Evaluación rápida "in situ" de punción con aguja fina guiada por endosonografía mejora rendimiento diagnóstico de lesiones pancreáticas sólidas / Rapid on-site evaluation with endoscopic ultra sound-guided fine needle improves diagnostic yield of solid pancreatic masses

BACKGROUND: The use of endoscopic ultrasound with fine needle aspiration (EUS-FNA) has improved the characterization and staging of pancreatic solid masses. The primary strategy for improving the ability to diagnose malignant masses is the use of rapid on site evaluation (ROSE) by a cytopathologist. OBJECTIVE: To evaluate the diagnostic yield of EUS-FNA after the implementation of ROSE in an academic center. MATERIAL AND METHODS: Prospective enrollment and follow-up of EUS-FNA with ROSE during 2015 and 2016, was compared to EUS-FNA without ROSE in previous years (2011-2014) in Hospital Clínico UCChristus. Clinical and endosonographic features, cytopathological and histological diagnosis and number of passes per procedure were evaluated. All EUS-FNA included cytology and cellular block for definitive diagnosis. RESULTS: 59 pancreatic solid masses were included in the analysis. 44 EUS-FNA were performed with ROSE, compared with 15 EUS-FNA without ROSE. The mean age of patients included was 62.8 years, 54.2% male gender, and most masses studied were in the head of pancreas (77.6%). In EUS 86.5% were hypoechoic and 56.9% had poor defined margins. No differences in baseline characteristics were observed between groups. EUS-FNA led to diagnosis in 86.2% of the overall sample. The diagnostic rate was superior in the group of EUS-FNA with ROSE, compared to EUS-FNA without ROSE (97.7% vs 50%, p < 0.0001). The mean number of passes was inferior in EUS-FNA ROSE (+) (2.71 vs 5.78, p < 0.0001). No differences in rate of complications were observed between groups. CONCLUSION: The use of ROSE associated to EUS-FNA improves the diagnostic yield in the evaluation of pancreatic solid masses. Our findings are consistent with those described in the literature, recommending the use of ROSE in EUS-FNA in centers where the diagnostic yield is less than 90% without the use of ROSE

INTRODUCCIÓN: La adquisición de tejido mediante el uso de endosonografía, con punción con aguja fina, (EUS-FNA) ha mejorado el diagnóstico de lesiones pancreáticas sólidas. La principal medida para aumentar el rendimiento diagnóstico de la EUS-FNA es la evaluación por citopatólogo próximo al lugar de punción (in situ) (técnica conocida en inglés como ROSE "rapid on-site evaluation"). OBJETIVO: Evaluar el rendimiento diagnóstico de EUS-FNA en lesiones pancreáticas sólidas posterior a la implementación de ROSE en un centro universitario. MATERIAL Y MÉTODOS: Registro prospectivo de EUS-FNA realizadas con ROSE durante el período 2015-2016, comparado con EUS-FNA con evaluación histopatológica diferida realizada entre los años 2011-2014, en Hospital Clínico UC-Christus. Se evaluaron características clínicas, endosonográficas, diagnóstico histopatológico y número de pases por procedimiento. Todas las EUS-FNA incluyeron citología y block celular para diagnóstico definitivo. RESULTADOS: Se incluyeron en el análisis 59 lesiones pancreáticas sólidas evaluadas con EUS-FNA. Seguimiento prospectivo de 44 EUS-FNA con ROSE, que fueron comparadas con 15 EUS-FNA sin evaluación in situ (retrospectivo). La muestra total incluyó individuos con un promedio de 62,8 años de edad, 54,2% hombres, donde 77,6% de las lesiones se ubicaba en la cabeza pancreática. Endosonográficamente 86,5% de las lesiones eran hipoecoicas y 56,9% tenían márgenes poco definidos. La EUS-FNA fue diagnóstica en 86,2% del total de la muestra. Las EUS-FNA realizadas con ROSE presentaron un mayor rendimiento diagnóstico respecto a las efectuadas sin evaluación in situ (97,7% vs 50%, p < 0,0001). El número de pases por procedimiento fue menor (2,7% vs 5,8%, p < 0,0001) en el grupo con ROSE. No hubo diferencias en complicaciones en ambos grupos. CONCLUSIÓN: La evaluación por citopatólogo in situ de la muestra obtenida por EUS-FNA mejora el rendimiento diagnóstico de las lesiones pancreáticas sólidas. Nuestros hallazgos apoyan el uso de ROSE asociado a EUS-FNA, siendo concordantes con las recomendaciones actuales de utilizar evaluación histopatológica in situ en EUS-FNA, especialmente en centros donde el rendimiento diagnóstico sin uso de ROSE es menor a 90%.

Aumento de detección de lesiones gástricas premalignas mediante protocolo Sydney en comparación con biopsias no protocolizadas / Increased detection of premalignant gastric lesions through Sydney protocol in comparison with non-protocolized gastric biopsies

Introduction: Gastric cancer (GC) is the leading cause of cancer mortality in Chile. The development ofgastric adenocarcinoma its preceded by a histopathologic cascade composed of gastric atrophy, intestinal metaplasia and gastric dysplasia. Sydney protocol has been proposed as the standard method for diagnosingthese conditions. The aim of this research study was to establish whether Sydney protocol increase thedetection of premalignant gastric lesions, as gastric atrophy and intestinal metaplasia, compared to non protocolizedendoscopies/biopsies. Methods: Upper gastroduodenal endoscopies (GDE) from Hospital Clí-nico Universidad Católica de Chile between April-May 2015 and April-May 2016 was analyzed. Patientswith histological study with 18 years-old or older were included. Patients with history of GC or malignantlesions at GDE where excluded. Detection of gastric atrophy, intestinal metaplasia and suggestive findingsof autoimmune gastritis where compared between Sydney protocol and non-protocolized endoscopies/biopsies...

