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We present a case of a 53-year-old female with an 11 year history of myasthenia gravis (MG) with palpebral ptosis in the left eye which had become more marked over the previous year. Examination revealed a painless left orbital mass causing ptosis. The tumor was surgically removed and histopathology revealed deposits of a hyaline substance which when stained with Congo Red had an apple-green birefringence with polarized light, typical of amyloid. In the absence of amyloid deposits elsewhere in the body, amyloid tumor (AT) was diagnosed. No myelo- or lymphoproliferative syndromes, systemic involvement by amyloidosis or any autoimmune disease were found. The evolution and aesthetic results where satisfactory. Only two cases of orbital AT associated with MG have been described previously; however, in one of the cases, the symptoms of the AT had led to a false diagnosis of MG.

Resumen El adenoma sebaceo de la conjuntiva es una lesion muy rara y de un origen incierto. Habitualmente se asocia al sindrome de Muir-Torre en el que ademas hay neoplasias en otras partes del organismo. Presentamos el caso de un varon de 71 anos sin afectacion neoplasica ni antecedentes familiares, con un cuadro inflamatorio e infeccioso severo en el ojo derecho asociado a una tumoracion a nivel conjuntival proximo a la caruncula. La lesion se extirpo y el estudio anatomopatologico revelo un adenoma sebaceo. No se observo inmunohistoquimicamente inestabilidad de microsatelites. La evolucion fue satisfactoria.

Purpose The association between mRNA expression of 13 candidate genes in surgical breast cancer, molecular tumor subtypes and response to neoadjuvant chemotherapy has been investigated in order to identify potential markers with predictive and prognostic value. Methods Tumor pretreatment core biopsies of 92 breast cancer patients treated with neoadjuvant chemotherapy were submitted to gene expression profiling. Medians and percentiles of mRNA expression for each gene were calculated and correlated to molecular tumor subtype and pathological response. Results Positive-hormone receptor (HR) tumors showed significantly higher mRNA levels of AXL (p = 0.006), FGFR1 (p = 0.006), RAP80 (p = 0.007), GAS6 (p = 0.05), BTRCP (p = 0.003) and ZNF217 (p = 0.005). A significant association between gene expression and pathological complete response (pCR) was observed for four genes; AXL (p = 0.03), FGFR1 (p = 0.018), YAP (p = 0.023), BRCA1 (p = 0.027). Multivariate analysis identified low levels of AXL and BRCA1 mRNA as independent factors associated with pCR, with an OR 14.03 (CI95% 1.44-136.61) in AXL and 7.07 (CI95% 1.41–35.43) in BRCA1. The expression signature combining BRCA1 and AXL low levels associated with pCR in 100% of the cases (p AXL and BRCA1 associates with pCR to neoadjuvant chemotherapy and can have predictive value.

BACKGROUND Quality control in cytology must be established through reliable and easily measurable indicators. METHODS From the Catalan Society of Cytopathology a group of experts has been established to write a document with 13 indicators that cover the entire cytological process, based on its Cytopathology Quality Guide. It has been elaborated through guides and documents with scientific evidence and DELPHI methodology in order to reach a structured consensus on the opinions of a group of experts. RESULTS Thirteen indicators, covering all the cytologic process are expressed in worksheets specifying all their characteristics. CONCLUSION This document allows the control of all stages of the cytological process.

Objective: The study aimed to determine the impact of age, age at menopause, body mass index (BMI), and lumbar and hip bone mineral density (BMD) on muscle strength in young postmenopausal women wi...

Resumen Introduccion El adenocarcinoma endometrioide del endometrio (AEE) es un tumor generalmente de buen pronostico. Recientemente se ha descrito el patron MELF (del ingles microcystic, elongated, and fragmented) de infiltracion miometrial que se asocia a invasion linfovascular y a metastasis ganglionares. Se revisan 70 casos de AEE para establecer la presencia de MELF y correlacionar su presencia con otros factores pronosticos. Material y metodos Se han revisado las histerectomias practicadas por AEE en un periodo de 5 anos en busca del patron MELF de infiltracion miometrial. Su presencia se ha correlacionado con otras variables como el grado histologico, el nivel de infiltracion miometrial, las metastasis ganglionares pelvicas y/o paraaorticas, los implantes peritoneales y la evolucion. Resultados En 17 (24%) casos se observo el patron MELF. Aunque era mas frecuente en tumores de bajo grado, estaba presente en 4 casos de grado 3. En 9 (53%) casos la infiltracion miometrial era profunda. Cinco casos mostraron metastasis ganglionares pelvicas y 3 aorticas. Una de las pacientes fallecio, otra mostro recidiva vulvar y otra, metastasis pulmonares. Conclusion El patron MELF puede encontrarse en adenocarcinomas de alto grado y se correlaciona con otros hallazgos morfologicos de mal pronostico como la infiltracion miometrial profunda y la afectacion de ganglios linfaticos pelvicos. Su presencia no parece influir en la evolucion.

