Úlcera labial secundaria a leishmaniasisvisceral en un paciente VIH-positivo / Lip ulceration due to visceral leishmaniasis in a HIV-positive patient

La Leishmaniasis es una infección intracelular poducida por el protozoo Leishmania.En países mediterráneos, L infantum puede causar leishmaniasis cutánea (LC) y visceral (LV).En pacientes VIH-positivos con LV, las lesiones cutáneas son en ocasiones el primer signo de afectación visceral. Presentamos el caso de un pacienteVIH-positivo con una ulceración de labio. Este hallazgo representó el primer síntoma de una LV oculta (AU)

Leishmaniasis is an intracellular infection caused by the protozoa Leishmania.L. infantum may cause both cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL) in Mediterranean countries.In HIV-positive patients with VL, cutaneous lesions are sometimes the first sign of visceral involvement. We report the case of a HIV-positive patient,with a lip ulceration as a first symptom of an occult LV (AU)

Laringitis por rhodococcus equi en paciente con sida / Laryngeal infection by rhodococcus equi in a patient with aids

El Rhodococcus equies un bacilo aerobio gram positivo pleomórfico, que fue aislado por primera vez como productor de bronconeumonía en caballos jóvenes. Cada vez con mayor frecuencia, está siendo reconocido como patógeno en humanos, sobre todo en la población inmunocomprometida. Describimos un caso, hasta ahora excepcional, de infección laríngea por Rhodococcus equi en un paciente con serología positiva para el virus de la inmunodeficiencia humana (VIH), y revisamos algunas características clínicas y epidemiológicas de las infecciones por este germen. El tratamiento es rifampicina y/o eritromicina, siendo el pronóstico malo, pues suelen ser pacientes inmunocomprometidos (AU)

The Rhodococcus equi is an aerobic gram positive pleomorphic bacillus, that was isolated for the first time like a producer of bronchopneumonia in young horses. Every time more often, it is being recognized as a pathogen in humans, mainly in the immunodepressed population. We described a case, until now exceptional, of laryngeal infection by Rhodococcus equi in a patient with positive serology for the virus of the human immunodeficiency (HIV), and we reviewed some clinical and epidemiological characteristics of the infections by this germ. The treatment is riphampicine and/or erythromycin, being the prognosis bad, because usually they are immunodepressed patients (AU)

Nódulos subcutáneos en la infancia: granuloma anular subcutáneo / Subcutaneous nodules in the childhood: subcutaneous granuloma annulare

El granuloma anular subcutáneo es una lesión inflamatoria crónica de carácter benigno y típica de la edad pediátrica. Puede ser única o múltiple y su localización habitual es el cuero cabelludo o las extremidades. Su etiología es desconocida y no se ha relacionado con ninguna enfermedad sistémica. Una historia clínica detallada y la normalidad en las exploraciones complementarias son suficientes para su diagnóstico, si bien el estudio histológico permite el diagnóstico de certeza. Su evolución natural es a la desaparición, por lo que no precisa tratamiento. Presentamos el caso de un niño de tres años que fue remitido por presentar lesiones, induradas en cuero cabelludo, indoloras, de larga evolución y sin otros antecedentes de interés. Se practicó estudio radiológico simple y analítica básica (hemograma, bioquímica básica y VSG) que resultaron normales. Dos meses después se apreció un aumento de tamaño en una de la lesiones, por lo que se practicó su exéresis-biopsia. El estudio histológico fue diagnóstico de granuloma anular subcutáneo. Tras 10 meses de seguimiento no se han apreciado cambios en las lesiones restantes. (AU)

[Subcutaneous nodules in children: subcutaneous granuloma annulare]. / Nódulos subcutáneos en la infancia: granuloma anular subcutáneo.

Subcutaneous granuloma annulare is a benign, chronic inflammatory lesion located usually at scalp or extremities and typical of childhood. Its etiology is unknown and no link with systemic diseases has been found. A thorough clinical history and normality at complementary tests are enough for its identification. It tends to dissaparition, so no therapy is needed although histologic study will let a definitive diagnosis. A case in a three years-old boy is reported. He was submitted because of four asymptomatic, long-lasting tough lesions at his scalp, without other antecedents. Radiologic and hematologic tests found no alteration. Two months later a larger size was appreciated in one of them, so it was removed and its histology was diagnostic for granuloma annulare. After a 10 months follow-up, no change in size has been detected in the remaining ones.

[Laryngeal infection by Rhodococcus equi in patient with AIDS]. / Laringitis por Rhodococcus equi en paciente con SIDA.

The Rhodococcus equi is an aerobic gram positive pleomorphic bacillus, that was isolated for the first time like a producer of bronchopneumonia in young horses. Every time more often, it is being recognized as a pathogen in humans, mainly in the immunodepressed population. We described a case, until now exceptional, of laryngeal infection by Rhodococcus equi in a patient with positive serology for the virus of the human immunodeficiency (HIV), and we reviewed some clinical and epidemiological characteristics of the infections by this germ. The treatment is riphampicine and/or erythromycin, being the prognosis bad, because usually they are immunodepressed patients.

