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World J Surg Oncol ; 20(1): 177, 2022 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-35659690


BACKGROUND: Poorly differentiated diffuse-type gastric adenocarcinoma often presents at an advanced stage. While gastric cancer typically metastasizes to the liver, lung and bone, metastasis to the uterine cervix is extremely rare. To our knowledge, less than forty cases have been described in the medical literature. CASE PRESENTATION: We report a case of a 47-year-old woman who presented to us with symptomatic uterine leiomyomas and subsequently underwent a successful total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. The diagnosis of metastatic cancer involving the cervix was established incidentally on histopathology, which demonstrated atypical signet ring cells in the lymphovascular spaces of the cervix. Further investigations for a primary malignancy revealed a poorly differentiated diffuse-type gastric adenocarcinoma. CONCLUSION: Gastric cancer involving the uterine cervix is rare and associated with a poor prognosis. When presented with isolated cervical metastases, the gastrointestinal tract should be considered as a possible primary source. Due to the limited publications on this clinical entity, we expect to raise awareness and study this unique manifestation of gastric cancer by presenting our case.

Adenocarcinoma , Neoplasias Gástricas , Neoplasias del Cuello Uterino , Adenocarcinoma/patología , Cuello del Útero/patología , Femenino , Humanos , Histerectomía , Persona de Mediana Edad , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/cirugía
Cureus ; 13(10): e18919, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34812303


Intrinsic ureteral endometriosis is a very rare presentation of deep infiltrating endometriosis. It can lead to urinary tract obstruction and loss of renal function. Clinical suspicion and radiologic assessment can aid in preoperative diagnosis and help plan surgical treatment. Herein we report a case of a 29-year-old female who presented with left-sided pelvic and flank pain. Imaging revealed left obstructive uropathy and a left ureteral mass. She underwent laparotomy and resection of the diseased ureter with primary re-anastomosis. Histology confirmed intrinsic ureteral endometriosis. There was subsequently complete resolution on follow-up imaging, with no permanent loss of renal function.

Int J Surg Case Rep ; 87: 106408, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34534815


INTRODUCTION: Lobular breast cancer (LBC) has an increased risk of gastrointestinal (GI) spread compared with ductal breast carcinoma. Breast cancer commonly metastasises to bone, lung, liver, central nervous system and rarely to the gastrointestinal tract. As the prognosis for breast cancer continues to improve with modern medical practice it is important to be aware of the various clinical presentations and the appropriate management of breast cancer metastases. CASE PRESENTATION: We describe a case of a 60-year-old woman who presented with symptoms of bowel obstruction 30 months after undergoing mastectomy and adjuvant chemotherapy for LBC. A Computer Tomography (CT) scan showed terminal ileal thickening suggestive of Crohn's disease but histopathology revealed metastatic lobular carcinoma. Surgical resection to relieve her small bowel obstruction confirmed LBC. CLINICAL DISCUSSION: This case illustrates an unusual presentation of metastatic breast cancer causing small bowel obstruction with radiological features mimicking Crohn's disease. CONCLUSION: Patients with breast cancer can present with intestinal obstruction due to metastatic spread to the small intestine; this may resemble Crohn's disease clinically and radiologically.

Cureus ; 12(5): e8369, 2020 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-32617240


