Distrofia de membrana basal epitelial corneal: a propósito de un caso / Epithelial basement membrane corneal dystrophy: A case report

La distrofia de la membrana basal epitelial corneal es una entidad poco frecuente, que se presenta en forma de erosiones corneales de repetición debidas a una alteración en la unión del epitelio corneal a la membrana basal. Esta patología ha sido presentada en la literatura con un enfoque eminentemente oftalmológico, dejando en un segundo plano la anatomía patológica. El objetivo de este artículo es resaltar la imagen microscópica de esta patología a propósito de un caso, así como realizar una aproximación clínica y terapéutica de esta entidad.(AU)

Epithelial basement membrane corneal dystrophy is a rare entity, characterized by recurrent corneal erosions secondary to a disorder in the attachment of the corneal epithelium to the basement membrane. To date, mainly the ophthalmological aspect of cases has been reported, with little emphasis on the pathology of this lesion. Here we aim to describe the microscopy and discuss the clinical and therapeutic aspects of a case.(AU)

[Epithelial basement membrane corneal dystrophy: A case report]. / Distrofia de membrana basal epitelial corneal: a propósito de un caso.

Epithelial basement membrane corneal dystrophy is a rare entity, characterized by recurrent corneal erosions secondary to a disorder in the attachment of the corneal epithelium to the basement membrane. To date, mainly the ophthalmological aspect of cases has been reported, with little emphasis on the pathology of this lesion. Here we aim to describe the microscopy and discuss the clinical and therapeutic aspects of a case.

Experiencia clínica en una consulta de alta resolución de nódulo tiroideo / Clinical experience in a high-resolution thyroid nodule clinic

Fundamentos y objetivos El hallazgo de un nódulo tiroideo es un hecho muy frecuente en la práctica clínica habitual. El manejo del nódulo tiroideo necesita un abordaje multidisciplinar que puede ser facilitado con la creación de unidades de alta resolución de nódulo tiroideo. Describimos la experiencia clínica y los resultados obtenidos en una consulta de alta resolución y acto único de nódulo tiroideo. Material y métodos Se han evaluado todos los pacientes derivados a la consulta de nódulo tiroideo del Hospital Virgen de la Victoria (Málaga) desde el año 2005 al 2007. Se han seguido las guías de práctica clínica de nódulo tiroideo para la recomendación de punción aspirativa con aguja fina (PAAF) y cirugía tiroidea. Se realizó análisis estadístico con programa SPSS. Resultados Durante el periodo de estudio, la consulta de nódulo tiroideo atendió a 658 pacientes (edad media 48,6 años, 89,8% mujeres). Mediante ecografía se confirmó la existencia de nódulo tiroideo en el 85,5% de los pacientes. Con un diámetro medio de 1,96cm, un 74,2% de nódulos fueron sólidos, un 55,8% hipoecoicos, y un 4,7% presentaron microcalcificaciones. Se realizó la PAAF a 475 pacientes. El 76,5% de las citologías fueron benignas, el 19,1% sospechosas, el 2,1% malignas y el 2,3% insuficientes. Se derivó a cirugía al 23,3% de los pacientes (principalmente por tamaño nodular o sospecha de malignidad). Se confirmó la existencia de patología maligna (principalmente carcinoma papilar) en el 24,9% de los nódulos intervenidos. La sensibilidad/especificidad de la citología (considerando la biopsia como el gold standard) fue del 81,8 y el 94,7%, respectivamente. Conclusiones La instauración de una consulta monográfica de nódulo tiroideo permite la optimización de recursos y reduce la demora diagnóstica, obteniendo unos resultados clínicos ampliamente satisfactorios (AU)

Background and objectives: The finding of a thyroid nodule is a very common occurrence inclinical practice. Management of thyroid nodules requires a multidisciplinary approach that may be eased by a high-resolution thyroid nodule clinic. We report our clinical experience and outcomes in a high-resolution thyroid nodule clinic. Patients and methods: All patients referred to Virgen de la Victoria Hospital (Málaga) from 2005to 2007 were evaluated following thyroid nodule guidelines. Statistical analysis was performed using SPSS software. Results: In the study period, 658 patients (mean age 48.6 years, 89.8% females) were seen atthe thyroid nodule clinic. Thyroid nodules were discovered in 85.5% of patients. Mean nodule diameter was 1.96 cm. Of these nodules, 74.2% were solid, 55.8% hypoechogenic, and 4.7% showed microcalcifications. Fine needle aspiration (FNA) was performed in 475 patients (76.5% of all cytological samples were benign, 19.1% had suspected malignancy, 2.1% were malignant, and 2.3% inadequate). Referral for surgery was required in 23.3% of patients (mainly because of nodule size or suspected malignancy). Malignancy was confirmed in 24.9% of nodules. Sensitivity and specificity of cytology (considering biopsy as gold standard) were 81.8% and 94.7%respectively.Conclusions: Implementation of a high-resolution thyroid nodule clinic decreases delay in diagnosis and optimizes available resources, thus providing for satisfactory clinical outcomes (AU)

[Clinical experience in a high-resolution thyroid nodule clinic]. / Experiencia clínica en una consulta de alta resolución de nódulo tiroideo.

