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Resumen Introduccion y objetivos Con frecuencia los urologos remiten el tejido resecado durante las vasectomias para estudio anatomopatologico con el fin de confirmar la presencia de conducto deferente. El estudio microscopico es sencillo y se suele hacer con hematoxilina-eosina. En ocasiones, se ve dificultado por artefactos de la muestra y la inmunohistoquimica puede ayudar a reconocer la presencia de deferente. Materiales y metodos Hemos investigado la utilidad de la determinacion inmunohistoquimica de cadherina E y GATA-3 para confirmar epitelio del deferente en 110 secciones de vasectomias con diferentes artefactos, utilizando anticuerpos monoclonales y tecnica de multimero conjugado con peroxidasa; 5 arterias y 5 venas renales fueron controles negativos. Resultados Con cadherina E se observo tincion de membrana moderada (2,7%) o intensa (97,3%) en el epitelio del deferente en todos los casos: 35 sin artefacto, 7 con epitelio denudado, 56 con epitelio comprimido o distorsionado, 8 con epitelio desprendido y 4 con epitelio desplazado. GATA-3 mostro positividad nuclear moderada (31%) o intensa (69%) en todos los casos, incluyendo los 76 con los artefactos senalados. Las arterias y venas fueron negativas para ambos marcadores en el endotelio, con positividad para GATA-3 en ocasionales linfocitos de la pared. Conclusiones La inmunohistoquimica puede ayudar a reconocer la presencia de epitelio del deferente en vasectomias artefactadas con positividad de membrana para cadherina E y expresion nuclear de GATA-3. El endotelio vascular, por el contrario, es negativo para ambos marcadores. No se debe malinterpretar como positividad la posible tincion para GATA-3 de linfocitos de la pared.

Objectives The incidental presence of seminal vesicle epithelium in prostate needle biopsies is generally recognizable through routine microscopy. However, it can sometimes be erroneously interpreted as malignant due to its architectural and cytological characteristics, and immunohistochemistry can be useful for correctly identifying the seminal epithelium. Our objective was to analyze the potential usefulness of GATA-3 as a marker of seminal epithelium. Material and methods Through immunohistochemistry with a monoclonal anti-GATA-3 antibody (clone L50-823), we studied seminal vesicle sections from 20 prostatectomy specimens, 12 prostate needle biopsies that contained seminal vesicle tissue and 68 prostate biopsies without seminal vesicle epithelium, 36 of which showed adenocarcinoma. Results Staining for GATA-3 was intense in the 20 seminal vesicles of the prostatectomy specimens and in the 12 prostate needle biopsies that contained seminal epithelium. In the 60 biopsies without a seminal vesicle, GATA-3 was positive in the prostate basal cells and even in the secretory cells (57 cases), although with less intensity in 55 of the cases. One of the 36 prostatic adenocarcinomas tested positive for GATA-3. Conclusions The intense immunohistochemical expression of GATA-3 in the seminal vesicle epithelium can help identify it in prostate biopsies. This marker is also positive in the basal cells of healthy prostates and, with less intensity, in the secretory cells. Positivity, weak or moderate, is observed on rare occasions in prostatic adenocarcinomas.

