Fracasos de la embolización en el tratamiento del mioma uterino / Embolization failures in the treatment of uterine myoma

La embolización de la arteria uterina ha sido descrita como un método efectivo y seguro en el tratamiento de los miomas sintomáticos. Se presentan 3 casos de pacientes con útero miomatoso sintomático, y su tratamiento mediante esta técnica. En estos 3 casos, las complicaciones postembolización de los miomas hizo necesaria la práctica de una histerectomía. Así mismo se describen otras complicaciones derivadas de la técnica señaladas en la revisión bibliográfica realizada

Uterine artery embolization has been described as an effective and safe treatment for women with symptomatic uterine leiomyomata. We report three cases of women with symptomatic myomatous uterus and their treatment by this approach. In these three cases, hysterectomy was required due to complications following the embolizations. We also describe other complications of this therapeutic approach that came to light in the literature review

Estudio inmunohistoquímico de los factores de trancripción de desarrollo neural (TTF1, ASCL1 y BRN2) en los tumores neuroendocrinos de próstata / Immunohistochemical study of the neural development transcription factors (TTF1, ASCL1 and BRN2) in neuroendocrine prostate tumours

Objetivo: El carcinoma neuroendocrino de célula pequeña de próstata es una neoplasia infrecuente que supone el 0,5-1% de todas las neoplasias prostáticas. La mediana de supervivencia cáncer-específica de los pacientes con carcinoma neuroendocrino de célula pequeña de próstata es de 19 meses, y el 60,5% de los pacientes presentan enfermedad metastásica. Los factores de transcripción de desarrollo neural son moléculas implicadas en la organogénesis del sistema nervioso central y de precursores neuroendocrinos de diversos tejidos, que incluyen la glándula suprarrenal, el tiroides, el pulmón y la próstata, entre otros órganos. Material y métodos: Presentamos 3 casos de esta infrecuente entidad, aplicando los nuevos criterios de la OMS. Realizamos estudios mediante tinción de H-E y analizamos la expresión de los factores de transcripción de desarrollo neurales Achaete-scute homolog like 1, Thyroid transcription factor 1 y los factores de transcripción clase iii/iv POU, como nueva línea de investigación en la carcinogénesis de los tumores neuroendocrinos de próstata. Resultados: En el caso 1 no se observó inmunoexpresión para TTF1. Los casos 2 y 3 presentaron inmunotinción positiva para ASCL1, e inmunotinción negativa en el caso 1. La inmunotinción para BRN2 fue negativa en el caso 1 y positiva en los casos 2 y 3. Conclusión: Actualmente, la OMS no reconoce ningún marcador molecular ni genético con valor pronóstico. ASCL-1 está relacionado con las vías de señalización NOTCH y WNT. ASCL-1, TTF1 y BRN2 podrían usarse para el diagnóstico precoz y como factor pronóstico y diana terapéutica

Objective: Prostatic small-cell neuroendocrine carcinoma is an uncommon malignancy that constitutes 0.5-1% of all prostate malignancies. The median cancer-specific survival of patients with prostatic small-cell neuroendocrine carcinoma is 19 months, and 60.5% of the patients have metastatic disease. Neural development transcription factors are molecules involved in the organogenesis of the central nervous system and of neuroendocrine precursors of various tissues, including the suprarenal gland, thyroid glands, lungs and prostate. Material and methods: We present 3 cases of this uncommon condition, applying the new World Health Organisation criteria. We conducted studies through haematoxylin and eosin staining and analysed the expression of the neural development transcription factors achaete-scute homolog like 1, thyroid transcription factor 1 and the class III/IV POU transcription factors, as a new research line in the carcinogenesis of prostatic neuroendocrine tumours. Results: In case 1, there was no TTF1 immunoexpression. Cases 2 and 3 had positive immunostaining for ASCL1, and Case 1 had negative immunostaining. BRN2 immunostaining was negative in case 1 and positive in cases 2 and 3. Conclusion: The World Health Organisation does not recognise any molecular or genetic marker with prognostic value. ASCL-1 is related to the NOTCH and WNT signalling pathways. ASCL-1, TTF1 and BRN2 could be used for early diagnosis and as prognostic factors and therapeutic targets

Immunohistochemical study of the neural development transcription factors (TTF1, ASCL1 and BRN2) in neuroendocrine prostate tumours. / Estudio inmunohistoquímico de los factores de trancripción de desarrollo neural (TTF1, ASCL1 y BRN2) en los tumores neuroendocrinos de próstata.

