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Objetives. Our aim is to analyze and compare the clinico-pathological features in renal cell carcinomas (RCC) with sarcomatoid and rhaboid phenotype. MATERIAL AND METHODS: We reviewed consecutive patients with nephrectomy RCC from January 1988 to January 2015. The subtyping of the RCC followed the recommendations of the College of American Pathologists. Cases with at least 1% of sarcomatoid and/or rhabdoid change were selected. They were classified as sarcomatoid or rhabdoid according with the predominant morphology, considering the global frecuency of both phenotypes as dedifferentiated component. The following variables were collected: sex, age, symptoms and existence of metastases at diagnosis, parameters listed in the protocol of renal carcinoma of the American College of Pathologists, pattern of tumor growth, perineural invasion, percentage of both tumor necrosis and characteristics of the inflammatory infiltrate. They were described by mean / median or percentage, and compared with Student-t / Mann-Whitney U or ? 2 / Fisher, depending on the sample characteristics. RESULTS: From 1,258 RCC, we identified 45 RCC with sarcomatoid predominance (3,6%) and twenty-nine with rhabdoid predominance (2,3%). RCC with sarcomatoid features showed a higher dedifferentiated component and perineural invasion (27.5 vs. 13.5%, p=0.003 and 28.9 vs. 3.4%, p=0.006, respectively) than RCC with rhabdoid features, while the former showed a higher proportion of neutrophilic inflammation (44.8 vs. 22.2%, p=0.04) and arose more frequently over high grade RCC (55.9 vs. 90.5%, p<0,001). CONCLUSIONS: There was overlapping of the clinico-pathological features of RCC with sarcomatoid and rhaboid phenotype, except for the dedifferentiated component, perineural invasion and neutrophilic inflammation. This close relationship could be explained by a common underlying mechanism, the epithelial-mesenchymal transition, with a double morphological expression that, if confirmed, could lead to selecting patients that would benefit from follow-up or treatment depending on their molecular characteristics.
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Carcinoma de Células Renales/patología , Neoplasias Renales/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fenotipo , Adulto JovenRESUMEN
BACKGROUND: Synchronous liver metastases (LM) from gastric (GC) or esophagogastric junction (EGJ) adenocarcinoma are a rare events. Several trials have evaluated the role of liver surgery in this setting, but the impact of preoperative therapy remains undetermined. METHODS: Patients with synchronous LM from GC/EGJ adenocarcinoma who achieved disease control after induction chemotherapy (ICT) and were subsequently scheduled to chemoradiotherapy (CRT) to the primary tumor and surgery assessment were retrospectively analyzed. Pathological response, patterns of relapse, progression-free survival (PFS), and overall survival (OS) were calculated. From July 2002 to September 2012, 16 patients fulfilling the inclusion criteria were identified. RESULTS: Primary tumor site was GC (nine patients) or EGJ (seven patients). LM were considered technically unresectable in nine patients. Radiological response to the whole neoadjuvant program was achieved in 13 patients. Eight patients underwent surgical resection of the primary tumor; in five of these LM were resected. A complete pathological response in the primary or in the LM was found in four and three patients, respectively. The most frequent site of relapse/progression was systemic (eight patients). Local and liver-only relapses were observed in two patients each. After a median follow-up of 91 months, the median OS and PFS were 23.0 (95% CI 13.2-32.8) and 17.0 months (95% CI 11.7-22.3). 5-year actuarial PFS is 17.6%. CONCLUSION: Our results suggest that an intensified approach using ICT followed by CRT in synchronous LM from GC/EGJ adenocarcinoma is feasible and may translate into prolonged survival times in selected patients.
