[Positive margins. Surgical techniques and progression after radical prostatectomy]. / Márgenes positivos. Técnica quirúrgica y progresión tras prostatectomía radical.

OBJECTIVE: Repercussion of positive surgical borders (SB+) after radical prostatectomy (RP) in the oncological management of this condition is not yet well defined. The article analyzes their incidence and relevance for tumoral progression. MATERIAL AND METHODS: A review of 204 RPs is made. The erectors' preservation technique has been preferentially used until 1994, while the extracapsular standard technique was used afterwards. SB+ have been correlated to pre-operative PSA, Gleason grade, pathological stage and surgical technique. Also, status of borders has been correlated to progression. RESULTS: SB+ have been detected in 88 patients (43.13%) and were significantly correlated to the pathological stage and Gleason, but not to pre-operative PSA. Although no relation has been ascribed to the surgical technique used in terms of incidence, a decrease of posterolateral borders from 51.8% to 26.2% has been noticed using the extracapular standard technique. Progression is greater in SB+ patients (27.2% vs. 19.2%) but the difference is not statistically significant. SB+ patients who have progressed had all extracapsular tumour, 66% poorly differentiated. CONCLUSIONS: There is a decrease of posterolateral SB+ when the extracapsular standard technique is used. A correlation between presence of SB+ and progression has not been established. No patients with intracapsular tumour and SB+ has progressed. Therefore, it can be inferred his factor has little influence on the evolution of these patients.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): diagnosis with fine-needle aspiration in a case with nodal and nasal involvement.

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare entity characterized by the proliferation of cells belonging to the macrophage-histiocyte family, but whose exact origin is unknown. A case of SHML occurring in a 62-yr-old female is described in which the diagnosis is initially suggested by fine-needle aspiration (FNA) of a cervical node. The smears show a background of lymphocytes and plasma cells and large histiocytes with well-preserved lymphocytes in their cytoplasm (emperipolesis or lymphophagocytosis). Both nodal and extranodal (nasal mass) involvement are confirmed by surgical biopsy. The immunohistochemistry suggests that SHML cells are functionally activated macrophages. Eight months after diagnosis, the patient is clinically well, with partial improvement of lymphadenopathy.

[Non-Hodgkin's lymphomas. I. Clinico-biological features of 307 cases]. / Linfomas no hodgkinianos. I. Características clínico biológicas de 307 casos.

PURPOSE: To assess the clinico-biological features appearing in 307 patients with non-Hodgkin's lymphomas (NHL). PATIENTS AND METHODS: The clinical records of 338 patients diagnosed of NHL between January 1975 and December 1988 were revised in retrospect. All cases with histologic diagnosis of NHL aged over 14 years were included, and classified in accordance with the Working Formulation criteria. The following data were analysed: age, sex, first complaints, time elapsed since onset, histologic type, number of sites involved, bulky disease, anaemia, thrombocytopenia, LDH, stage, type of treatment and initial response, survival, and cause of death. The statistical evaluation was performed by actuarial analysis (Kaplan and Meier) and comparison (log-rank test) of survival. RESULTS: According to the three categories of the malignancies, the NHL were distributed into low-grade (37.8%), intermediate (36.1%) and high-grade (26.9%). The mean age of the series was 56.6 years and the M/F ratio was 1.3. Lymph node enlargement was the commonest finding; 36.4% of the patients had symptoms related with the disease, and 26.7% had bulky disease. Anaemia was present in 37.7% of the cases and thrombocytopenia in 14.3%, with similar distribution among the three grades. High LDH levels were found in 44% of the patients. At diagnosis, 85% of the patients were in advanced stages (III+IV) already. Complete response was attained in 51.1% of the cases, with median survival of 48 months. CONCLUSIONS: The clinico-evolutive data found here are similar to other reports in the literature. In one-half of the patients the cause of the first visit is lymph node enlargement. Complete remission is achieved by one out of two patients, this figure being similar for each of the histologic groups. The Working Formulation is useful in determining the different prognostic groups with respect to survival.

[Consistency of the histologic diagnosis of Lauren's classification of gastric cancer]. / Concordancia en el diagnóstico histológico de la clasificación de Laurén del cáncer gástrico.

