Clinical and pathologic features of patients with non-epithelial ovarian cancer: retrospective analysis of a single institution 15-year experience

Purpose. Non-epithelial ovarian cancers (NEOCs) are rare diseases. Despite their overall good prognosis, the best management and current prognostic factors remain unclear. The objective of our study was to assess the clinical and pathological features of NEOC patients treated in our institution in the last 15 years and to explore risk factors for relapse and survival. Methods/patients. All patients with a pathological diagnosis of NEOC referred to the medical oncology department at Hospital Universitario Virgen del Rocio between 1999 and 2014 were included. Demographics, tumor characteristics, treatment procedures, and clinical follow-up were retrospectively collected. Risk factors for disease-free survival (DFS) and overall survival (OS) were assessed. Results. Fifty-seven patients were included, 33 (58 %) had a sex cord-stromal tumor (SCST) and 24 (42 %) had a germ-cell tumor (GCT). Median age, non-conservative surgery rates and DFS were lower in the GCT cohort; however, salvage chemotherapy led to a high proportion of complete responses in this group translating into a 90 % 3-year OS rate in both NEOC subtypes. The only identified risk factors statistically significant were stage and tumour relapse that associated, respectively, with DFS (HR = 8.84; 95 % CI 1.85-42) and OS (HR = 11.02; 95 % CI 1.76-68.7). Conclusions. Despite their rarity, NEOCs remain a highly curable group of neoplasm. In our series, a more conservative treatment approach in ovarian GCTs revealed comparable OS outcomes to SCST. No new risk factors that would help in patient stratification were identified (AU)

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Afectación ganglionar en endometriosis rectal aislada / Lymph node involvement in isolated rectal endometriosis

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Clinical characteristics and outcomes of uterine tumors resembling ovarian sex-cord tumors (UTROSCT): a systematic review of literature.

Uterine tumor resembling ovarian sex-cord tumors (UTROSCT) is an extremely rare type of uterine tumor, and its clinical characteristics are not fully understood. A systematic literature search was conducted in PubMed and MEDLINE using the keywords, "uterine tumors resembling ovarian sex cord tumors", limited to case reports. Clinico-pathological characteristics and survival data were abstracted and evaluated for the analysis. Among 43 cases reporting UTROSCT, Type I (endometrial stromal tumors with sex cord-like elements, ESTSCLE) and Type II (classic UTROSCT) were reported in 5 (11.6%) and 17 (39.5%), respectively, and nearly half of reported UTROSCT did not subcategorize the histology pattern into Type I or II (unspecified, n=21, 48.8%). Mean age was 52.2. The two most common symptoms were postmenopausal vaginal bleeding (44.2%) and abnormal menstruation (39.5%). The majority underwent total hysterectomy with adnexectomy (65.1%) followed by hysterectomy alone (18.6%) and tumor resection alone (14.0%). Mean tumor size was 6.2cm, and extra-uterine spread was seen in 7.0%. By immunohistochemistry, calretinin expression was significantly correlated with CAM5.2, inhibin, and progesterone receptor expression (all, p<0.05). In survival analysis, disease-free survival (DFS) rates for all 43 cases at 1, 2, and 5 years for all cases were 97.0%, 92.7%, and 69.7%, respectively. Among recurrent cases, median time to recur was 24 months (range 9-48). Decreased DFS was significantly associated with pelvic pain (2-year rate, 81.8% versus 94.7%, p=0.006), histology subcategory (Type I versus II, 23.8% versus 100%, p=0.006), tumor size ≥10cm (75.0% versus 100%, p=0.046), cervical/extra-uterine metastasis (46.7% versus 100%, p=0.024), and lymphovascular space involvement (50% versus 100%, p=0.002). Treatment patterns were not statistically associated with DFS (hysterectomy, p=0.28; and adnexectomy, p=0.38). When histology patterns were examined, Type II disease was associated with less aggressive tumor behavior when compared to Type I disease: extra-uterine spread (Type I versus II, 40% versus 5.9%, p=0.007) and lymphovascular space invasion (50% versus 6.7%, p=0.012). Among 17 cases of Type II disease, disease recurrence was reported in 1 (5.9%) case at 3 years after the initial treatment. In conclusion, our study showed that UTROSCT was often not subcategorized. Because classic UTROSCT has a distinct clinical outcome and characteristic histological patterns when compared to ESTSCLE, distinguishing UTROSCT from ESTSCLE is an integral component of the diagnosis. While classic UTROSCT typically has a favorable prognosis, it has been known to develop a late recurrence. If risk factors for recurrence are absent, both hysterectomy and mass resection alone are possible options for management.

