Human intestinal spirochetosis, histological finding associated with diarrhea with poor clinical evolution

Human intestinal spirochetosis was described by Harland and Lee in 1971, after observing colonization of the apical membrane of the intestinal mucosa by spirochetes. The clinical importance of these findings is not clear, since it is unknown whether the presence of these microorganisms is pathogenic or commensal. The clinical presentation is variable. It can be asymptomatic or manifest with abdominal pain, changes in intestinal rhythm and rectal bleeding. The prevalence of intestinal spirochaetosis is notably higher in developing countries than in developed countries, with the most likely route of transmission being fecal-oral, although sexual transmission has also been suggested as it is more prevalent in homosexual men. We present the case of a 42-year-old man, in treatment for 3 years with Tenofovir, with an HIV-positive partner, who went to the hospital for persistent diarrhea associated with eating a hamburger. (AU)

Placenta Accreta in a COVID-19 positive patient

Placenta accreta spectrum is a state of abnormal attachment of the placenta to the myometrium, resulting in hemorrhage and delayed or impossible delivery of the placenta. It`s an infrequent pathology, and this condition can be life-threatening. We present an interesting case of a 41-year-old female with COVID-19 that attends the emergency room due to scanty vaginal bleeding at 14 days postpartum. A hemostatic hysterectomy was performed, and the diagnosis of placenta accreta was made. (AU)

Lesiones osteolíticas multifocales / Multifocal osteolytic lesions

A 79-year-old woman with multiple pathologies and multiple osteolytic lesions during the Covid-19 pandemic. Histopathological and radiological differential diagnosis of injuries. (AU)

Actualización del diagnóstico histopatológico de las enfermedades intersticiales difusas del pulmón / Current histopathologic diagnosis of the pulmonary diffuse interstitial diseases

Las enfermedades pulmonares intersticiales difusas (EDIP) son un grupo de procesos caracterizados por tener un patrón radiológico pulmonar difuso, asociado a un déficit fisiológico, cuya lesión histológica puede ser inflamatoria, fibrosante o ambas, dañando fundamentalemtne el intersticio pulmonar de forma multifocal o difusa. Se describen siete “patrones histológicos”: neumonía intersticial usual, neumonía intersticial no específiva, neumonía organizada, daño alveolar difuso, bronquiolitis respiratoria, neumonía intersticial descamativa y neumonía intersticial linfocítica. Se presenta un problema importante para el diagnóstico de las biopsias transbronquiales o quirúrgicas, debido a sus consecuencias pronósticas, fundamentalmente. Se discute la validez de la toma de biopsias múltiples, teniendo en cuenta la variabilidad de los cuadros morfológicos

The pulmonary diffuses interstitial diseases (EDIP) are a cluster of processes characterized by a pulmonary diffuse radiological pattern associated to an organic physiological deficit, whose histological lesion is an inflammatory one, fibrous or both, damaging the pulmonary interstice mainly in a multifocal or diffuse way. Seven “histological patterns” are described: usual interstitial pneumonia, non specific interstitial pneumonia, organized pneumonia, diffuse alveolar damage, respiratory bronchiolitis, interstitial desquamative pneumonia and lymphocytes interstitial pneumonia. An important difficult is shown at diagnosis in the cronchial biopsies as much as the surgical ones, mainly due to its prognostic consequences. The validity of multiple biopsy takes is discussed, considering the morphological variation

[Primary esophageal melanoma]. / Melanoma esofágico primario.

Primary malignant melanoma of the esophagus is an extremely rare non-epithelial neoplasm with a fatal prognosis. At present, approximately 184 cases have been published in the world literature. Of all published cases, 10 (5.4%) occurred in Spain. A 76 year-old man with malignant melanoma of the esophagus presented with dysphagia and weight loss, and treated by subtotal esophageal resection is reported. There was no history of previous cutaneous melanoma and ophthalmologic examination had been normal. At esophagoscopy a polypoid and pigmented mass (diameter 5 cm) almost completely occluding the lumen in the lower third of the esophagus was found. Multiple tumor biopsies were obtained. Histological diagnoses were made by examining endoscopic biopsy specimens and confirmed with resected specimens. The purpose of this communication is to present a case of primary esophageal malignant melanoma proved preoperatively by histological and immunohistochemical studies (positive reaction to the HMB-45 and S-100 antigen), followed by a review of the literature of these exceptional tumors.