Introducción: El cáncer gástrico (CG) es la principal causa de muertes por cáncer en Chile. El desarrollo del adenocarcinoma gástrico es precedido por una cascada histopatológica (gastritis; atrofia gástrica/AG; metaplasia intestinal/MI). Se ha propuesto la biopsia del cuerpo, ángulo y antro a través del protocolo de Sydney para la búsqueda de estas condiciones. Objetivo: Determinar la diferencia en la detección delesiones premalignas gástricas a través del protocolo de Sydney comparado con el estudio endoscópico habitual. Métodos: Se analizaron las endoscopias digestivas altas (EDA) realizadas en el Centro de Endoscopia Digestiva del Hospital Clínico de la Universidad Católica en los períodos entre abril y mayo del 2015 y 2016. Se incluyeron las EDA de pacientes mayores de 18 años con estudio histológico. Fueron excluidos los pacientes con antecedente personal de CG o lesiones de aspecto maligno macroscópicas. Se comparó la detección de AG, MI y gastritis autoinmune (GA) en el estudio histológico entre los pacientes con protocolo Sydney y el estudio endoscópico no protocolizado...

[Estimation of thyroid cancer incidence in Chile based on pathological reports]. / Epidemiología del cáncer de tiroides en Chile: Resultados del estudio INCATIR.

BACKGROUND: Thyroid cancer (TC) detection is increasing steadily. AIM: To determine the incidence of TC based on pathological reports of thyroidectomies. MATERIAL AND METHODS: Fifty pathology laboratories performing thyroid gland pathological studies were identified. Those that accepted to participate were required to send trimestral reports of all thyroid pathological studies, from March 2011 to February 2012. RESULTS: In the study period, 1309 case of TC were confirmed in 2614 thyroidectomy surgical samples. Considering the susceptible population according to 2012 census, the estimated incidence of TC during 2011 should be higher than 7.86 cases per 100,000 persons/year. Papillary cancer was the most common pathological type in 92% of samples (95% confidence intervals 90-93%). The proportion of microtumors was significantly higher in women than in men and among papillary than in follicular or medullary tumors. Only one fourth of tumors came from thyroidectomies performed in the Ministry of Health network. CONCLUSIONS: The incidence and features of TC in Chile are similar to the figures reported abroad.

Epidemiología del cáncer de tiroides en Chile: Resultados del estudio INCATIR / Estimation of thyroid cancer incidence in Chile based on pathological reports

Background: Thyroid cancer (TC) detection is increasing steadily. Aim: To determine the incidence of TC based on pathological reports of thyroidectomies. Material and Methods: Fifty pathology laboratories performing thyroid gland pathological studies were identified. Those that accepted to participate were required to send trimestral reports of all thyroid pathological studies, from March 2011 to February 2012. Results: In the study period, 1309 case of TC were confirmed in 2614 thyroidectomy surgical samples. Considering the susceptible population according to 2012 census, the estimated incidence of TC during 2011 should be higher than 7.86 cases per 100,000 persons/year. Papillary cancer was the most common pathological type in 92% of samples (95% confidence intervals 90-93%). The proportion of microtumors was significantly higher in women than in men and among papillary than in follicular or medullary tumors. Only one fourth of tumors came from thyroidectomies performed in the Ministry of Health network. Conclusions: The incidence and features of TC in Chile are similar to the figures reported abroad.

Perfil de metilación de genes supresores de tumores APAF1, ASSP1, p73 y FHIT en pacientes con leucemia linfoblástica aguda infantil / Detection of hypermethylation in tumor suppressor genes APAF1, ASSP1, p73 and FHIT in childhood acute lymphoblastic leukemia

La leucemia linfoblástica aguda (LLA), es la neoplasia mas frecuente en la población infantil. Se manifiesta por una perdida de diferenciación de progenitores linfoides produciendo un aumento de células inmaduras. La hipermetilación en la región promotora de genes supresores de tumores (GST) puede producir un silenciamiento génico que le proporciona a la célula leucémica una ventaja proliferativa o la previene de la apoptosis. Se estudia el estado de hipermetilación de 4 GST involucrados en la apoptosis: APAF1, ASPP1, p73 y FHIT y su asociación con la sobrevida de pacientes menores de 15 años con diagnóstico de LLA. Se analizaron 38 muestras de médula ósea mediante modificación con bisulfito del ADN y reacción en cadena de la polimerasa especifica de metilación (MSP). El rango de edad al diagnóstico fue de 10 meses a 13,8 años. La sobrevida global fue de 69 por ciento a los 5 años. El 81,5 por ciento de los pacientes tuvo al menos un gen hipermetilado. La frecuencia de metilación observada fue: APAF1 68,4 por ciento, FHIT 56,4 por ciento, p73 42 por ciento y ASPP1 18,4 por ciento. La asociación entre hipermetilación y grupo <5 años y 5 años fue: Global p=0,20, APAF1 p=0,03, FHIT p=0,51, p73 p=0,51 y ASPP1 p=0.67. Las curvas de sobrevida se calcularon según frecuencia de hipermetilación de cada gen: APAF1 p=0,05, FHIT p=0,31, p73 p=0,98 y ASPP1 p=0,82. La alta frecuencia de hipermetilación obtenida reafirma la participación de la metilación en la región promotora de GST en la patogénesis de la LLA. La hipermetilación del gen APAF1 fue muy frecuente y se asoció significativamente a la sobrevida del grupo de estudio, mostrando a este gen como un factor predictivo de mal pronostico en pacientes con LLA.

Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. It is manifested by a loss of differentiation of lymphoid progenitors, producing an increase of immature cells. Hypermethylation in promoter region of tumor suppressor genes (GST) may produce a gene silencing that provides a leukemic cell a proliferative advantage or prevent apoptosis. We studied the hypermethylation status of 4 GST involved in apoptosis: APAF1, ASPP1, p73 and FHIT and its association with survival of patients <15 years diagnosed with ALL. We analyzed 38 samples of bone marrow by DNA bisulfite modification and chain reaction methylation-specific polymerase (MSP). The mean age at diagnosis was 10 months to 13.8 years. Overall survival was 69 percent at 5 years. 81.5 percent of patients had at least one hypermethylated gene. The frequency observed was: APAF1 68.4 percent, 56.4 percent FHIT, p73 ASPP1 42 percent and 18.4 percent. The association between hypermethylation and group <5 years and 5 years was: Global p = 0.20, APAF1 p = 0.03, FHIT p = 0.51, p73 p = 0.51, ASPP1 p = 0.67. Survival curves were calculated by frequency of hypermethylation of each gene: APAF1 p = 0.05, p = 0.31 FHIT, p73 p = 0.98 and ASPP1 p = 0.82. The high frequency of hypermethylation obtained confirms enrollment of methylation in the promoter region of GST in the pathogenesis of ALL. APAF1 gene hypermethylation was very frequent and was significantly associated with survival in the study group, showing this gene as a predictor of poor prognosis in patients with ALL.

Infección por el virus del papiloma humano en el hombre y su relación con el cáncer: estado actual y prospectivas / Human papillomavirus infection in men and its relation with cancer: Current status and prospectics

Introducción. El virus del papiloma humano (HPV por sus siglas en inglés) es una de las infecciones de transmisión sexual más frecuentes en el mundo y es descrito como el principal agente causal del cáncer cervicouterino (99,7%). En mujeres existe abundante información sobre esta infección, mientras que sus características en población masculina son poco conocidas. Material y método. Se realizó una búsqueda de bibliografía actualizada de la infección por HPV en hombres y su relación con distintos tipos de cáncer. Resultados. La infección por HPV en hombres podría estar asociada a tumores de piel, región perianal, amígdala, orofaringe, laringe, esófago, próstata y uretra. La infección por HPV generalmente es silente, por lo cual no produce síntomas o signos clínicos evidentes, provocando que un gran número de personas estén infectadas sin saberlo, lo cual constituye un problema tanto para el hombre como para su pareja sexual. Los estudios de prevalencia muestran que las zonas de mayor presencia del virus son en poblaciones jóvenes de África y América Latina, donde los programas de vacunación contra este virus tardarán en concretarse. Discusión. Es importante incorporar métodos diagnósticos para HPV en la población masculina e incrementar la vacunación de esta. Asimismo, el control periódico de la población de hombres infectados por la asociación entre HPV y cáncer es crucial, especialmente en las áreas anatómicas asociadas a las enfermedades de transmisión sexual (AU)

Introduction. Human papillomavirus (HPV) is one of most frequent sexually transmitted infections worldwide. It has been described as the principal agent for cervical uterine carcinoma (99.7%). There is abundant information on this infection in women, however, its characteristics in the male population still remains unclear. Materials and methods. A search of updated bibliography on HPV infection in males and its relationship with several forms of cancer was conducted. Results. HPV infection in men could be associated to skin, perianal, tonsils, oropharynx, pharynx, esophagus, prostate and urethra carcinoma. HPV infection is usually silent, so that there are no clear symptoms or clinical signs. Therefore, there are many infected people who are unaware that they have HPV infection. This is a problem for men as well as their sexual partner. Prevalence studies show that the areas having the greatest presence of the HPV virus are in the young populations of Africa and Latin America. This is where the vaccine programs against this virus are slow in materializing. Discussion. It is important to incorporate diagnosis methods in male population and to increase HPV vaccine in men. Furthermore, periodic control of the HPV-infected male population is crucial, especially in the anatomical areas associated to sexual transmission diseases (AU)

Prevalencia de enfermedad diverticular del apéndice cecal en pacientes apendicectomizados por apendicitis aguda / Diverticular disease of the appendix in appendectomies

