Etiología de la mastitis crónica: propuesta de secuencia diagnóstica / Proposed diagnosis sequence for chronic mastitis aetiology

Introducción: Las lesiones inflamatorias mamarias precisan con frecuencia de estudio histopatológico por su capacidad de imitar a los tumores mamarios malignos. El objetivo es proponer una secuencia diagnóstica de las inflamaciones mamarias benignas crónicas. Material y método: Se han revisado en la literatura los métodos y algoritmos diagnósticos de las mastitis crónicas. Resultados: Se propone un algoritmo diagnóstico para los procesos inflamatorios crónicos mamarios. Requiere determinar el patrón histopatológico inflamatorio y su localización, así como un estudio microbiológico apropiado. Posteriormente puede precisar de nuevas pruebas bioquímicas y serológicas orientadas por una correlación clinicopatológica para establecer un diagnóstico específico. Discusión: No se han identificado en la literatura otros algoritmos diagnósticos avalados por estudios de alto nivel de evidencia. Los patrones histopatológicos no son uniformes. Conclusiones: El diagnóstico etiológico precisa identificar patrones histopatológicos inflamatorios benignos y su localización, un estudio microbiológico y pruebas orientadas por correlación clinicopatológica. Se precisan estudios de investigación con niveles de evidencia altos

Introduction: Inflammatory breast lesions require histopathological study due to their ability to clinically and radiologically mimic malignant mammary tumours. The objective is to propose a diagnostic technique for benign chronic inflammatory processes of the breast. Material and methods: We reviewed the literature on the diagnostic methods used in chronic mastitis. Results: We propose a diagnostic algorithm for chronic inflammatory processes of the breast. The aetiological diagnosis requires identifying benign inflammatory histopathologic patterns and locations, and microbiological study. New biochemical and serological tests oriented by clinicopathological correlation may then be required to establish a specific diagnosis. Discussion: No diagnostic algorithms based on studies with a high level of evidence have been identified. No uniformity in histopathologic patterns has been described. Conclusions: The etiologic diagnosis requires identifying benign inflammatory histopathologic patterns and locations, microbiological study and tests oriented by clinicopathological correlation. There is a lack of studies with a high level of evidence

Aberrant DNA methylation is associated with aggressive clinicopathological features and poor survival in cutaneous melanoma.

BACKGROUND: Promoter methylation of tumour suppressor genes (TSGs) has recently been implicated in the pathogenesis of several types of cancer. Regarding melanoma, over 100 genes that contribute to its pathogenesis have been identified to be aberrantly hypermethylated. OBJECTIVES: This is a retrospective observational study that aims to analyse the prevalence of CpG island methylation in a series of primary melanomas, to identify the associations with the main clinicopathological features, and to explore the prognostic significance of methylation in melanoma survival. MATERIALS AND METHODS: DNA methylation was analysed using methylation-specific multiplex ligation-dependent probe amplification in a series of 170 melanoma formalin-fixed paraffin-embedded tumour samples. The relationship between the methylation status, known somatic mutations and clinicopathological features was evaluated. Disease-free survival (DFS) and overall survival (OS) were displayed by the Kaplan-Meier method. RESULTS: In the entire cohort, one or more genes were detected to be methylated in 55% of the patients. The most prevalent methylated genes were RARB 31%, PTEN 24%, APC 16%, CDH13 16%, ESR1 14%, CDKN2A 6% and RASSF1 5%. An association between aberrant methylation and aggressive clinicopathological features was observed (older age, increased Breslow thickness, presence of mitosis and ulceration, fast-growing melanomas, advancing stage and TERT mutations). Furthermore, Kaplan-Meier survival analysis showed a correlation of methylation and poorer DFS and OS. CONCLUSIONS: Aberrant methylation of TSGs is a frequent event in melanoma. It is associated with aggressive clinicopathological features and poorer survival. Epigenetic alterations may represent a significant prognostic marker with utility in routine practice.

