Pleomorphic mastocytoma in an adult.

Cutaneous mastocytoma (CM) is a localized variant of mastocytosis, characterized by an over-accumulation of mast cells in the skin, without extra-cutaneous organ involvement. It is defined as the presence of up to 3 isolated mast-cell skin lesions and commonly develops in newborns and children. We report the case of a 35-year-old healthy Caucasian woman presenting with a 4-year history of a pruritic brown plaque on her left breast. Hematoxylin-eosin staining showed a dense dermal infiltrate of atypical mast cells extending to the subcutis. The cells presented a marked nuclear pleomorphism with bilobed and multilobed nuclei. Immunohistochemical studies revealed strongly expressed KIT (CD117) and CD25 proteins. Serum tryptase levels and bone marrow biopsy were normal. The diagnosis was a solitary cutaneous pleomorphic mastocytoma. This case can be added to 17 other cases of adult mastocytoma documented in the literature, although, unlike other reported cases, and as far as we are aware, this is the first case of pleomorphic mastocytoma in an adult.

Localized xanthomas associated with primary lymphedema.

Cutaneous xanthomas arising in chronic lymphedema are rare. We present a case of verruciform xanthoma involving the left foot and toes of a 10-year-old boy who had developed a primary lymphedema (lymphedema praecox) in the left lower extremity. Laboratory studies demonstrated a normal lipid profile.

Identification of t(17;22)(q22;q13) (COL1A1/PDGFB) in dermatofibrosarcoma protuberans by fluorescence in situ hybridization in paraffin-embedded tissue microarrays.

Dermatofibrosarcoma protuberans is genetically characterized by the translocation t(17;22)(q22;q13) resulting in the PDGFB/COL1A1 fusion gene. Fluorescence in situ hybridization with specific probes enables a rapid detection of this gene. In this study, the presence of the translocation t(17;22)(q22;q13) by fluorescence in situ hybridization in paraffin-embedded tissue microarrays was analyzed. Two tissue microarrays including 40 cases of dermatofibrosarcoma protuberans and 20 dermatofibromas were evaluated. Fluorescence in situ hybridization analyses were performed using a dual-color dual-fusion noncommercial probe. Clinical and histopathologic features were examined, and the association with fluorescence in situ hybridization results was assessed. A total of 29 samples of dermatofibrosarcoma protuberans and 16 of dermatofibromas were successfully evaluated. Twenty-five (86%) dermatofibrosarcoma protuberans samples were positive for the translocation, which was absent in all samples of dermatofibromas. Two of the negative dermatofibrosarcoma protuberans showed unusual, hypercellular areas with marked cytologic atypia, whereas 1 case exhibited overlap features with dermatofibroma. Tumors with fibrosarcomatous areas seemed to have a higher percentage of positive cells and the number of copies of the COL1A1/PDFGB gene. In conclusion, the COL1A1/PDGFB fusion gene was present in most of the dermatofibrosarcoma protuberans tissue samples. The detection of the translocation may be an additional diagnostic tool in cases of dermatofibrosarcoma protuberans showing nonconclusive histologic features.

Adjuvant docetaxel for high-risk, node-negative breast cancer.

BACKGROUND: A regimen of docetaxel, doxorubicin, and cyclophosphamide (TAC) is superior to a regimen of fluorouracil, doxorubicin, and cyclophosphamide (FAC) when used as adjuvant therapy in women with node-positive breast cancer. The value of taxanes in the treatment of node-negative disease has not been determined. METHODS: We randomly assigned 1060 women with axillary-node-negative breast cancer and at least one high-risk factor for recurrence (according to the 1998 St. Gallen criteria) to treatment with TAC or FAC every 3 weeks for six cycles after surgery. The primary end point was disease-free survival after at least 5 years of follow-up. Secondary end points included overall survival and toxicity. RESULTS: At a median follow-up of 77 months, the proportion of patients alive and disease-free was higher among the 539 women in the TAC group (87.8%) than among the 521 women in the FAC group (81.8%), representing a 32% reduction in the risk of recurrence with TAC (hazard ratio, 0.68; 95% confidence interval [CI], 0.49 to 0.93; P=0.01 by the log-rank test). This benefit was consistent, regardless of hormone-receptor status, menopausal status, or number of high-risk factors. The difference in survival rates (TAC, 95.2%; FAC, 93.5%) was not significant (hazard ratio, 0.76; 95% CI, 0.45 to 1.26); however, the number of events was small (TAC, 26; FAC, 34). Rates of grade 3 or 4 adverse events were 28.2% with TAC and 17.0% with FAC (P<0.001). Toxicity associated with TAC was diminished when primary prophylaxis with granulocyte colony-stimulating factor was provided. CONCLUSIONS: As compared with adjuvant FAC, adjuvant TAC improved the rate of disease-free survival among women with high-risk, node-negative breast cancer. (Funded by GEICAM and Sanofi-Aventis; ClinicalTrials.gov number, NCT00121992.).

