Glioblastomas de larga supervivencia: un análisis sistemático de la literatura a propósito de un caso / Long-term survival of glioblastoma: A systematic analysis of literature about a case

Introducción: A pesar de las modificaciones introducidas en el tratamiento de los glioblastomas a partir del 2005, los pacientes supervivientes de más de 10 años se han mantenido constantes, siendo dicha cifra muy pobre e inferior al 1% en la mayoría de los estudios.Material y métodos: Se realiza un análisis sistemático de la literatura identificando los factores que pueden influir en los pacientes de larga supervivencia. Se identifica un caso en nuestro medio de más de 20 años de supervivencia realizándose un análisis actual del bloque de parafina que se conservaba del paciente.Resultados: La variable que más se asocia a la larga supervivencia en todos los análisis multivariantes es la edad, aunque, cuando se analiza las características genéticas y moleculares de los tumores, parecen existir otras variables como la metilación del promotor MGMT que juegan un papel muy importante. El análisis anatomo-patológico actual de la muestra comprueba la certeza del diagnóstico en nuestro paciente de muy larga supervivencia.Conclusiones: Múltiples variables son encontradas que influencian la larga supervivencia en distintas series, si bien los estudios analizados son muy heterogéneos resultando muy difícil la comparación entre ellos. La mayoría de los estudios referenciados pertenecen a bases de datos nacionales de distintos países que engloban a cientos de pacientes. Sería interesante fomentar el uso de una única base de datos en España que permita, entre otros, el análisis de estos pacientes de larga supervivencia afectos de glioblastoma (AU)

Introduction: In spite of the changes for the treatment of glioblastoma since 2005, we haven’t seen differences between long-survival patients of more than 10 years showing a value minor than 1%.Material and method: We realize a systematic analysis and identify important factors for long survivor patients. We also show an own case with more of 20 years of survival. We make a new pathological study of the old paraffin block of this patient.Results: The most important variable associated with long-survival between all multivariant studies is the age. When we try to find genetic and molecular alterations in glioblastoma associated with prolongated survival, the MGMT promoter methylation play the most important role. We find a correct diagnosis in the current analysis of our patient's sample with very long survival.Conclusions: Multiple variables are found that affect long survival of glioblastoma series but analyzed studies are very heterogeneous and it is very difficult comparation between them. Most articles we review are obtained from databases of different countries with hundreds of patients. It would be very interesting to promote the use of a single database in Spain that allows us to study these long-term glioblastoma survivors (AU)

[How has the Paris System contributed to urine cytology? Evaluating the contribution of the Paris System to urine cytology. A comparative study of the Paris System and the Papanicolaou method in a tertiary centre]. / ¿Qué ha aportado el sistema de París al diagnóstico en citología de orina? Estudio comparativo del sistema de París con el sistema clásico en un centro terciario.

INTRODUCTION AND OBJECTIVES: The Paris System (PS) has replaced the classical Papanicolaou System (PapS) in reporting urine cytology, due to its improved sensitivity and negative predictive value (NPV) without loss of specificity. Furthermore, it has enabled the risk of malignancy to be established in each cytological category. The aim of this study is to compare the Paris System with previous results and determine the changes in sensitivity, specificity, positive predictive value, NPV and risk of malignancy in our centre, MATERIALS AND METHODS: Evaluation of the diagnostic power of urine cytology by means of a retrospective cohort study, comparing two series of 400 cytological studies, one using the Papanicolaou System and the other the Paris System. RESULTS: In the detection of high-grade urothelial carcinoma, Paris System has better specificity (93.82% PapS vs 98.64% PS; P=.001) and PPV (39.5% PapS vs 70.6% PS; P=.044) than Papanicolaou System, without changes in sensitivity (53.5% PapS vs 37.5% PS; P=.299) or NPV (96.4% PapS vs 94.8% PS; P=.183). The risk of malignancy for the atypical category increases from low to high levels (1.6% PapS vs 40.0% PS; P=.001); the other categories showed no significant statistical changes. CONCLUSION: The Paris System improves specificity and positive predictive value and establishes a better indication of risk of malignancy for each category, enabling specific clinical management in each case.

