[Pathological complete response after multimodal treatment of adult Ewing sarcoma]. / Respuesta patológica completa al tratamiento multimodal en sarcoma de Ewing del adulto.

Ewing sarcoma is a rare and highly aggressive neoplasm that occurs most frequently in male adolescents. The incorporation of neoadjuvant therapy and new surgical techniques has improved survival. We present the case of a 41-year-old man diagnosed with Ewing sarcoma of the chest wall, whose tumor showed a pathological complete response to a multimodal treatment consisting of concurrent chemotherapy, radiotherapy, and surgical resection. Ewing sarcoma rarely occurs in adults, who generally have a worse prognosis. A multimodal approach for the treatment of patients older than 40 years has proven to improve oncological results.

El sarcoma de Ewing es una neoplasia rara y altamente agresiva que afecta con cierta predilección adolescentes varones. La incorporación de terapia neoadyuvante y nuevas técnicas quirúrgicas ha mejorado la supervivencia. Presentamos el caso de un varón de 41 años con sarcoma de Ewing de pared torácica, quien recibió tratamiento multimodal consistente en quimio-radioterapia concurrente y tratamiento quirúrgico, y alcanzó respuesta patológica completa. El sarcoma de Ewing rara vez se presenta en la edad adulta y, cuando lo hace, suele tener mal pronóstico. El tratamiento multimodal de pacientes mayores de 40 años ha probado mejorar los resultados oncológicos.

Respuesta patológica completa al tratamiento multimodal en sarcoma de Ewing del adulto / Pathological complete response after multimodal treatment of adult Ewing sarcoma

Resumen El sarcoma de Ewing es una neoplasia rara y altamente agresiva que afecta con cierta predilección adolescentes varones. La incorporación de terapia neoadyuvante y nuevas técnicas quirúrgicas ha mejorado la supervivencia. Presentamos el caso de un varón de 41 años con sarcoma de Ewing de pared torácica, quien recibió tratamiento multimodal consistente en quimio-radioterapia concurrente y tratamiento qui rúrgico, y alcanzó respuesta patológica completa. El sarcoma de Ewing rara vez se presenta en la edad adulta y, cuando lo hace, suele tener mal pronóstico. El tratamiento multimodal de pacientes mayores de 40 años ha probado mejorar los resultados oncológicos.

Abstract Ewing sarcoma is a rare and highly aggressive neoplasm that occurs most frequently in male adolescents. The incorporation of neoadjuvant therapy and new surgical techniques has improved survival. We present the case of a 41-year-old man diagnosed with Ewing sarcoma of the chest wall, whose tumor showed a pathological complete response to a multimodal treatment consisting of concurrent chemotherapy, radiotherapy, and surgical resection. Ewing sarcoma rarely occurs in adults, who generally have a worse prognosis. A multimodal approach for the treatment of patients older than 40 years has proven to improve oncological results.

Calcitonin negative neuroendocrine thyroid carcinoma: Case report and literature review

SUMMARY Medullary thyroid carcinoma (MTC) is a relatively rare neuroendocrine tumor that originates in the parafollicular C cells of the thyroid gland. It is characterized by the synthesis and secretion of calcitonin. Usually, serum calcitonin is used as part of the diagnosis and follow-up of these patients. Few cases of MTC with negative calcitonin have been reported worldwide, whose diagnosis is a clinical challenge.

El carcinoma medular de tiroides (MTC) es un tumor neuroendocrino relativamente raro que se origina en las células C para foliculares de la glándula tiroides. Se caracteriza por la síntesis y secreción de calcitonina. Por lo general, la calcitonina sérica se utiliza como parte del diagnóstico y seguimiento de estos pacientes. Se han notificado pocos casos de MTC con calcitonina negativa en todo el mundo, cuyo diagnóstico es un desafío clínico.

Intrathyroidal thymic carcinoma misdiagnosed as a medullary thyroid carcinoma.

The intrathyroidal thymic carcinoma is a rare neoplasm. The probable origin of this neoplasm is the presence of ectopic thymic tissue or remnants of the third and fourth branchial arch. The case of a 49-year-old female with an initial diagnosis of medullary thyroid cancer is presented. When she was operated for regional recurrence, 16 years later, the pathology report demonstrates the presence of a intrathyroidal thymic carcinoma. Intrathyroidal thymic carcinoma is considered an independent type of thyroid carcinoma because this entity has specific clinical-pathological characteristics similar to thymic carcinomas and different prognosis than known thyroid carcinomas. We present the case of a patient initially treated as having a medullary thyroid carcinoma who, upon presenting recurrence, the presence of intrathyroidal thymic carcinoma was demonstrated.

