Hodgkin's lymphoma of the thyroid in a woman with autoimmune thyroiditis / / Linfoma Hodgkin de tiroides en una mujer con tiroiditis autoinmune

No disponible

[Management of lymphoid hyperplasia of the ocular adnexa]. / Manejo de las hiperplasias linfoides orbitarias.

OBJECTIVE: Lymphoid Hyperplasia (LH) is a benign proliferative lymphocyte-rich process. Histologically, LH may be similar to a lymphoma. Its incidence has decreased because of new sophisticated diagnostic procedures and a better knowledge of lymphomas. Most of the cases are seen in patients between forty and sixty years of age. As there was no consensus about the best treatment, determining this was the objective of our study. METHOD: We describe three patients with a lymphoproliferative process affecting the ocular anexae, in whom histologic, immuno-histochemical and molecular studies were performed. PCR analysis allowed a definitive diagnosis to be made. RESULTS: Histologically, all three cases were diagnosed as LH; immuno-histochemically, one was diagnosed as an idiopathic orbital inflammation, and the other two, as LH. After PCR analysis, one of these latter two cases was definitively diagnosed as B-cell Non-Hodgkin's lymphoma. CONCLUSIONS: Today's molecular techniques allow us to make a definite diagnosis of lymphoma, because sometimes histology and immuno-histochemistry alone can result in a wrong diagnosis being made. LH of the ocular adnexae may be the first stage of a much more serious disease, and a benign hyperplasia at this site must lead to suspicion of lymphoma, which can then be diagnosed or excluded by the improved diagnostic procedures. Therefore, when we make a diagnosis of LH it is necessary to complete a full evaluation and institute a defined follow-up of the patient's clinical condition.

Manejo de las hiperplasias linfoides orbitarias / Management of lymphoid hyperplasia of the ocular adnexa

Objetivo: La hiperplasia linfoide (HL) es una proliferación benigna e hipercelular, rica en linfocitos, que morfológicamente puede simular un linfoma. Su incidencia ha disminuido debido a la sofisticación de las técnicas diagnósticas y mejor conocimiento de los linfomas. Se presenta entre la 4.ª y 6.ª década de la vida y no está determinado un manejo apropiado, objetivo de nuestro trabajo.Método: Se ha estudiado tres pacientes con alteración linfoproliferativa de anexos oculares en los que se aplicó las técnicas de histología, inmunohistoquímica y biología molecular y cuyo diagnostico definitivo se realizó gracias a la reacción en cadena de la polimerasa (PCR).Resultados: Las tres muestras fueron diagnosticadas por histología de HL, con las técnicas inmunohistoquímicas el resultado fue de una inflamación orbitaria idiopática y las otras dos restantes de HL. La PCR diagnosticó un linfoma no-Hodgkiniano tipo B y la otra muestra confirmó una HL.Conclusión: Hoy en día las técnicas de biología molecular son las que permiten definir que es un linfoma, en algunos casos sólo la histología y la inmunohistoquímica pueden inducir a error. Las HL de los anexos pueden suponer un estado inicial de la enfermedad. El hallazgo de una hiperplasia presumiblemente benigna en dicha localización debe hacer sospechar un posible linfoma. El diagnóstico de linfoma está en continuo cambio debido a la sofisticación de las técnicas diagnósticas. Por tanto el diagnóstico de una HL inicialmente benigna, obliga a realizar una exploración sistémica y a un seguimiento de los pacientes estrecho y muy minucioso

Objective: Lymphoid Hyperplasia (LH) is a benign proliferative lymphocyte-rich process. Histologically, LH may be similar to a lymphoma. Its incidence has decreased because of new sophisticated diagnostic procedures and a better knowledge of lymphomas. Most of the cases are seen in patients between forty and sixty years of age. As there was no consensus about the best treatment, determining this was the objective of our study. Method: We describe three patients with a lymphoproliferative process affecting the ocular anexae, in whom histologic, immuno-histochemical and molecular studies were performed. PCR analysis allowed a definitive diagnosis to be made. Results: Histologically, all three cases were diagnosed as LH; immuno-histochemically, one was diagnosed as an idiopathic orbital inflammation, and the other two, as LH. After PCR analysis, one of these latter two cases was definitively diagnosed as B-cell Non-Hodgkin’s lymphoma. Conclusions: Today’s molecular techniques allow us to make a definite diagnosis of lymphoma, because sometimes histology and immuno-histochemistry alone can result in a wrong diagnosis being made. LH of the ocular adnexae may be the first stage of a much more serious disease, and a benign hyperplasia at this site must lead to suspicion of lymphoma, which can then be diagnosed or excluded by the improved diagnostic procedures. Therefore, when we make a diagnosis of LH it is necessary to complete a full evaluation and institute a defined follow-up of the patient’s clinical condition