Resumen Objetivos La presencia incidental de epitelio de la vesicula seminal en las biopsias por aguja de prostata es generalmente reconocible mediante el estudio microscopico de rutina. Sin embargo, en ocasiones, se puede interpretar erroneamente como maligno debido a sus caracteristicas arquitecturales y citologicas, y la inmunohistoquimica puede ser util para identificarlo correctamente. Nuestro objetivo ha sido analizar la posible utilidad de GATA-3 como marcador de epitelio seminal. Material y metodos Se han estudiado mediante inmunohistoquimica con un anticuerpo monoclonal anti-GATA-3 (clon L50-823) secciones de vesicula seminal procedentes de 20 piezas de prostatectomia, 12 biopsias por aguja de la prostata que contenian tejido de vesicula seminal y 68 biopsias de prostata sin epitelio de vesicula seminal, 36 de las cuales presentaban adenocarcinoma. Resultados La tincion para GATA-3 fue intensa en las 20 vesiculas seminales de las piezas de prostatectomia y en las 12 biopsias por aguja de prostata que contenian epitelio seminal. En las 60 biopsias sin vesicula seminal GATA-3 fue positiva en las celulas basales de la prostata, e incluso en las celulas secretoras (57 casos), aunque con menor intensidad en 55 de los casos. Uno de los 36 adenocarcinomas prostaticos fue GATA-3 positivo. Conclusiones La expresion inmunohistoquimica intensa de GATA-3 en el epitelio de la vesicula seminal puede ayudar a identificarlo en las biopsias prostaticas. Este marcador tambien es positivo en las celulas basales de la prostata normal y, con menor intensidad, en las secretoras. Raramente se observa positividad, debil o moderada, en adenocarcinomas prostaticos.

Epidermal inclusion cysts are very common lesions that very rarely undergo malignant transformation-in the English-language literature we have only found 18 adequately documented cases. We present the case of a man with a 2-month history of a retroauricular skin lesion in which histological study revealed squamous cell carcinoma arising on an epidermal inclusion cyst. Cysts that grow rapidly, reach a large size, ulcerate, develop a fistula, or that do not respond to medical treatment, and those that recur should be excised completely and histological study performed of the whole lesion.

Immunohistochemical detection of mediators of inflammation, such as P-Selectin, has been proposed to assess vitality of wounds. Forty-five incised cutaneous wounds (24 vital, 14 post-mortem, seven with induced autolysis/putrefaction) were immunostained with antibodies against P-Selectin and CD31. The percentage of stained lumina for P-Selectin out of the total of CD31 positive vessels (P-S/CD31 index) was calculated at both edges of every specimen. In vital samples, the P-S/CD31 index ranged from 10.7% to 71.4% at the wound edge, and was 12.5-58.8% for the opposite margin, with a ratio between both indices of 0.37-1.77 (mean: 0.94). In post-mortem cases, the index ranged from 22.5% to 69.2% at the wound edge, and was 28-89.5% at the opposite margin, with a ratio between both indices of 0.76-1.9 (mean: 0.96). Differences between ratios were not statistically significant and thus precluded any assessment of vitality. The analysis of P-Selectin/CD31 immunoreactivity in skin wounds was not useful for the diagnosis of vitality when evaluating both edges for each specimen. Moreover, P-Selectin has been detected in post-mortem injuries and it is not specific to vital injuries. Microscopic evaluation becomes difficult after autolysis/putrefaction.

CDX2 is a transcription factor expressed by intestinal epithelium. It is considered as a sensitive marker for a colorectal or-less frequently-gastric origin of adenocarcinomas. The pattern of coordinated expression of cytokeratin (CK) 7 and CK20 is also useful for the diagnosis of the origin of metastatic adenocarcinomas. Expression of CDX2, CK7 and CK20 was investigated in 14 cases of sinonasal intestinal-type adenocarcinoma (SIA), a particular tumor with an enteric-cell-type appearance. Formalin-fixed, paraffin embedded tissue sections were immunostained with monoclonal antibodies using the biotin-labeled streptavidin technique. All of the cases expressed CDX2, being stained 50 to 100% of the tumor cells (mean: 87.2%). CK7 positivity was detected in 8 cases (57.1%), with the staining of 10 to 100% of cells (mean: 65.6%), and CK20 was found in all the tumors (10 to 100% of cells; mean: 78.8%). The histologic resemblance between SIA and colorectal adenocarcinoma is reinforced by the expression of CDX2 and CK20, which are virtually constant in both neoplasms. CDX2 seems to be a marker for cellular phenotype better than an indicator of the origin of adenocarcinomas. CK7 is expressed in SIA less frequently than in colonic adenocarcinoma, but with a rate similar to the subset of rectal tumors, making the differential diagnosis between the two neoplasms difficult.

