RESUMEN

Se presentan dos casos clínicos de metástasis orbitaria. El primero es el de un varón de 63 años con pérdida de agudeza visual reciente asociada a diplopía binocular. Las pruebas de neuroimagen revelan una tumoración de características agresivas con extensión intraconal e invasión ósea. El estudio sistémico nos lleva al diagnóstico de carcinoma broncogénico microcítico en estadio IV. El segundo caso corresponde a una mujer de 69 años con cáncer de mama en estadios precoces que presenta alteraciones de motilidad ocular y proptosis. Mediante tomografía computarizada se evidencia infiltración tumoral de musculatura extraocular. El estudio anatomopatológico confirma el diagnóstico de metástasis orbitaria. La enfermedad metastásica orbitaria es una entidad relativamente infrecuente, con presentación clínica variada y pronóstico desfavorable. Constituye un reto diagnóstico que se debe sospechar en pacientes con factores de riesgo para enfermedad tumoral y recurrir a las técnicas de imagen para definir la extensión y severidad del cuadro

Two clinical cases of orbital metastasis are presented. The first is a 63 year-old male with a recent loss of visual acuity associated with binocular diplopia. Neuroimaging tests revealed a tumour of aggressive features with intraconal extension and bone invasion. The systemic study led to the diagnosis of stage IV small cell bronchogenic carcinoma. The second case is a 69 year-old woman with breast cancer in early stages that showed alterations in ocular motility and proptosis. Computed tomography showed tumour infiltration of extraocular musculature. The anatomo-pathological study confirmed the diagnosis of orbital metastasis. Orbital metastatic disease is a relatively infrequent entity with varied clinical presentation and an unfavourable prognosis. It constitutes a diagnostic challenge that should be suspected in patients with risk factors for tumour disease and imaging techniques used to define the extent and severity of the condition

Asunto(s)

RESUMEN

Two clinical cases of orbital metastasis are presented. The first is a 63 year-old male with a recent loss of visual acuity associated with binocular diplopia. Neuroimaging tests revealed a tumour of aggressive features with intraconal extension and bone invasion. The systemic study led to the diagnosis of stage IV small cell bronchogenic carcinoma. The second case is a 69 year-old woman with breast cancer in early stages that showed alterations in ocular motility and proptosis. Computed tomography showed tumour infiltration of extraocular musculature. The anatomo-pathological study confirmed the diagnosis of orbital metastasis. Orbital metastatic disease is a relatively infrequent entity with varied clinical presentation and an unfavourable prognosis. It constitutes a diagnostic challenge that should be suspected in patients with risk factors for tumour disease and imaging techniques used to define the extent and severity of the condition.

Asunto(s)

RESUMEN

OBJECTIVE: According to the literature, the typical histological findings and simple colloidal iron staining permit the identification of chromophobe cell renal carcinoma, a genetically well-established entity. Our doubts on whether this tumor type can be recognized by conventional methods are presented in this study. METHODS: 130 cases of renal carcinoma were treated from 1977 to 1997. Of these, 12 showed characteristic general histological features compatible with chromophobe cell renal carcinoma and reticulated and intense, diffuse cytoplasmic positivity on colloidal iron staining. These tumors were reviewed for the following: 1) gross appearance, 2) architecture, 3) cytoplasmic characteristics, 4) nuclear characteristics, 5) colloidal iron histochemical staining which is considered fundamental and exclusive, 6) immunohistochemical phenotype. Ultrastructural study of material fixed in paraffin was also performed. RESULTS: One case met all 6 criteria, 3 met 5 of them, 6 cases met 4, and 2 cases met 3 of the criteria. The ultrastructural study was not useful in making the diagnosis due to the poor quality of the material. CONCLUSIONS: If all cases were chromophobe cell renal carcinoma, then this tumor type can be recognized and diagnosed by simple techniques in any pathology laboratory, and its incidence, presence of necrosis, hemorrhage and high nuclear grade would be even greater than currently accepted. Furthermore, it would be expected that the prognosis, by each grade and stage, would not be so different from that of the conventional renal carcinoma, as some large series have already indicated. On the other hand, if our cases or some of them were in fact conventional renal cell carcinoma that closely resembled chromophobe cell renal carcinoma, an exact diagnosis cannot be made without a genetic or ultrastructural study (using adequately fixed material), and most of the published studies would therefore have to be questioned.

