Fibroadenoma vulvar: a propósito de un caso clínico / Vulvar fibroadenoma: about a clinical case

RESUMEN El fibroadenoma vulvar es un tumor benigno poco frecuente con muy pocos casos descritos en la literatura. Por lo general, se diagnostica entre los 20 y 70 años. Tiene un buen pronóstico y rara vez recurre después de la escisión. Presentamos un caso de fibroadenoma vulvar, en una mujer de 33 años, manifestado como un tumor localizado, bien definido de partes blandas en el labio mayor izquierdo. La lesión fue extirpada completamente y la histología confirmó un fibroadenoma con marcador de estrógeno positivo.

ABSTRACT Vulvar fibroadenoma is a rare benign tumor with few cases reported in the literature. It usually occurs between 20 and 70 years of age. It has a good prognosis and rarely recurs following excision. We present a case of vulvar fibroadenoma as a localized, well-defined soft tissue mass in the left labium majus of a 33-year-old woman. The mass was excised completely, and histology demonstrated a fibroadenoma positive for estrogen receptor.

Carcinoma epidermoide de cuello uterino con extensión superficial a endometrio / Squamous cell carcinoma of the cervix with superficial extension to the endometrium

El cáncer de cuello uterino es la neoplasia más frecuente del tracto genital femenino, que en su forma avanzada puede invadir localmente a tejido paracervical, vagina, vejiga y recto. Se presenta un caso, muy poco frecuente, de carcinoma cervical con extensión endometrial como neoplasia in situ, en una paciente de 76 años y que se manifestó clínicamente como piometra.

Cervical cancer is the most common malignant tumor of the female genital tract, which in its advanced stage can invade locally paracervical tissue, vagina, bladder and rectum. A case extremely rarely is reported of cervical carcinoma with in situ carcinoma involving to endometrium in a patient of 76 years old and clinically manifested as pyometra.

Asociación entre diastematomielia y meduloepitelioma: reporte de un caso y revisión de la literatura / Association between diastematomyelia and medullo epithelioma: case report and literature review

Aim: Case report of association between diastematomyelia and medulloepithelioma. Method: 14-year-old patient with lower back pain and recent neurological deficit in extremities. CT and MRI scans of the thoracolumbar spine revealed a diastematomyelia. Intraoperative examination confirmed the presence of a spinal dysraphism and associated tumor, which was almost completely resected. Result: Histopathological and immunohistochemical findings were consistent with medulloepithelioma. Her postoperative course was uneventful. Conclusion: Diastematomyelia may manifest during adolescence as lower back pain and neurological deficit. The association of this malformation with a neoplasia is extremely rare; the present case describes concomitance with medulloepithelioma.

Reporte de un caso de asociación de diastematomielia y meduloepitelioma. Método: Paciente de 14 años con dolor lumbar y déficit neurológico en extremidades de reciente instalación. En TAC y RNM de columna dorsolumbar se pesquisa una diastematomielia. La exploración intraoperatoria, comprueba la presencia de una disrafia espinal y un tumor asociado al defecto, que se reseca casi en su totalidad. Resultado: Los hallazgos histopatológicos e inmunohistoquímicos son concordante con meduloepitelioma. La paciente tuvo un postoperatorio satisfactorio. Conclusión: La diastematomielia se puede manifestar durante la adolescencia como dolor lumbar y déficit neurológico. La asociación de esta malformación, con una neoplasia es muy poco frecuente, el presente caso describe la concomitancia con un meduloepitelioma.

Tejido prostático en teratoma quístico maduro del ovario: Caso clínico / Prostatic tissue in a mature cystic teratoma of the ovary: Report of one case

Male accessory sexual glands arising in ovarian cystic teratoma are exceedingly rare. We report a 56-year-old female subjected to an ovariohysterectomy due to a left ovarian mass. The pathological study of the surgical piece revealed a tumor composed of different mature tissue elements and well defined nodules of benign prostatic tissue.

