Revista Espanola de Patologia最新文献

Introduction and Objectives

The histopathological identification of Helicobacter pylori using the routine method (haematoxylin–eosin) is not only very difficult but also has low sensitivity. Giemsa staining is often used in addition, but different protocols do not produce homogeneous results. Furthermore, the Gold Standard recommended by the European Helicobacter Pylori Study Group has been applied in very few studies, thus resulting in uncertain outcomes. Therefore, a new staining method is required to overcome these limitations. The aim of this study was to evaluate the diagnostic capacity and inter-observer agreement of “Gissell's stain”.

Material and Methods

A cross-sectional study evaluated 99 gastric paraffin blocks from a private laboratory. Three sections were prepared from each block, and haematoxylin–eosin (HE), Giemsa and “Gissell's stain” methods were applied. The kappa statistics, sensitivity, specificity, and predictive values were calculated.

Results

“Gissell's stain” obtained the highest inter-observer agreement (kappa = 0.87) compared to the other two methods (HE, kappa = 0.51; Giemsa, kappa = 0.83). It also obtained the best sensitivity and negative predictive value (97.1% and 98.3%, respectively) compared with the other two methods (HE: 68.6% and 85.1%, respectively; Giemsa: 88.6% and 93.9%, respectively).

Conclusions

Given its unique characteristics (fast, cheap, accessible, and easy to use), in addition to its statistical reliability, “Gissell's stain” has great potential for routine use in the identification of H. pylori.

Synovial sarcoma is a soft tissue tumor of uncertain origin. Generally, it is a monophasic spindle cell neoplasm that can have glandular-like structures. Ossification and presence of calcification is a rare phenomenon with only a few reported cases. We present the case of a young male with a synovial sarcoma of the right foot. Histology revealed prominent deposits of tumoral osteoid and coarse calcifications. The diagnosis was confirmed by the expression of SS18 by immunohistochemistry and the demonstration of the rearrangement of the SS18 gene by fluorescent in situ hybridization. We reviewed the literature for synovial sarcoma with prominent ossification or calcification, and to the best of our knowledge, this is the first case with expression of SS18 by immunohistochemistry. The main differential diagnoses are osteosarcoma (both primary of bone and extraosseous) and sclerosing epithelioid fibrosarcoma.

Yellow nail syndrome is a rare disease of unknown aetiology. Patients with YNS have a characteristic yellowish-coloured nails, pulmonary alterations and primary lymphedema. To the best of our knowledge, only a few reports of autopsy findings in these patients have been published. Its aetiology possibly involves a primary malformation of larger lymph vessels. We describe autopsy findings not previously associated with yellow nail syndrome, such as expansion of mediastinal lymph-nodes and splenic sinusoids.

The present autopsy reveals hitherto unreported findings associated with YNS, such as alterations in splenic sinusoids and mediastinal lymph-node sinuses.

Large cell carcinoma of the lung with null-immunophenotype (LCC-NI) is a diagnostic entity that is especially uncommon now as it does not have any type of cell differentiation or its own molecular alterations. It presents an exceptional diagnostic challenge; indeed, the diagnosis is only possible with complete surgical excision and adequate immunohistochemical and molecular studies. We report the case of a 69-year-old male, with a history of long-term smoking who presented with pleuritic pain. A tumor in the upper lobe of the right lung was detected and removed by lobectomy. Histopathology revealed a neoplasm with large cell morphology without any specific immunophenotype, molecular or genomic rearrangements through next-generation sequencing (NGS) studies, which was diagnosed as LCC-NI.

José Luis Arteta, was one of Cajal's last students at the outstanding institute of neurohistology. His career highlights a time of transition in Spanish pathology during the difficult years between the 1940s and the early 1950s, following the Spanish civil war. Diagnostic pathology was beginning to take place within the hospital setting and eventually, in 1959, the Spanish Society of Pathology (SEAP) was founded. Like many of his peers, he was expert in clinical autopsies, but he also had the opportunity, in the Provincial Hospital in Madrid, to develop skills in biopsy diagnosis under the tutelage of Carlos Jimenez Díaz, the most brilliant clinician of the time. He continued his research at the Cajal Institute and in collaboration with Gregorio Marañón. However, not only was Arteta a notable physician and pathologist, he was also a cultured humanist and close friend of Pío Baroja. His premature death at age 45 from poliomyelitis remains somewhat of a mystery: was it caused by an environmental infection or an accidental inoculation during his research on the virus?

Idiopathic multicentric Castleman disease (iMCD) is rare. The differential diagnosis includes inflammatory, autoimmune and neoplastic disease. The identification of the histopathological features of Castleman disease in the lymph node is the main diagnostic criterion.

Fifty-three experts from three medical societies (SEMI, SEHH and SEAP) have created a multi-disciplinary consensus document in order to standardise the diagnosis of Castleman disease. Using the Delphi method, specific recommendations for the initial clinical, laboratory and imaging studies have been made for an integrated diagnosis of iMCD as well as for the best way to obtain samples for histopathological confirmation, correct laboratory procedure and interpretation and reporting of results.

We present a case of a 64-year-old male with a history of Crohn's disease who presented with an episode of acute abdominal pain. He was being investigated for a dermatological lesion. A skin and lung biopsy both revealed histiocytosis of the “L” (Langerhans) group. The skin biopsy showed a proliferation of histiocytic cells expressing Langerin, CD1a and S100 and the molecular study was positive for the BRAF p.V600E mutation. In the lung biopsy, a proliferation of histiocytic cells was found, which were positive for CD68 and S100 and negative for Langerin and CD1a; mutations in NRAS c.38G>A in exon 2 (p.G13D) were also detected.

We report a rare case of a poorly differentiated synovial sarcoma (SS) with rhabdoid features. A 33-year-old woman was referred to our hospital with a chest wall tumor. MRI revealed a diffuse mass that invaded the pleura and extended into the esophagus, aorta, diaphragm and pancreas. Histopathological examination of the neoplasm showed it to be composed of sheets of small/medium cells with rhabdoid morphology, consisting of round, eccentrically localized nuclei, conspicuous nucleoli, and eosinophilic cytoplasm. Immunohistochemical studies demonstrated the tumor cells to be positive for TLE1, Bcl-2, EMA, CAM5.2, CD138 and CD56 and negative for desmin, smooth muscle actin or S100 protein. Fluorescent in-situ hybridization technique, performed on the paraffin section, showed SS18 gene rearrangement in the nuclei of the tumor cells. Poorly differentiated SS with “rhabdoid” features was diagnosed. This is only the 8 th case of a SS with “rhabdoid” features reported to date.