Anatomía patológica de la patología de tiroides y paratiroides. Sistema Bethesda del diagnóstico citológico de la patología de tiroides / Thyroid and parathyroid gland pathology. The Bethesda System for reporting thyroid cytopathology

INTRODUCCIÓN Y OBJETIVO: La PAAF es el mejor método para el manejo de pacientes con nódulos tiroideos, como método de cribado y para seleccionar a los pacientes que pueden ser sometidos a tratamiento quirúrgico. El objetivo de este artículo es hacer una breve descripción de las categorías diagnósticas del Sistema Bethesda en su segunda edición (2018). SÍNTESIS: El Sistema Bethesda establece 6 categorías diagnósticas: Insatisfactorio /No diagnóstico, Benigno, Atipia de significado Indeterminado/Lesión folicular de significado indeterminado, Neoplasia folicular/Sospechoso de neoplasia folicular, Sospechoso de Malignidad Maligno. Cada categoría lleva implícito el riesgo de malignidad y el manejo de estos pacientes, con lo cual el diagnóstico va a influir en la actitud a seguir. CONCLUSIONES: El Sistema Bethesda permite a los patólogos realizar informes sistematizados y al clínico establecer la actitud a seguir en función de cada categoría diagnóstica

INTRODUCTION AND OBJECTIVE: The FNA is the best method for the management of patients with thyroid nodules, as a screening method and for selecting patients who can undergo surgical treatment. The objective of this article is to make a brief description of the diagnostic categories of the Bethesda System in its second edition (2018). SYNTHESIS: The Bethesda System establishes 6 diagnostic categories: No diagnostic-Unsatisfactory, Benign, Atypia od Undetermined Significance/Follicular Lesion of Undetermined Significance, Follicular Neoplasm/Suspicious for a Follicular Neoplasm, Suspicious for Malignant and Malignant. CONCLUSIONS: The Bethesda System allows pathologists to make systematized reports and the clinician to establish the attitude to follow according to each diagnostic category

[Eosinophilic cystopathy in association with infiltrative transitional cell carcinoma]. / Asociación de cistopatia eosinofilica con carcinoma transicional vesical infiltrante.

OBJECTIVES: To report a case of eosinophilic cystopathy associated to infiltrative transitional-cell carcino ma of the bladder in an adult. METHODS: We describe the case of a 79-year-old wo man who complains of meso and hipogastric pain since several months before, and to whom a parietal thickening of the bladder was detected by means of abdominal CT scan during the diagnostic work up for a digestive disease indicated by the Internal Medicine Service. Cistoscopy confirmed that finding, together with areas of greater endoluminal protrusion. Cold biopsy showed an inflammatory in filtrate with eosinophilic component. Transurethral resection was indicated. RESULTS: The pathological assessment was compatible with high-grade infiltrative transitional carcinoma of the bladder. The patient developed multiple lung metastases and died five months after surgery. CONCLUSIONS: Reports describing the coincidence of both entities are infrequent. We emphasize the importance of a correct filiation of apparently "pseudotumoral" endoluminallesions.

Asociación de cistopatia eosinofilica con carcinoma transicional vesical infiltrante / Eosinophilic cystopathy in association with infiltrative transitional cell carcinoma

OBJETIVOS: Presentación de un caso de cistopatía eosinofílica asociada a carcinoma vesical infiltrante de células transicionales en adulto.MÉTODO: Describimos el caso de una paciente mujer de 79 años que refiere dolor meso e hipogástrico de varios meses de evolución, y a la que se detecta en escáner abdominal un engrosamiento parietal vesical durante el estudio de descarte de patología digestiva por parte del Servicio de Medicina Interna. La cistoscopia permitió confirmar dicho hallazgo, junto a zonas de mayor protrusión endoluminal. La biopsia fría mostró la existencia de infiltrado inflamatorio con componente eosinofílico. Se indicó resección transuretral. RESULTADOS: El estudio anatomopatológico resultó compatible con carcinoma transicional vesical infiltrante de alto grado. Desarrollo de metástasis pulmonares múltiples y éxitus de la paciente cinco meses después de la cirugía.CONCLUSIONES: Infrecuencia de las descripciones de aparición coincidente de ambas entidades referidas. Destacamos la importancia de una correcta filiación de lesiones endoluminales aparentemente “pseudotumorales”(AU)

OBJECTIVES: To report a case of eosinophilc cystopathy associated to infiltrative transitional-cell carcino ma of the bladder in an adult.METHODS: We describe the case of a 79-year-old wo man who complains of meso- and hipogastric pain since several months before, and to whom a parietal thickening of the bladder was detected by means of abdominal CT scan during the diagnostic work up for a digestive disease indicated by the Internal Medicine Service. Cistoscopy confirmed that finding, together with areas of greater endolu minal protrusion. Cold biopsy showed an inflammatory in filtrate with eosinophilic component. Transurethral resection was indicated.RESULTS: The pathological assessment was compatible with high-grade infiltrative transitional carcinoma of the bladder. The patient developed multiple lung metastases and died five months after surgery.CONCLUSIONS: Reports describing the coincidence of both entities are infrequent. We emphasize the importance of a correct filiation of apparently “pseudotumoral” endoluminal lesions(AU)

[Bladder leiomyosarcoma: case report]. / Leiomiosarcoma vesical: aportacion de un nuevo caso.

