Tumor neuroectodérmico maligno del tracto gastrointestinal: a propósito de un caso / Malignant neuroectodermal tumor of the gastrointestinal tract: case report

El tumor neuroectodérmico maligno del tracto gastrointestinal es una neoplasia rara con pocos casos reportados en la literatura, especialmente en América Latina. Descrito por primera vez en 2003, se trata de una entidad sin tratamiento estandarizado y de pobre pronóstico. Se presenta el caso de una paciente de 22 años de edad que acude a la consulta por dolor abdominal, anemia y masa abdominal palpable. Luego de estudios pertinentes se decide la conducta resectiva y el posterior tratamiento oncológico. (AU)

Malignant gastrointestinal neuroectodermal tumor (GNET), formerly known as clear cell sarcoma of the gastrointestinal tract, is an extremely rare tumor of mesenchymal origin, which presents great microscopic and molecular similarity to clear cell sarcoma found in other parts of the body, such as tendons and aponeurosis. It is characterized by its rapid evolution, high recurrence rate and frequent diagnosis as metastatic disease.1,2 (AU)

Current treatment strategies for inflammatory bowel disease patients at the risk of developing cancer: a comprehensive review

Inflammatory bowel disease (IBD) is a chronic condition that affects the digestive tract and can lead to inflammation and damage to the intestinal lining. IBD patients with cancer encounter difficulties since cancer treatment weakens their immune systems. A multidisciplinary strategy that strikes a balance between the requirement to manage IBD symptoms and the potential effects of treatment on cancer is necessary for effective care of IBD in cancer patients. To reduce inflammation and avoid problems, IBD in cancer patients is often managed by closely monitoring IBD symptoms in conjunction with the necessary medication and surgical intervention. Anti-inflammatory medications, immunomodulators, and biologic therapies may be used for medical care, and surgical options may include resection of the diseased intestine or removal of the entire colon. The current study provides a paradigm for shared decision-making involving the patient, gastroenterologist, and oncologist while considering recent findings on the safety of IBD medicines, cancer, and recurrent cancer risk in individuals with IBD. We hope to summarize the pertinent research in this review and offer useful advice. (AU)

Tumor inflamatorio miofibroblástico gastrointestinal. Reporte de caso / Gastrointestinal myofibroblastic inflammatory tumor. Case report

Introducción. El tumor miofibroblástico inflamatorio es una enfermedad proliferativa rara, de etiología incierta, caracterizada por la proliferación de miofibroblastos epitelioides o fusionados mezclados con células inflamatorias, predominantemente mononucleares. En general se considera una lesión benigna, aunque en algunos casos esta neoplasia ha mostrado un comportamiento agresivo en cuanto a recidiva local y metástasis. El tratamiento definitivo es la resección quirúrgica completa. Caso clínico. Paciente de 67 años con dos meses de evolución de fiebre y masa abdominal, en quien se realizó una tomografía computarizada de abdomen que identificó una lesión de aspecto infiltrativo tumoral, comprometiendo la grasa retroperitoneal en la transcavidad de los epiplones. Por vía percutánea se tomó una biopsia que informó un pseudotumor inflamatorio retroperitoneal. Fue llevado a cirugía radical abdominal, con patología quirúrgica final que describió un tumor miofibroblástico inflamatorio de compromiso multifocal, adherido a la serosa del estómago e intestino delgado, sin compromiso muscular. Discusión. El tumor inflamatorio miofibroblástico es una entidad rara, de etiología por esclarecer y difícil diagnóstico. Presentamos el caso clínico de un paciente con tumor inflamatorio miofibroblástico gastrointestinal.Conclusión. Se describe el caso clínico de un paciente con un tumor inflamatorio miofibroblástico gastrointestinal, de presentación rara en nuestro medio. Es importante la comparación con casos similares para poder hacer conclusiones útiles en la práctica clínica

Introduction. Inflammatory myofibroblastic tumor is a rare proliferative disease of uncertain etiology, characterized by the proliferation of epithelioid or fused myofibroblasts mixed with predominantly mononuclear inflammatory cells. In general, it is considered a benign lesion, although in some cases this neoplasm has shown aggressive behavior in terms of local recurrence and metastasis. The definitive treatment is complete surgical resection. Clinical case. A 67-year-old patient with a two-month history of fever and an abdominal mass underwent a computed tomography scan of the abdomen that identified an infiltrative tumor, compromising the retroperitoneum fat in the lesser cavity. A biopsy was taken percutaneously, which reported a retroperitoneal inflammatory pseudotumor. He was taken to radical abdominal surgery, with final surgical pathology describing an inflammatory myofibroblastic tumor with multifocal involvement attached to the serosa of the stomach and small intestine without muscle involvement. Discussion. Inflammatory myofibroblastic tumor is a rare entity, of unknown etiology and difficult to diagnose. We present a clinical case of gastrointestinal myofibroblastic inflammatory tumor to better understand this entity.Conclusion. The clinical case of a patient with a gastrointestinal myofibroblastic inflammatory tumor, a rare presentation in our environment, is described. Comparison with similar cases is important to draw useful conclusions in clinical practice

Angiosarcoma gastrointestinal multifocal, con compromiso extenso de estómago, intestino delgado y colon. Reporte de un caso / Multifocal gastrointestinal angiosarcoma, with extensive gastric, small intestine and colon involvement. A case report

Introducción. El angiosarcoma es una neoplasia vascular originada a nivel del endotelio, de baja frecuencia, conocido por su agresividad y crecimiento acelerado. Alcanza solo el 1 al 2 % del total de los sarcomas. La presentación gastrointestinal es infrecuente y su incidencia es poco conocida debido al escaso reporte de casos en la literatura. Suele identificarse en etapas avanzadas debido a la dificultad del diagnóstico histopatológico por sus características morfológicas, siendo necesario aplicar tinciones especiales o estudio inmunohistoquímico. Caso clínico. Por su interés y singularidad, presentamos el caso de un paciente masculino de 54 años, quien consultó con hemorragia digestiva profusa, anemización y requerimiento de terapia transfusional. Resultados. Durante el proceso diagnóstico, en la endoscopia encontraron diversas lesiones multifocales que se extendían por gran parte del tracto gastrointestinal. El estudio histopatológico mostró angiosarcoma gastrointestinal. Discusión. El angiosarcoma del tracto gastrointestinal es extremadamente infrecuente, de difícil diagnóstico y bajas posibilidades de manejo curativo, con opciones terapéuticas limitadas, lo que configura un mal pronóstico a corto plazo

