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Diffuse Large B-Cell Lymphoma of the Central Nervous System. Immunophenotype, Clinicopathological Features and Differential Diagnosis

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Open Journal of Pathology 2012年第4期2卷 133-139页

作者： mónica belinda romero-guadarrama maría Esther Gutiérrez Díaz-Ceballos Fiacro Jiménez-Ponce Samantha Thingen-Velarde Hemathology Service Hospital General de México Mexico City Mexico mónica belinda romero-guadarrama Neurosurgery Unit Hospital General de méxico Mexico City Mexico Unit Pathology Hospital General de méxico Medicine School Autonomous University of Mexico Mexico City Mexico

Background: Diffuse large B-cell lymphomas of the central nervous system (DLBCL CNS) represent less than 1% of all lymphomas and between 2% and 3% of all cerebral tumors. They occur in adults of 60 years of age or more. The objective of this work is to describe the clinical-pathological characteristics, the immunophenotype and the differential diagnosis. Clinical Case: From the files of the surgical pathology unit we found four cases of primary diffuse large B cell lymphoma of the central nervous system in a 6-year period. Three corresponded to women over 47 years of age and the other to a 42-year-old man. The time of evolution was between 2 and 4 months. The symptoms were headache, blurred vision, hemiparesis, and seizures. Localization was in the pineal region, the frontal, parietal regions, and the right thalamus. morphologically, large lymphoid cells with a diffuse growth pattern and necrosis were observed. Immunohistochemical markers, such as CD 20 and bcl2 were positive, one was positive to CD3. Expression of bcl6 and CD 10 was positive in one case, and mUm-1 was positive in three cases. All the cases were negative for Epstein-Barr virus. Conclusions: The diffuse large-B cell lymphoma of the central nervous system is rare. Its average age of presentation is at 60 years or older. The localization is in the pineal, frontal, parietal and thalamic regions. Three cases were originated by activated B lymphocyte (mUm-1 expression) and other from the Germinal Center (GC) (CD 10 expression). The clinical course was bad. The four patients died shortly after the diagnosis.

关键词： Primary Lymphoma Central Nervous System

Antenatal use of bosentan and/or sildenafil attenuates pulmonary features in rats with congenital diaphragmatic hernia

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World Journal of Pediatrics 2014年第4期10卷 354-359页

作者： maría de Lourdes Lemus-Varela Amed Soliz belinda Claudia Gómez-meda Ana Lourdes Zamora-Perez José manuel Ornelas-Aguirre Valery melnikov Blanca miriam Torres-mendoza Guillermo moisés Zúñiga-González Division of Neonatology High Specialty Medical UnitPediatric HospitalWestern National Medical CenterMexican Social Security InstituteGuadalajaraJaliscoMéxico Neonatal Intensive Care Unit Division of NeonatologyMiami Children's HospitalMiami FLDUSA molecular Biology in medicine Institute Molecular Biology and Genomic DepartmentHealth Sciences University CenterUniversity of GuadalajaraGuadalajaraJaliscoMéxico Odontology Research Institute Integrated Odontology Clinic DepartmentHealth Sciences University CenterUniversity of GuadalajaraGuadalajaraJaliscoMéxico Pathology Department High Specialty Medical UnitNorth-western National Medical CenterMexican Social Security InstituteCiudad ObregónSonoraMéxico School of medicine University of ColimaColimaMéxico Division of Neurosciences Western Biomedical Research CenterMexican Social Security Institute and Department of ClinicsHealth Sciences University CenterUniversity of GuadalajaraGuadalajaraJaliscoMéxico mutagenesis Laboratory Western Biomedical Research CenterMexican Social Security InstituteGuadalajaraJaliscoMéxico