Estudio descriptivo del nuevo sistema morcelador de histeroscopia diagnóstica-terapéutica / Descriptive study of a new diagnostic-therapeutic hysteroscopic morcellation system

Hipótesis. El nuevo sistema de morcelación es una técnica histeroscópica diagnóstica-terapéutica eficaz y segura para el tratamiento ambulatorio de pólipos endometriales. Objetivo. Describir nuestra experiencia inicial con el nuevo sistema de morcelación histeroscópica Truclear System (Smith & Nephew) en término de polipectomías realizadas a nivel ambulatorio sin necesidad de derivación quirúrgica de la paciente. Pacientes y métodos. Estudio observacional prospectivo no aleatorizado que incluye las 100 primeras pacientes en las que se les realizó una histeroscopia con el nuevo sistema morcelador entre junio del 2011 a enero del 2012 en el Hospital de Igualada. Se diferencian 2 grupos de pacientes. Grupo 1: 55 primeras pacientes que cumplen alguno de los criterios de inclusión establecidos para la realización de una histeroscopia; Grupo 2: 45 pacientes con sospecha diagnóstica-ecográfica de pólipo endometrial. Resultados. Se realizó un total de 41 y 40 histeroscopias en el grupo 1 y 2 respectivamente, obteniendo una sospecha histeroscópica de pólipo endometrial en el 56 y 82,5% respectivamente. La tasa de éxito en la polipetomía fue del 100%, sin necesidad de derivación quirúrgica posterior en ningún caso y con una tolerancia buena o regular en el 91,3% de las pacientes. Conclusión. El nuevo sistema morcelador permite la realización de la polipectomía a nivel ambulatorio sin necesidad de derivación quirúrgica en aquellas pacientes con diagnóstico ecográfico de pólipo (AU)

Hypothesis: The new morcellation system is a safe and effective diagnostic-therapeutic technique for the outpatient management of endometrial polyps. Objective: To describe our inicial experience with the new mechanical Truclear System (Smith&Nephew) hysteroscope in a number of polypectomies performed in the outpatient setting without the need for surgical referral. Patients and methods: An observational prospective non-randomized study was performed in 100 patients who underwent hysteroscopy between June 2011 and January 2012 at the Igualada Hospital. There were two patient groups: group 1 included the first 55 patients who met the inclusion criteria for hysteroscopy and group 2 included 45 patients with endometrial polyps suspected on ultrasound. Results: We performed 41 and 40 uneventful hysteroscopies in groups 1 and 2, respectively, 56 and 82.5% were suspected endometrial polyps, respectively. Polypectomy was 100% successful in all patients. None of the patients were referred for surgery. Tolerance was moderate to good in 91.3% of the patients. Conclusion: The new morcellator system allows polypectomies to be conducted in outpatients with an ultrasound diagnosis of polyps, without the need to refer the patient for surgery (AU)

Tumor mixto epitelial y estromal del riñón con diferenciación endometrioide asociado a un tumor sólido seudopapilar de páncreas / Mixed epithelial and stromal tumor of the kidney with endometrioid differentiation associated with pancreatic solid pseudopapillary tumor

El tumor mixto epitelial y estromal del riñón (MESTK) es una neoplasia quística benigna. El tumor sólido seudopapilar pancreático (SPT) es un carcinoma quístico de bajo potencial maligno. Este artículo describe un MESTK sincrónico con un SPT en una mujer con un cuerpo lúteo quístico ovárico. Las glándulas mostraban diferenciación endometrioide y el estroma fusocelular creaba complejas estructuras foliáceas similares a un adenofibroma mulleriano. El SPT estaba formado por células poligonales con patrón seudopapilar y un área quística. La expresión de receptores de estrógenos y progesterona en las células estromales del MESTK y de receptores de progesterona en el SPT es clave para su diagnóstico, confirmando una dependencia hormonal en la patogénesis. Dado que nuestro MESTK es polipoide y tiene diferenciación endometrioide, discutimos el diagnóstico diferencial con la endometriosis polipoide(AU)

