Prognostic value of the detection of lymph node micrometastases in colon cancer

INTRODUCTION AND OBJECTIVES: A study is made of the clinical repercussions of occult metastases-micrometastases (MMs+)-or isolated tumour cells (ITCs+) in the lymph nodes of patients with stage IIA and IIB colon adenocarcinoma initially considered as corresponding to N0. MATERIAL AND METHODS: A retrospective study of 39 patients with stage IIA and IIB (T3-T4 N0 M0) colon adenocarcinoma, subjected to similar surgical and adjuvant chemotherapy treatment, with long and careful follow-up (minimum: 5 years, mean: 81.7 months) was performed on their previously resected lymph nodes, with the aid of new histological and immunohistochemical (cytokeratin) sections, in order to detect MMs or ITCs. Disease-free survival (DFS) and global survival (GS) in the two groups (patients with MMs+ or ITCs+ vs. patients without MMs or ITCs) were compared at 5 years based on the corresponding Kaplan-Meier survival curves, with the Breslow test. RESULTS: A total of 382 lymph nodes from the 39 patients (mean: 9.8; standard deviation: 6.09) were revised. MMs+ were detected in 2 cases and ITCs+ in 2 more cases on the Cytokeratin study. GS of the whole series at 5 years was 89.74% (35 patients alive) with a DFS at 5 years of 79.49% (31 patients free of disease), but the 2 cases with MMs+ were dead at 5 years, with high statistical differences between both groups (MMs+/MMs-) (p<0.0001). When comparing the group of MMs+/ITCs+ patients and the group of MM-/ITCs- patients, the DFS and GS times at 5 years were higher in the MMs-/ITCs- group (p=0.0692 and p=0.006 respectively). CONCLUSIONS: Although the incidence of MMs+ or ITCs+ in the examined lymph nodes was low, the presence of MMs is related to a dramatic reduction in GS and DFS at 5 years. We encourage a detailed histological study of lymph nodes resected in patients with deep penetrating colon tumours in order to assure a pN0 status (AU)

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Carcinomatosis peritoneal mucinosa tratada con cisplatino (CDDP) intraperitoneal y 5-FU endovenoso / Mucinous peritoneal carcinomatosis treated with intraperitoneal cisplatin (CDDP) and intravenous 5-FU

• Propósito: describir el tratamiento de una entidad clínica poco frecuente de curso clínico variable.• Material y método: se presenta el caso de un paciente con carcinomatosis peritoneal mucinosa, varianteintermedia.• Resultados y conclusiones: una cirugía de citoreducción adecuada, seguida de quimioterapia conCDDP Intraperitoneal (IP) y 5FU ev, puede lograr una larga supervivencia en pacientes afectos de carcinomatosisperitoneal, con buena tolerancia al tratamiento

• Purpose: To describe the treatment of a slightly frequent clinical entity of variable clinical course.• Material and methods: We present the case of a patient with mucinous peritoneal carcinomatosis,intermediate variant.• Results and conclusion: A suitable cytoreductive surgery, followed by chemotherapy withintraperitoneal CDDP and intravenous 5-FU, can achieve a long survival of patients with peritonealcarcinomatosis, with good tolerance for the treatment

Atypical pleomorphic extraosseous ewing tumor/peripheral primitive neuroectodermal tumor with unusual phenotypic/genotypic profile.

A pleomorphic undifferentiated tumor primarily located in the retroperitoneum with a phenotype compatible with an extraosseous Ewing tumor/peripheral primitive neuroectodermal tumor (ET/pPNET) pattern and unusual molecular features is described. Immunohistochemically, HBA-71 (CD99/mic2) and several neural markers were intensively expressed together with scattered cells expressing carcinoembryonic antigen (CEA). Short-term culture showed biphasic neuroblastic and epithelioid cell populations, with the latter expressing germ cell markers (CEA, alpha-fetoprotein, and the beta-subunit of chorionic gonadotrophin). Conventional cytogenetics displayed several chromosomic rearrangements, especially a complex translocation t(17,2,22,13) (q21::q11-->q33::q12-->q13::q14). These structural abnormalities were confirmed using fluorescence in situ hybridization analysis. Molecular studies revealed EWS-FEV fusion transcripts (exon 7 of the EWS gene and exon 2 of the FEV gene). In addition, a new p53 mutation not previously reported in ET/pPNET involving exon 5 codon 138: GCC to GAC (Ala/Asp) was detected. In our case, we emphasize the presence of atypical features not only from the phenotypic point of view but also at the genetic level as well as the value of detecting such markers in the differential diagnosis with other abdominal pleomorphic tumors.

Neuroanatomic basis for pain in patellar tendinosis ("jumper's knee"): a neuroimmunohistochemical study.

