Validation of digital image slides for diagnosis in cervico-vaginal cytology.

OBJECTIVE: To test the diagnostic concordance between microscopic (MI) and digital (DG) observation of cervico-vaginal (CV) cytology in a validation study of the technique. METHODS: Five cytotechnologists (CT) reviewed 888 routine CV cytology cases from the Cervical Pathology Unit of our center over a 2-week period of time. The cases were first observed by MI and at the end of the day the cases were observed by DG. STATISTICAL ANALYSIS USED: Agreement calculated using the Kappa index. RESULTS: Most of the diagnoses corresponded to benign (64%) or inflammatory conditions (14%) and 24% corresponded to the intraepithelial lesion or malignancy (ILM) category. The overall kappa coefficient of concordance was strong (0.87). Among the different CTs it was almost perfect in two, strong in two and moderate in one. In 18 cases (10%) there were discrepancies between techniques in the category of ILM. In 10 (56%) cases there was an overdiagnosis in DG and in 8 (44%) an overdiagnosis in MI. Only in two cases, the diagnostic discrepancy exceeded one degree of difference between lesions, and they were ASCUS or AGUS for DG and CIN 2 for MI. CONCLUSIONS: In this validation test in which routine cases during a two-week period have been used, observing the cases with both techniques on the same day, we have obtained a strong degree of concordance. The discordances obtained have not been considered relevant.

Orbital amyloid tumor associated with myasthenia gravis.

We present a case of a 53-year-old female with an 11 year history of myasthenia gravis (MG) with palpebral ptosis in the left eye which had become more marked over the previous year. Examination revealed a painless left orbital mass causing ptosis. The tumor was surgically removed and histopathology revealed deposits of a hyaline substance which when stained with Congo Red had an apple-green birefringence with polarized light, typical of amyloid. In the absence of amyloid deposits elsewhere in the body, amyloid tumor (AT) was diagnosed. No myelo- or lymphoproliferative syndromes, systemic involvement by amyloidosis or any autoimmune disease were found. The evolution and aesthetic results where satisfactory. Only two cases of orbital AT associated with MG have been described previously; however, in one of the cases, the symptoms of the AT had led to a false diagnosis of MG.

Requerimientos del esquema de control de calidad europeo para el tratamiento de las pacientes con cáncer en las unidades de mama. Iniciativa de la Comisión Europea para el Cáncer de Mama (ECIBC) / Requirements of the European quality assurance scheme for the treatment of cancer patients in breast units. European Commission Initiative on Breast Cancer (ECIBC)

Consciente del problema que supone el cáncer de mama, tanto a nivel de incidencia como de mortalidad, la Dirección General para la Salud y la Seguridad Alimenticia de la Comisión Europea ha creado el programa de la Iniciativa para el Cáncer de Mama de la Comisión Europea (ECIBC) para establecer una igualdad en la oportunidad del manejo del cáncer de mama en todas las pacientes de la Unión con independencia del país en el que se traten. En este proyecto se han redactado 86 requerimientos que engloban aspectos generales de cribado, de diagnóstico, de tratamiento, de rehabilitación, de seguimiento y de cuidados paliativos del cáncer de mama, que han de cumplir aquellas Unidades de Mama (UM) que quieran obtener esta certificación. De momento se ha lanzado un programa piloto para las UM voluntarias con la finalidad de evaluar la viabilidad de la aplicación de estos requerimientos y obtener un feedback por parte de las mismas para el redactado final de estos. En esta contribución se exponen los requerimientos que integran el proyecto. (AU)

Aware of the problem of breast cancer in terms of both incidence and mortality, the European Commission's Directorate General for Health and Food Safety has created the European Commission Initiative on Breast Cancer (ECIBC) program to establish equal opportunity in the management of breast cancer in all patients in the Union, regardless of the country in which they are treated. In this project, 86 requirements have been designed, covering general aspects of: screening, diagnosis, treatment, rehabilitation, follow-up and palliative care of breast cancer, which must be met by those Breast Cancer Services (BCS) that wish to obtain this certification. A pilot program has been launched for voluntary BCS in order to evaluate the feasibility of applying these requirements and to obtain feedback from them for the final drafting of these requirements. This contribution sets out the requirements. (AU)

[Isolated conjunctival sebaceous adenoma associated with acute endophtalmitis]. / Adenoma sebáceo conjuntival aislado asociado a endoftalmitis aguda.