ObjectivesTo describe sonographic features of the microcystic elongated and fragmented (MELF) pattern of myometrial invasion (MI) using the International Endometrial Tumor Analysis (IETA) criteria; to assess the effect of the MELF pattern on preoperative ultrasound evaluation of MI; and to determine the relationship of the MELF pattern to more advanced stage (≥ IB) and lymph node metastases in women with endometrioid endometrial cancer.Methods/materialsWe included 850 women with endometrioid endometrial cancer from the prospective IETA 4 study. Ultrasound experts performed all ultrasound examinations, according to the IETA protocol. Reference pathologists assessed the presence or absence of the MELF pattern. Sonographic features and accuracy of ultrasound assessment of MI were compared in cases with the presence and the absence of the MELF pattern. The MELF pattern was correlated to more advanced stage (≥IB) and lymph node metastases.ResultsThe MELF pattern was present in 197 (23.2%) women. On preoperative ultrasound imaging the endometrium was thicker (p = 0.031), more richly vascularized (p = 0.003) with the multiple multifocal vessel pattern (p < 0.001) and the assessment of adenomyosis was more often uncertain (p < 0.001). The presence or the absence of the MELF pattern did not affect the accuracy of the assessment of MI. The MELF pattern was associated with deep myometrial invasion ≥ 50% (p < 0.001), cervical stromal invasion (p = 0.037), more advanced stage (≥ IB) (p < 0.001) and lymph node metastases (p = 0.011).ConclusionsTumors with the MELF pattern were slightly larger, more richly vascularized with multiple multifocal vessels and assessment of adenomyosis was more uncertain on ultrasound imaging. The MELF pattern did not increase the risk of underestimating MI in preoperative ultrasound staging. Tumors with the MELF pattern were more than twice as likely to have more advanced stage (≥ IB) and lymph node metastases.

Sebaceous adenoma of the conjunctiva is a very rare lesion of uncertain origin. It is usually associated with Muir-Torre syndrome in which neoplasms are also found in other parts of the body. We present the case of a 71-year-old man without a previous or family history of neoplasia, who presented with severe inflammation and an infection in his right eye associated with a tumor of the conjunctiva near the caruncle. The lesion was excised and histopathology revealed a sebaceous adenoma. Microsatellite instability was not observed immunohistochemically. He remains alive and well.

In order to determine whether posterior capsule opacification after cataract surgery, could be delayed or inhibited through the application of hydrogen peroxide (H2O2) or distilled water (H2Od),we extracted lens capsules from 25 human donor eye globes. Samples were treated for 5 min with either 30 mM H2O2 or H2Od or used as controls, and cultured for one month, during which dark field and tilt illumination photos were taken. These were used to observe and quantify, time until cellular growth and confluence on the posterior capsule. After culture, histological sections were stained for H&E, α-SMA, Ki-67 and vimentin and evaluated. We prevented cellular growth in 50% of H2Od and 58% H2O2 of treated samples. The overall prevention of cell growth compared to cultured controls was significant for both treatments while there was no significant difference between them. In the cases where cellular growth was not prevented, both treatments significantly delay cellular growth. Until day 28 none of the treated samples of either type that had shown growth reached total confluence. All cultured controls reached total confluence before treated samples (median = day 11.5). Also, histologically, there was a clear morphological difference between cultured controls and treated samples.

To identify the characteristics of uterine sarcomas and assess the impact of morcellation on prognosis.Case-control study. (Canadian Task Force classification II-2).Hospital Quiron-Dexeus, an academic hospital.Patients with uterine sarcoma histologically diagnosed and treated in our center between 1987 and 2013.All descriptive data, including type of surgery and clinical and pathological data, were reviewed. Survival analysis was performed comparing patients with hysterectomy/myomectomy without any type of morcellation and patients with morcellation during surgery.A total of 37 sarcomas were diagnosed during the study period. The most common symptom was metrorrhagia (50%). The indication for surgery was related to myoma growth in 40% of cases and to metrorrhagia in 37.1% of cases. Open surgery was performed in 23 patients (62.2%), and laparoscopy was performed in 9 (24.3%). Myomectomy was performed in 14 patients (37.8%), and 23 patients (62.1%) underwent hysterectomy as initial surgery. Morcellation for tumor extraction was done in 8 cases (21.6%). Survival analysis by surgical approach showed increased disease-free survival (DFS) in the laparotomy group compared with the laparoscopy group (median, 70.3 months vs 10.4 months; p = .018). Median DFS according to type of surgery was 6.3 months in morcellation cases, 11.9 months in vaginal fragmentation cases, and 149.9 months in nonmorcellated cases (p.002). The median time to progression was shorter in morcellated cases (laparocopic and vaginal) compared with nonmorcellated cases (11.9 vs 14.9 months; p.001). No statistically significant differences in prognosis were related to myomectomy versus hysterectomy; however, there were significants difference between morcellation and nonmorcellation cases.Taking into account the negative impact of morcellation in sarcomas, the use of this technique should be reconsidered in cases of myoma with atypical clinical presentation or symptomatology. Patients must be informed about the possibility of a nonidentified sarcoma and the possible impact on prognosis resulting from its morcellation.

