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Adenoma , Resección Endoscópica de la Mucosa , Neoplasias del Íleon , Válvula Ileocecal , Humanos , Resección Endoscópica de la Mucosa/métodos , Adenoma/cirugía , Adenoma/patología , Válvula Ileocecal/cirugía , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/patología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Colonoscopía/métodosRESUMEN
Background: Malignant melanoma (MM) is one of the most prevalent and deadliest forms of skin cancer, resulting from the malignant transformation of melanocytes. It accounts for approximately 1.7% of global cancer diagnoses and is the fifth most common cancer in the US. MM can metastasize to almost any part of the body, with early detection significantly improving prognosis. Case presentation: We report the case of an 81-year-old female with a history of malignant melanoma (primary lesion on the left calf) and various comorbidities. She presented with severe anemia of unknown origin. A CT scan was performed due to her medical history, revealing a circumferential, asymmetrical parietal thickening at the level of a hypogastric ileal loop. The lesion suggested a tumoral substrate. Subsequent colonoscopy showed no metastatic lesions, but surgical intervention confirmed a malignant melanoma ileal metastasis. The patient underwent laparoscopic segmental resection with favorable post-surgery outcomes. Histopathological examination of the resected tissue confirmed the diagnosis of small intestine secondary lesions from the malignant melanoma. Conclusion: This case underscores the necessity of considering metastatic melanoma in patients with a history of MM and vague gastrointestinal symptoms. Early and accurate diagnosis through advanced imaging and endoscopic techniques can significantly improve patient outcomes.
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Neoplasias del Íleon , Melanoma , Neoplasias Cutáneas , Humanos , Melanoma/secundario , Melanoma/diagnóstico , Melanoma/cirugía , Femenino , Anciano de 80 o más Años , Neoplasias del Íleon/secundario , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/diagnóstico , Neoplasias Cutáneas/secundario , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patología , Resultado del Tratamiento , Melanoma Cutáneo Maligno , Laparoscopía/métodosAsunto(s)
Neoplasias del Íleon , Linfangioma Quístico , Humanos , Femenino , Linfangioma Quístico/diagnóstico , Linfangioma Quístico/cirugía , Linfangioma Quístico/patología , Niño , Neoplasias del Íleon/diagnóstico , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/patología , Diagnóstico Diferencial , Inmunohistoquímica , Dolor Abdominal/etiología , Ultrasonografía , Íleon/patología , Íleon/cirugía , Íleon/diagnóstico por imagenRESUMEN
BACKGROUND: Carcinoid tumors are rare neuroendocrine malignancies presenting in an increasing number in our center. The incidence of carcinoid tumors is approximatively between 2.5 and 5 cases per 100,000 people of whom about 50% develop carcinoid syndrome. Once the carcinoid syndrome has developed, a carcinoid cardiomyopathy can occur. Carcinoid heart disease (CaHD) remains a serious and rare complication associated with a significant increase in morbidity and mortality. Although carcinoid tumors have been known and studied for several years, there are still scarce data on the anesthetic management and the peri operative period. CASE PRESENTATION: We describe a case of a Caucasian 44-year-old woman with an unusual presentation of left CaHD with an ileal neuroendocrine tumor and liver metastases. Our preoperative somatostatin administration protocol, limit the cardiac damage. The maintenance of stable hemodynamics, the use of balanced anesthetic technique, all along with a good understanding of the pathology, played a major role in the successful management of anesthesia. This case report allows us to introduce our decision algorithm for the management of this type of pathology in our tertiary hospital, Cliniques Universitaires Saint-Luc. CONCLUSION: Despite the paucity of data, anesthetic management of patients with carcinoid tumor can be safely performed with effective hemodynamic monitoring and a good understanding of the pathophysiology. Knowledge and application of a clear institutional algorithm for octreotide administration and multidisciplinary consultation at a referral center are essential for the management of these patients.
