[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.

[Expresion of E-cadherin and catenins in urothelial carcinomas]. / Expresión de cadherina E y cateninas en los carcinomas uroteliales.

OBJECTIVE: We examined the presence of E-cadherin and alpha, beta and gamma catenins detected by immunohistochemistry and correlated with the classic variables: grade, stage and recurrence. MATERIAL AND METHOD: The authors evaluated 37 transitional cell carcinomas. Biopsy specimens included no recurrent transitional cell carcinoma (n=19) and recurrent transitional cell carcinoma (n=18). Association of E-cadherin and alpha, beta and gamma catenins immunoreactivity with tumor grade, clinical stage and tumor recurrence was examined. RESULTS: E-cadherin and gamma catenin expression were related to the clinical stage of the disease, alpha and beta catenins were not correlated with grade, stage and recurrence of disease. CONCLUSIONS: Decreased E cadherin and gamma catenin expression were associated with advanced stage of the disease.

[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.

[Lymphoepithelial cyst of the thyroid gland: a case report and review of the literature]. / Quiste linfoepitelial intratiroideo: caso clínico y revisión de la literatura.

We report a case of lymphoepithelial cyst of the thyroid gland in a 31 year-old-man with chronic lymphocytic thyroiditis and history of multinodular goiter. The lesion was resected and the histopathologic examination showed that the cystic mass was lined by squamous and focally columnar epithelium, an it was surrounded by follicular lymphoid tissue. To our knowledge only twenty cases of this lesion have been reported in the medical literature. An association with chronic thyroiditis has been noted in 10 cases.

[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.

[Expression of the cerbB-2 (HER-2/neu) oncoprotein in prostatic adenocarcinoma]. / Estudio de la expresión de cerbB-2 en el adenocarcinoma de próstata.

OBJECTIVES: Our aim is to determine the expression of the cerbB-2 oncoprotein in prostate cancers using an immunohistochemistry staining and to compare these results with several clinical and histological prognostic factors. METHODS: An immunohistochemical staining using the cerbB-2 monoclonal antibody (Dako) was performed in 32 radical prostatectomy specimens diagnosed of adenocarcinoma. The intensity of cerbB-2 expression was evaluated with a scale that variated from 0 (no staining) to 3+ (strong complete membrane staining) according to published guidelines. Association of cerbB-2 index immunoreactivity with clinical and histological prognostic factors was examined. RESULTS: Definite positive membranous staining was detected in 14 of 32 neoplastic cases (44%). Such overexpression was correlated with higher Gleason grade (p=0.04) and higher stage of disease (p=0.038). CONCLUSIONS: 1) This study shows that 44% of all prostate cancer express the cerbB-2 oncoprotein with immunohistochemical technique. 2) These findings suggest that is necessary to standardize the immunohistochemical staining procedure with cerbB-2 in prostate adenocarcinoma. 3) The level of cerbB-2 expression was correlated with Gleason grade and clinical stage.

Immunohistochemical detection of fibronectin and tenascin in incised human skin injuries.

Immunohistochemical detection of molecules involved in inflammatory reaction can be useful for the diagnosis of vitality in skin wounds. We studied the expression of fibronectin (FN) and tenascin (TN) in 58 human skin wounds (48 vital and 10 postmortem). The age of vital injuries ranged from 3 min to 8 h and postmortem specimens were collected after a postinfliction interval of 15-180 min. One hundred thirty-seven formalin-fixed paraffin-embedded sections (mean: 2.3 sections per case) were stained with each of two monoclonal antibodies against FN and TN using the streptABC technique. A reticular staining for FN in wound edge and dermis was observed in 50% of vital specimens versus 0% in postmortem cases. Immunoreactivity was reduced in 10 autolysed cases. FN positivity exclusively at the injury margin was observed in 39.4% of vital wounds and 10% of postmortem cases. TN was negative in all specimens. Vital and postmortem hemorrhage areas showed positivity for FN and TN. Due to its low sensitivity, immunohistochemical analysis of FN is useful for determining vitality only in a minority of cases. Different factors in everyday practice, including autolysis and technical problems often produce false negative reactions with the result that FN cannot be regarded as a reliable parameter of vitality. Positive reactions (network staining) are more valuable than negativity but are not pathognomonic. Both vital and postmortem hemorrhages show an enhanced positivity for FN and TN, thus impeding the diagnosis.

[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.

[Low grade collecting duct carcinoma of the kidney. Presentation of one case and literature revision]. / Carcinoma renal de los conductos colectores de bajo grado. Presentación de un caso y revisión de la literatura.

Collecting duct renal cell carcinoma is an uncommon variant of renal carcinoma. Typically its behaviour is more aggressive than other forms of renal carcinoma and usually it is diagnosed at advanced stages. A 57-year-old man visited our hospital by right lumbar pain. Abdominal CT showed a enhanced mass on the right kidney. A right partial nephrectomy was done. Histological examination of the surgical specimen showed a low grade collecting duct carcinoma of the kidney. This is a new entity, with unknown behaviour but seems to be less aggressive than classical collecting duct carcinoma of the kidney. The clinical, radiological, pathological and immunohistochemical characteristics of this tumor are reported, and the literature is reviewed.

[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.

[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.

[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.

[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.

[Integration of orbitary polyethilene implants (MEDPOR). Histologic study]. / Integración de los implantes orbitarios de polietileno (MEDPOR). Estudio histológico.

PURPOSE: We study the histological integration of high-density porous polyethylene orbital implants and its clinical meaning. METHODS: During the last 16 months we have used 14 implants of MEDPOR. Two were removed because of migration, the first one and partial extrusion, the second one, after 3 and 9 months since implantation, respectively. They were preserved and softened in formaldehyde for one month, and later processed for histological study. RESULTS: Macroscopically, a fibrous pseudocapsule firmly attached to the implant was seen. A fibrovascular tissue ingrowth covered the polyethylene porous surface and penetrated its total cross-sectional area. Occasional inflammatory cells were present. There was no evidence of macrophagical activity. CONCLUSIONS: We demonstrate a good fibrovascular integration of the implant at the time of extraction. This means that this material can be successfully used in anophthalmic socket surgery. However, new pathological and clinical studies are necessary to elucidate their biocompatibility in long follow-up time.

[Nasal encephalocele: differential diagnosis with nasal glioma]. / Encefalocele nasal: diagnóstico diferencial con el glioma nasal.

Congenital nose neoplasms are infrequent, between them neurogenic tumors of the middle line include nasal gliomata (glial ectopies) and nasal encephaloceles, according to an existing or lacking communicating link with the intracranial cavity. We report one congenital naso-encephalocele case in a 16-year-old girl suffering from repeated meningitis events after several nasal polypectomies performed in other departments. She underwent complete removal through fronto-neurosurgical and paralateronasal approach, being the young woman asymptomatic for 3 years. We discuss about both intranasal gliomata and encephaloceles, certainly of not easy pathologic identification, stressing the decisive value of imaging techniques, as magnetic resonance, in order to clearcut both the diagnosis and the therapeutical planning.

Xantogranuloma juvenil de pene / Juvenile xantogranuloma of the penis

Presentamos un caso de xantogranuloma juvenil de pene en un paciente de 30 años de edad que clínicamente fue diagnosticado de quiste de inclusión epidérmica. Describimos la histología y etiopatogenia de la lesión haciendo hincapié en el diagnóstico diferencial con otras lesiones similares con pronóstico adverso (AU)

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 (AU)