Carcinoma epidermoide oral y orofaríngeo: estudio clínico-patológico / Oral and oropharingeal squamous cells carcinoma: clinico-pathological study

Introduction: Oral cancer is a common disease in many parts of the world, in Chile only accounts for 1.6 percent of all cancers. The majority is squamous cell carcinoma with important clinical, epidemiological and pathological differences between lip, oral and orofaringeal locations. Objective: To analyze clinical and pathological characteristics of oral and oropharingeal squamous cell carcinoma in Temuco, Chile. Materials and Methods: A descriptive, retrospective study of all diagnosed cases in 15 years (1994 and 2008). The patients were analyzed according to gender, age; and the tumors were classified based on anatomic location, size, macroscopical findings and degree of differentiation. Results: We found 93 carcinomas, with male to female ratio of 5:1, average age 67 years. Patients under 50 years accounted for only 8 percent of cases. The most common sites were lower lip, tongue and gingiva, with an average size of 28 mm, which increased towards orofarinx and more than half were moderately differentiated. Conclusions: In our region, this carcinoma most often affects the seventh decade of life and male population and has similar characteristics to those in other countries which is predominantly. The size at diagnosis is significant. The detection of some differences in the group with mapuche surnames warrants a study with a larger number of cases.

Introducción: El cáncer oral es una enfermedad frecuente en muchas partes del mundo, en Chile corresponde al 1,6 por ciento del total de cánceres. La gran mayoría corresponde a carcinoma epidermoide, con importantes diferencias clínicas, epidemiológicas y patológicas entre las localizaciones labial, intraoral y orofaríngea. Objetivo: Analizar las características clínicas y patológicas del carcinoma epidermoide oral y orofaríngeo en Temuco, Chile. Material y Método: Estudio descriptivo, retrospectivo de todos los casos diagnosticados en 15 años (1994 y 2008), en el Hospital Regional de Temuco. Los pacientes fueron analizados de acuerdo a género, edad, y los tumores fueron clasificados basados en su localización anatómica, tamaño, características macroscópicas y grado de diferenciación. Resultados: Se encontraron 93 carcinomas, con relación hombre:mujer de 5:1, edad promedio 67 años. Pacientes menores a 50 años correspondían sólo al 8 por ciento de los casos. Las localizaciones más frecuentes fueron labio inferior, lengua y encía, con un tamaño promedio de 28 mm, el que aumentó hacia la orofarinx, más de la mitad eran moderadamente diferenciados. Conclusiones: En nuestra región, este carcinoma afecta con mayor frecuencia a la séptima década de la vida y a población masculina y posee características similares a las descritas en otros países donde predomina la raza blanca. El tamaño al diagnóstico es considerable. La detección de algunas diferencias en el grupo con apellidos mapuches amerita un estudio con un mayor número de casos.

Puntaje de Gleason en cáncer de próstata: Correlación de la biopsia por punción y prostatectomía radical / Concordance between Gleason scores of trans rectal biopsies and the surgical piece of radical prostatectomy

Background: Gleason pathological score in prostate cancer is an importantprognostic indicator. However, the concordance between the score of trans rectal needle biopsies and the final score of the surgical piece may be variable. Aim: To analyze the concordance between Gleason scores of trans rectal prostate biopsies and those of the surgical piece obtained after prostatectomy. Material and Methods: Retrospective analysis of 168 pathological records of radical prostatectomies, performed between 1993 and 2009. All these patients had also a trans rectal biopsy performed previously. Patients with less than 12 tissue cylinders obtained during the trans rectal biopsy or incomplete data were not included in this analysis. Results: Sixty eight percent of trans rectal biopsies had Gleason scores that were concordant with those of the surgical piece. The score was higher or lower in 27 and 10 percent of biopsies, respectively. Conclusions: Gleason scores of trans rectal biopsies and those of the surgical piece were concordant in 68 percent of cases in this series of pathological records.