[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.

[Sarcomatoid carcinoma of the larynx]. / Carcinoma sarcomatoide de laringe.

Sarcomatoid carcinoma of the upper aerodigestive tract is an unusual neoplasm with differential cellular differentiation. Microscopically, sarcomatoid carcinomas have an element of squamous-cell carcinoma and a pleomorphic sarcoma-like component, which may simulate granulation tissue, malignant fibrous histiocytoma, osteosarcoma, or malignant giant-cell tumor of soft tissues.

[Intravesical hemangiopericytoma]. / Hemangiopericitoma intravesical.

OBJECTIVE: To report on a case of hemangiopericytoma of the urinary bladder mimicking a urothelial tumor. METHODS: A case of hemangiopericytoma arising from the urinary bladder in a 78-year-old man is described. The initial symptoms included gross hematuria, and it was confused with a urothelial tumor. The difficulty in making the diagnosis in regard to the site of origin and histological findings are discussed. The literature is briefly reviewed. RESULTS/CONCLUSIONS: Ultrasound and urographic evaluation showed an intravesical mass which was suspected to be a urothelial tumor. The patient was submitted to transurethral surgery. Histological analysis and immunohistochemical techniques demonstrated a hemangiopericytoma.

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.

[Bladder malacoplakia: apropos of 2 cases]. / Malacoplaquia vesical: a propósito de dos casos.

OBJECTIVES: To describe two cases of malakoplakia of the bladder with an unusual form of presentation and review the cases previously reported in the literature. METHODS/RESULTS: Two patients, a 61-year-old female and a 71-year-old male, are described. Both patients had a history of recurrent infection caused by coliform pathogens. Treatment consisted of trimethoprim sulfamethoxazole, ascorbic acid and bethanecol chloride, together with extended TUR of the bladder lesion. CONCLUSIONS: Although malacoplakia of the bladder is considered to be a benign disease, close follow-up is warranted due to frequent recurrence of symptoms and the difficulty in achieving long-lasting effects since it is frequently associated with immunosuppression.

Inhibitory effect of calcium on carcinogenesis at the site of colonic anastomosis: an experimental study.

PURPOSE: A study was made to assess the effect of oral calcium supplementation on colorectal carcinogenesis at the colocolic suture line and in the rest of the colon following administration of a carcinogen. METHODS: Fifty-nine rats were randomly divided into two groups: control (given a standard diet for rats and mice containing 0.8 percent calcium) and treatment (given the same diet as before but with 2 percent calcium). Carcinogenesis was induced by 26 weekly injections of 1,2-dimethylhydrazine. All animals were subjected to an end-to-end colonic anastomosis at the beginning of the experiment using five stitches of steel wire. RESULTS: The control group developed significantly more tumors per animal at both the anastomosis (P < 0.001) and in the rest of the colon (P < 0.001). In addition, the percentage of rats with tumors was significantly higher in the control group at both the anastomosis (chi-squared = 12; df = 1, P < 0.001) and in the rest of the colon (chi-squared = 7.12; df = 1, P < 0.01). The mean surface of tumors was likewise greater in the control group at the anastomosis (P < 0.001) and throughout the rest of the colon (P < 0.001). Finally, there were significantly more small-bowel tumors (excluding the duodenum) in the control group (P < 0.05). CONCLUSIONS: It is concluded that calcium supplementation decreases the tumor yield at the site of end-to-end colonic anastomosis and in the rest of the colon and small bowel (excluding the duodenum).

[Adrenal epithelial cyst of embryonal vestiges]. / Quiste epitelial suprarrenal de restos embrionarios.

A 10 x 6.5 cm cyst with ciliated cell lining was removed from a 43-year-old woman. The immunohistochemical studies demonstrated that the cyst cells expressed keratins (Lu 5+) and the adrenal cortical cells did not, suggesting that the cyst lining was not derived from adrenal cells. The presence of ciliated cells indicates that the cyst was derived from embryonal vestiges.

[Solitary metachronous pancreatic metastasis of renal adenocarcinoma]. / Metástasis solitaria pancreática metacrónica de un adenocarcinoma renal.

We report the case of a patient who underwent a left nephrectomy for clear cell adenocarcinoma. Four years later he presented with jaundice due to a single metastasis of the same tumour in the head of the pancreas which was resected. The favourable prognosis with surgery encourages a radical approach.

[Renal angiomyolipoma in childhood: a clinical case]. / Angiomiolipoma renal en la infancia: caso clínico.

The renal angiomyolipomas are unusual benign tumors which more than 50 per cent, are associated with tuberous sclerosis or intestinal linphangiomatosis. They can be discovered in a radiologic study by chance or to be associated with flank and abdominal pain and hematuria. The ultrasonographic imagen is characteristic and its management is conservative.