[Experience with sunitinib in hormone-resistant metastatic prostate cancer that is unresponsive to docetaxel]. / Experiencia con sunitinib en cáncer de próstata metastásico hormonorresistente sin respuesta a docetaxel.

INTRODUCTION: systemic treatment options for patients with hormone-refractory prostate cancer (HRPC) that progress despite the use of Docetaxel are very limited. One of the options of compassionate use currently available is the use of Sunitinib. We present a joint preliminary experience with the use of Sunitinib in this clinical case. PATIENTS AND METHODS: a series of eight cases is presented, which sets forth a prospective multicentre experience with Sunitinib in patients with hormone-refractory metastatic and progressive prostate cancer, previously treated with at least a regime of Docetaxel-based chemotherapy. Other alternative chemotherapy regimes had already been tried in some patients. The primary objective of our study was the PSA response rate and our secondary objective was the progression-free period. We administered a dosage of 50mg/day for four-week cycles, followed by a two-week rest per cycle, until we reached a total of eight cycles or up to clinical progression or intolerable toxicity. RESULTS: in four cases, the PSA dropped to below 50% of the baseline level at the beginning of the treatment, and five patients presented some decrease in PSA. The progression-free time was 16.4 weeks. Toxicity arising from the treatment was moderate and manageable. CONCLUSIONS: despite the limits of this experience, we can say that Sunitinib appears to be an active and safe option in patients with hormone-refractory prostate cancer that is resistant to chemotherapy with Docetaxel.

Experiencia con sunitinib en cáncer de próstata metastásico hormonorresistente sin respuesta a docetaxel / Experience with sunitinib in hormone-resistant metastatic prostate cancer that is unresponsive to docetaxel

Introducción: las opciones de tratamiento sistémico para los pacientes con cáncer de próstata hormonorrefractario (CPHR) que progresan a pesar del uso de docetaxel son muy limitadas. Una de las opciones de uso compasivo disponibles en la actualidad es el empleo de sunitinib. Presentamos una experiencia preliminar conjunta con el uso de sunitinib en esta circunstancia clínica. Pacientes y métodos: se presenta una serie de 8 casos que refleja una experiencia multicéntrica prospectiva con sunitinib en pacientes con cáncer de próstata metastático, hormonorrefractario y en progresión, previamente tratados con al menos un régimen quimioterápico a base de docetaxel. En algunos pacientes ya se habían ensayado otros regímenes quimioterápicos alternativos. El objetivo primario de nuestro estudio fue la tasa de respuesta de PSA, y el objetivo secundario el tiempo libre de progresión. Se administró una dosis de 50mg/ día durante ciclos de 4 semanas, seguidos de 2 semanas de descanso por ciclo, hasta alcanzar un total de 8 ciclos o hasta la progresión clínica o toxicidad intolerable. Resultados: en 4 casos el PSA descendió por debajo del 50% del nivel basal al inicio del tratamiento, y 5 pacientes presentaron algún descenso del PSA. El tiempo libre de progresión fue de 16,4 semanas. La toxicidad derivada del tratamiento fue moderada y manejable. Conclusiones: a pesar de lo limitado de esta experiencia, podemos decir que sunitinib parece una opción activa y segura en pacientes con cáncer de próstata hormonorrefractario y resistente a quimioterapia con docetaxel (AU)

Introduction: systemic treatment options for patients with hormone-refractory prostate cancer (HRPC) that progress despite the use of Docetaxel are very limited. One of the options of compassionate use currently available is the use of Sunitinib. We present a joint preliminary experience with the use of Sunitinib in this clinical case. Patients and methods: a series of eight cases is presented, which sets forth a prospective multicentre experience with Sunitinib in patients with hormone-refractory metastatic and progressive prostate cancer, previously treated with at least a regime of Docetaxel-based chemotherapy. Other alternative chemotherapy regimes had already been tried in some patients. The primary objective of our study was the PSA response rate and our secondary objective was the progression-free period. We administered a dosage of 50mg/day for four-week cycles, followed by a two-week rest per cycle, until we reached a total of eight cycles or up to clinical progression or intolerable toxicity. Results: in four cases, the PSA dropped to below 50% of the baseline level at the beginning of the treatment, and five patients presented some decrease in PSA. The progression-free time was 16.4 weeks. Toxicity arising from the treatment was moderate and manageable. Conclusions: despite the limits of this experience, we can say that Sunitinib appears to be an active and safe option in patients with hormone-refractory prostate cancer that is resistant to chemotherapy with Docetaxel (AU)

Encapsulated apocrine papillary carcinoma of the breast: case report with clinicopathologic and immunohistochemical study.

