Prostatic remnants in mature cystic teratoma of the ovary.

Mature cystic teratomas of the ovary containing prostatic remnants are reported in 2 women aged 31 and 20 years. Both cases showed the expected histology of mature teratomas with a mixture of ecto- and endodermal structures lying in a fibrous stroma. In both cases, the foci of prostate tissue were composed of typical prostatic glands arranged in acinar structures. One case displayed a transitional cell-lined duct resembling the urethra. Prostate glands showed intense positive immunostaining with prostatic specific antigen and prostatic acidic phosphatase. Focal images suggesting high-grade prostatic intraepithelial neoplasia were detected in 1 case. The literature on this unusual finding in these common tumors is reviewed and commented on.

Orbital giant cell angiofibroma.

A case of giant cell angiofibroma in a 73-year-old man is reported. The tumour was located in the upper-inner quadrant of the right orbit and recurred 16 months after surgical removal. The clinicopathological features of this rare neoplasm--that is nowadays considered a variant of solitary fibrous tumour--are reviewed and briefly commented on.

Role of ultrasound-guided core biopsy in the evaluation of spleen pathology.

Core biopsy has not traditionally been recommended in the study of spleen nodules due to the supposed fragility of this organ leading to a high risk of post-core biopsy complications. A total of 13 patients who presented solid spleen nodules, diffuse splenomegaly, or both on imaging studies (CT, MR, US) were biopsied under ultrasound control with 18G BioPince needles. Cytological (imprints and cytocentrifugates) and histological material were obtained for diagnosis in every case. Malignant lymphomas were the most commonly found pathology (four diffuse large B-cell lymphomas, two follicular lymphomas, one Hodgkin's disease, one B-cell lymphoma, NOS). In addition, there was one littoral-cell angioma, one well-differentiated neuroendocrine carcinoma, metastatic, and one haemangioma. The remaining two cases showed congestive features, and supposed spleen involvement by lymphoma in one of them was ruled out. On follow up, there were no complications related to the core biopsy. Splenectomy was performed in six cases, two diagnostic and four therapeutic. We conclude that core biopsy is a safe and efficient method in the diagnosis of spleen nodules that could be considered in the routine diagnostic algorithm of these lesions.

Temporal bone secretory meningioma presenting as a middle ear mass.

A 44-year-old woman presented with a history of increasing left hypoacusis and sporadic vertigo. CT scan revealed a tumor occupying the mastoid, middle ear, and external auditory canal. After surgical removal, a typical secretory meningioma was diagnosed. The histological hallmark and the immunohistochemical profile of secretory meningiomas are reviewed. The differential diagnosis of this tumor in this location is also commented on. As far as we know, primary temporal bone meningiomas with secretory histology have not been previously reported in the medical literature.

Primary sinonasal ameloblastoma.

A case of primary ameloblastoma of the right sinonasal tract in a 66-year-old man is reported. The tumour presented as a radiographically solid mass filling the right nasal cavity and sinuses and without continuity with maxillary alveola. After radical surgery plus postoperative radiotherapy, the patient has pursued a non-aggressive clinical course after nine months of follow-up. The paper reviews the clinico-pathological features of this rare tumour and supports the theory of its sinonasal epithelium origin.

Usefulness and limitations of ultrasound-guided core biopsy in the diagnosis of musculoskeletal tumours.

Ultrasound-guided needle biopsy is a safe and efficient diagnostic method increasingly used in the initial approach to superficial and deep musculoskeletal tumours. However, so far no general consensus has been reached regarding its reliability. During a 6-year period (1999-2004), biopsies were taken from 188 patients (100 females, 88 males; age average 55.8 years) with musculoskeletal tumours under ultrasound guidance using 18G BioPince or 14G ProMag 2.2 true-cut type needles. Cytological (imprints and cytocentrifugates) and histological material was obtained for diagnosis in every case. The lower extremity (59 cases) and the abdominal wall (29 cases) were the most commonly affected sites. Benign/reactive tumours (77 cases), metastatic epithelial malignancies (40 cases), and sarcomas (36 cases) were most frequently diagnosed. In 180 (95.75%) cases, core needle results were concordant with the definitive diagnosis (97 true positives and 83 true negatives). Relevant diagnostic discordance was seen in 8 (4.25%) cases (8 false negatives and 0 false positives). Sensitivity, specificity and positive and negative predictive values were 92%, 100%, 100%, and 91%, respectively. Ultrasound-guided core biopsy is thus a useful method in the initial approach to musculoskeletal tumours that allows correct patient management in the vast majority of cases.

Basaloid squamous cell carcinoma of the head and neck: a clinicopathological and follow-up study of 40 cases and review of the literature.