Quistes de rafe medio en el varón. Presentación de nuestra experiencia y revisión de la literatura / Median raphe cysts in men. Presentation of our experience and literature review

Objetivos: Presentar nuestra experiencia en el diagnóstico y tratamiento de los quistes de rafe medio atendidos en nuestro servicio en los últimos 25 años. Material y método: Realizamos un estudio retrospectivo de 28 varones afectos de quistes de rafe medio intervenidos en nuestro servicio desde junio de 1990 a marzo de 2015. Se analizan la edad de presentación, el motivo de consulta, las manifestaciones clínicas, los hallazgos en el estudio histológico, el tratamiento realizado y la evolución tras su exéresis. Resultados: La mayor parte de los pacientes (22; 79%) estaban asintomáticos y consultaron por el defecto estético; 4 casos (14%) presentaron alteraciones miccionales y 2 (7%) refirieron molestias durante el acto sexual. En todos los casos el tratamiento consistió en la extirpación quirúrgica del quiste, obteniendo excelentes resultados estéticos y funcionales, sin recidiva de la lesión en ninguno de los pacientes durante un seguimiento medio de más de 10 años. El tipo histológico más frecuentemente encontrado fue el de células transicionales en 15 casos (54%), seguido del tipo mixto (transicional y escamoso) en 11 casos (39%); en un caso (6%) fue de tipo escamoso puro y en otro caso (6%) el epitelio fue de tipo glandular. Conclusiones: Los quistes de rafe medio constituyen un tipo infrecuente de disembrioplasia que pueden localizarse en cualquier punto del rafe medio, desde el meato balánico hasta los márgenes del ano. Generalmente son asintomáticos y su tratamiento de elección es la extirpación quirúrgica

Objectives: To present our experience with the diagnosis and treatment of median raphe cysts treated in our department in the last 25 years. Material and method: We conducted a retrospective study of 28 men with median raphe cysts who underwent surgery in our department from June 1990 to March 2015. We analysed the age of presentation, reason for consultation, clinical manifestations, histological findings, treatment and outcome after exeresis. Results: The majority of the patients (22; 79%) were asymptomatic and consulted for the aesthetic defect. Four cases (14%) presented urinary abnormalities, and 2 cases (7%) reported discomfort during sexual intercourse. In all cases, the treatment consisted of surgical extirpation of the cysts, with excellent aesthetic and functional results and no lesion recurrence in any of the patients during a mean follow-up of more than 10years. The most common histological type was the transitional cell type in 15 cases (54%), followed by the mixed type (transitional and squamous) in 11 cases (39%). One case (6%) was pure squamous type, and in another case (6%) the epithelium was glandular. Conclusions: Median raphe cysts are an uncommon type of disembryoplasia that can occur in any location of the median raphe, from the balanic meatus to the edges of the anus. These cysts are generally asymptomatic and their treatment of choice is surgical extirpation

Median raphe cysts in men. Presentation of our experience and literature review. / Quistes de rafe medio en el varón. Presentación de nuestra experiencia y revisión de la literatura.

OBJECTIVES: To present our experience with the diagnosis and treatment of median raphe cysts treated in our department in the last 25years. MATERIAL AND METHOD: We conducted a retrospective study of 28men with median raphe cysts who underwent surgery in our department from June 1990 to March 2015. We analysed the age of presentation, reason for consultation, clinical manifestations, histological findings, treatment and outcome after exeresis. RESULTS: The majority of the patients (22; 79%) were asymptomatic and consulted for the aesthetic defect. Four cases (14%) presented urinary abnormalities, and 2 cases (7%) reported discomfort during sexual intercourse. In all cases, the treatment consisted of surgical extirpation of the cysts, with excellent aesthetic and functional results and no lesion recurrence in any of the patients during a mean follow-up of more than 10years. The most common histological type was the transitional cell type in 15 cases (54%), followed by the mixed type (transitional and squamous) in 11 cases (39%). One case (6%) was pure squamous type, and in another case (6%) the epithelium was glandular. CONCLUSIONS: Median raphe cysts are an uncommon type of disembryoplasia that can occur in any location of the median raphe, from the balanic meatus to the edges of the anus. These cysts are generally asymptomatic and their treatment of choice is surgical extirpation.

