Autoimmune hepatitis and agranulocytosis.

UNLABELLED: Autoimmune hepatitis is a generally progressive, chronic hepatitis of unknown cause but with an autoimmune background. In fact, one clue to diagnosis autoimmune hepatitis is the presence of other diseases with autoimmune features like thyroiditis, ulcerative colitis or type 1 diabetes. Although non-specific hematologic abnormalities have been described during the course of autoimmune hepatitis we have not found agranulocytosis in association in a review of the literature. We describe a case of agranulocytosis which appeared simultaneously associated with a flare of autoimmune hepatitis. A possible autoimmune origin of the neutropenia could be extrapolated to explain the association on the basis of the nature of the underlying liver disease, temporal association, sex, positive anti-neutrophil cytoplasm antibodies, and the successful and dose-dependent effect of corticoids on both processes. CONCLUSION: We report on for the first time a case of concurrent severe autoimmune hepatitis and agranulocytosis. An autoimmune common mechanism could explain both processes.

Reconstrucción tridimensional in vitro de mucosa vesical humana / In vitro three-dimensional reconstruction of human bladder mucosa

Objetivo: Aplicar las técnicas de cultivo in vitro de queratinocitos así como los principios de la ingeniería tisular al epitelio urinario humano, con el fin de reconstruir tridimensionalmente una mucosa vesical humana in vitro, apta para trasplantar. Material y Métodos: Se obtuvieron muestras de mucosa vesical de pacientes programados para cirugía abierta de próstata, previo consentimiento de los mismos, las cuales fueron cultivadas in vitro, para proceder posteriormente al estudio histomorfológico de los tejidos obtenidos. Resultados: Se obtuvo un tejido tridimensional compuesto por una submucosa bioartificial a base de un gel de fibrina y fibroblastos, sobre la que descansan las células uroepiteliales, pudiendo utilizar una malla de ácido poliglicólico, que facilite la manipulación de la mucosa y el posterior injerto de la misma. El tejido obtenido tenía el aspecto de un epitelio inmaduro con muy escasa reacción a citoqueratinas, sin poderse demostrar inmunohistoquímicamente el desarrollo de una membrana basal. Conclusiones: Las técnicas de cultivo in vitro de queratinocitos son aplicables a otros epitelios, entre ellos el urotelio humano. En un periodo de tiempo relativamente corto se puede obtener un tejido in vitro tridimensional apto para trasplantar, precisando posiblemente de las interacciones con el lecho receptor para poder madurar

Objetive: The purpose of this study is to apply the in vitro keratinocyte culture techniques and the tissue engineering principles to human urothelium, to reconstruct an in vitro three-dimensional human bladder mucosa, suitable for grafting. Material and Methods: Biopsy specimens of human bladder mucosa were obtained from patients undergoing suprapubic prostatectomy, in vitro cultured and finally, an immunohistochemical study was made. Results: A three-dimensional in vitro tissue was obtained, composed of a bio-artificial submucosa (fibrin gel and fibroblast) where the uroepithelial cells were seeding. We used a biodegradable polyglycolic acid mesh to facilitate the tissue manipulation and implantation. An immature epithelium was obtained with a weak immunostaining to cytokeratins. The immunohistochemical study could not demonstrate the development of basement membrane. Conclusions: In vitro keratinocyte culture techniques could be applied to other epithelial tissues like the urothelium. We obtained a three-dimensional in vitro tissue suitable for grafting in a relatively short time, which needs the matrix interactions in order to mature

[Treatment of Bowen's disease of the penis with imiquimod 5% cream]. / Tratamiento tópico con imiquimod crema al 5% de la enfermedad de Bowen del pene.

We present an alternative treatment of the intraepithelial neoplasms of penis (Bowen's disease), the topical application of imiquimod 5% cream. It was applied 3 times weekly for 5 weeks. Imiquimod is an imidazoquinolone immune response modifier that has been shown to have indirect antiviral and antitumor effects with few adverse effects. Imiquimod 5% cream may represent an alternative treatment option for Bowen's disease.