Low-grade myofibroblastic sarcoma is a recently defined tumor that is part of the spectrum of malignant mesenchymal tumors, showing features of myofibroblastic differentiation. These tumors occur most commonly in the head and neck regions, especially in the tongue, and less frequently in the limbs, trunk, and abdominal/pelvic cavity. We describe a 51-year-old woman with a low-grade myofibroblastic sarcoma. The distal phalanx of the finger was amputated with a clear surgical margin. The treatment of this tumor should include a simple local excision with free surgical margins and a long clinical follow-up period with imaging studies. At the 28-month follow-up evaluation the patient was free from this tumor.

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.

The efficiency of immunohistochemical techniques for the diagnosis of vitality of wounds decreases for lesions occurring fairly close to death. We analyzed the expression of fibronectin (FN) and tenascin (TN) in wounds inflicted in abdominal skin of 12 adult rats. An incised injury was made at 5, 10 or 15 min before death and another at 5 min after sacrifice, and collected after 45 min. Formalin-fixed paraffin-embedded sections from a total of 36 samples (mean 1.5 per wound) were immunostained following the streptABC technique. Microscopic examination revealed a reticular pattern staining in 18 out of 20 vital samples for FN, 16 out of 20 for TN, 2 out of 16 postmortem samples for FN and 3 out of 16 for TN. Intracellular staining of muscle fibres was observed in 7 out of 20 vital and 5 out of 16 postmortem samples. FN and TN were detected in most of the vital injuries but they are not completely specific. Postmortem staining occurred in a few cases probably related to a passive extravasation of these molecules from damaged blood vessels. Reactivity of muscle fibres occurs both in vital and postmortem lesions, and is not useful in the diagnosis of vitality.

A 44-year-old woman with left kidney tumor involving the perirenal and retroperitoneal lymph nodes is presented. Imaging findings including ultrasonography and computerized tomography showed renal and para-aortic masses and no features of lymphangioleiomyomatosis or angiomyolipoma were seen. The histopathological examination was considered as a renal smooth muscle tumor with features of lymphangioleiomyomatosis. Diagnosis considerations, particularly histopathological, immunohistochemical and hormonal studies are discussed and we comment the distinction of this case from the benign mesenchymal tumors.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) rarely develop outside the digestive tract and in the soft tissues of abdomen and retroperitoneum. Such tumors are designated extraGISTs (EGISTs). Cytologic and immunocytochemical features of a case of EGIST are reported. CASE: A 54-year-old woman presented with a peritoneal mass, diameter 22 cm, adherent to the omentum and without a connection to the digestive tract. Fine needle aspiration biopsy (FNAB) of the excised tumor showed high cellularity in two patterns: monotonous spindle cells were intermingled with a mildly atypical epithelioid component. Immunocytochemistry performed on cytospins revealed reactivity for c-kit (CD117), CD34 and smooth muscle actin and negativity for S-100. The findings were concordant with a histologic diagnosis of EGIST. CONCLUSION: EGISTs are infrequent neoplasms and can be diagnosed in FNAB samples. The clinical/radiologic setting must be considered together with the cytologic features. Immunocytochemistry is a clue to the diagnosis when it detects c-kit reactivity.

Bilateral adrenal metastases are rare, and the first manifestation from non-small cell lung cancer is also exceptional. We report a case of bilateral adrenal metastases from a poorly differentiated lung adenocarcinoma in a 50 year-old-man. The treatment was local excision of tumor and the diagnosis was histological. We comment the clinical presentation, diagnosis, treatment and evolution of this case, with special attention to the histopathological analysis of this lesion and literature review.

