The foamy variant of pancreatic intraepithelial neoplasia.

Foamy gland adenocarcinoma is a variant of pancreatic ductal carcinoma, whose precursor has not been described. We describe here the morphologic and immunohistochemical features of the pancreatic intraepithelial neoplasia (PanIN) lesions associated with invasive foamy pancreatic adenocarcinoma. The staining properties and morphologic and immunohistochemical features of 3 foamy PanIN lesions were compared with those of 7 pancreatic foamy gland adenocarcinomas. Hematoxylin and eosin, Mayer mucicarmine, periodic acid-Schiff, and Alcian blue stains were available for review in all cases. Immunohistochemical labeling for cytokeratin (CK)7, CK20, carcinoembryonic antigen polyclonal, MUC1, MUC2, CDX2, p53, and cyclin D1 was performed. The PanIN-1 lesions were found in the nonneoplastic pancreas and were similar to the PanIN-1 lesions of ordinary pancreatic ductal carcinoma. The PanIN-2 and -3 lesions were recognized immediately adjacent to or within the invasive foamy gland carcinoma. In these lesions, small or markedly dilated ducts were lined by cuboidal and columnar dysplastic nonfoamy cells and foamy cells. Hobnail cells were present in 2 cases. The PanIN-1, 2, and 3 lesions and the invasive foamy gland adenocarcinomas stained with mucicarmine, periodic acid-Schiff, and Alcian blue. The 3 PanIN-2 and -3 lesions and all 7 invasive foamy adenocarcinomas labeled with CK7, carcinoembryonic antigen polyclonal, and MUC1, whereas only 2 PanIN-2 and -3 lesions and 5 invasive adenocarcinomas showed immunoreactivity for cyclin D1 and p53. Three distinctive foamy PanIN lesions were identified within 7 invasive foamy gland pancreatic adenocarcinomas. The gradual progression of cytological and architectural abnormalities of the PanIN lesions from PanIN-1 to PanIN-3 excludes neoplastic ductal spread. These foamy PanIN lesions probably represent cancer precursors.

[Bone marrow infiltration as an early sign of gastric cancer]. / Infiltración a médula ósea como manifestación temprana de carcinoma gástrico.

The symptomatic infiltration to bone marrow by gastric carcinoma is an extremely infrequent condition even so as an early manifestation. Very few reports exist in the worldwide literature about it. In this paper we report a case of a 47 years woman who was attended in our Institute because of the presence of thrombocytopenia, anaemia, fever involuntary weight loss and linfadenopathy, and also dyspepsia. Through her diagnostic evaluation the diagnosis of an occult gastric cancer was established. The aim of this report is to present the clinical, radiological and pathological characteristics of this unusual presentation of gastric cancer; and also we present a brief literature review of the cases that had been reported and their clinical implication.

[Autoimmune hepatitis and primary sclerosing cholangitis: dependent or independent association?]. / Hepatitis autoinmune y colangitis esclerosante primaria: asociación dependiente o independiente?

BACKGROUND AND OBJECTIVE: The diagnosis of an autoimmune liver disease is based on clinical, biochemical, immunological and histological criteria particular to each disease, such as autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). Hepatic overlap syndromes (OS) are defined by the presence of a well established autoimmune liver disease, primarily AIH plus two or more characteristics associated with another liver disease (PBC or PSC); however the association of HAI and PSC is considered rare in adult population, and only 43 cases have been reported in the literature. The aim of this study is to review and reappraise the characteristics of this rare association, and to discuss current concepts on OS. METHODS: We describe the clinical presentation, evolution, radiologic studies, histological characteristics and therapeutic options in a Mexican woman with OS (HAI-PSC). We also include an updated review of the literature. RESULTS: Overlap ofAIH and PSC has been described in a number of repqrts during the last decade, and is assumed to exist in a considerable part of mainly young patients with autoimmune liver diseases. Sequential appearance of AIH and PSC has been described in children, but also may be observed in adults. This association has been reported between 1.4%-8%, probably because differences in age of the study populations, range of autoantibodies taken into consideration, and degree of completeness of analyzed data. CONCLUSIONS: HAI-PSC is a rare disease, more common in children, and its outcome and evolution seem to be similar of AIH alone. Ursodesoxycholic acid in combination with an immunosuppressive regimen may be an adequate medical treatment for most patients with this association, and liver transplantation should be considered in late stage disease.

Biliary stricture caused by portal biliopathy: case report and literature review.

Portal biliopathy is a rare condition that is usually not diagnosed and only in few cases causes symptoms. Those symptoms are caused by vascular obstruction of the biliary tree in patients with portal hypertension. We report a case of a 29 years man who presented with history of intermittent jaundice, persistent elevation of hepatic function test and hematemesis as a manifestation of portal hypertension without liver damage. We present the clinical, radiological and pathological characteristics and literature review of the cases that had been reported, their diagnoses, treatment and clinical implication.