Introduction. Angiosarcoma is a vascular neoplasm originating from endothelial cells, known for its aggressiveness, accelerated growth and reduced frequency. Reach only 1 to 2% of total sarcomas. Gastrointestinal presentation is extremely rare, the true incidence is poorly known, due to the limited reports of this entity in the literature. It is usually identified in advanced stages in view of the difficulty of the histopathological diagnosis, attributable to its morphological characteristics, being necessary to apply special stains or immunohistochemical study. Case report. Due to their interest and uniqueness, we present the case of a 54-year-old male patient, who presented with a profuse gastrointestinal bleeding, anemia, and requirement for transfusion therapy. Results. The endoscopy detected several multifocal lesions that extended most of the gastrointestinal tract. The histopathological study showed gastrointestinal angiosarcoma. Discussion. Angiosarcoma of the gastrointestinal tract is extremely uncommon, difficult to diagnose and has low possibilities of curative management, with limited therapeutic options, which configures a poor prognosis in the short term

Avaliação nutricional de pacientes cirúrgicos com câncer gastrointestinal em uso de suplemento alimentar / Nutritional evaluation of surgical patients with gastrointestinal cancer using food supplements

Objetivo: Avaliar a nutrição de pacientes cirúrgicos com neoplasia no trato gastrointestinal em uso de suplemento alimentar. Método: Trata-se de uma revisão sistemática de literatura realizada nas bases de dados Google Scholar, PubMed, Scielo e Web of Science, no período de maio a junho de 2021, sem recorte temporal ou restrição de idioma, através dos descritores: "enteral nutrition e immunenutrition", "cancerpatients e gastriccancerpatients", "preoperative, perioperative e postoperative". Resultados: Foram selecionados 8 estudos, destes, a maioria identificou benefícios na utilização da suplementação em razão da diminuição de células TNF-a, do cortisol e da transferrina, diminuindo o tempo de internação e melhora no estado funcional dos participantes suplementados. Conclusão: Os achados foram positivos, no entanto, houve algumas limitações como a heterogeneidade em abordagens terapêuticas e perda de pacientes durante o estudo, apesar de apresentarem baixo risco de viés, ainda há a necessidade de mais estudos.(AU)

Objective: To evaluate the nutrition of surgical patients with neoplasia in the gastrointestinal tract using food supplements. Method: This is a systematic literature review carried out in Google Scholar, PubMed, Scielo and Web of Science databases, from May to June 2021, without time frame or language restriction, using the descriptors: "enteral nutrition and immunenutrition", "cancerpatients and gastriccancerpatients", "preoperative, perioperative and postoperative". Results: Eight studies were selected, most of which identified benefits in the use of supplementation due to the decrease in TNF-a cells, cortisol and transferrin, reducing the length of hospital stay and improving the functional status of supplemented participants. Conclusion: The findings were positive, however, there were some limitations such as heterogeneity in therapeutic approaches and loss of patients during the study, despite having a low risk of bias, there is still a need for further studies(AU)

Objetivo: Evaluar la nutrición de pacientes quirúrgicos con neoplasia en el tracto gastrointestinal utilizando suplementos alimenticios. Método: Se trata de una revisión sistemática de la literatura realizada en las bases de datos Google Scholar, PubMed, Scielo y Web of Science, de mayo a junio de 2021, sin franja horaria ni restricción de idioma, utilizando los descriptores: "nutrición enteral e inmunonutrición", "pacientes oncológicos y pacientes con cáncer gástrico", "preoperatorio, perioperatorio y postoperatorio". Resultados: Se seleccionaron ocho estudios, la mayoría de los cuales identificaron beneficios en el uso de la suplementación por la disminución de células TNF-a, cortisol y transferrina, reduciendo la estancia hospitalaria y mejorando el estado funcional de los participantes suplementados. Conclusión: Los hallazgos fueron positivos, sin embargo, hubo algunas limitaciones como la heterogeneidad en los enfoques terapéuticos y la pérdida de pacientes durante el estudio, a pesar de tener un bajo riesgo de sesgo, aún existe la necesidad de realizar más estudios(AU)

Avaliação nutricional de pacientes cirúrgicos com câncer gastrointestinal em uso de suplemento alimentar / Evaluación nutritional de pacientes quirúrgicos con cáncer gastrointestinal utilizando complementos alimentarios / Nutritional evaluation of surgical patients with gastrointestinal cancer using food supplements

Objetivo: Avaliar a nutrição de pacientes cirúrgicos com neoplasia no trato gastrointestinal em uso de suplemento alimentar. Método: Trata-se de uma revisão sistemática de literatura realizada nas bases de dados Google Scholar, PubMed, Scielo e Web of Science, no período de maio a junho de 2021, sem recorte temporal ou restrição de idioma, através dos descritores: "enteral nutrition e immunenutrition", "cancerpatients e gastriccancerpatients", "preoperative, perioperative e postoperative". Resultados: Foram selecionados 8 estudos, destes, a maioria identificou benefícios na utilização da suplementação em razão da diminuição de células TNF-a, do cortisol e da transferrina, diminuindo o tempo de internação e melhora no estado funcional dos participantes suplementados. Conclusão: Os achados foram positivos, no entanto, houve algumas limitações como a heterogeneidade em abordagens terapêuticas e perda de pacientes durante o estudo, apesar de apresentarem baixo risco de viés, ainda há a necessidade de mais estudos.(AU)

Objective: To evaluate the nutrition of surgical patients with neoplasia in the gastrointestinal tract using food supplements. Method: This is a systematic literature review carried out in Google Scholar, PubMed, Scielo and Web of Science databases, from May to June 2021, without time frame or language restriction, using the descriptors: "enteral nutrition and immunenutrition", "cancerpatients and gastriccancerpatients", "preoperative, perioperative and postoperative". Results: Eight studies were selected, most of which identified benefits in the use of supplementation due to the decrease in TNF-a cells, cortisol and transferrin, reducing the length of hospital stay and improving the functional status of supplemented participants. Conclusion: The findings were positive, however, there were some limitations such as heterogeneity in therapeutic approaches and loss of patients during the study, despite having a low risk of bias, there is still a need for further studies.(AU)