Endometrioid adenocarcinoma of the endometrium (EAE) usually has a favorable prognosis. Recently, the MELF (microcystic, elongated and fragmented) pattern of myometrial infiltration has been described. It is associated with lymphovascular invasion and lymph node metastasis. Seventy cases of EAE were reviewed to identify the presence of MELF and its correlation with other prognostic factors.Hysterectomies performed for EAE during a 5-year period were reviewed, searching for MELF pattern. Its presence was correlated with other variables such as histological grade, depth of myometrial infiltration, pelvic and/or aortic lymph node metastasis, peritoneal implants and evolution.In 17 (24%) cases MELF pattern was detected. It was more frequent in low grade tumors; it was present in four grade 3 cases. In 9 (53%) cases there was deep myometrial infiltration. Five cases had lymph node metastasis in the pelvis and three in the para-aortic region. One of the patients died, another presented a vulvar recurrence and another pulmonary metastasis.MELF pattern can be seen in high grade EAE and correlates with deep myometrial infiltration and pelvic lymph node metastasis. Its presence does not seem to influence survival.

We report our experience in neoadjuvant breast cancer chemotherapy in a single centre between 2000 and 2011. We looked for predictive factors for response to neoadjuvant chemotherapy in the present study. A total of 110 consecutive breast cancer patients were treated with neoadjuvant chemotherapy in our centre. Pathological response was achieved in 24 HR+/HER2- (38.7%), 25 HER2+ (67.6%) and five triple-negative (45.5%) (p = 0.02) patients. No statistically significant differences were found in pathological tumour response according to T stage. The multivariate analysis revealed tumour subtype was the only associated factor for pathological response, with HER2 + tumours the best responders, OR 3.9 (1.5-9.9): 5-year DFS was 40% HER2+/no response; 78% HER2+/response; 65% HR+/HER2-/no response; 82% HR+/HER2-/response; 25% triple-negative/no response and 100% triple-negative/response. HR and HER2 status were the only prognostic factors for pathological response. pCR was correlated with survival in all tumour subtypes.

Resumen Objetivo La puncion aspiracion con aguja fina (PAAF) es un metodo sencillo, rapido y eficaz para el diagnostico de lesiones mamarias. No obstante, su utilizacion ha cambiado por el incremento en el uso de la biopsia por puncion (BPP), que ofrece una mayor eficacia diagnostica. El objetivo de este estudio es establecer el papel actual de la citologia en el diagnostico combinado y multidisciplinar de la patologia mamaria en las unidades de mama espanolas. Metodos Estudio descriptivo a partir de los datos obtenidos en una encuesta de 16 preguntas dirigida a 153 unidades de mama espanolas. Resultados Se obtuvieron 30 respuestas, principalmente de centros publicos (97%) en los que mayoritariamente se estudiaban entre 250 y 500 casos anuales, de los cuales entre 150 y 300 eran canceres. En el 77% de casos la PAAF formaba parte de los protocolos de actuacion de la unidad y su uso se combinaba con el de la BPP. En el 86% de centros se utilizaba para el estudio de la axila. Conclusiones La PAAF, por su sencillez y efectividad, forma parte de la mayoria de protocolos de actuacion de las unidades de mama espanolas encuestadas, sobre todo para establecer el estatus ganglionar prequirurgico para la indicacion de la tecnica de la biopsia selectiva del ganglio centinela. El estudio de las lesiones mamarias tiende a efectuarse mediante BPP, aunque en muchas ocasiones se lleva a cabo de forma combinada con la PAAF.

Resumen Fundamento y objetivo El cancer de mama asociado al embarazo se define como aquel que aparece durante la gestacion o durante el primer ano posparto. Pacientes y metodo Estudio retrospectivo analitico observacional en el que se comparan 56 canceres de mama y embarazo (CME) diagnosticados entre 1976-2008 con 73 pacientes con cancer de mama no asociado al embarazo (CMNE). Se analizan los diversos datos demograficos, los factores pronosticos, el tratamiento y la supervivencia en ambos grupos. Resultados La prevalencia de CME en nuestro centro es 8,13/10.000 embarazos. La mayor frecuencia (62%) aparecio durante el puerperio. Los estadios son mayores en el CME respecto al CMNE, siendo el 31,3% avanzados en el CME frente al 13,3% en el CMNE (p iii frente al 15,8% del CMNE. En el grupo CME el 33,3% tenian receptores para estrogeno negativos, el 48,7% receptores para progesterona negativos y el 34,5% eran Her2Neu positivo frente al 22,2, 24,1 y 31%, respectivamente, en CMNE. En el 52,8% de CME aparecieron ganglios afectados frente al 33,8% del CMNE (p Conclusiones El peor pronostico que se observa en el grupo CME es debido posiblemente a la presencia de factores de pronostico adversos: metastasis ganglionares, receptores hormonales negativos y grado tumoral tipo iii , asi como al diagnostico tardio, con un porcentaje mayor de canceres avanzados.

In order to study the mechanisms involved in the development of posterior capsule opacification (PCO) we compared in vivo developed PCO with PCO formed in tissue culture with focus on the periphery of the lens capsule to evaluate lens regeneration potential. We studied three human tissue groups: Cultured lens capsules after mock cataract surgery (n = 6, 30 days), lens capsules from donors that had previously undergone cataract surgery (IOL capsules) (n = 12) and intact lenses (n = 6). All samples were stained with Vimentin, alpha Smooth Muscle Actin, Picro Sirius Red (for collagen) and Paired box protein (Pax6). We found that cultured capsules and less developed IOL capsules consisted mainly of monolayers of mesenchymal cells, while more developed IOL capsules, contained lens epithelial cells (LECs), globular cells and lens fiber cells. Many IOL capsule samples expressed collagen I and III in areas where cells were in contact with the IOL. Pax6 had a similar dispersed distribution in less developed IOL capsules and cultured capsules, while more developed IOL capsules and intact lenses, concentrated Pax6 in LECs at the equatorial lens bow. The similarities between cultured capsules and less developed IOL capsules indicate that our in vitro developed PCO is comparable to early in vivo developed PCO. The similar morphology of more developed IOL capsules and intact lenses seems to indicate an attempt at lens regeneration.

