Examinando por Autor "Lozano Castillo, Alfonso"

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    Desmoplastic infantile ganglioglioma with late presentation : A clinical, radiological and histopathological analysis
    (2013-12) Romero Rojas, Alfredo E.; Diaz Perez, Julio A.; Lozano Castillo, Alfonso
    Desmoplastic infantile ganglioglioma (DIG) is a rare supratentorial tumor in the central nervous system. Definitive diagnosis of this neoplasm is based on histopathologic analysis evaluating distinctive findings such as the fibroblastic differentiation. Here we present a clinical case of DIG with a long follow-up in an eight-year-old boy with a six-month history of recurrent emesis, psychomotor hyperactivity and generalized tonic-clonic seizures. Computed tomography scan and magnetic resonance imaging (MRI) showed a cystic, heterogeneous, mass on the right temporal uncus. A histopathological diagnosis of late presentation DIG was made. We documented the immunohistochemical expression of a molecular soft tissue / muscle differentiation marker (h-CaD) in addition to a low proliferative index (Ki-67) in this case. After surgical intervention, a control MRI showed changes of right frontal-temporal craniotomy and a persistent mass in the anterior and medial temporal lobe with basal extension. Further surgical intervention was performed, completely removing the tumor, which had the same characteristics. The patient is asymptomatic while receiving anticonvulsant therapy (phenytoin) with no evidence of tumor recurrence on MRI after a follow-up of five years. The low grade and soft tissue appearance in images are correlated with the histopathologic and immunohistochemical profile of this tumor, but the rarity of this tumor makes a presumptive diagnosis by images a challenge. The above-mentioned molecular markers or new ones could be used as molecular targets for molecular imaging studies to increase the probability of a pre-operative diagnosis based on molecular features through images.
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    Glioblastoma metastasis to parotid gland and neck lymph nodes : Fine-needle aspiration cytology with histopathologic correlation
    (2013-12) Romero Rojas, Alfredo E.; Diaz Perez, Julio A.; Amaro, Deirdre E.; Lozano Castillo, Alfonso; Chinchilla Olaya, Sandra I.
    Glioblastoma (GBM) is one of the most highly aggressive neoplasms of the central nervous system. Extracranial metastases in GBM are rare. Here we present the case of a 26-year-old man with extra-cranial metastasis of a frontal lobe GBM to the parotid gland, cervical lymph nodes, and bones, with initial diagnosis made by fine needle aspiration cytology (FNAC) of the parotid gland. FNAC is a reliable technique in the study of primary and secondary parotid gland neoplasms, allowing a presumptive diagnosis in difficult cases. We correlate the cytologic, histopathologic, and immunohistochemical findings in thiscase and discuss previous literature reports.
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    Histopathological and immunohistochemical profile in anaplastic gangliogliomas
    (2013-11) Romero Rojas, Alfredo E.; Diaz Perez, Julio A.; Chinchilla Olaya, Sandra I.; Amaro, Deirdre E.; Lozano Castillo, Alfonso; Restrepo Escobar, Ligia I.
    The anaplastic ganglioglioma (AG) is the high-grade counterpart of ganglioglioma, a rare mixed tumor composed of neuronal/ganglion and glial cells. Materials and methods We describe the histopathology and immunohistochemistry in 7 cases of AG and correlate them with the clinical and radiological features. Results Our AG patients correspond to 2.5% of the central nervous system tumor patients evaluated in our institution. The mean age at presentation was 25.7 years, with a male predominance. The most common clinical presentation was generalized tonic–clonic seizures (3/7 cases), in correlation with frequent cortical/subcortical location (6/7 cases). Histopathologically, all our cases showed high-grade features in glial (glial fibrillary acid protein-positive) and neuron-ganglion cells (synaptophysin, PGP-9.5, neurofilament, NSE and CD56-positive), as well as moderate cellularity, frequent mitotic figures and a Ki-67 labeling index >5%. All our patients had poor survival. Conclusion We found that a typical histopathological and immunohistochemical profile is constant and can be useful in early diagnosis of these aggressive neoplasms.
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    Neuroradiology and histopathology in two cases of adult medulloblastoma
    (2014) Romero Rojas, Alfredo E.; Diaz Perez, Julio A.; Raju, Sharat; Lozano Castillo, Alfonso
    Medulloblastoma (MB) is the most common central nervous system neoplasm in children and only rarely presents in the adult population. Recent molecular biology findings have characterized MB as a heterogeneous neoplasm distinguished by well-defined tumour subsets each with specific histologic and molecular features. Available immunohistochemical stains can now be used to differentiate the distinct molecular types of MB. This report analyzed the histopathologic and neuroradiologic features of two new cases of adult MB. Imaging studies in these patients revealed the morphological appearance of high-grade, well-circumscribed heterogeneous tumours with necrosis, located laterally within the posterior cranial fossa. Histopathology of resected samples demonstrated high-grade tumours (WHO grade IV) containing sheets of undifferentiated neural cells with high mitotic activity and evidence of necrosis. The histopathologic and molecular characteristics of these cases of MB are reviewed for potential applications in new molecular methods of imaging.
