SAGES masters program: the top 10 seminal articles for the laparoscopic left and sigmoid colectomy pathway for complex disease.

BACKGROUND: The SAGES University Colorectal Masters Program is a structured educational curriculum that is designed to aid practicing surgeons develop and maintain knowledge and technical skills for laparoscopic colorectal surgery. The Colorectal Pathway is based on three anchoring procedures (laparoscopic right colectomy, laparoscopic left and sigmoid colectomy for uncomplicated and complex disease, and intracorporeal anastomosis for minimally invasive right colectomy) corresponding to three levels of performance (competency, proficiency and mastery). This manuscript presents focused summaries of the top 10 seminal articles selected for laparoscopic left and sigmoid colectomy for complex benign and malignant disease. METHODS: A systematic literature search of Web of Science for the most cited articles on the topic of laparoscopic complex left/sigmoid colectomy yielded 30 citations. These articles were reviewed and ranked by the SAGES Colorectal Task Force and invited subject experts according to their citation index. The top 10 ranked articles were then reviewed and summarized, with emphasis on relevance and impact in the field, study findings, strength and limitations and conclusions. RESULTS: The top 10 seminal articles selected for the laparoscopic left/sigmoid colectomy for complex disease anchoring procedure include advanced procedures such as minimally invasive splenic flexure mobilization techniques, laparoscopic surgery for complicated and/or diverticulitis, splenic flexure tumors, complete mesocolic excision, and other techniques (e.g., Deloyers or colonic transposition in cases with limited colonic reach after extended left-sided resection). CONCLUSIONS: The SAGES Colorectal Masters Program top 10 seminal articles selected for laparoscopic left and sigmoid colectomy for complex benign and malignant disease anchoring procedure are presented. These procedures were the most essential in the armamentarium of practicing surgeons that perform minimally invasive surgery for complex left and sigmoid colon pathology.

Nevo de Ota bilateral: presentación de un caso de distribución poco frecuente / Bilateral nevus of Ota: an unusual presentation

RESUMEN El Nevo de Ota, es una melanocitosis dérmica que se desarrolla por un defecto embrionario en la migración de los melanocitos desde la cresta neural a la piel y mucosas. Presentamos una paciente de 32 años, con Nevo de Ota bilateral de presentación infrecuente.

ABSTRACT Nevus of Ota is a dermal melanocytosis that develops due to an embryonic defect in the migration of melanocytes from the neural crest to the skin and mucous membranes. We report a 32-year-old female patient with a bilateral nevus of Ota with a rare manifestation due to its unusual distribution.

Fibrohistiocitoma maligno / Malignant fibrohystiocytoma

RESUMEN El fibrohistiocitoma maligno es el sarcoma de partes blandas más frecuente en adultos; es poco frecuente como tumor primario cutáneo. Presenta predilección por el sexo masculino con una mayor incidencia entre la quinta y sexta década de la vida. Se localiza predominantemente en las extremidades. Presentamos a continuación el caso clínico de un paciente con diagnóstico de fibrohistiocitoma maligno localizado en hallux de pie derecho y realizaremos una revisión de la literatura.

ABSTRACT Malignant fibrohistiocytoma is the most frequent soft tissue tumor in adults; it is rare as a primary cutaneous tumor. It presents a predilection for males with the highest incidence between the fifth and sixth decade of life. It is located predominantly on the extremities. We will perform a literature review. We present below the clinical case of a patient diagnosed with malignant fibrohistiocytoma located in hallux of the right foot.

Dermatosis Pustulosa Subcórnea / Subcorneal pustular dermatosis

RESUMEN La dermatosis pustulosa subcórnea o enfermedad de Sneddon Wilkinson, es una enfermedad poco frecuente, caracterizada por lesiones pustulosas, recurrentes que suelen coalescer. Esta afección también se relaciona con enfermedades neoplásicas o inmunológicas. El propósito de este estudio es describir un caso clínico de ladermatosis referida en una paciente de 54 años de edad inicialmente tratada con dapsona, aunque,si bien, durante dos meses hubo mejoría, posteriormente se observa desarrollo de nuevas lesiones y alteración de las transaminasas. Por este motivo se procede a cambiar de tratamiento, por trimetoprima /sulfametoxazol.

Abstract Subcorneal pustular dermatosis or Sneddon Wilkinson's disease is a rare disease characterized by recurrent pustular lesions that often coalesce. This condition is also associated with neoplastic or immunologic diseases. The purpose of this study is to describe a clinical case of the referred dermatosis in a 54-year-old female patient initially treated with dapsone, although there was improvement for two months, subsequently new lesions developed and transaminase alteration was observed, for this reason the treatment was changed to trimethoprim/sulfamethoxazole.

