Esplenectomía por tumor hematopoyético extramedular esclerosante del bazo / Splenectomy for sclerosing extramedullary hematopoietic tumor of the spleen

RESUMEN Los tumores hematopoyéticos extramedulares son infrecuentes; se caracterizan por la presencia de elementos formes de la sangre en distintas etapas madurativas, con megacariocitos atípicos y proliferación fibroblástica. Se comunica el caso clínico de un tumor hematopoyético extramedular esclerosante del bazo en un varón de 71 años, con antecedentes patológicos de hipertensión, diabetes, portador de virus hepatitis C. En estudio por malestar abdominal se identificaron mediante imágenes lesiones esplénicas múltiples. Se planteó origen vascular, sin poder descartar otro tipo de lesiones, por lo que se decidió esplenectomía laparoscópica. El estudio histopatológico e inmunohistoquímico diagnosticó un tumor hematopoyético extramedular esclerosante del bazo. Son neoplasias de baja incidencia y escasa evidencia en cuanto a etiopatogenia, diagnóstico y tratamiento. Se presentan como lesiones únicas o múltiples, y pueden afectar diferentes órganos. Están asociados a síndromes mieloproliferativos crónicos. Solo su confirmación histopatológica permite diferenciarlos de otros tumores malignos.

ABSTRACT Extramedullary hematopoietic tumors are rare and characterized by the presence of hematopoietic elements at various stages of maturity, atypical megakaryocytes, and fibroblastic proliferation. We report the case of a patient with sclerosing extramedullary hematopoietic tumor of the spleen.The patient was 71-year-old man with a history of hypertension, diabetes, and hepatitis C virus infection. Multiple spleen lesions were identified in imaging tests during workup due to abdominal discomfort. Although a vascular tumor was suspected, laparoscopic splenectomy was decided after considering other possible causes. The pathology examination revealed a sclerosing extramedullary hematopoietic tumor of the spleen, which was confirmed by immunohistochemical tests. These tumors are usually single or, less frequently, multiple lesions affecting different organs and are associated with chronic myeloproliferative syndromes. The histologic confirmation is mandatory due to their similarity to malignant tumors. Extramedullary hematopoietic tumors are rare, and there is little scientific clinical evidence regarding their diagnosis and management. The histological confirmation is mandatory due to their similarity to malignant tumors.

Plasmocitoma extramedular solitario rinosinusal: reporte de caso y revisión de literatura / Solitary extramedullary plasmacytoma of the rhinosinusal cavity: a case report and literature review

Resumen El plasmocitoma extramedular solitario (PES) es una neooplasia maligna infrecuente caracterizada por una proliferación aislada de células plasmáticas monoclonales en tejido extramedular. La localización más frecuente es en cabeza y cuello con predominio en el territorio rinosinusal, sin embargo, estas lesiones malignas representan menos del 1% de los tumores de esta región anatómica. El diagnostico requiere una alta sospecha clínica, análisis histopatológico acucioso, estudios serológicos y exámenes radiológicos sistémicos de acuerdo a los criterios diagnósticos establecidos en la literatura internacional. Se analiza el caso de un paciente masculino con un PES que se presentó como un tumor de fosa nasal derecha y obstrucción nasal de meses de evolución con hallazgos clínicos e imagenológicos inespecíficos. El diagnóstico definitivo se realizó mediante biopsia endoscópica nasal y estudio histopatológico. El tratamiento fue abordado de manera multidisciplinaria entre otorrinolaringología, hematología y radiooncología. De acuerdo a las guías internacionales, se decidió realizar radioterapia localizada con buen resultado clínico precoz. El PES requiere un abordaje multidisciplinario para lograr un diagnóstico y tratamiento oportuno, siendo imprescindible la exclusión del mieloma múltiple debido a las diferencias terapéuticas y en pronóstico clínico. El tratamiento puede realizarse con radioterapia y/o cirugía, siendo la radioterapia el pilar de tratamiento.