Resumen En los ultimos anos se ha observado con mayor frecuencia la aparicion de piezas de prostatectomia que contienen un volumen minimo o nulo de tumor a pesar de un diagnostico histologico preoperatorio de adenocarcinoma en una biopsia por aguja (“fenomeno del cancer evanescente”: FCE). Hemos revisado 145 prostatectomias realizadas en nuestro hospital entre enero de 1988 y octubre de 1997, encontrando 3 casos de FCE (2%). Para explicar este fenomeno se deben diferenciar dos grupos de pacientes. En aquellos que recibieron bloqueo hormonal preoperatorio, el tratamiento puede provocar una drastica reduccion del volumen tumoral y producir, ademas, cambios microscopicos que dificultan el reconocimiento de malignidad. El FCE ocurre en menos del 5% de estas prostatectomias. En los pacientes no tratados hormonalmente el FCE es extremadamente raro y se intenta explicar como una consecuencia del uso extendido de metodos de “screening” que conduce a la deteccion de tumores de muy pequeno tamano, probablemente de poca relevancia clinica, que se descubren en la biopsia por aguja, no observandose neoplasia residual en la pieza por limitaciones tecnicas del metodo anatomopatologico o por autentica ablacion completa de la lesion mediante la biopsia.

In spite of the long-standing use of the appendage in urological reconstructive surgery, it wasn't until the 80's that became popular. Anatomical and histological normality is the major consideration to allow use of the appendage in autografting. Over a 9-year period, performance of incidental appendicectomies in abdominal major surgery in adult patients was included as a surgical routine practice in our service. This paper describes the pathoanatomical findings of incidentally removed appendages, discussing the relevance of such findings in the incorporation of the appendage to the urinary tract.

We are reporting a case of neurobrucellosis that was clinically and radiologically indistinguishable from a cerebral tumor. The histological diagnosis was granulomatous encephalitis. The diagnosis was established by enzyme-linked immunosorbent assay (ELISA), detecting high levels of Ig G and Ig M Brucella antibodies in the serum and the cerebrospinal fluid. We suggest that patients with granulomatous encephalitis, without a clear etiological agent, should be studied for Brucella.

Background Secondary tumors involving the uterus are rare, and most come from the close vicinity. Among non-gynecologic origins, breast tumors are the most frequent, being predominantly of the lobular carcinoma type. Case A 69-year-old woman presented with metrorrhagia. The patient had been diagnosed 4 years before with infiltrating lobular breast carcinoma. Follow-up was uneventful. She underwent hysteroscopy with biopsy. An endometrial polyp was seen. Microscopically, small malignant cells diffusely infiltrated the endometrial stroma and surrounded the atrophic endometrial glands. Immunohistochemical studies confirmed the diagnosis of metastatic lobular breast carcinoma. Conclusion Although rare, breast tumors can metastasize to an endometrial polyp, even in the absence of other disseminations. Abnormal vaginal bleeding in a patient with known breast carcinoma can be the first sign of metastasis.

Bcl-2 and Bax proteins play major roles in the control of apoptosis. The Bcl-2/Bax ratio is considered a marker of a cell's susceptibility to apoptotic stimuli. Immunohistochemical expression of Bcl-2 and Bax in Meissner corpuscles was investigated in 30 human skin samples. All of the Meissner corpuscles showed immunoreactivity for Bcl-2 and Bax was negative. These data support a role for Bcl-2 as a resistance mechanism of these mechanoreceptors to apoptosis.

Resumen La amiloidosis primaria de la vejiga es una patologia rara que se manifiesta con depositos extracelulares de una proteina fibrilar en forma de substancia amiloide La clinica de presentacion asemeja a un cancer vesical, debido a que la hematuria es la manifestacion clinica mas comun La afectacion mas frecuente en organo unico es la vesical, a pesar de esto, hemos encontrado publicados menos de 100 casos Presentamos el caso de una mujer con amiloidosis vesical primaria cuyo sintoma fue la hematuria y el examen endoscopico hacia sospechar un tumor vesical

The appearance of solitary late metastases of renal cell carcinoma has seldom been documented. A male patient, who 5 years ago underwent left radical nefrectomy for renal cell carcinoma, presented with a solitary pancreatic metastasis (an uncommon site of metastasis for renal cell carcinoma), which was successfully treated with partial pancreatectomy. The diagnostic, treatment and prognostic implications of solitary late metastases are discussed.

