José Manuel Suárez Peñaranda

Atypical fibroxanthoma showing diffuse staining for CD31.

To the Editor, We read with interest the article by Luzar and Calonje1 reviewing the immunophenotype of atypical fibroxanthoma (AFX). In their article, they state that true cytoplasmic expression of CD31 by the AFX tumor cells is unusual and typically focal. They observed CD31 expression by AFX in only 4 of the 42 cases and only 1 previously reported case has shown this immunohistochemical feature.2 Recently, we had the opportunity to study an AFX located in the nose of a 71-year-old woman. The tumor was located in the dermis and extended to the subjacent subcutis. The surface epidermis was thinned and eroded, but the tumor showed no continuity with it. The tumor was composed mostly of spindle-shaped cells with a few admixed epithelioid cells (Fig. 1). The tumor cells were atypical and showed marked proliferative activity (with up to 7 mitotic figures/mm2). Immunohistochemical analysis was consistent with the diagnosis of AFX, as cytokeratins AE1/AE3, 34ßE12, CK5/6, S-100 protein, HMB45, smooth muscle actin, desmin and epithelial membrane antigen (EMA) all showed a lack of reactivity. Vimentin labeled most of the cells of interest, while CD99 and CD68 were only focally positive. The antibody panel also included CD31. Interestingly, it showed strong and diffuse labeling of virtually all tumor cells with spindled morphology (Fig. 2), and intratumoral vessels were also labeled. As a consequence of the CD31 expression, other vascular antibodies (CD34, factor VIII and D2-40) were also utilized, but all lacked reactivity. On the basis of the overall immunophenotype, a vascular sarcoma was considered to be excluded and the tumor was interpreted as AFX. Immunohistochemistry plays a major role in the diagnosis of AFX, which remains a diagnosis of exclusion. A precise combination of negative and positive staining results enables the correct diagnosis to be made.3 The antibody CD31 reacts with platelet Fig. 1. Low power view of the tumor close to the epidermis, but not infiltrating and showing no continuity between them. The neoplastic cells were mostly spindle-shape with few epithelioid cells.

Granuloma annulare of the penis: a uncommon location for an usual disease.

The subcutaneous clinical variant of granuloma annulare (GA) is rare and tends to present more frequently in children, in locations unusual for conventional GA. Involvement of the penis is exceptional and has been rarely reported. Most cases are located in the shaft of the penis and tend to persist without spontaneous remission. Diagnosis is done only after biopsy, and surgical resection of the lesions is not unusual. We report a new case of subcutaneous GA of the penis in a 13-year-old boy with lesions persistent for the past year. Surgical excision of one of them allowed the correct diagnosis. No further treatment was done, and the condition has not remitted 1 year later. We stress the importance of clinical recognition of unusual presentations of GA to avoid overtreatment of lesions that do not need an aggressive approach.

Adenocarcinoma de laringe: presentación de un caso

El adenocarcinoma de laringe es un tipo de tumor muy infrecuente, que supone solo un 0,35-0,5 % de las neoplasias laringeas malignas. Se caracteriza por su elevada agresividad y por su tendencia a producir metastasis en los ganglios linfaticos regionales y a distancia. Presentamos el caso de un varon de 64 anos de edad con un adenocarcinoma de laringe con metastasis ganglionares en el momento del diagnostico. Fue tratado con una combinacion de cirugia y radioterapia postoperatoria. Siete meses despues presento recidiva regional.

Laryngeal Adenocarcinoma: Case Report

Laryngeal adenocarcinomas are extremely unusual (only 0.35%–0.5% of all laryngeal malignancies). It usually behaves as a highly malignant tumour, with tendency for local lymph node and distant organ metastases. We report a case of a 64-year-old man with an adenocarcinoma of the larynx with cervical lymph node involvement at the moment of the diagnosis. The patient was treated with surgery (total laryngectomy and cervical lymph node dissection) and postoperative radiotherapy. Seven months later, the patient had a local recurrence.

Hernia umbilical con endometriosis

Resumen —Presentamos el caso de una mujer de 35 anos con un nodulo umbilical violaceo y doloroso adherido al saco de una hernia umbilical. Histologicamente se observan glandulas endometriales proliferativas en la dermis sin alcanzar el paniculo adiposo. La particularidad del caso reside en la localizacion unicamente cutanea de la endometriosis y su asociacion a una hernia umbilical.