Abstract Solitary extramedullary plasmacytoma (SEP) is a rare malignant neoplasm characterized by isolated proliferation of monoclonal plasma cells in extramedullary tissue. The most frequent location is in the head and neck with a predominance in the rhinosinusal territory; however, these malignant lesions represent less than 1% of the tumors in this anatomical region. The diagnosis requires a high clinical suspicion, careful histopathological analysis, serological studies and systemic radiological examinations according to the diagnostic criteria established in the international literature. We analyze the case of a male patient with SEP that presented as a tumor of the right nostril and nasal obstruction of months of evolution with nonspecific clinical and imaging findings. The definitive diagnosis was made by nasal endoscopic biopsy and histopathological study. The treatment was approached by multidisciplinary teamwork. According to international guidelines, it was decided to perform localized radiotherapy with good early clinical results. SEP requires a multidisciplinary approach to achieve a timely diagnosis and treatment, being essential exclusion of multiple myeloma due to the therapeutic differences and prognosis. Treatment can be done with radiation therapy and/or surgery; radiation therapy is the mainstay of treatment.

Revascularización ósea: aloinjerto estructural intramedular versus extramedular. Trabajo experimental / Bone revascularization: structural allograft intramedullary vs extramedullary. Experimental work

Resumen: Introducción: el tratamiento exitoso en pacientes con importantes defectos óseos secundarios a infección, no consolidación y fracturas osteoporóticas consecuentes a traumatismos previos representa un desafío. En la literatura actual no encontramos ningún reporte que compare el uso de Tablas de aloinjerto intramedular versus las mismas colocadas lateral a la lesión. Material y métodos: se trabajó sobre una muestra de 20 conejos (dos grupos de 10 conejos cada uno). El grupo 1 fue operado mediante la técnica de colocación extramedular del aloinjerto, mientras que el grupo 2 con técnica intramedular. A los cuatro meses postquirúrgico se realizaron estudios por imágenes e histología para comparar un grupo con el otro. Resultados: el análisis de los estudios por imágenes evidenció una diferencia estadísticamente significativa entre ambos grupos con mayor reabsorción e integración ósea del aloinjerto colocado intramedular. Respecto a la histología, no hubo diferencias estadísticamente significativas, pero sí una predicción significativa con p valor < 0.10 a favor del aloinjerto intramedular. Conclusión: mediante nuestro trabajo pudimos mostrar la gran diferencia que hay entre la técnica de colocación del aloinjerto respecto al análisis imagenológico e histológico utilizando marcadores de revascularización. Si bien el aloinjerto colocado de manera intramedular nos muestra mayor integración ósea, el injerto extramedular brindará más soporte y estructura en pacientes que así lo requieran.

Abstract: Introduction: successful treatment in patients with significant bone defects secondary to infection, non-union and osteoporotic fractures resulting from previous trauma is challenging. In the current literature we did not find any reports that compare the use of intramedullary allograft boards versus the same ones placed lateral to the lesion. Material and methods: we worked on a sample of 20 rabbits (2 groups of 10 rabbits each). Group 1 underwent surgery using the extramedullary allograft placement technique, while group 2 with the intramedullary technique. Four months after surgery, imaging and histology studies were performed to compare between groups. Results: the analysis of the imaging studies showed a statistically significant difference between both groups with greater resorption and bone integration of the intramedullary placed allograft. Regarding histology, there were no statistically significant differences, but there was a significant prediction with a p value < 0.10 in favor of the intramedullary allograft. Conclusion: through our work we were able to show the great difference between the allograft placement technique with respect to imaging and histological analysis using revascularization markers. Although the intramedullary placed allograft shows us greater bone integration, the extramedullary graft will provide more support and structure in patients who require it.

Plasmocitoma extramedular de canal auditivo externo: caso clínico / Extramedullary plasmacytoma of external auditory canal: a case report

Resumen El plasmocitoma extramedular es una neoplasia de células plasmáticas poco frecuente, que se ubica en 80% a 90% de los casos en la cabeza o cuello. Esta neoplasia representa menos del 1% de toda la patología maligna de cabeza y cuello. Dada la poca frecuencia de la patología y la escasez de casos publicados, esta entidad presenta una gran dificultad clínica y terapéutica. El diagnóstico se basa en el análisis histológico con inmunohistoquímica de la muestra obtenida, y el tratamiento varía según la ubicación, donde se puede realizar radioterapia o cirugía. En este artículo presentamos el caso de una paciente de 56 años, con antecedentes de otorrea de larga data en oído derecho, al examen físico presentaba un tumor que obstruía todo el conducto auditivo externo. Se realizó exéresis tumoral y la biopsia evidenció un plasmocitoma.

