Neumonía eosinofílica inducida por mesalazina: caso clínico / Eosinophilic pneumonia caused by mesalazine: report of 1 case

A 50 years old male with a diagnosis of ulcerative colitis treated with mesalazine, developed after 2 months of treatment, cough, fever and progressive dyspnea. Chest X ray examination and CT scan showed pulmonary infiltrates in the right upper lobe that subsequently involved both lower lobes. A biopsy, made through videothoracoscopy, showed an eosinophilic pneumonia. After the discontinuation of mesalazine and the use of glucocorticoids, the respiratory involvement resolved, and pulmonary infiltrates regressed. Mesalazine is widely used in the treatment of inflammatory bowel diseases. Pulmonary toxicity is an uncommon complication of mesalazine treatment. Nevertheless, this complication should be considered in patients that use it and develop respiratory symptoms

Bursitis tuberculosa: caso clínico / Tuberculous bursitis: clinical case

We report a previously healthy 51 years old woman with a one year history of pain in the left hip associated with a mass without fever or local inflammatory changes. Magnetic resonance imaging located the mass in the medial gluteal muscle. The pathological examination of the mass disclosed unspecific inflammatory changes. Due to worsening of pain, a left throchanteric bursitis was diagnosed two weeks later and a throchanteric bursectomy was performed, obtaining a second biopsy. Aerobic, anaerobic and fungal cultures were negative. Lowenstein-Jensen culture showed development of mycobacteria and a genetic probe confirmed the presence of Mycobacterium tuberculosis. The second biopsy also identified several granulomas with areas of caseation and the Ziehl-Nielsen stain was positive for acid fast bacilli. Osteoarticular tuberculosis, specially bursitis, shoulds be suspected in the presence of chronic pain associated with swelling

Patología molecular del cáncer pulmonar y sus lesiones precursoras: parte II patología molecular de las lesiones precursoras del cáncer pulmonar / Molecular pathology of lung cancer and its precursor lesions: part II molecular pathology of lung cancer precursor lesions

Aunque se ha avanzado en forma importante en el conocimiento de las alteraciones genéticas en las lesiones que preceden el desarrollo del cáncer pulmonar, existe una gran cantidad de interrogantes por investigar. Aun cuando la aplicación de estos resultados al diagnóstico precoz de esta neoplasia y el control de individuos en riesgo de adquirirla son promisorios, no existen estudios con gran número de pacientes que permitan conocer en forma fehaciente el real significado clínico de estas alteraciones. Este es un campo de la investigación científica básica aplicada al campo clínico que concita gran interés en la actualidad y presenta una gran actividad. Por ello, es posible que en el futuro la utilización de marcadores moleculares sea un elemento complementario al estudio diagnóstico clínico y patológico convencional

Osteoartropatía hipertrófica asociada a carcinoma bronquioalveolar / Hypertrophic osteoarthropathy associated with bronchioloalveolar carcinoma

La osteoartropatía hipertrófica (OAH) es una entidad clínica poco frecuente, que en general se asocia a neoplasias pulmonares. Se presenta el caso de un paciente de 55 años, fumador, que consultó en múltiples oportunidades en los últimos 2 años por cuadro de poliartralgias simétricas. Evaluados en Reumatología se sospechó una OAH secundaria. Se solicitó una radiografía de tórax en la que se detectó un nódulo pulmonar solitario en la periferia del lóbulo inferior izquierdo. A través de una toracotomía se realizó lobectomía y linfadenectomía mediastinal. La biopsia demostró un carcinoma bronquiloalveolar. Luego de la resección del tumor, la sintomatología articular desapareció

Neumonía intersticial no específica / Diffuse idiopathic interstitial lung disease

Se presenta un paciente, clínicamente calificado como broncoquiolitis obliterante con neumonía demostró una neumonía intersticial inespecífica, entidad poco frecuente, recientemente descrita, cuyo reconocimiento es importante por responder a tratamiento corticoidal, al contrario de la fibrosis intersticial usual, afección más frecuente con la cual ha sido confundida bajo la categoría clínica de fibrosis pulmonar idiopática

Bronquiolitis obliterante con neumonía en organización secundaria a quimioterapia, en un niño con sarcoma pericárdico primario / Bronchiolitis obliterans organizing pneumonia secondary to chemotheraphy in a child with pericardial sarcoma

