Toxic megacolon: a rare presentation of primary lymphoma of the colon.

Primary colonic lymphoma is rare and accounts for less than 1% of colon malignancies. Moreover, diffuse neoplastic invasion of the colon is exceptional. This case describes a patient with primary non-Hodgkin's lymphoma of the colon presenting as toxic megacolon. This unique presentation is the first case reported in the literature of a diffuse colonic lymphoma diagnosed in the setting of a toxic megacolon. Histological confirmation was performed on the piece of colectomy.

[Lynch syndrome. (Hereditary colonic carcinoma without polyposis)]. / Síndrome de Lynch. (Carcinoma hereditario de colon sin poliposis).

Colonic carcinoma is a well-defined tumor with a low frequency among young people. We report the case of a 34 year old patient having two synchronous colorectal carcinomas of the right colon, who also had a family history of colonic and extracolonic neoplasms. We performed an extended right colectomy without chemotherapy. Fourteen months after surgery he had tumor recurrence and liver metastases. We reviewed then the clinical features, inclusion criteria, screening and the discussed treatment of the hereditary non-poliposis colorectal cancer or Lynch Syndrome, limited to the colon or associated to extracolonic carcinoma (Lynch I and II). A clear and detailed familial history is the only definite criteria for the diagnosis. We recommend early colonoscopy follow-up on first degree relatives considered as a high risk population.

Acute typhlitis in inmunocompromised patient: an eight year experience.

INTRODUCTION: Acute typhlitis is usually associated with severe immunosuppressive conditions. Initially described as closely associated with infantile myeloid leukaemia, its incidence increased along the last decade. DESIGN: retrospective review. PATIENTS: 12 immunodepressed patients affected of acute typhilis in our hospital between 1994 and 2001. Suspected diagnosis was established by clinical symptoms and abdominal CT findings, and was confirmed with pathological finding in the surgical specimen. Clinical and radiological diagnosis, treatment, complications and survival of patients are discussed. RESULTS: 3 patients with a previous diagnosis af acute myeloid leukemia, 2 patients with non-Hodgkin lymphoma, 2 patients with aplastic anaemia, one patient with AIDS, and 4 patients with kidney transplantation were included in our study. Prednisone, cyclosporine, Ara-C and vincristine were the most frequently involved drugs. Most frequent clinical findings included abdominal pain, fever, nausea-vomiting and abdominal distension. CT diagnosis revealed caecum and colic involvement with rarefaction of pericaecal fat. Medical treatment was successful in only 33% of all patients, the other patients requiring a surgical procedure including right hemicolectomy with or without intestinal anastomosis. Mortality reached 58.3 per cent, representing multiorganic sepsis the main cause of death. CONCLUSIONS: although early diagnosis of acute typhlitis bears a better prognosis, mortality rates are up 50 % in spite of an established treatment.

[Synchronous or metachronous extragastric neoplasms associated with gastric neoplasia. Common pathogenesis of gastric intestinal and colonic carcinoma?]. / Neoplasias extragástricas síncronas o metacronas asociadas a neoplasia gástrica. Patogénesis común del carcinoma gástrico intestinal y cólico?

Coexistence of syncronous or metacronous extragastric carcinomas, particularly of the colon and small bowel may favour the hypothesis of a common origin with gastric carcinoma. Three cases of colonic carcinoma coexisting with early gastric cancer, are presented. The etiopathogenesis of intestinal-type gastric cancer and colonic cancer are discussed in the light of a possible common mechanism.

[Idiopathic segmental infarct of the epiploon. Apropos a new case and a review of the literature]. / Infarto segmentario idiopático de epiplón. A propósito de un nuevo caso y revisión de la literatura.

A case of epiploic segmental infarction is presented. The presenting symptoms were compatible with acute appendicitis, which was excluded by the pathological examination.

[Neoplasms of the Meckel diverticulum. Apropos of 2 new cases]. / Neoplasias del divertículo de Meckel. A propósito de dos nuevos casos.

We present two new cases of cancer in a Meckel's diverticulum, representing 3.3% of the complicated Meckel's diverticula encountered in our department. The first case was a carcinoid tumor encountered in a pathology study of an inflamed Meckel's diverticulum, and the second case was a leiomyosarcoma on a Meckel's diverticulum that presented as diverticular perforation. We emphasize the advanced age of the two patients and review the cases reported in Spain and in the Western literature.

[Adenocarcinoma at the site of colostomy. Is it local recurrence or subsequent cancer?]. / Adenocarcinoma de colostomía. Recidiva local o cáncer metacrónico?

This paper presents on case of adenocarcinoma at the site of colostomy in a patient treated by abdominoperineal amputation five years earlier due to rectal cancer. The case raised the doubt as to whether the carcinoma represented a late, local recurrence or a second metachronic neoplasia. The most frequent location and pathogenesis of each were analyzed. The role of follow-up of these patients in detecting cases such as the one presented here are discussed.

[Colonic perforation in patients with kidney transplant]. / Perforación cólica en pacientes con trasplante renal.

Of a total of 320 renal transplants performed at our center in the last 8 years, two patients presented colonic perforation (0.62%). We emphasize the clinical manifestations, which were masked by the antiinflammatory properties of the steroids; for this reason, careful and repeated physical exams should be made out in the case of any episode of abdominal pain in these patients, as well as ancillary studies for early diagnosis. Surgical measures, which consist of exclusion of the septic focus in the peritoneal cavity, do not differ from those carried out in the general population with the same colonic pathology, although they require more cautious maneuvers and meticulous lavage of the peritoneal cavity. Alternatively, when exclusion is not possible, proximal colostomy and adequate drainage must be performed.

[Gastric leiomyosarcoma]. / Leiomiosarcoma gástrico.

We present a case of gastric leiomyosarcoma of special characteristics, given its clinical and pathologic divergence the existence of antecedents of sarcomatous neoplasm previously excised in the same patient. We emphasize the association of these tumors with the appearance of malignant neoplasms in other sites previously, synchronically or metachronically, and the necessary preoperative staging, based fundamentally on CAT and endoscopy, to establish the therapeutic approach according to the predicted behavior of these tumors.