Neoplasia papilar intraductal de la vía biliar: radiología en una nueva entidad / Intraductal papillary neoplasm of the bile duct: Radiologic findings in a new disease

La neoplasia papilar intraductal de la vía biliar (NPI-VB) es una entidad poco conocida en nuestro medio por su baja prevalencia. Hasta su nueva definición en la cuarta edición de la clasificación de la Organización Mundial de la Salud de los tumores del aparato digestivo publicada en 2010, la enfermedad se agrupaba bajo una terminología heterogénea y poco precisa. Además, en los últimos años se ha avanzado en el conocimiento de su etiopatogenia, su historia natural y sus hallazgos en imagen. El propósito de este artículo es repasar estos datos subrayando los hallazgos radiológicos de la enfermedad y su diagnóstico diferencial

Intraductal papillary neoplasm of the biliary tract (B-IPN) is a scarcely known entity in our daily practice due to its low prevalence. Until its new definition in the fourth edition of the WHO classification of the digestive tract tumors of 2010 the disease was grouped under a heterogeneous and imprecise terminology. In addition, in recent years there has been progress in the knowledge of its etiopathogenesis, its natural history and its findings in image. The purpose of this paper is to review these data underlining the radiological findings of the disease and its differential diagnosis

Adenocarcinoma papilar de nasofaringe de bajo grado "thyroid-like". Caso clínico y revisión de la literatura / Low-grade papillary adenocarcinoma of nasopharynx. Case report and review of the literatura

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Ictericia obstructiva secundaria a adenoma en conducto hepático común / Obstructive jaundice caused by an adenoma of the common hepatic duct

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Mutación del gen BRAF V600E en el cáncer papilar de tiroides y su efecto en la terapia con yodo radiactivo (131I) posquirúrgica: ¿deberíamos modificar nuestra estrategia terapéutica? / BRAF V600E mutation in papillary thyroid cancer and its effect on postoperative radioiodine (131I) therapy: Should we modify our therapeutic strategy?

INTRODUCCIÓN: La mutación BRAF V600E en el cáncer papilar de tiroides (CPT) parece asociarse a una resistencia al 131I. Nuestro principal objetivo fue cuantificar la respuesta al 131I tras la cirugía tanto en pacientes que presentaban la mutación (BRAF+) como en los que no presentaban el gen mutado (BRAF-). MÉTODO: Estudio prospectivo de los CPT intervenidos y tratados con 131I desde septiembre de 2015 hasta enero de 2017. VARIABLES: edad, género, estadio tumoral, histológicas, tiroglobulina antes de 131I, a las 48h y a los 6 meses; dosis absorbida y % de actividad a los 2 y a los 7días y tiempo de eliminación. RESULTADOS: Cuarenta y un pacientes y 67 restos tiroideos. El 61% eran BRAF+. En los estadios III y IV, el 80% eran BRAF+. En el vaciamiento ganglionar terapéutico, el 100% eran BRAF+. El número de ganglios fue superior en BRAF+: 3,4 vs 1,2 (p = 0,01). La variante clásica fue predominante en BRAF+ (91,7% vs 8,3%; p = 0,03). El 85,7% vs 14,3% de los BRAF+ tuvieron reacción desmoplásica (p = 0,02). Los BRAF+ presentaban menor dosis absorbida respecto a la actividad administrada (5,4 vs 20Gy/MBq; p = 0,02); menor % de actividad respecto a la unidad de masa a los 2 (0,046 vs 0,103%/g; p = 0,02) y a los 7 días (0,006 vs 0,034%/g, p = 0,04). CONCLUSIONES: La mutación del gen BRAF V600E se relaciona con una mayor resistencia al tratamiento posquirúrgico con 131I desde el inicio de la enfermedad

