[Squamous cell carcinoma arising on an epidermal inclusion cyst: a case presentation and review of the literature]. / Carcinoma epidermoide desarrollado sobre quiste de inclusión epidérmica cutáneo. Presentación de un nuevo caso y revisión de la literatura.

Epidermal inclusion cysts are very common lesions that very rarely undergo malignant transformation-in the English-language literature we have only found 18 adequately documented cases. We present the case of a man with a 2-month history of a retroauricular skin lesion in which histological study revealed squamous cell carcinoma arising on an epidermal inclusion cyst. Cysts that grow rapidly, reach a large size, ulcerate, develop a fistula, or that do not respond to medical treatment, and those that recur should be excised completely and histological study performed of the whole lesion.

[Juvenile xanthogranuloma of the penis]. / Xantogranuloma juvenil de pene.

We report a case of juvenile xanthogranuloma of the penis in a 30 year old patient with clinical suspicion of epidermoid cyst. Histology and ethiopathogenesis are reviewed, with special emphasis on the differential diagnosis with other similar lesions with worst prognosis.

[Soft tissue metastases by micropapillary bladder carcinoma. Metastatic disease]. / Metástasis en partes blandas por un carcinoma micropapilar de vejiga.

Micropapillary transitional cell carcinoma is a rare (incidence of 0.7%) and highly aggressive variant of bladder carcinoma. Morphologically, it is characterized by small tight clusters of neoplastic cell floating in clear spaces resembling lymphatic channels. Its usual presentation is like a high grade and stage carcinoma and most often is associated with a variable component of conventional carcinoma or other variants. The usual sites of bladder cancer metastases are the lymph nodes, lungs, bone and liver. Soft tissues metastases from transitional cell carcinoma of the bladder occur infrequently. We report the cases of a 77-year-old man presenting with an abdominal soft tissue mass a six years after local excision of a micropapillary bladder carcinoma.

[Expression of cytokeratin 5 and calretinin in clear-cell renal cell carcinoma]. / Expresión de citoqueratina 5 y calretinina en el carcinoma renal de células claras.

PURPOSE: Cytokeratin 5 (CK5) and calretinin have been useful in different studies as immunohistochemical markers suggestive of mesothelioma, and their expression is analyzed for the histological differential diagnosis with adenocarcinomas, specially when confronting with metastatic tumors of unknown origin. We have analyzed the expression of CK5 and calretinin in clear cell renal cell carcinoma. METHODS: A series of 63 clear cell renal cell carcinomas was studied. 46 of these cases were embedded in two tissue arrays, and a second group, of 17 cases, was constituted by conventional paraffin blocks from high-grade tumors (grade 4 of Fuhrman). Immunohistochemical staining was performed with monoclonal antibodies against CK5 and calretinin, following the labeled sptreptavidin-biotin technique. RESULTS: No positivity for calretinin was observed in any case, while CK5 was focally expressed, in an isolated group of cells, in 1 of the 63 cases (1,59%) which corresponded to a high-grade carcinoma (grade 4 of Fuhrman). CONCLUSIONS: Expression of calretinin was not observed in clear cell renal cell carcinoma and positivity for CK5 occurred only in one case, in a very small proportion of tumor cells. Therefore, in practice, although the positivity for these markers cannot completely exclude renal cell carcinoma, this result is very rare in this tumor and other diagnostic posibilities should be considered.

[Verrucous carcinoma of the penis arising from a lichen planus. A true preneoplastic lesion?]. / Carcinoma verrucoso de pene desarrollado sobre un liquen plano. Una auténtica lesión preneoplásica?

INTRODUCTION: Up to 30% of squamous cell carcinomas of the penis arise from a lichen sclerosus, but very few reports in which lichen planus was the preexisting lesion have been published. We report a male with verrucous carcinoma of penis that developed in an area of lichen planus. CLINICAL CASE: A 53-year-old male presented with an exophytic tumor on the glans penis that had been present for about 6 months. The lesion developed in a previously biopsied area of lichen planus hypertrophicus. After excision, histological diagnosis was verrucous carcinoma. COMMENT: The development of any subtype of squamous cell carcinoma of penis in a lichen planus can be coincidental, or a neoplastic transformation of lichen planus can take place.

[Expression of CD10 and renal cell carcinoma marker in clear cell renal cell carcinoma: analysis on tissue arrays]. / Expresión de CD10 y del marcador de carcinoma renal en el carcinoma renal de células claras: análisis en matrices tisulares.