Buena respuesta a tratamiento con triamcinolona en Sarcoidosis Cutánea / Good response to treatment with triamcinolone in Cutaneous Sarcoidosis

RESUMEN La sarcoidosis es una enfermedad granulomatosa multisistémica, de etiología desconocida y evolución crónicaque afecta con mayor frecuencia los pulmones, los ojos y la piel. Aproximadamente un 25% de los pacientes presentan como única manifestación la forma cutánea. Se presenta el caso clínico de una paciente con diagnósticode sarcoidosis cutánea, a quien se le realizó tratamiento con infiltraciones de triamcinolona obteniendo muy buena respuesta. Se realiza unarevisión de la literatura.

ABSTRACT Sarcoidosis is a multisystemic granulomatous disease of unknown etiology with chronic evolution the most frequently affectes the lungs, eyes and skin. Approximately 25% of patients present as the only manifestation the cutaneous form. We present the clinical case of a patient diagnosed with cutaneous sarcoidosis, who underwent treatment with triamcinolone infiltrations, obtaining a very good response. Areview of the literatureisalso carried out.

Helmet-CAM: Strategically Minimizing Exposures to Respirable Dust Through Video Exposure Monitoring.

Exposure to respirable crystalline silica (RCS) remains a serious health hazard to the US mining workforce who are potentially exposed as various ore bodies are drilled, blasted, hauled by truck, crushed, screened, and transported to their destinations. The current Mine Safety and Health Administration (MSHA) permissible exposure limit (PEL) for RCS remains at approximately 100 µg/m3, but it is noteworthy that the Occupational Safety and Health Administration (OSHA) has lowered its PEL to 50 µg/ m3 (with enforcement dates staggered through 2022 for various sectors), and the National Institute for Occupational Safety and Health (NIOSH) has held a 50 µg/m3 recommended standard since 1976. To examine a method for reducing RCS exposure using a NIOSH-developed video exposure monitoring (VEM) technology (referred to as Helmet-CAM), video and respirable dust concentration data were collected on eighty miners across seven unique mining sites. The data was then collated and partitioned using a thresholding scheme to determine exposures that were in excess of ten times the mean exposure for that worker. Focusing on these short duration, high magnitude exposures can provide insight to implement controls and interventions that can dramatically lower the employee's overall average exposure. In 19 of the 80 cases analyzed, it was found that exposure could be significantly lowered by 20% or more by reducing exposures that occur during just 10 min of work per 8-hour shift. This approach provides a method to quickly analyze and determine which activities are creating the greatest health concerns. In most cases, once identified, focused control technologies or behavioral modifications can be applied to those tasks.

Poor agreement between the automated risk assessment of a smartphone application for skin cancer detection and the rating by dermatologists.

BACKGROUND: Several smartphone applications (app) with an automated risk assessment claim to be able to detect skin cancer at an early stage. Various studies that have evaluated these apps showed mainly poor performance. However, all studies were done in patients and lesions were mainly selected by a specialist. OBJECTIVES: To investigate the performance of the automated risk assessment of an app by comparing its assessment to that of a dermatologist in lesions selected by the participants. METHODS: Participants of a National Skin Cancer Day were enrolled in a multicentre study. Skin lesions indicated by the participants were analysed by the automated risk assessment of the app prior to blinded rating by the dermatologist. The ratings of the automated risk assessment were compared to the assessment and diagnosis of the dermatologist. Due to the setting of the Skin Cancer Day, lesions were not verified by histopathology. RESULTS: We included 125 participants (199 lesions). The app was not able to analyse 90 cases (45%) of which nine BCC, four atypical naevi and one lentigo maligna. Thirty lesions (67%) with a high and 21 with a medium risk (70%) rating by the app were diagnosed as benign naevi or seborrhoeic keratoses. The interobserver agreement between the ratings of the automated risk assessment and the dermatologist was poor (weighted kappa = 0.02; 95% CI -0.08-0.12; P = 0.74). CONCLUSIONS: The rating of the automated risk assessment was poor. Further investigations about the diagnostic accuracy in real-life situations are needed to provide consumers with reliable information about this healthcare application.

Frequency and prognosis of associated malignancies in 504 patients with lymphomatoid papulosis.

