Ultrasonido endoscópico y puncion aspiración con aguja fina en tumores del páncreas: experiencia de 2 años. Servicio oncológico hospitalario del IVSS 2010 / Endoscopic ultrasound and fine needle aspiration puncture in tumors of the pancreas: 2 years experience. Hospital oncology service IVSS 2010

La punción aspiración guiada por ultrasonido endoscópico (PAAF-USE) se ha convertido en una herramienta fundamental en el diagnóstico de los tumores de páncreas. Es un procedimiento con baja tasa de complicaciones que además provee información determinante que puede modificar la conducta terapéutica. Métodos: Estudio retrospectivo, descriptivo. Se incluyeron pacientes con diagnóstico de tumor de páncreas referidos para la realización PAAF-USE en el período comprendido entre 2008-2009. Resultados: 36 pacientes fueron estudiados, 58.30% (n=21) del sexo femenino. Se evidenciaron tumores sólidos en el 80.5%. Según la histología, fueron reportados adenocarcinoma en el 47.05% (n=16), cistoadenoma mucinoso en el 8.88% (n=3), cistoadenocarcinoma en el 5.88% (n=2), linfoma no Hodgkin en el 5.88% (n=2), tumor neuroendocrino (insulinoma) en el 2.94 % (n=1), cistodenoma seroso en el 2.94% (n=1), tumor sólido pseudopapilar en el 2.94% (n=1), tumor metastásico a páncreas en el 2.94% (n=1) y el 17.64% (n=6) fueron reportados negativos para malignidad. No hubo complicaciones asociadas al procedimiento. Conclusiones: Los hallazgos obtenidos por PAAF-USE permiten establecer el diagnóstico en un alto porcentaje de las lesiones tumorales del páncreas, con una baja tasa de complicaciones, permitiendo seleccionar conductas terapéuticas adecuadas.

Endoscopic ultrasound-guided fine-needle-aspiration (EUS-FNA) has become an essential tool for the diagnosis and staging of pancreatic neoplasms. It is a procedure with low complication rates and also provides crucial information which could alter the therapeutic management. Methods: A retrospective analysis of patients referred for USE-FNA with presumed pancreatic neoplasms between January 2008 and December 2009. Results: 36 patients were studied, 58.30% (n = 21) were females. Solid tumors were evident in 80.5%. According to their histology, adenocarcinoma were reported in 47.05% (n = 16), mucinous cystadenoma in 8.88% (n = 3), cystadenocarcinoma in 5.88% (n = 2), non-Hodgkin lymphoma in 5.88% (n = 2), neuroendocrine tumor (insulinoma) in 2.94% (n = 1), serous cystoadenoma in 2.94% (n = 1), solid pseudopapillary tumor in 2.94% (n = 1), metastatic tumor 2.94 % (n = 1) and 17.64% (n = 6) were reported negative for malignancy. There were no complications associated with the procedure. Conclusions: The fi ndings obtained by EUS-FNA make diagnosis possible in a high percentage of tumoral lesions of the pancreas, with no procedural complication rates overall in this study. Consequently, the accurate histological diagnosis will have the potential to affect the selection of an appropriate treatment.

Enhanced magnification endoscopy: a new technique to identify specialized intestinal metaplasia in Barrett's esophagus.

BACKGROUND: Specialized intestinal metaplasia (SIM) in Barrett's esophagus (BE) is not identifiable by standard endoscopy. Acetic acid instillation enhances the ability to detect columnar epithelium at the squamocolumnar union. Enhanced magnification endoscopy involves the combined use of magnification endoscopy with acetic acid. This study assessed the value of enhanced magnification endoscopy in detecting SIM in patients with BE. METHODS: Patients undergoing endoscopic surveillance because of short segment BE without dysplasia underwent enhanced magnification endoscopy with 1.5% acetic acid instillation. Standard endoscopy was followed by magnification endoscopy and repeated after acetic acid spraying. Surface patterns were characterized prior to and after acetic acid spraying. The observed surface patterns were compared with histology results. RESULTS: Forty-nine patients, 9 women and 39 men, with a mean age of 50.5 years were studied. One was excluded because of unclear definition of the surface pattern. Enhanced magnification endoscopy detected 4 different mucosal surface patterns: I, round pits; II, reticular; III, villous; and IV, ridged. A total of 129 areas were examined. Standard endoscopy identified an endoscopic pattern in 1.5% of the areas, standard endoscopy and acetic acid in 8.5%, magnification endoscopy alone in 38%, and enhanced magnification endoscopy in all 129 endoscopic areas. The yields for detecting SIM according to endoscopic patterns were as follows: pattern I, 0%; II, 11% (odds ratio 0.5, p = 0.54); III, 87% (odds ratio 36, p = 0.001); and IV, 100% (odds ratio 14, p = 0.015). CONCLUSIONS: Enhanced magnification endoscopy is an accurate method of predicting SIM in BE. The simplicity of the technique and its ability to identify characteristic endoscopic patterns with outstanding clarity and resolution that correlate with histologic identification of specialized intestinal metaplasia make enhanced magnification endoscopy an excellent method for the evaluation of patients with BE.

