Composite anatomical-clinical-molecular prognostic model in non-small cell lung cancer.

The objective of the present study was to elaborate a survival model that integrates anatomic factors, according to the 2010 seventh edition of the tumour, node and metastasis (TNM) staging system, with clinical and molecular factors. Pathologic TNM descriptors (group A), clinical variables (group B), laboratory parameters (group C) and molecular markers (tissue microarrays; group D) were collected from 512 early-stage nonsmall cell lung cancer (NSCLC) patients with complete resection. A multivariate analysis stepped supervised learning classification algorithm was used. The prognostic performance by groups was: areas under the receiver operating characteristic curve (C-index): 0.67 (group A), 0.65 (Group B), 0.57 (group C) and 0.65 (group D). Considering all variables together selected for each of the four groups (integrated group) the C-index was 0.74 (95% CI 0.70-0.79), with statistically significant differences compared with each isolated group (from p = 0.006 to p < 0.001). Variables with the greatest prognostic discrimination were the presence of another ipsilobar nodule and tumour size > 3 cm, followed by other anatomical and clinical factors, and molecular expressions of phosphorylated mammalian target of rapamycin (phospho-mTOR), Ki67cell proliferation index and phosphorylated acetyl-coenzyme A carboxylase. This study on early-stage NSCLC shows the benefit from integrating pathological TNM, clinical and molecular factors into a composite prognostic model. The model of the integrated group classified patients with significantly higher accuracy compared to the TNM 2010 staging.

Solitary angiokeratoma of the tongue in adults.

Angiokeratomas are vascular malformations that usually appear as multiple or solitary cutaneous plaques. Several clinical variants have been described, with the same underlying histopathological lesion. Mucosal involvement, including the oral cavity, is occasionally found either as a component of the systemic variety, called angiokeratoma corporis diffusum, or associated with cutaneous lesions in more locations. Isolated oral involvement seems to be rather infrequent and only five cases have been described in adults in the world literature. We herein report another case of this rare entity affecting a 62-year-old woman in the dorsum at the tip of the tongue. This is the first report including an immunohistochemical study to discard a lymphatic origin of the tumor.

Pulmonary ceroidosis.

We describe a patient with pulmonary ceroid histiocytosis. Skin pigmentation, chest x-ray film and laboratory findings were normal. Only pulmonary function tests were abnormal (TLC = 63 percent, DLco = 52 percent). Based on these functional data, the patient was submitted to a lung biopsy by thoracotomy. Brown pigmented histiocytes were shown occupying alveolar spaces. Similar brown pigmented hepatocytes were seen in the liver biopsy.

Tripe palms: a cutaneous marker of internal malignancy.

Tripe palms is a distinctive paraneoplastic cutaneous sign which is frequently associated with internal malignancy, specially carcinomas of the lung and stomach. We describe a patient with ovary carcinoma who showed a curious rugose thickening of the palms with accentuation of the normal dermatoglyphic ridges. The lesions were a specially prominent on the fingertips. The patient also showed classical acanthosis nigricans in the axillae and groin. The soles were spared. Histopathologic findings in palmar lesions consisted of an undulant epidermis, with hyperkeratosis, acanthosis, and papillomatosis. Excision of the ovary carcinoma was followed by complete regression of the cutaneous lesions. We review the literature about tripe palms and discuss the relationship between this striking cutaneous manifestation and internal malignancy.

A facial variant of steatocystoma multiplex.

A case of steatocystoma multiplex confined to the face is reported. Review of the literature disclosed similar cases in this striking location. We therefore believe that this facial variant is a distinctive but less well known variant of steatocystoma multiplex. We review the relationship between steatocystoma multiplex and eruptive vellus hair cysts.

[Inverted papillomas in nasal fossa and sinuses. Bringing up to date their clinical, radiological and pathological diagnosis and treatment]. / Papilomas invertidos de las fosas nasales y senos. Actualización sobre el diagnóstico clínico, radiológico y anatomopatológico y de su tratamiento.

The present work shows 13 cases of inverted papillomas of the nasal fossae treated at the Fundación Jiménez Díaz from 1954 to 1992. Four of them were found in the lateral wall of the nose, one in the nasal septum and the other one in the frontal sinus. The latter coexisted with a transient carcinoma. One of them suffered a secondary malignant process. This paper discusses the etiology of these tumors, their histology, clinical features, radiological aspects, trend to relapse or malignancy, as well as the most effective treatment in the authors' opinion.

