ABSTRACT
El canal anal es la porción distal del tracto digestivo y mide entre 2,5 a 4 cm. de longitud. El cáncer del canal anal es una enfermedad relativamente rara, siendo el carcinoma de células escamosas el más frecuente, con una sobrevida de 5 años de aproximadamente 58%. En los años recientes existe un aumento en la incidencia y prevalencia de la neoplasia intraepitelial y del cáncer del canal anal. El diagnóstico temprano de la neoplasia intraepitelial y del cáncer precóz del canal anal, permite una adecuada estrategia terapéutica curativa. La endoscopia mediante la técnica de la cromoendoscopia virtual y magnificación endoscópica, logra la detección y caracterización de la neoplasia intraepitelial y del carcinoma precoz de células escamosas del canal anal, mediante la observación de las alteraciones en la arquitectura microvascular subepitelial, con alta seguridad diagnóstica. Se presenta la experiencia con 4 pacientes con carcinoma precóz de células escamosas del canal anal, detectados por cromoendoscopia virtual + magnificación y su correlación endoscópica e histológica.
The anal canal is the terminal portion of the digestive tract. The anal canal is 2.5 to 4cm in lenght. The cancer of anal canal is a relatively rare malignancy and the most frequent is the type squamous cell carcinoma, accounting for a 5 year survival of 58 %. The endoscopic evaluation of microvascular pattern of superficial lesions of the anal canal, by virtual chromoendoscopy and magnifying endoscopy, achieves the diagnosis of intraepithelial neoplasia and early squamous cell carcinoma of the anal canal. Here we report our experience in 4 patients with early squamous cell carcinoma and show the endoscopy-histopathological correlation. The early diagnosis of the disease, permit curative treatment with local resection.
ABSTRACT
BACKGROUND: Intestinal lesions in celiac disease (CD) and tropical sprue (TS) can be patchy. Improved endoscopic identification of affected areas may increase the diagnostic yield of biopsy specimens. Enhanced magnification endoscopy [EME] combines magnification endoscopy with 3% acetic acid instillation. OBJECTIVE: This study describes endoscopic findings associated with villous atrophy during EME. DESIGN: Patients underwent EME with a magnifying endoscope with acetic-acid application. Surface mucosal patterns were characterized before and after acetic-acid spraying. Observed surface patterns were compared with histologic results obtained from a single targeted biopsy specimen. SETTING: Policlinica Metropolitana in Caracas, Venezuela. PATIENTS: Patients with diagnosed but untreated CD or TS. RESULTS: Fifty-two biopsy specimens were obtained from 27 patients (17 men, 10 women; mean age 50.5 years; range, 24-76 years; 12 with CD and 15 with TS). EME of the duodenum revealed 4 different mucosal patterns: I, normal; II, stubbed; III, ridged; and IV, foveolar. Three of the 4 patterns were strongly associated with the presence of villous atrophy (pattern I, 1/18 [5.5%]; II, 16/17 [94%]; III, 12/12 [100%]; and IV, 5/5 [100%]). EME was more sensitive than standard endoscopy for detecting villous atrophy, 100% versus 58% in CD and 93% versus 20% in TS. Furthermore, EME identified patchy areas of partial villous atrophy in 16 patients (5 CD and 11 TS) in whom standard endoscopy was normal. CONCLUSIONS: EME identifies 3 characteristic endoscopic patterns that correlate with the presence of villous atrophy. EME could help identify patchy areas of partial mucosal atrophy, potentially reducing the need for blind biopsies.
