Solid pseudopapillary neoplasms of the pancreas: Multicenter Vasepa study.

INTRODUCTION: Solid pseudopapillary tumors (SPT) of the pancreas are rare exocrine neoplasms of the pancreas. Correct preoperative diagnosis is not always feasible. The treatment of choice is surgical excision. These tumors have a good prognosis with a high disease-free survival rate. OBJECTIVE: To describe the clinicopathological and radiological characteristics as well as short- and long-term follow-up results of patients who have undergone SPT resection. METHODS: Multicenter retrospective observational study in patients with SPT who had undergone surgery from January 2000-January 2022. We have studied preoperative, intraoperative, and postoperative variables as well as the follow-up results (mean 28 months). RESULTS: 20 patients with histological diagnosis of SPT in the surgical specimen were included. 90% were women; mean age was 33.5 years (13-67); 50% were asymptomatic. CT was the most used diagnostic test (90%). The most frequent location was body-tail (60%). Preoperative biopsy was performed in 13 patients (65%), which was correct in 8 patients. Surgeries performed: 7 distal pancreatectomies, 6 pancreaticoduodenectomies, 4 central pancreatectomies, 2 enucleations, and 1 total pancreatectomy. The R0 rate was 95%. Four patients presented major postoperative complications (Clavien-Dindo > II). Mean tumor size was 81 mm. Only one patient received adjuvant chemotherapy. With a mean follow-up of 28 months, 5-year disease-free survival was 95%. CONCLUSION: SPT are large, usually located in the body-tail of the pancreas, and more frequent in women. The R0 rate obtained in our series is very high (95%). The oncological results are excellent.

Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: A Spanish multicenter study (PANMEKID).

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.

The Second Highest Prevalence of Celiac Disease Worldwide: Genetic and Metabolic Insights in Southern Brazilian Mennonites.

Celiac disease (CD), despite its high morbidity, is an often-underdiagnosed autoimmune enteropathy. Using a modified version of the Brazilian questionnaire of the 2013 National Health Survey, we interviewed 604 Mennonites of Frisian/Flemish origin that have been isolated for 25 generations. A subgroup of 576 participants were screened for IgA autoantibodies in serum, and 391 participants were screened for HLA-DQ2.5/DQ8 subtypes. CD seroprevalence was 1:29 (3.48%, 95% CI = 2.16-5.27%) and biopsy-confirmed CD was 1:75 (1.32%, 95% CI = 0.57-2.59%), which is superior to the highest reported global prevalence (1:100). Half (10/21) of the patients did not suspect the disease. HLA-DQ2.5/DQ8 increased CD susceptibility (OR = 12.13 [95% CI = 1.56-94.20], p = 0.003). The HLA-DQ2.5 carrier frequency was higher in Mennonites than in Brazilians (p = 7 × 10-6). HLA-DQ8 but not HLA-DQ2.5 carrier frequency differed among settlements (p = 0.007) and was higher than in Belgians, a Mennonite ancestral population (p = 1.8 × 10-6), and higher than in Euro-Brazilians (p = 6.5 × 10-6). The glutathione pathway, which prevents reactive oxygen species-causing bowel damage, was altered within the metabolic profiles of untreated CD patients. Those with lower serological positivity clustered with controls presenting close relatives with CD or rheumatoid arthritis. In conclusion, Mennonites have a high CD prevalence with a strong genetic component and altered glutathione metabolism that calls for urgent action to alleviate the burden of comorbidities due to late diagnosis.

Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID).

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.

Quality Standards for Surgery of Colorectal Peritoneal Metastasis After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