Objetivo: Evaluar la nutrición de pacientes quirúrgicos con neoplasia en el tracto gastrointestinal utilizando suplementos alimenticios. Método: Se trata de una revisión sistemática de la literatura realizada en las bases de datos Google Scholar, PubMed, Scielo y Web of Science, de mayo a junio de 2021, sin franja horaria ni restricción de idioma, utilizando los descriptores: "nutrición enteral e inmunonutrición", "pacientes oncológicos y pacientes con cáncer gástrico", "preoperatorio, perioperatorio y postoperatorio". Resultados: Se seleccionaron ocho estudios, la mayoría de los cuales identificaron beneficios en el uso de la suplementación por la disminución de células TNF-a, cortisol y transferrina, reduciendo la estancia hospitalaria y mejorando el estado funcional de los participantes suplementados. Conclusión: Los hallazgos fueron positivos, sin embargo, hubo algunas limitaciones como la heterogeneidad en los enfoques terapéuticos y la pérdida de pacientes durante el estudio, a pesar de tener un bajo riesgo de sesgo, aún existe la necesidad de realizar más estudios.(AU)

Gastrointestinal Stromal Tumor in a Patient with Neurofibromatosis Type I: Diagnosis after Intestinal Occlusion Secondary to Adhesions after an Episode of Pancreatitis / Tumor Estromal Gastrointestinal em Paciente com Neurofibromatose Tipo I: Diagnóstico após Oclusão Intestinal Secundária a Aderências após Episódio de Pancreatite / Tumor del Estroma Gastrointestinal en Paciente con Neurofibromatosis Tipo I: Diagnóstico tras Oclusión Intestinal Secundaria a Adherencias tras Episodio de Pancreatitis

Introduction: Gastrointestinal stromal tumors (GIST), although relatively rare, account for 80% of mesenchymal tumors of the digestive tract. They manifest in any part of the alimentary tract and are derived from Cajal cells. They may occur sporadically or be associated with familial syndromes such as neurofibromatosis type I. The clinical picture is variable, and they are often diagnosed incidentally. The diagnosis requires imaging tests associated with histopathological and immunohistochemical analysis. The best strategy for treatment is surgical resection and cases should be analyzed individually to verify additional advantages with the association of systemic therapy. This study aims to present an unusual case of GIST associated with neurofibromatosis type I in a patient with incidental diagnosis after semi-intestinal occlusion secondary to an episode of pancreatitis, in addition to performing a literature review on the subject. Case report: A 49-year-old woman with a history of severe pancreatitis presented with intestinal obstruction approximately 8 months after this episode. Abdominal computed tomography revealed a heterogeneous formation in the mesogastric region, measuring 6.6 x 5.1 x 5.3 cm. She underwent surgical resection and histopathological and immunohistochemical studies confirmed the diagnosis of GIST. Six months after diagnosis, the patient is in good general condition and is on systemic therapy. Conclusion: GIST are rare tumors, but their diagnosis should come to mind in patients with neurofibromatosis type 1 with abdominal masses

Introdução: Os tumores do estroma gastrointestinal (GIST), embora relativamente raros, correspondem a 80% dos tumores mesenquimais do trato digestivo. Manifestam-se em qualquer parte do trato alimentar e são derivados das células de Cajal. Podem ocorrer de forma esporádica ou associados a síndromes familiares como a neurofibromatose tipo I. O quadro clínico é variável, sendo frequentemente diagnosticados de forma incidental. O diagnóstico requer realização de exames de imagem associados à análise histopatológica e imuno-histoquímica. A melhor estratégia para o tratamento é a ressecção cirúrgica e os casos devem ser analisados individualmente para verificar vantagens adicionais com a associação da terapia sistêmica. O objetivo deste trabalho é apresentar um caso incomum de GIST associado à neurofibromatose tipo I em uma paciente com diagnóstico incidental após semioclusão intestinal secundárias a episódio de pancreatite, além de realizar revisão de literatura sobre o assunto. Relato do caso: Mulher, 49 anos de idade,com passado de pancreatite grave,apresentou quadro de oclusão intestinal cerca de oito meses após esse episódio. A tomografia computadorizada de abdome revelou formação heterogênea em região mesogástrica, medindo 6,6 x 5,1 x 5,3 cm. Foi submetida à ressecção cirúrgica, e os estudos histopatológico e imuno-histoquímico corroboraram o diagnóstico de GIST. Seis meses após o diagnóstico, a paciente encontra-se em bom estado geral e em uso de terapia sistêmica. Conclusão: Os GIST são tumores raros, porémseu diagnóstico deve ser lembrado em pacientes com neurofibromatose tipo 1 apresentando massas abdominais

Introducción: Los tumores del estroma gastrointestinal (GIST), aunque relativamente raros, representan el 80% de los tumores mesenquimales del tubo digestivo. Se manifiestan en cualquier parte del tubo digestivo y se derivan de las células de Cajal. Pueden presentarse de forma esporádica o asociarse a síndromes familiares como la neurofibromatosis tipo I. El cuadro clínico es variable y con frecuencia su diagnóstico es incidental. El diagnóstico requiere pruebas de imagen asociadas al análisis histopatológico e inmunohistoquímico. La mejor estrategia de tratamiento es la resección quirúrgica y los casos deben analizarse individualmente para verificar ventajas adicionales con la asociación de terapia sistémica. El objetivo de este trabajo es presentar un caso inusual de GIST asociado a neurofibromatosis tipo I en un paciente con diagnóstico incidental tras una semioclusión intestinal secundaria a un episodio de pancreatitis, además de revisar la literatura sobre el tema. Informe del caso: Mujer de 49 años, con antecedente de pancreatitis severa, presentó oclusión intestinal aproximadamente ocho meses después de este episodio. La tomografía computarizada de abdomen reveló una formación heterogénea en la región mesogástrica, que medía 6,6 x 5,1 x 5,3 cm. Se le realizó resección quirúrgica y los estudios histopatológicos e inmunohistoquímicos corroboraron el diagnóstico de GIST. Seis meses después del diagnóstico, la paciente se encuentra en buen estado general y en tratamiento sistémico. Conclusión: Los GIST son tumores raros, pero su diagnóstico debe considerarse en pacientes con neurofibromatosis tipo 1 que presentan masas abdominales

Tumor de GIST, presentación no habitual / GIST tumor: an unusual presentation

RESUMEN El tumor estromal gastrointestinal representa el 3% de las neoplasias gastrointestinales; es el tumor mesenquimático más frecuente. Afecta a hombres mayores de 50 años. El 80% son benignos, la mayoría afectan el estómago e intestino delgado. La incidencia de localización extragastrointestinal es desconocida. Paciente masculino de 56 años, tabaquista, obeso, con hipertensión arterial (HTA) y diabético (DBT), anticoagulado, consulta por dolor en fosa ilíaca derecha, posterior a esfuerzo físico. Se realiza tomografía computarizada (TC) donde se visualiza lesión de aspecto expansivo intraperitoneal que muestra realce periférico. Se decide conducta quirúrgica. Se halla un tumor mesentérico. En su presentación, estos tumores hasta en un 60% suelen ser asintomáticos por lo que resultan solo un hallazgo imagenológico; es indispensable, pues, su sospecha clínica y fundamentalmente el aporte de la inmunohistoquímica para la definición de la patología. El CD 117 es el principal marcador. Su tratamiento de preferencia es siempre quirúrgico, acompañado de tratamientos quimioterápicos.

