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Objective: We report 2 cases of small cell neuroendocrine carcinomas (CCP) of the urinary bladder in patients aged 37 and 80 years. CCP is a malignancy with poor prognosis. We review the literature, under the current WHO classification (2016)., Methods: Paraffin blocks were cut for HE staining and immunohistochemistry to analyze the expression of neuroendocrine differentiation., Results: The main diagnosis was based on histopathologic features, which revealed a diffuse growth pattern of small cells with scant cytoplasm and hyperchromatic nuclei. The result of the additional technical immunoreaction was positive for synaptophysin and CD56., Conclusions: Our cases have been reviewed with the literature to discuss the evolution and differential diagnosis of small cell carcinoma of the urinary bladder. This is a rare tumor with very aggressive behavior and its diagnosis lies in its morphology, and immunohistochemical profile.

Small cell carcinoma of ovary-hypercalcemic type is an undifferentiated carcinoma. We describe two cases in women aged 32 and 29. Both presented with large masses and complete surgical extirpation was impossible. Histologically, the images were similar, with diffuse cell proliferation, accompanied by the presence of follicle-like spaces. In both cases it was necessary to make a differential diagnosis with entities such as adult or juvenile granulosa cell tumour, small cell carcinoma of pulmonary type, dysgerminoma and even peripheral neuroectodermal tumour. The absence of SMARCA4/BRG1 immunostaining proved very useful in the diagnosis of hypercalcemic small cell ovarian carcinoma., (Copyright © 2017 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The main function of the HLA-G molecule in its membrane-bound and soluble forms is to inhibit the immune response by acting on CD4+ T cells, cytotoxic T cells, NK cells and dendritic cells. Lung cancer is a leading cause of death worldwide, and annual incidence is high in both women and men. Some studies have reported an increase of HLA-G serum levels in lung cancer, probably generated by tumor cells escaping the antitumor immune response. In this study the concentration of soluble HLA-G in bronchoalveolar lavage (BAL) in patients with primary and metastatic lung cancer was measured to determine its relation with tumor histological type and overall patient status according to the Karnofsky scale., Methods: Thirty-one lung cancer patients were included. A tumor biopsy was obtained by bronchoscopy and the tumor type was determined by hematoxylin and eosin staining. BAL samples were obtained to measure soluble HLA-G concentrations in an ELISA sandwich assay., Results: The average value of soluble HLA-G was 49.04ng/mL. No correlation between soluble HLA-G levels and age, gender or smoking was observed. A highly significant difference was observed in the levels of soluble HLA-G in BAL from patients with different histological types of lung cancer, especially in metastatic tumors. The Karnofsky index showed a significant and inverse correlation with soluble HLA-G levels in BAL., Conclusions: Soluble HLA-G protein is significantly associated with metastatic tumors and patients with lower Karnofsky index and may be useful as a prognostic marker in lung cancer., (Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Ovarian small cell pulmonary type carcinoma is a rare and aggressive tumor with higher incidence in young women. Multidisciplinary treatment seems to increase survival in a small number of cases. We present the case of a woman diagnosed with this type of tumor of small cells, their clinical evolution and the treatment he received.

Background: Small cell carcinoma of the urinary bladder is an infrequent lesion., Clinical Case: We present the case of a 68-year-old male who arrived at the emergency room with a history of 24-h gross hematuria. Imaging studies show a urinary bladder tumor with a 218 cc volume that during a 20-day period increased to 426 cc. Histopathological images with hematoxylin-eosin show an infiltrating solid mass with uneven borders. It is composed of neoplastic cells with evident nuclei predominance and scant cytoplasm (small cells). Chromogranin immunohistochemical staining shows a diffusely positive cytoplasmic granular pattern on neoplastic cells. High molecular weight cytokeratin staining shows a negative pattern on neoplastic cells along with a positive pattern on reporsurrounding normal urothelium. Tumoral mass is positive for synaptophysin and CD-56 and negative for CK-7 and CK-20. Patient therapy was based on radiation plus chemotherapy., Conclusion: Small cell carcinoma of the urinary bladder represents 0.35-0.70% of urinary bladder tumors. Histological and immunohistochemical identification are key elements in the diagnosis. Treatment approach is based on cisplatin-based chemotherapy plus radical cystectomy, except when metastatic disease is present.