¿Qué ha aportado el sistema de París al diagnóstico en citología de orina? Estudio comparativo del sistema de París con el sistema clásico en un centro terciario / How has the Paris System contributed to urine cytology? Evaluating the contribution of the Paris System to urine cytology. A comparative study of the Paris System and the Papanicolaou method in a tertiary centre

Introducción y objetivos: El sistema de París (SP) ha sustituido al sistema de Papanicolaou (SPap) como sistema de citodiagnóstico de orina. La evidencia indica que el SP ha logrado aumentar la sensibilidad y el valor predictivo negativo (VPN) sin perder especificidad, y establecer un riesgo de malignidad para cada categoría diagnóstica. El objetivo de este estudio es conocer los cambios que han experimentado la sensibilidad, especificidad, valor predictivo positivo (VPP), VPN y el riesgo de malignidad en la transición en nuestro centro. Materiales y métodos: Evaluación de prueba diagnóstica a través de una cohorte retrospectiva en la que se comparan dos series de 400 citologías de orina, una diagnosticada mediante el SPap y otra con SP. Resultados: Para la detección de carcinoma urotelial de alto grado describimos con el SP mejor especificidad (93,82 SPap vs. 98,64% SP; p=0,001) y VPP (39,5 SPap vs. 70,6% SP; p=0,044), sin observar cambios significativos en la sensibilidad (53,5 SPap vs. 37,5% SP; p=0,299) y VPN (96,4 SPap vs. 94,8% SP; p=0,183), respecto al SPap. El riesgo de malignidad en el SP experimenta un cambio estadísticamente significativo para la categoría atipia con respecto a la atipia en el SPap (1,6 SPap vs. 40,0% SP; p=0.001), manteniéndose el resto de las categorías sin cambios estadísticamente significativos. Conclusiones: El SP ha conseguido mejorar la especificidad y el VPP de la citología de orina y establece un riesgo de malignidad propio para la categoría de atipia, permitiendo establecer un manejo específico para cada resultado.(AU)

Introduction and objectives: The Paris System (PS) has replaced the classical Papanicolaou System (PapS) in reporting urine cytology, due to its improved sensitivity and negative predictive value (NPV) without loss of specificity. Furthermore, it has enabled the risk of malignancy to be established in each cytological category. The aim of this study is to compare the Paris System with previous results and determine the changes in sensitivity, specificity, positive predictive value, NPV and risk of malignancy in our centre. Materials and methods: Evaluation of the diagnostic power of urine cytology by means of a retrospective cohort study, comparing two series of 400 cytological studies, one using the Papanicolaou System and the other the Paris System. Results: In the detection of high-grade urothelial carcinoma, Paris System has better specificity (93.82% PapS vs 98.64% PS; P=.001) and PPV (39.5% PapS vs 70.6% PS; P=.044) than Papanicolaou System, without changes in sensitivity (53.5% PapS vs 37.5% PS; P=.299) or NPV (96.4% PapS vs 94.8% PS; P=.183). The risk of malignancy for the atypical category increases from low to high levels (1.6% PapS vs 40.0% PS; P=.001); the other categories showed no significant statistical changes. Conclusion: The Paris System improves specificity and positive predictive value and establishes a better indication of risk of malignancy for each category, enabling specific clinical management in each case.(AU)

Targeting mechanosensitive endothelial TXNDC5 to stabilize eNOS and reduce atherosclerosis in vivo.