Background:Lung hypoplasia,pulmonary persistent hypertension of the newborn and its morphological changes are the main features in congenital diaphragmatic hernia(CDH).This study was undertaken to investigate if antenatal use of sildenafil and/or bosentan attenuates vascular remodeling,promotes branching,and improves alveolarization in experimental nitrofeninduced ***:Nitrofen(100 mg)was gavage-fed to pregnant rats at post conception day(PCD)9 to induce *** rats were randomized to 5 groups:1)control;2)nitrofen;3)nitrofen+sildenafil 100 mg/kg per day at PCD 16-20;4)nitrofen+bosentan 30 mg/kg per day,at PCD 16-20,and 5)nitrofen+bosentan+sildenafil,same doses and administration *** cesarean delivery,the offsprings were sacrifi *** diaphragmatic defect and pulmonary hypoplasia were identified,and the lungs were *** wall thickness,bronchiolar density and alveolarization were ***:The offsprings with CDH were characterized by severe pulmonary hypoplasia(lung weight-to-body weight ratio:0.0263[95%confidence interval(CI)0.0242-0.0278)]in the nitrofen group versus 0.0385(95%CI 0.0355-0.0424)in the control group(P=0.0001).Pulmonary arterial wall thickness was decreased to 3.0(95%CI 2.8-3.7)μm in the nitrofen+sildenafil group versus 5.0(95%CI 4.1-4.9)μm in the nitrofen group(P=0.02).Terminal bronchioles increased to 13.7(95%CI 10.7-15.2)μm in the nitrofen+bosentan group in contrast to 8.7(95%CI 7.2-9.4)μm in the nitrofen group(P=0.002).more significant differences(P=0.0001)were seen in terminal bronchioles in the nitrofen+sildenafil+bosentan group than in the nitrofen group[14.0(95%CI 12.5-15.4)μm versus 8.5(95%CI 7.1-9.3)μm].Pulmonary arterial wall thickness was also decreased in the former ***:In this rat model,antenatal treatment with sildenafil attenuates vascular *** promotes the development of terminal bronchioles in nitrofen-induced CDH.

关键词： antenatal treatment bosentan congenital diaphragmatic hernia pulmonary hypoplasia sildenafil

Kikuchi-Fujimoto Disease Associated to the Epstein-Barr Virus. A Type of Rare Necrotizing Lymphadenitis and Its Differential Diagnosis

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Open Journal of Pathology 2013年第4期3卷 186-192页

作者： mónica belinda romero guadarrama Oscar Daniel Guzmán-Aguilar Adriana Carolina López-Ugalde José Samuel Almeida Navarro Humberto Cruz-Ortíz Unidad de Patología Hospital General de México “Dr. Eduardo Liceaga” México D.F. México

Introduction: Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a specific and self-limited disease;its etiology is unknown. Some causal microorganisms have been proposed. The objective of the present article is to emphasize the clinicopathological characteristics of this disease that has been associated to the Epstein-Barr virus and to compare the histological changes with other types of necrotizing lymphadenopathies. material and methods: We studied 32 patients of the Surgical Pathology Service with necrotizing lymphadenitis, diagnosed in the years from 2004 to 2012 to found more cases of this rare disease in our Institution. Patients were 18 women and 14 men with an average age of 37 years. Results: The lymph nodes were cervical and axillary ones, some were associated to autoimmune diseases and no cause was identified in others. One of the cases, was diagnosed as KFD, presented morphological changes characteristic of this disease, such as subcapsular lymphoid follicles, zones with cell debris, epithelioid macrophages, clear-cytoplasm histiocytes, and immunoblast-reactive lymphocytes. Immunohistochemical markers were determined, such as CD20, CD2, CD4, CD8, CD68, lysozyme, CD56, granzyme B and EBER, which demonstrated the presence of B, T lymphocytes, histiocytes and cells positive to EBER. Histological changes in KFD occurred in three stages: proliferative stage, necrotizing, and xanthomatous. It is important to identify the histological stages of the disease because a differential diagnosis must be performed in regard to lymphadenopathies with necrosis and diverse types of lymphomas. Conclusion: We present a case of necrotizing lymphadenitis (KFD) associated to the Epstein-Barr virus and in some cases it is not possible to render a specific diagnosis based on morphologic findings, alone, and a diagnosis of necrotizing lymphadenitis may be used.

关键词： Kikuchi-Fujimoto Disease Epstein Barr Virus

Association of morphology and Immunophenotype in Diffuse Large B-Cell Lymphomas with Bone marrow Infiltration in a Sample mexican Population

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Open Journal of Pathology 2012年第2期2卷 29-37页

作者： mónica-belinda romero-guadarrama Fiacro Jiménez Ponce Armando medina Cruz Elsa Lorena Durán Ramírez Icela Palma Lara molecular and Celular morphology Laboratory Escuela Superior de Medicina Instituto Politécnico Nacional and Morphology Department Facultad de Medicina Veterinaria y Zootecnia (UNAM) México City México Unidad de Patología del Hospital General de méxico Facultad de Medicina Universidad Nacional Autónoma de México (UNAM) México City México

