Abstract: In recent years the study of disease has advanced in complexity, focusing on molecular and laboratory studies. The valuable advances in these areas are best guided by accurate clinical examinations of pathology. To correctly identify the patterns prevalent in each disease, a clinician needs a solid foundation in general pathology to determine a correct diagnosis. In order to aid in the instruction and illustration of these macroscopic patterns, a medical atlas of different pathological states for common diseases has been constructed in this book. The book has 21 chapters, each focusing on a specific organ or organ system affected by particular diseases. The initial chapters focus on the non-neoplastic diseases, and the later chapters describe the neoplastic diseases. Each chapter has illustrations and diagrams showing the clinical practice and gross pathology analysis of the disease. The images were chosen in a manner to give the reader complete information about the disease with respect to pathologically identifying features of the disease.
Abstract: The practice of surgical pathology in modern times has become increasingly complex and sophisticated and has moved from a strictly morphologic science to one that encompasses the study of disease biology in intricate detail, utilizing histochemical, immunohistochemical, and various molecular techniques. Tumor pathology, in particular, has transcended its role as a âdiagnosticâ science and has become essential for guiding treatment and establishing prognosis.
Abstract: This book is focused in general pathology and modalities for management, sampling and reporting of surgical specimens in order to establish common rules for defining the prognosis and treatment of various illnesses.
Abstract: Rare congenital tumors can be localized in the peribulbar area. Here we report an unusual case presented in a 3-year-old child with a history of a congenital tumor in the lacrimal caruncle of the right eye, associated with epiphora and constant discomfort. A surgical resection was performed, and the final histopathological diagnosis was lacrimal caruncle complex choristoma. Choristomas are growths of apparently normal tissue in an abnormal location, which can be situated anywhere in the body, including ocular and peribulbar structures. These almost unknown congenital tumors constitute the most common conjunctival tumors in children and can be interpreted clinically as different lesions, which are only differentiated through precise histopathological analysis.
Abstract: Here, we report a retrospective series of 47 EBV-positive diffuse large B-cell lymphoma associated with advanced age. Histopathology allowed to the identification of different histological patterns: cases with polymorphic diffuse large B-cell lymphoma (29 cases), Hodgkin-like (8 cases) and polymorphic lymphoproliferative disorder-like (9 cases) patterns. One case was purely monomorphic diffuse large B-cell lymphoma. We show that this lymphoma type is a neoplasm with prominent classical and alternative nuclear factor-kB pathway activation in neoplastic cells (79% of the cases showed nuclear staining for p105/p50, 74% for p100/p52 and 63% for both proteins), with higher frequency than that observed in a control series of EBV-negative diffuse large B-cell lymphoma (Ï(2) <0.001). Most cases showed an activated phenotype (95% non-germinal center (Hans algorithm); 78% activated B cell (Choi algorithm)). Clonality testing demonstrated IgH and/or K/Kde/L monoclonal rearrangements in 64% of cases and clonal T-cell populations in 24% of cases. C-MYC (1 case), BCL6 (2 cases) or IgH (3 cases) translocations were detected by FISH in 18% cases. These tumors had a poor overall survival and progression-free survival (the estimated 2-year overall survival was 40±10% and the estimated 2-year progression-free survival was 36±9%). Thus, alternative therapies, based on the tumor biology, need to be tested in patients with EBV-positive diffuse large B-cell lymphoma of the elderly.Modern Pathology advance online publication, 27 April 2012; doi:10.1038/modpathol.2012.52.
Abstract: Parathyroid carcinoma is unusual and its intrathyroidal variant is extremely rare. Therefore, few cases have been reported to describe a case of parathyroid carcinoma located inside the thyroid gland. The case corresponds to a 14-year-old girl who came to the office with a severe osteoarticular disease, depression, calcemia of 14.3Â mg/dl and parathyroid hormone of 2,792Â pg/ml. Right neck exploration was conducted and a parathyroid carcinoma was found located intrathyroidally. A right thyroid lobectomy was performed. A 20-month follow-up period revealed no recurrence of clinical or biochemical signs. In patients with severe hypercalcemia and significant elevation of parathyroid hormone, the diagnosis of parathyroid carcinoma has to be considered. It is worth highlighting the early age of presentation in this case. Treatment has allowed the effective control of the disease and its recommended long-term follow-up.
Abstract: Background:
Primary pericardial mesothelioma (PPM) is an extremely rare neoplasm originated from pericardium mesothelial cells. This tumor has the ability to invade adjacent structures and cause distant metastases, but its location, is usually fatal early. About 200 cases are worldwide reported.
