Histopathologic and immunohistochemical features of sea urchin granulomas.

BACKGROUND: Paracentrotus lividus is the most common variety of sea urchin in the west coasts of Spain and has commercial value for the alimentary industry. Puncture with the spine of its rigid external skeleton may cause mechanical injury by skin penetration. It causes immediate local symptoms and, in some cases, a delayed reaction occurs in the site of injury, weeks to months later. In this case, persistent, firm, flesh-colored papules or nodules develop. MATERIAL AND METHODS: Twenty-four biopsies from 21 patients with the diagnosis of sea urchin granuloma were studied, as well the clinical data. Specimens were routinely processed and stained with hematoxylin-eosin and leucocyte common antigen, CD20, CD3, CD4, CD8, CD30, CD68, kappa and lambda. RESULTS: Patients presented with persistent, single or multiple, nodules or papules, usually located in the hands. They developed from 2 weeks to over 1 year after the injury. Histopathologically, granulomas were present in all but one case. Sarcoidal granulomas were more common than suppurative or necrobiotic granulomas. Immunohistochemistry showed a polymorphous lymphoid inflammatory infiltrate, with T leucocytes predominating in most cases. CONCLUSION: Histopathological examination of sea urchin granulomas shows a non-specific granulomatous inflammation, in most cases of sarcoidal type. Being aware of the triggering event is necessary for the correct diagnosis.

Renal cell carcinoma in young adults: a study of 130 cases and a review of previous series.

OBJECTIVE: To characterize a large series of renal cell carcinomas (RCCs) in young patients and to compare the data obtained to previously published data. PATIENTS AND METHODS: A total of 130 RCCs diagnosed in patients <40 years of age were collected from 9 different hospitals in Spain. Cases were re-evaluated following the diagnostic criteria of the 2004 WHO classification of renal tumors. RESULTS: Histologically, tumors were classified as clear cell (50.7%), papillary (8.5%), chromophobe (14.6%), unclassified (16.9%) and clear cell papillary (9.3%) RCCs. Organ-confined disease (OCD) was detected in 83.6% of the cases. Tumor size and Fuhrman's grade were statistically correlated (Spearman's rho = 0.391). CD10 (p = 0.000), CK7 (p = 0.000), CD15 (p = 0.016), CD117 (p = 0.000), 34betaE12 cytokeratin (p = 0.034) and e-cadherin (p = 0.000) immunostaining significantly differentiated the five histological categories. CONCLUSIONS: OCD was more common in young RCC patients. The clear cell phenotype accounted for only 50% of RCCs in this age group, with an increasing number of chromophobe and unclassified RCCs. Clear cell RCCs with a papillary growth pattern accounted for a significant proportion of the cases.

[Large adrenal pseudocyst mimicking cystic pheochromocytoma: excision minimising laparoscopic access]. / Seudoquiste adrenal grande que simula feocromocitoma quístico: exéresis minimizando el acceso laparoscópico.

INTRODUCTION: Adrenal cysts and pseudocysts are rare and usually benign and asymptomatic; they are discovered either accidentally or during examination for non-specific abdominal discomfort. Less frequently, they may cause gastrointestinal symptoms or abdominal or lumbar pain, particularly when they are quite large. Histologically, they are classified as epithelial, endothelial, parasitic and pseudocysts (with a fibrous wall but no epithelium). The differential diagnosis for adrenal cysts must consider cystic adrenal carcinoma and cystic pheochromocytoma, which are both extremely rare, but more severe and difficult to treat. PATIENTS AND RESULTS: A 55 year-old woman reported right-side flank pain; imaging studies discovered a 10 cm cystic adrenal tumour, with radiological indications of cystic pheochromocytoma. Total transperitoneal laparoscopic excision was performed through three access ports. The cyst was drained by intra-abdominal bagging and aspiration before excision, in order to minimise surgical incisions. Pathological study showed benign pseudocyst. CONCLUSIONS: As less invasive laparoscopic procedures become widespread, an increasing number of case reports and series of cases regarding adrenal cyst operations have recently been reported. A review of the literature shows that the cysts are generally benign, but it is not always possible to identify cystic adrenal carcinoma or cystic pheochromocytoma from the radiology image. Draining the cyst using an aseptic and oncologically safe procedure is useful for minimising surgical wounds and increases the benefits of laparoscopic access.

