Tuberculosis anexial simuladora de malignidad ovárica coexistente con neutropenia con metamizol / Ovarian tuberculosis mimicking carcinoma and neutropenia due to metamizol

Se presenta el caso de una paciente intervenida ante la sospecha ecográfica de carcinoma ovárico y marcadores tumorales elevados. La anatomía patológica diagnosticó tuberculosis anexial. Antes de la intervención debutó con fiebre y se siguió tratamiento empírico con metamizol. La paciente desarrolló granulopenia, que mejoró tras la retirada del fármaco (AU)

We describe the case of a patient who underwent surgery due to sonographic suspicion of ovarian carcinoma and high tumoral marker levels. The histopathological analysis revealed adnexal tuberculosis. Before the surgery, the patient presented with fever and empirical metamizole treatment was administered. The patient developed granulopenia, which improved after withdrawal of the drug (AU)

Tumor de Krukenberg primario ovárico: un hallazgo infrecuente / Primary ovarian Krukenberg tumor: an infrequent finding

El tumor de Krukenberg es un adenocarcinoma ovárico raro que tiene una anatomopatología peculiar. Aunque habitualmente representa una metástasis de origen digestivo, en este estudio se presenta un caso con análisis morfológico e inmunohistoquímico de Krukenberg sin que demostrara la existencia de tumor primario extraovárico (AU)

Krukenberg tumor is a rare ovarian adenocarcinoma with characteristic histopathological features. Although this tumor usually represents metastasis from a digestive carcinoma, we present a case morphologically and immunohistochemically identified as ovarian Krukenberg tumor, no extraovarian primary tumor was detected (AU)

Sistemas de información en anatomía patológica: análisis de las soluciones existentes / Information System in anatomical pathology: Analysis of the existing solutions

Antecedentes: En los últimos dos años se está procediendo a la renovación de los sistemas informáticos en anatomía patológica de numerosos hospitales. Por ello consideramos interesante revisar los sistemas informáticos más habituales y conocer los principales aspectos que debemos exigir en estos programas. Material y métodos: Cuatro sistemas informáticos (Master-Pat NovoPath, PatWin e InfoPAT) han sido evaluados por los usuarios de siete hospitales distribuyendo entre los usuarios y los fabricantes una encuesta con 105 variables. Resultados: Los sistemas más modernos ofrecen un número muy alto de funcionalidades, destacando los más modernos por su integración en el resto del sistema de información hospitalario, si bien los sistemas de ayuda, la codificación y la gestión de imágenes son algunos aspectos que la mayoría de programas necesitan mejorar. Conclusión: Los nuevos programas informáticos son de gran calidad y las prestaciones muy parecidas, por lo que es aconsejable evaluar las necesidades de cada servicio para poder escogerla solución óptima (AU)

[Ectopic ovarian pregnancy]. / Embarazo ectópico ovárico.

Ovarian ectopic pregnancy is a rare form of ectopic pregnancy, with an estimated incidence ranging from 0.5% to 3% of the extrauterine pregnancies. For a correct diagnosis of the ovarian pregnancy, the traditional criteria proposed by Spiegelberg in 1878 must be fulfilled. This forced us sometimes to reject pregnancies which, despite being initially ovarian, during its evolution the adjacent tubal structures have been affected. Currently, the ectopic pregnancies are being diagnosed more early, mainly given the echographic advances, which have lead to very conservative treatments in order to avoid a reduced fertility. However, it is many times an intraoperative diagnosis. We present four new cases of ovarian ectopic pregnancy from our casuistry of the last three years with anatomoclinical study and literature review.

[Synchronous metastasis of renal adenocarcinoma to gallbladder and ipsilateral adrenal gland]. / Metástasis en vesícula biliar y suprarrenal ipsilateral sincrónica de adenocarcinoma renal.

Herein we describe a patient in whom a renal mass had been detected. He had no previous urological symptoms or signs, but had undergone laryngectomy in 1989 for well-differentiated squamous cell carcinoma of the glottic region. The radiological and ultrasound evaluations disclosed a right renal mass, a mass in the ipsilateral adrenal gland and a polypoid mass in the gallbladder. The patient underwent radical nephrectomy, adrenalectomy and cholecystectomy. The surgical specimens of the gallbladder and adrenal gland showed histological evidence of clear cell carcinoma with the same characteristics as those of the primary renal tumor.

[Postoperative fusiform cell nodule. Relationship with other benign fibrous proliferations]. / Nódulo de células fusiformes postquirúrgico. Relación con otras proliferaciones fibrosas benignas.

We report on a patient who developed postoperative spindle cell nodule one month following TURP for prostatic adenocarcinoma. The foregoing was compared with other benign fibrous lesions from our records: one case of nodular fasciitis and one case of proliferative myositis. Although they were all well-defined and clinically distinct disease entities, a very close relationship concerning their origin was demonstrated histologically and immunohistochemically.