BACKGROUND: The standardization of surgical outcomes throughout surgical procedures is mandatory. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) should provide proficient oncological and surgical outcomes. STUDY DESIGN: The aim of this study was to identify clinically relevant quality indicators and their quality standard, and to determine their acceptable quality limit. A systematic review on cytoreductive results from 2000 to 2018 was performed focusing on clinical guidelines, consensus conferences, and publications. After the selection of quality indicators, a systematic review of indexed references was performed in order to calculate the quality standard for each indicator. STUDY SELECTION: Unicentric/multicentric series, comparative studies, and clinical trials. Studies were to include outcomes after cytoreduction of colorectal origin and series with more than 50 patients. Quality indicators with at least 10 series were mandatory and objective measurements were also mandatory for inclusion. MAIN OUTCOME MEASUREMENTS: Quality indicators selected were 1- to 5-year survival, overall disease-free survival, 1- to 5-year disease-free survival, complete surgical resection, duration of surgery, length of stay, overall morbimortality, major morbidity, re-intervention, postoperative hemorrhage, intestinal fistula, anastomotic leakage, wound infection, postoperative medical complications, overall recurrence, and failure to rescue. RESULTS: The most relevant quality indicators and critical quality limits were overall disease-free survival and 5-year overall disease-free survival (14 months and <10 months, and 14% and <4%, respectively), completeness of surgical resection (89% and <80%, respectively), overall mortality (3% and >8%, respectively), overall morbidity (47% and >63%, respectively), failure to rescue (12% and <30%, respectively), reintervention (13 and <22%, respectively), anastomotic leakage (6% and <13%, respectively), and overall recurrence (60% and <74%, respectively). CONCLUSION: This is the first study to assess quality standards in CRS + HIPEC for colorectal peritoneal metastases. The current data are of particular relevance for future studies to control the variability of this surgery.

Angiomiolipoma epitelioide/PEComa hepático e hiperplasia nodular focal en una paciente con antecedentes de melanoma cutáneo / Hepatic epithelioid angiomyolipoma/PEComa and focal nodular hyperplasia in a patient with a previous history of cutaneous melanoma

Los tumores de células epitelioides perivasculares (PEComas) hepáticos son lesiones mesenquimales poco comunes. La ocurrencia simultánea de PEComas y otras lesiones hepáticas es inusual, con solo dos reportes de casos adicionales en la literatura inglesa. Reportamos un caso de PEComa primario hepático asociado con una hiperplasia nodular focal en una paciente con antecedentes de melanoma cutáneo. El diagnóstico radiológico fue sugestivo de adenoma hepático, por lo que se realizó una resección segmentaria hepática. El tumor estaba constituido por una proliferación de células epitelioides, tejido adiposo y fibras de músculo liso entremezcladas con vasos sanguíneos. Las células tumorales mostraron positividad difusa e intensa para HMB-45, Melan-A y actina de músculo liso, siendo negativas para Hepatocyte, S100, MITF y BRAF. No se detectó mutación BRAFV600 en el estudio por biología molecular. El diagnóstico patológico final fue de angiomiolipoma epitelioide hepático/PEComa. Se realiza una discusión del diagnóstico diferencial de los PEComas hepáticos

Hepatic perivascular epithelioid cell tumors (PEComas) are uncommon mesenchymal neoplasms. PEComas concurrent with other hepatic lesions is a very rare occurrence, with only two previously reported cases. We report a primary hepatic PEComa associated with focal nodular hyperplasia in a patient with a previous history of cutaneous melanoma. Diagnostic imaging studies suggested a hepatic adenoma and the patient underwent a segmentectomy. The tumor was mainly composed of epithelioid cells, adipose tissue and smooth muscle fibers intermixed with blood vessels. The neoplastic cells were diffusely immunoreactive for HMB-45, Melan-A and smooth muscle actin, but not for Hepatocyte, S100, MITF or BRAF. Molecular studies were negative for BRAFV600 mutation. The final diagnosis was hepatic epithelioid angiomyolipoma/PEComa. The differential diagnosis of hepatic PEComa is discussed

[Hepatic epithelioid angiomyolipoma/PEComa and focal nodular hyperplasia in a patient with a previous history of cutaneous melanoma]. / Angiomiolipoma epitelioide/PEComa hepático e hiperplasia nodular focal en una paciente con antecedentes de melanoma cutáneo.

Hepatic perivascular epithelioid cell tumors (PEComas) are uncommon mesenchymal neoplasms. PEComas concurrent with other hepatic lesions is a very rare occurrence, with only two previously reported cases. We report a primary hepatic PEComa associated with focal nodular hyperplasia in a patient with a previous history of cutaneous melanoma. Diagnostic imaging studies suggested a hepatic adenoma and the patient underwent a segmentectomy. The tumor was mainly composed of epithelioid cells, adipose tissue and smooth muscle fibers intermixed with blood vessels. The neoplastic cells were diffusely immunoreactive for HMB-45, Melan-A and smooth muscle actin, but not for Hepatocyte, S100, MITF or BRAF. Molecular studies were negative for BRAFV600 mutation. The final diagnosis was hepatic epithelioid angiomyolipoma/PEComa. The differential diagnosis of hepatic PEComa is discussed.