Contribution of one case of prostate cancer presenting with a large abdominal mass associated to anaemia and weight loss. Serum PSA level was greater than 10,000 ng/mL. Imaging studies showed large retroperitoneal mass that led to other differential diagnoses. Biopsy revealed findings suggestive of adenocarcinoma with a distinct immunohistochemical pattern. No metastasis was evidenced in bone scan. Complete hormonal blockade resulted in significant decreased PSA levels and almost complete involution of adenopathies, as well as overall improvement.

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.

We report a case of lymphoepithelial cyst of the thyroid gland in a 31 year-old-man with chronic lymphocytic thyroiditis and history of multinodular goiter. The lesion was resected and the histopathologic examination showed that the cystic mass was lined by squamous and focally columnar epithelium, an it was surrounded by follicular lymphoid tissue. To our knowledge only twenty cases of this lesion have been reported in the medical literature. An association with chronic thyroiditis has been noted in 10 cases.

Resumen Objectivos Los anticuerpos CD10 y marcador de carcinoma renal (MCR) reaccionan frente a proteinas del epitelio normal del tubulo contorneado proximal, expresandose por tanto en los carcinomas de celulas renales. Se analizan la frecuencia y el patron de expresion de ambos marcadores inmunohistoquimicos en una serie de carcinomas renales de celulas claras. Metodo Se han utilizado dos matrices tisulares (“tissue arrays”) constituidas por cilindros obtenidos con aguja 16G de 40 bloques de parafina correspondientes a carcinomas renales de celulas claras. Se realizo tecnica de estreptavidina marcada - biotina (LSAB2, Dako) con anticuerpos monoclonales CD10 y MCR (Novocastra), ensayandose para este ultimo distintos metodos de recuperacion antigenica. Se valoro la positividad como + (aislada o muy focal); ++ (moderada) y +++ (extensa). Resultados Con CD10 fueron positivos 30 casos (75%): 12 +; 5 ++ y 13 +++. Con respecto a MCR, el mejor metodo de desenmascaramiento antigenico fue un doble tratamiento enzimatico (tripsina + proteasa). Se encontro positividad para MCR en 20 casos (50%): 7+; 5 ++ y 8 +++. De los 20 casos positivos para MCR, cuatro habian sido negativos para CD10. Los otros 16 expresaban tambien CD10. Conclusiones CD10 y MCR se expresan con frecuencia en los carcinomas renales de celulas claras, por lo que pueden ser marcadores utiles para sugerir en un carcinoma un origen renal. MCR presenta menor sensibilidad que CD10. Al ser la expresion de ambos habitualmente focal, la sensibilidad de estas tecnicas es menor cuando se utilizan muestras pequenas, como son las matrices tisulares. En la tecnica IHQ para MCR resulta crucial el metodo de desenmascaramiento antigenico, obteniendose los mejores resultados con el uso de enzimas proteoliticos.

Resumen Objetivo La citoqueratina 5 (CK5) y la calretinina se han revelado en numerosos estudios como marcadores inmunohistoquimicos sugestivos de mesotelioma y su analisis se utiliza para el diagnostico diferencial histologico con adenocarcinomas, especialmente ante metastasis de origen desconocido. En el presente estudio hemos analizado la expresion de CK5 y calretinina en el carcinoma renal de celulas claras Metodos Se estudio un total de 63 casos de carcinoma renal de celulas claras. De ellos, 46 fueron incluidos en dos matrices tisulares (“tissue arrays”), y un segundo grupo, de 17 casos, estuvo constituido por bloques convencionales de tumores de alto grado (grado 4 de Fuhrman) Se realizaron tinciones inmunohistoquimicas con anticuerpos monoclonales anti CK5 y anti calretinina, mediante el metodo de estreptavidina marcada con peroxidasa-biotina Resultados No se obtuvo positividad en ninguno de los casos para calretinina, mientras que la CK5 se expreso focalmente, en celulas aisladas, en 1 de los 63 casos (1,59%), que correspondio a un carcinoma de alto grado (grado 4 de Fuhrman) Conclusiones En el carcinoma renal de celulas claras no hemos observado expresion de calretinina y la positividad para CK5 ha ocurrido de manera aislada y en un porcentaje muy pequeno de celulas tumorales. Por tanto, en la practica si bien la positividad para estos marcadores no excluye de manera absoluta carcinoma de celulas renales, dicho resultado es muy improbable en este tumor y obliga a considerar otras opciones diagnosticas

