Lesiones papilares de mama: estudio clínico-patológico y sobre pronóstico en 144 casos de Medellín, Colombia / Breast papillary lesions: Clinical, pathological, and prognostic study in 144 cases in Medellin, Colombia / Lesões papilares mamárias: estudo clínico-patológico e prognóstico em 144 casos de Medellín, Colômbia

Objetivo: describir los datos sociodemográficos, las manifestaciones clínicas, los paraclínicos, el tratamiento y la recurrencia, en un grupo de pacientes con lesiones papilares. Metodología: estudio analítico de cohorte retrospectiva con fuentes secundarias de información, historias clínicas. Se incluyeron pacientes evaluados entre el 1º enero de 2016 y el 31 de diciembre de 2019. Se recopilaron datos demográficos, clínicos y paraclínicos, que fueron analizados con estadística descriptiva. Resultados: la prevalencia en la muestra fue de 4.7%; todos los casos fueron en mujeres, la media de edad fue 55,5 años; el motivo de consulta más frecuente fue alteración en la imagen de mama (n=79, 54.9%), el tamaño medio de la lesión fue 1,9 cm (rango 0,1-20). Se encontró discordancia entre el diagnóstico por biopsia cortante y el espécimen de patología en 70 (48.6%) casos, en estos se encontró infraestimación de lesiones con mayor riesgo en el 36,1% (n=52). Según la clasificación histológica, el tipo más frecuente de lesión fue el papiloma intraductal 34.7% (n=50), seguido por el carcinoma papilar en 11,8% (n=17). El tipo de cirugía más efectuado fue la cuadrantectomía, con un 68.7% (n=99). La media de seguimiento fue de 28.5 meses y se encontró recaída en siete casos (4.9%). Conclusión: las lesiones papilares comprenden un grupo heterogéneo, que incluye desde las benignas hasta aquellas con potencial maligno. Afectan a las mujeres en la quinta década de la vida, se presentan como una masa, pequeña, unilateral, sin predominio de lateralidad, de crecimiento lento. El tratamiento óptimo para las lesiones de riesgo y con atipias es la cirugía con márgenes negativos, el riesgo de recurrencia es clínicamente relevante.

Objective: to describe the sociodemographic data, the clinical and paraclinical ma-nifestations, the treatment and the recurrence, in a group of patients diagnosed with papillary lesions.Methodology:analytical study of a retrospective cohort with secondary sources of information from users' medical records in the period of January 1, 2016 to December 31, 2019. The demographic, clinical and paraclinical data collected were analyzed using descriptive statistics.Results:the prevalence in the sample was 4.7%; all cases were women, the mean age was 55.5 years; the most frequent reason for consultation was abnormal breast imaging examination (n=79, 54.9 %), the mean size was 1.9 cm (range 0,1-20). Disagreement was found between the diagnosis by sharp biopsy and the pathology specimen in 48.6% of cases (n=70); lesion underestimation with higher risk was found in 36.1% of them (n=52). According to the histological classification, the most frequent was intraductal papilloma in 34.7% (n=50), followed by papillary carcinoma in 11.8% (n=17). The type of surgery most performed was quadrantectomy, 68.7% (n=99). The mean follow-up was 28.5 months and relapse was found in 4.9% (n=7).Conclusion:papillary lesions comprise a heterogeneous group, with a spectrum that includes both benign lesions and those with malignant potential. The lesions affect women in their fifties. They become apparent as a small, unilateral mass, without a pre-dominance of laterality, and of slow growth. The optimal treatment in risk lesions and with atypia is surgery with negative margins. The risk of recurrence is clinically important.

