Síndrome confusional en paciente con hiponatremia severa / Confusional syndrome in a patient with severe hyponatremia

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Lymphoepithelioma-like carcinoma of the urinary bladder: a clinicopathologic study of 13 cases.

Lymphoepithelioma-like carcinoma (LELCA) of the urinary bladder is a rare variant of bladder cancer characterized by a malignant epithelial component densely infiltrated by lymphoid cells. It is characterized by indistinct cytoplasmic borders and a syncytial growth pattern. These neoplasms deserve recognition and attention, chiefly because they may be responsive to chemotherapy. We report on the clinicopathologic features of 13 cases of LELCA recorded since 1981. The chief complaint in all 13 patients was hematuria. Their ages ranged from 58 years to 82 years. All tumors were muscle invasive. A significant lymphocytic reaction was present in all of these tumors. There were three pure LELCA and six predominant LELCA with a concurrent transitional cell carcinoma (TCC). The remainder four cases had a focal LELCA component admixed with TCC. Immunohistochemistry showed LELCA to be reactive against epithelial membrane antigen and several cytokeratins (CKs; AE1/AE3, AE1, AE3, CK7, and CK8). CK20 and CD44v6 stained focally. The lymphocytic component was composed of a mixture of T and B cells intermingled with some dendritic cells and histiocytes. Latent membrane protein 1 (LMP1) immunostaining and in situ hybridization for Epstein-Barr virus were negative in all 13 cases. DNA ploidy of these tumors gave DNA histograms with diploid peaks (n=7) or non-diploid peaks (aneuploid or tetraploid; n=6). All patients with pure and 66% with predominant LELCA were alive, while all patients having focal LELCA died of disease. Our data suggest that pure and predominant LELCA of the bladder appear to be morphologically and clinically different from other bladder (undifferentiated and poorly differentiated conventional TCC) carcinomas and should be recognized as separate clinicopathological variants of TCC with heavy lymphocytic reaction relevant in patient management.

Estudio del nevus displásico mediante citometría de imagen / Dysplastic nevi by image cytometry study

Hemos realizado un estudio de la ploidía de ADN de 25 nevus displásicos (ND) mediante análisis de imagen computarizado. Los ND fueron seleccionados previamente desde el punto de vista clínico, e histopatológicamente se valoró el grado de atipia celular y arquitectural siguiendo las recomendaciones de la European Organization for Research and Treatment of Cancer Cutaneous (EORTC).Se han seleccionado 200 núcleos neoplásicos de la zona de mayor espesor tumoral, determinándose el área nuclear, densidad óptica integrada (DOI), índice de ADN (IADN), y valor de ploidía mayor de 5c (5cER), y se ha realizado estadística analítica y descriptiva con los resultados obtenidos. Hemos encontrado cierta asociación entre aneuploidía y atipia citológica, si bien, no hemos hallado diferencias significativas en los parámetros estudiados en el ND (AU)

Merkel cell (neuroendocrine) carcinoma of the vulva. A case report with immunohistochemical and ultrastructural findings and review of the literature.

A new case of primary Merkel cell carcinoma (MCC) of the vulva is reported and the literature reviewed for noting its clinical presentation, microscopic, immunohistochemical and ultrastructural features, as well as for establishing the role of immunohistochemistry in the ultimate diagnosis of this uncommon and aggressive tumor. The lesion occurred in a 79 year old patient. Histologically, the tumor was composed of intradermal small cells with high mitotic index and frequent apoptosis. The immunohistochemical study showed positivity for wide spectrum and low molecular weight cytokeratins, epithelial membrane antigen, neurofilaments, neuron specific enolase and chromogranin A. Electron microscopy revealed intermediate filaments in a typical globular paranuclear arrangement. The coexpression of cytokeratins (including cytokeratin 20) and neurofilaments, both in typical globular paranuclear arrangement, made possible the diagnosis of MCC, differentiating it from other malignant small cell tumors such as neuroendocrine metastatic carcinoma.