Aim: A case of PPM diagnosed by autopsy is presented.
Case report: 56-years-old Female, who was admitted for anorexia, weight loss, dysphagia, and dyspnea of one year of evolution, later accompanied by right supraclavicular neck mass. Was evident respiratory effort. The chest radiograph and CT scan documented increased mediastinal space and pleural and pericardial effusion. The cytological analyses of the fine needle aspiration of neck mass and pleural fluid were compatible with malignancy. The patient had progressive deterioration and death. Autopsy was performed which was found completely incarcerated heart by a multinodular tumor with multiple areas of necrosis. The histopathological study show a PPM.
Conclusion: PPM is a rare malignancy, which is usually fatal because of the sensitivity of organs compromised. Therefore, this tumor is usually diagnosed at autopsy after death, in most cases secondary to cardiac tamponade.
Abstract: The malignant peripheral nerve sheath tumor (MPNST) is a malignant neoplasm originated in the Schwan cells of the periferic nerves sheath. We describe a case of a man with Neurofibroatosis Type 1 (NF1), who developed a low grade MPNST, and subsequent to a discussion of this disease. 28-year-old Man with pleuritic pain in the left hemithorax, dyspnea and weight loss, with a previous diagnosis of NF1, from the age of 15 and a family history of NF1. At chest examination the patient had an intense thoracic kyphosis, with a decline in the ventilation of the inferior two thirds of the left hemithorax, where a dull sound to percusión was also found. The chest X rays showed a large radiopaque and well delimited mass in the posterior mediastinum, that pushed the cardiovascular structures to the anterior region, which was also documented by chest computed tomography (CT). In view of the above, a puncture biopsy was performed with thick needle guided by CT, from where a malignant mesenhymal neoplasm was identified. It was decided to perform the resection of the tumor of the left posterior mediastinum, by left posterior lateral thoracotomy, in which a large mass of 8x9x9 cm was obtanied, with irregular external surface, brown-violet, and firm. The histopathological and inmunophenotypic study concluded the diagnosis of MPNST in the posterior mediastinum grade 1. Following surgery the patient was asymptomatic. We present a case of MPNST which originated in a patient with NF1, who would usually have a worse prognosis. A brief review of the more relevant aspects of this disease was also reported, some of which have shown important progress in recent years.
Abstract: Background: The intravascular large B-cell lymphoma (DLBCL-IV) is a rare type of non- Hodgkin lymphoma, with vascular compromise. This lesion has been described in various organs and preexisting vascular neoplasms. Aim: We describe a clinical case of DLBCL-IV originated on a skin hemangioma.
Case report: Women 59 years of age, with papule, purple, 1.2 cm in diameter located in the right flank of 6 months. The histopathological examination making the diagnosis of LCBG-IV cell germinal center phenotype associated with a skin capillary hemangioma. Conclusions: The LCBG-IV is a rare hematolymphoid malignancy, with multiple forms of presentation. This tumor has a high affinity for blood vessels. These tumors present with a denouement almost always fatal, leading to the death of the affected patient in a few months.
Abstract: Solitary fibrous tumor (SFT) was first described in the pleura by Lietaud in 1767; later in 1870, Wagner described the localized nature of this type of tumor and Klemperer and Rabin classified pleural tumors into two types: diffuse mesotheliomas and localized mesotheliomas. Recent years have seen the redefinition of this neoplasm, due to better technology; it is now proven that this neoplasm may have multiple different extrapleural origins including the head and neck regions. This diversity of locations is related to the particular mesenchymal histogenesis of SFT which allows its development from very unusual sites such as the salivary glands (SGs). In this particular site, this neoplasm is very infrequent and most of reported cases refer to benign disease, with just one case informed so far of primary malignant SFT.
Abstract: Neoplasms originating from the urachus are rare. The most common urachal malignancy is adenocarcinoma, whereas extragonadal germ cell tumors, primarily of the urachus, are an extremely rare finding.
Abstract: Primary or secondary neoplasms can affect the heart. Secondary are more common. However, primary neoplasms are relevant because is a group with diverse genesis, behavior, treatment and clinical manifestations. We present a case of a 45 year-old woman, with recurrent syncope started 1 year before her first consult. She had palpitations and chest pain. Echocardiography identified a left atrium mass of 2.1 x 1.8 cm. Endomyocardial biopsy document a primary rhabdomyosarcoma of the heart. The patient dies after a overall-survival of 22 months. This case presented had a good study of its symptoms with an accurate diagnosis and early treatment, which provided prolonged survival of this rare and aggressive neoplasm.
