Tratamiento de liquen escleroso y atrófico vulvar con láser de dióxido de carbono fraccionado. Presentación de cuatro casos / Treatment of Vulvar Lichen Sclerosus et Atrophicus With Fractional Carbon Dioxide Laser Therapy: A Report of 4 Cases

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Cáncer de mama: determinación del perfil genético a partir de la biopsia percutánea ecoguiada diagnóstica / Breast cancer: determining the genetic profile from ultrasound-guided percutaneous biopsy specimens obtained during the diagnostic workups

Objetivos. Evaluar la posibilidad de obtener el perfil genético de los tumores primarios malignos de la mama a partir de las muestras obtenidas mediante la biopsia percutánea ecoguiada realizada durante el proceso diagnóstico. Material y métodos. Estudio retrospectivo sobre 13 pacientes consecutivas diagnosticadas de cáncer infiltrante de mama mediante biopsia ecoguiada (Modo B) con aguja gruesa (BAG) de calibre 12 G. Tras indicación clínica, el anatomopatólogo determinó, sobre los bloques de parafina, la aparente idoneidad de las muestras, antes de enviarlas al laboratorio para análisis genético con la plataforma MammaPrint®. Se han evaluado los siguientes aspectos: tamaño tumoral, validez de la muestra y porcentaje de células tumorales. Resultados. El tamaño ecográfico tumoral osciló entre 0,6 cm y 5 cm. En 11 pacientes la muestra conservada se consideró "válida" y apta para la determinación del perfil genético. En una paciente (tamaño tumoral de 1 cm) y a juicio del anatomopatólogo, hubo que repetir la BAG para obtener muestras adicionales. En otra paciente (tamaño tumoral de 5 cm), la muestra no fue considerada "válida" por el laboratorio genético. El porcentaje de células tumorales, entre las muestras válidas, osciló entre el 60% y 70%. En 11 de 13 (84,62%) casos fue posible el análisis genético a partir de las muestras diagnósticas previas. Conclusión. Resulta posible obtener el perfil genético en la BAG ecoguiada con agujas de 12 G, a partir de las muestras diagnósticas conservadas en bloques de parafina, en la mayoría de los casos, independientemente del tamaño tumoral (AU)

Objectives. To evaluate the possibility of determining the genetic profile of primary malignant tumors of the breast from specimens obtained by ultrasound-guided percutaneous biopsies during the diagnostic imaging workup. Material and methods. This is a retrospective study in 13 consecutive patients diagnosed with invasive breast cancer by B-mode ultrasound-guided 12 G core needle biopsy. After clinical indication, the pathologist decided whether the paraffin block specimens seemed suitable (on the basis of tumor size, validity of the sample, and percentage of tumor cells) before sending them for genetic analysis with the MammaPrint® platform. Results. The size of the tumors on ultrasound ranged from 0.6 cm to 5 cm. In 11 patients the preserved specimen was considered valid and suitable for use in determining the genetic profile. In 1 patient (with a 1 cm tumor) the pathologist decided that it was necessary to repeat the core biopsy to obtain additional samples. In 1 patient (with a 5 cm tumor) the specimen was not considered valid by the genetic laboratory. The percentage of tumor cells in the samples ranged from 60% to 70%. In 11/13 cases (84.62%) it was possible to do the genetic analysis on the previously diagnosed samples. Conclusion. In most cases, regardless of tumor size, it is possible to obtain the genetic profile from tissue specimens obtained with ultrasound-guided 12 G core biopsy preserved in paraffin blocks (AU)

Breast cancer: determining the genetic profile from ultrasound-guided percutaneous biopsy specimens obtained during the diagnostic workups. / Cáncer de mama: determinación del perfil genético a partir de la biopsia percutánea ecoguiada diagnóstica.

OBJECTIVES: To evaluate the possibility of determining the genetic profile of primary malignant tumors of the breast from specimens obtained by ultrasound-guided percutaneous biopsies during the diagnostic imaging workup. MATERIAL AND METHODS: This is a retrospective study in 13 consecutive patients diagnosed with invasive breast cancer by B-mode ultrasound-guided 12 G core needle biopsy. After clinical indication, the pathologist decided whether the paraffin block specimens seemed suitable (on the basis of tumor size, validity of the sample, and percentage of tumor cells) before sending them for genetic analysis with the MammaPrint® platform. RESULTS: The size of the tumors on ultrasound ranged from 0.6cm to 5cm. In 11 patients the preserved specimen was considered valid and suitable for use in determining the genetic profile. In 1 patient (with a 1cm tumor) the pathologist decided that it was necessary to repeat the core biopsy to obtain additional samples. In 1 patient (with a 5cm tumor) the specimen was not considered valid by the genetic laboratory. The percentage of tumor cells in the samples ranged from 60% to 70%. In 11/13 cases (84.62%) it was possible to do the genetic analysis on the previously diagnosed samples. CONCLUSION: In most cases, regardless of tumor size, it is possible to obtain the genetic profile from tissue specimens obtained with ultrasound-guided 12 G core biopsy preserved in paraffin blocks.

