Perspectiva sobre avances en cáncer de mama / Advances on breast cancer: a perspective

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Tumoral presentation of primary central nervous system lymphomatoid granulomatosis.

PURPOSE: Lymphomatoid granulomatosis (LYG) is an angiocentric Epstein-Barr virus (EBV) related B-cell proliferation associated with a reactive T-cell component with an uncertain malignant potential. LYG present at diagnosis as a mass lesion in the central nervous system (CNS) is rare, and only a few cases have been reported. In this article we present four cases of tumoral CNS-LYG and propose some guidelines for its management. METHODS: Clinical, pathological, imaging and laboratory information of four immunocompetent patients, all of them treated surgically, with a final diagnosis of LYG and presenting with an isolated intracranial tumoral mass is reviewed. RESULTS: Two parenchymal lesions were located in the cerebellum and temporal lobe, and the other two involved the cavernous sinus. At surgery they were avascular, hard, lard-like, necrotic and plastic well-defined lesions, with invasion of the leptomeninges and thrombosis of the small leptomeningeal arteries and veins. Intraoperative pathology excluded any tumor. Pathological studies showed a polymorphic and polyclonal infiltration around, in the wall and into the lumen of medium-sized cortical and leptomeningeal vessels causing their obstruction and tissular necrosis. EBV-infected cells were present. CONCLUSIONS: Making a preoperative diagnosis of CNS-LYG appearing initially as a tumoral mass is difficult because of the lack of pathognomonic clinical symptoms or imaging signs. Surgical management with radical resection of the mass is almost always followed by the long-term local control of the lesion, although the disease may have a disseminated, systemic or malignant evolution.

Descripción microscópica e inmunohistoquímica en el diagnóstico anatomopatológico / Microscopy and immunohistochemistry as diagnostic tools in pathology

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Novedades en el conocimiento del cáncer de mama / New understanding of breast cancer

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¿Hacia el diagnóstico pragmático?. Reto para el patólogo de los nuevos tiempos / No disponible

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[Leydig cell tumor. Case report and review of the literature]. / Tumor de células de Leydig. A propósito de un nuevo caso y revisión de la literatura.

OBJECTIVE: To report a new case of the rare Leydig cell tumor, and to perform bibliographic review. METHODS: We report the case of a 38-year-old male with the clinical and ultrasound diagnosis of testicular tumor, and normal hormonal and extension studies. He underwent inguinal radical orchyectomy and the pathology report of the specimen showed a Leydig cell tumor. It was staged as T1N0M0, not receiving any further treatment with chemotherapy or radiotherapy. Five years after surgery there is no evidence of disease on follow-up. RESULTS: The patient does not show evidence of recurrence after chest x-rays, abdominal-pelvic CT scan, ultrasound of the contralateral testis, and tumor markers. CONCLUSIONS: We recommend a long-term follow-up with contralateral testicle ultrasound, CT scan, chest x-ray, and tumor markers.

[Bladder endometriosis. Case report and review of the literature]. / Endometriosis vesical. A propósito de un nuevo caso y revisión de la literatura.

OBJECTIVE: To report a new case of bladder endometriosis and to perform a bibliographic review. METHODS: We report the case of a 34-year-old female with the diagnosis of bladder endometriosis treated by transurethral resection and subsequent hormonal therapy with good outcome one year after diagnosis. RESULTS: Treatment with analogs was started after TUR, in conjunction with the Gynecology Department, and maintained six months. The patient remained asymptomatic one year after diagnosis, with a negative cystoscopic study. CONCLUSIONS: We emphasize the need of early diagnosis due to the increased morbidity and health-care expenses; also the need of surgical treatment of all urological lesions before any hormonal therapy, mainly ureteral lesions. We finally emphasize that definitive treatment should be performed by the gynecologist.

Endometriosis vesical. A propósito de un nuevo caso y revisión de la literatura / Bladder endometriosis. Case report and bibliographic review

OBJETIVO: Describir un nuevo caso de endometriosis vesical y hacer una revisión de la literatura MÉTODOS: Presentamos el caso de una enferma de 34 años diagnosticada de endometriosis vesical tratada mediante R.T.U. y soporte hormonal posterior con buenos resultados al año del diagnostico. RESULTADOS: Tras la R.T.U. se instaura conjuntamente con el Servicio de Ginecología, un tratamiento con análogos durante seis meses, estando la enferma asintomática al año del diagnóstico y con un estudio cistoscópico normal. CONCLUSIONES: Como conclusiones, destacar la necesidad de diagnóstico precoz dado el evidente aumento de morbilidad y gasto sanitario, así como la necesidad del tratamiento quirúrgico de todas las lesiones urológicas, antes de toda maniobra hormonal, fundamentalmente las lesiones ureterales. Destacar finalmente que el tratamiento definitivo corresponde, por lógica y por derecho, al ginecólogo

OBJECTIVE: To report a new case of bladder endometriosis and to perform a bibliographic review. METHODS: We report the case of a 34-year-old female with the diagnosis of bladder endometriosis treated by transurethral resection and subsequent hormonal therapy with good outcome one year after diagnosis. RESULTS: Treatment with analogs was started after TUR, in conjunction with the Gynecology Department, and maintained six months. The patient remained asymptomatic one year after diagnosis, with a negative cystoscopic study. CONCLUSIONS: We emphasize the need of early diagnosis due to the increased morbidity and health-care expenses; also the need of surgical treatment of all urological lesions before any hormonal therapy, mainly ureteral lesions. We finally emphasize that definitive treatment should be performed by the gynecologist

Tumor de células de Leydig. A propósito de un nuevo caso y revisión de la literatura / Leydig cell tumor. Case report and bibliographic review

