Pancreatic fusocellular sarcoma. The importance of endoscopic ultrasound-guided fine needle aspiration in the differential diagnosis of solid pancreatic tumors

In the presence of a pancreatic tumor, the main diagnostic problem is to determine the benign o malignant nature of the lesion, and then to evaluate its resectability. A preoperative biopsy was usually rejected based on the fact that negative results do not exclude malignancy, that such biopsy may hamper the possibility of curative surgery because of potential seeding along the biopsy s trajectory, that surgical morbidity and mortality are low, and also because of the high diagnostic sensitivity of the various imaging techniques. Biopsy for solid pancreatic tumors was limited to irresectable tumors, and isolated cases with suspicion of tuberculosis, lymphoma or neuroendocrine tumors. Nowadays the performance of a pancreatic biopsy is becoming essential for the correct management of solid lesions, and is useful not only to establish malignancy, but also for a better knowledge of all kind of pathologies and, thus, for better therapeutic management. In this context, endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has proven a safe technique with a low rate of complications and a diagnostic accuracy superior to other procedures, this being considered the method of choice for the study of solid pancreatic lesions. An illustrative example is the case we report in this article -a patient diagnosed of a solid, locally advanced-stage pancreatic tumor with imaging techniques (abdominal ultrasounds and EUS) under EUS-guided FNA; the procedure could establish a final diagnosis of pancreatic fusocellular sarcoma.

Solitary focus in the liver in a thyroid cancer patient after a whole body scan with 131 iodine

A 51-year-old woman diagnosed with follicular variant of papillary thyroid carcinoma underwent a total thyroidectomy followed four weeks later by an ablative dose of 3.7 GBq of 131I. A whole body scan 5 days after ablation showed an intense uptake within the thyroid bed and a focal uptake located in the right lung base or liver dome. Computed tomography examination revealed a hypodense hepatic node in segment VII resembling a liver metastasis. Histological examination after ultrasound-guided fine-needle aspiration characterized the lesion as a liver abscess. The abscess regressed after antibiotic therapy. Liver metastases from papillary thyroid carcinoma are uncommon. On the other hand, false positive findings of 131I whole body scans have been described. A focal hepatic uptake might represent a metastasis (rare in papillary carcinomas) or be related to other causes (cysts, inflammation or infection, non-thyroidal neoplasms, etc.).

Improvement in motor and cognitive impairment after hyperbaric oxygen therapy in a selected group of patients with cerebrovascular disease: a prospective single-blind controlled trial

BACKGROUND

Clinical and experimental evidence suggests that a localized decrease in oxygen brain tissue availability contributes to the neurological deficit in patients with cerebrovascular disease (CVD) who also present with frontal leukoaraiosis (LA) (periventricular hypodensity on CT scan) and lacunar infarcts. In a prospective controlled trial blinded to patients but not to investigators, we tested the effect of HBO2 on this group of patients.

METHODS

Selected patients with symptomatic CVD, LA and lacunar infarcts received daily exposures of 45 minutes for 10 days to hyperbaric oxygen (n=18, HBO2 group) or hyperbaric air (n=8, control group). The control group subsequently received HBO2. Scores of conventional scales for motor and cognitive functions were obtained and videotaped before and after exposure. After the exposures, participants were followed on a monthly basis with systematic clinical neurological examination for up to 6 months. Results. There was a statistically significant improvement in all scales for the HBO2 group compared with the placebo group and in the placebo group after receiving HBO2 (p<0.05). Neurological improvement persisted in the majority of patients for up to 6 months. Repetition of the HBO2 protocol in 9 patients in whom symptoms recurred after 6 months resulted in improvement of symptoms.

CONCLUSIONS

These data provide evidence consistent with the notion that HBO2 improves neurological function in patients with CVD, lacunar infarcts and frontal LA. Because of the lack of investigator blinding and a relatively small sample size in this study, larger, randomized controlled studies are needed to further test this hypothesis and to further define the role of oxygen therapy for brain repair in chronic brain disease.

[Epidermoid carcinoma of the larynx: anatomo-pathological results of 58 cases]

In this study was considered 58 patients diagnosed of squamous cell carcinoma of larynx and operated between 1991 and 1996 at the Ear Nose and Throat Service of the University Hospital Complex of Santiago de Compostela. They are all men but one female and the biggest percentage were T2 (39.7%) and T3 (37.9%) tumours. The macroscopic characters such as the average diameter of the pieces was 6.91 cm and 2.66 cm of the tumour. The most usual tumoral shape encounter was exofitic and ulcerous. And between the microscopic characters we valued the histologic grade of differentiation and the most usual were the well (44.8%) and moderated (41.4%) differentiated. The average of mitosis was 20.6 and 31 tumours presented necrosis.