We describe a case of encapsulated papillary carcinoma (EPC), apocrine variant in a 50-year-old woman. The patient presented a cystic lesion in her right breast, measuring 8 cm in diameter, containing three solid papillary nodules. A fine-needle aspiration showed isolated apocrine cells containing round nuclei, irregular nuclear membranes, fine chromatin, and prominent macronucleoli. The lesion was excised and showed a pure papillary apocrine carcinoma, which stained diffusely with GCDFP-15 and androgen receptors. The lesion was totally devoid of myoepithelial cells (smooth muscle actyn, p63, calponin, and collagen IV stains were negative). With MIB1 the proliferative activity was 10%. To the best of our knowledge, this is the first report of EPC apocrine variant with cytologic and immunohistochemical study. This lesion must be included in the list of apocrine lesions of the breast.

Parotid gland metastasis of a breast cancer.

Parotid gland metastases from malignant tumors are extremely rare. A 61-year-old woman was diagnosed with an early breast cancer with no expression of oestrogen and progesterone receptors. Five years later the patient presented a tumour in parotid gland. After total parotidectomy, microscopic analysis of the gland demonstrated an invasive duct carcinoma (IDC) with positive expression of oestrogen receptor. The patient was treated with chemotherapy followed by complementary local radiotherapy. Diagnosis of a metastasic tumour in parotid gland poses a challenge. In our case an immunohistochemical study of oestrogen receptor was fundamental to establish a diagnosis.

Parotid gland metastasis of a breast cancer

Parotid gland metastases from malignant tumors are extremely rare. A 61-year-old woman was diagnosed with an early breast cancer with no expression of oestrogen and progesterone receptors. Five years later the patient presented a tumour in parotid gland. After total parotidectomy, microscopic analysis of the gland demonstrated an invasive duct carcinoma (IDC) with positive expression of oestrogen receptor. The patient was treated with chemotherapy followed by complementary local radiotherapy. Diagnosis of a metastasic tumour in parotid gland poses a challenge. In our case an immunohistochemical study of oestrogen receptor was fundamental to establish a diagnosis (AU)

Síndrome de Meigs: presentación de dos casos / Meig's syndrome: presentation of two cases

Propósito: El síndrome de Meigs es una entidad nosológica poco frecuente que aparece en mujeres adultas. El cuadro clinicopatológico se caracteriza por la asociación entre fibroma ovárico, derrame pleural y ascitis. Se define como pseudo-Meigs la asociación con tumores de características histológicas diferentes de la descripción clásica. El tratamiento consiste en la resección quirúrgica de la masa pélvica, tras la cual se produce la resolución espontánea del derrame pleural y peritoneal. Pacientes y métodos: Se presentan dos pacientes con este síndrome pero con características que difieren de la descripción clásica, como la edad de aparición, la asociación con un tumor de origen extraovárico y el retraso en la resolución del derrame pleural. Resultados: Este caso ofrece la oportunidad de revisar esta infrecuente entidad nosológica y sus vertientes clinicopatológicas. (AU)

[Transitional carcinoma of the ureter and ipsilateral synchronous renal cell carcinoma in hydronephrotic atrophic kidney: infrequent association]. / Carcinoma transicional de uréter y carcinoma ipsilateral sincrónico de células renales en riñón atrófico hidronefrótico: asociación infrecuente.

We report a new case of simultaneous occurrence of renal cell carcinoma and transitional cell carcinoma into ipsilateral ureter. A review of the literature to date indicates this is the 45 world-wide case and the 8 in the Spanish publications.

Carcinoma transicional de uréter y carcinoma ipsilateral sincrónico de células renales en riñón atrófico hidronefrótico: asociación infrecuente / Transitional cell carcinoma of the ureter and sinchronous ipsilateral renal cell carcinoma in hydronephrotic-atrophic kidney: an infrequent association

Presentamos un nuevo caso de aparición simultánea de adenocarcinoma de células renales y carcinoma urotelial del uréter ipsilateral. La revisión de la literatura indica que éste es el caso 45 mundial y 8 en publicaciones españolas (AU)

Carcinoma escamoso de pene y lesiones precursoras / Squamous carcinoma of the penis and precursor lesions

El carcinoma epidermoide de pene es una neoplasia con una incidencia variable dependiendo de las condiciones socioeconómicas de la población. Se revisan las lesiones precursoras haciendo hincapié en la correlación clinicopatológica para establecer el diagnóstico correcto de la entidad con implicancias pronósticas. También se mencionan los factores epidemiológicos que: han demostrado relación directa con su etiología. Se describen los aspectos anatomopatológicos más relevantes desde el punto de vista pronóstico tales como tipo y grado histológico, patrón de crecimiento, profunclidad de penetración y metástasis linfáticas. (AU)

Soft-tissue osteosarcoma with prominent aneurysmatic bone cyst-like features: a case report.

