Metástasis espinal por carcinoma de células de Merkel en paciente inmunodeprimido: caso clínico / Merkel cell carcinoma spinal metastases in an immunosuppressed patient: Clinical case

El carcinoma de células de Merkel es un tumor cutáneo maligno poco frecuente, originado a partir de las células neuroendocrinas de la epidermis, denominadas células de Merkel. Presenta un pronóstico infausto cuando la enfermedad es diseminada. Dentro de las metástasis a distancia, la localización espinal es muy poco frecuente y no existe un consenso en cuanto a su manejo. Presentamos el segundo caso descrito en la literatura hasta el momento de afectación metastásica espinal por carcinoma de células de Merkel en paciente inmunodeprimido (AU)

Merkel cell carcinoma is a rare epidermal malignant tumor arised from neuroendocrine epidermal cells, called Merkel cells. Prognosis is poor when tumor spreads to distant locations. Among metastases sites, spinal is not frequent at all and its management remains controversial. We present the second reported case of spinal metastases from Merkel cell carcinoma in an immunosuppressed patient (AU)

Merkel cell carcinoma spinal metastases in an immunosuppressed patient: Clinical case. / Metástasis espinal por carcinoma de células de Merkel en paciente inmunodeprimido: caso clínico.

Merkel cell carcinoma is a rare epidermal malignant tumor arised from neuroendocrine epidermal cells, called Merkel cells. Prognosis is poor when tumor spreads to distant locations. Among metastases sites, spinal is not frequent at all and its management remains controversial. We present the second reported case of spinal metastases from Merkel cell carcinoma in an immunosuppressed patient.

Variabilidad pronóstica del meningioma atípico con resección completa. Propuesta de algoritmo de tratamiento / Prognostic variability in atypical meningioma with complete resection. Proposed treatment algorithm

Objetivo: Los autores pretenden evidenciar que los factores pronósticos actuales que intentan evaluar el riesgo de recidiva de los meningiomas atípicos se muestran insuficientes para predecir el devenir de dicha patología. Material y método: Mediante los datos obtenidos de las bases de datos hospitalarias se adquiere una muestra de 27 pacientes con un diagnóstico anatomopatológico de meningioma atípico, con un tiempo mínimo de seguimiento de 6meses tras el diagnóstico. Posteriormente se evalúan los factores pronóstico (edad < 50años, sexo masculino, afectación ósea, edema perilesional, volumen tumoral, localización, Ki67/MIB-1) tras la estratificación de los pacientes sometidos a resección completa en recidivantes y no recidivantes. El análisis univariante se realiza mediante test de Mann-Whitney, test χ2 de homogeneidad/test exacto de Fisher. Finalmente se realiza el análisis multivariante mediante regresión logística binaria, obteniéndose los valores correspondientes a la R2 de Nagelkerke y el test de Hosmer-Lemeshow para evaluar la bondad del ajuste. Resultados: Los análisis uni y multivariante no muestran diferencias estadísticamente significativas entre los subgrupos recidivante y no recidivante de los pacientes sometidos a resección completa. Como resultado destacable se objetiva que por cada año de edad por encima de los 50años se disminuye el riesgo de recidiva un 5,8%. Conclusiones: Aunque los factores pronósticos actuales puedan mostrar un incremento del riesgo de recidiva una vez se estratifica a los pacientes por los 2 factores más importantes (anatomía patológica y grado de resección), dichos factores se muestran insuficientes para predecir el pronóstico final de los pacientes afectos por dicha patología

