Abordaje laparoscópico de la neoplasia mucinosa apendicular de bajo grado / Laparoscopic approach of low-grade appendiceal mucinous neoplasm

RESUMEN Las neoplasias mucinosas apendiculares son infrecuentes y se clasifican en neoplasias mucinosas de bajo grado, de alto grado y adenocarcinoma mucinoso. Se consideran precursoras del pseudomixoma peritoneal, caracterizado por la acumulación de mucina dentro de la cavidad abdominal. Informamos tres casos de neoplasia mucinosa apendicular de bajo grado, dos varones y una mujer, que presentaron dolor abdominal agudo, diagnosticados preoperatoriamente mediante tomografía y que fueron manejados con un abordaje laparoscópico (apendicectomía, resección parcial de ciego y colectomía derecha, respectivamente). Los tres casos tuvieron una buena evolución posoperatoria y no hubo complicaciones. Se concluye que las neoplasias mucinosas apendiculares son raras y no tienen una presentación clínica específica. El abordaje laparoscópico es una opción segura y factible. La frecuencia y la duración del seguimiento de estos pacientes es motivo de controversia.

ABSTRACT Appendiceal mucinous neoplasms are rare and are classified in low-grade mucinous neoplasm, high-grade mucinous neoplasm and mucinous adenocarcinoma. They are considered precursors of pseudomyxoma peritonei, characterized by the accumulation of mucin within the abdominal cavity. We report three cases of low-grade appendiceal mucinous neoplasm, two men and one woman, who presented with acute abdominal pain. The diagnoses were made preoperatively by computed tomography scan and the tumors were managed through laparoscopic approach (appendectomy, partial resection of the cecum and right colectomy, respectively). The three patients evolved with favorable postoperative outcome without complications. Appendiceal mucinous neoplasms are rare without specific clinical presentation. The laparoscopic approach is a safe and feasible option. The frequency and duration of surveillance in these patients are still controversial.

Mucinous cystic neoplasm of the liver

A 55-year-old woman was investigated for occasional epigastric pain and weight loss. T2-weighted abdominal magnetic resonance imaging and magnetic resonance cholangiography revealed a multilocular cyst with multiple septa and a solid component in the liver, measuring 6.1 × 4.8 × 6.5 cm. Given the patient's symptoms and malignant potential, a laparoscopic segmentectomy with partial resection of segments IV B and V was performed to completely remove the cystic lesion, associated with cholecystectomy. Histopathology demonstrated a cyst lined by columnar mucinous epithelium. Therefore, the diagnosis was mucinous cystic neoplasm of the liver. This article presents a case report and literature review of this entity.

Primary malignant neoplasms of the cecal appendix: unusual findings in acute appendicitis

Introduction: To evaluate the prevalence of appendix neoplasia correlating with patient profile, histological types and frequency. Methods: Data collection was performed in the Pathology Department of a General Hospital, with the objective of identifying patients diagnosed with malignant cecal appendix tumors by histopathologic study of specimens from acute appendicitis. Results: The prevalence of malignant primary epithelial neoplasia of the appendix was 1%. Fifty percent of the cases were neuroendocrine tumors, 35% were mucinous, and 15% were adenocarcinomas. The mean age at diagnosis was 41.3 (SD, 20.4) years (range 16-81), with a women/men ratio of 3:1. Discussion: Appendiceal neoplasms are rare and should be suspected manly in women over 40 years of age with suggestive symptoms of acute appendicitis. The size, location, extent, margins and presence of mucin are essential findings for the treatment of these patients. (AU)

A rare cecal subepithelial tumor in a Crohn´s Disease patient

Appendiceal tumors comprise a variety of histologic types, including appendiceal mucinous neoplasms, which can be grouped as premalignant lesions, tumors of uncertain malignant potential, and malignant lesions. The appendiceal mucinous neoplasms are characterized by mucinous epithelial proliferation with extracellular mucin and pushing tumor margins, commonly an incidental finding during operative exploration. We report the case of a low-grade appendiceal mucinous neoplasm presenting as a subepithelial lesion in Crohn´s Disease patient. The diagnosis was not straightforward, and only surgical resection allowed an accurate diagnosis. Although Inflammatory Bowel Disease is a risk factor for the development of colorectal neoplasms, the absolute risk for appendiceal tumors is uncertain. The frequency of progression to malignancy remains to be determined.