ABSTRACT Gastrointestinal stromal tumors (GISTs) account for < 3% of gastrointestinal neoplasms and are the most common mesenchymal tumors. They are more common in men > 50 years. They are benign in 80% of the cases and usually occur in the stomach and small intestine. The incidence of extragastrointestinal GISTs is unknown. A 56-year-old male patient sought medical care for abdominal pain in the right iliac fossa that appeared after exercising. The patient was a current smoker, obese, had a history of hypertension (HTN) and diabetes (DBT) and was receiving anticoagulants. A computed tomography (CT) scan showed an expansive mass within the peritoneum with peripheral enhancement. Surgical management was decided. During the procedure, a tumor was found in the mesentery. Up to 60% of these tumors are usually asymptomatic and are incidentally found in imaging tests; therefore, clinical suspicion and, most importantly immunohistochemistry, are essential for the diagnosis. CD117 is the main marker. Surgery is the treatment of choice for GISTs and chemotherapy is also indicated.

GIST gástrico complicado. Una forma de presentación inusual / Complicated gastric GIST. An unusual presentation

RESUMEN Los tumores GIST son un motivo de consulta cada vez más frecuente en las entrevistas de cirugía gastroenterológica. Suelen ser derivados como hallazgos incidentales o por presentar síntomas derivados de su crecimiento. Se presenta el caso clínico de una paciente que requirió internación de urgencia por síndrome anémico agudo. Se comenta su algoritmo diagnóstico y su resolución quirúrgica. Asimismo se comentan los estándares de diagnóstico y tratamiento actuales con especial foco en la estrategia quirúrgica, la cual debe ser individualizada según cada caso.

ABSTRACT Gastrointestinal stromal tumors (GISTs) are becoming an increasingly common reason for consultation in gastroenterology surgery interviews. Patients are usually referred for surgery due to an incidental finding or symptoms associated with tumor growth. We report the case of a female patient who required urgent hospitalization due to acute anemic syndrome. The diagnostic algorithm and surgical approach are described. The current standards of diagnosis and treatment are also discussed, with special focus on the surgical strategy, which must be tailored to each case.

Descripción de la variación en el tiempo del cáncer gastrointestinal en el centro occidente de Colombia / Description of the variation in time of gastrointestinal cancer In Central-Western Colombia

Introducción. A nivel mundial los tumores gastrointestinales tienen un impacto importante en la mortalidad y se asocian a diferentes factores, entre ellos regionales y sociodemográficos. El objetivo de este estudio fue describir la variación en el tiempo del cáncer gastrointestinal en una población del centro occidente de Colombia, dada su alta incidencia y desenlace frecuentemente fatal.Métodos. Se realizó un estudio retrospectivo observacional con muestreo no probabilístico en un tiempo de seis años. Se seleccionaron pacientes diagnosticados con algún tipo de neoplasia del tracto digestivo, en un hospital de tercer nivel del centro occidente de Colombia. Resultados. Se evaluaron un total de 1152 pacientes. Los tumores del tracto digestivo superior (esófago, unión esófago-gástrica y estómago) fueron los más frecuentes (44 %), seguidos de los tumores del tracto digestivo medio e inferior (intestino delgado, colon, recto y ano; 31 %) y de los tumores hepato-bilio-pancreáticos (25 %). La edad media de presentación fue 64,6 años, con una mayor frecuencia en el sexo masculino (51,6 %). El adenocarcinoma fue el tipo histológico más común.Conclusión. Los resultados de este estudio muestran que los tumores gastrointestinales son una neoplasia frecuente en nuestro país, siendo los tumores gástricos los que se presentan con mayor prevalencia, seguidos de los tumores colorrectales y las neoplasias biliopancreáticas, las cuales se mantiene en el tiempo.

Introduction. Worldwide, gastrointestinal tumors have a significant impact on mortality and are associated with different factors, including regional and sociodemographics. The objective of this study was to describe the variation over time of gastrointestinal cancer in a population from Central-Western Colombia, given its high incidence and frequently fatal outcome. Methods. An observational retrospective study with non-probabilistic sampling was carried out over a period of six years. Patients diagnosed with some type of neoplasm of the digestive tract were selected in a tertiary care hospital in the Central-Western Colombia. Results. A total of 1152 patients were evaluated. Tumors of the upper digestive tract (esophagus, esophagogastric junction, and stomach) were the most frequent (44%), followed by tumors of the middle and lower digestive tract (small intestine, colon, rectum and anus; 31%), and hepatobiliary-pancreatic tumors (25%). The mean age of presentation was 64.6 years with a higher frequency in males (51.6%). Adenocarcinoma was the most common histological type.Conclusion. The results of this study show that gastrointestinal tumors are a frequent neoplasm in our country, with gastric tumors being the most prevalent, followed by colorectal tumors and biliopancreatic neoplasms, which are maintained over time.

