Compositional and structural analysis of engineered stones and inorganic particles in silicotic nodules of exposed workers.

BACKGROUND: Engineered stone silicosis is an emerging disease in many countries worldwide produced by the inhalation of respirable dust of engineered stone. This silicosis has a high incidence among young workers, with a short latency period and greater aggressiveness than silicosis caused by natural materials. Although the silica content is very high and this is the key factor, it has been postulated that other constituents in engineered stones can influence the aggressiveness of the disease. Different samples of engineered stone countertops (fabricated by workers during the years prior to their diagnoses), as well as seven lung samples from exposed patients, were analyzed by multiple techniques. RESULTS: The different countertops were composed of SiO2 in percentages between 87.9 and 99.6%, with variable relationships of quartz and cristobalite depending on the sample. The most abundant metals were Al, Na, Fe, Ca and Ti. The most frequent volatile organic compounds were styrene, toluene and m-xylene, and among the polycyclic aromatic hydrocarbons, phenanthrene and naphthalene were detected in all samples. Patients were all males, between 26 and 46 years-old (average age: 36) at the moment of the diagnosis. They were exposed to the engineered stone an average time of 14 years. At diagnosis, only one patient had progressive massive fibrosis. After a follow-up period of 8 ± 3 years, four patients presented progressive massive fibrosis. Samples obtained from lung biopsies most frequently showed well or ill-defined nodules, composed of histiocytic cells and fibroblasts without central hyalinization. All tissue samples showed high proportion of Si and Al at the center of the nodules, becoming sparser at the periphery. Al to Si content ratios turned out to be higher than 1 in two of the studied cases. Correlation between Si and Al was very high (r = 0.93). CONCLUSION: Some of the volatile organic compounds, polycyclic aromatic hydrocarbons and metals detected in the studied countertop samples have been described as causative of lung inflammation and respiratory disease. Among inorganic constituents, aluminum has been a relevant component within the silicotic nodule, reaching atomic concentrations even higher than silicon in some cases. Such concentrations, both for silicon and aluminum showed a decreasing tendency from the center of the nodule towards its frontier.

New European Union Regulations Related to Whole Slide Image Scanners and Image Analysis Software.

Whole slide imaging (WSI) scanners and automatic image analysis algorithms, in order to be used for clinical applications, including primary diagnosis in pathology, are subject to specific regulatory frameworks in each country. Until May 25, 2018, in the European Union (EU), in vitro diagnostic (IVD) medical devices were regulated by directive 98/79/EC (in vitro diagnostic medical device directive [IVDD]). Main scanner vendors have obtained a Conformité Européenne mark of their products that in Europe were classified as General Class IVDD, so that conformity is only based on a self-declaration of the manufacturer. This contrasts with the initial classification of the US Food and Drug Administration (FDA) of WSI system as Class III medical devices, although the first digital pathology WSI system to be cleared by FDA was classified as Class II, with special controls. Other digital pathology solutions (automated cervical cytology slide reader) are considered of higher risk by US and European regulations. There is also some disparity in the classification of image analysis solutions between Europe and the United States. All IVD-MDs must be approved under the new European regulation (in vitro diagnostic medical device regulation) 2017/746 after May 26, 2024. This means the need of a performance evaluation, including a scientific validity report, an analytical performance report, and a clinical performance report. According to its clinical use (e.g., screening, diagnosis, or staging of cancer), a WSI slide scanner can be now classified as Class C device. A special regulation is applied to companion diagnostics. The new EU regulation 2017/746 contemplates the use of standard unique identifiers for medical devices and the creation of a European database on medical devices (Eudamed). Existing validation studies and clinical guidelines already available in the literature are a sound basis to avoid that this new regulation becomes a barrier for digital pathology development in Europe.

Adenoma de conductos biliares (hamartoma de glándulas peribiliares): la importancia de su adecuado reconocimiento / Bile duct adenoma (hamartoma of peribiliary glands): Importance of an adequate diagnosis

No disponible

Interaction between capecitabine and brivudin in a patient with breast cancer.

BACKGROUND: A 66-year-old woman with metastatic mammary carcinoma, who was being treated with capecitabine, contracted a herpes zoster infection that was treated with the antiviral drug brivudin. A drug-drug interaction between brivudin and capecitabine caused medullar aplasia, serious toxic effects to the intestinal mucous membrane, hand-foot syndrome, onycholysis and dental pigmentation. INVESTIGATIONS: Physical examination, blood analysis, blood cultures, chest X-ray, bone marrow aspiration and biopsy. DIAGNOSIS: Serious adverse event secondary to inhibition of dihydropyrimidine dehydrogenase by a drug-drug interaction between capecitabine and brivudin. MANAGEMENT: Intravenous hydration, imipenem, red blood cell and platelet transfusions, filgrastim, omeprazole, care of the mouth and feet, topical anesthetics, systemic analgesics and parenteral nutrition.