Abstract Extramedullary plasmacytoma is a rare plasma cell neoplasm, affecting 80% to 90% of the head or neck. This neoplasm represents less than 1% of all malignant head and neck pathology. Given the infrequency of the pathology and the scarcity of published cases, this entity presents great clinical and therapeutic difficulty. Diagnosis is based on histology and immunohistochemistry and treatment varies depending on the location, where radiation therapy or surgery can be performed. In this article, we present the case of a 56-year-old patient with a history of long-standing otorrhea in the right ear. Physical examination presented a tumor that obstructed the entire external auditory canal. Tumor excision was performed, and the biopsy revealed a plasmacytoma.

Mielolipoma suprarrenal, revisión de literatura en México a propósito de dos casos / Adrenal myelolipoma, review of the literature in Mexico apropos of two cases

Introducción: los mielolipomas suprarrenales (ML) son neoplasias benignas poco frecuentes constituidas por tejido adiposo y mieloide. Clínicamente asintomáticas, suelen ser diagnosticados incidentalmente. En México existen solo 32 casos publicados de ML, presentándose en pacientes de entre 37 a 65 años, siendo la relación hombre-mujer 1:1.1, el síntoma más comúnmente reportado es dolor abdominal inespecífico, y la cirugía abierta es el principal abordaje quirúrgico empleado en nuestro país (89%). Caso clínico: presentamos una recopilación de la literatura actual sobre ML en México, además de dos casos clínicos de pacientes con ML: un hombre de 67 años con enfermedad diverticular y una mujer de 40 años con dolor en hipocondrio; en ambos se realizó resección tumoral, midiendo 9.5 cm y 13.3 cm, respectivamente. Conclusiones: presentamos dos casos nuevos en nuestro país que corresponden a incidentalomas. En ambos casos la cirugía se realizó para confirmar el diagnóstico, así como para prevenir posibles complicaciones.

Background: Adrenal myelolipomas (ML) are rare benign neoplasms compound of adipose and myeloid tissue. Clinically they are usually asymptomatic, being diagnosed generally by incident. In Mexico, there are only 32 published cases of ML, these occur between 37 and 65 years, with the male-female ratio being 1:1.1, clinically they present with abdominal or lumbar pain, open surgery being the main surgical approach (89%). Clinical case: We made a literature review of ML in Mexico and present two clinical cases: a 67-year-old man in followup for diverticular disease and a 40-year-old woman with pain in the left upper quadrant. In both cases, tumor resection was performed measuring 9.5 cm and 13.3 cm long respectively. Conclusions: We present two new cases in our country that correspond to incidentalomas. In both cases, surgery was performed to confirm the diagnosis, as well as to prevent possible complications

Evaluation of extramedullary plasmacytoma of the larynx with radiologic and histopathological findings.

Extramedullary plasmacytoma (EMP) is a plasma cell neoplasm of soft tissue without bone marrow involvement or other systemic characteristics of multiple myeloma. Approximately 80%-90% of EMPs involve the head and neck region, especially in the nasal cavity, paranasal sinuses, tonsillar fossa, and oral cavity. An EMP of the larynx is extremely rare and is a locally destructive lesion without systemic spread. Clinical features vary depending on the tumor location. A diagnosis is established by histopathology, immunohistochemistry, and a systemic survey to exclude systemic plasma cell proliferative diseases. Extramedullary plasmacytomas are highly radiosensitive and radiotherapy is therefore used as a treatment. In this study, we report on a rare case of EMP of the larynx evaluated with computed tomography and present histopathologic findings for a 74-year-old female patient.