Introduction: Diffuse large B-cell lymphoma (DLBCL), not otherwise specified, is a large B-cell lymphoma with a diffuse growth pattern and aggressive clinical course. It is divided in subgroups according to its morphology, immunophenotype, and primary site. Dissemination to bone marrow occurs in 11% to 35% of cases and can be of concordant or discordant morphology. Objective: To examine the association, the type of bone marrow involvement in relation to the primary site, morphology, immunohistochemistry of DLBCLs and to determine the cases of Epstein-Barr virus positive DLBCLs. materials and methods: We reviewed lymph node and extranodal biopsies as well as the respective bone marrow biopsies in all cases of DLBCL diagnosed in the Hospital General de méxico during the period from 2002 to 2010. We used immunohystochemistry for immunophenotype identification (Hans’s algorithm) and an in-situ hybridization technique to detect presence of Epstein Barr encoded RNA (EBER). Results: We included 108 patients with a mean age of 51.9 years, 59 (55%) were men. DLBCL involved lymph nodes in 60% of cases and palatine tonsils in 13%. The centroblastic variant predominated (80%) and 58% originated from activated B-cells. Infiltration of bone marrow was present in 30% of cases and was discordant in 55% of these cases. Correlation between morphology and bone marrow infiltration was statistically significant (P = 0.0003). Presence of Epstein-Barr virus was demonstrated in 15% of patients older than 50 years. Conclusions: Dissemination to bone marrow occurred in 30% of cases and discordant involvement was most common. DLBCL originating from activated B-lymphocytes predominated and the most common extranodal sites were palatine tonsils, suggesting that our population has a clinical behavior similar to Asiatic populations.

关键词： Dissemination to Bone marrow Diffuse Large B-Cell Lymphoma Immunophenotype

Plasma Cell Neoplasms, Clinicopathological Characteristics and Immunophenotype of 21 Patients

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Open Journal of Pathology 2012年第4期2卷 127-132页

作者： mónica belinda romero-guadarrama Cinthia Adriana meza medina Elvira Aguilar martínez Facultad de medicina Universidad Autónoma de Nayarit Tepic Mexico Unidad de Hematología del Hospital General de méxico Mexico City Mexico Unidad de Patología del Hospital General de méxico Mexico City Mexico

Introduction: Plasma cell neoplasms are monoclonal proliferations characterized by the secretion of an immunoglobulin product known as component "m" or monoclonal. The World Health Organization (WHO 2008) defines as plasma cell neoplasms the following: plasma cell myeloma, plasmacytoma and those syndromes defined by immunoglobulin deposits and primary amyloidosis, The objective of the present work was to correlate their clinical, morphological and phenotype characteristics in 21 patients. material and methods: A 2-year retrospective review was performed of the files of the surgical pathology laboratory and of the hematology service of the General Hospital of mexico, searching for patients with a diagnosis of plasma cell neoplasm. We analyzed the following variables: age, gender, clinical symptoms, evolution, localization, laboratory tests, morphology, and expression of immunohistochemical markers. Of the 21 patients, 12 (57.1%) corresponded to plasma cell myelomas and 9 (42.8%) were plasmacytomas (seven extraosseous and two solitary bone plasmacytoma);women predominated with 61.4% and age ranged between 22 and 84 years. mass and epistaxis were observed in the patients with plasmacytomas, and symptoms of medullary compression and anemia were observed in those patients with plasma cell myeloma. The time of symptomatology varied from 3 to 12 months. Laboratory tests revealed that lactate dehydrogenase (LDH), beta 2 microglobulin, C-reactive protein were altered and that hypercalcemia and anemia were present more in the systemic form of the disease. Treatment depended on the clinical staging and laboratory data. mature forms predominated morphologically. Immunohistochemical stain revealed a constant expression for CD 138, six patients expressed CD 56, and expression of the Kappa and Lambda light chains was while.