Asunto(s)

RESUMEN

OBJECTIVE: Based on the clinicopathological findings of two additional cases of sarcomatoid chromophobe renal cell carcinoma and a review of the literature, we analyzed the prognosis in this and other forms of sarcomatoid carcinoma to determine the differences, if any, and their histopathological basis. METHODS: Of 139 cases of renal cell carcinoma that were surgically resected during the period 1977-1999, two were sarcomatoid chromophobe renal cell carcinoma, accounting for 15% of 13 cases of chromophobe cell carcinoma and 18% of 11 cases of sarcomatoid cell carcinoma in the same series. RESULTS: The first case was a 73-year-old male with a locally advanced, non-metastatic tumor. Palliative resection was performed and the histological analysis showed a predominantly sarcomatoid mass with small epithelial foci with the morphological, histochemical and immunohistochemical characteristics of chromophobe renal cell carcinoma. The patient died 11 months later. The second case was a 70-year-old female who presented with flank and lumbar pain and episodes of gross hematuria. Anatomopathological analysis showed a chromophobe cell carcinoma with sarcomatous foci, stage pT2pN0M0. The patient is disease-free at 46 months' follow-up. Immunohistochemically, in both cases the sarcomatoid component was found to be strongly positive for vimentin and focally for EMA, and negative for actin, desmin and myoblogin; isolated cells were positive for AE1 and AE3 in the second case. The epithelial component was positive for AE3 and EMA, and negative for AE1, vimentine and CD68. CONCLUSIONS: Like our first case, most of the reported cases of sarcomatoid chromophobe renal cell carcinoma show a sarcomatoid mass with foci of carcinoma, and a poor prognosis. In our view, as in all renal cell carcinomas, prognosis depends on tumor grade and stage, which is the highest for sarcomatoid chromophobe renal cell carcinoma. Furthermore, although the epithelial component (chromophobe, chromophilic, clear cells, etc.) may probably have little significance, the influence that the proportion of epithelial and sarcomatoid component might have in these tumors cannot be completely discarded.

Asunto(s)

RESUMEN

OBJECTIVE: To analyze the incidence and the clinical and histopathological features of non-inflammatory scrotal lesions with special reference to the non-neoplastic lesions, which are the most common. METHODS: The cases of scrotal surgical pathology of the Hospital Nuestra Señora del Pino from 1988-1997 were reviewed. Skin biopsies for dermatological conditions, Fournier's gangrene, inflammatory-infectious lesions, hydroceles, lesions that could cause secondary involvement of the scrotal wall (e.g., spermatoceles) and invasive lesions from adjacent tumors were excluded from the study. RESULTS: 14 cases (4 neoplastic and 10 non-neoplastic lesions) were specifically analyzed. Of these 10 non-neoplastic lesions, 7 were epidermoid cysts (3 multiple) and 3 idiopathic calcinosis. The latter, which are discussed at length, presented in middle-aged patients (56, 45 and 42 years) as multiple nodules that had gradually appeared over several years (20 years in one of the cases) and had been invariably diagnosed as "sebaceous scrotal cysts". Their form of presentation and treatment are similar to those of true scrotal epidermoid cysts, with which they might be related. CONCLUSIONS: In our series, the most common primary scrotal lesions were non-neoplastic and comprised two types whose pathogenic relationship has as yet not been elucidated: simple epidermoid or epidermal cysts (half of which were multiple lesions) and less frequently idiopathic calcinosis of the scrotum.

Asunto(s)

RESUMEN

AIMS: Dermatofibrosarcoma protuberans (DFSP) is a distinctive cutaneous spindle cell neoplasm that invariably infiltrates the subcutaneous tissue. Other reports have suggested that exceptional cases of DFSP may be confined to the subcutaneous tissue and lack dermal involvement. We wish to confirm this observation by describing cases of a rare variant of DFSP confined to the subcutaneous tissue, and analyse possible histogenetic implications. METHODS AND RESULTS: Three cases of DFSP located in the subcutaneous tissue are reported. Multiple step sections demonstrated the lack of dermal involvement in two of them, whereas the third case infiltrated the dermis at the junction with the subcutis minimally in one of five blocks. Immunohistochemical studies using a battery of monoclonal antibodies were performed. All the tumours stained strongly for vimentin and CD34. CONCLUSIONS: Because of the lack of dermal involvement in two cases and only minimal dermal involvement in one case, we called this variant deep DFSP. Except for deep setting of the tumour, deep DFSP is indistinguishable from typical DFSP clinically, histologically and immunohistochemically. The existence of deep DFSP provides evidence that specific structures of the skin may be not involved in this tumour's histogenesis.