[An undifferentiated neuroendocrine carcinoma of the rectum with cervical metastases]. / Carcinoma indiferenciado neuroendocrino de recto con metástasis cervicales.

Sigma undifferentiated carcinoma of the rectum is a neuroendocrine tumor embracing less than 1% of all primary malignant epithelial tumors in this location. Recent studies have demonstrated that these tumors are biologically aggressive neoplasias with early metastatic extension. We present one case of loco-regional invasion at the time of the intervention and with distal metastasis within a period of time shorter than one year. We perform a clinical, histological and immunohistochemical study and we comment on the histogenesis of these tumors, their prognosis and treatment, stressing the need of an early diagnosis, an aggressive treatment and an adequate follow-up.

[Congenital mesoblastic nephroma in an adult: immunohistochemical study]. / Nefroma mesoblástico congénito en el adulto: estudio inmunohistoquímico.

A case of congenital mesoblastic nephroma in a 60-year-old female patient is described. The clinical onset was gross hematuria of 48 hours evolution and pain in the right renal fossa which irradiated to the iliac fossa of the same side. A routine pathological analysis was carried out on the surgical specimen including an extensive immunohistochemical analysis which was highly positive for keratin in the epithelial lining of the tubular and cystic structures and for desmine and vimentin in the fusocellular stroma of the tumor. The different histogenetic hypotheses are discussed. The importance of a precise anatomopathological diagnosis in order to institute adequate treatment is underscored.

Thymic carcinosarcoma associated with a spindle cell thymoma: an immunohistochemical study.

A case of thymic carcinosarcoma associated with a spindle cell thymoma in a 71-year-old woman is reported. Histological and immunohistochemical studies of the carcinosarcoma showed two quite different components: the sarcomatous component included cells with myoid differentiation which stained for desmin and muscle specific actin, and some isolated cells which stained positively for low molecular weight cytokeratin, while the carcinomatous component, which formed less than 10% of the tumour, showed an epithelial phenotype, being positive for low and high molecular weight cytokeratin and epithelial membrane antigen. The thymoma cells showed epithelial markers, and a few cells were also positive for desmin and muscle specific actin. The rarity of this tumour and its possible histogenesis are discussed.

[Incrusted cystitis with isolation of Corynebacterium group D2]. / Cistitis incrustante con aislamiento de Corynebacterium grupo D2.

Three cases of encrusted cystitis caused by Corynebacterium group D2 are described. The vesical damage previous to the establishment of this bacteria is noteworthy and the very rapid increase in urease activity explains the pathogenesis of the situation. Thus allowing for its identification and is relevant to treatment. Cloudy urine with a strong smell of ammonium, alkaline pH and crystals of ammonium magnesium phosphate in the sediment will bring this microorganism and its characteristic growth pattern to mind thus avoiding a falsely negative report. Treatment combining an antimicrobial agent and cystoscopic resection of the encrusted stones, where Corynebacterium group D2 has lodged, has proved efficacious. Vancomycin and teicoplanin have always been active and are eliminated through the kidneys.

[Undifferentiated small-cell carcinoma of the urinary bladder]. / Carcinoma indiferenciado de células pequeñas de vejiga urinaria.

We report a case of undifferentiated small cell carcinoma of the urinary bladder in a 64-year-old male patient. Microscopically the tumor was similar to the intermediate type of small cell carcinoma of the lung, with some foci of transitional papillary carcinoma, adenocarcinoma and carcinoma in situ. Small cell carcinoma is seldom encountered in the urinary bladder. It is more aggressive and must be distinguished from poorly differentiated transitional cell carcinoma.

Varix of the heart causing outflow tract obstruction.

We report a case about a neonate who died of severe subaortic stenosis due to a giant vascular dilation of the left ventricular outflow tract. We emphasize the fatal result of this benign lesion and make differential diagnosis with haemangiomas and valvular blood cysts.

[Epidermoid carcinoma of the urinary tract. Immunohistochemical study]. / Carcinoma epidermoide de vías urinarias. Estudio inmunohistoquímico.

Six patients diagnosed as having urothelial carcinoma with varying degrees of squamous features are described. Four had pure squamous carcinoma. Two had transitional cell carcinoma (1 with squamous areas and the other had carcinoma in situ). The histological analyses of specimens were performed using immunohistochemical techniques to detect epithelial markers with low molecular weight monoclonal antibodies to cytokeratin. The tests were positive for pure squamous carcinoma and transitional cell carcinoma with squamous areas, and were negative for all areas of transitional cell carcinoma. We underscore the importance of the squamous component in the prognosis of urothelial carcinomas as well as the usefulness of this type of markers, particularly low molecular weight antibodies to cytokeratin, in differentiating squamous areas.