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Resumen Introduccion Nos planteamos el problema: ?cual es el numero adecuado de facultativos en un servicio de anatomia patologica (SAP) para responder sin demora al numero de solicitudes de estudio que se reciben? Material y metodos Aplicamos conceptos basicos de teoria de colas y motivamos al lector a introducirse en ellos. Resultados y discusion Un SAP funciona como un sistema de colas y se ajusta a los modelos de cola infinita con uno (M/M/1) y, todavia mejor, con multiples recursos (M/M/m). El numero de facultativos (m) ha de cumplir: m >> velocidad de llegada de biopsias al SAP/velocidad de cierre de biopsias por facultativo. Conclusiones Como sistema de colas, un SAP solo es viable si su capacidad de respuesta es mayor que las necesidades planteadas por la demanda. El modelo de multiples recursos (facultativos) amortigua mejor los aumentos sostenidos de la demanda.

Resumen Objetivo Presentar un metodo de analisis grafico de costes ocasionados por los falsos positivos (FP) y falsos negativos (FN) de una prueba diagnostica. Material y metodos Construimos una funcion de costes ligada a la sensibilidad (S) y a la especificidad (E) de la prueba diagnostica. A partir de esta funcion obtenemos lineas de isocoste, cuya pendiente es la relacion coste FP/coste FN. Representamos cada prueba diagnostica en el espacio ROC como el punto (1-E, S). Resultados Las lineas de isocoste permiten visualizar si el gasto asociado a FP y FN de una nueva prueba diagnostica es menor o igual que el de la antigua. Conclusiones El analisis grafico de la funcion de costes de una prueba diagnostica ayuda a decidir su introduccion o su rechazo.

Background A new system for the classification of galactograms is reported. To date, there is no universally accepted classification system. Purpose To evaluate inter- and intra-observer agreement of the Galactogram Imaging Classification System (GICS) Material and Methods Six observers with different levels of experience retrospectively evaluated 30 galactograms using the GICS. Images were reviewed independently twice within a four-week period. The kappa statistic was calculated for intra- and inter-observer variability. Results The kappa for inter-observer agreement was moderate to substantial (range 0.41–0.72). Overall, the intra-observer kappa values were excellent (range 0.80–0.94). Conclusion The present study shows a good to very good inter- and intra-observer agreement with the GICS. We believe the GICS can be incorporated into daily practice.

Resumen El glioma cordoide del tercer ventriculo es un tumor cerebral poco frecuente, de reciente descripcion, localizado en la region hipotalamica - III ventriculo. Hasta la fecha, tan solo hay 56 casos publicados desde que se describiera por primera vez en 1998 por Brat y cols. Histologicamente, el tumor esta compuesto por celulas poligonales dispuestas en nidos o cordones, inmersas en una matriz mucoide con un intenso infiltrado inflamatorio linfoplasmocitario. Las celulas neoplasicas coexpresan caracteristicamente marcadores inmunohistoquimicos de Proteina Acida Gliofibrilar (PAGF), Citoqueratinas, Vimentina y CD-34. A nivel ultraestructural muestra caracteristicas de diferenciacion ependimaria y recientemente tambien se han identificado alteraciones geneticas caracteristicas distintas a las de los gliomas. La extirpacion tumoral fue incompleta tras un abordaje anterior. Nosotros describimos un nuevo caso de este tumor en un varon de 26 anos y revisamos la literatura.

Resumen Los Diagnosticos Criticos en Anatomia Patologica han sido recientemente introducidos y son equiparables a los establecidos a nivel clinico, de forma que, situaciones clinicas concretas pueden precisar de un diagnostico rapido (ya sea por parte del patologo o del citopatologo) y del contacto urgente con el clinico con el fin de facilitar una intervencion clinica urgente o instaurar un tratamiento determinado, de los que el paciente se beneficiaria. Basandonos en la experiencia diaria, presentamos diferentes situaciones clinico- patologicas en las que el diagnostico es critico.