Introduction: Diverticular disease of the appendix is an infrequent finding in the study of surgical specimens from patients operated on for clinically suspected acute appendicitis. Our aim was to determine the prevalence of diverticular disease of the appendix in patients who underwent appendectomies based on the clinical diagnosis of acute appendicitis. Material and Method: Design: Cross-sectional study. Inclusion criteria: Patients who underwent appendectomies based on a clinical diagnosis of acute appendicitis. Studyperiod: january 2000 to december 2008. Sampling: Non-probabilistic sampling of consecutive cases. Methodology: A review was conducted of the clinical records and surgical specimens from patients who underwent appendectomies based on a clinical diagnosis of acute appendicitis. Results: Within the study period, 11.472 appendectomies were performed based on a clinical diagnosis of acute appendicitis. Ninety-four patients presented diverticular disease of the appendix (0.8 percent). The median age was 40 years and 62.8 percent were male. The disease appeared as: appendicular diverticulitis (45.7 percent), appendicular diverticulosis with acute appendicitis (28.7 percent), appendicular diverticulitis with acute appendicitis (17.0 percent), appendicular diverticulosis (5.3 percent), and appendicular pseudodiverticulosis with acute appendicitis (3.2 percent). Operative morbidity was 12.7 percent. One patient presented an adenocarcinoma of the appendix associated with diverticular disease. Conclusion: The prevalence of diverticular disease of the appendix is low in our population and the characteristics are different to reported by other authors.

Introducción: La enfermedad diverticular del apéndice cecal es un hallazgo infrecuente en apendicectomizados por sospecha clínica de apendicitis aguda. Nuestro objetivo es evaluar la prevalencia de enfermedad diverticular del apéndice cecal en pacientes apendicectomizados por sospecha clínica de apendicitis aguda. Material y Método: Diseño de estudio: Estudio de corte transversal. Criterios de inclusión: Pacientes apendicectomizados por sospecha clínica de apendicitis aguda. Período de estudio: enero de 2000 a diciembre de 2008. Muestreo: No probabilístico de casos consecutivos. Metodología: Se realizó una revisión de los registros clínicos y de las piezas quirúrgicas de los pacientes sometidos a apendicectomía por diagnóstico clínico de apendicitis aguda. Resultados: Se estudiaron 11.472 apendicectomías. Noventa y cuatro pacientes presentaron enfermedad diverticular del apéndice (0,8 por ciento). La mediana de edad fue 40 años y el 62,8 por ciento fue género masculino. La enfermedad se presentó como: diverticulitis apendicular (45,7 por ciento), diverticulosis apendicular con apendicitis aguda (28,7 por ciento), diverticulitis apendicular con apendicitis aguda (17,0 por ciento), diverticulosis apendicular (5,3 por ciento) y pseudodiverticulosis apendicular con apendicitis aguda (3,2 por ciento). La morbilidad operatoria fue 12,7 por ciento. Un paciente presentó un adenocarcinoma del apéndice cecal asociado a la enfermedad diverticular del apéndice. Conclusión: La prevalencia de enfermedad diverticular del apéndice cecal es baja en nuestra población y con características que difieren a lo reportado por otros autores.

Compromiso ganglionar extracapsular en pacientes con cáncer gástrico: determinación del valor pronóstico / Prognostic value of extracapsular lymph node involvement among patients with gastric cancer

Background: Extracapsular lymph node involvement has a negative prognosis in malignant tumors. Aim: To assess the prognostic importance of extracapsular lymph node involvement in patients with gastric cancer with lymph node metastases. Material and Methods: Clinical and morphological features and survival of patients with gastric cancer and lymph node involvement operated between 1986 and 2003, were analyzed. Patients with and without extracapsular involvement were compared. Results: During the study period, 459 gastrectomies were performed, 312 patients (68 percent) had lymph node involvement and 144 (31 percent) had extracapsular involvement. Patients with and without extracapsular involvement were followed for a median of 10 (range 1 to 120) and 41 (range 1 to 193) months, respectively. Five years actuarial survival for patients with and without extracapsular involvement was 23 and 40 percent respectively. Extracapsular lymph node involvement and level of wall infiltration were identified as prognostic factors using a multivariate analysis. Conclusions: Extracapsular lymph node involvement is an independent risk factor for mortality among patients with gastric cancer.

Cáncer de la vesícula biliar: estudios necesarios para el diseño de estrategias de prevención y diagnóstico precoz / Gallbladder cancer: necessary studies to design strategies for prevention and early diagnosis

Chile tiene la mayor tasa de incidencia de cáncer de vesícula biliar (CVB) en el mundo (> 30 por 100.000). Siendo la principal causa de muerte por cáncer entre las mujeres chilenas. Para diseñar estrategias de prevención y diagnóstico precoz del CVB hay que entender los factores etiológicos del proceso carcinogénico vesicular. Hay consenso que para el desarrollo de este cáncer concurren factores -genéticos, hormonales, infecciones crónicas, e inflamaciones crónicas asociadas a litiasis vesicular; y también que este cáncer ocurre en condiciones de pobreza. Desafortunadamente es insuficiente el conocimiento sobre la carcinogénesis vesicular, sobre el mecanismo de acción de los factores de riesgo clásicos y sobre cuáles son relevantes en la iniciación y promoción del CVB. En este artículo centramos la discusión en la litiasis vesicular, considerado el principal factor de riesgo del CVB. Se analiza las estrategias de prevención y control y se discuten los programas actuales. Finalmente se presentan dos estudios sobre factores de riesgo y de susceptibilidad para CVB que están siendo implementados en Chile.