Detección y tipificación de virus papiloma humano en lesiones preneoplásicas de cuello uterino / Human papillomavirus genotyping of cervical uterine preneoplastic lesions in a high risk area

The relationship between human papillomavirus (HPV) and uterine cervical cancer (UCC) is widely known and accepted. Aim: To determine the frequency of genotypes of HPV in cervical preneoplastic lesions in a high risk area of UCC. Material and Methods: Using a combination of PCR and Reverse Line Blot technique, 235 formalin fixed paraffin embedded samples, with diagnosis of low-grade squamous intraepithelial lesion (LSIL) or high-grade squamous intraepithelial lesion (HSIL) were genotyped. Results: HPV was detected in 61.2 percent of LSIL and 78.1 percent of HSIL. The main genotypes found were HPV 16, 18, 31, 45, 56 y 58. HPV 16 was the most common in both LSIL (18.1 percent) and HSIL (36.9 percent). HPV 16 or 18 were present in 25.1 percent and 47.1 percent of the LSIL and HSIL respectively. In both LSIL and HSIL, the predominant viral genotypes were those types classified as with a high oncogenic risk. Conclusions: HPV genotypes 16, 18, 31, 45, 56 y 58 were the most common in our series. HPV 16 and 18, viral types with high oncogenic risk and included in commercial vaccines, were found in 25.1 percent and 47.1 percent of LSIL and HSIL, respectively.

Hallazgos morfológicos en casos fatales de síndrome cardiopulmonar por hantavirus: Estudio de 7 autopsias / Morphological findings in fatal cases of hantavirus cardiopulmonary syndrome: Report of 7 autopsies

Introducción: El síndrome cardiopulmonar por hantavirus (SCPH) es una enfermedad infecciosa aguda, caracterizada por insuficiencia cardio-respiratoria súbita y alta mortalidad, causada por un virus ARN del género Hantavirus, familia Bunyaviridae. Un 15 por ciento de los casos chilenos ha sido pesquisado en la Araucanía. Objetivo: Conocer en casos fatales de SCPH, sus características clínicas y morfológicas. Material y Método: Estudio descriptivo-retrospectivo de siete casos fatales con examen postmortem, de SCPH, atendidos entre 1997 y 2009 en el Hospital Regional de Temuco. Resultados: Los casos fueron principalmente pacientes jóvenes, rurales, con un cuadro de compromiso respiratorio progresivo, con leucocitosis, trombopenia e infiltrado pulmonar intersticial bilateral. Los principales hallazgos histopatológicos fueron un acentuado edema pulmonar intra-alveolar e intersticial, con escaso daño epitelial e infiltrado mono-nuclear y leve edema miocárdico con infiltrado mononu-clear. Conclusiones: Los antecedentes epidemiológicos, clínicos y laboratorio permiten sospechar SCPH. En los casos fatales la autopsia permite diferenciar el SCPH de otras patologías similares y aporta tejidos para confirmar el diagnóstico.

Introduction: Hantavirus cardiopulmonary syndrome (HCPS) is an acute infectious disease characterized by sudden cardiorespiratory failure and high mortality, caused by a RNA virus of the genus Hantavirus, family Bunyaviridae, 15 percent of Chilean cases have been detected in the Araucania Region. Objective: To determine in fatal cases of HCPS, clinical and morphological characteristics. Materials and Methods: Descriptive-retrospective analysis of seven fatal cases with postmortem study of HCPS, attended between 1997 and 2009 at the Hospital of Temuco, Chile. Results: Cases were young patients from rural areas, and presented as an illness of progressive respiratory failure, with leukocytosis, thrombocytopenia and bilateral interstitial pulmonary infiltrates. Main morphological findings were marked intersticial and intraalveolar pulmonary edema, with minimal epithelial injury and mononuclear cell intersticial infiltrate and mild edematous intersticial inflamatory process. Conclusions: Epidemiological, clinical and laboratory background allow to suspect HCPS. In fatal cases, the autopsy makes possible to discard other similar pathologies and provide tissue for confirmation of the disease.