We describe the cytological features of a soft-tissue high-grade spindle and pleomorphic sarcoma. The smears showed hypercellularity composed of pleomorphic round and elongated cells, and a striking population of multinucleated osteoclast-type giant cells. Microscopically the tumor showed multiple patterns such as highly cellular pleomorphic, less cellular, and hyalinized areas with neoplastic cartilage and osteoid, and areas with hemorrhage and multicystic appearance with numerous osteoclastic giant cells, resembling aneurysmal bone cysts. Immunohistochemical studies showed positivity for vimentin, while chondroid tissue was positive for S-100, and osteoclastic giant cells stained positively for CD68. Due to the varied microscopic patterns, the differential diagnosis included many tumors containing osteoclastic giant cells and osteochondroid tissue.

Vascular adrenal pseudocyst: cytologic and immunohistochemical study.

Adrenal vascular cysts are rare lesions that might be considered in the differential diagnosis of adrenal tumors. Their origin is not clear. We report the clinicopathological findings of a large adrenal hemorrhagic pseudocyst (AHP) in a 73-yr-old man who complained of abdominal pain. An abdominal CT showed a 9 cm tumor in the left adrenal. A fine-needle aspiration biopsy (FNAB) was hemorrhagic and inconclusive. The tumor was excised and touch imprints were taken showing groups of spindled and fusiform cells with elongated nuclei, without atypia. Histologically, the tumor was well delimited by a fibrous capsule and contained numerous cystic spaces lined by endothelial cells and filled with erythrocytes, fibrin thrombus, and necrotic debris. Immunohistochemical study showed strong positivity for factor VIII-RA, CD31, and CD34. Also, the remaining adrenal showed a prominent frame of thin and medium caliber vessels, supporting a vascular origin for this entity. This case illustrates the difficulty in making a diagnosis by FNA and to keep in mind AHP when hematic aspirates are obtained from an adrenal tumor mass.

Giant adrenal cortical carcinoma, clinically "nonfunctional": report of a case containing cytoplasmic hyaline globules of vimentin.

Adrenal cortical carcinoma (ACC) is a rare neoplasm that affects all age groups, with a bimodal peak of incidence, in young individuals in the first decade or two of life and in older subjects in the fifth to seventh decades. It may be clinically "functional" with Cushing's syndrome, virilization, or feminization, or it may be "nonfunctional." We report on the case of a 42-yr-old woman who complained of abdominal pain and a large adrenal tumor measuring 20 cm in size. No endocrine symptoms were observed. Laboratory tests showed increased levels of adrenocorticotropic hormone (ACTH), serum cortisol, and urinary free cortisol. Cytohistologic features were typical of ACC. A striking presence of hyaline cytoplasmatic globules was seen in cytologic smears and histologically, being immunoreactive for vimentin, consistent with an intracellular store of intermediate filaments. The tumor showed high proliferative activity (40%) with Ki-67 and negativity for p53, cerbB2, and bcl-2. Although hyaline globules are more frequent in pheochromocytomas and other neoplasms, they may also be present in ACC. These globules may be observed in cytologic smears. Also, the identification and immunohistochemical characterization of these hyaline globules in metastases may be useful in determining the origin of primary occult tumors. Diagn. Cytopathol. 1999;21:394-397.

Multicentric oncocytoma of the lung diagnosed by fine-needle aspiration.

A 50-yr-old man presented with dyspnea. On chest X-ray, multiple pulmonary nodules were observed. Fine-needle aspiration biopsy (FNAB) showed tridimensional aggregates of atypical round epithelial cells, containing numerous cytoplasmic granules. The tissue fragment confirmed the presence of an epithelial tumor composed of trabecular sheets of clear cells, with numerous cytoplasmic granules which stained with phosphotungstic acid hematoxylin (PTAH). Immunohistochemically, the tumor cells were positive for cytokeratins and antimitochondrial antigen, whereas chromogranin, synaptophysin, S-100 protein, and HMB-45 were negative. Clinical and tomographic studies ruled out any tumor mass elsewhere. The rarity of this lesion in the lung and the potential difficulties for its diagnosis prompted us to report the clinical, cytological, and immunohistochemical findings in this case.