BACKGROUND: Lauren's classification of gastric cancer is usually followed in epidemiological studies thus requiring evaluation of its reproducibility. This classification defines 2 principal histological types: intestinal and diffuse with different proportions in high and low risk areas possibly being associated to different causal factors. METHODS: The concordance diagnosis in an aleatory sample of 81 gastric carcinomas stratified according to the participation of 14 hospitals in an epidemiological study of 354 cases and 354 controls was analyzed. The initial diagnosis carried out was compared by more than 20 pathologists with the reclassification diagnosis by consensus of 2 pathologists by the proportion of agreement or concordance observed in the kappa index. Keeping the final reclassification by consensus as a reference, sensitivity, specificity and predictive values were also calculated. RESULTS: The proportion of concordance observed was of 78% for the intestinal and 90% for the diffuse with a kappa index of 0.55 and 0.74, respectively. Sensitivity for the intestinal type was of 88% and for the diffuse 81% with specificity being of 67% in the intestinal and 93% in the diffuse. CONCLUSIONS: Subjectivity in the interpretation of certain parameters necessary for histological diagnosis may be reduced by the elaboration of protocols in which the principal histological criteria to follow are detailed. Nonetheless, the distinction made between the two principal types, intestinal and diffuse, is valid enough to be used in multicenter epidemiological studies and in comparative studies.

[Experimental cryptorchism in the Wistar rat]. / Criptorquidia experimental en rata Wistar.

Experimental cryptorchidism was performed on Wistar rats, fixing the left testicle into the peritoneum for a month. Animals under study (84) were divided into four groups: control, control treated with hCG, cryptorchid and cryptorchid treated with hCG. Cryptorchid testes were biopsied at three, five and eight months and all were excised at 12 months. Cellular counts on spermatogonia, young and late spermatocytes, Sertoli cells and vacuolized Sertoli cells, together with the slough tubular and germinal cell percentage and the tubular diameter, let us affirm by means statistical studies (ANOVA, Chi square) that a testes recovering is already shown at the age of five months, although this recovering still differs from the one shown in the control groups.

Muscular structural changes following fadenoperation.

The authors describe the macroscopic, histological, and ultrastructural findings observed in an experimental animal model of the fadenoperation . Grossly, muscular fibrosis and musculo-scleral adhesions were well established after the second postoperative month. Histologic findings demonstrated the development of a granulomatous, foreign body reaction around the musculo-scleral fixation suture, collagenization of the muscle tissue from the first postoperative month and degenerative phenomena in the muscle fibers. Electron transmission microscopic study showed atrophy and angulation with distortion of the myofibrillar matrix, along with alteration of the Z bands of muscle fibers, mitochondrial alteration, and dilatation of the sarcotubular system. All these experimental findings suggest the relative irreversible effects of the fadenoperation after the early postoperative period and for the first time, demonstrated that this surgical technique alters the muscle structure.

Anterior chamber metastasis from neuroblastoma.

An apparently normal 10-day-old girl had, since birth, a gray-white vascularized tumor in the inferior quadrants of the right anterior chamber. General physical examination revealed abdominal distension, hepatomegaly, splenomegaly, and a deeply located abdominal mass. Multiple subcutaneous nodules scattered all around the body's surface could be palpated. Surgical exploration confirmed the presence of a left adrenal neuroblastoma. Six months after a complete resection of the abdominal tumor and general radiotherapy and chemotherapy, the right anterior chamber mass regressed almost completely, leaving only a calcified residue. The child is living and well six years after the diagnosis of neuroblastoma. This is the first case known to us in the literature of a congenital anterior chamber metastasis, as well as the first case reported of an anterior segment metastasis from a neuroblastoma.

[Achondrogenesis type I and II and hypochondrogenesis (author's transl)]. / Acondrogénesis, tipos I y II e hipocondrogénesis.

A study is made of achondrogenesis in relation to four observations of early fatal development. One case corresponds to type I (Parenti-Fraccaro); another to type II (Langer-Saldino); the final two, brothers, seem to come under the variation of hypochondrogenesis. In this study, authors stress the heterogenous nature of lethal, neonatal (short-limb) nanisms of which currently include: Type I and II achondrogenesis, hypochondrogenesis, homozygote achondroplasia, classical Torrance-type and San Diego-type thanatophoric dysplasia.