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INTRODUCTION: Annexins A1 and A2 have been related with the maintenance of tissue integrity. They have been identified in a wide variety of tissues, but little is known regarding their expression in upper the aerodigestive tract. The aim of this work is to describe the expression of these proteins in the mucosa of the upper aerodigestive tract. MATERIAL AND METHODS: Tissue samples from respiratory (nasal and laryngeal) and digestive (oral and pharyngeal) mucosa from non-oncological patients were studied. Annexin A1 and A2 expression was determined by immunohistochemistry. RESULTS: Both annexins were expressed in the ciliated and in the stratified non-keratinized epithelia, but with a different pattern; ANXA1 was expressed in the more differentiated cells whereas ANXA2 was expressed in the less differentiated ones (with the exception of the cilia of ciliated cells). CONCLUSION: Although annexins A1 and A2 are structurally and philogenetically related its expression pattern in the upper aerodigestive tract suggests that they have different functions.

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Introducción: Las anexinas A1 y A2 se han relacionado con el mantenimiento de la integridad tisular. Han sido identificadas en varios tejidos humanos pero su expresión en el tracto aerodigestivo superior es poco conocida. El objetivo de este trabajo es estudiar la expresión de estas proteínas en la mucosa del tracto aerodigestivo superior. Material y métodos: Se estudian muestras de mucosa respiratoria (nasal y laríngea) y digestiva (de cavidad oral y faringe) de pacientes intervenidos de cirugía no oncológica. La expresión de las anexinas A1 y A2 se estudia por inmunohistoquímica. Resultados: Ambas anexinas se expresan tanto en el epitelio ciliado pseudoestratificado como en el plano poliestratificado no queratinizado, pero con un patrón diferente; la anexina A1 se expresa en las células más diferenciadas, mientras que la A2 lo hace en las menos diferenciadas (con la excepción de los cilios de las células ciliadas). Conclusión: Aunque las anexinas A1 y A2 están estructural y filogenéticamente relacionadas, su diferente expresión en la mucosa del tracto aerodigestivo superior sugiere que participan en funciones claramente diferenciadas (AU)

INTRODUCTION: Annexins A1 and A2 have been related with the maintenance of tissue integrity. They have been identified in a wide variety of tissues, but little is known regarding their expression in upper the aerodigestive tract. The aim of this work is to describe the expression of these proteins in the mucosa of the upper aerodigestive tract. MATERIAL AND METHODS: Tissue samples from respiratory (nasal and laryngeal) and digestive (oral and pharyngeal) mucosa from non-oncological patients were studied. Annexin A1 and A2 expression was determined by immunohistochemistry. RESULTS: Both annexins were expressed in the ciliated and in the stratified non-keratinized epithelia, but with a different pattern; ANXA1 was expressed in the more differentiated cells whereas ANXA2 was expressed in the less differentiated ones (with the exception of the cilia of ciliated cells). CONCLUSION: Although annexins A1 and A2 are structurally and philogenetically related its expression pattern in the upper aerodigestive tract suggests that they have different functions (AU)

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- Propósito: La búsqueda de marcadores celulares en el diagnóstico y pronóstico las lesiones melanocíticas es uno de los actuales retos de la dermatología. El objetivo de este trabajo ha sido la cuantificación de la expresión ki67 en nevus melanocíticos (clinicamente atípicos) y en melanomas malignos, y su correlación con los factores pronósticos y la supervivencia.- Material y métodos: Se han estudiado 30 melanomas malignos en fase de crecimiento vertical (MM), 30 nevus melanocíticos (NM) (20 intradérmicos y 10 compuestos) y 30 biopsias cutáneas sanas (BCS). La expresión del antígeno ki67 fue demostrada por histoinmunoquímica. Posteriormente se realizó un estudio cuantitativo mediante el programa de análisis de imagen Qwin colour RGB. Finalmente, se estudió el número de núcleos marcados y el análisis estadístico de los resultados. - Resultados: En BCS y en NM el número de núcleos ki67 era, respectivamente, 12.56 ñ 8.79 y 21.48 ñ 11.49. Los núcleos ki67 positivos en los MM mostraba un número de 234.54 ñ 52.67. El análisis estadístico demostró diferencias significativas entre las lesiones pigmentadas benignas y malignas. También, el número de núcleos ki67 en los MM se correlacionó significativamente con el espesor (Breslow), la presencia de ulceración y del nivel de infiltración (Clark) del tumor. El número de núcleos ki67 positivos estaba correlacionado con la supervivencia total y con el periodo libre de enfermedad. - Conclusiones: Estos resultados sugieren que la expresión ki67, especialmente su cuantificación, es un claro indicador diagnóstico y puede tener interés como parámetro pronóstico en los MM: el antígeno ki67 es indicador de mal pronóstico. Esta técnica sería de interés en la valoración oncológica del melanoma maligno (AU)

