Ainara Azueta

Aneurysm of the right renal vein arising from an idiopathic arteriovenous fistula

A renal vein aneurysm is rarely secondary to an arteriovenous fistula. A symptomatic 4.7-cm aneurysm of the right renal vein arising from an idiopathic arteriovenous fistula in a 41-year-old woman is described. Imaging techniques have a critical role in planning the treatment. The 4.7-cm aneurysm showed a venous wall with uneven thickening of the intima, irregular atrophy and architectural disarray of the media, and partial loss of elastic fibers. Potential for rupture supports surgical intervention in a selected patient with a macroaneurysm.

Paratesticular cellular angiofibroma with atypical (bizarre) cells: Case report and literature review

We report the extremely unusual occurrence of a cellular angiofibroma (CAF) with atypical (bizarre) cells in the spermatic cord. We present a 63-year-old man, who was referred to the Urology Service with a six-month history of a slowly growing painless nodule in the right inguino-scrotal area. The clinical impression was that of a lipoma. The mass was locally excised. Gross examination showed a well-circumscribed neoplasm attached to the spermatic cord and measuring 5cm in the greatest dimension. Microscopic examination of the tumor showed the appearance of CAF with scattered severely atypical (bizarre) cells distributed throughout the lesion. By immunohistochemistry, atypical cells showed diffuse expression of p16, CDK-4, CD34 and vimentin. Keratin AE1/AE3, S-100 protein, p53, and epithelial membrane antigen were negative. The patient is free of disease two months after tumor excision. To the best of our knowledge, this is the third case of CAF with atypical (bizarre) cells occurring in the paratesticular area. Pathologists should be aware of this morphological variation of CAF to avoid misdiagnosis and over-treatment.

Incidental lipoma-like hibernoma arising from the adrenal gland: A well-differentiated liposarcoma mimicker

Hibernomas are uncommon benign lipomatous tumors which show differentiation toward brown fat. To our knowledge, only one case of adrenal hibernoma has been previously reported. We describe a 55-year-old woman showing an incidental, 1.7 cm-hibernoma associated with a 2.6 cm-cortical adenoma producing primary hyperaldosteronism (Conns syndrome), both in the left adrenal gland. The hibernoma was composed predominantly of univacuolated mature fat cells admixed with small vessels. Scattered areas composed of large multivacuolated pale cells with central or paracentral nuclei, mimicking lipoblasts, accounting for less than 30% of the tumor, were found. These cells lacked nuclear hyperchromasia or marked atypia, were S100-positive, and showed numerous mitochondria reactive with the anti-mitochondrial antibody. A diagnosis of lipoma-like hibernoma was made. Pathologists should be aware of this variant of hibernoma to avoid misdiagnosis and excessive treatment.

Síndrome de Wünderlich por rotura de vena iliaca, secundario a trombosis venosa profunda

Wünderlich syndrome, or spontaneous retroperitoneal hematoma, secondary to spontaneous rupture of the iliac vein is a rare clinical entity and a medical emergency. Often the aetiology is difficult to identify and different hypotheses have been proposed, such as the presence of hormonal, inflammatory and/or mechanical factors. It may be important to assess the presence of a factor that triggered the deep vein thrombosis and secondary rupture of the iliac vein and retroperitoneal hematoma. We present a case where venous thrombosis could have caused rupture of the iliac vein and we discuss the entity in light of the current literature.

Collagen Type XI Alpha 1 Expression in Intraductal Papillomas Predicts Malignant Recurrence

Despite the progress achieved in the treatment of breast cancer, there are still many unsolved clinical issues, being the diagnosis, prognosis, and treatment of papillary diseases, one of the highest challenges. Because of its unpredictable clinical behavior, treatment of intraductal papilloma has generated a great controversy. Even though considered as a benign lesion, it presents high rate of malignant recurrence. This is the reason why there are clinicians supporting a complete excision of the lesion, while others support an only expectant follow-up. Previous results of our group suggested that procollagen 11 alpha 1 (pro-COL11A1) expression correlates with infiltrating phenotype in breast lesions. We analyzed the correlation between expression of pro-COL11A1 in intraductal papilloma and their risk of malignant recurrence. Immunohistochemistry of pro-COL11A1 was performed in 62 samples of intraductal papilloma. Ten out 11 cases relapsed as carcinoma presents positive staining for COL11A1, while just 17 out of 51 cases with benign behaviour present immunostaining. There were significant differences (P < 0.0001) when comparing patients with malignant recurrence versus nonmalignant relapse patients. These data suggest that pro-COL11A1 expression is a highly sensitive biomarker to predict malignant relapse of intraductal papilloma and it can be used as indicative factor for prevention programs.

Incidental bladder lipoma: a case report and review of the literature.

ABSTRACT Conventional lipoma is the most common benign mesenchymal neoplasm in adults. However, bladder lipoma is a rare tumor. We report an incidental 0.5-cm, mucosal, bladder lipoma in a 75-year-old man, successfully treated with endoscopic excision. The tumor was found during the extension study of a high-grade urothelial carcinoma of the renal pelvis. A review of the published cases, including the present report, yielded a total of 16. Conclusions on this review are presented. The case is being reported because its rarity and to highlight the importance of complete workup to clarify associated disorders that may suggest extension of a malignant process. ÖZ Lipom erişkinlerde en sık rastlanan benign mezenkimal neoplazidir. Ancak, mesanede nadiren izlenir. Burada, 75 yaşında erkek hastanın mesanesinde saptanan ve endoskopik eksizyon ile tedavi edilen 0,5 cm çapında bir lipom sunulmaktadır. Tümör, renal pelvis yerleşimli yüksek dereceli ürotelyal karsinom nedeni ile yapılan tarama sırasında saptanmıştır. Literatürde olgumuzla birlikte yayınlanmış olan olgu sayısı 16’dır. Olgumuz, nadir olduğu için ve ayrıntılı ve tam bir taramanın malignitelerden ayırımının yapılabilmesi için önemli olduğunu vurgulamak amacı ile sunulmaktadır.

