Coristoma pancreático en la vesícula biliar: Reporte de dos casos / Pancreatic choristoma in the gallbladder: Report of two cases

Pancreatic choristoma is the ocurrence of normal pancreatic tissue in an abnormal location without any anatomic continuity with the main body of the gland. Although heterotopia is uncommon in the gallbladder and biliary tract, anecdotic cases of gastric mucosa, liver, adrenal gland and pancreas among other tissues have been described. We report an eight year-old male and a 22 year-old female, electively operated for symptomatic cholelithiasis. On pathology, a nodule identified as a pancreatic endocrine and exocrine choristoma, was found in the gallbladder wall of both patients. We employed immunohistochemistry to characterize this choristoma. Tubular and epithelial structures were immunoreactive to cytokeratins 7, 8, 18, 19 and 20 and to CA19-9. Exocrine activity was documented by immunoreactivity to al-antitrypsin and al-chemotrypsin. Other immunohistochemical markers such as insulin and somatostatin were positive identifying endocrine activity.

[Pancreatic choristoma in the gallbladder: report of two cases]. / Coristoma pancreático en la vesícula biliar: reporte de dos casos.

Pancreatic choristoma is the occurrence of normal pancreatic tissue in an abnormal location without any anatomic continuity with the main body of the gland. Although heterotopia is uncommon in the gallbladder and biliary tract, anecdotic cases of gastric mucosa, liver, adrenal gland and pancreas among other tissues have been described. We report an eight year-old male and a 22 year-old female, electively operated for symptomatic cholelithiasis. On pathology, a nodule identified as a pancreatic endocrine and exocrine choristoma, was found in the gallbladder wall of both patients. We employed immunohistochemistry to characterize this choristoma. Tubular and epithelial structures were immunoreactive to cytokeratins 7, 8, 18, 19 and 20 and to CA19-9. Exocrine activity was documented by immunoreactivity to al-antitrypsin and al-chemotrypsin. Other immunohistochemical markers such as insulin and somatostatin were positive identifying endocrine activity.

Human papillomavirus in esophageal squamous cell carcinoma in Colombia and Chile.

AIM: To examine the presence of human papillomavirus (HPV) in esophageal squamous cell carcinoma (ESCC) specimens collected from Colombia and Chile located in the northern and southern ends of the continent, respectively. METHODS: We examined 47 and 26 formalin-fixed and paraffin-embedded ESCC specimens from Colombia and Chile, respectively. HPV was detected using GP5+/GP6+ primer pair for PCR, and confirmed by Southern blot analysis. Sequencing analysis of L1 region fragment was used to identify HPV genotype. In addition, P16(INK4A) protein immunostaining of all the specimens was conducted. RESULTS: HPV was detected in 21 ESCC specimens (29%). Sequencing analysis of L1 region fragment identified HPV-16 genome in 6 Colombian cases (13%) and in 5 Chilean cases (19%). HPV-18 was detected in 10 cases (21%) in Colombia but not in any Chilean case. Since Chilean ESCC cases had a higher prevalence of HPV-16 (without statistical significance), but a significantly lower prevalence of HPV-18 than in Colombian cases (P = 0.011) even though the two countries have similar ESCC incidence rates, the frequency of HPV-related ESCC may not be strongly affected by risk factors affecting the incidence of ESCC. HPV-16 genome was more frequently detected in p16 positive carcinomas, although the difference was not statistically significant. HPV-18 detection rate did not show any association with p16 expression. Well-differentiated tumors tended to have either HPV-16 or HPV-18 but the association was not statistically significant. HPV genotypes other than HPV-16 or 18 were not detected in either country. CONCLUSION: HPV-16 and HPV-18 genotypes can be found in ESCC specimens collected from two South American countries. Further studies on the relationship between HPV-16 presence and p16 expression in ESCC would aid understanding of the mechanism underlying the presence of HPV in ESCC.

Interposición de asa tipo Henley-Longmire en gastrectomía total: experiencia en Hospital San Camilo de San Felipe / Henley-Longmire loop in total gastrectomy: experience in Hospital San Camilo of San Felipe

Presentamos nuestra experiencia en cirugía radical de cáncer gástrico en que realizamos la técnica quirúrgica de interposición de asa tipo Henley-Longmire para la reconstitución intestinal. Se revisaron las fichas de 102 pacientes que en nuestro hospital fueron sometidos a esta cirugía entre enero de 1975 y junio del año 2003. La edad promedio de los enfermos fue de 65 años y el 73 por ciento fueron hombres. El 86,3 por ciento tenía un cáncer avanzado y un 13,7 por ciento incipiente. 12,7 por ciento de los enfermos presentaron alguna complicación y un 4,9 por ciento falleció. La sobrevida fue de 80 por ciento, 35 por ciento y 25 por ciento al año, 5 y 10 años respectivamente. Consideramos que la interposición de asa tipo Henley-Longmire es una buena alternativa en la reconstrucción del tránsito intestinal, después de una gastrectomía total, que no tiene mayor incidencia de complicaciones ni mortalidad que otras técnicas habitualmente utilizadas y que los pacientes logran una buena calidad de vida.

Síndrome de embolia múltiple por colesterol / Multiple emboli syndrome by cholesterol

Se presenta el caso de un amujer de 56 años, hipertensa grave incontrolable, a quien se practica arteriografía selectiva renal por Seldinger femoral derecha, para pesquisar probable origen renovascular de su hipertensión. El procedimiento invasivo se realizó con cierta dificultad al paso del catéter a nivel de arteria ilíaca; en forma precoz, la enferma presenta isquemia severa y progresiva de la pelvis y extremidades inferiores, agregándose luego, dolor abdominal. La paciente es intervenida a las 24 h. de iniciada la complicación, comprobándose necrosis parcelar de intestino delgado y grueso, por lo que se efctúa resección de los segmentos comprometidos más embolectomía de ambos miembros inferiores. Evoluciona en muy malas condiciones, falleciendo 60 h. después de realizado el estudio invasivo. La necropsia demostró embolización masiva de colesterol en riñones, intestino delgado, colon, glándulas suprarrenales y extremidades inferiores, originada por desprendimiento de cristales de colesterol desde la aorta abdominal. La embolia por colesterol se caracteriza por livedo reticularis e insuficiencia renal progresiva debido a embolización arteriolar de colesterol, cuyas imágenes aciculares en la histológica son patognomónicas. Este cuadro clínico masivo, de evolucíon aguda y fatal, no ha sido descrito en nuestro medio y existen pocas publicaciones similares en la literatura extranjera