Solitary fibrous tumor arising in the fallopian tube.

BACKGROUND: Solitary fibrous tumor (SFT) is an uncommon neoplasm that usually arises in the pleura. Although this tumor has been described at other sites, in the female genital tract it is extremely uncommon. CASE: We present a case of solitary fibrous tumor arising in the fallopian tube. A 32-year-old woman who presented with acute flank pain had a presumptive diagnosis of leiomyoma of the fallopian tube after abdominopelvic ultrasound. The adnexal mass was excised laparoscopically. Histologic examination showed the characteristic features of a solitary fibrous tumor. CONCLUSION: Although rare, the diagnosis of solitary fibrous tumor can be considered in the differential diagnosis of adnexal masses.

Syncytial giant cell component. Review of 55 renal cell carcinomas.

Different types of multinucleated giant cells (MGC) have been documented in tumors with osteoclast-like appearance, with trophoblastic differentiation or as tumoral malignant giant cells. A new variety of MGC has been described in renal cell carcinoma. In order to study the frequency, nature and significance of this cellular type, we have reviewed our files. To assess the presence, nature and significance of these MGC in renal cell carcinomas and associated histologic subtype. To review all malignant renal tumors diagnosed in the last 5 years in our hospital and to carry out a morphologic and immunohistochemical study in renal cell carcinomas with syncytial type MGC. 55 renal cell carcinomas were reviewed. Clear cell (conventional) renal cell carcinoma was the most common type encountered (40 cases); two of these cases showed syncytial type MGC and low grade malignancy. Microscopically the MGC contained from 5 to 40 nuclei. Immunohistochemically, mononucleated and multinucleated cells were positive for cytokeratin CAM 5.2, cytokeratin AE1/AE3 and weakly positive for vimentin. Histiocytic, muscular, neural markers, beta-HCG and alpha-fetoprotein were negative. The presence of syncytial type MGC in renal cell carcinomas is an exceptional event. Among 55 renal cell carcinomas we found two cases, both of which were of clear cell subtype and low grade malignancy. The MGC proved positive for epithelial markers and probably are the result of mononucleated tumoral cell fusion. We are unaware of the impact of this MGC in the outcome of patients; such cells appear in low grade carcinomas and do not seem to be of dismal prognosis.

[Thoracocentesis for the assessment of lung cancer with pleural effusion]. / La toracocentesis en la evaluación del cáncer de pulmón con derrame pleural

OBJECTIVE: To analyze the pleural and mediastinal effect of thoracentesis tumor-positive cytology in pleural effusions (PE) detected by chest X ray of lung cancer patients. PATIENTS AND METHODS: The study was performed in patients with lung cancer for whom PE was evident in chest X ray films, who then underwent thoracentesis followed by video-assisted thoracoscopy (VAT) to evaluate direct pleural tumor infiltration, mediastinal node involvement and the existence of pleural metastasis. Patients without contraindication underwent the procedure, even if tumor positive cytology was present. When pleural metastasis was found the treatment employed was talc pleurodesis and chemotherapy. Descriptive statistics were compiled and the validity of VAT for pleural metastasis diagnosis, of thoracentesis pleural cytology to detect infiltration of the tumor-adyacent pleura, N2 disease and pleural metastasis were calculated. Survival was also analyzed. RESULTS: PE was present in 188 of 971 consecutive lung cancer patients. Seventy two PEs were visible in the chest X ray films. Volume exceeded 425 mL. Tumor positive pleural cytology was detected in 29 cases (40%). Pleural metastasis were found in 54 patients, 23 of whom had tumor positive pleural cytology. In the other 6 patients with positive cytology the primary neoplasm infiltrated the visceral pleura, completely in 5. In 4 of those 5, the mediastinal pleura was also involved. The primary tumor and diseased lymph nodes were removed from 11 patients, 3 of them with tumoral pleural cytology. Visual pleural inspection by VAT had a sensitivity of 93%, specificity of 82%, positive predicted value (PPV) of 94% and negative predicted value (NPV) of 78% for the diagnosis of pleural metastasis. Thoracentesis cytology showed a sensitivity of 43%, specificity of 67%, PPV of 79% and NPV of 28% for pleural metastasis. For the evaluation of adjacent pleura infiltration, without pleural metastasis, the sensitivity of cytology was 40%, specificity 100%, PPV 100% and NPV 25%. For mediastinal node invasion clinically evaluated, the sensitivity of cytology was 55%, specificity of 62%, PPV 18% and NPV 90%. Survival after thoracotomy was 39% after 2 years, and the median survival time was 14.5 months. In the 11 resected patients, survival was 53% at two years. The difference in survival between patients treated by thoracotomy and those treated by talc pleurodesis after VAT was significant (p < 0.01). The 3 resected patients with pleural tumor-positive cytology survived 84, 39 and 25 months. CONCLUSIONS: Nineteen percent of patients with lung cancer have PE, of which 7% can be seen in chest X ray films. In such patients the likelihood of pleural metastasis is 75%. Pleural metastasis is not necessarily present when PE cytology indicates that tumor is present. VAT can be considered the ideal technique for the assessment of direct pleural invasion by the tumor or of pleural metastasis.