[Secondary obstructive uropathy to inverted papilloma of the ureter]. / Uropatia obstructiva secundaria a papiloma invertido de ureter.

We report a new case of inverted papilloma of the ureter, with an uncommon clinic manifestation as a obstructive uropathy. In spite of the bening nature the inverted papilloma of the urinary tract, it can be multifocal and relapsing and it may be associated with low rate urothelial carcinomas. A precise pre-operative diagnosis is necessary for a conservative or endourologic treatment. The followup of these cases with periodic urography and cystoscopy is mandatory.

Uropatia obstructiva secundaria a papiloma invertido de ureter / Secundary obstructive uropathy to inverted papilloma of the ureter

Presentamos un nuevo caso de papiloma invertido de uréter, con una inusual forma de presentación en forma de uropatía obstructiva. A pesar de haberse considerado una patología benigna, el papiloma invertido del tracto urinario puede recidivar o asociarse a carcinoma transicional de bajo grado. Su tratamiento, disponiendo de un diagnóstico preoperatorio fiable, puede ser conservador o endourológico, siendo obligatorio el seguimiento urográfico y cistoscópico de estos pacientes (AU)

We report a new case of inverted papilloma of the ureter, with an uncommon clinic manifestation as a obstructive uropathy. In spite of the bening nature the inverted papilloma of the urinary tract, it can be multifocal and relapsing and it may be associated with low rate urothelial carcinomas. A precise pre-operative diagnosis is necessary for a conservative or endourologic treatment. The followup of these cases with periodic urography and cystoscopy is mandatory (AU)

Consideraciones en torno a la Hiperplasia Angiolinfoide con Eosinofilia (ALHE). A propósito de un caso localizado en el pene / Considerations about angiolymphoid hyperplasia with eosinophilia (ALHE) with regard to a case localized in the penis

Presentamos el caso de un paciente varón de 27 años de edad que presentaba un nódulo en la cara ventral del pene que aumentaba de tamaño y se volvía doloroso durante la erección por lo que se sospechó que se trataba de una lesión vascular, confirmado posteriormente mediante estudio Doppler. Se realizó la extirpación del nódulo con anestesia local. El informe anatomopatológico fue de “hiperplasia angiolinfoide con eosinofilia” en su variante intravascular. Este caso representa la tercera comunicación de esta lesión en el pene, pero ninguna otra adoptaba la variante intravascular como la aquí presentada. Se discute acerca de esta excepcional entidad y se revisa la literatura

We report the case of a 27 years old man who presented a nodule in the ventral face of the penis, which increased in volume an turned painful during erection so a vascular lesion was suspected, later confirmed with a Doppler study. A complete excision of the lesion was carried out with local anaesthesia. The pathological specimen was informed as “angiolimphoid hyperplasia with eosinophilia” in its intravascular form. This is the third communication of this kind of lesion in the penis but no other adopted the intravascular variant like the present case. We discuss about this exceptional entity and make review of the most relevant literature

Chondroid lipoma. A newly described lesion that may be mistaken for malignancy.

A case of chondroid lipoma located in the submandibular region of a 21-year-old man is presented. On macroscopic evaluation the tumor was lobulated and quite yellow. Microscopic examination showed that this tumor was composed of mature adipose tissue and eosinophilic cells. The eosinophilic cells displayed single or multiple vacuoles and resembled lipoblast or hibernoma-like cells. These were set in a myxoid or chondromyxoid stroma. Most cells reacted with antibodies directed against vimentin and neuron-specific enolase. Focal weak positivity for S-100 protein was noted. Principal considerations in the histopathologic differential diagnosis included hibernoma, myxoid liposarcoma, and extraskeletal myxoid chondrosarcoma (chordoid sarcoma).