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Cardiopatía Carcinoide , Neoplasias del Íleon , Tumores Neuroendocrinos , Humanos , Femenino , Adulto , Cardiopatía Carcinoide/complicaciones , Neoplasias del Íleon/complicaciones , Tumores Neuroendocrinos/complicaciones , Anestesia/métodos , Tumor Carcinoide/complicaciones , Somatostatina/análogos & derivados , Somatostatina/administración & dosificación , Somatostatina/uso terapéutico , Neoplasias Hepáticas/secundarioAsunto(s)
Neoplasias del Íleon , Tumor Rabdoide , Proteína SMARCB1 , Humanos , Masculino , Carcinoma/patología , Carcinoma/genética , Carcinoma/cirugía , Neoplasias del Íleon/patología , Neoplasias del Íleon/cirugía , Tumor Rabdoide/patología , Tumor Rabdoide/genética , Proteína SMARCB1/genética , Proteína SMARCB1/deficiencia , Persona de Mediana EdadAsunto(s)
Neoplasias del Íleon , Intususcepción , Humanos , Intususcepción/cirugía , Intususcepción/etiología , Intususcepción/diagnóstico por imagen , Neoplasias del Íleon/complicaciones , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Enfermedades del Íleon/cirugía , Enfermedades del Íleon/etiología , Enfermedades del Íleon/diagnóstico por imagen , Femenino , MasculinoRESUMEN
ABSTRACT: 64 Cu-DOTATATE PET/CT of a 44-year-old man with an ileal neuroendocrine tumor demonstrated the primary tumor, local nodal metastases, and a pericaval nodal metastasis. Localization of the pericaval node during surgery may be difficult, thus 4.4 mCi of 111 In-pentetreotide was administered before surgery to assist with localization and resection. At surgery, the pericaval nodal metastasis was readily detected by gamma probe, which could then be resected and pathologically proven to be a metastasis. This demonstrates the use of somatostatin receptor-targeted imaging for intraoperative localization of an otherwise difficult to surgically localize metastasis. Without intraoperative somatostatin receptor-targeted radiosurgery, disease may have been incompletely resected.
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Neoplasias del Íleon , Tumores Neuroendocrinos , Radiocirugia , Somatostatina , Humanos , Masculino , Adulto , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/patología , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/patología , Somatostatina/análogos & derivados , Metástasis Linfática , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/cirugía , Neoplasias Retroperitoneales/patología , Periodo Intraoperatorio , Cirugía Asistida por Computador , Tomografía Computarizada por Tomografía de Emisión de PositronesRESUMEN
A 53-year-old man with an abnormal routine physical examination was referred to our hospital. Colonoscopy showed a 5-mm submucosal tumor that was 7cm proximal to the ileocecal valve. It was identified as a neuroendocrine tumor (NET) on biopsy. Preoperatively, we conducted a double balloon endoscopy to examine the entire small intestine. Another 7-mm submucosal tumor was found on the ileocecal valve, which was missed during the first colonoscopy. A final diagnosis of multiple ileal NETs (<10mm in diameter) was made, and the patient underwent ileocecal resection with lymphadenectomy. Histopathological evaluation of the surgical specimen verified the diagnosis of NET Grade 1 with submucosal invasion. Metastasis to lymph node #202 was also detected. He remained relapse-free for 5 years and 5 months after the operation. In conclusion, this was a case of multiple ileal NETs (<10mm in diameter) with lymph node metastasis that could not be detected preoperatively on contrast-enhanced computed tomography. This case highlights the significance of detailed endoscopic observation of the terminal ileum.
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Neoplasias del Íleon , Metástasis Linfática , Tumores Neuroendocrinos , Humanos , Masculino , Persona de Mediana Edad , Neoplasias del Íleon/patología , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/cirugía , Tumores Neuroendocrinos/patología , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/diagnóstico por imagen , Colonoscopía , Escisión del Ganglio Linfático , Endoscopía GastrointestinalAsunto(s)
Adenocarcinoma , Poliposis Adenomatosa del Colon , Reservorios Cólicos , Proctocolectomía Restauradora , Humanos , Adenocarcinoma/cirugía , Adenocarcinoma/etiología , Poliposis Adenomatosa del Colon/cirugía , Reservorios Cólicos/efectos adversos , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/etiología , Proctocolectomía Restauradora/efectos adversosAsunto(s)
Neoplasias del Íleon , Tumores Neuroendocrinos , Receptores de Somatostatina , Humanos , Masculino , Neoplasias del Íleon/diagnóstico por imagen , Metástasis de la Neoplasia , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/patología , Compuestos Organometálicos/uso terapéutico , Radiofármacos , Receptores de Somatostatina/metabolismo , Receptores de Somatostatina/antagonistas & inhibidores , AncianoRESUMEN
