RESUMEN
PURPOSE: Schwannoma is a rare mesenchymal tumor. In this study, we analyzed clinicopathologically 99 schwannomas.This retrospective study delves into the clinical, pathological, and immunohistochemical dimensions of abdominal schwannomas. RESULTS: A cohort of 99 cases, comprising 4 malignant and 95 benign schwannomas, was meticulously examined. Clinical analysis revealed a notable gender distribution (1:1.7, male to female) and an average age of 58.5 years. The majority of cases were asymptomatic. A cohort of 99 cases, comprising 4 malignant and 95 benign schwannomas, was meticulously examined. Clinical analysis revealed a notable gender distribution (1:1.7, male to female) and an average age of 58.5 years. The majority of cases were asymptomatic. Tumor sizes ranged from 0.5 to 30 cm, with distinct locations in the stomach for most benign cases and the abdomen/small intestine for malignancies. Initial misdiagnoses were frequent. Pathological evaluations revealed distinct features, including Antoni A and B patterns, spindle cells, and lymphatic sheath structures in benign schwannomas. Malignant cases exhibited atypical cells, ulcers, and invasive growth. Immunohistochemical markers, such as S100, SOX10, and vimentin, consistently demonstrated positivity by contributing to accurate diagnoses. Treatment outcomes indicated a poor prognosis in malignant cases, with overall survival ranging from 10 to 41 months. Conversely, benign cases displayed no recurrence or metastasis during follow-up, despite atypical behaviors. CONCLUSION: This study underscores the rarity of abdominal schwannomas and underscores the need for a comprehensive diagnostic morphology and immunohistochemistry. SOX10 emerges as a crucial and specific marker for accurate diagnosis. Further research is imperative to refine diagnostic protocols and enhance our understanding of the clinical behavior of abdominal schwannomas.
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Neoplasias Abdominales , Neurilemoma , Humanos , Neurilemoma/patología , Neurilemoma/diagnóstico , Neurilemoma/terapia , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Neoplasias Abdominales/patología , Neoplasias Abdominales/diagnóstico , Neoplasias Abdominales/terapia , Estudios Retrospectivos , Anciano de 80 o más Años , Biomarcadores de Tumor/metabolismo , Pronóstico , Inmunohistoquímica , Adulto JovenRESUMEN
RATIONALE: Solitary fibrous tumor (SFT) is a rare mesenchymal tumor, especially the giant one from the abdominal pelvic cavity. We report on a rare case of a giant SFT of the abdominal pelvic cavity to review the existing literature in detail to improve the diagnosis and treatment of SFT. PATIENT CONCERNS: The patient is a 52-year-old female who presented with 2 weeks of abdominal distension. Abdominal magnetic resonance imaging showed a giant mass (>20â cm) in the abdominal pelvic cavity, considered a mesenchymal tumor. She denies a history of tumor disease. DIAGNOSES: A whole abdomen bulge and a mass of about 18â cmâ ×â 10 cm on the right side and middle side were found in the physical examination after admission. Abdominal enhanced computed tomography revealed a giant cystic-solid mass located on the middle and right side of the abdominal pelvic cavity, measuring approximately 20.4â cmâ ×â 11.7â cm, with multiple cystic changes and necrosis and compression of adjacent organs and tissues, and marked inhomogeneous enhancement. INTERVENTIONS: The patient underwent an open abdominal pelvic cavity giant tumor operation to achieve a radical resection, and did not undergo chemotherapy or radiotherapy. OUTCOMES: The patient underwent open complete resection of a giant abdominal pelvic tumor with no complications and was diagnosed as SFT according to the pathology, immunohistochemistry showed that the tumor tested positive for CD34(+), STAT-6(+), and Ki-67 (10%). Abdominal computed tomography scans were performed 6 months after resection, and no signs of recurrence or metastasis were found. LESSONS: The clinical symptoms and imaging features of giant abdominal pelvic cavity SFT are not typical. Preoperative diagnosis is difficult and has the potential for malignancy. Based on the results of the current study, there is no standard treatment strategy around the world and the therapeutic effect of radiation therapy and chemotherapy is relatively limited. Thus, complete surgical resection and close clinical follow-up are advocated.
