Triple-negative breast carcinoma: heterogeneity in immunophenotypes and pharmacokinetic behavior.

OBJECTIVES: To evaluate the morphokinetic, pharmacokinetic, and diffusion characteristics of triple-negative breast cancers on magnetic resonance (MR) imaging and to analyze whether there is a relation between these parameters and the time to progression. MATERIAL AND METHODS: This was a retrospective observational study of a consecutive series of 100 patients with histologically confirmed triple-negative breast cancer studied at our center between January 2005 and December 2010. We reviewed the findings on MR locoregional extension studies, the histological findings, and the follow-up of patients until August 2014. RESULTS: The most common MR findings for these tumors were a rounded mass (47.3%), well-defined borders (53.7%), ring enhancement (46.2%), type 3 curves (50.5%), hyperintensity within the tumor on T2-weighted sequences, high ADC values (1.04 × 10(-3) mm2/s), and increased capillary permeability (Kep) (0.94 min(-1)). No significant association was observed between the morphokinetic or pharmacokinetic characteristics and the time to progression. The in situ component in the surgical specimens was high, although its expression was low. During follow-up, 25% of patients had metastases, with a predilection for the visceral organs, and survival was low. CONCLUSION: Tumors with the triple-negative phenotype mostly presented in MR as rounded tumors with well-defined borders and ring enhancement. We found no significant association between the morphokinetic or pharmacokinetic characteristics and the time to progression.

[Idiopathic retroperitoneal fibrosis: clinico-pathological characteristics]. / Fibrosis retroperitoneal idiopática: características clínico-patológicas.

Idiopathic retroperitoneal fibrosis is a rare disease often causing obstructive uropathy because the fibrosis entraps the ureters. The retroperitoneal tissue is constituted by a fibrous component and a chronic inflammatory infiltrate with the former characterized by miofibroblasts. The infiltrate displayed perivascular. Last years, the immunosuppressive therapy and the decompression of obstructive renal failure have improved the prognostic. We reported 9 patients with Idiopathic retroperitoneal fibrosis in a Centre. We evaluate clinical symptoms at the presentation with the signs of renal and non-renal involvement. We evaluate the achieved therapy and the follow-up. All 9 patients had a radiological and/or histological diagnosis in the absence of malignancy, previous radiotherapy or gadolinium's administration with severe renal failure. The patients were treated with 1 mg/kg/day of prednisone three months and possibly the insertion of ureteral catheters. 89% patients have a high rate of initial success without renal failure, despite frequent disease relapse. A patient developed progression of the fibrosis.

[Gadolinium-induced systemic fibrosis in advanced kidney failure]. / Fibrosis sistémica por gadolinio en insuficiencia renal avanzada.

Nephrogenic systemic fibrosis is a debilitating disease occurring exclusively in patients with severe renal failure. Originally it was described as nephrogenic fibrosing dermopathy. The pathogenesis of the disease is not yet known, but the observations suggest a close association with the exposure to gadolinium-containing contrast agents. These agents cause systemic fibrosis by releasing free gadolinium into tissues. International commissions in drug control recommend avoiding gadolinium based contrast agents ion patients with GFR <30 ml/min. The prevention is the best treatment because the observations are series with limited patients, or a case-report communication. So, we report a case with a fatal evolution, the first case in Spain, with a multisystemic involvement showed in the autopsy. The patient had repeated exposure to gadodiamide; it increases the possibility of the systemic fibrosis. We review the recent literature of the nephrogenic systemic fibrosis.

Idiopathic retroperitoneal fibrosis: clinico-pathological characteristics

Idiopathic retroperitoneal fibrosis is a rare disease often causing obstructive uropathy because the fibrosis entraps the ureters. The retroperitoneal tissue is constituted by a fibrous component and a chronic inflammatory infiltrate with the former characterized by miofibroblasts. The infiltrate displayed perivascular. Last years, the immunosuppressive therapy and the decompression of obstructive renal failure have improved the prognostic. We reported 9 patients with Idiopathic retroperitoneal fibrosis in a Centre. We evaluate clinical symptoms at the presentation with the signs of renal and non-renal involvement. We evaluate the achieved therapy and the follow-up. All 9 patients had a radiological and/or histological diagnosis in the absence of malignancy, previous radiotherapy or gadolinium’s administration with severe renal failure. The patients were treated with 1 mg/kg/day of prednisone three months and possibly the insertion of ureteral catheters. 89% patients have a high rate of initial success without renal failure, despite frequent disease relapse. A patient developed progression of the fibrosis (AU)

Introducción: La fibrosis retroperitoneal idiopática es una entidad clínica de presentación poco frecuente, que suele cursar con uropatía obstructiva por atrapamiento ureteral por el tejido fibroso e inflamatorio crónico, constituido por miofibroblastos de disposición perivascular. En los últimos años, el pronóstico parece haber mejorado con el tratamiento médico inmunosupresor y con las intervenciones urológicas de liberación de los uréteres. Hemos revisado los pacientes diagnosticados de fibrosis retroperitoneal idiopática en nuestro centro con el objetivo de revisar el motivo de presentación clínica, de afectación renal y extrarrenal, el tratamiento realizado y la evolución clínica seguida. Han sido nueve enfermos no neoplásicos, no tratados previamente con radioterapia y sin administración previa de gadolinio en presencia de insuficiencia renal avanzada. Seis de ellos tienen diagnóstico histológico y tres radiológico. Han sido tratados con prednisona, 1 mg/kg/día durante tres meses, y la posibilidad de colocación de catéteres endoluminales doble J. El89% de estos pacientes ha seguido una buena evolución sin insuficiencia renal crónica progresiva. Las recidivas han sido frecuentes a lo largo de su seguimiento (AU)

[Acute renal insufficiency associated to cocaine consumption]. / Insuficiencia renal aguda por consumo de cocaína.

Acute renal insufficiency associated to cocaine consumption is well known, and normally secondary to rhabdomyolisis. The possibility that renal failure is related to hypertension and to renal histopathological findings indistinguishable of other malignant hypertension conditions is a not as well known fact. Certain derivatives of cocaine are powerful vasospasm inducers, which could be the key of the origin of the ischemic lesions that appears not only in the kidney but in other organs, especially in the nervous system. We present four patients with acute renal insufficiency, two of them because of malignant hypertension, another one because of cocaine consumption with very severe ischemic neurological lesions, but reversible with the withdrawal of the drug, and another one because of rhabdomyolisis. The latest patient had a different evolution probably related to the different habit of consumption and perhaps as a consequence of different derivatives of cocaine.

Hipertensión arterial maligna e insuficiencia renal aguda por consumo de cocaína / Malignant hypertension and acute renal failure due to cocaine abuse

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