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Introduction: With the routine use of prostatic specific antigen blood determination, sextant biopsies and immunohistochemical studies, focal carcinomas and atypical glandular proliferations (AGP), limited to isolated histologic fields are being detected more frequently. The recognition of these lesions is important since many of them correspond to potentially curable cancers or to benign lesions that mimic carcinoma., Material and Methods: 1,000 consecutive prostatic biopsies performed during the period of 2000-2007 were reviewed. 42 focal prostatic lesions were retrieved. We reassessed the original HE slides. Additional histologic sections and immunohistochemical studies were performed in those cases with uncertain diagnoses in order to clarify the nature of the lesions., Results: Thirteen (1.3%) lesions corresponded to focal carcinomas and 29 (2.9%) to AGP. Immunohistochemical studies and the analysis of additional histologic sections allowed the classification of 17 cases of AGP into specific categories (prostatic adenosis, atrophy, atypical basal cell hyperplasia and seminiferous ducts). Only three of the 13 patients diagnosed with focal carcinomas were subjected to radical prostatectomy in our institution; all of them had disease limited to the prostatic gland. Of the 29 AGP, additional biopsies were taken in four cases and in one of them prostatic carcinoma was the final diagnosis., Conclusions: A significant number of AGP biopsies could be sub classified in to specific diagnostic categories with the use of immunohistochemical studies and additional HE levels. The frequency of focal carcinoma and AGP in our material was similar to other series; however in many of the AGP cases additional biopsies were not performed despite its high predictive value for carcinoma. Increase use of follow-up biopsy procedures is needed in order to detect early potentially curable lesions.

Background: High-grade intraepithelial neoplasia (HGPIN) is the only lesion regarded as precursor of prostatic carcinoma, though its frequency is unknown in many countries. Here we studied the frequency of HGPIN in a population with high grade frequency of prostatic carcinoma., Material and Methods: A total of 486 cases of sextant prostatic biopsies performed from January 2001 to January 2006 were reviewed. These included 280 biopsies from patients belonging to an urban population, with medium or high socioeconomic status, from two hospitals in Mexico City. For comparison, 206 cases from the Regional Hospital of Tabasco located in the tropical zone of the country were included. This hospital receives patients from a rural population with low income and socioeconomic status., Results: Of the total 486 cases, 162 (33.33%) cases were diagnosed as prostatic carcinoma and 319 (65.64%) as benign conditions. Only in five (1.03%) biopsies was HGPIN found. Three of these patients were from Mexico City, and two from the Regional Hospital of Tabasco., Conclusions: Even when our results were obtained only in three hospitals, they suggest that a low frequency of HGPIN on needle prostate biopsies does not necessarily mean a low frequency of prostatic carcinoma in the same population. The reason for such a disparity could be related to a reduced extension of HGPIN areas in the prostate gland. In populations with low frequency of HGPIN and high incidence of prostatic carcinoma, perhaps more biopsy cores should be obtained in order to minimize false negative results for premalignant lesions or early adenocarcinoma.

Introduction: Detailed revision of prostate biopsies with benign alterations may show potentially malignant lesions limited to isolated fields, which may be overviewed in routine analysis., Aim: To exam the morphological alterations in patients with suspicious of prostatic carcinoma and benign diagnosis in needle biopsies., Materials and Methods: During 2000-2001, one hundred consecutive patients with first prostate biopsy diagnosed as benign were included. Biopsies were performed by sextants or modified sextants technique. Slides were reviewed by two observers with knowledge of original diagnosis and this was accepted or modified in accordance to the findings found during the review., Results: Patients age ranged between 57 and 79 years old. Nine per cent of biopsies originally diagnosed as benign revealed different potentially malignant lesions, which should be noted due to possible association with carcinoma. In this group, there were five biopsies with atypical small acinar proliferation, three with few isolated glands with xanthomatous cytoplasm, and one with scarce atypical cells in the prostatic stroma. In contrast with Caucasian and Afro-American population, frequency of high grade intraepithelial neoplasia in needle biopsy seems to be very low and this lesion was not found in any of the 100 biopsies reviewed. Some lesions that simulate carcinoma, as atypical basal cell hyperplasia, post-atrophic hyperplasia, and adenosis were diagnosed as benign, and there was none false positive result., Conclusions: A small but significant group of the biopsies originally diagnosed as benign lesions, showed atypical lesions in isolated fields that were overlooked in the routine analysis. It is necessary the urologist to ask for a directed review of the biopsies if clinical and laboratory data strongly suggest prostatic carcinoma. Additional histological cuts, immunohistochemical studies and more than one observer may increase the frequency of detection of potentially malignant lesions.

