A 39 year-old woman with severe neutropenia due to bone marrow hypoplasia and ethmoidal and sphenoidal sinusitis by Aspergillus spp. developed a right cavernous sinus thrombosis. The patient died despite of the treatment with amphotericin B.

Paciente varón de 28 años con dos meses de dolor punzante en el hemitórax superior, cuello y congestión facial.

El síndrome de Sweet (SS) fue descrito por primera vez por Robert Douglas Sweet, en 1964, tras observar a ocho pacientes mujeres en el Hospital General de Plymouth. Entre 1949 y 1964 se describieron las cuatro características fundamentales para el diagnóstico de la enfermedad: fiebre; leucocitosis neutrofílica; erupción aguda en forma de placas y/o nódulos eritematosos y edematosos generalizados; infiltrado neutrofílicodérmico masivo sin vasculitis. El SS se ha descrito en todo el mundo sin predilección racial y es caracterizado por la aparición abrupta de fiebre, neutrofilia, lesiones eritematoso cutáneas e, histológicamente, por un infiltrado difuso de neutrófilos ubicado en la dermis superior.

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Mujer de 18 años que ingresó al hospital por presentar dolor torácico y disnea de esfuerzos en los últimos nueve meses, más hemoptisis recurrente. Los estudios de imagen revelaron una masa en el mediastino anterior superior. Después de la resección quirúrgica, la histopatología demostró varios tejidos epiteliales y cartilaginosos compatible con teratoma quístico maduro.

Colonic polyp refers to lesions that exhibit a protrusion of the mucosa, regardless of histology. The most recent WHO classification is based on a better understanding of these lesions; however, its application in daily practice could be subject to interobserver variability biases that could have clinical implications. Objectives: To determine the interobserver variability in the histopathological reporting and grading of dysplasia of samples obtained from elevated colon lesions in a private laboratory in the city of Lima. Materials and methods: Observational, descriptive, and prospective study: Case series type. All biopsies of elevated colon lesions received over a period of 3 months were evaluated by two observers without clinical information of the cases, to diagnose the lesions according to the WHO classification. In cases of diagnostic differences, the cases were evaluated together...

A 30-year-old woman with a previous diagnosis of systemic lupus erythematosus presented with fever, night sweats, mild dyspnea, epigastric pain, and weight loss. The tomography showed a mediastinal mass. The pathology and immunohistochemistry of the tumor was compatible with a B1 thymoma. Even the low frequency among SLE patients, we must include thymoma in every patient with SLE and a mediastinal mass.

Mujer de 40 años, sin antecedente de patología tiroidea, con historia de enfermedad de cuatro semanas caracterizado por baja de peso, aumento rápido del tamaño de la glándula tiroides y dolor óseo generalizado. El examen físico mostró bocio multinodular no doloroso con múltiples ganglios cervicales. Los análisis de laboratorio mostraron anemia y niveles elevados de transaminasas, fosfatasa alcalina y deshidrogenasa láctica. El perfil tiroideo fue normal y los anticuerpos antiperoxidasa tiroidea fueron negativos. La biopsia por aspiración mostró carcinoma de tiroides. Se realizó una tiroidectomía total con disección amplia de los ganglios del cuello y en el estudio de anatomía patológica resultó un carcinoma anaplásico de tiroides. La evolución de la paciente fue desfavorable, falleciendo por insuficiencia respiratoria, secundaria a embolismo pulmonar. El carcinoma an...

We present the case of a 53-year-old male patient, a man who had sex with men. He described the presence of inguinal adenopathy and non-painful ulcer with indurated edges on his penis that heal spontaneously after 3 months. In the same period of time the patient presented: tenesmus, bleeding and rectal pain. In the proctoscopy was observed at the level of the rectum: deep ulcer with regular and indurated edges, ulcerated bed with abundant mucus; The rectal mucosa around the ulcer had multiple circumferential erosions 2-4 mm in diameter. The biopsy showed infiltration of lymphomonocollar cells and granulomas. The HIV ELISA test was positive, CD 4: 275 cel./uL, HIV viral load: 10 300 copies / ml, VDRL: Non-reactive, FTA-Abs: 1/10 (positive). Warthin-Starry staining was used in the rectal ulcer biopsy sample identifying spirochetes. After the administration of benzatinic Penicillin G, the s...

Acute gastric dilation is based on two theories, the mechanical one that is explained by the superior mesenteric artery syndrome and the atonic one; The latter is the product of a medical condition in which the stomach progressively becomes hypotonic and over-distended even in the absence of an obstructive mechanical cause; it most often occurs in patients with eating disorders; which can lead to a rare but fatal complication such as gastric perforation; We present the case of an 18-year-old patient who comes to the emergency service of our hospital with acute abdominal pain, undergoes surgery, where there is perforation of the anterior gastric wall, and a proximal partial gastrectomy is performed, and a sends the specimen for pathology study. Histopathology shows transmural necrosis predominantly in the gastric fundus.

