Lytic bone lesion as the first manifestation of late recurrence of gastric cancer.

The incidence of gastric cancer has declined worldwide, it is the second most common cancer worldwide and two thirds of these occurs in developing countries. In Peru, this neoplasm, has one of the highest incidence and mortality rates. The main sites of gastric adenocarcinoma metastasis are the liver and lung; In contrast, bone metastasis are an uncommon finding up to 0.9 to 2% of patients and is associated with an ominous prognosis. We present the case of a 48-year-old female patient diagnosed with gastric cancer treated surgically and with regular controls. 5 years later, she was admitted due to pain in the left knee and increased volume. Knee radiographs reported a lytic lesion in the medial condyle and distal diaphysis of the left femur, with soft tissue involvement, wide transition zone, cortical rupture. Bone scintigraphy described bone oligo metastatic disease. Extension studies were negative for visceral metastasis. Palliative biopsy and curettage of the femur lesion was performed; the pathology was consistent with gastric adenocarcinoma metastasis.

Paraneoplastic acquired hemophilia A associated with hilar cholangiocarcinoma arising in an intraductal papillary neoplasm of the bile duct.

A 74-year-old female was admitted for painless jaundice. Laboratory tests showed hyperbilirubinemia, cholestasis, normal coagulation, and Ca19-9:163U/L. The CT-scan reported dilation of the intrahepatic and extrahepatic bile ducts secondary to a 24mm tumor in the intrapancreatic common bile duct. The magnetic cholangioresonance showed multiple endoluminal polypoid lesions, suggestive of intraductal papillary neoplasm of the bile duct (IPNB). The endoscopic bile duct brushing was non-conclusive.

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.

The rectosigmoid junction: are limits important?

The rectosigmoid junction (RSJ) is the limit between the sigmoid colon and the rectum. The limits of this transition zone have been a source of controversy. There are multiple definitions that aim to establish the beginning of the rectum. Some organizations propose the use of more than one definition. Generally, these definitions use either radiological markings, endoscopic measurements or anatomical landmarks. However, no consensus exists currently.

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.

[Colorectal cancer in young adults: clinical and epidemiological features in the Peruvian population]. / Cáncer colorrectal en adultos jóvenes: características clínico epidemiológicas en la población peruana.

OBJECTIVES: To determine the clinical epidemiological characteristics of young adult patients with colorectal cancer. MATERIALS AND METHODS: Information collected by the Direccion General de Epidemiologia by the surveillance strategy in non-communicable diseases for the period 2006-2014 was requested. The rate of age-adjusted incidence and a descriptive statistical analysis of the variables studied were calculated. RESULTS: 1261 CRC cases were reported in patients between 20-49 years of age. The annual percentage change (APC) for the incidence is declining -0.09% (p=0.004). The CPA for CRC cases was -3.9% in men (p=0.009) and -5.22% in women (p=0.014). 640 women and 621 men were reported. Most cases of CRC in the studied population is the group of 40-49 years with 60.3% of cases. Lima was the region with the highest number of reported cases (42.6%). 63.7% of CRC cases were represented by colon tumors. CONCLUSIONS: Based on case reports provided by the DGE, there is a trend of decrease in the incidence of CRC cases in young adults Peruvian in the last 10 years.

Impact of cancer awareness campaigns in Peru: a 5-year Google Trends analysis.

Background: The aim of this research was to characterise the interest on the most frequent cancers in Peru through Google Trends, its geographic and temporal relationship with massive awareness campaigns. Methods: A temporal trends analysis for the last 5 years was carried out, comparing the Relative Search Volume (RSV) with the dates of mass cancer awareness campaigns in Peru. Google Trends application was used to evaluate the interest in the topics: breast, prostate, cervical stomach and colorectal cancer between 1 January 2016 and 31 December 2020, expressed in RSV. The annual RSV for each neoplasm was compared, as well as its annual variation using the Kruskal-Wallis test. The correlation between the RSV and the estimated incidence for each province was measured using the Spearman test. Results: The topics with the highest RSV were breast (median: 20, range: 6-100) and prostate cancer (median: 28, range: 9-48). The topic 'breast cancer' showed a cyclical punctual increase in October, its awareness month. Searches for cervical, stomach and colorectal cancer were smaller and did not show peaks of interest. It was observed that the RSV was variable when compared with previous years (p < 0.05 for all the evaluated topics). Geographically, different provincial configurations of interest were observed according to neoplasia. When correlating the RSV with the incidence by province, a non-significant positive correlation (p > 0.05) was found for breast, cervical and colorectal cancer. Conclusions: This study suggests a positive temporal correlation between RSV and awareness cancer campaigns in Peru specially to breast cancer and, to a lesser extent, prostate cancer. Significant variations of interest were demonstrated for each neoplasm among the evaluated years. No significant correlation was found between the incidence rate and the average RSV among Peruvian provinces.