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of cancer that mainly arises in the upper aerodigestive tract. This study reviews the clinico-pathological features and follow-up of a series of cases occurring in the head and neck. During a 32-year period (1974-2005), a total of 40 BSCCs have been diagnosed in the head and neck in our Institution. Males predominated in the series (35M/5F). The average age was 60.2 years (range, 40-85). Tobacco and alcohol consumption was found in more than 80% of the cases. Topographic distribution was as follows: larynx and hypopharynx, 22 cases (55%); oropharynx, 12 cases (30%); and oral cavity 6 cases (15%). The basaloid component predominated in 29 cases (72.5%). Vasculo-lymphatic invasion was detected in 5 cases (12.5%). Lymph node metastases were seen in 25 cases (62.5%, levels II and III in the neck dissection). Local recurrences appeared in 11 cases (27.5%) and distant metastases in 6 (15%). In 7 cases (17.5%) a second primary tumour was detected. The 2002 TNM staging was as follows: Stage I, 5 cases (12.5%); Stage II, 7 cases (17.5%); Stage III, 8 cases (20%), and Stage IV, 20 cases (50%). On follow-up, 21 cases (52.5%) are alive and 19 (47.5%) died of disease. Three- and 5-year overall survival was 50% and 38.5%, respectively. A significant shorter survival was detected in node positive patients (P<0.05).

Hipertrofia adiposa del septo interauricular. Presentación de un caso quirúrgico / Lipomatous hypertrophy of the atrial septum. Report of a surgical case

Introducción: La hipertrofia adiposa del septo interauricular es cada vez más frecuentemente reconocida gracias al desarrollo creciente de las técnicas de imagen no invasivas. Presentación del caso: Se presenta el caso de una paciente de 72 años de edad aquejada de angina de esfuerzo a la que en el estudio clínico se detectó una hiperplasia adiposa del septo interauricular. El estudio de la pieza de resección quirúrgica mostró la histología típica de esta entidad, con adipocitos maduros y lipoblastos entremezclados con fibras musculares cardiacas. Conclusiones: Aunque esta patología es relativamente frecuente, rara vez necesita ser corregida quirúrgicamente, motivo por el cual los patólogos la suelen diagnosticar en el estudio autópsico. Se revisa la literatura reciente en relación con las lesiones adiposas auriculares

Introduction: Lipomatous hypertrophy of the atrial septum is diagnosed more frequently after the use of non-invasive imaging techniques. Case presentation: A case of lipomatous hypertrophy of the atrial septum in a 72 year-old woman who consulted because of effort-related angina is reported. The study of the excised tissue fragments showed the typical histology, with mature adipocytes and lipoblasts intermingled with cardiac muscle fibres. Conclusions: This lesion is relatively frequent but surgical treatment is rarely needed. So, pathologists take contact with it mainly in the autopsy. The recent literature related to atrial lipomatous lesions is reviewed (AU)

El adenocarcinoma de próstata en los años 1999 y 2006. Diferencias en el estudio comparativo de biopsias transrectales y de prostatectomías radicales / Prostate adenocarcinoma in 1999 and 2006. Differences in the comparative study of core biopsies and radical prostatectomies

Antecedentes: El incremento en el diagnóstico del cáncer de próstata en la última década en nuestros hospitales ha llevado consigo un aumento similar en el número de prostatectomías radicales. En este trabajo se analizan las diferencias histológicas observadas entre los pacientes tratados con cirugía radical en los años 1999 y 2006 y se evalúa la evolución habida en la indicación de cirugía radical en un lapso de 7 años. Métodos: Se analizan de forma comparativa los datos histológicos de las prostatectomías radicales, y de sus biopsias transrectales previas, diagnosticadas en 1999 y en 2006. Sólo se han incluido en el análisis los casos con la totalidad de los datos evaluables tanto en la biopsia como en la cirugía. En las biopsias transrectales se valoran la afectación uni o bilateral, el número de focos de tumor, los milímetros totales de tumor, la presencia de PIN de alto grado, el índice de Gleason, y la invasión perineural. En las prostatectomías radicales se evalúa el estadio (pT), el índice de Gleason, la presencia de PIN de alto grado, la invasión de los bordes, la afectación del ápex, la invasión perineural y vascular, la extensión extraprostática, y la invasión de las vesículas seminales. El estudio estadístico comparativo entre ambos grupos se realiza mediante pruebas de c2, t de Student, y Mann-Whitney. Resultados: El estudio incluye 24 prostatectomías radicales de 1999 y 50 de 2006. El pT es significativamente más bajo en 2006 que en 1999 (p=0,032). Asimismo, hay mayor número de carcinomas organo-confinados en 2006 (p=0,034). Además, la extensión extraprostática del cáncer y la invasión de vesículas seminales son significativamente menores en 2006 (p=0,090 y p=0,011, respectivamente). Conclusiones: En 2006, entre los pacientes que han sido tratados con cirugía radical, se observa una disminución significativa en el estadio tumoral. El número de casos con extensión extraprostática y con invasión de vesículas seminales es, asimismo, menor