El carcinoma tímico intratiroideo es una neoplasia rara. El origen probable de esta neoplasia es la presencia de tejido tímico ectópico o de restos del tercer y cuarto arcos branquiales. Se presenta el caso de una mujer de 49 años con diagnóstico inicial de cáncer medular de tiroides. Cuando fue operada por recurrencia regional, 16 años después, se demostró la presencia de un carcinoma tímico intratiroideo, que se considera un tipo independiente de carcinoma tiroideo debido a que tiene características clínico-patológicas específicas similares a los carcinomas tímicos y un pronóstico diferente a los carcinomas de tiroides conocidos. Este caso se trató inicialmente como carcinoma medular de tiroides y al presentar recurrencia se demostró la presencia de un carcinoma tímico intratiroideo.

Liver Resection as Part of Cytoreductive Surgery for Ovarian Cancer.

Objective: The aim of this study was to describe and evaluate the safety of hepatic resections for ovarian cancer liver metastases and the benefit in terms of survival as part of cytoreductive surgery among peritoneal seeding and parenchymal metastases. Materials and Methods: Data were reviewed retrospectively from patients who underwent liver resection as part of cytoreductive surgery for ovarian cancer at the Instituto Nacional de Enfermedades Neoplásicas, in Lima, Perú, from January 2009 to December 2017. Results: From January 2009 to December 2017, 1211 patients underwent surgical cytoreduction for ovarian cancer; 39 of these patients had liver resection as part of their surgical treatment, with 9, 17, and 13 patients receiving primary, secondary, and tertiary, resections, respectively. The mean age of the patients was 46, the majority (87%) had stage III/IV ovarian cancer. In addition, 21 patients had parenchymal metastasis resections, and 95% of the patients had Dindo-Clavien I and II grade complications. The 30-day mortality rate was 0. Conclusions: Liver resection for advanced ovarian cancer is a safe procedure for primary up to quaternary cytoreduction and may confer survival benefits to patients.

Myasthenia gravis posterior to thymectomy: Case report. / Miastenia grave posterior a timectomía: reporte de caso.

BACKGROUND: The association between myasthenia gravis (MG) and thymoma is a frequent finding; however, the post-thymectomy MG is rare. The pathogenic mechanisms are poorly understood and include thymoma recurrence, surgical exposure and activation of peripheral lymphocytes after surgery. CLINICAL CASE: 39-year-old male patient who 6 months after surgical treatment of B1 thymoma presented a clinical picture, characterized by dysphagia, global weakness, diplopia and respiratory failure. The antibodies against acetylcholine receptor were positive (16.10 nmol/L). Electromyography was not performed due to technical problems. With these results, the patient's clinic was attributed due to MG Osserman IV crisis. The patient had medical management with parasympathomimetics, ventilatory support and plasmapheresis, with favorable clinical evolution. CONCLUSIONS: The late onset of MG and other autoimmune disorders should be considered as possible complications of the surgical treatment of thymomas. Therefore, after the resection of a thymoma, follow-up care with post-operative MG consideration is necessary.

INTRODUCCIÓN: La asociación entre miastenia grave (MG) y timoma es un hallazgo frecuente; sin embargo, la MG posterior a una timectomía es rara. Los mecanismos patogénicos son poco entendidos e incluyen recurrencia del timoma, exposición quirúrgica y activación de los linfocitos periféricos después de la cirugía. CASO CLÍNICO: Varón de 39 años, quien 6 meses después del tratamiento quirúrgico de un timoma B1 cursó con cuadro clínico caracterizado por disfagia, debilidad global, diplopía y dificultad respiratoria. Los anticuerpos contra el receptor de acetilcolina fueron positivos (16.10 nmol/l). No se realizó electromiografía por problemas técnicos. Con estos resultados se atribuyó que la clínica del paciente fue compatible con crisis de MG Osserman IV. El paciente tuvo manejo médico con parasimpaticomiméticos, soporte ventilatorio y plasmaféresis, con una evolución clínica favorable. CONCLUSIONES: El inicio tardío de la MG y otros trastornos autoinmunitarios deben ser considerados como posibles complicaciones del tratamiento quirúrgico de los timomas. Por lo tanto, después de la resección de un timoma es necesario el cuidado de seguimiento con consideración de la MG posoperatoria.

Ruptured hepatic sarcoma as a cause of acute abdomen.

A 24-year-old male patient, in study for a hepatic tumor, was admitted to emergency due to hypovolemic shock and anemia. The abdominal CT scan showed an extensive expansive lesion of 11.8x11.7cm in liver segments II and III with rupture signs and lamellar hyperdense component of haematic and necrotic aspect, associated with free fluid in the abdominal cavity (Fig 1.A). The tumor markers (DHL, AFP, CEA) and viral serology were negative. The patient was submitted to surgery, an exploratory laparotomy + Pringle maneuver + II and III hepatic segmentectomy was performed. Abundant intra-abdominal blood was evidenced, and an extensive multilobed 20x20cm tumor dependent on II and III hepatic segments, a R2 surgery was achieved. The histological study showed a non-classifiable high grade sarcoma, CD56 positive (Fig. 1.B). The patient was discharged after 7 days.