Abstract: Thyroid carcinomas are rare during childhood and adolescence. They have increased recently probably due to a higher frequency radiation over the head, neck and mediastinum. The papillary carcinoma is the most common and true follicular carcinoma is far less common. Follicular thyroid carcinoma is associated with endemic goiter, genetic disorders, and increased TSH levels. Its morphological characteristics are peculiar and have been recently redefined, thus helping the diagnosis. A minimally invasive follicular thyroid carcinoma in 13 years old girl is described, presenting a hypocaptant thyroid nodule in the left lobe lower pole. The fine needle aspiration biopsy revealed a follicular cell lesion suspicious of malignancy. Thyroid lobectomy was performed reporting minimally invasive follicular carcinoma.
Abstract: Introduction: Sacrococcygeal teratomas are neoplasm that despite their low frequency, are one of the most common in newborns. We describe a case of a dead fetus with an immature sacrococcygeal teratoma, its radiological and histological findings. Patients and Methods: A 26 years old woman in the fourth pregnancy of 32 weeksâ of gestation, who presented the threat of pre-term birth. We performed obstetric ultrasound reporting the presence of a fetal sacral mass and fetal hydrops. Caesarean section was run and got a female fetal death. Pathologic study showed immature sacrococcygeal teratoma. Conclusion: In fetal sacrococcygeal teratomas, the development of fetal hydrops, heart failure and large tumor size are indicators of poor prognosis. Prenatal diagnosis, planning delivery, the postnatal stabilization period and surgical resection of the tumor, can make survival possible in these patients.
Abstract: The malignant peripheric nerve sheath tumor (MPNST), is a malignant neoplastic lesion originated in Schwann cells of the lining sheath of peripheral nerves. This neoplasia may appear with benign or malignant heterologous components, with divergent differentiation, as the glandular one.
Abstract: Neurothekeomas, or nerve sheath myxomas, are rare benign tumours, arising from the sheath of peripheral nerves. They are usually found in young adults, in the dermis and subcutaneous tissue of the head, neck and upper limbs and only rarely occur in the lower limbs. Objective: A case of atypical cellular neurothekeoma of the foot in a child is presented.
Case report: A 10 year-old child presented with 3 year history of a well circumscribed nodule on the dorsum of the right foot. A 0.6 ? 0.5 nodule was surgically removed and a diagnosis of atypical cellular neurothekeoma was made. Conclusion: Neurothekeomas are a rare new entity, a few cases of which have been described in the foot. Three distinct varieties have been reported, each of which is probably of a different origin, which would explain their morphological features and immunohistochemical findings. The atypia only refers to morphological findings and is not reflected in their clinical behaviour. These tumours can easily be confused with many other lesions and immunohistochemistry is helpful in the differential diagnosis.
Abstract: BACKGROUND: The gastric cancer is one of the most frequent neoplasms. In Colombia this disease is the principal cause of death by cáncer. Its early diagnosis is diffcult, for that reason, the mass evaluation, using endoscopy and histopathology of biopsy specimens has been imposed as detection method of the early gastric cancer.
OBJECTIVE: To describe the characteristics of the patients who went under early detection of gastric cancer at the Liga Santandereana de Lucha Contra el Cancer during 2004 and 2005.
MATERIALS AND METHODS: Retrospective observational study.
RESULTS: 155 patients were studied, 103 men (66,5%) with a mean of age of 45.43 ± 14.15 years. The principal referred symptoms were epigastric pain 63.4%, pirosis 55.5%, regurgitation 26.5%, weight loss 26.5%, metheorism 18%, nausea 16%, vomit 14.8% and abdominal distention 14.8%. The most frequent antecedents were toxicological 25.5%, followed by the massive corn intake 11.6%, having A + blood type 58% and having history of cáncer in the frst degree family 21.3%. The only sign found was abdominal mass 0.6%. The principal endoscopic finding were gastritis 67.72%. Finally, the most frequent pathological fndings were chronic gastritis 31.61%, chronic follicular gastritis 16.77%, peptic ulcer 1.29%, follicular peptic ulcer 1.29% and adenocarcinoma 1.29%.
