Solución del caso 34. Adenoma hepático / Solution to case 34. Adenoma of the liver

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Valor pronóstico de los factores clinicopatológicos Ki67, ciclina D1, ciclina D3 y CDK4 en el carcinoma gástrico / Pronostic value of clinicopathologic factors Ki67, cyclin D1, cyclin D3 and CDK4 in gastric carcinoma

- Propósito: Conocer el valor pronóstico de la ciclina Dl, ciclina D3, cdk4 y Ki67, estudiados por métodos inmunohistoquímicos, junto con las características clinicopatológicos de los carcinomas gástricos.- Métodos y resultados: Realizamos estudio inmunohistoquimicos de material incluido en parafina para ciclina D1, ciclina D3, cdk4 y Ki67 en 74 pacientes con carcinoma gástrico. Las inmunotinciones para ciclinas D1, D3 y cdk4 así el índice de proliferación de Ki67, el grado histológico y el tipo histológico (según la clasificación de Lauren) se compararon con la supervivencia. El 97 por ciento de los casos eran Ki67 positivos, el 29 por ciento para ciclina D1, el 23 por ciento para ciclina D3 y el 35 por ciento para cdk4. El análisis multivariante sólo mostró correlación entre el Ki67 (PI) (p<0,01) y la supervivencia. En el análisis univariante el grado histológico también se correlaciona con la supervivencia (p<0,03). La expresión de ciclina D3 se relaciona con cdk4 (p<0,001) y Ki67 (PI) (p<0,02) y la expresión de ciclina D1 con el grado histológico (p<0,03).- Conclusiones: Nuestros resultados sugieren que un índice de proliferación elevado de Ki67 y el grado histológico son marcadores de mal pronóstico. La sobreexpresión de la ciclina D1 podría tener un importante papel en la proliferación celular. La relación entre ciclina D3, cdk4 y Ki67 podrían explicarse por su papel a lo largo del ciclo celular. (AU)

Tumor primitivo neuroectodérmico primario de nasofaringe. Descripción de un caso / Primary primitive neuroectodermal tumor of the nasopharynx. A case report

Objetivos: El tumor primitivo neuroectodérmico (PNET) es un tumor maligno de células pequeñas que muestra diferenciación neuroepitelial. Se han descrito varios casos aislados. Aquí presentamos un caso de PNET nasofaríngeo. Métodos y resultados: Hombre de 32 años de edad que presentaba sangrado nasal ocasional de ocho meses de duración. La lesión mostraba características morfológicas e inmunofenotipicas compatibles con un tumor primitivo neuroectodérmico periférico. Conclusiones: Éste es el primer caso documentado de PNET de la nasofaringe (AU)

Apoptosis en tumores carcinoides gastrointestinales / Apoptosis in gastrointestinal carcinoid tumors

Propósito: Estudiar el significado de la apoptosis usando la técnica de TUNEL así como los factores reguladores de la muerte celular en los carcinoides gastrointestinales. Material y métodos: En 10 carcinoides gastrointestinales diagnosticados desde 1995 hasta 1998 se analizaron sus características clinicopatológicas y se realizó el estudio inmunohistoquímico de cromogranina, enolasa, bcl-2, p53, y apoptosis. Resultados: Cinco pacientes eran hombres y 5 mujeres. La edad media fue de 55 años, la localización más frecuente fue apéndice y estómago, el tamaño medio fue de 1,5 cm. Fallecieron dos pacientes. El p53 fue positivo en el 10 por ciento de los casos, bcl-2 en el 30 por ciento y la apoptosis en el 20 por ciento. La bcl-2 y el p53 fueron positivos en carcinoides gástricos, la apoptosis se demostró en un carcinoide gástrico y en un carcinoide mucinoso apendicular. Conclusiones: La expresión de p53, bcl-2 y la apoptosis es escasa en los carcinoides gastrointestinales. La muerte celular programada y sus factores reguladores podrían tener más importancia en los carcinoides gástricos que en los localizados en otros lugares (AU)

Linfomas MALT CD5+ / CD5+ MALT lymphomas

Propósito: Los linfomas MALT son linfomas de bajo grado y se caracterizan por ausencia de expresión de CDS. No obstante, se han descrito algunos casos CD5 positivos. Material y métodos: Presentamos 6 linfomas MALT de bajo grado, 5 de estómago y uno de colon, CD5 positivos. Resultados: Los pacientes tenían una enfermedad localizada y no había invasión de médula ósea. El seguimiento medio fue de 12,6 meses. Concusiones: Nuestros casos demuestran que los linfomas MALT de bajo grado pueden presentar de forma atípica expresión de CD5 (AU)

[Epidermoid carcinoma of the penis]. / Carcinoma epidermoide de pene.