INTRODUCTION: The BRAF V600E mutation in papillary thyroid cancer (PTC) has been associated with resistance to 131I. Our aim was to quantify the response to 131I after surgery in patients who had the mutation (BRAF+) and those who did not have the mutated gene (BRAF-). METHOD: A prospective cohort study was designed, from September 2015 to February 2016, which included patients with PTC receiving therapy after surgical treatment. Variables were described for age, gender, histology, tumor stage, thyroglobulin values before, 48 h after and 6months after 131I; absorbed dose and % activity on days 2 and 7 and elimination time. RESULTS: 41 patients giving in total 67 thyroid remnants were included. 61% were BRAF+. In stagesiii and IV, 80% were BRAF+. In lateral resection, 100% were BRAF+. The number of nodes was higher in BRAF+: 3.4 vs 1.2 (P = .01). The classic variant was predominant in BRAF+ (91.7% vs 8.3%, P = .03). 85.7% vs 14.3% of BRAF+ had desmoplastic reaction (P = .02). The BRAF+ had a lower absorbed dose than the administered activity (5.4Gy/MBq vs 20Gy/MBq, P = .02); lower% activity with respect to the unit of mass at 2 (0.046%/g vs 0.103%/g, P = .02) and at 7days (0.006%/gr vs 0.034%/gr, P = .04) CONCLUSIONS: The mutation of the BRAF V600E gene is related with greater resistance to postoperative treatment with 131I since the onset of the disease

Micropapillary bladder cancer: a clinico-pathological characterization and treatment analysis

Purpose. Micropapillary bladder cancer (MPBC) is a very rare and aggressive variant of urothelial carcinoma (UC). The aim of this study was to investigate the clinico-pathological characteristics, treatment, and prognosis of MPBC to improve the understanding of this invasive disease. Methods. We reviewed the records of 6 patients with MPBC who were evaluated and treated at our hospital between 2009 and 2015, and additionally reviewed 38 cases reported in the literature. Results. In 44 cases, 36 cases (81.8%) were male and 8 cases (18.2%) were female, with a male:female ratio of 4.5:1; the median age of the patients was 68 years (range 45-91 years). A majority (81.8%) of patients with cT1 above or with lymph node and distant metastasis (cT2N0 in 18.2%, cT3-4N0 in 13.6%, cTanyN+ in 43.2%, and cTanyM+ in 6.8%). There was a high grade in 70.5% of patients. Lymphovascular invasion (LVI) was present in 61.4% of patients, and LVI in cT2 was more common than in cT1 (71.4 vs 22.2%). 52.3% of patients were treated with radical cystectomy (RC). After a mean follow-up of 16.2 months, 77.3% of patients developed distant metastases, and 47.7% of patients died of the disease. The mean overall survival (OS) was 28.9 months and the median OS was 20 months, and the amount of micropapillary (MPP) is correlated inversely with prognosis. Conclusions. Micropapillary bladder cancer is a rare variant of UC associated with a poor prognosis, which often presents at an advanced stage with LVI and distant metastases. The optimal treatment strategy is early RC combined with chemotherapy (AU)

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Aumento de la incidencia de cáncer de tiroides en Navarra. Evolución y características clínicas, 1986-2010 / Increased incidence of thyroid cancer in Navarra (Spain). Evolution and clinical characteristics, 1986-2010