Mixed epithelial and stromal tumor of the kidney (MESTK) is a benign cystic neoplasm. Pancreatic solid-pseudopapillary tumor (SPT) is a typically cystic carcinoma of low malignant potential. We describe a MESTK synchronous with a SPT in a female with an ovarian cystic corpus luteum. Glands showed endometrioid differentiation and the spindle cell stroma created complex leaflet-like structures similar to Müllerian adenofibroma. The SPT consisted of polygonal cells with a pseudopapillary pattern and a cystic area. Expression of estrogen and progesterone receptors in MESTK stromal cells and progesterone receptors in SPT provided a diagnostic clue, confirming the hormonal dependence in pathogenesis. Given that our MESTK is a polypoid tumor with endometrioid differentiation, the differential diagnosis with polypoid endometriosis is considered(AU)

Endometriosis umbilical / Umbilical endometriosis

La endometriosis umbilical es la forma clínica más común de endometriosis extrapélvica y el tipo más habitual de endometriosis cutánea. Puede ser primaria o secundaria. Las endometriosis umbilicales secundarias se producen sobre cicatrices de laparotomías o laparoscopias en las que ha habido exposición al tejido endometrial. La endometriosis umbilical es relativamente rara, pero se debe tener en cuenta al realizar el diagnóstico diferencial de lesiones de localización umbilical. Presentamos un caso de endometriosis umbilical en una mujer de 39 años sin antecedentes de cirugía abdominal previa (AU)

Umbilical endometriosis is the most common clinical form of extrapelvic and cutaneous endometriosis and can be primary or secondary. Secondary umbilical endometriosis is produced in surgical scars from laparotomy or laparoscopy with exposure to endometrial tissue. Umbilical endometriosis is a rare disease but must be considered in the differential diagnosis of an umbilical node. We report a case of umbilical endometriosis in a 39-year-old woman without previous abdominal surgery (AU)

Tumor virilizante de células esteroideas del ovario / Virilizing steroid cell tumor of the ovary

Los tumores de células esteroideas representan el 0,1% de los tumores ováricos. Pertenecen al grupo de los tumores del estroma, también llamados de los cordones sexuales. Aunque pueden aparecer a cualquier edad, son más frecuentes en mujeres menopáusicas y con frecuencia se asocian a síndromes endocrinos. El hirsutismo y la virilización son los hallazgos clínicos más significativos. El manejo debe individualizarse en función de la histología, el estadio quirúrgico y el deseo genésico de la mujer. Presentamos el caso de una paciente de 78 años con alopecia e hirsutismo severo, marcado incremento de testosterona y tumoración en ovario derecho de 4cms., informada de tumor de células esteroideas (AU)

Steroid cell tumors account for 0.1% of ovarian tumors and are classified within the group of stromal tumors, also known as sex cord tumors. These neoplasms can appear at any age but are more common in menopausal women and are associated with endocrine syndromes. The most significant clinical findings are hirsutism and virilization. Management should be individualized according to histological findings, surgical stage and the woman's reproductive wishes. We describe a 78-year-old patient with alopecia and severe hirsutism, a marked increase in testosterone and a 4-cm tumor of the right ovary, diagnosed as a steroid cell tumor (AU)

Metástasis clínicamente silente de un carcinoma lobulillar de mama en un pólipo endometrial / Metastasis of a clinically silent lobular breast carcinoma to an endometrial polyp

Las metástasis del cáncer de mama en útero son raras y generalmente, cuando existen, los ovarios suelen estar afectados como muestra de una enfermedad diseminada. Sólo hay 14 casos descritos de metástasis de un carcinoma de mama en un pólipo endometrial en pacientes tratadas con tamoxifeno. Tanto su evolución, como su pronóstico son inciertos. Presentamos un caso de metástasis en un pólipo endometrial de un carcinoma lobulillar de mama con buena evolución posterior y un período libre de enfermedad de 5 años(AU)

Metastases to uterus from breast cancer are rare, and in most of the cases the ovaries are also involved. Metastases from breast cancer to an endometrial polyp have been only described in 14 cases; therefore the prognosis and survival are uncertain. We described a case of metastasis from breast carcinoma to an endometrial polyp in a patient who received tamoxifen therapy, with a good outcome and disease-free at 5-years(AU)

Tumores mesenquimales diagnosticados en la unidad de gastroenterología del HMPC entre los años 2007 aL 2009 / Mesenchymal tumors diagnosed in the gastroenterology unit of HPMC from 2007 to 2009