The uncommon bronchiolitis obliterans organizing pneumonia can be idiopathic or caused by infection or medications. We report a 5 year old boy with pericardial sarcoma that was treated with chemotherapy (vincristine, doxorubicin, etoposide, cyclophosphamide) and radiotherapy. During the third cycle of chemotherapy, he developed progressive cough and dyspnea, needing oxygen therapy. Chest X-ray examination showed bilteral infiltrates. After discarding infectious etiologies, an open lung biopsy was performed, and the pathological examination showed a bronchiolitis obliterans organizing pneumonia. He was treated with prednisolone for 7 days, followed by prednisone for additional 45 days. He continued with fluticasone propionate as maintenance and remains in good condition with a ches X ray showing mild interstitial images, after seven months of follow up

Reflexiones sobre la práctica actual de la anatomía patológica en Chile / Reflections on the current state of anatomic pathology in Chile

The present article reviews the most relevant aspects of the practice of Anatomic Pathology in Chile. The importance of biopsy and autopsy are analysed, in particular the consequences of the fall in the number of autopsies performed in our hospitals, in the recent decades. The modern pathologist is confronted with two situations: the renovation of the value of the autopsy and the acquisition of new diagnostic technologies, both not usually considered in the classical morphologic approach of Pathology. The ways to solve these problems in a discipline that is still a fundamental specialty in modern medicine are analyzed

Cuerpo extraño vegetal en la vía aerea: una causa poco frecuente de hemoptisis en la niñez: caso clínico / Vegetal foreign body in the lower airway: an anusual cause of hemoptysis in childhood: report of one case

Hemoptysis is an infrequent symptom in childhood and potentially life threatening. The most common causes in this age group are bronchiectasis secondary to cystic fibrosis, cardiovascular and pulmonary congenital anomalies and a miscelaneous group of causes including retained intrabronchial aspirated foreign bodies. We report a previously healthy 5-year-old girl with recurrent pneumonias associated with episodes of hemoptysis. She was admitted in our institution to investigate the persistence of hemoptysis. Based on clinical history, aspiration of a vegetal foreign body was postulated as the etiology and it was confirmed in the pathological examination after surgical exploration, with pulmonary lobe resection. The importance of a good history taking in pediatric hemoptysis is emphatized

Enfermedad pulmonar intersticial crónica en un lactante: caso clínico / Chronic interstitial pneumonia in an infant: clinical case

La enfermedad pulmonar interstical crónica es frecuente en lactantes y comprende un grupo heterogéno de enfermedades con patrón histológico semejante. Se presenta el caso de una lactante que inició su sintomatología en el período neonatal, con neumonías y atelectasias repetidas, asociadas a transtornos de la deglución con aspiración hacia la vía aérea. El estudio radiológico de tórax demostró infiltrados intersticiales bilaterales persistentes. La biopsia pulmonar fue compatible con una neumonía crónica interstical histiocitaria. Se trató con oxigenoterapia permanente, corticoides inhalatorios, broncodilatadores, kinesiterapia respiratoria, prednisona oral, que luego se cambió a cloroquina, la cual se mantiene hasta la fecha (tiempo de admini9stración 34 meses). La evolución clínica y radiológica ha sido favorable, lográndose la suspensión de la oxigenoterapia luego de un año de uso. Después del primer año de tratamiento no ha presentado neumonías y no han aparecido efectos secundarios por el uso prolongado de cloroquina. Su desarrollo pondoestatural no ha sido adecuado ya que es portadora de una genopatía aún no precisada, sin relación con la enfermedad pulmonar

Disquinesia ciliar primaria: experiencia en 6 pacientes / Primary ciliary dyskinesia: a experience in 6 patients

Background: Primary ciliary dyskinesia is characterized by a congenital alteration of the ciliary ultrastructure and function. As a consequence, their respiratory tract sweeping action is lost and recurrent respiratory infections ensue. Aim: To analyze a clinical series of patients with primary ciliary dyskinesia, their clinical and laboratory features. Patients and methods: a retrospective review of patients with primary ciliary dyskinesia seen a university hospital, between 1994 and 1998. Bronchial biopsies were obtained with 3.6 mm diameter Olympus fibrobronchoscope, using a cayman type forceps. Ultrastructural alterations of respiratory tract ciliated cells were recorded. Results: six patients (four male) aged 9 months to 13 years old were reviewed. Three patients had situs inversus. All had repeated bouts of obstructive bronchitis and pneumonia, five had sinusitis, four atelectasis, three recurrent otitis and three had bronchiectasis. Cystic fibrosis and immunological alterations were ruled out in five children. Ultrastructural analysis revealed absence of dynein arms in three cases, absence of the internal dynein arm in one, additional peripheral microtubules and absence of dynein arms in one case. Conclusions: primary ciliary dyskinesia must be considered in the differential diagnosis of recurrent respiratory infections. Ultrastructural analysis of ciliary structure can be done in bronchial biopsies obtained through bronchoscopy