OBJETIVO: Presentar un nuevo caso del infrecuente tumor de células de Leydig, junto a na revisión de la literatura. MÉTODOS: Presentamos el caso de un varón de 38 años de edad con u diagnostico clínico y ecográfico de tumoración testicular, con estudio hormonal y de extensión normal. Se interviene practicándose orquiectomía radical vía inguinal y la pieza fue informada como un tumor de células de Leydig. Estudiado como T1N0M0 no recibió tratamiento posterior con quimioterapia ni radioterapia. Tras 5 años de seguimiento no se ha evidenciado recidiva. RESULTADOS: El enfermo no presenta recidiva de la enfermedad, habiéndose realizado estudios radiológicos de Radiografía de Tórax, T.C. abdominopélvico, Ecografía del teste contralateral, así como estudio de marcadores tumorales. CONCLUSIONES: Como conclusión, se aconseja el seguimiento a largo plazo con la práctica de ecografia del teste contralateral, otros estudios radiológicos como T.A.C y radiografía de tórax, así como marcadores tumorales

OBJECTIVE: To report a new case of the rare Leydig cell tumor, and to perform bibliographic review. METHODS: We report the case of a 38-year-old male with the clinical and ultrasound diagnosis of testicular tumor, and normal hormonal and extension studies. He underwent inguinal radical orchyectomy and the pathology report of the specimen showed a Leydig cell tumor. It was staged as T1N0M0, not receiving any further treatment with chemotherapy or radiotherapy. Five years after surgery there is no evidence of disease on follow-up. RESULTS: The patient does not show evidence of recurrence after chest x-rays, abdominal-pelvic CT scan, ultrasound of the contralateral testis, and tumor markers. CONCLUSIONS: We recommend a long-term follow-up with contralateral testicle ultrasound, CT scan, chest x-ray, and tumor markers

Comparative assays for the HER-2/neu oncogene status in breast cancer.

CONTEXT: Tumor marker assays, especially those used to indicate the right therapy, should be standardized. OBJECTIVE: To analyze the current methods for the HER-2/neu (h2n) oncogene status by immunohistochemical (IHC) analysis, fluorescence in situ hybridization (FISH), and chromogenic in situ hybridization (CISH) and compare those results with the chromosome 17 copy number and the status of the topoisomerase II alpha (TPIIalpha) gene. DESIGN: We tested 50 infiltrating ductal breast carcinomas (pTNM status varied from pT1 N0 to pT4 N1) using the Food and Drug Administration (FDA)-approved methods HercepTest and Pathway for overexpression of h2n. We also used FISH and CISH to test for h2n amplification and CISH to test for chromosome 17 (c17) and TPIIalpha. The p53 and Ki-67 factors were also evaluated by IHC analysis. RESULTS: h2n overexpression (3+) and amplification were observed in only 6 (12%) of 50 cases by IHC analysis, FISH, and CISH. Three cases that initially scored 3+ and 2+ had 4 to 5.95 signals (equivocal) by FISH but when corrected by the h2n/c17 ratio were nonamplified. TPIIalpha isomerase was amplified in only 2 (4%) of the 50 cases. Nineteen (38%) of the 50 cases were aneuploidic. All h2n amplified cases had high proliferative activity, but only 2 of 6 had p53 protein alterations. CONCLUSIONS: The HercepTest and Pathway IHC assay h2n were fully concordant for the 3+ cases. The 3+ cases had to be confirmed in 75% of the tumor area examined. These 2 IHC assays were fully concordant with FISH and CISH. The 2 in situ hybridization (ISH) assays were 94% concordant for the 50 cases. The cutoff signal points for both ISH assays should be 6 or more. Thus, there is no need for the c17 ratio correction. Tumor heterogeneity appears not be a major problem, but our percentage of amplified cases is lower than previously reported. The FDA-approved IHC and ISH assays should give relatively uniform results when used following our recommendations.

Carta a los patólogos más jóvenesen el siglo XXI / A letter to the younger pathologist in 21st Century

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Ganglio centinela frente a genómica funcional en el pronóstico y tratamiento del cáncer de mama / Sentinel lymph node versus functional genomics for prognosis and treatment of breast cancer

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Klippel-Feil syndrome associated with posterior fossa dermoid cyst. Case report.

A patient with association of Klippel-Feil syndrome and posterior fossa dermoid cyst is presented. The patient, a 36-year-old man, presented with an acute obstructive hydrocephalus due to the cyst and exhibited the typical triad of the Klippel-Feil abnormality with short neck, low hairline implantation and limited neck motion along with a complex cervical vertebrae fusion. The anatomical and clinical features as well as the pathophysiology of this rare association are discussed after a review of the literature.

Carcinoma suprarrenal oncocítico de bajo grado / Low grade oncocytic adrenocortical carcinoma

OBJETIVO: Presentamos un caso de un varón de 47 años con un tumor suprarrenal izquierdo heterogéneo de 16x10x7 cm., al que tras una punción-biopsia se le practicó una suprarrenalectomía por vía abdominal. MÉTODO/RESULTADOS: Estudios inmunohistoquímicos con el anticuerpo anti Melan-A A103 nos indican un origen en la corteza suprarrenal de las células tumorales. Los oncocitos son ricos en mitocondrias, y el anticuerpo antimitocondrial mES-13 nos permite ponerlas de manifiesto sin necesidad de recurrir a estudios ultraestructurales. CONCLUSIÓN: En este tipo de tumores sólo los criterios histológicos de necrosis y aumento de las mitosis permiten hacer un diagnóstico de malignidad, pero aún así su comportamiento es indolente (AU)