Introduction: Opsoclonus-myoclonus-ataxia syndrome (OMAS) is characterised by the acute or subacute development of chaotic eye movements and diffuse myoclonus. On some occasions it is associated with ataxia and encephalopathy. In adults there are multiple causations and a possible paraneoplastic origin must always be taken into account., Case Reports: We report two cases of OMAS of a paraneoplastic origin with a post mortem study. In the first case, the syndrome was associated to a small-cell carcinoma in the lungs, and in the second patient it was associated to a digestive lymphoma. Neuroimaging studies did not reveal any kind of alterations in either of the two cases. In our cases, none of the antibodies that are relatively frequently associated to this syndrome were found. In both of them, an immunomodulator treatment regimen was established; only the patient with the lymphoma showed an initial improvement with antineoplastic therapy. In the pathological study, alterations were observed in the brain stem, and in the second patient alterations were also found in the cerebellum., Conclusions: This is a rare condition that obliges the specialist to think in order to reach a correct diagnosis, and to search for the primary tumour and establish early treatment in order to bring about an improvement and even the remission of the neurological signs and symptoms. The pathological findings are not pathognomonic, but they are typical of this syndrome.

Small cell lung cancer is one of the most aggressive solid tumors because of its rapid growth and early tendency to spread to distant organs. Nonetheless, it is also one of the most sensitive tumors to chemotherapy and radiotherapy, which can give patients with limited disease a chance to become long-term survivors. These characteristics have made this tumor a clinical model to explore various treatment strategies, including concomitant chemotherapy and radiotherapy, alternant chemotherapy, high-dose chemotherapy with hematologic support, or use of whole-brain prophylactic radiotherapy. In addition, in recent years, small cell lung cancer has been used as a platform to develop some new targeted therapy agents or immunotherapeutic approaches.

Objective: To report one case of transitional cell carcinoma with areas of small cell carcinoma presenting in its evolution an adrenal metastasis with the neuroendocrine component only. We perform a bibliography review for the cases of small cell carcinoma of the bladder, its epidemiology, prognosis and treatment., Methods: We describe the clinical case and perform a Medline review., Results: Small cell carcinoma of the bladder is a rare entity with a more aggressive behaviour and poorer prognosis than transitional cell carcinoma. The pathologic characteristics allow differentiation of primary tumor and metastatic disease. In the bibliographic search we did not find any previous report of exclusive dissemination of the neuroendocrine histological component in cases of mixed tumors., Conclusions: There is no standard treatment for small cell carcinoma of the bladder. For metastatic disease the most commonly used combination is cisplatin and etoposide.

Primary small cell carcinomas of the bladder are extremely rare tumors with an aggressive behavior. To date, no standard therapy has been proposed. There are some brief reports about the role of conservative surgery in patients not suitable for radical surgery. We report a case of a primary bladder small cell carcinoma treated with partial cystectomy.

Objective: To describe the clinical, histological, and epidemiological characteristics of patients diagnosed with lung cancer in our hospital over a period of 5 years and compare them with those of historical cases treated at the same hospital., Patients and Methods: The cases of patients diagnosed with lung cancer from January 1998 through December 2002 were studied retrospectively and compared with data published for the period from 1978 through March 1981., Results: A total of 678 patients (89% men, mean age 67 years) were studied. Fifty-six percent of the men and 38% of the women were smokers (P<.001). The most common histological types were squamous cell carcinoma (33%) and adenocarcinoma (30%): squamous carcinoma in men (36%) and adenocarcinoma in women (56%). Metastasis was present in 42% of the patients with non-small cell lung cancer and in 55% of those with small cell lung cancer. In patients with a history of neoplastic disease, laryngeal tumors were most common in patients with squamous carcinoma whereas bladder tumors were the most frequent in patients with adenocarcinoma. The ratio of men to women was lower in the recent series than in the historical one. The percentage of squamous carcinoma was lower and that of adenocarcinoma higher (P<.001). The percentage of patients diagnosed with regional involvement was greater in the recent series (P<.001)., Conclusions: Squamous cell carcinoma continues to be the most frequent histological type. Male sex and smoking are associated with squamous carcinoma and female sex is associated with adenocarcinoma. Epidemiological and histological patterns have changed, possibly in relation to changes in smoking habits.

Objectives: To report a new case of infiltrative small cell bladder cancer., Methods: We describe the case of a 60-year-old male patient who consulted for monosymptomatic hematuria over a few weeks. Cystoscopy showed a neoplasia in the anterior wall of the bladder. Pathological analysis of the TUR chips was compatible with infiltrative small cell tumor. After a negative staging study radical cystectomy plus adjuvant chemotherapy were indicated., Results: Pathological study of the surgical specimen confirmed the diagnosis with involvement of the surrounding fat. There is no evidence of neoplasic involvement after 24 months follow-up., Conclusions: We point out the validity of a radical surgical approach for this tumor, also emphasizing the importance of adjuvant chemotherapy. We concur with other authors in the need of multicentric studies to outline the most effective surgical option, due to the limited number of cases of this entity.