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Adenocarcinoma/patología , Adenocarcinoma/terapia , Neoplasias Hepáticas/terapia , Terapia Neoadyuvante/métodos , Neoplasias Gástricas/terapia , Adenocarcinoma/mortalidad , Adulto , Anciano , Quimioradioterapia/métodos , Terapia Combinada , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Supervivencia sin Enfermedad , Femenino , Humanos , Quimioterapia de Inducción/métodos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/secundario , Resultado del TratamientoRESUMEN
PURPOSE: Neoadjuvant chemotherapy is being actively tested as an emerging alternative for the treatment of locally advanced colon cancer (LACC) patients, resembling its use in other gastrointestinal tumors. This study assesses the mid-term oncologic outcome of LACC patients treated with oxaliplatin and fluoropyrimidines-based preoperative chemotherapy followed by surgery. METHODS AND PATIENTS: Patients with radiologically resectable LACC treated with neoadjuvant therapy between 2009 and 2014 were retrospectively analyzed. Radiological, metabolic, and pathological tumor response was assessed. Both postoperative complications, relapse-free survival (RFS), and overall survival (OS) were studied. RESULTS: Sixty-five LACC patients who received treatment were included. Planned treatment was completed by 93.8 % of patients. All patients underwent surgery without delay. The median time between the start of chemotherapy and surgery was 71 days (65-82). No progressive disease was observed during preoperative treatment. A statistically significant tumor volume reduction of 62.5 % was achieved by CT scan (39.8-79.8) (p < 0.001). It was also observed a median reduction of 40.5 % (24.2-63.7 %) (p < 0.005) of SUVmax (Standard Uptake Value) by PET-CT scan. Complete pathologic response was achieved in 4.6 % of patients. Postoperative complications were observed in 15.4 % of patients, with no cases of mortality. After a median follow-up of 40.1 months, (p 25-p 75: 27.3-57.8) 3-5 year actuarial RFS was 88.9-85.6 %, respectively. Five-year actuarial OS was 95.3 %. CONCLUSION: Preoperative chemotherapy in LACC patients is safe and able to induce major tumor regression. Survival times are encouraging, and further research seems warranted.
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Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Colon/terapia , Terapia Neoadyuvante , Recurrencia Local de Neoplasia/terapia , Adenocarcinoma/patología , Anciano , Capecitabina/administración & dosificación , Neoplasias del Colon/patología , Terapia Combinada , Femenino , Fluorouracilo/administración & dosificación , Estudios de Seguimiento , Humanos , Masculino , Clasificación del Tumor , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Complicaciones Posoperatorias , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: Perineural invasion (PNI) in colon cancer (CC) has been associated with poorer prognosis even in stage II disease (T3-4 N0 M0). The aim of this study is to analyze prognostic histopathologic factors in stage II colon cancer in patients treated with curative surgery as established in National Comprehensive Cancer Network guidelines. METHODS: From a prospective database of CC cases, 507 patients with stage I-II disease who had undergone curative resection from January 2000 and December 2012 were identified. Of these patients, 17 % received 5-flurouracil-based adjuvant chemotherapy. Together with demographic and anatomic variables, we also studied perineural and lymphovascular invasion, degree of differentiation, and their correlation with disease-free survival. RESULTS: Perineural invasion was identified in 57 patients (11.2 %) and lymphovascular invasion (LVI) in 82 (16.2 %) of the 507 patients. Perineural invasion was associated with LVI, the depth of invasion of the wall of the colon, and location of the tumor. Overall and disease-free survival of the complete series at 5 and 10 years was 89.5, 85.2, 83.2 and 81.6 %, respectively. In the PNI positive patients, disease-free survival at 5 years was significantly lower than in those without PNI (73.5 vs 88.6 %; p = 0.02). Multivariate analysis showed the presence of PNI to be a significant independent prognostic factor for disease-free survival (p = 0.025). Adjuvant chemotherapy reversed the impact of PNI on 5- to 10-year disease-free survival. CONCLUSIONS: PNI a major prognostic and predictive factor in stage II colon cancer, and our results support the use of adjuvant chemotherapy in patients with PNI.
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Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/patología , Nervios Periféricos/patología , Adenocarcinoma/cirugía , Anciano , Vasos Sanguíneos/patología , Quimioterapia Adyuvante , Neoplasias del Colon/cirugía , Supervivencia sin Enfermedad , Femenino , Fluorouracilo/administración & dosificación , Humanos , Vasos Linfáticos/patología , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Invasividad Neoplásica , Estadificación de Neoplasias , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND AND OBJECTIVES: The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiotherapy (CRT) followed by surgery. Pathological findings remain the most significant prognostic factor. The presence of mucin pools and their prognostic significance is a controversial issue. The aim of this study was to analyze the incidence of cellular and acellular mucin pools and their clinical significance. METHODS: Four-hundred and forty-six consecutive prospectively collected specimens from patients with LARC treated with long-course preoperative CRT and surgery were analyzed. Kaplan-Meier analysis was performed. RESULTS: Mucin pools were present in 182 specimens (40.8 %); 66 (14.7 %) were acellular, and viable tumor cells were identified in 116 (26 %). The complete pathological response rate was 13.5 % (60 of 446). With a median follow-up of 79.0 months, the 5- and 10-year disease-free survivals for patients with acellular and cellular mucin pools were 81.5, 78.1, 63.7 and 61.2 %, respectively (p ≤ 0.026). The presence of cells in the colloid response to treatment was associated with a 17.8 and 16.9 % decrease in 5- and 10-year disease survival vs. acellular colloid response. CONCLUSIONS: Our results suggest that cellular mucin pools are an indicator of an aggressive phenotype and harbingers of a worse prognosis.