Evaluación del plasmocitoma extramedular de laringe con hallazgos radiológicos e histopatológicos / Evaluation of Extramedullary Plasmacytoma of the Larynx with Radiologic and Histopathological Findings

El plasmocitoma extramedular (PEM) es una neoplasia de células plasmáticas del tejido blando sin afectación de la médula ósea ni otras características sistémicas de mieloma múltiple. Aproximadamente el 80-90% de los PEM afectan a la región de la cabeza y el cuello, especialmente a la cavidad nasal, los senos paranasales, la fosa amigdalina y la cavidad oral. Los casos de PEM de laringe son extremadamente raros y se trata de una lesión destructiva a nivel local sin propagación sistémica. Las características clínicas varían en función de la localización del tumor. El diagnóstico se establece mediante histopatología, inmunohistoquímica y un estudio sistémico para excluir las enfermedades sistémicas de proliferación de células plasmáticas. Los plasmocitomas extramedulares son altamente sensibles a la radiación, por lo que se utiliza la radioterapia como tratamiento. En este estudio, notificamos un caso raro de PEM de laringe evaluado con tomografía computarizada y presentamos los resultados histopatológicos de una paciente de 74 años.(AU)

Extramedullary plasmacytoma (EMP) is a plasma cell neoplasm of soft tissue without bone marrow involvement or other systemic characteristics of multiple myeloma. Approximately 80-90% of EMPs involve the head and neck region, especially in the nasal cavity, paranasal sinuses, tonsillar fossa, and oral cavity. An EMP of the larynx is extremely rare and is a locally destructive lesion without systemic spread. Clinical features vary depending on the tumor location. A diagnosis is established by histopathology, immunohistochemistry, and a systemic survey to exclude systemic plasma cell proliferative diseases. Extramedullary plasmacytomas are highly radiosensitive and radiotherapy is therefore used as a treatment. In this study, we report on a rare case of EMP of the larynx evaluated with computed tomography and present histopathologic findings for a 74-year-old female patient.(AU)

Fracturas trocántereas inestables. ¿Fijación extramedular o intramedular? / Unstable trochanteric fractures. Extramedullary or intramedullary fixation?

Introducción: Las fracturas trocantéreas inestables presentan dificultad para lograr la osteosíntesis estable, el apoyo precoz y la rápida reintegración social. Se tratan mediante osteosíntesis extra o intramedular. La osteosíntesis extramedular mediante placa atornillada estática o dinámica. Los implantes intramedulares poseen clavos o tornillos deslizantes. Objetivo: Revisar la literatura publicada entre 2015 y 2020 que comparen los diferentes métodos de fijación quirúrgica de las fracturas trocantéreas inestables. Estrategia de búsqueda: En PubMed de publicaciones entre los años 2010-2020 en ingles con los términos: fracturas trocantéreas inestables, tratamiento de las fracturas extracapsulares de fémur proximal, osteosíntesis en fracturas trocantéreas femorales inestables. Conclusiones: Las fracturas trocantéreas inestables poseen tendencia al desplazamiento en varo con medialización de la diáfisis. El clavo-placa estático muestra elevados índices de fallo, superiores al del clavo-placa deslizante (DHS), pero la placa estabilizadora trocantérea (TSP) parece ser el mejor implante para osteosíntesis extramedular muy semejante a lo reportado con los implantes intramedulares(AU)

Introduction: Unstable trochanteric fractures show difficulty in achieving stable osteosynthesis, early support and rapid social reintegration. They are treated by intra or extramedullary osteosynthesis, the later, by using a static or dynamic screw plate. Intramedullary implants have sliding nails or screws. Objective: To review the literature published from 2015 and 2020 that compares the different methods of surgical fixation of unstable trochanteric fractures. Search strategy: We searched in PubMed for publications from 2010 to 2020 in English with the terms unstable trochanteric fractures, treatment of extracapsular fractures of the proximal femur, osteosynthesis in unstable femoral trochanteric fractures. Conclusions: Unstable trochanteric fractures have a tendency to varus displacement with medialization of the diaphysis. The static nail-plate shows high failure rates, higher than that of the sliding nail-plate (DHS), but the trochanteric stabilizing plate (TSP) seems to be the best implant for extramedullary osteosynthesis, which is very similar to that reported with intramedullary implants(AU)

