Melanoma metastásico en intestino delgado: causa infrecuente de perforación: reporte de caso / Metastatic melanoma in the small intestine: infrequent cause of perforation: case report / Melanoma metastático em intestino delgado: causa rara de perfuração: relato de caso

El intestino delgado es el sitio de asiento más frecuente del melanoma metastásico. Su diagnóstico es un desafío por cursar asintomático o con síntomas inespecíficos. Son pocos los casos que presentan complicaciones, siendo infrecuente la peritonitis por perforación. El objetivo del trabajo es comunicar el caso clínico de una peritonitis por perforación de una metástasis de melanoma en intestino delgado. Caso clínico: Paciente de sexo masculino de 66 años con diagnóstico de melanoma de cuello y secundario óseo, encefálico y pulmonar, fue intervenido de urgencia por peritonitis aguda por perforación de metástasis en intestino delgado. El estudio histológico confirmó secundarismo de melanoma cutáneo. Conclusión: Sabiendo que el yeyuno íleon es el sitio de asiento más frecuente de las metástasis de melanoma, ante la presencia de síntomas digestivos inespecíficos o anemia se debe sospechar su compromiso y evaluar posibles alternativas terapéuticas.

The small intestine is the most frequent site of metastatic melanoma. However, its diagnosis continues to be a challenge since it is usually asymptomatic or with non-specific symptoms. Few cases result in complications, peritonitis due to perforation being infrequent. The objective of the work is to report a clinical case of peritonitis due to perforation of a melanoma metastasis in the small intestine. Clinical case: A 66-year-old male patient diagnosed with melanoma of the neck and secondary bone, brain and lung melanoma, underwent emergency surgery for acute peritonitis due to perforation of metastasis in the small intestine, which was resected and anastomosed. The histology confirmed the secondary nature of the cutaneous melanoma. Conclusion: Knowing that the jejunum-ileum is the most frequent site of melanoma metastases, in the presence of non-specific digestive symptoms or anemia, its involvement should be suspected and possible therapeutic alternatives should be evaluated.

O intestino delgado é o local mais frequente de melanoma metastático. O diagnóstico é um desafio por ser assintomático ou apresentar sintomas inespecíficos. Há poucos casos que apresentam complicações, sendo pouco frequente a peritonite por perfuração. O objetivo deste trabalho é relatar um caso clínico de peritonite por perfuração de metástase de melanoma no intestino delgado. Caso clínico: Paciente do sexo masculino, 66 anos, diagnosticado com melanoma no pescoço com metástase óssea, cefálica e pulmonar. Foi submetido a cirurgia de emergência por peritonite aguda por perfuração de metástases do intestino delgado. O estudo histológico confirmou melanoma cutâneo. Conclusão: Sabendo que o jejuno e o íleo é o local mais frequente de metástase de melanoma, na presença de sintomas digestivos inespecíficos ou anemia deve-se suspeitar de seu acometimento e avaliar possíveis alternativas terapêuticas.

Use of synthetic stomata in abdominal carcinomatosis. Case report and literature review.

BACKGROUND: The successful performance of ostomies for the treatment of different diseases has been described since 1706. We report herein the first case of successful ostomy utilizing a synthetic stoma created in a patient with peritoneal carcinomatosis. CLINICAL CASE: A 40-year-old woman presented with abdominal carcinomatosis due to psammomatous papillotubular adenocarcinoma consistent with primary ovarian carcinoma. The patient had negative estrogen and progesterone receptors and Ki-67 proliferative activity was 83%. She was initially treated with cytoreduction therapy, chemotherapy, and hyperthermic intraperitoneal chemotherapy. Because the patient presented with enteric perforations and the extensive tumor invasion and adhesions in all the intestinal segments made it impossible to create autologous decompression stomas, a synthetic stoma was constructed. CONCLUSIONS: Synthetic stomas can be a good treatment option when autologous stomas can not be created.