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Biomarcadores de Tumor/análisis , Mucinas/biosíntesis , Neoplasias del Recto/patología , Adulto , Anciano , Quimioradioterapia , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Mucinas/análisis , Terapia Neoadyuvante , Neoplasias del Recto/mortalidadRESUMEN
BACKGROUND: The prognostic significance of perineural and/or lymphovascular invasion (PLVI) and its relationship with tumor regression grade (TRG) in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (CRT) and surgery. METHODS: A total of 324 patients with LARC were treated with CRT and operated on between January 1992 and June 2007. Tumors were graded using a quantitative 5-grade TRG classification and the presence of PLVI was histologically studied. RESULTS: At a median follow-up of 79.0 months (range 3-250 months), a total of 80 patients (24.7%) relapsed. The observed 5- and 10-year overall survival (OS) was 83.2 and 74.9 %, respectively. The 5- and 10-year disease-free survival (DFS) was 75.1 and 71.4%, respectively. A significant correlation was found between the TRG and survival (log rank, p < 0.001). The 10-year OS was 32.7% for grade 1, 63.8% for grade 2, 75.0% for grade 3, 90.4% for grade 3+, and 96.0%,for grade 4. The 10-year DFS was 31.8% for grade 1, 58.6% for grade 2, 70.4% for grade 3, 88.4% for grade 3+, and 97.1% for grade 4. In patients with PLVI, the TRG had no impact on survival. When excluding patients with PLVI, the TRG was an independent prognostic factor for OS and DFS. CONCLUSIONS: The presence of PLVI is a more powerful prognostic factor than TRG in LARC patients treated with neoadjuvant CRT followed by surgery. PLVI denotes an aggressive phenotype, suggesting that these patients may benefit from adjuvant systemic therapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Neoadyuvante , Recurrencia Local de Neoplasia/mortalidad , Neoplasias del Sistema Nervioso Periférico/mortalidad , Neoplasias del Sistema Nervioso Periférico/secundario , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Adenocarcinoma/mortalidad , Adenocarcinoma/secundario , Adenocarcinoma/terapia , Anciano , Carboplatino/administración & dosificación , Quimioradioterapia , Terapia Combinada , Femenino , Fluorouracilo/administración & dosificación , Estudios de Seguimiento , Humanos , Leucovorina/administración & dosificación , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/terapia , Estadificación de Neoplasias , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Neoplasias del Sistema Nervioso Periférico/terapia , Periodo Posoperatorio , Pronóstico , Neoplasias del Recto/terapia , Inducción de Remisión , Tasa de SupervivenciaRESUMEN
Plasmacytoid urothelial carcinoma is an extremely rare pathological finding. We report our experience of one case. A 60 year old male with hematuria of two years evolution, with frequency and dysuria. A tumor was found and he received surgical treatment by TURB at first. The pathology result was a plasmacytoid urothelial carcinoma. Subsequently a radical cystectomy with urinary diversion was performed. The patient received follow-up until his death.
