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Case report: Large-cell calcifying Sertoli cell tumor
No full textCase history
21-year-old male with a painless mass in the right testicle and a prior history of cutaneous lesions.
Histologic findings
Figures show a proliferation composed of large, polygonal cells with ample, eosinophilic cytoplasm, round nuclei, evident nucleoli, with a trabecular, cord-like pattern of growth, associated with foci of dystrophic calcification and psammomatous bodies, within a myxoid loose stroma.
Discussion
Large-cell calcifying Sertoli cell tumor is an unusual morphological variant of Sertoli cell tumors composed of large polygonal Sertoli cells associated with calcification. Around one third of all cases appear in patients with the Carney or, less frequently, with the Peutz-Jeghers syndrome.
Clinically, it presents as a small (
Microscopically, solid, tubular, and cord-like growth patterns can be observed. Tumor cells are large polygonal with abundant eosinophilic, finely granular cytoplasm, vesicular nuclei with prominent nucleoli, within a myxohyaline stroma. Distinct calcifications characterized by large, laminated calcified nodule, psammoma bodies and focal ossification, and neutrophilic infiltration, can be also found.
The presence of large tumor size (>4 cm), overt nuclear atypias, increased mitotic activity (>3 mitosis/10 HPF), necrosis, extratesticular extension, and vascular invasion are associated with clinical aggressive behavior. Malignant tumors appear in patients older than 25 years old and are usually not associated with syndromes.
Tumor cells are positive for vimentin, S-100, EMA, melan-A, desmin, and inhibin, and focally positive for cytokeratins. The main differential diagnoses of large-cell calcifying Sertoli cell tumor include Sertoli cell and Leydig cell tumors.
Most of the cases behave indolently, and surgical excision is the treatment of choice.</p
Case report: Adenosquamous carcinoma of the penis
No full textCase history
55-year-old patient with a penile tumor located in the perimeatal area of the glans
Histologic findings
Microphotographs show a biphasic proliferation of tumors cells showing squamous and glandular differentiation, deeply infiltrating penile erectile tissues. Squamous and glandular structures are found either segregated or in the same tumor nests.
Discussion
Adenosquamous carcinoma is a rare penile SCC variant characterized by the presence of solid squamous tumor nests intermingled with areas of glandular differentiation. Less than 20 cases have been reported. The tumor originates in the glans central/perimeatal region and has a tendency for deep infiltration. Most tumors are of high-grade, with frequent vascular and perineural invasion. Metastatic rate is high but cancer-specific mortality remains low.
Histologically, areas with squamous differentiation predominate. The glandular component is positive for mucin stains and CEA.
The main differential diagnosis is with penile tumors with glandular features, including mucoepidermoid, pseudoglandular, urothelial carcinomas of distal urethra with glandular differentiation and true adenocarcinomas of Littré glands. Mucoepidermoid carcinoma of penis is an exceedingly rare tumor which is histologically similar to its cervical counterpart. Neoplastic population is composed of cell with squamous differentiation and cells showing evidence of glandular differentiation (pale, granular and ample cytoplasm with positivity for mucin stains and CEA) without well-defined glandular or ductal structures. Although more data are needed, it seems that mucoepidermoid carcinoma is more aggressive than conventional adenosquamous carcinoma.
In pseudoglandular carcinoma the extensive acantholysis can simulate glands lumina but there is no true epithelial lining. Urothelial carcinomas originating in the penile distal urethra or extending from prostate, bladder or even ureter/renal pelvis, can depict glandular features. However, a previous history of urothelial carcinoma elsewhere and the frequent finding of in situ urothelial carcinoma (which is absent in adenosquamous carcinoma) aid in the differential diagnosis.
In adenocarcinomas originating in Littré glands there is no true squamous differentiation and tumors tend to be ventrally located with only secondary extension to the perimeatal glans area. Finally, entrapment of Littré’s glans by an otherwise usual SCC can simulate the aspect of an adenosquamous carcinoma. However, the morphology of the glandular component remains bland and admixtures are limited to the periurethral area.
Selected references
Chaux & Cubilla. Semin Diagn Pathol. 2012 29(2): 72-82
Cubilla et al. Am J Surg Pathol. 1996 20(2): 156-60
Romero et al. Clinics (Sao Paulo). 2006 61(4): 363-4</p
Case report: Papillary squamous cell carcinoma of the penis
No full textCase history
62-year-old male with a verruciform tumor located in distal penis and involving glans.
