Salivary gland tumors in Veracruz. Experience of two institutions / Tumores de glándulas salivales en Veracruz. Experiencia de dos instituciones

Background: The aim of this paper was to know the epidemiological characteristics of the salivary gland tumors in a Mexican population. Methods: A descriptive, retrospective and cross-sectional study was performed. All cases of salivary gland tumor were collected in a period of 5 years (2009-2014) in two hospitals of our State, the Hospital General de Veracruz and the Unidad Médica de Alta Especialidad y Hospital de Especialidades No. 14, with the study of variables like: age, gender, location, biological behavior and histological type. The series studied included a total of 79 cases. Results: 51% (40 cases) corresponded to female patients, the average age was 52.13 years (range of 14 to 87 years). The most frequent location of neoplasia was in the parotid gland (72%). The most frequent benign neoplasms were the pleomorphic adenoma and Warthin's tumor. The most frequent malignancy was cystic adenoid carcinoma, followed by moderately differentiated carcinoma. Conclusions: Our results are similar to those previously reported in Mexico. The main neoplasms were the pleomorphic adenoma as a benign tumor and as malignant tumors the adenoid cystic carcinoma and the moderately differentiated carcinoma.

Introducción: el objetivo de este trabajo fue conocer las caracteristicas epidemiológicas de los tumores de glándulas salivales en nuestra población. Métodos: estudio de tipo descriptivo, retrospectivo y de corte transversal. Se recolectaron todos los casos de tumor de glándulas salivales en un periodo de 5 años (2009-2014) en dos hospitales de nuestro Estado, el Hospital General de Veracruz y la Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, con el estudio de las variables edad, genero, localización, comportamiento biológico y tipo histológico. La serie estudiada incluyó un total de 79 casos. Resultados: el 51 % (40 casos) correspondió a pacientes de género femenino, la edad promedio fue de 52.13 años (rango de 14 a 87 años). La localización más frecuente de neoplasia fue en la glándula parótida (72%). Las neoplasias benignas más frecuentes fueron el adenoma pleomorfo y el tumor de Warthin. La neoplasia maligna más frecuente fue el carcinoma adenoideo quístico, seguido del carcinoma moderadamente diferenciado. Conclusiones: nuestros resultados son similares a lo reportado previamente en México. Las neoplasias principales fueron el adenoma pleomorfo como tumor benigno y como tumores malignos el carcinoma adenoideo quístico y el carcinoma moderadamente diferenciado.

[Mullerian adenosarcoma of the cervix: case report with conservative management]. / Adenosarcoma mulleriano del cérvix: reporte de caso con manejo conservador.

BACKGROUND: Mullerian adenosarcoma is a rare gynecological malignancy with a low malignant potential, with biphasic growth, consisting of a benign epithelial element and a malignant mesenchymal element. It occurs in all ages predominating in postmenopausal women. Cervical localization of Mullerian adenosarcomas is rare; however, it is associated with a presentation in young women. The diagnosis is made by anatomopathological study of the lesion and immunohistochemistry. The prognosis is generally good although the recurrence rate is high. CLINICAL CASE: We present the case of a 27-year-old patient who attended a gynecological consultation with bleeding and transvaginal flow. During the gynecological examination, a polypoid lesion originating in the cervix was identified, which was removed by torsion and was diagnosed as Mullerian cervical adenosarcoma. Subsequently, a cervical cone was performed because the patient refused hysterectomy. CONCLUSIONS: Mullerian cervical adenosarcoma is a rare neoplasm with a recurrence rate that can reach up to 50% of cases, so close follow-up is necessary. A local excision can be considered in patients without poor prognosis factors and who wish to preserve their fertility.