CONCLUSIONS: Sifting for gastric cancer allows detecting multiple alterations of the superior gastrointestinal tract. In the studied population the most of the patients who underwent to the early diagnosis, had symptoms and/or antecedents that suggested gastrointestinal lesions. Finally, it must be encouraged the continuity in the programs of early detection of preneoplastic lesions
Abstract: Introduction: Systemic infections by S. aureus are an important cause of hospital morbidity and mortality. Adequate clinical assessment of cutaneous manifestations could allow an opportune diagnosis of S. aureus septicemia.
Objective: To describe the cutaneous manifestations on deaths caused by S. aureus septic shock.
Materials and Methods: Descriptive study of autopsies.
Results: Nine autopsies of patients with a clinical cause of death of S. aureus septic shock were analyzed. The cases represent the 3.1% of the total autopsies performed by the institution during that year (9/285). Mean age of the cases was 15.8 years (range, 2 to 47), seven males and two females (male/female relationship, 3.5:1). All patients adquired the infection in the community. The clinical manifestations evolved during four to six days. However, only in three cases an appropriate clinical diagnosis was made. Microbiological diagnosis of S. aureus was documented in all cases. The primary focus was the skin in seven patients and the osteoarticular system in two patients. Cutaneous macroscopic alterations included generalized pustules (5 cases), generalized petechial erythema with subcutaneous edema (2 cases), and a vesicular-pustulous varicelliform eruption (2 cases). Histologically, a septic vasculitis were found in the seven patients with generalized pustules. In the cases of generalized erythema the biopsies showed mononuclear perivascular superficial infiltrate and edema.
Conclusions: Septic shock by S. aureus is associated with multiple cutaneous manifestations which allows the identification of the disease.
Abstract: This article describes the case of a 24-year old woman with a pelvic chondroblastoma localized at the top of the right iliac crest, with six months of evolution and progressive growth. X-rays revealed an osteolytic lesion with heterogeneous density, extending toward soft tissue; the hisopathologic study provided evidence of chondroblastoma. Chondroblastomas are benign bone tumors producers of cartilage which appears in the long bone epiphysis of young people. Nearly 75% of such tumors affect the long bones, principally the femur, the tibia, and the humerus; exceptions include those in the flat craniofacial bones and the pelvis bones. Chondroblastomas have distinct radiological and histopathologic characteristics, and despite their benign biological behavior, can cause elevated morbidity among patients due to their localization and being treated exclusively with surgery.
Abstract: Synovial sarcoma is a clinically and morphologically well defined entity which, in spite of its name, is rare in joint cavities. This sarcoma affects zones without any apparent relation to synovial structures and represents from 5% to 10% of all sarcomas in soft tissues. It is most frequently found in the extremities, especially the lower ones, where it tends to be located in the vicinity of the major articulations; there are very few favorable reports on the clinical evolution of synovial sarcomas in the hands or feet. It is most frequent between the ages of 15 to 40 (median age, 34). This article presents the case of an adult woman who underwent histopathologic and immunohistochemical diagnosis of a synovial sarcoma on the little finger of her right hand.
Abstract: Introduction. The use of learning styles combined with concept maps and the use of learning based on the resolution of problems (LSCMLRP) are a new educational strategy.
Aim. To evaluate the effectiveness of the method LSCMLRP in the acquisition of significant learning of neuroanatomy, compared with the usual method of learning in physiotherapy students. These students, attended the subject general morphofisiology in the Industrial University of Santander (UIS) between the years 2004 and 2007.
Subjects and methods. A controlled clinical test was carried out to determine the performance of the LSCMLRP. The students were randomized and assigned to two groups with a 1:1 relation. In the treated group the LSCMLRP method was used and in the control the lecture method. Subsequent to a period of 1 year the acquisition of significant learning was evaluated.
Results. 55 students were studied. The average age was of 23 years and the ratio woman: man was of 3:1. When evaluating the students after 1 year of the intervention 15 students of the treated group failed the examination compared to 26 students of the control group control (55% versus 92%, p = 0.002). The calculated absolute risk reduction of 0.37 (CI 95% = 0.16-0.56) and NNT 2,7 (CI 95% = 1.7-6.3).
Conclusion. The acquisition of significant learning was greater in the treated group, demonstrated by a significant minor proportion of exam failures compared to the control group, and with a low student to intervene in order to produce favorable outcomes.
Abstract: To evaluate the performance of endoscopic visualization in the identification of premalignant gastric lesions, with histopathological examination of biopsy samples as a reference test, in Bucaramanga, Colombia.
Abstract: Introduction
Occasionally, granulosa cell tumours are found in unusual, extragonadal locations, although such ectopic forms are extremely rare and the origin of these neoplasms is controversial.
