RESUMO
A 78-year-old male with high-risk surgical presented severe acute cholecystitis and required cholecystostomy. The patient was referred later for assessment of the surgical treatment. A cholangio-MRI revealed a lesion on the gallbladder fundus with hepatic lesions suggestive of metastatic gallbladder carcinoma, which was confirmed in the histological analysis. The tumor progressed despite the chemotherapy through the cholecystostomy tract and developed peritoneal carcinomatosis. The patient did not respond to chemotherapy and he died 12 months later. (AU)
Assuntos
Humanos , Masculino , Idoso , Colecistostomia/métodos , Carcinoma/cirurgia , Vesícula Biliar , Adenocarcinoma , Colecistite AgudaAssuntos
Humanos , Feminino , Criança , Vesícula Biliar/anormalidades , Anormalidades Congênitas , Refluxo Gastroesofágico/tratamento farmacológico , Esomeprazol/uso terapêutico , Resultado do Tratamento , Pacientes Internados , Exame Físico , Avaliação de Sintomas , Atenção Primária à Saúde , Vesícula Biliar/diagnóstico por imagemRESUMO
Serrated lesions outside the low digestive tract are scarce, with only two traditional serrated adenomas (TSA) reported in the gallbladder, with limited information about the serrated pathway outside the colon. Our case was an incidental finding in a patient undergoing surgery to treat a cholecystitis, when a polypoid lesion was observed. The epithelium formed gland structures with ectopic crypts, serrated slits and eosinophilic cytoplasm. MUC4 and MUC5A were positive, but mismatch repair proteins (MSI) retained nuclear staining. BRAF showed a not mutated profile and NRAS/KRAS was inconclusive due to the absence of remaining tissue. MSI and CpG island (CIMP), the most common genetic hallmarks of the serrated pathway, have been proven in gallbladder carcinomas, although serrated polyps are not recognized as premalignant precursors. Hereby we report one TSA of the gallbladder without the usual genetic drivers. A larger evidence is needed to improve the diagnosis and management.(AU)
Las lesiones serradas no suelen localizarse fuera del tracto digestivo bajo, con solo 2 adenomas serrados tradicionales (TSA) descritos. Por ello, la información sobre la vía serrada fuera del colon es limitada. Nuestro caso trata de un hallazgo incidental en un paciente al que se le realizó una colecistectomía y en el que se observó una lesión polipoide. Esta formaba estructuras glandulares con criptas ectópicas, serración y citoplasma eosinófilo. MUC4 y MUC5A eran positivos, pero las proteínas implicadas en la inestabilidad de microsatélites (MSI) conservaban tinción nuclear. BRAF no estaba mutado y NRAS/KRAS no fue concluyente. La MSI y la metilación de CpG (CIMP) son las vías oncogénicas más comunes de la vía serrada y se ha demostrado en carcinomas de vesícula biliar. Sin embargo, los pólipos serrados no se reconocen como precursores premalignos. Nuestro caso trata de un adenoma serrado tradicional de vesícula biliar sin rasgos genéticos habituales. Se necesita mayor casuística en la literatura.(AU)
Assuntos
Humanos , Masculino , Idoso , Vesícula Biliar , Adenoma , Achados Incidentais , Colecistectomia , Pólipos , Pacientes Internados , Exame FísicoRESUMO
A 90-years-old man comes to the emergency department with diffuse abdominal pain and fever three days. On physical examination, the abdomen is soft and depressible with air-fluid sound present and bilateral reductible inguinal hernias. A mass is palpated at the level of the roght hypochondrium with a positive Murphy´s sign whitout signs of peritoneal irritation. An abdominal CT with intravenous contrast is requested due to the suspicion of acute abdominal pathology, observing cholelithiasis and a markedly distended gallbladder with torsion. (AU)
Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Hipertensão , Anemia , Apendicectomia , Náusea , Vesícula BiliarAssuntos
Fluordesoxiglucose F18 , Vesícula Biliar , Linfonodos , Melanoma/diagnóstico por imagem , Melanoma/patologia , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Compostos Radiofarmacêuticos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologiaRESUMO
Se presenta el caso de un lactante con agenesia de la vesícula biliar de diagnóstico prenatal. Este hallazgo es poco común. En la mayor parte de los casos se detecta de manera casual durante una exploración quirúrgica. No es infrecuente que produzca sintomatología (25-30%), y cuando lo hace, esta es indistinguible de otras patologías de vías biliares. El reto fundamental en esta entidad es su diagnóstico prequirúrgico, cada día más factible dados los avances en las técnicas de imagen. Dada la baja tasa de complicaciones y la buena evolución de estas, es una entidad con un pronóstico favorable
