Acute diverticulitis in younger patients: any rationale for a different approach?

AIM: To compare the natural history and course of acute diverticulitis in a younger age group with an older population and to evaluate whether younger patients should be managed differently. METHODS: This study was a retrospective review of 157 patients treated with acute diverticulitis between January 1, 2004 and December 31, 2007. Diverticulitis was stratified according to the Hinchey classification. Patients were divided into 2 populations: group A ≤ 50 years (n = 31); group B > 50 years (n = 126). Mean patient follow-up was 15 mo. RESULTS: The median age was 60 years. A significantly higher proportion of patients in group B presented with complicated diverticulitis (36.5% vs 12.9%, P = 0.01). Recurrence was more frequent in group A (25.8% vs 11.1%, P = 0.03) and the mean time-to-recurrence was shorter (12 mo vs 28 mo, P = 0.26). The most severe recurrent episodes of acute diverticulitis were classified as Hinchey stage I and none of the patients required emergency surgery. In multivariate analysis, only age (P = 0.024) was identified as an independent prognostic factor for recurrence. CONCLUSION: Based on the results of this study, the authors recommend that diverticulitis management should be based on the severity of the disease and not on the age of the patient.

Surgical margin status and prognosis of gastrointestinal stromal tumor.

BACKGROUND: Surgery is the best treatment for primary GIST and may be curative, but resection extension/completeness impact on the prognosis remains controversial. The authors aim was to evaluate the clinicopathological (CP) parameters and surgical margins status influence on GIST patients' outcome. MATERIALS AND METHODS: The study evaluated 113 consecutive patients with sporadic GIST; the influence of CP parameters on recurrence-free survival (RFS) and disease-specific survival (DSS) was determined by univariate analysis (UA) and multivariate analysis (MA). RESULTS: Of 104 cases, macroscopically complete resection was achieved in 96: R0 surgical margin status in 78 and R1 in 18. Recurrence rates (12.5%) were significantly lower in R0 (9.0%) than in R1 (27.8%). Tumor > 10 cm, mitotic count > 5/50 high power field (HPF), and high-risk GIST predicted poor RFS and DSS (UA). Disease-specific survival was significantly shorter after macroscopic incomplete (R2) resection, for mixed cellular morphology, and in tumors with necrosis (UA). High-risk GIST (p = 0.016) and R2 resection (p = 0.013) predicted poor DSS of patients (MA). CONCLUSIONS: High risk and positive macroscopic surgical margin status are parameters associated with poor disease-specific survival in GIST patients.

Carcinoma secretor da mama no adulto, existem parâmetros bem definidos para decisäo terapêutica? / Secretory carcinoma of the breast in adults. are there well defined parameters for decision making?

O carcinoma secretor (CS) da mama é uma neoplasia muito rara. O CS da mama foi inicialmente descrito em crianças e adolescentes, mas a maioria dos casos é descrito em doentes adultos. É muitas vezes associado a um prognóstico particularmente favorável, mas em doentes adultos com tumores de maiores dimensöes pode apresentar um comportamento mais agressivo. Apresenta-se um caso de uma doente com 62 anos de idade, que apresentava uma volumosa tumefacçäo da mama com 16 anos de evoluçäo. O exame objetivo revelou extensa fixaçäo da lesäo à pele, com sinais inflamatórios acentuados e áreas de necrose cutânea. O tratamento inicial consistiu numa mastectomia simples, com intençäo paliativa. O diagnóstico anatomopatológico de carcinoma secretor (3,5 cm), sem invasäo cutânea, motivou a posterior realizaçäo de esvaziamento ganglionar axilar, que revelou metástases em 2 dos 13 gânglios isolados. A doente faleceu 24 meses depois, por disseminaçäo da doença, comprovando a maior agressividade do CS em doentes adultos com tumores de maiores dimensöes (T2) e com metastizaçäo ganglionar (N1). Os autores revêem a literatura com particular ênfase nos factores de prognóstico importantes para decisäo terapêutica deste tipo raro de carcinoma da mama, em doentes adultos.

Esophageal carcinoma originating in a duplication cyst: case report

Apresenta-se um caso de homem com 61 anos de idade, portador de carcinoma do terço médio do esôfago. Foi submetido a ressecçäo gastro-esofágica radical através de laparotomia mediana e toracotomia direita. O exame histopatológico mostrou carcinoma de células escamosas nitidamente originado da camada epitelial de cisto esofágico duplicado. Mostrou-se mediante imunohistoquímica células tumorais coradas para p53. Em 11 meses de evoluçäo o paciente permanece asssintomático

A case report of a rare disease: primary malignant melanoma of the esophagus

The case of 69 year-old caucasean woman with a primary malignant melanoma of the esophagus is described. She came to us with a 12-month history of digestive symptoms and was submitted to a near-total esophageal resection, followed by a cervical esophago-gastric anastomosis. The pathological study of the surgical specimen revealed an esophageal melanoma having foci of "junctional activity" involving the entire esophagus. The tumor invaded but did not extend beyond the muscularis propria. All lymph nodes were without metastases, but lymphatic invasion was present. Two courses of chemotherapy with DTIC, Cisplatinum, BCNU and Tamoxifen and later with Interferon and Carboplatin were tried. She died 2 years and 2 months after surgery.