OBJECTIVE: Prostatic small-cell neuroendocrine carcinoma is an uncommon malignancy that constitutes 0.5-1% of all prostate malignancies. The median cancer-specific survival of patients with prostatic small-cell neuroendocrine carcinoma is 19 months, and 60.5% of the patients have metastatic disease. Neural development transcription factors are molecules involved in the organogenesis of the central nervous system and of neuroendocrine precursors of various tissues, including the suprarenal gland, thyroid glands, lungs and prostate. MATERIAL AND METHODS: We present 3 cases of this uncommon condition, applying the new World Health Organisation criteria. We conducted studies through haematoxylin and eosin staining and analysed the expression of the neural development transcription factors achaete-scute homolog like 1, thyroid transcription factor 1 and the class III/IV POU transcription factors, as a new research line in the carcinogenesis of prostatic neuroendocrine tumours. RESULTS: In case 1, there was no TTF1 immunoexpression. Cases 2 and 3 had positive immunostaining for ASCL1, and Case 1 had negative immunostaining. BRN2 immunostaining was negative in case 1 and positive in cases 2 and 3. CONCLUSION: The World Health Organisation does not recognise any molecular or genetic marker with prognostic value. ASCL-1 is related to the NOTCH and WNT signalling pathways. ASCL-1, TTF1 and BRN2 could be used for early diagnosis and as prognostic factors and therapeutic targets.

Gastrointestinal stromal tumors (GISTs): CD117, DOG-1 and PKCθ expression. Is there any advantage in using several markers?

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. Expression of CD117, DOG1 and PKCθ was investigated immunohistochemically in a series of 99 paraffin-embedded GISTs in order to determine the sensitivity and diagnostic value of these markers. KIT exons 9, 11, 13 and 17 and PDGFRA exons 12 and 18 were amplified by PCR and sequenced. A total of 94/99 (94%) GISTs stained positive for CD117, 81/99 (82%) for PKCθ and 90/99 (91%) for DOG-1. A significant correlation was noted between CD117 and DOG-1 expression (p=0.0001). All three markers were expressed in 74% (73/99) of GISTs. Of the five CD117-negative cases, two were PKCθ-negative/DOG1-negative and had mutations in KIT exon 11. Two were PKCθ-positive/DOG1-positive and had mutations in PDGFRA (one each in exons 12 and 18), and one was DOG1-negative/PKCθ-positive, with a PDGFRA exon 18 mutation. The most sensitive marker was CD117, followed by DOG-1 and PKCθ. Although PKCθ was less sensitive, and its staining is more challenging and difficult to interpret, the use of this marker is highly recommended, particularly in CD117-negative/DOG-1-negative GISTs.

Tumores del estroma gastrointestinal múltiples no metastásicos. Aspectos diferenciales / Multiple non-metastatic gastrointestinal stromal tumors. Differential features

Introducción: los tumores del estroma gastrointestinal (GIST)son neoplasias mesenquimales del tubo digestivo que generalmenteexpresan el receptor KIT (CD117) y muestran mutaciones enlos genes KIT o PDGFRA. Aunque la forma de presentación clínicahabitual es como una neoplasia mural solitaria, excepcionalmentepueden presentarse formas múltiples en el mismo o diferenteórgano.Objetivo: revisar las características morfológicas, inmunohistoquímicasy moleculares de las formas de GIST múltiples no metastásicos.Fuentes: revisión de la literatura en Medline y la propia experiencia.Conclusiones: los GIST múltiples pueden presentarse en trescontextos diferentes: lesiones espontáneas (del adulto o de la edadinfantil); síndrome familiar propio (transmitido con herencia autosómicadominante); y lesiones asociadas a síndromes específicos(tríada de Carney, síndrome de Carney-Stratakis, y neurofibromatosistipo I). Fuera de estos ámbitos, se interpreta que todo GISTmúltiple es el resultado de siembras tumorales metastásicas y, portanto, corresponde a enfermedad avanzada. Estas variantes debenser conocidas por el clínico dado las connotaciones pronósticas yterapéuticas que ello conlleva(AU)