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Tumores Fibrosos Solitarios , Humanos , Femenino , Tumores Fibrosos Solitarios/cirugía , Tumores Fibrosos Solitarios/patología , Tumores Fibrosos Solitarios/diagnóstico , Tumores Fibrosos Solitarios/diagnóstico por imagen , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Imagen por Resonancia Magnética , Neoplasias Abdominales/patología , Neoplasias Abdominales/cirugía , Neoplasias Abdominales/diagnóstico por imagen , Neoplasias Abdominales/diagnóstico , Neoplasias Pélvicas/cirugía , Neoplasias Pélvicas/patología , Neoplasias Pélvicas/diagnóstico por imagen , Neoplasias Pélvicas/diagnóstico , Cavidad Abdominal/patología , Cavidad Abdominal/diagnóstico por imagen , Cavidad Abdominal/cirugíaRESUMEN
Ewing sarcoma is a tumor primarily affecting children and young adults, and usually affects long bones. Extraosseous Ewing sarcoma (EES) is a rare primary tumor of soft tissues. We present a case of abdominal EES with metastasis to thoracic cavity, which presented as abdominal pain and vomiting in a 21-year-old previously healthy gentleman.
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Abdomen Agudo , Sarcoma de Ewing , Humanos , Masculino , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/complicaciones , Adulto Joven , Abdomen Agudo/etiología , Abdomen Agudo/diagnóstico , Neoplasias Abdominales/diagnóstico , Neoplasias Abdominales/complicaciones , Neoplasias Torácicas/diagnóstico , Neoplasias Torácicas/complicacionesRESUMEN
RATIONALE: Desmoid tumor (DT) is a rare soft tissue tumor that can occur anywhere in the body. Abdominal wall DT presents unique clinical challenges due to its distinctive manifestations, treatment modalities, and the lack of biomarkers for diagnosis and recurrence prediction, making clinical decisions exceedingly complex. PATIENT CONCERNS: A 32-year-old female who underwent radical resection combined with patch reinforcement for rectus abdominis DT, successfully alleviating abdominal discomfort, with no recurrence during the 6-month follow-up after surgery. DIAGNOSES: Based on the imaging studies and medical history, the patient underwent radical surgical resection. Histopathology reveals that the tumor cells predominantly composed of proliferative fibroblasts with local collagen deposition. The lesional cells show positive staining for ß-catenin, indicating a diagnosis of DT. INTERVENTIONS: The patient underwent radical surgical resection with patch reinforcement to repair the abdominal wall defect. Pathology confirmed negative margins, achieving an R0 resection, and genetic testing identified a T41A mutation in CTNNB1. Consequently, no additional adjuvant therapy was administered postoperatively. OUTCOMES: The patient was discharged with the incision healing well after 3 days postoperation. Upon reexamination 6 months later, no recurrence or adverse complications were observed. LESSONS: Abdominal wall DT treatment requires personalized plans from multidisciplinary team discussions. Genetic testing plays a crucial role in identifying novel biomarkers for abdominal wall DT. We have once again demonstrated the significant clinical significance of CTNNB1 mutations in the diagnosis and progression of abdominal wall DT. Additionally, genes such as CCND1, CYP3A4, SLIT1, RRM1, STIM1, ESR2, UGT1A1, among others, may also be closely associated with the progression of abdominal wall DT. Future research should delve deeper into and systematically evaluate the precise impact of these genetic mutations on treatment selection and prognosis for abdominal wall DT, in order to better guide patient management and treatment decisions.
