Salivary gland myoephitheliomas: cytological, histological, immunohistochemical and electromicroscopical studies of four cases

Se presentan los resultados multidisciplinarios de cuatro casos de mioepiteliomas de glándula salival diagnosticados por biopsia por aspiración con aguja fina y resecados posteriormente. Histológicamente dos casos fueron benignos y dos malignos. Los extendidos celulares de las variedades benignas contenían una población uniforme de células discretamente alargados con citoplasma bipolar y membranas celulares conspicuas. El núcleo fue pequeño y oval con cromatina homogénea. Las células se disponían en grupos y nidos sobre un fondo proteináceo. Se observaron células aisladas adyacentes que presentaban citoplasma eosinófilo, granular y claro con núcleo central, redondo e hipercromático. En uno de los extendidos se observó numerosos capilares con células endoteliales prominentes y fondo con matrix condroide. Dos casos presentaron cambios citológicamente malignos con un fondo necrohemorrágico, pleomorfismo, nucléolo prominente, hipercromatismo y mitosis atípicas ocasionales. Las reacciones de inmunohistoquímica demostraron positividad para proteína S-100 y vimentina y focalmente para citoqueratina. Los hallazgos de la microscopia electrónica correspondieron a células mioepiteliales.

Human herpesviruses HHV-4 (EBV) and HHV-6 in Hodgkin's and Kikuchi's diseases and their relation to proliferation and apoptosis.

BACKGROUND: Human herpesviruses types 4 and 6 (EBV, HHV-6) are frequently found in Hodgkin 's disease (HD) and--to a certain extent--in Kikuchi-Fujimoto's disease (KFD). Both viruses are apparently related to proliferative and/or apoptotic processes as represented by HD or KFD respectively. OBJECTIVE: To correlate frequency and location of antigen- and DNA expression of both viruses in HD and KFD tissue sections in relation to markers for cell proliferation and apoptosis. STUDY DESIGN: Archival lymph node biopsies from 103 patients with HD and 14 KFD patients were investigated immunohistologically for viral antigen expression (EBV LMP- 1: HHV-6 pl 10/60), Ki67/PCNR, marker for proliferation (MIB1)/p53 and WAF1 for apoptosis. Viral DNA was shown by in situ hybridization. Apoptosis was determined by ISEL and TUNEL techniques. RESULTS: HD is frequently infected by both EBV and HHV-6 while KFD tends to be infected only by HHV-6. EBV in HD is present in HD cells and in Reed-Sternberg cells (HD/RS cells), HHV-6 preferentially in lymphocytes and in histiocytes in both HD and in KFD. Proliferation marker Ki67 is found in lymphocytes and histiocytes of both diseases and in HD and RS cells in HD. Apoptosis is demonstrated in lymphocytes and histiocytes preferentially in KFD and to a lesser extent also in HD. CONCLUSION: Although EBVand HHV-6 may not be openly oncogenic in HD and KFD, they may well influence the course of the disease. Dual infection in HD appears to support proliferative processes, i.e. a predominance of EBV effects. Single infection with HHV-6 in KFD instead appears to favor an apoptotic course. These effects are--according to the literature--possibly cytokine-mediated.

[Sarcomas of the vulva. Report of 2 cases]. / Sarcomas de la vulva. Informe de dos casos.

We report two cases of vulvar sarcomas that are our Institutional experience in 29 years. The first case was a teenager of 14 years-old with a low grade leiomyosarcoma surgically treated. Along a 22 years follow-up the disease has had four local recurrences of more than 5 cm each one: two after surgery and two after surgery plus chemotherapy and surgery plus radiotherapy respectively. She is alive disease evidence after two years from the last combined treatment. The second one, was a 26 years-old patient with a malignant schwannoma of 12 cm in diameter treated with combined radical surgery, radiotherapy, and chemotherapy. She is alive and without disease evidence 52 months after surgery. We emphasized that these tumors are very rare and the fact that the first patient is the youngest and with more years of follow up according the bibliography consulted. Treatment of vulvar sarcomas is radical local excision followed mainly by radiotherapy with infiltrating margins. The value of postoperative adjuvant chemotherapy is uncertain. According to the natural history and behavior of vulvar sarcomas, we conclude that the elective treatment of these tumors should be carry out in institutions of high level.

AIDS-associated nephropathy: 5-year retrospective morphologic analysis of 87 cases.

Morphologic findings in the kidneys of 138 consecutive acquired immunodeficiency syndrome (AIDS) autopsies performed at the Mexico City General Hospital between 1986 and 1991 were studied. A total of 87 cases (63%) had renal disease, 62 cases presented glomerular alterations, and 80 cases showed tubulointerstitial damage. Glomerular collapse was seen in 30 cases (48%), mesangial expansion in 22 cases (35%), focal and segmental glomerulosclerosis in 20 cases (32%) and glomerular proliferation in only eight cases (11%). Nephrocalcinosis was seen in 25 cases (31%). Thirty-six cases (45%) presented tubulointerstitial infections: Mycobacterium tuberculosis in 19 cases (23%), Cryptococcus in 10 cases (12.5%), Cytomegalovirus CMV in eight cases (10%), Gram-negative bacteria in 3 cases (3.7%), and one case with histoplasmosis. In six cases the pathogens were multiple. Two cases showed infiltration of large-cell non-Hodgkin lymphoma. Based on the results obtained by autopsies, we conclude that in our country there is a high frequency of renal affection in AIDS patients. Clinically, this disease is infrequently diagnosed and not always related to the cause of death.