Gastric myeloid sarcoma: A case report.

BACKGROUND: Myeloid sarcoma (MS) is a rare hematologic malignancy defined as an extramedullary tumor of immature granulocytic cells. It can occur as primary or de novo and be associated with myelodysplasia or myeloproliferative neoplasms. The most frequent locations are the skin, lymph nodes and bones. The case of a patient with a diagnosis of primary granulocytic de novo gastric MS is reported. CASE SUMMARY: A 19-year-old female patient with MS, whose abdominal computed tomography showed a bulky tumor of 16.5 cm in the gastric chamber with infiltration in the retroperitoneal, pancreatic and bile duct region; the histological study showed gastric mucosa diffusely infiltrated by mononucleated cells and the immunohistochemistry expressed myeloperoxidase. After receiving induction chemotherapy based on the 3 + 7 regimen (daunorubicin/cytarabine), the patient developed severe hematological toxicity and neutropenic typhlitis which required a prolonged medical treatment. She presented a rapid disease progression. Although she received supportive treatment, the patient died. CONCLUSION: Gastric primary de novo MS is a rare and aggressive course neoplasm, fostering knowledge is very important to decide its management and to promote more approaches focused on understanding this pathology and its particularities in our population.

[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.

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.

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.

Benign Multicystic Peritoneal Mesothelioma in a Male Teen: Case Report and Review of the Literature.

The case of a Peruvian 15-year-old male with a left-flank abdominal mass suspected to be a peritoneal pseudomyxoma is presented. The patient underwent a R0 surgery, and the pathology review showed a benign multicystic peritoneal mesothelioma. Characterized by recurrent mesothelial peritoneal cysts originating in the epithelial and mesenchymal elements of mesothelial tissue, this benign tumor is unusual among young males.

Cancer incidence and mortality trends in young adults in Metropolitan Lima young adults, 1990-2012.

AIMS: The purpose of this research was to calculate and compare standardised incidence and mortality ratios in young adults, based on the data published by the population-based cancer registry of Metropolitan Lima. METHOD: A secondary analysis was carried out on the data published by the population-based cancer registry of Metropolitan Lima in its last five volumes. Calculating the standardised incidence ratio, in accordance with the World Health Organization's standard population, was done using the direct method, and the annual percentage change was calculated using the Joinpoint Regression Program. RESULTS: From 1990 to 2012, 12,380 new cases of cancer in young adults between the ages of 20 and 49 were reported in Metropolitan Lima. The neoplasms with the highest standardised incidence ratio in the young adult male group were testicular cancer, brain and nervous system cancer, stomach cancer, non-Hodgkin's lymphoma and bowel cancer. The neoplasms with the highest standardised mortality ratio for this group were stomach cancer, brain and nervous system cancer, non-Hodgkin's lymphoma, tracheal cancer, bronchial and lung cancer and liver cancer. The neoplasms with the highest standardised incidence ratio in the young adult female group were breast cancer, cervical cancer, thyroid cancer, ovarian cancer and brain and nervous system cancer. The neoplasms with the highest standardised mortality ratio for this group were breast cancer, cervical cancer, stomach cancer, brain and nervous system cancer and non-Hodgkin's lymphoma. CONCLUSIONS: Young adults represent a highly unique group, characterised by little diagnostic suspicion, distribution and aggressiveness of the neoplasms that occur in them. Assessing and reporting incidence and mortality ratios in this age group can contribute to decision making.

Use of drains and post-operative complications in secondary peritonitis for complicated acute appendicitis at a national hospital.