BACKGROUND: Lymphomatoid papulosis (LyP) can be associated with other haematological malignancies (HM), but reported percentages vary from 20% to over 50%. OBJECTIVE: To evaluate the frequency and prognostic significance of associated HM and non-HM in LyP patients. METHODS: In this multicentre cohort study, the complete Dutch LyP population was included from the Dutch Cutaneous Lymphoma Registry between 1985 and 2018. Clinical and histopathological information was retrieved from every individual patient. RESULTS: After a median follow-up of 120 months (range, 6-585), an associated HM was observed in 78/504 (15.5%) patients. Most common associated HM were mycosis fungoides (MF; n = 31) and anaplastic large-cell lymphoma (ALCL; n = 29), while 19 patients had another HM of B-cell (n = 14) or myeloid origin (n = 5). Even after a 25-year follow-up period, percentages of associated HM did not exceed 20%. Thirty-nine of 465 patients (8.4%) without a prior or concurrent associated HM developed an associated HM during follow-up, after a median of 68 months (range of 3-286 months). Nine of 78 patients died of associated HM, including 6/22 patients developing extracutaneous ALCL, while all patients with associated MF or skin-limited ALCL had an excellent prognosis. Compared with the general population, LyP patients showed an increased risk (relative risk, 2.8; 95% confidence intervals, 2.4-3.3) for non-HM, in particular cutaneous squamous cell carcinoma, melanoma and intestinal/lung/bladder cancer. CONCLUSIONS: An associated HM was reported in 15.5% of the LyP patients, particularly MF and ALCL. Although the frequency of associated HM is lower than suggested and the prognosis of most patients with associated HM is excellent, a small subgroup will develop aggressive disease, in particular extracutaneous ALCL. Furthermore, LyP patients have a higher risk of developing other malignancies. Clinicians should be aware of these risks, and LyP patients require close monitoring.

Criptococosis Cutánea Primaria / Primary Cutaneous Cryptococcosis

RESUMEN La Criptococosis es una infección crónica que afecta a pacientes inmunucompetentes e inmunodeprimidos; producida por la levadura encapsulada del hongo Criptococo neoformans. Afecta principalmente al pulmón, a partir del cual puede diseminarse. La forma cutánea se divide en primaria cuando es producida por inoculación directa del hongo, y secundaria como consecuencia de un foco a distancia. Presentamos el caso clínico de un paciente de sexo masculino de 57 años de edad inmunocompetente, con diagnóstico de Criptococosis cutánea primaria, forma de presentación poco frecuente.

ABSTRACT Cryptococcosis is a chronic infection that affects immunocompetent and immunosuppressed patients caused by the encapsulated yeast Cryptococcus neoformans. It primarily affects the lungs and it may disseminate. The cutaneous form is divided into primary, occurring after direct inoculation or secondary, due to dissemination from a distant site of infection. We present a case of a 57 years-old immunocompetent male with primary Cutaneous Cryptococcosis which is infrequent.

Clonality testing as complementary tool in the assessment of different patient groups with canine chronic enteropathy.

Differentiation between canine chronic enteropathy (CCE) and intestinal lymphoma is a diagnostic challenge as histopathology might fail to yield unequivocal results. Detection of clonal rearrangements of the T-cell-receptor gamma (TCRG) chain and IG heavy chain (IGH) V-J genes offer a useful solution. In this retrospective study, histopathology samples of 35 CCE patients and 7 healthy Beagle dogs underwent clonality testing. Patients suffered either from inflammatory bowel disease (IBD), food responsive diarrhea (FRD) or protein loosing enteropathy secondary to IBD (PLE/IBD). Healthy Beagles served as controls (CO). Canine IBD activity index (CIBDAI) and histopathological WSAVA-grading differed significantly (p<0.001) between groups. CIBDAI improved significantly after appropriate therapy (p < 0.0001). Intestinal biopsies of all CO showed polyclonal patterns for B- and T-cell primers. All samples from CCE patients showed polyclonal patterns for the B-cell primers. Targeting TCRG, 4 patients showed a monoclonal or oligoclonal pattern of the lymphocytic infiltrates in the duodenum and/or colon. Clinical improvement was observed in all dogs. Although a small cell lymphoma cannot be excluded in view of the short follow up duration, a false positive result, in the sense of a canonical rearrangement or unspecific amplification due to a antigenic stimulation in a non-neoplastic inflammatory process is possible.

A review of environmental enrichment for laying hens during rearing in relation to their behavioral and physiological development.