Although atherosclerosis preferentially develops at arterial curvatures and bifurcations where disturbed flow (DF) activates endothelium, therapies targeting flow-dependent mechanosensing pathways in the vasculature are unavailable. Here, we provided experimental evidence demonstrating a previously unidentified causal role of DF-induced endothelial TXNDC5 (thioredoxin domain containing 5) in atherosclerosis. TXNDC5 was increased in human and mouse atherosclerotic lesions and induced in endothelium subjected to DF. Endothelium-specific Txndc5 deletion markedly reduced atherosclerosis in ApoE-/- mice. Mechanistically, DF-induced TXNDC5 increases proteasome-mediated degradation of heat shock factor 1, leading to reduced heat shock protein 90 and accelerated eNOS (endothelial nitric oxide synthase) protein degradation. Moreover, nanoparticles formulated to deliver Txndc5-targeting CRISPR-Cas9 plasmids driven by an endothelium-specific promoter (CDH5) significantly increase eNOS protein and reduce atherosclerosis in ApoE-/- mice. These results delineate a new molecular paradigm that DF-induced endothelial TXNDC5 promotes atherosclerosis and establish a proof of concept of targeting endothelial mechanosensitive pathways in vivo against atherosclerosis.

Long-term survival of glioblastoma: A systematic analysis of literature about a case.

INTRODUCTION: In spite of the changes for the treatment of glioblastoma since 2005, we have not seen differences between long-survival patients of more than 10 years showing a value minor than 1%. MATERIAL AND METHOD: We realize a systematic analysis and identify important factors for long survivor patients. We also show an own case with more of 20 years of survival. We make a new pathological study of the old paraffin block of this patient. RESULTS: The most important variable associated with long-survival between all multivariant studies is the age. When we try to find genetic and molecular alterations in glioblastoma associated with prolongated survival, the MGMT promoter methylation play the most important role. We find a correct diagnosis in the current analysis of our patient's sample with very long survival. CONCLUSIONS: Multiple variables are found that affect long survival of glioblastoma series but analyzed studies are very heterogeneous and it is very difficult comparation between them. Most articles we review are obtained from databases of different countries with hundreds of patients. It would be very interesting to promote the use of a single database in Spain that allows us to study these long-term glioblastoma survivors.

Protocolo para la valoración anatomopatológica de las piezas de cirugía de carcinomatosis peritoneal de origen ovárico, tubárico y peritoneal / Protocol for the examination of surgical specimens from patients with peritoneal carcinomatosis originating in ovary, fallopian tube and peritoneum

La carcinomatosis peritoneal (CP) es una entidad tumoral con una alta tasa de morbimortalidad, considerada la evolución común de varias neoplasias abdominopélvicas, entre ellas, el carcinoma de ovario, trompa uterina y peritoneo. Aunque muchos de estos tumores son sensibles a quimioterapia sistémica, el pronóstico es desfavorable por la elevada tasa de recurrencia. La cirugía de citorreducción (CC) se emplea como tratamiento de primera línea en los estadios avanzados, ya que aumenta la supervivencia de los pacientes cuando la CC es óptima. El procedimiento terapéutico descrito por Sugarbaker para el carcinoma de colon en la década de los 80, que incluye CC y quimioterapia intraperitoneal ha sido adaptado a la CP de origen ginecológico. El estudio anatomopatológico de esta cirugía empieza a ser una práctica habitual en algunos de nuestros servicios. Es un procedimiento complejo, que requiere especialización y sistematización para valorar un gran número de piezas quirúrgicas, cuantificando de forma lo más objetiva posible la carga tumoral. El objetivo de este trabajo es mostrar la experiencia inicial en nuestro servicio de anatomía patológica con pacientes diagnosticadas de CP de origen ovárico, tubárico y peritoneal y sometidas a cirugía citorreductora, destacando el papel del patólogo. Mostramos el esquema de trabajo utilizado en nuestro servicio y resumimos los resultados iniciales de 31 pacientes intervenidas entre enero de 2013 y julio de 2014

Peritoneal carcinomatosis (PC) is a malignant entity with a high rate of morbimortality. It is considered an end-stage common to several abdominal and pelvic malignant tumours, such as epithelial ovarian, fallopian tubal and peritoneal cancer. Although many of these tumors have a good response to chemotherapy, prognosis is poor due to the high rate of recurrence. Surgeons, gynecologists and oncologists are increasingly concerned with improving the survival. The surgical technique described by Sugarbaker in the eighties is a plausible option. It aims for a complete resection of macroscopic carcinomatosis (cytoreductive surgery) followed by intraoperative or perioperative intraperitoneal chemotherapy. This therapeutic option necessarily involves specific multidisciplinary units; histopathology of specimens from this surgical technique is now more frequent in our department. We describe our initial experience with PC originating from epithelial ovarian, tubal and peritoneal cancer treated with the modified Sugarbaker surgery employed in our hospital. We outline our protocol designed to achieve uniformity in procedure, and summarize the initial results