Objective
A case of extraovarian granulosa cell tumour is described and its origin, clinical features and histopathology are discussed.
Case history
A 69 year old woman presented with an abdominal mass. She had undergone hysterectomy and bilateral salpingooophorectomy for uterine leiomyomas 14 years previously. A large, tender mass was present in the left hypochondrium and left lumbar region, which was seen on abdominal ultrasonography and CT scan to be situated in the retroperitoneum near the tail of the pancreas. Surgery revealed that the left kidney and colon were involved. Pathology: The 950 g, 12 Ã 11.5 Ã 10 cm mass was composed of both solid and cystic areas. Histological and immunophenotypical findings indicated a diagnosis of extraovarian granulosa cell tumour.
Review of the literature
A review of the literature was made from Medline, Imbiomed and Scielo databases, using the Cochrane methodology.
Conclusion
Extraovarian granulosa cell tumours are extremely infrequent neoplasms, with only 10 cases reported to date. They would appear to arise from ectopic gonadal tissue or from the differentiation of primitive mesenchymal cells. Clinical, morphological and immunophenotypical features should all be considered in order to reach a correct differential diagnosis from a wide range of entities
Abstract: Primary prostatic tuberculosis is a very rare form of presentation of the tuberculous infection, which is generally caused by the M. tuberculosis, and which has shown an increase in incidence and prevalence, due to an increase of immunocompromised patients and the pandemic of the Syndrome of Acquired Immune Deficiency (AIDS).We describe a case of primary prostatic tuberculosis attended at the Hospital Universitario de Santander, Colombia, and to perform a discussion about this topic.
Abstract: The collecting duct carcinoma (Bellini's carcinoma) is an unfrequent lesion; its macro and microscopic characteristics can help diagnosis. 65-year-old Colombian woman presenting left-flank and hypochondrio stub-type episodic pain associated with hematuria, nausea and weight loss.
Abstract: Central nervous system cryptococcosis is an important cause of morbidity and mortality in immunocompromised patients; nevertheless, its presentation in immuno-spared patients is extremely rare, giving rise to a hole different spectrum, since it is manifested like granulomatous masses named cryptococomas. AIM. To describe an intracerebral case of cryptococcoma in an immuno-spared woman in the Hospital Universitario de Santander and to discuss the most relevant topics of this pathology.
Abstract: Fine needle aspiration (FNA) is commonly used in the study of neoplastic lesions of the parotid gland, however controversy exists regarding its diagnostic accuracy.
Abstract: A symptomatic mass in the thymus is due to anomalies in the development of the pharyngeal pouches and is also an unusual cause of consultation. These anomalies may be found anywhere along the natural path of the embryonic thymus, from the angle of the jaw to the upper mediastinum.
Abstract: Rhabdomyomatous mesenchymal hamartoma is an extremely rare congenital lesion, and very few cases have been reported even though its macroscopic and microscopic features make diagnosis easy. An 18-year-old woman consulted with a pedunculated mass in the medial region of her neck. The mass was surgically removed, and rhabdomyomatous mesenchymal hamartoma was diagnosed. The clinical, macroscopic, histologic, and immunochemical characteristics that allow diagnosis of this entity are discussed. Although association with congenital abnormalities is uncommon, this possibility should be assessed by the clinician.
Abstract: Background. The Oncocytic neoplasms of the parotid gland include Diffuse Oncocytosis, oncocytoma and Oncocytic carcinoma. The oncocytomas are rare benign tumors, with distinctive characteristics .
Objective. To describe the clinical and pathological characteristics of the oncocytoma of the parotid gland in Bucaramanga.
Materials and methods. We performed a retrospective observational study on 7 clinics in Bucaramanga, Colombia from 2004 to 2006 at 2008, identifying the Neoplasms of the Parotid gland surgically removed and their characteristics. Later on, all the oncocytoma cases were selected to study their diverse clinical, radiological, surgical and pathological characteristics.
Results. 84 Parotid Gland tumors were identified. Four of them were oncocytomas. (4,7%). The average patient age was 50 years( range 27 to 77 years); The women- to -men ratio was 3:1. All these patients presented with hard , mobile, slowly growing masses with various sizes varying from 15 to 40 mm (mean 35mm), associated with pain on 2 cases (50%), and facial nerve paralysis on 1 patient (25%). The cytological examination of the samples obtained by FNA was negative for malignancy in 100% of cases. Superficial Lobe Parotidectomy was performed in all cases. Permanent sections stained with hematoxylin and eosin revelaed multiple cells with abundant granular and intensely eosinophilic cytoplasm, forming small tubular structures. The PAS showed high reactivity of the cytoplasmatic granules. There were two recurrences identified in the follow up period(20 and 29 months).