Paraneoplastic limbic encephalitis (PLE) is a disorder characterized by severe cognitive dysfunction and seizures. It is usually associated with small cell lung carcinoma. Diagnosis is difficult because clinical markers are often lacking, and symptoms usually precede the diagnosis of cancer. Serological detection of antineuronal antibodies can be useful. We describe a patient with symptoms of limbic encephalitis, negative for paraneoplastic antibodies, in whom lung cancer was detected.

Objectives: To report a new case of neuroendocrine renal cell carcinoma., Methods: We report the case of a 76-year-old woman with neuroendocrine renal cell carcinoma who underwent radical nephrectomy without any further adjuvant treatment. We performed a bibliographic review about this rare renal neoplasia of which there are less than 20 published case reports., Results: Patient is asymptomatic four years after surgery, although she has local recurrence., Conclusions: Small cell renal cell carcinoma is a very rare neoplasia, affecting people over the age of 60 years, large in size, and metastatic at diagnosis. It has bad prognosis, with short survival times. The most adequate treatment has not been determined due to the scarcity of published cases; the combination of surgery and chemotherapy is the most frequently used.

Introduction: Anti CV2 antibodies are a type of paraneoplastic antibodies that interact with the cytoplasmatic antigens of a subpopulation of oligodendrocytes. They are usually associated with the presence of a small cell carcinoma. We report the case of a patient with an epidermoid carcinoma of the lung and paraneoplastic cerebellous ataxia associated with anti CV2 antibodies., Case Report: Male aged 73, ex smoker for 10 years, with a 45 packet/year habit. He presented a 5 month old constitutional syndrome. Altered gait with a sensation of instability. During the course of the exploration, we detected an increase in the support base, the impossibility to walk in tandem, non exhaustible horizontal nystagmus in bilateral extreme look, and vertical when looking down, with abolition of Achilles reflexes. Brain MR revealed supratentorial demyelinating lesions of a probable ischemic origin. Anti CV 2 antibodies in serum positive (anti HU negative). Biopsy performed using bronchial brushing in the left upper lobe detected the presence of malign epithelial strain, not microcytic, cells, which are compatible with epidermoid carcinoma., Discussion: Anti CV2 antibodies have only been found in patients who have developed a neurological syndrome within the context of a neoplasia. The detection of these antibodies in serum is related with the presence of a concealed neoplasia

Introduction: Oat (small) cell carcinoma is the type of tumour most frequently associated to neurologic paraneoplastic syndromes. It is usually located in the lungs although it has been described in some other locations. Cerebellar symptoms may appear alone, associated to anti Yo antibodies ( Breast and gynaecologic carcinomas), or as manifestation of a more generalized paraneoplastic encephalopathy, associated to signs and symptoms of some other neurologic systems affected., Case Report: A 52 year old patient consulted due to a pancerebellar clinical picture, which started about two months before, and later associated to polineuropathy. Abdominal CT showed a 4 cm mass in the head of the pancreas. Pathologic evaluation demonstrated a poorly differentiated small cell pancreatic tumour. Anti Hu antibodies in high titres were found both in serum and cerebrospinal fluid., Discussion: The association of anti Hu immunity and paraneoplastic encephalomyelitis has been observed in patients with neuroblastoma, seminomas, colorectal, breast and prostate carcinomas and some types of sarcoma. Only about 1% of pancreatic malignancies correspond to small cell type. We have not found any previous report about the association between a paraneoplastic syndrome and pancreatic poorly differentiated small cell carcinoma.

Small cell carcinoma of the bladder is a rare entity occurring in fewer than 1% of all the primary bladder tumors. Its clinic and epidemiologyc characteristics are similar to the transitional cell carcinoma. But, its more aggressive with a high tendency to infiltrate the muscular layer and to metastasize. Thus, therapeutic approach used by the pulmonary form has been applied to the bladder carcinoma. The best results has been achieved using systemic chemotherapy, not only in survival rates but in preserving the bladder integrity, playing the radical cystectomy a rescue role in cases of recurrence or persistence of the tumor. We report a new case of small cell carcinoma of the bladder and review the literature with special attention to the different therapeutic approaches.