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Fibromatosis Agresiva , Recto del Abdomen , Humanos , Femenino , Adulto , Fibromatosis Agresiva/cirugía , Fibromatosis Agresiva/diagnóstico , Fibromatosis Agresiva/genética , Fibromatosis Agresiva/patología , Recto del Abdomen/cirugía , beta Catenina/genética , Neoplasias Abdominales/cirugía , Neoplasias Abdominales/genética , Neoplasias Abdominales/diagnóstico , Neoplasias Abdominales/patologíaRESUMEN
The purpose of the present study is to evaluate whether an online reference system (ORS, STATdx Elsevier, Amsterdam, Netherlands) impacts finding the histologically confirmed diagnosis of rare or atypical abdominal tumors and lesions in radiologic imaging. In total, 101 patients with rare tumor entities or lesions and atypical manifestations of common tumors were enrolled retrospectively. Blinded readings were performed by four radiologists with varying levels of experience, who reported on: (a) correct diagnosis (CD), (b) time needed to find the diagnosis, and (c) diagnostic confidence, initially without followed by the assistance of the ORS. The experienced reader (3 years of experience post-residency, CD 49.5%), as well as the advanced reader with 1 year of experience post-residency (CD 43.6%), and a resident with 5 years of experience (CD 46.5%) made the correct diagnosis more frequently compared to the less experienced reader (CD 25.7%). A significant improvement in making the correct diagnosis was only achieved by the advanced reader, the resident with 5 years of experience (CD with ORS 58.4%; p < 0.001). The advanced reader with 1 year of experience post-residency improved slightly (CD ORS 47.5%). The experienced reader (CD ORS 50.5%) and the less experienced reader (CD ORS 27.7%) did not improve significantly. The overall subjective confidence increased significantly when ORS was used (3.2 ± 0.9 vs. 3.8 ± 0.9; p < 0.001). While the ORS had a positive impact on making the correct diagnosis throughout all readers, it favored radiologists with more clinical experience rather than inexperienced residents. Moreover, the ORS increased the diagnostic confidence of all radiologists significantly. In conclusion, the ORS had no significant impact on the diagnosis of rare or atypical abdominal tumors and lesions except for one reader. The greatest benefit is the increase in diagnostic confidence.
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Neoplasias Abdominales , Humanos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Adulto , Neoplasias Abdominales/diagnóstico , Neoplasias Abdominales/patología , Estudios Retrospectivos , Anciano de 80 o más Años , Adulto Joven , Adolescente , Sistemas en LíneaAsunto(s)
Actinomicosis , Hernia Umbilical , Humanos , Diagnóstico Diferencial , Actinomicosis/diagnóstico , Actinomicosis/diagnóstico por imagen , Hernia Umbilical/diagnóstico , Hernia Umbilical/cirugía , Neoplasias Abdominales/diagnóstico por imagen , Neoplasias Abdominales/diagnóstico , Masculino , Femenino , Persona de Mediana EdadAsunto(s)
Neoplasias de Células Germinales y Embrionarias , Humanos , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/diagnóstico , Neoplasias de Células Germinales y Embrionarias/cirugía , Neoplasias de Células Germinales y Embrionarias/diagnóstico por imagen , Masculino , Neoplasias Abdominales/patología , Neoplasias Abdominales/diagnóstico por imagen , Neoplasias Abdominales/diagnóstico , Neoplasias Abdominales/cirugía , AdultoRESUMEN
ABSTRACT: Sister Mary Joseph's nodule is an umbilical nodule found in patients with metastatic abdominal cancers. It is quite rare finding and needs a high index of suspicion for diagnosis. Detection of Sister Mary Joseph's nodule should warrant widespread search for abdominal carcinoma and it universally carries quite poor clinical prognosis. Here, we describe the case of a 28-year-old patient who presented with Sister Mary Joseph's Nodule and was found to have metastatic signet ring cell gastric carcinoma on investigation. A brief discussion about this rare condition is also presented.