La toracocentesis en la evaluación del cáncer de pulmón con derrame pleural / Thoracentesis for the assessment of lung cancer with pleural effusion

OBJETIVO: Analizar la repercusión pleural y ganglionar mediastínica de la citología tumoral obtenida por toracocentesis del derrame pleural (DP) diagnosticado mediante radiografía de tórax en pacientes con cáncer de pulmón (CP). PACIENTES Y MÉTODOS: Estudio realizado en pacientes con CP primario y DP evidente en la radiografía de tórax a los que se les realizó toracocentesis seguida de videotoracoscopia (VT) para valorar la infiltración pleural directa por el tumor, la afección ganglionar mediastínica y la existencia de diseminación metastásica pleural. Fueron intervenidos quirúrgicamente aquellos sin contraindicación, pese a tener citología tumoral. Al encontrar metástasis pleural se practicó pleurodesis con talco y tratamiento quimioterápico. El estudio estadístico contempló los siguientes aspectos: descripción de las variables epidemiológicas; validez de la VT para el diagnóstico de metástasis pleural y de la citología por toracocentesis para evaluar la infiltración pleural por contigüidad, enfermedad N2 y la existencia de metástasis pleural; supervivencia. RESULTADOS: En 971 pacientes consecutivos con CP hubo 188 con DP, 72 visibles en la radiografía de tórax. El volumen fue superior a 425 ml. La citología fue tumoral en 29 casos (40 per cent). Hubo metástasis pleural en 54 pacientes (75 per cent), 23 con citología tumoral. En los otros 6 pacientes con citología tumoral, la neoplasia primaria infiltraba la pleura visceral, en 5 de forma completa, 4 de los cuales presentaban infiltración de la pleura mediastínica. Se realizó la exéresis del tumor primario y adenopatías en 11 pacientes, 3 con citología tumoral. La evaluación pleural de visu por VT para el diagnóstico de mestástasis pleural dio una sensibilidad (S) del 93 per cent, especificidad (E) del 82 per cent, un valor predictivo positivo (VPP) del 94 per cent y un valor predictivo negativo (VPN) del 78 per cent. La citología por toracocentesis para el diagnóstico de metástasis pleural presentó: S 43 per cent, E 67 per cent, VPP 79 per cent y VPN 28 per cent; para infiltración pleural por contigüidad, sin metástasis pleural: S 40 per cent, E 100 per cent, VPP 100 per cent y VPN 25 per cent; y en la invasión ganglionar mediastínica evaluada clínicamente: S 55 per cent, E 62 per cent, VPP 18 per cent y VPN 90 per cent. La supervivencia tras toracotomía alcanzó el 39 per cent a los 2 años, con una mediana de 14,5 meses y en los 11 pacientes resecados fue del 53 per cent a los 2 años. La comparación de las supervivencias de los pacientes intervenidos por toracotomía y los tratados mediante pleurodesis tras VT fue significativa (p < 0,01). La supervivencia de los 3 pacientes con citología tumoral resecados alcanzó 84, 39 y 25 meses. CONCLUSIONES: El 19 per cent de los pacientes con CP tiene un DP y el 7 per cent puede ser diagnosticado en la radiografía de tórax, en cuyo caso la probabilidad de que coexista con metástasis pleural es del 75 per cent. El hallazgo de citología tumoral en el DP no es equivalente de metástasis pleural. La toracoscopia se puede considerar la técnica idónea en el análisis de la invasión pleural directa por el tumor o la diseminación metastásica. (AU)

The usefulness of antibodies to the BRCA1 protein in detecting the mutated BRCA1 gene. An immunohistochemical study.