Resumen Objetivo Determinar la variabilidad entre 2 sistemas de gradacion a la hora de catalogar la respuesta patologica a la quimioterapia neoadyuvante en una misma lesion. Material y metodos En 8 anos se han estudiado 51 pacientes con cancer infiltrante de la mama sometidas a quimioterapia neoadyuvante de forma consecutiva. Se ha establecido la respuesta patologica de cada caso siguiendo el sistema de Miller y Payne (MyP) y el de la carga tumoral residual (RCB) correlacionando los resultados de ambos sistemas en la misma lesion. Resultados Segun el sistema de gradacion de MyP las lesiones se clasificaron en grado 1 (6%), 2 (25%), 3 (27%), 4 (27%) y 5 (14%). La clase RCB fue 0 (13%), I (13%), II (54%) y III (20%). La correlacion entre MyP 5 y RCB 0, entre MyP 4 y RCB I, y entre MyP 2 y RCB III fue buena. Se detectaron mas discrepancias entre MyP 1, 2, 3 y RCB II. Conclusion La correlacion en la respuesta completa es buena entre los 2 sistemas de gradacion. Hay discrepancias en la clasificacion en la ausencia de respuesta entre ambos sistemas. Estas discrepancias pueden ser debidas a la inclusion del estado ganglionar en el sistema RCB.

Resumen Objetivo Evaluar el estudio citologico de las secreciones en el diagnostico de las lesiones papilares de la mama. Material y metodos Estudio descriptivo y retrospectivo de 6.127 secreciones mamarias obtenidas desde 1986 hasta 2012. En 137 de ellas se obtuvo correlacion histopatologica. Resultados El resultado citologico fue no valorable por ausencia de material en 513 casos (8,4%), benigno en 4.975 (81,2%), inflamatorio en 234 (3,8%), papiloma en 321 (5,2%), proceso papilar en 28 (0,5%), carcinoma papilar en 8 (0,1%) y carcinoma en 21 (0,3%). Veintisiete casos (0,4%) fueron diagnosticados de otros procesos. La correlacion con el resultado histopatologico fue buena en los papilomas (45 de 81, 56%). Conclusion Aunque la correlacion entre el diagnostico citologico de papiloma y la benignidad de la lesion es alta, la citologia de las secreciones es una tecnica especifica para el diagnostico de malignidad, pero con baja eficacia para establecer el diagnostico preciso de la lesion.

Resumen Objetivos La quimioterapia neoadyuvante (QNA) es el tratamiento de eleccion en las pacientes con cancer de mama localmente avanzado. El objetivo de este estudio es evaluar la utilidad de QNA en tumores pequenos pero con factores pronosticos desfavorables. Material y metodos Se compara la respuesta a la QNA en pacientes con tamano tumoral T3-T4 frente a T1c-T2. Desde enero de 2000 a enero de 2011, 110 pacientes han recibido QNA. Se han revisado los datos demograficos, el tamano tumoral, los factores pronosticos, la respuesta radiologica y anatomopatologica a la QNA, segun la clasificacion de Miller y Payne (MP), y la supervivencia en ambos grupos. Resultados Se revisaron 76 casos en el grupo T1c-T2 y 34 en el T3-T4. En el grupo T3-T4 se observo en mayor porcentaje tumores con factores pronosticos desfavorables (afectacion ganglionar, receptores hormonales negativos y Her2Neu positivo). En el grupo T1c-T2, 23 casos (30,3%) recibieron antraciclinas y 53 (69,7%) antraciclinas y taxanos, mientras que en el grupo T3-T4, 10 (29,4%) y 24 (70,6%) casos recibieron dichas pautas, respectivamente. En el grupo T1c-T2 se observo en mayor porcentaje el subtipo tumoral receptores hormonales positivos frente a tumores Her2Neu positivos en los T3-T4. En relacion con la respuesta a la QNA no se observaron diferencias estadisticamente significativas en la valoracion radiologica o anatomopatologica, 38 pacientes (50%) T1c-T2 presentaron MP 4/5 frente a 16 (47,1%) en T3-T4. Conclusiones En las pacientes con cancer de mama precoz existe la misma respuesta anatomopatologica a la QNA que en el grupo T3-T4. En nuestro estudio, el unico factor independiente asociado a la respuesta patologica tumoral es el subtipo tumoral, presentando los tumores Her2Neu positivos mejor respuesta.

Clinical case A 22-year-old woman patient, diagnosed with an inclusion cyst of the conjunctiva in the nasal sector of the left eye, who after 2 shot/needle injections in the lesion came to our clinic with a dense subconjunctival hemorrhage in four quadrants and with severe pain. After excision biopsy, a capillary hemangioma of the conjunctiva was diagnosed. Discussion Conjunctival capillary hemangioma is mainly a benign lesion, asymptomatic and mostly congenital in origin, its progression or de novo growth is rare in adulthood.