Resumen Introduccion El objetivo de este trabajo es determinar la posible asociacion de cinco perfiles diferentes de expresion inmunohistoquimica con variables clinicas, histopatologicas e inmunohistoquimicas de conocido valor pronostico en el cancer de mama. Material y metodo Se estudiaron 194 muestras de carcinoma ductal infiltrante de mama. Se definieron 5 perfiles inmunohistoquimicos basados en la expresion de receptores hormonales (estrogenicos o de progesterona) y/o Her2neu (luminal A, luminal B, mixto, Her2neu y triple negativo) y se estudio si habia diferencias entre ellos en relacion con variables clinicas, histopatologicas e inmunohistoquimicas de conocido valor pronostico. Resultados En la serie se encontraron 134 (69%) casos correspondientes a un inmunofenotipo luminal, de los que 98 (50,5%) fueron del grupo luminal A y 36 (18,6%) del luminal B; 29 (15,9%) casos fueron triples negativos, en 18 (9,3%) se daba un tipo mixto y en 13 (6,7%), del tipo Her2neu. Destaca la relacion entre los inmunofenotipos triple negativos y Her2neu con formas histologicas peor diferenciadas (el 62 y el 60%, respectivamente) y del grupo luminal A con tumores bien diferenciados (p = 0,008). La expresion de ki67 fue mayor en el grupo triple negativo (73,9%) y baja en el luminal A (26,3%) (p = 0,001). La expresion de p53 tambien fue mayor para los grupos Her2neu (55,5%) y triple negativo (60,8%) (p = 0,0005) respecto a los otros. Conclusiones Los subgrupos sin expresion de receptores hormonales, con sobreexpresion de Her2neu o sin ella (triple negativo) presentan caracteristicas asociadas con variables de peor pronostico. La perdida de expresion de receptores a progesterona tambien parece asociarse con ellas.

Resumen Presentamos cuatro casos clinico-citologicos del aparato respiratorio, poco habituales en la practica diaria, donde la morfologia ademas de las tecnicas especiales, son suficientes para llegar a un diagnostico correcto (Strongyloides stercoralis, Cuerpos ferruginosos, Aspergillus y virus del herpes en carcinoma epidermoide).

In this work we want to know the long-term rates of locoregional recurrence and distant metastasis in a population of breast cancer patients with pT1–pT2 tumours and one to three positive lymph nodes who were treated with mastectomy and axillary lymphadenectomy, and to study the relationship of certain clinical and histopathological parameters to their development. Ninety patients diagnosed with a breast tumour of less than 5 cm and one to three affected lymph node, and undergoing a modified radical mastectomy with axillary lymphadenectomy, were studied. The mean overall follow-up was 132 months, and the minimum follow-up for the living patients was 10 years. Locoregional recurrence and metastasis development rates were studied and clinical and pathological parameters were evaluated. We found locoregional recurrence in 22.5% of the patients, and systemic metastases in 30.3%. In the study of locoregional recurrences significant differences were found for tumour size (T2) (p=0.001) and metastasis were more frequent with extracapsular lymph node extension (p=0.02) and non-administration of chemotherapy (0.019). The parameter related to the development of locoregional recurrence was tumour size (stage T2) and those related to the development of metastasis were extracapsular lymph node extension and non-administration of chemotherapy.

Frozen-section examination (FSE) has traditionally been used for the intraoperative diagnosis of thyroid cancer. However, the utility of the technique is now controversial, especially in multinodular goiter (MNG), on which there are few studies. The aim of this study was to analyze the utility of FSE for ruling out malignancy in patients undergoing surgery for MNG.FSE was performed in 197 patients with MNGs undergoing surgery for suspected malignancy, either preoperatively (n = 145; 74%) or intraoperatively (n = 52; 26%), and where the preoperatively planned surgical technique was partial resectional surgery. The FSE diagnosis was classified as benign, suggestive of malignancy, or malignant. The following FSE parameters were calculated for diagnosing MNG-associated carcinoma: true- and false-positives and true- and false-negatives, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy. The chi2 and Student's t tests were applied.The FSE revealed benignity in 191 cases (97%), suggested malignancy in 3 (1.5%), and were malignant in the remaining 3. The final histology revealed 16 carcinomas (8%), of which only 3 were detected by FSE. Only tumor size was a factor significantly associated with FSE carcinoma detection (p = 0.0012). The sensitivity of the technique for detecting carcinoma was 19%, specificity, 100%; positive predictive value, 100%; negative predictive value, 93%; and diagnostic accuracy, 93%.FSE should not be used routinely in the management of MNG, and considering its low rate of sensitivity for detecting malignancy, the decision on the extent of the thyroidectomy should be based on other factors and explorations.