Chronic patellar tendinosis or "jumper's knee" is a frequent source of persistent and often recurrent anterior knee pain in active, young people. Seventeen pathologic specimens retrieved during surgery for jumper's knee were evaluated by means of immunohistochemical (S-100) analysis. The patellar tendon-bone junction and the Hoffa fat pad adjacent to the inferior pole of the patella are structures that have a nerve supply that can be a potential source of nociceptive output resulting in the perception of pain at any given moment. In this study, pathologic neural changes also were observed. In eight cases, free nerve endings showed a histologic pattern of "nerve sprouting" in the patellar tendon-bone junction. Vascular innervation was seen in seven cases. S-100 positive fibers were observed within the muscular layer of medium and small arteries. These findings show an increase in vascular innervation. Lastly, neuromatous changes were observed in four cases, demonstrating a clear relationship with pain. These observations provide a neuroanatomic basis for pain in active, young patients with jumper's knee.

Neural growth factor expression in the lateral retinaculum in painful patellofemoral malalignment.

We studied 7 samples of lateral retinaculae excised at the time of surgical realignments. They were obtained from patients with isolated symptomatic patellofemoral malalignment resistant to conservative treatment and were evaluated with immunohistochemistry and immunoblotting. We found that neural growth factor is higher in patients with pain than in those with instability as the main symptom. Neural growth factor is related to neural proliferation in vessels and perivascular tissue and to the release of neuroceptive transmitters, such as substance P. We postulate that both mechanisms are involved in the pathogenesis of pain in isolated symptomatic patellofemoral malalignment.

Immunohistochemical analysis for neural markers of the lateral retinaculum in patients with isolated symptomatic patellofemoral malalignment. A neuroanatomic basis for anterior knee pain in the active young patient.

We evaluated 13 lateral retinacula excised at the time of Insall proximal realignments or isolated lateral retinacular releases performed in patients with isolated symptomatic patellofemoral malalignment recalcitrant to nonoperative treatment. Evaluation was performed by means of conventional histologic and immunohistochemical analysis for neural markers (S-100 protein, neurofilament protein, substance P, and neural growth factor). The observations reported here provide a neuroanatomic basis for anterior knee pain syndrome in active young patients with isolated symptomatic patellofemoral malalignment and support the clinical observation that the lateral retinaculum may have a key role in the origin of this pain as a result of increased neural growth factor production, which induces proliferation of nociceptive axons, mainly in a perivascular location.

Pathogenesis of anterior knee pain syndrome and functional patellofemoral instability in the active young.

Although it is universally accepted that patellofemoral malalignment is the main cause of anterior knee pain and functional patellar instability in the active young, the question remains to be answered: what is the mechanism whereby patellofemoral malalignment produces pain and instability? Currently, there are two theories to explain the origin of pain and instability in patients with patellofemoral malalignment: the neural theory and the mechanical theory. Both theories are not exclusive, but complementary. We believe it is the neural factor that precipitates the symptoms in patients with certain mechanical anomalies who also subject the knee to overuse.

Healing of the patellar tendon donor defect created after central-third patellar tendon autograft harvest. A long-term histological evaluation in the lamb model.

Patellar tendon donor defect (PTDD) healing after patellar tendon autograft (PTA), was evaluated in 12 lambs (24 knees), by means of conventional histology, immunohistochemistry and image analysis. The results of this study indicate that the PTDD is replaced by a tissue that does not assume the histological characteristics of a normal patellar tendon. Both the Hoffa fat pad (HFP) and the paratenon play an important role in the healing process, although qualitative and quantitative chronological differences were found, which supports the concept of a "two-time process". The HFP initiates the repair process, and is the main active proliferative tissue compartment during the first week. Once the process is established, the paratenon and, in particular, its synovial lining, starts proliferative activity and virtually substitutes that of the HFP, which rapidly loses activity in a few days. Moreover, donor-site morbidity after PTA could be the result of histological changes in the patellar tendon and environs in only a few cases. We have found inflammatory and neural changes in the refilled PTDD that could explain the anterior knee pain after PTA. Likewise, we have observed loss of Golgi corpuscles in the refilled PTDD, which could lead to proprioceptive loss after ACL reconstruction with PTA. Finally, we have observed shrinkage of the PTDD scar that could contribute to the etiopathogenia of a patella infera.

Quantitative analysis of nerve changes in the lateral retinaculum in patients with isolated symptomatic patellofemoral malalignment. A preliminary study.

