Search

Resumen Objetivos Valorar la reproducibilidad interobservador y evaluar el sistema de gradacion propuesto por Paner et al. para el carcinoma de celulas renales cromofobo. Material y metodos Tras seleccionar 23 casos de carcinoma renal de tipo cromofobo de los hospitales Xeral-Cies, Meixoeiro y POVISA de Vigo de los ultimos 15 anos se ha realizado una sesion informativa de los criterios del sistema de gradacion de Paner et al. Posteriormente los patologos observadores han aplicado dicho sistema a cada caso, valorando una laminilla seleccionada. Se ha calculado el indice Kappa de reproducibilidad interobservador, ponderado segun la escala de Landis y Koch. Resultados La distribucion de grados en la mayoria de los 6 observadores participantes es similar, con predominio del grado 1 en 4 de los mismos. Los 2 observadores restantes consideraron una mayoria relativa de casos como grado 2. Los valores de Kappa oscilan entre 0,136 y 0,674, observandose un predominio de valores indicadores de reproducibilidad discreta-moderada (0,21-0,60). El mayor valor de Kappa (0,674) se ha dado entre un observador novel y el patologo mas experto. Entre los 2 observadores mas veteranos se ha obtenido el indice mas bajo (0,136). Conclusiones La reproducibilidad interobservador en nuestros centros para el grado propuesto por Paner et al. es discreta-moderada. La asignacion de los grados 1 y 2 no es homogenea entre los 6 observadores participantes. En espera de la existencia de una gradacion consensuada por las sociedades cientificas, creemos prudente no utilizar ningun sistema de gradacion en los carcinomas de celulas renales de tipo cromofobo.

Resumen El tumor de celulas de Sertoli-Leydig de ovario es poco frecuente. Es predominantemente solido pero puede haber areas quisticas; cuando tiene abundante componente heterologo de tipo intestinal puede ser predominantemente quistico. El contenido de celulas de Sertoli y de Leydig es variable,y puede ser muy escaso. Este conjunto de hechos puede llevar a confundir esta lesion con un tumor mucinoso quistico. Enalgunas ocasiones se ha descrito elevacion de AFP,lo que obliga a plantear el diagnostico diferencial con un tumor de celulas germinales. El tumor de celulas deSertoli-Leydig se presenta el 80% de las veces en unestadio IA,y dado que en general se presenta en mujeres jovenes en edad fertil,el tratamiento es conservador,y una anexectomia simple es suficiente. El pronostico,generalmente bueno,esta en funcion del estadio y del grado de diferenciacion. Se presenta el caso de una paciente de 25 anos de edad con polimenorreas,aumento del volumen abdominal y elevacion de AFP serica.

To evaluate interobserver reproducibility of a grading system proposed by Paner et al. for chromophobe renal cell carcinoma.After selecting 23 cases of chromophobe renal cell carcinoma from the Xeral-Cíes Hospital, Meixoeiro Hospital and POVISA Hospital from the last 15 years, an informative meeting on the Paner et al. grading system criteria was held. After, the participating pathologists applied the system to each case, evaluating one slide selected. Kappa index for interobserver reproducibility was calculated, and it was classified according to the Landis and Koch scale.The grading distribution was similar for most of the 6 participating observers, with grade 1 predominance. The remaining 2 observers considered a relatively higher proportion of grade 2. Kappa index values ranged from 0.136 to 0.674, with a discrete-moderate reproducibility index predominance (0.21-0.60). Highest Kappa value (0.674) was obtained between the most novel and the most expert interobservers. The lowest Kappa value was obtained among the most veteran pathologists (0.136).Interobserver reproducibility for chromophobe renal cell carcinoma is discrete-moderate in our institutions when the novel grade proposed by Paner et al. is used. Labeling of grades 1 and 2 is not homogeneous among 6 participating observers. While awaiting a grading consensus on a new classification by the scientific societies, we consider that the routine use of a grading system for chromophobe renal cell carcinoma should not be used.

Micropapillary transitional cell carcinoma is a rare (incidence of 0.7%) and highly aggressive variant of bladder carcinoma. Morphologically, it is characterized by small tight clusters of neoplastic cell floating in clear spaces resembling lymphatic channels. Its usual presentation is like a high grade and stage carcinoma and most often is associated with a variable component of conventional carcinoma or other variants. The usual sites of bladder cancer metastases are the lymph nodes, lungs, bone and liver. Soft tissues metastases from transitional cell carcinoma of the bladder occur infrequently. We report the cases of a 77-year-old man presenting with an abdominal soft tissue mass a six years after local excision of a micropapillary bladder carcinoma.

El carcinoma micropapilar es una variante infrecuente de carcinoma vesical (incidencia del 0.7%) con comportamiento clínico agresivo. Histológicamente está constituido por nidos pequeños de células uroteliales dispuestas en lagunas que simulan invasión vascular y se suelen asociar a estadios clínicos avanzados y alto grado histológico. Estos tumores generalmente se asocian a otras variantes histológicas de carcinoma transicional. Los tumores de vejiga suelen metastatizar a ganglios linfáticos, pulmón, hueso e hígado, pero son excepcionales las metástasis a partes blandas. Presentamos el caso de un varón de 77 años que presentó una masa metástasica en partes blandas de pared abdominal a los 6 años de realizarle resección de un carcinoma transicional variante micropapilar de vejiga.