Background: The increase in number of prostate cancer diagnoses in the last decade is accompanied by a similar increase in the number of radical prostatectomy specimens. We analyse the histological differences between patients treated with radical surgery in 1999 and in 2006. The evolution in the indications for surgery is also evaluated. Methods: Histological data in core biopsies and radical prostatectomies of cases diagnosed in 1999 and 2006 have been compared. Only cases with complete histological information have been included in the study. Bi/unilateral tumour invasion, number of tumour foci, total millimetres of cancer, high-grade PIN, Gleason index, and perineurial invasion have been evaluated in core biopsies. Pathological staging, Gleason index, high-grade PIN, margin status, apex invasion, perineurial and vascular permeation, extraprostatic extension and seminal vesicle invasion have been analysed in radical prostatectomies. The statistical study included c2, Student’s t, and Mann-Whitney test. Results: The study includes 24 radical prostatectomies in 1999 and 50 in 2006. The pathological staging is significantly lower in 2006 than in 1999 (p=0.032). Similarly, organ-confined disease is more frequent in 2006 (p=0.034). Extraprostatic extension and seminal vesicle invasion by prostate adenocarcinoma are significantly lower in 2006 (p=0.090 y p=0.011, respectively). Conclusions: Prostate adenocarcinoma patients treated with radical surgery in 2006 are at a lower stage compared with 1999 cases

Carcinoma basaloide escamoso del pene. Presentación de un caso / Basaloid squamous cell carcinoma of the penis. A case report

Introducción: Los tumores malignos epiteliales delpene son muy infrecuentes en los países desarrollados. Sehan descrito distintas variedades de carcinoma entre las cualesuna de las más infrecuentes y más agresivas es el carcinomabasaloide escamoso. Pacientes y métodos: Se presentaun caso de un carcinoma basoescamoso del pene en unpaciente de 75 años. Resultados: Se analizan los datos histológicosclaves en el diagnóstico de este tumor: nidostumorales constituidos por células de núcleo hipercromáticoy citoplasma escaso de hábito basal, con empalizadasperiféricas, centrados por elementos escamosos con queratinizaciónevidente. Discusión y conclusiones: Se revisa laescasa literatura existente sobre esta entidad en esta localizaciónhaciendo hincapié en su relación con la infección porvirus de papiloma humano (HPV) tipo 16

Introduction: Penis malignant epithelial tumors arevery infrequent in developed countries. Basaloid squamouscell carcinoma is one of the most infrequent and aggressivevarieties of penile carcinomas. Patients and methods: Acase of basaloid squamous cell carcinoma of the penis in a75 year old man is reported. Results: Main histological featuresof this rare and aggressive subtype of penile carcinomaare: tumor nests composed of basal-type cells withhyperchromatic nuclei and scanty cytoplasms presentingperipheral palisading centered by squamous cells with evidentkeratinization. Discussion and conclusions: Currentliterature is reviewed ad commented putting special emphasison the possible relationship with human papillomavirus(HPV) type 16 infection

Utilidad de la biopsia cilindro guiada por control ecográfico en el diagnóstico y manejo de los tumores renales / Usefulness of ultrasound-guided core biopsy in the diagnosis and management of renal tumours

Antecedentes: La biopsia guiada por control ecográfico está siendo utilizada de manera creciente en los últimos años como aproximación diagnóstica inicial en los tumores renales, aunque su aceptación entre radiólogos y patólogos aún no es generalizada. Métodos: Durante un periodo de 6 años (2000-2005), se han biopsiado por este método y con agujas 18G un total de 48 tumores renales en 47 pacientes. Resultados: Se observó un predominio de varones (34V/13M) y la edad promedio se situó en 51,7 años (rango 1-92). Treinta y siete (77,1%) casos correspondieron a neoplasias, incluyendo adenocarcinomas renales (25 casos), oncocitomas (3 casos), linfomas (3 casos), tumores de Wilms (2 casos), un tumor carcinoide metastásico, un carcinoma epidermoide metastático, un nefroma quístico y un sarcoma fusocelular. Cinco casos (10,4%) correspondieron a pseudotumores (3 quistes renales y 2 pielonefritis crónicas). La biopsia proporcionó tejido renal normal en 4 casos y tejido fibroadiposo en 2. Se detectaron mínimas discrepancias en la adjudicación de la variante histológica del cáncer en 2 casos. Conclusiones: La biopsia cilindro guiada por ecografía es un método muy útil y fiable para el diagnóstico de los tumores renales, y debería ser incluida como herramienta de primera línea en su manejo. Sin embargo, para la obtención de óptimos resultados que puedan llevar a un tratamiento individualizado, se precisa una estrecha colaboración entre clínicos, radiólogos y patólogos