OBJECTIVES: To report a new case of bladder leiomyoma in an adult. METHODS: 64-year-old female patient consulting for a four-month hematuria diagnosed of a bladder intraluminal tumor on ultrasound during a routine gynecologic revision. Cystoscopy confirmed the presence of the tumor. Transurethral resection was indicated. RESULTS: Pathology reported a definitive diagnosis of leiomyosarcoma. Anterior pelvic exenteration was subsequently performed. On one year follow-up there is no evidence of disease. CONCLUSIONS: We emphasize the rarity of these neoplasias. We comment on their main characteristics, pointing out the importance of immunohistochemical staining for the definitive histological diagnosis. We refer the therapeutic options described in the literature.

Leiomiosarcoma vesical: aportación de un nuevo caso / Bladder leiomyosarcoma: case report

OBJETIVO: Presentación de un nuevo caso de leiomiosarcoma vesical en adulto.MÉTODO: Describimos el caso de una paciente mujer de 64 años que refiere hematuria de cuatro meses de evolución,y a la que se detecta ecográficamente durante revisiónginecológica rutinaria una neoformación intraluminal vesical. La cistoscopia permitió confirmar la existencia de dicha lesión. Se indicó resección transuretral de la misma.RESULTADOS: El estudio anatomopatológico permitió un diagnóstico definitivo compatible con leiomiosarcoma. Se procedió en un segundo acto quirúrgico a la realización de exanteración pélvica anterior. No evidencia de recidiva tras un año de la cirugía.CONCLUSIONES: Destacamos la infrecuencia de este tipo de neoplasias. Comentamos las principales característicasde las mismas, señalando la importancia de las técnicas de inmunohistoquímica de cara a su diagnóstico histológico definitivo. Hacemos referencia a las posibilidadesterapéuticas descritas en la literatura

OBJECTIVES: To report a new case of bladder leiomyoma in an adult. ;;METHODS: 64-year-old female patient consulting for a four-month hematuria diagnosed of a bladder intraluminal tumor on ultrasound during a routine gynecologic revision. Cystoscopy confirmed the presence of the tumor. Transurethral resection was indicated. ;;RESULTS: Pathology reported a definitive diagnosis of ;;leiomyosarcoma. Anterior pelvic exenteration was subsequently performed. On one year follow-up there is no evidence of disease. ;;CONCLUSIONS: We emphasize the rarity of these ;;neoplasias. We comment on their main characteristics, ;;pointing out the importance of immunohistochemical ;;staining for the definitive histological diagnosis. We refer the therapeutic options described in the literature

[Malignant recurrence of a penile cutaneous horn]. / Recidiva malignizada de cuerno cutáneo peneano.

OBJECTIVES: To report one case of malignant recurrence of a cutaneous horn of the glans penis. METHODS: We report the case of a 66-year-old male patient presenting with penile discomfort over several months. Physical examination showed a corneal lesion in the glans-penis, the biopsy of which was reported as hyperkeratosis on top of pseudoepiteliomatous hyperplasia. Partial penectomy of the glans penis was performed after recurrence three months later. RESULTS: Pathological study of the specimen identified a microinvasive squamous cell carcinoma in the base of the lesion. The patient is disease-free after two years of follow-up. CONCLUSIONS: We emphasize the capacity the penile cutaneous horn has to become malignant. We also point out the need for observation of these lesions after excision.

Recidiva malignizada de cuerno cutáneo peneano / MAlignant recurrence of a penile cutaneous horn

OBJETIVO: Presentación de un caso de recidivamalignizada de cuerno cutáneo localizado en glande.METODO: Describimos el caso de un paciente varón de 66años que refiere molestias peneanas de varios meses de evolución.La exploración física evidenció una lesión córnea cuyabiopsia en cuña demostró hiperqueratosis sobre base dehiperplasia pseudoepiteliomatosa. La recidiva a los tres mesesnos hizo indicar glandectomía.RESULTADOS: El estudio anatomopatológico de la pieza permitióidentificar un carcinoma escamoso microinvasor en labase de implantación del cuerno cutáneo. El paciente seencuentra libre de enfermedad tras dos años de seguimiento.CONCLUSIONES: Destacamos el potencial de malignizacióndel cuerno cutáneo de localización peneana.Señalamos asimismo la necesidad de vigilancia en el tiempode dichas lesiones tras su extirpación

OBJECTIVES: To report one case ofmalignant recurrence of a cutaneous horn of the glanspenis.METHODS: We report the case of a 66-year-old malepatient presenting with penile discomfort over severalmonths. Physical examination showed a corneal lesionin the glans-penis, the biopsy of which was reported ashyperkeratosis on top of pseudoepiteliomatous hyperplasia.Partial penectomy of the glans penis was performedafter recurrence three months later.RESULTS: Pathological study of the specimen identifieda microinvasive squamous cell carcinoma in the base ofthe lesion. The patient is disease-free after two years offollow-up.CONCLUSIONS: We emphasize the capacity thepenile cutaneous horn has to become malignant. Wealso point out the need for observation of these lesionsafter excision