Introducción: En los últimos estudios publicados se observa un aumento de la incidencia de cáncer de tiroides a nivel mundial. El objetivo del presente estudio fue analizar los cambios en la incidencia de cáncer de tiroides en Navarra, y su presentación en cuanto a sexo, subtipo histológico y tamaño a lo largo de los últimos 25 años. Métodos: Se calcularon las tasas de incidencia de cáncer de tiroides a partir de los datos del Registro de Cáncer de Navarra durante el periodo 1986-2010. Los datos clínicos se obtuvieron de la cohorte histórica del Registro Hospitalario de Cáncer de Navarra, que incluye todos los nuevos casos de carcinoma diferenciado de tiroides diagnosticados y tratados en la red sanitaria pública de esta comunidad en dicho periodo. Resultados: La incidencia global de cáncer de tiroides en Navarra ha aumentado en estos 25 años con un incremento en la tasa ajustada en varones de 2,24 (1986-1990) a 5,85 (2006-2010) por 100.000 habitantes/año (p<0,001), y en mujeres de 9,05 a 14,04, respectivamente (p<0,001). Este aumento se produjo únicamente a expensas del carcinoma papilar. En el ámbito hospitalario, se estudiaron 739 pacientes con cáncer diferenciado de tiroides. La edad media al diagnóstico aumentó a lo largo de los años y el predominio de mujeres (alrededor del 80%) se mantuvo estable. El tamaño tumoral medio disminuyó a lo largo de los quinquenios de 30,9 a 22,5mm (p<0,001), la proporción de microcarcinomas (T1a) aumentó de 8,8% a 30% (p<0,001) y, a pesar de este aumento, no hubo diferencias estadísticas en el estadio TNM al diagnóstico durante el periodo de estudio. La distribución de las variantes histológicas de carcinoma papilar y folicular no se modificó a lo largo de los 25 años. Conclusiones: Durante el período estudiado la incidencia de cáncer de tiroides ha aumentado en Navarra en ambos sexos. El aumento se ha producido a expensas del carcinoma papilar, sin cambios en la distribución de las variantes histológicas. Destaca el aumento en la proporción de tumores T1a, pero se mantiene la distribución por estadio TNM. Estos resultados sugieren un incremento del diagnóstico de microcarcinomas tiroideos por cambios en la práctica clínica, sin descartar además un incremento real de la incidencia del carcinoma papilar en Navarra (AU)

Introduction: The latest published studies show an increased incidence of thyroid cancer worldwide. The aim of this study was to analyze the changes in the incidence of thyroid cancer in Navarra and its clinical presentation regarding sex, histological subtype and size over the last 25 years. Methods: Thyroid cancer incidence rates were calculated on the basis of data from the Cancer Registry of Navarra during 1986-2010. Clinical data were obtained from the historical cohort of the Hospital Registry of Cancer of Navarra, which includes all the new cases of differentiated thyroid carcinoma diagnosed and treated in the public health network of this Community in that period. Results: The overall incidence of thyroid cancer in Navarra increased over the last 25 years, with an increase in the adjusted rate in men from 2.24 (1986-1990) to 5.85 (2006-2010) per 100,000 population/year (P<.001) and in women from 9.05 to 14.04, respectively (P<.001). This increase occurs only in papillary carcinoma. The clinical characteristics of 739 patients with differentiated thyroid cancer were studied. The mean age at diagnosis increased over the years and the predominance of women (about 80%) remains stable. Mean tumor size decreased over the five-year periods from 30.9 to 22.5mm (P<.001), the proportion of microcarcinomas (T1a) increased from 8.8% to 30% (P<.001) and, despite this increase, there were no statistical differences in the TNM stage at diagnosis during the study period. The distribution of histological variants of papillary and follicular carcinoma did not change over 25 years. Conclusions: During the period studied, the incidence of thyroid cancer increased in Navarra in both sexes. The increase occurred only in papillary carcinoma, without changes in the distribution of his histological variants. The increase in the proportion of T1a tumors is remarkable, but the TNM stage distribution was maintained. These results suggest an increase in the diagnosis of thyroid microcarcinomas due to changes in clinical practice, without ruling out a real increase in the incidence of papillary carcinoma in Navarra (AU)

Hypoparathyroidism following thyroidectomy: predictive factors / Hipoparatiroidismo tras tiroidectomía: factores predictivos