Introduction: Les fractures trochantériennes instables présentent des difficultés pour obtenir une ostéosynthèse stable, un soutien précoce et une réinsertion sociale rapide. Ils sont traités par ostéosynthèse extra ou intramédullaire. Ostéosynthèse extramédullaire à l'aide d'une plaque vissée statique ou dynamique. Les implants intramédullaires ont des clous ou des vis coulissants. Objectif: Bilan des travaux 2015-2020 comparant les différentes méthodes de fixation chirurgicale des fractures trochantériennes instables. Stratégie de recherche: Dans PubMed des publications 2010-2020 en anglais avec les termes: instable trochanteric fractures, treatment of extracapsular fractures of the proximal fémur, Ostéosynthesis in instable fémoral trochantic fractures. Conclusions: Les fractures trochantériennes instables ont tendance à se déplacer en varus avec médialisation de la diaphyse. La plaque à clous statique présente des taux d'échec élevés, supérieurs à ceux de la plaque à clous coulissante (DHS), mais la plaque de stabilisation du trochanter (TSP) semble être le meilleur implant pour l'ostéosynthèse extramédullaire très similaire à celle rapportée avec les implants intramédullaires(AU)

Evaluation of Extramedullary Plasmacytoma of the Larynx with Radiologic and Histopathological Findings. / Evaluación del plasmocitoma extramedular de laringe con hallazgos radiológicos e histopatológicos.

Extramedullary plasmacytoma (EMP) is a plasma cell neoplasm of soft tissue without bone marrow involvement or other systemic characteristics of multiple myeloma. Approximately 80-90% of EMPs involve the head and neck region, especially in the nasal cavity, paranasal sinuses, tonsillar fossa, and oral cavity. An EMP of the larynx is extremely rare and is a locally destructive lesion without systemic spread. Clinical features vary depending on the tumor location. A diagnosis is established by histopathology, immunohistochemistry, and a systemic survey to exclude systemic plasma cell proliferative diseases. Extramedullary plasmacytomas are highly radiosensitive and radiotherapy is therefore used as a treatment. In this study, we report on a rare case of EMP of the larynx evaluated with computed tomography and present histopathologic findings for a 74-year-old female patient.

Plasmocitoma extramedular de laringe: a propósito de un caso / Extramedullary plasmacytoma of the larynx: a case report

Resumen Los plasmocitomas solitarios son una rara forma de presentación de neoplasias de células plasmáticas. Deben ser diferenciados del mieloma múltiple en el momento del diagnóstico y realizar un seguimiento estricto por el riesgo de transformación a mieloma. La localización de los mismos en la laringe es muy inusual, dado que sólo se han publicado 56 casos. Se presenta el caso de una paciente con un plasmocitoma extramedular de laringe que se trató mediante cirugía y radioterapia. Se revisan los criterios diagnósticos y los problemas terapéuticos.

Abstract Solitary plasmacytomas are a rare form of plasma cell neoplasms. They should be differentiated from multiple myeloma at the time of diagnosis and strictly monitored for the risk of transformation to myeloma. Their location in the larynx is very unusual, since only 56 cases have been published. We present the case of a patient with extramedullary plasmacytoma of the larynx that has been treated with surgery and radiotherapy. We reviewed the literature for diagnostic criteria and therapeutic problems.

Plasmocitoma de cuello uterino. Informe de un caso y revisión de la bibliografía / Plasmacytoma of uterine cervix. A case report and literature review

Resumen ANTECEDENTES: La incidencia de plasmocitoma extramedular es baja y su localización ginecológica es excepcional. Hasta la fecha se han reportado 27 casos de plasmocitomas ginecológicos (11 correspondientes a localización cervical). CASO CLÍNICO: Paciente de 37 años, sin antecedentes médicos de interés, que acudió a consulta por sangrado uterino anormal y postcoito. En la especuloscopia se apreció el cuello uterino hipertrófico y friable. Con la biopsia cervical se estableció el diagnóstico de plasmocitoma. Posteriormente, un estudio de extensión descartó la afectación en otras localizaciones. El tratamiento consistió en histerectomía y linfadenectomía pélvica, sin tratamiento coadyuvante. Los estudios de anatomía patológica e inmunohistoquímica confirmaron el diagnóstico. En la actualidad, la paciente se encuentra en seguimiento y libre de enfermedad. CONCLUSIONES: Debido a los pocos casos reportados de plasmocitoma cervical, no existe un tratamiento de referencia. A pesar de ello, no parece haber diferencias entre las pacientes tratadas con radioterapia o cirugía. La tasa de evolución a mieloma múltiple varía de 14 a 36%. La quimioterapia no disminuye la tasa de evolución a mieloma múltiple, por lo que está contraindicada.