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Propósito: Valoración de los AgNORs, especialmente el número de partículas por núcleo en nevus melanocíticos y en melanomas malignos, y su correlación con los factores pronósticos y la supervivencia. Pacientes y métodos: Se han estudiado 29 casos de melanoma maligno en fase de crecimiento vertical (MMFCV), 30 nevus melanocíticos (NM) (20 intradérmicos y 10 compuestos) y 30 biopsias cutáneas sanas. Resultados: En piel normal y en NM el número de partículas de AgNORs por célula era, respectivamente, 1.22ñ0.41 y 1.35ñ0.54 (menos 3 por núcleo). Los AgNORs estaban bien definidos, pequeños e independientes. Los AgNORs por núcleo en los MMFCV mostraba un número de 8.02ñ 5.31 y su morfología estaba mal definida, mayor tamaño y tendencia a confluir. El número de AgNORs en los MMFCV depende significativamente del espesor (Breslow) y del número de mitosis, pero resulta independiente del nivel infiltrante (Clark) del tumor. El número de AgNORs estaba correlacionado con la supervivencia teórica pero era independiente de la supervivencia real. Conclusiones: Estos resultados sugieren que los AgNORs, especialmente su número y morfología, son un claro indicador diagnóstico y pueden tener interés como parámetro pronóstico en los MMFCV, siendo además una técnica rápida, barata y asequible, por lo cual debe incorporarse a la rutina oncológica del melanoma maligno (AU)

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Propósito: Valoración de la expresión morfológica p53, especialmente el porcentaje de núcleos marcados en melanomas malignos y su correlación con los factores pronósticos y la supervivencia. Material y métodos: Se han estudiado 29 casos de melanoma maligno en fase de crecimiento vertical (MMFCV) y 30 nevus melanocíticos (NM) con la técnica inmunohistoquímica anti-p53.Resultados: En piel normal y en NM el inmunomarcaje anti-p53 era negativo. La expresión p53 se demostró en el 31.03 por ciento (9 cle los 29 casos) de los MMFCV. Los MMFCV p53 positivos dependieron significativamente del espesor (Breslow) y el nivel infiltrante (Clark) del tumor, número de mitosis y número de granulaciones AGNORs por núcleo. En los MMFCV p53 positivos, el porcentaje de células marcadas variaba del 1 por ciento al 34 por ciento de las células. El porcentaje de núcleos p53 estaba correlacionado con la supervivencia teórica y el número de granulaciones AgNORs, pero era independiente de la supervivencia real. Concusiones: Estos resultados sugieren que la expresión p53 demostrada mediante este método, especialmente el análisis del porcentaje de células marcadas, tiene interés como indicador pronóstico en los MMFCV (AU)

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El pólipo fibroide inflamatorio es una lesión poco frecuente del tracto gastrointestinal caracterizada por una proliferación celular no neoplásica compuesta por fibroblastos, vasos sanguíneos y células inflamatorias en el seno de una estroma edematosa y colágena. Presentamos el caso de una mujer de 78 años de edad en la que la enfermedad se manifestó inicialmente con un cuadro de suboclusión intestinal. El estudio histológico puso de manifiesto una estructura polipoide constituida por una proliferación de vasos de variado tamaño, algunos congestivos, y de fibroblastos, que se disponían en áreas de forma concéntrica. La estroma se acompañaba de un intenso infiltrado inflamatorio con abundantes eosinófilos. El pólipo fibroide inflamatorio podría considerarse una lesión no neoplásica de carácter reactivo e inflamatorio, y explicarse como una cicatrización hipertrófica del tejido conectivo submucoso, a modo de queloide (AU)

