusión: El pulmón es el órgano que con mayor frecuencia produce DPM como primera manifestación de enfermedad neoplásica, seguido por las neoplasias pleurales. En ausencia de otros síntomas, el clínico debe dirigir sus esfuerzos iniciales a descartar uno de estos órganos como el origen tumoral. En mujeres, nuestro estudio obliga a cambiar la sospecha y enfoque clínico, ya que en esta situación el carcinoma mamario es muy infrecuente

Objective: To determine the origin of neoplasms in patients with malignant pleural effusion (MPE) as the initial manifestation of tumor disease. Material and methods: This is a retrospective, multicenter study. It was developed at 11 public hospitals in the Community of Madrid, and included all consecutive patients with MPE and no history of previously detected neoplasm between April 1, 2008 and April 1, 2013. Results: We studied 402 patients with MPE. We obtained a cytohistological diagnosis of the primary tumor in 339 of them (84%). Lung cancer was the most frequent origin of the MPE in both men (59%) and in women (46%), while adenocarcinoma was the most frequent histological type. Primary pleural tumors were the second most frequent (20%), 92% of which were mesotheliomas. Third were both hematological cancers and ovarian tumors (5,5%). Breast cancer, along with gastrointestinal, renal and urological tumors, were very rare (<2%). It was not possible to determine the origin of the neoplasm in 39 patients (9,7%). Other distant metastases were found in 187 patients (47%). Conclusion: The lungs are the organs that most frequently produce MPE as the initial manifestation of neoplastic disease, which is followed in frequency by pleural neoplasms. Therefore, in the absence of other symptoms, clinicians should aim their initial efforts at ruling out one of these organs as the tumor origin. Our study shows that the clinical suspicion and focus should be changed when diagnosing women, because MPE is uncommon as the first manifestation of breast cancer

Reduced mitochondrial Ca(2+) transients stimulate autophagy in human fibroblasts carrying the 13514A>G mutation of the ND5 subunit of NADH dehydrogenase.

Mitochondrial disorders are a group of pathologies characterized by impairment of mitochondrial function mainly due to defects of the respiratory chain and consequent organellar energetics. This affects organs and tissues that require an efficient energy supply, such as brain and skeletal muscle. They are caused by mutations in both nuclear- and mitochondrial DNA (mtDNA)-encoded genes and their clinical manifestations show a great heterogeneity in terms of age of onset and severity, suggesting that patient-specific features are key determinants of the pathogenic process. In order to correlate the genetic defect to the clinical phenotype, we used a cell culture model consisting of fibroblasts derived from patients with different mutations in the mtDNA-encoded ND5 complex I subunit and with different severities of the illness. Interestingly, we found that cells from patients with the 13514A>G mutation, who manifested a relatively late onset and slower progression of the disease, display an increased autophagic flux when compared with fibroblasts from other patients or healthy donors. We characterized their mitochondrial phenotype by investigating organelle turnover, morphology, membrane potential and Ca(2+) homeostasis, demonstrating that mitochondrial quality control through mitophagy is upregulated in 13514A>G cells. This is due to a specific downregulation of mitochondrial Ca(2+) uptake that causes the stimulation of the autophagic machinery through the AMPK signaling axis. Genetic and pharmacological manipulation of mitochondrial Ca(2+) homeostasis can revert this phenotype, but concurrently decreases cell viability. This indicates that the higher mitochondrial turnover in complex I deficient cells with this specific mutation is a pro-survival compensatory mechanism that could contribute to the mild clinical phenotype of this patient.