Analysis of the pathologic response to primary chemotherapy in patients with locally advanced breast cancer grouped according to estrogen receptor, progesterone receptor, and HER2 status.

PURPOSE: In clinical practice, it is possible to classify breast tumors according to estrogen receptor (ER), progesterone receptor (PgR), and HER2 overexpression: ER negative, PgR negative, and HER2 overexpressing; ER negative, PgR negative, and HER2 negative; ER positive, PgR positive, and HER2 negative; ER positive, PgR positive, and HER2 overexpressing; and the less frequent remaining 4 combinations. The aim of this study was to determine the percentage of pathologic complete response (pCR) in patients with locally advanced breast cancer (LABC) treated with neoadjuvant or primary chemotherapy with anthracyclines and taxanes grouped according to ER, PgR, and HER2 status. PATIENTS AND METHODS: Patients with LABC treated with primary chemotherapy including anthracyclines and taxanes were grouped according to ER, PgR, and HER2 status; pCR rates were analyzed using the chi(2) test; and correlations with a P value of < or = 0.05 were considered statistically significant. RESULTS: A total of 103 patients were treated. Only 100 patients were included for the analysis of pCR. Eighteen patients exhibited pCR. The pCR rate for each subgroup was as follows: 39.1% (9 of 23) had ER-negative, PgR-negative, and HER2-negative disease (P < 0.01); 35.7% (5 of 14) had ER-negative, PgR-negative, and HER2-overexpressing disease; 33.3% (3 of 9) had ER-positive, PgR-positive, and HER2-overexpressing disease; and 2.8% (1 of 36) had ER-positive, PgR-positive, and HER2-negative disease (P < 0.01). CONCLUSION: In patients with LABC, grouping breast tumors according to ER, PgR, and HER2 status can help predict pCR to primary chemotherapy.

Multicentric reticulohistiocytosis-mimicking dermatomyositis. Case report and review of the literature.

Multicentric reticulohistiocytosis is a rare disorder of unknown etiology, characterized by skin and mucosal papulonodular eruptions and destructive polyarthritis. Histopathological study of these lesions shows a nodular infiltrate composed of histiocytes and multinucleated giant cells, with an eosinophilic, granular, 'ground-glass' cytoplasm. We report a case of multicentric reticulohistiocytosis with skin lesions mimicking dermatomyositis and we also review previously reported cases describing such a clinical situation. Our case further emphasizes that multicentric reticulohistiocytosis can mimic clinical features of dermatomyositis. A macular or patch-like erythema in a photodistributed fashion, in addition to other clinical manifestations, can be mistaken for dermatomyositis. However, skin biopsies from these areas may early differentiate both conditions with different treatment options and morbidity.

Breast core biopsy reporting categories--An internal validation in a series of 3054 consecutive lesions.

We reviewed 3226 consecutive core biopsies (CBs) of 3054 mammographically detected breast lesions performed at our Centre from November 1993 to June 2003. CB diagnoses, classified according to the Non-operative Diagnosis Subgroup of the British National Health Service Breast Cancer Screening Programme (NHSBSP), were B5 (37.1%), B4 (0.5%), B3 (7.6%), B2 (50.9%) and B1 (3.9%). It was necessary to repeat the procedure in 172 cases (5.3%). The values for absolute sensitivity and specificity are 90.8% and 83.8%, respectively. The positive predictive value for categories B4 and B5 is 100%, with no false-positives. The positive predictive value for category B3 is 16.3%. The negative predictive value for B2 category is 97.2%, with a false-negative rate of 3.5%. In conclusion, this system of analysis has enabled us to confirm that our CB results surpass the minimum recommended standards proposed by the NHSBSP.

An unusual case of tophaceous gout involving the anterior cruciate ligament.

Abstract We describe a very unusual case of a 49-year-old man with tophaceous gout involving and infiltrating the base of the anterior cruciate ligament of the left knee. To our knowledge, such a case has never been reported in the literature, although gout is well known and widely studied. Magnetic resonance imaging findings and differential diagnosis were analyzed before arthroscopy. Tophaceous gout was suspected at arthroscopy and confirmed on pathologic examination. Treatment consisted of partial removal of the tumor by arthroscopy, conserving the anterior cruciate ligament.

Granuloma piogénico recurrente con satelitosis / Recurring pyogenic granuloma with satellitosis

El granuloma piogénico es una tumoración vascular benigna de la piel y las mucosas que puede aparecer espontáneamente o tras un traumatismo. Se describe el caso de un varón de 15 años de edad que, tras la exéresis de un granuloma piogénico en la zona clavicular, desarrolló múltiples lesiones alrededor de la lesión primaria. La aparición de satelitosis es un fenómeno poco frecuente (AU)

Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle.