To assess whether there are differences in ovarian echogenicity and vascularization as assessed by three-dimensional power Doppler angiography (3D-PDA) between women with polycystic ovaries (PCO) and women with normal ovaries (NO).Eighty-three women were classified into two groups according to the 2003 Rotterdam consensus criteria. The NO group comprised women (n = 45) with regular menstrual cycles and proven fertility, whereas the PCO group comprised women (n = 38) with oligo-anovulation, clinical and/or biochemical features of hyperandrogenism, and polycystic ovary morphology at two-dimensional ultrasound. All women were evaluated by means of 3D-PDA. The parameters studied in both groups were follicle number per ovary (FNPO), ovarian volume (OV), mean gray value (MG) and three vascular indices: vascularization index (VI), flow index (FI) and vascularization flow index (VFI).The PCO group showed a higher mean OV as well as FNPO. No differences in MG, VI, FI and VFI were found between the groups.3D-PDA indices are not useful for discriminating between normal and polycystic ovaries.

Resumen Presentamos un caso de tumor de origen no ginecologico que simula un tumor maligno de ovario, descubierto en el transcurso de una revision ginecologica mediante ecografia ginecologica transvaginal con power Doppler. El resultado de la anatomia patologica revela que se trata de un tumor estromal gastrointestinal de bajo riesgo (TEGI). Este tipo de tumores tiene un buen pronostico y evolucion si cuando son detectados son menores de 5 cm. El tratamiento de este tipo de tumor es quirurgico

Objective. A case of Bartholin gland nodular hyperplasia with review of the literature and diagnostic criteria is reported. Material and Methods. In a 31-year-old woman, a nodular mass was found arising in the left labium minus. The mass size increased during sexual intercourse. Results. The mass was well-circumscribed but not encapsulated and showed a proliferation of acini lined by mucus-secreting columnar epithelium. The lesion retained the lobular pattern and the relationship between acini and ducts as seen in the normal Bartholin gland. Conclusion. Nodular hyperplasia of the Bartholin gland should be differentiated from adenoma, in which architecture is disrupted. Variation in size during sexual intercourse probably is mediated by vascular engorgement. Surgical excision is curative.

Breast metastases from gynecologic cancer are infrequent and are mainly from the ovary. They usually appear in advanced stages and have poor survival rates after diagnosis. Two cases of breast metastasis of serous ovarian carcinoma are presented. In both cases fine-needle aspiration (FNA) study of breast revealed a lesion with morphologic characteristics of serous carcinoma, while one of them was with immunocytochemical study. Origin was confirmed by histological examination of this lesion.

Resumen Se presenta el caso de una paciente de 50 anos de edad, con unas microcalcificaciones mamograficas de nueva aparicion y sospechosas de malignidad. La lesion se extirpo quirurgicamente y el examen microscopico evidencio una lesion constituida por islotes maduros de tejido adiposo y cartilaginoso con focos de calcificacion y osificacion. El condrolipoma es un tumor benigno del que hay pocos casos descritos en la bibliografia. Se presentan los aspectos clinicos e histologicos y se discuten los diagnosticos diferenciales y la etiopatogenia del tumor.

BACKGROUND: The aim of this study was to quantify blood vessel density (BVD) and immunoreactive vascular endothelial growth factor (VEGF) levels in endometrial biopsies taken from women suffering breakthrough bleeding (BTB) under different exogenous hormonal regimes. METHODS: Endometrial biopsies from women in Melbourne with BTB were divided into four groups: combined-continuous hormone therapy (HT) (estrogen and progestin taken daily), cyclical HT (daily estrogen with progestin for 14 days each cycle), progestin-only, or no HT. Subjects from Barcelona were using the Mirena intrauterine levonorgestrel-releasing system for contraceptive purposes, with menstrual diaries for classification into four groups (amenorrhea, infrequent, regular and prolonged). Control biopsies from Melbourne were included in the study. Endometrial samples were immunostained for VEGF and blood vessel localization using an antibody to CD34. RESULTS: Results showed that BVD was significantly reduced in the progestin-only treated group compared with the other three treatment groups (P = 0.028). In addition, all four Mirena BTB groups had significantly reduced BVD compared with controls. Considerable heterogeneity was observed in VEGF immunostaining within and between individual samples with no major differences between HT or Mirena. CONCLUSION: These results provide strong evidence that unopposed progestins reduce endometrial BVD and that there is no link between VEGF immunostaining and BVD or BTB.

Resumen Introduccion En raras ocasiones se diagnostica un adenocarcinoma originado en un polipo endometrial. Material y metodos De un total de 1.989 polipos endometriales diagnosticados en 8 anos y medio, 6 presentaban un adenocarcinoma endometrioide. Se analizan sus caracteristicas clinicopatologicas y evolucion. Resultados La histeroscopia diagnostico un polipo en todas las pacientes, y en 3 de ellas con signos sospechosos de malignidad. En todas las ocasiones la lesion estaba confinada al polipo y no se observo infiltracion miometrial en ningun caso. Los carcinomas fueron de la variedad endometrioide, y el endometrio adyacente era normal. Todas las pacientes estan vivas y libres de enfermedad tras un seguimiento medio de 45 meses (entre 6 y 96 meses). Conclusion Los polipos endometriales pueden albergar un adenocarcinoma que en muchas ocasiones esta confinado al polipo, y que es de bajo grado de malignidad, por lo que se puede plantear un tratamiento conservador.