[Protocol for the examination of surgical specimens from patients with peritoneal carcinomatosis originating in ovary, fallopian tube and peritoneum]. / Protocolo para la valoración anatomopatológica de las piezas de cirugía de carcinomatosis peritoneal de origen ovárico, tubárico y peritoneal.

Peritoneal carcinomatosis (PC) is a malignant entity with a high rate of morbimortality. It is considered an end-stage common to several abdominal and pelvic malignant tumours, such as epithelial ovarian, fallopian tubal and peritoneal cancer. Although many of these tumors have a good response to chemotherapy, prognosis is poor due to the high rate of recurrence. Surgeons, gynecologists and oncologists are increasingly concerned with improving the survival. The surgical technique described by Sugarbaker in the eighties is a plausible option. It aims for a complete resection of macroscopic carcinomatosis (cytoreductive surgery) followed by intraoperative or perioperative intraperitoneal chemotherapy. This therapeutic option necessarily involves specific multidisciplinary units; histopathology of specimens from this surgical technique is now more frequent in our department. We describe our initial experience with PC originating from epithelial ovarian, tubal and peritoneal cancer treated with the modified Sugarbaker surgery employed in our hospital. We outline our protocol designed to achieve uniformity in procedure, and summarize the initial results.

Factores histopatológicos con valor pronóstico en el cordoma sacro. Estudio de 10 casos del Hospital Universitario Doctor Peset y el Hospital Clínico Universitario de Valencia / Histopathological factors of prognositic value in sacral chordoma. A 10 case study from the University Hospital «Doctor Peset» and the University Clinical Hospital of Valencia

El cordoma es una neoplasia de la línea media espinal que tiene su origen en derivados normales o en remanentes de la notocorda. Representa entre 1 y 4% de todos los tumores de hueso y suele afectar los extremos del esqueleto axial. Se considera una neoplasia de bajo grado con crecimiento lento e infrecuentes metástasis, sin embargo su gran capacidad de invasión local y su alto índice de recurrencia causan una considerable mortalidad tardía. Varios autores han propuesto múltiples factores clínicos y biológicos para predecir el pronóstico de la enfermedad, sin embargo la utilidad de la evaluación histopatológica pronóstica no está aún bien definida en estos casos. El objetivo de este estudio es evaluar las características histopatológicas de 10 casos de cordomas y correlacionar dichos datos con la evolución de la enfermedad (AU)

Chordomas are rare midline neoplasms arising from notochord tissue remnants. They account for 1-4% of all bone malignancies. Although considered to be slow growing, low grade neoplasms which rarely metastasize, their tendency for local invasion and frequent recurrence mean that they have a considerable late mortality rate. Several clinical and biological factors have been proposed as prognostic indicators, however, histopathological characteristics have not yet been considered. Our aim is to evaluate the histopathological features of ten cases of chordoma in relation to the clinical outcome (AU)

Classical Hodgkin's lymphoma of the thyroid / Linfoma de Hodgkin clásico del tiroides

Hodgkin's lymphoma is characterized by the presence of Reed–Sternberg cells. The majority of cases originate at nodal sites and only rarely does it occur in extranodal locations. Here we report a case of a woman with a classical Hodgkin's lymphoma of the thyroid developed from a Hashimoto thyroiditis. She presented with a mass in her thyroid which was surgically removed. Biopsy showed a nodular sclerosis classical Hodgkin's lymphoma. Our results were similar to previously reported cases. It would appear that the lesions grew over a MALT tissue created by the lymphoid proliferation of the thyroiditis. Differential diagnosis was made between the different types of lymphomas considering those most commonly occurring in extranodal lymphoid tissues. A final diagnosis was reached after consideration of the histopathology, immunophenotyping and molecular biology (AU)