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Neoplasias Abdominales , Carcinoma de Células en Anillo de Sello , Nódulo de la Hermana María José , Neoplasias Gástricas , Humanos , Adulto , Nódulo de la Hermana María José/diagnóstico , Nódulo de la Hermana María José/patología , Ombligo/patología , Neoplasias Abdominales/diagnóstico , Neoplasias Abdominales/cirugía , Neoplasias Abdominales/patología , Carcinoma de Células en Anillo de Sello/patología , Neoplasias Gástricas/patologíaRESUMEN
La infección por Actinomices (actinomicosis), es una entidad poco frecuente y que puede crear dificultades diagnósticas y terapéuticas; principalmente cuando por su presentación se asemeja a neoplasias malignas. El objetivo de este estudio fue reportar un caso de actinomicosis de pared abdominal con infiltración hepática y revisar la evidencia existente. Se trata de una paciente sexo femenino, de 33 años de edad, sin antecedentes quirúrgicos ni de utilización de dispositivos intra-uterinos. Consultó por dolor abdominal y masa palpable a nivel epigástrico. Se estudió con imágenes, las que permitieron verificar una masa de pared abdominal con trayecto fistuloso al hígado. Se realizó una exéresis amplia de la lesión antes descrita. Una vez extirpado el espécimen, se fue a estudio histopatológico, que reveló gránulos de azufre consistentes con actinomices. La paciente evolució de forma satisfactoria, sin inconvenientes. Presentamos un caso poco común de actinomicosis de pared abdominal con infiltración hepática. Cuando se encuentra una gran masa intraperitoneal, la actinomicosis debe incluirse en el proceso de diagnóstico diferencial.
Actinomyces infection (actinomycosis) may create diagnostic conflicts and be confused with malignant neoplasms, especially in the abdomen. The objective of this study was to report a case of abdominal wall actinomycosis with hepatic infiltration, and review the existing evidence. Female patient, 33 years of age, with no surgical history or use of intra-uterine devices. She consulted for abdominal pain and palpable mass at the epigastrium. It was studied with images, which allowed verifying an abdominal wall mass with hepatic fistulae. A broad extirpation of the lesion was performed. The histological study revealed sulfur granules consistent with actinomyces. The patient has evolved satisfactorily, without problems; and is currently in treatment with amoxicillin. We present an unusual case of abdominal wall actinomycosis with hepatic infiltration that resulted in a difficult diagnosis. When a large intraperitoneal mass is found, actinomycosis needs to be included as a differential diagnoses.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Actinomicosis/diagnóstico , Actinomicosis/cirugía , Actinomicosis/patología , Pared Abdominal/microbiología , Diagnóstico Diferencial , Absceso Hepático/etiología , Neoplasias Abdominales/diagnósticoRESUMEN
Abstract Objective: To describe the success rate and the complications after procedures to diagnose abdominal non-Hodgkin's lymphoma in children and adolescents. Methods: A retrospective cross-sectional study was conducted with a population consisting of children and adolescents with abdominal non-Hodgkin's lymphoma diagnosed between September 1994 and December 2012. The sample comprised of 100 patients who underwent 113 diagnostic procedures, including urgent surgery (n = 21), elective surgery (n = 36), and non-surgical diagnosis (n = 56). Results: The most frequent procedures were laparotomy (46.9%) and ultrasound-guided core biopsy (25.6%). The rate of diagnostic success was 95.2% for urgent surgeries; 100% for elective surgeries and 82.1% for non-surgical procedures (p < 0.05). The rates of complication during the three diagnosis procedures considered were significant (p < 0.001; 95.2% of the urgent surgeries, 83.8% of the elective surgeries, and 10.7% of the non-surgical procedures). The length of time before resuming a full diet and starting chemotherapy was significantly reduced for patients who underwent non-surgical procedures when compared with the other procedures (p < 0.001). Conclusion: Non-surgical procedures for the diagnosis of pediatric abdominal non-Hodgkin's lymphoma are an effective option with low morbidity rate, allowing an earlier resumption of a full diet and chemotherapy initiation. Furthermore, non-surgical procedures should also be considered for obtaining tumor samples from patients with extensive disease.
