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Rev Electron Autopsia 2015;13(1)

Rev Electron Autopsia Vol 13, No 1 (2015)

Revista Electrónica de la Autopsia

Tabla de contenidos

Protocolos y Colaboraciones

Guía de Patología Autópsica PDF
Fidel Fernández Fernández, Felix P. Arce Mateos, Iván Fernández-Vega, Ignasi Galtés Vicente, Isabel Guerra Merino, Joaquín Lucena Romero, Marta Mayorga Fernández, Rita María Regojo, María Paz Suárez Mier, Nuria Terán 2-11

Cartas al Editor

Carta Abierta sobre el Síndrome del Bebé Sacudido y los Tribunales: Una Premisa Falsa y Defectuosa PDF
Marta Cohen, Lynne Wrennall, Bill Bache, Charles Pragnell 13-16


REA/EJAutopsy en las redes sociales


Revista Electrónica de la Autopsia


Estimado lector de la Revista Electrónica de la Autopsia:


Queremos informarte que nuestra revista está presente ya en las redes sociales. Se acaba de crear una cuenta en Twitter bajo el nombre @EJAutopsy a través de la cual os enviaremos información puntual de los artículos que vayamos publicando y de otra información que pudiera ser de vuestro interés tanto sobre la autopsia clínica como forense. Ya sabes que si dispones de una cuenta en Twitter te invitamos a que nos sigas.


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Aprovechamos finalmente la ocasión para animaros a enviar vuestros manuscritos a la Revista Electrónica de la Autopsia. No lo dejéis para mañana. Los esperamos.

Recibe un cordial saludo
Equipo Editor de la Rev Electon Autopsia

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LÍNEA 24 HORAS EN ESPAÑA: 693 632 326

Rescatadores Juan Pablo II: Desde el respeto a la mujer y la voluntad firme de querer ayudarla, recluta "personas apasionadas por ayudar a mujeres en situación de vida o muerte para sus hijos".

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Entrevista con el Cardenal Ricardo Ezzati, Mensaje

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Current status of human papillomavirus vaccination

Current status of human papillomavirus vaccination

Brotherton, Julia M.L.; Ogilvie, Gina S.

Abstract: Purpose of review: In this article, we review the impact of the quadrivalent and bivalent prophylactic human papillomavirus (HPV) vaccines on HPV infection and disease, review alternative vaccine dosing schedules, the vaccination of men and the nine-valent HPV vaccine. Recent findings: HPV vaccines have had dramatic impacts on the prevalence of targeted HPV types (6,11,16 and 18), genital warts and precancerous cervical lesions. Population coverage would be facilitated by adopting two-dose schedules, with recent findings that two-dose schedules in young adolescents are as immunogenic as three doses in young adults. Extension of vaccination to men, particularly for men who have sex with men, could further reduce population prevalence of HPV and provide direct protection to men against genital warts and anal, penile and oropharyngeal cancers. The nine-valent HPV vaccine has demonstrated equivalent protection against the four types in the quadrivalent vaccine and high efficacy against the next five commonest causes of cervical cancer (HPV types 31,33,45,52 and 58). If cost-effective, it may extend the spectrum of protection against cervical cancer available through vaccination. Summary: HPV vaccination is an effective strategy for reducing the burden of HPV-related disease. New schedules, target populations and vaccines promise to expand this potential further.

Current Opinion in Oncology. 2015; 2(5):399–404

Recent Papillomavirus Research Articles

Recently published articles available on ScienceDirect.

Elsevier wordmark

Recent Papillomavirus Research Articles

Additional Guidance Online for Providers Regarding 9-Valent HPV Vaccine Use Among Persons Who Previously Received HPVVaccination

CDC. Centers for Disease Control and Prevention. CDC 24/7: Saving Lives. Protecting People.