INTRODUCTION: Acute appendicitis is the main cause of emergency surgical care. Post-operative patients with complicated acute appendicitis present complications, many of them expected. The use of drains is one of the measures to prevent these complications; however, recent meta-analyzes do not justify this therapeutic measure. This study evaluates the relationship between use and non-use of drains, post-operative complications in patients with complicated peritonitis secondary to acute appendicitis. METHODS: A retrospective observational cohort study was conducted. The outcomes were analyzed by Chi-square test and Student's t-test; Fisher exact test was performed. RESULTS: The average operating time was 1.46 h (1.0-2.5) and 1.66 (1-3) for patients without drains and with drains, respectively, the difference was significant (p = 0.001). Post-operative fever was more prevalent in group with a drains odds ratio (OR) 3.4 (confidence interval [CI] 95% 1.4-7.9). The mean time of hospitalization was 7.3 (3-20) and 8.8 days (3-35) for patients without drains and with drains, respectively. (p = 0.01). The Chi-square analysis was significant for evisceration Grade III and residual collection p = 0.036, OR not evaluable. Reoperation was not significant among both groups, p = 0.108 OR 6.3 (CI 95% 0.6-62.4). CONCLUSIONS: There is a relationship between the non-use of drains and collections and evisceration in post-operative patients with open appendectomy, by complicated acute appendicitis.

ANTECEDENTES: La apendicitis aguda es la principal causa de emergencia quirúrgica. Los pacientes posoperados de apendicitis aguda complicada presentan complicaciones, muchas de ellas esperadas. El uso de drenajes es una de las medidas para prevenir estas complicaciones; sin embargo, recientes metaanálisis no justifican esta medida terapéutica. Este estudio evalúa la relación del uso o no uso de drenajes con las complicaciones en los pacientes con peritonitis secundaria a apendicitis aguda. MÉTODO: Se realizó un estudio de cohorte observacional retrospectivo. Los resultados se analizaron mediante la prueba de ji al cuadrado, la prueba t de Student y la prueba exacta de Fisher. RESULTADOS: El tiempo operatorio promedio fue de 1.46 horas (rango: 1.0-2.5 h) y de 1.66 horas (rango: 1-3 h) para pacientes sin drenajes y con drenajes, respectivamente; la diferencia fue significativa (p = 0.001). La fiebre posoperatoria fue más prevalente en el grupo con drenajes (odds ratio [OR]: 3,4; intervalo de confianza [IC] del 95%: 1,4-7,9). El tiempo promedio de hospitalización fue de 7.3 días (rango: 3-20 días) y de 8.8 días (rango: 3-35 días) para los pacientes sin y con drenajes, respectivamente (p = 0.01). La prueba de ji al cuadrado fue significativa para evisceración de grado III más colección residual (p = 0.036; OR no evaluable). Las tasas de reoperación no fueron significativamente diferentes entre ambos grupos (p = 0.108; OR: 6.3; IC 95%: 0.6-62.4). CONCLUSIONES: Existe relación entre la no utilización de drenajes y la presencia de colecciones y evisceración en pacientes posoperados con apendicetomía abierta por apendicitis aguda complicada.

Mucinous carcinoma of the breast: a case report and review of the literature. / Carcinoma mucinoso de la mama: reporte de caso y revisión de la literatura.

Mucinous carcinoma of the breast is a rare histological type, which represents between 1 and 4% of breast cancers. Treatment does not differ from other histological types, and it occurs more frequently in older adult women. Prognosis is good. We report the case of a 72-year-old patient with a 1-year disease course characterized by the appearance of a slow-growing tumor in the left upper quadrant of the left breast, in which the core biopsy showed mucinous breast carcinoma of a low nuclear grade. The patient underwent quadrantectomy plus a sentinel node biopsy, which confirmed the initial diagnosis.

El carcinoma mucinoso de la mama es un tipo histológico raro, que representa entre el 1 y el 4% de los cánceres de mama. Su tratamiento no difiere de los demás tipos histológicos. Se presenta con mayor frecuencia en mujeres adultas mayores y se distingue por un buen pronóstico. En este artículo, se reporta el caso de una paciente de 72 años, con tiempo de enfermedad de un año, caracterizado por la aparición de una tumoración de crecimiento lento y progresivo en el cuadrante superior externo de la mama izquierda, a la cual se realizó biopsia core. La biopsia arrojó un resultado de carcinoma mucinoso de mama, con grado nuclear bajo. La paciente fue sometida a cuadrantectomía más biopsia de ganglio centinela, lo cual confirmó el diagnóstico inicial.

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.

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.