BACKGROUND AND OBJECTIVES: The finding of a thyroid nodule is a very common occurrence in clinical practice. Management of thyroid nodules requires a multidisciplinary approach that may be eased by a high-resolution thyroid nodule clinic. We report our clinical experience and outcomes in a high-resolution thyroid nodule clinic. PATIENTS AND METHODS: All patients referred to Virgen de la Victoria Hospital (Málaga) from 2005 to 2007 were evaluated following thyroid nodule guidelines. Statistical analysis was performed using SPSS software. RESULTS: In the study period, 658 patients (mean age 48.6 years, 89.8% females) were seen at the thyroid nodule clinic. Thyroid nodules were discovered in 85.5% of patients. Mean nodule diameter was 1.96 cm. Of these nodules, 74.2% were solid, 55.8% hypoechogenic, and 4.7% showed microcalcifications. Fine needle aspiration (FNA) was performed in 475 patients (76.5% of all cytological samples were benign, 19.1% had suspected malignancy, 2.1% were malignant, and 2.3% inadequate). Referral for surgery was required in 23.3% of patients (mainly because of nodule size or suspected malignancy). Malignancy was confirmed in 24.9% of nodules. Sensitivity and specificity of cytology (considering biopsy as gold standard) were 81.8% and 94.7% respectively. CONCLUSIONS: Implementation of a high-resolution thyroid nodule clinic decreases delay in diagnosis and optimizes available resources, thus providing for satisfactory clinical outcomes.

Estudio clínico-radiológico de tres casos de linfomas testiculares de curso agresivo / Clinical and radiological study of three cases of aggressive course testicular lymphomas

OBJETIVO: Describir las características clínico-radiológicas y las pruebas de imagen en el diagnóstico y extensión/seguimiento del linfoma testicular (LT).MÉTODOS: Se realizó ecografía-doppler color testicular, inguinal, estadiaje con Tomografía Computarizada Multidetector (TCMD); y ecografía-doppler y TCMD en una metástasis cutánea.RESULTADOS: Caso 1: Paciente de 65 años con LT hace 11 años, recidiva en el testículo contralateral 5 años después, metástasis orbitaria a los 8 años y actualmente recidiva con infiltración del nervio cubital. Caso 2: Paciente de 44 años con LT y adenopatías inguinales metastásicas. Caso 3: Paciente de 85 años con LT, adenopatías retroperitoneales y uropatía obstructiva.Histología: LNH difuso B.CONCLUSIONES: El LT suele cursar de forma agresiva, con afectación testicular contralateral, extensión extratesticular o a distancia. Las principales técnicas radiológicas son la ecografía-doppler para el estudio de la enfermedad primaria y el TCMD en la extensión. El diagnóstico es histológico y el tratamiento quirúrgico asociado a radioterapia o quimioterapia, siendo el pronóstico malo(AU)

OBJECTIVE: To describe the clinical and radiological features, and the role of imaging in diagnosis and extension study of testicular lymphoma (TL).METHODS: Testicular and inguinal color Doppler ultrasound, extension-study Multidetector Computed Tomography (MDCT), and Doppler ultrasound and MDCT in an upper extermity metastasis were performed.RESULTS: Case 1: A 65-year-old man with TL 11 years ago, recurrence in the contralateral testis 5 years later, orbital involvement at 8 years and currently recurrence in the arm with ulnar nerve infiltration. Case 2: A 44-year-old man with TL and metastatic inguinal lymphadenopathy. Case 3: An 85 year-old man with TL, retroperitoneal lymph nodes and obstructive uropathy. Histological subtype: B-cell non-Hodgkin´s lymphoma.CONCLUSIONS: TL typically presents as an aggressive disease with contralateral testicular involvement and spreading to regional lymph nodes and non-contiguous extranodal sites. The main radiological techniques are Doppler ultrasound for the study of the primary disease and MDCT in the evaluation of disease extension. Diagnosis is usually obtained after orchiectomy by histological study, and despite the aggressive treatment modalities (surgery associated with radiotherapy or chemotherapy) prognosis remains poor(AU)