Resumo Objetivo: Descrever a taxa de sucesso e as complicações dos procedimentos para o diagnóstico de linfoma não Hodgkin abdominal em crianças e adolescentes. Métodos: Estudo retrospectivo transversal em uma população de crianças e adolescentes com linfoma não Hodgkin abdominal diagnosticada entre setembro de 1994 e dezembro de 2012. A amostra foi composta por 100 pacientes submetidos a 113 procedimentos diagnósticos, inclusive cirurgia de urgência (n = 21), cirurgia eletiva (n = 36) e diagnóstico não cirúrgico (n = 56). Resultados: Os procedimentos mais frequentes foram laparotomia (46,9%) e biópsia guiada por ultrassonografia (25,6%). A taxa de sucesso diagnóstico foi de 95,2% para cirurgias de urgência; 100% para cirurgias eletivas e 82,1% para procedimentos não cirúrgicos (p < 0,05). Houve diferença significativa entre as taxas de complicação associadas aos três grupos (p < 0,001; 95,2% das cirurgias urgentes, 83,8% das cirurgias eletivas e 10,7% dos procedimentos não cirúrgicos). O tempo decorrido até o reinício da dieta plena e o início a quimioterapia foi significativamente reduzido para os pacientes submetidos a procedimentos não cirúrgicos quando comparados com os outros procedimentos (p < 0,001). Conclusão: Os procedimentos não cirúrgicos para o diagnóstico do linfoma não Hodgkin abdominal pediátrico são uma opção efetiva com baixa taxa de morbidade, permitem uma retomada mais precoce de uma dieta plena e início de quimioterapia. Em pacientes com doença extensa, os procedimentos não cirúrgicos também devem ser considerados para a obtenção de amostras tumorais.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Biopsia/métodos , Linfoma no Hodgkin/diagnóstico , Laparotomía/métodos , Neoplasias Abdominales/diagnóstico , Biopsia/efectos adversos , Estudios Transversales , Estudios Retrospectivos , Laparotomía/efectos adversos , Estadificación de NeoplasiasRESUMEN
Abstract Fascioliasis is a zoonotic disease caused by a leaf-like worm (fluke) called Fasciola. Herein, we present a case of human hepatic fascioliasis. A 57-year-old man was referred to the hospital for ambiguous gastrointestinal symptoms with suspected hemangioma. Hepatic fascioliasis was diagnosed using abdominal computed tomography and serology. He tested positive for the IgG antibody against Fasciola hepatica. The patient was treated successfully with triclabendazole. This is the first published report on the occurrence of fascioliasis in Northeast Iran, a non-endemic area for fascioliasis. Our results suggest the emergence of a new focus in the region.
Asunto(s)
Humanos , Animales , Masculino , Fascioliasis/diagnóstico , Hemangioma/diagnóstico , Neoplasias Abdominales/diagnóstico , Diagnóstico Diferencial , Fascioliasis/epidemiología , Irán/epidemiología , Persona de Mediana EdadRESUMEN
Los tumores estromales gastrointestinales son neoplasias que se originan en el tejido mesenquimal de la pared del tracto gastrointestinal. Se ha postulado que las células que originan estos tumores son las células intersticiales de Cajal, las cuales constituyen el marcapaso del tracto digestivo, se hallan en el plexo mientérico de Auerbach y responden al oncogén CD117, c-KIT. Pueden presentarse a cualquier edad pero tienen un pico de incidencia durante la sexta década de la vida. La localización más frecuente es en estómago. Tienen variedad de tamaños desde pocos milímetros hasta 20 cm o más. En este trabajo se presenta un paciente de 56 años de edad que fue ingresado en el centro hospitalario del territorio de Colón por presentar un cuadro de sangrado digestivo alto en forma de melena. Se le realizaron exámenes de laboratorio, estudios imagenológicos (Rx contrastado de estómago-duodeno, ultrasonido y TAC abdominal) y endoscopia digestiva superior. Se comprobó la presencia de una tumoración polipoide de 5 cm de diámetro en la región prepilórica gástrica. Fue sometido a operación quirúrgica y los resultados definitivos de Anatomía Patológica arrojaron un tumor del estroma gastrointestinal de bajo grado de malignidad (AU).