Genotipificación del virus papiloma humano en mujeres con adenocarcinoma cervical de la Región de La Araucanía-Chile / Human papillomavirus genotyping in cervical adenocarcinoma in the Region of La Araucanía-Chile

El virus papiloma humano (VPH) es el principal factor causal del cáncer cervicouterino (CCU). Así, detectar y genotipificar el VPH es importante para conocer la frecuencia de los genotipos presentes en la región. En este trabajo se estudiaron 44 biopsias de adenocarcinoma cervical (ACC). Para la detección del VPH se empleó una reacción de polimerasa en cadena anidada dirigida al gen L1 (RPCL1), para la genotipificación viral se utilizaron enzimas de restricción (Rsa I, Dde I, Pst I) y secuenciación. Se detectó ADN viral mediante RPCL1 anidada en 100 por ciento de las biopias. Se logró tipificar 38/44 casos: 81,6 por ciento VPH 16; 13,2 por ciento VPH 18; 2,6 por ciento VPH 33 y 2,6 por ciento VPH 18/33. Conclusiones: La metodología fue exitosa para identificar el tipo viral en 86 por ciento de las biopsias. Se observó una estrecha asociación ACC-VPH, especialmente con el tipo viral 16, detectado en 81,6 por ciento de los casos tipificados.

Human papillomavirus (HPV) is the main cause of cervical cancer. Thus, HPV detection and typing becomes important in order to know the frequency of genotypes present in the region. In this paper we studied 44 biopsies of cervical adenocarcinoma. For HPV detection nested polymerase chain reaction (PCR) was used to amplify the L1 gene. For viral typing restriction enzymes (Rsa I, Dde I, Pst I) and DNA sequencing were used. Viral DNA was detected by nested L1 PCR in 100 percent of biopsies; 38/44 cases could be typed: 81.6 percent HPV16; 13.2 percent HPV 18; 2.6 percent VPH 33 and 2.6 percent HPV 18/33. Conclusions: The technique was successful in identifying the virus type in 86 percent of biopsies. There was a strong association ACC-HPV, especially with the viral type 16, detected in 81.6 percent of established cases.

Descripción clínico-morfológica y factores pronósticos en carcinomas de apéndice cecal: estudio de cohorte / Appendiceal malignant tumors: review of 84 cases

Background: Malignant appendiceal tumors account for only 0.5 percent of all gastrointestinal tumors and there are usually diagnosed during the pathological study of excised appendices. Aim: To assess the factors influencing the survival of patients with appendiceal carcinomas. Material and Methods: Retrospective review of records of all primary appendiceal carcinomas diagnosed in the pathology unit of a regional hospital between 1993 and 2008. The surgical procedure, clinical history, morphological features of tumor and survival were recorded. Results: Eighty four patients aged 32 ± 15 years (44 women) with appendiceal carcinoma were identified. In 93 percent of patients, the clinical diagnosis was acute appendicitis. Sixty one patients (73 percent) had a carcinoid tumor, 20 (24 percent) an adenocarcinoma and three (3 percent), an adenocarcinoid tumor. Preoperative suspicion of a malignant tumor, level of tumor infiltration, pathological type, involvement of surgical borders, tumor size over 2 cm in the case of carcinoid tumors and the degree of differentiation of adenocarcinomas, had prognostic value. For adenocarcinomas, performing a right hemicolectomy significantly improved survival. Conclusions: Carcinoid tumors are the most common malignant tumor of the appendix. A right hemicolectomy may improve the survival of patients with appendiceal adenocarcinomas.