Chile has the highest gallbladder cancer (GBC) incidence rate in the world (>30 per 100,000 person-years) and is the leading cause of cancer deaths among Chilean women. To design strategies of prevention and early diagnosis of GBC we must understand the etiological factors of the gallbladder carcinogenic process; There is consensus that in the development of this cancer concurs genetic and hormonal factors, infection, and chronic inflammation associated with lithiasis; and that is strongly associated with poverty conditions; But unfortunately there is not enough information about this process or how the classic risk factors associated play a role in its development. There is also no information on which are important in the initiation and promotion of GBC. In this article we focus the discussion in gallstones, considered the main risk factor for GBC. We analize some strategies of prevention and control and discuss some aspects of the current program. Finally we will point out two studies on risk factors and genetic susceptibility to GBC that are being implemented in Chile.

Factores asociados al pronóstico de pacientes operados por cáncer gástrico avanzado / Pathological factors associated with survival in advanced gastric cancer

Background: The degree of tumor infiltration and lymph node involvement are the most relevant pathological features to determine prognosis of advanced gastric cancer. Aim: To determine the association between clinical and pathological features of advanced gastric cancer and patient survival. Material and Methods: The pathological records of patients with advanced gastric cancer subjected to gastrectomy and lymph node excision between 1986 and 2007 were analyzed. Follow up was performed according to data in the clinical records and death certificates obtained at the Chilean National Death Registry. The main outcome analyzed was survival after surgery. Results: The records of 299 patients aged 62 +/- 11 years (68 percent males), were analyzed. Mean follow up ranged from 1 to 206 months. Five and 10 years actuarial survival was 39 and 34 percent, respectively. The pathological predictors of survival were microscopic tumor stage, tumor size and location, Bormann classification, infiltration level, degree of differentiation, pathological type of tumor according to Lauren, Ming y Nakamura, lymph node involvement and the absence of residual tumor after surgical excision. Conclusions: The pathological study of the surgical piece in advanced gastric cancer has important prognostic implications.

Introducción: El estudio de la pieza operatoria de pacientes resecados por cáncer gástrico (CG) ha permitido identificar variables anatomo-patológicas con valor pronóstico en la supervivencia (SV) y recurrencia de estos pacientes, siendo el compromiso ganglionar linfático y nivel de infiltración tumoral, los factores más relevantes identificados. El objetivo de este estudio es determinar asociación entre variables clínicas y morfológicas con la SV de pacientes resecados por CG avanzado (CGA). Material y Método: Estudio de cohorte retrospectiva. Se estudiaron variables clínicas y morfológicas de 299 pacientes operados por CGA entre enero de 1986-diciembre de 2001. Los datos fueron obtenidos desde la Unidad de Anatomía Patológica del Hospital Hernán Henríquez Aravena de Temuco. Se aplicó estadística descriptiva y analítica; confección de curvas de supervivencia, y finalmente se aplicaron modelos de regresión logística para realizar ajuste, calcular odds ratios y sus respectivos intervalos de confianza de 95 por ciento. Resultados: La cohorte tuvo una mediana de edad de 63 años y el 68 por ciento de ella correspondió al género masculino. Con una mediana de seguimiento de 21 meses (1 a 206), se observó una SV actuarial global a 5 y 10 años de 39 por ciento y 34 por ciento respectivamente. En el análisis bivariado, se verificó asociación con la SV en: etapa tumoral macroscópica, localization y tamaño tumoral, tipo según Bormann, nivel de infiltración, grado de diferenciación histológico, tipo histológico según Lauren, Ming y Nakamura, estado ganglionar linfático (N), estadio TNM y resultado de la resección realizada. Conclusiones: Las variables mencionadas deben ser cuidadosamente evaluadas al momento de decidir terapias en pacientes con CGA.

Factores morfológicos asociados al pronóstico de pacientes operados por cáncer gástrico incipiente / Pathological features associated with survival in early gastric cancer

Background: Early gastric cancer corresponds to those tumors that only involve mucosa and submuco-sa. It is associated with a high survival rate. Aim: To determine pathological factors associated with survival in early gastric cancer. Material and Methods: Analysis of pathological records of 106 patients, with a median age of 63 years (60 percent> males), subjected to a gastrectomy for early gastric cancer. Follow up was performed according to data in the clinical records and death certificates obtained at the Chilean National Death Registry. Results: Five years global survival of patients was 91 percento. Lymph node involvement was more common among tumors bigger than 35 mm, with a low degree of differentiation and among those tumors classified as diffuse according to Lauren. Survival was significantly lower for bigger tumors, those with of a low degree of differentiation, diffuse tumors according to Lauren and those with lymph node involvement. Conclusions: Early gastric cancer has a high five years survival. Bigger tumors, those with a low degree of differentiation and those with lymph node involvement are associated with lower survival rates.