Conclusions. The oncocytomas are rare benign neoplastic tumors of the Parotid gland consisting of a proliferation of oncocytic cells produced by the great mitochondrial hyperplasia. Our patients showed features similar to those reported by other studies. These tumors should be taken into account primarily by easy confusion with low-grade malignant lesions and their recurrence tendency.
Abstract: Objective
A case of RT in a Colombian woman attended at the University Hospital of Santander in 2006, will be described.
Clinical case
Female Patient, 63 years old, with history of 6 months of evolution, cervical mass right and painful with 5 cm of diameter, associated to asthenia and adynamia.
Intervention
Total thyroidectomy.
Conclusions
We presented a case of this unusual and fascinating disease, in which have made significant advances in the pathogenesis, diagnose and treatment. The clinical, gross, microscopic and immunohistochemical characteristics are analyzed.
Abstract: JUSTIFICATION: colorectal cancer is the third most frequent neoplasm in the World, which have had notable advances in screening, diagnosis and treatment.
OBJECTIVE: a revision of epidemiology, diagnosis and therapeutic advances of colorectal cancer was made.
MATERIALS AND METHODS: following Cochrane´s methodology, a Medline research of articles published between January of 1980 and January of 2006 was made, using the words colorectal carcinoma; the articles considered relevants by the autors were selected of this research.
CONCLUSIONS: notable advances have been developed in early diagnosis and treatment of colorectal cancer, which traduces in a better prognosis for the patients affected by this disease.
Abstract: Justification. Parathyroid cancer is uncommon; however, it should be considered in the differential diagnosis of primary hyperparathyroidism. Objective. We review the epidemiology, pathogenesis, diagnosis, and treat- ment of parathyroid cancer.
Materials and methods. A MedLine search was carried out using the Cochrane methodology on articles published between January 1980 and January 2006 and the keywords «Parathyroid Carcinoma»; the articles found that were con- sidered important were selected.
Conclusions. Parathyroid cancer should be taken into account in the diffe- rential diagnosis of cases of primary hyperparathyroidism, as an early diagno- sis enables better outcomes in these patients.
Abstract: Aim
Determine the prevalence of the pathological lesions in the cytology, colposcopy and biopsy, and their association with the final diagnosis of carcinoma invader of uterine cervix.
Material and methods
Design: cross sectional study. Location: League of Fight Against the Cancer in Santander, Colombia. Participants: The study included 2088 patients. 454 cytologies, 454 colposcopies and 346 biopsies of cervix were selected from the patients with epithelial alterations. Intervention: Review of anatomopathologic information and clinical histories.
Results
The age of the women varies between 17 and 87 years. There is a positive association with the final diagnosis of invading cancer in the sociodemographic variables: age (p=0.0001) and menstrual cycles (p=0.0009); in cytologies: hemorrhages (RP=36.8; p=0,000001), invading cancer (RP=62.2; p<0.0001), and glandular lesion (RP=27.5;p=0.024); in the colposcopic diagnoses: invading cancer (RP=314.3; p <0.001) and visible squamous/cellular union (RP=15.0; p=0.001); and in the histopathologic diagnoses none. There is negative association in the cytology: the flora (RP=0.1; p=0.0077) and LIE of low degree (RP=0.1; p=0.001); in the colposcopy: inflammation (RP=0.15; p=0.008) and NIC (RP=0.1; p=0.007); and in biopsy: the squamous metaplasia (RP=0.13; p=0.004).
Conclusions
There are significant associations of the lesions found in the cytology, colposcopy and biopsy with the final diagnosis of squamous cell cancer. This helps increasing cancer diagnostic probability according to the screening findings.
Abstract: Chromobacterium violaceum is found in tropical and subtropical regions; it is the only Chromobacterium species pathogenic for humans. Due to its rare presentation, physicians often ignore the importance of this pathogen. We report a fulminant fatal case of bacteremia in a 38-year-old Colombian man. The clinical manifestations were fever, thoracic pain, respiratory failure and death. His condition, from the beginning of clinical diagnosis, went into continuous deterioration, till his death, within a few days after the symptoms began. Two hemocultures isolated C. violaceum. We conclude that doctors should consider this differential diagnosis in patients with systemic inflammatory response syndrome, with continuous deterioration.