Molecular epidemiology of human herpesvirus 8 in africa: both B and A5 K1 genotypes, as well as the M and P genotypes of K14.1/K15 loci, are frequent and widespread

We have studied 52 new HHV8 strains by sequencing the complete hypervariable K1 gene and genotyping the K14.1/K15 loci located at both sides, respectively, of the viral genome. The samples originated from 49 patients with Kaposi's sarcoma (KS; 32 patients), multicentric Castleman's disease (MCD; 12 patients), or primary effusion lymphoma (PEL; 5 patients). Among these patients, 32 were of African origin (West and Central African countries and Creoles from French Guiana) and the 17 others were mostly French homosexuals. Comprehensive phylogenetic studies allowed the identification of distinct groups within the three already known main subtypes. Interestingly, two new sequences that did not cluster within a known subtype or group could be considered as prototypes of early/ancient variants of the C subtype and A/C set, respectively. Among the 32 African strains, the majority were either of the B subtype (13 cases) or of the A5 group (11 cases), indicating that this latter genotype is frequent and widespread in Africa. In contrast, a subtype C strain infected most of the 17 other patients. PCR-based genotyping of the K14.1/K15 loci revealed an overall predominance of P subtype, except in the A5 and B K1 groups, in which the P and M alleles were equally represented. The implications of these data on the evolution and spread of HHV8 among human African populations are discussed.

The relationship between survival and cell proliferation index in squamous cell carcinoma of larynx

Cell proliferation index is one of the most important factors in assessment of growth and progression of tumours. At present, the most suitable method of determining cell proliferation is by means of immunohistochemical techniques which use the monoclonal anti-body MIB-1 which reacts against Ki-67, a protein released only in the proliferation phases of the cell cycle. In this study, 44 patients diagnosed with squamous cell carcinoma of the larynx were analysed retrospectively and different macroscopic and microscopic parameters were assessed, such as MIB-1 in relation to the current status of the patient. A statistically significant relationship was found between the cell proliferation index, the histological grade of differentiation and the clinical evolution of the illness.

[Hyperbaric oxygenation in subcortical frontal syndrome due to small artery disorders with leukoaraiosis]

INTRODUCTION

Frontal leukoaraiosis (LA) is a common finding in patients with subcortical small-vessel disease and currently its pathogenesis is attributed to ischemic-hypoxic mechanisms. It associates to a vascular subcortical frontal syndrome (VSFS) for which an effective treatment does not exist.

CLINICAL CASES

We present four subjects from a prospective patient-blind controlled pilot trial to study efficacy and safety of hyperbaric oxygen therapy (HBO) vs hyperbaric air in VSFS with LA. All of them had frontal or extended LA on computed tomography scan and lacunes in basal ganglia and centrum ovale, with moderate to severe gait disorders, urinary dysfunction, cognitive impairment, and dependence in the daily living activities. Deficits had begun two to ten years before and had remained stable three months previous to the treatment. Patients were assessed with validated scales and tests one week before and after being administrated ten daily sessions of HBO at 2.5 atmospheres absolute for 45 minutes with a multiplace chamber. Serious adverse effects did not occur. After treatment a noticeable gait, urinary and cognitive improvement was observed in all subjects, increasing their independence. They remained clinically improved during four to five months, after which the previous deficits reappeared. Then, three patients received ten daily sessions of air at 1.1 atmospheres absolute for 45 minutes (controls) and the other a new HBO regimen, which improved as the first time. From the controls, there were no changes in two, while the other did only improve cognitively.

CONCLUSION

These patients show that HBO is effective and safety in reversing, at least partially, although at great length, chronic neurological deficits associated to vascular frontal LA, highlighting that a functional reserve therapeutically useful exists.

[Smooth muscle tumor of the lower lip. A report of a case of rapid growing and increased mitotic activity]

Smooth-muscle tumors are not often found in the oral cavity. The tumors found usually are benign tumors of the angioleiomyoma type. We report a new case of oral smooth-muscle tumor, in the lower lip of a 74-year-old woman. Immunohistochemistry and electron microscopic study confirmed the nature of the lesion. Although some mitoses were visible, the outcome has been favorable.

Waldeyer's ring lymphomas: an epidemiological study of 55 cases

Waldeyer's ring is a relatively common location for non-Hodgkin's lymphoma. Here, we report an epidemiological study of Waldeyer's ring lymphomas based on data for 55 cases treated over a 19-year period at three centers in northern Spain. In most respects our results confirm those of previous studies. The average delay between first consultation and diagnosis was 3.8 months, and was longer for nasopharyngeal lymphomas than for tonsillar lymphomas.

[Primary epidermoid carcinoma of the stomach]

Squamous cell carcinoma primary of the stomach is an exceedingly rare neoplasm of unknown etiology. We report on a case of an antral tumour arising in the antrum of a 49-year-old woman. Histopathological study revealed a typical squamous cell carcinoma without evidence of glandular differentiation. Immuno-histochemical positivity for p53 suggests common etiopathogenic pathways with other histological types of gastric carcinoma.

Peutz-Jeghers syndrome in a neonate

A 15-day-old girl was found to have generalized gastrointestinal polyposis resulting from Peutz-Jeghers syndrome. Her manifestations included abdominal distention, hematemesis, bloody diarrhea, and edema. She died at 1 year of age of multiple complications of her disease.