José M. Abascal García

Simultaneous Hodgkin's disease in three siblings with identical HLA‐genotype

We report 3 cases of Hodgkins disease (HD) within a family of seven children. All three children had mixed cellularity type in different stages of the disease (IV‐B, III‐A, and II‐A). The diagnosis was made within a one‐month interval. HLA typing shows an identical genotype in the 3 HD patients, which was different from the rest of the family. One of the patients developed an idiopathic thrombocytopenic purpura (ITP) with temporary response to prednisone and MOPP‐C chemotherapy that subsided after splenectomy. The HLA identity, in addition to the simultaneous onset of the HD, suggests a combination of both genetic and environmental factors in the pathogenesis of this disease.

Adrenalectomía laparoscópica transperitoneal: resultados tras 70 procedimientos

OBJECTIVES: To present our surgical experience in laparoscopic adrenalectomy after 70 procedures, comparing our results with the published series and analyzing the learning curve. METHODS: Between June 1997 and December 2007 we performed 87 adrenalectomies (70 transperitoneal laparoscopy, 1 retroperitoneoscopy and 16 open surgery); 60% were female. Mean age was 54 years 15-80); 35 were left adrenalectomies, 33 right and one bilateral. Mean mass size was 3,7 cm (1-10). All patients were assessed regarding the following variables: preoperative diagnosis, histopathology, operative time, blood loss, complications, conversion to open surgery and hospital stay. We compared the results of the first 40 surgical procedures (Group 1) and the last 30 (Group 2). We also compared our re-sults with published series. Mean time follow-up was 12 months (2-60). RESULTS: The most frequent preoperative diagnoses were: active suprarenal mass (50%), incidentaloma (20%), pheochromocytoma (20%). Histopathology confirmed 60% adenomas, 14% pheochromocytomas and 11% cortical nodular hyperplasia. Mean operative time was 161 minutes (60-300). Average blood loss (hematocrit) was 5.2 (1-10). Conversion and complication rate were 8.5 and 7%, respectively. Mean hospital stay was 4 days (2-30). In group 2, only reduction on mean operative time (120 min) and hospital stay (3 days) was statistically significant. CONCLUSIONS: Transperitoneal laparoscopic adrenalectomy is a feasible and safe procedure in urological groups with previous laparoscopic experience. Our results are similar to the published series and confirm the efficacy, safety and reproducibility of this technique.

Management of Advanced Pancreatic Cancer with Gemcitabine Plus Erlotinib: Efficacy and Safety Results in Clinical Practice

CONTEXT The combination of gemcitabine and erlotinib is a standard first-line treatment for unresectable, locally advanced or metastatic pancreatic cancer. We reviewed our single centre experience to assess its efficacy and toxicity in clinical practice. METHODS Clinical records of patients with unresectable, locally advanced or metastatic pancreatic cancer who were treated with the combination of gemcitabine and erlotinib were reviewed. MAIN OUTCOME MEASURES Univariate survival analysis and multivariate analysis were carried out to indentify independent predictors factors of overall survival. RESULTS Our series included 55 patients. Overall disease control rate was 47%: 5% of patients presented complete response, 20% partial response and 22% stable disease. Median overall survival was 8.3 months). Cox regression analysis indicated that performance status and locally advanced versus metastatic disease were independent factors of overall survival. Patients who developed acne-like rash toxicity, related to erlotinib administration, presented a higher survival than those patients who did not develop this toxicity. CONCLUSIONS Gemcitabine plus erlotinib doublet is active in our series of patients with advanced pancreatic cancer. This study provides efficacy and safety results similar to those of the pivotal phase III clinical trial that tested the same combination.

Experiencia inicial en el diagnóstico y tratamiento del tumor vesical superficial con Hexvix

Resumen es: Objetivo: El actual standar en el diagnostico y seguimiento del tumor vesical es la cistoscopia con luz blanca. Recientes estudios sugieren que la cistos...