Se evaluaron las historias médicas con diagnóstico de tumores mesenquimales confirmados por análisis inmunohistoquímico entre los años 2007 y 2009. El objetivo fue describir a la población según características clínicas, epidemiológicas, diagnósticos por imágenes y análisis anatomopatológico. Se obtuvieron 11 pacientes con diagnósticos de GIST(7), Leiomiomas(2), GANT(1) y Leiomiosarcoma(1). Del género femenino (82%) y masculino (18%). Con un promedio de 55 años de edad. Clínicamente presentaron dolor abdominal (45%), mareos (27%), pirosis (9%) y disfagia (1%). El 18% permaneció asintomático. Entre los signos encontrados figuran: melena (36%), pérdida de peso (27%), palidez cutánea (9%) y vómitos (9%). El 36% de los pacientes no presentaron hallazgos al examen físico. Se realizó ultrasonido abdominal en el 100% de los pacientes, con hallazgos patológicos relacionados con el tumor en el 27 % de los casos. Al 90% de los pacientes se les realizó una Endoscopia Digestiva Superior, el 82% de los hallazgos se describieron como Tumores Submucosos y 9% se reportó como normal. Las lesiones se ubicaron en el estómago (60%), 27% en el intestino delgado ( duodeno y yeyuno); 9% en esófago y 9% en retroperitoneo. El ultrasonido endoscópico fue practicado al 82% de los pacientes, con un porcentaje de aciertos diagnósticos en el 90% de los tumores localizados en esófago, estómago e intestino delgado, y de 87,5% si se incluye el tumor retroperitoneal. La Tomografía Computada (TC) de abdomen fue practicada en 45% de los pacientes, con hallazgos patológicos en el 100% de los casos, descritos como Lesiones Ocupantes de Espacio (LOE), en estómago, intestino, esófago y retroperitoneo; y en el 20% de los pacientes se encontró enfermedad metastásica hepática Recibieron tratamiento quirúrgico el 82%, el 18% restante no se realizó por contraindicación médica o se encuentran en espera del procedimiento. Y un 18% de los pacientes recibieron tratamiento médico con Imatinib...

We evaluated the clinical records with a diagnosis of mesenchymal tumors confirmed by immunohistochemical analysis, from 2007 to 2009. The objective was to describe the population according to clinical and epidemiological features, diagnostic imaging and histopathological analysis. We found 11 patients with diagnoses of GIST(7), leiomyoma(2), leiomyosarcoma(1) and GANT(1); (82%) female and (18%) male, with a mean age of 55 years. They clinically presented abdominal pain (45%), dizziness (27%), heartburn (9%) and dysphagia (1%). 18% remained asymptomatic. Among the symptoms were: melena (36%), weight loss (27%), paleness (9%) and vomiting (9%). 36% of the patients had no findings at physical examination. Abdominal ultrasound was performed in 100% of the patients, with pathological findings related to the tumor in 27% of cases. In 90% of patients an upper digestive endoscopy was performed. 82% of findings were described as submucosal tumors and 9% was reported as normal. Lesions were located in stomach (60%); 27% in small bowel (duodenum and jejunum), 9% in esophagus and 9% in retroperitoneum. Endoscopic ultrasound was performed to 82% of patients, with a diagnostic accuracy of 90% for the tumors located in esophagus, stomach and small bowel; and 87,5% if the retroperitoneal tumor is included. The abdomen Computed Tomography (CT) was performed in 45% of patients with pathological findings in 100% of the cases, described as Space occupying lesion (SOL) in stomach, intestine, esophagus and retroperitoneum; and, in 20% of patients metastatic liver cancer was found. 82% received surgical treatment, the remaining 18% was not performed due to contraindication or are waiting for the procedure. And 18% of patients received medical therapy with Imatinib...