We report a case of a mucoid degeneration of the anterior cruciate ligament (ACL) that produced osseous erosion of the medial aspect of the lateral femoral condyle. The MRI findings and differential diagnosis are discussed.

Fine-needle aspiration cytology diagnosis of metastatic gastrointestinal stromal tumor in the liver: a report of three cases.

Gastrointestinal stromal tumor (GIST) is the designation for a major subset of gastrointestinal mesenchymal tumors that histologically, immunocytochemically, and genetically differ from leiomyomas, leiomyosarcomas, and schwannomas. GISTs derive from the interstitial cells of Cajal and, in addition to variable expression of smooth muscle and neural markers, they characteristically express CD34 and CD117. The cytological appearance, including immunocytochemical and mutational analysis of c-kit gene in primary GIST has been well described. To our knowledge, only two cases of metastatic GIST diagnosed by fine-needle aspiration (FNA) have been reported. We illustrate three cases of metastatic GIST in the liver. Two cases had no prior history of gastrointestinal tumor and the third case had a 4-yr previous history of duodenal tumor. Consistent immunocytochemistry and ultrastructual studies supported the diagnosis of GIST. We emphasize that in the appropriate clinical and radiological setting, a confident diagnosis of GIST can be established by FNA of metastatic lesions.

Incontinencia urinaria en la mujer: plan de cuidados de enfermería / Urinary incontinence in women: nursing care plan

Existe la necesidad de un abordaje integral del problema de la incontinencia urinaria en las mujeres en el ámbito de la atención primaria. Hasta ahora se han dedicado la mayor parte de los esfuerzos y recursos al tratamiento paliativo (dispositivos absorbentes) y, en menor medida, a los tratamientos farmacológicos, que presentan una gran cantidad de efectos secundarios. En la actualidad, los cuidados de enfermería facilitan la resolución del problema desde un abordaje integral y con una alta efectividad, tal como se ha demostrado en numerosos estudios (AU)

Impacto de una estrategia de implantación de diagnósticos de enfermería en un área de atención primaria / Effect of an implementation strategy for nursing diagnoses in a primary care district

El objetivo de nuestro estudio es conocer el impacto tras la intervención realizada en el área de salud de El Bierzo para la implantación de los diagnósticos de enfermería (DE) y planes de cuidados estandarizados, y evaluar el éxito o el fracaso de esta estrategia de implantación. Por tanto, al valorar la efectividad de esta estrategia, lo que se pretende es facilitar una herramienta de gestión que podría ser utilizada por aquellas áreas de atención primaria que lo consideren oportuno, conociendo los resultados que con ella obtuvimos en nuestra área, con el margen de error que nos dicta la estadística y teniendo en cuenta las características propias de cada área de salud. El diseño del estudio es experimental, del tipo cuasiexperimental. Como resultados podríamos destacar que el 62,5 per cent de los profesionales de enfermería demuestra conocer los DE, frente al 24,6 per cent que lo demostraba antes de la intervención. Utiliza sistemáticamente los DE el 10,93 per cent, y de forma esporádica el 32,81 per cent, frente al 3,5 y el 17,5 per cent, respectivamente, que lo hacían antes de la intervención. La conclusión más importante es la necesidad de profundizar en otras estrategias de gestión diferentes de la formación para conseguir la utilización de los DE de forma mayoritaria por los profesionales de enfermería de nuestra área (AU)

Diagnósticos de enfermería en el área de atención primaria de El Bierzo: punto de partida y estrategia de implantación / Nursing diagnoses in the primary health care area of El Bierzo (Spain): starting point and implementation strategy

Hay estudios que consideran de vital importancia realizar investigaciones sobre la aplicación del proceso de enfermería en el ámbito profesional. Los antecedentes sobre este tipo de estudios que nos encontramos a través de la revisión bibliográfica son de Dakota del Sur (EE.UU.) y Lleida en España. El objetivo de nuestro estudio es conocer el grado de utilización de los diagnósticos de enfermería en particular y del proceso de atención de enfermería en general, entre las enfermeras del Área de Salud de El Bierzo y describir los factores que condicionan tal situación. El diseño del estudio es observacional descriptivo de tipo transversal. Como resultados podríamos destacar que utilizan sistemáticamente el proceso de atención de enfermería en su trabajo el 10,63 por ciento de los enfermeros. Demuestra conocer los diagnósticos enfermeros el 24,6 por ciento de las enfermeras y de éstas sólo los utiliza habitualmente el 3,5 por ciento. Las causas de la no utilización son principalmente la falta de conocimientos en el 50 por ciento de los casos. Como conclusiones cabe destacar la importancia de los planes de estudios universitarios y la necesidad de desarrollar estrategias de implantación de la metodología enfermera basados en estudios de situación del área de salud (AU)