Histiocytic necrotizing lymphadenitis. Report of three cases Histiocytic necrotizing lymphadenitis (HNL), also known as Kikuchi's disease is a rare condition of unknown etiology. Patients present with cervical lymph node enlargement, fever and malaise. The diagnosis is made by excision biopsy. However, this entity must be distinguished from both reactive processes and malignant tumors such as lymphoma. The clinical course is self limited with spontaneous resolution within a few months. We report three patients with the disease. A 37 year-old woman with a 4 months history of a painless submaxillary mass of 2.5 cm diameter, attached to the deep tissues of the neck. The mass was excised and the biopsy report was HNL. After 26 months of follow up, the patient is asymptomatic. A 30 year-old woman with a history of 2 months of a painless lateral cervical mass and aspiration biopsy was reported as suspicious for lymphoma. An excision biopsy was performed, that was reported as HNL. In both patients, lymphoma was ruled out by immunohistochemistry. A 33 year-old woman with a 3 weeks history of an asymptomatic lateral cervical mass. Biopsy was reported as HNL. This condition must be included in the differential diagnosis of cervical asymptomatic masses. The clinician must be aware of it to avoid longterm, costly treatments (
Depending on age, sex, and geographic area, 19 to 67% of the general population is found to have thyroid nodules when submitted to ultrasonically-guided diagnostic puncture. Being benign in more than a 80%, most of them corresponds to colloid nodules. Indiscriminate fine-needle aspiration not only increases health costs but also generates anxiety in patients. The echographic-histological correlation of thyroid nodules made it possible to define five typical patterns (colloid patterns 1, 2, 3; neoplastic type, and malignant pattern). Thirty three percent of colloid nodules may appear as follicular neoplasms or malign nodules, being puncture the only means for recognizing and establishing the difference between them. Nevertheless, 67% of nodules presents a typical appearance that corresponds to colloid patterns 1, 2, and 3, which show a weak association to cancer risk (0%, 0% and 1,5%, respectively). On this basis, ultrasound follow-up is advised to recognize them in order to significantly diminish unnecessary diagnostic histological punctures.
El rabdomiosarcoma (RMS) es un tumor sólido maligno de origen mesenquimático. Es el sarcoma de tejidos blandos más común en la infancia y adolescencia. Un 65% de los casos son diagnosticados antes de los 6 años. Los subtipos histológicos incluyen al RMS embrionario, alveolar, pleomórfico y de células fusadas. El subtipo embrionario es más frecuente en los niños, mientras que el alveolar es más frecuente en adolescentes y adultos.Objetivo: Describir la presentación clínica de un rabdomiosarcoma alveolar primario en una escolar.Caso Clínico: Escolar femenina de 7 años que debuta con dolor progresivo en el muslo izquierdo de un mes de evolución. La radiografía muestra un tumor con compromiso lítico a nivel diafisiario de fémur izquierdo. Se realizó estudio con 2 biopsias, inmunohistoquímica y estudio de PAX-FOXO1 compatibles con RMS alveolar. Recibió quimioterapia, con buena evolución posterior.Conclusión: El Rabdomiosarcoma alveolar primario óseo es infrecuente, pero debe ser considerado dentro del diagnóstico diferencial de los tumores óseos primarios de células pequeñas, redonadas y azules. Este tipo de tumor, a pesar de presentar una citogenética de mal pronóstico, parece tener un mejor comportamiento biológico, siendo necesario para un tratamiento exitoso tener un alto índice de sospechar para instalar una terapia multimodal en el contexto de un protocolo nacional.
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