Describimos una vasculitis granulomatosa necrotizante del cordón espermático en un varón de 35 años que presentó tres años antes un accidente cerebrovascular agudo (ACVA) de etiología no filiada. La forma de presentación clínica fue una masa no dolorosa en región testicular izquierda. El diagnóstico fue realizado en biopsia del cordón espermático. Se comentan las características clínicas, radiológicas e histológicas de este caso y se revisa la literatura.

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.

A case of mucinous urothelial-type adenocarcinoma of the prostate in a 68-year-old man is reported. This is a rare neoplasm which probably originates from the proximal prostatic ducts or the prostatic urethra. This tumor does not express prostate-specific antigen, in contrast to the more common mucinous adenocarcinoma of the prostate, and may be misdiagnosed as a secondary, mainly colorectal, tumor. Clinical examinations and immunohistochemistry may help in the differential diagnosis. Owing to local recurrences two transurethral resections of the prostate were performed in our patient during 3 years of follow-up. He died from this tumor 40 months after the first biopsy.

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.

"TESTICULAR ADRENAL REST TISSUE HYPERPLASIA: AN UNUSUAL CAUSE OF MALE INFERTILITY" We report the case of a 37-year-old man with infertility caused by bilateral testicular masses secondary to congenital adrenal hyperplasia (21-hydroxylase deficiency). Testicular biopsy was done and its was initially interpreted as Leydig cell tumor but after clinical information was histologically reclassified as tumor of the adrenogenital syndrome. The differential diagnosis with Leydig cell tumor is discussed and it must be established through the clinical, biochemical, radiological and pathological features.

Most of the studies have reported that cases of pediatric rhabdomyosarcoma (RMS) with hyperdiploid DNA and low cellular proliferative activity have better outcomes. The aim of our study was to evaluate the possible clinical relevance of DNA ploidy and proliferative activity in childhood genitourinary RMS. Twelve childhood genitourinary RMS cases were reexamined histologically and correlated with clinical features and patient survival. DNA analysis was performed on cytospin single-cell preparations obtained from the paraffin-embedded tissue blocks. MIB-1 was the proliferative marker used on paraffin sections. All patients were male with a mean age at diagnosis of 65 months. There were 5 tumors on the bladder, 5 on the paratesticular region, and 2 on the prostate. All cases were treated with multimodality therapy using the protocols proposed by the International Society of Pediatric Oncology. The following subtypes of RMS were recognized: embryonal (n=6), spindle cell (n=4), and botryoid (n=2). DNA hyperdiploid was detected in 11 tumors (92%) and high MIB-1 index (>19%) in 4 cases (33%). Now, 10 patients are alive without evidence of disease and 2 patients are alive with evidence of disease. Our data suggested that childhood RMS of the genitourinary tract are preponderantly DNA hyperdiploid and have low cellular proliferative activity. It is also interesting that 83% of our genitourinary pediatric RMS patients are alive. As consequence of this study, we propose that DNA content and proliferative activity is a useful method to supplement findings in children with RMS.