OBJECTIVE: To analyze our series and review the prognostic factors in the treatment of epidermoid carcinoma of the penis. METHODS: Age, time to consultation, circumcision, form of presentation, local treatment, tumor stage and grade, lymph node involvement and outcome were analyzed in 27 cases of carcinoma of the penis diagnosed at our hospital from 1981 to 1999. RESULTS: The incidence rate was 1.8 cases/100,000 men/year. No patient had been circumcised, except one who was circumcised in the adult age. The median time to consultation was 24 months (interquartile range: 60-7.75). The median follow-up was 37 months (interquartile range: 84-12). All patients with pT1GI-II and pT2G-II primary tumor (n = 21; 78% of the series) and with no lymphadenopathy were disease-free at 6 months' minimum follow-up [17 of the 21 patients (81%) had more than 32 months' follow-up]. Only one patient with pT1-GII tumor, but with a vertical growth pattern, had positive inguinal lymph nodes (pN2). The remaining patients with lymph node involvement showed infiltration of the erectile tissue and moderately or poorly differentiated tumors. Only two prophylactic lymphadenectomy procedures were performed (pN0). Regardless of treatment, 5 of the 6 patients with lymph node involvement died within one year after diagnosis. CONCLUSIONS: Given the demonstrated relationship between carcinoma of the penis and hygiene, and phimosis which makes hygiene difficult, circumcision should be performed in childhood. Furthermore, circumcision at this age has been demonstrated to have a prophylactic value that disappears in the adult age.

[Expression of p53 in prostatic carcinoma]. / Expresión de p53 en carcinomas de próstata.

The expression of the p53 protein was studied in 10 men with prostate cancer by means of an immunohistochemical method. Strong staining for p53 was found in six of ten prostate cancer (60%, mean: 26% of malignant cells stained in the positive tumours). On the other hand, the cell nuclei in benign glands did not stain positively. Immunohistochemical pattern of p53 was not related significantly to clinicopathologic parameters in the cases examined. However, significant relationship was observed between prostate cancer stage D and stage B and mean of expression of p53 in both groups. Also, relationship between mean of expression of p53 of tumoral cells of grade IV and mean of expression of p53 of tumoral cells of grades I, II and III was observed.

[Pseudo-tuberculous pyelonephritis]. / Pielonefritis pseudotuberculosa.

We report on a 67-year-old woman with caseating granulomatous pyelonephritis associated with nephrolithiasis. Caseating granulomas resembling renal tuberculosis were observed in the renal parenchyma, but no TB or other microorganisms were detected in the renal tissue or urine cultures. To our knowledge, this is the second case reported in the literature.

Cytomegalovirus infection of the appendix in patient with the acquired immunodeficiency syndrome.

Disseminated cytomegalovirus infection occurs predominantly in immunocompromised hosts. Involvement of the gastrointestinal tract in the acquired immunodeficiency syndrome is frequent, but to our knowledge there is only one report of involvement of the appendix. In this study, a patient with a history of the acquired immunodeficiency syndrome who presented with fever and an acute abdomen is described. At surgery, appendicitis was found. In the surgical specimen, appendicitis and cytomegalovirus infection were found. Cytomegalovirus should be considered as a possible cause of appendicitis in the acquired immunodeficiency syndrome.

[Changes in autopsies in cancer in Navarra from 1980 to 1988]. / Modificaciones de la autopsia por cáncer en Navarra desde 1980 hasta 1988.

BACKGROUND: Autopsies may be used to know the causes of death in population. In Navarra, the number of patients who died by cancer and were autopsied has increased. A similar pattern appeared in other communities. METHODS: We reviewed 2,643 autopsies performed in the main hospitals of Navarra. In each autopsy, age, sex, existence of primary malignant tumor, and its histologic type and localization were analyzed. The results were compared to the statistics of mortality of the Tumoral Register of Navarra. The modifications from 1980 to 1988 were studied. RESULTS: There is a significant increase of autopsy and mortality by cancer in Navarra. In autopsy cases, there is a high incidence of colon carcinoma and hepato-biliary carcinoma. The incidence in all cancer dead patients is similar being greater in hepato-biliary carcinoma and pancreas carcinoma. The percentage of autopsies in patients over 60 years of age is decreased, but it has increased in all cancer dead patients of the same group of age in the community of Navarra. In the autopsies of patients over 60 years of age there has been a rise in breast carcinoma, while there has been a general increase in all dead patients. In all deaths of people under 60 years of age, there has been a decrease, but in autopsy cases there has been an increase of colon carcinoma. CONCLUSIONS: In autopsy series from 1980 to 1988, cancer deaths increased significantly. There is not relationship between cancer dead patients and autopsy cases in the studied data. In hepato-biliary carcinoma, there is an increase in autopsy cases and cancer dead patients. Discrepancies between the number of deaths of cancer patients and autopsy patients revealed that the performance of autopsy depends of multiple causes.

[Signet-ring cell carcinoma of the urinary bladder: study of 4 cases and review of the literature]. / Carcinoma de células en anillo de sello de la vejiga urinaria: estudio de cuatro casos y revisión de la literatura.

Four cases of primary signet-ring cell adenocarcinoma of the urinary bladder are described. All patients were men, with ages ranging from 46 to 81 years. The number of signet-ring cells varied and showed a direct correlation with poor prognosis. PAP analyses of acid phosphatase and prostate-specific antigen were negative. The results show that signet-ring cell carcinoma has a poor prognosis. This cell type should be sought in all bladder carcinomas since its presence is likely to worsen prognosis.

Cystadenofibroma of fallopian tube.

We present two cases of cystadenofibroma of the fallopian tube in 2 patients of 49 and 32 years, respectively. The first tumor was a chance finding in a hysterosalpingo-oophorectomy because of multiple leiomyomas. The second tumor appeared in a pregnant woman; the tumor was considered in an echographic study as an ectopic pregnancy. This tumor was a borderline cystadenofibroma. The second case is the first report of cystadenofibroma of the fallopian tube associated with pregnancy.