关键词： Plasma Cell Neoplasms

Diffuse Large B-Cell Lymphoma with Anaplastic Clear Cells: A Rare Variant

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Open Journal of Pathology 2012年第4期2卷 150-154页

作者： mónica belinda romero-guadarrama Leslie Elizmara Aguilar-Ayala German Ott Jorge Pérez-Espinosa Department of Clinical Pathology Robert-Bosch-Hospital Stuttgart Germany Unit Pathology Hospital General de México OD and Medicine School Autonomous National University of Mexico Mexico City Mexico

Introduction: Diffuse Large B-Cell Lymphoma (DLBCL) is a heterogeneous group conformed by morphological and clinical varieties of neoplasms;it originates from peripheral B-cells and is distinguished into three groups: germinal center (GC), activated B lymphocyte (ABL), and the third type. The existence of DLBCL with anaplastic morphology and expression of CD30 without t (2;5) translocation is rare. The aim of the present article is to describe this morphologic variant in a 54-year-old woman and a 74-year-old man, respectively. materials and methods: Patients diagnosed with DLBCL with anaplastic variant were identified from the surgical pathology records. Results: Out of 357 biopsies with this diagnosis, 11 (3%) corresponded to the anaplastic variant, 2 presented morphological clear cells;they became visible because of an increase in volume in the cervical area of 4 months of evolution, usually associated to diaphoresis and weight loss with clinical fulminating progression. An autopsy study was performed to one patient and it showed infiltration in supraclavicular lymph nodes, thyroid, and lung. The neoplastic cells presented abundant clear cytoplasm and pleomorphic nuclei that expressed CD20, CD30 and CD45. Conclusion: This variation is rare. The clinical presentation and prognosis are controversial;we present the morphological and immunophenotype changes of this variant. The differential diagnosis from other clear cell neoplasms should be made.

关键词： B-Cell Anaplastic Lymphoma with Clear Cells

Posterior approach (Kraske procedure) for surgical treatment of presacral tumors

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World Journal of Gastrointestinal Surgery 2012年第5期4卷 126-130页

作者： José manuel Aranda-Narváez Antonio Jesús GonzálezSánchez Custodia montiel-Casado belinda Sánchez-Pérez Carolina Jiménez-mazure marta Valle-Carbajo Julio Santoyo-Santoyo Department of General Digestive Surgery and Abdominal Organs TransplantationUniversity Hospital Carlos HayaCarlos Haya Avenue29010MálagaSpain

Presacral tumors are rare,but can comprise a great variety of histological *** tumors are the most *** the diagnosis is established,surgical resection is essential because of the potential for malignancy or *** biopsy is not necessary or may be even *** decide the best surgical approach(abdominal,sacral or combined) an individual and multidisciplinary analysis must be carried *** report three cases of cystic presacral masses in which a posterior approach(Kraske procedure) enabled complete resection,the only way to decrease local *** patients had a satisfactory recovery.A brief overview of retrorectal tumors is presented,focusing on classification,clinical presentation,diagnosis and surgical management.

关键词： Presacral tumors Posterior approach Surgical management

在 laparoscopic 肝外科的快轨道的节目: 理论或事实？

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World Journal of Gastrointestinal Surgery 2012年第11期4卷 246-250页

作者： belinda Sánchez-Pérez José manuel Aranda-Narváez miguel Angel Suárez-muoz moises elAdel-delFresno José Luis Fernández-Aguilar Jose Antonio Pérez-Daga Ysabel Pulido-Roa Julio Santoyo-Santoyo Department of General Digestive and Transplantation SurgeryUniversity Regional Hospital Carlos Haya29010 MálagaSpain

AIm:To analyze our results after the introduction of a fast-track(FT) program after laparoscopic liver surgery in our Hepatobiliarypancreatic ***:All patients(43) undergoing laparoscopic liver surgery between march 2004 and march 2010 were included and divided into two consecutive groups:Control group(CG) from march 2004 until December 2006 with traditional perioperative cares(17 patients) and fast-track group(FTG) from January 2007 until march 2010 with FT program cares(26 patients).Primary endpoint was the influence of the program on the postoperative stay,the amount of re-admissions,morbidity and *** we considered duration of surgery,use of drains,conversion to open surgery,intensive cares needs and ***:Both groups were homogeneous in age and *** differences in technique,time of surgery or conversion to open surgery were found,but more malignant diseases were operated in the FTG,and then transfusions were higher in *** and morbidity were similar in both groups,without *** stay was similar,with a median of 3 for CG vs 2.5 for ***,the 80.8% of patients from FTG left the hospital within the first 3 d after surgery(58.8% for CG).CONCLUSION:The introduction of a FT program after laparoscopic liver surgery improves the recovery of patients without increasing complications or re-admissions,which leads to a reduction of the stay and costs.

关键词： Liver surgery Laparoscopy Fast-track