Enfisema pulmonar experimental en la rata: fenómenos inflamatorios y progresión del daño pulmonar / Experimental pulmonary emphysema in the rat: inflammatory phenomena and progression of lung damage

Background: Although the hamster model of elastase induced emphysema is well characterized, the rat model has received less attention. Aim: To evaluate the effect of a single intratracheal elastase dose on lung pathological changes of Sprague-Dawley rats. Material and methods: Rats were injected with a single intratracheal elastase dose of 28 U/100 g body weight or saline and studied 7, 15, 30 and 365 days after injection. Results: Forty percent of rats died in the first 48 hours after injection, six were sacrificed at 7 days, 6 at 15 days, 7 at 30 days and 12 at 365 days. Progressive centroacinar emphysema was found from day 7 after elastase, with a persistent inflammatory reaction in the vicinity of emphysematous areas. Conclusions: Present findings differ from the panacinar emphysema described in the hamster using a similar elastase dose

Marcadores tumorales inmunohistoquímicos en carcinoma ductal infiltrante de la mama / Immunohistochemical tumoral markers in infiltrating ductal mammary carcinoma

Background: Immunohistochemical techniques allow the study of tumoral markers with predictive or prognostic value. Aim: To study tumoral markers in mammary carcinoma and to relate these markers with age and tumoral histological grade. Material and methods: The expression of nuclear estrogen receptor (RE), nuclear progesterone receptor (PGR), p53 and c-erb-B2 proteins was analyzed in 382 cases of infiltrating ductal carcinoma of the breast. Results: The histological grade was I in 22 percent tumors, II in 56 percent and III in 23 percent. Forty nine percent of tumors had positive staining for RE, 41 percent for RPG, 45 percent for p53 and 57 percent for c-erb-B2. Correlation was found between histological grade and expression of RE, p53 and c-erb-B2 between RE and PGR, RE and c-erb-B2 and between c-erb-B2 and p53. RE expression correlated with age. Conclusions: A reliable and rapid evaluation of these markers can be achieved using immunohistochemical staining. The present results are similar to other biochemical and immunohistochemical studies

Pólipo fibroepitelial con estroma atípico en piel y mucosa anogenital / Fibroepithelial polyp with atypical stroma in skin and anal-genital mucosa

El pólipo fibroepitelial es una lesión benigna de piel y mucosa genital y perineal. Se presenta en mujeres jóvenes, es poco frecuente e histológicamente muestra estroma laxo con prominentes y numerosas células atípicas, pleomórficas, multinucleadas. La lesión puede confundirse con rabdomiosarcoma botrioide, angiomixoma agresivo y neurofibroma mixoideo. Se revisaron los casos de nuestro archivo del período 1990-1996. Se recolectaron 13 casos, todas mujeres, cuya edad varió de recién nacido a 74 años. El tamaño de la lesión fluctuó de 0,3 a 2,5 cm; 12 lesiones únicas y 1 múltiple; localizaciones: vagina 6 (46,2 por ciento), ano 3 (23,1 por ciento), vulva 2 (15,4 por ciento) y uretra 1 (7,7 por ciento); en 1 caso la localización no se consignó. Histológicamente, las lesiones presentaban revestimiento escamoso normotípico, estroma, conjuntiva laxo, vascularizado, con moderada cantidad de células atípicas, pleomórficas, en partes formando rosetas, sin mitosis ni invasión del epitelio. Esta veriedad de papiloma es una lesión benigna, que simula sarcoma, que debe tenerse presente en el diagnóstico diferencial de sarcoma y pseudosarcoma de mucosa vaginal y piel perineal

Hemangiopericitoma de cuello uterino / Hemangioperycitoma of uterine cervix

Se presenta el caso de una paciente de 67 años a la que durante una cirugía ginecológica se le encontraron nódulos retroperitoneales que resultaron ser un hemangiopericitoma. Después de la cirugía resectiva presentó recidiva tumoral en cuello uterino. Se comenta el tratamiento efectuado y una revisión de la literatura en relación a este tumor poco común