Hemangiopericitoma nasosinusal / Sinonasal hemangiopericytoma

El hemangiopericitoma es un tumor vascular infrecuente a nivel nasal, que produce epistaxis y clínica obstructiva respiratoria como principales síntomas. Tiene a nivel nasal características clínicas especiales que lo diferencian de los de otras localizaciones. Presentamos un caso de hemangiopericitoma nasosinusal con apariencia polipoidea y tratado mediante cirugía endoscópica nasosinusal, con remisión completa y controles continuos sin observar recidiva. Revisamos la bibliografía y comentamos sus principales características (AU)

The hemangiopericytoma is an infrequent vascular tumour in the nose, that produces epistaxis and obstructive respiratory clinical like principal symptoms. It has, in the nose, special clinical characteristics that makes it different of the others localitations. We report a case of nasosinusal hemangiopericytoma with appearance of polyposis and treated with nasosinusal endoscopic surgery; after that, the patient had a complete remission and subsequent follow-up without recurrence. We review the literature and study the most important characteristics (AU)

[Sinonasal hemangiopericytoma]. / Hemangiopericitoma nasosinusal.

The hemangiopericytoma is an infrequent vascular tumour in the nose, that produces epistaxis and obstructive respiratory clinical like principal symptoms. It has, in the nose, special clinical characteristics that makes it different of the others localitations. We report a case of nasosinusal hemangiopericytoma with appearance of polyposis and treated with nasosinusal endoscopic surgery; after that, the patient had a complete remission and subsequent follow-up without recurrence. We review the literature and study the most important characteristics.

[Low-grade oncocytic adrenal carcinoma]. / Carcinoma suprarrenal oncocítico de bajo grado.

OBJECTIVE: To report a case of left adrenocortical neoplasm. METHODS: A case of left adrenocortical neoplasm measuring 16 x 10 x 7 cm in a 47-year-old male is presented. After puncture biopsy, a left adrenalectomy through the abdominal approach was performed. RESULTS: Immunohistochemical studies showed reactivity to the anti-Melan-A A103 antibody, suggesting an adrenal origin of the tumor cells. Strong reactivity to the mES-13 mitochondrial antibody, which is characteristic of oncocytes, made ultrastructural studies unnecessary. CONCLUSIONS: In this type of tumor, an increased mitotic activity and necrosis are suggestive of malignancy. Despite the foregoing, most of this type of lesions are clinically benign and nonfunctioning.

Myofibroblastoma of the breast with diverse histological features.

We report two cases of myofibroblastoma with unusual pathological features, in a 66-year-old woman and a 49-year-old man. Both tumours were unilateral, grossly nodular and well circumscribed, but not encapsulated. The lesions were made up of bipolar spindle cells arranged in fascicular clusters separated by bands of hialinized collagen; one included several islands of mature cartilage next to fat cells. The other contained atypical mononucleated and multinucleated giant cells. No mitotic figures were observed. Immunohistochemically, both tumours showed strong and diffuse cytoplasmic staining for vimentin and CD 34 and focal positivity for alpha-smooth muscle actin, and both were negative for cytokeratins, CD 68, Ham 5, 6, Mac 387, and S-100 protein. Desmin was positive in one case. Ultrastructural study revealed populations composed of fibroblastic cells without signs of myofibroblastic differentiation in one case; the second featured abundant undifferentiated mesenchymal cells with myofibroblastic differentiation. Both patients remain disease-free 38 and 36 months after lumpectomy.

[Primary intestinal T lymphoma with massive eosinophilia]. / Linfoma T primario de intestino asociado a intensa eosinofilia.

Primary intestinal T lymphoma with eosinophilia is an infrequent tumour. Its rarity account for the paucity of similar cases recorded in the literature. It affects predominantly middle-aged men and may be associated with ulceration, fistula formation and intestinal perforation with an abdominal mass. Lesions of the intestine with massive tissue eosinophilia may be a difficult diagnostic problem, but this entity displays distinctive histological features. The presence of intense tissue eosinophilia is a T-cell dependent lymphomas response. We describe a case of T lymphoma involving small intestine with massive eosinophilia.

Characterization of solid liver lesions with color and pulsed Doppler imaging.