Introduction: gastrointestinal stromal tumors (GISTs) are specific,generally KIT (CD117)-positive, mesenchymal tumors of thedigestive tract displaying KIT or PDGFRA gene mutations. Clinically,they tend to present as solitary tumors of the intestinal wall;more rarely, multiple tumors may occur in one or more organs.Objective: to review the morphological, immunohistochemicaland molecular features of multiple, non-metastatic forms ofGIST.Sources: review of the literature on Medline, and authors’own experience.Conclusions: multiples GISTs may occur in three differentcontexts: as spontaneous lesions (in both adults and children); dueto familial GIST syndrome (autosomal dominant inheritance); orin association with specific syndromes (e.g. Carney’s triad, Carney-Stratakis syndrome, type I neurofibromatosis). Outside thesecontexts, the existence of multiple GISTs is deemed to be the resultof tumor metastasis, and therefore indicative of advanced-stagedisease. Clinicians need to be aware of these variants, whoseprognosis and treatment differ(AU)

Multiple non-metastatic gastrointestinal stromal tumors. Differential features.

INTRODUCTION: gastrointestinal stromal tumors (GISTs) are specific, generally KIT (CD117)-positive, mesenchymal tumors of the digestive tract displaying KIT or PDGFRA gene mutations. Clinically, they tend to present as solitary tumors of the intestinal wall; more rarely, multiple tumors may occur in one or more organs. OBJECTIVE: to review the morphological, immunohistochemical and molecular features of multiple, non-metastatic forms of GIST. SOURCES: review of the literature on Medline, and authors own experience. CONCLUSIONS: multiples GISTs may occur in three different contexts: as spontaneous lesions (in both adults and children); due to familial GIST syndrome (autosomal dominant inheritance); or in association with specific syndromes (e.g. Carney s triad, Carney-Stratakis syndrome, type I neurofibromatosis). Outside these contexts, the existence of multiple GISTs is deemed to be the result of tumor metastasis, and therefore indicative of advanced-stage disease. Clinicians need to be aware of these variants, whose prognosis and treatment differ.

Metástasis lingual de carcinoma renal / Lingual metastasis from renal carcinoma

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[Cystic lymphangioma of the adrenal glands. Case report]. / Linfangioma quístico de glándula suprarrenal. A propósito de un caso.

OBJECTIVE: Lymphangiomas are rare adrenal lesions, most of them asymptomatic. METHODS: We report one case of adrenal lymphangioma in a 41-year-old female patient with elevated serum catecholamine levels. RESULTS: Lymphangiomas are multicystic lesions covered by endothelium and with serous content, the differential diagnosis of which is mainly established with hemangioma and adenomatoid tumor. CONCLUSIONS: Surgical treatment is indicated in big lesions and symptomatic cases, which are left asymptomatic after surgery.

Linfangioma quístico de glándula suprarrenal. A propósito de un caso / Cystic lymphangioma of the adrenal glands. Case report

OBJETIVOS: El linfangioma es una lesión infrecuente a nivel suprarrenal que suele cursar de manera asintomática. METODOS: Presentamos un caso de linfangioma en tal localización en una paciente de 41 años con elevación de los niveles de catecolaminas. RESULTADOS: Se trata de lesiones multiquísticas revestidas de endotelio que muestran un contenido seroso cuyo diagnóstico diferencial se establece principalmente con el hemangioma y con el tumor adenomatoide. CONCLUSIONES: El tratamiento es quirúrgico en casos de gran tamaño o en aquellos que cursan con sintomatología remitiendo en todos la misma tras la intervención (AU)

OBJECTIVE: Lymphangiomas are rare adrenal lesions, most of them asymptomatic. METHODS: We report one case of adrenal lymphangioma in a 41-year-old female patient with elevated serum catecholamine levels. RESULTS: Lymphangiomas are multicystic lesions covered by endothelium and with serous content, the differential diagnosis of which is mainly established with hemangioma and adenomatoid tumor. CONCLUSIONS: Surgical treatment is indicated in big lesions and symptomatic cases, which are left asymptomatic after surgery