[Advanced gestational choriocarcinoma. A clinical-pathological study of 40 cases]. / Coriocarcinoma gestacional avanzado. Estudio clínico patológico de 40 casos.

Forty two cases of advanced gestational choriocarcinoma were examined, with 4 of these patients being hospitalized for less than 24 hours. Given the non specific and atypical nature of the symptomatology, it was correctly diagnosed in 20 of these cases. In the other 22 cases where the predominant clinical status was established as a result of the localized invasion of neighboring structures or through metastasis, a variety of diagnoses were given, including uterine cervical carcinoma, endometrial carcinoma, pulmonary metastasis, brain tumor, bleeding of the gastrointestinal tract. The 20 patient diagnosed with choriocarcinoma were treated in the following manner: nine were operated for hysterectomies, with one of these also receiving an omentectomy, seven more were given chemotherapy treatment based upon methotrexate, and the remaining for were simply stabilized, which produced unfavorable results in that they survived from one to twenty weeks longer, with an average on only five weeks.

Angiosarcoma de mama: reporte de un caso y revisión de la literatura / Angiosarcoma of the breast: a case report and review of the literature

Se presenta un caso de una paciente de 22 años de edad, con tres meses de evolución, con una mancha roja en casi la totalidad de la mama derecha, sin una masa bien definida. La mama izquierda y zonas linfoportadoras locorregionales fueron normales. Una xeromastografía demostró aumento en la densidad de la mama derecha y discreto adelgazamiento de la piel. el diagnóstico clínico fue angiosarcoma vs. hemangioma de mama. El estudio histológico de una biopsia incisional demostró nagiosarcoma bien diferenciado. Se realizó una incisión local amplia, dando margen para lograr bordes quirúrgicos libres de tumor; se incluyó la glándula derecha, parte del pectoral mayor, el pectoral menor y disección de ganglios linfáticos axilares bajos. El reporte del estudio histopatológico definitivo fue de angiosarcoma bien diferenciado de mama. La evolución postoperatoria fue satisfactoria. Actualmente, a tres años de la cirugía, se encuentra viva y libre de enfermedad. Se realiza una revisión de la literatura médica

Unusual types of gallbladder carcinoma. A report of 16 cases.

In a review of 159 gallbladder carcinomas, we identified four unusual histologic types: oat-cell carcinoma (five cases), giant-cell adenocarcinoma (seven cases), intestinal-type adenocarcinoma (three cases), and adenocarcinoma with choriocarcinoma-like areas (one case). Oat-cell carcinomas were similar at light- and electron-microscopic levels to those previously described in other anatomic locations. Giant-cell adenocarcinomas coexisted with well-differentiated adenocarcinomas and exhibited transition areas. For these reasons, we believe that they originate from preexistent adenocarcinomas. Intestinal-type adenocarcinomas consisted predominantly of goblet cells or glandular structures similar to colonic crypts. These four histologic types of gallbladder carcinoma were more common in women than in men, usually coexisted with lithiasis, and had a highly aggressive clinical behavior. Fourteen patients died of direct local extension and metastases, and two were unavailable for follow-up.

[Gastric plasmacytoma. Review of the literature and report of a case]. / Plasmocitoma gástrico. Revisión de la literatura y reporte de un caso.

A case of gastric plasmacytoma without evidence of tumor in other localizations is reviewed. Based upon the clinical and laboratory findings we can conclude this was a non secretory plasmacytoma of the stomach. Clinical and hystopathological aspects are reviewed.

The precursor lesions of invasive gallbladder carcinoma. Hyperplasia, atypical hyperplasia and carcinoma in situ.

In 200 consecutive cholecystectomy specimens excised for cholelithiasis or cholecystitis, 83% exhibited epithelial hyperplasia, 13.5%, atypical hyperplasia and 3.5%, carcinoma in situ. Carcinoma in situ was also observed in the mucosa adjacent to invasive carcinomas in 79% of 39 evaluable surgical cases and in 52.9% of 17 autopsy cases. Our findings suggest that a small number of hyperplasias of the gallbladder evolve toward atypical hyperplasia and that this progresses to in situ carcinoma which finally becomes invasive carcinoma. A simple cytologic technique is recommended for the diagnosis of atypical hyperplasia and carcinoma in situ in excised gallbladders. Preoperative identification of these two lesions in high-risk patients as well as comments on 156 invasive carcinomas are presented.

[Teratoma of the thyroid gland in children]. / Teratoma del tiroides en el nino

Two cases of teratoma of the thyroid gland occurring in children are presented. Both tumors were discovered shortly after birth and were not associated with clinical hypothyroidism. One of the patients was thoroughly studied from the endocrinological point of view utilizing several techniques. There was some iodine uptake by the gland, formation of tirosine and thyroid hormones as well as their release into the blood serum. The clinical and pathological features of teratoma of the thyroid are discussed.