Fundamento y objetivo: Los tumores primarios del timo de estirpe no linfoide son infrecuentes, aunque presentan una gran variedad. El objetivo de este trabajo es identificar las variables clinicas, terapeuticas e histologicas que tienen valor pronostico. Pacientes y metodo: Se estudiaron 58 tumores primarios del timo de estirpe no linfoide que correspondieron a 52 neoplasias epiteliales (NEPT) (90%), 4 timolipomas (7%) y 2 tumores neuroendocrinos (3%). La clinica mas frecuente fue la miastenia grave (41%) y la disnea (21%). Cabe destacar la presencia de 13 pacientes asintomaticos (24%). Para el analisis estadistico se utilizaron las curvas de supervivencia de Kaplan-Meier y el modelo de regresion de Cox. Resultados: Se intervino a todos los pacientes con timectomia, excepto en 4 casos en que se efectuo una biopsia. La mortalidad perioperatoria fue del 3% (n = 2) y la morbilidad, del 31% (n = 18), principalmente por afecciones respiratorias y de la herida. Se administro tratamiento adyuvante con quimioterapia y/o radioterapia en las 24 NEPT grados de Masaoka III y IV, y en el carcinoma linfoepitelial. Con un seguimiento medio (DE) de 13 (5) anos, fallecieron 12 pacientes con NEPT y 1 con un tumor neuroendocrino, debido a evolucion de la enfermedad. La supervivencia acumulada fue del 80% a los 5 anos, del 71% a los 7 anos y del 63% a los 10 anos. Actualmente existen 2 recidivas locales en 2 NEPT, tras 9 y 8 anos de seguimiento, respectivamente. Los principales factores pronosticos son el tipo y subtipo histologicos, asi como el estadio clinico (p < 0,001). Conclusiones: El diagnostico precoz en los tumores primarios del timo de estirpe no linfoide es fundamental para instaurar un tratamiento correcto antes de que presenten un estadio clinico mas avanzado. Los principales factores pronosticos son el tipo y subtipo histologicos, asi como el estadio clinico.

This is a review of the cytologic and clinicopathological findings seen in a series of six fibrolamellar hepatocellular carcinomas (FL-HCC) studied by means of fine-needle aspiration (FNA). A comparison of several cellular measurements (cell, nuclear and nucleolar sizes, and N/C ratios) of FL-HCC, ordinary hepatocellular carcinoma (O-HCC), and normal hepatocytes was also carried out in order to find out if these figures could be of help in the cytologic diagnosis. Aspirates were made up of a rather monotonous population of large discohesive cells resembling the morphology of the oncocytes seen in thyroid aspirates; trabecular arrangement of tumor cells was not observed. Cytoplasmic pale bodies and hyaline cytoplasmic bodies were seen in variable quantities. Microbiopsies displaying the fibrolamellar pattern were observed in four cases. FL-HCC individual tumor cells were larger than individual O-HCC tumor cells (P < 0.001), as were nuclear (P < 0.007) and nucleolar sizes (P < 0.001), but N/C ratio of O-HCC was higher than the N/C ratio of FL-HCC (P < 0.005). Based on the findings, a single cell aspirated from an FL-HCC is three times the size of a normal hepatocyte and 1.60 times the size of a single cell aspirated from a well-differentiated O-HCC. The cytologic findings of FL-HCC are very characteristic and permit a correct diagnosis of this liver malignancy, provided the cytopathologist is aware of the clinical, demographic, CT-image, biochemical, and pathological features of this neoplasm. Diagn. Cytopathol. 21:180–187, 1999. © 1999 Wiley-Liss, Inc.

We present a case of hamartoma of the breast. This is an infrequent tumour that requires the correct diagnosis to distinguish it from other histopathology types because it has a better prognosis. The characteristic image from a mammogram is useful in its diagnosis.

We have studied one undifferentiated (embryonal) sarcoma of the liver (USL) by fine-needle aspiration cytology (FNAC) and have correlated the cytologic findings with those seen in the histologic sections. The main cytologic and immunocytochemical features were: cellular aspirates, mesenchymal clusters, disparity in individual cell size (small round cells, and multinucleated giant cells, sometimes bizarre), absence of biliary pigment, AFP-negative and vimentin-negative tumor cells, AFP-negative and PAS-positive hyaline globules, and apoptotic cells. Only immunostaining for alpha-1-antitrypsin, alpha-1-antichymotrypsin, and carcinoembryonic antigen were positive in tumor cells in histologic sections. The differential diagnosis should be carried out with rhabdomyosarcomas, hepatoblastomas, malignant fibrous histiocytomas, and poorly differentiated hepatocarcinomas. We think that the cytologic features observed in this case, evaluated both in the appropriate clinical context and in the light of the laboratory findings, may permit the correct diagnosis of this infrequent liver tumor. Nevertheless, more cases need to be studied to assess the reliability of our findings.