Additional Guidance Online for Providers Regarding 9-Valent HPV Vaccine Use Among Persons Who Previously Received HPV Vaccination

July 31, 2015 / 64(29);806

A 9-valent human papillomavirus (HPV) vaccine (Gardasil 9, Merck and Co., Inc.) was licensed for use in females and males in the United States in December 2014. This is the third HPV vaccine licensed by the Food and Drug Administration; the other vaccines are the bivalent HPV vaccine, licensed for use in females, and the quadrivalent HPV vaccine, licensed for use in females and males.

In February 2015, the Advisory Committee on Immunization Practices (ACIP) recommended 9-valent HPV vaccine as one of three HPV vaccines that can be used for routine vaccination of females and one of two HPV vaccines for routine vaccination of males. ACIP recommendations were published in a March 2015 report. Additional information has been posted on the CDC website to provide guidance on issues that were not addressed in the March report but are likely to arise during the transition to 9-valent HPV vaccine, including questions about use of 9-valent HPV vaccine among persons who previously received bivalent or quadrivalent HPV vaccine 9vHPV Guidance PDF.

Fuente: Tweet de @CDC_Cancer -

Detection of Human Papillomavirus in Non-Small Cell Carcinoma of the Lung

Detection of Human Papillomavirus in Non-Small Cell Carcinoma of the Lung

Sing Yun Chang, Michael Keeney, Mark Law, Janis Donovan, Marie-Christine Aubry, Joaquin Garcia

Abstract: High-risk human papillomavirus (hrHPV) is an etiologic agent in squamous cell carcinoma (SqCC) arising in the oropharynx and cervix, and a proven prognostic factor in oropharyngeal SqCC. Many studies have found HPV in non-small cell lung carcinoma (NSCLC). Recent studies advocate the detection of mRNA transcripts of E6/E7 as more reliable evidence of transcriptively active HPV in tumor cells. The clinical significance of finding HPV remains unclear in NSCLC. This study sought to determine the prevalence of biologically active HPV infection in NSCLC comparing different methodologies. Surgical pathology material from resected primary lung adenocarcinoma (ADC; n = 100) and SqCC (n = 96) were retrieved to construct tissue microarrays. In-situ hybridization (ISH) for hrHPV DNA (DNA-ISH), hrHPV E6/E7 RNA (RNA-ISH), and p16 immunohistochemistry (IHC) were performed. Cases of oropharyngeal SqCC with known HPV infection were used as positive controls. Expression of p16 was scored as positive if at least 70% of tumor cells showed diffuse and strong nuclear and cytoplasmic staining. Punctate nuclear hybridization signals by DNA-ISH in the malignant cells defined an HPV-positive carcinoma. Of the 196 patients (range 33-87 years; 108 men), p16 was positive in 19 ADC and 9 SqCC, but HPV DNA-ISH and RNA-ISH were negative in all cases. Our study did not detect HPV infection by DNA-ISH or RNA-ISH in any cases of primary NSCLC despite positive p16 expression in a portion of ADC and SqCC. p16 should therefore not be used as a surrogate marker for HPV infection in NSCLC.

Human Pathology (in press) - DOI: j.humpath.2015.07.012

Fuente: Tweet de @pbaleixo

Gardasil 9 Vaccine Protects against Additional HPV Types

Gardasil 9 Vaccine Protects against Additional HPV Types

Summary: In a large randomized clinical trial, a new human papillomavirus (HPV) vaccine effectively prevented infection and disease caused by nine high-risk HPV types, including seven types that cause cervical and other cancers—five of which were not covered by the previously available HPV vaccines—and two types that cause genital warts.

A 9-Valent HPV Vaccine against Infection and Intraepithelial Neoplasia in Women

Elmar A. Joura, Anna R. Giuliano, Ole-Erik Iversen, Celine Bouchard, Constance Mao, Jesper Mehlsen, Edson D. Moreira, Jr., Yuen Ngan, Lone Kjeld Petersen, Eduardo Lazcano-Ponce, Punnee Pitisuttithum, Jaime Alberto Restrepo, Gavin Stuart, Linn Woelber, Yuh Cheng Yang, Jack Cuzick, Suzanne M. Garland, Warner Huh, Susanne K. Kjaer, Oliver M. Bautista, Ivan S.F. Chan, Joshua Chen, Richard Gesser, Erin Moeller, Michael Ritter, Scott Vuocolo, and Alain Luxembourg, for the Broad Spectrum HPV Vaccine Study

