Case 214: Adrenal pheochromocytoma with perirenal brown fat stimulation.

History A 61-year-old woman with well-controlled diabetes presented with a 10-year history of hypertension, stifling sensation, and flushing. Her body mass index was 19.1 kg/m(2) (normal range, 18.5-25.0 kg/m(2)). She was being followed up for mild hypercalcemia (calcium level, 10.8 mg/dL [2.7 mmol/L]) (normal range, 8.5-10.5 mg/dL [2.12-2.62 mmol/L]) by the endocrinologist (S.J.M.), who decided to perform a technetium 99m sestamibi ((99m)Tc MIBI) parathyroid scan. The test showed an abnormal tracer deposit in the region of the clavicle and sternum; thus, unenhanced thoracic computed tomography (CT) was performed. No mass was seen in the region of abnormality. In light of these findings, the patient underwent contrast material-enhanced (120 mL of iopromide, Ultravist 300; Schering, Berlin, Germany) thoracic abdominopelvic CT. There was no history of underlying malignancy, and the complete blood counts were normal. The axial and appendicular skeleton showed no sign of lesions.

Mullerianosis vesical / Mullerianosis of the urinary bladder

La mullerianosis vesical, entidad raramente descrita, fue definida por primera vez en 1996 por Young y Clement como la combinación de al menos 2 tipos de tejido ectópico de origen mulleriano (endometriosis, endocervicosis y endosalpingiosis) en el espesor de la pared vesical. Se ha intentado explicar su origen tanto por un mecanismo de implantación como metaplásico. El carácter cíclico de la sintomatología, que puede aparecer hasta en el 50% de las pacientes, debería hacer sospechar su presencia. Aunque la resección transuretral tiene un valor diagnóstico indudable, el carácter transmural de la lesión aconseja su exéresis completa (cistectomía parcial), como ocurrió en nuestro caso (AU)

Müllerianosis of the urinary bladder, a rare entity, was first defined by Young and Clement in 1996 as the combination of at least two types of ectopic tissue of Müllerian origin (endometriosis, endocervicosis, and endosalpingiosis) in the bladder wall. Theories of implantation or metaplasia have been proposed to explain the origin of this entity. Recurrent or cyclic symptomatology, which is reported in up to 50% of patients, is highly suspicious of müllerianosis of the bladder. Although transurethral resection is useful in diagnosis, complete removal of the lesion (partial cystectomy) is highly advisable, as performed in the patient presented herein (AU)

Predictors for tumor recurrence after primary definitive surgery for oral cancer.

PURPOSE: The purpose of this study was to identify significant predictors for oral squamous cell carcinoma recurrence. PATIENTS AND METHODS: This Ambispective cohort study was performed in consecutive metastasis-free patients treated for oral squamous cell carcinoma with curative intent from 1998 through 2003. Variables included gender, age, tumor site, macroscopic pattern of the lesion, coexisting disorders (diabetes, hepatic and heart disorders, other tumors/diseases), degree of differentiation, and pathologic TNM stage. Tumor recurrence was considered the dependent variable (outcome). The distribution of recurrences was assessed with χ(2) test. Survival times were estimated by Kaplan-Meier curves and differences were examined with log-rank test. Multiple Cox regression study was also performed. The significance level chosen for all tests was P < .05. RESULTS: One hundred eighteen patients entered the study. Tumor recurrence was 44.9% during the follow-up period (10% local, 29.7% regional, and 5% distant). The mean period that had elapsed before recurrence was 15 months (1.5 to 81.8), with most recurrences (66%) during the first year after treatment (84.9% before 2 years). Multivariate Cox regression analysis indicated the presence of a coexisting disorder (P = .022) as the most relevant prognostic factor for relapse, because patients with associated diseases had a 2.43-fold risk of recurrence. Tumor stage (P = .037), degree of differentiation (P = .042), and macroscopic pattern of the lesion (P = .022) were also identified as prognostic factors for relapse. CONCLUSIONS: The risk profile for oral cancer recurrence includes patients younger than 60 years with coexisting diseases whose primary tumor occurred as an ulcerated lesion, and diagnosed at an advanced stage with a poorly differentiated tumor.

Presentación testicular de un linfoma no Hodking tipo NK nasal y revisión de la literatura / Testicular presentation of a nasal type NK non Hodgkin lymphoma and review of the literature

Objetivos: Comunicar un caso de un tumor de células NK de tipo nasal originado en el testículo y realizar una revisión de la literatura publicada. Método/Resultado: Presentamos un paciente de 68 años de la edad, sin historia urológica previa, que acudió a nuestra consulta refiriendo desde hace 11 meses clínica de inflamación del teste derecho y afectación de la piel escrotal con mala respuesta a tratamiento antibiótico. Se realizó una orquiectomía por vía inguinal y se resecó la piel afectada. El diagnóstico histológico definitivo fue de linfoma no Hodgkin tipo NK nasal de células grandes. Posteriormente fue derivado al servicio de hematología que realizó un estudio de extensión confirmando con un frotis sanguíneo el diagnóstico de linfoma y tras estudiar al paciente se realizó un tratamiento sistémico con 3 ciclos de CHOP y profilaxis intratecal. Tras 20 meses de seguimiento desde el inicio de los síntomas el paciente no ha presentado afectación ganglionar o de algún otro órgano. Conclusiones: Los linfomas de células T/NK nasales son tumores poco frecuentes en nuestro medio siendo su presentación extra nasal toda una rareza y encontrado en la literatura revisada sólo 12 casos de esta presentación testicular. Es esencial el estudio anatomopatológico mediante inmunohistoquímica para clasificar dichos linfomas, ya que este tipo se caracteriza por una rápida diseminación sistémica y mala respuesta al tratamiento.

Objectives: To report a case of a nasal type NK cell tumor originated in the testicle and review the published literature. Method/Results: We report a 68 years old patient, without previous urological history, who came to our clinic referring clinical inflammation of the right testicle with scrotal skin involvement for eleven months, with poor response to antibiotic treatment. Inguinal orchiectomy was performed with resection of the affected skin. The definitive histologic diagnosis was nasal type NK large cell non-Hodgkin lymphoma. He was subsequently referred to Hematology which conducted an extension study and confirmed the lymphoma diagnosis with a blood smear. After staging, the patient underwent systemic treatment with 3 cycles of CHOP and intrathecal prophylaxis. After 20 months follow up from the onset of symptoms the patient has had no lymph node or other organ involvement. Conclusions: Nasal type T/NK cell lymphoma tumors are infrequent being extranasal presentation a rarity. We found only 12 cases of this testicular presentation in the literature. Pathological analysis using immunohistochemistry is essential to classify these lymphomas, as rapid systemic spread and poor response to treatment is characteristic is essential to classify these lymphomas, as rapid systemic spread and poor response to treatment is characteristic.