Nipple-sparing mastectomy as treatment for patients with ductal carcinoma in situ: A 10-year follow-up study.

The objective was to determine the 10-year oncological safety of nipple-sparing mastectomy (NSM) in patients diagnosed with ductal carcinoma in situ (DCIS). The use of NSM preserves the nipple-areola complex (NAC). As residual fibroglandular breast tissue can remain behind the spared NAC, its use for patient with breast cancer is controversial. The oncologic outcomes and complication rates after performing NSM compared to other techniques are still under debate and a concern when treating patients with breast cancer. We retrospectively reviewed 69 consecutive NSM patients diagnosed with DCIS during 1984-2016 at the Valencia Institute of Oncology, Valencia, Spain. 13 of 82 reviewed cases were excluded from the analysis owing to the presence of invasive tumor in the final pathologic report. All 69 patients who underwent NSM due to DCIS were included and analyzed. The indications were as follows: unfavorable correlation between tumor size and breast size in 53 patients, 10 patients with multifocal or multicentric tumors and breast cancer recurrence after breast-conserving surgery in six patients. The reconstruction was performed using a prosthetic implant: saline-filled implant 33 (47.8%) or tissue expander 36 (52.2%). No frozen section was performed in the patients included in our study. The presence of DCIS was confirmed in 60 patients and in the other nine patients we found no tumor in the mastectomy specimen (removed due to excisional biopsy procedure). High risk features were: tumor grade 3 in 27 (39.2%) cases and comedonecrosis in 32 (46.4%) cases. In 27 patients surgical axillary staging was performed and no residual disease in the axilla was observed. After a mean follow-up period of 142.6 ± 70.7 months no nipple necrosis was observed. In 15 patients (21.7%) an additional surgical procedure was performed. 48 patients (69.6%) did not receive any adjuvant treatment. Adjuvant hormone therapy was given to 20 patients (29%) and one patients received radiation therapy (1.4%). Eight patients showed a local relapse (11.6%). One patient developed a recurrence within the nipple-areola region presented as Paget's disease (1.4%). One patient presented a thorax wall relapse after 42 months of disease-free survival and died because of metastatic dissemination of the tumor. The DFS rate was 88.4% and the overall survival rate was 98.6%. In patients with DCIS that are not candidates to breast-conserving therapy, NSM is a realistic option of treatment. No case of nipple necrosis was observed. A low rate of nipple relapse (1.4%) and a good survival rate (98.5%) were observed after a median follow-up of 142.6 months.

Micrometástasis en ganglios peripancreáticos por carcinoma mamario en paciente con adenocarcinoma ductal pancreático / Peripancreatic lymph node micrometastases from a mammary carcinoma in a patient with pancreatic ductal adenocarcinoma

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Estudio de factores histológicos predictivos de metástasis ganglionar locorregional en adenocarcinoma colorrectal mínimamente invasivo pT1 / Histological factors predicting loco-regional lymph node metastasis in early invasive colorectal adenocarcinoma pT1

INTRODUCCIÓN: El tratamiento habitual del adenocarcinoma colorrectal pT1 consiste en la resección endoscópica siempre que sea posible. Se requiere la evaluación de los ganglios linfáticos locorregionales cuando se detectan factores histológicos adversos en las polipectomías endoscópicas. MATERIALES Y MÉTODOS: Se seleccionaron 29 adenocarcinomas colorrectales pT1 incluyendo las polipectomías endoscópicas y piezas quirúrgicas correspondientes. Se evaluaron por 2 patólogos todos los parámetros histológicos asociados a N+, incluyendo: grado de diferenciación tumoral, profundidad de invasión en submucosa, invasión angiolinfática (IAL), invasión perineural, inflamación crónica, gemaciones tumorales, grupos de tumor pobremente diferenciados, adenoma preexistente, borde tumoral y margen de resección endoscópico. Se realizó un análisis de regresión logística univariante y multivariante para evaluar la capacidad individual de cada variable para predecir N+. RESULTADOS: En el análisis univariante, la localización rectal, la presencia de IAL y la presencia de grupos de tumor pobremente diferenciados se asociaron significativamente con metástasis ganglionares. De todas estas variables, la presencia de IAL presentó la mayor área bajo la curva ROC (0,875). El análisis multivariante no encontró ninguna variable independiente asociada a N+. CONCLUSIONES: La IAL y la presencia de grupos de tumor pobremente diferenciados se asocia frecuentemente con N+ en cáncer colorrectal precoz, por lo que se debe implementar rutinariamente la evaluación de estos parámetros histológicos