Derrame pleural por síndrome de Dressler / No disponible

El síndrome de Dressler (SD) se caracteriza por fiebre, dolor torácico de tipo pleurítico y derrame pericárdico después de 2-3 semanas de un infarto agudo del miocardio o lesión pericárdica; suele mejorar con AAS u otro AINE; los glucocorticoides se reservan para pacientes con dolor intenso y refractario. Se presenta el caso de un varón con derrame pleural (DP) secundario a SD en paciente con antecedente de cirugía cardiaca reciente recidivante y con mala evolución, en probable relación a tratamiento con dosis bajas de antiinflamatorios y rápido descenso de los mismos de forma inicial, presentando mejoría al reintroducir tratamiento a dosis altas y de forma prolongada

Dressler’s syndrome (DS) is characterized by fever, chest pleuritic pain and pericardial effusion that may appear 2-3 weeks after an acute myocardial infarction or pericardial injury and usually improves with aspirin or other NSAIDs; glucocorticoids reserved for patients with severe and refractory pain. The case of a man with pleural effusion (PE) secondary to DS with history of recent heart surgery, which was recurrent and poor outcome, probably related to treatment with low doses of anti-inflammatory and rapid decline of the same initial presenting improvement to reintroduce treatment with high doses and for long periods

Características generales del derrame pleural maligno secundario a neoplasias de diferentes orígenes / No disponible

La presencia de un derrame pleural maligno (DPM) complica la evolución de los pacientes diagnosticados de un cáncer porque implica un estadio más avanzado de la enfermedad, un peor pronóstico y una peor calidad de vida. Aproximadamente el 50% de los pacientes con un cáncer diseminado desarrollará un DPM. El cáncer de pulmón, el cáncer de mama y los linfomas son los tumores que con más frecuencia lo producen. El diagnóstico del DPM se basa en la presencia de células tumorales malignas en la citología del líquido pleural o en la histología de la biopsia pleural. Existen varias opciones terapéuticas: la toracocentesis evacuadora, la pleurodesis, las derivaciones pleuroperitoneales, la colocación de catéteres pleurales tunelizados, la quimioterapia en tumores quimiosensibles y otros en estudio como la instilación intrapleural de agentes antineoplásicos

The presence of malignant pleural effusion (MPE) complicates the course of cancer-diagnosed patients because it implies a more advanced stage of the disease, worse prognosis and worse quality of life. Approximately 50% of the patients with disseminated cancer develop MPE. Lung cancer, breast cancer and lymphomas are the tumors that more frequently cause it. The diagnosis of MPE is based on the presence of malignant tumor cells in the pleural fluid cytology or in the pleural biopsy histology. There are several therapeutic options: evacuating thoracentesis, pleurodesis, pleuroperitoneal shunting, placement of tunnelled pleural catheters, chemotherapy in chemosenstive tumors and others that are under study such as intrapleuralinstillation of antineoplastic drugs

TMBIM3/GRINA is a novel unfolded protein response (UPR) target gene that controls apoptosis through the modulation of ER calcium homeostasis.

Transmembrane BAX inhibitor motif-containing (TMBIM)-6, also known as BAX-inhibitor 1 (BI-1), is an anti-apoptotic protein that belongs to a putative family of highly conserved and poorly characterized genes. Here we report the function of TMBIM3/GRINA in the control of cell death by endoplasmic reticulum (ER) stress. Tmbim3 mRNA levels are strongly upregulated in cellular and animal models of ER stress, controlled by the PERK signaling branch of the unfolded protein response. TMBIM3/GRINA synergies with TMBIM6/BI-1 in the modulation of ER calcium homeostasis and apoptosis, associated with physical interactions with inositol trisphosphate receptors. Loss-of-function studies in D. melanogaster demonstrated that TMBIM3/GRINA and TMBIM6/BI-1 have synergistic activities against ER stress in vivo. Similarly, manipulation of TMBIM3/GRINA levels in zebrafish embryos revealed an essential role in the control of apoptosis during neuronal development and in experimental models of ER stress. These findings suggest the existence of a conserved group of functionally related cell death regulators across species beyond the BCL-2 family of proteins operating at the ER membrane.

Fine needle aspiration cytology of basal cell adenoma of the salivary gland: a cytohistological correlation study of 35 cases.