Condroma pulmonar y paraganglioma carotídeo como manifestaciones de la tríada de Carney: reporte de un caso / Pulmonary chondroma and carotid paraganglioma as expressions of Carney's triad: report of a case

Resumen Objetivos: Presentar caso clínico y revisión de la literatura sobre asociación de tumores poco frecuentes compatibles con diagnóstico de tríada de Carney. Paciente y Métodos: Revisión de ficha clínica de paciente de sexo femenino de 39 años de edad con antecedentes de asma, quien acude a servicio de urgencias por síntomas respiratorios. En estudio con imágenes se evidencia masa pulmonar en lóbulo superior derecho probablemente hamartoma y masa en la bifurcación carotídea izquierda compatible con posible paraganglioma. Se completó el estudio con endoscopia digestiva alta sin evidencia de tumor gástrico y PET-CT (tomografía de emisión de positrones-tomografía computarizada) que descartó otras lesiones. Resultados: La paciente fue sometida a resección quirúrgica de ambos tumores (pulmonar y carotídeo). En estudio histopatológico diferido, se plantean los diagnósticos de paraganglioma carotideo y hamartoma pulmonar, el cual, luego de una segunda revisión histopatológica, es corregido a condroma pulmonar. Discusión: La tríada de Carney se compone por la asociación de al menos 2 de 3 tumores: tumor estromal gastrointestinal (GIST), paraganglioma extra-adrenal y condroma pulmonar. Su expresión es variable, coexistiendo en forma completa en solo el 22% de los casos. Conclusión: Los pacientes con sospecha de tríada de Carney deben recibir evaluación multidisciplinaria, estudio completo en búsqueda de tumores asociados y seguimiento a largo plazo por posibles recurrencias o metástasis.

Objective: To present a clinical case and review of the literature on the infrequent association of pulmonary and extra thoracic tumors compatible with Carney's triad. Patient and Methods: Review of clinical records of a 39 years-old female patient with history of asthma who presented in the emergency department with respiratory symptoms. An imaging study showed a pulmonary mass in the right upper lobe with the aspect of hamartoma and a mass in the left carotid artery bifurcation compatible with a possible paraganglioma. Upper gastrointestinal endoscopy showed no evidence of gastric tumor and a PET-CT (Positron Emission Tomography - Computed Tomography) excluded other lesions. Results: Patient underwent surgical resection of both tumors (pulmonary and carotid). Diagnosis of carotid paraganglioma and pulmonary hamartoma were stated by histopathology. However, lung tumor after a second pathological analysis was confirmed to be a pulmonary chondroma. Discussion: Carney's triad is defined by the association of at least 2 of 3 tumors: Gastrointestinal Stromal Tumor (GIST), extraadrenal paraganglioma and pulmonary chondroma. Its expression is variable, coexisting completely in only 22% of cases. Conclusion: Patients with suspected Carney's triad should receive a multidisciplinary assessment, a complete study searching associated tumors and long-term follow-up for recurrences or metastases.

Manejo laparoscópico de tumor benigno del apéndice cecal: reporte de caso / Laparoscopic Management of Benign Cecal Appendix Tumor: A Case Report / Manejo laparoscópico de tumores benignos do apêndice cecal: relato de caso

La patología tumoral apendicular tiene una incidencia inferior al 0,5% de todos los tumores gastrointestinales, al ser una afección poco frecuente se detalla un análisis de los datos clínicos, imagenológicos y del manejo de la patología. Se presenta el caso de una paciente femenina de 25 años que consulta por dolor abdominal localizado en fosa ilíaca derecha de larga data. Al examen físico impresiona abdomen doloroso a la palpación superficial y profunda en fosa ilíaca derecha, ausencia de signos de irritación peritoneal. En los exámenes complementarios; la tomografía simple y contrastada de abdomen y pelvis evidencia imagen tubular, hipodensa que comienza desde la base del ciego con un calibre aproximado de 29 mm, en relación con mucocele apendicular. Se decide manejo quirúrgico, realizando hemicolectomía derecha por vía laparoscópica, sin ninguna complicación. El reporte histopatológico de la muestra enviada concluye neoplasia mucinosa apendicular de bajo grado. La paciente mostró una evolución postquirúrgica satisfactoria, siendo dada de alta, al día siguiente de su intervención quirúrgica.

Appendicular tumor pathology has an incidence of less than 0.5% of all gastrointestinal tumors, being a rare condition, an analysis of the clinical and imaging data and the management of the pathology is detailed. We present the case of a 25-year-old female patient who consulted for long-standing abdominal pain located in the right iliac fossa. Physical examination revealed a painful abdomen on superficial and deep palpation in the right iliac fossa, with no signs of peritoneal irritation. In the complementary examinations; the simple and contrasted tomography of abdomen and pelvis evidences a tubular image, hypodense that begins from the base of the cecum with an approximate caliber of 29 mm, in relation to appendicular mucocele. Surgical management was decided, performing laparoscopic right hemicolectomy, without any complications. The histopathological report of the sample sent concluded low grade appendicular mucinous neoplasia. The patient showed a satisfactory postoperative evolution and was discharged the day after surgery.

A patologia do tumor apendicular tem uma incidência de menos de 0,5% de todos os tumores gastrointestinais. Por ser uma condição rara, uma análise dos dados clínicos e de imagem e o manejo da patologia é detalhada. Apresentamos o caso de uma paciente feminina de 25 anos de idade que se consultou por dores abdominais de longa data localizada na fossa ilíaca direita. O exame físico revelou um abdômen doloroso à palpação superficial e profunda na fossa ilíaca direita, sem sinais de irritação peritoneal. Nos exames complementares, a tomografia simples e contrastada do abdômen e da pélvis mostrou uma imagem tubular hipodensa, começando na base do ceco com um calibre aproximado de 29 mm, em relação à mucocele apendicular. O gerenciamento cirúrgico foi decidido, realizando uma hemicolectomia laparoscópica direita, sem nenhuma complicação. O relatório histopatológico da amostra enviada concluiu uma neoplasia da mucosa apendiceal de baixo grau. O paciente apresentou uma evolução pós-operatória satisfatória e teve alta no dia seguinte à cirurgia.

Prognostic factors and management of colorectal gastrointestinal stromal tumors

Introduction: The gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Even though it can be found in any location of the digestive tract, the colorectal GIST is rare. With this study, we aim to review the current knowledge regarding the prognosis and management of colorectal GIST. Methods: A literature search was conducted in PubMed, and 717 articles were collected. After analyzing these studies, 60 articles were selected to use in this review. Results: The mitotic index, as well as tumor size and location were identified as good discriminators of prognosis in various studies. Surgery remains the only curative therapy for potentially resectable tumors. However, even after surgical resection, some patients develop disease recurrence and metastasis, especially those with highrisk tumors. Therefore, surgical resection alone might be inadequate for the management of all colorectal GISTs. The discovery of GIST's molecular pathway led to a shift in its therapy, insofar as tyrosine kinase inhibitors became part of the treatment schemes for this tumor, revolutionizing the treatment's outcome and prognosis. Discussion/Conclusion: The controversy concerning colorectal GIST prognosis and treatment can be, in part, attributed to the limited number of studies in the literature. In this review, we gathered the most recent knowledge about the prognosis and management of GIST in this rare location and propose two algorithms for its approach. Lastly, we highlight the importance of an individualized approach in the setting of a multidisciplinary team. (AU)