INTRODUCTION: Endoscopic resection is the common treatment in pT1 colorectal adenocarcinoma whenever possible. The presence of adverse histological factors requires subsequent lymph node evaluation. MATERIALS AND METHODS: We selected 29 colorectal pT1 adenocarcinoma including endoscopic polypectomies and the corresponding surgical specimens. All histologic parameters associated with N+ were evaluated by 2 pathologists, including: tumor differentiation grade, depth of invasion in the submucosa, angiolymphatic invasion (ALI), perineural invasion, chronic inflammation, tumor budding, poorly differentiated cluster, pre-existing adenoma, tumor border, and endoscopic resection margin. Univariate and multivariate logistic regression analysis were performed to assess the individual capacity of each variable to predict N+. Results In the univariate analysis, rectal tumor localization, ALI and poorly differentiated cluster was significantly associated with N+. Among the significant parameters, ALI had the highest area under the ROC curve (0.875). Multivariate analysis showed no independent variables associated with N+. CONCLUSIONS: We confirm that ALI and the presence of poorly differentiated cluster are frequently associated with N+ in early colorectal cancer. Consequently, these parameters should be routinely evaluated by pathologists

[Histological factors predicting loco-regional lymph node metastasis in early invasive colorectal adenocarcinoma pT1]. / Estudio de factores histológicos predictivos de metástasis ganglionar locorregional en adenocarcinoma colorrectal mínimamente invasivo pT1.

INTRODUCTION: Endoscopic resection is the common treatment in pT1 colorectal adenocarcinoma whenever possible. The presence of adverse histological factors requires subsequent lymph node evaluation. MATERIALS AND METHODS: We selected 29 colorectal pT1 adenocarcinoma including endoscopic polypectomies and the corresponding surgical specimens. All histologic parameters associated with N+ were evaluated by 2 pathologists, including: tumor differentiation grade, depth of invasion in the submucosa, angiolymphatic invasion (ALI), perineural invasion, chronic inflammation, tumor budding, poorly differentiated cluster, pre-existing adenoma, tumor border, and endoscopic resection margin. Univariate and multivariate logistic regression analysis were performed to assess the individual capacity of each variable to predict N+. RESULTS: In the univariate analysis, rectal tumor localization, ALI and poorly differentiated cluster was significantly associated with N+. Among the significant parameters, ALI had the highest area under the ROC curve (0.875). Multivariate analysis showed no independent variables associated with N+. CONCLUSIONS: We confirm that ALI and the presence of poorly differentiated cluster are frequently associated with N+ in early colorectal cancer. Consequently, these parameters should be routinely evaluated by pathologists.

Preoperative chemotherapy in patients with intermediate-risk rectal adenocarcinoma selected by high-resolution magnetic resonance imaging: the GEMCAD 0801 Phase II Multicenter Trial.

BACKGROUND: The need for preoperative chemoradiation or short-course radiation in all T3 rectal tumors is a controversial issue. A multicenter phase II trial was undertaken to evaluate the efficacy and safety of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab in patients with intermediate-risk rectal adenocarcinoma. METHODS: We recruited 46 patients with T3 rectal adenocarcinoma selected by magnetic resonance imaging (MRI) who were candidates for (R0) resection located in the middle third with clear mesorectal fascia and who were selected by pelvic MRI. Patients received four cycles of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab (final cycle without bevacizumab) before total mesorectal excision (TME). In case of progression, preoperative chemoradiation was planned. The primary endpoint was overall response rate (ORR). RESULTS: On an intent-to-treat analysis, the ORR was 78% (n = 36; 95% confidence interval [CI]: 63%-89%) and no progression was detected. Pathologic complete response was observed in nine patients (20%; 95% CI: 9-33), and T downstaging was observed in 48%. Forty-four patients proceeded to TME, and all had R0 resection. During preoperative therapy, two deaths occurred as a result of pulmonary embolism and diarrhea, respectively, and one patient died after surgery as a result of peritonitis secondary to an anastomotic leak (AL). A 13% rate of AL was higher than expected. The 24-month disease-free survival rate was 75% (95% CI: 60%-85%), and the 2-year local relapse rate was 2% (95% CI: 0%-11%). CONCLUSION: In this selected population, initial chemotherapy results in promising activity, but the observed toxicity does not support further investigation of this specific regimen. Nevertheless, these early results warrant further testing of this strategy in an enriched population and in randomized trials.