ANTECEDENTES: El adenosarcoma mulleriano (AM) es una neoplasia ginecológica rara, de bajo potencial maligno, con crecimiento bifásico, constituida por un elemento epitelial benigno y otro mesenquimatoso maligno. Se presenta en todas las edades, pero predomina en mujeres posmenopáusicas. La localización cervical de los AM es poco frecuente; sin embargo, se asocia a una presentación en mujeres jóvenes. El diagnóstico se realiza mediante estudio anatomopatológico de la lesión e inmunohistoquímica. El pronóstico es generalmente bueno, aunque la tasa de recidiva es alta. CASO CLÍNICO: Presentamos el caso de una paciente de 27 años que acudió a consulta ginecológica con sangrado y flujo transvaginal. En la exploración ginecológica se identificó una lesión polipoide originada en el cérvix, la cual se extirpó por torsión y fue diagnosticada como AM cervical. Posteriormente se realizó conización cervical debido a que la paciente rechazó la histerectomía. CONCLUSIÓN: El AM cervical es una neoplasia poco frecuente que tiene una tasa de recidiva que puede llegar hasta al 50% de los casos, por lo que es necesario un seguimiento estrecho. La escisión local puede ser considerada en pacientes sin factores de mal pronóstico y que deseen conservar su fertilidad.

[Bile duct lesions repaired with peritoneal tube grafts]. / Reparación de colédoco con autoinjerto de peritoneo.

BACKGROUND: A significant number of people suffer iatrogenic bile duct injury during laparoscopic cholescystectomy. Biliary-digestive bypass may be complicated by stenosis and biliary sepsis, affecting both quality of life and life expectancy. To avoid bypass synthetic grafts have been used, which are expensive. OBJECTIVE: Evaluating autologous implantation of peritoneus as alternative of bile duct repair. METHODS: Under general anesthesia, ten New Zealand adult rabbits were operated, common bile duct approached and sectioned underneath the cystic duct followed by a liver biopsy. An autologous graft was built of peritoneum and graft-bile duct proximal and distal end-to-end anastomosis done. Animals were followed-up by weekly bilirrubin and transferases. Rabbits were scheduled euthanized and a liver biopsy done for histological examinations. RESULTS: Autologous graft was easy to create and all rabbits survived. They did not develop jaundice or alterations in their normal habits. At necropsy, autologous grafts were removed and no signs of occlusion were noticed. Moderate short-term liver damage was observed but long-term damage was negligible. Bileoma and pyogenic liver abscess were observed in two animals, respectively. DISCUSSION: Our results favourably match well-known procedures used for bile duct repair, especially in cases of severe injury (Bismuth-Strasberg E1-3): it seems less complicated than biliary-digestive bypass, not as expensive as synthetic grafts, and much easier to build than human amnion graft. CONCLUSION: Interposing an autologous graft of peritoneum is an easy-to-create surgical procedure and circumferential bile duct injuries were adequately repaired.

Antecedentes: un número significativo de individuos sufrirá daño por iatrogenia del colédoco durante colecistectomías laparoscópicas. Las derivaciones bilio-digestivas pueden complicarse con estenosis y sepsis biliar y afectar la calidad y expectativa de vida. Para evitar la derivación se utilizan injertos sintéticos. Objetivo: evaluar el implante autólogo de peritoneo en la reparación de colédoco. Material y métodos: estudio experimental efectuado en 10 conejos Nueva Zelanda adultos a los que se les resecó un segmento del colédoco y para la reparación término-terminal de la vía biliar se construyó un neo-conducto con peritoneo parietal como auto-injerto. Se vigilaron con ontroles semanales de bilirrubinas y transaminasas. A la necropsia programada se estudió el segmento injertado, se realizó biopsia epática durante el procedimiento y la autopsia. Resultados: los animales no mostraron alteraciones en sus hábitos normales, la herida quirúrgica no tuvo complicaciones, no cursaron con ictericia y a la necropsia el segmento injertado se apreció totalmente integrado. En dos animales hubo como complicación un bilioma y un absceso hepático. El daño hepático observado inicialmente fue disminuyendo a lo largo del seguimiento. Discusión: nuestros resultados se equiparan con ventaja con los métodos conocidos de reparación de vías biliares, especialmente en lesiones severas (Bismuth-Strasberg E1-3). Adolece de las complicaciones de las derivaciones bilio-digestivas, no es caro como los injertos intéticos y es de mucho más fácil construcción que el injerto de amnios humano. Conclusiones: el auto-injerto de peritoneo es un procedimiento adecuado como alternativa para tratar lesiones circunferenciales de colédoco.