Objetivo: descrever os dados sociodemográficos, manifestações clínicas e paraclínicas, tratamento e recorrência, em um grupo de pacientes com lesões papilares.Metodologia: estudo analítico de coorte retrospectivo com fontes secundárias de informação, prontuários. Foram incluídos os pacientes avaliados entre 1º de janeiro de 2016 e 31 de dezembro de 2019. Foram coletados dados demográficos, clínicos e paraclínicos, os quais foram analisados com estatística descritiva.Resultados: a prevalência na amostra foi de 4,7%; todos os casos eram em mulheres, a média de idade foi de 55,5 anos; o motivo de consulta mais frequente foi a alteração da imagem da mama (n = 79, 54,9%), o tamanho médio da lesão foi de 1,9 cm (variação de 0,1-20). Houve discordância entre o diagnóstico por biópsia cortante e o espécime anatomopatológico em 70 (48,6%) casos, nestes casos subestimação das lesões de maior risco em 36,1% (n = 52). De acordo com a classificação histológica, o tipo de lesão mais frequente foi o papiloma intraductal em 34,7% (n = 50), seguido do carcinoma papilífero em 11,8% (n = 17). O tipo de cirurgia mais realizada foi a quadrantectomia, com 68,7% (n = 99). O seguimento médio foi de 28,5 meses e recidiva foi encontrada em sete casos (4,9%).Conclusão: as lesões papilares constituem um grupo heterogêneo, que inclui desde as benignas até as com potencial maligno. Atingem mulheres na quinta década de vida, aparecem como uma massa, pequena, unilateral, sem predomínio da lateralidade, de crescimento lento. O tratamento ideal para lesões de risco e com atipia é a cirurgia com margens negativas, o risco de recorrência é clinicamente relevante.

The Role of FNAC in the Diagnosis and Management of Warthin Tumour: Analysis of 74 Cases

Abstract Introduction After pleomorphic adenoma, Warthin tumor gets its popularity as the second most common benign neoplasm of the parotid gland. Fine-needle aspiration cytology (FNAC) is the most cost-effective and minimally-invasive way to determine the histological character of a parotid gland tumor. Objective To determine the accuracy of FNAC in the diagnosis of Warthin Tumour. Methods A retrospective study conducted between 2014 and 2018. Out of 243 FNACs performed for parotid lesions, a histopathological correlation was established in 74 cases to reveal the accuracy of FNAC in the diagnosis of Warthin tumor. Results A total of 243 FNACs of parotid lesions were performed, and a histopathological correlation was established in 74 (30.4%) cases. Later on, we confirmed that 16 (21.6%) out of these 74 patients had cases of Warthin tumor. In total, 15 (20.3%) out of those 74 cases were confirmed as Warthin tumors on the initial cytology, which revealed a true positive concordance between the cytology and the final histological diagnosis; 55/74 (74%) were true negative results; on the other hand, 1/74 (1.4%) was a false negative, and 3/74 (4.1%) were false positive results. The sensitivity of the FNAC in the diagnosis of Warthin tumor was of 93%, while the specificity was of 94.8%, and the accuracy, of 94.6%. Conclusion In the present study, FNAC had a high diagnostic accuracy, reaching 94%.

Reporte del primer caso de cistoadenoma papilar de epidídimo en Colombia, Hospital Universitario de Santander / Report of the first case of papillary cystadenoma of the epididymis in Colombia

Resumen La presencia de una masa en la región escrotal comprende un amplio espectro de patologías, unas con mayor urgencia para el manejo que otras, dado el riesgo asociado de pérdida testicular o desarrollo de cáncer. Dentro de las posibilidades diagnósticas se encuentran las neoplasias, destacando las originadas en el epidídimo, con un 75% de casos de etiología benigna, correspondiendo un 9% al cistoadenoma papilar de epidídimo que sobresale por su baja frecuencia dado que en la literatura mundial existen aproximadamente 70 reportes publicados con escasos provenientes de literatura médica en castellano, en los que se incluye el presente caso expuesto en el que se confirma histopatológicamente un cistoadenoma papilar de epidídimo y se presenta una revisión del tema acerca del enfoque de un paciente con masa escrotal. Asimismo se resalta el hecho de que esta lesión puede asociarse con la enfermedad de Von Hippel Lindau, sobre todo en presentaciones bilaterales. MÉD.UIS. 2020;33(2):95-100.

Abstract The presence of a mass in the scrotal region comprises a wide spectrum of pathologies, some with greater urgency for management than others, given the associated risk of testicular loss or cancer development. Among the diagnostic possibilities are the neoplasms, highlighting those originating in the epididymis, with 75% of cases of benign etiology, 9% corresponding to the papillary cystadenoma of the epididymis that stands out for its low frequency given that in the world literature there are approximately 70 published reports with few from medical literature in Spanish, which include the present case presented in which a papillary cystadenoma of the epididymis is confirmed histopathologically and a review of the topic about the approach of a patient with scrotal mass is presented. Also the fact that this lesion can be associated with von Hippel Lindau disease, especially in bilateral presentations is highlighted. MÉD.UIS. 2020;33(2):95-100.