Histologic findings
The microphotographs show an exophytic verruciform tumor mass characterized by papillomatosis, slight to moderate acanthosis, and hyperkeratosis. Papillae are complex, some with blunt and others with spiky tips. Fibrovascular are present in most but not all papillae and are irregularly shaped. Tumor base is jagged and there is a prominent stromal reaction. Neoplastic cells in papillae and infiltrative tumor nests are well to moderately differentiated (grades 1-2) and no koilocytic atypia is observed.
Discussion
Verruciform penile tumors comprise about one-quarter of all penile squamous cell carcinomas (SCC) and include papillary, verrucous, and warty carcinomas, as well as giant condylomas and carcinoma cuniculatum. As a group, verruciform carcinomas are characterized by the presence of papillomatosis, acanthosis, and hyperkeratosis. However, there are distinctive morphological features for each one of these tumors. For papillary SCC, the most distinguishing feature is the presence of complex papillae with irregularly shaped fibrovascular cores. Papillary carcinomas tend to be polymorphic with some areas exhibiting condylomatous papillae and others with a more verrucous-like aspect. Fibrovascular cores are readily found in the former and are scant or even absent in the latter.
Another important clue in the differential diagnosis with other verruciform tumors is the presence of a jagged tumor-stroma interface. In verrucous and cuniculatum carcinomas the tumor front is broad-based. The absence of koilocytosis allows the distinction from warty carcinomas and giant condylomas, tumors in which koilocytes are conspicuous. HPV status may be helpful in problematic cases, since in papillary carcinomas the HPV detection rate is very low or even null. Immunohistochemistry for p16INK4a is also useful since the vast majority of papillary carcinomas do not overexpress this protein. In order for a penile tumor to be considered as p16INK4a positive all neoplastic cells should be stained. Cases like this one in which some cells stain and others do not should be regarded as negative for p16INK4a overexpression.
The inguinal metastatic rate of penile papillary carcinomas is very low and the prognosis is good. Less than one-fifth of all patients present inguinal involvement and even in these cases the mortality rate is low. Even when tumors invade penile erectile tissues prognosis is good as long as no high-grade areas (observed in a minority of the patients) are identified.
Clinically patients should be managed using risk-group stratification systems and taking into account histological grade, anatomical level of maximum tumor infiltration, and the presence of vascular and perineural invasion.
References
Chaux et al. Am J Surg Pathol. 2010 34(2): 223-30
Chaux & Cubilla. Semin Diagn Pathol. 2012 29(2): 72-82
Chaux & Cubilla. Semin Diagn Pathol. 2012 29(2): 67-71</p
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
La importancia crítica del consentimiento informado en la práctica médica y la investigación biomédica contemporánea
Get PDFInformed consent is a fundamental ethical and legal principle in medical practice and biomedical research, essential for protecting patient autonomy. This article offers a comprehensive analysis of its importance, starting with the definition of its essential components: comprehension, voluntariness, competence, and adequate disclosure of information. Significant contemporary challenges to its effective acquisition are examined, including communication barriers, cultural variations, systemic limitations, the increasing complexity of interventions, and the impact of new technologies. Subsequently, evidence-based strategies and technological tools, such as multimedia resources, electronic consent, health literacy initiatives, and interactive processes, designed to improve patient understanding and satisfaction, are explored. The article also documents the profound impact of the quality of the consent process on clinical outcomes, patient trust, treatment adherence, and the incidence of litigation and ethical breaches. Finally, emerging trends and unresolved ethical dilemmas arising from advances in genomic medicine, artificial intelligence, big data research, and global health initiatives are analyzed. This underscores the need for continuous adaptation and reflection to ensure that informed consent remains a significant and robust practice in a constantly evolving healthcare environment.El consentimiento informado es un principio ético y legal fundamental en la práctica médica y la investigación biomédica, esencial para proteger la autonomía del paciente. Este artículo ofrece un análisis integral de su importancia, comenzando por la definición de sus componentes esenciales: comprensión, voluntariedad, competencia y divulgación adecuada de la información. Se examinan los desafíos contemporáneos significativos para su obtención efectiva, incluyendo las barreras de comunicación, las variaciones culturales, las limitaciones sistémicas, la creciente complejidad de las intervenciones y el impacto de las nuevas tecnologías. Posteriormente, se exploran estrategias basadas en la evidencia y herramientas tecnológicas, como recursos multimedia, consentimiento electrónico, iniciativas de alfabetización en salud y procesos interactivos, diseñadas para mejorar la comprensión y la satisfacción del paciente. El artículo también documenta el profundo impacto de la calidad del proceso de consentimiento en los resultados clínicos, la confianza del paciente, la adherencia al tratamiento y la incidencia de litigios y brechas éticas. Finalmente, se analizan las tendencias emergentes y los dilemas éticos no resueltos que surgen con los avances en medicina genómica, inteligencia artificial, investigación con macrodatos e iniciativas de salud global, subrayando la necesidad de una adaptación y reflexión continuas para asegurar que el consentimiento informado siga siendo una práctica significativa y robusta en un entorno sanitario en constante evolución