Histiocitosis de celulas de langerhans (HCL) enfermedad localizada: experiencia en el S.A. Hospital de Niños J.M. de Los Ríos Caracas-Venezuela: enero 1985-diciembre 1997 / Histiocytosis of langerhan's cell (HCL) disease localizada: experience in the S.A Hospital od Niños J.M de Los Ríos Caracas-Venezuela: january 1985-december 1997

Durante el período comprendido entre el 01-01-1985 al 31-12-1997, 46 pacientes menores de 16 años con diagnóstico de Histiocitosis de Células de Langerhans (HCL) ingresaron al Servicio de Oncología del SA Hospital de Niños J.M de Los Ríos de Caracas, Venezuela. De ellos, 26 pacientes (56,52 por ciento) tenían enfermedad localizada, 88,3 por ciento eran < 9 años, 57,6 por ciento tenían edades comprendidas entre 0 y 4 años. La edad mínima fue de 10 meses y la máxima de 11 años, el promedio de edad fue 4,7 años. La relación sexo V: H 1,3: 1.4 pacientes (53,84 por ciento) presentaban lesión única, 13 pacientes Hueso, 1 paciente Ganglio. 12 pacientes (46,16 por ciento) presentaron lesiones óseas múltiples. Los huesos más frecuentemente afectados fueron: Cráneo, Pelvis y Femur. En el 100 por ciento de los casos se corrobora el diagnóstico a través de estudio histológico. 26 pacientes (100 por ciento) fueron evaluados para tratamiento. en 9 pacientes (34,61 por ciento) el tratamiento fue cirugía; en 2 pacientes ésta se asoció a Radioterapia. En 4 pacientes (15,4 por ciento) fue Radioterapia; y en 7 pacientes (26,9 por ciento) se utilizó Quimioterapia; en 4, Quimioterapia se asocia a Radioterapia. Los agentes antineoplásicos empleados fueron: Cisdiaminodicloroplatino, Etopósido, Viblastina, Ciclofosfamida y Prednisona. 1 paciente abandonó tratamiento. Respuesta Completa se obtuvo en 22 pacientes (84,6 por ciento), Respuesta Parcial en 4 pacientes (15,4 por ciento), estos fueron rescatados con Quimioterapia y Radioterapia SLE fue de 92 por ciento a 150 meses de observación e.e 0,05. Ningún paciente falleció, la SG fue 100 por ciento a 150 meses de observación e.e. 0,0. Se concluye en el buen pronóstico de la HCL localizada y en la efectividad de las medidas terapéuticas

Prevalence of Helicobacter pylori in neonates and young infants undergoing ERCP for diagnosis of neonatal cholestasis.

This study was carried out to determine the prevalence of Helicobacter pylori infection in 20 neonates and young infants from lower socioeconomic background undergoing endoscopic retrograde cholangiopancreatography (ERCP) examination for diagnosis of neonatal cholestasis. One young asymptomatic infant (5%) who was breast-feeding with complementary formula had H. pylori infection. Endoscopy showed a normal appearing mucosa and histology demonstrated mild superficial acute gastritis. A follow-up gastroscopy performed 14 months after the initial study showed normal histology without evidence of H. pylori, suggesting that the infection was transient. Nineteen (95%) of the 20 mothers had H. pylori infection, including the mother with the infant positive for H. pylori. All mothers had gastritis on biopsy specimens. Despite the high prevalence of H. pylori in the mothers, infection in neonates and young infants was uncommon.

The value of fine-needle aspiration cytology in the diagnosis of inflammatory pancreatic masses.

In order to determine the accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of inflammatory pancreatic masses (pseudocyst and abscess), we reviewed 91 FNAC specimens performed during 1985-1989 at the University of Miami/Jackson Memorial Medical Center. All specimens were collected under computed tomographic guidance. A sensitivity of 100% and a specificity of 98% were recorded in the diagnosis of inflammatory pancreatic masses. The sensitivity and specificity of the method in the diagnosis of malignant neoplasms were 79.5% and 100%, respectively. We conclude that fine-needle aspiration cytology of pancreas is not only an important diagnostic tool in patients with pancreatic cancer, but can also be used to diagnose inflammatory masses of the pancreas. In fact, aspiration of such masses may not only be diagnostic, but also therapeutic in some patients.

Pseudosarcomatous myofibroblastic proliferations in the urinary bladder of children.

Ten examples of a pseudosarcomatous myofibroblastic proliferation occurring in the urinary bladder of children (aged 2 to 16 years) are reported. The lesions appeared as polypoid nodular masses of variable size with myxoid and hemorrhagic areas. They consisted of compact fascicles of elongated spindle cells with minimal atypia. Myxoid areas of variable extension and scattered inflammatory cells were constant features, whereas diffuse collagen deposition was not common. Despite the striking cellularity of some of the lesions, most showed minimal mitotic activity. Ultrastructurally, the predominant cells had features of myofibroblasts. Six cases studied by immunocytochemical methods expressed vimentin and muscle-specific actin. In addition, two of these cases expressed desmin and two others cytokeratin. Infiltration into the muscularis propria of the urinary bladder was demonstrated in six cases and into the perivesical soft tissues in two. However, none of the eight patients for whom follow-up information is available has had local recurrence or metastasis develop 18 months to 6 years after surgical excision.

Small cell carcinoma of the renal pelvis: a clinicopathological, morphological and immunohistochemical study of 2 cases.

Two women, 62 and 66 years old, with combined small cell carcinoma and transitional cell carcinoma of the renal pelvis are reported. The clinical picture was similar to that seen in conventional transitional cell carcinoma. A brief review of the literature indicates that in the urinary tract, small cell carcinoma occurs most commonly in the bladder and is exceedingly rare in the renal pelvis; only 2 cases have been reported previously. The morphological spectrum of the small cell carcinomatous component is similar to that seen in lung tumors. Neuroendocrine differentiation of the small cell carcinoma component was supported by a positive immunoreaction to neuron-specific enolase in both cases and to synaptophysin in 1. One patient died with metastases 8 months after diagnosis, and 1 was alive with clinical evidence of lymph node metastases and contralateral papillary transitional cell carcinoma of the renal pelvis 16 months after diagnosis.