OBJECTIVE: In order to evaluate the possibility of a specific cytological recognition of basal cell adenoma (BCA) we reviewed our experience with 35 histologically proven cases. Few series describing cytological features of BCA are available and diagnostic cytological criteria are not well established. METHODS: This study was based on 41 cytology samples from 35 patients with BCA. Thirty-five aspiration procedures were performed pre-operatively and six on tumour recurrence. Nineteen of the 35 patients were men and 16 women. The mean age at diagnosis was 55 years old (range 24-92). The series includes one non-representative case. Except for one tumour located in the upper lip, all of them involved the parotid gland. RESULTS: Aspirates were cellular, showing groups with dense, homogeneous metachromatic stroma and single cells. Relevant features were the trident-like configuration of groups, intimate relationship between neoplastic cells and stroma and cellular polymorphism. In approximately half of the cases a precise diagnosis was given. Most of the remaining tumours were diagnosed as benign but they were difficult to differentiate from pleomorphic adenoma. Regarding malignancy, there were two misdiagnoses of acinic cell carcinoma, due to high epithelial cellularity along with scarcity of stroma, and one case was considered to be suspicious of malignancy. CONCLUSION: BCA shows characteristic cytological features that allow a precise diagnosis. The main differential diagnosis is epithelial-rich pleomorphic adenoma, while acinic cell carcinoma is a potential false positive.

Acute rheumatic fever in a grown up with repaired tetralogy of Fallot: the role of acquired diseases in patients with congenital heart diseases.

We report a 20 year old patient with repaired Tetralogy of Fallot who presented with acute right side heart failure. The echocardiogram showed severe mitral regurgitation which was not present one year before. Because of mitral insufficiency, pulmonary pressure increased and it was nearby 70% systemic pressure. Pulmonary regurgitation got worse, and the patient came to the hospital in a state of anasarca. After valve replacement, histopathological study of the mitral valve and the aortic valve revealed Aschoff nodules and rheumatic fever was confirmed.

Marcadores biológicos en el diagnóstico del derrame pleural maligno / Biological markers for malignant pleural effusions

En el proceso diagnóstico de los pacientes con derrame pleural y alta sospecha de malignidad, nos preguntamos con cierta frecuencia sobre la utilidad de algunos marcadores tumorales séricos o del líquido pleural. Hasta la fecha, los marcadores tumorales analizados de forma aislada no han mostrado una precisión diagnóstica lo suficientemente elevada como para prescindir del estudio mediante citología e histología de la pleura. Esta cuestión ha estimulado el desarrollo de múltiples paneles de marcadores bioquímicos e inmunohistoquímicos cuya combinación ha permitido mejorar la sensibilidad y la especificidad, discriminar entre lesiones benignas y malignas, y entre diferentes estirpes tumorales. Asimismo, ha permitido que dichos paneles de marcadores sirvan como factores pronósticos y de supervivencia. Hoy por hoy, no es posible recomendar unos paneles de marcadores específicos para cada estirpe. Nuestro objetivo es acercar al clínico la evidencia existente sobre esta materia para que tenga un conocimiento del significado de estos marcadores y de la conveniencia de saber interpretar los resultados obtenidos (AU)

The diagnostic process of patients with pleural effusion and high suspicion of malignancy often leads us to question the utility of some serum or pleural fluid tumor markers. Up to date, the tumor markers analyzed separately have not demonstrated sufficiently high diagnostic accuracy to obviate the study by cytology and histology of the pleura. This question has encouraged the development of multiple biochemical and immunohistochemical marker panels whose combination has made it possible to improve sensitivity and specificity, discriminate between benign and malignant lesions and between different tumor strains and it behaves as prognostic and survival factors. Currently, it is not possible to recommend specific marker panels for each strain, our objective being to make the existing evidence on this material more available to the clinician in order to have knowledge of the meanings of these markers and the convenience of knowing how to interpret the results obtained (AU)

Derrame pleural paraneumónico y empiema pleural / Parapneumonic pleural effusion and pleural empyema