Background: Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms of the gastrointestinal tract. They are positive for the expression of c-Kit protein at immunohistochemistry and their clinical presentation is variable. We conducted a study to identify true GISTs with known pathological and immunohistochemical criteria from other tumors of the gastrointestinal tract., Methods: The clinical records of patients with the diagnosis of schwannoma, leiomyoma, leiomyosarcoma and tumor of uncertain biological behavior of the gastrointestinal tract were identified and the slides of paraffin obtained for review by two experienced pathologists in the diagnosis of GISTs. The clinical presentation, treatment and outcomes were analyzed., Results: Twenty four GISTs (11 low-risk and 13 high-risk) were identified from 76 cases reviewed. All the confirmed GISTs were positive at immunohistochemistry for c-Kit expression. The two predominant location of the tumors were the stomach and small intestine. The outcome was good for benign and completely resected tumors., Conclusions: True GISTs can be recognized from other tumors by histological analysis. Immunohistochemistry to identify c-Kit protein expression is useful to confirm the diagnosis. Physicians must consider GISTs in patients with a lesion of the gastrointestinal tract resembling a smooth muscle tumor or/and in association with chronic or acute bleeding.

Background: Some studies performed in developed countries with caucasian population have suggested an increase in the frequency of primary gastric lymphoma (PGL) in the past two decades., Objective: To establish the frequency of PGL in two National Institutes of Health in Mexico in an interval of 18 years., Methods: We reviewed 1,854 gastric malignant neoplasms diagnosed between 1979-1996 in mestizo patients seen at two different institutions. One of them (INC) is an oncological hospital, whereas the other one (INN) is a general hospital which treats patients with benign as well as malignant gastrointestinal diseases., Results: A hundred and sixty three (8.8%) gastric lymphomas were identified from 1,854 gastric malignant tumors. The incidence of PGL showed a two to three-fold increase in the last years of the study in both institutions. The increased frequency was highly significant when compared to the initial rate. This increase does not appear to be due to patient selection criteria nor to the number of malignant gastric tumors in our institutions., Conclusions: Our results indicate an increased frequency of PGL the patient population of two National Institutes of Health in Mexico during the last years. Additional studies are necessary in order to define in the increase in PGL is limited to certain geographical areas or ethnic groups.

Objective: To define the PSA levels (Prostatic Specific Antigen) in our patients with benign or malignant prostatic biopsy., Methods: 100 patients with clinical suspicion of prostatic carcinoma (high levels of PSA and/or abnormal findings at digito-rectal examination) and who underwent a prostatic needle biopsy were reviewed., Results: There were 66 benign and 34 carcinomas. The median PSA was 11.2 ng/mL in the benign cases and 45.6 in cancer. In cases with small increases in PSA (49.9 ng/mL), 94% were benign; there was still a majority of benign cases (63%) in patients with a PSA of 10-29.9 ng/mL. Only in those with levels of 30+, malignancy was a majority (81%)., Conclusions: There was a considerable overlap of PSA levels in our benign and malignant patients, and only values of 30+ ng/mL were highly suggestive of carcinoma. Our levels are higher than those informed in the literature and may have been due, at least partly, to the source of our reagent kits for PSA assays (Cedex from France and Diagnostic Products Corp from the U.S.).

We report the first case of pleomorphic lipoma in the hypopharynx. A 69-year-old man was admitted because of a 12 year history of dysphagia and cough. Direct laryngo-pharyngoscopy revealed a polypoid, yellow, smooth, submucosal tumor with well defined borders. At CT scan the tumor showed a hypodense pattern and measured 3 cm. Microscopically the neoplasm was composed mainly by typical lipomatous tissue, bundles of collagen and pleomorphic multinucleated cells, some with floret-like appearance. Lipoblasts and mitoses were not found. Six months after resection there was no evidence of recurrence.

A 71-year-old female with primary biliary cirrhosis, multiple myeloma and hypothyroidism is reported. The liver biopsy showed stage II-III histologic damage according to Scheuer's classification and the multiple myeloma was IgG-lambda type, stage II-A at the time of diagnosis. Another three cases of primary biliary cirrhosis associated with multiple myeloma were found in the literature. As a group, the four cases had mild or moderate liver damage, extensive bone lesions and three of four cases had multiple myeloma IgG-lambda type. Although this association could be incidental, there is evidence that implies a pathogenic relationship. This information is summarized in this report.

In order to define the frequency and morphological characteristics of low grade adenocarcinomas misdiagnosed as benign prostatic hyperplasia in needle prostatic biopsies, we reviewed 135 consecutive needle biopsies with prostatic cancer. In three biopsies (2.2%) low grade adenocarcinoma was found as a single neoplastic pattern simulating benign hyperplastic gland in some histological fields and prostatic adenosis in others. These biopsies showed the histological features described for carcinomas originating in the transition zone and were seen in isolated histological fields. Retrospectively, it was found that these biopsies showed features of adenocarcinoma although some histologic criteria of malignancy such as infiltrative pattern, prominent nucleoli and nuclear enlargement were seen only focally. Blue mucinous secretions, crystalloids, occasional stromal single cells and mitotic figures were absent. We conclude that a detailed analysis of architectural and cytological features must be made of all glandular proliferations, since this type of low grade adenocarcinoma can occasionally be found in needle prostatic biopsies as the only neoplastic pattern in needle biopsy specimens and simulate benign glandular lesions.