Abstract: Background: Basal cell carcinoma is the malignant neoplasm most prevalent in the world; nevertheless, its location in vulva is infrequent.
Objective: To describe a case of basal cell carcinoma of the vulva from the Hospital Universitario de Santander.
Clinical case: Female patient 62 years old, with a lesion in mayor labia of 3 years of evolution. Physical examination revealed an ulcerated lesion of 2.5x1.2 cm, poorly delimited, with bleeding and necrosis. After skin ellipse excision, the pathological study recognized a basal cell carcinoma of vulva. The patient at the moment is asymptomatic without signs of recurrence of the disease.
Conclusions: Basal cell carcinoma of vulva is an infrequent cancer, un-commonly metastasizing but sometimes itâs locally aggressive. Its etiology is not completely known. Its clinical presentation is varied, which makes difficult an opportune diagnose. The election treatment is the surgical split with clean margins.
Abstract: Introduction. The conventional cytology universally accepted in the screening of the cervical uterine cancer, its implementation has brought an important reduction in the number of deaths by cancer, but its performance is discussed. Objective: The aim is to perform a systematic revision that evaluate the performance of this test in the diagnose of cervical cancer. Materials and methods A search of published literature was made in the data bases MEDLINE, Scielo, BIREME, Latindex and EMBASE, in the languages english, spanish and portuguese. There were found 1388 citations from which the original studies were selected that evaluated the yield of the cytology to diagnose cancer. Results: The obtained data was valued by two reviewers in parallel, selected 41 original, independent articles, that evaluated the cytology like a diagnostic test of cancer. There were from values of sensitivity of the 9,8 to the 99 percent and of specificity of the 24 to the 99 percent for the screening of cancer. Conclusions: The implementation of the conventional cytology, in the massive screening of the population in risk, has helped to decrease in a drastic form morbi-mortality by cancer. In spite of the previous thing it has great variability in its results and consolidated of the specificity and sensitivity they do not offer acceptable performance if it is used as it proves diagnoses only. Is recommendable to redefine the criteria in its implementation, as well as looking for new technologies for diagnose and evaluation.
Abstract: Cytological alterations of the uterine cervix in the Liga santandereana de lucha contra el cancer between 2002 and 2003. The lack of study in the pathology of the cervix, one of the most signif- icant health problems in female population. Objetive: to determine the prevalence of cytological alterations of the cervix, between 2002 and 2003 in liga santandereana de lucha contra el cáncer. Design: Descrip- tive retrospective study, 2088 charts were open, 454 cytology reports were selected, in patients with epithelial pathologic disorders. Review- ing of anatomopathologic and clinical charts. Results: 21,74% of reports yielded cervical pathologic lesions; patients between 17 and 87, the average being 38. ACUS was found in 21,3%; AGUS in 19.2%; low- grade intraepithelial lesions in 44,7%; high-grade intraepithelial le- sions in 16.7%; and invasive carcinoma in 1,3% of them. Conclusions: we found that the proportion of patients with epithelial cervicouterine alterations of every kind was higher than that detected in other parts of the world.
Abstract: Justification. The Micobacterium tuberculosis is the main causal microorganism of the tuberculosis, is nowadays the infectious agent who causes more death in the world, Goal. Give answer to the following questions: how has done it during as long time?, how has been able to escape of the eradication strategies?, which is the situation in our country? and how affects the health?, with a structured review, Material and Methods. A search was made in MedLine and Scielo using the term «tuberculosis», additionally reviewed Literature in books and another type of publications like information of committees it considered for the topic, Conclusions. It made a review of first-rate aspects in public health and epidemiology of the TBC, besides to make recommendations in the matter of prevention and control of this disease, for childrenâs and adults.
Abstract: BACKGROUND: The adrenal crisis is infrequently in the emergency departments, but it has a generally fatal outcome if not it's recognized and it treats correctly.
CLINICAL CASE: Masculine Patient of 53 years oÃd, who consults by nauseas, vomit and diarrea, in the physioal examination documents hypotension maintained with systolic pressures in to the 70 rank from 60 mmHg. Intravenous hidratation begins, nevertheless the patient persists with an arterial pressure of 70/42, the Paraclinic examinations document hypoglycaemia, hiponatremia and hiperkalemia, thus is made impression diagnoses Addison's Disease, and beginning treatment with glucocorticoids with suitable evolution.
CONCLUSIONS: Is due to remember that the adrenal crises are due to suspect in all patient with refractory hypotension to the treatment with parenteral hidratation and/or use catecholamines, the treatment must begin immediately is made the confirmation by laboratory examinations, the prognosis is good if it is diagnosed and it treated in suitable form.