Resumen Introduccion La leiomiomatosis difusa del utero es una entidad rara que cursa con un aumento del tamano uterino. Descripcion de los casos Se revisan las caracteristicas clinicopatologicas de 5 casos. La sintomatologia mas frecuente fue por sangrado uterino. Tres de las pacientes tenian hijos, y 2 de ellas habian tenido algun aborto. En 3 ocasiones se efectuo una histerectomia subtotal. En las otras 2 se practico una reseccion parcial por deseos de la paciente de conservar la fertilidad. Conclusion La leiomiomatosis difusa uterina es una lesion benigna que puede afectar a la fertilidad o complicar de forma significativa el parto.

Resumen El objetivo de nuestro estudio es determinar la inestabilidad de tres microsatelites (BAT25, BAT26 y NME1) y observar si esta implicada en el desarrollo de los tumores esporadicos de ovario. El trabajo se ha llevado a cabo en 40 pacientes intervenidas quirurgicamente por tumor de ovario esporadico. La comprobacion de la inestabilidad se realizo por comparacion del tejido sano y tumoral de cada una de las pacientes. Solo se encontro inestabilidad en 3 casos: en BAT26 en tumor borderline; en BAT25 en cistoadenocarcinoma de celulas claras, y en NME1 en cistoadenocarcinoma papilar seroso en diferentes pacientes. La inestabilidad microsatelite no parece estar implicada en la aparicion o el desarrollo de los tumores esporadicos de ovario

Purpose The aim of the study was to determine the value of gray-scale and color Doppler sonography in distinguishing borderline cystic tumors (BCTs) from benign cysts and malignant tumors of the ovary. Methods The gray-scale and color Doppler sonographic features of 383 ovarian lesions in 374 nonpregnant women were retrospectively studied. Sonography was performed transvaginally for all but 7 lesions, which were imaged suprapubically. All of the lesions were surgically resected via laparoscopy or laparotomy. Results The histopathologic diagnoses were 27 BCTs, 35 ovarian carcinomas, and 321 benign cysts. Sonography diagnosed 24 (89%) of 27 BCTs as malignant lesions. Patients with BCTs, were younger than those with ovarian cancer (p < 0.001). BCTs showed intracystic papillae in 17 cases (63%), diffuse internal echoes in 11 (41%), intracystic septa in 8 (30%), a heterogeneous echo pattern in 7 (26%), and a solid pattern in 4 (15%). BCTs showed blood flow in 24 cases (89%) and lower pulsatility and resistance indices (RI) compared with benign lesions (p < 0.001 for both). Multivariate analysis revealed intracystic papillae as the only independent predictor of BCTs (p < 0.001). Conclusions When a cystic mass has papillae, this is the only abnormal finding detected by gray-scale transvaginal sonography, and color Doppler imaging shows low RI values within the mass, a BCT should be suspected. © 2002 John Wiley & Sons, Inc. J Clin Ultrasound 30:76–82, 2002; DOI 10.1002/jcu.10028

Resumen Objetivo La afeccion de los ganglios linfaticos es el factor pronostico mas importante en las pacientes con cancer de la mama. El examen del ganglio centinela es una alternativa al estudio completo de la axila Material y metodos Se han estudiado 164 ganglios centinela en 100 pacientes con cancer de mama. Se utilizo un protocolo estandar para el estudio de 21 laminas (cuatro de ellas tenidas con inmunohistoquimica). Se relaciono el numero de laminas estudiadas con la positividad o no de los ganglios, y en el primer caso con el tipo de afeccion. Tambien se tuvo en cuenta el tamano del tumor y el estado del resto de la linfadenectomia Resultados Un total de 52 ganglios centinela fue positivo, 17 de ellos evidenciaron metastasis, 19 micrometastasis y 16 celulas tumorales aisladas. Todas las metastasis se diagnosticaron en la primera lamina estudiada tenida con hematoxilinaeosina; sin embargo, para el diagnostico de todas las micrometastasis y de las celulas tumorales aisladas se precisaron 16 y 19 laminas, respectivamente (cuatro de ellas tenidas con inmunohistoquimica) Conclusion Para el diagnostico de micrometastasis y de celulas tumorales aisladas se precisa un protocolo que incluya multiples secciones y tecnicas de inmunohistoquimica

Resumen Objetivo Revisar los hallazgos clinicopatologicos de los fibroadenomas afectados por un carcinoma de la mama Pacientes Y Metodo Se han observado 8 casos en los que existia infiltracion de un fibroadenoma por un carcinoma durante un periodo de 11 anos. Se revisan los aspectos clinicopatologicos de estos tumores, asi como el de las lesiones asociadas en el parenquima circundante Resultados Cuatro de los casos presentaron lesiones in situ (dos ductales y dos lobulillares), identificandose en tres de ellos la presencia de neoplasia en el parenquima mamario circundante. En los otros 4 casos la lesion era infiltrante (dos ductales y dos lobulillares) y en todos ellos se extendia mas alla del fibroadenoma Conclusion La asociacion de carcinoma y fibroadenoma es poco frecuente y, en estos casos, tanto el tratamiento como el pronostico estan en funcion de las caracteristicas propias del tumor que infiltra al fibroadenoma