Globally, laying hen production systems are a focus of concern for animal welfare. Recently, the impacts of rearing environments have attracted attention, particularly with the trend toward more complex production systems including aviaries, furnished cages, barn, and free-range. Enriching the rearing environments with physical, sensory, and stimulatory additions can optimize the bird's development but commercial-scale research is limited. In this review, "enrichment" is defined as anything additional added to the bird's environment including structurally complex rearing systems. The impacts of enrichments on visual development, neurobehavioral development, auditory stimulation, skeletal development, immune function, behavioral development of fear and pecking, and specifically pullets destined for free-range systems are summarized and areas for future research identified. Visual enrichment and auditory stimulation may enhance neural development but specific mechanisms of impact and suitable commercial enrichments still need elucidating. Enrichments that target left/right brain hemispheres/behavioral traits may prepare birds for specific types of adult housing environments (caged, indoor, outdoor). Similarly, structural enrichments are needed to optimize skeletal development depending on the adult layer system, but specific physiological processes resulting from different types of exercise are poorly understood. Stimulating appropriate pecking behavior from hatch is critical but producers will need to adapt to different flock preferences to provide enrichments that are utilized by each rearing group. Enrichments have potential to enhance immune function through the application of mild stressors that promote adaptability, and this same principle applies to free-range pullets destined for variable outdoor environments. Complex rearing systems may have multiple benefits, including reducing fear, that improve the transition to the layer facility. Overall, there is a need to commercially validate positive impacts of cost-effective enrichments on bird behavior and physiology.

Evaluation of treatment results in multifocal primary cutaneous anaplastic large cell lymphoma: report of the Dutch Cutaneous Lymphoma Group.

BACKGROUND: There is no consensus on the treatment of multifocal primary cutaneous anaplastic large cell lymphoma (C-ALCL). Radiotherapy (RT) and methotrexate (MTX) are the current treatment options, but their efficacy is unknown. Recently, targeted therapies showed promising results in C-ALCL, and may therefore be an attractive first choice of treatment. OBJECTIVES: To assess the efficacy of conventional treatment strategies for patients with multifocal C-ALCL, and to define which patients may require novel targeted therapies. METHODS: In this multicentre study, treatment was evaluated in patients initially presenting (n = 24) or relapsing with multifocal C-ALCL (n = 17; 23 relapses). Distinction was made between patients with five or less lesions (n = 36) and more than five lesions (n = 11). RESULTS: Treatments most commonly used were RT (n = 21), systemic chemotherapy (n = 9) and low-dose MTX (n = 7) with complete response rates of 100%, 78% and 43%, respectively, and an overall response rate of 100%, 100% and 57%, respectively. Four patients showed complete spontaneous regression. In total, 16 of 24 patients (67%) first presenting with multifocal C-ALCL relapsed, including all five patients initially treated with CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone). Compared with patients presenting with two to five skin lesions, patients presenting with more than five lesions had a higher chance of developing extracutaneous relapse (56% vs. 20%) and more often died of lymphoma (44% vs. 7%). CONCLUSIONS: Patients with five or less lesions should be treated with low-dose RT (2 × 4 Gy). Maintenance low-dose MTX (20 mg weekly) is a suitable option in patients with more than five lesions. Targeted therapies may be considered in rare patients who are refractory to MTX or patients developing extracutaneous disease.

Treatment of superficial basal cell carcinoma by topical photodynamic therapy with fractionated 5-aminolaevulinic acid 20% vs. two-stage topical methyl aminolaevulinate: results of a randomized controlled trial.

BACKGROUND: Basal cell carcinoma (BCC) is the most common type of skin cancer and incidence rates are increasing. Photodynamic therapy (PDT) is a frequently used treatment, especially for superficial BCC (sBCC). Two topical photosensitizing agents are currently used to treat sBCC, namely 5-aminolaevulinic acid (ALA) and its ester, methyl aminolaevulinate (MAL). Previous research showed a high efficacy for ALA-PDT using a twofold fractionated illumination scheme in which two light fractions of 20 J cm-2 and 80 J cm-2 were delivered 4 h and 6 h after ALA application. OBJECTIVES: To evaluate whether twofold ALA-PDT is superior to conventional MAL-PDT for sBCC. METHODS: We performed a single-blind, randomized, multicentre trial in the Netherlands. RESULTS: Overall, 162 patients were randomized either to conventional MAL-PDT or twofold ALA-PDT. After 12 months, a total of six treatment failures occurred following ALA-PDT and 13 treatment failures occurred following MAL-PDT. The 12-month cumulative probability of remaining free from treatment failure was 92·3% [95% confidence interval (CI) (83·7-96·5)] for ALA-PDT and 83·4% (95% CI 73·1-90·0) for MAL-PDT (P = 0·091). CONCLUSIONS: The twofold ALA-PDT scheme resulted in fewer recurrences, although the difference between both treatment groups was not statistically significant. However, ALA-PDT resulted in higher pain scores and more post-treatment side-effects compared with MAL-PDT.