Leiomiosarcoma con patrón fusocelular y epitelioide en cuerpo del páncreas. Utilidad de la inmunohistoquímica en el diagnóstico diferencial de las neoplasias mesenquimales pancreáticas / Leiomyosarcoma with spindle and epithelioid pattern in the pancreatic body. The role of immunohistochemistry in the differential diagnosis of mesenchymal pancreatic tumours

Los leiomiosarcomas pancreáticos son neoplasias altamente agresivas con muy mal pronóstico. Se describe un caso de un paciente masculino de 78 años de edad que presenta un tumor abdominal en el que los estudios radiológicos confirmaron el origen primario en el páncreas. El estudio morfológico mostró un sarcoma con morfología fusocelular y epitelioide, con un perfil inmunohistoquímico positivo para actina músculo liso y desmina con negatividad para miogenina, h-caldesmon, CD117, DOG-1, S100, MyoD1, cromogranina-A, HMB-45, Melan A y EBV, confirmando el diagnóstico de leiomiosarcoma fusocelular y epitelioide. Se discute el diagnóstico diferencial con otras neoplasias mesenquimales pancreáticas(AU)

Pancreatic leiomyosarcoma is a highly aggressive malignancy with a poor prognosis. We report a case of a 78-year-old man with an abdominal mass which was diagnosed radiologically as a primary pancreatic sarcoma. Histopathology revealed a spindle/epithelioid cells morphology and immunohistochemistry showed strong positivity for smooth muscle actin and desmin, with negative results for myogenin, h-caldesmon, CD117, DOG-1, S100, MyoD1, chromogranin-A, HMB-45, Melan-A and EBV. The diagnosis of spindle and epithelioid leiomyosarcoma was confirmed. The differential diagnosis with pancreatic mesenchymal lesions is discussed(AU)

Empleo de mallas biológicas en la reconstrucción inmediata posmastectomía. Primeros resultados y consideraciones / Use of biological mesh in immediate post-mastectomy reconstruction. Preliminary results

Objetivo: Presentamos nuestros resultados con el uso de mallas biológicas para la cobertura de los implantes en la reconstrucción mamaria posmastectomía. Pacientes y métodos: Se intervino a 40 pacientes consecutivas. La indicación fue de cáncer de mama en 29 casos y de forma profiláctica en 11. Se administró neoadyuvancia en 12 pacientes. Resultados: Hubo 8 necrosis cutánea, 8 seroma-derrames periprotésicos, 5 hematomas, 3 abscesos, 2 con dolor y 1 extrusión. Se reintervino a 12 pacientes (30%), y en 8 casos (20%) se llevó a cabo la retirada de malla y prótesis/expansor. La radioterapia previa tras una cirugía conservadora de inicio obligó a retirar la malla y la prótesis en todos los casos. Conclusión: La radioterapia y el volumen del implante son factores importantes para la aparición de complicaciones(AU)

Objective: This study describes the use of biological mesh in breast reconstruction and its results. Patients and methods: A study was conducted on 40 consecutive patients with mastectomy and immediate reconstruction with biological mesh and implants. The indication was breast cancer in 29 cases, and prophylactic in 11 patients. Neoadjuvant treatment was administered to 12 patients. Results: There were 8 skin necrosis, 8 perigraft seroma, 5 haematomas, 3 abscesses, 2 with pain and 1 extrusion. Twelve patients underwent surgery (30%) with removal of the mesh and implant /expander in 8 cases (20%). The mesh and the implant had to be removed in all cases were there had been conservative surgery followed by radiotherapy. Conclusions: Radiotherapy and implant volume are important factors for failed reconstruction(AU)

Long-term results with oral fluoropyrimidines and oxaliplatin-based preoperative chemoradiotherapy in patients with resectable rectal cancer. A single-institution experience.