La caja de Pandora digital: Consideraciones bioéticas en la era de los macrodatos en salud
Get PDFThe proliferation of big data in the health sector promises to transform research and clinical practice, but simultaneously poses profound bioethical challenges. This narrative review, informed by a search on Scite.ai, synthesizes the key ethical considerations associated with the use of health big data. The challenges of obtaining valid informed consent are examined, and alternative models such as broad consent, dynamic consent, and meta-consent are discussed. The persistent risks to patient privacy arising from anonymization and deidentification techniques, and their ethical implications, are analyzed. It is explored how the use of big data can perpetuate or exacerbate inequities and biases, highlighting considerations of distributive justice and non-discrimination. The debates on ownership, governance, and control of data are addressed, contrasting individual control with the common good and institutional stewardship. The proposed ethical frameworks for the fair distribution of benefits and the requirements for transparency and accountability in AI algorithms are reviewed. Specific considerations for vulnerable populations and the necessary adaptation of Research Ethics Committees are discussed. Finally, the factors that influence public trust and the ethical challenges of international data exchange are analyzed. In conclusion, the ethical navigation in the era of big data requires robust frameworks, transparent governance, rigorous privacy protection, promotion of equity, and an ongoing commitment to public trust and individual rights.La proliferación de macrodatos (big bata) en el sector salud promete transformar la investigación y la práctica clínica, pero simultáneamente plantea profundos desafíos bioéticos. Esta revisión narrativa, informada por una búsqueda en Scite.ai, sintetiza las consideraciones éticas clave asociadas al uso de macrodatos sanitarios. Se examinan los desafíos para obtener un consentimiento informado válido y se discuten modelos alternativos como el consentimiento amplio, dinámico y meta-consentimiento. Se analizan los riesgos persistentes para la privacidad del paciente derivados de las técnicas de anonimización y desidentificación, y sus implicaciones éticas. Se explora cómo el uso de macrodatos puede perpetuar o exacerbar inequidades y sesgos, destacando consideraciones de justicia distributiva y no discriminación. Se abordan los debates sobre propiedad, gobernanza y control de los datos, contrastando el control individual con el bien común y la custodia institucional. Se revisan los marcos éticos propuestos para la distribución justa de beneficios y los requisitos de transparencia y rendición de cuentas en algoritmos de IA. Se discuten consideraciones específicas para poblaciones vulnerables y la necesaria adaptación de los Comités de Ética en Investigación. Finalmente, se analizan los factores que influyen en la confianza pública y los desafíos éticos del intercambio internacional de datos. Se concluye que la navegación ética en la era de los macrodatos requiere marcos robustos, gobernanza transparente, protección rigurosa de la privacidad, promoción de la equidad y un compromiso continuo con la confianza pública y los derechos individuales
El filo digital de la medicina: Navegando los desafíos bioéticos del uso de redes sociales por médicos y pacientes
Get PDFBackground: The increasing integration of social media in daily life has transformed the interaction between doctors and patients, presenting opportunities for communication and education, but also significant bioethical challenges. The management of confidentiality, professionalism, relationship boundaries, and misinformation are central concerns. The objective of this review is to synthesize the key bioethical considerations for the use of social media by doctors and patients.
Methods: A narrative review was carried out, analyzing recent literature on ethical challenges, the impact on the doctor-patient relationship, proposed guidelines, privacy risks, and the management of misinformation on social media in the health context.
Results: The main ethical challenges for doctors include the risk of violating patient confidentiality, the difficulty in maintaining clear professional boundaries, the management of online identity, and responsibility for the dissemination of erroneous information. The use of social media by patients impacts the doctor-patient relationship by blurring boundaries and posing privacy risks, although it can also foster patient participation. There are ethical guidelines proposed by professional organizations and academic literature, focused on confidentiality, professionalism, and responsible communication. Significant bioethical risks focus on data privacy, confidentiality, and potential “privacy fatigue.” Addressing misinformation requires doctors to balance factual correction with sensitivity to patients\u27 perspectives and promote health literacy.