Immunohistochemical detection of molecules involved in inflammatory reaction can be useful for the diagnosis of vitality in skin wounds. We studied the expression of fibronectin (FN) and tenascin (TN) in 58 human skin wounds (48 vital and 10 postmortem). The age of vital injuries ranged from 3 min to 8 h and postmortem specimens were collected after a postinfliction interval of 15–180 min. One hundred thirty-seven formalin-fixed paraffin-embedded sections (mean: 2.3 sections per case) were stained with each of two monoclonal antibodies against FN and TN using the streptABC technique. A reticular staining for FN in wound edge and dermis was observed in 50% of vital specimens versus 0% in postmortem cases. Immunoreactivity was reduced in 10 autolysed cases. FN positivity exclusively at the injury margin was observed in 39.4% of vital wounds and 10% of postmortem cases. TN was negative in all specimens. Vital and postmortem hemorrhage areas showed positivity for FN and TN. Due to its low sensitivity, immunohistochemical analysis of FN is useful for determining vitality only in a minority of cases. Different factors in everyday practice, including autolysis and technical problems often produce false negative reactions with the result that FN cannot be regarded as a reliable parameter of vitality. Positive reactions (network staining) are more valuable than negativity but are not pathognomonic. Both vital and postmortem hemorrhages show an enhanced positivity for FN and TN, thus impeding the diagnosis.

Demonstrating the vital character of an injury and estimation of the age are routine tasks in forensic pathology and although many different techniques have been applied to this problem none have been found to be completely satisfactory. Apoptosis, an active genetically controlled process, is the major mechanism by which homeostasis of a number of physiological systems in the body is regulated and changes in the rate following different kinds of stimuli have prompted us to test it as an indicator of vitality. We used an in situ end-labelling technique (Apop-Tag) in 30 human surgical skin injuries with age since injury ranging from 3 min to 8 h and found that apoptotic keratinocytes are found in over 50% of the cases with a post-infliction interval of at least 120 min. Apoptosis was not seen in injuries less than 120 min old or in normal skin, which was used as an external control. These results suggest that apoptosis could be a useful indicator for the intravital occurrence of injuries and could help to estimate the date of the skin injuries in some cases. The importance of strict technical control is stressed and the necessity of a complementary technique to confirm apoptosis is discussed.

S. stercoralis es un nematodo capaz de desarrollar un ciclo de autoinfeccion en el huesped, responsable de la larga persistencia de la infeccion. A pesar de esto, la mayoria de los pacientes permanecen asintomaticos, en equilibrio con el parasito. Este equilibrio puede verse alterado en ciertas circunstancias, especialmente si hay alteraciones en la inmunidad y se producen ciclos de autoinfeccion incontrolados, durante los que pueden aparecer dos formas graves de enfermedad potencialmente mortales: el sindrome de hiperinfeccion (gran cantidad de larvas en luCaso clinico

llones de unidades en dosis unica. Se establecio esta pauta basandose en una serologia luetica negativa apreciada en un control realizado un ano antes y con LCR normal. Las lesiones desaparecieron en el plazo de 3 semanas. Consideramos la via sexual como modo de adquisicion de la sifilis en este caso, pero el no tener pareja estable hizo imposible el estudio de contactos. La sifilis en los pacientes infectados por el VIH y severamente inmunodeprimidos se caracteriza por la mayor gravedad de las manifestaciones clinicas, la aparicion mas precoz de la sifilis terciaria y solapamiento de los periodos clasicos1-3, asi como la posibilidad de imitar cuadros liquenoides, ulcerosos, lepra, linfomas, sarcoma de Kaposi, carcinomas verrugosos, etc.3,4-8. En nuestro caso podria ser etiquetado de eczema, dermatofitosis, psoriasis o queratodermia palmoplantar. Por todo ello recomendamos realizar la determinacion de serologia luetica a todo paciente VIH positivo con dermatosis no filiada y tambien en el seguimiento de pacientes infectados por el VIH asintomaticos (sexualmente activos)1-3,5,8. Por ultimo, mencionar la aparicion en nuestro servicio de cinco nuevos casos de sifilis secundaria en los ultimos meses, por lo que tambien nosotros consideramos que estamos asistiendo a un resurgimiento de dicha patologia9,10.