Sebaceous adenoma of the conjunctiva is a very rare lesion of uncertain origin. It is usually associated with Muir-Torre syndrome in which neoplasms are also found in other parts of the body. We present the case of a 71-year-old man without a previous or family history of neoplasia, who presented with severe inflammation and an infection in his right eye associated with a tumor of the conjunctiva near the caruncle. The lesion was excised and histopathology revealed a sebaceous adenoma. Microsatellite instability was not observed immunohistochemically. He remains alive and well.

Adenoma sebáceo conjuntival aislado asociado a endoftalmitis aguda / Isolated conjunctival sebaceous adenoma associated with acute endophtalmitis

El adenoma sebáceo de la conjuntiva es una lesión muy rara y de un origen incierto. Habitualmente se asocia al síndrome de Muir-Torre en el que además hay neoplasias en otras partes del organismo. Presentamos el caso de un varón de 71 años sin afectación neoplásica ni antecedentes familiares, con un cuadro inflamatorio e infeccioso severo en el ojo derecho asociado a una tumoración a nivel conjuntival próximo a la carúncula. La lesión se extirpó y el estudio anatomopatológico reveló un adenoma sebáceo. No se observó inmunohistoquímicamente inestabilidad de microsatélites. La evolución fue satisfactoria.(AU)

Sebaceous adenoma of the conjunctiva is a very rare lesion of uncertain origin. It is usually associated with Muir-Torre syndrome in which neoplasms are also found in other parts of the body. We present the case of a 71-year-old man without a previous or family history of neoplasia, who presented with severe inflammation and an infection in his right eye associated with a tumor of the conjunctiva near the caruncle. The lesion was excised and histopathology revealed a sebaceous adenoma. Microsatellite instability was not observed immunohistochemically. He remains alive and well.(AU)

Developing indicators for quality assurance in cytopathology. Catalan Society of Cytopathology.

BACKGROUND: Quality control in cytology must be established through reliable and easily measurable indicators. METHODS: From the Catalan Society of Cytopathology a group of experts has been established to write a document with 13 indicators that cover the entire cytological process, based on its Cytopathology Quality Guide. It has been elaborated through guides and documents with scientific evidence and DELPHI methodology in order to reach a structured consensus on the opinions of a group of experts. RESULTS: Thirteen indicators, covering all the cytologic process are expressed in worksheets specifying all their characteristics. CONCLUSION: This document allows the control of all stages of the cytological process.

Histological comparison of in vitro and in vivo development of peripheral posterior capsule opacification in human donor tissue.

In order to study the mechanisms involved in the development of posterior capsule opacification (PCO) we compared in vivo developed PCO with PCO formed in tissue culture with focus on the periphery of the lens capsule to evaluate lens regeneration potential. We studied three human tissue groups: Cultured lens capsules after mock cataract surgery (n = 6, 30 days), lens capsules from donors that had previously undergone cataract surgery (IOL capsules) (n = 12) and intact lenses (n = 6). All samples were stained with Vimentin, alpha Smooth Muscle Actin, Picro Sirius Red (for collagen) and Paired box protein (Pax6). We found that cultured capsules and less developed IOL capsules consisted mainly of monolayers of mesenchymal cells, while more developed IOL capsules, contained lens epithelial cells (LECs), globular cells and lens fiber cells. Many IOL capsule samples expressed collagen I and III in areas where cells were in contact with the IOL. Pax6 had a similar dispersed distribution in less developed IOL capsules and cultured capsules, while more developed IOL capsules and intact lenses, concentrated Pax6 in LECs at the equatorial lens bow. The similarities between cultured capsules and less developed IOL capsules indicate that our in vitro developed PCO is comparable to early in vivo developed PCO. The similar morphology of more developed IOL capsules and intact lenses seems to indicate an attempt at lens regeneration.