[Testicular metastasis as first clinical expression of unknown origin malignant melanoma]. / Metástasis testicular como primera manifestación clínica de melanoma maligno de origen desconocido.

OBJECTIVE: To report a rare process and to stimulate clinicians and pathologists to have this possibility present in their diagnoses. METHODS: We report the case of an adult male with pain and swelling in the left inguinal region and increased volume of the homolateral testicle. CONCLUSIONS: It is appropriate to bear in mind the possibility of testicular metastasis of a primary unknown tumor in adult males since metastatic affectation can constitute the first manifestation of the disease.

Metástasis testicular como primera manifestación clínica de melanoma maligno de origen desconocido / Testicular metastasis as first clinical expression of unknown origin malignant melanoma

OBJETIVO: Aportar información sobre un raro proceso y alentar a clínicos y patólogos para que tengan presente en sus diagnósticos esa posibilidad.MÉTODOS: Presentamos el caso de un varón adulto con dolor y tumefacción en región inguinal izquierda y aumento de volumen del testículo homolateral.CONCLUSIONES: Es conveniente en varones adultos tener presente la posibilidad de metástasis testicular de un tumor primario oculto ya que la afectación metastásica puede constituir la primera manifestación de la enfermedad(AU)

OBJECTIVE: To report a rare process and to stimulate clinicians and pathologists to have this possibility present in their diagnoses.METHODS: We report the case of an adult male with pain and swelling in the left inguinal region and increased volume of the homolateral testicle.CONCLUSION: It is appropriate to bear in mind the possibility of testicular metastasis of a primary unknown tumor in adult males since metastatic affectation can constitute the first manifestation of the disease(AU)

Tumores renales sincrónicos: carcinoma renal de células claras y linfoma B de bajo grado, tipo MALT / Synchronous kidney neoplasms: renal carcinoma, clear cells type, and B lymphoma, low grade, MALT type

Introducción: Los linfomas MALT que afectan al riñónson muy raros; siendo la primera descripción la de Pelstringy colaboradores en 1991. Pacientes y métodos: Presentamosun caso de un varón de 71 años al que se le practicó unanefrectomía radical por laparoscopia. En el estudio delriñón se observaron un carcinoma renal, tipo de células claras,y un linfoma B, tipo MALT. Conclusiones: La presenciasimultánea en el riñón de un carcinoma renal y un linfomaMALT es extremadamente rara. Los linfomas MALTque surgen en el riñón podrían estar relacionados con unaenfermedad autoinmune, como el síndrome de Sjögren, ocon la inflamación crónica, como las pielonefritis (AU)

Introduction: Mucosa-associated lymphoid tissue(MALT) lymphoma involving the kidney is extremely rare;and was first reported in 1991 by Pelstring et al. Patientsand methods: We report a case of 71 year-old man underwenta radical nephrectomy by laparos copy. Pathologicalstudy of the kidney revealed a renal cell carcinoma, clearcell type, and a B-cell lymphoma, MALT type. Conclusions:The simultaneous occurrence in the kidney of a renalcarcinoma and MALT lymphoma is extremely rare. MALTlymphoma arising from the kidney could be associated withautoinmune disease such as a Sjögren syndrome or withchronic inflammation, such as pyelonephritis (AU)

Tumor amorfo calcificante intracardiaco / No disponible

No disponible

Chondrosarcoma of the uterus: case report and literature review.

BACKGROUND: Pure heterologous sarcomas of the uterine corpus are extremely rare, accounting for 4% of all uterine sarcomas. Primary chondrosarcoma, which is characterized by the absence of epithelial or other heterologous mesenchymal elements, is included in this group. To this date, only 17 cases, including the presenting case, have been reported. CASE: A 55-year-old female presenting with post-menopausal bleeding was diagnosed with chondrosarcoma of the uterus, after abdominal hysterectomy and bilateral salpingoophorectomy. After 8 months of surgery, there is no evidence of recurrence after receiving external radiotherapy and brachytherapy. CONCLUSION: Primary chondrosarcoma of the uterus is an extremely rare uterine tumour most frequently diagnosed by the pathologist. They are usually aggressive malignant tumours with an early relapse and metastases.