The rare case of a cystic pancreatic neuroendocrine tumor

The pancreatic neuroendocrine tumors (PanNETs) most commonly present as solid neoplasms; however, very rarely, they may present primarily as cystic neoplasms. Most of the cystic PanNETs are non-secreting tumors, and the radiological features are not well defined. Hence pre-operative diagnosis is usually challenging and the tumors are misdiagnosed as mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, serous cystic neoplasms, solid pseudopapillary neoplasms, and non-neoplastic cysts. However, the management depends on the accurate diagnosis of these cystic lesions, which poses a dilemma. Herein, we report the case of a cystic PanNET in the tail of the pancreas, which was clinically and radiologically misdiagnosed as a mucinous cystic neoplasm. This case is reported to highlight this issue to the medical community regarding the diagnostic difficulty in such rare non-functioning pancreatic neuroendocrine tumors.

Características de la neoplasia quística mucinosa del páncreas en pacientes atendidos en un Hospital Nacional del Perú / Characteristics of pancreatic mucinous cystic neoplasm in patients treated at a National Hospital in Peru

RESUMEN Con el objetivo de analizar las características clínico, patológicas y quirúrgicas de la Neoplasia Quística Mucinosa de páncreas (NQM), se realizó un análisis de los pacientes del servicio de Cirugía de Páncreas, Bazo y Retroperitoneo del Hospital Nacional Guillermo Almenara Irigoyen en Lima, Perú desde enero del 2009 hasta octubre del 2018. La presencia del estroma ovárico se usó como criterio diagnóstico de NQM. De diez pacientes con edad promedio de 47,8 años, nueve fueron mujeres, las lesiones estuvieron localizadas en el páncreas distal, el tamaño tumoral promedio fue de 88,6 mm. En todos los pacientes se realizó una pancreatectomía distal siendo tres laparoscópicas, no hubo reoperaciones ni fallecidos, dos pacientes tuvieron carcinoma invasor asociado. En conclusión, la presentación de NQM es mayor en mujeres de edad media siendo la localización en el páncreas distal y el porcentaje de malignidad bajo. La cirugía laparoscópica es una alternativa de manejo.

ABSTRACT In order to analyze the clinical, pathological, and surgical characteristics of pancreatic mucinous cystic neoplasm (MCN), an analysis of the patients from the Pancreas, Spleen, and Retroperitoneal Surgery Service of the Guillermo Almenara Irigoyen National Hospital in Lima, Peru, was performed from January 2009 to October 2018. The presence of ovarian stroma was used as a diagnostic criterion for MCN. From ten patients with an average age of 47.8 years, nine were women; the lesions were located in the distal pancreas, and the average tumor size was 88.6 mm. All patients underwent a distal pancreatectomy, three of which were laparoscopic; there were no reoperations or deaths; two patients had associated invasive carcinoma. In conclusion, the frequency of MCN is higher in middle-aged women, being the location in the distal pancreas and the percentage of malignancy is low. Laparoscopic surgery is a disease management option.

Neoplasia quística mucinosa en hígado. Presentación de un caso / Mucinous cystic neoplasm of the liver: A case report

Anteriormente la neoplasia quística mucinosa del hígado (NQM-H) se había clasificado como cistoadenoma biliar o cistoadenocarcinoma biliar. Sin embargo, la Organización Mundial de la Salud en la clasificación del 2010 definió la NQM-H como contrapartida de la NQM del páncreas (NQM-P). En ambos casos se requiere la presencia de estroma ovárico para establecer el diagnóstico. La NQM-H es una rara enfermedad que se produce en una frecuencia mucho menor que la pancreática y sus características biológicas han sido poco esclarecidas. Presentamos un caso de NQM-H en una paciente de 33 años que fue tratada con resección quirúrgica.(AU)

