ABSTRACT
El cambio oncocítico es un agrandamiento del citoplasma ocasionado por la acumulación de mitocondrias, que se presenta en una amplia variedad de condiciones reactivas y neoplásicas. En la glándula tiroides, dicho cambio es un fenómeno de metaplasia que ocurre en distintas situaciones que provocan estrés celular y en ocasiones da lugar a verdaderas neoplasias benignas y malignas, entre las que destaca el adenoma oncocítico. A propósito de cuatro casos estudiados en el Departamento de Patología del Hospital ABC con características citomorfológicas inusuales que representaron un reto diagnóstico, hacemos una revisión del espectro morfológico de estos tumores. Las características presentadas incluyeron necrosis isquémica masiva posterior a toma de biopsia por aspiración, tamaño mayor al esperado en un adenoma, coexistencia con una neoplasia maligna independiente y características histológicas similares a las observadas en carcinoma papilar. Es de gran importancia para el patólogo conocer estas características, para evitar errores diagnósticos que puedan implicar un inadecuado manejo terapéutico.
Oncocytic change involves a cytoplasmic enlargement due to mitochondrial accumulation observed in a wide variety of conditions and in multiple organs. It can be reactive or neoplastic. In the thyroid gland, this change is a metaplastic phenomenon that takes place under different circumstances that promote cellular stress, and could even produce a true neoplasm, both benign or malignant. The oncocytic adenoma, a malignant tumor will be described. We analyzed four cases studied at the surgical pathology department of the American British Cowdray Medical Center in Mexico City that displayed unusual cytomorphological features. They became a diagnostic challenge and in order to solve it we reviewed their morphological spectrum. Tumor characteristics in all cases included: massive ischemic necrosis short after a fine needle aspiration biopsy was performed, unexpected large size, coexistence with a malignant independent neoplasm and cytological features similar to those observed in papillary carcinomas. It is of utmost importance for the pathologist to acknowledge the existence of these features in order to avoid diagnostic mistakes that could lead to unsuccessful treatment.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Adenoma, Oxyphilic/pathology , Thyroid Neoplasms/pathologyABSTRACT
Kikuchi-Fujimoto disease also known as histiocytic necrotizing lymphadenopaty (HNL) is a rare entity, originally described in Japanese population, although currently it has been described all over the world. It is more frequent in young women and it is usually located in cervical lymph nodes. We report 14 cases of HNL in Mexican population, their clinicopathological and immunohistochemical study as well as a comparative study with other necrotizing lymphadenopaties due to B or T-cell lymphomas, tuberculosis, Epstein Barr virus infection, and non-specific necrosis. In our study we found that there was more expression of the immunomarkers CD68, MPO, CD123 and antikerat in OSCAR in the cases of HNL in contrast with the lesser or even null expression of the same markers in the necrotized lymph nodes of the comparative study group.
La enfermedad de Kikuchi-Fujimoto o linfadenitis histiocítica necrosante (LHN) es una entidad poco frecuente, inicialmente descrita en población japonesa. Sin embargo, actualmente se ha descrito alrededor de todo el mundo. Es más frecuente en mujeres jóvenes y su localización habitual es en ganglios linfáticos cervicales. Presentamos estudio clinicopatológico de 14 casos de LHN en pacientes mexicanos, y los comparamos con linfadenitis necrosantes secundarias a linfomas B y T, tuberculosis, virus de Epstein Barr y necrosis inespecífica. Encontramos mayor expresión de los anticuerpos CD68, MPO, CD 123 y antiqueratina OSCAR en los casos de LHN comparados con la expresión baja o nula de los mismos anticuerpos en las necrosis ganglionares del grupo comparativo.