El linfoma de Hodgkin se caracteriza por la presencia de células de Reed–Sternberg. La mayor parte de los casos se originan en ganglios linfáticos y raramente en localizaciones extranodales. Comunicamos un caso de una paciente con un linfoma de Hodgkin clásico desarrollado sobre una tiroiditis de Hashimoto. Se presentó como una masa tiroidea que fue extirpada. Histológicamente mostró un linfoma de Hodgkin clásico de tipo esclerosis nodular. Nuestros resultados concuerdan con casos publicados anteriormente. La lesión posiblemente se originó sobre un tejido MALT creado por la proliferación linfoide relacionada con la tiroiditis. Realizamos diagnósticos diferenciales entre diferentes tipos de linfoma que tienen lugar en tejido linfoide extranodal. El diagnóstico final fue realizado tras considerar su histopatología, inmunofenotipo y genética molecular (AU)

Defectos congénitos en recién nacidos y fetos procedentes de interrupción del embarazo tras diagnóstico prenatal en el período 1982-2009 / Evolution of the frequency of congenital defects in newborn infants and fetuses from terminations of pregnancy after prenatal diagnosis in the period 1982-2009

Fundamento y objetivo: El estudio de la frecuencia de los defectos congénitos (DC) requiere incluir interrupciones voluntarias del embarazo (IVE) por DC y evaluar los factores que influyen en aquella. Pacientes y método: Serie consecutiva de 517 recién nacidos (RN) y 202 IVE con DC en 38.191 nacimientos entre 1982-2009. Resultados: La frecuencia media de RN con DC es 13,54‰ y la de RN + IVE por DC de 18,73‰. Los DC aislados suponen el 61,12% en RN y el 52,17% en IVE. El 18,37% de los DC en RN y el 40,58% en IVE son sindrómicos. La media de edad gestacional en IVE es 17,92 semanas. La frecuencia global de anencefalia es 2,62 y 6,77 por 10.000, respectivamente, en RN y en RN + IVE. La de la espina bífida es 3,14 y 5,99 por 10.000, respectivamente. La frecuencia global de síndrome de Down es 10,74 por 10.000 RN y 22,14 por 10.000 RN + IVE. El porcentaje de madres extranjeras en nuestra maternidad alcanza el 35,9% en 2009. La media de edad materna asciende significativamente a lo largo del tiempo. Conclusiones: Observamos una disminución estadísticamente significativa de DC en RN, pero no en su concepción. No detectamos prevención primaria de anencefalia ni espina bífida. El descenso de síndrome de Down en RN no alcanza significación estadística. La diversidad étnica y la mayor edad materna pueden estar modificando la frecuencia. El 53% de los casos (RN + IVE) con DC del trienio 2007-2009 fueron IVE. Se precisa el estudio completo de IVE por DC para ofrecer consejo reproductivo (AU)

Background and objective: The study of congenital defects (CD) must include termination of pregnancy (TOP) for CD and evaluate risk factors that modify their frequency. Patients and methods: Consecutive series of 517 newborn and 202 TOP with CD among 38,191 childbirths, between 1982-2009 years. Results: The mean frequency for newborns with CD is 13.54‰ and for newborn and TOP with CD is 18.73‰. Single CD are 61.12% in newborns and 52.17% in TOP. The 18.37% of CD in newborn and 40.58% of TOP are syndromic. Mean gestational age for TOP is 17.92 weeks. Overall frequency of anencephaly is 2.62‰ for newborns and 6.77 for 10,000 for newborns and TOP. Spina bifida is 3.14 for 10,000 newborns and 5.99 for 10,000 newborns and TOP. Overall frequency of Down syndrome (DS) is 10.74 for 10,000 newborns and 22.14 for 10,000 newborns and TOP. The percentage of foreign mothers was 35.9% in 2009 and the mean maternal age significantly increased in this period. Conclusion: We observe a significant decrease of CD in newborns but not in their conception. We have not detected primary prevention for neural tube defects. The decrease in DS in newborns is not statistically relevant but ethnic diversity and maternal aging may be modifying the frequency. The 53% of CD were TOP in the period 2007-2009. It is mandatory a complete study for CD in TOP in order to offer serious reproductive counseling (AU)

[Evolution of the frequency of congenital defects in newborn infants and fetuses from terminations of pregnancy after prenatal diagnosis in the period 1982-2009]. / Defectos congénitos en recién nacidos y fetos procedentes de interrupción del embarazo tras diagnóstico prenatal en el período 1982-2009.