Primary squamous cell carcinoma of the breast is an infrequent tumour, that requires to rule out a tumor from other location to be diagnosed. Several characteristics as big size, and necrosis or cyst presence, have been associated rather than adenocarcinoma, although clinic and radiological squamous cell carcinoma non-specific characteristics are difficult to distinguish from adenocarcinomas. We present a woman with a 4-cm primary squamus cell carcinoma of the breast. Pathogenic, diagnostic, and therapeutic aspects in accordance with medical literature, are discussed.

We describe a case of intramedullary melanocytic schwannoma (MS) studied by means of fine-needle aspiration cytology (FNAC). The main cytologic features were (1) large three-dimensional clusters overshadowed by heavy pigment deposits which tested positive for Fontana Masson (and bleached with potassium permanganate), HMB-45, Vimentin, and S-100 protein; (2) loose syncytial monolayered sheets with very little pigment deposit; and (3) isolated spindle cells with polarized nucleus and tapered, thin cytoplasmic ends. Both the cytologic features and the immunophenotypic profile were nonspecific and on their own were insufficient to allow the diagnosis of MS to be reached. Clinical data and the magnetic resonance image (MRI) in conjuction with the cytologic findings did suggest the diagnosis of intramedullary MS. Diagn Cytopathol 1994;11:291–296. © 1994 Wiley-Liss, Inc.

Resumen El tumor filodes es un tumor mamario infrecuente, de estirpe fibroepitelial, que tiene generalmente un comportamiento biologico benigno. En el presente trabajo presentamos un caso clinico de tumor filodes maligno multicentrico y unilateral.

Background: Galactography is the technique of choice for investigating pathological nipple discharge. However, there is no standardized interpretation system for this procedure. Purpose: To evaluate radiological and histological correlation using a Galactogram Imaging Classification System (GICS). Material and Methods: We retrospectively studied all galactograms obtained in 62 women with pathological nipple discharge who subsequently had biopsy at our institution between 1999 and 2007. The GICS proposes five categories for galactographic findings: GICS 1: negative; GICS 2: benign; GICS 3: probably benign; GICS 4: suspect for malignancy; GICS 5: highly suspect for malignancy. Results: The galactographic findings were classified as follows: GICS 2: 25.8% (16/62); GICS 3: 30.6% (19/62); GICS 4: 25.8% (16/62); and GICS 5: 17.7% (11/62). A good correlation was observed between histological diagnosis and GICS categories ( P < 0.05). All the cases diagnosed with carcinoma ( n = 11) were classified in GICS category 5. Conclusion: The present study shows a good correlation between GICS categories and histological diagnosis.

The aim of this paper is to determine the possible association between five different profiles of immunohistochemical expression related to clinical, histopathological and immunohistochemical known prognostic value variables for breast cancer.A total of 194 breast carcinoma tumour samples were studied. In this study five groups or immunohistochemical profiles were defined, based on expression of hormone receptors (oestrogen or progesterone) and/or Her2/neu (luminal-type A, luminal-type B, mixed profile, Her2/neu profile and triple-negative-type profile) and we studied whether there are differences between them with regard to clinical, histopathological and immunohistochemical variables that have a known prognostic significance.In the series we found 134 (69%) cases corresponding to a luminal immunophenotype, of which 98 (50.5%) were from the luminal A group and 36 (18.6%) from luminal B. Twenty-nine cases (15.9%) were triple-negative, 18 (9.3%) mixed and 13 (6.7%) Her2/neu type. It is worth noting the relationship between the triple-negative and Her2/neu immunophenotypes and the more poorly differentiated histological forms (62% and 60%, respectively) and between the luminal A group and well-differentiated tumours (p = 0.008). Expression of ki67 was high in the triple-negative group (73.9%) and low in the luminal A group (26.3%; p = 0.001). The expression of p53 was also greater for the Her2/neu (55.5%) and triple-negative (60.8%) groups (p = 0.0005) than for the others.The subgroups without hormone receptor expression, with Her2/neu overexpression or without (triple-negative group), have characteristics associated with variables of a poorer prognosis. The lack of progesterone receptor expression also seems to be associated with these.