We have compared the protein profiles in plaques and tangles in the hippocampus of post-mortem Alzheimer brains and in opaque and clear regions in the deep cortex of eye lenses of the same donors. From the 7 Alzheimer donors studied, 1 had pronounced bilateral cortical lens opacities, 1 moderate and 5 only minor or no cortical opacities. We focused on beta-sheet levels, a hallmarking property of amyloid-beta, the major protein of plaques and tau protein, the major protein of tangles in Alzheimer brains. Confocal Raman microspectroscopy and imaging was used in combination with hierarchical cluster analysis. Plaques and tangles show high levels of beta-sheets with a beta-sheet to protein ratio of 1.67. This ratio is 1.12 in unaffected brain tissue surrounding the plaques and tangles. In the lenses this ratio is 1.17 independently of the presence or absence of opacities. This major difference in beta-sheet conformation between hippocampus and lens is supported by Congo red and immunostaining of amyloid-beta and tau which were positive for plaques and tangles in the hippocampus but fully negative for the lens irrespective of the presence or absence of opacities. In line with a previous study (Michael et al., 2013) we conclude that cortical lens opacities are not typical for Alzheimer patients and are not hallmarked by accumulation of amyloid-beta, and can thus not be considered as predictors or indicators of Alzheimer disease as claimed by Goldstein et al. (2003).

Duct endoscopy is a recent technique used for a direct view of the breast ductal system. The aim of this study is to determine any morphological changes in breast tissue attributable to low-pressure irrigation with saline solution that the technique requires. A total of 26 breast biopsies from patients who underwent ductal endoscopy before surgery were compared with 26 breast specimens from the retroareolar region. Breast specimens from duct endoscopy showed more frequent epithelial detachment (73%), epithelial loss (35%), periductal clefts (77%), stromal disaggregation (46%) and displacement of epithelial cells into the stroma (27%) than the control group in which epithelial detachment was seen in 4% of patients, periductal clefts in 15%, and stromal disaggregation in 15%. Epithelial loss and epithelial displacement where not seen in the control group. Although low-pressure fluid perfusion used for duct endoscopy induced morphological changes in breast tissue, these can easily be distinguished from malignancy, and are most likely to occur as the result of duct rupture.

Purpose Accurate presurgical assessment of tumor size in breast cancer is important for choosing appropriate treatment. We retrospectively compared presurgical sonographic measurements of tumor size with postsurgical measurements of size and other variables. Methods In 174 cases, tumor size was measured by sonography before surgery, and those measurements were compared with values obtained by histopathologic examination of the specimens. The histologic type and grade, the number of lesions, and the presence of an extensive intraductal component also were considered in the intramodal correlations of tumor size. Results Sonographic measurements of tumor size correlated well with size measured after surgery (r = 0.72; 95% confidence interval, 0.64–0.78). The correlation was higher for lesions of 20 mm or less in their longest diameter than for larger lesions. The intramodal size correlation was lower for tumors with an extensive intraductal component than for tumors without an extensive intraductal component. The sonographic versus pathologic correlation of tumor size was less accurate when several lesions were present. Conclusions Sonography is useful for presurgical assessment of tumor size in patients with breast cancer, especially for single lesions of 20 mm or less and without an extensive intraductal component. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:485–491, 1999.

Resumen Introduccion El carcinoma micropapilar infiltrante de la glandula mamaria representa una variante histologica con una alta incidencia de metastasis ganglionares y un alto indice de recidivas locorregionales, que se ha descrito de forma muy ocasional en la mama masculina. Caso clinico Se presenta un caso de un varon de 75 anos con un carcinoma micropapilar infiltrante de la mama derecha de 2 cm y con metastasis en uno de 11 ganglios axilares. Los receptores hormonales fueron positivos y el c-erbB 2 determinado inmunohistoquimicamente fue negativo. La evolucion a los 17 meses del diagnostico fue satisfactoria. Conclusion El carcinoma micropapilar infiltrante tambien puede presentarse en la mama masculina con las mismas caracteristicas clinicas y morfologicas que en la mama femenina.

Cutaneous ossifications or osteoma cutis can be found in many syndromes. Primary osteoma cutis, present since birth or the first months of life, in the absence of metabolic disorders or trauma, is found in congenital plate-like osteoma cutis and progressive osseous heteroplasia, coexisting in the latter with deep connective tissue ossifications. This report documents the case of a 7-year-old female with a plate-like cutaneous ossification of the forehead causing aesthetic deformities. Other dermal ossifications in the inguinal and preauricular region, as well as the left hand and a small focus in the extraocular muscles of the left orbit, were also present. These lesions did not show progression, and most of them were present since birth. The lesion of forehead was treated surgically. The lack of progression and the fact that the orbital lesion was solitary still fits the criteria for the diagnosis of plate-like osteoma cutis. Plate-like osteoma cutis and progressive osseous heteroplasia may represent varieties of the same disorder.