Clinical and Ultrasound Characteristics of the Microcystic Elongated and Fragmented (MELF) Pattern in Endometrial Cancer According to the International Endometrial Tumor Analysis (IETA) criteria.

OBJECTIVES: To describe sonographic features of the microcystic elongated and fragmented (MELF) pattern of myometrial invasion (MI) using the International Endometrial Tumor Analysis (IETA) criteria; to assess the effect of the MELF pattern on preoperative ultrasound evaluation of MI; and to determine the relationship of the MELF pattern to more advanced stage (≥ IB) and lymph node metastases in women with endometrioid endometrial cancer. METHODS/MATERIALS: We included 850 women with endometrioid endometrial cancer from the prospective IETA 4 study. Ultrasound experts performed all ultrasound examinations, according to the IETA protocol. Reference pathologists assessed the presence or absence of the MELF pattern. Sonographic features and accuracy of ultrasound assessment of MI were compared in cases with the presence and the absence of the MELF pattern. The MELF pattern was correlated to more advanced stage (≥IB) and lymph node metastases. RESULTS: The MELF pattern was present in 197 (23.2%) women. On preoperative ultrasound imaging the endometrium was thicker (p = 0.031), more richly vascularized (p = 0.003) with the multiple multifocal vessel pattern (p < 0.001) and the assessment of adenomyosis was more often uncertain (p < 0.001). The presence or the absence of the MELF pattern did not affect the accuracy of the assessment of MI. The MELF pattern was associated with deep myometrial invasion (≥ 50%) (p < 0.001), cervical stromal invasion (p = 0.037), more advanced stage (≥ IB) (p < 0.001) and lymph node metastases (p = 0.011). CONCLUSIONS: Tumors with the MELF pattern were slightly larger, more richly vascularized with multiple multifocal vessels and assessment of adenomyosis was more uncertain on ultrasound imaging. The MELF pattern did not increase the risk of underestimating MI in preoperative ultrasound staging. Tumors with the MELF pattern were more than twice as likely to have more advanced stage (≥ IB) and lymph node metastases.

Prevention of posterior capsule opacification through intracapsular hydrogen peroxide or distilled water treatment in human donor tissue.

In order to determine whether posterior capsule opacification after cataract surgery, could be delayed or inhibited through the application of hydrogen peroxide (H2O2) or distilled water (H2Od),we extracted lens capsules from 25 human donor eye globes. Samples were treated for 5 min with either 30 mM H2O2 or H2Od or used as controls, and cultured for one month, during which dark field and tilt illumination photos were taken. These were used to observe and quantify, time until cellular growth and confluence on the posterior capsule. After culture, histological sections were stained for H&E, α-SMA, Ki-67 and vimentin and evaluated. We prevented cellular growth in 50% of H2Od and 58% H2O2 of treated samples. The overall prevention of cell growth compared to cultured controls was significant for both treatments while there was no significant difference between them. In the cases where cellular growth was not prevented, both treatments significantly delay cellular growth. Until day 28 none of the treated samples of either type that had shown growth reached total confluence. All cultured controls reached total confluence before treated samples (median = day 11.5). Also, histologically, there was a clear morphological difference between cultured controls and treated samples.

