A practical approach to diagnose soft tissue myeloid sarcoma preceding or coinciding with acute myeloid leukemia.

Myeloid sarcoma involving soft tissue is rare and may present a pathologic diagnostic challenge, particularly when it precedes or coincides with hematological malignancies. Furthermore, it may mimic non-Hodgkin lymphoma, poorly differentiated carcinoma, melanoma, or round blue cell tumors, which is a potential diagnostic pitfall. In addition to a retrospective review of myeloid sarcoma (MS) cases seen at our institution, we describe differential diagnoses, diagnostic pitfalls, and practical approaches to diagnosing soft tissue MS preceding or coinciding with acute myeloid leukemia. Our institutional retrospective review (1999-2011) of MSs identified 12 cases of MS in which there was no known blood or bone marrow involvement at diagnosis. A panel of immunohistochemical stains and/or flow cytometry was reviewed; marker selection was subject to the pathologist's discretion. These tumors were consistently positive for CD117 (9/9), CD43 (7/7), myeloperoxidase (8/10), CD68 (4/5), and CD34 (5/9) by flow cytometry and/or immunohistochemistry. We also described a referral case, which had classic MS morphology and a myelomonocytic immunophenotype including positivity for CD45, lysozyme, and CD117 with supporting molecular information. Based on our institution's experience and review of the literature, we recommend that when the index of suspicion for MS is high, an immunohistochemical stain and/or flow cytometry panel should include CD43, lysozyme, CD117, CD68, CD33, Human Leukocyte Antigen DR (HLA-DR), and myeloperoxidase, in addition to thorough review of the patient's history, cytogenetic studies, and proper discussion with the clinician.

Multimodality imaging of a rare intracardiac bronchogenic cyst.

The authors report a case of pathologically proven intracardiac bronchogenic cyst embedded within the interatrial septum of a 30-year-old woman presenting with chest pain and first-degree AV block. Multimodality imaging played an essential role in the discovery, investigation, and diagnosis of this extremely rare entity.

Targeted cellular ionic calcium chelation by oxalates: Implications for the treatment of tumor cells.

BACKGROUND: In malignant melanoma, it has been published that up to 40% of cancer patients will suffer from brain metastasis. The prognosis for these patients is poor, with a life expectancy of 4 to 6 months. Calcium exchange is involved in numerous cell functions. Recently, three types of cellular calcium sequestration have been reported in the medical literature. The first describes a transgenic mouse model in which an increase of aberrant calcium channels triggers hypertrophy and apoptosis. The second provides a protective mechanism whereby astrocytes in the brain inhibit apoptosis of tumor cells by moving ionic calcium out of the tumor cells thru gap junctions. The third is via calcium chelation, which causes cell apoptosis by converting ionic calcium into a calcium salt. This process has been shown to operate in atrial myocardial cells, thus not allowing the intracellular calcium stores to flow through the myocytes intercalated discs. Ideally chemotherapeutic agents would be those that initiate apoptosis in tumor cells. PRESENTATION OF THE HYPOTHESIS: We hypothesize that the recent reported intracellular calcium sequestration by oxalate chelation, due to its chemical process of converting ionic calcium into a calcium salt, may inhibit the protective effect of astrocytes on brain tumor metastasized melanoma cells by not allowing free calcium to leave the metastatic cells, simultaneously apoptosis of tumor and some healthy adjacent cells could occur. This hypothesis could be extended to include other cancerous tumors such as skin cancers amongst others. TESTING THE HYPOTHESIS: Using the experimental model showing the protective mechanism of co-cultured reactive astrocytes and tumor cells treated with oxalates could be used to test this hypothesis in vitro. The calcium specific von Kossa technique could be used to confirm the presence of chelated intracellular calcium architecture of the metastatic cells (which is a sign of apoptosis), and extracellular calcium chelation stores of the Astrocytes (which has been shown to slow neural conduction). IMPLICATIONS OF THE HYPOTHESIS: The life expectancy in patients with metastasized malignant melanoma brain tumors could be significantly prolonged if the chemotherapeutic issue of brain metastasis is overcome. Other cancerous tumors can also be treated by this Targeted Chelation Approach. Ionic calcium sequestration using naturally occurring calcium chelators, viz., oxalates, could accomplish this desired outcome.

Cardiac Myxoma with Cerebral Metastases and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Case Report and Review.

