Oralia Barboza Quintana

Prevalence of eosinophilic esophagitis in patients with refractory gastroesophageal reflux disease symptoms: A prospective study

BACKGROUND Eosinophilic esophagitis (EoE) is not routinely considered in the differential diagnosis of refractory gastroesophageal reflux disease (GERD). AIMS To prospectively evaluate the prevalence of EoE and describe the clinical features and predictors of EoE in patients with refractory symptoms of GERD. METHODS Esophageal biopsies were obtained in patients with symptoms of GERD refractory to 8 weeks of conventional antisecretory therapy. Diagnosis of EoE was defined as at least 20 eosinophils × high power field and clinical unresponsiveness to proton pump inhibitors. Clinical and manometric features were compared. Independent risk factors predicting EoE were identified. RESULTS Six out of 150 included patients (4%) met the diagnostic criteria for EoE. Patients with EoE were significantly younger, had significantly more dysphagia, atopy, ineffective esophageal peristalsis, esophageal rings and esophageal strictures than patients without EoE. Independent predictors of EoE were: age under 45 years (OR 4.8, 95% CI 2.4-8.6), dysphagia (OR 12.2, 95% CI 4.3-19.4), and atopy (OR 3.4, 95% CI 1.5-7.4). CONCLUSIONS EoE is an uncommon condition (4%) in patients with refractory symptoms of GERD. Age under 45 years, atopy or dysphagia may warrant suspicion of EoE in this subset of patients.

Negative images due to MAI infection detected in Papanicolaou‐stained duodenal brushing cytology

Atypical mycobacteriosis of the duodenum was diagnosed by duodenal brush cytology in a woman with AIDS. Smears were fixed in alcohol and stained by the method of Papanicolaou. The cytological characteristics of this disease have been described previously in other cytological specimens such as imprints or fine‐needle aspirations stained with Diff‐Quik or Wrights stain. We found that alcohol fixation and routine Papanicolaou staining allow observation of numerous foamy and striated macrophages (pseudo‐Gaucher cells), as well as negative images both within the cytoplasm of the macrophages and in the background of smears in areas of air‐drying artifact. These findings should suggest the diagnosis of atypical mycobacteriosis, and special staining techniques such as PAS and Ziehl‐Neelsen are useful in corroborating it. This has not been previously described. Diagn. Cytopathol. 1998;19:462–464.

EMBARAZO ECTÓPICO MOLAR CORNUAL: CASO CLÍNICO

Antecedentes: La incidencia de embarazo ectopico es 20/1000 embarazos y en la region cornual se presentan en el 2-4%. La mola hidatiforme ocurre en 1/1000 embarazos en EEUU y 1/500 en Mexico. La presentacion simultanea es muy rara. Se han descrito solamente 40 casos en la literatura medica, con una incidencia estimada de 0,04% de localizacion cornual. Caso clinico: Primigesta de 30 anos, que cursando un embarazo de 8 semanas, acude de urgencia por presentar nauseas y vomitos de 1 dia de evolucion, con dolor abdominal y sangrado vaginal. Prueba de embarazo positiva. A la exploracion fisica presenta dolor abdominal difuso y signos de irritacion peritoneal. El ultrasonido transvaginal mostro imagen ecogenica multiquistica intrauterina cercana a la region cornual, por lo que se sospecha embarazo molar. En la laparotomia exploradora se realizo reseccion cornual y posteriormente dilatacion y curetaje de la cavidad uterina. La anatomia patologica confrmo el diagnostico. Negativizo s-hGC a las 7 semanas despues de la cirugia.

Overexpression of the matrix metalloproteinase 11 gene is a potential biomarker for type 1 endometrial cancer

Metalloproteinase matrix 11 (MMP11) is a member of the matrix metalloproteinase family, which are able to degrade extracellular matrix components, and may serve a central function in the enhancement of tumor-induced angiogenesis, cell migration, proliferation, apoptosis and connective tissue degradation. In the present study, MMP11 gene expression was investigated using the reverse transcription-polymerase chain reaction in 68 cases of type I endometrial carcinoma, and all data were analyzed in association with clinical characteristics. Overexpression of MMP11 was demonstrated in 75%, and sub-expression was demonstrated in 25%, of endometrial cancer cases. Sub-expression cases were associated with good histological parameters, including low histological grade (G1 and G2), early pathological stage, and absence of vascular invasion, metastasis and recurrence. In total, 76.4% of endometrial cancer cases with sub-expression were identified as early stage 1A and B; however, 23.6% of cases were identified as stage 2, with vascular invasion present in 29.4% of cases. On the other hand, cases which demonstrated overexpression with high ranges (>10 times more than control) were associated with adverse histopathological characteristics, including high grade tumor (G3) and vascular invasion. In conclusion, the increased expression of MMP11 may be used as a prognostic biomarker in patients with type 1 endometrial cancer.

Cytological diagnosis of Rosai‑Dorfman disease: A case report and revision of the literature

Rosai-Dorfman disease also known as sinus histiocytosis with massive lymphadenopathy (SHML) is characterized by distorted lymph node architecture with marked dilation of lymphatic sinuses occupied by numerous lymphocytes, as well as histiocytes with vesicular nucleus and abundant clear cytoplasm with phagocytized lymphocytes or plasma cells, also known as ‘emperipolesis’. This disease of unknown etiology progresses with a benign prognosis strictly and only when an early diagnosis and treatment is made. A late diagnosis and a generalized lymph node involvement contribute to a poor prognosis. In this study, we focussed on the cytological characteristics of the Rosai-Dorfman disease and differential diagnoses. We reported a case of a 61-year-old Mexican male with a 9-month history of painless bilateral cervical masses and low-grade fever with the final diagnosis of Rosai-Dorfman disease. The final diagnosis was made by fine needle aspiration (FNA) biopsy of parotid gland and cervical lymph node. In conclusion, FNA biopsy can be enough to make the diagnosis in most cases due to the distinct cytological features of SHML, thereby avoiding more invasive approaches that potentially are unnecessary.

Prostatic Blastomycosis: An Infrequent Cause of Granulomatous Prostatitis

Background: Granulomatous prostatitis is an uncommon inflammatory process of the prostate, which in most cases, is nonspecific. Clinical presentation, treatment, and evolution are similar to those of benign prostatic hypertrophy, but this lesion is also a clinical mimicker of prostate. Fungal granulomatous prostatitis is rare and there are only a few reported cases. Clinical case: We report the case of a patient diagnosed with prostatitis blastomycosis. The patient had obstructive and irritative lower urinary tract symptoms, which showed slight improvement the first days of medical treatment. Finally, he underwent transurethral resection of the prostate due to the persistence of the obstructive symptoms. Results: The histopathologic result showed granulomatous prostatitis with features of blastomycosis fungal structures. Diagnosis was confirmed through molecular biology techniques. Conclusion: Despite its low incidence, the diagnosis of fungal granulomatous prostatitis is important to keep in mind, because it can mimic other prostatic pathologies.