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Intestinal mucormycosis is a rare manifestation of the Mucor fungus, associated with high mortality and typically found in immunocompromised patients, though it has also been described in immunocompetent individuals. The mode of acquisition is digestive. It usually presents as abdominal pain, with ischemia and intestinal perforation, and the diagnosis is often histopathological after surgical resection. We present the case of a 54-year-old female patient with recurrent acute myeloid leukemia undergoing treatment with daunorubicin-cytarabine and experiencing febrile neutropenia. She developed patchy and progressive intestinal ischemia that evolved into intestinal necrosis, which was treated with antifungal medications and surgery. Examination of the surgical specimen revealed aseptate wide hyphae with branching at right angles, suggestive of Mucor fungus. This is a rare but highly mortal pathology in which clinical, radiological, and surgical suspicion is essential for early diagnosis and treatment, thus improving the patient's prognosis.
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BACKGROUND AND OBJECTIVES: Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease-free survival. METHODS: Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected. RESULTS: The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895). CONCLUSION: Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection.
Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Neoplasias Pancreáticas , Humanos , Carcinoma de Células Renales/cirugía , Carcinoma de Células Renales/patología , Estudios Retrospectivos , Pancreatectomía/métodos , Neoplasias Pancreáticas/patología , Neoplasias Renales/cirugía , Neoplasias Renales/patología , RecurrenciaRESUMEN
La exenteración pélvica masculina es un procedimiento complejo con elevada morbilidad. En casos muy seleccionados, el abordaje robótico puede facilitar la disección y reducir la morbilidad gracias a la mejor visión y versatilidad de movimientos. Describimos la técnica de exenteración pélvica robótica sistematizada con DaVinci Xi y sus variantes en varones, tras haber intervenido tres casos en nuestro Centro. Describimos la colocación de trocares, material necesario, localización de minilaparotomía y secuencia de los procedimientos a realizar paso a paso. Distinguimos tres supuestos: exenteración pélvica total con amputación de recto, colostomía y urostomía; exenteración pélvica con preservación de esfínter, anastomosis colo-rectal/anal y urostomía; exenteración pélvica con amputación de recto, colostomía y reconstrucción de tracto urinario. (AU)
Male pelvic exenteration is a challenging procedure with high morbidity. In very selected cases robotic approach could make dissection easier and decrease morbidity due to a better view and higher range of movements. In this paper we describe port placement, instruments, minilaparotomy location and sequence of procedures step by step. We differentiate three situations: total pelvic exenteration with abdominoperineal resection, colostomy and urostomy; pelvic exenteration with colo-rectal/anal anastomosis and urostomy; pelvic exenteration with abdominoperineal resection, colostomy and urinary tract reconstruction. (AU)
Asunto(s)
Humanos , Masculino , Exenteración Pélvica/métodos , Procedimientos Quirúrgicos Robotizados , Proctectomía , Colostomía , Procedimientos Quirúrgicos Mínimamente InvasivosRESUMEN
Male pelvic exenteration is a challenging procedure with high morbidity. In very selected cases, the robotic approach could make dissection easier and decrease morbidity due to the better vision provided and higher range of movements. In this paper, we describe port placement, instruments, minilaparotomy location, and the stepwise sequence of these procedures. We address 3 different situations: total pelvic exenteration with abdominoperineal resection, colostomy and urostomy; pelvic exenteration with colorectal/anal anastomosis and urostomy; and pelvic exenteration with abdominoperineal resection, colostomy and urinary tract reconstruction.
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Exenteración Pélvica , Proctectomía , Procedimientos Quirúrgicos Robotizados , Masculino , Humanos , Exenteración Pélvica/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Estudios Retrospectivos , Recto/cirugía , Proctectomía/métodosRESUMEN
SANT (sclerosing angiomatoid nodular transformation) tumor is a rare splenic tumor of unknown etiology and vascular lineage, first described in 2004. Most cases are asymptomatic, although cases of anemia or abdominal pain in association with growth have been described. Spontaneous ruptures have not been described. Radiologically it presents a radial pattern with centripetal filling in dynamic MRI, being a characteristic feature, but not pathognomonic. It may present hypermetabolism in PET-CT. Its incidence is increasing since its description as an independent clinical and histopathological entity, especially in the oncological patients follow-up. Due to its radiological resemblance to metastatic lesions and its growth despite being a vascular lesion, splenectomy is indicated following the principles of oncologic surgery until a definitive diagnosis is made. It presents a benign behavior, requiring neither treatment nor specific subsequent surveillance. Two diagnosed cases of SANT are presented, as well as a review of the clinical, radiological and histopathological characteristics of this little-known splenic lesion.
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BACKGROUND: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. METHODS: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. RESULTS: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). CONCLUSIONS: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival.
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Carcinoma de Células Renales/cirugía , Neoplasias Renales/patología , Metastasectomía , Pancreatectomía , Neoplasias Pancreáticas/cirugía , Complicaciones Posoperatorias/epidemiología , Anciano , Carcinoma de Células Renales/secundario , Femenino , Humanos , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Nefrectomía , Neoplasias Pancreáticas/secundario , España/epidemiología , Resultado del TratamientoRESUMEN
Different techniques for delivering perioperative intraperitoneal chemotherapy have been described, but no significant differences have been found among them. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a safe treatment for the patient and for the health care workers involved in the procedure provided standard protective and environmental measures are employed.
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Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Quimioterapia del Cáncer por Perfusión Regional/efectos adversos , Quimioterapia del Cáncer por Perfusión Regional/métodos , Neoplasias Peritoneales/tratamiento farmacológico , Humanos , Inyecciones Intraperitoneales , SeguridadAsunto(s)
Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Conductos Biliares Intrahepáticos/cirugía , Neoplasias Colorrectales/patología , Hepatectomía/métodos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Adenocarcinoma/prevención & control , Neoplasias de los Conductos Biliares/prevención & control , Progresión de la Enfermedad , Drenaje , Femenino , Humanos , Persona de Mediana EdadRESUMEN
No disponible
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Anciano , Humanos , Masculino , Ablación por Catéter/métodos , Neoplasias Hepáticas/cirugía , Metástasis de la Neoplasia , Necrosis/etiología , Complicaciones Posoperatorias , Neoplasias del Colon/patologíaRESUMEN
No disponible