BACKGROUND: To assess the usefulness of color Doppler and duplex sonography in the characterization of solid liver lesions. METHODS: We performed color Doppler and duplex sonography on 106 solid hepatic lesions. With color Doppler, we evaluated the aspect and distribution of tumoral vessels. The pulsed Doppler parameters considered were only those showing the highest systolic peak velocity values. RESULTS: Intratumoral color and pulsed Doppler signals were obtained in 81% (59/73) of malignant tumors (p < 0. 0001) but only in 18% (6/33) of benign tumors. Ninety-six percent (45/47) of the lesions with arterial intratumoral and peritumoral signals were malignant, whereas 4% were benign (p < 0.0001). Only eight (11%) malignant lesions had intratumoral venous signal vis-a-vis 23 (70%) benign. Twelve cases showing intratumoral venous Doppler signal as a single finding were benign. No statistically significant differences were observed in the quantitative parameters recorded by pulsed Doppler (Student t test, p < 0.05), there having been a clear overlapping in the values obtained in benign and malignant lesions. CONCLUSIONS: (a) The type of signal (arterial or venous) and its distribution detected by color and pulsed Doppler is more helpful than the assessment of the spectral quantitative parameters obtained by pulsed Doppler. (b) The presence of intratumoral venous flow remarkably suggests benignancy. (c) The presence of both intra- and peritumoral arterial flow in the same lesion strongly suggests malignancy.

[Gastric carcinoma in patients younger than 30 years of age. Report of 11 cases]. / Carcinoma gástrico en pacientes menores de 30 años. Presentación de once casos.

Eleven cases of gastric carcinoma occurring in patients younger than 30 years were found in a pool of 929 diagnosed in Hospital General de Castelló during the period of 1976 to 1995. Ten patients were male (10/11). The mean age was 26.9 years. In eight cases precancerous lesions were present. The mean time between diagnosis and surgery was 9 months. The most frequent location was the antrum (63.6%) and the most common histology was gastric/diffuse adenocarcinoma of signet-ring cell type (45.5%). Amplified partial gastrectomy was performed in 81.8%, with Billroth II anastomosis in 36.4%. Immediate postoperative mortality rate was 9.1% and the overall mean survival 56 months, being of 54% and 36% at two and five years, respectively.

[Solitary nasal plasmocytoma]. / Plasmocitoma solitario nasal.

Report of the case of one patient diagnosed of a nasal extramedullary solitary plasmacytoma, starting as an suppurated panophtalmia. Biopsy of the mass inside the nose led to diagnosis. Comments about the difficulties of histopathological differential diagnosis, underlying the need to rule out any other systemic process (multiple myeloma). The subject was treated with inductive chemotherapy and radiotherapy, being free of the illness after 4 years follow up.

Morphological and immunohistochemical support for the interstitial cell origin of oestrogen-induced kidney tumours in the Syrian golden hamster.

The oestrogen-induced kidney tumour of the Syrian golden hamster has been extensively used not only as a model for renal carcinogenesis, but also for hormonal carcinogenetic studies. In spite of all the different approaches, its histogenesis remains unresolved. The two classical hypotheses are an epithelial origin (in the proximal convoluted tubules) or a mesenchymal-blastemal origin (in the interstitial cells). In the present study two types of preneoplastic lesions were seen: tubular dysplasia and interstitial cell hyperplasia. The first neoplastic stage consisted of interstitial or blastemal cells aggregated in the form of microscopic nodules (tumourlets). In the more advanced tumours the blastemal pattern was the more predominant, but we also observed other patterns of epithelial, mesenchymal or neural types. These findings were confirmed by ultrastructural analysis, which revealed blastemal-epithelial transitions and mesenchymal and mesonephric features, as well as the presence of neurosecretory granules. The paucity of immunohistochemical studies on these tumours led us to apply a panel of the most frequently used antibodies in diagnostic pathology to 36 cases of our series. There was co-expression of cytokeratins and vimentin, which were the most intensely stained, together with S-100 protein. Further positivities were seen for carcinoembryonic antigen, desmin, neuron-specific enolase and HNK-1. These results lend support to the revised, new histological classification confirmed by the ultrastructural findings, allowing us to postulate a tumoural origin in the renal interstitial cells, which may be nephrogenic undifferentiated cells that possess an epithelial, mesenchymal and neuroectodermal phenotype.

Estrogen and progesterone receptors in the diethylstilbestrol-induced kidney neoplasms of the Syrian golden hamster: correlation with histopathology and tumoral stages.