Subject(s)
Celiac Disease/pathology , Duodenoscopy , Duodenum/pathology , Intestinal Mucosa/pathology , Sprue, Tropical/pathology , Female , Humans , Male , Microscopy , Middle AgedABSTRACT
Los tumores estromales del tracto gastrointestinal (GIST), aunque infrecuentes, son tumores mesenquimatosos importantes de origen mesodérmico. Macroscópicamente se presentan como una masa intramural submucosal, siendo los mas comunes dentro de los tumores mesenquimatosos. La forma maligna, típicamente agresiva y resistente al tratamiento, es afortunadamente rara. Un importante avance ha sido la caracterización del marcador oncogénico KIT y su relación a la patogénesis del Tumor Estromal Gastrointestinal. Sin embargo, recientes investigaciones han demostrado la génesis de los GIST que son KIT negativos. Por lo tanto, la positividad del marcador oncogénico KIT, si bien es altamente sensible, no es requerimiento indispensable para el diagnóstico de GIST. Presentamos nuestra paciente con un GIST del intestino delgado y negatividad al c-KIT(CD 117).
Gastrointestinal stromal tumors (GIST) are uncommon but important mesenchymal tumors of the Gastrointestinal Tract, defined as being of mesodermal origin. Macroscopically they present as intramural submucosal masses, being the most common mesenchymal tumors to arise from the gastrointestinal tract. The malignant form, typically aggressive and resistant to treatment, in fortunately rare. An important development has been the characterization of the oncogene marker KIT, and its relation to the pathogenesis of GIST. However recent research has shed light on the genesis of GIST that is KIT negative. KIT is highly sensitive for GIST (though not 100%) but is not a marker of malignancy or essential requirement to the diagnosis of GIST. We show a patient with a GIST of the small intestine, KIT- negative.
ABSTRACT
Paciente femenina de 63 años de edad, quien fue referida por su cardiólogo por presentar desde hace dos meses una lesión violácea, no dolorosa, en línea de implantación del cabello, en región frontal derecha (Foto 1). Al examinarla, se evidenciaba una mácula eritemato-violácea de bordes mal definidos, de aproximadamente 3x7 cm. A la palpación llamaba la atención que se hundía el pulpejo del dedo por pérdida de sustancia local (Foto 2), motivo por el cual se decidió realizar Tomografía Axial Computarizada de alta resolución (Foto 3) la cual reporto: aumento de densidad del tejido celular subcutáneo que alcanza a medir 32 Unidades Hounsfeld (U.H.) en relación con tejido denso, hallazgo que se relaciona con la palpación. Sin alteraciones óseas. (U.H. da valores negativos en tejido adiposo)
Subject(s)
Humans , Female , Aged , Hemangiosarcoma , Dermatology , VenezuelaABSTRACT
Se describe un caso de prolapso de ampolla tubárica a cúpula vaginal poshisterectomía que ocasionó flujo y dispareunia
Subject(s)
Humans , Female , Uterine Prolapse , Dyspareunia , Hysterectomy , Iatrogenic Disease , Venezuela , GynecologyABSTRACT
CONTEXT: Current conventional tissue-processing methods employ fixation of tissues with neutral buffered formalin, dehydration with alcohol, and clearing with xylene before paraffin impregnation. Because the time required for this procedure is usually 8 hours or longer, it is customary to process tissues in automated instruments throughout the night. Although this time-honored method continues to serve histology laboratories well, it has a number of shortcomings, such as a 1-day delay of diagnosis, the need to batch specimens, the relatively large volumes and toxicity of reagents used, and the extent of RNA degradation. OBJECTIVE: To describe a rapid new method of tissue processing using a continuous-throughput technique. Design.-We used a combination of common histologic reagents, excluding formalin and xylene, as well as microwave energy, to develop a rapid processing method. The effect of this method on the quality of histomorphology, histochemistry, immunohistochemistry, and RNA content of processed tissue was compared with that of adjacent tissue sections processed by the conventional processing technique. We also assessed the impact of this rapid processing system on our practice by comparing the turnaround times of surgical pathology reports before and after its implementation. RESULTS: The new processing method permitted preparation of paraffin blocks from fresh or prefixed tissue in about 1 hour. The procedure allowed continuous flow of specimens at 15-minute intervals. It eliminated the use of formalin and xylene in the processing and used considerably lower volumes of other chemical reagents. Histomorphologic, histochemical, and immunohistochemical results were comparable to the parallel sections prepared by the conventional method. The new technique, however, preserved higher quality RNA. Use of the new methodology led to the diagnosis and reporting of more than one third of surgical pathology specimens on the same day that they were received, as compared to 1% of same-day reporting before the implementation of the rapid processing system. CONCLUSION: The quality of hematoxylin-eosin, histochemical, and immunohistochemical tissue sections provided by the new system is comparable to that obtained following the conventional processing method. The new system preserves RNA better than the conventional method. It also shortens the processing time to about 1 hour from the receipt of fresh or prefixed tissue, eliminates the need for formalin and xylene, and reduces the volume of other chemicals. Most importantly, it impacts overall patient management by allowing for considerably shorter turnaround times for completion of surgical pathology reports.