Objective: The authors attempt to show how the current prognostic factors that try to assess the risk of recurrence of atypical meningiomas are insufficient to predict the future of this disease. Materials and method: Using data obtained from hospital databases, a sample of 27 patients was obtained with pathological diagnosis of atypical meningioma, and who had a minimum follow-up time of 6months after diagnosis. Later prognostic factors (age <50years, male gender, bone involvement, peri-lesional swelling, tumour volume, location, Ki67/MIB-1) were evaluated after the stratification of patients undergoing complete resection in recurrencies and non-recurrencies. Univariate analysis was performed using Mann-Whitney test, χ2 homogeneity test/Fisher exact test. Finally, multivariate analysis was performed using binary logistic regression to obtain the values for R2 Nagelkerke and the Hosmer-Lemeshow to evaluate the goodness of fit. Results: The uni- and multivariate analysis showed no statistically significant differences between recurrent and non-recurrent subgroups of patients undergoing complete resection. It is noted in the results that for each year of age above 50years, the risk of recurrence is decreased by 5.8%. Conclusions: Although current prognostic factors may show an increased risk of recurrence once patients are stratified by the two most important factors (pathology and extent of resection), those factors are insufficient to predict the ultimate outcome of patients affected by this pathology

[Prognostic variability in atypical meningioma with complete resection. Proposed treatment algorithm]. / Variabilidad pronóstica del meningioma atípico con resección completa. Propuesta de algoritmo de tratamiento.

OBJECTIVE: The authors attempt to show how the current prognostic factors that try to assess the risk of recurrence of atypical meningiomas are insufficient to predict the future of this disease. MATERIALS AND METHOD: Using data obtained from hospital databases, a sample of 27 patients was obtained with pathological diagnosis of atypical meningioma, and who had a minimum follow-up time of 6months after diagnosis. Later prognostic factors (age <50years, male gender, bone involvement, peri-lesional swelling, tumour volume, location, Ki67/MIB-1) were evaluated after the stratification of patients undergoing complete resection in recurrencies and non-recurrencies. Univariate analysis was performed using Mann-Whitney test, χ(2) homogeneity test/Fisher exact test. Finally, multivariate analysis was performed using binary logistic regression to obtain the values for R(2) Nagelkerke and the Hosmer-Lemeshow to evaluate the goodness of fit. RESULTS: The uni- and multivariate analysis showed no statistically significant differences between recurrent and non-recurrent subgroups of patients undergoing complete resection. It is noted in the results that for each year of age above 50 years, the risk of recurrence is decreased by 5.8%. CONCLUSIONS: Although current prognostic factors may show an increased risk of recurrence once patients are stratified by the two most important factors (pathology and extent of resection), those factors are insufficient to predict the ultimate outcome of patients affected by this pathology.

Microsurgical Relations between Internal Carotid Artery-Posterior Communicating Artery (ICA-PComA) Segment Aneurysms and Skull Base: An Anatomoclinical Study.

Purpose The study of the clinical, anatomic, imaging, and microsurgical characteristics of the aneurysms of the internal carotid-posterior communicating artery (ICA-PComA) segment and their relationships with the skull base structures. Methods The anatomic relationships of PComA with neurovascular elements and skull base structures were studied in cadavers. The clinical, imaging, and microsurgical findings of 84 microsurgically treated ICA-PComA aneurysms compiled in a prospective database were reviewed. Results The most important anatomic relations of the PComA and ICA-PComA aneurysms are with the oculomotor nerve around the oculomotor triangle that forms the roof of the cavernous sinus. Aneurysms of the ICA-PComA are classified according to the orientation of the aneurysmal sac in infratentorial, supratentorial, and tentorial. Infratentorial aneurysms frequently present with subarachnoid hemorrhage (SAH) and oculomotor nerve paralysis. They have relations with skull base structures that often make it necessary to totally or partially resect the anterior clinoid process (6.7%) or anterior petroclinoid dural fold (15%). Supratentorial aneurysms course with SAH and without oculomotor nerve involvement, but they often are associated with intracranial hematoma. Conclusion ICA-PComA aneurysms have complex anatomic relations. The orientation of the aneurysmal fundus induces relevant differences in the anatomic relations, clinical presentation, and microsurgical approach to ICA-PComA aneurysms.