Leiomyosarcoma of the kidney / El Leiomiosarcoma del riñón

The case of a 42- year old woman with leiomyosarcoma of the kidney, a very rare renal lesion, is presented. Leiomyosarcomas are the most common of the primary renal sarcomas which account for less than 1% of renal tumours in adults.

Se presenta el caso de una mujer de 43 años de edad con un leiomiosarcoma del riñón - una lesión renal muy rara. Los leiomiosarcomas son los más comunes de los sarcomas renales primarios, y representan menos del 1% de los tumores renales en adultos.

Trends in incidence and histological subtypes of lung cancer, Kingston and St Andrew, Jamaica, 1968-1997 / Tendencias en la incidencia y subtipos histológicos de cáncer pulmonar en Kingston y St Andrew, Jamaica, 1968­1997

Several scientific publications have reported a progressive shift in the distribution of the histologic subtypes of lung carcinoma in the latter decades of the 20th century, with adenocarcinoma now surpassing squamous cell carcinoma as the most commonly diagnosed morphologic pattern. A 30-year review (1968-1997) of lung cancer cases registered in the Jamaica cancer registry shows a similar trend among males in Kingston and St Andrew with a progressive increase in the documented cases of adenocarcinoma relative to squamous cell carcinoma. Similar changes were not observed in females.

Varias publicaciones científicas han reportado un desplazamiento progresivo en la distribución de los subtipos histológicos del carcinoma pulmonar en las últimas décadas del siglo 20. En las mismas se evidencia que, en el presente, el adenocarcinoma supera al carcinoma celular escamoso como patrón morfológico más comúnmente diagnosticado. Una revisión de 30 años (1968–1997) de casos de cáncer pulmonar registrados en el registro de cáncer de Jamaica, muestra una tendencia similar entre los hombres en Kingston y Saint Andrew, con un aumento progresivo en los casos documentados de adenocarcinoma en relación con el carcinoma celular escamoso. No se observaron cambios similares en las mujeres.

Clinicopathologic profile of gastric carcinomas at the University Hospital of the West Indies / Perfil clínico-patológico de los carcinomas gástricos en el Hospital Universitario de West Indies

The objective of this study was to examine the clinicopathologic features of gastric cancer seen at the University Hospital of the West Indies (UHWI) and to compare the findings with other studies. A retrospective study was conducted using data obtained from the surgical pathology reports of all gastrectomies and gastric biopsies during the period January 1993 and December 2002. Additional cases were identified from the Department of Surgery's audit database. Demographic, clinical and pathological features were analyzed. Two hundred and sixteen patients were identified, 126 males and 90 females. One hundred and thirty-six underwent biopsy procedures but no definitive surgery aimed at cancer eradication, while 70 had gastrectomy. The peak age prevalence in both males and females was the 70-79-year age group. While the antrum was the commonest site, there was an overall increase in tumours of the gastro-oesophageal junction and tumours of the entire stomach in the latter five-year period of the review especially in the 50-59-year age group. Epigastric pain and constitutional symptoms were the common presenting features, and the most common gross tumour characteristic was an ulcerating mass, while histologically, the intestinal variety was most common. Lymph node metastases were common. Helicobacter pylori (Hpylori) were present in 16.7while chronic multifocal atrophic gastritis was present in 40. This study indicates that the gastric cancer pattern is typical of developing countries. However, the low prevalence of H pylori in the resected specimens may indicate the importance of other risk factors for gastric cancer development in this population. This warrants further study.

El objetivo de este estudio fue examinar los aspectos clínicopatológicos del cáncer gástrico observados en el Hospital Universitario de West Indies, y comparar nuestros hallazgos con los de otros estudios. Se llevó a cabo un estudio retrospectivo usando datos obtenidos de los reportes patológicos quirúrgicos de todas las gastrectomías y biopsias gástricas durante el período de enero de 1993 y diciembre de 2002. Se identificaron casos adicionales de la base de datos de auditoría del Departamento de Cirugía. Se analizaron aspectos demográficos, clínicos y patológicos. Se identificaron doscientos dieciséis pacientes, 126 hombres y 90 mujeres. Ciento treinta y seis fueron sometidos a procedimientos de biopsia, pero no se realizó ninguna cirugía definitiva encaminada a la erradicación del cáncer, en tanto que a setenta se les practicó gastrectomía. La prevalencia de edad pico tanto en hombres como mujeres fue el grupo de 70–79 años. Si bien el antro gástrico fue el sitio más común, hubo un aumento general en tumores de la unión gastroesofágica y tumores de todo el estómago en el último período quinquenal de la revisión especialmente en el grupo de 50–59 años de edad. El dolor epigástrico y los síntomas constitucionales fueron los síntomas más comunes que se presentaron, y la característica más común del tumor macroscópico fue una masa ulcerosa, mientras que histológicamente la variedad intestinal fue más común. Fueron comunes las metástasis del nódulo linfático. Helicobacter pylori (H pylori) estuvieron presentes en el 16.7 %, en tanto que la gastritis crónica atrófica multifocal estuvo presente en el 40%. Este estudio indica que nuestro patrón de cáncer gástrico es típico de los países en vías de desarrollo. Sin embargo, la baja prevalencia de H pylori en nuestros especímenes resecados, pueden ser un índice de la importancia de otros factores de riesgo tales como fumar, el uso consuetudinario del alcohol, o la dieta, en relación con el desarrollo del cáncer en nuestra población. Esto merece un estudio ulterior.