Abstract BACKGROUND: The incidence of extramedullary plasmacytoma is low and, specifically, the gynecological location is exceptional. To date, 27 cases of gynecological plasmacytomas have been published (11 corresponding to cervical location). CLINICAL CASE: 37-year-old patient, with no relevant medical history, who came to a consultation for abnormal uterine bleeding and bleeding. By spectroscopy, the hypertrophic and friable cervix was appreciated. Cervical biopsy verifies the diagnosis of plasmacytoma. Subsequently, an extension study ruled out involvement in other locations. Treatment consists of hysterectomy and pelvic lymphadenectomy, without adjuvant chemotherapy. The pathological and immunohistochemical studies confirmed the diagnosis. Currently, the patient is in follow-up and free of disease. CONCLUSIONS: Due to the scarcity of published cases of cervical plasmacytoma, there is no reference treatment. Despite this, there do not appear to be any differences between the patients treated with radiotherapy or surgery. The rate of progression to multiple myeloma varies from 14-36%. The adjuvant therapy does not change the rate of progression to multiple myeloma, so it is contraindicated.

Hematopoese extramedular como achado incidental em exame de imagem na emergência: relato de caso / Extramedular hematopoiesis as an incidental finding in emergency: case report

A hematopoese extramedular (HEM) é um mecanismo fisiológico compensatório de produção de células sanguíneas fora da medula óssea motivada por uma produção inadequada dessas células. Os locais mais comuns da HEM são o fígado, o baço e as regiões paraespinhais do tórax, mas pode acometer praticamente qualquer órgão ou tecido e simular lesões neoplásicas. No presente artigo relatamos o caso de um paciente atendido na emergência por um trauma de baixo impacto que, ao exame tomográfico, apresentava hepatoesplenomegalia e massas abdominais consideradas compatíveis com focos de hematopoese extramedular em correlação com dados clínicos do paciente de mielofibrose

Extramedullary hematopoiesis is a compensatory physiological mechanism of production of blood cells outside the bone marrow motivated by inadequate production of these cells. The most common sites are the liver, spleen and paraspinal regions of the chest but can affect virtually any organ or tissue and simulate neoplastic lesions. In the present article we report the case of a patient treated in the emergency room with a low impact trauma who presented on computed tomography hepatosplenomegaly and abdominal masses considered compatible with foci of extramedullary hematopoiesis in correlation with clinical data of myelofibrosis

Stem cells hematopoietic niches and inflammatory response to different synthetic prosthesis implanted in rat with incisional hernias / Nichos de células-tronco hematopoiéticas e resposta inflamatória a diferentes próteses sintéticas na parede abdominal de ratos com hérnias incisionais

ABSTRACT Background: Extramedullary hematopoiesis depends on complex pathophysiological mechanisms linked to hematopoietic stem cells and the proteins considered mediators of the inflammation. The identification of hematopoietic cells outside bone marrow in the adult is an occurrence that can occasionally follows the inflammatory response, was considered a secondary occurrence, but current biomolecular studies have changed that concept. Aim: Describe the presence of clusters of precursor cells of platelets (megakaryocytes), and cells of the inflammatory response in the abdominal wall and spleen of rats with experimentally induced incisional hernias and repaired with different synthetic prostheses. Methods: Twenty-five rats with incisional hernias previously performed, were divided into groups of five animals each: Group 1, repair of the hernia defect without prosthetic implant; Group 2, repair with polypropylene prosthesis; Group 3, repair using polypropylene with low weight; Group 4, the use of polypropylene and polyglecaprone prosthesis; Group 5, of polypropylene and polyglactin prosthesis. All prostheses were cut in rhombus format with area 2,625 cm². The animals were reoperated after 10 days, the abdominal walls were removed with the viscera attached to them and the material was processed for histological study. Results: Megakaryocyte niches in the abdominal wall and spleen, occasionally removed together with the adhesions produced in animals with implantation of prostheses and significant inflammatory reaction. Conclusion: The intense inflammatory reaction due to the prostheses with polypropylene in their composition was disproportionate to the expected response, indicating that further studies should be accomplished including immunophenotyping evaluation and specific panels of monoclonal antibodies to better understand the findings.