Protocolos para acompanhamento por telefone de pessoas com neoplasia gastrointestinal em quimioterapia / Protocolos para el acompañamiento telefónico de personas con neoplasia gastrointestinal en quimioterapia / Protocols for telephone follow-up of people with gastrointestinal cancer undergoing chemotherapy

Resumo Objetivo descrever o processo de construção e validação de conteúdo e aparência de protocolos para o acompanhamento por telefone na redução dos efeitos colaterais (inapetência, náusea e vômito, diarreia e constipação) associados à quimioterapia antineoplásica ambulatorial para pessoas com neoplasia maligna gastrointestinal. Métodos Estudo metodológico e quantitativo, realizado no período de setembro a novembro de 2020, em três etapas: realização de scoping review, construção dos protocolos e avaliação do material por especialistas. Foram desenvolvidos segundo o referencial metodológico da psicometria de Pasquali. Para avaliação de conteúdo, empregou-se a técnica de Delphi em duas rodadas (Delphi I [16 juízes] e Delphi II [12 juízes]) e, considerou-se válidos aqueles itens com Coeficiente de Validação de Conteúdo (CVC) maior que 0,80 e consenso de mais de 80,0% na técnica de Delphi. Os dados foram analisados por meio da estatística descritiva e inferencial (Teste binominal). Resultados Todos os requisitos dos protocolos alcançaram concordância entre os juízes superior a 80,0%, bem como todos os itens atingiram níveis de avaliação estatisticamente significativos. Ao final do Delphi II, os quatro protocolos se apresentaram expressivamente válidos (inapetência [CVC = 0,98]; náusea e vômito [CVC = 0,99]; diarreia [CVC = 0,99]; e, constipação [CVC = 0,98]). Conclusão O conteúdo dos protocolos demonstrou alta credibilidade e, sua adoção nas instituições de saúde, pode contribuir para o acompanhamento por telefone na redução dos efeitos colaterais (inapetência, náusea e vômito, diarreia e constipação) associados à quimioterapia antineoplásica ambulatorial para pessoas com neoplasia maligna gastrointestinal.

Resumen Objetivo Describir el proceso de construcción y validación de contenido y apariencia de protocolos para el acompañamiento por teléfono en la reducción de los efectos colaterales (inapetencia, náuseas y vómitos, diarrea y constipación) asociados a la quimioterapia antineoplásica ambulatoria para personas con neoplasia maligna gastrointestinal. Métodos Estudio metodológico y cuantitativo, realizado en el período de septiembre a noviembre de 2020, en tres etapas: realización de scoping review , construcción de los protocolos y evaluación del material por especialistas. Fueron desarrollados según el referente metodológico de la psicometría de Pasquali. Para la evaluación de contenido se utilizó la técnica de Delphi en dos rondas (Delphi I [16 jueces] y Delphi II [12 jueces]) y se consideraron válidos los ítems con Coeficiente de Validez de Contenido (CVC) superior a 0,80 y consenso superior al 80,0 % en la técnica de Delphi. Se analizaron los datos por medio da estadística descriptiva e inferencial (Prueba binominal). Resultados Todos los requisitos de los protocolos alcanzaron la coincidencia entre los jueces superior al 80,0 %, así como todos los ítems alcanzaron niveles de evaluación estadísticamente significantes. Al fin del Delphi II, los cuatro protocolos se mostraron expresivamente válidos (inapetencia [CVC = 0,98]; náuseas y vómitos [CVC = 0,99]; diarrea [CVC = 0,99]; y constipación [CVC = 0,98]). Conclusión El contenido de los protocolos demostró alta credibilidad y su adopción en las instituciones de salud, puede contribuir para el acompañamiento por teléfono en la reducción de los efectos colaterales (inapetencia, náuseas y vómitos, diarrea y constipación) asociados a la quimioterapia antineoplásica ambulatoria para personas con neoplasia maligna gastrointestinal.

Abstract Objective To describe the process of construction and validation of protocol content and appearance for telephone follow-up to reduce side effects (lack of appetite, nausea and vomiting, diarrhea and constipation) associated with outpatient antineoplastic chemotherapy for people with gastrointestinal malignancy. Methods This is a methodological and quantitative study, carried out from September to November 2020, in three stages: scoping review development, protocol construction and material assessment by experts. They were developed according to the Pasquali's psychometrics methodological framework. For content assessment, the Delphi technique was used in two rounds (Delphi I [16 judges] and Delphi II [12 judges]) and, those items with Content Validation Coefficient (CVC) were considered valid greater than 0.80 and consensus of more than 80.0% in the Delphi technique. Data were analyzed using descriptive and inferential statistics (Binominal test). Results All protocol requirements reached agreement among the judges above 80.0% as well as all items reached statistically significant levels of assessment. At the end of Delphi II, the four protocols were significantly valid (lack of appetite [CVC = 0.98]; nausea and vomiting [CVC = 0.99]; diarrhea [CVC = 0.99]; and constipation [CVC = 0.98]). Conclusion The content of the protocols demonstrated high credibility and their adoption in health institutions can contribute to telephone follow-up in reducing side effects (lack of appetite, nausea and vomiting, diarrhea and constipation) associated with outpatient antineoplastic chemotherapy for people with gastrointestinal malignancies.

Tumores del estroma gastrointestinal en un Hospital de México / Gastrointestinal stroma tumor in a hospital of Mexico

Introducción: Los tumores del estroma gastrointestinal son neoplasias de comportamiento benigno o maligno. Se originan de las células intersticiales de Cajal del tubo digestivo. Objetivo: Describir dos formas distintas de presentación clínica de los tumores del estroma gastrointestinal. Casos clínicos: El caso 1, paciente femenina de 65 años de edad que acudió por síntomas compresivos del tubo digestivo superior a causa de un gastrointestinal gástrico. El caso 2, paciente masculino de 56 años de edad que acudió por sangrado de tubo digestivo medio ocasionado por un gastrointestinal intestinal. Conclusiones: Los tumores del estroma gastrointestinal tienen distinta presentación clínica. Su tratamiento es esencialmente quirúrgico y en algunos casos complementados con terapia molecular dirigida(AU)