Introduction: Cutaneous anthrax is a zoonosis caused by Bacillus anthracis characterized by painless necrotic ulcer that usually heals spontaneously and without complications. The case of a farmer and cattle breeder male patient who presented a bullous serosanguineous ulcer surrounded by necrotic lesions in the ventral right forearm and multiple purulent satellite vesicles associated with extensive edema and disabling pain in the affected limb is reported. On admission, examinations revealed leukocytosis (15 000/mL), total CPK (1 730 U/L) and positive test for Bacillus anthracis by polymerase chain reaction (PCR). Compartment syndrome was diagnosed and emergency fasciotomy was performed. Surgical report was necrotizing fasciitis by finger test. Mild Volkmann ischemic contracture was found during follow-up. Diagnosis of compartment syndrome should be considered when disabling pain is pres...

Varón de 52 años con antecedente de pancreatitis aguda cuatro años antes de su ingreso; acudió con tiempo de enfermedad de 30 días caracterizado por tumoraciones dolorosas de color violáceo en miembros inferiores. La biopsia de piel mostró signos compatibles con paniculitis pancreática. Durante su hospitalización el paciente cursó con un nuevo cuadro de pancreatitis aguda con respuesta favorable a tratamiento de soporte con lo que las lesiones en miembros inferiores evolucionaron favorablemente.

Varón de 76 años, con antecedentes de hipertensión arterial y enfermedad de Parkinson que ingresó por un accidente cerebrovascular isquémico derecho. Se le halló cuatro módulos indoloros en la región subescapular izquierda, uno de ellos drenando secreción purulenta, de un año y medio de evolución. Se demostró una fístula y los estudios iniciales fueron negativos, excepto la presencia de Staphylococcus aureus como superinfección. La biopsia reveló una reacción inflamatoria crónica de tipo granulomatoso con formación de cáseo. El test de tuberculina fue positivo y el cultivo MODS fue positivo para Mycobacterium tuberculosis. Hubo mejoría clínica luego del tratamiento convencional. Además, se le diagnosticó depresión mayor severa. 

A 52-year-old female patient who presented pain and swelling in the right lower limb, a left-sided supraclavicular lymph node and microcytic hypochromic anemia. It was ruled out gastrointestinal blood loss through normal upper and lower endoscopies. The abdominal tomography showed an irregular pattern in the gallbladder, whose biopsy resulted in adenocarcinoma. It is concluded that it was a patient with a malignant neoplasm of the gallbladder who presented as a Trousseaus’s syndrome and a Virchow-Troisier’s lymph node.

Mucormycosis is an opportunistic infection caused by a group of filamentous fungi belonging to the subphylum Mucormycotina. The clinical presentation is diverse including rhino-cerebral, pulmonary, cutaneous, gastrointestinal and disseminated locations. Cutaneous mucormycosis account for 19% of all cases. We report the case of a young male presenting with extensive cutaneous involvement after a burn with an unknown substance followed by local application of herbal medicines. He was initially treated in a peripheral health care center and was subsequently transferred to our hospital, where a surgical debridement was performed plus intravenous antimicrobial therapy with no improvement. A skin biopsy was performed showing fat necrosis and inflammation with granulocyte predominance. Broad hyphae were observed inside necrotic adipocytes characteristic of mucormycosis. The patient received par...

Immunohistochemistry (IH) allows to classify breast cancer in subtypes that are relevant for treatment and prognosis. Compared to genetic markers, IH is cheaper, easier to perform and has good correlation with molecular subtypes. Objective: To describe the immune phenotypic profile of patients with breast cancer attended at a public hospital in Lima, Peru. Methods: Cross-sectional study that included all cases of invasive breast cancer diagnosed from May 1st 2015 to April 30, 2017. Histopathological description was performed and cases were classified based on current protocols into four subtypes. Results: 330 cases were included; 71 were excluded; 259 were left for analysis. Mean age was 54.64 ± 14.07 years. In half of cases the cancer was located in the right breast. The invasive ductal carcinoma accounted for 88.03% of cases; the intermediate histological degree was found in 53.28% of...

Mujer de 42 años que ingresó por hipertensión arterial maligna. Se le halló una tumoración suprarrenal izquierda de característica grasa, con elevación de las metanefrinas en orina de 24 horas. Con el diagnóstico de feocromocitoma, se le realizó una adrenalectomía. Se halló un mielolipioma. Después, la presión arterial se normalizó y la excreción de metanefrinas en orina de 24 horas estuvieron dentro de valores normales.

Varón de 20 años, procedente de Cuzco. Ingresó por dolor abdominal y en anasarca. Antecedente de retardo mental leve. Al examen pápulas rojizas faciales (Figuras 1 y 2), fibroma periungueal (Figura 3). Máculas hipopigmentadas en tórax y glúteos (Figura 4). Placas rugosas a nivel lumbosacro (Figura 5). La biopsia de piel mostró angiofibromas. La TEM cerebral reveló calcificaciones subependimarias periventriculares (Figura 6). Evolucionó con síndrome nefrótico y falla renal aguda. La biopsia renal mostró angiomiolipomas (Figura 7) y glomeruloesclerosis focal y segmentaria.

This is the case of an elderly patient with a 40-year history of stomach ulcer, whose relatives perceived behavioral changes for the last two months. Those changes progressively included disorientation, psychomotor agitation, negativism and delirium of persecution, which caused him to be brought to the emergency room. He also showed marked pallor and multiple ecchymosis, due to which he was hospitalized in our service and diagnosed with reversible dementia caused by pernicious anemia. Pancytopenia and neurological changes were also found. The patient responded favorably to the administration of vitamin B12.

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