Asunto(s)

RESUMEN

OBJECTIVE: To describe a case of nephrogenic adenoma occurring in the intestinal mucosa of the neobladder urethro-sigmoid anastomosis in a patient who had undergone cystectomy for a bladder carcinoma. METHODS/RESULTS: Of 14 cases of nephrogenic adenoma in 11 patients, one involved the lamina propria of large bowel mucosa. A 67-year-old patient submitted to radical cystoprostatectomy and orthotopic bladder substitution using a detubulized sigmoid neobladder due to multicentric G3 pTa, pTis urothelial bladder carcinoma had two episodes of stricture of the distal anastomosis. After the second episode, endoscopic resection of the area was performed. Histological examination of the specimen disclosed nephrogenic adenoma of the intestinal mucosa. CONCLUSIONS: Nephrogenic metaplasia has been observed in the intestinal mucosa of patients undergoing different urological procedures. To our knowledge, our patient is the third case involving large bowel mucosa reported in the literature. These three cases suggest that nephrogenic adenoma might not be a metaplastic process specific to the urothelium.

Asunto(s)

RESUMEN

OBJECTIVE: To describe a case of blue nevus of the prostate and propose a more precise terminology in order to avoid the confusion arising from the presence of melanin pigment in the prostatic epithelium and/or stroma. METHODS/RESULTS: A 58-year-old patient with adult polycystic kidney is described. The patient demonstrated clinical and radiological findings compatible with benign prostatic hyperplasia and had a PSA of 11.4 ng/ml. After three transrectal biopsies showing no malignancy, the patient underwent transurethral resection. Pathological examination of the specimen disclosed glandular-stromal hyperplasia and extensive melanin pigmentation of stroma or blue nevus of the prostate. CONCLUSION: The presence of pigment in the prostate is an extraordinary histological finding that can be ascribed, in most of the cases, to one of the following conditions: a) melanosis or true melanocytosis, in which the melanin pigmentation is produced by the prostatic stromal cells, with or without involvement of the surrounding epithelium (probably in a secondary passive process); b) pseudomelanosis, in which the lipofuscin pigmentation is produced and stored by epithelial cells. In both cases the histopathological findings have no clinical significance or prognostic implications.

Asunto(s)

RESUMEN

OBJECTIVE: To describe a case of prostatic xanthoma, a benign condition of inflammatory origin related with granulomatous prostatitis. METHODS: A 70-year-old patient with voiding syndrome and a DRE suggestive of grade II hyperplasia of the prostate is described. A bilateral biopsy of the prostate was negative. The patient was submitted to transurethral resection with normal analytical data. Histological examination of the specimen showed benign prostatic hyperplasia associated with sclerosing adenosis and a clear, foamy cytoplasmic cell and an unremarkable nucleus. Immunocytochemical analysis with the KP-1 lysosomal marker (CD-68) disclosed macrophages. Cytokeratin labelling (AE1-AE3) was negative, thereby discarding any type of epithelial cell proliferation. CONCLUSION: Due to its rarity, making the differential histological diagnosis of prostatic xanthoma can be difficulty in certain cases and it can occasionally present as a palpable mass. However, it must be emphasized that it is a benign condition and clinically irrelevant in most of the cases.

Asunto(s)

RESUMEN

OBJECTIVE: To describe a case of metanephric adenoma, a rare and little known tumor with no potential to malignancy. This tumor type can occasionally coexist with Wilms' tumor, with which it is histogenically related. METHODS/RESULTS: A 54-year-old female patient was referred to the Urology Service for a small mass in the left kidney that had been incidentally detected during an ultrasound evaluation. Patient evaluation disclosed a solid, circumscribed, unencapsulated mass of 2.3 cm in its largest segment. It was mainly localized in the medulla of the kidney, although it was extensively in contact with the renal cortex. Histologically, it was comprised of small epithelial cells in a tubular or papillary arrangement, without atypia, mitosis, necrosis or invasion of adjacent renal parenchyma or vascular structures, and with abundant psammoma-like calcifications. The histological findings were characteristic of metanephric adenoma. CONCLUSION: Metanephric adenoma is an uncommon, morphologically distinct tumor type, with characteristic histopathological features. Despite its size, it is benign and should be distinguished from renal cell carcinoma or Wilms' tumor.

Asunto(s)

RESUMEN

This report describes a patient with a poorly differentiated cutaneous angiosarcoma (CA) of the face superinfected with pseudomonas aeruginosa. Neoplastic cells were positive for CD-34, CD-31 and vimentin, whereas they failed to express other vascular markers such as Factor VIII and Ulex europeaus lectin. The tumor spread rapidly through the skin and the superficial soft tissue before metastasizing. The patient died of disease 6 months after histopathological diagnosis. An autopsy revealed widespread metastases in the lung and the liver. The aim of this report is to call attention to some circumstances in which CA may masquerade as an inflammatory process, delaying the right diagnosis with serious consequences for the patient.

Asunto(s)

RESUMEN

Cutaneous lymphadenoma is an uncommon benign epithelial neoplasm with a prominent lymphocytic infiltrate. Both a pilosebaceous and an eccrine origin have been suggested. We herein document three cases of cutaneous lymphadenoma. Our findings support the hypothesis that cutaneous lymphadenoma is a benign tumor with follicular differentiation representing a peculiar form of nodular trichoblastoma with adamantinoid features and a significant inflammatory cell infiltrate.