Objective. To evaluate the incidence and predictive factors for transient and permanent hypocalcemia and hypoparathyroidism following thyroidectomy. Method. We studied all the 162 patients that underwent thyroid surgery in the ENT department of the Centro Hospitalar Vila Nova Gaia/Espinho from January 2005 to December 2014. We reviewed pre-operative, 6h and 12h after surgery ionized calcium and PTH levels. All patients were reviewed and evaluated according to the following criteria: gender, age, thyroid function, histologic diagnosis of the specimen, surgery extension and presence or absence of hypoparathyroidism. Results. There were 31 (19.1%) cases of transient hypoparathyroidism and 8 (5%) of permanent hypoparathyroidism. No significant difference was found for transient hypoparathyroidism when patients were analyzed by gender. However, all cases of permanent hypoparathyroidism were observed in female individuals. Comparing hemithyroidectomy with all other surgical procedures, we found that extension of surgery was a great predictor of transient (p=0.0001) and permanent (p=0.001) hypoparathyroidism. Diagnosis of malignancy was a strong predictor of transient hypoparathyroidism (p=0.002). It was also associated with permanent hypoparathyroidism, although differences did not reach statistical significance (p=0.096). Conclusion. Extension of surgery (total thyroidectomy) and diagnosis of malignancy are predictors of transient and permanent hypoparathyroidism (AU)

Objetivo. Evaluar la incidencia y los factores predictivos de hipocalcemia transitoria y permanente e hipoparatiroidismo tras la tiroidectomía. Método. Se estudiaron todos los pacientes sometidos a cirugía de tiroides en el Servicio de ORL del Centro Hospitalario de Vila Nova de Gaia/Espinho desde enero de 2005 a diciembre de 2014. Se revisaron los valores de calcio ionizado preoperatorio, a las 6 y a las 12h de la intervención, y los niveles de PTH. Se revisaron y evaluaron todos los archivos de acuerdo con los siguientes criterios: sexo, edad, función tiroidea, diagnóstico histológico de la muestra, extensión de la cirugía y presencia o ausencia de hipoparatiroidismo. Resultados. Encontramos 31 (19,1%) casos de hipoparatiroidismo transitorio y 8 (5%) de hipoparatiroidismo permanente. No se encontraron diferencias significativas en cuanto a hipoparatiroidismo transitorio cuando los pacientes fueron analizados por sexo. Sin embargo, todos los casos de hipoparatiroidismo permanente se observaron en individuos de sexo femenino. Comparando la hemitiroidectomía con el resto de los procedimientos quirúrgicos, se encontró que la extensión de la cirugía fue un gran factor predictivo de hipoparatiroidismo transitorio (p=0,0001) y permanente (p=0,001). El diagnóstico de malignidad es un fuerte factor predictivo de hipoparatiroidismo transitorio (p=0,002). También de hipoparatiroidismo permanente, aunque las diferencias no alcanzaron la significación estadística (p=0,096). Conclusión. La extensión de la cirugía y el diagnóstico de malignidad son factores predictivos de hipoparatiroidismo transitorio y permanente (AU)

FGFR2 overexpression predicts survival outcome in patients with metastatic papillary renal cell carcinoma

Background. Up to date, there are no data about FGFR2 expression and its predictive role in papillary RCC (pRCC) patients. The aim of the present study was to test FGFR2 expression and mutations for association with survival outcome in patients with pRCC. Methods. Specimens of removed primary tumors from 214 untreated metastatic pRCC patients were evaluated by immunohistochemistry with FGFR2 antibody. FGFR2 mutations were assessed by PCR and direct sequencing, with DNA obtained from 62 paraffin-embedded pRCC samples. FGFR2 expression was tested for associations with progression-free survival (PFS), overall survival (OS) and best objective response. Results. Expression of FGFR2 was observed in 23 % (49/214) of primary pRCC, mostly in cytoplasm of tumor cells. Expression of FGFR2 was significant lower in normal tissue of kidney (1 %, P = 0.001). FGFR2 S252W mutation was found in one patient (1.6 %), and no N549K mutation was detected. FGFR2 expression was strongly associated with a number of metastatic sites, type 2 of pRCC, lower nucleolar grade (P < 0.001). FGFR2-positive patients had significantly shorter OS and PFS (P < 0.05). On multivariate analysis, FGFR2 expression, MSKCC risk group and type of pRCC were found to be independent predictors of survival. Conclusions. In this study, we described immunohistochemical expression of FGFR2 in a large series of pRCC specimens. FGFR2 expression was found to be prognostic factor for survival in patients with metastatic pRCC. FGFR2 mutations are rare across papillary types of RCC (AU)