Caracterización ecográfica de un modelo experimental de metástasis hepáticas de carcinoma de colon / Ultrasonographic characterization of an experimental model of liver metastases from colon carcinoma in rats

Objetivo: Determinar las características ultrasonográficas de la patología metastásica hepática inducida en un modelo múrido, para evaluar la utilidad de la ecografía en la valoración no invasiva de la infiltración tumoral. Material y métodos: El hígado de 46 ratas WAG/RijCrl fue diseminado con células singénicas de carcinoma colorrectal CC-531 mediante inoculación intraesplénica. En los días 21, 28, 35, 42 y 70 posteriores a la siembra tumoral, se realizaron series de ecografías para valorar inducción tumoral en diferentes grupos de animales; 37 ratas se estudiaron mediante sonda lineal de 10Mhz y 9 con sonda multifrecuencia de 6–18Mhz. Como signos ecográficos de desarrollo tumoral se consideró la detección de nódulos intrahepáticos, festoneado del contorno hepático, megalias de lóbulos y masas extrahepáticas. Los hallazgos ecográficos se verificaron tras necropsia, y en ambas técnicas se determinó el número de implantes, tamaño (<3, entre 3–7 y >7mm) y localización lobular. Resultados: Comparado con los resultados de la necropsia, en ecografía se detectaron lesiones en el 64% de los animales con patología. Todas las masas extrahepáticas fueron correctamente diagnosticadas. Se identificaron metástasis en el 90% de ratas afectadas por lesiones>7mm, en el 75% de animales con implantes de 3–7mm y en el 25% con lesiones<3mm. Con la sonda de 6–18Mhz se detectaron el 50% de lesiones

Objective: To determine the ultrasonographic characteristics of liver metastases induced in a rat model; to evaluate the usefulness of ultrasonography in the noninvasive evaluation of tumor infiltration. Material and methods: We seeded the livers of 46 WAG/RijCrl rats with CC-531 syngeneic colorectal carcinoma cells by intrasplenic inoculation. At 21, 28, 35, 42, 70 days after tumor seeding, we performed a series of ultrasonographic examinations to evaluate tumor induction in different groups of animals: 37 rats were studied with a 10MHz linear probe and 9 were studied with a 6–18MHz multifrequency probe. The following signs were considered indicative of tumor development: intrahepatic nodules, sinuate liver borders, lobe enlargement, and extrahepatic masses. Ultrasonographic findings were verified at autopsy. We determined the number of implants, size (less than 3mm, between 3 and 7mm, or greater than 7mm), and lobe location for each technique. Results: Compared to the autopsy results, ultrasonography detected 64% of the animals with disease. All the extrahepatic masses were correctly diagnosed. Metastases were identified in 90% of the rats with lesions greater than 7mm, in 75% of those with implants between 3 and 7mm, and in 25% of those with lesions less than 3mm. In the group in which we used the 6–18 MHz probe, we detected 50% of the lesions less than 3mm.ConclusionUltrasonography was useful for monitoring the experimental model and enabled the noninvasive oncologic evaluation of the rat liver with reasonable sensitivity (AU)

[Ultrasonographic characterization of an experimental model of liver metastases from colon carcinoma in rats]. / Caracterización ecográfica de un modelo experimental de metástasis hepáticas de carcinoma de colon.

OBJECTIVE: To determine the ultrasonographic characteristics of liver metastases induced in a rat model; to evaluate the usefulness of ultrasonography in the noninvasive evaluation of tumor infiltration. MATERIAL AND METHODS: We seeded the livers of 46 WAG/RijCrl rats with CC-531 syngeneic colorectal carcinoma cells by intrasplenic inoculation. At 21, 28, 35, 42, 70 days after tumor seeding, we performed a series of ultrasonographic examinations to evaluate tumor induction in different groups of animals: 37 rats were studied with a 10 MHz linear probe and 9 were studied with a 6-18 MHz multifrequency probe. The following signs were considered indicative of tumor development: intrahepatic nodules, sinuate liver borders, lobe enlargement, and extrahepatic masses. Ultrasonographic findings were verified at autopsy. We determined the number of implants, size (less than 3mm, between 3 and 7 mm, or greater than 7 mm), and lobe location for each technique. RESULTS: Compared to the autopsy results, ultrasonography detected 64% of the animals with disease. All the extrahepatic masses were correctly diagnosed. Metastases were identified in 90% of the rats with lesions greater than 7 mm, in 75% of those with implants between 3 and 7 mm, and in 25% of those with lesions less than 3mm. In the group in which we used the 6-18 MHz probe, we detected 50% of the lesions less than 3mm. CONCLUSION: Ultrasonography was useful for monitoring the experimental model and enabled the noninvasive oncologic evaluation of the rat liver with reasonable sensitivity.

