Síndrome hematofagocítico como manifestación inicial de linfoma de Hodgkin clásico / Hemophagocytic syndrome as the initial manifestation of Hodgkin lymphoma

Introducción: las histiocitosis son un grupo heterogéneo de enfermedades; una de ellas es el síndrome hematofagocítico (SHF). Sus causas pueden ser infecciosas, neoplásicas, autoinmunes o relacionadas a inmunodeficiencias adquiridas; el linfoma de Hodgkin clásico (LHc) es una causa poco frecuente. Se reporta el caso de un hombre inmunodeprimido de 35 años que ingresa al hospital febril y con insuficiencia respiratoria grave.Métodos: se recopiló información clínica pertinente y se revisó material de biopsia estudiado con tinción de hematoxilina ­ eosina, técnica inmunohistoquímica e hibridación in situ cromogénica. Resultados: estudios de laboratorio muestran pancitopenia, altera-ción de pruebas hepáticas, hipertrigliceridemia, hipoalbuminemia e hiperferritinemia. El estudio de médula ósea hematopoyética con mielograma y biopsia muestran hallazgos compatibles con LHc, signos de hemofagocitosis e infección por virus Epstein-Barr (VEB). Se diagnostica SHF como primera manifestación de LHc e infección por VEB. Conclusiones: a la fecha, se describen 74 pacientes re-portados con SHF como manifestación de LHc; en el 84% fue su primera manifestación. Si bien la presentación clínica presentada es infrecuente, se ha propuesto una asociación en hombres con inmunodeficiencia, SHF, LHc e infección por VEB; por lo que se sugiere una sospecha diagnóstica alta.

Introduction: histiocytosis are a heterogeneous group of diseases; one of them is the hemophagocytic syndrome (HS). Its causes can be infectious, neoplastic, autoimmune or related to acquired immunodeficiencies; classic Hodgkin lymphoma (cHL) is a rare cause.We present the case of an immunosuppressed 35-year-old male who was admitted with fever and acute respiratory failure. Methods:pertinent clinical reports and biopsy material were reviewed; including hematoxylin-eosin stained slides from formalin-fixed and pa-raffin-embedded tissue blocks and immunohistochemical and chromogenicin situhybridisation studies. Results:laboratory studies revealed pancytopenia, abnormal liver functions, hypertriglyceridemia, hypoalbuminemia e hyperferritinemia. Bone marrow aspiration smear and biopsy showed a malignant lymphoid neoplasm consistent with cHL, signs of hemophagocytosis, and Epstein-Barr virus (EBV) infection. HS, as an initial manifestation of cHL, was diagnosed.Conclusions:to our best knowledge, there are 74 reported cases of cHL with HS; in 84% it was the initial clinical manifestation. Though this is an unusual presentation, an association between immu-nodeficiency, HS, cHL, and EBV infection has been proposed; so a high diagnostic suspicion is suggested.

Angioma de células litorales del bazo: un diagnóstico de lesión focal esplénica: caso clínico / Littoral cell angioma of the spleen: report of one case

Splenic vascular neoplasms are the most common form of spleen tumors. Among them, littoral cell angioma is rare and it is frequently an incidental finding in imaging studies. It has no specific clinical, laboratory or imaging findings. Splenectomy allows definitive diagnosis throughout a histopathological examination. We report a 52-year-old man presenting with asthenia and abdominal distension. Computed tomography with intravenous contrast showed multiple splenic hypodense masses and a prostatic enlargement. Presuming a lymphoma, a laparoscopic splenectomy was performed. Histopathologic examination diagnosed littoral cell angioma. During urological follow-up, a prostate adenocarcinoma was diagnosed.

Linfoma anaplásico de células grandes asociado a implantes mamarios diagnosticado mediante punción por aguja fina. Caso clínico

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of non-Hodgkin T-cell lymphoma, recently defined in the 2016 World Health Organization (WHO) classification of lymphoid neoplasms. It occurs more commonly when textured implants are used and appears clinically as a late seroma. Cytologically, these lesions are composed of large atypical cells with pleomorphic nucleus and an immunophenotype positive for T cell markers and CD30, and negative for ALK1. We report a 56-years-old woman with breast implants who developed a periprosthetic seroma three years after surgery. A fine needle aspiration of the lesion was carried out. Cytology and the immunocytochemical study revealed cells compatible with BIA-ALCL. The flow cytometric study was negative. Excisional biopsy of the capsule was performed, observing that the neoplastic cells were confined to the inner surface of the capsule. Imaging studies did not find evidence of disseminated disease. The present case demonstrates the importance of the study of any late periprosthetic effusion, which can be performed using fine needle aspiration.

Consideraciones para el diagnóstico de linfoma primario de tiroides: esperiencia en 6 casos / Primary thyroid lymphoma: report of six cases

Background: Primary thyroid lymphoma is uncommon but must be suspected in certain clinical situations. Aim: To report a series of six patients with primary thyroid lymphoma. Patients and Methods: Six patients aged 50 to 84 years (five women), treated between 2004 and 2010. All patients had rapidly growing cervical mass; four had compressive signs and symptoms. In three cases the lymphoma was associated to Hashimoto's thyroiditis. Needle biopsy was performed in three patients. In one case was diagnostic for lymphoma and in the other two was suspicious. Five patients had a diffuse large B cell lymphoma, one of them associated to an extranodal marginal zone B cell lymphoma. One patient had a follicular lymphoma. Conclusions: Thyroid lymphoma must be suspected in female patients with rapidly growing cervical mass, older than fifty years, with a nodular goiter suspicious of malignancy (firm, non-tender, fixed and associated to compression signs). The diagnostic must be confirmed with a needle biopsy (fine needle or TrueCut®) and, if it's necessary open biopsy.