RESUMO Racional: A hematopoiese extramedular depende de mecanismos fisiopatológicos complexos, havendo relação destas células-tronco hematopoiéticas com proteínas mediadoras da inflamação. A identificação de células hematopoiéticas fora da medula óssea no adulto, situação que ocasionalmente pode acompanhar a resposta inflamatória era considerada ocorrência secundária, mas estudos biomoleculares modificaram este conceito. Objetivo: Descrever agrupamentos de células precursoras das plaquetas (megacariócitos) e células da resposta inflamatória, na parede abdominal e no baço de ratos com hérnias incisionais induzidas experimentalmente e reparadas com diferentes próteses sintéticas. Métodos: Vinte e cinco ratos com hérnias incisionais previamente realizadas foram distribuídos em grupos com cinco animais: Grupo 1, reparo do defeito herniário sem implante de prótese; Grupo 2, reparo com prótese de polipropileno; Grupo 3, reparo empregando polipropileno com baixa gramatura; Grupo 4, utilização de prótese de polipropileno e poliglecaprone; Grupo 5, prótese de polipropileno e poliglactina. Todas as próteses foram recortadas na forma de losangos com área de 2,625 cm². Os animais foram reoperados após 10 dias, as paredes abdominais foram retiradas em bloco com as vísceras a elas aderidas e o material foi processado em rotina histológica. Resultados: Foram evidenciados nichos de megacariócitos na parede abdominal e no baço coletado juntamente com as aderências em animais com implante de próteses, além de reação inflamatória significativa. Conclusão: A intensa reação inflamatória, local e sistêmica em relação às próteses com polipropileno em sua composição, foi desproporcional à resposta esperada, requerendo aprofundamento do estudo com avaliação da imunofenotipagem e painéis específicos de anticorpos monoclonais para melhor esclarecimento.

Plasmocitoma de la mama / Breast plasmocytoma

El plasmocitoma de la mama es muy infrecuente y en la mayoría de los casos aparece asociado a mieloma múltiple. Se describe una paciente de 42 años de edad con diagnóstico conocido de plasmocitoma solitario del cuello asociado a mieloma múltiple, que 11 meses después de alcanzada la remisión se presenta con una tumoración en la mama derecha sin manifestaciones sistémicas de mieloma. El estudio histológico e inmunohistoquímico del tumor confirmaron el diagnóstico de plasmocitoma. El diagnóstico diferencial en ocasiones es difícil y debe hacerse con tumores primarios y secundarios de la mama. El tratamiento de elección es la radioterapia local siempre que no existan manifestaciones sistémicas de la enfermedad subyacente(AU)

Breast plasmocytoma is infrequent and in most of the cases is associated to multiple myeloma. We describe a 42 year old woman with a diagnosis of solitary plasmocytoma of the neck associated to multiple myeloma that went into remission and eleven months later she presented a right breast lump which was confirmed by core biopsy and immunohistochemical study to be a plasmocytoma. Sometimes differential diagnosis is difficult and should be performed in primary and secondary breast tumours. The election treatment is radiotherapy if there are not manifestations of a subyacent sistemic disease(AU)

Plasmocitoma de la mama / Breast plasmocytoma

El plasmocitoma de la mama es muy infrecuente y en la mayoría de los casos aparece asociado a mieloma múltiple. Se describe una paciente de 42 años de edad con diagnóstico conocido de plasmocitoma solitario del cuello asociado a mieloma múltiple, que 11 meses después de alcanzada la remisión se presenta con una tumoración en la mama derecha sin manifestaciones sistémicas de mieloma. El estudio histológico e inmunohistoquímico del tumor confirmaron el diagnóstico de plasmocitoma. El diagnóstico diferencial en ocasiones es difícil y debe hacerse con tumores primarios y secundarios de la mama. El tratamiento de elección es la radioterapia local siempre que no existan manifestaciones sistémicas de la enfermedad subyacente(AU)