Conclusions: The use of social media in the health field presents a complex bioethical panorama. Careful navigation is required by doctors and patients, guided by solid ethical principles, clear guidelines, and continuous education on digital professionalism and information management. A balanced approach can take advantage of the benefits of these platforms while minimizing their inherent risks.Antecedentes: La creciente integración de las redes sociales en la vida cotidiana ha transformado la interacción entre médicos y pacientes, presentando oportunidades para la comunicación y la educación, pero también significativos desafíos bioéticos. La gestión de la confidencialidad, el profesionalismo, los límites de la relación y la desinformación son preocupaciones centrales. El objetivo de esta revisión es sintetizar las consideraciones bioéticas clave para el uso de redes sociales por parte de médicos y pacientes.
Métodos: Se realizó una revisión narrativa, analizando literatura reciente sobre los desafíos éticos, el impacto en la relación médico-paciente, las guías propuestas, los riesgos de privacidad y el manejo de la desinformación en redes sociales en el contexto sanitario.
Resultados: Los principales desafíos éticos para los médicos incluyen el riesgo de violar la confidencialidad del paciente, la dificultad para mantener límites profesionales claros, la gestión de la identidad en línea y la responsabilidad ante la diseminación de información errónea. El uso de redes sociales por parte de los pacientes impacta la relación médico-paciente al difuminar límites y plantear riesgos de privacidad, aunque también puede fomentar la participación del paciente. Existen directrices éticas propuestas por organismos profesionales y la literatura académica, enfocadas en la confidencialidad, el profesionalismo y la comunicación responsable. Los riesgos bioéticos significativos se centran en la privacidad de los datos, la confidencialidad y la potencial «fatiga de privacidad». Abordar la desinformación requiere que los médicos equilibren la corrección fáctica con la sensibilidad hacia las perspectivas de los pacientes y promuevan la alfabetización en salud.
Conclusiones: El uso de redes sociales en el ámbito de la salud presenta un complejo panorama bioético. Se requiere una navegación cuidadosa por parte de médicos y pacientes, guiada por principios éticos sólidos, directrices claras y una educación continua sobre el profesionalismo digital y la gestión de la información. Un enfoque equilibrado puede aprovechar los beneficios de estas plataformas minimizando sus riesgos inherentes
El swipe infinito: Efecto de las aplicaciones de citas en las relaciones románticas vis-à-vis
Get PDFThis article examines the role of dating apps in shaping romantic relationships, highlighting the main challenges that arise in digital interaction. Although apps have democratized access to potential partners and offer greater opportunities for encounters, their intensive use brings about obstacles such as the perception of an “infinite” supply, the propensity for evasive behaviors (ghosting, breadcrumbing), and the constant search for validation. These dynamics can lead to relationships characterized by immediacy and superficiality, hindering the development of intimacy and commitment. Likewise, competitiveness reflects the tension between the convenience of virtual contacts and the need to cultivate fundamental values for solid bonds, such as empathy and honesty. In this light, the article emphasizes the importance of digital responsibility at both the user and platform levels, as well as the relevance of having clear objectives and a conscious approach to balance technological advantages with the relational and emotional essence inherent in face-to-face encounters.Este artículo analiza el papel de las aplicaciones de citas en la configuración de las relaciones románticas, destacando los principales desafíos que surgen en la interacción digital. A pesar de que estas aplicaciones han democratizado el acceso a posibles parejas y ofrecen mayores oportunidades de encuentro, su uso intensivo acarrea obstáculos como la percepción de una oferta «infinita», la propensión a comportamientos evasivos («ghosting», «breadcrumbing») y la búsqueda de validación constante. Dichas dinámicas pueden derivar en relaciones marcadas por la inmediatez y la superficialidad, dificultando la maduración de la intimidad y el compromiso. Asimismo, la competitividad refleja la tensión entre la conveniencia de los contactos virtuales y la necesidad de cultivar valores fundamentales para vínculos sólidos, como la empatía y la honestidad. Con ello, se destaca la importancia de la responsabilidad digital tanto a nivel de los usuarios como de las plataformas, así como la relevancia de la claridad de objetivos y un enfoque consciente para equilibrar las ventajas tecnológicas con la esencia relacional y afectiva de los encuentros presenciales
Bioética en el desempeño profesional
No full textEn este artículo revisamos el rol que tiene la bioética en el ejercicio de la profesión de médicos y otros profesionales de la salud. En primer lugar, discutimos la relación que hay entre la bioética y la educación médica. En segundo lugar, presentamos los principios del profesionalismo médico y cómo la bioética es parte integral de dicho profesionalismo. En tercer lugar, detallamos cómo la bioética se relaciona con la práctica clínica. Finalmente, discutimos la bioética de los ensayos clínicos y otros estudios que involucran seres humanos
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