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Histological grade and depth of invasion are among the best outcome pathological predictors in penile cancer. The TNM system is based on a combination of both for some stages. It is assumed that high-grade and deep tumors carry the worst prognosis, and the opposite occurs with superficial and low-grade neoplasms. However, there is no systematic evaluation of the phenomenon. We studied 147 patients from the Hospital de Oncologia - Instituto Mexicano del Seguro Social (period 2000 to 2013). They were treated by total or partial penectomies. Lymph node involvement was evaluated by bilateral inguinal node dissection (126 cases) or ultrasonography (21 cases). Tumor thickness was measured in mm from tumor surface to deepest invasion point, using a cut-point for superficial (≤10 mm) vs deep (>10 mm) tumors. Histological grade was from 1 to 3 according to WHO and AFIP criteria and considering G1 and G2 as low-grade and G3 as high-grade. Average age was 62 (26-98) years old. Tumor thickness mean was 15 mm (2-30 mm). G1, G2 and G3 tumors corresponded to 19 (13 %), 48 (33 %), and 80 (54 %) cases, respectively. Follow-up ranged from 10 to 82 months (median: 57 months). Fifty-three (36 %) patients died of disease. There was an overall correlation of tumor thickness and grade in most of the cases. Low-grade tumors were encountered in 92 % (12/13 cases) of superficial tumors. Deep tumors showed high-grade in 75 % of cases (73/97 cases). Superficial tumors with low histological grade had negative inguinal nodes and no mortality whereas deep tumors showing high histological grade were associated with high metastatic risk to lymph nodes (62/73 cases) and mortality (52/73 cases). Out of 24 deep tumors with low histological grade, seven had nodal spread (29 %) but only one died of disease. No outcome difference was found in HPV associated vs HPV independent tumors. Tumor thickness and grade are important synergistic and predictive pathological factors in relation to prognosis.

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Background: Cutaneous melanoma is one of the most common malignancies to metastasize to the gastrointestinal tract. Presence of tumor metastasis is an important prognostic factor. Despite clinical advances, the five-year survival rate of patients with stage IV malignant melanoma is only about 14%. We present three clinical cases with metastasis of cutaneous melanoma. Clinical cases: Man 68 years old and woman 55 years old, with colon metastasis; and man 75 years old with metastasis to the small intestine. All of them underwent resection alone when they presented gastrointestinal symptoms and they obtained relief after it. Two patients had initial cutaneous lesions with Breslow´s thickness < 2 mm. The three patients died months after the surgery. Conclusion: Meticulous attention to patients with prior history of cutaneous melanoma who present with subtle gastrointestinal symptoms is highly recommended.

Introducción: el melanoma cutáneo es una de las neoplasias malignas que con mayor frecuencia metastatiza al tracto gastrointestinal. La presencia de metástasis es un factor pronóstico importante. A pesar de los avances clínicos, la supervivencia libre de enfermedad a 5 años en pacientes con melanoma cutáneo en estadio clínico IV es únicamente de 14%. Se presentan tres casos clínicos, con melanoma cutáneo metastásico a intestino. Casos clínicos: hombre de 68 años y mujer de 55 años de edad, con metástasis en colon; hombre de 75 años de edad con metástasis a intestino delgado. Cuando presentaron síntomas grastrointestinales, fueron tratados únicamente con cirugía, con alivio de los síntomas iniciales. Dos pacientes tenían diagnóstico previo de melanoma cutáneo, con espesor de Breslow < 2 mm. Los tres pacientes fallecieron meses después de la cirugía. Conclusión: se recomienda prestar atención especial a pacientes con historia previa de melanoma cutáneo que presenten síntomas gastrointestinales inespecíficos.

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BACKGROUND: Health care workers are experiencing increasing numbers of occupational illnesses. Safety practices in anatomical pathology laboratories (APL) are crucial to prevent unnecessary exposures to both chemical and biological agents. METHODS: The main goal of this study was to determine if pathologists perceptions and actual practice mirror regulatory guidelines. Current available recommendations for APL were reviewed and used to construct an online survey distributed to pathologists. The survey was completed by 121 participants. RESULTS: Eighty-seven (72 %) of respondents reported receiving inadequate safety training. Most pathologists (82 %) were not well-informed about biosafety practices. Sixty-three (52 %) participants felt that the risks of chemical and infectious disease exposures in the APL were low. Most respondents reported having a needle stick or cut (71 %). Eighty-six (71 %) of participants reported musculo skeletal problems. CONCLUSIONS: This study indicated that there is a need for improving training in anatomical pathology safety practices in Mexican laboratories as daily practices do not reflected current guidelines.

Introducción: Los trabajadores de la salud pueden padecer de numerosas enfermedades relacionadas con su ocupación. Las prácticas de seguridad (PS) en los laboratorios de anatomía patológica (LAP) son indispensables para prevenir las exposiciones innecesarias a los agentes químicos o biológicos en dicha área de trabajo. El objetivo fue evaluar el nivel de conocimientos de los patólogos con respecto a las PS. Se revisaron las regulaciones y recomendaciones actuales para las PS en los LAP y con esa información se elaboró un cuestionario que se envió por Internet a los participantes. Métodos: La evaluación fue realizada por 121 patólogos, de los cuales 87 (71 %) reportaron un entrenamiento inadecuado en PS. La mayoría de los encuestados (82 %) no tenían una idea clara del significado de las medidas o prácticas de seguridad en el LAP. Resultados: Un total de 63 (52 %) de los participantes consideraron que el riesgo de enfermedades secundarias a la exposición a sustancias químicas peligrosas y agentes biológicos era bajo. De los participantes (71 %) reportaron algún accidente con un agente punzocortante o cortante. De 86 encuestados (71 %) reportaron problemas musculoesqueléticos. Conclusión: En este estudio se manifestó que existe una necesidad de implementar programas de capacitación en prácticas de seguridad en los laboratorios de anatomía patológica del Instituto Mexicano del Seguro Social.

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OBJECTIVE: To determine the frequency of metastatic ovarian tumors and to identify their clinicopathologic features. STUDY DESIGN: A total of 150 patients with pathologically confirmed metastatic ovarian carcinoma who were treated between 1995 and 2011 at the Mexican Oncology Hospital were identified by retrospective review. Clinicopathologic data were analyzed. RESULTS: Metastatic ovarian carcinoma accounted for 15.7% of all ovarian malignancies. The primary sites of nongynecologic tumors were the colon (30%), stomach (16%), appendix (13%), breast (13%), pancreas (12%), biliary tract (15%), and liver (4%). Gynecologic primary sites were the uterine cervix (4%) and the uterine body (23%). Primary malignancies were detected first in 66 patients (44%) and simultaneously with ovarian metastasis in 53 patients (35.3%). An ovarian mass was the first manifestation of disease in 20.6% of the cases. The patients ranged in age from 26 to 72 years (mean, 51). Krukenberg tumors were found in 35 patients (23%). The cut surfaces of the ovaries were solid in 68 patients, solid-cystic in 38, and multicystic in 44. CONCLUSION: Metastatic ovarian carcinomas are an important group of ovarian neoplasms, constituting 15.7% of all ovarian malignancies. Most of them arise from the gastrointestinal tract.

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