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This paper describes the clinical case of a patient diagnosed with diffuse large B-cell lymphoma with splenic involvement, focusing on the role of abdominal ultrasound (US) in this context. The patient experienced dyspepsia and progressive asthenia over several months so an abdominal US was performed. The US showed multiple heterogeneous and hypoechogenic focal splenic lesions together with a moderate left pleural effusion. Lymphoma was suspected due to these findings and the diagnosis was then confirmed with the performance of a CT scan and a biopsy that revealed the presence of a diffuse large B-cell lymphoma with metastatic disease. Chemotherapy containing rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone was administered and the patient is currently on clinical remission. This study highlights the role of abdominal ultrasound as a useful technique in the non-invasive assessment of this entity, considering an appropriate clinical context and mainly after detecting multiple hypoechogenic splenic lesions in the US.
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The recertification of the specialist doctor is the individualized recognition of the level reached by the doctor in terms of knowledge, experience in healthcare, teaching and research tasks.
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Certificación , Médicos , Humanos , Competencia ClínicaRESUMEN
La recertificación del médico especialista es el reconocimiento de forma individualizada del nivel alcanzado por el médico en cuanto a conocimientos, experiencia en las tareas asistenciales, docentes y de investigación (AU)
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Humanos , Especialización , CertificaciónRESUMEN
Amyloidosis is a disease caused by extracellular deposition of abnormally folded proteins. While gastrointestinal involvement is relatively frequent in its systemic form, isolated gastrointestinal disease is rare. We present the case of a 62-year-old man assessed for iron deficiency anemia and abdominal pain after starting antiplatelet therapy with acetylsalicylic acid and ticagrelor for ischemic heart disease. An esophagogastroduodenoscopy was performed as part of the study, showing thickened folds with pseudopolypoid morphology and nodular mucosa with a preserved crypt pattern in the duodenal bulb and second duodenal portion.
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Amiloidosis , Anemia Ferropénica , Enfermedades Gastrointestinales , Masculino , Humanos , Persona de Mediana Edad , Duodeno , Amiloidosis/complicaciones , Enfermedades Gastrointestinales/complicaciones , Mucosa Intestinal , Anemia Ferropénica/etiologíaRESUMEN
We present the case of a 37-years old male, who consulted for an extended history of intermittent nausea and vomiting. Laboratory tests showed moderate elevated bilirubin (1.30 mg/dL) and GGT (106 U/L). An abdominal CT scan performed showed a solid 18-centimetres (cm) mass located in the right liver lobe. A biopsy of the lesion was performed, revealing metastastic cells of a well-differentiated neuroendocrine tumour (NET, G3 (Ki-67: 25%). Further study was performed with MRI, and SPECT-CT, showing a 2-cm lesion in the pancreatic tail suggestive of being the primary NET. Chromogranin A levels were high (114.100 ng/ml). In our case, despite the large size of the liver metastasis a full resection of the tumours was achieved.
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Neoplasias Hepáticas , Tumores Neuroendocrinos , Neoplasias Pancreáticas , Adulto , Humanos , Neoplasias Hepáticas/cirugía , Masculino , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/patología , Páncreas/patología , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patologíaRESUMEN
An 86-year-old female presented with anemia and dyspepsia. She underwent esophagogastroduodenoscopy, which revealed a giant pedunculated polyp located in the gastric corpus, protruding into the duodenal bulb, causing gastric outlet obstruction (GOO). Thus, an endoscopic resection was scheduled.
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Obstrucción de la Salida Gástrica , Linfoma de Células B de la Zona Marginal , Anciano de 80 o más Años , Duodeno/patología , Femenino , Obstrucción de la Salida Gástrica/diagnóstico por imagen , Obstrucción de la Salida Gástrica/etiología , Obstrucción de la Salida Gástrica/cirugía , Humanos , Tejido Linfoide/patología , Linfoma de Células B de la Zona Marginal/complicaciones , Linfoma de Células B de la Zona Marginal/diagnóstico por imagen , Linfoma de Células B de la Zona Marginal/cirugía , Membrana Mucosa/patologíaRESUMEN