Gastrointestinal stromal tumors are neoplasias originated in the mesenchymal tissue of the gastrointestinal tract wall. It has been stated that cells originating these tumors are the Cajal´s interstitial cells, the digestive tract pacemaker, that are located in he Auerbach´s myoenteric plexus and answer to CD117, c-KIT oncogen. They may occur at any age but have an incidence peak during the sixth decade of life. The most common location is the stomach. There is a variety of sizes, from few millimeters to 20 cm or more. The case of a 56-years-old patient is presented in this work; he was admitted in the territorial hospital of Colon for presenting a high digestive bleeding in a melena form. Laboratory tests, imagine studies (contrasted Rx of stomach and duodena, abdominal ultrasound and CAT) and high digestive endoscopy were made. It was proved the presence of a 5 cm polypoid tumor in the gastric pre-pyloric region. It was surgically operated and the final results of Pathologic Anatomy showed a gastrointestinal stromal tumor of low level malignancy (AU).
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Humanos , Masculino , Femenino , Biopsia , Tumores del Estroma Gastrointestinal/epidemiología , Ultrasonido/métodos , Tumores del Estroma Gastrointestinal/cirugía , Tumores del Estroma Gastrointestinal/complicaciones , Tumores del Estroma Gastrointestinal/diagnóstico , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/terapia , Quimioterapia/métodos , Neoplasias Abdominales/cirugía , Neoplasias Abdominales/diagnóstico , Neoplasias Abdominales/epidemiologíaRESUMEN
ABSTRACT Abdominal tumors are one of the most common types of pediatric cancer. Therefore, they should always be included in the differential diagnosis of abdominal masses. Here, we present the case of a child whose initial hypothesis of diagnosis contemplated this possibility. Later, it was demonstrated that the abdominal mass found was secondary to a common parasitosis. A 2-year old, moderately malnourished and pale white boy was referred with a history of a rapidly growing, well-limited, middle abdominal mass. The mass was 10 by 3 cm, hard and poorly movable, apparently involving both abdominal rectus muscles. A complete resection was performed, revealing an abdominal wall abscess, with intense eosinophilic proliferation, secondary to a local and intense reaction to innumerous Ascaris lumbricoides eggs. Extra luminal infestations with Ascaris, that usually form peritoneal granulomas have been previously described. However, neither external trauma nor fistula, that could explain the superficial presence of the eggs, was found. This description reinforces the relevance of infectious diseases within the differential diagnosis of abdominal masses, particularly in areas with high prevalence of parasitic infestations.
Asunto(s)
Humanos , Masculino , Preescolar , Neoplasias Abdominales/diagnóstico , Pared Abdominal/parasitología , Ascariasis/diagnóstico , Diagnóstico DiferencialRESUMEN
Alrededor del 20 por ciento de los tumores diagnosticados en pediatría corresponden a masas intraabdominales y de ellos, el 20 por ciento son tumores malignos, por lo que un alto índice de sospecha asociado a un diagnóstico precoz pueden incidir positivamente en el pronóstico de los pacientes. El objetivo de este trabajo fue realizar una revisión actualizada de la literatura disponible sobre el estudio de una masa abdominal en pediatría, enfocado principalmente en la epidemiología y orientación diagnóstica que debería seguir el médico al enfrentarse a un paciente con este hallazgo. La forma de presentación clínica de una masa abdominal es variable. En un número importante de pacientes será de forma asintomática, lo que dificulta el diagnóstico precoz, por lo que es necesario mantener un alto índice de sospecha frente esta patología. Como herramientas para la evaluación de una masa abdominal contamos cada vez más con exámenes radiológicos, marcadores tumorales e histología, sin embargo, los exámenes deben realizarse orientados a comprobar la sospecha diagnóstica que obtengamos de una completa anamnesis y examen físico.