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    Primary gliosarcoma of the brain : Radiologic and histopathologic features
    (2013) Romero Rojas, Alfredo E.; Diaz Perez, Julio A.; Ariza Serrano, Lina María; Amaro, Deirdre E.; Lozano Castillo, Alfonso
    Gliosarcoma is a rare central nervous system (CNS) neoplasm with biphasic glial and non-glial malignant components. Here we describe the radiologic and histopathologic features observed in five cases of primary gliosarcoma. The mean age at diagnosis in the studied patients was 54.2 years; these patients were predominantly males (male: female ratio = 4:1). At diagnosis all patients had several clinical deterioration. The most common symptoms of presentation were: headache (5/5 cases), seizures (4/5 cases) and hemiparesis (1/5 cases). All the tumors were large (mean major diameter= 4.12±1.64 cm) at diagnosis as evidenced in computer tomography (CT) scans and magnetic resonance images (MRIs), with preferential involvement of the temporal lobe and frequent associated deviation of the midline structures. Other common characteristics identified on CT scans and MRIs were partial contrast medium uptake with annular pattern (5/5 cases), peripheral edema (5/5 cases), and central calcification (3/5 cases). In additional a peak of dye uptake was observed (4/5 cases) on MRI spectrometry. In the histopathology, the glial component showed malignant astrocytes, with high Ki67 (>60%) and p53 positivity; the sarcomatous components displayed pleomorphic spindle cells similarly with p53 positivity and high Ki67 (75-90%) in all cases. Dedifferentiation to pleomorphic sarcoma (two cases), fibrosarcoma (one case), leiomyosarcoma (one case) and MPNST (one case) were documented. All patients received radiotherapy/chemotherapy and had a median overall survival of ten months. The study of radiologic and histopathologic features in primary gliosarcomas of the brain is a priority to achieve early diagnosis that can be translated to better outcomes. Here we describe the radiologic and histopathologic features observed in a group of gliosarcoma patients with variable histopathologic dedifferentiation.
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    Tumor maligno de la vaina del nervio periférico (MPNST) glandular de la órbita : Primera descripción de la literatura de localización orbitaria en un paciente con neurofibromatosis tipo 1
    (2010-02) Romero Rojas, Alfredo E.; Diaz Perez, Julio A.; Lozano Castillo, Alfonso
    Introducción. El tumor maligno de la vaina del nervio periférico (MPNST, por sus siglas en ingles Malignant Peripheral Sheath Tumor), es una neoplasia maligna originada en las células de Schwann de la vaina de revestimiento de los nervios periféricos. Esta neoplasia puede presentar componentes heterólogos benignos o malignos, con diferenciación divergente, como la diferenciación glandular. Objetivo. Describir el primer caso en la literatura de MPNST glandular maligno localizado a nivel orbitario y realizar una revisión sobre esta neoplasia. Caso clínico. Niño de 9 años de edad, con diagnostico de NF1, quien presentó exoftalmos ocular, dolor retro-ocular, cefalea, asimetría facial y descenso del globo ocular derecho de 1 año de evolución; a quien se documento masa sólida orbitaria, delimitada, lobulada, que se proyecta al parénquima cerebral frontal y temporal en los estudios de tomografía computarizada y resonancia magnética. La lesión se abordó en forma fronto-orbito-cigomática con resección completa de la misma. Posteriormente, se hizo una plastia dural en base de cráneo y reconstrucción con malla de titanio. Actualmente el paciente se encuentra asintomático después de 6 meses de tratamiento. En el estudio anatomopatológico se observó una neoplasia maligna bifásica, reactiva en los elementos mesenquimales para S100, PGP 9.5, neurofilamentos y vimentina. El componente glandular fue positivo para AE1/AE3, EMA, CEA y focalmente para CD57. Se observó además reactividad para cromogranina, sinaptofisina, serotonina y somatostatina. Se realizo el diagnostico de MPNST glandular de la órbita. Conclusión. Se describe el primer caso de MPNST glandular localizado en la órbita, el cual se presentó en un niño con NF1. Esta neoplasia extremadamente infrecuente debe ser tenida en cuenta en el estudio de lesiones bifásicas malignas, ya que su diagnostico es de peculiar importancia debido al pésimo pronóstico de los pacientes afectados.