INTRODUCCIÓN: Desde el año 1706 se han descrito ostomías realizadas con éxito para el tratamiento de diferentes enfermedades; los autores describen el primer caso de éxito en una ostomía sintética en la carcinomatosis peritoneal. CASO CLÍNICO: Mujer de 40 años de edad con carcinomatosis abdominal por adenocarcinoma papilar tubulopapilar psamomatoso más consistente con cáncer primario de ovario, negativo a receptores de estrógenos y progesterona, con marcador Ki-67 al 83% de actividad. De modo inicial se trató con cirugía de citorreducción, quimioterapia, quimioterapia intraperitoneal hipertérmica y por último realización de estomas sintéticos debido a perforaciones entéricas e imposibilidad de realizar estomas descompresivos autólogos por la invasión tumoral extensa y adherencias de todas las asas intestinales. CONCLUSIONES: Los estomas sintéticos pueden ser una buena opción terapéutica cuando es imposible realizar estomas autólogos.

Adenocarcinoma del intestino delgado asociado al síndrome de Lynch / Adenocarcinoma of the small intestine associated with Lynch syndrome

El síndrome de Lynch (SL) es una enfermedad autosómica dominante causada por una mutación en los genes de reparación del ADN que predispone al cáncer colorrectal (CCR) y a otros tumores extracolónicos. Entre estos predominan los del endometrio, estómago, tracto urinario alto y ovario. La incidencia de los tumores de intestino delgado (TID) si bien es baja (0,4-2,9%), supera en más de 25 veces a la de la población general. El objetivo de este trabajo es presentar un caso de carcinoma del duodeno en un paciente masculino de 47 años con criterios de Amsterdam II, y discutir las características de los TID en el SL.

Lynch Syndrome (LS) is an autosomal dominant condition caused by mutations in the mismatch repair genes that predispose to colorectal cancer (CRC) and other extracolonic tumors. Among these, endometrial, gastric, ovarian, and urinary tract tumors are the commonest. The incidence of small bowel tumors (SBT), although low (0.4-2.9%), exceeds in more than 25 times that of the general population. The purpose of this paper is to communicate a case of carcinoma of the duodenum in a 47 years old male with Amsterdam II criteria, and discuss the characteristics of SBT in LS.

Surgical implications of mesenteric lymph node metastasis from advanced ovarian cancer after bowel resection.

BACKGROUND: Studies addressing mesenteric and mesocolic lymph node metastasis in patients with advanced ovarian cancer that have undergone bowel resection are lacking. METHODS: A retrospective analysis was performed in a series of 50 individuals who underwent surgical cytoreduction for epithelial ovarian cancer that included bowel resection from April 2004 to September 2010. RESULTS: Forty-one patients had bowel resection with mesenteric lymph nodes that were suitable for analysis. Twenty-four (58.5%) patients underwent retosigmoidectomies, 14 (34.1%) received other types of colectomies, and three (7.3%) underwent small bowel resection. There was serosal involvement in 14 cases (34.1%), muscularis propria invasion in 13 cases (31.7%), submucosa invasion in six cases (14.6%), and mucosa in eight cases (19.5%). Lymphatic invasion was observed in 24 patients (58.5%). A median of 14 mesenteric lymph nodes were analyzed. Metastatic lymph nodes were observed in 29 (70.7%) cases. Invasion into the muscularis propria (P = 0.036), lymphatic invasion (P = 0.045), and retroperitoneal lymph node metastasis (P = 0.002) correlated significantly with mesenteric lymph node involvement. CONCLUSIONS: Resection of regional lymph nodes of affected organs that is similar to surgical procedures that are performed for colorectal carcinoma is an appropriate, optimal debulking surgery for patients with ovarian carcinoma.

Síndrome de carcinoide con manifestación inicial a nivel valvular cardíaco: a raíz de un caso clínico / Carcinoid syndrome presenting as valvular diseas: report of one case

Carcinoid syndrome is observed in one third of carcinoid tumors and usually appears when there are liver metastases. One of the main complications of this syndrome is the appearance of tricuspid or pulmonary valvular disease. We report a 56 years old male presenting with malaise and a weight loss of 10 kg. On physical examination, a heart murmur suspicious of a double tricuspid lesion was found. The echocardiogram was suggestive of a carcinoid valvular disease. The abdominal CAT scan showed a small bowel tumor. Urinary 5-hydroxy-indol- acetic acid values were highly elevated. The patient was subjected to excision of the distal ileum, liver metastasectomy and hemicolectomy. The pathological study of the surgical piece confirmed the diagnosis of carcinoid tumor. Two years after surgery, the patient is in stable conditions.

