Una inusual causa de estrechez de la vía aérea laringotraqueal / An unusual cause of laryngotracheal airway narrowing

La enfermedad relacionada con inmunoglobulina (Ig) G4 es una enfermedad de reciente conocimiento que puede comprometer cualquier órgano teniendo preferencias por ciertas regiones del cuerpo, donde la región de cabeza y cuello es uno de sus principales puntos afectados, pudiendo comprometer tanto la órbita, glándulas salivales, glándulas lagrimales, glándula tiroides, cavidades paranasales, hueso temporal, faringe y laringe. Este último órgano es infrecuentemente comprometido, solo existiendo 12 casos registrados en la literatura antes de la publicación de este escrito. Presentamos un caso de una mujer de 49 años con historia de disnea frente a esfuerzo, diagnosticándose una estenosis subglótica la cual fue manejada quirúrgicamente con una reconstrucción laringotraqueal. En el estudio histopatológico se evidenció histología compatible con enfermedad relacionada con IgG4, por lo que se inició tratamiento médico con corticotera- pia oral por un lapso de 2 meses en conjunto con inmunología. Paciente luego de 4 años de seguimiento, no ha presentado recaídas, manteniendo un lumen subglótico adecuado.

Immunoglobulin (Ig) G4-related disease is a medical condition of recent knowledge that can compromise any organ, having preferences for certain regions of the body, where the head and neck region is one of the main affected points, being able to affect orbit, salivary glands, lacrimal glands, thyroid gland, paranasal cavities, temporal bone, pharynx and larynx. The latter is infrequently compromised, with only 12 cases registered in the literature before the publication of this writing. We present a case of a 49-year-old woman with a history of exertional dyspnea, diagnosed with a sub- glottic stenosis which was managed surgically with laryngotracheal reconstruction. The histopathological study revealed histology compatible with IgG4-related disease, so medical treatment with oral corticosteroid therapy was started for a period of 2 months in conjunction with immunology. After 4 years of follow-up, the patient has not presented relapses, maintaining an adequate subglottic lumen.

¿Es posible utilizar las muestras de colecistectomías con cáncer en investigación?: Calidad del ADN de muestras obtenidas del sistema público y privado de salud / Quality of DNA from archival pathological samples of gallbladder cancer

Background: The quality of the archival samples stored at pathology services could be a limiting factor for molecular biology studies. Aim: To determine the quality of DNA extracted from gallbladder cancer samples at different institutions. Material and Methods: One hundred ninety four samples coming from fve medical centers in Chile, were analyzed. DNA extraction was quantifed determining genomic DNA concentration. The integrity of DNA was determined by polymerase chain reaction amplification of different length fragments of a constitutive gene (β-globin products of 110, 268 and 501 base pairs). Results: The mean DNA concentration obtained in 194 gallbladder cancer samples was 48 ± 43.1 ng/µl. In 22% of samples, no amplification was achieved despite obtaining a mean DNA concentration of 58.3 ng/ul. In 81, 67 and 22% of samples, a DNA amplification of at least 110, 268 or 501 base pairs was obtained, respectively. No differences in DNA concentration according to the source of the samples were demonstrated. However, there were marked differences in DNA integrity among participating centers. Samples from public hospitals were of lower quality than those from private clinics. Conclusions: Despite some limitations, in 80% of cases, the integrity of DNA in archival samples from pathology services in our country would allow the use of molecular biology techniques.

Expresión y amplificación del gen HER2 en el cáncer gástrico avanzado / HER2 gene amplification and overexpression in advanced gastric cancer