BACKGROUND AND OBJECTIVE: The study of congenital defects (CD) must include termination of pregnancy (TOP) for CD and evaluate risk factors that modify their frequency. PATIENTS AND METHODS: Consecutive series of 517 newborn and 202 TOP with CD among 38,191 childbirths, between 1982-2009 years. RESULTS: The mean frequency for newborns with CD is 13.54‰ and for newborn and TOP with CD is 18.73‰. Single CD are 61.12% in newborns and 52.17% in TOP. The 18.37% of CD in newborn and 40.58% of TOP are syndromic. Mean gestational age for TOP is 17.92 weeks. Overall frequency of anencephaly is 2.62‰ for newborns and 6.77 for 10,000 for newborns and TOP. Spina bifida is 3.14 for 10,000 newborns and 5.99 for 10,000 newborns and TOP. Overall frequency of Down syndrome (DS) is 10.74 for 10,000 newborns and 22.14 for 10,000 newborns and TOP. The percentage of foreign mothers was 35.9% in 2009 and the mean maternal age significantly increased in this period. CONCLUSION: We observe a significant decrease of CD in newborns but not in their conception. We have not detected primary prevention for neural tube defects. The decrease in DS in newborns is not statistically relevant but ethnic diversity and maternal aging may be modifying the frequency. The 53% of CD were TOP in the period 2007-2009. It is mandatory a complete study for CD in TOP in order to offer serious reproductive counselling.

Reflexiones sobre la patología ocular / No disponble

No disponible

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Uncommon occupational lung diseases: high-resolution CT findings.

OBJECTIVE: The purpose of this article is to describe the high-resolution CT (HRCT) features of uncommon occupational lung diseases. CONCLUSION: HRCT plays an increasing role in the evaluation of occupational lung diseases. We present several cases of unusual occupational lung diseases and their HRCT findings. The diseases studied were siderosis, talcosis, berylliosis, calcicosis, hypersensitivity pneumonitis (due to wheat flour and isocyanates), and Ardystil syndrome. The characteristic HRCT findings together with clinical features and related occupational history improve the diagnostic accuracy of these diseases.

Malignant cells are not found in ovarian cortex from breast cancer patients undergoing ovarian cortex cryopreservation.

BACKGROUND: Breast cancer is a frequent indication for ovarian cortex cryopreservation due to its high incidence. The main concern of this procedure is the possibility of reintroducing metastatic cells within the implant, an issue that has not been addressed systematically. Thus, a study was designed to analyse the presence of ovarian metastases in breast cancer patients undergoing ovarian tissue cryopreservation. METHODS: Morphological and immunohistochemical studies following the concept of the sentinel lymph node (SLN) were performed on 100 cortical ovarian biopsies obtained from 63 patients and on six frozen-thawed entire cortex from patients with the diagnosis of infiltrating ductal breast carcinoma undergoing ovarian cortex extraction and cryopreservation. The antibody panel included Cytokeratin CAM 5.2, Gross Cystic Disease Fluid Protein-15 (GCDFP15), Wilms' tumour antigen-1 (WT1) and Mammaglobin 1. RESULTS: Employing only morphologic criteria, suspicious neoplastic cells were detected in five biopsies, but in none of the six entire cortex analysed. These five cases were reclassified as hyperplasic surface epithelium-inclusion cysts (CAM 5.2+, WT1+) or apoptotic granulosa cells (CAM 5.2-, GCDFP15+, WT1-). CONCLUSIONS: Using the methodology of the SLN our data suggest the absence of tumour cells in biopsies obtained from patients undergoing ovarian cortex cryopreservation to preserve their fertility potential, although future methods of cancer screening may change our perception of this procedure.