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Carcinoma de Células Transicionales/patología , Neoplasias de la Vejiga Urinaria/patología , Carcinoma de Células Transicionales/clasificación , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Vejiga Urinaria/clasificaciónRESUMEN
OBJECTIVES Analysis of the results on the treatment of esophageal cancer by transthoracic esophagectomy by a multidisciplinary team of surgeons and oncologists. METHODS Between January 1990 and December 2009, 100 consecutive patients underwent transthoracic esophagectomy. Data were collected prospectively and clinical, pathological and histological features of the tumors were analyzed as well as the results of postoperative morbidity and mortality. RESULTS The average patient age was 55 years (range 31- 83 years). In 59 cases the tumor was located in the lower third and in 41 cases in the middle third. Forty-six patients had adenocarcinoma and 54 squamous cell carcinoma. In 54 cases radio-chemotherapy was planned preoperatively. Classifi cation according to pathological tumor stage was: stage 0 in 21 patients, stage I in 10 patients, stage IIa in 28, stage IIb in 9, stage III in 21 and stage IV in 11. The mean number of lymph nodes examined was 14 (range 0-28). Hospital mortality occurred in 4 cases and postoperative complications in 29 patients (33%). The most frequent postoperative complication was pulmonary complications in 17 cases. The average hospital stay was 15.2 days (range 10-40 days) CONCLUSIONS The results of esophageal cancer have been improved in recent years due to the formation of multidisciplinary teams in this pathology. In our study we have shown that the results obtained with the transthoracic technique for cancer of the esophagus are within the ranges reported in the literature for teams with high prevalence of the disease.
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Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía , Escisión del Ganglio Linfático , Adenocarcinoma/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Neoplasias Esofágicas/mortalidad , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Complicaciones Posoperatorias , Estudios Prospectivos , Tasa de Supervivencia , Resultado del TratamientoAsunto(s)
Humanos , Masculino , Femenino , Adulto , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/fisiopatología , Pronóstico , Pancreatectomía/métodos , Inmunohistoquímica/métodos , Pancreaticoduodenectomía/métodos , Estudios Retrospectivos , Páncreas/citología , Páncreas/patología , Neoplasias Pancreáticas , InmunohistoquímicaRESUMEN
BACKGROUND: intraductal papillary mucinous neoplasm (IPMN) shows a series of lesions which evolve from benign lesions -adenoma- to invasive carcinoma. AIM: To analyze the clinical and pathological results of 15 patients diagnosed of IPMN, and surgically treated according to the guidelines of International Consensus Conference. MATERIAL AND METHODS: A retrospective analysis of 15 patients surgically treated between March 1993 and September 2009, according to the International Consensus recommendation. Demographic, diagnostic tools, surgical report, pathologic database and actuarial survival were analyzed with a follow-up from one and a half month through nine years. RESULTS: 6 Patients underwent pancreaticoduodenectomies, 4 total pancreatectomies, 2 body or central pancreatectomies, 2 partial pancreatectomies (enucleation) and 1 distal pancreatectomy. A morbidity of 46 and 0% hospital mortality were assessed, with a median length hospital stay of 10 days. In five cases, the IPMN was combined type (both main and branch pancreatic ducts involved) in four main duct-type and branch duct-type in the another six as well. Several atypia (IPMN carcinoma in situ) was observed in 2 patients and invasive carcinoma with negative lymph nodes was identified in 3 patients. A patient without invasive carcinoma died at 66 months of follow-up for pancreas adenocarcinoma. The actuarial survival up to recurrence or death was 105,133 months with a range of follow-up from 1 month and a half until 9 years. CONCLUSIONS: IPMN main duct or mixed type warrants complete resection due to its incidence of invasive carcinoma or precursor lesions of malignancy as well. Due to its multifocal pattern, patients should be followed in long-term surveillance. The management of asymptomatic IPMN type branch less than 3 cm is controversial.
