Ascitis por carcinoma lobulillar infiltrante bilateral de mama / Ascites due to bilateral invasive lobular carcinoma of the breast

Resumen El cáncer de mama representa sólo 3% de la proporción de cánceres que causan ascitis maligna. Suele relacionarse con el carcinoma lobulillar infiltrante, pues se manifiesta como enfermedad multicéntrica y es propenso a metastatizar a las regiones del peritoneo (en 10% de las admisiones), meninges, serosas, retroperitoneo y órganos ginecológicos; además, es el que con mayor frecuencia metastatiza al tubo gastrointestinal (64%). Por tanto, debe considerarse el diagnóstico de cáncer lobulillar infiltrante en mujeres con ascitis, hidronefrosis o masas pélvicas.

Abstract Breast cancer occupies accounts for 3% of the proportion of cancers that develop malignant ascites. It is usually associated with infiltrating lobular carcinoma. It pre-sents as a multicentric disease. It metastasizes to peritoneal (in 10% of admissions), meninges, serous, retroperitoneum and gynecological organs. In addition, frequently metastasizes to the gastrointestinal tract (64%). Therefore, in women with ascites, hydronephrosis or pelvic masses, the diagnosis of infiltrating lobular cancer should be considered.

[Abnormalities in cervical smears stored in plastic bags: potential cause of false negatives]. / Alteraciones en citologías cervicales almacenadas en un medio ambiente húmedo: causa potencial de falsos negativos.

INTRODUCTION: Cervical smear is the most economic and efficient diagnostic tool for the screening of cervical cancer. However, since plastic bags have been used in Guanajuato to transport and store smears, we have observed cytological abnormalities which difficult the diagnosis and lead to false negatives. OBJECTIVE: To describe those abnormalities. METHODS: Out of 340 women registered in a primary care center in Mexico, 68 were selected through systematic random sampling during 2007. A cervical smear was obtained and placed on two slides. The first sample was allowed to dry but the second one was placed into the plastic bag immediately after fixation. After 15 days all the smears were stained with the Papanicolaou technique. A certified pathologist, blinded about the variable of study, interpreted the samples according to the Bethesda system, and evaluated the presence of necrosis, edema, holes, and opportunistic microorganisms. RESULTS: Of the 68 smears exposed to a humid storage, 36 (53%) were inadequate for diagnosis (Fisher's exact probability < 0.001). From them, 36 (53%) had holes or lagoons, 34 (50%) had edema, 31 (46%) had necrosis, and 15 (22%) had fungus. On the other hand, the 68 dried cervical smears were all adequate for diagnosis and none had the changes or cytological abnormalities. CONCLUSION: The humid transport and storage of cervical smears produced abnormalities in the normal morphology that could lead to false negative results. The guideline for the handling of cervical smears must stress the importance of allowing the smears to dry completely after fixation and before storing them in plastic bags.

Transitional cell carcinoma of the uterine cervix. A report of six cases with clinical, histologic and cytologic findings.

BACKGROUND: Transitional cell carcinoma of the cervix (TCCC) is a rare neoplasm of recent description. The cytologic characteristics of the tumor have not been published to date. Six cases of TCCC are described, including their clinical, histologic, cytologic and immunohistochemical features. CASES: All cases presented at an advanced clinical stage; two recurred, and one metastasized. Five cases showed a papillary exophytic pattern, and one case showed an "inverted" endophytic pattern similar to that of transitional cell carcinoma of the urothelium (TCCU). The cytokeratin profile was similar to that of squamous cell carcinoma of the cervix (SCCC), positive for CK 7 and negative for CK 20. The cervical smears showed a background that was necrotic or hemorrhagic. The cells with transitional features formed cohesive groups in a multilayered fashion and had an oval or spindle shape with tapered ends. The nuclei were hyperchromatic, with coarse and medium-sized granules that frequently displayed a wrinkled membrane, nuclear grooves and rare pseudoinclusions. The nucleoli were small or absent. Others cells with cytologic characteristics of SCCC were seen in all cases. CONCLUSION: TCCC is a rare neoplasm that probably represents a subgroup of SCCC. The most frequent histologic pattern is papillary-exophytic, but it can be inverted-endophytic. In cervical smears there are cells with characteristics of regular SCCC and others resembling those of TCCU. A larger number of cases is needed to define the evolution and clinical outcome.

Comportamiento biológico atípico del rabdomiosarcoma alveolar en cinco pacientes / Atypical biological behavior of alveolar rhabdomyosarcoma in five patients

Se informan cinco casos de rabdomiosarcoma alveolar con presentación clínica atípica. Tres pacientes presentaron linfadenomegalias como primera manifestación clínica, imitando el comportamiento de un linfoma o de un tumor primario no identificado con metástasis ganglionares. Un sujeto presentó enfermedad tumoral sistémica, y dos presentaron el tumor primario en localizaciones atípicas, como el mediastino y el retroperitoneo. Todos los enfermos fallecieron y cuatro fueron autopsiados. El diagnóstico histopatológico fue confirmado por medio de estudios de inmunohistoquímica en cuatro casos. El rabdomiosarcoma alveolar tiene mal pronóstico y puede presentar un comportamiento clínico y una morfología variable, simulando linfomas, leucemias y enfermedad metastásica sistémica sin tumor primario conocido, como en los casos que aquí se informan