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INTRODUCTION: Tumor collision is the cohesion in a time of 2 tumors in the same space or organ but of different cell lineage. PRESENTATION OF CASE: 72-year-old patient with a history of black stools, involuntary weight loss and moderate protein-calorie malnutrition, asthenia, and adynamia; with endoscopic studies with the finding of esophageal candidiasis that leads to taking a rapid test for HIV (human immunodeficiency virus) which is positive; CT (computerized axial tomography) of the abdomen is performed, showing thickening of the cecum and distal ileum, as well as striation of fat in the same area, findings related to a primary neoformative process, for which it is decided to carry out a right hemicolectomy laparoscopically with pathology that reports ulcerated moderately differentiated adenocarcinoma that invades up to the muscle layer, associated with lymphoid proliferation with immunohistochemical findings consistent with lymphoplasmablastic lymphoma, this is probably linked to his diagnosis of HIV, configuring the diagnosis of tumor collision; extension studies with no findings of metastatic neoplastic disease. DISCUSSION: Tumor collision is a rare entity, which implies failure in the genomic control and replication sites of different cell lines, which, due to their lineage, have different regulatory processes, all this occurring at the same time in the same tissue. CONCLUSION: The casuistry for collision tumors is scarce; even in the reference centers for oncology, the treatment is challenging given the multiple variables to consider, the particularity of each case, and the scarce evidence on the subject.
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OBJETIVO: describir la experiencia inicial en Colombia en el manejo del melanoma de extremidad con perfusión aislada y comparar la respuesta de los subtipos histológicos más frecuentes en Colombia con la literatura. MATERIALES Y MÉTODOS: estudio descriptivo, retrospectivo de una serie de pacientes con diagnóstico de melanoma con metástasis en tránsito tratados con perfusión aislada de extremidad, seleccionados entre 2007 y 2016. Las variables cualitativas se analizaron con frecuencias absolutas y relativas. Las cuantitativas con medidas de tendencia central y dispersión. RESULTADOS: 11 pacientes fueron tratados con perfusión aislada de extremidad. Hubo respuesta parcial en siete pacientes (63,6%), enfermedad estable en dos pacientes (18,2%) y progresión en dos pacientes (18,2%). Después del tratamiento, cinco pacientes (45,5%) presentaron complicaciones menores. CONCLUSIONES: la perfusión aislada sigue siendo importante para el tratamiento del melanoma localmente avanzado con el fin de mejorar la calidad de vida de los pacientes. La respuesta puede cambiar según el tipo clínico de melanoma, siendo menor, según este estudio, en pacientes con melanoma lentiginoso acral y nodular, aunque por el bajo poder, esto no se puede concluir. OBJECTIVE: to describe the initial experience in Colombia of locally advanced melanoma treated by isolated limb perfusion and compare the response rate of our melanoma subtypes with the literature. METHODS: descriptive, retrospective study of a series of patients selected between 2007 and 2016. Qualitative variables were analyzed with proportions and frequencies, and quantitative variable with central tendency measures and measures of dispersion. RESULTS: 11 patients were treated by isolated limb perfusion. After the treatment, seven patients (63.6%) had partial response, two patients (18.2%) had stable disease and two patients (18.2%) had disease progression. Five patients (45.5%) had mild complications. CONCLUSIONS: Isolated limb perfusion is still an important treatment strategy for locally advanced melanoma, with the goal of improving the patient quality of life. The response can change according to the type of melanoma, and could be smaller in patients with acral lentiginous and nodular melanoma, although we cannot make this conclusion with this type of study because it has low power and lack of a comparison group.
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Melanoma , Calidad de Vida , Humanos , Melanoma/tratamiento farmacológico , Estudios RetrospectivosRESUMEN
Abstract Introduction: Actinomycosis is a rare infectious disease that affects abdominal organs and simulates oncological disease, hardly ever presents itself as a cause of intestinal obstruction. Symptoms: A 43 years old, male patient with two months of left abdominal pain associated to a growth and an 8 kg weight loss, no fever or bowel habit disruption. Interventions: A colonoscopy and an abdominal scanography. Results: A solid heterogeneous 7 × 3.8 cm mass localized in the splenic flexure of the colon with infiltration of its walls and its surrounding fat. Colon cancer was considered as the first diagnostic possibility. During hospitalization, the patient was taken to an emergency exploratory laparotomy, due to an acute abdominal pain with bowel obstruction symptoms. Histopathological diagnosis: Actinomycetoma. Conjoint continuous monitoring with the infectious disease attending, abdominal US and observation did not show new growths. Weight gain and progressive return to daily life was obtained within 8 weeks. Conclusion: In low income countries, intestinal actinomycosis should be considered in the differential diagnosis of abdominal masses and chronic inflammatory processes, patient prognosis with proper management is excellent.
Resumo Introdução: A actinomicose é uma doença infecciosa rara que acomete órgãos abdominais, simula doença oncológica e dificilmente causa de obstrução intestinal. Sintomas: Paciente do sexo masculino, 43 anos, com quadro de dor abdominal esquerda por dois meses, associado ao surgimento de massa e perda de peso de 8 kg, sem febre ou alterações dos hábitos intestinais. Intervenções: Colonoscopia e uma tomografia computadorizada abdominal. Resultados: Observou-se massa sólida heterogênea de 7 × 3,8 cm localizada na flexão esplênica do cólon, com infiltração de suas paredes e gordura adjacente. Câncer de cólon foi a primeira possibilidade diagnóstica considerada. Durante a internação, o paciente foi submetido a uma laparotomia exploradora de emergência, devido a uma dor abdominal aguda com sintomas de obstrução intestinal. Diagnóstico histopatológico: Actinomicetoma. Monitoramento contínuo em conjunto com o tratamento da infecção, ultrassom abdominal e observação; não foram observados novos crescimentos. Ganho de peso e retorno progressivo à vida diária foram observados por oito semanas. Conclusão: Em países de baixa renda, a actinomicose intestinal deve ser considerada no diagnóstico diferencial de massas abdominais e processos inflamatórios crônicos; com manejo adequado, o prognóstico é excelente.