Mucocele apendicular / Appendiceal mucocele

El mucocele apendicular es una dilatación quística de la luz del apéndice ileocecal de etiología obstructiva que produce un acúmulo retrógrado de sustancia mucoide. Representa un 8-10% de todos los tumores apendiculares, con una incidencia del 0,2-0,3% de todas las apendicectomías. La etiología hace referencia a procesos no neoplásicos o tumorales (cistoadenoma o cistoadenocarcinoma mucinoso). Un incorrecto abordaje terapéutico o un diagnóstico histológico poco definido o incompleto, pueden provocar un síndrome de pseudomixoma peritoneal. El objetivo de este trabajo es describir un caso de mucocele apendicular. Se trata de una paciente de sexo femenino de 68 años de edad, que consultó en el servicio de emergencia por dolor abdominal a nivel de epigastrio, irradiado a la fosa iliaca derecha, con clínica sugerente de proceso inflamatorio apendicular, y tomográficamente se evidenció imagen probable de mucocele apendicular. Luego del tratamiento quirúrgico, la paciente mejoró significativamente. La TC con contraste es más comúnmente utilizada para el diagnóstico prequirúrgico. El objetivo final de la terapéutica es la de evitar la ruptura del mucocele apendicular y el síndrome de pseudomixoma peritoneal, por lo cual es importante contar con la TC simple y contrastada de abdomen y pelvis para la adecuada planeación quirúrgica en los casos sospechosos de mucocele apendicular.

The appendiceal mucocele is cystic dilation light ileocecal appendix obstructive etiology which causes a retrograde accumulation of mucoid substance. A 8-10% of all appendiceal tumors, with an incidence of 0.2 to 0.3% of all appendectomies. The etiology refers to non-neoplastic or tumor (cystadenoma or mucinous cystadenocarcinoma) processes. Incorrect therapeutic approach or poorly defined or incomplete histological diagnosis, can cause peritoneal pseudomixoma syndrome. The aim of this paper is to describe a case of appendiceal mucocele. It is a female patient of 68 years old who consulted in the emergency department for abdominal pain at epigastrium, radiating to the right iliac fossa, with suggestive clinical appendicular inflammatory process, and tomographic image likely was evident appendiceal mucocele. After surgery, the patient improved significantly. Contrast CT is most commonly used for presurgical diagnosis. The ultimate goal of therapeutic is to prevent rupture of the appendiceal mucocele syndrome peritoneal pseudomixoma, so it is important to have the simple and contrast CT of the abdomen and pelvis for proper surgical planning in suspected cases of appendiceal mucocele.

Cirugía mínimamente invasiva de tumoración quística abdominal gigante en paciente puérpera / Minimally invasive surgery of a giant abdominal cyst tumor in a puerperal patient

La incidencia de masas anexiales diagnosticadas durante el embarazo varía según las diferentes series consultadas; sin embargo, masas de tamaño superior a 6 cm suponen casos excepcionales en la literatura. El manejo de este tipo de pacientes supone un reto para el equipo multidisciplinario, ya que se debe tener en cuenta el riesgo de cáncer de ovario en este tipo de pacientes. Se trata de una gestante de 34 años a la que se le diagnostica una masa anexial gigante durante el control ecográfico del primer trimestre. Ante la ausencia de sufrimiento fetal y teniendo en cuenta las características radiológicas de la lesión, se decide mantener una actitud expectante a la espera de un parto vía vaginal y poder realizar una cirugía electiva para la exéresis de la lesión. Tras el parto, la paciente sufre una anemización progresiva, por lo que se decide priorizar la intervención quirúrgica. Se llevó a cabo una exéresis de la masa mediante un abordaje mínimamente invasivo. Tanto la paciente como el recién nacido, tuvieron una evolución favorable. La paciente fue dada de alta tres días después de la cirugía(AU)

The incidence of adnexal masses diagnosed in pregnancy varies by the different consulted series; however, over 6cm long masses represent exceptional cases in literature. The management of this type of patients is a challenge for the multidisciplinary team since the risk of ovarian cancer should be taken into consideration in this type of patients. This is a 34 years-old pregnant patient who was diagnosed with giant adnexal mass during the echographic control of the first trimester. Due to the lack of fetal distress and the radiological characteristics of the lesion, it was decided to keep surveillance to wait for the vaginal delivery and to perform an elective surgery to remove the lesion. After the childbirth, the patient suffered a process of anemia, so it was decided to prioritize surgery. The mass was excised through a minimally invasive approach. Both the mother and the newborn had favorable recovery and the patient was discharged from hospital three days after surgery(AU)

Glial Cyst inside the Cerebellar Parenchyma: Case Report and Literature Review

Cystic lesions inside the brain parenchyma are a common pathological finding in the investigation of patients with suspicion of cerebral tumor. Histological diagnosis is important to guide the patient's treatment and follow-up, and to determine prognosis. Among patients diagnosed with cerebral cysts, most are located in the parenchyma above the tentorium. The authors describe the case of a patient who had been suffering from dizziness and balance disturbance for 4 months; the investigation identified a cyst inside the cerebellar right hemisphere. A surgical procedure was performed, and the biopsy microscopic analysis diagnosis was glial cyst.