Introducción: El cáncer gástrico incipiente (CGI) es aquel que compromete la mucosa o submucosa gástrica independientemente del compromiso ganglionar linfático, estimándose su prevalencia en Chile inferior al 20 por cientoo. El objetivo de este estudio es determinar prevalencia de CGI y asociación de variables biode-mográficas y morfológicas con la supervivencia (SV) de pacientes resecados por CGI. Material y Método: Estudio de cohorte retrospectiva. Se estudiaron variables biodemográficas y morfológicas de 106 pacientes resecados por CGI entre 1986-2007. Se aplicó estadística descriptiva y analítica; confección de curvas de SV, y finalmente se aplicaron modelos de regresión logística para realizar ajuste, calcular odds ratio y sus respectivos intervalos de confianza de 95 por ciento. Resultados: 15 por ciento correspondió a CGI. La mediana de edad fue 63 años y el 60 por ciento correspondió a género masculino con una SV global a 5 años de 91 por ciento. Se observaron diferencias estadísticas significativas entre tumores mucosos y submucosos en cuanto a la localización tumoral y compromiso linfonodal junto con presentarse el compromiso nodal más frecuentemente en tumores > 35mm poco diferenciados y difusos de Lauren. El análisis multivariado identificó como factores asociados a la SV: tamaño tumoral, grado de diferenciación histológica en su variedad poco diferenciado, tipo difuso de Lauren y compromiso ganglionar linfático. Conclusiones: Se verificó una prevalencia de CGI de 15 por ciento, los que resecados presentan SV de 91 por ciento a 5 años. El compromiso linfonodal es un factor asociado a la SV; y además, se relaciona con tamaño tumoral, tipo histológico según Lauren, grado de diferenciación histológico y nivel de infiltración.

Cáncer gástrico sin compromiso ganglionar linfático (pN0): características demográfico-patológicas y factores pronósticos / Prognostic factors for gastric cancer without lymph node involvement

Background: The absence of lymph node involvement (N0) in gastric cancer is associated with a better survival. However some N0 gastric tumors still have a bad prognosis. Aim: To study demographic and morphological variables associated with prognosis in N0 gastric carcinoma. Material and Methods: Review of pathologica records of a regional general hospital, identifying patients with a N0 gastric cancer surgically excised between 1986 and 2003. Results: In the study period, 459 gastrectomies were performed for gastric cancer and in 32 percent, the tumor was devoid of lymph node involvement. These later patients were followed for a median of 64 months with a 71 percent fve years actuarial survival. Bivariate analysis identifed age, tumor size, gastric wallinfiltration, pathological type according to Lauren and Ming, lymphovascular involvement, number of lymph nodes excised and TNM stage as prognostic values Multivariate analysis disclosed the level of gastric wallinfiltration, the presence of a poorly differentiated tumor, lymphatic vascular involvement, number of excise lymph nodes and tumor size as independent prognostic factors. Conclusions: N0 gastric tumors are found in 32 percent of gastrectomies for gastric cancer and have a 71 percent fve years actuarial survival. Gastric wallinfiltration, pathological degree of differentiation tumor size and lymphovascular involvement are independent prognostic factors.

Tumores del estroma gastrointestinal (GIST): características clinico-morfológicas y perfil inmunohistoquímico / Gastrointestinal stromal tumors (GIST): clinical-morphological features and immunohistochemical profile

Los tumores del estroma gastrointestinal (GIST) son neoplasias de origen mesenquimático que representan aproximadamente el 0,3 por ciento de todas las neoplasias del tubo digestivo, caracterizadas inmunohistoquímicamente por expresar CD117 en el 95 por ciento de los casos y afectando más frecuentemente estómago e intestino delgado. El objetivo de este estudio fue describir aspectos clínicos, morfológicos y de inmunohistoquímica en pacientes con diagnóstico de GIST en la Unidad de Anatomía Patológica del Hospital Hernán Henríquez Aravena de Temuco, Chile. Estudio de cohorte retrospectiva. Se estudiaron 30 pacientes con diagnóstico de GIST intervenidos entre 1999 y 2010 en el Hospital Hernán Henríquez Aravena de Temuco. Las variables clínicas y morfológicas estudiadas fueron edad, género, localización y tamaño tumoral, tipo histológico, índice mitótico, compromiso de mucosa, grado de pleomorfismo nuclear y presencia de necrosis. El estudio inmunohistoquímico consideró c-KIT, CD34 y S-100. Se utilizaron estadísticas descriptivas y analíticas; aplicando chi-cuadrado de Pearson y exacto de Fisher para las variables categóricas; y, T-test para variables continuas. El promedio de edad fue 60 años (17-81 años), verificándose un 60 por ciento de mujeres en el grupo estudiado. El 90 por ciento correspondió a tumores de localización gastro-intestinal, representando estómago e intestino delgado el 80 por ciento de los casos. El tamaño tumoral promedio fue 75,9 mm. Correspondió a patrón fusocelular el 77 por ciento, observándose necrosis en el 37 por ciento de los casos. El 50 por ciento presentó > 5 mitosis/50 CAM, verificándose compromiso de la mucosa en un 67 por ciento. Según el grupo pronóstico se verificó 7 por ciento grupo 1, 23 por ciento grupo 2, 20 por ciento grupo 3, 0 por ciento grupo 4, 10 por ciento grupo 5 y 40 por ciento grupo 6. El 100 por ciento expresó positividad para c-KIT, 63 por ciento para CD34 y 3 por ciento para S-100. Los GIST afectan mayormente...

