Xantogranuloma juvenil mitóticamente activo. Presentación de un caso y revisión de la literatura / Mitotically active juvenile xanthogranuloma. Case report and review of the literature

Presentamos el caso de una lactante de 4 meses de vida con un xantogranuloma cutáneo occipital de rápido crecimiento. Histológicamente muestra una proliferación difusa de histiocitos xantomizados y no xantomizados, con algunas células gigantes tipo Touton. Presenta una alta actividad mitótica, más evidente en las áreas no lipidizadas. Nuestra paciente se encuentra bien y sin recidiva 2 años después de la extirpación. Aunque la actividad mitótica no es habitual en este tumor —y puede ser causa de inquietud— según lo publicado en la literatura, su comportamiento biológico es igual al del xantogranuloma habitual (AU)

We present a case of rapidly growing occipital cutaneous juvenile xantogranuloma in a 4-month-old girl. Histologically, it showed diffuse proliferation of lipidized and non-lipidized histiocytes with some Touton-type giant cells and a high mitotic activity, more evident in non-lipidized areas. Two years postoperatively, the patient is alive and well, with no recurrence. Although high mitotic activity is not habitual in this tumour and can cause alarm, the current literature suggests that its biological behaviour does not differ from that of normal xanthogranulomas (AU)

The role of accessibility policies and other determinants of health care provision in the initial prognosis of malignant melanoma: a cross-sectional study.

BACKGROUND: The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear. OBJECTIVE: To analyze the role of health care provision determinants in the initial prognosis of MM. METHODS: A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed. RESULTS: In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness <1 mm (T1) representing 51.72% of the total number of MMs in 2000, increasing to 62.23% by the end of the study period (P = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio [OR], 1.43 [P < .001]; multivariate OR, 1.36 [P = .005]) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 [P = .01]; multivariate OR, 1.59 [P = .025]) were shown to explain the increasing frequency of Tis-T1 MM. LIMITATIONS: The primary potential limitation of this study is its retrospective nature. CONCLUSION: Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM.

Microcarcinoma papilar de tiroides. Revisión de 30 casos / Pappillary microcarcinoma of thyroid gland

Introducción: Se revisan 30 casos de microcarcinoma papilar de tiroides aparecidos en nuestras instituciones desde 1993 hasta 1999. Métodos: de 90 carcinomas papilares de tiroides diagnosticados en este periodo, 30 (33%) son microcarcinomas, considerando como tales aquellos que miden 1 cm. o menos de diámetro. Todos los datos son recogidos a partir de las historias clínicas y de los informes anatomopatológicos correspondientes, habiendo sido todos los diagnósticos efectuados por uno de nosotros. Resultados: 18 microcarcinomas medían 5 mm o menos y 12 entre 5,1 y 10 mm. (media: 4,6 mm.). La edad media de los pacientes es de 46,6 años. 27 eran mujeres. Ocho tumores eran de patrón folicular. Los restantes eran papilares, dos de ellos encapsulados y uno esclerosante. Seis eran multifocales (20%). Una paciente tenía metátasis ganglionares en el momento del diagnóstico. Dos presentaban invasión de la cápsula tiroidea. Dos presentaban invasión vascular. Ningún paciente ha experimentado recidiva hasta el presente. Ninguno ha muerto de la enfermedad. Conclusiones: corroboramos el buen pronóstico de los microcarcinoma papilares de tiroides, ya sean únicos o múltiples. Pensamos que el carcinoma papilar multifocal de tiroides probablemente se origina a partir de localizaciones distintas dentro de la misma glándula, y no a partir de la extensión intraglandular de una lesión original única, ya que la proporción de microcarcinomas múltiples es similar a la de carcinomas convencionales múltiples (AU)

Aims: 30 cases of papillary microcarcinoma of the thyroid gland, were seen at our institutions from 1993 to 1999. Methods: Of 90 papillary carcinomas diagnosed, 30 (33%) were microcarcinomas. All diagnoses were made by one of us. Results: 18 microcarcinoma measured 5 mm.or les, and 12 measured between 5.1 and 10 mm (mean 4.6 mm). Mean age of patients was 46.6 years. 27 were women. Eight tumors were of folicular structure, all the others being papillary, two encapsulated and one of sclerosing type. Six (20%) were multifocal. One patient presented with lymph node metastasis. Two lesions showed thyroid capsule invasion. Two showed vascular invasion. None of the tumors has recurred so far. None of the patients has died of the disease. Conclusions: We corroborate the good prognosis of papillary microcarcinoma of the thyroid gland, whether unique or multiple. We think that multiple thyroid papillary carcinoma probably arises from different locations within the same gland, and not by intrathyroid extension from just one lesion, since the proportion of multiple microcarcinomas is similar to that of multiple carcinomas (AU)