Enrique Bellolio J

Puntaje de Gleason en cáncer de próstata: Correlación de la biopsia por punción y prostatectomía radical

Background: Gleason pathological score in prostate cancer is an importantprognostic indicator. However, the concordance between the score of trans rectal needle biopsies and the final score of the surgical piece may be variable. Aim: To analyze the concordance between Gleason scores of trans rectal prostate biopsies and those of the surgical piece obtained after prostatectomy. Material and Methods: Retrospective analysis of 168 pathological records of radical prostatectomies, performed between 1993 and 2009. All these patients had also a trans rectal biopsy performed previously. Patients with less than 12 tissue cylinders obtained during the trans rectal biopsy or incomplete data were not included in this analysis. Results: Sixty eight percent of trans rectal biopsies had Gleason scores that were concordant with those of the surgical piece. The score was higher or lower in 27 and 10% of biopsies, respectively. Conclusions: Gleason scores of trans rectal biopsies and those of the surgical piece were concordant in 68% of cases in this series of pathological records.

Hidatidosis ósea: Reporte de 5 casos y revisión de la literatura

Bone location of hydatid cysts occurs in 0.5 to 3% of all cases of hydatidosis. The most common bones involved are spine, long bones and pelvis. We report five patients with bone hydatidosis. A 24-year-old male consulting for paraparesis and numbness of lower limbs; CAT scan showed hydatid cysts located in D2, D3 and D4 vertebral bodies. A 47-year-old male consulting for a fracture of the femur; X rays disclosed multiple hydatid cysts in the femur. A 13-year-old female consulting for claudication of the right lower limb; X ray examination showed a hydatid cyst in the iliac bone. A 21-year-old women presenting with weakness of the lower limbs and voiding problems; CAT scan showed a vertebral hydatidosis and spinal cord compression. A 67-year-old female presenting with weakness of the lower limb and loss of sphincter control; CAT scan showed hydatid cysts in D4 vertebral body.

Evaluación de factores histológicos pronósticos de sobrevida en melanoma maligno cutáneo, seguimiento de 13 años

Prognostic factors for survival of malignant melanomas Background: The incidence of malignant melanoma is increasing steadily. Aim: To study pathologi- cal prognostic factors in malignant melanomas. Material and Methods: Review of pathological records of cutaneous malignant melanomas diagnosed between 1995 and 2008. Medical records of patients were re- viewed and those with distant metastases at the moment of surgery were excluded. Follow up was performed contacting patients and reviewing death records at the Chilean National Identification Registry. The cause of death was classified as related to the melanoma or unrelated. Results: One hundred sixty two records, corres- ponding to patients aged from 13 to 93 years (51% women), were included in the study. Twenty nine percent of patients died during the follow up period that ranged from 1 to 127 months. Five and ten years survival was 71 and 60% respectively. A multivariable Cox analysis demonstrated that only the TNM classification of the primary tumor, which is categorized using the Breslow maximal depth, had prognostic significance. Compared to women, men had a 1.97 higher relative risk of dying due to the melanoma. Conclusions: TNM classification of melanomas is the most important prognostic factor for survival.

Validez diagnóstica de la biopsia intraoperatoria en cirugía de lesiones mamarias palpables

Background: During the surgical treatment of breast neoplasms (benign or malignant), frozen section biopsy is frequently requested to assess the kind of lesion and determine the surgical margins. Aim: To assess the diagnostic yield of frozen section breast biopsy. Material and methods: All the pathological reports of frozen section biopsies and definitive biopsies of 337 women aged 26 to 88 years, operated for suspected breast neoplasms between 2002 and 2006, were reviewed. The sensitivity, specificity and predictive value of frozen section biopsy, were calculated using the definitive biopsy as the gold standard. Results: The definitive biopsy confirmed the presence of cancer in 290 women (86%). There were two false negative (0.59%) and no false positive frozen section biopsies for cancer detection. The sensibility for cancer detection was 99.3% and the specificity 100%. The positive predictive value was 100% and the negative predictive value 96.1%. The diagnosis of phyllodes tumor was missed by frozen section biopsy in three cases. The margins were informed in the 258 frozen section biopsies (79%) and in 59 cases (18%), these were positive for cancer. Conclusions: Frozen section biopsy is useful and reliable for cancer detection and margin status assessment

Tumor de Células de la Granulosa del Testículo, Tipo Juvenil: Reporte de un Caso y Revisión de la Literatura

El Tumor de Celulas de la Granulosa Juvenil (TCGJ) del testiculo es una entidad clinico-patologica poco frecuente, que tipicamente se presenta en la edad pediatrica representando el 15% de los tumores del estroma gonadal. Su comportamiento biologico es considerado benigno y la orquiectomia considerada curativa en estos pacientes. Se presenta el caso de un lactante de sexo masculino de 3 meses de edad con un TCGJ del testiculo diagnosticado en la Unidad de Anatomia Patologica del Hospital Hernan Henriquez Aravena de Temuco.