Patrón MELF de infiltración miometrial en el adenocarcinoma endometrioide del endometrio. Revisión de 70 casos / MELF pattern in myometrial infiltration in endometrioid adenocarcinoma of the endometrium. A retrospective study of 70 cases

Introducción. El adenocarcinoma endometrioide del endometrio (AEE) es un tumor generalmente de buen pronóstico. Recientemente se ha descrito el patrón MELF (del inglés microcystic, elongated, and fragmented) de infiltración miometrial que se asocia a invasión linfovascular y a metástasis ganglionares. Se revisan 70 casos de AEE para establecer la presencia de MELF y correlacionar su presencia con otros factores pronósticos. Material y métodos. Se han revisado las histerectomías practicadas por AEE en un periodo de 5 años en busca del patrón MELF de infiltración miometrial. Su presencia se ha correlacionado con otras variables como el grado histológico, el nivel de infiltración miometrial, las metástasis ganglionares pélvicas y/o paraaórticas, los implantes peritoneales y la evolución. Resultados. En 17 (24%) casos se observó el patrón MELF. Aunque era más frecuente en tumores de bajo grado, estaba presente en 4 casos de grado3. En 9 (53%) casos la infiltración miometrial era profunda. Cinco casos mostraron metástasis ganglionares pélvicas y 3 aórticas. Una de las pacientes falleció, otra mostró recidiva vulvar y otra, metástasis pulmonares. Conclusión. El patrón MELF puede encontrarse en adenocarcinomas de alto grado y se correlaciona con otros hallazgos morfológicos de mal pronóstico como la infiltración miometrial profunda y la afectación de ganglios linfáticos pélvicos. Su presencia no parece influir en la evolución (AU)

Introduction. Endometrioid adenocarcinoma of the endometrium (EAE) usually has a favorable prognosis. Recently, the MELF (microcystic, elongated and fragmented) pattern of myometrial infiltration has been described. It is associated with lymphovascular invasion and lymph node metastasis. Seventy cases of EAE were reviewed to identify the presence of MELF and its correlation with other prognostic factors. Material and methods. Hysterectomies performed for EAE during a 5-year period were reviewed, searching for MELF pattern. Its presence was correlated with other variables such as histological grade, depth of myometrial infiltration, pelvic and/or aortic lymph node metastasis, peritoneal implants and evolution. Results. In 17 (24%) cases MELF pattern was detected. It was more frequent in low grade tumors; it was present in four grade 3 cases. In 9 (53%) cases there was deep myometrial infiltration. Five cases had lymph node metastasis in the pelvis and three in the para-aortic region. One of the patients died, another presented a vulvar recurrence and another pulmonary metastasis. Conclusion. MELF pattern can be seen in high grade EAE and correlates with deep myometrial infiltration and pelvic lymph node metastasis. Its presence does not seem to influence survival (AU)

[MELF pattern in myometrial infiltration in endometrioid adenocarcinoma of the endometrium. A retrospective study of 70 cases]. / Patrón MELF de infiltración miometrial en el adenocarcinoma endometrioide del endometrio. Revisión de 70 casos.

INTRODUCTION: Endometrioid adenocarcinoma of the endometrium (EAE) usually has a favorable prognosis. Recently, the MELF (microcystic, elongated and fragmented) pattern of myometrial infiltration has been described. It is associated with lymphovascular invasion and lymph node metastasis. Seventy cases of EAE were reviewed to identify the presence of MELF and its correlation with other prognostic factors. MATERIAL AND METHODS: Hysterectomies performed for EAE during a 5-year period were reviewed, searching for MELF pattern. Its presence was correlated with other variables such as histological grade, depth of myometrial infiltration, pelvic and/or aortic lymph node metastasis, peritoneal implants and evolution. RESULTS: In 17 (24%) cases MELF pattern was detected. It was more frequent in low grade tumors; it was present in four grade 3 cases. In 9 (53%) cases there was deep myometrial infiltration. Five cases had lymph node metastasis in the pelvis and three in the para-aortic region. One of the patients died, another presented a vulvar recurrence and another pulmonary metastasis. CONCLUSION: MELF pattern can be seen in high grade EAE and correlates with deep myometrial infiltration and pelvic lymph node metastasis. Its presence does not seem to influence survival.