El potencial maligno de los pólipos endometriales / Malignant potential of endometrial polyps

Objetivo Determinar el potencial premaligno y maligno de los pólipos endometriales e investigar sobre posibles factores clínicos asociados al potencial maligno de estos. Material y métodos Se revisan 452 polipectomías por histeroscopia. Se analizan de forma estadística el diagnóstico histológico y parámetros clínicos como el sangrado uterino anormal y el tamaño del pólipo. Resultados En nuestro estudio se incluyó a 203 mujeres premenopáusicas y 249 mujeres posmenopáusicas. La edad media ± desviación estándar de las mujeres premenopáusicas fue de 44,3±0,4 años, y de 59,1±0,5 años en las mujeres posmenopáusicas. El diagnóstico de los pólipos endometriales se realizó mediante ecografía sola o en combinación con histerosonografía, o mediante histeroscopia. La principal indicación de histeroscopia fue el sangrado uterino anormal, en un 65,1% en el grupo de mujeres premenopáusicas y un 74,7% en el grupo de mujeres posmenopáusicas. Se hallaron 23 (11,3%) casos de hiperplasia sin atipia en el grupo de mujeres premenopáusicas, y 8 (3,2%) casos en el grupo de mujeres posmenopáusicas. Se encontraron 2 (0,9%) casos de hiperplasia con atipia en el grupo de mujeres premenopáusicas, y 9 (3,6%) casos en el grupo de mujeres posmenopáusicas. Se encontraron 16 (6,45) casos de carcinoma de endometrio, todos ellos en el grupo de pacientes posmenopáusicas. Sólo uno de los 16 casos cursó de forma asintomática; la sospecha ecográfica de pólipo endometrial fue la indicación de histeroscopia. Se encontró una asociación estadísticamente significativa entre el estado menopáusico y el potencial premaligno y maligno de los pólipos. Sin embargo, no se encontró una asociación estadística entre la presencia de sangrado uterino anormal y el tamaño del pólipo, con el potencial premaligno y maligno de los pólipos. Conclusiones Deben extirparse todos los pólipos en las pacientes menopáusicas, tengan o no tengan síntomas. En cuanto a las pacientes premenopáusicas asintomáticas, se debe individualizar cada caso, y aquellas sin ningún factor de riesgo puede obviarse la extirpación del pólipo y llevarse a cabo un seguimiento (AU)

Objectives To determine the pre-malignant and malignant potential of endometrial polyps, and to asses whether different clinical parameters are associated with malignancy in the polyps. Material and methods 452 hysteroscopic resections of endometrial polyps were reviewed. Histological diagnosis and clinical characteristics (presence of abnormal uterine bleeding and polyp size) were analyzed. Statistical analysis was performed. Results The study included 203 pre-menopausal and 249 post-menopausal women. The mean age of pre-menopausal women was 44.3±0,4 years, and 59.1±0.5 years for postmenopausal women. The diagnosis of polyps was by ultrasound with or without hysterosonography, or by hysteroscopy. The main indication of hysteroscopy was abnormal uterine bleeding, which was 65.1% in the pre-menopausal group and 74.7% in the post-menopausal group. There were 23 cases (11.3%) of hyperplasia without atypia in the pre-menopausal group, and 8 cases (3.2%) in the post-menopausal group. Hyperplasia with atypia was found in 2 cases (0.9%) in the pre-menopausal group, and in 9 cases (3.6%) in the post-menopausal group. There were 16 cases of endometrial carcinoma (6.4%), all of them in post-menopausal women. In 1 of these 16 patients there was no abnormal bleeding, but an endometrial polyp was suspected in the ultrasound. Menopause status was significantly associated with pre-malignant or malignant changes. No significant association was found between the presence of abnormal uterine bleeding and polyp size with pre-malignancy or malignancy in the polyp. Conclusions Post-menopausal women with endometrial polyp, whether symptomatic or not, should be evaluated by hysteroscopic resection. Asymptomatic pre-menopausal patients, without any risk factor, should be followed up (AU)

Lung metastases of low grade phyllodes tumor of the prostate: histopathologic confirmation / Metástasis pulmonares de tumor filoides prostático: confirmación histopatológica

Objective: Phyllodes tumor of the prostate is a rare neoplasm. We report the clinical, histopatho-logical, and immunohistochemical features of a low grade phyllodes tumor of the prostate with lung metastases. Methods: A 68-year-old man presented acute urinary obstruction. Suprapubic prostatectomy was performed, and one month later he developed acute urinary obstruction, shortness of breath and cough. Results: Microscopically, the prostatic tumor showed elongated ducts and cellular stroma. Lung biopsy was composed of stromal cells with enlarged, hyperchromatic nuclei. Conclusion: This case represents a typical low grade prostatic phyllodes tumor to lung. Grading of these neoplasm is not always of value to predict patient prognosis (AU)