Collagen, type xi, alpha 1 is expressed in neoplastic cells with sarcomatoid transformation in renal cell carcinoma

Background: Clear cell carcinoma (CCC) is the most prevalent malignancy of the kidney. Sarcomatoid differentiation can occur in all others histologic subtypes, and it is associated with a significant poor prognosis and grade 4 in Führman scoring. The recent use of core needle biopsies (CNB) has hindered the correct diagnosis of RCC sarcomatoid differentiation. Our hypothesis is that the presence of COL11A1 in the tumor can be a reliable sarcomatoid differentiation predictor, as it plays an important role in ephitelial-mesenchymal transition program. Methods: Immunohistochemistry of proCOL11A1 was performed (as previously described) in samples of 122 renal cell carcinomas of different histological subtypes. Results: Our results showed a significant difference (p < 0.001) in COL11A1 expression between sarcomatoid carcinomas (12/15 positive) and the rest of the tumors (20/107). Furthermore, while sarcomatoid differentiated cells were positive by themselves, expression of COL11A1 in the rest of the tumor types was identified in peritumoral fibroblastic cells. Conclusion: COL11A1 expression renal cell carcinoma may predict sarcomatoid differentiation even in samples with low numbers of cells, as may occur in a CNB, so it can be beneficial to clinicians in order to modify treatment options and follow-up protocols.

Collagen, type xi, alpha 1: new marker of muscularis propria infiltration in bladder cancer

Background: Bladder cancer is one of the most prevalent neoplasias; although it does not have a high mortality, its great incidence causes a large number of deaths. This is why a proper diagnosis is necessary. Currently, transurethral resection (TUR) based biopsy provides the best tool for the diagnosis of bladder carcinoma. However, technical problems inherent to the resection1 sometimes make the diagnosis inaccurate, especially when there is lack of muscularis propria or fulguration artifacts are present. Our hypothesis is that the presence of COL11A1 in the tumor stroma can be a reliable infiltrative growth predictor, as it has been shown in other tumors such as breast, lung, stomach or pancreas. Methods: Immunohistochemistry of COL11A12 was performed in TUR samples of 43 patients. We finally examined 11 pTa, 15 pT1, 11 pT2 and 6 non-neoplastic lesions. Results: Our results showed a significant difference (p < 0.001) in COL11A1 expression between pT2 tumors (10/11 positive) and the rest of the lesions, both tumoral (1/26) or non-neoplastic (0/6). Conclusion: These data suggest that fibroblast expression of COL11 1 is an accurate malignant marker, with high levels of sensitivity and specificity greater than 90%, which could be used as a predictive marker of muscular infiltration. ReferencesRamírez-Backhaus M, Domínguez-Escrig J, Collado A, et al. Restaging transurethral resection of bladder tumor for high-risk stage Ta and T1 bladder cancer. Curr Urol Rep 2012; 13: 109–14.García-Ocaña M, Vázquez F, García-Pravia, et al. Characterization of a novel mouse monoclonal antibody, clone 1E8.33, highly specific for human procollagen 11A1, a tumor-associated stromal component. Int J Oncol 2012; 40: 1447–54.

RAS mutations distribution in a 108 patients series of colorectal cancer

Background: As described previously in high impact studies,1 patients with other activating RAS out of codon 2 of kras mutations may also be negative predictive biomarkers for anti-EGFR therapy. Here we present the description of a new series in which has been performed the analysis of mutations in KRAS and NRAS genes. Methods: Samples of 108 patients with colorectal cancer were used. DNA were extracted from formalin fixed paraffin embedded samples using COBAS DNA sample preparation kit (Roche). Mutation status was determined by targeted pyrosequencing with N/K RAS Pyro Kit (Qiagen). Results: Sixty-four out of 108 samples were wild type (WT) both for KRAS and NRAS. Thirty-five patients presented mutation on KRAS (27 in codon 12, 4 in 13, 1 in 117, and 3 in 146). The rest of the patients (9) presented alterations in NRAS (1 in codon 12, 3 in 13, and 5 in 61). Conclusion: Our results closely resemble those published to date,2 but due to small sample size are not fully comparable. Further studies must be done to determine the real distribution of the new RAS mutations. ReferencesDouillard JY, Oliner KS, Siena S, et al. Panitumumab-FOLFOX4 treatment and RAS mutations in colorectal cancer. N Engl J Med 2013; 369: 1023–34.Oliner KS, Douillard JY, Siena S, et al. Analysis of KRAS/NRAS and BRAF mutations in the phase III PRIME study of panitumumab (pmab) plus FOLFOX versus FOLFOX as first-line treatment (tx) for metastatic colorectal cancer (mCRC). J Clin Oncol 2013; 31 (Suppl): Abstr 3511.