Aseguramiento de la calidad en el laboratorio de Anatomía Patológica / Quality assurance in Pathology laboratory

No disponible

Encuesta nacional sobre el estado actual del estudio citológico de la patología mamaria / A national survey on the present use of cytology in breast pathology

Objetivo. La punción aspiración con aguja fina (PAAF) es un método sencillo, rápido y eficaz para el diagnóstico de lesiones mamarias. No obstante, su utilización ha cambiado por el incremento en el uso de la biopsia por punción (BPP), que ofrece una mayor eficacia diagnóstica. El objetivo de este estudio es establecer el papel actual de la citología en el diagnóstico combinado y multidisciplinar de la patología mamaria en las unidades de mama españolas. Métodos. Estudio descriptivo a partir de los datos obtenidos en una encuesta de 16 preguntas dirigida a 153 unidades de mama españolas. Resultados. Se obtuvieron 30 respuestas, principalmente de centros públicos (97%) en los que mayoritariamente se estudiaban entre 250 y 500 casos anuales, de los cuales entre 150 y 300 eran cánceres. En el 77% de casos la PAAF formaba parte de los protocolos de actuación de la unidad y su uso se combinaba con el de la BPP. En el 86% de centros se utilizaba para el estudio de la axila. Conclusiones. La PAAF, por su sencillez y efectividad, forma parte de la mayoría de protocolos de actuación de las unidades de mama españolas encuestadas, sobre todo para establecer el estatus ganglionar prequirúrgico para la indicación de la técnica de la biopsia selectiva del ganglio centinela. El estudio de las lesiones mamarias tiende a efectuarse mediante BPP, aunque en muchas ocasiones se lleva a cabo de forma combinada con la PAAF (AU)

Aim. Fine needle aspiration (FNA) is a safe, rapid and minimally invasive technique for the diagnosis of breast lesions. However, its role has altered due to an increase in needle core biopsy (NCB) which has a higher diagnostic accuracy. The aim of this study is to establish the present use of FNA in the combined and multidisciplinary diagnosis of breast lesions in national breast clinics. Methods. Descriptive study of data obtained in a 16 question survey carried out in 153 Spanish breast clinics. Results. Thirty answers were obtained, mainly from public health service centres (97%) where between 250 and 500 cases were studied annually and of which 150-300 were malignant. In 77%, FNA was incorporated into the unit's guidelines, mainly in combination with NCB. In 87% of the centres FNA was performed for axillary staging. Conclusions. The accuracy and simplicity of FNA make it a useful factor in the basic protocol of the national breast clinics taking part in this survey, mainly for presurgical axillary staging and indication for sentinel lymph node biopsy. NCB, sometimes in combination with FNA, is more generally used in the study of breast lesions (AU)

Cáncer de mama asociado al embarazo: estudio analítico observacional / Pregnancy-Associated Breast Cancer: An analytical observational study

Fundamento y objetivo: El cáncer de mama asociado al embarazo se define como aquel que aparece durante la gestación o durante el primer año posparto. Pacientes y método: Estudio retrospectivo analítico observacional en el que se comparan 56 cánceres de mama y embarazo (CME) diagnosticados entre 1976-2008 con 73 pacientes con cáncer de mama no asociado al embarazo (CMNE). Se analizan los diversos datos demográficos, los factores pronósticos, el tratamiento y la supervivencia en ambos grupos. Resultados: La prevalencia de CME en nuestro centro es 8,13/10.000 embarazos. La mayor frecuencia (62%) apareció durante el puerperio. Los estadios son mayores en el CME respecto al CMNE, siendo el 31,3% avanzados en el CME frente al 13,3% en el CMNE (p < 0,05). En cuanto a factores pronósticos, el 27,3% de CME eran grado tumoral iii frente al 15,8% del CMNE. En el grupo CME el 33,3% tenían receptores para estrógeno negativos, el 48,7% receptores para progesterona negativos y el 34,5% eran Her2Neu positivo frente al 22,2, 24,1 y 31%, respectivamente, en CMNE. En el 52,8% de CME aparecieron ganglios afectados frente al 33,8% del CMNE (p < 0,05). En el grupo CME la supervivencia global y libre de enfermedad a 5 años fue del 63,7 y del 74,2%, respectivamente. Conclusiones: El peor pronóstico que se observa en el grupo CME es debido posiblemente a la presencia de factores de pronóstico adversos: metástasis ganglionares, receptores hormonales negativos y grado tumoral tipo iii, así como al diagnóstico tardío, con un porcentaje mayor de cánceres avanzados (AU)