Introduction: Gastrointestinal stromal tumors are neoplasms of benign or malignant behavior. They originate from the interstitial cells of Cajal in the digestive tract. Objective: The objective of this work is to describe two different forms of clinical presentation. Case report: case 1: 65-year-old female patient who presented for compression symptoms of the upper digestive tract due to gastric GIST; case 2: 56-year-old male who presented with bleeding from the middle digestive tract caused by intestinal GIST. Conclusions: GISTs have different clinical presentation. Its treatment is essentially surgical and in some cases supplemented with targeted molecular therapy(AU)

CARACTERIZAÇÃO DAS ENDOSCOPIAS DIGESTIVAS ALTAS REALIZADAS NO MUNICÍPIO DE MOSSORÓ-RN / CHARACTERIZATION OF HIGH DIGESTIVE ENDOSCOPIES PERFORMED IN THE MUNICIPALITY OF MOSSORÓ-RN

Objetivou-se caracterizar as EDA realizadas na Comunidade de Saúde de Mossoró, RN, no período de 2008 a 2013, definindo a taxa de exames normais e a prevalência dos principais achados sugestivos de patologias digestivas. Trata-se de um estudo transversal e retrospectivo, no qual se analisou 10311 laudos de EDA. As análises estatísticas foram realizadas pelo SPSS (Statistical Package for the Social Sciences, versão 20.0), com nível de confiança95% e um p < 0,05, utilizando-se testes Qui-quadrado. Pelos dados levantados, constatamos que a EDA é um exame prático e seguro, com raríssimas complicações, sendo a agitação e a presença de alimento no estômago as limitações mais comuns. Na análise descritiva geral observou-se que a maioria dos exames foi realizada no gênero feminino, formando mais de 70% da amostra total. A faixa etária predominante, independente do gênero, foi 41 a 60 anos. As patologias frequentes no segmento esofágico foram as Esofagites. No segmento gástrico, a maior frequência de achados foram as Gastrites, que são mais frequentes com o avançar da idade. Na Transição Gastroduodenal, as úlceras de Canal Pilórico são os achados mais descritos, mas observamos também modestos achados de duodenites. No duodeno, os principais achados foram úlceras duodenais, seguidas pelas duodenites e sinais de atrofia. Portanto, as EDA são mais realizadas no gênero feminino, mas apresentam maior percentual de exames normais, sendo a maior frequência de achados encontrada no gênero masculino. Assim, após analisar as 10.311 EDA, é possível prever os achados mais comuns encontrados a EDA.

This study aimed to characterize the EDA held in Mossoro Health Community, RN, from 2008 to 2013, setting the rate of normal examinations and the prevalence of the main findings suggestive of digestive pathologies. It is a cross-sectional retrospective study, which analyzed 10,311 reports of EDA. Statistical analyzes were performed using SPSS (Statistical Package for Social Sciences, version 20.0), with a confidence level 95% and p <0.05, using chi-square tests. Raised by the data, we found that EDA is a practical and safe exam, with very few complications, agitation and presence of food in the stomach the most common limitations. In general descriptive analysis it was observed that most of the exams was held in females, forming more than 70% of the total sample. The predominant age group, regardless of gender, was 41-60 years. The frequent pathologies in esophageal segment were Esophagitis. Gastric segment, the highest frequency of findings were Gastritis, which are more common with advancing age. Gastroduodenal in Transition, the Channel Pyloric ulcers are the most described findings, but also observed modest findings of duodenitis. In the duodenum, the main findings were duodenal ulcers, followed by duodenitis and signs of atrophy. Therefore, the EDA are more performed in females, but have a higher percentage of normal results, with the highest frequency of findings found in males. So after analyzing 10,311 EDA, it is possible to predict the most common findings EDA.

Tumores estromales gastrointestinales (GIST) gástricos, serie de casos / Gastrointestinal stromal tumors (GIST). Case series

Resumen Introducción: Los tumores estromales gastrointestinales (GIST) representan hasta el 2 % de las neoplasias gastrointestinales, estos aparecen en cualquier parte del tracto gastrointestinal y son encontrados más frecuentemente en el estómago (60 %). El diagnóstico se realiza por la expresión de un receptor de factor de crecimiento de tirosina-cinasa, antígeno de diferenciación (CD) 117, lo que lo diferencia de los otros tumores mesenquimales como leiomiomas, leiomiosarcomas, leiomioblastomas y tumores neurogénicos, que no expresan esta proteína. Objetivo: El objetivo de nuestro trabajo es caracterizar los GIST de localización gástrica con respecto a su presentación clínica, diagnóstico, manejo, recurrencia y supervivencia. Métodos: Se trata de un estudio observacional, retrospectivo basado en una serie de casos. Se realizó una extracción de la información por medio de la revisión de las historias clínicas de los pacientes con GIST gástricos en un centro oncológico de Bogotá entre enero de 2005 y diciembre de 2015. La información recolectada incluyó tipo de manejo y abordaje quirúrgico, localización, tamaño, índice mitótico y clasificación de riesgo. Resultados: Se encontraron 31 pacientes con diagnóstico de GIST gástrico. La edad media fue de 62,3 años, con una mediana de 61 años. De los 31 pacientes, 18 fueron mujeres y 13 hombres. El tiempo de seguimiento estuvo entre un mínimo de 2,4 meses y un máximo de 214 meses, La mediana de seguimiento fue de 36 meses. Conclusiones: Los GIST son tumores potencialmente malignos, y el de localización gástrica es el más frecuente. El diagnóstico y tratamiento dependen de su tamaño y localización dentro del estómago. El manejo es variado y consiste en la resección quirúrgica, en la que los procedimientos son mínimamente invasivos, en combinación con la endoscopia, que son una buena alternativa al tratamiento abierto hasta que haya necesidad de terapia sistémica.

Abstract Introduction: Gastrointestinal stromal tumors (GIST) account for up to 2% of gastrointestinal neoplasms. They may appear anywhere in the gastrointestinal tract and are most frequently found in the stomach (60%). The diagnosis is made based on the expression of the tyrosine-protein kinase KIT CD117, which differentiates it from other mesenchymal tumors such as leiomyomas, leiomyosarcomas, leiomyoblastomas, and neurogenic tumors, that do not express this protein. Objective: To characterize the clinical presentation, diagnosis, treatment, recurrence, and survival of GISTs in the stomach. Materials and methods: This is an observational retrospective study based on a case series. Data was collected after reviewing the medical records of patients diagnosed with GIST at a cancer center in Bogotá between January 2005 and December 2015. The data included type of treatment and surgical approach, location, size, mitotic index, and risk classification. Results: There were 31 patients diagnosed with GIST. Their mean age was 62.3 years, with a median of 61 years. Of the 31 patients, 18 were women and 13 were men. Follow-up time ranged from a minimum of 2.4 months to a maximum of 214 months. The median follow-up time was 36 months. Conclusions: GISTs are potentially malignant tumors, with gastric location being the most frequent. Diagnosis and treatment depend on their size and location in the stomach. Treatment options vary, ranging from surgical resection, where minimally invasive procedures along with endoscopy are a suitable alternative to open surgery, to the need for systemic therapy.