Introducción: Los tumores malignos del apéndice cecal representan tan sólo el 0,5 por ciento de todas las neoplasias gastrointestinales. Su diagnóstico generalmente no es sospechado por el clínico, siendo su diagnóstico un hallazgo durante el examen de la pieza operatoria. Algunos de estos tumores presentan buena supervivencia con la sola apendicetomía, aunque en ocasiones es necesario realizar tratamientos complementarios. El objetivo de este estudio es determinar la asociación entre variables clínicas y morfológicas con la supervivencia de pacientes con carcinomas del apéndice cecal y analizar el tratamiento quirúrgico realizado. Material y Método: Cohorte retrospectiva de 84 pacientes con carcinomas apendiculares diagnosticados en el Hospital Hernán Henríquez Aravena de Temuco entre los años 1993-2008. Se estudiaron variables clínico-morfológicas, el tratamiento quirúrgico realizado y la supervivencia para estos pacientes. Se utilizó estadística descriptiva y analítica, aplicando Chi-cuadrado y test exacto de Fisher para variables categóricas y T-Student para variables continuas; y prueba Log-rank (Mantel-Cox) para comparación de curvas de supervivencia con un IC de 95 por ciento. Resultados: Del total de apendicectomías (18.563) se verificaron 84 casos (0,45 por ciento); 48 por ciento hombres y 52 por ciento mujeres con una edad promedio de 31,9 +/- 15 años. En el 93 por ciento de los casos el diagnóstico clínico fue apendicitis aguda. Correspondieron a carcinoide, adenocarcinoma y adenocarcinoide en 61 (73 por ciento), 20 (24 por ciento) y 3 (3 por ciento) casos respectivamente. En el análisis bivariado las siguientes variables mostraron asociación pronóstica estadísticamente significativa: sospecha pre-operatoria (p = 0,009), nivel de infiltración tumoral (p = 0,04), tipo histológico (p = 0,009), compromiso de bordes quirúrgicos (p < 0,001), tamaño tumoral > 2 cm en tumores carcinoides (p = 0,001) y grado de diferenciación en adenocarcinomas...

Cáncer gástrico en una región de Chile: comparación de variables clínicas y morfológicas en dos períodos (1986-1995 y 1996-2005) / Changes in morphological an clinical characteristics of gastric cancer from 1986 to 2005

Background: In the last decade, changes in therapy and on the epidemiological and pathological behavior of gastric cancer have occurred in Chile. Aim: To compare the natural history of gastric cancer in two periods (1986-1995 and 1996-2005) in the ninth region of Chile. Material and Methods: Medical records of 563 gastrectomies for gastric cancer, performed between January 1986 and December 2005 and kept at a Pathology Unit of a public hospital, were reviewed. Clinical and morphological variables were analyzed (histological Lauren type, differentiation degree, location and macroscopic type, infiltration level, number of resected and involved lymph nodes). Results: A significant increase in the frequeney of the diffuse type of gastric cancer was observed in the seeond period in study, with a concomitant deerease of the intestinal type. A reduction in tumor size and number of excised lymph nodes was also observed. Conclusions: In the seeond study period, morphological changes in gastric cancer, were observed.

Introducción: El cáncer gástrico (CG) es la primera causa de muerte por cáncer en Chile (tasa de mortalidad general de 19,5 x 10(5) y 24,8 x 10(5) habitantes a nivel nacional y IX Región respectivamente). Se han descrito cambios epidemiológicos, histopatológicos y de tratamiento para CG. El objetivo de este estudio es describir la historia natural del CG en la IX región de Chile comparando dos periodos (1986-1995 y 1996-2005). Material y Método: Cohorte histórica. Se incluyeron todos los casos de gastrectomías por CG de la Unidad de Anatomía Patológica del Hospital Hernán Henríquez Aravena entre Enero de 1986 y Diciembre de 2005 (n = 563). Se estudiaron variables clínicas (edad, género y estadio TNM) y morfológicas (tipo histológico según Lauren, grado de diferenciación, localización y tipo macroscópico de la lesión, nivel de infiltración, número de ganglios resecados y comprometidos por el tumor). Se aplicó estadística descriptiva y analítica usando t-test y ANOVA para variables continuas, chi² y exacto de Fisher para variables categóricas. Resultados: De las características estudiadas, se evidenció un incremento estadísticamente significativo del tipo difuso en el segundo período en estudio a expensas de un decremento del tipo intestinal; así también una disminución en el tamaño tumoral y número de ganglios linfáticos resecados. Conclusiones: Se verificaron cambios morfológicos del CG experimentados a nivel regional en los períodos estudiados.

