RESUMEN
La presencia de un segundo nódulo en el contexto de un paciente con una neoplasia pulmonar constituye una situación poco frecuente, encontrada hasta en el 4,5% de las resecciones, pero que representa un reto para el patólogo. El riesgo de sobreestadificación, asumiendo que se trata de un mismo tumor, cuando en realidad se está ante una neoplasia con comportamiento biológico diferente, obliga a un correcto diagnóstico histopatológico y adecuada estadificación, antes de interpretar el segundo nódulo como metástasis (AU)
Although unusual, a second pulmonary nodule in a patient with a lung tumour, can be found in up to 4.5% of pulmonary resections. Synchronous lung tumours present a challenge for the pathologist; however, an accurate histopathological diagnosis is necessary to avoid misinterpretation of the second nodule as a metastatic (AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Carcinoma Neuroendocrino/patología , Carcinoma de Células Grandes/patología , Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/patología , Neoplasias Primarias Múltiples/patología , Diagnóstico Diferencial , Estadificación de Neoplasias , Neumonectomía , Escisión del Ganglio LinfáticoRESUMEN
BACKGROUND: Lynch syndrome (LS) is a hereditary condition that increases the risk for endometrial and other cancers. The identification of endometrial cancer (EC) patients with LS has the potential to influence life-saving interventions. We aimed to study the prevalence of LS among EC patients in our population. METHODS: Universal screening for LS was applied for a consecutive series EC. Tumor testing using microsatellite instability (MSI), immunohistochemistry (IHC) for mismatch-repair (MMR) protein expression and MLH1-methylation analysis, when required, was used to select LS-suspicious cases. Sequencing of corresponding MMR genes was performed. RESULTS: One hundred and seventy-three EC (average age, 63 years) were screened. Sixty-one patients (35%) had abnormal IHC or MSI results. After MLH1 methylation analysis, 27 cases were considered suspicious of LS. From these, 22 were contacted and referred for genetic counseling. Nineteen pursued genetic testing and eight were diagnosed of LS. Mutations were more frequent in younger patients (<50 yrs). Three cases had either intact IHC or MSS and reinforce the need of implement the EC screening with both techniques. CONCLUSION: The prevalence of LS among EC patients was 4.6% (8/173); with a predictive frequency of 6.6% in the Spanish population. Universal screening of EC for LS is recommended.