Abstract: Background. The investigational 9-valent viruslike particle vaccine against human papillomavirus (HPV) includes the HPV types in the quadrivalent HPV (qHPV) vaccine (6, 11, 16, and 18) and five additional oncogenic types (31, 33, 45, 52, and 58). Here we present the results of a study of the efficacy and immunogenicity of the 9vHPV vaccine in women 16 to 26 years of age.
Methods. We performed a randomized, international, double-blind, phase 2b–3 study of the 9vHPV vaccine in 14,215 women. Participants received the 9vHPV vaccine or the qHPV vaccine in a series of three intramuscular injections on day 1 and at months 2 and 6. Serum was collected for analysis of antibody responses. Swabs of labial, vulvar, perineal, perianal, endocervical, and ectocervical tissue were obtained and used for HPV DNA testing, and liquid-based cytologic testing (Papanicolaou testing) was performed regularly. Tissue obtained by means of biopsy or as part of definitive therapy (including a loop electrosurgical excision procedure and conization) was tested for HPV. Results. The rate of high-grade cervical, vulvar, or vaginal disease irrespective of HPV type (i.e., disease caused by HPV types included in the 9vHPV vaccine and those not included) in the modified intention-to-treat population (which included participants with and those without prevalent infection or disease) was 14.0 per 1000 person-years in both vaccine groups. The rate of high-grade cervical, vulvar, or vaginal disease related to HPV-31, 33, 45, 52, and 58 in a prespecified per-protocol efficacy population (susceptible population) was 0.1 per 1000 person-years in the 9vHPV group and 1.6 per 1000 person-years in the qHPV group (efficacy of the 9vHPV vaccine, 96.7%; 95% confidence interval, 80.9 to 99.8). Antibody responses to HPV-6, 11, 16, and 18 were noninferior to those generated by the qHPV vaccine. Adverse events related to injection site were more common in the 9vHPV group than in the qHPV group. Conclusions. The 9vHPV vaccine prevented infection and disease related to HPV-31, 33, 45, 52, and 58 in a susceptible population and generated an antibody response to HPV-6, 11, 16, and 18 that was noninferior to that generated by the qHPV vaccine. The 9vHPV vaccine did not prevent infection and disease related to HPV types beyond the nine types covered by the vaccine. (Funded by Merck; number, NCT00543543).

Source: New England Journal of Medicine, February 18, 2015

Fuente: Tweet de @theNCI - Pubmed

Squamous Cell Carcinoma of the Vulva: A Subclassification of 97 Cases by Clinicopathologic ...

Squamous Cell Carcinoma of the Vulva: A Subclassification of 97 Cases by Clinicopathologic, Immunohistochemical, and Molecular Features (p16, p53, and EGFR)

Dong, Fei; Kojiro, Sakiko; Borger, Darrell R.; Growdon, Whitfield B.; Oliva, Esther

Abstract: Squamous cell carcinomas (SCCs) of the vulva develop through human papilloma virus (HPV)-associated or HPV-independent pathways, but the relationship between pathogenesis, classification, and prognosis of these tumors is controversial. Therefore, we review the morphology, immunophenotype, and select molecular features of a consecutive series of 97 patients with vulvar SCC with a median clinical follow-up of 3.6 years. Tumors were histologically classified as basaloid (13), warty (11), mixed basaloid and warty (1), keratinizing (68), nonkeratinizing (3), and sarcomatoid (1). Diffuse p16 expression was associated with younger age at presentation (P<0.0001), basaloid and warty carcinoma subtypes (P<0.0001), and usual vulvar intraepithelial neoplasia (P<0.0001) and was negatively associated with p53 immunopositivity (P=0.0008). Five keratinizing SCCs showed p16 and p53 coexpression, but only 1 was positive for high-risk HPV by in situ hybridization. Among 8 of 36 tumors with EGFR gene amplification, 4 were p53 positive but none p16 positive. In a Cox regression model, early clinical stage (P<0.006), p16 expression (P=0.002), and absent p53 expression (P=0.02) were independent predictors of improved overall survival. These findings utilize morphologic and immunohistochemical analysis to support HPV-associated and HPV-independent pathogenesis of vulvar SCCs and support p16 and p53 immunohistochemistry as markers of disease biology and clinical outcome.