Quick fixes to improve workers' health: Results using engineering assessment technology.

Personal respirable dust sampling and the evaluation of control technologies have been providing exposure information to the mining industry but not necessarily in a way that shows how technology can be integrated to provide organizational support and resources for workers to mitigate dust sources on site. In response, the U.S. National Institute for Occupational Safety and Health (NIOSH) used previously developed Helmet-CAM technology to design and engage in a behavioral/engineering cooperative intervention to initiate and enhance mine site conversations about the risks and potential occurrences of respirable silica dust exposures on the job as well as provide impetus and solutions for mitigating higher sources of dust. The study involved 48 workers from five mine sites, who agreed to participate between April 2015 and September 2016. Using the Helmet-CAM in this series of longitudinal interventions revealed several exposure trends in respirable silica dust sources and, in many cases, simple quick-fix strategies to reduce their sources. This paper focuses on several specific identified sources of dust that were elevated but could be reduced through basic engineering fixes, low-cost resources, and supportive communication from management to remind and engage workers in protective work practices.

Immunophenotype of Peripheral Blood Lymphocytes in Dogs with Inflammatory Bowel Disease.

BACKGROUND: Inflammatory bowel disease (IBD) is common in dogs. Despite the known importance of intestinal lymphocytes in its pathogenesis, little is known about the role of peripheral blood lymphocytes (PBLs) in IBD. OBJECTIVES: The aims of this study were (1) comparison of PBLs analyzed by flow cytometry (FCM) in IBD dogs and healthy controls and (2) comparison of PBLs in IBD dogs at the time of diagnosis and in dogs in clinical remission. ANIMALS: Whole blood samples of 19 IBD dogs at the time of diagnosis and blood samples of 6 dogs in clinical remission were collected. Ten healthy dogs served as controls. METHODS: In this prospective observational study, PBLs were analyzed with multicolor FCM by staining with a panel of anticanine and cross-reactive monoclonal antibodies against T- and B-cell differentiation antigens, including CD45, CD3, CD4, CD8α, CD8ß, TCRαß, TCRγδ, CD79αcy, and CD21. RESULTS: The IBD patients' PBLs had significantly decreased percentages of TCRγδ+ T lymphocytes (median: healthy dogs, 3.32; IBD dogs, 0.97; P = 0.03) and CD21+ B cells (median: healthy dogs, 27.61; IBD dogs, 17.26; P = 0.04). There were no significant differences in PBLs between pretreatment and follow-up samples. CONCLUSIONS AND CLINICAL IMPORTANCE: The differences between PBLs in healthy and IBD dogs analyzed by FCM indicate an imbalance of lymphocytes with different immunologic functions and emphasize the potential value of this technique in a larger cohort of dogs. The PBLs did not differ between IBD dogs before treatment and clinically well-controlled dogs after treatment.

Recommendations for treatment in folliculotropic mycosis fungoides: report of the Dutch Cutaneous Lymphoma Group.

BACKGROUND: Folliculotropic mycosis fungoides (FMF) is an aggressive variant of mycosis fungoides (MF) and generally less responsive to standard skin-directed therapies (SDTs). Recent studies distinguished indolent (early-stage FMF) and more aggressive (advanced-stage FMF) subgroups. The optimal treatment for both subgroups remains to be defined. OBJECTIVES: To evaluate initial treatment results in patients with early- and advanced-stage FMF. METHODS: A study was undertaken of 203 patients (84 early-stage, 102 advanced-stage, 17 extracutaneous FMF) included in the Dutch Cutaneous Lymphoma Registry between 1985 and 2014. Type and results of initial treatment were retrieved from the Dutch Registry. Main outcomes were complete remission (CR); sustained complete remission; partial remission (PR), > 50% improvement; and overall response (OR; CR + PR). RESULTS: Patients with early-stage FMF were treated with nonaggressive SDTs in 67 of 84 cases resulting, respectively, in CR and OR of 28% and 83% for monotherapy topical steroids, 0% and 83% for ultraviolet B (UVB), and 30% and 88% for psoralen plus ultraviolet A (PUVA). In patients with advanced-stage FMF these SDTs were less effective (combined CR and OR 10% and 52%, respectively). In patients with advanced-stage FMF local radiotherapy (CR 63%; OR 100%), total skin electron beam irradiation (CR 59%; OR 100%) and PUVA combined with local radiotherapy (CR 5%, OR 75%) were most effective. CONCLUSIONS: The results of the present study demonstrate that not all patients with FMF should be treated aggressively. Patients with early-stage FMF may benefit very well from standard SDTs also used in early-stage classic MF and have an excellent prognosis.