Hepatitis tóxica por escitalopram / No disponible

No disponible

Sarcoma histiocítico con rasgos inmunohistoquímicos yultraestructurales de células dendríticas interdigitantes / Histiocytic sarcoma with immunohistochemical and ultraestructural interdigitating dendritic cell features

Introducción: El Sarcoma histiocítico (SH) es una neoplasiamuy poco frecuente, con mucha controversia respectoa los criterios diagnósticos de esta entidad. Desde que lastécnicas inmunohistoquímicas y citogenéticas presentan unamayor disponibilidad universal, muchos casos que inicialmentese diagnosticaron como sarcoma histiocítico, hansido reclasificados como otras enfermedades. Presentacióndel caso: Describimos el caso de un sarcoma histiocíticoque se presentó como una masa abdominal. En la autopsiatambién se observó afectación tumoral de pulmones, hígado,bazo y múltiples adenopatías. El examen histológicomostró proliferación difusa de células grandes con áreas denecrosis. Las células malignas eran de aspecto histiocitarioy pleomórficas. Inmunohistoquímicamente, las célulastumorales fueron positivas para tinciones contra marcadoreshistiocíticos y negativas para marcadores mieloides, dendríticos,CD30, ALK1, y otros marcadores linfoides. En elestudio ultraestructural las células mostraron extensionescitoplásmicas interdigitantes, pero no gránulos de Birbeck.Conclusiones: El sarcoma histiocítico plantea diagnósticodiferencial con otras neoplasias. El diagnóstico en este caso,se basa en la morfología, técnicas inmunohistoquícas yultraestructurales (AU)

Introduction: Histiocytic sarcoma (HS) is a rare disease.There has been much confusion concerning the diagnosticcriteria for this entity. Since immunohistochemicaland cytogenetic techniques have become more universallyavailable, many cases that were initially diagnosed as histiocyticsarcoma are now being classified as other diseases.Case presentation:We describe a case of HS that began asabdominal mass. At autopsy the tumour also involved lungs,liver, spleen and multiple lymph nodes. Histological examinationshowed proliferation of numerous large histiocyticpleomorphic and malignant cells with areas of necrosis.Immunohistochemically, tumour cells expressed histiocyticmarkers but did not stain with antibodies directed againstmyeloid markers, dendritic markers, CD30, ALK1, or otherlymphoid markers. Ultrastructural examination demostratedinterdigitating cytoplasmic extensions, but not Birbeckgranules. Conclusions: Histiocytic sarcoma raises differentialdiagnosis with other neoplasms. In this case, morphological,immunohistochemical and ultraestructural findingsare necessary for diagnosis (AU)

Histologic retinacular changes associated with ischemia in painful patellofemoral malalignment.

Ischemic changes in 31 samples of lateral retinacula excised at surgical realignment in patients with isolated symptomatic patellofemoral malalignment resistant to conservative treatment were evaluated with conventional histology, electron microscopy, immunohistochemistry, and molecular biology. Morphologic and ultrastructural changes associated with ischemia including hypervascularization and increased vascular endothelial growth factor release were identified in painful patellofemoral malalignment. It is hypothesized that periodic short episodes of ischemia could be implicated in the pathogenesis of anterior knee pain in most cases of isolated symptomatic patellofemoral malalignment in active young patients by triggering neural proliferation.

Anterior knee pain in the young patient--what causes the pain? "Neural model".

Anterior knee pain in young patients is the commonest type of knee disorder in clinical practice. However, the pathogenesis of this condition is unknown. On the basis of our recent research, we suggest a "neural model". In our view, hyperinnervation in the lateral retinaculum, mainly nociceptive substance P-positive nerves induced by the release of neural growth factor, is involved in the pathogenesis of anterior knee pain. We hypothesize that periodic short episodes of ischemia may trigger neural proliferation.