Gastrointestinal stromal tumors (GIST) are mesenchymal neoplasms that represent approximately 0.3 percent of all malignancies of the gastrointestinal tract, characterized immunohistochemically for CD117 expression in 95 percent of cases and most commonly affects the stomach and small intestine. The aim of this study is to describe the clinical, morphological and immunohistochemical diagnosis of gist patients in the unit of pathology Hernán Henríquez Aravena Hospital in Temuco. Retrospective cohort study. We studied 30 patients with gist who underwent surgery between 1999 and 2010 in the Hernan Henríquez Aravena Hospital in Temuco. The clinical and morphological variables studied were age, gender, location and tumor size, histological type, mitotic index, commitment mucosa, degree of nuclear pleomorphism and necrosis. immunohistochemical study found c-KIT, CD34 and S-100. Descriptive statistics and analytical, using Pearson chi-square and Fisher exact tests for categorical variables, and T-test for continuous variables. The average age was 60 years (17-81 years), verified 60 percent of women in the study group. 90 percent corresponded to tumors located gastro-intestinal, stomach and small intestine represents 80 percent of cases. The average tumor size was 75.9 mm. spindle pattern accounted for 77 percent, with necrosis in 37 percent of cases. 50 percent had> 5 mitosis/50 cam, mucosal involvement verified by 67 percent. according to the prognostic group was observed 7 percent group 1, group 2 23 percent, 20 percent in group 3, 0 percent in group 4, 10 percent and 40 percent group 5 group 6. 100 percent expressed positive for c-KIT, CD34 63 percent and 3 percent for S-100. GIST mostly affect patients from the 4 th -6 decade of life with a slight female predominance, stomach and small intestine being the organs most commonly affected. Immunohistochemical study showed positivity for c-KIT and CD34 in 100 percent and 63 percent of cases.

Carcinosarcoma de la vesícula biliar: caso clínico / Gallbladder carcinosarcoma: case report

Gallbladder Carcinosarcoma corresponds to less than 1 percent of all malignant tumors of the gallbladder. We report an 82 years old female subjected to an open cholecystectomy with the preoperative diagnosis of acute cholecystitis. The pathological study of the surgical piece showed a malignant tumor with epithelial (carcinoma) and stromal (sarcoma) components. A postoperative CAT scan showed multiple nodular lesions in the peritoneum and omentum. The patient died eight months after the operation.

El carcinosarcoma de la vesícula biliar (CSVB) es una neoplasia maligna con diferenciación bifásica (epitelial y estromal) y que representa menos del 1 por ciento de todas las neoplasias malignas de la vesícula biliar. Presentamos el caso de una mujer de 82 años sometida a una colecistectomía abierta de urgencia en Septiembre de 2007 con diagnóstico de colecistitis aguda. El examen histológico de la pieza operatoria describe una lesión neoplásica maligna compuesta por una mezcla de componente epitelial (carcinoma) y estromal (sarcoma), este último con extensas áreas de diferenciación heteróloga de tipo condroide. Estos tumores presentan un comportamiento agresivo con rápida diseminación local y recurrencia siendo generalmente difícil la realización de cirugías con intención curativa (R0), condiciones que explican el pobre pronóstico asociado al CSVB.

Puntaje de Gleason en cáncer de próstata: Correlación de la biopsia por punción y prostatectomía radical / Concordance between Gleason scores of trans rectal biopsies and the surgical piece of radical prostatectomy

Background: Gleason pathological score in prostate cancer is an importantprognostic indicator. However, the concordance between the score of trans rectal needle biopsies and the final score of the surgical piece may be variable. Aim: To analyze the concordance between Gleason scores of trans rectal prostate biopsies and those of the surgical piece obtained after prostatectomy. Material and Methods: Retrospective analysis of 168 pathological records of radical prostatectomies, performed between 1993 and 2009. All these patients had also a trans rectal biopsy performed previously. Patients with less than 12 tissue cylinders obtained during the trans rectal biopsy or incomplete data were not included in this analysis. Results: Sixty eight percent of trans rectal biopsies had Gleason scores that were concordant with those of the surgical piece. The score was higher or lower in 27 and 10 percent of biopsies, respectively. Conclusions: Gleason scores of trans rectal biopsies and those of the surgical piece were concordant in 68 percent of cases in this series of pathological records.

[Prognostic value of extracapsular lymph node involvement among patients with gastric cancer]. / Compromiso ganglionar extracapsular en pacientes con cáncer gástrico: determinación del valor pronóstico.

BACKGROUND: Extracapsular lymph node involvement has a negative prognosis in malignant tumors. AIM: To assess the prognostic importance of extracapsular lymph node involvement in patients with gastric cancer with lymph node metastases. MATERIAL AND METHODS: Clinical and morphological features and survival of patients with gastric cancer and lymph node involvement operated between 1986 and 2003, were analyzed. Patients with and without extracapsular involvement were compared. RESULTS: During the study period, 459 gastrectomies were performed, 312 patients (68%) had lymph node involvement and 144 (31%) had extracapsular involvement. Patients with and without extracapsular involvement were followed for a median of 10 (range 1 to 120) and 41 (range 1 to 193) months, respectively. Five years actuarial survival for patients with and without extracapsular involvement was 23 and 40% respectively. Extracapsular lymph node involvement and level of wall infiltration were identified as prognostic factors using a multivariate analysis. CONCLUSIONS: Extracapsular lymph node involvement is an independent risk factor for mortality among patients with gastric cancer.