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Intestinal tuberculosis (ITB) is an always difficult clinical diagnosis; we must keep in mind it in the diagnosis of patients with abdominal pain, even without concomitant lung involvement. Seven patients with ITB were revised. Five patients were male and two female, with a mean age of 45 years; all of them presented abdominal pain. Ileocecal region was involved in 71.4% of the cases. Only one patient showed old specific pulmonary lesions radiologically. Neoplasia was the most frequent clinical presumption. ITB diagnosis was made only in one case, as first possibility. Histopathological examination revealed caseous granulomas in all the cases, with acid-alcohol resistant bacilli in 71.4% of them. We want to underline the need of thinking about ITB, in the clinical evaluation of in specific abdominal pain, above all in immunosuppressed patients, and to emphasize the importance of histopathologic findings in the final diagnosis of this entity.

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La tuberculosis intestinal (TBI) es un diagnóstico clínico siempre difícil que es necesario tener en cuenta al valorar cuadros de dolor abdominal, incluso sin afectación pulmonar concomitante. Revisamos siete casos de TBI, en cinco varones y dos mujeres, con una edad media de 45 años; todos se presentaron como dolor abdominal. La localización pricipal fue íleo-cecal (71,4%). En un enfermo se documentó radiografía de tórax anormal por tuberculosis pulmonar antigua. El diagnóstico de presunción más frecuente fue el de neoplasia y sólo en un caso se pensó en TBI como primera posibilidad. Se llegó al diagnóstico final tras el estudio histopatológico, en el que se observaron granulomas caseificantes en todos los casos, con bacilos ácido-alcohol resistentes en el 71,4%. Queremos subrayar la necesidad de pensar en TBI, al valorar cuadros de dolor abdominal, sobre todo en inmunodeprimidos y destacar la importancia del estudio anatomopatológico en el diagnóstico final de estos enfermos (AU)

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Pulmonary artery intimal sarcomas tend to be presented with symptoms of pulmonary thromboembolism and grow regionally, with little capacity to metastasize. They probably originate from subendothelial cells, that become myofibroblasts. Knowledge of it is important to establish a presurgery diagnosis, with the possibility of a total resection, the only useful treatment until now. We report a case of a pulmonary artery primary sarcoma, in a 73 year old woman, admitted with hemoptysis and pleuritic chest pain, who died ten days after. Autopsy revealed an intraluminal mass at the pulmonary artery trunk, without regional nor distance involvement. Microscopic study showed a pleomorphic tumor with spindle and epithelioid cells, positive for actin, desmin and vimentin. All these data support the diagnosis of primary intimal sarcoma of the pulmonary artery. We want to emphasize the myogenic differentiation of the tumor, uncommon in previously reported cases.

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We report a case of alveolar rhabdomyosarcoma (AR) with massive infiltration of bone marrow at presentation, and initial diagnosis in bone marrow aspirate. A 35 year old man presented with a submandibular mass, and hematomas after mild traumatisms. Peripheral blood showed thrombocytopenia and a normocytic anaemia. Bone marrow film showed diffuse involvement by undifferentiated blasts with rhabdomyoblastic features. Subsequent biopsy of submandibular lymph node confirmed the diagnosis with positivity for specific muscle actin and desmin, and negativity for lymphoid markers. Initial presentation of AR with extensive bone marrow involvement is extremely rare, and it could lead to wrong diagnosis and treatment of acute leukaemia, with the serious consequences that this would have. Immunohistochemical study and morphologic differential features can be of great diagnostic help.

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A case of extramedullary plasmacytoma of the maxillary sinus, locally aggressive, in a 65 years old man is presented. Clinical diagnosis of adenocarcinoma was suspected but the pathological study showed an anaplastic morphology, with little plasmacytic differentiation and lack of stain with cytokeratins and epithelial membrane antigen (EMA), immunohistochemical marker of plasmatic cells, among others. Definitive diagnosis was based on light chain restriction and lack of multiple myeloma.

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The case of an adenomatoid odontogenic tumor developing over a dentigerous cyst is reported. A 12-year-old boy was referred by his pediatric dentist to the service of Oral and Maxillofacial Surgery of the Asturias Central Hospital (Spain) for evaluation of a radiolucent image compatible with a dentigerous cyst. Microscopic examination revealed the presence of an adenomatoid odontogenic tumor located over the linear epithelium of a dentigerous cyst. Based on the literature, the clinico-pathological, diagnostic, radiological and therapeutic characteristics of the case are commented in detail.