Cistoadenoma papilar oncocítico de glándula parótida: caso clínico / Papillary oncocytic cystoadenoma of the parotid gland: case report

RESUMEN El cistoadenoma es un tumor epitelial benigno raro de glándulas salivales, de crecimiento lento y asintomático, que forma grandes masas uni o multiloculares con desarrollo papilar intraluminal. Si bien es más frecuente en glándulas salivales menores, se ha destacado lo inusual de la lesión en glándulas salivales mayores. Se presenta el caso de una mujer de 60 años, quien consultó por una masa indolora, blanda y de consistencia quistica en glándula parótida derecha, de crecimiento lento y progresivo. Su evolución fue de varios meses con piel de la zona intacta. Se realizó parotidectomia superficial. El examen histopatológico demostró cistoadenoma papilar oncocitico, tumor que ha sido destacado por su infrecuencia, y con una manifestación en parótida sumamente rara y de variados patrones histológicos. Su reconocimiento es trascendente para el profesional en casos como el que se presenta, pues su diagnóstico diferencial incluye lesiones con aspecto clínico similar y en algunos casos comportamiento agresivo.

ABSTRACT The cystadenoma is a rare benign epithelial tumor of salivary glands, characterized by slow growing and asymptomatic presentation, forming large uni or multilocular masses with intraluminal papillary development. Although it is more frequent in minor salivary glands, it has been emphasized the unusual of the major salivary glands affection. We present the case of a 60-year-old woman consulting for a painless, soft mass with cystic consistency in the right parotid gland, slow and progressive growing. The tumor evolved for several months keeping the skin of the area intact. A superficial parotidectomy was performed. Histopathological examination demonstrated a papillary oncocytic cystadenoma, a tumor that has been noted for its low frequency, and with extremely rare parotid manifestation and varied histological patterns. Its recognition is relevant for the professional in cases such as the one presented, since its differential diagnosis includes lesions with similar clinical appearance and in some cases aggressive behavior.

Warthin Tumor on the Parotid Gland: A Case Report

Mucinous cystadenoma of the liver with ovarian-like stroma: the need for complete resection / 대한외과학회지

Cystadenoma of the liver is a rare neoplasm. Although many cystadenomas are asymptomatic, symptoms can include abdominal pain, postprandial epigastric discomfort, and nausea. Dramatic changes in hepatic imaging techniques have been helpful for diagnosing cystic lesions of the liver, such as simple cyst, hydatid cyst, cystadenoma, cystadenocarcinoma, and metastatic neuroendocrine tumors. However, it remains difficult to differentiate cystadenoma from cystadenocarcinoma for multiseptated cystic hepatic lesions with papillary projection on computed tomography (CT) and magnetic resonance imaging (MRI). Here we report the case of a 47-year-old woman with several months of postprandial discomfort and abdominal fullness. CT and MRI revealed multiseptated cystic lesions with papillary excrescences. A left hemihepatectomy was performed. Histology showed a benign mucinous cystic tumor with ovarian-like stroma.

Clear Cell Papillary Cystadenoma of the Epididymis Associated with Multiple Renal and Pancreatic Cysts / 대한남성과학회지

Papillary cystadenoma of the epididymis is a rare benign tumor that accounts for only 5% of all epididymal tumors. A case of epididymal cystadenoma was presented in a 25 year old man. The patient was hospitalized initially because of infertility and bilateral painless palpable scrotal masses. He had multiple renal cysts and pancreatic cysts. He had no renal, adrenal, cerebellar or retinal lesion as cardinal manifestation of the Von Hippel-Lindau Syndrome (VHL). The VHL gene mutation in this case was not identified. For evaluation and management, we planned left epididymovasostomy and left testicular biopsy. However, due to a cystic change on the left epididymis and left tunica albuginea, we instead performed a left partial epididymectomy for the cystic lesion, excision of the cystic mass from the left tunica albuginea, and diagnostic left testicular biopsy. The pathologic evaluation revealed a papillary cystadenoma of the epididymis and tunica albuginea, but with normal spermatogenesis.

