The OLGA-OLGIM staging and the interobserver agreement for gastritis and preneoplastic lesion screening: a cross-sectional study.

Stomach cancer (SC) incidence and mortality are relevant public health issues worldwide. In Colombia, screening for preneoplastic lesions (PNL) and the presence of H. pylori is not routinely performed. Therefore, the aim of this study was to evaluate OLGA-OLGIM staging and the interobserver agreement in gastritis and preneoplastic lesions in patients with gastroduodenal symptoms from Colombia. A cross-sectional study was conducted in 272 patients with gastroduodenal symptoms. Gastric biopsies were taken following the Updated Sydney System with the OLGA-OLGIM classification, and the results were evaluated by two pathologists. Chronic gastritis and PNL were reported in 76% and 24% of the patients, respectively. Furthermore, 25% of the patients with PNL displayed gastric atrophy (GA) and 75% intestinal metaplasia (IM). Agreement in the histopathological reading for IM was good, whereas for OLGA was variable, and for the H. pylori quantity was poor. OLGA-OLGIM stages 0-II were the most frequent (96%), while stage III (4%) and SC (4%) were the least frequent. Age and coffee consumption were associated with a higher prevalence of PNL. This work determined that 4% of the population is at high risk of developing SC and would benefit from follow-up studies. Reinforcement of training programs to improve the agreement in histopathology readings is required.

Nodular Pulmonary Amyloidosis: A Manifestation of Sjögren's Syndrome.

CASE DESCRIPTION: A 72-year-old woman with primary Sjögren Syndrome (SS) was diagnosed during an inpatient hospital stay with dry symptoms. The patient had respiratory and constitutional symptoms, requiring a pulmonary imaging evaluation by high-resolution computed tomography (HRCT) of the thorax. CLINICAL FINDINGS: Multiple cavitary pulmonary nodules, halo sign, and focal areas of ground-glass opacity with predominance in both bases were found in the images. Complementary studies were done where a neoplastic focus was ruled out. The diagnosis of nodular pulmonary amyloidosis was confirmed with a pulmonary biopsy performed by videothoracoscopy for histopathological study, which reported the formation of nodules in the parenchyma with amyloid deposits and positive immunohistochemical markers for CD3, CD20, and CD38 lymphocytic infiltration. TREATMENT AND OUTCOME: Initial inpatient management with intravenous cyclophosphamide and methylprednisolone was given. Subsequent outpatient management was given with high dose glucocorticoids. CLINICAL RELEVANCE: We presented a case of nodular pulmonary amyloidosis in a female patient with primary SS, which is a rare pulmonary manifestation of this syndrome.

Panhipopituitarismo secundario a metástasis del sistema nervioso central por un adenocarcinoma broncogénico / Panhypopituitarism secondary to metastasis of the central nervous system due to a bronchogenic adenocarcinoma

Resumen Mujer de 45 años de edad con antecedente de extabaquismo pesado, cursó con cuadro crónico de cefalea en región occipital irradiado a región temporal asociado a disminución de la agudeza visual de ojo izquierdo. El cuadro empeoró en los últimos seis meses y se asoció a polidipsia y poliuria. Presentó cuadro sincopal con amnesia retrógrada, para lo cual se realizó una tomografía axial computarizada (TAC) contrastada de cráneo que mostró múltiples lesiones parenquimatosas cerebrales y del cerebelo compatibles con metástasis. Se hizo estudio hormonal para evaluar la función hipofisiaria evidenciando un panhipopituitarismo secundario. Se detectó foco primario neoplásico mediante TAC contrastada de tórax, evidenciando una lesión espiculada en el lóbulo superior derecho sugestiva de carcinoma broncogénico, posteriormente se tomó biopsia por fibrobroncoscopia el cual confirmó por histopatología e inmunohistoquímica el diagnóstico de un adenocarcinoma broncogénico. (Acta Med Colomb 2018; 43: 115-118).

