ABSTRACT
El pólipo estromal mesodérmico de vagina es una lesión benigna, asintomática que se diagnóstica en forma incidental y se presenta a cualquier edad (recién nacidas a 71 años). Se localiza en las paredes laterales en el tercio inferior de la vagina, es generalmente único, de aspecto digitiforme o nodular. Aun cuando su origen no es claro, la presentación en mujeres embarazadas o con manejo hormonal hace suponer que la estimulación hormonal juega un papel relevante en su desarrollo. Se informan cuatro casos estudiados en el Instituto, la edad de presentación osciló entre 19 y 54 años, dos pacientes se encontraban embarazadas y dos con manejo hormonal, el diagnóstico se realizó en todas de forma incidental, el tamaño de las lesiones varió de 1.5 a 5 cm de eje mayor. Se efectuó excisión local en todos los casos, sin presentar recurrencias con un seguimiento de 1 a 40 meses. Histológicamente eran bien circunscritos, revestidos por epitelio escamoso, el estroma incluyó un espectro de lesiones constituidas por tejido fibroconectivo laxo, poco celular sin atipias, hasta lesiones constituidas por estroma fibroconectivo denso, con aumento en la celularidad, presencia de atipias y escasa actividad mitótica . Los receptores hormonales fueron positivos en todos lo casos. Estos resultados apoyan el comportamiento indolente y la influencia de los factores hormonales en el desarrollo de estas lesiones.
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Mixed Tumor, Mesodermal/surgery , Mixed Tumor, Mesodermal/physiopathology , Vaginal Neoplasms , Histological Techniques , Immunohistochemistry/methodsABSTRACT
OBJECTIVE: To determine whether the frequency or severity of invasive amebiasis is increased in patients with AIDS. DESIGN: A case-control sampling approach, based on an autopsy registry. SETTING: General Hospital of Mexico City, Mexico, a large government-supported, tertiary care medical institution. PATIENTS, PARTICIPANTS: Ninety-four patients with AIDS and 335 historical and contemporary, age- and sex-matched controls who were defined as dying, but not because of AIDS. RESULTS: The odds ratio (OR) for mortality from invasive amebiasis was the same for cases and controls (0.7; 95% confidence interval, 0.07-7.2). By contrast, the OR for other diseases, such as miliary tuberculosis, cytomegalovirus infection, Pneumocystis carinii pneumonia and toxoplasmosis was greatly increased. Only one patient with AIDS had amebiasis of the common amebic ulcerative colitis type, without extraintestinal involvement. CONCLUSION: In conclusion, we show that the frequency and severity of invasive amebiasis is not increased in Mexican patients with AIDS.
PIP: The incidence of diseases among AIDS patients and controls was investigated through autopsies at the General Hospital of Mexico City. Of particular interest was the association between amebiasis and AIDS, and other parasitic diseases. AIDS cases and controls were selected from a registry of 600 autopsies/year which represents about 50% of all hospital-occurring deaths. 94 AIDS cases were obtained between August 1986-December 1989, which represents 85% of AIDS mortality cases. Case controls were matched by month of death, age, and gender in 2 periods, between 1972-79 before the 1st case of AIDS was diagnosed and between 1982-89. Analysis was conducted for each control group, but because results were almost identical, data were pooled and presented as 1 analysis. Conditional logistic regression models were used to estimate the odds ratios at a 95% confidence interval level. Of the AIDS autopsies, 55.4% were homosexual/bisexual men, 13.8% were infected through blood transfusions, 5.3% through heterosexual contact, and 24.9% in a no-risk category. Results indicate that there is no difference in the relative frequency or severity of amebiasis among AIDS compared with control cases. This finding is unrelated to the administration of antiamebic drugs to AIDS patients, since none were administered during the hospital stay. This finding is also supported by other studies including invasion by E. histolytica among HIV-infected patients in populations with a high incidence of chronic diarrhea. Another common parasitic disease, cysticercosis, was found also to be less frequent among AIDS patients compared with controls. Other infections found to greater than controls among AIDS patients were military tuberculosis, cytomegalovirus infection, pneumocystis carinii pneumonia, and cerebral toxoplasmosis.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Amebiasis/epidemiology , Adult , Amebiasis/complications , Autopsy , Case-Control Studies , Female , Humans , Male , Mexico/epidemiologyABSTRACT
Carcinoid tumors of the extrahepatic bile ducts are extremely rare neoplasms. The authors report the case of a 36-yr-old male patient with a carcinoid tumor that arose in the common hepatic bile duct. The non-neoplastic mucosa showed areas of gastric and intestinal metaplasia that included scattered argyrophil endocrine cells. Since the normal mucosa of the bile ducts lacks the latter type of cells, this case provides evidence for the first time that carcinoid tumors of this anatomic site probably originate from metaplastic endocrine cells.
