RESUMO
This report describes the case of a young patient who underwent laparoscopic surgery to reduce for a retrograde intussusception of the sigmoid-descending colon caused by adenoma of the sigmoid colon. A 36-year-old woman visited our hospital, complaining primarily of vomiting and abdominal pain. Abdominal CT scan showed the typical finding of intussusception. An emergency colonoscopy revealed that the invaginated colon with a polypoid mass was protruding into the descending colon. A gastrografin enema showed the invaginated bowel segment at the descending colon. We performed endoscopic polypectomy and then hand-assisted laparoscopic reduction. The pathological finding showed tubular adenoma. Laparoscopy is a diagnostic or therapeutic tool for selected cases of adult intussusception. Benign tumor is one of the causes of intussusception in adults and a good indication for laparoscopic surgery.
Assuntos
Adenoma/complicações , Neoplasias do Colo/cirurgia , Colonoscopia/métodos , Intussuscepção/etiologia , Laparoscopia/métodos , Adenoma/diagnóstico , Adenoma/cirurgia , Adulto , Doenças do Colo/diagnóstico , Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Neoplasias do Colo/complicações , Neoplasias do Colo/diagnóstico , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Intussuscepção/diagnóstico , Intussuscepção/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Major outputs of the neocortex are conveyed by corticothalamic axons (CTAs), which form reciprocal connections with thalamocortical axons, and corticosubcerebral axons (CSAs) headed to more caudal parts of the nervous system. Previous findings establish that transcriptional programs define cortical neuron identity and suggest that CTAs and thalamic axons may guide each other, but the mechanisms governing CTA versus CSA pathfinding remain elusive. Here, we show that thalamocortical axons are required to guide pioneer CTAs away from a default CSA-like trajectory. This process relies on a hold in the progression of cortical axons, or waiting period, during which thalamic projections navigate toward cortical axons. At the molecular level, Sema3E/PlexinD1 signaling in pioneer cortical neurons mediates a "waiting signal" required to orchestrate the mandatory meeting with reciprocal thalamic axons. Our study reveals that temporal control of axonal progression contributes to spatial pathfinding of cortical projections and opens perspectives on brain wiring.
Assuntos
Córtex Cerebral/fisiologia , Vias Neurais/fisiologia , Tálamo/fisiologia , Fatores Etários , Animais , Axônios/fisiologia , Padronização Corporal/genética , Calbindina 2 , Córtex Cerebral/citologia , Contactina 2/metabolismo , Proteínas do Citoesqueleto , Proteínas de Ligação a DNA/metabolismo , Embrião de Mamíferos , Regulação da Expressão Gênica no Desenvolvimento/genética , Glicoproteínas/genética , Proteínas de Homeodomínio/genética , Peptídeos e Proteínas de Sinalização Intracelular , Complexo Antígeno L1 Leucocitário/metabolismo , Proteínas Luminescentes/genética , Proteínas Luminescentes/metabolismo , Glicoproteínas de Membrana/genética , Proteínas de Membrana/genética , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Proteínas Nucleares/metabolismo , Fatores do Domínio POU/genética , Proteínas Repressoras/metabolismo , Proteína G de Ligação ao Cálcio S100/metabolismo , Semaforinas , Proteínas com Domínio T , Tálamo/citologia , Fator Nuclear 1 de Tireoide , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo , Proteínas Supressoras de Tumor/metabolismo , Proteína Wnt3A/genética , Proteínas tau/genéticaRESUMO
CASE REPORT: We herein report a case of huge gastric carcinoma showing an exophytic growth pattern. The gastric carcinoma measured 160 x 130 mm in size. A radical resection was judged to be impossible preoperatively since the tumor invasion of the pancreas and liver was demonstrated on computed tomography. A pancreaticoduodenectomy combined with a resection of the transverse colon was performed. A pathological examination demonstrated the tumor to directly invade the pancreas and transverse colon; however, no metastasis was observed in the regional lymph nodes. The patient is alive and doing well without any recurrence at 5 years postoperatively. DISCUSSION: To obtain a better prognosis for huge gastric carcinoma showing an exophytic growth pattern, extended radical surgery is recommended since the size of the exophytic mass sometimes does not indicate the extent of the tumor.