Dural enhancement with primary calvarial lesions.

The purpose of this study was to relate the pathological and imaging features of dural enhancement and meningeal sign ("dural tail") on contrast-enhanced T1-weighted magnetic resonance (MR) images from patients with primary calvarial lesions as well to assess the accuracy of MR imaging in predicting dural invasion. Thirty-two calvarial tumors studied with contrast-enhanced MR imaging and histopathological examination of the dural specimens were reviewed. Sixteen patients presented dural enhancement, eight with tumor invasion. Tumoral invasion of the dura was observed in one case without enhancement. Malignant lesions showed enhanced dura more commonly than benign lesions (P=0.02). Nodular and discontinuous dural enhancement was statistically associated with dural invasion (P=0.05). Dural tail did not show a specific pathological association. Meningeal enhancement is a nonspecific reaction to calvarial lesions unless nodular and discontinuous. False-negative and -positive cases of dural invasion imply some limitation of contrast-enhanced MR imaging in predicting dural invasion by calvarial neoplasms.

[Simple thyroid cyst]. / Quiste simple de tiroides.

Simple or true thyroid cysts are very rare. We only have found one case in which colorless and acellular transparent fluid has been found by means of the fine needle aspiration puncture (FNAP). We report the case of a 33 year old female who first presented with a rapidly growing thyroid nodule. The thyroid scintigraphy revealed the existence of a cold nodule and the ultrasonography showed a lesion having a cystic appearance. The FNAP was performed and was both diagnostic and therapeutic in this case.

[Primary transitional carcinoma of the prostatic ductus]. / Carcinoma transicional primario de ductus prostáticos.

Primary prostate transitional cell carcinoma is a very rare tumour originating in the transitional epithelial cells of the intraprostate periurethral ductus. Only 17 of 829 patients diagnosed with prostate carcinoma were found to have the transitional cell variety. Eight (8) of those had pure transitional cell carcinoma and 9 a mixed presentation of acinar adenocarcinoma and transitional cell ductal carcinoma. Bladder origin of the tumour was ruled out in all cases. We report a retrospective study on the clinical behaviour of prostate transitional cell carcinoma. Compared to acinar carcinomas, few differences were found when age, symptoms, physical findings and imaging diagnosis were evaluated. Clinical presentation, DRE, PSA, metastatic spread and presence of supravesical obstructive uropathy where also studied to establish a diagnosis. Radiotherapy was the most frequently used therapeutical approach. Mean survival is 26.6 months (4-60 months) and there has been 11 death up to now. Compared to acinar forms, this tumour shows a hormone-resistant, aggressive biological behaviour with poor prognosis. Early diagnosis and radical surgery are the only options available to increase life expectancy for these patients.

Lesiones cutáneas en paciente con trasplante cardíaco / Skin lesions in patient with heart transplant

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Carcinoma transicional primario de ductus prostáticos / Primary transitional carcinoma of prostate ductus

El carcinoma transicional primario de próstata es un tumor muy poco frecuente, que tiene su origen en las células epiteliales transicionales de los ductos intraprostáticos periuretrales. De 829 casos de pacientes con diagnóstico de carcinoma de próstata, hemos encontrado 17 con la variedad transicional. De ellos, 8 tenían un carcinoma puro de células transicionales y 9 correspondían a formas mixtas de adenocarcinoma acinar y carcinoma ductal de células transicionales. En todos ellos se descartó el origen vesical de la tumoración. Nuestro objetivo es el estudio retrospectivo del comportamiento clínico del carcinoma transicional de próstata. Encontramos pocas diferencias en comparación con los carcinomas acinares cuando evaluamos la edad, los síntomas, los hallazgos físicos y el diagnóstico por imagen. La presentación clínica, el tacto rectal, el PSA, la diseminación metastásica y la existencia de uropatía obstructiva supravesical al inicio del diagnóstico fueron otras características clínicas a estudio. El tratamiento aplicado ha sido heterogéneo siendo el más utilizado la radioterapia. Respecto a la supervivencia, actualmente se han producido 11 exitus, con una supervivencia media de 26,6 meses (4-60 meses).El comportamiento biológico de este tumor se caracteriza por ser hormonorresistente, agresivo y de peor pronóstico que las formas acinares. Su diagnóstico precoz y la cirugía radical es lo único que podría aumentar la expectativa de vida de estos pacientes (AU)

[Mucinous prostate adenocarcinoma initially presented as an intestinal subocclusive picture]. / Adenocarcinoma mucinoso de próstata inicialmente manifiesto como cuadro suboclusivo intestinal.

Mucinous prostate adenocarcinoma is an infrequent tumour, with no more that 50 cases described to date. This paper contributes a new case of the entity. Rather than on the rarity of the tumour, the interest in our case focuses in the unusual nature of its clinical presentation. It initially appeared as a presumable rectoanal neoplasia but the pathoanatomical examination discovered the prostatic origin of the tumoration.

[Comparative study of pure epidermoid carcinoma of the bladder and transitional cell carcinoma with squamous or mixed differentiated foci]. / Estudio comparativo del carcinoma epidermoide de vejiga puro y el carcinoma transicional con focos de diferenciación escamosa o mixto.

INTRODUCTION: The epidermoid bladder carcinoma is an infrequent tumour in our environment accounting for 5-8% of total vesical tumours, but is not so uncommon to find foci of squamous differentiation within a transitional carcinoma. We conducted a comparative study between these two histologic forms and analyzed the pattern of their clinical behaviour. MATERIAL AND METHODS: Retrospective study on a total of 32 cases of epidermoid carcinoma diagnosed between 1986-1996 that following histological confirmation were divided into two groups; plain epidermoid carcinoma (PEC), 11 cases; and transitional carcinoma with foci of squamous differentiation (MEC), 19 cases. After further review 2 cases were excluded. RESULTS: PEC appears in older patients. Both tumoral forms are more frequent in males, the male/female ratio being lower in PEC. Presence of irritative factors is significantly associated to PEC (P < 0.01) and smoking to MEC. Presentation signs are similar in both groups, and haematuria is the most frequent sign. Most usual location in both groups was the trigone, which caused uni/bilateral hydronephrosis in over 50% patients. At the time of diagnosis all PECs were invasive versus only 86% in the MEC group. TREATMENT: PEC group underwent the following procedures: 4 radical cystectomies, 2 cystectomies plus radiotherapy, 3 palliative TUR and 2 TUR with radiotherapy. In the MEC group there were 3 radical cystectomies, 2 cystectomies plus radiotherapy, 1 cystectomy with previous chemotherapy, 8 palliative TUR, 2 TUR with endovesical chemotherapy, 1 TUR with systemic chemotherapy, 1 TUR with radiotherapy and 1 systemic chemotherapy. Mean survival was 12.5 months (0-43) in PEC and 26.55 (0-96) in MEC. Disease-free time in PEC and MEC was 5 months (0-37) and 10.25 (0-70) respectively. Only one patient achieved 5-year survival. CONCLUSION: Epidermoid carcinoma both plain and mixed is an aggressive tumour with poor prognosis and short survival. 100% PECs in our series are invasive at diagnosis, and no statistically significant differences were found in survival and disease-free time between both histological variants. Cystectomy remains the choice therapy.