Validez diagnóstica de la biopsia intraoperatoria en cirugía de lesiones mamarias palpables / Diagnostic value of frozen section biopsy during surgery for breast lesions or neoplasms

Background: During the surgical treatment of breast neoplasms (benign or malignant), frozen section biopsy is frequently requested to assess the kind of lesion and determine the surgical margins. Aim: To assess the diagnostic yield of frozen section breast biopsy. Material and methods: AH the pathological reports of frozen section biopsies and definitive biopsies of 337 women aged 26 to 88 years, operated for suspected breast neoplasms between 2002 and 2006, were reviewed. The sensitivity, specificity and predictive value of frozen section biopsy, were calculated using the definitive biopsy as the gold standard. Results: The definitive biopsy confirmed the presence of cancer in 290 women (86 percent). There were two false negative (0.59 percent) and no false positive frozen section biopsies for cancer detection. The sensibility for cancer detection was 99.3 percent and the specificity 100 percent. The positive predictive value was 100 percent and the negative predictive value 96.1 percent. The diagnosis of phyllodes tumor was missed by frozen section biopsy in three cases. The margins were informed in the 258 frozen section biopsies (79 percent) and in 59 cases (18 percent), these were positive for cancer. Conclusions: Frozen section biopsy is useful and reliable for cancer detection and margin status assessment in breast cancer surgery (RevMéd Chile 2009; 137: 1173-8).

Adenocarcinoma gástrico primario concomitante con tumor estromal gastrointestinal: Reporte de un caso y revisión de literatura / Concomitant presence of a gastric adenocarcinoma and gastrointestinal stromal tumor: Report of one case

The concomitant presence of a primary gastric adenocarcinoma and a gastrointestinal stromal tumor in the stomach is uncommon. We report a 68-year-old male with an advanced gastric adenocarcinoma. During gastrectomy, a nodular intramural lesion was found. The pathological study, revealed a gastrointestinal stromal tumor, positive form CD117. After six months of follow up, there is no evidence of recurrence of either tumor.

Detección y tipificación de virus papiloma humano en adenocarcinoma de cuello uterino mediante reverse line blot, Región de La Araucanía, Chile / Detection and genotyping of human papillomavirus in biopsies of uterine cervical adenocarcinoma

Background: The genotyping of Human Papillomavirus (HPV) will improve knowledge about the local epidemiological association of this virus with adenocarcinoma. Aim: To determine the frequency of HPV genotypes in biopsies of women with uterine cervical adenocarcinoma in a geographic region of Chile. Materials and Methods: Forty-one cervical biopsies with a pathological diagnosis of adenocarcinoma, corresponding to all women diagnosed with this cancer between 2002 and 2004, were analyzed. Viral gene Ll was amplified by PCRfor viral detection. HPV genotyping was carried out by a Reverse Line Blot technique. Results: Seventy one percent of biopsies were positive for HPV. The most common genotypes found were HPV 16 (61 percent), followed by HPV 18 (19.5 percent). Eighty seven percent of biopsies had a single HPV infection. Three patients had a multiple HPV infection. All of the latter were infected by HPV 16, associated with other three viral genotypes (45, 52 and 66). No low-risk HPV genotypes were found. Conclusions: In this sample of biopsies, there was a high prevelence of HPV 16 and a low prevalence of HPV 18, which historically has been related to adenocarcinoma. The genotypes found correspond to those described in South America.