Objective: To explore the diagnostic concordancy of surgery pathologists in deceptive prostatic carcinoma biopsies (DPCs) purposely selected as of difficult interpretation., Setting: Ten experienced pathologists belonging to five tertiary care centers in Mexico City participated., Material and Methods: A total of 25 slides (16 DPCs and 9 benign biopsies) were marked and circulated among the participants. They were asked to classify each slide in one of five categories ranging from carcinoma to benign hyperplasia using the criteria of Epstein. The 16 DPCs had been confirmed by immunohistochemistry studies and by review of two expert uropathologists from the MD Anderson Medical Center in Houston TX. A weighted kappa was use to evaluate the concordancy of the pathologists., Results: The concordancy with the experts opinion ranged from substantial in one pathologist (KW = 0.77) to bad in another (KW = -0.07) and the mean kappa was 0.32. In two of the three institutions with more than one pathologist, the intrainstitucional concordancy improved (KW of 0.57-0.64). The pathologists were unable to reach a consensus (7 or more agreeing) in 12 of the 25 slides. Overall, 12% of the diagnosis were considered uncertain, 29% were incorrect (45% of DPCs and 19% of benign) and only 59% were correct (55% of DPCs and 67% of benign)., Conclusion: Efforts should be made to improve the diagnostic accuracy of pathologists in DPCs.

The clinicopathologic characteristics of two patients with Gorham's disease and bilateral recidivant pleural effusions are reported. The first case corresponded to a nine year-old girl with osteolysis in her right clavicle and ribs. The second case was a 55 year-old male with osteolytic lesions in ribs, cranium, pelvis and femurs; a thymic cyst was also documented. In both patients, biopsies were performed from ribs, which showed proliferating, benign, thin walled small vessels that extensively replaced the intertrabecular spaces. Thoracocentesis, instillation of talcum and radiation therapy were used in the former patient and no recidivant pleural effusions have developed after one year. The second patient was not treated with radiation therapy, persisted with pleural effusions and finally died two years after the diagnosis. Because Gorham's disease is rare, it was not immediately suspected in the cases described here. Its association with pleural effusion is even rarer and has been mentioned only occasionally in the literature. The utility of radiation therapy in Gorham's disease is commented.

The clinico-pathological characteristics of a 22 years old mestizo mexican patient with immunoproliferative small intestinal disease (IPSID) are described. The patient coursed with chronic diarrhea, malabsorption, and a 30 kg weight loss. The laboratory tests revealed hypokalemia, hypocalcemia, hypoalbuminemia and decreased levels of immunoglobulins. The histological changes in the endoscopic biopsies included a dense lymphoplasmacytic infiltrate in the lamina propria that produced vellosity blunting and distortion of the crypts. The immunohistochemical analysis disclosed that almost every cell was positive to heavy chains and negative to light chains. The radiological studies showed thickening of the intestinal folds and mesenteric adenomegalies. In the full thickness biopsy of the yeyunum, in addition to the lymphoplasmacytic infiltrate, a high grade malignant lymphoma infiltrating the regional lymph nodes was documented. An ultrastructural study revealed viruses that resembled the morphology described for the Epstein-Barr virus. The main clinico-pathological findings of other eight mexican patients with IPSID previously reported are commented. It is concluded that the IPSID is a rare disease in our country but it can be found sporadically.

We report the case of an 80 year old man who developed a small diffuse lymphoplasmacytic lymphoma that involved the entire gastrointestinal tract. The malignant lymphoma was associated with intestinal amyloidosis presumably produced by the neoplastic lymphocytes. The outstanding symptoms were asthenia, fever, marked weight loss, diarrhea and melena. The postmortem study disclosed, in addition, lymphomatous infiltration to the gallbladder, mesenteric lymph nodes and testis. The case represents an exceptionally widespread type of diffuse gastrointestinal lymphoma.

Fifty endoscopic biopsies with follicular gastritis (FG) were reviewed to define the frequency of association of FG and Helicobacter pylori (H pylori) infection. All biopsies were studied in sections stained with hematoxylin and eosin and no special techniques were employed. In forty-two out of the fifty cases (84%) H pylori was documented and most of the gastritis showed activity. There was no correlation between the quantity of follicles and the number of bacilli; some biopsies with few follicles showed many microorganisms and others with many follicles showed only a few. There was also no correlation between the presence of the follicles and the distribution of Helicobacter: in some biopsies the microorganisms were found in the tissue fragments with hyperplastic follicles but in others, it was observed in fragments without lymphoid follicles. The high frequency of association between FG and H pylori suggests that this microorganism has some antigenic properties that condition lymphoid tissue hyperplasia in gastric mucosa. It is concluded that the diagnosis of follicular gastritis should be considered an important finding and its presence should lead to a careful search for H pylori. In most cases the microorganism can be identified in routine sections using only hematoxylin and eosin stain.