Patologias intraparenquimatosas de características císticas são comumente identificadas em pacientes que estão sob investigação de neoplasias cranianas. Lesões císticas são mais prevalentes acima da tenda cerebelar, e o diagnóstico histológico é fundamental para determinar o tratamento, seguimento e prognóstico do paciente. Os autores relatam o caso de um paciente com sintomas de vertigem e alteração no equilíbrio dinämico de 4 meses de evolução, cuja investigação diagnosticou cisto intraparenquimatoso no hemisfério cerebelar direito. Procedeu-se com intervenção cirúrgica cujo diagnóstico histopatológico foi compatível com Cisto Glial

Características clínico patológicas de los tumores quísticos del páncreas / Clinicopathologic characteristics of the pancreatic cystic tumors

Los tumores quísticos del páncreas han pasado de ser una entidad poco frecuente a representar hasta el 25% de la patología quirúrgica de este órgano. Objetivo: Evaluar la frecuencia de presentación de cada variedad y el comportamiento de los tumores quísticos de páncreas operados en nuestra unidad. Materiales y métodos: Durante el período comprendido entre octubre de 2002 y diciembre de 2013 en la Unidad de Páncreas han sido operados 708 pacientes con tumores de páncreas, de los cuales se analizan 146 casos de tumores quísticos. Resultados: El diagnóstico preoperatorio de tumor quístico se realizó en el 91% de los casos, sin embargo solo fue posible identificar de qué tipo de tumor quístico se trataba en el 73%. En 128 (88%) casos se pudo resecar el tumor quístico, mientras en 3 pacientes se realizó una cirugía derivativa y en 15 se efectuaron una exploración y biopsia por tratarse de casos avanzados con extensión de la enfermedad. Al evaluar el comportamiento en lo que respecta a la malignidad de cada uno de los cuatro tipos de tumores quísticos, observamos que el que presentaba mayor incidencia de cáncer en la serie fue el intraductal papilar mucinoso con 53%, seguido de las neoplasias mucinosas quísticas con 50% en tanto que el sólido pseudopapilar presentó 29% de degeneración maligna, no existiendo ningún caso de cistoadenocarcinoma seroso con cáncer. Conclusiones: Los tumores quísticos son lesiones frecuentemente encontradas en el páncreas. Es muy importante diferenciar cada uno de ellos debido a que presentan un alto potencial de malignidad, el cual puede llegar hasta 53% como es el caso del intraductal papilar mucinoso...

Formerly an infrequent pathology, pancreatic cystic tumors stand nowadays for 25% of all pancreatic surgical diseases. Objective: Evaluate the frequency of the presentation of each type and the behavior of the pancreatic cystic tumors that went to surgery in our unit. Materials and methods: In our Pancreas Unit, 708 patients with pancreatic tumors underwent surgery in the period between October 2002 and December 2013. 146 cases of pancreatic cystic tumors taken from that group are the topic of the present study. Results: Even when diagnosing pancreatic tumors as cystic tumors was possible in 91% of cases during pre-op evaluation, categorizing the type of cystic tumor was only possible in 73% of cases. In 128 cases (88%), cystic tumors were removable. Due to advanced disease, in 3 cases only diversion surgery was possible and, in 15 cases, exploration and biopsy was the only choice. When the frequency of malignancy was assessed for all four types of pancreatic cystic tumors, the one most frequently becoming malignant was mucinous papillary intraductal (53%), followed by mucinous cystic (50%). Solid pseudopapillary pancreatic cystic tumors became malignant in 29% of cases and for serous cystoadenoma the frequency of malignancy was nihil. Conclusions: Cystic tumors are the most frequent type of pancreatic lesion. ItÆs of paramount importance to categotize them since risk of malignancy can be as high as 52% in case of mucinous intraductal papillary type...