Background Cardiac myxomas, the most common primary cardiac tumors, are generally benign neoplasms. Primary cardiac lymphoma is a rare cardiac malignancy with a very poor prognosis. Here we present a case of a cardiac myxoma with cerebral metastases and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) arising within the cerebral metastases. Case description A 62-year-old man, who presented with symptoms of multiple transient ischemic attacks, was found to have a left atrial myxoma. Twelve months after excision of the myxoma, the patient experienced a recurrence of neurologic symptoms. Brain magnetic resonance imaging revealed multiple hemorrhagic masses. Craniotomy was performed to resect the lesions. Histopathologic examination confirmed cardiac myxoma metastases and a small lymphocytic infiltrate within the tumor consistent with CLL/SLL. Conclusion Including the present case, there are 27 cases of cardiac myxoma cerebral metastases and 22 cases of lymphomas arising within myxomas. The present case is the first known instance of both entities in the same patient. There is no standard management for either cardiac myxoma metastases or lymphoma within a myxoma. For both diseases, surgical excision is the primary treatment modality, but postoperative chemotherapy and/or radiation have been attempted. Myxomas may create a chronic inflammatory state that could lead to the development of CLL/SLL.

Expression of inhibitory receptor ILT3 on neoplastic B cells is associated with lymphoid tissue involvement in chronic lymphocytic leukemia.

T cell responses against leukemia-associated antigens have been reported in chronic lymphocytic leukemia (CLL). However, the relentless accumulation of CLL B cells in some patients indicates that anti-tumor immune responses are inefficient. Inhibitory receptors from the Ig-like transcript (ILT) family, such as ILT3 and ILT4, are crucial to the tolerogenic activity of antigen presenting cells. In this study, we examined the expression of ILT3 on CD5+ B cells obtained from 47 patients with CLL. Using flow cytometry and RT-PCR, we found that B CLL cells from 23 of 47 patients expressed ILT3 protein and mature ILT3 mRNA. ILT3 protein and mRNA were not found in normal B cells obtained from donors without CLL. Expression of ILT4 in normal and B CLL cells showed a pattern similar to ILT3. The frequency of ILT3 positive CLL B cells was higher in patients with lymphoid tissue involvement, suggesting that ILT3 may have prognostic value in CLL. Our findings indicate that expression of ILT3 and ILT4 on CLL B cells represents a phenotypic abnormality that may play a role in tolerization of tumor-specific T cells.

In vivo Technique for Cellular Calcium Waves Documentation: A Light Microscopy Method.

BACKGROUND: We are introducing a novel in vivo technique to document cellular calcium deposits, which reflect a snapshot of the effect of calcium wave propagation. This technique however is not advocated enough to replace the accuracy and resolution of the confocal laser technique. Light microscopy equipment, calcium chelators and a histological calcium staining kit are essential. AIMS: The purpose of this study is to introduce the use of standard light microscopy to display in vivo ionic cellular calcium deposits. MATERIALS AND METHODS: Oxalic Acid (OA) (100 millimol) was the calcium chelator used in the study. This substance was injected into the dog right atrial tissue in vivo in an area of 1 cm(2). Samples were fixed and stained by the calcium specific von Kossa protocol. RESULTS AND CONCLUSIONS: Histological slides demarcated the intracellular calcium as black dots. Heterogeneity of calcium deposits mimicked images of both, the calcium sparks and calcium waves theories. This light microscopy technique could expand the number of experimental studies in the function of cellular calcium physiology.

Como Cirujanos ¿Qué sabemos de publicar? / As surgeons, What do we know about publishing

La publicación de un artículo científico es la culminación de todo trabajo de investigación. Las guías internacionales de publicación determinan las normas actuales para autores de manuscritos. El objetivo de este trabajo era determinar el grado de conocimiento de los conceptos de publicación sobre revisión por pares, autoría, conflicto de intereses y publicación secundaria aceptable de los cirujanos graduados y de los residentes de cirugía...

Comportamiento clínico de la apendicitis aguda / Acute appendicitis clinic comportment

Se revisaron 98 de 174 casos de apendicectomía por diagnóstico clínico de apendicitis aguda, de junio a octubre de 1995, en el Hospital General de Enfermedad Común del Instituto Guatemalteco de Seguridad Social, en busca de marcadores clínicos que pudieran diferenciar los distintos estadios patológicos de la enfermedad, clasificándose en base al diferenciar los distintos estadios patológicos de la enfermedad, clasificándole en base al estudio anatomopatológico de las piezas quirúrgicas. Estos estadios son cuatro: apéndice normal, apendicitis fase edematosa, apendicitis fase supurativa y apendicitis fase gangrenosa. Se revisaron los expedientes en busca de datos sobre el recuento de globulos blancos (RGB), recuento diferencial (RD) velocidad de eritrosedimentación (V/S), tiempo de evolución (TE), síntomas y signos clínicos y se sometieron a análisis estadístico. Se encontraron asociaciones estadísticamente significativas que permitieron detectar marcadores clínicos para cada fase