Aitor Fernández de Larrinoa

Role of ultrasound-guided core biopsy in the evaluation of spleen pathology.

Core biopsy has not traditionally been recommended in the study of spleen nodules due to the supposed fragility of this organ leading to a high risk of post‐core biopsy complications. A total of 13 patients who presented solid spleen nodules, diffuse splenomegaly, or both on imaging studies (CT, MR, US) were biopsied under ultrasound control with 18G BioPince® needles. Cytological (imprints and cytocentrifugates) and histological material were obtained for diagnosis in every case. Malignant lymphomas were the most commonly found pathology (four diffuse large B‐cell lymphomas, two follicular lymphomas, one Hodgkins disease, one B‐cell lymphoma, NOS). In addition, there was one littoral‐cell angioma, one well‐differentiated neuroendocrine carcinoma, metastatic, and one haemangioma. The remaining two cases showed congestive features, and supposed spleen involvement by lymphoma in one of them was ruled out. On follow up, there were no complications related to the core biopsy. Splenectomy was performed in six cases, two diagnostic and four therapeutic. We conclude that core biopsy is a safe and efficient method in the diagnosis of spleen nodules that could be considered in the routine diagnostic algorithm of these lesions.

Utilidad de la biopsia cilindro guiada por control ecográfico en el diagnóstico y manejo de los tumores renales

Resumen Antecedentes La biopsia guiada por control ecografico esta siendo utilizada de manera creciente en los ultimos anos como aproximacion diagnostica inicial en los tumores renales, aunque su aceptacion entre radiologos y patologos aun no es generalizada. Metodos Durante un periodo de 6 anos (2000-2005), se han biopsiado por este metodo y con agujas 18G un total de 48 tumores renales en 47 pacientes. Resultados Se observo un predominio de varones (34V/13M) y la edad promedio se situo en 51,7 anos (rango 1-92). Treinta y siete (77,1%) casos correspondieron a neoplasias, incluyendo adenocarcinomas renales (25 casos), oncocitomas (3 casos), linfomas (3 casos), tumores de Wilms (2 casos), un tumor carcinoide metastasico, un carcinoma epidermoide metastatico, un nefroma quistico y un sarcoma fusocelular. Cinco casos (10,4%) correspondieron a pseudotumores (3 quistes renales y 2 pielonefritis cronicas). La biopsia proporciono tejido renal normal en 4 casos y tejido fibroadiposo en 2. Se detectaron minimas discrepancias en la adjudicacion de la variante histologica del cancer en 2 casos. Conclusiones La biopsia cilindro guiada por ecografia es un metodo muy util y fiable para el diagnostico de los tumores renales, y deberia ser incluida como herramienta de primera linea en su manejo. Sin embargo, para la obtencion de optimos resultados que puedan llevar a un tratamiento individualizado, se precisa una estrecha colaboracion entre clinicos, radiologos y patologos.

El diagnóstico histológico de la patología tiroidea en biopsias guiadas por control ecográfico

Resumen La biopsia de tiroides obtenida con aguja guiada por control ecografico es una alternativa a la puncion aspiracion con aguja fina que, segun multiples autores, ofrece mayor sensibilidad y especificidad diagnostica que esta. Este trabajo revisa de una manera critica la metodologia de obtencion de la muestra, su manipulacion optima en el Laboratorio de Anatomia Patologica, lo que se puede diagnosticar, como hacerlo, y lo que no, y por que no. El rendimiento optimo de este procedimiento se obtiene en el contexto de un comite multidisciplinario en el que los diversos especialistas implicados discuten los casos complejos.

Middle-ear carcinoid tumor with distant metastasis and fatal outcome

Hematol Oncol Stem Cell Ther 1(1) January 2008 hemoncstem.edmgr.com 53 The term carcinoid, karzinoid (carcinomaslike), was first mentioned in the literature in 1907 by Oberndorfer.1 Since its recognition as a distinct entity it has been quite a controversial tumor, especially with respect to its biological behavior. In fact, although traditionally considered a benign neoplasm, distant metastases and tumorsrelated deaths were very soon sporadically recorded.1 Carcinoids are exceedingly rare neoplasms in the middle ear2 and are usually referred to as adenoma/ carcinoid tumors because they are considered benign glandsforming neoplasms with an overt tendency to des velop neuroendocrine and mucinous differentiations.3,4 Most literature reviews and textbooks on pathology highlight the benign clinical course of this entity. Some authors, however, have reported in recent years both los cal recurrences and extracranial lymph node metastases in the neck.5s8 Interestingly, no visceral metastases have been reported so far.9 The case reported here represents a unique example of middle ear carcinoid with regional lymph node and liver metastasis that led to the patient’s death after 11 years of follow up.

Carcinoma verrucoso del pene. Estudio anatomopatológico de 2 casos

SUMMARY Introduction: Penile carcinoma is a rare tumour, repre- senting about 1% of all male tumours. The verrucous subty- pe is quite infrequent, displays specific prognostic implica- tions and needs very strict criteria for its diagnosis. Patients, methods and results: Two cases of this entity in patients of 85 and 77 years-old are reported. Partial penec- tomy was performed in both cases. Conclusions: Pathologi- cal features and differential diagnosis of this entity are reviewed. The strict application of histological criteria is very important to perform an adequate diagnosis and prog- nosis.

El adenocarcinoma de próstata en los años 1999 y 2006. Diferencias en el estudio comparativo de biopsias transrectales y de prostatectomías radicales

SUMMARY Background: The increase in number of prostate cancer diagnoses in the last decade is accompanied by a similar increase in the number of radical prostatectomy specimens. We analyse the histological differences between patients treated with radical surgery in 1999 and in 2006. The evolution in the indications for surgery is also evaluated. Methods: Histological data in core biopsies and radical prostatectomies of cases diagnosed in 1999 and 2006 have been compared. Only cases with complete histological information have been included in the study. Bi/unilateral tumour invasion, number of tumour foci, total millimetres of cancer, high-grade PIN, Gleason index, and perineurial invasion have been evaluated in core biopsies. Pathological staging, Gleason index, high-grade PIN, margin status, apex invasion, perineurial and vascular permeation, extraprostatic extension and seminal vesicle invasion have been analysed in radical prostatectomies. The statistical study included χ2 , Student’s t, and Mann-Whitney test. Results: The study includes 24 radical prostatectomies in 1999 and 50 in 2006. The pathological staging is significantly lower in 2006 than in 1999 (p=0.032). Similarly, organ-confined disease is more frequent in 2006 (p=0.034). Extraprostatic extension and seminal vesicle invasion by prostate adenocarcinoma are significantly lower in 2006 (p=0.090 y p=0.011, respectively). Conclusions: Prostate adenocarcinoma patients treated with radical surgery in 2006 are at a lower stage compared with 1999 cases.

Carcinoma renal de los túbulos colectores de bajo grado (carcinoma túbulo-quístico)

Resumen Introduccion Esta variedad de carcinoma renal es extraordinariamente infrecuente y esta considerada como una subvariante poco agresiva del carcinoma renal de los tubulos colectores de Bellini. Pacientes y metodos Se presenta un caso en un paciente varon de 73 anos de edad que debuta con hematuria y dolor en el hipocondrio derecho. Resultados El diagnostico fue de carcinoma renal de los tubulos colectores de bajo grado. Discusion y conclusiones Se analizan sus caracteristicas histologicas e inmunohistoquimicas, y se revisan los casos previamente publicados y las teorias vigentes sobre su histogenesis.