Subject(s)
Histocytological Preparation Techniques/methods , Pathology, Clinical/methods , Female , Histocytological Preparation Techniques/instrumentation , Humans , Immunohistochemistry , Microwaves , RNA/analysis , Reverse Transcriptase Polymerase Chain Reaction , Time and Motion StudiesABSTRACT
OBJECTIVE: There are no endoscopic features that distinguish intestinal metaplasia of the cardia (CIM) from the normal cardia. Biopsy specimens are therefore randomly obtained from normal-appearing mucosa with significant potential sampling errors. Enhanced magnification endoscopy involves the combined use of magnification endoscopy with acetic acid instillation. This study assessed the value of enhanced magnification endoscopy in detecting CIM. METHODS: Patients undergoing elective upper endoscopy were invited to participate in the study. Patients were included if the squamocolumnar junction and the esophagogastric junction were judged to be at the same level. Enhanced magnification endoscopy was performed with 3% acetic acid instillation. Standard endoscopy was followed by magnification endoscopy and repeated after acetic acid spraying. Surface patterns were characterized before and after acetic acid spraying. The observed surface patterns were compared with histological results obtained from a single targeted biopsy specimen of each pattern. RESULTS: The overall prevalence of CIM was 34.8% (86/247 patients). After excluding 52 patients because of endoscopic evidence of Barrett's esophagus, 195 patients were eligible for participation in the study. In the study group, CIM was detected in 86 patients (44.1%) in targeted biopsy samples. No dysplasia was identified. Enhanced magnification endoscopy detected four different patterns of the mucosal surface: I) round pits, II) reticular, III) villous, and IV) ridged. The yields of detection of intestinal metaplasia according to endoscopic patterns were I) 0%, II) 5.3% (odds ratio = 0.05), III) 57.7% (odds ratio = 7.5, p = 0.0001), and IV) 95.8% (odds ratio = 42.8, p = 0.0001). CONCLUSIONS: CIM is more common than previously reported. Enhanced magnification endoscopy identifies two characteristic endoscopic patterns, villous (pattern III) and ridged (pattern IV), with outstanding clarity and resolution that correlate with histological identification of CIM with a single targeted biopsy sample. Enhanced magnification endoscopy will permit longitudinal studies of an entity that can be identified endoscopically.