Pérdida de inmunorreactividad de p53 en cortes de parafina almacenados sin teñir de carcinoma urotelial de vejiga urinaria / Loss of immunoreactivity of p53 in paraffin cross sections of urothelial carcinoma of the urinary bladder stored without staining

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Human papillomavirus DNA as a factor determining the survival of bladder cancer patients.

The natural history of transitional cell carcinoma (TCC) of the urinary bladder is somewhat variable, with a significant number of tumour recurrences that occasionally evolve towards an infiltrating disease. The aim of this study was to investigate the presence of human papillomavirus (HPV) DNA in 76 TCC specimens, and then correlate such findings with the overall patient survival. However, other classical prognostic clinical and pathological variables such as pathological grade and stage, koilocytosis, age and sex were also tested. HPV DNA was investigated by means of the highly sensitive polymerase chain reaction (PCR). DNA primers specific for HPV types 6, 11, 16 and 18 were used. Our results showed that 7 (9.21%) out of 76 such cases were reactive for HPV 16 DNA; one of them also reacted with HPV 6 DNA. The statistical analysis was done by the Kaplan-Meier method, Wilcoxon's generalised test for studying the differences in survival curves and Cox's regression analysis for independent prognostic factors. A significant P-value was found for pathological grade (P < 0.0001) and stage (P < 0.0001), HPV 16 DNA (P = 0.0418) and koliocytosis (P = 0.0140). Thus, pathological grade was the only independent factor in the bladder cancer survival. These observations may prove useful in prognostic stratification of patients with TCC of the bladder.

Inflammatory pseudotumor of the urinary bladder. A clinicopathological analysis of two cases.

We report 2 cases of inflammatory pseudotumor (IPS) of the urinary bladder observed in a man and a woman aged 63 and 66, respectively. Gross hematuria was the chief complaint. Immunohistochemical profile of IPS suggested a myofibroblastic proliferation. The DNA diploid pattern of IPS further supported the benign nature of the process. Immunohistochemistry seems to be the method of election in differentiating IPS from other spindle cell proliferations of the bladder.

[Usefulness of nuclear morphometry as predictive factor of progression in bladder papillary carcinoma]. / Utilidad de la morfometría nuclear como factor predictivo de progresión en los carcinomas papilares de vejiga.

Lately, nuclear morphometry methods are being used to analyze the malignant potential of tumoral cells. This paper presents a retrospective study of a series of 163 patients with the three histological grades (WHO), of superficial papillary transitional cell carcinoma (pTa-pT1) of the bladder with a mean follow-up of 60 months. A morphometric analysis of the initial tumour biopsies was made. Mean nuclear area (NA) and its standard deviation (NASD) were measured in a semi-automatic image analyzer (MOP-videoplan, Kontron). NA and NASD show increasingly higher values with increased grade (p < or = 0.0001). NA and NASD values raise in those progressing to muscle-infiltrant stage; tumours were, then, divided into two morphometric groups: small NA (< 50 microns 2) and large NA (> 50 microns 2); the difference between them being statistically significant. The likelihood of no tumoral progression at 30, 60 and 90 months was, respectively, 96, 94 and 92 percent, form small NAs, and 76, 65 and 64 percent for large NA (p < or = 0.0001).

[Incidental carcinoma of the kidney with renal vein thrombosis]. / Carcinoma incidental de riñon con trombosis de vena renal.

Incidental carcinoma of kidney is an increasingly common pathology as a result of a wider use of high resolution diagnostic methods. The special characteristics of these tumors, usually small and in a low grade or stage, make conservative surgery to be considered as a valid therapeutical option. An incidental carcinoma of kidney with tumoral thrombosis of the renal vein undetected in the pre-surgical study, circumstance which allows to emphasize the malignant potential of these tumors is presented here. Based on this, we believe that a meticulous evaluation of the renal vein condition should be made, in patients considered as possible candidates for conservative surgery. In this sense, selective renal phebography and magnetic resonance could be considered explorative means that play an important role in the introduction of renal preservation surgery, if future studies show that its use allows an early detection of the tumoral condition of renal vein.