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Las neoplasias mucinosas papilares intraductales (NMPI) y las neoplasias quísticas mucinosas (NQM), son dos de las lesiones quísticas más frecuentes en el páncreas y que se han visto que tienen mayor riesgo de progresión a adenocarcinoma pancreático. Ambas lesiones se presentan como quistes y se clasifican dependiendo de la localización, de las células epiteliales y el estroma que lo componen. Mediante el estudio inmunohistoquímico de las mucinas se puede evaluar el pronóstico de estas lesiones. Se describen dos casos clínico-patológicos relacionados con estas dos entidades.

El carcinoma acinar de páncreas exocrino es muy infrecuente. En este caso se trata de un paciente varón de 36 años donde la importancia del diagnóstico radicó en el estudio de imagen y los datos histológicos e inmunohistoquímicos, que orientaron al problema de origen pancreático y que a su vez descartaron el probable origen neuroendocrino como una de las principales sospechas diagnósticas. Otros diagnósticos diferenciales serían el pancreatoblastoma y el tumor seudopapilar sólido por tratarse de neoplasias del páncreas exocrino con también diferenciación acinar.

Background: Merkel cell carcinoma (MCC) is a malignant skin cancer with a 5-year survival rate of approximately 50%. Knowledge of MCC has increased in recent years mostly due to improved diagnosis techniques. In Spain there is lack of information regarding the incidence and tumour characteristics, and the treatment approaches are not standardised. The objective of this study was to provide information of the clinical and epidemiological characteristics of MCC patients in Spain. Methods: Retrospective, observational study involving 192 patients from 25 Spanish hospitals. Evaluated variables included overall survival and incidence rate of Merkel cell polyomavirus, in patients diagnosed from 2012 to 2016. Results: The Spanish incidence rate was estimated 0.32/100,000 inhabitants/year, with variations according to geographical regions, being slightly higher in areas with greater sunlight exposure. In total, 61.5% of tumours showed expansive growth (progressive growth of the tumour), 78.6% showed localisation in UV-exposed skin. 97.4% of patients were diagnosed by excisional biopsy. Surgery was the first line treatment in 96.6% of patients, radiotherapy in 24.6%, and chemotherapy in 6.3%. These treatments were not mutually exclusive. Median overall survival was 38.3 months (78.4% at 12 months and 60% at 24 months). MCPyV was present in 33.8% of patients. Conclusion: The incidence of MCC in Spain is one of the highest in Europe, with a slight predominance in men. The sample has shown that a biopsy is available for diagnosis in most cases. Moreover, the treatment is surgical when the tumour is localized and is associated with lymphadenectomy, and/or it is radiotherapy if widespread, This study has been developed with GETHI group (Spanish group of orphan and infrequent tumours, from the Spanish Grupo Espanol ˜ de Tumores Hu´erfanos e Infrecuentes) as promotor. This research was financially supported by Merck KGaA, Darmstadt, Germany, as part of an alliance between Merck KGaA and Pfizer. Merck KGaA, Darmstadt, Germany and Pfizer reviewed the manuscript for medical accuracy only before journal submission. The authors are fully responsible for the content of this manuscript, and the views and opinions described in the publication reflect solely those of the authors

Myeloid sarcoma, granulocytic sarcoma, chloroma or extramedullary myeloid leukemia, is an unusual tumor, with a dire prognosis. Up today, the clinical diagnosis continues to be extremely difficult due to the nonspecific symptoms. Histology, immunohistochemistry, and flow cytometry are valuable in the diagnose of the tumor, as well as in the differential diagnosis from multiple entities with different prognoses and treatments. We present 61-year-old men who presented with three days evolution abdominal pain, vomiting and abdominal distension. A diagnosis of adenocarcinoma was presumed. A final diagnosis of intestinal myeloid sarcoma without evidence of bone marrow infiltration was established. A review of the most relevant aspects of this disease is presented.

