Actualización del diagnóstico histopatológico de las enfermedades intersticiales difusas del pulmón / Current histopathologic diagnosis of the pulmonary diffuse interstitial diseases

Las enfermedades pulmonares intersticiales difusas (EDIP) son un grupo de procesos caracterizados por tener un patrón radiológico pulmonar difuso, asociado a un déficit fisiológico, cuya lesión histológica puede ser inflamatoria, fibrosante o ambas, dañando fundamentalemtne el intersticio pulmonar de forma multifocal o difusa. Se describen siete “patrones histológicos”: neumonía intersticial usual, neumonía intersticial no específiva, neumonía organizada, daño alveolar difuso, bronquiolitis respiratoria, neumonía intersticial descamativa y neumonía intersticial linfocítica. Se presenta un problema importante para el diagnóstico de las biopsias transbronquiales o quirúrgicas, debido a sus consecuencias pronósticas, fundamentalmente. Se discute la validez de la toma de biopsias múltiples, teniendo en cuenta la variabilidad de los cuadros morfológicos

The pulmonary diffuses interstitial diseases (EDIP) are a cluster of processes characterized by a pulmonary diffuse radiological pattern associated to an organic physiological deficit, whose histological lesion is an inflammatory one, fibrous or both, damaging the pulmonary interstice mainly in a multifocal or diffuse way. Seven “histological patterns” are described: usual interstitial pneumonia, non specific interstitial pneumonia, organized pneumonia, diffuse alveolar damage, respiratory bronchiolitis, interstitial desquamative pneumonia and lymphocytes interstitial pneumonia. An important difficult is shown at diagnosis in the cronchial biopsies as much as the surgical ones, mainly due to its prognostic consequences. The validity of multiple biopsy takes is discussed, considering the morphological variation

[Scrotal leiomyosarcoma with bone metastasis]. / Leiomiosarcoma escrotal con metástasis óseas.

A case of scrotum leiomyosarcoma is presented in a 87 year-old patient. It debuts as a painless lesion in left hemiescrotum, of one year of evolution. Bony metastasis were observed in the moment of the diagnosis. We carried out a literature revision proving the rarity of this lesion type (only 27 cases have been described), and that, contrary to another leiomiosarcomas type, their aggressive evolution is not habitual in this localization.

[Adenosquamous carcinoma of the stomach]. / Carcinoma adenoescamoso del estómago.

Adenosquamous carcinoma (ASC) of the stomach is a rare tumour. In this report we present a case of adenosquamous carcinoma in the antrum involving the duodenal bulb in a 84 year old woman. Although several theories about the possible origin of this kind of tumours had been proposed, histological and immunohistochemical findings agree with the possibility of a preexisting adenocarcinoma as the most reliable cause. The prognosis of ASC seems worse than that of adenocarcinoma because of the more extensive tumour depth and higher frequency of lymphatic and vascular permeation of the carcinomas cells when it is discovered.

[Retroperitoneal hibernoma]. / Hibernoma retroperitoneal.

We report a new case of retroperitoneal hibernoma. Hibernoma is a rare, benign soft tissue tumor whose constituent cells resemble those of brown fat tissue, which is present in human fetus and newborn infant and it gradually diminishes in quantity throughout adult life. Retroperitoneal location is unusual. Differential diagnosis with the liposarcoma (the most frequent tumour on this location) is based on the high vascularity of the hibernoma. Total resection of the tumour can achieve complete cure without recurrence nor metastasis.

[Malignant angioendotheliomatosis associated with an acute confusional syndrome: a case report and review of the literature]. / Angioendoteliomatosis maligna asociada a síndrome confusional agudo: presentación de un caso y revisión de la literatura.

We present a case of malignant angioendotheliomatosis (MAE) localized at the central nervous system (CNS) in a 74-years-old male, manifested as an acute confusional syndrome with fever, characteristics of lymphocytic meningitis in the cephalorhachidian liquid (CRL) and dilatation of the left lateral ventricle according to the cranial computerized tomography (CT). The diagnosis was established using post-mortem immunohistological techniques, concluding that it was an intravascular lymphomatous process with secretion of immunoglobulins.

[Sister Mary Joseph's nodule: metastatic umbilical carcinoma]. / Nódulo de la Hermana María José: carcinoma umbilical metastásico.

Maria Jose's Sister's lump (metastatic umbilical carcinoma) is a metastasis of more than one malignant tumor (frequently abdominal), but on occasions it is the first sign of disease. A case of a female patient diagnosed as having "umbilical hernia" with peritoneal carcinomatosis, liver metastasis and "frozen pelvis", who died 6 months later, is presented, demonstrating the bad prognosis of this sign.

[Malignant Caroli's disease. Etiopathogenic hypotheses, apropos a case]. / Enfermedad de Caroli malignizada. Hipótesis etiopatogénicas, a propósito de un caso.

We present a case report of Caroli's disease with related cholangiocarcinoma in a 30 years old white woman. The risk of Caroli's disease malignization is estimated about 7-12% being cholangiocarcinoma the histopathologic pattern most frequently found. This frequency, which is over 100 times higher than that expected in the general population, make us think over the possibility of being some premalignant agent, if not a really carcinogenic one in Caroli's disease. The risk of degeneration is proportional to time of evolution of the disease so, when it is possible, the resective surgery should be elected.

Premalignant changes in nasal and sinus polyps: a retrospective 10 year study (1979-1988).

One hundred and seventy cases of nasal and/or sinus polyps diagnosed in the Pathology Service of the Hospital Militar Central GOMEZ/ULLA of Madrid (Spain) between 1.9.79 and 1.9.88 are reviewed. In two cases areas of 'carcinoma in situ' in the epithelium covering the polyps were demonstrated. The literature is reviewed for reports of malignant transformation and dysplastic changes in nasal and sinusal polyps. We suggest that precancerous changes may occasionally be noted in inflammatory lesions, a fact that pathologists should keep in mind.