About 20 percent of the tumors diagnosed in pediatric patients correspond to intraabdominal masses. These can correspond to both benign and malignant pathology. Moreover, 20 percent of solid malignant tumors are located in the abdomen, so a high index of suspicion associated with an early diagnosis can positively affect the prognosis of these patients. The clinical presentation of an abdominal mass is variable. A significant number of patients will be asymptomatic, which makes early diagnosis difficult. This is why it is necessary to maintain a high index of suspicion in this pathology. As tools for the evaluation of an abdominal mass, we are increasingly counting on radiological examinations, tumor markers and histology. However, the examinations must be carried out in order to verify the diagnostic suspicion that we obtain from a complete anamnesis and physical examination. The objective of this work was to perform an updated review of the available literature on the study of abdominal mass in pediatrics, focused mainly on the epidemiology and diagnostic orientation that should be followed by the physician when confronting a patient with this finding.
Asunto(s)
Humanos , Niño , Neoplasias Abdominales/diagnóstico , Neoplasias Abdominales/epidemiología , Biomarcadores de Tumor , Diagnóstico Diferencial , PalpaciónAsunto(s)
Humanos , Preescolar , Niño , Adolescente , Neoplasias Abdominales/diagnóstico , Neoplasias Abdominales/diagnóstico por imagen , Neoplasias de la Médula Ósea/secundario , Neoplasias Óseas/secundario , Tumor Desmoplásico de Células Pequeñas Redondas/diagnóstico por imagen , Diagnóstico Diferencial , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Neuroblastoma/diagnóstico por imagen , Sarcoma de Ewing/diagnóstico por imagen , Tumor de Wilms/diagnóstico por imagenRESUMEN
Objetivo: Describir las características radiológicas de la secuencia de difusión y mapa de ADC y las secuencias de RM convencional, en la diferenciación de la patología abdominal benigna y maligna. Material y métodos: Estudio descriptivo, transversal y retrospectivo. Se revisaron las imágenes de Resonancia Magnética (RM) e historias clínicas de 276 pacientes durante el periodo de Agosto 2011 a Diciembre 2012 en el departamento de Radiodiagnóstico del H.N. Dos de Mayo incluyéndose a 211 pacientes. Los estudios de imágenes se realizaron en un equipo Phillips Achieva 3 Teslas. Los hallazgos fueron correlacionados mediante estudio histopatológico, o demostrando su concordancia entre los diferentes métodos diagnósticos, evolución clínica y su estabilidad en el tiempo. Resultados: Se estudiaron 83 pacientes hombres (39.3 por ciento) y 128 mujeres (60.7 por ciento) con edades entre los 9 y 91 años. El 25.2 por ciento de las lesiones fueron malignas, de las cuales el mayor porcentaje se encontraba en los grupos de edades mayores a los 50 años. El 91 por ciento de lesiones malignas mostraron restricción de la señal al analizar las secuencias de difusión y ADC, así mismo el 89 por ciento de las lesiones benignas no mostraron restricción a la difusión y ADC. El 30.9 por ciento de las lesiones se hallaron en el hígado de las cuales el 24.7 por ciento fueron malignas y en un 100 por ciento mostraron restricción de la señal, seguida del colédoco en frecuencia (24.2 por ciento) de las cuales el 21.5 por ciento fueron malignas y el 73 por ciento mostro restricción de la señal en la difusión. Conclusiones: La secuencia de Difusión por RM es una técnica que mejora la caracterización de los tejidos cuando los resultados se interpretan con cautela, comparándola con otras secuencias de RM convencional e información clínica.