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Spanish consensus for the management of patients with anaplastic cell thyroid carcinoma

Anaplastic thyroid cancer (ATC) is the most aggressive solid tumor and almost uniformly lethal in humans. The Boards of the Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the Grupo Español de Enfermedades Huérfanas e Infrecuentes of the Spanish Society of Oncology requested that an independent task force draft a more comprehensive consensus statement regarding ATC. All relevant literature was reviewed, including serial PubMed searches together with additional articles. This is the first, comprehensive Spanish consensus statement for ATC and includes the characteristics, diagnosis, initial evaluation, treatment goals, recommendations and modalities for locoregional and advanced disease, palliative care options, surveillance, and long-term monitoring. Newer systemic therapies are being investigated, but more effective combinations are needed to improve patient outcomes. Though more aggressive radiotherapy has reduced locoregional recurrences, median overall survival has not improved in more than 50 years (AU)

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Complicación infrecuente de cirugía de tiroides / Uncommon complication in thyroid surgery

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¿Qué hacer ante una neoplasia mucinosa papilar intraductal de páncreas? Nuestra experiencia / What to do with an intraductal papilary mucinous pancreatic neoplasm? Our experience

INTRODUCCIÓN: Las neoplasias quísticas pancreáticas representan un grupo heterogéneo de enfermedades, donde la neoplasia mucinosa papilar intraductal está alcanzando protagonismo. El objetivo del estudio es revisar nuestra serie de neoplasias quísticas pancreáticas intervenidas y valorar la concordancia con las recomendaciones de Fukuoka. MÉTODOS: Revisamos de forma retrospectiva nuestra experiencia analizando los datos clínicos y radiológicos, la indicación quirúrgica y el estudio histológico de los 11 pacientes intervenidos en nuestro centro desde julio de 2011 a julio de 2015 por esta enfermedad, con el objetivo de valorar la concordancia con los consensos actuales. RESULTADOS: En nuestra serie la mayoría de los casos (7/11) presentaban síntomas al diagnóstico. El diagnóstico preoperatorio se alcanzó en 10 pacientes mediante radiología y/o ecoendoscopia. Las indicaciones quirúrgicas fueron presencia de síntomas, datos radiológicos de sospecha de malignidad y neoplasia de rama secundaria asintomática mayor a 30mm. Los hallazgos en estudio histológico fueron de malignidad en 6/11 (2 neoplasia invasiva, 4 displasia de alto grado), displasia moderada en 2/11, displasia de bajo grado en 2/11 y ausencia de displasia en un paciente. CONCLUSIONES: La indicación quirúrgica de las neoplasias mucinosas papilares intraductales de páncreas depende de los síntomas asociados, dimensiones, localización, riesgo y sospecha de malignidad

INTRODUCTION: Cystic pancreatic neoplasms are a heterogeneous group of pathology, and intraductal papillary mucinous neoplasia is becoming more common. The aim of this study is to review our series of cystic pancreatic neoplasms that underwent surgery and to evaluate the similarities with Fukuoka recommendations. METHODS: Retrospective review of our experience analyzing clinical and radiological data, indication for surgery and pathology study of 11 patients operated on in our centre from july 2011 to july 2015, aiming to evaluate the degree of agreement with the current consensus. RESULTS: In our series the majority of cases (7/11) had symptoms at diagnosis. Preoperative diagnosis was achieved in 10 patients using radiology and/or endoscopy. Indications for surgery were the presence of symptoms, radiological data suspicious of malignancy, and secondary branch neoplasia over 30mm. Pathological findings were malignancy in 6/11 cases (2 invasive neoplasia, 4 high grade dysplasia), moderate dysplasia in 2/11, low-grade dysplasia in 2/11 and no dysplasia in one patient. CONCLUSIONS: Surgical indication of intraductal mucinous pancreatic neoplasms depends on the associated symptoms, size, location, risk and suspicion of malignancy