Detección y tipificación de virus papiloma humano en lesiones preneoplásicas de cuello uterino / Human papillomavirus genotyping of cervical uterine preneoplastic lesions in a high risk area

The relationship between human papillomavirus (HPV) and uterine cervical cancer (UCC) is widely known and accepted. Aim: To determine the frequency of genotypes of HPV in cervical preneoplastic lesions in a high risk area of UCC. Material and Methods: Using a combination of PCR and Reverse Line Blot technique, 235 formalin fixed paraffin embedded samples, with diagnosis of low-grade squamous intraepithelial lesion (LSIL) or high-grade squamous intraepithelial lesion (HSIL) were genotyped. Results: HPV was detected in 61.2 percent of LSIL and 78.1 percent of HSIL. The main genotypes found were HPV 16, 18, 31, 45, 56 y 58. HPV 16 was the most common in both LSIL (18.1 percent) and HSIL (36.9 percent). HPV 16 or 18 were present in 25.1 percent and 47.1 percent of the LSIL and HSIL respectively. In both LSIL and HSIL, the predominant viral genotypes were those types classified as with a high oncogenic risk. Conclusions: HPV genotypes 16, 18, 31, 45, 56 y 58 were the most common in our series. HPV 16 and 18, viral types with high oncogenic risk and included in commercial vaccines, were found in 25.1 percent and 47.1 percent of LSIL and HSIL, respectively.

Hidatidosis ósea: Reporte de 5 casos y revisión de la literatura / Bone hydatidosis: Report of five patients

Bone location of hydatid cysts occurs in 0.5 to 3 percent of all cases of hydatidosis. The most common bones involved are spine, long bones and pelvis. We report five patients with bone hydatidosis. A 24-year-old male consulting for paraparesis and numbness of lower limbs; CAT scan showed hydatid cysts located in D2, D3 and D4 vertebral bodies. A 47-year-old male consulting for a fracture of the femur; X rays disclosed multiple hydatid cysts in the femur. A 13-year-old female consulting for claudication of the right lower limb; X ray examination showed a hydatid cyst in the iliac bone. A 21-year-old women presenting with weakness of the lower limbs and voiding problems; CAT scan showed a vertebral hydatidosis and spinal cord compression. A 67-year-old female presenting with weakness of the lower limb and loss of sphincter control; CAT scan showed hydatid cysts in D4 vertebral body.

Carcinoma de células en anillo de sello gástrico: descripción clínico-morfológica y valor pronóstico / Prognosis of signet ring cell carcinoma of the stomach

Background: Signet ring cell carcinoma of the stomach corresponds to 3 to 39 percent of all gastric malignant tumors, and its prognostic significance is not well known. Aim: To compare the prognosis of signet ring cell carcinoma of the stomach with other types of gastric cancer. Material and Methods: Review of 451 patients operated for gastric carcinoma. Signet ring cell carcinomas were compared with the rest of tumors. Results: One hundred twenty tumors (27 percent) were signet ring cell carcinoma, they were more commonly located in the lower third of the stomach, were less differentiated, bigger and had more lymph nodes involved. Patients with this variety of tumor were younger, more often women and their survival was lower, even when separating incipient and advanced tumors. Conclusions: Signet ring cell carcinoma of the stomach had a worst prognosis that other type of gastric tumors.

Introducción: La incidencia de carcinoma gástrico (CG) de células en anillo de sello (CAS) varía de 3 por ciento a 39 por ciento. Trabajos de supervivencia en pacientes con tumores gástricos reportan resultados contradictorios en cuanto a la importancia pronostica del tipo histológico CAS respecto a los otros tipos histológicos. El objetivo del estudio es describir y evaluar la importancia pronostica del tipo histológico CAS comparado con los carcinomas no anillo de sello (CNAS). Material y Método: Estudio de cohorte retrospectiva. Se estudiaron variables clínicas y morfológicas de 451 pacientes operados por CG en el Hospital Hernán Henríquez Aravena de Temuco entre Enero/1986-Diciembre/2001 agrupándose para el análisis según el diagnóstico histopatológico en CAS y CNAS. Se realizó un análisis exploratorio de los datos y posteriormente se aplicó estadística descriptiva con cálculo de medidas de tendencia central y extrema; y estadísticas analíticas, aplicando Chi cuadrado de Pearson y test exacto de Fisher para variables categóricas, T-Student para variables continuas, Kaplan-Meier y Log-rank test para análisis de supervivencia. Resultados: Un 27 por ciento (120) correspondió a CAS observándose diferencias estadísticamente significativas entre los grupos CAS y CNAS para las siguientes variables: género, edad, localización y tamaño tumoral, grado de diferenciación histológico y compromiso ganglionar linfático. El análisis de supervivencia demostró un peor pronóstico para el grupo de CAS (p = 0,02). En el análisis por separado de tumores incipientes y avanzados respecto del tipo histológico, no observamos diferencias significativas para lesiones incipientes (p = 0,07) mientras que para lesiones avanzadas el CAS se asocia a un pronóstico desfavorable (p < 0,0001). Conclusiones: Observamos en nuestra serie un peor pronóstico asociado al tipo histológico CAS respecto a los otros tipos histológicos (CNAS), información crucial que, aportada al clínico, deberá ser...