[Pleural mesothelioma: experience with 62 cases in 9 years]. / Mesotelioma pleural: experiencia durante 9 años y descripción de 62 casos.

OBJECTIVES: To describe the diagnostic approach, clinical and radiological characteristics, and survival of patients with pleural mesothelioma treated in our hospital over a 9-year period. PATIENTS AND METHOD: All patients with a diagnosis of pleural mesothelioma diagnosed in our hospital from January 1992 through December 2000 were studied. RESULTS: Sixty-two patients (49 men) with a mean age of 65 years (range, 45-85) were diagnosed. Probable or known contact with asbestos was established for 41 patients (66%). Ninety-four percent of the patients had chest pain or dyspnea at the onset of clinical assessment. The tumor was situated in the right hemithorax in 33 patients; 59 patients had pleural effusion, and 3 only had pleural thickening. The pleural fluid was bloody in 19% of patients, glucose levels were less than 60 mg/dL in 44%, and the pH of pleural fluid was less than 7.20 in 19%. The diagnosis was established by pleural biopsy for 52%, and by thoracoscopy or thoracotomy for 44%. The median survival was 11 months (95% confidence interval, 8-15); the probability of survival was 0.22 after 2 years, and 0.09 after 5. For the subgroup of patients with epithelial tumors the probability of survival was 0.31 after 2 years and 0.16 after 5 years. In the univariate analysis the predictors of survival were general clinical status (Karnofsky scale), platelet count, serum albumin level, pleural pH, glucose and lactate dehydrogenase levels, and histological type. CONCLUSIONS: The clinical, radiological, and biochemical characteristics of the pleural fluid from patients with pleural mesothelioma and their survival rate were described.

Ultraestructura del carcinoma bronquioalveolar de pulmón. Estudio de 17 casos / Bronchioloalveolar carcinoma of the ling. Report of 17 cases

Introducción: El carcinoma bronquioloalveolar (CBA) se divide en mucinoso, no mucínoso y mixto. En microscopia electrónica (ME) muestra células mucinosos (CM), de Clara (CC), ciliadas, neumocitos tipo II (PN) y células indeterminadas (C1) de significado incierto. Material y métodos: Comparamos la microscopia óptica con la ultraestructura en 17 casos de CBA. Resultados: Por microscopia óptica, 4 casos eran de tipo mucinoso, 11 no mucinosos y 2 mixtos. Por ME, los 4 casos mucinosos mostraban diferenciación mucinosa y los 2 mixtos una mezcla de CC y CM (uno con abundantes Cl y PN). De los 11 casos no mucinosos, 7 mostraban diferenciación hacia CC (4 de tipo cilíndrico y 3 cúbicas), 2 mucinosa, otro mixta y el último exclusivamente Cl y PN. Conclusiones: Las Cl se encuentran en relación con PN y tienen cierta similitud con las CC cúbicas, lo que sugiere que pudieran ser el origen de algunos CBA (AU)

Combined use of novel epithelial (MOC-31) and mesothelial (HBME-1) immunohistochemical markers for optimal first line diagnostic distinction between mesothelioma and metastatic carcinoma in pleura.

AIMS: To determine the value of immunohistochemistry in differentiation of malignant pleural mesothelioma from carcinoma in a pleural biopsy we optimized a double panel of MOC-31 and HBME-1 and compared the results with others from the literature. METHODS AND RESULTS: A multi-antibody panel was applied to biopsy samples from 44 cases of malignant pleural mesothelioma and 23 cases of carcinoma metastatic to the pleura. We used monoclonal antibodies against keratins, epithelial membrane antigen (EMA), epithelial antigen Ber-EP4, carcinoembryonic antigen (CEA), tumour-associated glycoprotein (B72.3), LeuM1, vimentin, desmin, epithelial related antigen (MOC-31) and mesothelial cell (HBME-1). Positivity for MOC-31 and Ber-EP4 was found to have the highest nosologic sensitivity (94.1% and 84.6%, respectively) and specificity (86.3% both antibodies) for carcinoma. Positive staining for HBME-1 and vimentin had the highest sensitivity (90.9% and 100%, respectively) and specificity (91.3% and 60%, respectively) for mesothelioma. A two-marker antibody panel with HBME-1 and MOC-31 was the most efficient for the distinction between carcinoma and malignant pleural mesothelioma. CONCLUSION: A combination of MOC-31 (an anti- epithelial marker) and HBME-1 (an anti-mesothelial marker) has a diagnostic efficiency of 76.1% for the distinction between carcinoma and mesothelioma in pleura.

[Deteriorating natural killer activity in familial erythrophagocytic lymphohistiocytosis]. / Actividad "natural killer" deteriorada en la linfohistiocitosis eritrofagocítica familiar.

We report the occurrence of familial erythrophagocytic lymphohistiocytosis disease in a child who had greater involvement of the brain than of visceral organs. The diagnosis was made during life, allowing us to carry out biological, histological and immunological studies. The natural Killer activity was abolished in this patient. The combination chemotherapy--including systemic administration of VP 16-213, steroids and intrathecal methotrexate--, failed to stem the rapid course of the disease.

[Asphyxiating thoracic dysplasia in 2 dizygotic twins]. / Displasia torácica asfixiante en dos gemelas dicigóticas.

Two cases of asphyxiating thoracic dysplasia in a pair of dizygous twin females are described. Both were diagnosed at birth and presented characteristic clinical, radiological and pathological features of this rare entity.