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Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Papiloma Intraductal/patología , Papiloma Intraductal/cirugía , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Páncreas/patología , Páncreas/cirugía , Neoplasias Pancreáticas/mortalidad , Pancreaticoduodenectomía , Papiloma Intraductal/mortalidad , Periodo Posoperatorio , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Introducción: la neoplasia papilar mucinosa intraductal(NPMI) del páncreas comprende una serie de lesiones que evolucionandesde lesiones benignas (adenoma) hasta carcinoma ductalinvasivo.Objetivo: analizar los resultados clínicos y patológicos de 15pacientes diagnosticados de NPMI e intervenidos según las recomendacionesde conferencia de consenso.Material y métodos: análisis retrospectivo de 15 pacientescon NPMI, intervenidos entre marzo de 1993 y septiembre de2009; según pautas de conferencias de consenso internacionales.Se recogieron datos demográficos, pruebas diagnósticas, tipo deintervención, histopatología y supervivencia actuarial con un seguimientoentre mes y medio y nueve años.Resultados: se realizaron 6 duodenopancreatectomías cefálicas,4 pancreatectomías totales, 2 pancreatectomías centrales,2 pancreatectomías parciales y una pancreatectomía distal. Se registróuna morbilidad del 40%, sin mortalidad operatoria, con unaestancia media de 10 días. En 5 casos la NPMI fue de tipo mixto,en 4 afectaba al conducto pancreático y en los 6 restantes a ramasaccesorias. Dos pacientes presentaron carcinoma in situ y 3carcinoma invasivo con ganglios negativos. Un paciente, sin carcinomainvasivo, falleció a los 66 meses por adenocarcinoma depáncreas. La supervivencia actuarial hasta recidiva o muerte fuede 105,133 meses; con un rango de seguimiento entre mes y medioy 9 años.Conclusiones: la NPMI tipo ductal y mixto exige la reseccióncompleta debido a la elevada incidencia de carcinoma invasivo ode lesiones precursoras de malignidad. Por su carácter multifocallos enfermos deben ser revisados a largo plazo. Existen controversiasen las NPMI tipo accesorio asintomáticas y menores de 3 cm(AU)
Background: intraductal papillary mucinous neoplasm(IPMN) shows a series of lesions which evolve from benign lesionsadenoma to invasive carcinoma.Aim: to analyze the clinical and pathological results of 15 patientsdiagnosed of IPMN, and surgically treated according to theguidelines of International Consensus Conference.Material and method: a retrospective analysis of 15 patientssurgically treated between March 1993 and September 2009, accordingto the International Consensus recommendation. Demographic,diagnostic tools, surgical report, pathologic database andactuarial survival were analyzed with a follow-up from one and ahalf month through nine years.Results: 6 patients underwent pancreaticoduodenectomies,4 total pancreatectomies, 2 body or central pancreatectomies, 2 partialpancreatectomies (enucleation) and 1 distal pancreatectomy.A morbidity of 46 and 0% hospital mortality were assessed, witha median length hospital stay of 10 days. In five cases, the IPMNwas combined type (both main and branch pancreatic ducts involved)in four main duct-type and branch duct-type in the anothersix as well. Several atypia (IPMN carcinoma in situ) wasobserved in 2 patients and invasive carcinoma with negativelymph nodes was identified in 3 patients. A patient without invasivecarcinoma died at 66 months of follow-up for pancreas adenocarcinoma.The actuarial survival up to recurrence or deathwas 105,133 months with a range of follow-up from 1 monthand a half until 9 years.Conclusions: IPMN main duct or mixed type warrants completeresection due to its incidence of invasive carcinoma or precursorlesions of malignancy as well. Due to its multifocal pattern,patients should be followed in long-term surveillance. The managementof asymptomatic IPMN type branch less than 3 cm iscontroversial(AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Neoplasias Quísticas, Mucinosas y Serosas/epidemiología , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patología , Pancreaticoduodenectomía/métodos , Pancreaticoduodenectomía/tendencias , Pancreatectomía/métodos , Neoplasias Pancreáticas , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico , Intervalos de ConfianzaRESUMEN
Solid pseudo-papillary tumor (SPPT) is a rare cystic tumor of the pancreas (1-3% of exocrine tumors of the pancreas) which shows an "enigmatic" behavior on the clinical and molecular pattern. A retrospective analysis of the cytological studies and resected specimens of pancreatic cystic tumors from May 1996 to February 2010 was carried out. Three cases of SPPT were found, which are the objective of this study. The diagnosis was established upon occasional finding in the abdominal CT, in spite of sizing between 3 and 6 cm of diameter. In the three cases the preoperative diagnosis was confirmed by cytology and specific immunohistochemical staining. Cases 2 and 3 showed strong immunoreactivity for Beta-Catenin and E-Cadherin staining. Radical resection (R0) was carried out in the three cases. A young male -21 years of age (case 1)- who had duodenal infiltration and two lymph nodes metastases died of hepatic and peritoneal recurrence 20 months following surgery. The other two cases are free of disease. The current review of the literature reports roughly 800 cases since the first report in 1959, and shows the enigmatic character of this tumor regarding the cellular origin, molecular pathways, prognostic factors and clinical behavior.