Our aim is to determine the expression of the cerbB-2 oncoprotein in prostate cancers using an immunohistochemistry staining and to compare these results with several clinical and histological prognostic factors.An immunohistochemical staining using the cerbB-2 monoclonal antibody (Dako) was performed in 32 radical prostatectomy specimens diagnosed of adenocarcinoma. The intensity of cerbB-2 expression was evaluated with a scale that variated from 0 (no staining) to 3+ (strong complete membrane staining) according to published guidelines. Association of cerbB-2 index immunoreactivity with clinical and histological prognostic factors was examined.Definite positive membranous staining was detected in 14 of 32 neoplastic cases (44%). Such overexpression was correlated with higher Gleason grade (p=0.04) and higher stage of disease (p=0.038).1) This study shows that 44% of all prostate cancer express the cerbB-2 oncoprotein with immunohistochemical technique. 2) These findings suggest that is necessary to standardize the immunohistochemical staining procedure with cerbB-2 in prostate adenocarcinoma. 3) The level of cerbB-2 expression was correlated with Gleason grade and clinical stage.

EXPRESSION OF THE cerbB-2 (HER-2/neu) ONCOPROTEIN IN PROSTATIC ADENOCARCINOMA Objectives: Our aim is to determine the expression of the cerbB-2 oncoprotein in prostate cancers using an immunohistoche- mistry staining and to compare these results with several clinical and histological prognostic factors. Methods: An immunohistochemical staining using the cerbB-2 monoclonal antibody (Dako) was performed in 32 radical pros- tatectomy specimens diagnosed of adenocarcinoma. The intensity of cerbB-2 expression was evaluated with a scale that variated from 0 (no staining) to 3+ (strong complete membrane staining) according to published guidelines. Association of cerbB-2 index immunoreactivity with clinical and histological prognostic factors was examined. Results: Definite positive membranous staining was detected in 14 of 32 neoplastic cases (44%). Such overexpression was corre- lated with higher Gleason grade (p=0.04) and higher stage of disease (p=0.038). Conclusions: 1) This study shows that 44% of all prostate cancer express the cerbB-2 oncoprotein with immunohistochemical technique. 2) These findings suggest that is necessary to standardize the immunohistochemical staining procedure with cerbB-2 in prostate adenocarcinoma. 3) The level of cerbB-2 expression was correlated with Gleason grade and clinical stage.

CDX1 and CDX2 are transcription factors involved in the development and maintenance of the intestinal epithelial cell. Expression of CDX2 has been reported in normal and metaplastic intestinal epithelium, and in those adenocarcinomas with that cellular origin. We have analyzed the expression of this marker in reactive and tumoral lesions arising in urinary bladder, urethra and urachus.CDX2 was investigated through immunohistochemistry on paraffin-embedded tissue, using the labelled streptavidin-biotin method (LSAB2, Dako) with a monoclonal antibody (CDX2-88, BioGenex).Expression of CDX2 was observed in intestinal-type cistitis glandularis, intestinal metaplasia of urinary bladder, bladder adenocarcinoma, mucinous urothelial-type carcinoma of prostatic urethra and urachal mucinous carcinoma. CDX2 was not detected in normal urothelium and prostatic glandular epithelium, Von Brunn nests, typical-type cistitis glandularis, glandular adenosis and transitional carcinoma.Lesions, both benign and malignant, with enteric-cell morphological features show positivity for CDX2. Expression of this marker is not organ-specific but is just related to a cellular phenotype. Reactivity for CDX2 in an adenocarcinoma can be consistent with an origin in urinary tract or urachus.

EXPRESSION OF CDX2 IN LESIONS OF URINARY BLADDER AND URETHRA BACKGROUND: CDX1 and CDX2 are transcription factors involved in the development and maintenance of the intestinal epithelial cell. Expression of CDX2 has been reported in normal and metaplastic intestinal epithelium, and in those adenocarcinomas with that cellular origin. We have analized the expression of this marker in reactive and tumoral lesions arising in urinary bladder, urethra and urachus. METHOD: CDX2 was investigated through immunohistochemistry on paraffin-embedded tissue, using the labelled streptavidin-biotin method (LSAB2, Dako) with a monoclonal antibody (CDX2-88, BioGenex). RESULTS: Expression of CDX2 was observed in intestinal-type cistitis glandularis, intestinal metaplasia of urinary bladder, bladder adenocarcinoma, mucinous urothelial-type carcinoma of prostatic urethra and urachal mucinous carcinoma. CDX2 was not detected in normal urothelium and prostatic glandular epithelium, Von Brunn nests, typical-type cistitis glandularis, glandular adenosis and transitional carcinoma. CONCLUSIONS: Lesions, both benign and malignant, with enteric-cell morphological features show positivity for CDX2. Expression of this marker is not organ-specific but is just related to a cellular phenotype. Reactivity for CDX2 in an adenocarcinoma can be consistent with an origin in urinary tract or urachus.