BACKGROUND: The clinicopathological features and prognosis of primary small bowel adenocarcinoma (PSBA), excluding duodenal cancer, remain undetermined due to its rarity in Japan. METHODS: We analyzed 354 patients with 358 PSBAs, between January 2008 and December 2017, at 44 institutions affiliated with the Japanese Society for Cancer of the Colon and Rectum. RESULTS: The median age was 67 years (218 males, 61.6%). The average tumor size was 49.9 (7-100) mm. PSBA sites consisted of jejunum (66.2%) and ileum (30.4%). A total of 219 patients (61.9%) underwent diagnostic small bowel endoscopy, including single-balloon endoscopy, double-balloon endoscopy, and capsule endoscopy before treatment. Nineteen patients (5.4%) had Lynch syndrome, and 272 patients (76.8%) had symptoms at the initial diagnosis. The rates for stages 0, I, II, III, and IV were 5.4%, 2.5%, 27.1%, 26.0%, and 35.6%, respectively. The 5-year overall survival rates at each stage were 92.3%, 60.0%, 75.9%, 61.4%, and 25.5%, respectively, and the 5-year disease-specific survival (DSS) rates were 100%, 75.0%, 84.1%, 59.3%, and 25.6%, respectively. Patients with the PSBA located in the jejunum, with symptoms at the initial diagnosis or advanced clinical stage had a worse prognosis. However, multivariate analysis using Cox-hazard model revealed that clinical stage was the only significant predictor of DSS for patients with PSBA. CONCLUSIONS: Of the patients with PSBA, 76.8% had symptoms at the initial diagnosis, which were often detected at an advanced stage. Detection during the early stages of PSBA is important to ensure a good prognosis.
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Adenocarcinoma , Endoscopía Capsular , Neoplasias Duodenales , Neoplasias del Íleon , Neoplasias Intestinales , Neoplasias del Yeyuno , Anciano , Humanos , Masculino , Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/patología , Neoplasias del Íleon/diagnóstico , Neoplasias Intestinales/diagnóstico , Neoplasias Intestinales/terapia , Japón/epidemiología , Neoplasias del Yeyuno/diagnóstico , PronósticoAsunto(s)
Calcinosis , Mesenterio , Humanos , Masculino , Calcinosis/diagnóstico por imagen , Calcinosis/cirugía , Calcinosis/patología , Mesenterio/diagnóstico por imagen , Mesenterio/patología , Mesenterio/cirugía , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/patología , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias Peritoneales/patología , Neoplasias Peritoneales/cirugía , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/diagnóstico , AncianoRESUMEN
A 70s male, who had undergone single-incision laparoscopic ileocecal resection for ascending colon cancer with pathological diagnosis of T3N3M0, Stage â ¢c(without adjuvant chemotherapy), had enhanced-computed tomography(CT)for 3-month follow-up and a hepatic low-density area, an newly emergent nodule behind inferior vena cava and distal ileal tumor were found. Three months later, enhanced CT showed that the distal ileal tumor got exponentially larger and the diagnosis of"malignant lymphoma"was suspected. The patient became sepsis, so we planned and safely performed partial resection of the tumor. The pathological diagnosis was diffuse large B-cell lymphoma. Postoperative course was smooth except for the Clostridium difficile colitis and he was discharged on postoperative day 19. Although the regrowth of the remnant tumor was observed soon after surgery, partial response was confirmed after introduction of systemic chemotherapy. When we cope with malignant lymphoma of small intestine, we need to keep it in mind that surgery is an option for the prevention of perforation and bacterial translocation.
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Neoplasias del Colon , Neoplasias del Íleon , Linfoma de Células B Grandes Difuso , Masculino , Humanos , Colon Ascendente/cirugía , Recurrencia Local de Neoplasia , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/cirugía , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/cirugíaRESUMEN
ABSTRACT: A 71-year-old man with a newly discovered metastatic grade II neuroendocrine tumor of the terminal ileum was referred for a 68 Ga-DOTATATE PET/CT scan to stage the disease and assess suitability for PRRT (peptide receptor radionuclide therapy). The patient was known to have secondary nodal and bone/liver metastatic disease through prior morphological investigations. PET images revealed an atypical pattern of metastatic disease, showcasing secondary lesions in bilateral extraocular muscles, the myocardium, and both testes. The patient was pauci-symptomatic and only reported fatigue and diarrhea. Management involved lanreotide administration, and PRRT is being envisaged.
