[Clear cell renal cell carcinoma metastasized by a breast ductal carcinoma]. / Carcinoma renal de células claras metastatizado por carcinoma ductal de mama.

OBJECTIVE: To report a clear cell renal cell carcinoma recipient of a metastasizing ductal carcinoma of the breast: A tumor-to-tumor metastasis. METHODS: A 71 year-old woman with a past history of breast carcinoma, diagnosed 12 years before, underwent a nephrectomy for an incidental kidney mass found in a routine imaging examination. RESULTS: Histological examination revealed foci of ductal carcinoma of the breast in an otherwise typical clear cell renal cell carcinoma of the kidney. Immunohistochemical examination confirmed a metastasis of an infiltrating breast carcinoma to a clear cell renal cell carcinoma (positive to GATA3, hormonal receptors and mamoglobin) in a clear cell renal cell carcinoma (positive to PAX8, CD10 and vimentin). CONCLUSIONS: Awareness of this phenomenon should always be kept in mind by urologist in patients with a known history of a previous malignancy and by pathologists when finding a renal tumor with an unusual or dimorphic morphology. Immunohistochemistry plays an important role to establish the exact diagnosis.

Carcinoma renal de células claras metastatizado por carcinoma ductal de mama / Clear cell renal cell carcinoma metastasized by a breast ductal carcinoma

OBJETIVO: Comunicar un caso de carcinoma renal de células claras receptor de metástasis provenientes de un carcinoma ductal de mama. Metástasis de tumor a tumor. MÉTODOS: Una mujer de 71 años con historia de un carcinoma de mama, diagnosticado y tratado 12 años antes, fue nefrectomizada por el hallazgo de una masa renal en una revisión rutinaria. RESULTADOS: El examen histológico mostró focos de carcinoma ductal de mama en un típico carcinoma de células claras renal. El estudio inmunohistoquímico confirmó la metástasis de un carcinoma mamario (positivo a GATA 3, receptores hormonales y mamaglobina) en un carcinoma renal de células claras (positivo a PAX 8, CD10 y a vimentina). CONCLUSIONES: Los urólogos deben tener presente este fenómeno al encontrar una masa renal en pacientes con historia previa de un proceso maligno. También los patólogos deben estar alerta en estas situaciones, principalmente si encuentran un tumor renal con una morfología dimórfica o rara. La inmunohistoquímica juega un papel fundamental para establecer el diagnóstico exacto

OBJECTIVE: To report a clear cell renal cell carcinoma recipient of a metastasizing ductal carcinoma of the breast: A tumor-to-tumor metastasis. METHODS: A 71 year-old woman with a past history of breast carcinoma, diagnosed 12 years before, underwent a nephrectomy for an incidental kidney mass found in a routine imaging examination. RESULTS: Histological examination revealed foci of ductal carcinoma of the breast in an otherwise typical clear cell renal cell carcinoma of the kidney. Immunohistochemical examination confirmed a metastasis of an infiltrating breast carcinoma to a clear cell renal cell carcinoma (positive to GATA3, hormonal receptors and mamoglobin) in a clear cell renal cell carcinoma (positive to PAX8, CD10 and vimentin). CONCLUSIONS: Awareness of this phenomenon should always be kept in mind by urologist in patients with a known history of a previous malignancy and by pathologists when finding a renal tumor with an unusual or dimorphic morphology. Immunohistochemistry plays an important role to establish the exact diagnosis

Metástasis óseas, primera manifestación clínica de un carcinoma productor de calcitonina / Bone metastases as the first clinical manifestation of a thyroid medullar carcinoma

Introducción: el carcinoma medular de tiroides comprende entre el 5%-10% de todos los carcinomastiroideos. La presentación clínica más frecuente es una masa tiroidea. Caso clínico: varón de 32 años, con dolores debidos a múltiples metástasis óseas. Una biopsia de médulaósea mostró un carcinoma con positividad inmunohistoquímica a calcitonina y antígeno carcinoembrionario.Los niveles séricos de calcitonina y antígeno carcinoembrionario estaban muy altos. El paciente murió a los 12 meses del diagnóstico a pesar de ser sometido a quimio y radioterapia. Discusión: las metástasis a distancia son una manifestación inicial infrecuente en el carcinoma medularde tiroides. Pacientes con menos de 45 años tienen mejor supervivencia, pero la existencia de metástasis óseasse correlaciona con mal pronóstico. Las determinaciones inmunohistoquímicas y séricas de calcitonina y antígenocarcinoembrionario son importantes instrumentos diagnósticos. Conclusión: mostramos lo que creemos es un carcinoma medular de tiroides en un varón joven, con una presentación inicial atípica debido a múltiples metástasis óseas y curso fatal. La inmunohistoquimia es fundamentalpara diagnosticar el tumor primario en estas metástasis. En el caso de calcitonina y/o antígeno carcinoembrionarioplasmático elevado y no explicado, es imprescindible descartar un carcinoma medular de tiroides

Purpose: Thyroid medullary carcinoma comprises between 5 and 10 % of all thyroid cancers. The mostcommon clinical presentation is a thyroid mass. Study of a case with bone metastases. Case report: A 32 year old man with pain due to multiple bone metastases. A bone marrow biopsydisclosed a carcinoma immunologically positive to calcitonin and carcinoembryonic antigen. Serum level ofboth, calcitonin and carcinoembryonic antigen, were very high. The patient was treated with chemotherapy andradiotherapy, and died 12 months later. Discussion: Distant metastases are not a usual presentation of thyroid medullary carcinoma. Patientsyounger than 45 years have a better survival, but bone metastases correlate with a very bad prognosis.Immunohistochemistry and blood determination of carcinoembryonic antigen and calcitonin are importantdiagnostic tools. Conclusion: Atypical presentation of a thyroid medullary carcinoma in a young man with bonemetastases and short survival. Immunohistochemistry is very useful to establish the origin of the primarytumour in these metastases. In the event of an unexplained plasma rise of calcitonin and/or carcinoembryonicantigen, it is mandatory to rule out a thyroid medullary carcinoma

[Malignant fibrohistiocytoma of the spermatic cord]. / Fibrohistiocitoma maligno del cordón espermático.