Estrogen (ER) and progesterone (PGR) receptors were determined in the cytosols of 34 kidneys from diethylstilbestrol (DES)-treated Syrian golden hamsters, expressing lesions of amyloidosis, dysplasias and tumors. Nineteen were determined by the dextran-charcoal method and 15 by monoclonal antibodies. Positivity was found in 50% of the cases, seven being positive to both types of receptors and 10 positive only to one type. The yield was slightly better using monoclonal antibodies. The medium values obtained were 58.33 fmol/mg for ER receptors (range 13.6-109.09) and 106.14 fmol/mg for PGR receptors (range 12.94-532). Positivity was related both with tumoral size and grade of histologic differentiation, for both types of receptors. Moreover, the ER receptor values increased progressively in proportion to the successive stages of carcinogenesis and the DES exposure times.

[Nonamyloid light-chain deposit disease. A report of 2 cases]. / Enfermedad por depósito de cadenas ligeras no-amiloides. Presentación de dos casos.

Two cases of non-amyloid light chain deposit disease (EDCL) which were diagnosed by liver biopsy are presented, and the recent literature is reviewed. This disease is a dysproteinemia which shares numerous clinical and pathological features with amyloidosis. A commentary is made on the differential diagnosis between both diseases. This disease must be suspected when the conventional histochemical and immunohistochemical stains for amyloid are negative. Immunohistochemical assays for kappa and lambda chains should then be performed.

The levels of quinone reductases, superoxide dismutase and glutathione-related enzymatic activities in diethylstilbestrol-induced carcinogenesis in the kidney of male Syrian golden hamsters.

The level of quinone oxidoreductases (microsomal and cytosolic DT-diaphorase, NADPH-cytochrome P450 reductase and NADH-cytochrome b5 reductase), superoxide dismutase and glutathione-related enzymatic activities in diethylstilbestrol (DES)-induced carcinogenesis in kidney from Syrian golden hamsters are presented. Animals that exhibited two different stages of DES-induced carcinogenesis in kidney--pre- and neoplastic lesions and tumorous lesions (after 6 and 8 months of continuous exposure to DES respectively)--were studied in comparison to kidneys from control animals. A dramatic decrease in microsomal and cytosolic DT-diaphorase activities (13.6 and 37.8% of controls), as well as in glutathione disulphide reductase (39.5%), and less marked in superoxide dismutase (45.6%), NADH cytochrome b5 reductase (61.9%) glutathione transferase (GST) towards 1-chloro-2,4-dinitrobenzene (CDNB) (66.2%) and glutathione peroxidase (GSH-Px) (80%) activities, were observed in kidneys with pre- and neoplastic lesions. NADPH-cytochrome P450 reductase and GST activity towards 4-hydroxy-2,3-trans-nonenal (4-HNE) showed no statistically significant variation at this stage of carcinogenesis. In kidney from animals with tumorous lesions, all the enzymatic activities mentioned above decreased, except for superoxide dismutase, which was increased to 186% of the control activity. GST activity towards 4-HNE again showed no statistically significant variation. These results suggest that if one-electron reduction of diethylstilbestrol-4',4''-quinone (DESQ) occurs, it may play a very important role in the development of DES carcinogenesis (pre- and neoplastic lesions), since at this stage of carcinogenesis the primary defense mechanisms against the oxygen free radicals generated in this way, i.e. SOD activity, is reduced to less than a half of control values. Both cytosolic and microsomal DT-diaphorase activities are unable at this stage of carcinogenesis to promote effectively the two-electron reduction of DESQ, which would avoid the initial formation of superoxide anion. The consequences of these decreases may be an increased steady-state concentration of superoxide anion and hydrogen peroxide, which in the presence of iron might lead to lipid peroxidation. GST activity towards 4-HNE could be responsible for the possible higher steady-state concentration of this lipid peroxidation product during DES treatment. The induction of DT-diaphorase and its protective role in the prevention of the development of pre- and neoplastic lesions in kidney from Syrian golden hamster during DES treatment is also discussed.

Tuberculous panophthalmitis associated with drug abuse.

Tuberculous endophthalmitis is a rare condition not described to date in association with intravenous drug abuse. Characteristics such as the lack of proven tuberculous disease in other organs and intense progression towards panophthalmitis make this case all the more interesting. The histopathological diagnosis is based on the identification of acid-alcohol resistant bacilli, and typical granuloma lesions with focal caseosis in stained sections.