BACKGROUND: Cystic pancreatic lesions consist of a wide variety of lesions that are becoming increasingly diagnosed with the growing use of imaging techniques. Of these, mucinous cysts are especially relevant due to their risk of malignancy. However, morphological findings are often suboptimal for their differentiation. Endoscopic ultrasound fine-needle aspiration (EUS-FNA) with molecular analysis has been suggested to improve the diagnosis of pancreatic cysts. AIM: To determine the impact of molecular analysis on the detection of mucinous cysts and malignancy. METHODS: An 18-month prospective observational study of consecutive patients with pancreatic cystic lesions and an indication for EUS-FNA following European clinical practice guidelines was conducted. These cysts included those > 15 mm with unclear diagnosis, and a change in follow-up or with concerning features in which results might change clinical management. EUS-FNA with cytological, biochemical and glucose and molecular analyses with next-generation sequencing were performed in 36 pancreatic cysts. The cysts were classified as mucinous and non-mucinous by the combination of morphological, cytological and biochemical analyses when surgery was not performed. Malignancy was defined as cytology positive for malignancy, high-grade dysplasia or invasive carcinoma on surgical specimen, clinical or morphological progression, metastasis or death related to neoplastic complications during the 6-mo follow-up period. Next-generation sequencing results were compared for cyst type and malignancy. RESULTS: Of the 36 lesions included, 28 (82.4%) were classified as mucinous and 6 (17.6%) as non-mucinous. Furthermore, 5 (13.9%) lesions were classified as malignant. The amount of deoxyribonucleic acid obtained was sufficient for molecular analysis in 25 (69.4%) pancreatic cysts. The amount of intracystic deoxyribonucleic acid was not statistically related to the cyst fluid volume obtained from the lesions. Analysis of KRAS and/or GNAS showed 83.33% [95% confidence interval (CI): 63.34-100] sensitivity, 60% (95%CI: 7.06-100) specificity, 88.24% (95%CI: 69.98-100) positive predictive value and 50% (95%CI: 1.66-98.34) negative predictive value (P = 0.086) for the diagnosis of mucinous cystic lesions. Mutations in KRAS and GNAS were found in 2/5 (40%) of the lesions classified as non-mucinous, thus recategorizing those lesions as mucinous neoplasms, which would have led to a modification of the follow-up plan in 8% of the cysts in which molecular analysis was successfully performed. All 4 (100%) malignant cysts in which molecular analysis could be performed had mutations in KRAS and/or GNAS, although they were not related to malignancy (P > 0.05). None of the other mutations analyzed could detect mucinous or malignant cysts with statistical significance (P > 0.05). CONCLUSION: Molecular analysis can improve the classification of pancreatic cysts as mucinous or non-mucinous. Mutations were not able to detect malignant lesions.
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INTRODUCTION: the aim of our study was to develop a peroral endoscopic myotomy (POEM) program in our Unit following a two-step sequence: training on animal models and supervision by an experienced endoscopist during the first human cases. METHODS: a single endoscopist experienced in advanced endoscopy was trained in POEM. After observing POEM in referral centers, training was implemented on swine models (preclinical phase). Technical aspects and adverse events were prospectively recorded. A first subset of cases (group A) was compared to a second one (group B) to assess our progression. Finally, POEM was implemented in humans under the supervision of an experienced endoscopist (clinical phase). The outcomes and adverse events were prospectively recorded. RESULTS: during the preclinical phase, 15 POEM procedures were performed on live pigs. Severe adverse events (AE) were less frequent in group B than in group A (12 % vs 57 %, p = 0.07). After nine cases, a plateau of adverse events was reached. During the clinical phase, eleven POEM procedures were performed in patients under expert supervision. Technical and clinical (Eckardt score ≤ 3) success were 100 % and 91 %, respectively (follow-up 3-21 months). In two cases, intervention of an experienced endoscopist was required (cases 2 and 3) because of a difficult orientation at the esophagogastric junction. One mild pneumoperitoneum occurred, with no severe adverse events reported. CONCLUSIONS: training in animal models and supervision by an experienced endoscopist during the first cases could provide the necessary skills to perform POEM safely and effectively.
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Acalasia del Esófago , Miotomía , Cirugía Endoscópica por Orificios Naturales , Animales , Acalasia del Esófago/cirugía , Humanos , Estudios Retrospectivos , Porcinos , Resultado del TratamientoRESUMEN
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Humanos , Femenino , Anciano , Linfoma no Hodgkin/complicaciones , Linfoma no Hodgkin/diagnóstico por imagen , Linfoma Folicular/diagnóstico , Colonoscopía/métodos , Biopsia , Linfoma Folicular/tratamiento farmacológico , Rituximab/uso terapéutico , Pólipos/patologíaRESUMEN
We report the case of a 76-year-old female who underwent a colonoscopy for post-polypectomy follow-up. A nodular area was found in the proximal rectum that was suggestive of hyperplastic polyps by location and endoscopic appearance. Biopsies were taken due to its slightly atypical characteristics, with a final histological result of lymphoid aggregates.