Objective: The purpose of this article is to describe the radiological characteristics of Diffusion-weighted Magnetic Resonance Imaging and ADC in the differentiation of benign and malignant abdominal pathology. Materials and Methods: A descriptive, retrospective and cross study. We reviewed the magnetic resonance images (MRI) and clinical records of 276 patients during the period August 2011 to December 2012 in the Department of Radiology of H.N. Dos de Mayo including 211 patients. Imaging studies were performed on a Philips Achieva 3 Tesla scanner. The findings were correlated with histopathology, or demonstrating concordance between different diagnostic methods, clinical course and its stability over time. Results: We studied 83 male patients (39. 3 per cent) and 128 women (60.7 per cent) aged between 9 and 91 years old. The 25.2 per cent of the lesions were malignant, of which the highest percentage was in the age groups older than 50 years. 91 per cent of malignant lesions showed restriction in signal Diffusion-weighted imaging and ADC, also 82 per cent of the benign lesions didn't show restriction in Diffusion-weighted imaging and ADC. The 30.9 per cent of the lesions were found in the liver of which 24.7 per cent were malignant and 100 per cent showed restriction of the signal, often followed by bile duct (24.2 per cent) of which 21.5 per cent were malignant and 73 per cent showed restriction signal. Conclusion: Diffusion-weighted Magnetic Resonance Imaging is a technique that improves tissue characterization when the results are interpreted with caution, compared to other conventional MR sequences and clinical information.
Asunto(s)
Masculino , Femenino , Humanos , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Cavidad Abdominal , Imagen de Difusión por Resonancia Magnética , Neoplasias Abdominales/diagnóstico , Estudios Retrospectivos , Estudios TransversalesRESUMEN
Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics, more frequent in pediatrics. Objective: To report a case with unusual clinical presentation of lymphangioma. Clinical Case: A two-year old boy previously health who presented with abdominal pain, lipothymia, and generalized pallor ensuing an abdominal massage. Abnormal findings included an abdominal mass and Ht of 17.3 percent. Sonogram showed a large retroperitoneal mass with anechogenic areas and vasculari-zed septi. CT scans showed similar results. Surgical removal and biopsy confirmed the diagnosis. Discusion: Abdominal lymphangioma is uncommon in children, presentation varies from asymptomatic to acute abdomen. Images are essential in diagnosis and pre-op studies.
El linfangioma abdominal es una patología poco frecuente, benigna que corresponde a una malformación congénita del desarrollo linfático mesentérico y/o retroperitoneal. Es más frecuente en población infantil. Objetivo: Reportar un caso con presentación atípica de linfangioma. Caso clínico: Paciente de 2 años varón, previamente sano, que se presenta con dolor abdominal, luego lipotimia y palidez generalizada tras recibir un masaje abdominal. Al examen físico se encontró una masa abdominal, sin hepatomegalia, esplenomegalia ni adenopatías palpables. Presentaba un hematocrito de 17,3 por ciento. La Ecografía mostró una gran masa retrope-ritoneal con áreas anecogénicas y septos vascularizados. La TAC mostró hallazgos similares: masa quísti-ca, lobulada probablemente determinada por linfangioma abdominal. Se realizó extirpación quirúrgica y la biopsia confirma el diagnóstico. Discusión: El linfangioma abdominal es una patología infrecuente en niños. La presentación clínica es variable, puede ser desde asintomático hasta presentarse con abdomen agudo. Se requiere estudio imagenológico para su evaluación preoperatoria. La ecografía y TAC tienen un importante rol diagnóstico, en localización, tamaño, anatomía circundante y posibles complicaciones.