Enfermedad de Castleman: un enfoque integral a propósito de un reporte de caso / Castleman's Disease: A Comprehensive Approach Regarding a Case Report

Resumen Se presenta el caso clínico de una paciente del sexo femenino, de 30 años, con adenopatías supraclaviculares y axilares ipsilaterales, quien fue sometida a biopsia excisional con posterior estudio. El análisis histopatológico de la muestra de tejido resecado reveló una serie de características distintivas asociadas con la enfermedad de Castleman variante hialinovascular. La presentación de este caso no solo proporciona información detallada sobre la evolución clínica de la paciente, sino que también sirve como base para ilustrar los aspectos clave del diagnóstico histopatológico y las implicaciones inmunohistoquímicas en la enfermedad de Castleman. Además de hacer una revisión de tema respecto a esta patología poco común, en la cual los informes de casos son fundamentales para aumentar la comprensión de su variabilidad clínica y su abordaje diagnóstico, ilustrando los desafíos en el diagnóstico diferencial y como deben abordarse los mismos.

Abstract The clinical case of a 30-year-old female patient with supraclavicular and ipsilateral axillary lymphadenopathy who underwent excisional biopsy with subsequent study is presented. Histopathological analysis of the resected tissue sample revealed a series of distinctive features associated with hyalinevascular variant Castleman disease. The presentation of this case not only provides detailed information about the clinical evolution of the patient, but also serves as a basis to illustrate Key aspects of histopathological diagnosis and immunohistochemical implications in Castleman disease. In addition to making a review of the topic regarding this rare pathology in which case reports are essential to increase the understanding of its clinical variability and its diagnostic approach, illustrating the challenges in differential diagnosis and how they should be addressed.

Coping and Adaptation in Response to Environmental and Climatic Stressors in Caribbean Coastal Communities.

Cumulative and synergistic impacts from environmental pressures, particularly in low-lying tropical coastal regions, present challenges for the governance of ecosystems, which provide natural resource-based livelihoods for communities. Here, we seek to understand the relationship between responses to the impacts of El Niño and La Niña events and the vulnerability of mangrove-dependent communities in the Caribbean region of Colombia. Using two case study sites, we show how communities are impacted by, and undertake reactive short-term responses to, El Niño and La Niña events, and how such responses can affect their adaptive capacity to progressive environmental deterioration. We show that certain coping measures to climate variability currently deliver maladaptive outcomes, resulting in circumstances that could contribute to system 'lock-in' and engender undesirable ecological states, exacerbating future livelihood vulnerabilities. We highlight the significant role of social barriers on vulnerabilities within the region, including perceptions of state abandonment, mistrust and conflicts with authorities. Opportunities to reduce vulnerability include enhancing the communities' capacity to adopt more positive and preventative responses based on demonstrable experiential learning capacity. However, these will require close cooperation between formal and informal organisations at different levels, and the development of shared coherent adaptation strategies to manage the complexity of multiple interacting environmental and climatic pressures.

Arteria mediana persistente: una variación anatómica vascular en el miembro superior. Estudio anatómico, revisión bibliográfica y estudio clínico en 128 pacientes / Persistent median artery: a vascular anatomical variation in the upper limb. Anatomical study, bibliographic review and clinical study in 128 patients

Introducción y objetivo: En nuestra práctica diaria encontramos variaciones anatómicas que tienen repercusión tanto diagnóstica como terapéutica. Con este artículo ponemos el acento en la importancia de las variaciones anatómicas vasculares, presentando un caso anatómico de arteria mediana persistente que altera la vascularización de los dedos de la mano y que frecuentemente se asocia a la presencia de un nervio mediano bífido. Tras este hallazgo, realizamos una revisión bibliográfica y un estudio clínico para poner en relieve la asociación de esta malformación con el síndrome del túnel carpiano (STC). Material y método: Dividimos nuestro estudio en 2 partes: una anatómica y otra clínica. El estudio anatómico de un antebrazo presentó como hallazgo una arteria mediana palmar persistente responsable de la vascularización del 1er y 2º dedos de la mano, asociada a un nervio mediano bífido. Continuamos con una revisión bibliográfica y un estudio prospectivo para conocer el porcentaje de arterias medianas encontradas en la cirugía del STC en pacientes escogidos de manera aleatoria en función de su incorporación a la lista de espera de nuestro hospital durante un periodo de 4 meses. Resultados: Fueron intervenidos 128 pacientes de STC encontrando arteria mediana persistente en 3 casos, lo que corresponde a un 2.34% del total valorado. Discusión: El porcentaje de presentación de arteria mediana persistente en nuestro estudio coincide con los diversos estudios revisados en adultos. Coincidimos con ellos en la importancia del conocimiento de las variaciones anatómicas por si mismas y de su implicación en la sintomatología del STC. También es importante tenerlas en cuenta cuando nos enfrentamos a una lesión traumática o cuando disecamos un colgajo

Background and objective: In our daily practice we find anatomical variations that will have a diagnostic and therapeutic repercussion. With this article we emphasize the importance of vascular anatomical variations presenting an anatomical case of a persistent median artery which alters the vascularization of the fingers, and that is frequently associated with the presence of a bifid median nerve. Following this finding, a literature review and a clinical study were conducted to highlight the association of this malformation with carpal tunnel syndrome (STC) Methods: Our study is divided into two parts: anatomical and clinical. The anatomical study of a forearm showed us as a persistent median palmar artery which is responsible for vascularization of the 1st and 2nd fingers, associated with a bifid median nerve. Then, we conducted a literature review and a prospective study in order to know the percentage of medium arteries found in the STC surgery, chosen in a random way based on their incorporation to the waiting list of our hospital for a 4 months period. Results: A total of 128 STC patients were operated, finding a persistent median artery in 3 patients, which corresponds to 2.34% of the total valued. Discussion: The percentage of presentation of persistent medium artery in our study is coincident with the various studies reviewed in adult patients. We agree on the importance of the knowledge of anatomical variations by themselves and their implication in the symptomatology of STC. It is also important to keep in mind the existence of these anatomical variations when faced with a traumatic injury or when we dissect a flap