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Carcinoma Papilar/patología , Neoplasias Pancreáticas/patología , Adolescente , Adulto , Resultado Fatal , Femenino , Humanos , Inmunohistoquímica , Neoplasias Hepáticas/secundario , Metástasis Linfática , Imagen por Resonancia Magnética , Masculino , Pancreatectomía , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: Localized fibrous tumors of the pleura are rare. We report 7 cases and review the literature in order to define the range of clinical characteristics of these tumors, treatment options, and prognosis. METHODS: A retrospective review of 7 cases treated between 1997 and 2003, focusing on clinical presentation, diagnostic tests, and treatment. The tumor was removed surgically in all cases, by thoracotomy in 6 cases and by video-assisted thoracoscopic surgery in 1 patient. RESULTS: All patients recovered fully after surgery, with no postoperative complications. One patient experienced recurrence twice, 33 and 67 months after the initial resection. All are alive at the time of writing, after a mean follow up period of 19 months (range 1 month to 5 years and 10 months). CONCLUSIONS: The treatment of choice for a fibrous tumor of the pleura is full resection and follow-up to detect possible late recurrence.
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Fibroma , Neoplasias Pleurales , Adulto , Femenino , Fibroma/diagnóstico , Fibroma/terapia , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pleurales/diagnóstico , Neoplasias Pleurales/terapia , Estudios RetrospectivosRESUMEN
No disponible
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Humanos , Modelos Biológicos , Helicobacter pylori , Lesiones Precancerosas , Infecciones por Helicobacter , Infecciones por Helicobacter , Neoplasias Gástricas , Fenómenos Fisiológicos de la NutriciónRESUMEN
PTEN gene (10q23) is a relevant tumor suppressor gene whose protein is a phosphatase involved in the control of angiogenesis of some tumors including astrocytomas. There are no studies correlating molecular changes of PTEN and the immunohistochemical expression of its protein (pPTEN) with the expression of vascular endothelial growth factor (VEGF) in astrocytomas. Fifty-six surgically resected brain gliomas, 10 grade 2, 16 grade 3, and 30 grade 4, were studied by a combined approach, consisting of (1) PCR analysis using four microsatellite markers against the PTEN gene region (10q23), (2) the FISH technique to test chromosome 10 using a pericentromeric probe, and (3) immunohistochemical evaluation of pPTEN and VEGF. Loss of heterozygosity (LOH) of PTEN was observed in 10% of fibrillary grade 2 astrocytomas and all gemistocytic ones. In high-grade tumors, LOH was more frequent in grade 4 than in grade 3 (> or =2 loci deleted, 83% and 56%, respectively). Monosomy for chromosome 10 was observed especially in high-grade tumors (6% of grade 3 and 50% of grade 4) and in 20% of grade 2 tumors, corresponding to gemistocytic astrocytomas. Results with both antibodies against PTEN were concordant: loss of cytoplasmic immunoreactivity was frequently observed according to homogeneous or heterogeneous patterns in 70% and 50% of grades 4 and 3, respectively, but not in grade 2. Immunonegativity of pPTEN was associated with PTEN gene deletion (> or =2 loci deleted) (P = 0.04) but not with monosomy. Cytoplasmic immunoreactivity against VEGF was observed in high-grade and in gemistocytic astrocytomas, but not in conventional grade 2 tumors. Tumor expression of pPTEN was not associated with immunoreactivity against VEGF when the same areas were considered. In conclusion, loss of PTEN expression is frequent in high-grade astrocytomas, but not in grade 2 tumors, and correlates with PTEN deletion and loss of chromosome 10. PTEN immunoreactivity does not correlate with VEGF expression in astrocytomas when similar areas are considered.
