[Cutaneous B cell processes with nodular pattern]. / Procesos linfoides B cutáneos con patrón nodular.

Cutaneous lymphomas are low grade malignant neoplasms with favourable prognosis. Those related to the germinal centre with nodular pattern may be: follicular lymphomas (LFC) or extranodal marginal zone B-cell lymphomas (LMC). They are difficult to tell apart, and from reactive processes like cutaneous follicular hyperplasia and cutis immunocytomas. The objective of this study was to check the incidence and the value of both histology and immunohistochemistry in differential diagnosis. Fifty six patients with cutaneous lymphomas were selected within the period 1995-2004. The biopsies were studied with hematoxilin eosin and immunohistochemistry. Thirty two out of the fifty six cutaneous lymphoid infiltrates were of T origin (57.1%) and twenty four of B origin (42.8%), ten out of this last figure (17.7%) were lymphoid processes with nodular pattern Four LFC, three LMC and three HLC were diagnosed. Convergent follicles with scarce mantle and germinal centres with monomorph celullarity were observed in the LFC. Among the LMC, follicles with prominent mantle and nests of monocitoid cells in the mantle, interfollicular zone and in the germinal centers observed. In the HLC macrophages with detritus were found in the germinal centers. LFC showed: CD20 (+), CD 10 (+), bcl-2 (+) or (-), and bcl-6 (+) in the follicle and in the interfollicular area. LMC showed: CD 20 (+), bcl-2 (-), CD 10 (+/-), and bcl-6 (+) in the follicle, and bcl-2 (+), CD10 (-/+) and bcl-6 (-) in the interfollicular area. The HLC results were: bcl-2 (-), bcl-6 (+) and CD 10 (-) in the follicle and bcl-2 (+), bcl-6 (-) and CD 10 (-) in the interfollicular zone. We conclude that lymphoid B cell processes with nodular pattern are unusual. Histology and immunohistochemistry proved to be useful in the differential diagnosis of these lymphomas, and for differentiating these from lymphoid hyperplasias or non tumoral hyperplasias.

[Primary sarcomas of the breast]. / Sarcomas primarios de mama.

Primary sarcomas of the breast are extremely rare with less than 1% of all malignant tumours of the breast reported in literature. At our Institution 1315 malignant tumours of the breast were diagnosed between 1999-2004; nine of them corresponded to primary sarcomas: angiosarcoma (3), leiomyosarcoma (1), low-grade fibromyxoid sarcoma (1), dematofibrosarcoma protuberans (1), liposarcoma (1), osteosarcoma (1), malignant peripheral nerve sheath tumour (1). Histopathological specimens stained with routine techniques and immunoperoxidase were reviewed; proliferation index and p53 over-expression were also determined. Patients' clinical reports were also reviewed to determine prognosis (favorable and unfavorable). The incidence observed (0.7%) is similar to those already published by others authors. Proliferation index was correlated with type of evolution, being an unfavourable prognosis factor when it was equal or major to 30%. Most of the tumours (67%) showed p53 (mayor or equal to 20% of nuclear staining) over-expression but this did not show a direct relationship with the evolution of each neoplasm.

Sarcomas primarios de mama / Primary sarcomas of the breast

Los sarcomas primarios de mama son extremadamente raros y representan menos del 1% de lostumores mamarios comunicados en la literatura. Entre los años 1999 y 2004 se diagnosticaron ennuestra institución 1315 tumores malignos de mama, entre ellos nueve correspondieron a sarcomas primarios:tres angiosarcomas, un leiomiosarcoma, un sarcoma fibromixoide de bajo grado, un dermatofibrosarcoma, unliposarcoma, un osteosarcoma y un tumor maligno de la vaina de los nervios periféricos. Se revisaron los preparadoshistológicos, teñidos con técnicas de rutina y de inmunoperoxidasa, estableciéndose la fracción de crecimiento(FC) y sobre-expresión de proteína p53. Se estudiaron también las historias clínicas de las pacientespara determinar tipos de evolución (favorable y desfavorable). La incidencia observada (0.7%) es similar a lasya publicadas por otros autores. La FC se correlacionó con la evolución, siendo un factor pronóstico desfavorablecuando fue mayor o igual al 30%. La mayoría de los tumores (67%) mostró sobre-expresión de proteína p53(mayor o igual al 20% de tinción nuclear) pero esto no demostró tener una relación directa con la evolución decada neoplasia.

Primary sarcomas of the breast are extremely rare with less than1% of all malignant tumours of the breast reported in literature. At our Institution 1315 malignanttumours of the breast were diagnosed between 1999-2004; nine of them corresponded to primary sarcomas:angiosarcoma (3), leiomyosarcoma (1), low-grade fibromyxoid sarcoma (1), dematofibrosarcoma protuberans (1),liposarcoma (1), osteosarcoma (1), malignant peripheral nerve sheath tumour (1). Histopathological specimensstained with routine techniques and immunoperoxidase were reviewed; proliferation index and p53 over-expressionwere also determined. Patients´ clinical reports were also reviewed to determine prognosis (favorable andunfavorable). The incidence observed (0.7%) is similar to those already published by others authors. Proliferationindex was correlated with type of evolution, being an unfavourable prognosis factor when it was equal ormajor to 30%. Most of the tumours (67%) showed p53 (mayor or equal to 20% of nuclear staining) over-expressionbut this did not show a direct relationship with the evolution of each neoplasm.

Tumores de Merkel en cabeza y cuello / Merkel cell tumors in head and neck

Hasta la fecha han sido comunicados poco más de 400 casos de carcinoma a células de Merkel en la literatura médica mundial. Es un tumor raro, de presumible origen neuroendócrino, que se presenta habitualmente en áreas expuestas de cabeza y cuello, luego de la sexta década de vida. El diagnóstico correcto es sólo posible a través de la microscopia electrónica y la inmunohistoquímica. Es importante tenerlo en cuenta en los diagnósticos diferenciales de los tumores cutáneos primarios o metastásicos. Se presentan dos casos, ambos de sexo femenino, mayores de 70 años, con lesiones ubicadas en la cara, y diseminación ganglionar. Una de ellas murió por la enfermedad, y la otra sin evidencia de recidiva a las 26 meses de seguimiento. De acuerdo con lo aconsejado por la mayoría de los autores y la evolución de estos pacientes, se propone la exéresis amplia del tumor primario, y la disección apropiada del cuello hemolateral. Debe considerarse la radio terapia del área del primario y de los cuellos con ganglios hitológicamente positivos