High dose brachytherapy (real time) in patients with intermediate- or high-risk prostate cancer: technical description and preliminary experience

IntroductionIt has been well documented that the outcome of prostate cancer treatment depends on the dose administered. Hence, techniques have been developed that allow high-dose administration without increasing the complications, e.g. external radiotherapy combined with high-dose radiation (HDR) brachytherapy. In this article we analyse the technique and protocol of real-time HDR brachytherapy together with the preliminary results that support its use.Materials and methodsBetween June 1998 and December 2004, 100 patients with adenoma of the prostate were treated with 46 Gy of external irradiation to the pelvis and 2 HDR brachytherapy fractions (each of 1150 cGy) at the end of weeks 1 and 3 of a 5-week radiotherapy course. The 1997 American Joint Commission on Cancer (AJCC) system was used to establish disease stage. Patients with intermediaterisk (PSA 10–20 ng/ml or Gleason=7 or T2c) and high-risk (two intermediate risk factors or PSC >20 ng/ml or Gleason >7 or >T2c) without metastases were eligible for the brachytherapy. Biochemical failure was defined according to the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus panel statement. SPSS statistical package was used to quantify survival (Kaplan-Meier method). Toxicity was scored according to RTOG guidelines.ResultsThe mean age of patients was 67 years (range 49–78). Clinical stage was T2a in 22% of the patients, 26% T2b and 52% T3. Initial PSA was = 10 ng/ml in 22% of the patients and >10 ng/ml in 78%. Median follow-up was 28 months (range: 12–79). The 5-year overall survival and actuarial biochemical control were 99% and 87% respectively. No chronic severe complications were noted.ConclusionsThe good results of local control, disease-free survival and few complications that the external radiotherapy combined with HDR brachytherapy have shown suggest that the method should be considered as first-choice in the treatment of prostate tumours of high-and intermediate-risk.

An unusual form of persistent polyclonal B lymphocytosis in an infant

We report a case of persistent polyclonal lymphocytosis in an infant. The circulating lymphocytes were of a small to medium size and a small proportion were larger and had lymphoplasmacytoid features. The presence of either an infectious or mutagenic agent was excluded. The polyclonal B‐cell nature of the lymphocyte was demonstrated by immunological markers and confirmed by Southern blot analysis and by polymerase chain reaction targeting immunoglobulin genes. In contrast to the common form of polyclonal lymphocytosis, this case was not associated with HLA‐DR7 and/or abnormalities of chromosome 3, p53 or Bcl2/IgH. Whether this lymphocytosis represents a premalignant or a benign condition remains uncertain, although there has been no progression to date.

Molecular immaturity of the immune receptor genes in a case of acute leukaemia with complete lymphoid lineage switch.

To the Editor: It has been long recognized that haematologic malignancies can undergo phenotypic and genotypic evolution over the natural course of the disease. This evolution usually consists in a shift to a more or less mature phenotype within a given lineage, such as Richter’s transformation of chronic lymphocytic leukaemia or loss of the CDlO antigen in acute lymphoblastic leukaemia (ALL) (1,2). Recent progress in the study of human leukaemias and lymphomas has disclosed the diversity of morphological and immunological features of these neoplams. Rare but well-documented cases of biclonal lymphoma in which two clones of neoplastic cells proliferate concurrently or sequentially have been reported (3,4). Moreover, some ALLs can share both B and T-cell characteristics genotypically and phenotypically, but a complete shift from one lymphoid lineage to the other is rare, with only 5 cases described in the literature (5-8). We now report a molecular study of a new case of B-cell ALL occurring in a patient in complete remission from T-cell ALL. A previously healthy 4-year-old girl presented in 1991 with a 2-week history of cough, fatigue and anorexia. The liver and spleen were normal and no lymphadeno athy was noted. The leukocyte count was 1.8 x 10 /I with a normal differential count. The haemaglobin level was 6.9 g /dl and platelet count 15 x 109/l. The bone marrow showed an infiltration by 57% of blast cells with a lymphoid appearance. Cytochemical reaction for periodic acid-Schiff (PAS) was positive. Peroxidase and nonspecific esterase staining were negative. Immunophenotyping studies revealed that the blasts were: TdT + , CD2 + , C D 4 + , C D 5 + , CD7+ and CD10-, CD19-, CD20 , HLADr , CD22 -, CD13 -, CD33 . With these findings the diagnosis of T-ALL was made. The patient was treated with standard ALL therapy resulting in complete remission. In February 1993, 34 months after initial diagnosis, while conr tinuing on maintenance chemoterapy, she started with bone pain and fever. Bone marrow aspiraton showed ALL. Immunophenotypical markers performed on bone marrow cells demonstrated a precursor B-cell lineage without evidence for residual T-cell clonal population (HLA Dr + ,,CD10 + ,