Background and objective: Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy and up to one year postpartum. Patients and method: A retrospective, analytical, observational study comparing 56 cases of breast cancer and pregnancy (PABC) diagnosed 1976-2008 with 73 patients with breast cancer not associated with pregnancy (non-PABC) was performed. Demographic data, prognostic factors, treatment and survival were reviewed and compared. Results: The prevalence of PABC in our center is 8.3/10,000. The highest frequency (62%) appeared during the postpartum period. The stages are higher in PABC, being 31.3% advanced (EIII and EIV) in PABC versus 13.3% in non-PABC (P < .05). Regarding prognostic factors, 27.3% in PABC had a tumoral grade 3 versus 15.8% of non-PABC. Among women with PABC, 33.3% had negative estrogen receptors, 48.7% negative progesterone receptors and 34.5% positive Her2Neu compared with 22.2, 24.1 and 31%, respectively of non-PABC patients. Finally, positive lymph nodes were found in 52.8% of PABC, versus 33.8% non-PABC (P < .05). Overall and disease-free survival rate at 5 years for PABC was 63.7 and 74.2%, respectively. Conclusions: The poorer survival observed is possibly due to the presence of adverse prognostic features such as lymph node metastases, negative hormone receptors, tumoral grade III, as well as a delay in diagnosis with a higher rate of advanced stages (AU)

[Pregnancy-Associated Breast Cancer: An analytical observational study]. / Cáncer de mama asociado al embarazo: estudio analítico observacional.

BACKGROUND AND OBJECTIVE: Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy and up to one year postpartum. PATIENTS AND METHOD: A retrospective, analytical, observational study comparing 56 cases of breast cancer and pregnancy (PABC) diagnosed 1976-2008 with 73 patients with breast cancer not associated with pregnancy (non-PABC) was performed. Demographic data, prognostic factors, treatment and survival were reviewed and compared. RESULTS: The prevalence of PABC in our center is 8.3/10,000. The highest frequency (62%) appeared during the postpartum period. The stages are higher in PABC, being 31.3% advanced (EIII and EIV) in PABC versus 13.3% in non-PABC (P < .05). Regarding prognostic factors, 27.3% in PABC had a tumoral grade 3 versus 15.8% of non-PABC. Among women with PABC, 33.3% had negative estrogen receptors, 48.7% negative progesterone receptors and 34.5% positive Her2Neu compared with 22.2, 24.1 and 31%, respectively of non-PABC patients. Finally, positive lymph nodes were found in 52.8% of PABC, versus 33.8% non-PABC (P < .05). Overall and disease-free survival rate at 5 years for PABC was 63.7 and 74.2%, respectively. CONCLUSIONS: The poorer survival observed is possibly due to the presence of adverse prognostic features such as lymph node metastases, negative hormone receptors, tumoral grade iii, as well as a delay in diagnosis with a higher rate of advanced stages.

Absence of amyloid-beta in lenses of Alzheimer patients: a confocal Raman microspectroscopic study.