INTRODUCTION: Neoadjuvant 5-FU-based chemoradiotherapy in resectable rectal cancer (RC) is a standard of treatment. The use of oral fluoropyrimidines and new agents such as oxaliplatin may improve efficacy and tolerance. MATERIAL AND METHODS: Between 1999 and 2009, 126 RC patients with T3-T4 and/or N+ disease were given three successive protocols: UFT (32), UFT-oxaliplatin (75) and capecitabine-oxaliplatin (19), alongside 45 Gy of radiotherapy; with surgery 4-6 weeks after. Adjuvant treatment was given in all patients. The primary objective was pathologic complete response (pCR). RESULTS: Preoperative therapy was well tolerated, with no toxic deaths and a 15% grade 3-4 toxicity rate. Eighty-five percent of patients received the full chemotherapy dose, 56% had an abdominoperineal resection, 6% reinterventions and 57% received the full adjuvant chemotherapy planned. The pCR rate was 13%. The downstaging rate was 80%; 8% had progression of disease. The relapse rate was 20%, with local relapse in 6%. By 5 years of followup, 92% of relapses had occurred. Median follow-up was 73 months, 5- and 10-year disease-free survival rates were 75% and 50%, and 5- and 10-year overall survival rates were 79% and 66% respectively. There was no benefit from the use of oxaliplatin regarding survival or pCR rates. Older patients had worse long-term outcomes. CONCLUSIONS: Neoadjuvant chemoradiotherapy with oral fluoropyrimidines and oxaliplatin is feasible and well tolerated. The risk of early progression is low. However, there was no added benefit with the use of oxaliplatin. There were no relapses in patients with pCR. The role of adjuvant chemotherapy is unclear.

Granulomatosis intraabdominal por Cladosporium cladosporioides / Intraabdominal granulomatosis due to Cladosporium cladosporioides infection

Introducción. La infección intraabdominal granulomatosa por hongos es una entidad de difícil diagnóstico y escasa incidencia. La histopatología usualmente muestra tejido inflamatorio con células gigantes multinucleadas y levaduras, hifas o conidios. Material y métodos. Presentamos el caso de una mujer de 51 años con antecedentes de adenocarcinoma endometrial y múltiples intervenciones quirúrgicas en la cavidad abdominal asociados con sepsis intraabdominal, la cual fue tratada con varias combinaciones de antimicrobianos y antifúngicos. Resultados. Durante la última intervención quirúrgica se detectan múltiples formaciones nodulares que se envían al Laboratorio de Patología y se informan como granulomas necrotizante. Las técnicas de PAS demostraron la presencia de formas fúngicas y el estudio microbiológico por PCR realizado en material embebido en parafina de la biopsia detectó Cladosporium cladosporioides. Conclusiones. La infección intraabdominal formando granulomas por C. cladosporioides no ha sido previamente publicada. Se discute el diagnóstico diferencial con otras causas de granulomatosis intraabdominal(AU)

Introduction. Intra-abdominal granulomatosis caused by fungal infection is infrequent and difficult to diagnose. The histopathology usually reveals a chronic inflammatory reaction with multinucleated giant cells, yeast, hyphae and/or conidia. Material and methods. We report a case of a 51-year-old woman with a previous history of endometrial adenocarcinoma and repeated abdominal surgery associated with intrabdominal infection, which was treated with various antibiotics and antifungals. Results. The most recent surgical intervention revealed multiple nodules which were seen on microscopy to have necrotizing granulomatous inflammation. Histochemistry with PAS confirmed a fungal infection and the microbiological study with PCR in formalin-fixed paraffin-embedded tissue identified the pathogen as Cladosporium cladosporioides. Conclusions. To our knowledge, this is the first report of intraabdominal infection due to C. cladosporioides with granuloma formation. The differential diagnosis with other intraabdominal granulomatous is discussed(AU)

Metástasis hepática de cáncer de mama y cáncer primario de colon sincrónicos. ¿Qué hacer? / No disponible

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