Seudoquiste adrenal grande que simula feocromocitoma quístico: exéresis minimizando el acceso laparoscópico / Large adrenal pseudocyst mimicking cystic pheochromocytoma: excision minimising laparoscopic access

Introducción: Las lesiones adrenales quísticas o seudoquísticas son relativamente raras, generalmente benignas y asintomáticas, y se descubren de manera incidental o durante el estudio de molestias abdominales inespecíficas. Menos frecuentemente, pueden causar síntomas gastrointestinales o dolor abdominal o lumbar, sobre todo si son suficientemente grandes. Histológicamente, se clasifican en quistes epiteliales, endoteliales, seudoquistes (con pared fibrosa sin epitelio) y parasitarios. El diagnóstico diferencial de los quistes adrenales debe plantearse con el carcinoma adrenal quístico y con el feocromocitoma quístico, lesiones muy infrecuentes pero de mayor gravedad o de tratamiento más difícil. Pacientes y resultados: Una mujer de 55 años consultó por dolor en flanco derecho y en los estudios de imagen se halló un tumor suprarrenal quístico de 10 cm, con semiología radiológica de feocromocitoma quístico. Se realizó exéresis laparoscópica transperitoneal mediante tres accesos, evacuando el quiste mediante embolsado y aspiración intraabdominal, lo que permitió minimizar las heridas operatorias. El estudio histopatológico mostró seudoquiste. Conclusiones: Con la divulgación del acceso laparoscópico, menos invasivo, se ha comunicado recientemente un número creciente de casos aislados y de series de casos de quistes adrenales intervenidos. La revisión de la bibliografía científica muestra que, generalmente, se trata de quistes benignos, pero no siempre es posible identificar el carcinoma y el feocromocitoma quísticos por las características radiológicas. El vaciado del contenido quístico en condiciones de asepsia y de seguridad oncológica permite minimizar las heridas quirúrgicas, aumentando los beneficios del acceso laparoscópico (AU)

Introduction: Adrenal cysts and pseudocysts are rare and usually benign and asymptomatic; they are discovered either accidentally or during examination for non-specific abdominal discomfort. Less frequently, they may cause gastrointestinal symptoms or abdominal or lumbar pain, particularly when they are quite large. Histologically, they are classified as epithelial, endothelial, parasitic and pseudo cysts (with a fibrous wall but no epithelium).The differential diagnosis for adrenal cysts must consider cystic adrenal carcinoma and cystic pheochromocytoma, which are both extremely rare, but more severe and difficult to treat. Patients and results: A 55 year-old woman reported right-side flank pain; imaging studies discovered a 10cm cystic adrenal tumour, with radiological indications of cystic pheochromocytoma. Total transperitoneal laparoscopic excision was performed through three access ports. The cyst was drained by intra-abdominal bagging and aspiration before excision, in order to minimise surgical incisions. Pathological study showed benign pseudocyst. Conclusions: As less invasive laparoscopic procedures become widespread, an increasing number of case reports and series of cases regarding adrenal cyst operations have recently been reported. A review of the literature shows that the cysts are generally benign, but it is not always possible to identify cystic adrenal carcinoma or cystic pheochromocytoma from the radiology image. Draining the cyst using an aseptic and oncologically safe procedure is useful for minimising surgical wounds and increases the benefits of laparoscopic access (AU)

Metastatic tumours to the oral cavity: a survival study with a special focus on gingival metastases.

AIMS: To describe survival from oral metastases, particularly gingival metastases, and to identify clinical prognostic variables. MATERIALS AND METHODS: A series of 39 patients were studied, analysing age, gender, primary tumour site, oral metastases site and histological type. RESULTS: Mean age: 62.3+/-9.2 years, with similar prevalence by gender. The most frequent sites for primary tumours were the kidney (20.5%), lung (20.5%) and breast (20.5%). Gingival metastases represented 63.6% of all oral soft tissue metastases (7/11). The average time between primary tumour diagnosis and appearance of the gingival metastases was 9.7+/-13.4 months. The median survival time since gingival metastases appearance was 5.2 months [95% confidence interval (CI)=0-13.6]; no statistically significant difference with other oral locations was found by the Kaplan-Meier curves (log rank: 0.29; p>0.05). Oral metastases involving the gingiva were more frequently found in the maxilla (85.7%versus 14.3%), whereas intra-osseous metastatic tumours were more frequent in the mandible (77.8%versus 22.2%; p<0.05; odds ratio=21; 95% CI=2.0-210.1). None of the variables considered had a prognostic value as indicated by the Kaplan-Meier test. PRACTICAL IMPLICATIONS: The data in this paper show that 25% (and in other studies up to 37%) of oral metastases came from unknown primary tumours; thus a biopsy with histopathologic analysis is mandatory for every patient with a gingival mass. CONCLUSIONS: This study reinforces the significance of gingival metastases as a poor prognosis indicator. Dental practitioners should suspect that gingival masses mimicking benign or inflammatory lesions may represent a sign of underlying malignant tumours.