No disponible

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Prevención y tratamiento del tabaquismo en el medio hospitalario / Prevention and treatment of the smoking habit in the hospital setting

No disponible

Rara complicación de una prótesis metálica esofágica en el árbol traqueobronquial / Rare complication of metallic esophageal prosthesis in tracheal bronchial tree

No disponible

Neumonía de lenta resolución como presentación de secuestro pulmonar. Diagnóstico por TC torácico helicoidal / Slow resolution pneumonia as presentation of pulmonary sequestration. Diagnosis by thoracic spiral CT scan

El secuestro pulmonar es una malformación congénita rara caracterizada por tejido pulmonar no funcionante sin comunicación con el árbol traqueobronquial normal, con vascularización propia por una arteria anómala de origen sistémico. El diagnóstico ha sido tradicionalmente, mediante arteriografía de la arteria anómala.Describimos un caso de secuestro pulmonar intralobar de un paciente de 38 años que se presentó como una neumonía extrahospitalaria de lenta resolución y que fue diagnosticado por una tomografía computarizada torácica (TC) helicoidal con reconstrucción axial y sagital

Pulmonary sequestration is a rare congenital malformation characterized by non-functioning lung tissue with no communication with the normal tracheal-bronchial tree, with vascularization characteristic of an abnormal systemic artery. Diagnosis has traditionally been made by an arteriography of the abnormal artery.We describe a case of intralobar pulmonary sequestration of a 38-year old male patient who had slow-resolution community pneumonia and was diagnosed by thoracic spiral computed tomography (CT) with axial and saggital reconstruction (AU)

Sarcoidosis torácica. Nuestra experiencia: análisis de 26 casos / Thoracic sarcoidosis. Our experience: analysis of 26 cases

Objetivos: Describir el perfil clínico biológico de la sarcoidosis torácica en nuestro medio.Material y métodos: Búsqueda restrospectiva de casos sarcoidosis, desde enero/1998 hasta octubre/2004, a través del programa informático (DOCtor) de nuestro Hospital. Se contrastó con los registros de Anatomía Patológica que mostraran granulomas. Se excluyeron aquellos pacientes sin diagnóstico confirmado histológicamente a excepción del sd Lofgren,y los casos de sarcoidosis que no tuvieran afectación torácica.Resultados: De un total de 41 casos encontrados tras la explotación de datos se excluyeron 10 pacientes por no cumplir los criterios diagnósticos, y otros 5 por no presentar afectación torácica. La incidencia anual de los 26 casos de sarcoidosis torácica fue 1,48/100.000 habitantes. La distribución por sexos fue 14 mujeres (53,85%), edad media 41 años (27-76). Sólo 2 casos estaban asintomáticos (7,7%). Ningún paciente presentó afectación de más de 3 órganos. El estadioradiológico I por TAC fue el predominante (53,84%), y no hubo ningún caso de estadio III, IV; 4 casos tenían Rx tórax simple normal. Presentaban alteración ventilatoria restrictiva ligera con difusión normal sólo 2 (8,7%) , que corresponde a 18.18% de los casos con estadio II, ninguno presentaba afectación gasométrica significativa. La mediastinoscopia fue el método diagnóstico que lo consiguió en la mitad de los casos. La rentabilidad de la biopsia transbronquial global fue del 31%, pero en estadio II del 57%. De todos los casos los pacientes tratados fueron 8 (30,76%), con indicación correctaen el 50% casos. En el seguimiento se objetivaron 6 remisiones espontáneas, 6 casos perdidos (23%); en el momento actual no han completado seguimiento a 3 años desde el diagnóstico 13 casos.Conclusiones: La sarcoidosis torácica no es tan infrecuente en nuestro medio. El perfil clínico-biológico es similar aldescrito en la literatura, excepto en la distribución por sexos y el bajo número de pacientes asintomáticos. La realización de fibrobroncoscopia creemos debe incluirse entre las herramientas diagnósticas para confirmación histológica. La estadificación debemos intentar realizarla mediante TAC-AR por su mayor sensibilidad y especificidad que Rx tórax simple;y se debe completar con estudios de función pulmonar y búsqueda de manifestaciones extratorácicas por órganos