Pure small cell carcinoma of the prostate is rare (less than 1% of all prostatic neoplasm). As a result there are few reports in the literature that describe the salient features and appropriate management of this cancer (less than 200 cases reported). Small cell carcinomas of the prostate are a heterogeneous group of tumors, a number of them have neuroendocrine differentiation and are highly aggressive, commonly with visceral metastases at time of diagnosis. Complete temporary remission has been reported with chemotherapy but this tumor has a poor prognosis. The median overall survival from the time of diagnosis is between 5-17.5 months. We report 2 new cases of small cell carcinoma of the prostate and a review of the literature.

One hundred fifteen patients with 119 pulmonary lesions in which malignancy was suspected underwent a SPECT study with 99mTc-Tetrofosmin (TTF) to assess the possible factors involved in the uptake of the radiopharmaceutical. The TTF uptake rate in the lung tumor with respect to that of healthy tissue (TTF index) was evaluated in terms of: benignity and malignancy, histological type, stage, cell differentiation, size, necrosis, survival and the influence of P-glycoprotein (Pgp), detected by immunohistochemistry, on the TTF uptake. The mean TTF index in the 18 benign lesions studied was 1.01 0.05, while that of the 101 malignant lesions was 1.59 0.45 (p < 0.001), with a positive predictive value of 97.7% and a negative predictive value of 50%. The comparison of the histological types, degree of cell differentiation, necrosis and stage revealed no statistically significant differences. With respect to size, those tumors measuring > 3 cm showed greater uptake than smaller lesions. In patients with non-small cell lung cancer, a positive relationship was observed between the TTF index and survival, a circumstance that did not occur in patients with small cell lung cancer. In the cases in which the presence of Pgp was assessed, there was an inverse relationship between the TTF ratio and Pgp expression. In conclusion, thoracic SPECT with 99mTc-TTF has a high positive predictive value for the presence of lung cancer, although a negative study does not rule out the existence of the disease. The reason for this is the inverse relationship between 99mTc-TTF uptake and the density of Pgp expression.

A case of small-cell carcinoma of larynx was diagnosed in a 48-year-old man. This is an unusual laryngeal carcinoma (the incidence is lower than 1% of all carcinomata in this location). We analyzed some clinical and histopathological aspects of these carcinomata and some prognostic and therapeutic factors. A bibliographic review was made.

Introduction: Limbic encephalitis is an unusual presentation of paraneoplastic syndrome, which includes among its symptoms seizures., Clinical Case: We report a case with a rare presentation of limbic encephalitis as initial symptom of small cell lung carcinoma. A 69 year-old woman presented with partial non convulsive status epilepticus and neuropsychiatric disturbances. Chest radiography and computed tomography showed mediastinal lymphadenopathy and lung nodules. Subsequently, small cell lung carcinoma was diagnosed by lymph node biopsy. The cerebrospinal fluid study was normal. The electroencephalography and magnetic resonance imaging (MRI) findings had distinctive features compatible with temporo-limbic dysfunction. The anti-Hu antibodies were negative. The neuropsychiatric symptoms improved significantly after systemic chemotherapy and adjuvant radiotherapy. A serial follow-up MRI of the head showed no evidence of intracranial metastasis three months after the diagnosis of cancer. Limbic encephalitis may be an initial manifestation of lung cancer. Paraneoplastic limbic encephalitis is considered a remote effect of cancer commonly associated with anti-neuronal antibodies (anti-Hu) and small cell lung carcinoma., Conclusions: Status epilepticus could be an early sign of limbic encephalitis. The absence of anti-Hu antibodies does not rule out the presence of an underlying small cell lung carcinoma in patients with a clinical diagnosis of limbic encephalitis. Greater awareness for diagnosis and early treatment of the primary tumor offers the best chance for improvement in patients with lung cancer presenting with limbic encephalitis.

Adenocarcinomas (AC) account for more than 90% of the prostatic malignant neoplasias; a neuroendocrine differentiation (NE) component is to be considered in cases of atypical evolution for its diagnostic and therapeutic relevance. The (NE) originates by proliferation of the NE cells of the acinar epithelium and may develop into two different histologic patterns, a "Carcinoid" type and a "Small Cell" type. We report a patient with a prostatic AC diagnosed 5 years before his death with worsening of the disease together with a return of the prostatic specific antigen (PSA) to normal values and the presence of hepatic metastases of a tumor (NE) of the small cell type. The autopsy confirmed the presence of a prostatic tumor with areas of (AC) type and (NE) small cell type and multiple hepatic metastases (NE).