We have compared the protein profiles in plaques and tangles in the hippocampus of post-mortem Alzheimer brains and in opaque and clear regions in the deep cortex of eye lenses of the same donors. From the 7 Alzheimer donors studied, 1 had pronounced bilateral cortical lens opacities, 1 moderate and 5 only minor or no cortical opacities. We focused on beta-sheet levels, a hallmarking property of amyloid-beta, the major protein of plaques and tau protein, the major protein of tangles in Alzheimer brains. Confocal Raman microspectroscopy and imaging was used in combination with hierarchical cluster analysis. Plaques and tangles show high levels of beta-sheets with a beta-sheet to protein ratio of 1.67. This ratio is 1.12 in unaffected brain tissue surrounding the plaques and tangles. In the lenses this ratio is 1.17 independently of the presence or absence of opacities. This major difference in beta-sheet conformation between hippocampus and lens is supported by Congo red and immunostaining of amyloid-beta and tau which were positive for plaques and tangles in the hippocampus but fully negative for the lens irrespective of the presence or absence of opacities. In line with a previous study (Michael et al., 2013) we conclude that cortical lens opacities are not typical for Alzheimer patients and are not hallmarked by accumulation of amyloid-beta, and can thus not be considered as predictors or indicators of Alzheimer disease as claimed by Goldstein et al. (2003).

Respuesta patológica a la quimioterapia neoadyuvante: correlación entre 2 sistemas de gradación histológica / Pathologic response to neoadjuvant chemotherapy: Correlation between 2 histologic grading systems

Objetivo. Determinar la variabilidad entre 2 sistemas de gradación a la hora de catalogar la respuesta patológica a la quimioterapia neoadyuvante en una misma lesión. Material y métodos. En 8 años se han estudiado 51 pacientes con cáncer infiltrante de la mama sometidas a quimioterapia neoadyuvante de forma consecutiva. Se ha establecido la respuesta patológica de cada caso siguiendo el sistema de Miller y Payne (MyP) y el de la carga tumoral residual (RCB) correlacionando los resultados de ambos sistemas en la misma lesión. Resultados. Según el sistema de gradación de MyP las lesiones se clasificaron en grado 1 (6%), 2 (25%), 3 (27%), 4 (27%) y 5 (14%). La clase RCB fue 0 (13%), I (13%), II (54%) y III (20%). La correlación entre MyP 5 y RCB 0, entre MyP 4 y RCB I, y entre MyP 2 y RCB III fue buena. Se detectaron más discrepancias entre MyP 1, 2, 3 y RCB II. Conclusión. La correlación en la respuesta completa es buena entre los 2 sistemas de gradación. Hay discrepancias en la clasificación en la ausencia de respuesta entre ambos sistemas. Estas discrepancias pueden ser debidas a la inclusión del estado ganglionar en el sistema RCB(AU)

Objective. To determine the variability between 2 grading systems in the classification of pathologic response to neoadjuvant chemotherapy in the same lesion. Material and methods. Fifty-one patients with invasive breast cancer were consecutively treated with neoadjuvant chemotherapy in an 8-year period. Pathologic response in each patient was established according to the Miller and Payne (MP) and the residual cancer burden (RCB) systems and the results were correlated. Results. In the MP system, the lesions were classified in grade 1 (6%), 2 (25%), 3 (27%), 4 (27%) and 5 (14%). RCB class was 0 (13%), I (13%), II (54%) and III (20%). The correlation between MP 5 and RCB 0, between MP 4 and RCB I, and between MP 2 and RCB III was good. There were more discrepancies between MP 1, 2, 3 and RCB II. Conclusions. The correlation between the 2 grading systems is good. There are discrepancies in the assessment of lack of response between the 2 systems. This disagreement could be due to the inclusion of lymph node status in the RCB system(AU)

Citología de las secreciones mamarias. Valor en el estudio de lesiones papilares / Diagnostic role of cytological study of nipple discharge in papillary lesions

Objetivo. Evaluar el estudio citológico de las secreciones en el diagnóstico de las lesiones papilares de la mama. Material y métodos. Estudio descriptivo y retrospectivo de 6.127 secreciones mamarias obtenidas desde 1986 hasta 2012. En 137 de ellas se obtuvo correlación histopatológica. Resultados. El resultado citológico fue no valorable por ausencia de material en 513 casos (8,4%), benigno en 4.975 (81,2%), inflamatorio en 234 (3,8%), papiloma en 321 (5,2%), proceso papilar en 28 (0,5%), carcinoma papilar en 8 (0,1%) y carcinoma en 21 (0,3%). Veintisiete casos (0,4%) fueron diagnosticados de otros procesos. La correlación con el resultado histopatológico fue buena en los papilomas (45 de 81, 56%). Conclusión. Aunque la correlación entre el diagnóstico citológico de papiloma y la benignidad de la lesión es alta, la citología de las secreciones es una técnica específica para el diagnóstico de malignidad, pero con baja eficacia para establecer el diagnóstico preciso de la lesión(AU)