Breast plasmocytoma is infrequent and in most of the cases is associated to multiple myeloma. We describe a 42 year old woman with a diagnosis of solitary plasmocytoma of the neck associated to multiple myeloma that went into remission and eleven months later she presented a right breast lump which was confirmed by core biopsy and immunohistochemical study to be a plasmocytoma. Sometimes differential diagnosis is difficult and should be performed in primary and secondary breast tumours. The election treatment is radiotherapy if there are not manifestations of a subyacent sistemic disease(AU)

Plasmocitoma solitario de la base craneal: Reporte de tres pacientes / Solitary cranial base plasmocytoma: Three cases report

Plasmocytomas constitute a group of malignant neoplasm arise from clonal plasmatic cells being solitary extramedular form infrequent. Here we report three patients with solitary anterior and middle cranial base plasmocytoma. The importance of these tumors in differential diagnoses of cranial base lesions and the role of endoscopic endonasal biopsy before deciding definitive clinical approach was emphasized.

Los plasmocitomas constituyen neoplasias malignas de las células plasmáticas clónales. La forma extramedular solitaria en la base craneal es infrecuente. Se reportan tres pacientes con plasmocitoma solitario de la base craneal anterior y media. Se enfatiza en la importancia de esta afección en el diagnóstico diferencial de las lesiones de base de cráneo así como la biopsia endonasal endoscópica antes de decidir el tratamiento definitivo.

Mieloma múltiple con plasmocitoma extramedular cutáneo abscedado / Multiple myeloma with abscessed cutaneous extramedullary plasmacytoma

Se presentó un paciente con los diagnósticos de bronconeumonía bacteriana extrahospitalaria y anemia para estudio. Se describen la evolución clínica, los estudios imagenológicos, de laboratorio e histológicos que permitieron diagnosticar la presencia de un mieloma múltiple con plasmocitoma extramedular cutáneo abscedado.

A patient with a diagnosis of community-acquired bacterial bronchopneumonia and anemia was presented for study. We describe his clinical course, the imaging, laboratory and histological studies are described. They allowed diagnose the presence of multiple myeloma with abscessed cutaneous extramedullary plasmacytoma.

Mieloma múltiple con plasmocitoma extramedular cutáneo abscedado / Multiple myeloma with abscessed cutaneous extramedullary plasmacytoma

Se presentó un paciente con los diagnósticos de bronconeumonía bacteriana extrahospitalaria y anemia para estudio. Se describen la evolución clínica, los estudios imagenológicos, de laboratorio e histológicos que permitieron diagnosticar la presencia de un mieloma múltiple con plasmocitoma extramedular cutáneo abscedado(AU)

A patient with a diagnosis of community-acquired bacterial bronchopneumonia and anemia was presented for study. We describe his clinical course, the imaging, laboratory and histological studies are described. They allowed diagnose the presence of multiple myeloma with abscessed cutaneous extramedullary plasmacytoma(AU)

[Hemangioblastoma of the right L4 nerve root with radicular extraforaminal involvement]. / Hemangioblastoma radicular extraforaminal de la raíz L4 derecha.

Hemangioblastomas are benign hypervascular tumours, which are frequently located at the posterior fossa or the spinal cord. Nerve root hemangioblastomas account for less than 2% of total cases. Sometimes the initial diagnosis can be inaccurate and the final diagnosis is not reached until the surgical procedure is performed. Given the high vascularisation of this particular kind of tumour, preoperative embolisation of the tumour is recommended to reduce surgical bleeding and minimise the risk of injuries to motor nerve roots. In this particular case, the patient presented with radicular pain in the right L4 nerve root territory originated by a radicular extraforaminal hemangioblastoma. After tumour devascularization and under neurophysiological control, total excision of lesion was achieved without posterior neurological deficit.