Hepatopathy secondary to infiltration by malignant melanoma: diagnostic value of liver biopsy.

We present the case of a 61-year-old male with no relevant history of interest who was admitted to hospital due to constitutional syndrome and discomfort in the right hypochondrium. On admission, abdominal ultrasound was performed with findings of chronic liver disease and innumerable well-defined hypoechogenic lesions of small size. Although the study was extended with other imaging tests, they did not provide more information than what was available at the time. Subsequently, an ultrasound-guided liver biopsy was performed with pathological anatomy compatible with infiltration by malignant melanoma. Subsequently, a search for the primary origin of the melanoma was performed and it was found in the right thigh. Hepatic involvement by melanoma is infrequent and both the symptoms and the findings in the complementary tests are non-specific, characteristics that make diagnosis difficult. Therefore, in these cases liver biopsy plays a fundamental role in the diagnosis.

Gastrointestinal bleeding due to Heyde's syndrome resolved by transcatheter aortic valve implantation (TAVI).

We introduce the case of an 82-year-old woman with Heyde's syndrome (HS) whose gastrointestinal bleeding was refractory to medical and endoscopic therapy, for which a percutaneous aortic valve implantation (TAVI) was performed. The outcome after TAVI was good, gastrointestinal bleeding ceased and Hb remained stable during follow-up in the following 3 months. Currently, although SH is not an indication for TAVI, it could be an indication for TAVI in patients with recurrent gastrointestinal bleeding or refractory anemia to other therapies, using the percutaneous route in those with high surgical risk.

Upper gastrointestinal bleeding secondary to toxicity by anthracyclines, cytarabine and methotrexate in a patient with acute lymphoblastic leukemia.

A 60-year-old male patient with no medical history but acute lymphoblastic leukemia was admitted in the hematology ward for chemotherapy treatment (methotrexate, cytarabine, fludarabine and idarubicin). Approximately six days after finishing this chemotherapy, the patient began with symptoms of upper gastrointestinal bleeding (hematemesis and melena). Gastroscopy revealed erosive esophagitis, gastritis and duodenitis, as well as Forrest III ulcers in the duodenal bulb and multiple Forrest IIb ulcers in the second portion of the duodenum. Given the multiplicity of lesions, medical treatment with high doses of folinic acid, intravenous omeprazole, and transfusion of blood products was decided, with favorable evolution of the gastrointestinal bleeding. However, the patient died of respiratory infection.

Open wound and cutaneous fistulization after microwave ablation of hepatocarcinoma.

A 64-year-old male with a history of HBV Child A MELD 9 cirrhosis on treatment with oral entecavir 0.5 mg/day. Diagnosed with 2 cm hepatocarcinoma in segment 6 treated by radiofrequency in April 2016 with complete response until June 2021, when an increase in the size of the solid component of the treated lesion (28 x 20 mm in diameter) was detected with early enhancement after the administration of paramagnetic contrast, suggestive of local tumor recurrence. Microwave ablation is a percutaneous thermal treatment that creates an electromagnetic field around a monopolar electrode, inducing homogeneous heating and coagulative tissue necrosis. It allows treating several lesions simultaneously and in less time than radiofrequency ablation with low morbidity and mortality. The incidence of adverse events ranges between 2.6% and 7.5%. The most frequent complications are bleeding and hematoma. Ablation tract fistulization is an infrequent complication, with a higher risk of appearing in subcapsular or peripheral hepatic lesions, as was the case in our patient.

Herida abierta y fistulización cutánea tras ablación por microondas de hepatocarcinoma

Varón de 64 años con antecedentes de cirrosis VHB Child A MELD 9 en tratamiento con entecavir oral 0,5 mg/día. Diagnosticado de hepatocarcinoma de 2 cm en segmento 6 tratado con radiofrecuencia en abril de 2016 con respuesta completa hasta junio de 2021, cuando se detecta aumento del tamaño del componente sólido de la lesión tratada (28 x 20 mm de diámetro) con realce precoz tras la administración de contraste paramagnético, sugestivo de recidiva tumoral local. La ablación por microondas es un tratamiento térmico percutáneo que crea un campo electromagnético alrededor de un electrodo monopolar, lo que induce un calentamiento homogéneo y necrosis tisular coagulativa. Permite tratar varias lesiones simultáneamente y en menor tiempo que la ablación por radiofrecuencia con baja morbimortalidad. La incidencia de eventos adversos oscila entre el 2,6% y el 7,5%. Las complicaciones más frecuentes son el sangrado y el hematoma. La fistulización del trayecto de ablación es una complicación infrecuente, con mayor riesgo de aparecer en lesiones hepáticas subcapsulares o periféricas, como fue el caso de nuestro paciente. (AU)