We analyzed the survival after surgery for non-small cell lung cancer (NSCLC) classified as T3N0. Between January 1969 and 1995, 151 patients underwent surgery for NSCLC in our hospital. Survival analysis was performed using the Kaplan-Meier statistical method and the curves were compared using Mantel-Cox, Breslow and Tarone-Ware tests. The estimated five-year survival in the studied population was 44.46 +/- 4.30%. Four groups were defined based on degree of tumoral invasion of mediastinal structures, parietal pleura, chest wall or superior sulcus. Significant differences in five-year survival were observed between groups. Patients in the mediastinal group (59.98 +/- 8.71%) had the best prognosis, followed by patients with parietal pleura involvement (52.79 +/- 6.69%). Survival in the chest wall group was 27.53 +/- 7.22%. No patients with superior sulcus tumors survived over five years (median survival 1.50 +/- 1.16 years; 95% confidence interval 0.00 to 3.77 years). Prognosis is clearly determined by degree of tumoral invasion in T3N0 patients. In spite of the evident conceptual improvements achieved with the revised International Staging System, the system still fails to fully define prognosis in such cases.

Primary small-cell (also known as oat-cell) neuroendocrine carcinoma of the larynx is an infrequent tumor. We report a case of epiglottic oat-cell carcinoma in a 57-year-old man. Its association with other malignant neoplasms and aggressive behavior in spite of treatment are discussed.

Objective: To validate updated guidelines for stage I classification of patients with differentiated small-cell bronchogenic carcinoma., Methods: Seven hundred seventeen tumors of differentiated small-cell bronchogenic carcinoma were resected in our hospital and given a TNM classification of stage I based on guidelines recently issued by the Spanish Society of Pneumology and Chest Surgery (SEPAR). Survival was calculated using the Kaplan-Meier method and curves were compared with a log-rank test. The Cox proportional hazards model was used to analyze multiple variables., Results: One hundred forty-two cases were classified as stage IA and 575 as stage IB. Survival was significantly longer for stage IA than for stage IB (p = 0.0021). The prognosis was significantly better for stage IA patients who were asymptomatic (p = 0.0380) or who had tumors < or = 2 cm in diameter (p = 0.0431). In stage IB, histologic grade (p = 0.0104) and tumor diameter (p = 0.0002) significantly affected survival. A noteworthy finding was the 82% survival at five years in a group of 66 patients with a maximum tumor diameter of 3 cm classified as T2N0M0 due to invasion of the visceral pleura or to proximal involvement of a lobar bronchus at a site > 2 cm from the carina; that survival rate was not significantly different from survival for stage IA (p = 0.1573). Multivariate analysis showed that tumor diameter (p = 0.0272) was of prognostic importance in stage IA, while tumor diameter (p = 0.0005) and histologic grade (p = 0.0092) were relevant in stage IB., Conclusion: The new staging guidelines for differentiated small-cell bronchogenic carcinoma are nearer to prognostic reality given that survival for stage IA patients is significantly longer than for stage IB patients. However, the method continues to have shortcomings in that it fails to achieve one of its main objectives, namely prognostic homogeneity for each subgroup, as indicated by problems related to variables of tumor extension such as diameter, involvement of the visceral pleura or bronchial location, apart from other factors that affect survival.

Objective: To report an additional case of small cell (oat cell) carcinoma of the bladder., Methods/results: A 78-year-old patient who consulted for hematuria is described. A TUR biopsy demonstrated small cell undifferentiated carcinoma. The patient received neoadjuvant chemotherapy and subsequently underwent surgery, but died 6 months postoperatively., Conclusions: Regardless of the treatment utilized, this tumor type maintains its aggressive behaviour and can be associated with other carcinomatous components (papillary transitional cell carcinoma and carcinoma in situ). However, after treatment with CDDP + VP-16 and partial cystectomy, our patient was asymptomatic for 5 months.

A 69-year-old patient diagnosed, in 1985, of squamous cell carcinoma of the right vocal cord (T1, N0, M0) was treated with cordectomy and radiotherapy. Eleven years later he presented with a larynx tumor of the glotto-subglottic region. Histopathological examination stated a small cells neuroendocrine tumor. We contribute with one new case to those rare laryngeal tumors, which we see often published in the specialty journals, probably due to the wide employed immunohistochemistry dyes.