Objectives: Describe the biological clinical profile of thoracic sarcoidosis in our setting.Material and methods: Retrospective search for sarcoidosis cases, from January 1998 to October 2004, with the computer program (DOCtor) of our hospital Fundación Alcorcón. It was compared with the pathology registries that show granulomas. Those patients without histologically confirmed diagnosis, except for Lofgren syndrome, and the cases of sarcoidosis that did not have thoracic involvement were excluded.Results: Ten patients out of a total of 41 cases found after the data processing were excluded as they did not fulfill diagnostic criteria and 5 others because they had no thoracic involvement. Annual incidence of the 26 cases of thoracic sarcoidosis was 1.48/100,000 inhabitants. Distribution by gender was 14 women (53.85%), mean age 41 years (27-76). Only 2 cases were asymptomatic (7.7%). No patient had more than 3 organs affected. Radiology stage I by CT scan was predominant (53.84%), and there were no cases of stage III, IV; 4 cases had normal plain chest X-ray. Only 2 (8.7%)had mild restrictive ventilatory alteration with normal diffusion, that corresponded to 18.18% of the cases with stage II. None had significant gasometric involvement. The mediastinocopy was the diagnostic method that achieved it in half of the cases. Profitability of the global transbronchial biopsy was 31% but that of stage II was 57%. Of all the cases, 8 patients (30.76%) were treated, with correct indication in 50% of the cases. In the follow-up, 6 spontaneous remissions,6 lost cases (23%) were seen. At present 13 cases have not completed follow-up at 3 years from diagnosis.Conclusions: Thoracic sarcoidosis is not so rare in our setting. The clinical-biological profile is similar to that described in the literature, except in the distribution by gender and the low number of asymptomatic patients. We believe thatperforming the fibrobronchoscopy should be included among the diagnostic tools for histological confirmation. We should try to do the staging with the high resolution CT scan because it has greater sensitivity and specificity than the plain Xrayand should be completed with pulmonary function studies and search for extrathoracic manifestations by organs

[The impact of Glut-1 marker application on the diagnosis and treatment of congenital vascular anomalies]. / Impacto de la aplicación del marcador GLUT-1 en el diagnóstico y tratamiento de las anomalías vasculares congénitas.

Hemangiomas of infancy have a unique vascular phenotype demonstrated by glucose transporter 1 (GLUT-1) staining marker. Since its first description by P. E. North in 2000 its use has become widely spread by clinicians and researchers in the field of vascular anomalies. We prospectively and retrospectively used GLUT-1 marker on 90 patients divided in five groups over a two years period. Grupo I: Hemangiomas under 1 year of age. Grupo II: Hemangiomas between 1 and 15 years of age. Grupo III: Misdiagnosed angiomas in patients older than 15 years. Grupo IV: Patients with low and high flow vascular malformations Grupo V: Vascular tumors other than hemangiomas. As a result of the study, significant improvement has been noticed by the authors in appropiate vascular anomalies classification by primary care physicians involved in the study. Angioma is not anymore synonym of vascular birthmark. In addition the management of the newborn with a vascular tumour benefit from a more appropriate antiangiogenic therapy. Patients with RICH (rapidly involuting congenital hemangioma) or NICH (non involuting congenital hemangioma) pattern after biopsy and inmunohistochemical study did not receive any pharmacological agent as a part of their treatment. Finally GLUT-1 helped multidisciplinary vascular anomalies team development by promoting clinical, radiological and histopathologic correlations between different specialists.