Objetivo: El tumor phyllodes de la prostata es una rara neoplasia. Nosotros reportamos los hallazgos clínicos, histopatológicos e inmunohistoquímicos de un tumor phyllodes de la prostata con metastasis pulmonar. Métodos: Un paciente de 68 años sufrió de obstrucción urinaria aguda. Se practicó una prostatectomía suprapúbica, un mes después desarrollo obstrucción urinaria, dificultad respiratoria y tos. Resultados: Microscópicamente, el tumor prostático mostró ductos elongados y estroma celular. La biopsia pulmonar estaba compueta de células estromales con núcleos hipercromáticos, alargados. Conclusión: Este caso representa un típico phyllodes prostático de bajo grado metastizando al pulmón. La gradación de stas neoplasias no es siempre de valor para predecir el pronóstico (AU)

Tumores estromales yeyunales y hemorragia digestiva oculta. Empleo de técnicas mínimamente invasivas en tres casos clínicos / Stromal tumors of the jejunum and obscure gastrointestinal bleeding. Use of minimally invasive techniques in three cases

Se considera hemorragia digestiva oculta cuando las técnicas habituales endoscópicas (esofagogastroscopia y colonoscopia) no encuentran el origen de la hemorragia. Esta hemorragia supone el 5% de todas las hemorragias digestivas. El 27% de las hemorragias ocultas son por lesiones de intestino delgado; los tumores estromales (GIST) son una causa frecuente, fundamentalmente en pacientes de mediana edad. Presentamos 3 casos que reflejan la dificultad en el diagnóstico de este cuadro clínico y destacamos el empleo de técnicas poco invasivas, como la tomografía computarizada y la cirugía laparoscópica, en el complicado manejo de estos enfermos. Creemos que la incorporación de estas técnicas podría evitar otros procedimientos más agresivos y permiten aplicar el tratamiento definitivo quirúrgico de forma temprana con las ventajas de la cirugía laparoscópica (AU)

Gastrointestinal bleeding is considered to be obscure when routine endoscopic techniques (esophagogastroscopy and colonoscopy) fail to identify the origin of the hemorrhage. These hemorrhages represent 5% of all gastrointestinal bleeding. Twenty-seven percent of these hemorrhages are due to small bowel disease and gastrointestinal stromal tumors (GIST) are a frequent cause, especially in middle-aged patients. We present three cases that illustrate the difficulty of diagnosing this clinical entity. We emphasize the use of minimally invasive techniques such as computed tomography and laparoscopic surgery in the complicated management of these patients. We believe that the use of these techniques could avoid the need for other more aggressive procedures and allow the application of early definitive surgical treatment with the advantages of laparoscopic surgery (AU)

Granuloma periférico de células gigantes: análisis inmunohistoquímico de la población celular en tres casos clínicos / Peripheral giant cell granuloma: immunohistochemical analysis of different markers. Study of three cases

El granuloma periférico de células gigantes (GPCG) es una lesión de tejido blando no neoplásica ocasionada por una reacción hiperplásica a consecuencia de un traumatismo o inflamación. Es una lesión reactiva del tejido blando que se desarrolla exclusivamente en la cavidad oral y con una ligera predilección en el sexo femenino. La localización habitual de GPCG es en la región de los premolares y la mucosa de la cresta alveolar edéntula. Se presentan tres casos con GPCG (dos hombres y una mujer) con una edad comprendida entre los 25 y 35años. Todos los pacientes se trataron con resección quirúrgica y ninguno sufrió recidivas. Con el propósito de determinar el posible origen de las células estromales mononucleares y de las células gigantes multinucleares, las muestras de cada caso se estudiaron mediante inmunohistoquímica (marcadores CD-68, CD-34 y α-1antitripsina) con el fin de evaluar la expresión del linaje endotelial y del linaje monocito/macrófago. Los resultados inmunohistoquímicos mostraron una marcada positividad difusa de CD-68 en las células estromales mononucleares y en las células gigantes multinucleadas. Estas últimas resultaron ser inmunonegativas para CD-34 y sólo puntualmente positivas para α-1 antitripsina. Estos resultados sugieren que las células gigantes multinucleares poseen un fenotipo osteoclástico, proviniendo del linaje monocito/macrófago, y que no derivan del linaje de las células endoteliales de los capilares. Se establece la importancia de un exhaustivo diagnóstico y de una exéresis quirúrgica completa de la lesión (curetaje óseo) con el propósito de evitar la reabsorción del diente y hueso adyacente (AU)