A case study exploring field-level risk assessments as a leading safety indicator.

Health and safety indicators help mine sites predict the likelihood of an event, advance initiatives to control risks, and track progress. Although useful to encourage individuals within the mining companies to work together to identify such indicators, executing risk assessments comes with challenges. Specifically, varying or inaccurate perceptions of risk, in addition to trust and buy-in of a risk management system, contribute to inconsistent levels of participation in risk programs. This paper focuses on one trona mine's experience in the development and implementation of a field-level risk assessment program to help its organization understand and manage risk to an acceptable level. Through a transformational process of ongoing leadership development, support and communication, Solvay Green River fostered a culture grounded in risk assessment, safety interactions and hazard correction. The application of consistent risk assessment tools was critical to create a participatory workforce that not only talks about safety but actively identifies factors that contribute to hazards and potential incidents. In this paper, reflecting on the mine's previous process of risk-assessment implementation provides examples of likely barriers that sites may encounter when trying to document and manage risks, as well as a variety of mini case examples that showcase how the organization worked through these barriers to facilitate the identification of leading indicators to ultimately reduce incidents.

[Vismodegib for basal cell carcinoma: targeted therapy in case of locally advanced or metastasised disease]. / Vismodegib voor gevorderd basaalcelcarcinoom.

The development of the hedgehog pathway inhibitor vismodegib provides a new treatment option for metastasised and locally advanced basal cell carcinoma in which surgical excision or radiotherapy is contraindicated. Only a fraction of patients with basal cell carcinoma are eligible for this therapy, but it is effective in the majority of those who do receive vismodegib. However, development of tumour resistance is quite common and adverse events frequently lead to discontinuation of therapy. Intermittent treatment or combination therapy could reduce the occurrence of tumour resistance and diminish toxicity. We present three patients who were successfully treated with vismodegib: a 73-year-old man with locally advanced basal cell carcinoma, an 82-year-old man with basal cell carcinoma that had metastasised to the lungs, and a 42-year-old man with Gorlin syndrome.

Síndrome de Stewart-Treves / Stewart-Treves Syndrome

El síndrome de Stewart-Treves es un angiosarcoma cutáneo, poco frecuente, que se produce en pacientes con linfedema crónico. Se describe clásicamente luego de realizar mastectomía radical con vaciamiento ganglionar y/o radioterapia. Su mortalidad es elevada. Comunicamos el caso de una paciente de 76 años de edad, sometida a mastectomía radical con vaciamiento ganglionar axilar, seguido de quimioterapia y radioterapia. Consulta 13 años después por dolor intenso y lesión tumoral exofitica, ulcerada, angiomatosa, sangrante y maloliente en cara anterior del brazo izquierdo. Presentaba edema del miembro de varios años de evolución. Luego de realizar biopsia por punch de la lesión, los resultados histopatológicos resultaron compatibles con linfangiosarcoma. La familia junto con el servicio de Cirugía decide realizar la extirpación del tumor, con conservación del miembro. Falleció luego de once meses de realizado el diagnóstico de síndrome de Stewart-Treves, en nuestro Servicio.

The Stewart-Treves Syndrome is a rare cutaneous angiosarcoma, that occurs in patients with chronic lymphedema. It is classically described after performing radical mastectomy with lymph node dissection and/or radiation therapy. Its mortality is high. We have reported the case of a 76 years old patient, who underwent radical mastectomy with axillary lymph node dissection, followed by chemotherapy and radiotherapy. She came 13 years later with an intense pain and exophytic, ulcerated, angiomatous, bleeding and smelly tumor injury in front side of the left arm. She had an edema of the left upper limb with several years of evolution. After performing punch biopsy of the lesion the histopathological results were compatible with lymphangiosarcoma. The family, jointly with the surgery service decided to remove the tumor with limb preservation. She died 11 months after the diagnosis of Stewart-Treves syndrome, performed in our department.