Impacto de la aplicación del marcador GLUT-1 en el diagnóstico y tratamiento de las anomalías vasculares congénitas / The impact of GLUT-1 application on vascular anomalies program over a two years period

El transportador de glucosa 1 (GLUT-1) es un marcador inmunohistoquímico capaz de diferenciar los hemangiomas del resto de anomalías vasculares. Desde su descubrimiento en el año 2000 por P.E. North su uso se ha generalizado tanto en el diagnóstico clínico como en la investigación de las diferentes anomalías vasculares. Hemos utilizado este marcador en el análisis prospectivo y retrospectivo de 90 pacientes divididos en 5 grupos:• Grupo I: Pacientes menores de un año de edad con hemangiomas proliferativos.• Grupo II: Pacientes con hemangiomas proliferativos entre 1 y 15 años de edad.• Grupo III: Pacientes mayores de 15 años con anomalías vasculares diagnosticadas como «angiomas».• Grupo IV: Pacientes con malformaciones vasculares de alto y bajo flujo.• Grupo V: Pacientes con tumores vasculares distintos del hemangioma. De este estudio se han obtenido las siguientes conclusiones. En primer lugar, debemos seguir avanzando en la correcta nomenclatura de las anomalías vasculares, y GLUT-1 ayuda a los pediatras, radiólogos, patólogos, dermatólogos y cirujanos no familiarizados con estos trastornos a no denominar angioma a cualquier lesión vascular cutáneao visceral. En segundo lugar, la biopsia de los tumores vasculares en el recién nacido vuelve a tener interés ya que permite iniciar o desechar con garantías tratamientos farmacológicos agresivos en pacientes que no los necesitan. Finalmente, la inmunohistoquímica con GLUT-1 ayuda al desarrollo multidisciplinar de equipos de estudio de anomalías vasculares al permitir correlacionarla clínica, radiológica e histopatológicamente (AU)

Hemangiomas of infancy have a unique vascular phenotype demonstrated by glucose transporter 1 (GLUT-1) staining marker. Since its first description by P. E. North in 2000 its use has become widely spread by clinicians and researchers in the field of vascular anomalies. We prospectively and retrospectively used GLUT-1 marker on 90 patients divided in five groups over a two years period. • Grupo I: Hemangiomas under 1 year of age. • Grupo II: Hemangiomas between 1 and 15 years of age. • Grupo III: Misdiagnosed angiomas in patients older than 15 years. • Grupo IV: Patients with low and high flow vascular malformations • Grupo V: Vascular tumors other than hemangiomas. As a result of the study, significant improvement has been noticed by the authors in appropiate vascular anomalies classification by primary care physicians involved in the study. Angioma is not anymore synonym of vascular birthmark. In addition the management of the newborn with a vascular tumour benefit from a more appropriate antiangiogenic therapy. Patients with RICH (rapidly involuting congenital hemangioma) or NICH (non involuting congenital hemangioma) pattern after biopsy and inmunohistochemical study did not receive any pharmacological agent as a part of their treatment. Finally GLUT-1 helped multidisciplinary vascular anomalies team development by promoting clinical, radiological and histopathologic correlations between different specialists Hemangiomas of infancy have a unique vascular phenotype demonstrated by glucose transporter 1 (GLUT-1) staining marker. Since its first description by P. E. North in 2000 its use has become widely spread by clinicians and researchers in the field of vascular anomalies. We prospectively and retrospectively used GLUT-1 marker on 90 patients divided in five groups over a two years period.• Grupo I: Hemangiomas under 1 year of age.• Grupo II: Hemangiomas between 1 and 15 years of age.• Grupo III: Misdiagnosed angiomas in patients older than 15 years.• Grupo IV: Patients with low and high flow vascular malformations• Grupo V: Vascular tumors other than hemangiomas. As a result of the study, significant improvement has been noticed bythe authors in appropiate vascular anomalies classification by primary care physicians involved in the study. Angioma is not anymore synonym of vascular birthmark. In addition the management of the newborn with a vascular tumour benefit from a more appropriate antiangiogenic therapy. Patients with RICH (rapidly involuting congenital hemangioma) or NICH (non involutingcongenital hemangioma) pattern after biopsy and inmunohistochemical study did not receive any pharmacological agent as a part of their treatment. Finally GLUT-1 helped multidisciplinary vascular anomalies team developmentby promoting clinical, radiological and histopathologic correlations between different specialists (AU)

[Diagnosis of intracranial facial schwannoma: clinical, and radiological factors, and the value of immunohistochemistry]. / Diagnóstico del schwannoma intracraneal del nervio facial. Factores clínicos, radiológicos y valor de la inmunohistoquímica.