Granulomatosis linfomatoide cerebral primaria en paciente VIH positivo: Caso clínico / Primary cerebral lymphomatoid granulomatosis in a HIV-positive patient: Case report

We report a 34-years-old male, with a history of hepatitis B and human immunodeficiency virus (HIV) infection that was admitted to the hospital with malaise, weight loss, frontal behavior and chest pain. Imaging studies showed two frontal cortical/subcortical nodules. A stereotactic cerebral biopsy showed reactive gliosis and a prominent atypical angiocentric and angiodestructive lymphoid infiltrate containing large pleomorphic CD20 and EBV-positive cells consistent with Lymphomatoid granulomatosis. Other studies were negative. The patient was lost from follow up.

Leucemia de células velludas en el embarazo: Caso clínico / Hairy cell leukemia during pregnancy: Report of one case

Hairy cell leukemia (HCL) is a rare chronic B cell lymphoproliferative disorder that affects mostly men. It usually presents with pancytopenia, splenomegaly and bone marrow infiltration, without lymphadenopathy. Diagnosis is based on the presence of mononuclear cells with cytoplasmic projections in a blood smear, the typical bone marrow infiltration pattern and the immunophenotypic profile. HCL occurs seldom in young women and even more exceptionally during pregnancy. We report a 31-year-old woman in whom a splenomegaly was detected during routine prenatal care. Pancytopenia with 25 percent of hairy cells was found in her blood count. The patient was subjected to an open splenectomy and had an uneventful pregnancy. After two years of follow up, she has a normal blood count and has not required chemotherapy.

Sarcoma histiocítico cutáneo: Reporte de un caso / Cutaneous histiocytic sarcoma: Report of one case

Histiocytic sarcoma (HS) is a rare hematologic malignancy with morphologic and immunophenotypic evidence of histiocytic differentiation. Previously known as "true histiocytic lymphoma", the tumor follows an aggressive clinical course. Involvement of lymph nodes, skin, and extranodal sites has been described. Among the latter, approximately 29 cases involving the skin have been reported. On pathology, the lesion shows a diffuse proliferation of large epitheloid histiocytes with marked pleomorphism. We report a 78 year-old male who presented with a nodular lesion in the forehead, involving the skin and son tissue. The pathological diagnosis was a HS. The patient waslost from follow up.

Importancia de los ganglios en la supervivencia de los pacientes con cancer gastrico / The ganglion in the survival of patient with gastric cancer

En Colombia, el cáncer gástrico tiene una muy alta incidencia y la cirugía continúa siendo la modalidad terapéutica primaria. A pesar de que autores japoneses han encontrado que la gastrectomía radical con linfadenectomía hasta una cadena ganglionar mayor a la comprometida es la cirugía de elección, ea nuestro país no se ha realizado un estudio que lo demuestre. Para confirmar los beneficios de este tipo de abordaje, decidimos realizar un estudio de cohortes, empezando desde 1986, para comparar con los pacientes operados desde septiembre de 1995. Aquí se presentan los resultados de este estudio de cohortes. Cuatrocientos cuarenta pacientes cumplieron los criterios de inclusión: 220 controles históricos con los datos completos en sus registros y 200 pacientes prospectivos; la edad promedio fue de 56,1 años con una DE de 13,2 y un rango de 24-88 años, con el 44 por ciento de los pacientes entre los 40 y 60 años y el 37 por ciento entre los 60 y 80 años. La distribución entre los sexos fue similar. La clasificación endoscópica más común fue el Borrmann III con un 47 por ciento, con Idealización más frecuente en el antro y predominio del tipo histológico intestinal 67 por ciento. La tasa de complicaciones postoperatorias fue 14 por ciento; la mayoría de las complicaciones se debió a infección de la herida quirúrgica o a problemas respiratorios. La tasa de mortalidad fue 5 por ciento, siendo la dehiscencia de la anastomosis con sepsis secundaria la causa principal. La supervivencia a cinco años con respecto al nivel de disección ganglionar, controlando las otras variables que podían afectar la misma, se encontró distribuida así: supervivencia promedio global de 82 meses; supervivencia de los pacientes con cirugía paliativa 5 meses en promedio, comparado con una supervivencia de 50 meses en promedio para cirugía curativa relativa y de 80 meses en promedio para cirugía curativa absoluta, Utilizando el método de Wilcoxon, la supervivencia fue significativamente mayor en los pacientes sometidos a resección ganglionar D2 en comparación con cirugías paliativas o curativas relativas (p< 0,0001 en cada caso)...

Procesos de gestión administrativa y su realción con la siutación financiera unidad nivel 1 de atención en salud: Popayán Colombia 1998-2001 / Processes of administrative aAdministration and their relationship with the situation financial unit Level 1 of attention in health: Popayán Colombia 1998-2001

El Proyecto estudia el desempeño de la Dirección de una Unidad de Nivel 1 de Atención en Salud, mediante la gestión administrativa de variables críticas para determinar su situación financiera en los años 1998 a 2001. Su análisis permite adoptar o diseñar índices de gestión y estándares para el monitoreo permanente de la administración financiera de la Institución.El estuido trabaja un diseño no experimental, de tendencia longitudinal, estableciendo una hipótesis correlacional. La observación, medición y correlación determina la magnitutd con que cada variable participa en la situación financiera. Se ingresa los valores