[Candida endocarditis in non-addict patients: a disease with high mortality. A clinico-pathological study of 3 cases]. / Endocarditis por Candida en pacientes no adictos: una enfermedad de gran letalidad. Estudio clínico-patológico de tres casos.

Candida endocarditis is a rare infection which occurs under particular epidemiological circumstances, such a drug addiction, immunosuppression, prolonged intravenous therapy and valvular replacement surgery. Diagnosis requires a high suspicious index and is based on the demonstration of the organism in cardiac vegetations, peripheral embolisms or in positive blood-cultures; also when valvular insufficiency murmurs, embolic phenomena and echocardiogram-proved vegetations are present. In spite of antifungal therapy and valvular replacement, the mortality rate in Candida endocarditis is still higher than 80%. Three new cases of the entity are here reported stressing the diagnostic and therapeutical difficulties.

Chondrosarcoma of the trachea. Report of a case.

A tracheal chondrosarcoma was diagnosed in a 74-year-old man during his workup for a bacterial pneumonia. The clinicopathological features and the evolution of these uncommon tumors are discussed in the present report.

[Occult bronchial carcinoid tumor producing ACTH simulating Cushing's syndrome]. / Carcinoide bronquial oculto productor de ACTH simulando enfermedad de Cushing.

Cushing's Syndrome raises sometimes important diagnostic and therapeutic problems. A case of Cushing's Syndrome is discussed, induced by ectopic secretion of ACTH by a Benign Bronchial Carcinoid Tumor, which due to its clinical features (asymptomatic and invisible to conventional radiology and associated with typical signs of Chronic Hypercortisolism) and biochemical findings (ACTH only slightly raised and suppression with high doses dexamethasone), simulated an hypophyseal origin, the pulmonary tumor being showed only after 3 years of the diagnosis of Cushing's Syndrome.

Trichoblastic fibroma.

We report a trichoblastic fibroma in the groin of a 60-year-old woman. This unusual tumor showed a predominance of epithelial component, with abundant basophilic, well-circumscribed, epithelial lobules and some keratinous cysts. Several areas suggested stromal induction of differentiation, and in the keratinous cysts there were indications of outer hair sheath differentiation. We review the clinical data from published cases of trichogenic hair germ tumors and discuss the differential diagnosis.

Epithelioid angiosarcoma of the breast involving the skin: a highly aggressive neoplasm readily mistaken for mammary carcinoma.

BACKGROUND: Angiosarcomas are malignant neoplasms of endothelial cells. Angiosarcoma of the breast is a rare neoplasm that behaves in a highly malignant fashion. It must be differentiated from benign vascular proliferations and from mammary carcinoma. METHODS: We report on a 49-year-old-woman who presented with a large mass involving the left breast. RESULTS: The lesion had an erythematoviolaceous hue and livedoid pattern at the periphery. Histopathologic study showed an epithelioid malignant neoplasm, and immunohistochemical studies demonstrated that neoplastic cells expressed immunoreactivity for endothelial cell markers. CONCLUSIONS: A diagnosis of epithelioid angiosarcoma of the breast was established. The patient was treated with radical mastectomy, but she refused any other additional therapy.

[Splenic abscess: clinico-microbiologic study of 15 cases]. / Abscesos esplénicos: estudio clínico-microbiológico de quince casos.

We have reviewed 15 cases of splenic abscesses diagnosed using a histopathological and microbiological study. Mean age was 48 years (range 18-78). Eight of them were male and 7 female. Eighty per cent of them had predisposing diseases, amongst which the most frequent were endocarditis and bacteriemia of other origin (26.6% in both cases). All patients presented fever and in 7 of them (47%) splenomegaly was appreciated. The most frequently isolated germs were gramnegative bacteria (33%), anaerobics (20%), and with a similar incidence grampositive bacteria, tuberculosis and fungii; in only one case cultures were sterile. Seven patients had multiple splenic abscesses and 8 patients single abscesses. Thorax x-ray showed alterations in more than half of the patients (53%). Abdominal echography was the diagnostic method in 67% of the patients and TAC in all the cases in which it was performed. Eight patients underwent splenectomy and one was surgically drained being the mortality rate of this group of 22%. Overall mortality was 33% and was related to the presence of multiple splenic abscesses (5/7, 71.4%), positive hemocultures (6/6, 100%), extrasplenic abscesses (7/8, 87.5%), and endocarditis (4/4, 100%), fungii infections (2/2, 100%), and late diagnosis (6/6, 100%).