Background: Ultrasound-guided core biopsy (USCB) has being increasingly used in the last years for diagnosis of renal masses. However, its use has not still reached a generalised acceptance among radiologists and pathologists. Methods: Over a 6-year period (2000-2005), a total of 48 renal masses in 47 patients were biopsied under ultrasound guidance using 18G needles. Results: Males predominated in the series (34M/13F), and the average age was 51.7 years (range 1-92). Thirty-seven (77.1%) cases were neoplasms. Diagnostic categories included renal cell carcinoma (25 cases), oncocytoma (3 cases), malignant lymphoma (3 cases), Wilms tumour (2 cases), carcinoid tumour, squamous cell carcinoma, metastatic, cystic nephroma, and spindle cell sarcoma (one each). Five cases (10.4%) were pseudotumours (3 renal cysts and 2 chronic pyelonephritides). The core biopsy obtained was normal renal tissue in 4 cases and fibroadipous tissue in 2. Minor discrepancies in the assignment of the histological variant were detected in 2 cases. Conclusions: Ultrasound-guided core biopsy is a very useful and reliable method in the diagnosis of renal masses and should be included as a first-line tool in its management. Close cooperation between clinicians, radiologists and pathologists is needed to obtain optimal results that may prompt an individualised treatment in every case

Revisión de los adenocarcinomas de próstata con patrón pseudohiperplásico y pseudoatrófico / Pseudohyperplastic and pseudoatrophic patterns in prostate adenocarcinoma. A review

El adenocarcinoma de próstata es el cáncer más frecuentey la segunda causa de muerte por cáncer en la poblaciónmasculina en los países desarrollados. El volumen de biopsiasde próstata recibido en los laboratorios de AnatomíaPatológica de nuestros hospitales ha crecido espectacularmenteen la última década. El espectro morfológico de estaneoplasia es muy variado, en ocasiones difícil de reconocer,pudiendo simular lesiones benignas o estructuras histológicasnormales. Se revisan las características histológicas delos patrones pseudohiperplásico y pseudoatrófico del adenocarcinomade próstata, dos variedades que simulan los doshallazgos más frecuentes en patología prostática: la hiperplasiay la atrofia. El reconocimiento de estos patrones pocofrecuentes es especialmente importante en las biopsias transrectalespara facilitar el manejo correcto de los pacientes

Prostate adenocarcinoma is the leading neoplasm andthe second cause of death by cancer in males of developedcountries. Over the last decade, the number of prostate biopsieshas raised tremendously in the Pathology Labs of ourHospitals. The morphologic spectrum of this neoplasm isvaried, sometimes difficult to recognise, mimicking benignlesions or normal structures in the area. This paper reviewsthe histological features of the so-called pseudohyperplasticand pseudoatrophic patterns of prostate adenocarcinomas;the two subtypes of cancer that more closely mimic the twomore frequent benign lesions in the prostate. The recognitionof these histological variants in core biopsies is necessaryto favour the correct patient management

Displasia y carcinoma en papilomas schneiderianos nasosinusales. Estudio de 4 casos / Dysplasia and carcinoma in sinonasal schneiderian papillomas. A study of 4 cases

Se revisa en este trabajo la existencia de displasia y/ocarcinoma en una serie de 65 papilomas schneiderianosnasosinusales diagnosticados en nuestro centro en un periodode 17 años. Los papilomas se tipifican como fungiformes,invertidos, y oncocíticos de células cilíndricas,siguiendo las clasificaciones al uso. Se demuestran cambiosdisplásicos y/o carcinoma en 4 casos, todos ellos varones.En éstos, se estudian las características clínicas, incluyendoel seguimiento posterior al tratamiento, e histológicas. Porúltimo, se revisa la literatura existente sobre la asociaciónde papilomas nasosinusales con cambios neoplásicos o preneoplásicosen su epitelio

The presence of dysplasia and/or carcinoma in a seriesof 65 sinonasal schneiderian papillomas diagnosed in ourInstitution along a 17 year period is reviewed. The caseshave been typified as fungiform, inverted, and oncocyticwith cylindrical cells following current classifications.Dysplastic changes and/or carcinoma were demonstrated in4 cases, all of them male patients. Clinical data, includingpostreatment follow up and histological features of the caseswere analysed. Also, the literature concerning schneiderianpapillomas associated with dysplasia or carcinoma wasreviewed