GIST duodenal asociado a hemorragia digestiva alta: reporte de caso / Duodenal GIST associated with upper gastrointestinal bleeding: case report

Resumen Introducción Los tumores del estroma gastrointestinal (GIST) corresponden al 1% de todas las neoplasias gastrointestinales, sin embargo, sólo el 3-5% de estos se desarrollan en el duodeno. Objetivo Reportar el caso de un paciente masculino con localización atípica de un tumor de estroma gastrointestinal y su manejo. Caso clínico paciente masculino de 50 años con antecedente de traumatismo encefalo craneano (TEC) con daño orgánico cerebral secundario, tabaquismo, consumidor de alcohol ocasional y sometido a quistectomía branquial en la infancia, que consulta en el servicio de urgencias por cuadro de hemorragia digestiva alta con compromiso hemodinámico. Tras realizar endoscopia digestiva alta (EDA), resonancia nuclear magnética (RNM) y tomografía computada (TC) de abdomen, se pesquisa masa tumoral en segunda porción de duodenal. Discusión A pesar de que la presentación clínica de los GIST es variable, lo más frecuente es que sean pacientes asintomáticos. En algunas ocasiones, al igual que en este reporte, pueden presentarse con dolor abdominal y/o hemorragia digestiva alta. El diagnóstico preoperatorio fue difícil ya que el estudio con imágenes (TC, RNM, EDA) sólo permite establecer la sospecha; el diagnóstico definitivo se realizó con biopsia (no contamos con endosonografía en nuestro centro). Debido a los sitios de reparo anatómico, no existe una cirugía estandarizada; en este caso, debido a la localización, infiltración y características, se decidió realizar una pancreatoduodenectomía.

Introduction Gastrointestinal stromal tumors (GIST), corresponds to 1%, of all gastrointestinal neoplasms, however, only 3%-5% developed in duodenum. Aim To report a case of a male patient with atypical location of gastrointestinal stroma tumor and the treatment proposed. Case report 50-year-old male patient, with medical history of organic brain damage secondary a traumatic brain injury, smoker, occasional alcohol consumer and branquial cystomy during childhood. Consulted in the emergency department for a high digestive hemorrhage case with hemodynamic compromise. Upper digestive endoscopy, computed tomography and nuclear magnetic resonance were performed, which impresses tumor-like lesion in the second duodenal portion. Discussion Although the GIST clinical presentation is variable, most often they are asymptomatic patients. In some times, as in this report, they may present with abdominal pain and/or upper gastrointestinal bleeding. The preoperative diagnosis was difficult, because the imaging study (CT, RNM, EDA) only stablished the suspicion and the final diagnosis was made by biopsy (we don't have endosonography in our center). Due to the anatomic repair, there is not a standardized surgery, in this case, due tumor location, infiltration and characteristics, it was decided to perform a pancreatoduodenectomy.

Complicaciones quirúrgicas del linfoma con compromiso gastrointestinal / Surgical complications of lymphoma with gastrointestinal involvement

Introducción. El linfoma puede afectar el tracto gastrointestinal de manera primaria o secundaria, y representa hasta el 2 % de todas las neoplasias malignas del intestino delgado y colon. El tracto gastrointestinal es la ubicación extraganglionar primaria más común en el linfoma no Hodgkin. Métodos. Se realizó una búsqueda de la literatura en las principales bases de datos académicas, con revisión de textos publicados sobre el tema en los últimos 5 años. Discusión. La presentación clínica del linfoma con compromiso gastrointestinal es inespecífica y, hasta en la mitad de los pacientes, se puede presentar de manera inicial con complicaciones que requieran manejo quirúrgico. Entre las principales se encuentran la perforación intestinal, el sangrado digestivo y la obstrucción intestinal

Introduction. Lymphoma can affect the gastrointestinal tract, primarily or secondarily, and accounts for up to 2% of all malignant neoplasms of the small intestine and colon. The gastrointestinal tract is the most common primary extranodal location in non-Hodgkin lymphoma. Methods. A literature search performed in the main academic databases, with a review of texts published on the subject in the last 5 years.Discussion. The clinical presentation of lymphoma with gastrointestinal involvement is nonspecific and, in up to half of the patients, it can present initially with complications that require surgical management. Among the main ones are intestinal perforation, digestive bleeding and intestinal obstruction.

Ileal neuroendocrine tumor: diagnosis by endoscopic capsule / Tumor neuroendocrino ileal: diagnóstico por cápsula endoscópica

The diagnosis of neuroendocrine tumors of the small intestine is usually challenging. They are infrequent, and the clinical course is insidious with nonspecific manifestations. Routine endoscopic and abdominal imaging studies are more often unremarkable. Therefore, distant metastases are frequently detected at the time of diagnosis. The tumor markers chromogranin A, synaptophysin, and neuron-specific enolase, and capsule endoscopy, and device-assisted enteroscopy are useful resources to establish a diagnosis. The aim was to present a case of neuroendocrine tumor of small intestine diagnosed with base in findings of the capsule endoscopy and further open surgery.

El diagnóstico de tumores neuroendocrinos del intestino delgado suele ser un desafío. Son infrecuentes y el curso clínico es insidioso con manifestaciones inespecíficas. Los estudios de imágenes endoscópicos y abdominales de rutina suelen ser anodinos. Por tanto, las metástasis a distancia se detectancon frecuencia en el momento del diagnóstico. Los marcadores tumorales cromogranina A, sinaptofi-sina y enolasa neuronal específica, y la cápsula endoscópica y la enteroscopía asistida por dispositivo son recursos útiles para establecer un diagnóstico. El objetivo de este trabajo fue presentar un caso de tumor neuroendocrino de intestino delgado diagnosticado con base en hallazgos de la cápsula endoscópica y de una nueva cirugía abierta.