OBJECTIVES: CD10 and renal cell carcinoma (RCC) marker antibodies react against proteins of the epithelium of the renal proximal tubule, being expressed by renal cell carcinomas. The frequence and pattern of expression of both markers are analysed in a series of clear cell renal cell carcinomas. METHOD: Two tissue arrays were used, which were composed of cylinders obtained with a 16G needle from 40 paraffin blocks that corresponded to clear cell renal cell carcinomas. The labeled streptavidin-biotin technique was performed (LSAB2, Dako) using CD10 and RCC monoclonal antibodies (Novocastra), testing different antigen retrieval methods for RCC. Immunoreactivity was evaluated as + (isolated cells or focal staining); ++ (moderate) and +++ (extense). RESULTS: Thirty cases (75%) were positive for CD10: 12 +; 5 ++ and 13 +++. The best antigen retrieval method for RCC was a double enzyme digestion (trypsin + protease). Twenty cases (50%) were positive for RCC: 7 +; 5 ++ and 8 +++. Four cases out of the 20 immunoreactive for RCC were negative for CD10. The 16 remaining cases also expressed CD10. CONCLUSIONS: CD10 and RCC are often expressed by clear cell renal cell carcinomas, and they may be useful markers to suggest a renal origin of carcinomas. RCC is less sensitive than CD10. Staining for both of them is usually focal, and thus sensitivity of these techniques decreases when small samples are investigated, such as tissue arrays. The antigen retrieval method is essential for RCC immunohistochemical detection, obtaining the best results with the use of proteolytic enzymes.

[Conjunctival inclusion cyst after strabismus surgery by hang-back recession]. / Quiste conjuntival de inclusión tras cirugía de estrabismo según técnica de retroinserción en asa.

CASE REPORT: A 24-year-old woman, with a history of infantile esotropia and DVD operated on in infancy, had strabismus surgery performed by us. Four months later she presented with a cystic lesion that recurred after drainage and medical treatment. Complete excision of the cystic lesion was therefore performed. DISCUSSION: The epithelial cells implanted on the sclera at the time of the most recent surgery may have been the origin of inclusion cyst which developed after the strabismus surgery. This suggests a possible relationship with the scleral suture as the mechanism of cyst formation, independent of the muscle position. Complete excision is the recommended treatment for large cysts.

[Primary non-Hodgkin large B-cell lymphoma of bladder. Report of a case]. / Linfoma no hodgkin B de célula grande primario de vejiga. Presentación de un caso.

INTRODUCTION: primary genitourinary lymphomas are uncommon. Among them, bladder lymphomas are extremely unusual tumors, with clinico-radiological features similar to urothelial carcinomas of bladder. Histopathological, immunohistochemical and molecular studies are compulsory for the diagnosis. We report a case of this tumor. CLINICAL CASE: An 80-year-old woman was admitted to our hospital with hematuria. Abdominal ultrasound and cystoscopy revealed an infiltrating bladder tumor involving the right lateral wall. After transuretral biopsy, a diagnosis of non-Hodgkin large B-cell lymphoma was made. Neither clinical symptoms nor radiological findings showed disseminated disease, indicating that the tumor was localized in the bladder. After chemotherapy, the patient is disease-free after 9 months follow-up. COMMENT: if a bladder tumor with uncommon histopathological features is found, lymphoma should be excluded, because chemotherapy avoids cystectomy.

[Bilateral adrenal metastasis as first clinical manifestation of pulmonary carcinoma: report of a case and review of the literature]. / Metástasis adrenal bilateral como primera manifestación clínica de un carcinoma pulmonar: presentación de un caso y revisión de la literatura.

Bilateral adrenal metastases are rare, and the first manifestation from non-small cell lung cancer is also exceptional. We report a case of bilateral adrenal metastases from a poorly differentiated lung adenocarcinoma in a 50 year-old-man. The treatment was local excision of tumor and the diagnosis was histological. We comment the clinical presentation, diagnosis, treatment and evolution of this case, with special attention to the histopathological analysis of this lesion and literature review.

[Expression of CDX2 in urinary bladder and urethra lesions]. / Expresión de CDX2 en lesiones de vejiga urinaria y uretra.