[Left lobe mesenchymal hamartoma of liver. Uncommon location]. / Hamartoma mesenquimatoso del hígado en el lóbulo izquierdo. Localización poco común.

BACKGROUND: Mesenchymal hamartoma of the liver is a rare benign liver tumor in children, usually arising from the right liver lobe and represents about 5 to 6% of all primary hepatic tumors. Complete surgical resection of the tumor is curative. CLINICAL CASE: A 30 months old male presented with epigastrium abdominal pain and a palpable mass over a period of two days with no other symptom. The mass was excised completely. Postoperatively the patient recovered with an uneventful course and was discharge 13 days following surgery. All microscopic findings were consistent with the diagnosis of mesenchymal hamartoma of the liver. CONCLUSIONS: Approximately 75% of mesenchymal hamartoma of the liver occur in the right lobe of the liver. Several diagnostic considerations should be elucidated to differentiate these type of tumors in the left lobe from other benign liver tumors. Sometimes a multidisciplinary approach is necessary to complete a successful complete surgical excision. Our case exemplifies a rare entity in a rare location, an adequate treatment in a third level reference hospital setting.

[Inflammatory myofibroblastic tumour of the tonsil: case report and literature review]. / Tumor miofibroblástico inflamatorio de amígdala: informe de un caso con revisión de la literatura.

Inflammatory myofibroblastic tumour (inflammatory pseudotumor) is an idiopathic lesion, rare in the head and neck, of unknown aetiology. It is primarily a soft tissue, lung and orbital condition. In the world literature, only two cases with tonsillar disease have been found. We report a case of a 10-year-old girl admitted to our hospital with clinical complaints of pain in the neck region, cough with vomiting, dyspnoea and dyslexia. Clinical examination revealed halitosis and a neoformation dependent on the left tonsil. Bilateral tonsillectomy was performed.

[Ectopic sebaceous glands in the esophagus. Report of three cases]. / Glándulas sebáceas ectópicas en esófago. Reporte de tres casos.

Sebaceous glands typically are located in the pilosebaceous unit located in the superficial layers of the skin. Thus, ectopic sebaceous glands in the esophagus are a very unusual condition. Since 1962 when De la Pava and Pickren described that sebaceous glands could be ectopically located in the esophagus, no more than 30 cases have been reported in the literature. Macroscopically, single or multiple nodular yellowish lesions are found, and most of the times are overlooked. In this paper, we describe 3 cases (2 female and one male) of ectopic sebaceous glands in the esophagus incidentally detected during routine upper gastrointestinal tract endoscopic examination. Histopathology diagnoses were supported using immunohistochemestry for AE1/AE3 citokeratins and epithelial membrane antigen.

[Gastrointestinal stromal tumors in the pediatric population. Report of two cases and a review of the literature]. / Tumores estromales del tracto gastrointestinal en población pediátrica. Informe de dos casos y revisión de la literatura.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are uncommon mesenchymal tumors of the gastrointestinal (GI) tract that occur predominantly in adults. GISTs in pediatric patients are rare and not well characterized. We reviewed the presentation, diagnostic work-up, pathological specimens, and outcomes of two children with GIST that originated from the stomach. Literature pertaining to pediatric GISTs was also reviewed. CLINICAL CASES: Both patients presented with upper GI bleeding from a gastric tumor. The first patient was a 10-year-old male who underwent partial gastrectomy but had recurrence 26 years later requiring surgical exploration due to extensive infiltration into the surrounding organs; the tumor was not resected. The patient is currently being treated with imatinib mesylate. The second patient was a 12-year-old female who had a pedunculated mass originating from the stomach and requiring resection. She subsequently had a local recurrence 2 years later requiring partial gastrectomy. Adjuvant imatinib mesylate was recommended because of the large size of the tumor (8 cm). CONCLUSIONS: Pediatric GISTs represent a distinct subset of sarcomas with a strong predominance for females and gastric location, with 56 cases reported in the English-language literature.