Secretory breast carcinoma in a 63-year-old man.

A secretory carcinoma of the breast, associated with axillary node metastasis, occurred in a 63-year-old man. Secretory breast carcinoma is a rare variant of breast carcinoma, but it is the commonest type seen in children, although most of the cases have been described in females. Here, we describe a case in an adult man.

Muscle invasive bladder tumor 18 months after laparoscopic radical nephroureterectomy.

OBJECTIVE: The management of the distal ureter and bladder cuff is an important issue related to laparoscopic nephroureterectomy, because of the fear that local and bladder recurrences could be induced by an inadequate manipulation of the specimen. We present a case of muscle invasive bladder tumor that appeared 18 months after laparoscopic radical nephroureterectomy. METHODS/RESULTS: A 42 year-old woman with multifocal grade 3 pT3, right kidney urothelial carcinoma, treated by laparoscopic radical nephroureterectomy with early clipping of the distal ureter, transurethral detachment of the intramural ureter, and no bladder closure, presented with an invasive bladder recurrence after 18 months of follow-up. CONCLUSIONS: There is no a definitive answer to the question of what is the best and safest way of treating the intramural ureter to prevent local and bladder recurrences. However, early clip occlusion of the ureter to avoid downstream cell seeding during kidney manipulation, and an open approach to the distal ureter in case of concomitant distal ureter or bladder tumor is recommended.

Muscle invasive bladder tumor 18 months after laparoscopic radical nephrourectomy / Tumor vesical infiltrante 18 meses después de nefrectomía radical laparoscópica

Objective: The management of the distal ureter and bladder cuff is an important issue related to laparoscopic nephroureterectomy, because of the fear that local and bladder recurrences could be induced by an inadequate manipulation of the specimen. We present a case of muscle invasive bladder tumor that appeared 18 months after laparoscopic radical nephroureterectomy. Methods/Results: A 42 year-old woman with multifocal grade 3 pT3, right kidney urothelial carcinoma, treated by laparoscopic radical nephroureterectomy with early clipping of the distal ureter, transurethral detachment of the intramural ureter, and no bladder closure, presented with an invasive bladder recurrence after 18 months of follow-up. Conclussions: There is no a definitive answer to the question of what is the best and safest way of treating the intramural ureter to prevent local and bladder recurrences. However, early clip occlusion of the ureter to avoid downstream cell seeding during kidney manipulation, and an open approach to the distal ureter in case of concomitant distal ureter or bladder tumor is recommended (AU)

Objetivo: El manejo del uréter distal y del manguito vesical es uno de los aspectos más importantes y discutidos de la nefroureterectomía laparoscópica por tumor de urotelio, porque existe el temor de que una manipulación indecuada de la pieza pueda inducir una recidiva vesical o local. Describimos un caso de tumor vesical infiltrante aparecido a los 18 meses de una nefroureterectomía radical laparoscópica. Método/Resultado: Una mujer de 42 años con carcinoma de urotelio multifocal de la pelvis y cáliz inferior del riñón derecho, grado 3, pT3, que fue tratado mediante desinserción transuretral del uréter intramural y nefroureterectomía radical con clipado precoz del uréter distal, presentó una recidiva de tumor vesical infiltrante a los 18 meses de seguimiento, de curso fatal en poco tiempo. Conclusión: Aún no hay una respuesta definitiva a la cuestión de cuál es el mejor y más seguro modo de tratar el uréter intramural para prevenir una recidiva local o vesical, después de nefroureterectomia laparoscópica por tumor de urotelio. Se recomienda un oclusión precoz del uréter para evitar una potencial siembra de células durante la manipulación del riñón, y elegir un acceso abierto al uréter distal en caso de tumor de uréter pelviano o de tumor vesical concomitante (AU)

Neurobrucellosis mimicking cerebral tumor: case report and literature review.

