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.

Evaluación rápida "in situ" de punción con aguja fina guiada por endosonografía mejora rendimiento diagnóstico de lesiones pancreáticas sólidas / Rapid on-site evaluation with endoscopic ultra sound-guided fine needle improves diagnostic yield of solid pancreatic masses

BACKGROUND: The use of endoscopic ultrasound with fine needle aspiration (EUS-FNA) has improved the characterization and staging of pancreatic solid masses. The primary strategy for improving the ability to diagnose malignant masses is the use of rapid on site evaluation (ROSE) by a cytopathologist. OBJECTIVE: To evaluate the diagnostic yield of EUS-FNA after the implementation of ROSE in an academic center. MATERIAL AND METHODS: Prospective enrollment and follow-up of EUS-FNA with ROSE during 2015 and 2016, was compared to EUS-FNA without ROSE in previous years (2011-2014) in Hospital Clínico UCChristus. Clinical and endosonographic features, cytopathological and histological diagnosis and number of passes per procedure were evaluated. All EUS-FNA included cytology and cellular block for definitive diagnosis. RESULTS: 59 pancreatic solid masses were included in the analysis. 44 EUS-FNA were performed with ROSE, compared with 15 EUS-FNA without ROSE. The mean age of patients included was 62.8 years, 54.2% male gender, and most masses studied were in the head of pancreas (77.6%). In EUS 86.5% were hypoechoic and 56.9% had poor defined margins. No differences in baseline characteristics were observed between groups. EUS-FNA led to diagnosis in 86.2% of the overall sample. The diagnostic rate was superior in the group of EUS-FNA with ROSE, compared to EUS-FNA without ROSE (97.7% vs 50%, p < 0.0001). The mean number of passes was inferior in EUS-FNA ROSE (+) (2.71 vs 5.78, p < 0.0001). No differences in rate of complications were observed between groups. CONCLUSION: The use of ROSE associated to EUS-FNA improves the diagnostic yield in the evaluation of pancreatic solid masses. Our findings are consistent with those described in the literature, recommending the use of ROSE in EUS-FNA in centers where the diagnostic yield is less than 90% without the use of ROSE

INTRODUCCIÓN: La adquisición de tejido mediante el uso de endosonografía, con punción con aguja fina, (EUS-FNA) ha mejorado el diagnóstico de lesiones pancreáticas sólidas. La principal medida para aumentar el rendimiento diagnóstico de la EUS-FNA es la evaluación por citopatólogo próximo al lugar de punción (in situ) (técnica conocida en inglés como ROSE "rapid on-site evaluation"). OBJETIVO: Evaluar el rendimiento diagnóstico de EUS-FNA en lesiones pancreáticas sólidas posterior a la implementación de ROSE en un centro universitario. MATERIAL Y MÉTODOS: Registro prospectivo de EUS-FNA realizadas con ROSE durante el período 2015-2016, comparado con EUS-FNA con evaluación histopatológica diferida realizada entre los años 2011-2014, en Hospital Clínico UC-Christus. Se evaluaron características clínicas, endosonográficas, diagnóstico histopatológico y número de pases por procedimiento. Todas las EUS-FNA incluyeron citología y block celular para diagnóstico definitivo. RESULTADOS: Se incluyeron en el análisis 59 lesiones pancreáticas sólidas evaluadas con EUS-FNA. Seguimiento prospectivo de 44 EUS-FNA con ROSE, que fueron comparadas con 15 EUS-FNA sin evaluación in situ (retrospectivo). La muestra total incluyó individuos con un promedio de 62,8 años de edad, 54,2% hombres, donde 77,6% de las lesiones se ubicaba en la cabeza pancreática. Endosonográficamente 86,5% de las lesiones eran hipoecoicas y 56,9% tenían márgenes poco definidos. La EUS-FNA fue diagnóstica en 86,2% del total de la muestra. Las EUS-FNA realizadas con ROSE presentaron un mayor rendimiento diagnóstico respecto a las efectuadas sin evaluación in situ (97,7% vs 50%, p < 0,0001). El número de pases por procedimiento fue menor (2,7% vs 5,8%, p < 0,0001) en el grupo con ROSE. No hubo diferencias en complicaciones en ambos grupos. CONCLUSIÓN: La evaluación por citopatólogo in situ de la muestra obtenida por EUS-FNA mejora el rendimiento diagnóstico de las lesiones pancreáticas sólidas. Nuestros hallazgos apoyan el uso de ROSE asociado a EUS-FNA, siendo concordantes con las recomendaciones actuales de utilizar evaluación histopatológica in situ en EUS-FNA, especialmente en centros donde el rendimiento diagnóstico sin uso de ROSE es menor a 90%.