Subject(s)
Cardia/pathology , Gastroscopy , Image Enhancement , Intestinal Diseases/pathology , Metaplasia/pathology , Stomach Diseases/pathology , Acetic Acid , Adolescent , Adult , Aged , Female , Gastric Mucosa/pathology , Humans , Male , Middle Aged , Prospective Studies , Sensitivity and SpecificityABSTRACT
La infección por virus de la hepatítis B (VHB) es una causa importante de enfermedad hepática, tanto aguda como crónica. El interferón alfa (IFN) ha sido desde su introducción inicial a mediados de la década de los 80, el tratamiento de elección para la hepatítis crónica por virus B, siendo los porcentajes de respuesta observandos alrededor del 30 por ciento y 40 por ciento. El IFN se activo contra el VHB principalmente incrementando la citólisis de los hepatocitos infectados por este virus por intermedio de mecanismos de inmunidad celular, por lo necesario que exista un sistema inmune activo para que este medicamento pueda ser efectivo en erradicar el virus B. El lamivudine o 3-TC, un análogo de nucleósido, utilizado inicialmente en el tratamiento de la infección por virus de la inmunodeficiencia humana (VIH), demostró que administrado a dosis de 100 a 300 mg diarios suprime el VHB-ADN hasta niveles indetectables en el suero de los pacientes infectados. En conclusión el lamivudine a dosis de 150 mg. diarios es seguro y efectivo en el tratamiento de la hepatopatía causada por virus B, logrando la seroconversión del HBeAg a anti Hbe en la mayoría de los casos
Subject(s)
Humans , Male , Female , Hepatitis B, Chronic , Lamivudine , VenezuelaABSTRACT
Desde 1998-1999 en el Hospital Central del IVSS "Miguel Pérez Carreño" y 1987-1999 en el ejercicio privado de uno de los autores, fueron analizados 29 pacientes con pólipos gástricos múltiples de un total de 3671 endoscopias digestivas superiores. Los pólipos gástricos múltiples hiperplásicos fueron los más frecuentes del total de pólipos gástricos múltiples. Los pólipos gástricos múltiples hiperplásicos tienen una alta incidencia de pólipos incontables con tamaño alrededor de 5 mm, localizado en el cuerpo gástrico en la vasta mayoría. Histológicamente, 16 de nuestros 27 casos resultaron pólipos hiperplásicos originados de mucosa gástrica propia y la hiperplasia del epitelio foveolar el componente predominante. Es importante el seguimiento en pacientes que inhibidores de bomba de protones por períodos prolongados de tiempo debido a la posibilidad de aparición de pólipos gástricos múltiples hiperplásicos, y determinar si el helicobacter pylori coexiste. Recomendamos seguimiento periiódico clínico y endoscópico y realizar polipectomía a los pólipos gástricos con cambios en el aspecto macroscópico y tamaño mayor de 2cm.
Subject(s)
Humans , Male , Female , Focal Epithelial Hyperplasia , Polyps , Stomach Neoplasms , VenezuelaABSTRACT
El esófago de Barrett es una condición premaligna que consiste en el reemplazo del epitelio esofágico por epitelio columnar especializado. Para disminuir la mortalidad asociada al cáncer, los pacientes asintomáticos son sometidos a programas de vigilancia periódica con la finalidad de detectar la displasia antes de la aparición del cáncer. Sin embargo, esta detección puede no ser lo suficientemente sensible. Un marcados tumoral histológico, podría ser un método más sensible en la detección de cambios malignos precoces. Evaluar la asociación y el tiempo de aparición de la mutación p53 en relación con la displasia y el cáncer en pacientes con esófago de Barrett. Se estudió un grupo de 50 pacientes con esófago de Barrett sometidos a un programa de vigilancia periódica entre enero de 1982 y enero de 1996. Los especímenes de biopsias esófagicas fueron teñidos para p53 (inmunohistoquímica) y se revisaron las historias médicas para obtener la información clínica. Durante el período de vigilancia periódica, el p53 se detectó en 10 pacientes (20 por ciento), de los cuales 2 (20 por ciento) desarrollaron displasia severa/cáncer, mientras que en 40 (80 por ciento) el p53 fue negativo y ninguno (0 por ciento) desarrolló displasia/cáncer (p=.0498). El paciente con displasia severa, la desarrolló los 93 meses de seguimiento, mientras que el paciente con cáncer, lo desarrolló a los 78 meses de seguimiento. Los pacientes con p53 positivo tienen mayor probabilidad de desarrollar displasia severa/cáncer. Las biopsias con p53 positivo se observan precozmente en el desarrollo de displasia/cáncer. Los pacientes con p53 positivo, deben ser evaluados con mayor frecuencia