Objective. To establish the role of cytologic study of nipple discharge in the diagnosis of papillary lesions of the breast. Material and methods. Retrospective and descriptive study of 6,127 cytological smears of nipple discharges obtained between 1986 and 2012. Of these, histopathological results were available for comparison in 137. Results. Cytologic diagnosis was as follows: not feasible due to the absence of material in 513 cases of nipple discharge (8.4%), benign in 4,975 (81.2%), inflammatory in 234 (3.8%), papilloma in 321 (5.2%), papillary process in 28 (0.5%), papillary carcinoma in 8 (0.1%), and carcinoma in 21 (0.3%). Other processes were diagnosed in 27 cases (0.4%). The correlation with the histologic result was good in papillomas (45 of 81, 56%). Conclusion. Although there is a good correlation between the cytologic diagnosis of papilloma and the benign nature of the lesion, the cytology of mammary secretions is specific to the diagnosis of malignancy but has low accuracy in establishing the accurate diagnosis of the lesion(AU)

Absence of beta-amyloid in cortical cataracts of donors with and without Alzheimer's disease.

Eye lenses from human donors with and without Alzheimer's disease (AD) were studied to evaluate the presence of amyloid in cortical cataract. We obtained 39 lenses from 21 postmortem donors with AD and 15 lenses from age-matched controls provided by the Banco de Ojos para Tratamientos de la Ceguera (Barcelona, Spain). For 17 donors, AD was clinically diagnosed by general physicians and for 4 donors the AD diagnosis was neuropathologically confirmed. Of the 21 donors with AD, 6 had pronounced bilateral cortical lens opacities and 15 only minor or no cortical opacities. As controls, 7 donors with pronounced cortical opacities and 8 donors with almost transparent lenses were selected. All lenses were photographed in a dark field stereomicroscope. Histological sections were analyzed using a standard and a more sensitive Congo red protocol, thioflavin staining and beta-amyloid immunohistochemistry. Brain tissue from two donors, one with cerebral amyloid angiopathy and another with advanced AD-related changes and one cornea with lattice dystrophy were used as positive controls for the staining techniques. Thioflavin, standard and modified Congo red staining were positive in the control brain tissues and in the dystrophic cornea. Beta-amyloid immunohistochemistry was positive in the brain tissues but not in the cornea sample. Lenses from control and AD donors were, without exception, negative after Congo red, thioflavin, and beta-amyloid immunohistochemical staining. The results of the positive control tissues correspond well with known observations in AD, amyloid angiopathy and corneas with lattice dystrophy. The absence of staining in AD and control lenses with the techniques employed lead us to conclude that there is no beta-amyloid in lenses from donors with AD or in control cortical cataracts. The inconsistency with previous studies of Goldstein et al. (2003) and Moncaster et al. (2010), both of which demonstrated positive Congo red, thioflavin, and beta-amyloid immunohistochemical staining in AD and Down syndrome lenses, is discussed.

Lymphohistiocytoid mesothelioma of the pleura: a case report with cytological findings.

Lymphohistiocytoid malignant mesothelioma is an infrequent variant of sarcomatoid mesothelioma representing approximately 0.5-3.3% of malignant mesotheliomas. It has been related to asbestos exposure. The tumor is characterized by a diffuse large histiocyte-like cells proliferation mixed with an inflammatory infiltrate of lymphocytes and plasma cells. Its cytological diagnosis is difficult. We present a case of a 67-year-old female with lymphohistiocytoid mesothelioma involving the left pleura. The cytological, histological, and immunohistochemical features are discussed.