A Serous Papillary Cystadenoma of Borderline Malignancy in Testis / 대한남성과학회지

Serous papillary cystadenomas arising in testis have been rarely reported, and they often resemble ovarian serous tumors of borderline malignancy. Herein, we report a case of a serous papillary cystadenoma of the testis in a 59 year old man. Based on a clinical diagnosis of left testicular tumor, a left radical orchiectomy was performed. The pathologic evaluation revealed a serous papillary cystadenoma of borderline malignancy in the testis.

A Case of Ovarian Mullerian Mucinous Papillary Cystadenoma of Borderline Malignancy / 대한암학회지

Ovarian mucinous cystadenoma of borderline malignancy was consisted of intestinal mucinous cystadenomas of borderline malignancy and Mullerian mucinous papillary borderline tumors. Mullerian mucinous papillary tumors was lined by mucinous epithelium of endocervical type and characterized by papillae architecturally similar to those of serous borderline tumors. These tumors have clinical and pathologic differences from those of intestinal mucinous cystadenomas of borderline malignancy.We report a case of ovarian Mullerian mucinous papillary cystadenomas of borderline malignancy with review of literature.

A Serous Papillary Cystadenoma of Low Malignant Potential in Paratesticular Tissue

The serous papillary cystadenoma of low malignant potential in the paratesticular tissue is a tumor characterized by its resemblance to ovarian serous papillary tumor of low malignant potential. Several possible origins have been proposed but it is thought to originate from the Mullerian-type epithelium just like ovarian serous tumor of low grade malignancy. Because of the rarity of this tumor, the natural history and treatment have not been established. Herein we report on a serous papillary cystadenoma arising in the paratesticular tissue of a 12 year old . To our knowledge, this is the first reported case in the Korean literature. The size of this cystic tumor in this patient was 0.9x0.9x0.8 cm and had a sponge-like cut surface. The papillary structure was lined by both ciliated and nonciliated secretory cells, the same cellular structure as the salpinx. Areas with just a few mitoses and stratification of epithelial cells were noted, but invasion into the paratesticular tissue was absent, suggesting borderline malignancy. He is doing well after 5 months follow up. Prognosis of this scrotal tumor is thought to be better than the ovarian tumor of similar histology due to a better possibility of early detection.

Papillary Cystadenoma of the Epididymis: Component of von Hippel-Lindau Syndrome: A case report

Papillary cystadenoma of the epididymis is a rare benign tumor that represents the epididymal component of von Hippel-Lindau Syndrome. A case of epididymal papillary cystadenoma is presented in a 36 years old man. He also had pancreatic cysts, the pancreatic component of von Hippel-Lindau syndrome. His younger brother, who died of intracranial hemorrhage at age 27, revealed hemangioblastoma of the cerebellum, angioma of the retina and renal cell carcinoma on radiologic studies. These findings suggest familial occurrence of von Hippel-Lindau syndrome.

Von Hippel-Lindau's Disease: Case Report

Although cases of von Hippel-Lindau syndrome are not rare, the fact that hemangioblastomans can occur at sites in the nervous system other than the cerebellum is not appreciated. We are reporting a case of VHL complex in 23-year-old male. In this case, there were multiple cerebellar hemangioblastomas, retinal angiomas, multiple spinal hemangioblastomas, syringomyelia, and papillary cystadenoma of epididymis. There was no evidence of polycythe mia or abnormality of other organs. Large cystic cerebellar hemangioblastomas were removed surgically and papillary cystadenoma of epididymis were excised, too. Total laminectomy of T2, T3 and T4 revealed abnormal meningeal varicosities, enlarged spinal cord, inra-axial hemangioblastomas, and syringomyelia.

A Case of Papillary Cystadenoma of the Kidney / 대한비뇨기과학회지

Papillary cystadenoma is rarely detected during life because it seldom causes symptoms and signs, and is frequently discovered at necropsy. A case of papillary cystadenoma of the left kidney is reported with a review of literature. The patient reported herewith was a 39-year-old man with a large palpable mas in the left flank without any urinary symptom. On an excretary pyelography the right kidney appeared normal. However, the left kidney showed crescent elongation of lover calyx by a mass at the lower pole of kidney. Partial nephrectomy was performed for the circumscribed tumor localized to the left lower kidney. The surgical specimen revealed a large hard mass with cystic formation and the lesion measured 11 cm in diameter. Although the tumor was well demarcated where it lies extrarenally, it blended into the normal renal tissue where it is intrarenal.