Abstract: Background: The conventional cervico uterine cytology (CCUC) is the test of screening used in the precocious detection of the uterine cervix cancer, nevertheless its quality is discussed. Objectives: Evaluate the performance of the cytology in the screening of escamocelular invading cancer. Methods: 1980 users of Liga Santandereana de Lucha Contra el Cancer were selected. Following a prospective sampling, a statistical analysis was made to validate the cytology in the diagnosis to escamocelular invading carcinoma using like test of reference the histopathology information of biopsy. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was determined. Results: The cytology had a sensitivity of 12%, a specificity of 99%, a VPP of 83.3% and VPN of 98.2% in the identification to escamocelular invading carcinoma, in a population with a prevalence of the disease of 2%. Conclusions: In the present study the cytology had parameters of evaluation similar to the patterns internationally defined. Sensitivity as well gives to understand that it is not a screening method because it is not high, thus is recommendable the improvement of the criteria used in his interpretation to increase this parameter, as well as to make emphasis in the development of new technologies that they allow to a better screening and diagnosis of this pathology, that like the conventional cytology offers their service to low costs and with facility in their implementation.
Abstract: The Mirizzi syndrome is a rare entity, characterized by large calculus of numerous small calculi impacted in the Hartmanns's pouch or in the cystic duct, causing obstruction of the common hepatic duct by extrinces compression and local inflammatory process.
Abstract: Introduction: This summary reports the results and products of a developed project based in autopsy. Autopsy is a primary source of medical knowledge, and therefore, has established the fundamental medical basis used nowadays. However, autopsy is performed less and less. The amount of autopsies performed has declined nationally and globally and everyday causes the loss of a large body of knowl- edge gained at low cost and of high importance to the employer. One of the most sensible areas is the evaluation of Diagnostic Medical Error (DME), not only because without autopsy this was unknown, but also because it allows one to elucidate the cause, establish the patterns and build measures to avoid it. At present, the magnitude of the DME at the Hospital Universitario de Santander (HUS) is not know; despite it being a hospital with a significant number of autop- sies, there results a large loss of knowledge due to the impossibility of systematic evaluation. For these reasons, a goal arose to create a bio- informatics system allowing easy analysis of complex handling and performance assessment diagnosis, pre-mortem, in patients undergo- ing autopsy at the HUS during the years 2005â2008.
Material and Methods: To achieve these objectives, we developed a system to register the autopsies preformed at HUS (SIRAHUS); an easy to use tool recording and evaluating large volumes of data, capable of handling high complexity analysis. To test this system and develop the second objective an analytical study was performed using multiple diagnostic accurate evaluation, serial and parallel, and its characterized infomacio Ìn derived from autopsies of the last 4 years. We analyzed 494 autopsies, 208 non-perinatal and 286 perinatal performed in patients from 34 municipalities located in six departments and two countries. The age range of patients evaluated was between 12 weeks gestation and 94 years of age. The informa- tion obtained was categorized according to disease (using the Inter- national Classification of Diseases 10th Edition), life-dealer service, type of autopsy findings describing all organ systems examined. Results: This information allowed us to know the diagnostic per- formance: infectious diseases (LR + 7.87, LR â 0.41), neoplastic disease (LR + 11.47, LR â 0.51), endocrine and metabolic diseases (LR + 18.3, LR â 0.51), central nervous system diseases (LR +
7.27, LR â 0.78), cardiovascular disease (LR + 7.29, LR â 0.68), respiratory system disease (LR + 73.61, LR â 0.93), digestive dis- eases (LR + 7.61, LR â 0.71), skin diseases (LR + 12.25, LR â 0.83), diseases of pregnancy and puerperium (LR + 4.16, LR â 0.59), perinatal diseases (LR + 4.91, LR â 0.46), malformations and deformations (LR + 27.07, LR â 0.48), and other diagnoses (LR + 3.34, LR â 0.87).
Conclusion: In conclusion, weâve created a versatile tool capable of assessing highly complex data, specifications and innovative capac- ity, that is characterized by a large population of patients undergo- ing autopsy. Including findings and alterations, weâve finally managed to evaluate clinical practice, and because of our highly detailed operational parameters, the errors were identified and stratified by services and disease, which is globally unprecedented. This tool allows the manipulation of the vast amount of informa- tion generated by autopsy and gives a practical and appropriate use of knowledge at a level only seen in countries with a high level of health service development.