Background:Overexpression/amplification of the HER2 gene in advanced gastric cancer is a predictor of response to adjuvant therapy with monoclonal antibodies.Aim: To determine the frequency of HER2 gene overexpression and amplificationin advanced gastric cancer. Material and Methods: One hundred nine advancedgastric cancer biopsy specimens, from 76 men and 33 women aged 67 ± 14 and 62± 12 years respectively, were selected. Three histological patterns (diffuse, intestinaland mixed) were recognized. Automated immunohistochemistry was performedwith monoclonal c-erbB-2 (NCL-356) Novocastra. Fluorescent in situ hybridization (FISH) for HER2 was performed in positive cases. Results: In 39% of cases,immunohistochemical staining was negative. It was 1+, 2+ and 3+ positive in 15,36 and 11% of cases, respectively. It was positive in 16% and 3% of intestinal typeand mixed carcinomas, respectively. It was negative in all diffuse carcinomas. FISHwas performed in 39 (2 +) cases and in 11 (3 +) cases. The gene amplification waspositive in two (2 +) and 11 (3 +) cases (11.9%). The overall concordance betweenimmunohistochemical staining and in situ hybridization was 85%. Conclusions: Inadvanced gastric cancer, HER2 gene overexpression or amplification was observed in11% and 12% of cases, respectively.

Quince años de experiencia clínica con hidatidosis / Clinical presentation of hydatid disease during 15 years: a case series from Santiago, Chile

Introduction: Hydatidosis is a neglected parasitic disease that is endemic in Chile. We present the clinical experience of a single center in Santiago from 1996 to 2010. Methods: Cases were identified using hospital's database. Clinical and pathological features, treatment and outcomes were retrospectively analyzed. Results: In total, 23 patients were identified requiring 30 surgical interventions. Median age was 40 years old (range 5 to 73), and 76.5% visited or resided in regions of known endemicity in Chile. Abdominal cysts were predominant (78.3%), and most patients were symptomatic (73.9%). Elimination of cyst material by cough was reported in 42.9% of patients with symptomatic thoracic cysts. Eosinophilia was present in 41.2% of patients, and 57.1% had positive serology for hydatidosis. Aill patients underwent surgical treatment, in 60.9% in combination with albendazole treatment. While the majority of liver cysts (88.9%) were treated by complete cyst resection, lung cysts (83.3%) were predominantly treated by cyst resection plus capitonnage. Pathological examination revealed fertile cysts in 24%. Postsurgical morbidity was frequent (37.9%), and 13.3% of the series required readmission for this cause. Near 25% of patients remained in hospital > 14 days, a feature associated with fever during admission (p < 0.05). No recurrence was reported in the fraction of patients that were followed-up for 2 years or more. Conclusions: Our analysis of 23 cases demonstrates that patients were mainly adults suffering from abdominal cysts. Most patients were successfully treated by surgery with or without antiparasitic drugs but complications leading to prolonged hospital stays and readmissions were not infrequent.

Introducción: La hidatidosis es una enfermedad endémica en Chile. Se presenta la experiencia clínica de un hospital en Santiago, desde 1996 al 2010. Métodos: Los casos fueron identificados usando las bases de datos institucionales y se analizaron las características clínicas y patológicas, el tratamiento y la evolución en forma retrospectiva. Resultados: Se identificaron 23 pacientes intervenidos en 30 oportunidades. La mediana de edad fue de 40 años (rango 5 a 73) y 76,5% visitó o residía en zonas endémicas en Chile. Los quistes abdominales fueron predominantes (78,3%) y la mayor parte de los pacientes eran sintomáticos (73,9%). Un 42,9% de aquellos con quistes sintomáticos torácicos reportó eliminación de vesículas con la tos. Un 41,2% presentó eosinofilia y 57,1% tuvo serología positiva para hidatidosis. Todos los pacientes fueron tratados quirúrgicamente, en 60,9% en combinación con albendazol. La mayoría de los quistes hepáticos fueron tratados con cirugía radical (88,9%) y los pulmonares predominantemente con quistostomía y capitonaje (83,3%). Un 24% de los quistes eran fértiles. La morbilidad post-quirúrgica fue frecuente (37,9%) y 13,3% de la serie requirió reingresos por esta causa. Cerca de 25% de los pacientes estuvo hospitalizado por más de 14 días, un fenómeno asociado con la presencia de fiebre por complicación séptica al ingreso (p < 0,05). No se registraron recurrencias en la fracción de pacientes seguidos por más de dos años. Conclusiones: La hidatidosis afecta principalmente a adultos en su cavidad abdominal. Aunque los pacientes fueron tratados exitosamente con cirugía, las complicaciones, estadías prolongadas y reingresos por esta causa no fueron infrecuentes.