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Neoplasias del Íleon , Tumores Neuroendocrinos , Compuestos Organometálicos , Masculino , Humanos , Anciano , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/patología , Tomografía de Emisión de Positrones , Neoplasias del Íleon/diagnóstico por imagenRESUMEN
Small bowel adenocarcinoma (SBA) is a rare tumor with an unfavorable prognosis, and due to its rarity, few studies on its treatment are available. Chemotherapy remains the standard of treatment in advanced disease. Recently immunotherapy has demonstrated to be a valid therapeutic option for many solid tumors. We reviewed the data published in literature to understand the impact of immunotherapy in this cancer.
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Adenocarcinoma , Neoplasias Duodenales , Neoplasias del Íleon , Neoplasias del Yeyuno , Humanos , Intestino Delgado/patología , Neoplasias del Yeyuno/tratamiento farmacológico , Neoplasias del Yeyuno/patología , Neoplasias del Íleon/tratamiento farmacológico , Neoplasias del Íleon/patología , Neoplasias Duodenales/patología , Neoplasias Duodenales/terapia , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/patología , InmunoterapiaRESUMEN
AIM: Patients with Crohn's disease (CD) are at higher risk of small bowel adenocarcinoma (SBA). We aimed to identify radiological predictors of SBA in CD. METHODS: We conducted a retrospective case-control study at two tertiary inflammatory bowel disease centers and identified CD patients diagnosed with SBA between 2003 and 2019. Patients were matched with up to four controls. Pre-operative imaging (magnetic resonance imaging (MRI) or computed tomography (CT)) were reviewed by three gastrointestinal radiologists. RESULTS: Nineteen patients with CD-associated SBA with a mean age of 54.9 and 32 matched controls were included. Mean length of small bowel involvement was 216 (± 188) mm in the SBA group versus 156 (± 167) mm in the control group (p = 0.76). Only 11.8 % of cases had a diagnosis of SBA made preoperatively. In univariate analysis, focal loss of mural stratification (odds ratio [OR], 11; 95%CI, 2.43-49.5, p = 0.002), and wall thickening (OR, 1.32; 95%CI, 1.05-1.66, p = 0.02) were significantly associated with SBA. After adjustment, focal loss of mural stratification was the only independent risk factor (OR, 11; 95 % CI, 2.43-49.5, p = 0.002). CONCLUSIONS: Focal loss of mural stratification was identified as a predictor of CD-associated SBA, which should be described in imaging reports and further validated.
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Adenocarcinoma , Enfermedad de Crohn , Neoplasias Duodenales , Neoplasias del Íleon , Humanos , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico por imagen , Estudios Retrospectivos , Estudios de Casos y Controles , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/patología , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/etiología , Neoplasias del Íleon/patología , Neoplasias Duodenales/patología , Imagen por Resonancia Magnética , Adenocarcinoma/patologíaAsunto(s)
Linfoma de Burkitt , Enfermedades del Íleon , Neoplasias del Íleon , Intususcepción , Humanos , Linfoma de Burkitt/complicaciones , Linfoma de Burkitt/patología , Intususcepción/etiología , Intususcepción/cirugía , Neoplasias del Íleon/complicaciones , Neoplasias del Íleon/cirugía , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Íleon/patologíaAsunto(s)
Neoplasias del Íleon , Tumores Neuroendocrinos , Humanos , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/patología , Íleon/cirugía , Íleon/patología , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/patologíaRESUMEN
INTRODUCTION: Although Crohn's disease (CD) is a known risk factor of small bowel adenocarcinoma (SBA), early diagnosis remains a significant clinical challenge. Identification of biomarkers for SBA may lead to early detection. METHODS: This is a retrospective study comparing albumin levels and neutrophil-to-lymphocyte ratio (NLR) of patients with long-standing CD who underwent small bowel resection with and without malignancy. RESULTS: Forty-two patients with CD were included in this study (11 with SBA). Median NLR before surgery was 8.5 (interquartile range 6.2-31.3) in patients with SBA and 3.8 (interquartile range 2.8-5.3) for patients without SBA ( P < 0.05). Mean albumin levels before surgery were significantly lower among patients with SBA compared with patients without SBA (2.6 ± 0.6 g/dL vs 3.5 ± 0.6 g/dL, respectively, P < 0.05), despite patients with SBA being under longer total parenteral nutrition treatment duration. DISCUSSION: CD patients with SBA diagnosis have increased NLR and lower albumin before surgery compared with CD patients without detection of SBA.