AIM: To assess the value of immunohistochemistry in discriminating between BRCA1 associated and non-BRCA1 associated breast tumours. METHODS: Four commercially available anti-BRCA1 antibodies were used on 45 paraffin wax embedded tumoral samples from patients with (seven of 45) and without (38 of 45) BRCA1 germline mutations. In all patients, the BRCA1 gene had been studied previously by means of the protein truncation test (PTT), conformational sensitive gel electrophoresis (CSGE), and direct sequencing of genomic DNA. Immunohistochemistry was carried out using the standard avidin-biotin immunoperoxidase method. Antigen retrieval was carried out by means of microwave pretreatment or autoclaving. The antibody panel used comprised D-20 (1/500), I-20 (1/100), K-18 (1/100), and MS110 (Ab-1; 1/50). RESULTS: No immunohistochemical differences in BRCA1 protein expression were found between cases with and without BRCA1 germline mutations. All positive cases showed predominantly cytoplasmic staining, in both tumoral and non-tumoral cells, with the polyclonal antibodies D-20, I-20, and K-18. After heating pretreatment both nuclear and cytoplasmic staining were found in tumoral and non-tumoral cells with the I-20 antibody. Only the monoclonal antibody MS110 showed a predominantly nuclear staining after microwave oven treatment. CONCLUSIONS: Commercially available BRCA1 antibodies lack the specificity required to identify the BRCA1 protein and thus are not useful for establishing differences between familial and sporadic breast tumours, or between BRCA1 associated and non-BRCA1 associated breast tumours.

Extranodal peripheral T-cell lymphoma with angiocentric growth pattern and Epstein-Barr viral DNA associated affecting paratesticular soft tissue.

Peripheral T-cell lymphomas are uncommon, accounting for only 10% to 15% of all non-Hodgkin lymphomas and their classification has been controversial. We report a case of peripheral T-cell lymphoma with angiocentric growth pattern which presented as a paratesticular tumoral nodule in a 47-year-old-man. Formalin-fixed paraffin-embedded samples from the paratesticular tumor and non-infiltrated adjacent tissue were submitted to histological, immunohistochemical, polymerase chain reaction (PCR)-based and in situ hybridization analysis. Histopathologically, there was a lymphomatous infiltrate in the paratesticular soft tissue, composed of a variable mixture of medium-sized to large cells with large cytoplasm and irregular-shaped nuclei, together with blood vessel destruction, necrosis and karyorrhexis. Immunohistochemical study revealed a high p53 expression in neoplastic cells that showed T cytotoxic immunophenotype, failing to express the natural killer (NK)-cell antigen CD56. A monoclonal rearrangement of the T-cell receptor (TCR) gamma gene by a PCR technique was demonstrated. Type-A Epstein-Barr Virus (EBV) DNA was detected by PCR-based analysis. A combined in situ hybridization and immunohistochemical study revealed that most cells labeled positive for EBV RNA showed immunostaining with the CD45RO antibody. Based on the above results, the case reported was classified as extranodal peripheral T-cell lymphoma with cytotoxic phenotype and EBV associated. The present case does not fit neatly into any of the specific types of peripheral T-cell lymphomas of the REAL classification, so a diagnosis of peripheral T-cell lymphoma unspecified was made.

[Pseudosarcomatous lesions of the urinary bladder. Report of a case]. / Lesiones seudosarcomatosas de vejiga urinaria. Presentación de un caso.

OBJECTIVE: The present study describes a case of pseudosarcomatous lesion of the urinary bladder, a rare disease entity that may occasionally be clinically mistaken for malignant neoplasms. METHODS/RESULTS: A 79-year-old male with hematuria who had previously undergone surgery is described. Cystoscopic examination revealed a tumor which was resected by TUR. The histological analysis disclosed a benign proliferative mesenchymal lesion comprised of spindle cells. CONCLUSIONS: Pseudosarcomatous lesions of the urinary bladder are benign lesions of fibroblastic or myofibroblastic origin that are more frequent in young adults and prevalent in females. Clinically they present with hematuria and treatment is by surgical excision (partial cystectomy or TUR). The prognosis is excellent.