Lesões Císticas do Pâncreas / Prancreatic cystic lesions

As lesões císticas do pâncreas são peculiares em relação ao diagnóstico e ao tratamento. O recurso da ecoendoscopia promoveu melhor processo na diferenciação entre as lesões com características benignas e as malignas. Trata-se de afecção de alta possibilidade de cura na ocasião do diagnóstico precoce, oferecendo-se tratamento efetivo e impactante. Didaticamente, podemos dividir em tipos de lesões macro e microcística: a primeira poderá apresentar-se com características de malignidade; já a segunda demonstra-se ser lesão benigna. As lesões císticas tipo IPMN estão detalhadas neste artigo e o tratamento cirúrgico é a opção justificada naqueles pacientes com lesões no ducto pancreático principal. Caso contrário, nos pacientes com IPMN dos ductos secundários, o acompanhamento poderá ser feito pela ecoendoscopia. Finalmente, as lesões císticas do pâncreas devem ser avaliadas por abordagem multidisciplinar, alcançando-se assim o melhor tratamento possível ao paciente.

The cystic pancreatic lesions have particularities regarding diagnostic and treatment ways. The resources on EUS raised up better process to be diferetiating those cases with benign and malignant features. It is a lesion with high probability to bring an early diagnosis and with an effective and prompt treatment. It will be didactly share the types of lesions in macro and microcystics, the first one could be raised up the features of malignancy, on the other hand the last one push up the benigns lesions. IPMN lesions are detailed in the manuscript and in those patients with main pancreatic duct lesions the surgical treatment is the rationale otpion. Otherwise, patients with side branch IPMN, the follow up could be taken by using EUS findings. Finally, pancreatic cystic lesions should be assessed by multidisciplinary approach intending the best treatment chance.

Carcinoma de ovário seroso e não seroso: tipo histológico em relação ao grau de diferenciação e prognóstico / Serous and non-serous ovarian carcinoma: histological tumor type as related to the grade of differentiation and disease prognosis

OBJETIVO: Comparar as características clinicopatológicas de mulheres com carcinoma seroso e não seroso de ovário e identificar os fatores associados à sobrevida. MÉTODOS: Foram incluídas, neste estudo de coorte reconstituída, 152 mulheres com carcinoma de ovário, atendidas entre 1993 e 2008 e seguidas até 2010, nas quais o tipo histológico foi claramente estabelecido: 81 pacientes com carcinoma seroso e 71 pacientes com tumores não serosos (17 com carcinoma endometrioide, 44 com carcinoma mucinoso e 10 com carcinoma de células claras). Foram calculados os odds ratios (OR) brutos e os OR ajustados com os respectivos intervalos de confiança (IC95%) para as características clínicas e patológicas, comparando tumores serosos e não serosos. Foram calculados os Hazard Ratios (HR) com os respectivos IC95% em relação à sobrevida geral, para as variáveis clínicas e patológicas. RESULTADOS: Comparando os tipos seroso e não seroso, na análise univariada, os tumores serosos foram mais frequentes na pós-menopausa e eram preponderantemente carcinomas de alto grau histológico (G2 e G3), em estádios avançados, com CA125>250 U/mL e citologia peritoneal positiva. Após regressão múltipla, apenas o alto grau histológico se manteve associado com tumores serosos (OR ajustado 15,1; IC95% 2,9-77,9). Observamos 58 óbitos pela doença. O tipo histológico (seroso ou não seroso) não esteve associado com a sobrevida (HR 0,4; IC95% 0,1-1,1). Mulheres com idade de 50 anos ou menos (HR 0,4; IC95% 0,1-0,9) e aquelas que estavam em menacme (HR 0,3; IC95% 0,1-0,9) tiveram maior sobrevida quando comparadas, respectivamente, àquelas com idade acima de 50 anos e na menopausa. Carcinomas de alto grau histológico (G2 e G3) (p<0,01), estádio II a IV (p<0,008) e citologia peritoneal positiva (p<0,001) estiveram significativamente relacionados com pior prognóstico. O nível sérico de CA125 e a presença de ascite não se relacionaram com a sobrevida. A sobrevida foi menor quando a doença foi diagnosticada em estágios II a IV em comparação àquela das mulheres diagnosticadas no estádio I (log-rank p<0,01) independentemente do tipo histológico (seroso ou não seroso). CONCLUSÕES: A proporção de carcinomas de alto grau histológico (G2 ou G3) foi significativamente maior entre os carcinomas serosos comparados com não serosos. O tipo histológico seroso ou não seroso não esteve associado à sobrevida total.