Objective: To validate current guidelines for staging bronchogenic lung carcinoma., Methods: Between 1969 and 1996, small-cell non-anaplastic tumors of bronchogenic carcinoma classified by the recently proposed TNM guidelines of the Spanish Society of Pneumology and Chest Surgery (SEPAR) were resected from 1,433 patients. We used the Kaplan-Meier method to calculate survival and compared the curves using a log-rank test., Results: A stage IA classification was given to 142 patients and IB to 575. Thirty-seven cases were classified IIA and 336 were IIB. Of the latter, 177 were T2N1M0 and 159 were T3N0M0. Two hundred forty-eight patients were in stage IIIA, 54 T3N1M0, 23 T1N2M0, 120 T2N2M0 and 51 T3N2M0. Ninety-five stage IIIB patients were classified as follows: 37 T4N0M0, 35 T4N1M0, and 23 T4N2M0. Five-year survival for IA patients, at 75% was significantly better than the 60% rate for IB patients (p = 0.0021). Likewise, the prognosis for stage IIA, where five-year survival was 57%, was significantly better than for IIB at 39% (p = 0.0434). The prognosis for patients classified as T1NM0 was better than for those classified as T2N1M0, which was 38% (p = 0.0320). The survival of those classified as T3N0M0 (42%) was not significantly different from that of T1N1M0 (p = 0.1754) or T2N1M0 (p = 0.5360) patients. We found no significant difference between T1N1M0 and stage IB (p = 0.3847) patients. Among stage III patients, we observed no difference in survival between stage IIIA and IIIB (p = 0.1914). In stage IIIA, patients classified as T3N2M0 had a significantly lower rate of survival (p = 0.0399). The presence of mediastinal ganglia in stage IIIB was associated with a lower survival rate (p = 0.0328)., Conclusion: The new guidelines for staging non-small cell anaplastic lung carcinoma do not provide consistent prognoses for homogeneous groups of patients, at least not in certain categories.

We report a case of small cell carcinoma of the urinary bladder in 71-year-old male patient. Oat cell of the urinary bladder is extremely uncommon, and up to date only 135 cases have been reported in word literature. Histologic, microscopic, and immunohistochemical characteristics are similar to oat cell carcinoma of the lung and other extrapulmonary oat cell carcinomas. We conclude this report with immunohistochemical study with PGP 9.5, neuron-specific enolase a synaptophisine.

The prognosis for survival when small cell non-anaplastic bronchogenic carcinoma (SCN-ABC) invades the diaphragm has not been clearly established because the diagnosis is rare. We report a series of eight patients who underwent full resection of SCN-ABC with diaphragm invasion. One died during the postoperative period. Mean survival was eight months for the remaining seven and no patient lived five years. All died as a result of remote metastasis. Given these results, we question whether surgery is the most appropriate treatment for these patients.

Multiple primary cancer (MPC), a rare finding, is most often seen in the breast. In the lung, this cancer is rare (accounting for between 1.5 and 3% of cases), with epidermoid carcinoma usually being the principal tumor. The presentation of small-cell carcinoma as the principal tumor in MPC is thought to be extremely rare. The criteria for pulmonary MPC described by Martini and Melamed continue to provide the definition of reference. Pulmonary MPC can manifest in a synchronically (simultaneous appearance) or metachronically (with more than two years' lapse in appearance). Patients so-affected are usually male and heavy smokers. Survival with this type of lung cancer is usually less than for a single form. We report the case of a patient with synchronous MPC of the lung, with small cell carcinoma as the principal tumor associated with epidermoid carcinoma. We review the literature on this subject.

The intention of the study was to confirm the usefulness of the transthoracic fine needle biopsy aspiration (FNBA) procedure, in a second level hospital that did not have technologically advanced equipment to locate thoracic diseases, such as computerized tomography, fluoroscopy or ultrasonography. Employing a vertical and horizontal coordinate design and posteroanterior as well as lateral radiological studies, specimens were taken from 77 patients. Of this total only 60 (77.9%) were in proper conditions to be examined; in seven (11.6%) patients a second aspiration was required. Of the total suitable specimens, malignant neoplasms were found in 46 (76.7%), and inflammatory diseases were detected in 14 (23.3%). The most frequent diagnoses were squamous cell carcinoma in 20 (33.3%), undifferentiated carcinoma in seven (11.6%), and bronchoalveolar carcinoma in another seven (11.6%). In 12 patients, it was possible to obtain tissue samples and in two patients, autopsy was performed; in all of them, the FNBA diagnoses were confirmed. Four (6.6%) patients suffered complications like pneumothorax, three were cured spontaneously, and one was treated with tube drainage. FNBA demonstrated its usefulness in a hospital with limited technological resources; 77.9% of the patients were property diagnosed with reduced cost, minimal morbidity, and without mortality.

