Pancreatic panniculitis.

Pancreatic panniculitis (PP) is an infrequent manifestation of pancreatic pathology (2%). This condition has mainly been described in association with acute and chronic pancreatitis, in males aged 40-60 years with chronic alcoholism, as was the case of this patient. However, it might also be the outset manifestation of a pancreatic neoplasm.

Clinical and pathological features of Merkel cell carcinoma: A 4-year follow-up observational retrospective study in Spain.

BACKGROUND: Merkel cell carcinoma (MCC) is a malignant skin cancer with a 5-year survival rate of approximately 50%. Knowledge of MCC has increased in recent years mostly due to improved diagnosis techniques. In Spain there is lack of information regarding the incidence and tumour characteristics, and the treatment approaches are not standardised. The objective of this study was to provide information of the clinical and epidemiological characteristics of MCC patients in Spain. METHODS: Retrospective, observational study involving 192 patients from 25 Spanish hospitals. Evaluated variables included overall survival and incidence rate of Merkel cell polyomavirus, in patients diagnosed from 2012 to 2016. RESULTS: The Spanish incidence rate was estimated 0.32/100,000 inhabitants/year, with variations according to geographical regions, being slightly higher in areas with greater sunlight exposure. In total, 61.5% of tumours showed expansive growth (progressive growth of the tumour), 78.6% showed localisation in UV-exposed skin. 97.4% of patients were diagnosed by excisional biopsy. Surgery was the first line treatment in 96.6% of patients, radiotherapy in 24.6%, and chemotherapy in 6.3%. These treatments were not mutually exclusive. Median overall survival was 38.3 months (78.4% at 12 months and 60% at 24 months). MCPyV was present in 33.8% of patients. CONCLUSION: The incidence of MCC in Spain is one of the highest in Europe, with a slight predominance in men. The sample has shown that a biopsy is available for diagnosis in most cases. Moreover, the treatment is surgical when the tumour is localized and is associated with lymphadenectomy, and/or it is radiotherapy if widespread.

Post-transplant lymphoproliferative disorders after solid organ and hematopoietic stem cell transplantation.

Post-transplant lymphoproliferative disorders (PTLD) are a rare complication after both solid organ (SOT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this single center retrospective study, we compared clinical, biological, and histological features, and outcomes of PTLD after both types of transplant. We identified 82 PTLD (61 after SOT and 21 after allo-HSCT). The presence of B symptoms, Waldeyer ring, spleen, central nervous system, and liver involvement, and advanced Ann-Arbor stage were more frequent in allo-HSCT recipients. PTLD had an earlier onset in allo-HSCT than in SOT cohort (4 vs. 64 months, p < .0001). PTLD was EBV-positive in 100% of allo-HSCT, in contrast to 47% of SOT (p = .0002). Four years after PTLD diagnosis, median overall survival was 32% (95% CI, 22-48) and 10% (95% CI, 2-49) in SOT and allo-HSCT recipients, respectively (p = .002). In conclusion, the clinical presentation and the outcome of PTLD varies greatly depending on the type of transplant.

Evaluación in vitro de los dispositivos de energía para el sellado de colaterales de vena safena en cirugía de revascularización / In vitro model to assess energy devices for the sealing of saphenous vein collaterals in revascularization surgery

INTRODUCCIÓN: Los dispositivos de sellado por energía permiten la hemostasia de los vasos mediante su coagulación y transección de forma secuencial. OBJETIVOS: Comparar la eficacia in vitro de los principales dispositivos utilizados (electrocoagulación bipolar controlada por temperatura [EB] y bisturí armónico BA]) frente a la ligadura convencional en el sellado de colaterales de vena safena (VS) durante su preparación eventual para la cirugía de bypass. MATERIAL Y MÉTODOS: Estudio experimental in vitro de 25 fragmentos de VS extraída de donante cadáver o remanentes de cirugía de revascularización o amputación. En cada fragmento se realizó un sellado mediante ligadura con seda 3/0 (control) y otro con EB (n = 13) o BA (n = 12). Cada fragmento se incorporó a un circuito cerrado con flujo pulsátil y se aumentó progresivamente la presión hasta llegar a 300 mmHg (presión suprafisiológica) y, posteriormente, hasta provocar la rotura. Se registró el diámetro de las colaterales, la presión de estallido, el punto de fuga y el estudio histológico. RESULTADOS: La presión media de estallido fue ligeramente superior para la EB (788,9 ± 455 mmHg) que para el BA (602,5 ± 363,1 mmHg), aunque sin diferencias significativas (p = 0,268). En un solo caso (BA) se produjo el estallido en la zona de sellado a presiones inferiores a 300 mmHg. El punto de fuga para el BA ocurrió en la zona de sellado en todos los casos (12/12), mientras que para la EB se produjo en la zona de sellado en 8 de 13 fragmentos (p = 0,039). El estudio histológico no mostró diferencias entre ambos métodos. CONCLUSIONES: Los dispositivos de hemostasia por energía presentan una eficacia y seguridad no inferior al de la ligadura en el sellado de colaterales de VS. Dadas su rapidez y fácil manejo, pueden ser útiles en la preparación del injerto venoso durante la cirugía de revascularización. Aunque el EB mostró una mayor resistencia a la rotura al producirse el estallido a presiones suprafisiológicas, este hecho podría no tener relevancia clínica

