Cystic lesion of pectoralis minor muscle: learning from mistakes.

Hydatidosis is a frequent infestation in large endemic areas, caused by helminths. Primary localization within the muscle or bone tissues is rare. We report the case of a 52-year-old woman with a cystic lesion located in the right pectoralis minor muscle, who was initially diagnosed with cystic lymphangioma by imaging examination. She was submitted for surgical treatment; in block resection of the tumor along with the involved muscle was performed. The histopathological diagnosis was of hydatid cyst. The contribution of the ancillary lab tests is analyzed for a precise preoperative diagnostic approach. This case well illustrates that the most likely is not always what it appears to be. Facing of a cystic lesion in the lungs, liver or muscle, clinicians should always think on hydatid disease, particularly in endemic areas.

Cystic lesion of pectoralis minor muscle: learning from mistakes

Hydatidosis is a frequent infestation in large endemic areas, caused by helminths. Primary localization within the muscle or bone tissues is rare. We report the case of a 52-year-old woman with a cystic lesion located in the right pectoralis minor muscle, who was initially diagnosed with cystic lymphangioma by imaging examination. She was submitted for surgical treatment; in block resection of the tumor along with the involved muscle was performed. The histopathological diagnosis was of hydatid cyst. The contribution of the ancillary lab tests is analyzed for a precise preoperative diagnostic approach. This case well illustrates that the most likely is not always what it appears to be. Facing of a cystic lesion in the lungs, liver or muscle, clinicians should always think on hydatid disease, particularly in endemic areas.

Evolución de cirrosis biliar primaria a síndrome de solapamiento con hepatitis autoinmune en paciente con hepatitis B crónica / Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome in a patient with chronic hepatitis B infection

Se presenta el caso de una paciente con diagnóstico previo de cirrosis biliar primaria (CBP) y hepatitis B crónica en fase de portador inactivo que, en tratamiento con ácido ursodesoxicólico, presentó elevación de las transaminasas, sin datos de reactivación de su hepatitis B crónica. Se realizó biopsia hepática en la que se observaron cambios compatibles con hepatitis autoinmune (HAI) sobreañadida. Las alteraciones analíticas respondieron al tratamiento con budesonida. Se realiza una revisión sobre la entidad clínica del síndrome de solapamiento CBP-HAI y las características especiales de esta paciente para alcanzar el diagnóstico y su tratamiento (AU)

We describe the case of a female patient with a previous diagnosis of primary biliary cirrhosis (PBC) and chronic hepatitis B in inactive phase who developed increased transaminase levels with no evidence of hepatitis B virus reactivation while receiving ursodeoxycholic acid treatment. A liver biopsy showed changes compatible with overlapping autoimmune hepatitis (AIH). Budesonide treatment achieved normalization of transaminase levels. We provide a review of PBC and AIH overlap syndrome and discuss the particular features of this case that led us to this diagnosis, as well as the treatment provided (AU)

[Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome in a patient with chronic hepatitis B infection]. / Evolución de cirrosis biliar primaria a síndrome de solapamiento con hepatitis autoinmune en paciente con hepatitis B crónica.

We describe the case of a female patient with a previous diagnosis of primary biliary cirrhosis (PBC) and chronic hepatitis B in inactive phase who developed increased transaminase levels with no evidence of hepatitis B virus reactivation while receiving ursodeoxycholic acid treatment. A liver biopsy showed changes compatible with overlapping autoimmune hepatitis (AIH). Budesonide treatment achieved normalization of transaminase levels. We provide a review of PBC and AIH overlap syndrome and discuss the particular features of this case that led us to this diagnosis, as well as the treatment provided.

Leiomioma cotiledonoide disecante del útero. A propósito de dos casos y revisión de la literatura / Cotyledonoid dissecting leiomyoma of the uterus. Report of two cases and review of the literature

Introducción: El leiomioma cotiledonoide disecante del útero o tumor de Sternberg es un tumor benigno de músculo liso caracterizado por tener un patrón de crecimiento inusual. Pacientes y métodos: Presentamos los hallazgos histopatológicos de dos casos (pacientes de 41 y 56 años) de esta rara variante de leiomioma uterino. Inmunohistoquímicamente se confirmó la naturaleza muscular lisa de las lesiones. Resultados: En ambas pacientes se observó una gran masa polilobulada dependiente del útero que ocupaba la pelvis. Se realizó histerectomía y doble anexectomía con exéresis de masas pélvicas. En el estudio anátomopatológico se observaron múltiples masas bulbosas de aspecto alarmante compuestas por haces de músculo liso que se extendían por la superficie externa del útero y se continuaban con un componente intramiometrial que disecaba la pared uterina. No se encontraron atipia nuclear significativa, mitosis ni necrosis. Conclusiones: A pesar de su aspecto alarmante estos tumores, su comportamiento es benigno, por lo que hacemos hincapié en la importancia de su adecuado diagnóstico. Es muy aconsejable la realización de un estudio microscopico intraoperatorio para realizar un adecuado tratamiento de las pacientes (AU)

Introduction: Cotyledonoid dissecting leiomyoma or Sternberg tumor is a benign smooth muscle tumor with an unusual growth pattern. Patients and methods: Histopathological findings of two cases (41 and 56 year old females) of this rare variant of uterine leiomyoma are analyzed. Results: In both cases several nodules conforming an uterus-depending great mass occupying the pelvis were found. Total hysterectomy, bilateral salpingo-oophorectomy and pelvic masses removal were performed. On microscopic examination, several bulbous masses with alarming appearance were found. Masses were formed by bundles of smooth muscle cells extending over the external uterine surface and continuing with an intramyometrial tumoral component dissecting the uterine wall. Significant nuclear atypia, mitoses and necrosis were absent. Conclusions: In spite of the alarming aspect of these lesions, their evolution is benign in most cases. The importance of delivering a precise pathological diagnosis will prevent an inadequate treatment of the patients. An intraoperative pathological examination is recommended (AU)