Knowledge of the nature of ovarian lesions is important in order to establish the correct treatment and, especially, to detect ovarian cysts that do not require surgical treatment. With the purpose of demonstrating the utility of transvaginal sonography with colour Doppler of ovarian functional ovarian cysts, 378 ovarian tumours were studied, comparing sonographic diagnosis with pathological findings. Sensitivity and specificity of colour Doppler transvaginal sonography to detect functional ovarian cysts were 84.6 and 99.2% respectively. Positive and negative predictive values were 98 and 93.5% respectively. In our experience, transvaginal sonography with colour Doppler is a useful technique in the diagnosis of ovarian pathology.

Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy and up to one year postpartum.A retrospective, analytical, observational study comparing 56 cases of breast cancer and pregnancy (PABC) diagnosed 1976-2008 with 73 patients with breast cancer not associated with pregnancy (non-PABC) was performed. Demographic data, prognostic factors, treatment and survival were reviewed and compared.The prevalence of PABC in our center is 8.3/10,000. The highest frequency (62%) appeared during the postpartum period. The stages are higher in PABC, being 31.3% advanced (EIII and EIV) in PABC versus 13.3% in non-PABC (P.05). Regarding prognostic factors, 27.3% in PABC had a tumoral grade 3 versus 15.8% of non-PABC. Among women with PABC, 33.3% had negative estrogen receptors, 48.7% negative progesterone receptors and 34.5% positive Her2Neu compared with 22.2, 24.1 and 31%, respectively of non-PABC patients. Finally, positive lymph nodes were found in 52.8% of PABC, versus 33.8% non-PABC (P.05). Overall and disease-free survival rate at 5 years for PABC was 63.7 and 74.2%, respectively.The poorer survival observed is possibly due to the presence of adverse prognostic features such as lymph node metastases, negative hormone receptors, tumoral grade iii, as well as a delay in diagnosis with a higher rate of advanced stages.

This report describes three cases of localized fibrous tumor of the pleura (LFTP) with clinical and pathological differences. Case 1 presented with symptoms; the tumor size was 6.5 cm and it was attached to the lung and chest wall; histologically it was composed of spindle cells with pleomorphism, mitoses, hemorrhage and necrosis. Cases 2 and 3 were casual findings and consisted of well-circumscribed tumors of 3 and 8.5 cm, respectively; histologically both showed hypocellularity. All cases exhibited positive stains for vimentin and negative for keratin. These results, added to histological features, suggested a mesenchymal origin. Flow cytometry quantitation of DNA disclosed a diploid pattern in all three cases with a small "near diploid" cell population additionally in Case 1; the S-phase fraction was low in all cases. These findings, that could be considered favourable prognostic signs, and the complete tumoral resection performed in the three tumors, could explain the absence of recurrences after 32, 27 and 19 months, respectively.

Eye lenses from human donors with and without Alzheimer's disease (AD) were studied to evaluate the presence of amyloid in cortical cataract. We obtained 39 lenses from 21 postmortem donors with AD and 15 lenses from age-matched controls provided by the Banco de Ojos para Tratamientos de la Ceguera (Barcelona, Spain). For 17 donors, AD was clinically diagnosed by general physicians and for 4 donors the AD diagnosis was neuropathologically confirmed. Of the 21 donors with AD, 6 had pronounced bilateral cortical lens opacities and 15 only minor or no cortical opacities. As controls, 7 donors with pronounced cortical opacities and 8 donors with almost transparent lenses were selected. All lenses were photographed in a dark field stereomicroscope. Histological sections were analyzed using a standard and a more sensitive Congo red protocol, thioflavin staining and beta-amyloid immunohistochemistry. Brain tissue from two donors, one with cerebral amyloid angiopathy and another with advanced AD-related changes and one cornea with lattice dystrophy were used as positive controls for the staining techniques. Thioflavin, standard and modified Congo red staining were positive in the control brain tissues and in the dystrophic cornea. Beta-amyloid immunohistochemistry was positive in the brain tissues but not in the cornea sample. Lenses from control and AD donors were, without exception, negative after Congo red, thioflavin, and beta-amyloid immunohistochemical staining. The results of the positive control tissues correspond well with known observations in AD, amyloid angiopathy and corneas with lattice dystrophy. The absence of staining in AD and control lenses with the techniques employed lead us to conclude that there is no beta-amyloid in lenses from donors with AD or in control cortical cataracts. The inconsistency with previous studies of Goldstein et al. (2003) and Moncaster et al. (2010), both of which demonstrated positive Congo red, thioflavin, and beta-amyloid immunohistochemical staining in AD and Down syndrome lenses, is discussed.

Ovarian vein trombosis (OVT) is a pathologic entity classically considered as a postpartum complication and only rarely associated with other diseases. Due to its vague symptoms, it is usually underdiagnosed. However its consequences can be fatal. We report a case of an incidental finding of ovarian thrombosis in an asymptomatic 45-year-old woman who underwent surgery due to the ultrasonographic finding of a para-ovarian cyst.

Lymphohistiocytoid malignant mesothelioma is an infrequent variant of sarcomatoid mesothelioma representing approximately 0.5-3.3% of malignant mesotheliomas. It has been related to asbestos exposure. The tumor is characterized by a diffuse large histiocyte-like cells proliferation mixed with an inflammatory infiltrate of lymphocytes and plasma cells. Its cytological diagnosis is difficult. We present a case of a 67-year-old female with lymphohistiocytoid mesothelioma involving the left pleura. The cytological, histological, and immunohistochemical features are discussed.