American Journal of Surgical Pathology: August 2015 - Volume 39 - Issue 8 - p 1045–1053

Fuente: Tweet de @memoalexlope

Aumenta la incidencia de los tumores de cabeza y cuello causados por VPH

Increase in Head and Neck Cancer in Younger Patients Due to Human Papillomavirus (HPV)

D Young, CC Xiao, B Murphy, M Moore, C Fakhry, TA Day

The face of head and neck cancer has changed dramatically over the past 30 years. There has been a steady decline in the number of tobacco and alcohol related squamous cell carcinomas over the past 30 years, but and increasing incidence of human papillomavirus (HPV) related cancers. Some estimates suggest that 70–90% of new oropharyngeal cancers have evidence of HPV.

These patients have different demographic patterns, in that they are more likely to be younger, white adults in their 40 s and 50 s who are never smokers or have reduced tobacco exposure. Studies have shown that a higher number of lifetime oral sex partners (>5) and a higher number of lifetime vaginal sex partners (>25) have been associated with increased risk of HPV positive head and neck cancer. People can also reduce their risk of HPV linked head and neck cancer by receiving the HPV vaccine series prior to becoming sexually active. Recent evidence suggests HPV related head and neck cancers present with different symptoms than those caused by tobacco. The most popular test for HPV status is the p16 immunohistochemical stain because it is cheap, simple, and studies have shown it to have comparable sensitivity and specificity to the previous standards. It is widely recommended that all cancers of the oropharynx be tested for the presence of HPV, and some recommend it for all head and neck cancers. Overall 2-year and 5-year survival for HPV positive head and neck cancer is significantly greater than for HPV negative cancers, likely due to HPV positive cancers being more responsive to treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

PMID: 26066977
Oral Oncol 2015 Aug;51(8):727-30 [EPub Ahead of Print]
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TRIG Working Group

Preparing Pathologists for a Leading Role in Genomics


In 2010, the Training Residents in Genomics (TRIG) Working Group was formed through the Pathology Residency Directors Section (PRODS) of the Association of Pathology Chairs (APC). The goals of this group, made up of experts in medical education, molecular pathology, and clinical genetics, are to develop teaching tools, and promote genomic pathology education. The TRIG Working Group represents a unique collaborative effort in pathology education with members from many major pathology organizations and representatives from the National Society of Genetic Counselors, American College of Medical Genetics and Genomics, and the National Coalition for Health Provider Education in Genetics.

The TRIG Working Group has held genomic pathology workshops and courses at the annual meetings of major pathology organizations. An Instructor Handbook and Toolkit are now available to enable residency programs to locally implement similar training.

Based on their accomplishments, the TRIG Working Group received in 2012 an R25 grant from the National Cancer Institute. Providing approximately $1.3 million over five years, this funding will be used, with design support from ASCP, to develop additional educational resources such as online modules as well as assessment tools to determine curriculum efficacy. The specific aims of the grant are:

  • Aim #1.- To develop a pathology resident genomic medicine curriculum, with a major focus on cancer care, as well as tools for national implementation.”
  • Aim #2.- To evaluate the curriculum using a pre/post-test design at four pathology residency programs using validated assessment tools.”
  • Aim #3.- To promote curriculum implementation using the resources of major national pathology organizations so that >90% of pathology residency programs nationwide have high-quality training in cancer genomics by the end of year 5.”
  • Aim #4.- To assess the degree of nationwide implementation and efficacy of curricula in genomic medicine using the pathology resident in-service exam (RISE).”