Asunto(s)

RESUMEN

The diagnosis of nosocomial pneumonia is especially difficult in intubated patients due to the low specificity of their clinico-radiological signs. The objective of this study was to evaluate the usefulness of basing diagnosis on elastin fibers (EF) in bronchoaspirate (BAS) as an indication of pneumonia in mechanically-ventilated (MV) patients. Forty-seven MV patients suspected of having nosocomial pneumonia were studied prospectively. Fiber bronchoscopy was carried out on all patients and samples were obtained using a protected catheter brush (PCB) and bronchoalveolar lavage (BAL). A purulent sample of BAS was also examined, after addition of 40% KOH, to determine the presence of EF. EF was found in 15 patients, 11 of whom had pneumonia while 3 more had necrotizing pneumonia (sensitivity 52%, specificity 85%). Ten of the 17 microorganisms isolated in the cases of EF positive pneumonia were gram negative, although the germ found most often was S. aureus. There were no differences in the prognosis for pneumonia patients who were EF positive and those who were EF negative. In conclusion, once necrotizing pneumopathology has been ruled out, the presence of EF in BAS may offer reasonable support for firm diagnosis in some MV patients with pneumonia.

Asunto(s)

RESUMEN

We present a case of a very rare naso-sinusal malignant, teratoid neoplasia, recently called "terato-carcinosarcoma". The tumor appeared in right sinuses of a 18 year old male with nasal obstruction, headache and unilateral proptosis. In spite of surgery and radiotherapy, the patient showed, 4 months later, local massive relapse. Treatment was considered to not be possible. We review the literature about this topic, and we only find 26 published cases; the presented case would be the first published one in our country.

Asunto(s)

RESUMEN

Adrenal pseudocysts are cystic lesions in the gland whose wall has no internal lining to permit a more precise classification. These can develop into very large cysts containing several liters of liquid. They account for almost half of all adrenal cystic lesions in young or middle-aged adults. In 50% of the cases these are incidentally discovered during laparotomy or radiographic evaluation. Its origin is still a controversy. The present study describes the clinical and anatomopathological features of two giant pseudocysts of the adrenal gland. One of the patients was asymptomatic (an IVP incidentally disclosed the presence of a mass). The other case consulted for lumbar pain. Furthermore, the different types of adrenal cysts reported in the literature and the differential diagnosis from other adrenal cystic lesions, mainly tumors and infections, are discussed.

Asunto(s)

RESUMEN

We present three cases of Fibrous Hamartoma of infancy, a pediatric benign fibrous proliferation. The patients were two females (10 months and 6 and half years old) and one male (18 months old). The location was characteristic in two cases: axillae and the fore aspect of the chest wall; the other case corresponds to three separated lesions located at the pubic region. The tumoral diameters were between 0.5 and 3.5 cms. Two of the five tumors were adhered to the skin and fascia. In only one case the lesion was congenital. As it usually occurs, the three cases were diagnosed after the pathological study of the surgically exercised lesions, because the rarity of this entity. That turns exceptional if the lesions are multiple.

Asunto(s)

RESUMEN

The clinical and the gross and microscopic features of two multicystic masses in adult female patients are described. These met the Powell and Boggs and Kimelstiel criteria for multilocular renal cyst (MRC). MRC may be the common process and the gross expression of different disease entities with different biological significance which must be distinguished clinically and anatomopathologically. We present the data for differential diagnosis of conditions that may present as MRC: partially differentiated cystic nephroblastoma, mesoblastic congenital cystic nephroma, lymphangioma (more common in infants), cystic renal carcinoma and sarcoma, segmental polycystic kidney (more common in adults) and segmental renal dysplasia. The diagnosis of multilocular renal cyst should be made only after discarding the foregoing conditions.

Asunto(s)

Asunto(s)

RESUMEN

We report on a patient with chronic prostate disease diagnosed as having a pelvic desmoid tumor (abdominal fibromatosis localized to the pelvis) whose presenting features were those of complete acute urinary retention. The findings on initial examination led us to suspect a prostate neoplasm which, however, was discarded by the results of the radiographic work up. The clinical and pathologic findings are presented and attention is drawn to the possibility that these mesenchymal neoplasms can have urological presenting symptoms and signs.

Asunto(s)

RESUMEN

We report on a mesothelioma of the tunica vaginalis testis in a 33-year-old patient. Eleven years following tumor removal, the patient is well and no evidence of tumor has been observed. We describe the pathologic features of the tumor, and discuss the characteristic, constant, but unspecific presenting features of mesotheliomas that are uncommon to this site, and the major difficulties encountered in making a differential diagnosis.

Asunto(s)