BACKGROUND: CDX1 and CDX2 are transcription factors involved in the development and maintenance of the intestinal epithelial cell. Expression of CDX2 has been reported in normal and metaplastic intestinal epithelium, and in those adenocarcinomas with that cellular origin. We have analyzed the expression of this marker in reactive and tumoral lesions arising in urinary bladder, urethra and urachus. METHOD: CDX2 was investigated through immunohistochemistry on paraffin-embedded tissue, using the labelled streptavidin-biotin method (LSAB2, Dako) with a monoclonal antibody (CDX2-88, BioGenex). RESULTS: Expression of CDX2 was observed in intestinal-type cistitis glandularis, intestinal metaplasia of urinary bladder, bladder adenocarcinoma, mucinous urothelial-type carcinoma of prostatic urethra and urachal mucinous carcinoma. CDX2 was not detected in normal urothelium and prostatic glandular epithelium, Von Brunn nests, typical-type cistitis glandularis, glandular adenosis and transitional carcinoma. CONCLUSIONS: Lesions, both benign and malignant, with enteric-cell morphological features show positivity for CDX2. Expression of this marker is not organ-specific but is just related to a cellular phenotype. Reactivity for CDX2 in an adenocarcinoma can be consistent with an origin in urinary tract or urachus.

[Diffuse involvement and rapid progression of high-grade transitional carcinoma in a kidney transplant recipient]. / Afectación difusa y progresión rápida de un carcinoma transicional de alto grado en un paciente trasplantado renal.

In renal transplant patients, an increased risk of cancer has been seen, higher than in the general population, and the more frequent genitourinary neoplasms are the kidney and bladder ones. Moreover, in those patients the pattern of tumor growth is very rapid, with early tendency to local and systemic dissemination. The case here presented, a patient with kidney transplant 3 years before, with high grade, superficial transitional cell carcinoma involving the whole bladder, the pelvis and the ureter of the right native kidney, shown this fast progression. Four months after radical cystectomy plus bilateral nephroureterectomy, the disease progressed to intraperitoneal and hepatic metastases.

[Adenocarcinoma in ileocystoplasty]. / Adenocarcinoma en ileocistoplastia.

Case report of an adenocarcinoma in ileocystoplasty in a 54-year old female that at the age of 24 had undergone right nephrectomy and partial cystectomy surgery followed by vesical extension with ileon due to urinary tuberculosis. Discussion on the rare incidence of this condition, its diagnostic features, the need for long-term follow-up and the relevance of a broad resection of the affected intestinal portion.

["Evanescent" prostate carcinoma]. / Carcinoma "evanescente" de la próstata.

Occurrence of prostatectomy sections with minimum or no tumour volume have been increasingly seen over the last few years in spite of a preoperative histology-based diagnosis of adenocarcinoma with a needle biopsy ("evanescent cancer phenomenon" ECP). Our group has reviewed 145 prostatectomies performed in our hospital between January 1988 and October 1997, and found 3 cases of ECP (2%). To explain this phenomenon patients must be divided into two groups. In those who receive preoperative hormonal blockade, treatment may result in a drastic reduction of tumoral volume as well as microscopic changes that make malignancy recognition more difficult. ECP occurs in less than 5% of these prostatectomies. In patients with no previous hormonal treatment, ECP is extremely rare and any explanation comes as a consequence of the extended use of screening methods that lead to the detection of very small tumours, probably of little clinical relevance, that are found in the needle biopsy. Subsequently, however, no residual neoplasia is seen in the section either due to technical limitations of the pathoanatomical methods or because of a true, complete ablation of the lesion through the biopsy.

[Hyperplasia of adrenal rests in the testicle: a rare cause of male infertility]. / Hiperplasia de restos adrenales en el testículo: una causa infrecuente de infertilidad masculina.

We report the case of a 37-year-old man with infertility caused by bilateral testicular masses secondary to congenital adrenal hyperplasia (21-hydroxylase deficiency). Testicular biopsy was done and its was initially interpreted as Leydig cell tumor but after clinical information was histologically reclassified as tumor of the adrenogenital syndrome. The differential diagnosis with Leydig cell tumor is discussed and it must be established through the clinical, biochemical, radiological and pathological features.

[Coordinated expression of cytokeratin 7 and 20 in transitional carcinoma of the bladder: diagnostic usefulness]. / Expresión coordinada de citoqueratinas 7 y 20 en el carcinoma transicional de vejiga: utilidad diagnóstica.