Cáncer gástrico sin compromiso ganglionar linfático (pN0): características demográfico-patológicas y factores pronósticos

BACKGROUND The absence of lymph node involvement (N0) in gastric cancer is associated with a better survival. However some N0 gastric tumors still have a bad prognosis. AIM To study demographic and morphological variables associated with prognosis in N0 gastric carcinoma. MATERIAL AND METHODS Review of pathological records of a regional general hospital, identifying patients with a N0 gastric cancer surgically excised between 1986 and 2003. RESULTS In the study period, 459 gastrectomies were performed for gastric cancer and in 32%, the tumor was devoid of lymph node involvement. These later patients were followed for a median of 64 months with a 71% five years actuarial survival. Bivariate analysis identified age, tumor size, gastric wall infiltration, pathological type according to Lauren and Ming, lymphovascular involvement, number of lymph nodes excised and TNM stage as prognostic values Multivariate analysis disclosed the level of gastric wall infiltration, the presence of a poorly differentiated tumor, lymphatic vascular involvement, number of excise lymph nodes and tumor size as independent prognostic factors. CONCLUSIONS N0 gastric tumors are found in 32% of gastrectomies for gastric cancer and have a 71% five years actuarial survival. Gastric wall infiltration, pathological degree of differentiation tumor size and lymphovascular involvement are independent prognostic factors.

Quiste Broncogénico de Localización Poco Habitual: Reporte de 2 Casos y Revisión de la Literatura

El quiste broncogenico es un remanente del desarrollo de traquea y bronquios. Alteraciones en la migracion de celulas durante el desarrollo, permite que estos grupos originen quistes revestidos por epitelio respiratorio. La ubicacion mas habitual es la intratoraxica, dentro de ella, la intrapulmonar es la mas frecuente, seguida de la mediastinica. El diagnostico definitivo se establece mediante la biopsia diferida. Es una patologia poco frecuente y las presentaciones extra toracicas son muy infrecuentes, por lo que compartimos dos casos, uno de ubicacion sublingual y otro de ubicacion subcutanea en zona escapular.

Cáncer de Colon y Recto: Descripción Morfológica y Clínica de 322 Casos

El cancer de colon y recto (CCR) es actualmente la cuarta causa de muerte por cancer en Chile. Su incidencia, sin embargo, esta aumentando continuamente en nuestra poblacion. El objetivo de este estudio es describir aspectos morfologicos y clinicos de pacientes resecados por CCR. Estudio de cohorte retrospectiva. Se estudiaron 322 pacientes intervenidos por CCR entre 1987 y 2003 en el Hospital Hernan Henriquez Aravena de Temuco. Las variables clinicas y morfologicas estudiadas (todas ellas analizadas para los subgrupos de sujetos con tumores de colon y de recto) fueron edad, genero, localizacion tumoral, forma y tamano tumoral, nivel de infiltracion, tipo histologico, grado de diferenciacion histologico y compromiso tumoral de nodos linfaticos. Se utilizaron estadisticas descriptivas y analiticas; aplicando chi-cuadrado de Pearson y exacto de Fisher para las variables categoricas; y, T-test para variables continuas. La mediana de edad fue de 66 anos, con promedio de edad para tumores de colon derecho (CD), transverso (CT), izquierdo (CI) y recto fue 62,2, 64,6, 64, y 64,4 anos respectivamente (p=0,53). En CD e CI se verificaron 57% y 47% de mujeres respectivamente (p<0,05). El 69% de los casos correspondio a tumores de colon (24% CD, 4% CT y 41% CI) y 31% a tumores de recto. El tamano tumoral promedio fue 67,2±33,1 mm CD, 53,5±19,7 mm CT, 44,1±22,3 mm. CI y 41,5±17,5 mm en recto (p<0,001). En CD la forma tipo Bormann I se observo en el 57% mientras que en CI lesiones anulares y ulceradas en 45% en CI. Se encontro 75% de tumores moderadamente diferenciados; correspondiendo el 82% a adenocarcinomas, 16% adenocarcinoma mucinoso y 2% carcinoma de celulas en anillo de sello. El 76% correspondio a tumores T3 y T4. Se encontro compromiso tumoral de nodos linfaticos en 39% de los cuales el 95% correspondian a tumores T3-T4. Se verificaron a nivel regional para pacientes con CCR las variables clinicas y morfologicas descritas en la literatura.

Enfermedad de Castleman, un diagnóstico diferencial que no se debe olvidar en los tumores de mediastino: Caso clínico

Castlemans disease is an uncommon lymphoproliferative disorder which can be unicentric or multicentric. Hialine vascular variant is the most common pathologic form, which is usually unicentric and presenting as mediastinal tumors. We report a 31-year-old female with a history of retrosternal pain. A chest CAT sean showed a tumor in the posterior mediastinum. The patient was operated and the tumor excised. The pathology report showed a Castlemans disease. No other tumors were found in the patient, who had a favorable evolution.

Sarcoidosis esplénica: una infrecuente causa de esplenectomía

Correspondencia: Dr. Oscar Tapia E. Manuel Montt 112. Codigo Postal 478-1176. Temuco, Chile. otescalona@gmail.com y esplenomegalia de 21 cm (Figura 1). Se efectuo biopsia ganglionar que evidencio una linfoadenopatia granulomatosa no caseosa compatible con sarcoidosis. Se complemento estudio con niveles de enzima convertidora de angiotensina que resultaron elevados (271 U/L). Dado los hallazgos clinicos, de laboratorio e histopatologicos se diagnostico una sarcoidosis y realizo esplenectomia. El estudio macroscopico demostro un bazo de 19,8 cm de longitud mayor, de consistencia aumentada y levemente granular (Figura 2). El examen Mujer de 41 anos con historia de 8 meses de dolor en hemiabdomen izquierdo, baja de peso y compromiso del estado general. Al examen fisico se constataron adenopatias cervicales e inguinales y bazo acentuadamente aumentado de tamano. El hemograma demostro anemia normociticanormocromica, sin alteraciones de la serie blanca ni megacariocitica. La tomografia computada de cuello, torax y abdomen mostro ganglios linfaticos aumentados de tamano a nivel submandibular, yugular, mediastinico, axilar, retroperitoneal e inguinal,