PURPOSE: To compare the clinical-pathological features of women with serous and non-serous ovarian tumors and to identify the factors associated with survival. METHODS: In this reconstructed cohort study, 152 women with ovarian carcinoma, who attended medical consultations between 1993 and 2008 and who were followed-up until 2010 were included. The histological type was clearly established for all women: 81 serous carcinomas and 71 non-serous tumors (17 endometrioid, 44 mucinous and 10 clear cell carcinomas). The crude and adjusted odds ratios (OR), with the respective 95% confidence intervals (95%CI), were calculated for the clinical and pathological features, comparing serous and non-serous histological types. The Hazard Ratios (HR) with 95%CI was calculated for overall survival, considering the clinical and pathological features. RESULTS: Comparison of serous to non-serous tumor types by univariate analysis revealed that serous tumors were more frequently found in postmenopausal women, and were predominantly high histological grade (G2 and G3), advanced stage, with CA125>250 U/mL, and with positive peritoneal cytology. After multivariate regression, the only association remaining was that of high histological grade with serous tumors (adjusted OR 15.1; 95%CI 2.9-77.9). We observed 58 deaths from the disease. There was no difference in overall survival between women with serous carcinoma and women with non-serous carcinoma (HR 0.4; 95%CI 0.1 - 1.1). It was observed that women aged 50 years or less (HR 0.4; 95%CI 0.1-0.9) and those who were in menacne (HR 0.3; 95%CI 0.1-0.9) had a longer survival compared respectively to those above 50 years of age and menopaused. High histological grade (G2 and G3) (p<0.01), stages II-IV (p<0.008) and positive cytology (p<0.001) were significantly associated with worse prognosis. CA125 and the presence of ascites did not correlate with survival. Survival was poor when the disease was diagnosed in stages II to IV and compared to stage I (log-rank p<0.01) regardless of histological type (serous and non-serous). CONCLUSIONS: The proportion of high histological grade (G2 and G3) was significantly higher among serous than non-serous carcinomas. Serous and non-serous histological types were not related to overall survival.

Papel atual dos métodos de imagem no diagnóstico das neoplasias císticas e sólidas do pâncreas: 1ª parte / Current role of imaging methods in the diagnosis of cystic solid pancreas neoplasms: part I

Os autores fazem uma revisão considerando o valor da colangiopancreatografia endoscópica retrógrada, da ultrassonografia, da tomografia computadorizada, da ressonância magnética e da ecoendoscopia para o diagnóstico das neoplasias císticas e sólidas do pâncreas, demonstrando que cada um deles tem grande importância para aumentar, de forma inconteste, a acurácia diagnóstica das doenças do sistema biliopancreático. determinando qual o melhor método para cada um dos diversos tumores.

The authors address the value of endoscopic retrograde cholangiopancreatography, ultrasonography, computed tomography, magnetic resonance imaging and endoscopic ultrasound for the diagnosis of cystic and solid neoplasms of the pancreas, demonstrating that each of them is of great importance to undoubtedly increase the diagnostic accuracy of the biliopancreatic system diseases. The best method for each of several tumors is then determined.

Tumor sólido quístico pseudopapilar del páncreas: reporte del primer caso en Cuba / First clinical report from Cuba of solid-pseudopapillary tumors of the pancreas

Se presenta el caso de una paciente de 21 años de edad, portadora de un tumor sólido quístico pseudopapilar del páncreas. Se hace una revisión de los aspectos clínicos, diagnósticos y terapéuticos de esta rara neoplasia; al mismo tiempo, se hace énfasis en la anatomía patológica y en su diagnóstico diferencial. Esta es una entidad propia de mujeres jóvenes, sin embargo, en la actualidad ha incrementado su frecuencia, con variación en los aspectos clásicos del comportamiento clínico.

The case of a 21-year female patient with a solid-pseudopapillary tumor of the Pancreas is presented. Clinical, histopathological, diagnostic and therapeutic features of this rare tumor are presented and discussed with emphasis on pathology and differential diagnosis. This rare entity most frequently affects young women, but its incidence has increasing, and there have been changes its clinical behavior from those classically reported.