INTRODUCTION: energy sealing devices achieve hemostasis of the blood vessels through sequential coagulation and transection. OBJECTIVES: to compare the efficacy of the main sealing devices used (Electrothermal Bipolar Tissue Sealing System [EB] and Harmonic Scalpel [HS]) versus conventional vessel ligation of saphenous vein (SV) collaterals. MATERIAL AND METHODS: experimental in vitro study of 25 fragments of SV extracted from cadaveric donor, from residual fragments obtained during amputation or lower limb revascularization procedures. Two venous colateral seals were made on each fragment, one by conventional ligation with 3/0 silk (control) and the other one by EB (n = 13) or HS (n = 12). Each venous fragment was then incorporated into a pulsatile flow circuit, and the pressure was progressively increased until 300 mmHg (supraphysiological pressure) was reached, and, later on, until sealing breakage occurred. Collateral vein diameter, burst pressure, and leakage points were recorded. A histological study was also performed for each energy sealing device. RESULTS: the mean burst pressure was slightly higher for EB (788,9 ±455 mmHg) than for HS (602,5 ± 363,1 mmHg), but without significant differences (p = 0,268). Only in one case (HS) the outbreak occurred in the sealing zone at pressures below 300 mmHg. The leakage point for HS was detected in the sealing zone in all cases (12/12). The leakage point for EB occurred in the sealing zone in 8 of 13 fragments (p = 0,039). The histological study showed no differences. CONCLUSIONS: Vessel sealing devices are as effective for the sealing of saphenous vein collaterals as conventional ligation. These devices may be useful due to their fast sealing time and easy handling during surgical venous graft preparation for lower limb revascularization. Although the EB showed greater strength, the outbreak occurred at supraphysiological pressure, so this fact may not have clinical relevance

Paniculitis pancreática / Pancreatic panniculitis

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Correlación cito-histológica del tumor papilar de la glándula pineal. Presentación de un caso / Papillary pineal tumor: cyto-histological correlation. Case report

En la última revisión de la Organización Mundial de la Salud (OMS) en relación a los tumores del sistema nervioso central (SNC), se describieron nuevas entidades, como el Tumor Papilar de la Glándula Pineal. Esta lesión de rara aparición, se ha identificado en adultos jóvenes. El diagnóstico de estos tumores es complejo ya que depende de su ubicación, edad de aparición y el aspecto histológico; éste último tiene similitudes con otras lesiones como el ependimoma papilar o el papiloma/carcinoma de plexos coroides. Citológicamente presentan características claras que pueden ayudar al diagnóstico a través de la impronta en el estudio intraoperatorio; reconocer ciertos criterios con éste importante y sencillo método diagnóstico ha sido la motivación principal para el estudio de entidades poco frecuentes del SNC, además de corroborar el necesario trabajo de un equipo multidisciplinar.

In the latest revision of the central nervous system tumors (CNS) of the World Health Organization (WHO), new entities has been described, as papillary tumor of the pineal region. This rare lesion has been identified in young adults. The diagnosis of these tumors is complex, depends on the location, age of onset and histological appearance. Histological characteristics have similarities with other lesions such as papillary ependymoma, papiloma / choroid plexus carcinoma. Cytologically have clear characteristics that can aid in the diagnosis through the smears on the intraoperative study. Certain criteria for recognize this important and simple diagnostic method has been the main motivation for the study of CNS rare entities, as our case, in addition to corroborating the necessary work of a multidisciplinary team.