The case of a 72-year-old woman presenting sensory neuropathy and anti-Hu antibodies is reported. She was admitted in November 1995 with a one year history of sensory neuropathy. Her first symptoms were painful numbness and dysesthesias in both feet. She experienced progression of the sensory symptoms affecting upper limbs, and clumsiness of gait. One month before admission she complained of diminished strength in both hands. The neurologic examination showed anicocoric fixed pupils, with no reaction to light; convergence miosis was evident in the right eye (Argyll-Robertson pupil). In the lower limbs she had very mild distal weakness, and tendon reflexes were universally abolished. Pin and touch sensation, position sense and pallesthesia were absent in all four limbs. Romberg test was elicited, and a tabetic gait was patent. Pseudoathetotic movements were observed in hands and feet. An ulcer was present in the fifth finger of the right foot. Routine blood biochemistry and hematology showed a ESR of 105 and an increased IgG in the immune-electrophoretic run. Neurophysiologic evaluation disclosed a mild demyelinating neuropathy. Positive anti-Hu antibodies were found in the serum (Western blot - Athena Diagnostics); CSF was normal but not tested for anit-Hu. An abdominal CT scan disclosed multiple hypodense nodules in liver, right adrenal gland and peritoneum. A chest CT scan showed a hyperdense mass in the lower right pulmonary lobe and enlarged retrocava-pretracheal lymph nodes. A biopsy of the peritoneal nodule was performed, showing a metastatic small cell carcinoma. The patient died eight days after discharge. Although multiple organs were affected, she was independent until death, showing an indolent clinical course.

To date, only 45 cases of oat cell carcinoma of the major salivary glands have been reported in the literature, which represents less than 1% of primary malignant tumors of the parotid glands. Two subtypes exist: ductal and neuroendocrine. We report two new cases of neuroendocrine oat cell carcinoma of the parotid gland which were treated by surgery associated with radiation therapy and chemotherapy. The literature review showed a predominance of males (61.7%), age 50-70 years, and location in parotid gland (83%). Treatment consists of radical surgery of the tumor associated with radiation therapy and chemotherapy. The prognosis is poor, with survivals at one, three and five years of 77.7%, 40.7%, and 29.6%, respectively, although this is better than the prognosis for other sites.

Background: The specific cell type in primary lung cancer (LC) has important consequences, both for treatment and prognosis. Our objective has been to evaluate the degree of accuracy of several preoperative techniques in the LC diagnosis., Patients and Methods: We have studied 442 diagnostic techniques realized in 360 patients who underwent thoracotomy for LC in our hospital (1988-1994). Twelve sputum cytologies, 93 transthoracic needle biopsies (TNB), 73 bronchial aspirated cytologies, 30 bronchial brushing, 205 bronchial biopsies (BB) and 29 transbronchial biopsies were included. In each case the cellular type of LC, obtained through these techniques, was compared with the result derived from the study of surgical piece (reference diagnosis). To calculate the degree of concordance between both diagnoses we used the kappa coefficient (K)., Results: The overall concordance between the cellular type observed in the different preoperative techniques and the definitive result obtained by thoracotomy was 0.61. The worst test was TNB (K = 0.41). Sputum cytology and BB presented a good histopathological precision (K = 0.75 and 0.70 respectively). The rest of techniques showed moderate results. On the different histologies, the best result was obtained in squamous carcinoma (K = 0.68) and the worst in undifferentiated large cell carcinoma (LCC) (K = 0.39). Small-cell lung cancer only showed a moderate concordance (K = 0.58). The coexistence and coincidence of two or more tests with the same cellular type were associated with a higher proportion of accuracy (0.97 vs 0.73; p = 0.00002; odds ratio: 12.02)., Conclusions: The preoperative histopathological diagnoses should be interpreted with caution, especially those obtained by TNB and those where it is implied the LCC. In these two circumstances and in cases in which the knowledge of the cellular type have relevance, we think that the initial diagnosis should be reinforced with a second result. The precision of the preoperative diagnoses in small-cell lung cancer must be reevaluated.

We report a case of primary duodenal carcinoma showing neuroendocrine and glandular differentiation, in a 65-years-old male. Both components were closely related and transition between them was observed. The neuroendocrine component was composed of an undifferentiated "oat-cell" type, with positive immunostaining for neuroendocrine and epithelial markers. Ultrastructural findings confirmed this double differentiation, with dense cytoplasmatic granules of neurosecretory type. The neuroendocrine component showed greater aggressiveness with lymph node metastasis.

Small cell carcinoma of the lung occasionally presents as a single pulmonary nodule, but its expression in the form of multiple pulmonary nodules has not been reported in the literature. We describe a single case of small cell carcinoma of the lung presenting as multiple pulmonary nodules that seems to have been cured by chemotherapy.