Eosinophilic follicular reaction induced by Demodex folliculorum mite: a different disease from eosinophilic folliculitis.

Eosinophilic folliculitis (EF) is an idiopathic dermatitis included in the spectrum of eosinophilic pustular follicular reactions. Demodex folliculorum has been implicated as contributing to the pathogenesis of human immunodeficiency virus-associated EF, but it has not been described outside this context. We present an immunocompetent 65-year-old white man with a 5-year history of recurrent pruritic erythematous and oedematous lesions on his face, neck and scalp. Histopathologically, an eosinophilic microabcess with Demodex folliculorum mite within a pilosebaceous follicle was seen, and considered the causal agent. There were also accumulations of eosinophil granules on collagen bundles, and flame figure formations in the dermis. We believe that 'eosinophilic follicular reaction' is an appropriate term to describe this case of EF induced by D. folliculorum and thus distinguish it from the idiopathic form of EF. Moreover, this case suggests that D. folliculorum can sometimes induce an eosinophilic immune reaction.

Syncytial giant cell component. Review of 55 renal cell carcinomas.

Different types of multinucleated giant cells (MGC) have been documented in tumors with osteoclast-like appearance, with trophoblastic differentiation or as tumoral malignant giant cells. A new variety of MGC has been described in renal cell carcinoma. In order to study the frequency, nature and significance of this cellular type, we have reviewed our files. To assess the presence, nature and significance of these MGC in renal cell carcinomas and associated histologic subtype. To review all malignant renal tumors diagnosed in the last 5 years in our hospital and to carry out a morphologic and immunohistochemical study in renal cell carcinomas with syncytial type MGC. 55 renal cell carcinomas were reviewed. Clear cell (conventional) renal cell carcinoma was the most common type encountered (40 cases); two of these cases showed syncytial type MGC and low grade malignancy. Microscopically the MGC contained from 5 to 40 nuclei. Immunohistochemically, mononucleated and multinucleated cells were positive for cytokeratin CAM 5.2, cytokeratin AE1/AE3 and weakly positive for vimentin. Histiocytic, muscular, neural markers, beta-HCG and alpha-fetoprotein were negative. The presence of syncytial type MGC in renal cell carcinomas is an exceptional event. Among 55 renal cell carcinomas we found two cases, both of which were of clear cell subtype and low grade malignancy. The MGC proved positive for epithelial markers and probably are the result of mononucleated tumoral cell fusion. We are unaware of the impact of this MGC in the outcome of patients; such cells appear in low grade carcinomas and do not seem to be of dismal prognosis.

Extranodal peripheral T-cell lymphoma with angiocentric growth pattern and Epstein-Barr viral DNA associated affecting paratesticular soft tissue.

Peripheral T-cell lymphomas are uncommon, accounting for only 10% to 15% of all non-Hodgkin lymphomas and their classification has been controversial. We report a case of peripheral T-cell lymphoma with angiocentric growth pattern which presented as a paratesticular tumoral nodule in a 47-year-old-man. Formalin-fixed paraffin-embedded samples from the paratesticular tumor and non-infiltrated adjacent tissue were submitted to histological, immunohistochemical, polymerase chain reaction (PCR)-based and in situ hybridization analysis. Histopathologically, there was a lymphomatous infiltrate in the paratesticular soft tissue, composed of a variable mixture of medium-sized to large cells with large cytoplasm and irregular-shaped nuclei, together with blood vessel destruction, necrosis and karyorrhexis. Immunohistochemical study revealed a high p53 expression in neoplastic cells that showed T cytotoxic immunophenotype, failing to express the natural killer (NK)-cell antigen CD56. A monoclonal rearrangement of the T-cell receptor (TCR) gamma gene by a PCR technique was demonstrated. Type-A Epstein-Barr Virus (EBV) DNA was detected by PCR-based analysis. A combined in situ hybridization and immunohistochemical study revealed that most cells labeled positive for EBV RNA showed immunostaining with the CD45RO antibody. Based on the above results, the case reported was classified as extranodal peripheral T-cell lymphoma with cytotoxic phenotype and EBV associated. The present case does not fit neatly into any of the specific types of peripheral T-cell lymphomas of the REAL classification, so a diagnosis of peripheral T-cell lymphoma unspecified was made.