El aumento de la incidencia del cáncer diferenciado de tiroides no se relaciona con un incremento en la detección de microcarcinomas incidentales / Rise in differentiated thyroid cancer incidence in our hospital is not related with an increased incidental microcarcinoma detection

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Endoscopic ampullectomy: a technical review

Background and aim: This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges. Methods: We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques. Results: Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy. Conclusions: Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention (AU)

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Hemoperitoneo espontáneo secundario a metástasis en el ligamento redondo hepático, una presentación atípica / Spontaneous hemoperitoneum secondary to metastases in the liver round ligament, an atipical presentation

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Metástasis cutáneas craneocervicales de un carcinoma papilar de tiroides variedad folicular / Cutaneous metastases on the head and neck from a papillary thyroid carcinoma, follicular variant

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Recomendaciones para el diagnóstico, la estadificación y el tratamiento de las lesiones premalignas y el adenocarcinoma de páncreas / Recommendations for the diagnosis, staging and treatment of pre-malignant lesions and pancreatic adenocarcinoma

Antecedentes y objetivo. El tratamiento del adenocarcinoma de páncreas es complejo y requiere un enfoque multidisciplinar, al igual que sucede con las lesiones premalignas, cuyo diagnóstico es cada vez más frecuente. Este documento constituye una puesta al día sobre el diagnóstico y el tratamiento de las lesiones premalignas y del adenocarcinoma de páncreas. Pacientes y método. Para ello, el Grupo Español Multidisciplinar en Cáncer Digestivo organizó una conferencia en Barcelona durante la cual un panel formado por expertos en esta enfermedad, procedentes de diversas especialidades (Gastroenterología, Cirugía, Radiología, Anatomía Patológica, Oncología Médica y Oncología Radioterápica), estableció las bases para la revisión y la elaboración del manuscrito. Resultados. Se ha revisado la literatura, discutido y, finalmente, deliberado sobre las evidencias. Conclusiones. Con todo ello, se han establecido unas recomendaciones (AU)

Background and objective. Clinical management of adenocarcinoma of the pancreas is complex, and requires a multidisciplinary approach. The same applies for the premalignant lesions that are increasingly being diagnosed. The current document is an update on the diagnosis and management of premalignant lesions and adenocarcinoma of the pancreas. Patients and methods. A conference to establish the basis of the literature review and manuscript redaction was organized by the Grupo Español Multidisciplinar en Cáncer Digestivo. Experts in the field from different specialties (Gastroenterology, Surgery, Radiology, Pathology, Medical Oncology and Radiation Oncology) met to prepare the present document. Results. The current literature was reviewed and discussed, with subsequent deliberation on the evidence. Conclusions. Final recommendations were established in view of all the above (AU)