Peripheral giant cell granuloma (PGCG) is a non-neoplastic lesion representing a local hyperplastic reaction to injury or inflammation. It is known to be a reactive soft tissue lesion that develops only within the oral cavity, with a slightly predilection for female sex. The usual localization for PGCG is the premolar region and the crest of the edentulous ridge. This study presents three cases of PGCG, including 2 male and 1 female, with an age comprised between 25 and 35 years. All patients were treated with resection biopsy and no one relapsed. With the aim of determine the probable origin of stromal mononuclear cells and multinuclear giant cells, each case was then studied by immunohistochemistry to evaluate the expression of endothelial and monocyte/macrophage lineage. Immunohistochemical results showed a strong diffuse positivity for CD-68 in round mononuclear stromal cells and in multinucleate giant cells. These latter were immunonegative for CD-34 and only focally positive for α-1 antitrypsin. These results suggest that multinucleated giant cell shows an osteoclast phenotype and that probably derive from monocyte/macrophage lineage and that do not derive from the endothelial cells of the capillary. In second instance, we underlined the importance of an exhaustive dia (AU)

Tumor mixto de la estroma endometrial y del músculo liso: recurrencia atípica. Presentación de un caso y revisión de la bibliografía / Mixed endometrial stromal and smooth muscle tumor: atypical recurrence. Case report and review of the literature

Los tumores mixtos de la estroma endometrial y del músculo liso son tumores raros. Para clasificar un tumor dentro de este grupo debe presentar al menos un 30% de cada tipo celular, y diagnosticarse por la evaluación con microscopio óptico. Clásicamente se denominaban «stromomyomas». El comportamiento de los tumores mixtos de la estroma endometrial y del músculo liso suele ser benigno. En este caso la paciente presentó una recurrencia pélvica, con un tumor puro únicamente de músculo liso al año de la primera intervención (AU)

Mixed endometrial stromal and smooth muscle tumors of the uterus are unusual. For tumors to be classified within this group, at least 30% of each component must be present and diagnosis must be based on light microscopy. Traditionally these tumors were named stromomyomas. Mixed endometrial stromal and smooth muscle tumors are usually benign. In the present case, the tumor recurred in the pelvis 12 months after surgery as a pure smooth muscle tumor (AU)

HPLC-RIA analysis of steroid hormone profile in a virilizing stromal tumor of the ovary.

The pathological steroid biosynthesis of a virilizing ovarian tumor was examined via high performance liquid chromatography-radioimmunoassay (HPLC-RIA) determination of the intratissular steroid concentrations. Sex cord-stromal tumor of the ovary was obtained surgically from an 18-year-old female patient with extremely high androst-4-ene-3,17-dione (4-en-dione) and testosterone (Test) blood serum levels. The tissue specimen was extracted with ethyl acetate and the extract was then purified on a C18 mini-column with methanol-water eluents. Steroids were isolated by reversed-phase HPLC on a C18 silica gel column with 51%, 55% and 64% v/v methanol-water eluents. Steroids in the collected eluent fractions were detected by the radioactivity of tritiated internal standards and then quantified by specific RIAs. In the tumor specimen, very high 17alpha-hydroxyprogesterone (17-OH-Prog; 6300 fmol/g), dehydro-epiandrosterone (2870 fmol/g), androst-4-ene-3,17-dione (3000 fmol/g), testosterone (5700 fmol/g) concentrations, and less progesterone (PROG; 320 fmol/g) and androst-5-ene-3beta,17beta-diol (5-en-diol; 320 fmol/g), were determined. Tissue levels of 5alpha-dihydrotestosterone (DHT), 5alpha-androstane-3alpha,17beta-diol (3alpha-diol), 5alpha-androstane-3beta,17beta-diol (3beta-diol), and 17beta-estradiol were found to be 71, 20, 28, and 12 fmol/g, respectively. Steroid profile analysis verified a pathological steroid biosynthesis in the ovarian tumor and suggested that the 17alpha-hydroxylase (17alpha-H), 17,20-lyase (17,20-L), and 3beta-hydroxysteroid dehydrogenase/Delta5-4-isomerase (Delta5-3beta-HSD) activities were particularly elevated in this tumorous tissue. Present data demonstrate that the analysis of intratissular steroid profile by a HPLC-RIA method may valuably contribute to the steroidal pathophysiology of endocrine tumors.