[Prognostic value of positive cytology found in pleural lavage of patients with cancer of the lung. Prospective study]. / Valor pronóstico de la citología positiva hallada en el lavado pleural de pacientes con cáncer de pulmón. Estudio prospectivo.

Pulmonary neoplasms can deposit malignant cells in the pleural cavity by a variety of mechanisms, depending not only on histological type but also on clinical stage. We investigated the effect on survival rate of a finding of malignant cells in pleural lavage. We also investigated the effect of the presence of pleural metastasis on postoperative course of disease. Two hundred surgical patients at Hospital General Universitario in Valencia between 1 February 1990 and 30 March 1993 were studied. Two groups were formed. Group one: 150 patients with lung cancer, none of whom had had pleural effusion prior to suffering transthoracic puncture during the preoperative study. Patients treated with parallel chemotherapy or radiotherapy were excluded in order to circumvent false positives. Group two: 50 patients with no tumors who underwent thoracotomy for reasons other than lung cancer. All patients underwent pleural lavage with saline before and after lung exeresis. We found 26.6% (40/150) positive cytologies in the pre-and postoperative lavages in the first group. None were found in the control group.

[Study of the expression of proliferating cell nuclear antigen and p185 in non-small cell lung carcinoma]. / Estudio de la expresión del antígeno nuclear de proliferación celular y p185 en el carcinoma no microcítico de pulmón.

We assessed immunohistochemical expression of p185 and the proliferating cell nuclear antigen (PCNA) in 68 patients undergoing surgery for non-small cell lung cancer. Adenocarcinoma of the lung was the histological type whose expression of p185 at levels exceeding 10% was greater to a statistically significant degree. Epidermoid carcinoma, on the other hand, was associated with the highest PCNA indices. Although these 2 markers had no prognostic value in the survival study, it must be pointed out that the longest survivors were patients with p185 expression less than 10% in neoplastic cells.

[Moderately differentiated neuroendocrine carcinoma of the larynx]. / Carcinoma neuroendocrino medianamente diferenciado de laringe. A propósito de un caso.

We present a case of moderately differentiated neuroendocrine carcinoma of the larynx. These tumors represent 0.6% of all laryngeal carcinomas. Histological diagnosis requires the use of immunohistochemical methods, the tumoral cells presenting positivity for epithelial markers (cytokeratin) and neuroendocrine markers (chromogranin). Clinically, their location is supraglottic and they affect mainly males between the 6th-7th decades of life. The prognosis is better than that of squamous carcinoma or adenocarcinoma. The differential diagnosis must be made with granular cell tumor and paragangliomas.

[Anal polypoid tumor formation as the form of presentation of rectal gastric heterotopia]. / Tumoración anal polipoide como forma de presentación de una heterotopia gástrica rectal.

Heterotopic gastric epithelium occurs in all portions of the alimentary tract, but it is extremely rare in the rectum. The authors report the finding of a pedunculated anal polyp in a 9-year-old girl with a six-month history of rectal bleeding. Microscopically, the polyp consisted of epithelium of the fundic type. Both the age of the patient and the finding of heterotopic epithelium of the fundic type alone supports a congenital malformation and not an inflammatory condition.

[Cholesteatoma of the middle ear. An enzymatic study]. / Colesteatoma del oído medio. Estudio enzimático.

Forty specimens of aural cholesteatoma have been studied histoenzymological techniques. Acid phosphatases were the most representatives.

[Lymphoma of the splenic mantle. Morphologic, immunologic and ultrastructural characterization of a case]. / Linfoma del manto esplénico. Caracterización morfológica, inmunológica y ultraestructural de un caso.

We present a splenic primary mantle lymphoma in a 64 year old woman, without peripheral lymphoadenopathy and stage IV at the moment of the diagnosis. Grossly a splenic infiltration was observed. Microscopically, a nodular lymphoma of small lymphocytes proliferating around benign germinal centers makes the diagnosis. Immunohistochemically, tumoral lymphocytes expressed SIgG/kappa and CD5 (Leu-1). Markers of follicular center origin CD10 (CALLA) were negative. According to working formulation mantle-cell lymphoma is considered a lymphoma of intermediate grade of malignancy. In our case, the morphologic, immunologic, ultrastructural findings and clinical evolution were more characteristics of a low grade lymphoma that a intermediate grade of malignancy.