Últimos avances en tumores pancreáticos / Latest advances in pancreatic tumours

El cáncer de páncreas continúa siendo una entidad de pésimo pronóstico. Apenas existen avances terapéuticos en los últimos años, por lo que la mayor parte del esfuerzo se centra en tratar de diagnosticar la enfermedad en un estadio precoz. En este sentido, la ultrasonografía endoscópica y diferentes herramientas asociadas a esta, como la elastografía o el uso de contrastes intravenosos, continúan siendo la piedra angular en el diagnóstico diferencial. Los tumores quísticos del páncreas, en especial el tumor papilar mucinoso intraductal, con su conocido potencial de malignidad, inundan de trabajos esta última edición de la Digestive Disease Week. Además de incidir en los problemas para su caracterización preoperatoria, tanto por la evaluación citológica por ultrasonografía endoscópica, incluso con la presencia de patólogo 'en la sala', como por el estudio de marcadores intraquísticos, se potencia el papel de otras técnicas como la endomicroscopia láser confocal o el uso de contrastes intravenosos para la caracterización del nódulo mural. Abundan los trabajos acerca de la historia natural del tumor papilar mucinoso intraductal, que en mayor medida validan el espíritu, cada vez más conservador, de las recientes guías internacionales de Fukuoka. Ciertos aspectos, como las comorbilidades, a la hora de considerar la cirugía o el ritmo de crecimiento de la neoplasia se ponen de relieve. En el campo del tratamiento comienza a tomar relevancia, en casos concretos, la inyección mediante ultrasonografía endoscópica de gemcitabina y paclitaxel sin necesidad de alcohol como tratamiento ablativo de las neoplasias quísticas mucinosas (AU)

Pancreatic cancer continues to have an extremely poor prognosis. There have been hardly any therapeutic advances in the last few years and consequently attention is focussed on early diagnosis. In this regard, endoscopic ultrasonography and several associated techniques, such as electrography or the use of intravenous contrast agents, continue to be the cornerstone of differential diagnosis. In the latest Digestive Diseases Week, numerous presentations were made on cystic pancreatic tumours, especially intraductal papillary mucinous tumours, with their well-known potential for malignant trans formation. In addition to the problems of the preoperative characterization of these entities, by both endoscopic ultrasound cytological evaluation‑even with the presence of an on-site pathologist -and by intracystic markers, the role of other techniques was also mentioned, such as confocal laser endomicroscopy or the use of intravenous contrast agents to characterize the wall nodule. There were numerous studies on the natural history of intraductal papillary mucinous tumours, which mainly supported the increasingly conservative approach adopted by the recent Fukuoka international guidelines. Certain aspects were highlighted, such as comorbidities, when considering surgery, or the growth rate of the tumour. In treatment, endoscopic ultrasound-guided injection of gemcitabine and paclitaxel, without the need for alcohol as an ablative treatment of mucinous cystic tumours, is gaining ground in specific cases (AU)

SEOM clinical guidelines for the treatment of renal cell carcinoma

The purpose of this articlewas to provide updated recommendations for the diagnosis and treatment of renal cell carcinoma. Pathological confirmation is mandatory before treatment with ablative or focal therapies before any type of systemic therapy. Renal cell cancer should be staged according to the TNM classification system. A laparoscopic nephron-sparing surgery should be the approach for tumors cmif technically feasible.Otherwise, radical (or partial in selected cases) nephrectomy is the treatment of choice, with lymph node dissection only performed in patients with clinically detected lymph node involvement. Some retrospective evidence for a cytoreductive nephrectomy in the postimmunotherapy era suggests a benefit in patients with good or intermediate risk or for patients with a symptomatic primary lesion. Adjuvant treatment with chemotherapy or with targeted agents is not recommended and studies are ongoing today. Patients with metastatic disease should be staged by computed tomography scans of the chest, abdomen and pelvis. The efficacy of sunitinib, bevacizumab plus interferon-a, and pazopanib is well established in patients with good and intermediate risk as well for temsirolimus in poor-risk patients. These four agents are considered standard of care in first-line treatment. Sorafenib, axitinib and everolimus are standard of care in second line in different settings based on their benefit in PFS.Besides somebenefit described for IL-2 in highly selected patients in first line, there is a promising and emerging role for the new immunotherapeutic approaches in metastatic renal cell carcinoma (AU)

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Metástasis cervical de carcinoma papilar de tiroides / Cervical lymph node metastasis from papillary thyroid carcinoma

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Embolia pulmonar metastásica de un adenocarcinoma papilar de endocérvix / Pulmonary Embolism Due to Metastatic Papillary Adenocarcinoma of the Uterine Cervix

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