Post-transplant lymphoproliferative disorders (PTLD) are a rare complication after both solid organ (SOT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this single center retrospective study, we compared clinical, biological, and histological features, and outcomes of PTLD after both types of transplant. We identified 82 PTLD (61 after SOT and 21 after allo-HSCT). The presence of B symptoms, Waldeyer ring, spleen, central nervous system, and liver involvement, and advanced Ann-Arbor stage were more frequent in allo-HSCT recipients. PTLD had an earlier onset in allo-HSCT than in SOT cohort (4 vs. 64 months, p .0001). PTLD was EBV-positive in 100% of allo-HSCT, in contrast to 47% of SOT (p = .0002). Four years after PTLD diagnosis, median overall survival was 32% (95% CI, 22-48) and 10% (95% CI, 2-49) in SOT and allo-HSCT recipients, respectively (p = .002). In conclusion, the clinical presentation and the outcome of PTLD varies greatly depending on the type of transplant.

espanolIntroduccion: los dispositivos de sellado por energia permiten la hemostasia de los vasos mediante su coagulacion y transeccion de forma secuencial. Objetivos: comparar la efi cacia in vitro de los principales dispositivos utilizados (electrocoagulacion bipolar controlada por temperatura [EB] y bisturi armonico BA]) frente a la ligadura convencional en el sellado de colaterales de vena safena (VS) durante su preparacion eventual para la cirugia de bypass. Material y metodos: estudio experimental in vitro de 25 fragmentos de VS extraida de donante cadaver o remanentes de cirugia de revascularizacion o amputacion. En cada fragmento se realizo un sellado mediante ligadura con seda 3/0 (control) y otro con EB (n = 13) o BA (n = 12). Cada fragmento se incorporo a un circuito cerrado con fl ujo pulsatil y se aumento progresivamente la presion hasta llegar a 300 mmHg (presion suprafi siologica) y, posteriormente, hasta provocar la rotura. Se registro el diametro de las colaterales, la presion de estallido, el punto de fuga y el estudio histologico. Resultados: la presion media de estallido fue ligeramente superior para la EB (788,9 ± 455 mmHg) que para el BA (602,5 ± 363,1 mmHg), aunque sin diferencias signifi cativas (p = 0,268). En un solo caso (BA) se produjo el estallido en la zona de sellado a presiones inferiores a 300 mmHg. El punto de fuga para el BA ocurrio en la zona de sellado en todos los casos (12/12), mientras que para la EB se produjo en la zona de sellado en 8 de 13 fragmentos (p = 0,039). El estudio histologico no mostro diferencias entre ambos metodos. Conclusiones: los dispositivos de hemostasia por energia presentan una efi cacia y seguridad no inferior al de la ligadura en el sellado de colaterales de VS. Dados su rapidez y facil manejo, pueden ser utiles en la preparacion del injerto venoso durante la cirugia de revascularizacion. Aunque el EB mostro una mayor resistencia a la rotura al producirse el estallido a presiones suprafi siologicas, este hecho podria no tener relevancia clinica EnglishIntroduction: energy sealing devices achieve hemostasis of the blood vessels through sequential coagulation and transection. Objectives: to compare the effi cacy of the main sealing devices used (Electrothermal Bipolar Tissue Sealing System [EB] and Harmonic Scalpel [HS]) versus conventional vessel ligation of saphenous vein (SV) collaterals Material and methods: experimental in vitro study of 25 fragments of SV extracted from cadaveric donor, from residual fragments obtained during amputation or lower limb revascularization procedures. Two venous collateral seals were made on each fragment, one by conventional ligation with 3/0 silk (control) and the other one by EB (n = 13) or HS (n = 12). Each venous fragment was then incorporated into a pulsatile flow circuit, and the pressure was progressively increased until 300 mmHg (supraphysiological pressure) was reached, and, later on, until sealing breakage occurred. Collateral vein diameter, burst pressure, and leakage points were recorded. A histological study was also performed for each energy sealing device. Results: the mean burst pressure was slightly higher for EB (788,9 ± 455 mmHg) than for HS (602,5 ± 363,1 mmHg), but without significant differences (p = 0,268). Only in one case (HS) the outbreak occurred in the sealing zone at pressures below 300 mmHg. The leakage point for HS was detected in the sealing zone in all cases (12/12). The leakage point for EB occurred in the sealing zone in 8 of 13 fragments (p = 0,039). The histological study showed no differences. Conclusions: Vessel sealing devices are as effective for the sealing of saphenous vein collaterals as conventional ligation. These devices may be useful due to their fast sealing time and easy handling during surgical venous graft preparation for lower limb revascularization. Although the EB showed greater strength, the outbreak occurred at supraphysiological pressure, so this fact may not have clinical relevance.

we report three cases of pure cutaneous Rosai-Dorfman disease (RDD) showing prominent nuclear pleomorphism. This unusual finding confers a worrisome appearance to these lesions, challenging their recognition and creating difficulty in the differential diagnosis with malignant neoplasms. This article is protected by copyright. All rights reserved.