A case of an infant with prenatally diagnosed gallbladder agenesis is reported. This is an uncommon finding, being detected in most cases by chance during a surgical exploration. It is not uncommon for it to produce symptoms (25-30%), and when it does, it is indistinguishable from other biliary pathologies. The fundamental challenge in this entity is its pre-surgical diagnosis, each day more feasible given the advances in imaging techniques. Given the low rate of complications and their good evolution, it is an entity with a favorable prognosis
Assuntos
Humanos , Masculino , Lactente , Vesícula Biliar/anormalidades , Vesícula Biliar/diagnóstico por imagem , Ultrassonografia Pré-NatalRESUMO
El abordaje laparoscópico es el método de elección para el tratamiento de la litiasis vesicular sintomática, y para muchos también lo es para la coledocolitiasis. Algunas situaciones especiales e infrecuentes en el tamaño, número y ubicación de los cálculos o en alteraciones de la anatomía biliar embriológicas o adquiridas pueden generar dificultades para la resolución de estas afecciones con técnicas laparoscópicas habituales. Para estas situaciones describimos 10 estrategias quirúrgicas de aplicación relativamente sencilla y que requieren de escasos recursos económicos, por lo que creemos que pueden adaptarse a la mayor parte de los centros quirúrgicos
Laparoscopic surgery is the gold standard treatment of symptomatic gallstones. For some, it is also the treatment of choice for choledocholithiasis. Certain special and rare circumstances regarding the number, size and location of bile duct stones or altered bile duct anatomy (embryonic or acquired), can be challenging to resolve with usual laparoscopic techniques. For these situations, we describe 10 surgical strategies that are relatively simple and inexpensive to apply, making them appropriate to be used in most surgical centers
Assuntos
Humanos , Laparoscopia/métodos , Vesícula Biliar/cirurgia , Coledocolitíase/cirurgia , Cistectomia/métodos , Ligadura/métodos , Resultado do TratamentoRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Ductos Pancreáticos/cirurgia , Colangiopancreatografia por Ressonância Magnética/métodos , Ductos Pancreáticos/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Meios de Contraste , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Achados Incidentais , Fígado/diagnóstico por imagem , Fígado/patologia , Dor Abdominal/etiologiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Cromogranina B/análise , Carcinoma Neuroendócrino/terapia , Tumor Misto Maligno/terapia , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/terapia , Colecistectomia Laparoscópica/métodos , Pólipos/diagnóstico por imagem , Ultrassonografia , Imuno-Histoquímica , Dor Abdominal/diagnóstico , Vesícula Biliar/patologiaRESUMO
Indirect triple immunolabelling techniques were used to identify the presence of choline acetyl-transferase (ChAT), neuronal nitric oxide synthase (nNOS), Dopamine beta-hydroxylase (DβH), neuromedin U-8 (NMU-8), and neuropeptide Y (NPY) in the ganglionated plexuses of the human gallbladder. Of all the intrinsic cholinergic neurons examined, NMU-8-immunoreactive (-IR) neurons appeared to be the most populous, followed closely by neurons containing NPY-IR. nNOS-IR neurons were often observed to coexist with ChAT, NMU, and NPY. Occasionally, these nNOS positive neurons were seen triple labeled with ChAT, NMU-8, and NPY. Results also indicate that not all nNOS and NMU-8-IR coexistent neurons express NPY immunoposi-tivity. Our findings suggest that these intrinsic neurons may be categorized into a distinct population of neurons that express both inhibitory and excita-tory capabilities.Intrinsic cholinergic neurons that were ChAT-IR displayed a spectrum of immunopositivity. Interestingly, a small subpopulation of these neurons ap-peared to be extremely weak ChAT-IR or simply ChAT-immunonegative. These occasionally obser-ved ChAT-immunonegative neurons at times ex-pressed single immunopositivity for NMU-8 or nNOS, while more frequently, these ChAT-immunonegative neurons were found to be single immunopositive, or at times, double immunopositi-ve for NMU-8-, NPY-, or nNOS-IR.Dopamine beta-hydroxylase (DβH) antibodies were used to confirm the lack of intrinsic sympat-hetic innervation in the human gallbladder. As suspected, in all the sections examined, DβH-IR neu-rons were not detected. The only indication of DβH immunopositivity was noted among delicate fibers surrounding the neurons and blood vessels within the organ
No disponible
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Vesícula Biliar/anatomia & histologia , Imuno-Histoquímica/métodos , Coleta de Tecidos e Órgãos , Colina O-Acetiltransferase , Óxido Nítrico , Dopamina beta-Hidroxilase , Vesícula Biliar/enzimologia , Colecistectomia Laparoscópica , Colelitíase/cirurgia , Microscopia Confocal/métodosRESUMO
No disponible