Abstract A 45-year-old woman with a history of heavy extabaquism presented with chronic headache in the occipital region irradiated to the temporal region associated with decreased visual acuity of the left eye. The picture worsened in the last six months and was associated with polydipsia and polyuria. She presented a syncopal picture with retrograde amnesia, for which a contrast computed tomography (CT) of the skull was performed, which showed multiple parenchymal brain and cerebellar lesions compatible with metastasis. Hormonal study was done to evaluate the hypophyseal function evidencing a secondary panhypopituitarism. A primary neoplastic focus was detected by a contrast chest CT scan, showing a spiculated lesion in the right upper lobe suggestive of bronchogenic carcinoma. A biopsy was subsequently taken by fibrobronchoscopy, which confirmed the diagnosis of a bronchogenic adenocarcinoma by histopathology and immunohistochemistry. (Acta Med Colomb 2018; 43: 115-118).

Tumor neuroectodérmico primitivo renal. Reporte de un caso / Primitive neuroectodermal kidney tumor. Case report

Antecedentes: El tumor neuroectodérmico primitivo(TNEP) es un tumor de células redondas que se presenta principalmenteen tejidos blandos; excepcionalmente se encuentraen tracto intestinal, pelvis, retroperitoneo y riñón. Métodos:El espécimen quirúrgico renal, fue fijado en formol al 10%, eincluido en parafina. El estudio de inmunohistoquímica comprendiólos siguientes anticuerpos: enolasa neuronal específica,sinaptofisina y mic2. Resultados: Reportamos el caso deun hombre de 32 años de edad atendido en el hospital universitariosan Vicente de Paúl, Medellín con diagnóstico de tumorrenal izquierdo, sin hematuria macroscópica al momento deingreso ni metástasis a distancia documentadas, dolor de difícilmanejo y sensación de masa abdominal a nivel del flancoizquierdo. Con dicho diagnóstico se lleva el paciente a cirugíapara realizar nefrectomía radical, observando en el acto quirúrgico,gran compromiso ganglionar aortocavo y peripancreático.Sin ninguna posibilidad de ofrecer coadyuvancia de tiporadio o quimioterapia durante el post operatorio debido a suevolución clínica, fallece a los 2 meses postoperatorios conenfermedad diseminada. En el estudio anatomopatológico seevidencia proliferación renal difusa de células redondas conformación de rosetas, con infiltración de la cápsula haciaregión abdominal, y ganglios locales comprometidos. El estudiode inmunohistoquímica resulta positivo para enolasa neuronalespecífica, sinaptofisina y mic2. Conclusiones: En lospacientes con diagnóstico de tumor renal, se debe llevar a caboun estudio histopatológico completo, incluyendo el estudio deinmunohistoquímica antes de realizar una cirugía radical,debido al mal pronóstico de los TNEP, que pese a tener unabaja frecuencia que conlleva a una mortalidad por encima del80% (5). En la actualidad por medio del estudio inmunohistoquímicocon sobre expresión del gene MIC2, detección detranslocación especifica, estudios de hibridización con fluoresceínay trascripción reversa de polimerasa podemos diferenciarcon certeza los TNEP primarios de los sarcomas deEwing y otros sarcomas de células redondeadas

Background: Primitive Neuroectodermal Tumor(PNET) is composed of small round cells and mainly foundin soft tissues outside the central nervous system. However,urinary system is rarely involved. Patients and methods:A case of a 32 year old male complaining of severe pain inthe left flank was diagnosed of a left renal tumor at theHospital Universitario San Vicente de Paul, Medellin,Colombia. A palpable lump at left abdominal flank wasnoticed. There was no history of hematuria or documentedmetastatic lesions. Radical nephrectomy was performed. Adiffuse enlargement of the left kidney with prominentlymph nodes around aortic, vena cava and pancreas werefound. Because of the bad patient’s clinical condition, neitherradio nor chemotherapy was offered. Patient died 2months after surgery with disseminated metastases. Nephrectomyspecimen was fixed in 10% formaldehyde andsamples were paraffin embedded. An immunohistochemicalstudy was performed including the following antibodies:NSE, synaptophysin and mic2. Results: Histologicalexamination showed a diffuse renal proliferation of roundcells with rosette formations. Invasion of the renal capsuleand metastasis to lymph nodes were noticed. Immunohistochemicalstudy reveals positivity for NSE, synaptophysinand mic2. Conclusions: In patients diagnosed of renaltumor, a complete hispathological study should be performed,including an immunohistochemical study before performingradical surgery. Although Primitive PNET is veryinfrequent, its mortality rate reaches 80%. Immunohistochemistry(mic2), specific translocation, flourescein andreversal transcription polimerase, can differentiate primaryPNET from other round cell tumors