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Astrocitoma/genética , Neoplasias Encefálicas/genética , Regulación Neoplásica de la Expresión Génica , Genes Supresores de Tumor , Monoéster Fosfórico Hidrolasas/genética , Proteínas Supresoras de Tumor/genética , Factor A de Crecimiento Endotelial Vascular/genética , Astrocitoma/metabolismo , Astrocitoma/patología , Biopsia , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patología , ADN de Neoplasias/análisis , Humanos , Técnicas para Inmunoenzimas , Hibridación Fluorescente in Situ , Pérdida de Heterocigocidad , Fosfohidrolasa PTEN , Monoéster Fosfórico Hidrolasas/metabolismo , Proteínas Supresoras de Tumor/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismoRESUMEN
BACKGROUND: The distinction between pleural mesothelioma (MS), reactive mesothelium (RM), and adenocarcinoma (AC) in serous effusions continues as a diagnostic problem in pathology. Immunohistochemistry can help, especially in surgical samples, but the optimum panel of antibodies has yet to be reported. The application of these antibodies to serous effusions has displayed variable results. The aim of this study was to evaluate the usefulness of eight monoclonal antibodies in the differential diagnosis of MS, RM, and AC in serous effusions. METHODS: A total of 44 cytologic specimens of serous effusions (26 pleural, 15 peritoneal, and 3 pericardial) from 30 ACs, 3 MSs, and 11 RMs, previously stained with Papanicolaou stain, were selected retrospectively from our files and stained with HBME-1, thrombomodulin, calretinin, MOC-31, Ber-EP4, E-cadherin, CEA, and CD-15. The immunoreactions were evaluated independently by two pathologists. A stepwise logistic regression analysis was applied to the data to select an appropriate panel of antibodies. RESULTS: Statistical significance was found with HBME-1, thrombomodulin, MOC-31, Ber-EP4, and CD-15, when comparing both AC versus MS, and AC versus any type of mesothelial proliferation (MS or RM). Using HBME-1, 80% of ACs were negative whereas all three MSs reacted strongly with P = 0.003. A P = 0.02 was reached with thrombomodulin with 76.5% of ACs showing no immunoreactivity. Ber-EP4 and MOC-31 displayed good results with a P < 0.001 and 0.01, respectively. CD-15 reached a P = 0.034. No differences were found using the other antibodies. Ten ACs, all 3 MSs, and 10 RMs were double immunostained with HBME-1 and/or MOC-31 and Ber-EP4 successfully. CONCLUSIONS: Immunohistochemical studies performed on Papanicolaou stained cytologic smears proved to be useful in the differentiation between metastatic AC and mesothelial proliferation. HBME-1, thrombomodulin, MOC-31, Ber-EP4, and CD-15 were the most useful. In selected cases, it appeared that double immunostaining aided the differential diagnosis. Cancer (Cancer Cytopathol)
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Adenocarcinoma/patología , Anticuerpos Monoclonales , Citodiagnóstico , Epitelio/patología , Exudados y Transudados/citología , Mesotelioma/patología , Líquido Ascítico/patología , Diagnóstico Diferencial , Humanos , Inmunohistoquímica , Derrame Pericárdico/patología , Derrame Pleural/patología , Estudios RetrospectivosRESUMEN
Amiodarone is useful for the treatment of ventricular and supraventricular arrhythmias, but it has been associated with several adverse effects. Amiodarone-induced hepatotoxicity is a frequent complication and often consist in a mild and asymptomatic elevation of liver function tests, although severe cases have been described. A case of severe amiodarone-induced hepatotoxicity slowly resolving after discontinuation of the drug and in which liver biopsy was crucial for diagnosis is reported. Although there are no pathognomonic histopathological findings, phospholipidosis is the morphologic hallmark of amiodarone hepatotoxicity.
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Amiodarona/efectos adversos , Antiarrítmicos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas , Anciano , Bloqueo Cardíaco/tratamiento farmacológico , Humanos , Hígado/efectos de los fármacos , Hígado/patología , Hepatopatías/patología , MasculinoRESUMEN
A 74-year-old woman with a 4-month history of hoarseness had a granulomatous lesion of the vocal cords by laryngoscopy and a normal physical examination. Wegener's granulomatosis was confirmed by biopsy. Early treatment with trimethoprim-sulfamethoxazole prevented the evolution toward a more severe systemic form of the disease. The patient remains asymptomatic a year and a half after treatment.
Asunto(s)
Granulomatosis con Poliangitis/diagnóstico , Anciano , Antiinfecciosos/uso terapéutico , Combinación de Medicamentos , Quimioterapia Combinada , Femenino , Granulomatosis con Poliangitis/tratamiento farmacológico , Ronquera/diagnóstico , Humanos , Sulfametoxazol/uso terapéutico , Trimetoprim/uso terapéuticoRESUMEN
The incidence of retropharyngeal abscess is decreasing since the arrival on semisynthetic penicillins. We report one case of retropharyngeal abscess, after ingestion of a foreign body, in an adult patient, complicated with infective mediastinitis, pleural effusion and pericarditis. The spreading of the infection is able to be explained either by continuity or through the fascial sheets. The usefulness of the CT scan for diagnosis as well for the stretching of the condition is brought out. We underline the anterolateral cervicotomy as the best procedure for surgical drainage of these complications.