Primary soft tissue lymphoma associated with mesenteric lipodystrophy.

Skin involvement in non-Hodgkin lymphoma is usually specific and may precede systemic manifestations of the disease by months or even years. We report the case of a man with an inguinal plaque lesion of 1 year's evolution, diagnosed as polymorphous lymphoplasmocytoid lymphoma (immunocytoma). The evaluation of spread only revealed mesenteric lipodystrophy, whose association with lymphoid processes is more common than would be expected.

[Hematuria due to polypoid cystitis. Its differential diagnosis from bladder carcinoma]. / Hematuria por cistitis polipoide. Diagnóstico diferencial con carcinoma de vejiga.

Polypoid cystitis is not uncommon in patients with a permanent urethral catheter. In some cases difficulties are encountered when making the differential or anatomopathological diagnosis from transitional cell carcinoma of the bladder. We report a case of polypoid cystitis mimicking bladder carcinoma in a patient with a permanent urethral catheter.

[Nephrogenic adenoma of the bladder]. / Adenoma nefrogénico de vejiga.

Presentation of one case of vesical nephrogenic adenoma diagnosed as an accidental histological finding following TUR of vesical tumour. This case if considered of interest due to the rarity of the lesion (some 300 cases reported) and the limited number of quotations in the Spanish literature.

[Anal polypoid tumor formation as the form of presentation of rectal gastric heterotopia]. / Tumoración anal polipoide como forma de presentación de una heterotopia gástrica rectal.

Heterotopic gastric epithelium occurs in all portions of the alimentary tract, but it is extremely rare in the rectum. The authors report the finding of a pedunculated anal polyp in a 9-year-old girl with a six-month history of rectal bleeding. Microscopically, the polyp consisted of epithelium of the fundic type. Both the age of the patient and the finding of heterotopic epithelium of the fundic type alone supports a congenital malformation and not an inflammatory condition.

[Primary carcinoma of the male urethra: review of the literature and presentation of a new case]. / Carcinoma primario de la uretra masculina: revisión de la literatura y aportación de un nuevo caso.

A primary carcinoma of the male urethra is described. The etiology, diagnosis, clinical features and treatment of this uncommon tumor are discussed. Because this tumor frequently presents as a benign urethral process, biopsies should be performed in urethral conditions with a torpid clinical course.

[Lymphoma of the splenic mantle. Morphologic, immunologic and ultrastructural characterization of a case]. / Linfoma del manto esplénico. Caracterización morfológica, inmunológica y ultraestructural de un caso.

We present a splenic primary mantle lymphoma in a 64 year old woman, without peripheral lymphoadenopathy and stage IV at the moment of the diagnosis. Grossly a splenic infiltration was observed. Microscopically, a nodular lymphoma of small lymphocytes proliferating around benign germinal centers makes the diagnosis. Immunohistochemically, tumoral lymphocytes expressed SIgG/kappa and CD5 (Leu-1). Markers of follicular center origin CD10 (CALLA) were negative. According to working formulation mantle-cell lymphoma is considered a lymphoma of intermediate grade of malignancy. In our case, the morphologic, immunologic, ultrastructural findings and clinical evolution were more characteristics of a low grade lymphoma that a intermediate grade of malignancy.