Incidence of pathologic complete response in women treated with preoperative chemotherapy for locally advanced breast cancer: correlation of histology, hormone receptor status, Her2/Neu, and gross pathologic findings.

Neoadjuvant chemotherapy is the standard of care for patients with locally advanced breast cancer and is used increasingly for large operable breast cancer. The aim of this study was to assess the rate of pathologic complete response (pCR) in our patient population with locally advanced breast cancer and identify predictive factors for pCR after neoadjuvant chemotherapy. We studied a cohort of 205 patients and compared histologic features and biomarkers in the pretreatment biopsy with the corresponding pathologic response in the subsequent resection specimen. A pCR was defined as the absence of any microscopic evidence of tumor in the mastectomy specimen and axillary lymph node dissection. The tumor size was reduced in 60% of patients; 16 patients had a pCR. Histologic grade, histologic type, and hormone status did correlate with a pathologic response. None of the 29 invasive pure micropapillary carcinomas had a pCR. Pathologic complete response among Mexican patients with locally advanced breast cancer is low (8%), and the presence of invasive pure micropapillary carcinoma could be an independent predictor for pCR.

Tumores estromales del tracto gastrointestinal en población pediátrica: informe de dos casos y revisión de la literatura / Gastrointestinal stromal tumors in the pediatric population: report of two cases and a review of the literature

Introducción: El tumor estromal del tracto gastrointestinal es una neoplasia rara que se presentan por lo general en la quinta a séptima década de la vida; en pacientes pediátricos es menos frecuente que en adultos y no está bien caracterizado. En esta descripción se evalúa presentación, diagnóstico clínicopatológico y evolución de dos niños con tumor estromal del tracto gastrointestinal originado en el estómago; también se revisa la literatura respecto a la experiencia mundial que se tiene con este tipo de tumor en la población pediátrica. Casos clínicos: Ambos pacientes iniciaron con hematemesis debido a un tumor gástrico. El primer paciente tenía 10 años de edad cuando se le practicó gastrectomía parcial; después de 26 años experimentó recurrencia local de la enfermedad, por lo que se le practicó laparotomía exploradora que mostró neoplasia con extensa infiltración a órganos vecinos. La neoplasia fue irresecable; se prescribió tratamiento con mesilato de imatinib. El segundo caso correspondió a una niña quien a los 12 años de edad presentó una masa unida a la pared gástrica por un pedículo, la cual fue resecada. Dos años después por recurrencia local se le practicó gastrectomía parcial. Se recomendó mesilato de imatinib como tratamiento adyuvante debido a que el tumor tenía 8 cm de diámetro mayor. Conclusiones: El tumor estromal del tracto gastrointestinal de presentación en la edad pediátrica representa un subgrupo distintivo de sarcomas que predomina en niñas y que por lo general afecta el estómago. En una revisión de la literatura solo se encontraron 56 casos de dicha neoplasia. El pronóstico es variable y heterogéneo. La resección completa de la neoplasia es indispensable y el tratamiento adyuvante con mesilato de imatinib se recomienda para los casos con alto riesgo.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are uncommon mesenchymal tumors of the gastrointestinal (GI) tract that occur predominantly in adults. GISTs in pediatric patients are rare and not well characterized. We reviewed the presentation, diagnostic work-up, pathological specimens, and outcomes of two children with GIST that originated from the stomach. Literature pertaining to pediatric GISTs was also reviewed. CLINICAL CASES: Both patients presented with upper GI bleeding from a gastric tumor. The first patient was a 10-year-old male who underwent partial gastrectomy but had recurrence 26 years later requiring surgical exploration due to extensive infiltration into the surrounding organs; the tumor was not resected. The patient is currently being treated with imatinib mesylate. The second patient was a 12-year-old female who had a pedunculated mass originating from the stomach and requiring resection. She subsequently had a local recurrence 2 years later requiring partial gastrectomy. Adjuvant imatinib mesylate was recommended because of the large size of the tumor (8 cm). CONCLUSIONS: Pediatric GISTs represent a distinct subset of sarcomas with a strong predominance for females and gastric location, with 56 cases reported in the English-language literature.