Contribución de las anomalías cromosómicas ovocitarias en el fracaso de la fecundación humana in vitro / Contribution of chromosomal abnormalities to in vitro fertilization failures

Background: Present knowledge of mechanisms involved in human fertilization has uncovered a new group of pathologic conditions that have been generically named fertilization abnormalities. Aim: To determine the contribution of chromosomal alterations to in vitro fertilization failures. Material and methods: A cytogenetic analysis of oocytes that were not fertilized after insemination with normal spermatozoa. Oocytes were obtained from patients subjected to in vitro fertilization in a public hospital of Metropolitan Santiago. Ovulation was induced in these patients administering GnRh-a, FSH, HMG and HCG. The double fixation technique described by Wramsby was used to obtain chromosomes. Results: One hundred and seven oocytes coming from 45 women aged 25 to 42 years old were studied. The frequency of aneuploidy in these oocytes was 37.3 percent, with a 11.8 percent of hypohaploidy, a 21.6 percent of hyperhaploidy and a 3.9 percent of diploid oocytes. In hyperhaploid as well as in hypohaploid oocytes, the chromosomes involved in aneuploidy pertained to groups D and G. Conclusions: Although the total frequency of aneuploidy is within normal ranges, the frequency of hyperhaploidy is superior to previous reports. An explanation for this finding could be that the occurrence of a lack of disjunction with chromosomal retention in the parental cell occurs with a higher frequency than that in which the chromosomes are retained in the polocyte. We also suggest that oocyte chromosomal aneuploidy could contribute to the failure of in vitro fertilization procedures (

Fibromatosis musculoaponeurótica de la mama / Muscularaponeurotic fibromatosis of the breast

Se presenta un caso clínico de fibromatosis musculoaponeurótica de la mama en una mujer de 33 años, sin antecedentes de cirugía mamaria previa. Se analizan las características morfológicas y el diagnóstico diferencial con un cáncer mamario. Se presenta una revisión bibliográfica y se comenta el tratamiento de elección

Risk factors and survival from colorectal cancer in black patients in Soweto, South Africa.

In Africa, while colorectal cancer is very uncommon in the black population, it is rising in urban dwellers. A series of 42 patients treated at Baragwanath Hospital, Soweto, were compared with 92 controls. Average age of patients was relatively low 55 years. 73 per cent presented late with far advanced disease at Stages C and D. No familial component was apparent. Patient's years of schooling and social class were non-revealing compared with data on controls. Dietarily, the same applied to fat intake (relatively low) and fibre intake (considerably decreased). Median survival time was short, 7.5 months.

Appendicectomy incidence in black and white children aged 0 to 14 years with a discussion on the disease's causation.

Annual incidence of appendicectomy in urban black and white children of 0-14 yr. for 1985-1987 were estimated from hospital data obtained in Potchefstroom and Bloemfontein, also for black children at Baragwanath Hospital, Johannesburg. Rates per 10,000 children remain low for blacks, varying from 0.5, to 1.9: but were high for whites, 21.5 to 39.5. The latter are within the range of rates published in the West. As to diet, for blacks, mean daily fibre has fallen over several years to 10-14 g, similar to that of whites. Because of progressive fibre depletion, a marked rise in appendicectomies in blacks would be expected. The dietary fibre and the hygiene hypotheses afford only partial explanations for the disease's occurrence. Neither explains puzzling epidemiological differences including the recent fall in whites, nor throws light on the nature of precipitating factors.

Survival of black patients with gastric cancer in Soweto, Johannesburg, South Africa.

In a series of 39 black gastric cancer patients, treated at Baragwanath Hospital, Soweto, Johannesburg, the time of 50 per cent mortality was 3.5 months, half that of white patients. Patients' median age was lower than that of white patients, 58 versus 70 yr. Male/female ratio was 1.3:1. Black patients presented late; no patients' lesions were at clinical stages I and II, compared with 5-15 per cent reported for white patients. Weight loss, abdominal pain and vomiting were predominant features. Frequencies of smoking and of alcohol consumption in male and female patients appeared much the same as those prevailing in the general population. No marked differences between patients and controls were apparent in socioeconomic state, educational level, general dietary intake, nor in ownership of a refrigerator.