Giant cell carcinoma of the lung. Report of a case with cytohistologic and clinical correlation.

BACKGROUND: Giant cell carcinoma (GCC) of the lung is an unusual tumor characterized by an aggressive outcome. CASE: A peripheral lung tumor was observed in an elderly male. At presentation the clinical symptoms were cough, thoracic pain and hemoptysis. Chest roentgenography showed a left pleural effusion and neutrophilia in the blood. Bronchoscopic examination showed a peripheral tumor mass that could not be biopsied. Bronchoalveolar lavage was negative. The patient underwent a cerebrovascular accident and died. The autopsy showed a peripheral giant cell tumor of the left lung that involved regional and mediastinal lymph nodes. Touch imprints showed tridimensional clusters of pleomorphic and large cells, some of which were multinucleated, containing leukocytes in their cytoplasm. CONCLUSION: This case illustrates the typical cytohistologic features of GCT of the lung, which should be considered in the differential diagnosis of any peripheral lung tumor composed of large cells. Clinical correlation is helpful in reaching the correct diagnosis.

Nodular fasciitis of the vulva. Report of a case with immunohistochemical study.

Nodular fasciitis (NF) is a tumor-like condition composed of fibroblasts and myofibroblasts, usually located in the subcutaneous tissue of the extremities. Histologically, it can mimic a myogenic sarcoma because of its hypercellularity, brisk mitotic rate and the presence of actin. NF of the vulva is rare with only eleven cases reported in the English literature. A 40 year-old woman developed a nodule in labium majus that was surgically excised. Microscopical examination revealed a typical example of NF with occasional multinucleated giant cells. The immunohistochemical study showed positivity for vimentin and muscle-specific actin in the spindle cells. The multinucleated cells stained with CD68. MIB-1 was positive in less than 5% of the cells which indicated a low proliferative activity. The patient has been followed for 5 years and no relapses occurred. The rarity of this lesion in the vulva and the potential difficulties for its diagnosis led us to report the clinical and immunohistochemical study of this case.

Intramammary lymph node involvement by mycosis fungoides diagnosed by fine-needle aspiration biopsy.

We report on a case of a patient with diagnosis of mycosis fungoides (MF) who subsequently developed enlargement of the intramammary lymph nodes, which were demonstrated to be involved by tumor on fine-needle aspiration (FNA) cytology. The patient was a 66-yr-old female who had recently noticed the appearance of circumscribed bilateral breast nodules. A mammographic study showed clearly outlined nodules of low density. FNA showed atypical small and large lymphocytes with cerebriform appearance, consistent with intramammary lymph node infiltration by MF. To our knowledge this is the first report of intramammary palpable lymph nodes involved by MF and confirmed by FNA. This case provides support for the use of fine-needle aspiration biopsy as an accurate method for staging MF successfully.

Adenomyoepithelioma of the breast: report of two cases with prominent cystic changes and intranuclear inclusions.

Adenomyoepithelioma is a rare breast tumor. Histologically it may disclose different patterns of growth, and some additional features may result in diagnostic errors. We describe 2 cases of adenomyoepithelioma of the breast initially examined by fine-needle aspiration biopsy (FNAB). Cytologic features included hypercellularity, clusters of epithelial and myoepithelial cells with occasional intranuclear inclusions, prominent apocrine metaplasia, and foam cells. Histologically, both tumors were diagnosed as adenomyepithelioma tubular-variant, with prominent myoepithelial clear cells, apocrine metaplasia, and foci of squamous metaplasia. Immunohistochemically, the tumors showed strong positivity for keratins CAM 5.2, AE1/AE3, and EMA in the epithelial component, while the myoepithelial cells reacted with muscle-specific actin (A14 and HHF35) and S-100 protein. We point out that FNAB in this rare tumor may exhibit a varied spectrum of cells that may result in confusion with other lesions, and we call attention to the presence of intranuclear inclusions. The latter observation in the present cases by cytologic and histologic assessment provides and additional feature to the morphological characteristics of adenomyoepithelioma of the breast.