Classic descriptions of the visceral surface of the human liver only define three fissures: transverse, sagittal and umbilical fissures. Any additional fissures that are present on the visceral surface of the liver are considered variant inferior hepatic fissures (IHFs). This study was carried out to document the prevalence of IHFs in the Eastern Caribbean. Knowledge of these variants is important to clinicians who treat liver disorders in persons of the Caribbean diaspora. In this study, two independent researchers observed all consecutive autopsies performed at the facility over a period of 10 weeks. They examined the visceral surface of the unfixed liver in situ. Any specimen with variant IHFs was selected for detailed study. We documented the relation of the variant IHFs to nearby viscera and then explanted the livers using a standardized technique. The following details were recorded for each liver: number, location, depth, length, and width of IHFs. All measurements were checked independently by two researchers and the average measurement was used as the final dimension. Each liver was then sectioned in 1 cm sagittal slices to document the relationship of intraparenchymal structures. We observed 60 consecutive autopsies in unselected cadavers. Variant IHFs were present in 21 (35%) cadavers at a mean age of 68.25 years (range: 61 - 83; median 64.5; standard deviation (SD) ± 8.45). The variants included a deep fissure in the coronal plane between segments V and VI in 19 (31.7%) cadavers (related to the right branch of the portal vein in 63.2% of cases), a well-defined segment VI fissure running in a sagittal plane in four (6.7%) cadavers, a well-defined fissure incompletely separating the caudate process from the caudate lobe proper in five (8.3%) cadavers, a consistent fissure that arose from the left side of the transverse fissure and coursed between segments II and III in three (5%) cadavers, and a deep coronal fissure dividing the quadrate to form an accessory quadrate lobe in one (1.7%) cadaver. Almost one in three unselected persons in this population have anatomically variant fissures on the visceral surface of the liver. The variants include Rouvière's sulci (31.7%), caudate notches (8.3%), segment VI fissures (6.7%), left medial segment fissures (5%), and quadrate fissures (1.7%). The clinical relevance of these variants is discussed. Any clinician treating liver diseases in persons of Caribbean extract should be aware of their presence.

J Clin Pathol ; 71(3): 201-206, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29212656


AIM: To review the current understanding of signet-ring type oesophageal adenocarcinoma including evidence for prognosis. METHODS: We conducted a literature search of nine healthcare literature databases for articles detailing the biology and clinical outcomes of signet-ring cell adenocarcinoma of the oesophagus. The impact of signet-ring cell morphology was analysed and detailed in written text and tabular format. Current understanding of the biology of signet-ring cell adenocarcinoma of the oesophagus was summarised. RESULTS: Signet-ring cell carcinoma was represented in 7.61% of the 18 989 cases of oesophageal carcinoma reviewed in multiple studies. The presence of signet-ring cells conferred a worse prognosis and these tumours responded differently to conventional treatments as compared with typical adenocarcinoma. Little is known about the biological features of signet-ring cell adenocarcinoma of the oesophagus. Work in gastric lesions has identified potential targets for future treatments such as CDH1 and RHOA genes. Categorisation of signet-ring cell carcinomas by the proportion of signet-ring cells within tumours differs among clinicians despite WHO criteria for classification. The current UK guidelines for histopathological reporting of oesophageal tumours do not emphasise the importance of identifying signet-ring cells. CONCLUSION: The presence of signet-ring cells in oesophageal adenocarcinomas leads to poorer clinical outcomes. Current understanding of signet-ring cell biology in oesophageal cancer is limited.

Adenocarcinoma/diagnóstico , Carcinoma de Células en Anillo de Sello/diagnóstico , Neoplasias Esofágicas/diagnóstico , Adenocarcinoma/patología , Carcinoma de Células en Anillo de Sello/patología , Neoplasias Esofágicas/patología , Esófago/patología , Humanos , Pronóstico
J Clin Pathol ; 64(11): 1025-8, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22021565


The authors audited the value of toxicology/histology and reporting standards in sudden death autopsy cases in individuals with epilepsy/seizures. Of 83 cases with epilepsy/seizures and no macroscopically obvious cause of death, 40 had no history of drug/alcohol abuse. Toxicological analysis was performed in 11/40 (28%) and did not contribute to the cause of death in any. Conversely, in individuals with epilepsy with known drug/alcohol abuse and cases with a history of seizures related to drug/alcohol abuse, toxicological analysis was performed in 17/22 (77%) and 14/21 (67%), contributing to the causes of death in 8/17 (47%) and 10/14 (71%), respectively. Details of seizures were poorly reported, possibly due to a lack of information from the coroner's office, while autopsy findings were recorded diligently. The authors provide an evidence base for the RCPath guidelines and suggest that taking toxicology samples is essential only when there is a history of drug/alcohol abuse or suspicion of overdose.

Autopsia/métodos , Muerte Súbita/patología , Epilepsia/patología , Toxicología/métodos , Muerte Súbita/etiología , Adhesión a Directriz , Humanos , Auditoría Médica , Guías de Práctica Clínica como Asunto , Práctica Profesional/normas