We are reporting a case of neurobrucellosis that was clinically and radiologically indistinguishable from a cerebral tumor. The histological diagnosis was granulomatous encephalitis. The diagnosis was established by enzyme-linked immunosorbent assay (ELISA), detecting high levels of Ig G and Ig M Brucella antibodies in the serum and the cerebrospinal fluid. We suggest that patients with granulomatous encephalitis, without a clear etiological agent, should be studied for Brucella.

Expression of CDX2, cytokeratins 7 and 20 in sinonasal intestinal-type adenocarcinoma.

CDX2 is a transcription factor expressed by intestinal epithelium. It is considered as a sensitive marker for a colorectal or-less frequently-gastric origin of adenocarcinomas. The pattern of coordinated expression of cytokeratin (CK) 7 and CK20 is also useful for the diagnosis of the origin of metastatic adenocarcinomas. Expression of CDX2, CK7 and CK20 was investigated in 14 cases of sinonasal intestinal-type adenocarcinoma (SIA), a particular tumor with an enteric-cell-type appearance. Formalin-fixed, paraffin embedded tissue sections were immunostained with monoclonal antibodies using the biotin-labeled streptavidin technique. All of the cases expressed CDX2, being stained 50 to 100% of the tumor cells (mean: 87.2%). CK7 positivity was detected in 8 cases (57.1%), with the staining of 10 to 100% of cells (mean: 65.6%), and CK20 was found in all the tumors (10 to 100% of cells; mean: 78.8%). The histologic resemblance between SIA and colorectal adenocarcinoma is reinforced by the expression of CDX2 and CK20, which are virtually constant in both neoplasms. CDX2 seems to be a marker for cellular phenotype better than an indicator of the origin of adenocarcinomas. CK7 is expressed in SIA less frequently than in colonic adenocarcinoma, but with a rate similar to the subset of rectal tumors, making the differential diagnosis between the two neoplasms difficult.

Fine needle aspiration appearance of extragastrointestinal stromal tumor. A case report.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) rarely develop outside the digestive tract and in the soft tissues of abdomen and retroperitoneum. Such tumors are designated extra-GISTs (EGISTs). Cytologic and immunocytochemical features of a case of EGIST are reported. CASE: A 54-year-old woman presented with a peritoneal mass, diameter 22 cm, adherent to the omentum and without a connection to the digestive tract. Fine needle aspiration biopsy (FNAB) of the excised tumor showed high cellularity in two patterns: monotonous spindle cells were intermingled with a mildly atypical epithelioid component. Immunocytochemistry performed on cytospins revealed reactivity for c-kit (CD117), CD34 and smooth muscle actin and negativity for S-100. The findings were concordant with a histologic diagnosis of EGIST. CONCLUSION: EGISTs are infrequent neoplasms and can be diagnosed in FNAB samples. The clinical/radiologic setting must be considered together with the cytologic features. Immunocytochemistry is a clue to the diagnosis when it detects c-kit reactivity.

Quistes de vesículas seminales. ¿Un hallazgo irrelevante? / Cysts of the seminal vesicles: an irrelevant finding?

Objetivo: Analizar la relación entre quistes de vesículas seminales (QVS) y presencia de malformaciones congénitas del sistema genitourinario.Material y métodos: Se analizan retrospectivamente las imágenes abdominales de ocho pacientes con criterios ecográficos y diagnóstico definitivo de QVS, estudiados durante siete años. La valoración diagnóstica se completó con RM (cinco casos), TC (tres casos), UIV (un caso) y vesículo-deferentografía (dos casos).Resultados: En seis casos (75 por ciento) los QVS se asociaron a anomalías congénitas urológicas: enfermedad poliquística autosómica dominante (tres casos), agenesia-hipoplasia renal (dos casos) y estenosis de la unión pieloureteral (un caso). Los quistes fueron bilaterales en seis casos; dos casos unilaterales correspondieron a la asociación con agenesia-hipoplasia renal y fueron ipsilaterales a la malformación renal. Un caso de hipoplasia asoció uréter ectópico desembocando en la vesícula seminal afectada. En dos casos el QVS fue un hallazgo aislado, con antecedente de tuberculosis urinaria en uno, y sin antecedentes de interés en el otro.Conclusiones: Ante el hallazgo de QVS es preciso explorar todo el tracto urinario, dada la alta incidencia de asociación con malformaciones congénitas renales y del sistema excretor. En los casos aislados debe investigarse un posible antecedente infeccioso que pueda justificar una etiología obstructiva (AU)