OBJECTIVE: To analyze the clinical, radiological, and pathological features which may be useful to differentiate intracranial schwannomas of the facial nerve from vestibular schwannomas. MATERIAL AND METHODS: A retrospective study of 91 patients undergoing surgery with a clinical suspicion of vestibular schwannoma is presented. Clinical and radiological features are analyzed. Immunohistochemistry for neurofilaments was performed in selected cases of unilateral vestibular schwannomas, bilateral vestibular schwannomas, and facial nerve schwannomas. RESULTS: Facial function was normal in 83% of patients with vestibular schwannoma. Both patients with facial schwannomas had preoperative House-Brackmann grade II facial function. MRI showed no main differences between facial and vestibular schwannomas. A positive immunostaining was found in unilateral vestibular schwannomas, bilateral vestibular schwannomas, and facial nerve schwannomas. CONCLUSION: There are no specific clinical, radiological, or pathological factors to accurately differentiate schwannomas of the facial nerve from vestibular schwannomas.

Diagnóstico del Schwannoma intracraneal del nervio facial. Factores clínicos, radiológicos y valor de la inmunohistoquímica / Diagnosis of intracranial facial schwannoma: clinical, and radiological factors, and the value of immunohistochemistry

Objetivo: Analizar qué factores clínicos, radiológicos e inmunohistoquímicos pueden ser útiles para diferenciar los schwannomas vestibulares de los schwannomas intracraneales del nervio facial. Material y métodos: Presentamos un estudio retrospectivo de 91 pacientes operados con la sospecha clínica de schwannoma vestibular. Se analizaron factores clínicos y radiológicos. Se realizó una tinción inmunohistoquímica para neurofilamentos en casos seleccionados de schwannomas vestibulares unilaterales, schwannomas vestibulares bilaterales y schwannomas del nervio facial. Resultados: El 83 por ciento de los pacientes con schwannomas vestibulares tenían una función facial preoperatoria normal. Los dos pacientes con schwannomas del nervio facial tenían una función grado II de House-Brackmann. La RM no mostró diferencias entre los schwannomas vestibulares y faciales. La inmunohistoquímica fue positiva en los schwannomas vestibulares unilaterales, los schwannomas vestibulares bilaterales y los schwannomas del nervio facial. Conclusiones: No hay factores clínicos, radiológicos ni patológicos específicos para diferenciar los schwannomas vestibulares de los schwannomas del nervio facial. (AU)

OBJECTIVE: To analyze the clinical, radiological, and pathological features which may be useful to differentiate intracranial schwannomas of the facial nerve from vestibular schwannomas. MATERIAL AND METHODS: A retrospective study of 91 patients undergoing surgery with a clinical suspicion of vestibular schwannoma is presented. Clinical and radiological features are analyzed. Immunohistochemistry for neurofilaments was performed in selected cases of unilateral vestibular schwannomas, bilateral vestibular schwannomas, and facial nerve schwannomas. RESULTS: Facial function was normal in 83% of patients with vestibular schwannoma. Both patients with facial schwannomas had preoperative House-Brackmann grade II facial function. MRI showed no main differences between facial and vestibular schwannomas. A positive immunostaining was found in unilateral vestibular schwannomas, bilateral vestibular schwannomas, and facial nerve schwannomas. CONCLUSION: There are no specific clinical, radiological, or pathological factors to accurately differentiate schwannomas of the facial nerve from vestibular schwannomas (AU)