Gynaecologic cancer incidence, Kingston and St Andrew, Jamaica, 1973-1997, and gynaecologic cancer mortality, Jamaica, 1999

The incidence of gynaecologic cancers in women from Kingston and St Andrew for the period 1973-1997 were reviewed by analyzing data previously published by the Jamaica Cancer Registry. Gynaecologic cancer-related mortality statistics for the entire island for 1999 were compiled from data obtained from the Registrar General's Department (RGD) and the Statistical Institute of Jamaica (STATIN). Data were compared to gynaecologic cancer statistics for women from the United States of America for 1973-1997. A total of 2862 gynaecologic cancers were registered for the years 1973-1997, which represents 26.8 of all female cancers from Kingston and St Andrew. Cervical cancer accounted for 62 of these gynaecologic cancers. The 268 cancer-related deaths (168 due to cervical cancer) registered in Jamaican women for 1999 represent approximately 15 of all female cancer-related deaths. The present incidence (27.9 per 100,000) and mortality rate (15.8 per 100,000) of cervical cancer are much higher than that documented for American women--both African Americans and Caucasians--and signify the limited success, to date, of efforts to decrease the incidence and mortality of cervical cancer by the implementation of cervical cancer screening programmes. For the time period reviewed, an increase was noted in the incidence of cancer of the corpus uteri while decreases were recorded for the incidence of choriocarcinoma, ovarian cancer and cancers arising from the vulva, vagina and fallopian tube

Multiple endocrine neoplasia type 2B. A case report and review of the syndrome

This paper presents a case of the very rare multiple endocrine neoplasia Type 2B syndrome. It highlights that because of the presence of superficial neuromas in this condition, there is the possibility for early diagnosis. Recent knowledge of the molecular genetics of this syndrome and the ability to screen family members is also stressed since early thyroidectomy is now recommended to prevent the development of thyroid carcinoma which is the main determinant of prognosis

False positive troponin I in a case of metastatic small cell bronchogenic carcinoma complicated by pulmonary thromboembolism

From the search for the ultimate cardiac marker have emerged the cardiac troponins, which have offered high sensitivity and specificity for myocardial damage. Troponin I has arguably been the best of this group, but even this marker is not infallible. We present the case of an elderly woman who died shortly after being diagnosed with acute myocardial infarction on the basis of elevated Troponin I. Autopsy revealed a small cell lung cancer complicated by pulmonary thromboembolism. There was no evidence of myocardial infarction. Explanations for false elevation of serum Troponin I are proposed.

Male breast cancer. An analysis of four cases and review of the literature

We report the clinicopathological features and outcome of four cases of carcinoma of the male breast diagnosed at the University Hospital of the West Indies between 1988 and 1998. Male breast cancer is most commonly seen in men over age sixty years, and it exhibits the same prognosis, stage for stage, as the disease in females. However, some researchers report overall poorer survival in men, and explain this on the basis of advanced disease at presentation. Other researchers maintain that the majority of breast cancers in males present at early stages, and exhibit survival similar to that in females. The published literature concerning this uncommon malignancy is reviewed, and the data are compared with the features of our cases.

Turnaround time in the surgical pathology laboratory

One measure of the efficiency of a surgical pathology service is the rapidity of reporting the diagnosis to clinicians. The turnaround time (TAT) has been used for this purpose. This study showed that the TAT for 66of specimens submitted to the surgical pathology laboratory in the University Hospital of the West Indies was within 3 days and for 89within 6 days. The TAT within 7 days was considered acceptable, but it was shown that it was more than 7 days for 9, of the specimens submitted. The importance of this information is discussed and recommendations made for identifying more accurately the source of delays in those cases in which the TAT was considered to be unusually prolonged.