A malignant fibrous histiocytoma (MFH) of the spermatic cord is presented and a review of the literature has been performed. The patient here presented survived for eight years and is probably cured of his tumour. In general, MFHs of the spermatic cord have a good prognosis, even when they attain a big size. They have a worse evolution when satellite nodules are present. Although more experience is needed. It is our feeling, that a spermatic MFH smaller than 8 cm, without any satellite nodule and less than 25% nuclei positive to MIB-1 (cell proliferation marker), may have a conservative therapy, including only tumorectomy.

Fibrohistiocitoma maligno del cordón espermático / Malignant fibrous histiocytoma of the spermatic cord

Se presenta un fibrohistiocitoma maligno (FHM) del cordón espermático y se realiza una revisión de la literatura. El paciente aquí presentado, ha sobrevivido a su tumor por más de 8 años y podemos suponer que está curado del mismo. Parece ser que los FHMs del cordón espermático tienen un buen pronóstico, incluso cuando alcanzan un tamaño considerable. Tienen una evolución peor cuando se acompañan de nódulos satélites. Aunque se necesita más experiencia al respecto, pensamos que los FHMs del cordón espermático, con un tamaño inferior a 8 cm, sin nódulos satélites y menos del 25 per cent de los núcleos positivos con MIB-1 (marcador de proliferación celular), se pueden beneficiar de una terapia conservadora que incluya sólo la tumorectomía (AU)

Jacalin, another marker for histiocytes in paraffin-embedded tissues.

Jacalin is a lectin which reacts with D-galactose. We have tested jacalin on 75 samples of different formalin- and alcohol-fixed tissues. A consistent cytoplasmic stain of the histiocytes was observed in paraffin-embedded tissues in all cases studied of reactive sinus histiocytosis, macrophages in clear centres of follicular hyperplasia, in tuberculosis granulomas and in osteoclast-like giant cells in a breast carcinoma. We failed to find any clear binding of jacalin to the cells of eosinophilic granulomas, giant cell tumors of tendon sheath, pleomorphic malignant fibrous histiocytomas, Hodgkin's disease, melanomas, nevi or signet ring cell carcinomas of the breast and stomach. It seems that jacalin is a good marker for free histiocytes/macrophages, not for fixed histiocytes and tumors related to them. This lectin might play a role in differential diagnosis with histiocyte mimicking processes.

[Enterovesical fistula secondary to leiomyosarcoma]. / Fístula enterovesical secundaria a leiomiosarcoma.

We report an unusual case of an enterovesical fistula caused by leiomyosarcoma infiltrating the intestinal wall and urinary bladder. The patient had previously presented recurrent urinary tract infection for one year. Although he has residual tumor, so far this elderly patient has survived for three years post-operatively without further antineoplastic treatment.

Breast tumors: immunoglobulins in axillary lymph nodes.

The immunohistochemical determination of immunoglobulins IgA, IgG and IgM in axillary lymph nodes from 50 unselected breast ductal carcinomas disclosed that lymph nodes with IgG-positive lymphoid follicles and/or metastasized lymph nodes with IgM-positive lymphoid cells are statistically related to breast tumors with a high histologic grade and more than 3 lymph node metastases.

Correlation of histologic grade and lymph node status with some histopathologic discriminants in breast cancer.

In fifty non selected ductal carcinomas of the breast we found that a marked tumoral inflammatory infiltrate (P less than 0.025), perinodal tumoral infiltrate (P less than 0.01), sinus catarrh (P less than 0.05), follicular hyperplasia (P less than 0.025), mixed pattern in lymph nodes (P less than 0.01) and with 54 years of age or younger (P less than 0.01) correlated significantly with lymph node metastases and/or high histologic grade. On the contrary, elastosis (P less than 0.05), scanty or absent inflammatory infiltrate (P less than 0.01), sinus histiocytosis (P less than 0.001) and endothelial hyperplasia were statistically related to low histologic grade and/or lack of metastases. Elastosis is considered a defensive host response. Groups of lymphocytes in the perinodal fat is usually found in metastasized lymph nodes and may indicate metastasis should be sought in a lymph node which otherwise seems to be tumor-free.

Adenomatoid tumors. Immunohistochemical study and histogenesis.

Four testicular adenomatoid tumors were studied by immunohistochemistry, using the following antibodies to cytokeratin, epithelial membrane antigen, carcinoembryonic antigen, and factor VIII-related antigen. Cytokeratin and epithelial membrane antigen demonstrated a different pattern of positive immunostaining while carcinoembryonic antigen and factor VIII-related antigen proved constantly negative. Our findings support a mesothelial origin for adenomatoid tumors.