Aim: This report reviews the clinical and pathologic features of four patients with small-cell anaplastic carcinoma (SCAC) of the colon and describes in detail their histological and immunohistochemical characteristics., Methods: Four patients with a SCAC of the colon diagnosed by conventional light microscopy, immunohistochemistry and ultrastructure were reviewed; clinical presentation, tumor location and spread, surgical procedure, adjuvant therapy and clinical outcome were recorded., Results: There were two women and two man, with an average age of 55 (range, 40-66) years. Two tumors were located in the sigmoid and two in right colon. Cases 1, 3 and 4 were removed at laparotomy by segmental resection along with lymph nodes. All cases had liver metastases. Pathologic study identified out-cell subtype in all cases and two histopathologic patterns: pure SCAC (cases 2 and 4) and mixed exocrine-SCC differentiation (cases 1 and 3). Three patients were treated with cyclophosphamide, cisplatin and etoposide. Two patients (cases 2 and 4) died of widely metastatic disease; cases 1 and 3 had partial remission lasting 9 and 3 months, respectively., Conclusions: Due to extremely aggressive behavior of colon SCAC with early metastatic spread, CT scans of the chest-abdomen and radionuclide bone scan should be performed. In the presence of metastatic disease, multiagent chemotherapy with combined etoposide and cisplatin should be instituted.

Objectives: Oat cell carcinoma of the urinary bladder is extremely uncommon. To date, 87 cases have been reported in the literature. Histologically, these tumors are similar to oat cell carcinoma of the lung and in slightly more than half of the cases the tumor is associated with another carcinomatous component: urothelial, squamous carcinoma, adenocarcinoma or, more rarely, sarcomatoid carcinoma. A case of sarcomatoid small cell carcinoma is described herein., Methods/results: We report a case of sarcomatoid small cell carcinoma of the urinary bladder in a 79-year-old female patient. The tumor was in the advanced stages and was unamenable to resection. The patient was treated with multi-drug systemic chemotherapy, but she died five months after diagnosis. Light microscopy disclosed a carcinomatous component similar to oat cell carcinoma of the lung that stained with epithelial and neuroendocrine markers. The sarcomatoid component was histologically nondescript and showed extensive immunoreactivity to mesenchymal and epithelial markers., Conclusions: Sarcomatoid small cell carcinoma of the bladder is rare. To our knowledge, only five cases have been previously reported. It is aggressive, metastasizes early and has a poor diagnosis. Surgical resection with adjuvant multidrug systemic chemotherapy is currently the best available treatment.

In 88 patients diagnosed and intervened of lung carcinoma, we evaluate the security of the Diagnostic method--cytology: sputum, brushed bronchial, bronchial aspiration, puncture pulmonary aspiration and histology of the bronchial biopsy--when we correlate them with the histology of the dried up tumour. From the 88 patient, in 11 (12.5%) there was a disparity between some specimen and the piece tumour. If we analyze the specimen: the bronchial biopsy, was different in 3 cases, (4.8%); the brushed and the bronchial biopsy, aspiration in 2, (2.7% and 2.3% respectively); the puncture pulmonary aspiration in 6, (26%) and the cytology of sputum in 2 cases, (2.4%). In 8 patients (9%), the outputs of some specimen were not conclusive, if we remove these we find that: the bronchial biopsy was not conclusive in 2 cases, (3.2%), the brushed bronchial in 5, (6.8%); the bronchial aspiration in 9 (10.2%) and the cytology of sputum in 2 cases, (2.4%). With this data we could infer that sometimes the positive outputs of the specimen have no correlation with the histology of the tumour dried up. This disparity has not been observed in the oat-cells. Therefore when we send the specimens to the pathologist, it would always be advisable for him to inform us if there are any different cells belonging to the principal group of the tumor.

Small-cell anaplastic carcinoma of the colon is a very infrequent tumour (less than 1% of all colorectal neoplasms). Thirty-two cases have been described in the international literature up to 1992. A case, in a 54 year-old patient who underwent successful resection is presented. The importance of this tumour is due to its great aggressivity, and its great tendency to produce early hematogenous and lymph node metastases. It implies a bad prognosis and a survival of around 0% at one year. Because of these facts, treatment must include, beside surgical resection, an aggressive systemic protocol.

We comment a case of necrotizing myelopathy, a rare neurological paraneoplastic syndrome, that it was the first manifestation of a microcit anaplastic carcinoma. The diagnostic was made with the clinical and radiological base, after we deprive another diseases with similar clinical manifestations and the result of the Magnetic resonance image of the nervous system. We didn't obtain permise for the necropsic study.