Neoplasias císticas do pâncreas / Cystic neoplasms of the pancreas

Os autores fazem uma revisão sobre neoplasias císticas do pâncreas , abrangendo sua classificação aspectos clinico- cirúrgicos diagnostico , assim como algoritmos de tratamento, seguimento e prognóstico

Pseudomixoma peritonei: relato de caso e revisão de literatura / Pseudomyxoma peritonei: case report and literature

Objetivos: Relato de caso de uma doença rara e progressiva cujo diagnóstico preciso é realmente difícil devido a inespecificidade dos sintomas. Descrição do caso: Paciente masculino de 26 anos de idade, ganho de peso (4 kg em 4 meses), apresentado massa tumoral musinosa cmprometendo a cavidade peritoneal. Conclusões: Pseudomixoma peritonei é uma doença rara e pouco compreendida, caracterizada por ascite musinosa e implantes municiosos envolvendo a cavidade peritoneal, resultando em uma "gelatina". O tumor primário geralmente se origina no apêndice.

Postpartum incidental solid pseudopapillary tumor of the pancreas: case report

Solid pseudopapillary tumors of the pancreas are usually described as rare lesionswith low malignant potential and unpredictable behavior. The prognosis may be favorableeven with local or distant dissemination. Despite the steady increase of cases diagnosed,the pathogenesis of this neoplasm remains unclear. We present a case of an incidentaltumor discovered because of an acute abdomen in a postpartum woman without previousevidence of a tumor during the pregnancy.

Cistoadenoma mucinoso del páncreas: reporte de un caso / Pancreatic mucinous cystadenoma: a case report

Los tumores mucinosos de páncreas son poco frecuentes, representan el 1 por ciento de los tumores pancreáticos quísticos, incluyen a los tumores serosos y un grupo misceláneo. Aparecen con mayor frecuencia en mujeres adultas. Su diagnóstico está basado por dolor abdominal, síntomas derivados del efecto masa y de los diferentes métodos diagnósticos disponibles, principalmente la tomografía axial computarizada, la ecografía, la ecoendoscopía, la colangiopancreatografía endoscópica, la tomografía por emisión de positrones, la colangioresonancia y la biopsia por aspiración con aguja fina guiada. El tratamiento en los tumores mucinosos debe ser quirúrgico por su potencial maligno. Se presenta el caso de una paciente de 52 años, con los síntomas descritos y una tumoración de más de 10 cms en hemiabdomen superior izquierdo, con estudios concluyentes de una tumoración quística de cuerpo y cola del páncreas como cistoadenoma mucinoso del páncreas

Duodenopancreatectomía total en la neoplasia intraductal papilomucinosa del páncreas / Total pancreatectomy in the management of intraductal papillary-mucinous tumor

Antecedentes: La amplitud de la resección quirúrgica en la neoplasia intraductal papilomucinosa del páncreas (NIPM) es un tema de controversia actual. Objetivo: Presentar los resultados de la duodenopancreatectomía total (DPT) en la NIPM de páncreas y discutir sus indicaciones actuales y futuras. Lugar de aplicación: Servicio de Cirugía General de un hospital de atención terciaria. Diseño: Observacional prospectivo. Población: Pacientes operados por NIPM entre 1994 y 2005. Métodos: Se incluyeron todos los pacientes con diagnóstico anatomopatológico de NIPM. Se indicó la DPT cuando el 80 por ciento o más del páncreas estaba comprometido, o cuando existía un cáncer invasor en el segmento extirpado y la biopsia del margen remanente era positiva para cualquier tipo de displasia. Se examinaron los datos demográficos, el grado de displasia, el estado en caso de cáncer invasor y la morbimortalidad operatoria. Todos los pacientes fueron seguidos es el postoperstorio alejado mediante ecografía y tomografía computada para investigar recurrencias. Resultados: De 57 pacientes operados por NIPM, en 13 se realizó una DPT. En 8 casos existía un carcinoma invasor, en uno carcinoma in situ y en el resto adenoma bordeline. No hubo mortalidad y la morbilidad fue 53 por ciento. Durante el seguimiento fallecieron 2 pacientes con carcinoma invasor y ganglios positivos. Los restantes 11 pacientes siguen vivos (uno con recurrencia local). Conclusiones: La DPT es hoy una operación de morbimortalidad aceptable en centros de referencia. La diabetes insulinodependiente es la única limitante de su indicación. En el futuro, un incremento en la tasa de recurrencia en la neoplasia no invasora o el advenimiento de un tratamiento efectivo de la diabetes podrían extender sus indicaciones