Ileal intussusception secondary to small bowel metastases from melanoma.

A 54-year-old man on palliative treatment for disseminated cutaneous malignant melanoma presented with abdominal pain and abdominal distention. A computed tomography scan showed an area in the distal ileum suggesting intussusceptions. In an exploratory laparotomy, a 10-cm mass was found comprised of the distal ileum that had intussuscepted secondary to the small bowel metastases of melanoma. A palliative resection of 2 segments of the small bowel was performed.

Intussuscepção de delgado por melanoma maligno de sítio primário incerto / Small bowel intussusception for malignant melanoma of uncertain primary site

A metástase do melanoma maligno do intestino delgado é incomum. As manifestações clínicas são inespecíficas, e o quadro de abdome agudo obstrutivo pode ser a primeira manifestação. Apresenta-se um caso de intussuscepção intestinal devido a um melanoma metastático de sítio primário não detectado. São discutidos sua etiologia, seu diagnóstico e seu tratamento (AU)

Malignant melanoma metastasis to the small bowel is uncommon. Its clinical presentation is inespecific and an obstructive acute abdomen syndrome could be its first manifestation. A case of intestinal intussusception due to a metastatic melanoma with no primary site detected is described. Etiology, diagnosis and treatment are discussed (AU)

Perianal metastases from lobular breast carcinoma.

Breast cancer gastrointestinal and soft tissue metastases are extremely rare. We present the case of a woman with perianal metastases from a primary lobular breast carcinoma 11 years after mastectomy and local radiotherapy.

Hemorragias digestivas del intestino delgado de origen tumoral / Digestive hemorrages of small bowel from tumoral origin

Antecedentes: la literatura reporta que el leiomiosarcoma y el melanoma son dos de los tumores (primario y secundario respectivamente) que causan síndrome anémico por hemorragia digestiva oculta de intestino delgado. Objetivo: establecer pautas diagnósticas y tratamiento. Lugar de aplicación: Servicio de Cirugía General, Hospital Interzonal de Agudos General San Martín de La Plata, Hospital Español de La Plata. Material y métodos: dos pacientes, una de sexo femenino de 56 años de edad; paciente de sexo masculino de 69 años. Resultados: se describen el modo diagnóstico, hallazgo quirúrgico, anatomía patológica y tratamiento. Conclusiones: son patologías de habitual tardío y dificultoso diagnóstico dada la inespecificidad signosintomatológica. Existe un retraso diagnóstico de las mismas aproximadamente 6-8 meses. Es importante la ecografía como método diagnóstico de localización. La cirugía es el método de elección para su tratamiento

Melanoma metastásico de intestino delgado complicado: presentación de caso / Metastatic melanoma from small bowel: presentation of a case

Objetivo: presentación de un caso de metástasis de melanoma de intestino delgado que intercurre con abdomen agudo quirúrgico y es intervenido en nuestro hospital. Se realiza revisión bibliográfica actualizada de la patología. Lugar de aplicación: Servicio de Cirugía General Hospital Naval "Pedro Mallo" de Buenos Aires. Material y métodos: presentación de un paciente de 39 años de edad de sexo masculino portador de la patología tratado en el hospital. Revisión del tema. Resultados: se describe la anatomía patológica de la pieza quirúrgica y la evolución del paciente. Discusión: acerca de la conducta y los controles de su evolución

[Complicated acute appendicitis as intercurrent disease in patient with advanced gastric cancer]. / Apendicitis complicada como enfermedad intercurrente en pacientes con cáncer gástrico avanzado.

We report a case of a male 64 years old with acute abdomen who was operated with the presumptive diagnosis of complicated acute appendicitis. However the patient had black stools for two months, associated with epigastric pain. Endoscopic diagnosis was: Advanced Gastric Cancer: Borrmann II. Histology was informed as: Infiltrating adenocarcinoma intestinal type middlingly differentiated. Surgery findings were: peritonitis with perforated appendicitis in its base: Free coprolites and carcinomatosis. Histology was reported as: ulcerated mucous in caecal appendix, necrosis and perforation of the muscular wall in the base. Mesentery samples were informed with fat tissue involvement by infiltration of tubular adenocarcinoma.middlingly differentiated, suitable with primary gastric cancer.