Primary non-lymphoid thymus tumors (PNLTT) are an uncommon though quite varied pathology. Our objective was to identify the clinical, therapeutic and histologic variables with a prognostic value in these neoplasms.We studied 58 PNLTT cases, corresponding to 52 epithelial neoplams (PTEN), 4 thymolipomas (7%) and 2 neuroendocrine tumors (3%). Commonest clinical manifestations were myasthenia gravis (41%) and dyspnea (21%). Three patients were symptom-free (24%). We used Kaplan-Meier survival curves and Cox regression model.All patients underwent surgery which consisted of thymectomy. Four patients underwent a biopsy procedure alone. Perioperative mortality was 3% (n = 2) and morbidity was 31% (n = 18), mainly because of respiratory and wound problems. 24 patients with PTEN, Masaoka degrees III and IV, and a patient with a lymphoepithelial carcinoma received adjuvant chemotherapy and/or radiotherapy. With a follow-up of 13 + 5 years, 12 PTEN patients and one patient with a neuroendrocrine tumor died as a consequence of the evolution of the disease. Cumulative survival was 80% at 5 years, 71% at 7 years and 63% at 10 years. There are currently two local relapses in two PTEN cases after 9 and 8 years of follow-up, respectively. Main prognostic factors are the histologic type and subtype and the clinical stage (p0.001).In PNLTT early diagnosis is crucial in order to administer a correct treatment before the clinical stage is more advanced. Main prognostic factors are the histologic type and subtype and the clinical stage.

Although subacute granulomatous thyroiditis (SGT) is usually diagnose clinically, there are other thyroid conditions that must be ruled out. This task is achieved by means of fine-needle aspiration (FNA). In retrospect, the clinical and cytologic findings seen in 36 SGT cases are reassessed with a view to deciding which findings are most reliable for reaching a confident cytologic diagnosis. These are: the simultaneous presence in the same aspirate of the following cells: 1) follicular cells with intravacuolar granules and/or plump transformed follicular cells; 2) epithelioid granulomas; 3) multinucleated giant cells; 4) an acute and chronic inflammatory dirty background; 5) the absence of the following cells: fire-flare cells, hypertrophic follicular cells, oncocytic cells, and transformed lymphocytes. The absence of one or more of these requirements does not exclude SGT but does increase the number of thyroid conditions that come into the differential diagnosis. In these cases, it is essential to review clinical data carefully and to submit the patient to a close clinical and FNA follow-up.

We have reappraised the fine-needle aspirates (FNAs) of 5 cases of the follicular variant of papillary carcinoma of the thyroid (FVPCT). Three of these had been performed on cold thyroid nodules and had been diagnosed as follicular proliferations. The remaining 2 had been performed on cervical lymphadenopathies and had been diagnosed as metastatic papillary carcinoma, probably of thyroid origin. Careful reassessment of the slides did not allow any change of the original diagnoses. We found two constant cytologic features present in all cases studied: syncytial clusters without acinar formation, and monolayered sheets. Nonconstant findings included: follicular pattern, ropy colloid, multinucleated giant cells (MGCs), and nucleoli in FNAs performed on thyroid nodules, and papillae, pseudonuclear inclusions, nuclear grooves, MGCs, and nucleoli in FNAs performed on cervical lymphadenopathies. Our findings suggest that the cytologic diagnosis of FVPCT is very difficult if based solely on the cytologic features seen in FNAs, and that it is necessary to resort to the study of surgical specimens if a definitive diagnosis is to be achieved. We are also of the opinion that more weight should be given to the aforementioned nonconstant findings when faced by a thyroid aspirate with cell richness, syncytial clusters without acinar formation, and monolayered sheets.

This is a review of the fine-needle aspirates (FNAs) of nine pilomatrixomas (PMs) found in a series of 1,500 FNAs performed on skin nodules. The objective is to determine and list the cytologic findings that might mislead the less-experienced cytopathologist and to give him advice on how to avoid such errors. The following recommendations are made: 1) The FNAs should be carried out and the smears interpreted by the same person. 2) Clinical data, particularly age and location, are of paramount importance. 3) Shadow cells are pathognomonic of PMs. 4) Basaloid nuclei with prominent nucleoli should not be overdiagnosed. 5) Use both Papanicolaou and Diff-Quik stains. 6) Think of PM when performing and interpreting aspirations from subcutaneous growths located in the head and neck of young persons.

Adenocarcinoid tumour of the appendix is a rare entity characterised by the presence of a double component (neuroendocrine and glandular). It originates in the neuroendocrine cells of the appendicular mucosa. A preoperative diagnosis of a primary appendiceal tumour is uncommon and more so one suggesting an adenocarcinoid pathology. Optimal treatment is debated between a simple appendectomy and a more extensive resection, which occasionally includes hysterectomy and bilateral ovariectomy. Our aim is to report this rare entity and conduct a review of the literature on the different treatment options.