[Primary prostatic infiltration by Burkitt's lymphoma]. / Infiltración prostática primaria por linfoma de Burkitt.

OBJECTIVE: Genitourinary tract involvement arising from non-Hodgkin lymphoma occurs in 10% of patients; prostatic infiltration is uncommon and accounts for less than 0.1%. The uncommon clinical onset of this infrequent condition prompted us to report on the present case. METHODS/RESULTS: A 41-year-old male patient with lower urinary tract outflow obstruction arising from prostatic enlargement secondary to non-Hodgkin lymphoma (Burkitt's lymphoma) is described. Treatment with chemotherapy achieved good results. The clinical features, diagnostic and therapeutic aspects are discussed and the literature briefly reviewed. CONCLUSION: The present case emphasizes the need to include non-Hodgkin lymphoma in the differential diagnosis of lower urinary tract outflow obstructive symptoms in young men with prostatic enlargement.

[Synchronous manifestation of bladder inverted papilloma and transitional carcinoma of the renal pelvis]. / Presentación sincrónica de papiloma invertido vesical y carcinoma transicional de pelvis renal.

OBJECTIVE: To review briefly the histological and biological aspects of inverted papilloma and to determine whether it is a benign tumor or low-grade malignant lesion. METHOD/RESULTS: We report a patient with synchronous presentation of bladder inverted papilloma and renal pelvis transitional cell carcinoma. After endoscopic resection of the bladder tumor and left ureteral meatus, a radical nephroureterectomy was carried out with success. The clinical features, diagnostic and therapeutic aspects are briefly reviewed. CONCLUSIONS: Inverted papilloma accounts for 2.2% of all urothelial tumors; the bladder is most commonly involved. It is frequently a single lesion with endophytic growth pattern. The clinical significance remains a controversy. Most investigators consider them as benign neoplastic tumors, although in one third of the patients it may be associated with synchronous urothelial carcinomas, implying a malignant condition. Therapeutic management and follow-up are emphasized.

[Cryptorchidism and testicular cancer]. / Criptorquidia y cáncer testicular.

OBJECTIVE: This report underscores the higher risk of testicular cancer in cryptorchidism. METHODS/RESULTS: A patient undergoing evaluation for sterility, who was submitted to orchidopexy 15 years earlier for cryptorchidism, developed a seminoma-like tumor one year following a testicular biopsy that was compatible with testicular atrophy, but with no signs of dysplasia. The literature on the epidemiology, pathogenesis, diagnosis, and treatment is briefly reviewed. CONCLUSIONS: Cryptorchidism is the single factor that carries a higher risk of testicular cancer. This condition has been reported to have 3.5 to 5 times greater risk of progressing to malignancy compared to normal descended testes. Although orchiopexy does not prevent the risk of malignancy, it permits earlier detection. The need to follow these patients closely is underscored.

[Metachronous metastasis in ureteral stump secondary to ipsilateral renal adenocarcinoma]. / Metástasis metacrónica en muñón ureteral secundaria a adenocarcinoma renal ipsilateral.

OBJECTIVES: Ureteral metastasis from renal adenocarcinoma is uncommon. The rarity of this disease prompted us to report on the present case, with special reference to diagnosis. METHODS/RESULTS: A patient with metachronous metastasis in the ureteral stump from clear cell renal adenocarcinoma resected three years earlier is described. The etiopathogenic, clinical, diagnostic and therapeutic aspects are briefly reviewed. CONCLUSIONS: Ureteral metastases, although uncommon, are generally ipsilateral to the renal tumor and arise from aggressive renal carcinomas that are locally advanced with vascular and/or lymphatic spread. We underscore the importance of retrograde pyelography and ureterorenoscopy in the diagnostic workup of all patients with gross hematuria following nephrectomy due to hypernephroma.

[Ureteral endometriosis]. / Endometriosis del uréter.

OBJECTIVES: Ureteral involvement due to endometriosis is uncommon. Its silent onset and the progression of ureteral obstruction, if undiagnosed, can lead to the loss of the renal unit. The present case is described to underscore the importance of early diagnosis. METHODS/RESULTS: We report on a patient with obstructive uropathy secondary to intrinsic ureteric endometriosis that had undergone nephrectomy due to parenchymal destruction. One year following resection of the endovesical portion, recurrence in the ureteral stump was observed. The clinical features, the diagnostic and clinical aspects are briefly discussed. CONCLUSIONS: Although ureteric involvement is uncommon, renal function of patients with pelvic endometriosis must be followed closely by analyses, ultrasound and/or intravenous urography for early detection of this condition.