Effect on single-breath washout and lung function of elastase-induced emphysema in rats.

Lung volumes, diffusing capacity (DLCO), quasi-static pressure-volume curves (P-V), forced expiration (FE) and He-SF6 single-breath washout (SBW) were performed in Wistar rats with emphysema induced by different doses of pancreatic elastase in saline, instilled intratracheally 6 wk prior to the tests. Emphysema was quantitatively assessed by mean linear intercept (Lm) measurements on 5-microns lung sections. Lung volume, P-V curve, and FE dependence on Lm, as well as the nonsignificant dependence of DLCO on Lm, are generally similar to results reported by others. The most interesting observation concerns the SBW: N2 slopes of the alveolar plateau, compared for identical lung volumes, did not change with the degree of emphysema. By contrast, the He-SF6 slope difference did depend significantly on the degree of emphysema. Based on the diffusion front theory, the present work suggests that in rats with elastase-induced emphysema, the phase III slope modifications relate mainly to elastic and not to structural alterations.

Esophageal inflammatory fibroid polyp. Endoscopic and radiologic features.

We present the case of a 60-year-old male patient, who had several episodes of melena during the last years. One month ago he had a new episode of digestive bleeding, and an endoscopic study was performed that showed at 35 cm from the dental arcade a polypoid, pedunculated lesion, with a diameter of 5 cm and a submucosal aspect, a few erosions on its surface and a fibrin deposit. Its head reached the cardia, and it bled when touched by the endoscope. The biopsies taken were negative. X-ray and CT studies confirmed the existence of a mass compatible with a submucosal lesion. The patient was operated and the tumor was excised. The histologic study showed an inflammatory fibroid polyp, an entity very rarely described at the level of the stomach, duodenum, small intestine, and colon and exceptionally described at the esophageal level.

[Yellow nail syndrome: presentation of a case and review of the literature]. / Síndrome de las uñas amarillas: presentación de un caso y revisión de la literatura.

We discuss the yellow nails syndrome which is constituted by yellow nails, pleural effusion and lymphedema. After reviewing the literature, it can be said that nail disorders are an early and constant sign, and its absence could put in doubt the diagnosis of this syndrome. The most frequent pleuro-pulmonary disorder is the pleural effusion, chylous or exudative type. It is believed that the origin of this disease could be a congenital hypoplasia of the lymphatic vessels. Lymphography and the morphologic study performed show a diminution in the number and size of the lymphatics vessels (lymphedema) which are hypoplastic, varicosities and tortuous dilations are sometimes observed.

[Atypical radiologic manifestations of Pneumocystis carinii pneumonia]. / Manifestaciones radiológicas atípicas de la neumonía por Pneumocystis carinii.

Pneumonia due to Pneumocystis carinii (PC) is characterized, in most cases, by the existence of infiltrates of interstitium or bilateral interstitium-alveolar type on the thorax radiography. However atypical radiological findings associated with this type of opportunistic infection are being described more and more frequently. We present two patients with Acquire Immune Deficiency Syndrome (AIDS) and pulmonary infection due to PC, with very unusual radiological findings. First patient showed multiple pulmonary cavitated nodules; the other a cavitated infiltrate in superior right lobule. Clinicians dealing with AIDS patients must be familiar with this unusual radiologic findings associated with PC in order to avoid diagnostic mistakes.

[Open lung biopsy in immunocompromised patients with diffuse pulmonary infiltrates]. / La biopsia pulmonar abierta en pacientes inmunocomprometidos con infiltrados pulmonares difusos.

In order to evaluate the diagnostic usefulness of open lung biopsy and to determine how could it influence the treatment and the evolution of the disease, the clinical histories of 19 immunocompromised patients with diffuse lung infiltrates were reviewed. One or more specific diagnosis were obtained in 14 patients (73%) by open lung biopsy. However, the initial treatment was modified, in view of the results of the biopsy only in 3 cases (15%). Only 5 patients survived and were discharged. There were no differences in the survival rate of patients with a specific or a nonspecific diagnosis (11 out of 14 deaths and 3 out of 5 respectively). 5 patients suffered severe complications from the surgical procedure. Open lung biopsy should not be used routinarily in the study of diffuse lung infiltrates in immunocompromised patients.