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Pólipos del Colon , Linfoma no Hodgkin , Anciano , Colon/patología , Pólipos del Colon/patología , Colonoscopía , Femenino , Humanos , Mucosa Intestinal/patología , Linfoma no Hodgkin/diagnóstico por imagen , Recto/patologíaRESUMEN
BACKGROUND AND AIMS: several studies have shown that rectal indomethacin decreases the risk of acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, in recent studies, its effectiveness is being questioned, especially in average risk patients. Our principal aim was to evaluate the efficacy of rectal indomethacin prophylaxis in the development of post-ERCP pancreatitis (PEP). METHODS: a retrospective cohort study was conducted at a third-level university hospital. Data was collected from every patients who underwent ERCP between January 2014 and June 2016. After February 2015, all patients received 100 mg of rectal indomethacin prior to ERCP. We analyzed groups, with indomethacin and without indomethacin, in unselected patients. RESULTS: a total of 524 patients were analyzed, with a mean age of 71.1 ± 17.0 (standard deviation [SD]) years. Of the total number of patients, 393 (75%) had an average risk; 277 received rectal indomethacin prior to ERCP, while 247 did not. In the group with indomethacin, 12 patients developed PEP (4.33%) versus ten in the indomethacin-free group (4.04%) (OR 1.33; 95% confidence interval [CI], 0.52-3.40; p = 0.56). Severe-moderate PEP developed in seven patients (2.52%) in the indomethacin group and in two patients (0.81%) in the indomethacin-free group (p = 0.24). Previous sphincterotomy was a protective factor (OR 0.02; 95% CI, 0.02-0.2; p = 0.001) and age < 45 years was a risk factor: (OR 3.43; 95% CI, 1.14-10.32; p = 0.03). CONCLUSIONS: rectal indomethacin does not appear to decrease the risk of developing PEP in unselected patients
No disponible
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Antiinflamatorios no Esteroideos/administración & dosificación , Indometacina/administración & dosificación , Pancreatitis/prevención & control , Estudios Retrospectivos , Administración Rectal , Estudios de Cohortes , Factores de RiesgoRESUMEN
BACKGROUND AND AIMS: several studies have shown that rectal indomethacin decreases the risk of acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, in recent studies, its effectiveness is being questioned, especially in average risk patients. Our principal aim was to evaluate the efficacy of rectal indomethacin prophylaxis in the development of post-ERCP pancreatitis (PEP). METHODS: a retrospective cohort study was conducted at a third-level university hospital. Data was collected from every patients who underwent ERCP between January 2014 and June 2016. After February 2015, all patients received 100 mg of rectal indomethacin prior to ERCP. We analyzed groups, with indomethacin and without indomethacin, in unselected patients. RESULTS: a total of 524 patients were analyzed, with a mean age of 71.1 ± 17.0 (standard deviation [SD]) years. Of the total number of patients, 393 (75%) had an average risk; 277 received rectal indomethacin prior to ERCP, while 247 did not. In the group with indomethacin, 12 patients developed PEP (4.33%) versus ten in the indomethacin-free group (4.04%) (OR 1.33; 95% confidence interval [CI], 0.52-3.40; p = 0.56). Severe-moderate PEP developed in seven patients (2.52%) in the indomethacin group and in two patients (0.81%) in the indomethacin-free group (p = 0.24). Previous sphincterotomy was a protective factor (OR 0.02; 95% CI, 0.02-0.2; p = 0.001) and age < 45 years was a risk factor: (OR 3.43; 95% CI, 1.14-10.32; p = 0.03). CONCLUSIONS: rectal indomethacin does not appear to decrease the risk of developing PEP in unselected patients.
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Colangiopancreatografia Retrógrada Endoscópica , Pancreatitis , Enfermedad Aguda , Administración Rectal , Anciano , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Humanos , Indometacina , Persona de Mediana Edad , Pancreatitis/etiología , Pancreatitis/prevención & control , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Cap-poliposis es un síndrome benigno poco frecuente caracterizado por la aparición de pólipos cólicos de aspecto inflamatorio cubiertos por un exudado fibrinopurulento. La diarrea mucosa y sangrado rectal son síntomas frecuentes. En ocasiones resulta difícil su diagnóstico y es necesario realizar el diagnóstico diferencial con otras entidades. Su patogenia es desconocida y su evolución variable. El tratamiento no está claramente establecido
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Humanos , Masculino , Adulto , Poliposis Intestinal/diagnóstico por imagen , Poliposis Intestinal/patología , Poliposis Intestinal/cirugía , Endoscopía Gastrointestinal , ColonoscopíaRESUMEN
Cap-polyposis is a rare benign condition characterized by inflammatory colorectal polyps covered by a "cap" of fibrinopurulent exudate. Mucous diarrhea and rectal bleeding are frequent symtoms. It can be difficult to diagnose and it is necessary to make a differential diagnosis from other entities. Its pathogenesis is unknown and it has a variable clinical course. The optimal treatment has not been established.
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Pólipos del Colon , Resección Endoscópica de la Mucosa , Poliposis Intestinal , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Humanos , Pólipos Intestinales , RectoRESUMEN
No disponible
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Humanos , Masculino , Persona de Mediana Edad , Hemorragia Gastrointestinal/etiología , Pancreatitis Crónica/complicaciones , Embolización Terapéutica/métodos , Hemorragia Gastrointestinal/diagnóstico por imagenRESUMEN
The term 'hemosuccus pancreaticus' was first coined in 1970 by Sandblom (1). It refers to bleeding that occurs through the pancreatic duct and is a rare cause of gastrointestinal hemorrhage.
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Hemorragia Gastrointestinal/etiología , Hemorragia/complicaciones , Enfermedades Pancreáticas/complicaciones , Conductos Pancreáticos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
No disponible