BACKGROUND: Cytokeratins are intermediate filament proteins which are part of the framework of eucariotic cells. A characteristic pattern of expression of cytokeratins has been described for each type of epithelium. This pattern is maintained during the process of malignancy and metastasis. Immunohistochemical analysis of cytokeratins 7 and 20 (Ck 7 and Ck 20) has been considered particularly useful for identifying the origin of carcinomas. METHODS: A total of 122 cases of transitional cell carcinoma of urinary bladder were studied immunohistochemically with monoclonal antibodies against Ck 7 and Ck 20. The peroxidase labelled-streptavidin biotin technique was performed. Cases were considered positive when at least 1% of tumoral cells were stained. RESULTS: All cases investigated expressed Ck 7 whereas Ck 20 was positive in 75% of them. Reactivity for Ck 20 was always focal. No tumor was negative for Ck 7. CONCLUSION: Ck 7+/Ck 20+ immunophenotype is highly characteristic of transitional cell carcinoma of urinary bladder, whereas Ck 7+/Ck 20- is less frequent. Immunohistochemical determination of these cytokeratins is useful for the diagnosis when tumors are poorly differentiated and for identifying the primary site of metastatic carcinomas.

[A retroperitoneal cellular schwannoma]. / Schwannoma celular retroperitoneal.

We report the case of a 68-year-old woman with a cellular schwannoma in the retroperitoneum, which recurred 16 months after resection. This rare tumor is generally considered as benign in spite of its pseudosarcomatous histologic appearance. Immunohistochemical positivity for S-100 protein is very useful for the diagnosis. Recommended treatment is surgical excision but incomplete resections can be followed by recurrences.

[Comparative study of the expression of p53, Ki-67, bcl-2 and CK20 in superficial transitional carcinoma of the bladder: correlation with recurrence, histological grade, and clinical stage]. / Estudio comparativo de la expresión de p53, Ki67, bcl-2 y CK20 en el carcinoma transicional superficial de vejiga: correlación con la recurrencia, grado histológico y estadio clínico.

OBJECTIVE: We examined the presence of p53, Ki-67, bcl-2 and CK20, as detected by immunohistochemistry, and correlated with the classic variables (grade, stage and recurrence). MATERIAL AND METHOD: The authors evaluated 57 superficial transitional cell carcinomas. Biopsy specimens examined included non recurrent transitional cell carcinomas (n = 36) and recurrent transitional cell carcinomas (n = 21). Association of bcl-2, p53, Ki-67 y CK20 index immunoreactivity with tumor grade, clinical stage and tumor recurrence was examined. RESULTS: Ki-67 and p53 expression were related to the degree of differentiation and recurrence of the disease. bcl-2 and CK20 were not correlated with grade, stage and recurrence of the disease. CONCLUSIONS: Positivity for Ki-67 and p53 increase with grade of the disease. P53 and Ki-67 are predictors of tumor recurrence for patients with superficial transitional cell carcinoma.

[Renal failure secondary to granulomatous interstitial nephritis as initial manifestation of sarcoidosis]. / Insuficiencia renal secundaria a nefritis intersticial granulomatosa como primera manifestación de la sarcoidosis.

Sarcoidosis is a rare cause of renal failure and it has been associated with a wide spectrum of renal manifestations, including granulomatous interstitial nephritis. We present the case of a 48-year old male patient with rapidly progressive renal insufficiency due to sarcoid normocalcemic granulomatous interstitial nephritis who lacked the pulmonary signs of sarcoidosis. Prednisone therapy yielded a favorable outcome with fall in serum creatinine level and resolution of abnormalities of the urinary sediment.

[Refractory idiopathic liquefying panniculitis]. / Paniculitis lobular licuefaciente idiopática refractaria.

We present a 28-year-old patient with liquefying idiopathic lobular panniculitis, a variant of the Weber-Christian's disease and intermittent episodes of arthritis in the left foot refractory to sequential treatment with anti-inflammatory drugs, high doses of prednisone, chloroquine, dapsone, colchicine, cyclosporine and methotrexate.

[Delay in the diagnosis of McArdle's disease]. / Retraso en el diagnóstico de la enfermedad de McArdle.

We describe the case of a 14-year-old patient with fatigability and muscular cramps beginning in the first infancy and started by physical exercise. The clinical record, the increase of creatinine-kinase without clinical or biological signs of inflammation and the electromyographic normality, suggested the presence of this disease, which was confirmed through microscopic studies (optic and electronic) and histochemistry. We review the clinical and biological characteristics, the diagnostic methods for this type of glycogenosis and its differential diagnosis, because we think that the low suspicion levels among the clinicians contribute to the few cases published in the literature.