Neural damage in 16 lateral retinacula excised at the time of Insall proximal realignments or isolated lateral retinacular releases performed in patients with symptomatic patellofemoral malalignment was evaluated by means of conventional histology and immunohistochemical and morphometric analyses. A relationship between clinical and histologic findings was found. An increase in the proportion of innervated tissue was correlated with anterior knee pain syndrome. We found a significant relationship between total neural area and pain. The group with moderate pain had the highest number of nerves and the highest neural area. In reference to total neural area and pain, there was a significant difference only between the patients with moderate pain and those with light pain, but not between patients with severe pain and those with moderate pain. The group with severe pain also showed a high neural area, although with a lower number of nerves. The severe-pain group had the largest nerves (24% of nerve fibers surpassing 25 microns diameter) in a zonal disposition, in which there were groups of nerve fibers in some fields and no nerve fibers in others. The group with moderate pain had an increase in medium and small nerve fibers (mean diameter, 18 microns), predominantly of tiny perivascular fibers. Moreover, we believe that instability in patients with patellofemoral malalignment can be explained in part because of loss of proprioception due to neural damage.

Translocation (X;18) in a biphasic synovial sarcoma with morphologic features of neural differentiation.

The authors report a recurred neoplasm showing distinctive histologic, immunophenotypic, and ultrastructural features characteristic of biphasic synovial sarcoma with neural differentiation. The features include areas with a growth pattern of densely packed spindle cells in irregularly intersecting, broad fascicles, diffuse vimentin and HBA 71 immunoreactivity, expression of S-100 protein, and other neural markers. Moreover, areas with glandular structures and cellular expression of cytokeratin and epithelial membrane antigen were noted. Additionally, areas of neural-like growth pattern were positive for neuron-specific enolase, HNK-1, and protein gene product 9.5. Furthermore, cytogenetic analysis, two-color interphase fluorescence in situ hybridization, and reverse transcription polymerase chain reaction demonstrated the reciprocal translocation between chromosomes X and 18 associated with the different subtypes of tumor cells. The establishment and characterization of the tumor cell line are detailed. This cell line retains the distinct morphologic and genetic characteristics of the original biphasic synovial sarcoma with neural differentiation.

Primary epiploic appendagitis: US and CT findings.

A retrospective review is presented of seven cases of epiploic appendagitis, with surgical confirmation in one case. The main clinico-analytical data and the US and CT findings are described, as well as the histopathologic features in the sole case that underwent surgical resection. We also calculated the frequency of this entity in patients undergoing emergency abdominal US on clinical suspicion of diverticulitis. In all seven cases the clinico-analytical evidence was nonspecific (localized acute abdominal pain and slight leukocytosis), mimicking in six cases the clinical presentation of sigmoid diverticulitis and in one case that of acute appendicitis. US imaging findings were characteristic: a hyperechoic mass localized under the point of maximum pain, adjacent to the anterior peritoneal wall and fixed during deep breathing. In none of the cases did color Doppler US show flow. CT findings were also typical and showed a mass with a peripheral hyperattenuated rim surrounding an area of fatty attenuation. Overall 7.1 % of patients investigated to exclude sigmoid diverticulitis finally showed findings of primary epiploic appendagitis. Primary epiploic appendagitis thus shows characteristic US and CT findings that allow its diagnosis and follow-up. This entity is much more frequent than previously reported, especially in patients referred for US to exclude sigmoid diverticulitis.

Intra-articular osteoid osteoma of the humerus with synovitis simulating chronic monoarthritis of the elbow in a recreational tennis player.

We present a case of intra-articular osteoid osteoma of the humerus simulating chronic monoarthritis of the elbow in an 18-year-old male right-handed recreational tennis player. CT revealed a well-defined nidus in the coronoid fossa. Microscopic examination of the synovium showed a lymphofollicular synovitis that resembled the synovitis in rheumatoid arthritis.

[Myopathy associated with infection by the human immunodeficiency virus type-1 (HIV-1)]. / Miopatía asociada a la infección por el virus de la inmunodeficiencia humana tipo-1 (VIH-1).

We present a case of an active homosexual patient who was a paid donor of plasma and presented myopathy associated to infection by the human immunodeficiency virus type 1 (HIV-1). In the ultrastructural study of the muscular biopsy, we stress the formation of central intermyofibrillary "minocores", as well as the presence of nuclear extrusions in which the core is surrounded by mitochondrial accumulations. We review the clinical, histological and ultrastructural characteristics used to identity this pathology against the group of myopathies induced by zidovudine, as well as the several empirical therapies currently recommended.

[Intracerebral gangliocytoma: a histological and immunohistochemical study]. / Gangliocitoma intracerebral: estudio histológico e inmunohistoquímico.

We present a case of cerebral gangliocytoma placed on the right frontal lobe in a young adult, analyzing its morphological and clinical features. The immunohistochemical study defines it as a tumor with a neuronal population NSE and NFP positive, and a glial population with positivity for the GFAP. We emphasize the presence of neurosecretion in the mature neurones, typified by the positivity to the sinaptophisine and VIP. In the discussion we compare our immunohistochemical results, analyzing the histogenesis of this rare neoplasm.