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OBJECTIVE: To report a rare case of primary round cell liposarcoma of the urinary bladder. METHODS: A case of primary round cell liposarcoma of the urinary bladder in an 80-year-old female with hematuria is presented. The patient had a large, solid, non-circumscribed bladder tumor of 6.5 cms. The radiological, histological and immunohistochemical findings are discussed. RESULTS: The neoplasm was composed of isolated lipoblasts among numerous small round cells that were positive for S-100 and vimentin, and a high proliferation rate was demonstrated by Ki-67. The patient died 10 months after the histologic diagnosis. CONCLUSION: Primary liposarcoma of the urinary bladder is a very rare tumor with a poor prognosis that usually presents as a large tumor mass.

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Malignant melanoma of the esophagus is an extremely rare neoplasm. We presented a case of this neoplasm diagnosed on a cytologic smear from a 84 year-old women. The smear was characterized by scattered dissociated cells with hyperchromatic irregular nuclei, prominent nucleoli and occasional cytoplasmic brown pigment. The immunohistochemical study revealed positivity for HMB-45 and S-100 protein.

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The malignant degeneration of a cystic teratoma of the ovary is a rare complication which different authors place at between 0.8 to 4%. Adenocarcinomas represent a relatively rare complication, 8% of secondary cancers, those of thyroid origin being reported in only 5 cases. The aim of this paper is to present the sixth such case of thyroid carcinoma developed in a mature teratoma in the ovary.

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A retrospective anatomoclinic study of 29 cases of miliary tuberculosis, selected from 2.808 necropsies carried out at Hospital Central de Asturias between 1971 and 1994, is described. Fifty eight per cent of the patients were older than 50 years. Predisposing factors were identified in 80%: diabetes, alcoholism, chronic hepatopaty, silicosis, chronic renal failure, immunessupresive treatment and malignant neoplasms. A premorten correct clinical diagnosis were done in 8 cases (27.5%) and were suspected in 4 (13.7%). Typical miliary radiologic pattern was established in 17%. The more frequently affected organs were lungs (100%), liver (82%), spleen (75%), lymphatic nodes (55%) and bone marrow (41%). Early diagnosis and treatment is nowadays more difficult because of increasing of cryptic tuberculosis, involvement of resistant organs (pancreas), new predisposing factors (chronic renal failure), new risk groups (AIDS) and lack of demonstrative clinical and radiologic findings, so is necessary to maintain suspect of this disease always in mind.

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UNLABELLED: Because of its great incidence and poor prognosis the hepatocarcinoma (HPC) has become a first line clinical challenge. This is the reason we have performed a descriptive anatomo-pathological analysis of our own cases and a study of the possible prognostic value of nuclear parameters. DESIGN: We have performed a retrospective study of 83 cases. We reviewed the clinical records and histologic preparations. METHODS: We analysed the following parameters: 1) Tumour site; 2) Association to cirrhosis; 3) Microscopic features (cellular type differentiation grade, peritumoral lymphocytic infiltration, architecture, mitotic index); 4) Metastatic frequency and location; 5) Morphometric nuclear parameters (area, perimeter, major diameter, major and minor axis, circle diameter, sphere volume, ellipse volume, shape factor. RESULTS: We highlight the following: 1) 50% of HPC associated to liver cirrhosis; 2) Ascites was more frequent in the tumours located in the right lobe or both lobes than in tumours affecting the left lobe (p < 0.005); 3) Macroscopically, the commonest type was the nodular one (47.8%); 4) Microscopically, the commonest findings were as follows: cellular type (93%); differentiation grade type II (61.4%); trabecular architecture (64.9%); lymphocytic infiltration grade I (57.9%); 5) Mean mitotic index was 16.3 m./high power field. 6) There were distant metastases in 81.1% and portal vein invasion in 44.6%. 7) The nuclear morphometric study did not support any influence on patients' survival. CONCLUSIONS: 1) This descriptive analysis allows a morphological data base that is very useful for subsequent morphological or prognostic studies. 2) Our data do not support any influence of nuclear parameters on patients' survival, although we cannot exclude some relation in a greater series.

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